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Growing evidence has demonstrated exercise as an effective way to promote cardiovascular health and protect against cardiovascular diseases However, the underlying mechanisms of the beneficial effects of exercise have yet to be elucidated. Animal exercise studies are widely used to investigate the key mechanisms of exercise-induced cardiovascular protection. However, standardized procedures and well-established evaluation indicators for animal exercise models are needed to guide researchers in carrying out effective, high-quality animal studies using exercise to prevent and treat cardiovascular diseases. In our review, we present the commonly used animal exercise models in cardiovascular research and propose a set of standard procedures for exercise training, emphasizing the appropriate measurements and analysis in these chronic exercise models. We also provide recommendations for optimal design of animal exercise studies in cardiovascular research, including the choice of exercise models, control of exercise protocols, exercise at different stages of disease, and other considerations, such as age, sex, and genetic background. We hope that this position paper will promote basic research on exercise-induced cardiovascular protection and pave the way for successful translation of exercise studies from bench to bedside in the prevention and treatment of cardiovascular diseases., Competing Interests: Competing interests The authors declare that they have no competing interests., (Copyright © 2021. Production and hosting by Elsevier B.V.)

With the heavier burden of cardiovascular disease, an abundance of papers emerge every year in the research hotspots, which cover a wide range of types and content. In order to let readers interested in the cardiovascular field quickly understand the research hotspots and research frontier, it is necessary to sort out and summarize the research topic in time. According to the discipline classification, we screened papers in cardiovascular field from the Essential Science Indicators (ESI) hot papers published in 2019. Methods such as bibliometrics, statistical description, hierarchical induction, analysis and interpretation were used a step further to reveal the context and characteristics of research in the field of cardiovascular diseases, summarize the latest progress and development direction in this field, and provide information and hints for the expansion of future research directions. A total of 297 papers were finally included, which were mainly in the field of clinical medicine; The country with the most publications was the United States, while China ranked the fifth in terms of contribution; the research institution with the highest number of published papers was Harvard University; the New England Journal of Medicine ( NEJM ) has published the most papers, with contribution also from journals such as Circulation , Europe Heart Journal , JAMA , and Lancet . All the papers were categorized into disease burden, disease risk, drug treatment, device treatment and surgical treatment, clinical diagnosis, basic research and others, so as to review and summarize the research front in the field of cardiovascular diseases.

Background: After its outbreak in China, the novel COronaVIrus Disease 19 is spreading across the globe. It is an emergency the world has never seen before., Main Text: The attention of health systems is mainly focused on COronaVIrus Disease 19 patients and on the risk that intensive care units might be overwhelmed by the serious pulmonary complications. Different countries are also attempting to establish infection prevention and control strategies which proved effective in China where the outbreak was initially reported. We reflect on important lessons to be learnt from different countries. The effects that infection prevention and control strategies, such as social distancing or isolation, can have on the care of millions of patients with non-communicable diseases, who may be indirectly affected, have not been taken into consideration so much., Conclusions: When dealing with COronaVIrus Disease 19, policy makers and healthcare personnel should consider the indirect effects on the treatment of non-communicable diseases.

The clinical benefits of statins have well-established and recognized worldwide. Although statins are well-tolerated generally, however, the report of statin-related adverse event and statin intolerance are common in China, which results in insufficient use of statins and poor adherence. The main reason may be attributed to confusions or misconceptions in the clinical diagnosis and management in China, including the lack of unified definitions and diagnostic standards, broad grasp of diagnosis, and unscientific management strategies. Based on that, this consensus carefully summarized the statin-related gene polymorphism and statin usage issue among Chinese population, and comprehensively reviewed global research data on statin intolerance, referenced guidelines, and consensus literature on statin intolerance in foreign and different regions, proposes an appropriate and easy to implement statin intolerance definition as well as corresponding diagnostic criteria and management strategies for Chinese clinicians, in order to improve the clinical application of statin drugs and enhance the prevention and treatment level of atherosclerotic cardiovascular disease in China., (© 2024 The Authors. Clinical Pharmacology & Therapeutics © 2024 American Society for Clinical Pharmacology and Therapeutics.)

Background: Many patients with Covid-19 have underlying cardiovascular disease or develop acute cardiac injury during the course of the illness. Adequate understanding of the interplay between Covid-19 and Cardiovascular disease is required for optimum management of these patients. The study analyzed and evaluated the global publication output on "Covid-19 and Heart Diseases" to find out the current trends and present status of research, by identifing important countries, organizations, authors and journals and important topics and keywords from the global publications, using bibliometric methods. Methods: Relevant published literature from December 2019 to August 2021 were identified and analyzed on the topic "Covid-19 and Heart Diseases" using a well-defined search strategy in Scopus database. A list of keywords were identified for Covid-19 ("Covid 19" or "2019 novel Coronavirus" or "Coronavirus 2019" or "Coronavirus disease 2019" or "2019-novel CoV" OR "2019 ncov" or "Covid 2019" or "Covid19" or "Corona virus 2019" or "ncov-2019" or "ncov2019" or "nCoV 2019" or "2019-ncov" or "covid-19" or "Severe acute respiratory syndrome coronavirus 2" or "SARS-CoV-2") and Heart Diseases (cardi* or arrhythmia or myocardial* or heart*) and these keywords are used for search in "Keywords" and Title" tags of Scopus database, yielding 5298 records. Results: A total of 5298 relevant publications indexed in Scopus database were obtained on "Covid-19 and Heart Disease", which received 62459 citations, averaging 11.79 citations per paper. The total publications witnessed the participation of 123 countries, with USA, Italy, U.K. and China leading in global publication productivity (with 1757, 707, 551 and 413 papers) and China (35.31 and 2.99), France (23.01 and 1.95), Germany (23.0 and 1.95) and Italy (20.43 and 1.73) leading in citation impact per publication and relative citation index. The 1761 organizations and 2499 authors participated in these 5298 publications. Harvard Medical School, USA, Brigham and Women's Hospital, USA and Massachsetts General Hospital leads in publications productivity (with 178, 92 and 92 publications each) and New York Presbyterian Hospital, USA (121.53 and 10.31), Tongji Medical College, China (65.65 and 5.57) and Huazhong University of Science and Technology, China (65.41 and 5.55) leads in citations impact per paper and relative citation index. M. Metra, A. Harky and M.K. Chung leads in publications productivity (with 23, 22 and 153 papers each) and G.Y.H. Lip (U.K.)(114.67 and 9.73), A.J. Kirtane (USA)(109.67 and 9.3) and M. Metra (Italy)(87.04 and 7.38) leads in citations impact per publication and relative citation index. European Heart Journal, Circulation and Stroke leads in publication productivity (with 85, 81 and 73 publications) and JAMA Cardiology (154.23), Journal of the American College of Cardiology (54.99) and Circulation (43.54) leads in citation impact per paper. Major keywords appearing along with "Covid-19 and "Heart Diseases" in co-occurnces were "Cardiovascular Disease" (1176), "Heart Failure" (802), "Hypertension" (664), "Cerebrovascular Accidents" (659), "Stroke" (608), "Mycarditis" (511), "Heart Arrhytthrmia"(464), etc. Conclusion: The study presents the current trends and status of research in the field and indicate the important keywords where research is focused in global literature on cardiovascular manifestations in Covid-19 patients. Such a analysis tmay be useful to the research community and decision-makers to prioritize research needs and identify leading Covid-19 researchers, countries, institutes and authors. [ABSTRACT FROM AUTHOR]

Exposure to air pollution is linked with an elevated risk of cardiovascular diseases (CVDs) and CVDs-related mortality. However, there is a shortage of scientometric analysis on this topic. Therefore, we propose a scientometric study to explore research hotspots and directions in this topical field over the past decade. We used the core collection of Web of Science (WoS) to obtain relevant publications and analyzed them using Excel, the Bibliometix R-package, CiteSpace, and VOSviewer. The study covered various aspects such as annual publications, highly cited papers, co-cited references, journals, authors, countries, organizations, and keywords. Research on air pollution and CVDs has remarkable increase over the past decade, with notable researchers including Kan H, Brook RD, Peters A, and Schwartz J. The 3144 articles were published by 4448 institutions in 131 countries/regions. The leading countries were the USA and China, and the most published journal was Environmental Research. Mortality, hospital admissions, oxidative stress, inflammation, long-term exposure, fine particulate matter, and PM 2.5 are the top areas that merit further investigation and hold significant potential for advancing our understanding of the complex relationship between air pollution and CVDs., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Cardiovascular diseases (CVD) caused by household air pollution (HAP) have sparked widespread concern globally in the recent decade. Meanwhile, increased ischemic heart disease (IHD) mortality has been the leading cause of worldwide CVD deaths. Both China and India experienced a high IHD burden and high exposure to HAP. The present study aimed to estimate and compare the long-term trends of HAP-attributable IHD mortality in the two countries. The data of this study were extracted from the Global Burden of Diseases (GBD) Study 2019. The age-period-cohort (APC) analysis was utilized to estimate the independent trends of the age, period, and cohort effects from 1990 to 2019. The age-standardized mortality rates (ASMRs) of HAP-attributable IHD have fallen faster in China than in India for both sexes. The local drift and net drift values were < 0 for all age groups in both countries. The age effects in both countries and sexes increased with time, suggesting age is a risk factor for IHD; conversely, period and cohort effects in China demonstrated a faster decline in both genders than in India. It indicated that China has been more successful than India in decreasing HAP-attributable IHD mortality., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Heavy metals (HMs) have a very significant clinical role in the pathogenesis, progression and management of cardiovascular diseases (CVDs). The prevalence of CVDs was reported to be higher in critically environmentally HM-polluted (EHMP) steel industrial town Mandi-Gobindgarh (India) for the last more than a decade. To ascertain the role of HMs in the onset of CVDs, the present study was chosen to investigate HMs content in myocardial infarction (MI) patients from EHMP steel industrial town Mandi-Gobindgarh. Total of 110 MI patients along with number- and age-matched healthy volunteers were recruited in the present investigation. The CVDs risk factors estimated in MI patients were overweight (higher body mass index), hypertension (higher systolic and diastolic blood pressures), dyslipidaemia (higher serum cholesterol, triglycerides and lower HDL cholesterol), inflammation (higher-serum C reactive protein and aldosterone) and elevated oxidative stress (higher urinary 8-hydroxydeoxyguanosine). An imbalance of serum electrolyte concentrations including Na (hypernatremia), Ca (hypercalcaemia) and K (hypokalaemia) was also observed in MI patients in which CVDs risk factors were found to correlate positively with serum Na and Ca and negatively with serum K, respectively. Hair HM analysis was used as a bio-indicator for monitoring body HM status from past environmental HM exposure in which CVDs risk factors were observed to correlate positively with higher hair concentrations of Zn, Fe, Mo, Pb, As, Ca and Na and negatively with lower hair concentrations of Cu, Mg, Mn and K in MI patients, respectively. Thus, higher hair concentrations of Zn and Pb indicate their higher environmental exposure and possible cause of higher CVDs risk factors in MI patients from Mandi-Gobindgarh., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Objective: This study examined the effects of overweight/obesity on mortality and morbidity outcomes and the disparities, time trends, and projected future obesity health burden in China., Methods: Cohort studies that were conducted in China and published in English or Chinese between January 1, 1995, and July 31, 2021, were systematically searched. This study focused on overweight/obesity, type 2 diabetes mellitus (T2DM), hypertension, cardiovascular diseases, metabolic syndrome, cancers, and chronic kidney disease., Results: A total of 31 cohorts and 50 cohort studies reporting on mortality (n = 20) and morbidities (n = 30) associated with obesity met study inclusion criteria. Overall, BMI was nonlinearly (U-shaped) associated with all-cause mortality and linearly associated with risks of T2DM, cardiovascular diseases, hypertension, cancer, metabolic syndrome, and chronic kidney disease. In 2018, among adults, the prevalence of overweight/obesity, hypertension, and T2DM was 51.2%, 27.5%, and 12.4%, respectively. Their future projected prevalence would be 70.5%, 35.4%, and 18.5% in 2030, respectively. The projected number of adults having these conditions would be 810.65 million, 416.47 million, and 217.64 million, respectively. The urban-rural disparity in overweight/obesity prevalence was projected to shrink and then reverse over time., Conclusions: The current health burden of obesity in China is high and it will sharply increase in coming years and affect population groups differently. China needs to implement vigorous interventions for obesity prevention and treatment., (© 2022 The Obesity Society.)

Background: Chronic pruritus is a common problem among older adults, with a significant impact on their quality of life. However, it is under-studied epidemiologically, especially among Chinese older adults., Objective: The aim of this study was to identify the prevalence and explore the risk factors of chronic pruritus among the middle-aged and older adults in Beijing, China., Methods: A total of 929 participants aged ≥35 years from six communities in Beijing, China, were interviewed. The survey collected the demographic characteristics, the experience of chronic pruritus (>6 weeks), chronic disease history, the level of physical activities and sleep quality. A population-based case-control study was conducted, including 178 chronic pruritus cases and 697 controls. A multivariate logistic regression model was performed to explore the risk factors of chronic pruritus. Additionally, a random forest algorithm was used to rank the importance of potential risk factors and analyse the overall interpretation of risk factors., Results: The prevalence of chronic pruritus was 19.48% (181/929) among the Beijing middle-aged and elderly population. The findings indicated that older adults aged 65 years old or above, male, with college or higher degree, alcohol drinking, hypertension, hyperlipidaemia, chronic lung disease, cardiovascular disease, digestive system disease and osteoarthritis/rheumatism, and middle or low sleep quality were associated with the increased risk of chronic pruritus respectively. Physical activity level (≥3000 Met) was associated with a decreased risk of chronic pruritus. The rank according to the most contribution of chronic pruritus risk was sleep quality, education, physical activity level, osteoarthritis/rheumatism, age and gender., Conclusion: Prevalence of chronic pruritus was high among the Chinese middle-aged and elderly population. Age, gender, high education, alcohol drinking, hypertension, hyperlipidaemia, chronic lung disease, cardiovascular disease, digestive system disease, osteoarthritis /rheumatism and poor sleep quality may serve as risk factors of chronic pruritus. Moderate and high physical activity levels may serve as protective factors of chronic pruritus risk., (© 2022 European Academy of Dermatology and Venereology.)

The evidence regarding the association between long-term fine particulate (PM 2.5 ) exposure and cardiovascular disease (CVD) in developing countries is limited. This study investigated the association between long-term exposure to PM 2.5 and the prevalence of CVD among middle-aged and older adults. A total of 13,484 adults ≥ 45 years of age were surveyed in China, and logistic regression models were used to examine the association between PM 2.5 and the prevalence of CVD. Furthermore, stratified analyses were conducted to explore potential effect modifiers. In addition, the burden of CVD attributable to PM 2.5 was estimated. The analyses revealed that PM 2.5 was associated with CVD, with an adjusted odds ratio (OR) of 1.18 (95% confidence interval [CI]: 1.12, 1.26) for each 10 μg/m 3 increment in ambient PM 2.5 . Stratified analyses found that the elderly may be a vulnerable population. It was further estimated that approximately 20.27% (95% CI: 11.86%, 29.96%) of CVD cases could be attributable to PM 2.5 . This nationwide study confirmed that long-term exposure to PM 2.5 was associated with an increased prevalence of CVD in China., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background and Aims: Although low-density lipoprotein cholesterol (LDL-C) has been considered as a risk factor of atherosclerotic cardiovascular disease, limited studies can be available to evaluate the association of LDL-C with risk of mortality in the general population. This study aimed to examine the association of LDL-C level with risk of mortality using a propensity-score weighting method in a Chinese population, based on the health examination data., Methods: We performed a retrospective cohort study with 65,517 participants aged 40 years or older in Ningbo city, Zhejiang. LDL-C levels were categorized as five groups according to the Chinese dyslipidemia guidelines in adults. To minimize potential biases resulting from a complex array of covariates, we implemented a generalized boosted model to generate propensity-score weights on covariates. Then, we used Cox proportional hazard regression models with all-cause and cause-specific mortality as the dependent variables to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs)., Results: During the 439,186.5 person years of follow-up, 2403 deaths occurred. Compared with the median LDL-C group (100-130 mg/dL), subjects with extremely low LDL-C levels (group 1) had a higher risk of deaths from all-cause (HR = 2.53, 95% CI:1.80-3.53), CVD (HR = 1.84, 95% CI: 1.28-2.61), ischemic stroke (HR = 2.29, 95% CI:1.32-3.94), hemorrhagic stroke (HR = 3.49, 95% CI: 1.57-7.85), and cancer (HR = 2.12, 95% CI: 1.04-4.31) while the corresponding HRs in LDL-C group 2 were relatively lower than that in group 1., Conclusions: Low LDL-C levels were associated with an increased risk of all-cause, CVD, ischemic stroke, hemorrhagic stroke, and cancer mortality in the Chinese population., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The burden of five main air pollutants, including CO, O3, NO2, SO2, and PM2.5, on the emergency department visits (EDVs) during January 2016-December 2019 due to all cardiovascular diseases was assessed in Tehran by using a time-series model. The pollutants data were collected from Iran Department of Environment including 10 air pollution monitoring stations for the period of our study. Cumulative relative risk and attributable number/fraction were calculated for each pollutants by a Quasi-Poisson time-series regression and distributed lag non-linear model (DLNM). The maximum lag was set to 14 days because harvesting effect is more likely happened during few days. We used percentile 25 as reference value in order to calculate cumulative relative risk and attributable fraction. About 69,000 patients with cardiovascular symptoms have been admitted into the hospital during 4 years. The cumulative relative risk during the 14 days was 1.13 (1.01, 1.26), 1.15 (1.02, 1.29), and 1.08 (1.01, 1.18) for CO, NO2, and PM2.5, respectively. The numbers attributed to all values of CO were more than others; about 3800 EDVs were significantly attributed to CO, of which over 3000 were significantly attributed to high values of the pollutant. Low values of all pollutants were, not surprisingly, responsible for low number of EDVs. PM2.5, CO, and NO2 were responsible to considerable attributable number of EDVs. Our study emphasizes the need for local authorities to establish a program to reduce the air pollution in Tehran., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The aim of this study is to investigate the effect of cardiometabolic diseases (CMDs) on the development of depressive symptoms and to determine whether socioeconomic status (SES) moderates this effect. A total of 6,455 individual free from depressive symptoms were selected from the China Health and Retirement Longitudinal Study (CHARLS). CMDs and SES were self-reported. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CESD-10). Cox proportional hazards regression models were employed to examine the association between baseline CMDs and subsequent depressive symptoms. Stratified analysis were conducted to explore the moderating effect of SES on this association.Participants with any CMDs exhibited a higher risk of developing depressive symptoms compared to those without CMDs, with a hazard ratio (HR) of 1.10 (95% CI: 1.01, 1.20). Individuals with one CMD (HR = 1.08, 95% CI: 1.00, 1.20) or cardiometabolic multimorbidity (HR = 1.13, 95% CI: 1.02, 1.26) also demonstrated an increased risk. The effect of CMDs on depressive symptoms was observed primarily in adults aged 60 years and older with lower education attainment (HR = 1.28, 95%CI: 1.12, 1.46), lower income (HR = 1.29, 95%CI: 1.11, 1.50) and rural residency (HR = 1.29, 95%CI: 1.12,1.51). These findings emphasize the importance of closely monitoring the mental status of patients with CMDs and considering routine screening and evaluation for depressive symptoms, especially in individuals with low SES., Competing Interests: Declarations. Ethics approval and consent to participate: Study protocol carried out in this study is followed in accordance with the ethical guidelines laid down as per the Declaration of Helsinki. The study was approved by the Ethics Committee of the Peking University biomedical ethics committee approval (Ethical Approval Number: IRB00001052-11015), and written informed consent was obtained from either the participants. Competing interests: The authors declare no competing interests. CRediT authorship contribution statement: Dan Guo, Yanshang Wang: drafting the manuscript, study design, data analysis and interpretation. Yanan Zhao, Ruoxi Ding, Yanan Luo and Wanwei Dai: drafting the manuscript and critical revision of article for important intellectual content. Ping He: study concept and design, critical revision of article, and supervised the whole process of this work. All authors critically revised successive drafts of the paper and approved the final version. The authors have no possible conflicts of interest to declare., (© 2025. The Author(s).)

This study assessed the impact of various temperature indices, including mean temperature (MT), diurnal temperature range (DTR), and temperature changes between neighboring days (TCN) on hospitalization rates for cardiovascular system diseases among residents of Zhangye City, a typical western city in China. The Quasi-Poisson generalized additive regression model (GAM) in conjunction with a distributed lag nonlinear model (DLNM) was applied to estimate the association of temperature indices with CVD hospitalization rates in Zhangye City during the periods of 2015-2021. The exposure-response relationship and relative risk were discussed and stratified analyses by age and gender were conducted. We found that the hospitalization rates of cardiovascular disease (CVD) patients in Zhangye City was significantly related to different temperature indicators (MT, DTR, TCN). Both low and high MT, DTR, and TCN increased the risk of cardiovascular disease (CVD) among residents. Besides, different demographic populations exhibited distinct sensitivities to temperature conditions. Relevant authorities should devise corresponding preventive and control measures to protect vulnerable populations., Competing Interests: Declarations. Ethics approval and consent to participate: The present study is considered exempt from institutional review board approval since the data used was collected for administrative purpose without any personal identifiers. Consent for publication: Not applicable. Competing interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024. The Author(s) under exclusive licence to International Society of Biometeorology.)

Longitudinal evidence of long-term ozone exposure on heart rate variability (HRV, an early indicator of cardiovascular damage) is lacking and the potential mechanism remains largely unclear. Our objectives were to evaluate the cross-sectional and longitudinal associations of ozone exposure with HRV alteration, and the potential roles of protein carbonyl (PC, biomarker of oxidative protein damage) and transforming growth factor (TGF)-β1 in this association. This repeated-measures prospective study included 4138 participants with 6617 observations from the Wuhan-Zhuhai cohort. Ozone concentrations were estimated using a high temporospatial resolution model for each participant. HRV indices, PC, and TGF-β1 were also repeatedly measured. Cross-sectional and longitudinal relationships of ozone exposure with HRV alteration were evaluated by linear mixed model. Cross-sectionally, the strongest lag effect of each 10 ppb increment in short-term ozone exposure showed a 12.40 %, 8.47 %, 4.31 %, 8.03 %, 3.69 %, and 2.41 % decrement on very low frequency (VLF, lag 3 weeks), LF (lag 2 weeks), high frequency (HF, lag 0-7 days), total power (TP, lag 2 weeks), standard deviation of all normal-to-normal intervals (SDNN, lag 3 weeks), and square root of the mean squared difference between adjacent normal-to-normal intervals (lag 2 weeks), respectively. Longitudinally, each 10 ppb increment of annual average ozone was related with an annual change rate of -0.024 ms 2 /year in VLF, -0.009 ms 2 /year in LF, -0.013 ms 2 /year in HF, -0.014 ms 2 /year in TP, and -0.004 ms/year in SDNN. Mediation analyses indicated that PC mediated 20.77 % and 12.18 % of ozone-associated VLF and TP decline, respectively; TGF-β1 mediated 16.87 % and 27.78 % of ozone-associated VLF and SDNN reduction, respectively. Our study demonstrated that ozone exposure was cross-sectionally and longitudinally related with HRV decline in general Chinese urban adults, and oxidative protein damage and increased TGF-β1 partly mediated ozone exposure-related HRV reduction., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objectives: Studies have found that a high Life's Essential 8 (LE8) score is associated with a reduced risk of cardiovascular disease(CVD) in cancer populations and young adults. However, the association between LE8 and the risk of CVD in hyperuricemia (HUA) is not fully understood., Methods: The main analysis included 6814 HUA participants. In a secondary analysis, 5,418 participants were selected from the main analysis to model the trajectory of uric acid (UA) levels from 2006 to 2010. Cox regression model was used to investigate the relationship between LE8 total score and cardiovascular disease risk in different populations., Results: Follow-up of 15.79 years in the main analysis, 986 CVD events occurred. With tertile 1 as the control group, the HR and 95 % CI of CVD in tertile 2 and tertile 3 were 0.75(0.65,0.87) and 0.56(0.47,0.66). In the secondary analysis, the HR and 95 %CI of individuals with low and medium levels of UA reduced CVD were 0.49(0.26,0.89) and 0.56(0.41,0.76), respectively, but this association was not found in individuals with sustained high UA levels. The risk of CVD was different between the sexes. There are differences in cardiovascular disease risk among different age groups., Conclusions: The risk of CVD in HUA population decreased with the increase of LE8 score, especially in young and middle-aged people and women. However, it is important to note that LE8 may not reduce the risk of CVD in individuals with sustained high UA levels., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Aims: To investigate the impact of diagnosis age of type 2 diabetes mellitus (T2DM) on subsequent adverse outcomes within the Chinese population., Methods: 549,959 eligible T2DM patients were included from Ningbo and Jinhua city in Zhejiang province, China. Standardized ratio was used to evaluate the risks of coronary heart disease (CHD), stroke, cancer and all-cause death in different T2DM diagnosis age groups., Results: For all adverse outcomes, higher excess risks were observed in the youngest age group (30-39) than in the oldest age group (≥80) with T2DM. The standardized incidence ratios (SIR) were 5.93 (95% CI: 3.46, 10.14) for CHD, 5.45 (95% CI: 3.72, 7.99) for stroke and 1.85 (95% CI: 1.38, 2.49) for cancer in the youngest age group, and were 1.32 (95% CI: 1.08, 1.60) for CHD, 1.25 (95% CI: 1.08, 1.44) for stroke, and 0.78 (95% CI: 0.56, 1.09) for cancer, respectively, in the oldest age group. The standardized mortality ratios (SMR) for all-cause death were 3.15 (1.69, 5.84) vs. 1.12 (0.88, 1.43). These excess risks decreased with increasing diagnosis age (all P value < 0.001). Consistent results were observed when individuals were stratified by sex or further excluded with the time from T2DM diagnosis to endpoints less than 1 or 2 years., Conclusions: Th earlier the diagnosis of T2DM, the higher the risk for subsequent adverse outcomes. It is imperative to enhance the management and monitoring of early-onset patients during follow-up., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Phthalates are endocrine disruptors of increasing concern for human health; however, previous studies have only assessed the association between internal exposure and human health. We aimed to assess the non-carcinogenic and carcinogenic risks of non-dietary exposure to phthalates in indoor environments among primary school children and their correlations with health indicators. A study involving 54 children was conducted in Jinan, Shandong Province, China. Questionnaires and health examinations were conducted, dust in hard-to-clean corners of students' classrooms and homes was collected, and airborne phthalates in the middle of classrooms and family living rooms were sampled. The gas-phase phthalate concentrations, individual exposure, and non-carcinogenic and carcinogenic risks were calculated. Associations were estimated using linear mixed models. The findings revealed that phthalates posed a non-carcinogenic risk to 7.4 % of the children and a moderate carcinogenic risk to 27.8 % of the children, with higher non-carcinogenic and carcinogenic risks to girls than to boys. Five phthalates were negatively correlated with body mass index, dimethyl phthalate and diethyl phthalate (DEP) were significantly correlated with waist circumference, and di-iso-butyl phthalate (DiBP) was negatively correlated with hip circumference. DiBP, di-n-butyl phthalate, and DEP, were significantly correlated with cardiovascular disease, DEP and di (2-n-butoxyethyl) phthalate were correlated with decreased lung function, and di-n-octyl phthalate influenced airway inflammation. The findings indicated that phthalate exposure may negatively impact children's health, thereby warranting further comprehensive research on the health effects of these chemicals., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Patients with chronic kidney disease (CKD) are at an elevated risk of cardiovascular disease (CVD) and premature mortality compared to the general population., Objectives: This study aimed to investigate whether the excess risk of CVD events and death among patients with CKD could be reduced or eliminated through strict control of blood pressure (systolic blood pressure: <130 mm Hg), lipids (low-density lipoprotein cholesterol: <2.6 mmol/L), and glucose (fasting blood glucose: <6.1 mmol/L)., Methods: The authors included 20,254 patients with CKD who were free of CVD or end-stage renal disease and matched them with 35,236 control individuals based on age (±2 years) and sex from the Kailuan study., Results: During a median follow-up period of 12.2 to 12.8 years, 3,875 deaths, 1,888 cases of stroke, 513 cases of myocardial infarction, and 4,825 cases of CKD progression were documented. Among patients with CKD, risk factor controls showed an association with a reduction in myocardial infarction, stroke, CKD progression, and all-cause mortality risk in a dose-dependent manner. Moreover, compared to the non-CKD control individuals, having all 3 risk factors within the target ranges could theoretically eliminate the excess risk of CVD and mortality associated with CKD. Among patients with CKD who had all 3 risk factors controlled, the HRs were 0.80 (95% CI: 0.56-1.14) for myocardial infarction, 0.93 (95% CI: 0.78-1.12) for stroke, and 1.10 (95% CI: 0.98-1.24) for all-cause mortality compared to the non-CKD control individuals., Conclusions: Patients with CKD who had controlled blood pressure, lipids, and glucose showed no excess risk of death, myocardial infarction, or stroke compared to the general population., Competing Interests: Funding Support and Author Disclosures This research was supported by a startup grant at Fudan University (JIF201047Y and JIF201036Y) and the key projects in the 3-year plan of Shanghai municipal public health system (2023-2025) (GWVI-4). The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Backgrounds: Greenspaces are indispensable for the construction of a healthy city. Research has shown that greenspaces contribute to the reduction of cardiovascular risks. However, the role of greenspace morphology in the development of a healthy city is not well understood., Methods: Our study utilized data from a cardiovascular disease screening cohort comprising 106,238 residents in Anhui Province, China, aged between 35 and 75 years. We calculated landscape indices of each participant using high-resolution land cover data to measure the greenness, fragmentation, connectivity, aggregation, and shape of greenspaces. We used a multivariate linear regression model to assess the associations between these landscape indices and triglyceride risk, and employed a structural equation model to explore the potential contributions of heatwaves and fine particulate matter (PM 2.5 ) to this association., Results: Overall, triglyceride was expected to increase by 0.046% (95% CI: 0.040%, 0.052%) with a 1% increase in the percentage of built-up area. Conversely, an increase in the percentage of greenspace was associated with a 0.270% (95% CI: 0.337%, -0.202%) decrease in triglyceride levels. Furthermore, when the total greenspace was held constant, the shape, connectedness, and aggregation of greenspace were inversely correlated with triglyceride levels, with effects of -0.605% (95% CI: 1.012%, -0.198%), -0.031% (95% CI: 0.039%, -0.022%), and -0.049% (95% CI: 0.058%, -0.039%), respectively. Likewise, the protective effect of the area-weighed mean shape index was higher than that of the total amount of greenspace. The stratification results showed that urban residents benefited more from greenspace exposure. Greenspace morphology can minimize triglyceride risk by reducing pollutant and heatwaves, with aggregation having the greatest effect on reducing pollutants whereas fragmentation is more efficient at reducing heatwaves., Conclusion: Exposure to the greenspaces morphology is associated with a reduction in triglyceride risk. The study has important practical and policy implications for early health monitoring and the spatial layout of greenspace and will provide scientific information for healthy urban planning by reducing unfavorable health consequences., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Enhanced cardiovascular health (CVH) is linked to reduced mortality risks, whereas long-term exposure to fine particulate matter (PM 2.5 ), elevates these risks. Whether long-term exposure to PM 2.5 counteracts the health benefits of high CVH is unknown. The study aims to evaluate whether the association of CVH assessed by Life's Essential 8 (LE8) with death was consistent between participants with different PM 2.5 exposures., Methods: We included 134,727 participants in the field survey of China Chronic Disease and Risk Factor Surveillance which was conducted from August 2013 to June 2014. The deaths of participants were obtained by linking to the National Mortality Surveillance System (2013-2018). The environmental data is obtained by satellite inversion. The participants' CVH scores were calculated using the LE8 method. Hazard ratio (HR) and 95% confidence intervals (95%CI) for mortality were calculated using Cox regression models., Results: A total of 2,936 all-cause deaths and 1,158 cardiovascular disease (CVD) deaths were recorded. Compared to those with low CVH, adults with high CVH demonstrated a reduced risk of all-cause mortality, irrespective of their PM 2.5 exposure levels (P < 0.05, all P for interaction >0.05). Furthermore, in comparison to those with low CVH and highest PM 2.5 exposure, adults with high CVH and lowest PM 2.5 exposure exhibited HR of 0.18 (95%CI, 0.12-0.25) for all-cause mortality and 0.13 (95%CI, 0.08-0.22) for CVD mortality., Conclusions: High CVH is associated with reduced all-cause mortality risk, regardless of PM 2.5 exposure levels. For Chinese adults, sustaining high CVH is advisable, irrespective of their residential location., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: The health effects of ambient ozone have been investigated in many previous studies. However, the effects of long-term exposure to ambient ozone on the incidence of cardiovascular disease (CVD) remain inconclusive., Objectives: To estimate the associations of long-term exposure to maximum daily 8-hours average ozone (MDA8 O 3 ) with the incidence of total CVD, heart disease, hypertension, and stroke., Methods: This was a prospective cohort study, and the data was obtained from the China Health and Retirement Longitudinal Survey (CHARLS) implemented during 2011-2018 and the China Family Panel Studies (CFPS) implemented during 2010-2018. We applied a Cox proportional hazards regression model to evaluate the associations of MDA8 O 3 with total CVD, heart disease, hypertension, and stroke risks, and the corresponding population-attributable fractions (PAF) attributable to MDA8 O 3 were also calculated. All analyses were conducted by R software., Results: The mean MDA8 O 3 concertation of all included participants in the CHARLS and CFPS were 51.03 part per billion (ppb) and 51.15 ppb, respectively. In the CHARLS including 18,177 participants, each 10 ppb increment in MDA8 O 3 concentration was associated with a 31% increase [hazard ratio (HR) = 1.31, 95% confidence interval (CI): 1.22-1.42] in the risk of incident heart disease, and the corresponding population-attributable fractions (PAF) was 13.79% [10.12%-17.32%]. In the CFPS including 30,226 participants, each 10 ppb increment in MDA8 O 3 concentration was associated with an increase in the risk of incident total CVD (1.07 [1.02-1.13]), and hypertension (1.10 [1.03-1.18]). The PAFs of total CVD, and hypertension attributable to MDA8 O 3 were 3.53% [0.82%-6.16%], and 5.11% [1.73%-8.38%], respectively. Stratified analyses showed greater associations in males, urban areas, and Southern China., Conclusions: Long-term exposure to MDA8 O 3 may increase the incidence of CVD. Therefore, the policies that control O 3 and related precursors are persistently needed., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Production and hosting by Elsevier B.V.)

Background: The potential for residential greenness to improve cardiovascular health through both physical and psychological mechanisms is well recognized. However, evidence from rapidly urbanizing developing countries and cohort-based causal inference approaches, remains limited. We aim to examine the effect of residential greenness and time to cardiovascular mortality in South China., Methods: We utilized data from a community-based population survey involving 748,209 participants at baseline from 2009 to 2015, followed up until 2020. Residential greenness exposure was assessed by the annual Normalized Difference Vegetation Index (NDVI) in the 500 m radius of each participant's residence. We used time-varying proportional hazard Cox models coupled with inverse probability weighting to fit marginal structural models and obtain hazard ratios (HRs) for cardiovascular disease (CVD) mortality after adjusting for confounders. Multiple effect modifiers on both additive and multiplicative scales were further explored., Results: A total of 15,139 CVD-related deaths were identified during a median of 7.9 years of follow-up. A protective effect was found between higher greenness exposure and reduced CVD mortality, with a 9.3 % lower rate of total CVD mortality (HR 0.907, 95 % CI 0.859-0.957) based on a 0.1 increase in annual average NDVI. Demographic (age, marital status) and lifestyle factors (smoking, drinking status) were found to modify the association between residential greenness and CVD mortality (all P interaction values < 0.05 or 95 %CI for RERI excluded the value 0). Notably, this effect was more pronounced among older adults, married, and individuals having healthier lifestyles, indicating a greater benefit from greenness for these subgroups., Conclusions: Our findings support a causal link between increased residential greenness exposure and a reduced risk of CVD mortality in South China with marked heterogenous effects, which has public health implications for cultivating greener urban environments to mitigate the impact of CVD within the context of rapid urbanization., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: To our knowledge, no evidence exists to link dietary inflammatory potential to cardiovascular disease (CVD) in China. Furthermore, the precise mechanisms underlying the link between a pro-inflammatory diet and CVD remain incompletely understood., Objective: We aimed to investigate the relationship between dietary inflammatory potential and nonfatal CVD in the Chinese population and to explore the mediating role of insulin resistance., Methods: A total of 4822 adults who participated in the China Health and Nutrition Survey (CHNS) were included in this analysis. The dietary inflammatory index (DII) was used to assess dietary inflammatory potential. Cox proportional hazards models and restricted cubic spline were applied to assess the longitudinal associations. The triglyceride-glucose (TyG) index was calculated to measure insulin resistance. Mediation analysis using a two-stage regression method for survival data was employed to explore the mediating effects of the TyG index on the association between DII score and nonfatal CVD., Results: During a median follow-up of 18 y, 234 incident cases of nonfatal CVD, including 136 strokes and 114 myocardial infarctions (MIs), were observed. For each standard deviation of the DII score, nonfatal CVD incidence increased by 15% (hazard ratio [HR]: 1.15, 95% confidence interval [CI]: 1.01-1.31), and stroke incidence increased by 22% (HR = 1.22, 95% CI: 1.03-1.45). DII score displayed a linear association with nonfatal CVD and stroke (P for nonlinearity = 0.250 and 0.238, respectively). No significant association was found between the DII score and MI. Mediation analyses showed that the TyG index mediated 5.90% and 9.35% of the total association between DII score and nonfatal CVD and stroke, respectively., Conclusions: This study provides evidence that dietary inflammatory potential is positively associated with nonfatal CVD and stroke in Chinese adults, and the association was partly mediated by insulin resistance., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Background: Remnant cholesterol (RC) promotes cardiovascular disease (CVD) in the general population, but its role among rheumatoid arthritis (RA) patients remains unknown. We aimed to investigate circulating RC levels associated with incident CVD among Chinese patients with RA., Methods: A total of 1018 RA patients free of baseline CVD were included and followed up in a prospective RA CVD cohort from 2001 to 2022. Fasting serum levels of triglycerides, total cholesterol (TC), low-density (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were measured, while RC and Non-HDL-C levels were calculated. The primary exposure was RC levels. A LASSO Cox model was used to select covariates. The Fine-Gray competing risk model was used to estimate hazard ratios (HRs)., Results: RA patients had a mean age of 53.9 years, and 802 (78.8%) were females. After a median follow-up of 5.54 years, 131 patients developed CVD with an incidence rate of 21.6 per 1000 person-years. Continuous and quartile-categorized RC levels were associated with incident CVD before and after multivariate adjustment and Bonferroni correction (all P < 0.001). There were no robust associations of other lipids with incident CVD. The fully adjusted HRs for RC were 2.30 (95% CI 1.58-3.35) per 1 mmol/L increase, and 2.40 (1.36-4.25) and 2.81 (1.60-4.94) for patients in the 3rd and 4th versus the 1st quartile, respectively., Conclusions: Circulating RC levels are positively associated with incident CVD among Chinese RA patients independent of known risk factors, implying its clinically preferable use for improving the stratification of CVD risk in RA patients., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Long-term ozone (O 3 ) exposure has been associated with cardiovascular disease (CVD) mortality in mounting cohort evidence, yet its relationship with incident CVD was poorly understood, especially in low- and middle-income countries (LMICs) experiencing high ambient air pollution., Methods: We carried out a nationwide perspective cohort study from 2010 through 2018 by dynamically enrolling 36948 participants across Chinese mainland. Warm-season (April-September) O 3 concentrations were estimated using satellite-based machine-learning models with national coverage. Cox proportional hazards model with time-varying exposures was employed to evaluate the association of long-term O 3 exposure with incident CVD (overall CVD, hypertension, stroke, and coronary heart disease [CHD]). Assuming causality, a counterfactual framework was employed to estimate O 3 -attributable CVD burden based on the exposure-response (E-R) relationship obtained from this study. Decomposition analysis was utilized to quantify the contributions of four key direct driving factors (O 3 exposure, population size, age structure, and incidence rate) to the net change of O 3 -related CVD cases between 2010 and 2018., Results: A total of 4428 CVD, 2600 hypertension, 1174 stroke, and 337 CHD events were reported during 9-year follow-up. Each 10-μg/m³ increase in warm-season O 3 was associated with an incident risk of 1.078 (95% confidence interval [CI]: 1.050-1.106) for overall CVD, 1.098 (95% CI: 1.062-1.135) for hypertension, 1.073 (95% CI: 1.019-1.131) for stroke, and 1.150 (95% CI: 1.038-1.274) for CHD, respectively. We observed no departure from linear E-R relationships of O 3 exposure with overall CVD (P nonlinear = 0.22), hypertension (P nonlinear = 0.19), stroke (P nonlinear = 0.70), and CHD (P nonlinear = 0.44) at a broad concentration range of 60-160 µg/m 3 . Compared with rural dwellers, those residing in urban areas were at significantly greater O 3 -associated incident risks of overall CVD, hypertension, and stroke. We estimated 1.22 million (10.6% of overall CVD in 2018) incident CVD cases could be attributable to ambient O 3 pollution in 2018, representing an overall 40.9% growth (0.36 million) compared to 2010 (0.87 million, 9.7% of overall CVD in 2010). This remarkable rise in O 3 -attributable CVD cases was primary driven by population aging (+24.0%), followed by increase in O 3 concentration (+10.5%) and population size (+6.7%)., Conclusions: Long-term O 3 exposure was associated with an elevated risk and burden of incident CVD in Chinese adults, especially among urban dwellers. Our findings underscored policy priorities of implementing joint control measures for fine particulate matter and O 3 in the context of accelerated urbanization and population aging in China., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Previous studies have shown that remnant cholesterol (RC) was associated with cardiovascular disease (CVD) among middle-aged or older adults. However, lack of evidence on long-term exposures to RC and their role in CVD risk among young adults. We thus aimed to explore the association between cumulative RC burden and CVD in young adults., Methods: We enrolled participants younger than 45 years free of CVD history in the Kailuan Study who completed the first three health examinations from 2006 to 2010. Cumulative RC burden included cumulative RC burden score, time-weighted cumulative RC, exposure duration of high RC, and time course of RC accumulation. The outcome was the incidence of CVD. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) between cumulative RC burden and CVD risk., Results: A total of 15,219 participants were included (73.70% male, median age 39.13 years). During a median follow-up duration of 8.71 years (interquartile range: 8.4-9.15 years), 502 individuals developed CVD. After adjustment for traditional cardiovascular risk factors, highest risk of CVD was observed in participants with the highest cumulative RC burden score (HR, 1.66; 95% CI, 1.29-2.12), the highest quartile time-weighted cumulative RC (HR,1.50; 95% CI, 1.15-1.96), the longest exposure duration of high RC (HR, 1.71; 95% CI, 1.21-2.42), and those with cumulative RC burden and positive slope (HR, 1.79; 95% CI, 1.35-2.36)., Conclusions: Cumulative RC burden increased the risk of CVD among young adults, suggesting that maintaining low RC levels throughout young adulthood may minimize CVD risk., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Background: Ultrafine particle (UFP) has been linked with higher risks of cardiovascular diseases; however, the biological mechanisms remain to be fully elucidated., Objectives: This study aims to investigate the cardiovascular responses to short-term UFP exposure and the biological pathways involved., Methods: A longitudinal panel study was conducted among 32 healthy, non-smoking young adults in Shanghai, China, who were engaged in five rounds of follow-ups between December 2020 and November 2021. Individual exposures were calculated based on the indoor and outdoor real-time measurements. Blood pressure, arterial stiffness, targeted biomarkers, and untargeted proteomics and metabolomics were examined during each follow-up. Linear mixed-effect models were applied to analyze the exposure and health data. The differential proteins and metabolites were used for pathway enrichment analyses., Results: Short-term UFP exposure was associated with significant increases in blood pressure and arterial stiffness. For example, systolic blood pressure increased by 2.10 % (95 % confidence interval: 0.63 %, 3.59 %) corresponding to each interquartile increase in UFP concentrations at lag 0-3 h, while pulse wave velocity increased by 2.26 % (95 % confidence interval: 0.52 %, 4.04 %) at lag 7-12 h. In addition, dozens of molecular biomarkers altered significantly. These effects were generally present within 24 h after UFP exposure, and were robust to the adjustment of co-pollutants. Molecular changes detected in proteomics and metabolomics analyses were mainly involved in systemic inflammation, oxidative stress, endothelial dysfunction, coagulation, and disturbance in lipid transport and metabolism., Discussion: This study provides novel and compelling evidence on the detrimental subclinical cardiovascular effects in response to short-term UFP exposure. The multi-omics profiling further offers holistic insights into the underlying biological pathways., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: Few studies have examined the direct or indirect effect of chronic pain on cardiovascular diseases (CVD) within Chinese population. The objective aimed to investigate the mediating role of depressive symptoms between chronic pain and CVD., Methods: 6522 participants from China Health and Retirement Longitudinal Study were included in this retrospective cohort study. The main endpoint was the occurrence of CVD. Weighted multivariate logistic regression was used to assess the association between chronic pain and depressive symptoms. Distribution-of-product method was employed to examine the mediation effect of depressive symptoms. Subgroup analyses were performed., Results: 219 developed CVD at the end of follow-up period. After adjusting all confounding variables, chronic pain was associated with increased risk of depressive symptoms in total population [odds ratio (OR) = 3.85, 95%confidence interval (CI): 3.35-4.42]. Among total population, there was a positive association of chronic pain and CVD [risk ratio (RR) a  = 2.00, 95% CI: 1.33-3.00] (total effect). After further adjusting depressive symptoms, the association between chronic pain and CVD was significant (RR b  = 1.67, 95% CI: 1.16-2.41) (direct effect). According to the distribution-of-product test, we observed a mediating effect of depressive symptoms on the relationship between chronic pain and CVD with the percentage of mediation of 32.8%. The mediating effect of depression was observed in individuals of aged45-65 years old, female participants, participants who never drinking and not have hypertension., Conclusion: Chronic pain was positively associated with CVD for Chinese population, and depressive symptoms was considered to mediate the association between chronic pain and CVD., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Background: Despite increased literature focusing on the role of the built environment (BE) in health, few cohort studies have quantitatively analyzed neighborhood walkability environment in relation to the risk of death and cardiovascular disease (CVD). This longitudinal study aimed at evaluating the association between perceived BE attributeswith mortality and major CVD based on the Prospective Urban Rural Epidemiology study in China (PURE-China)., Methods: The PURE-China study recruited 47,931 participants aged 35-70 years from 12 provinces of China between 2005 and 2009. The perceived BE information, including land use, street, aesthetics, and safety, was collected using the neighborhood environment walkability scale (NEWS) questionnaire, with higher scores indicating a more favorable rating. Two primary outcomes are all-cause mortality and major CVD event. The Cox frailty model with random intercepts was used to assess the association between the perceived total BE/subscales score and outcomes., Results: Of 32,163 participants included in this study, 19,253 (59.9 %) were women, and the mean (SD) age was 51.0 (9.5) years. After a median follow-up period of 11.7 years (IQR 9.4 - 12.2), we observed that one standard deviation higher of combined BE scores was related to a lower risk of all-cause mortality (HR = 0.85; 95 %CI, 0.80-0.90), and major CVD events (HR = 0.95; 95 %CI, 0.90-0.99). The subscales of perceived BE were related to a lower risk, although a few were not significant. Land use mix-diversity and safety from crime were the two most significant subscales. Stronger risks were observed among urban and female participants., Conclusion: Favorable perceived BE characteristics were linked with a lower risk of all-cause mortality and major CVD events in Chinese population, especially in urban areas and females. Our findings can be used by policymakers to take action to mitigate the adverse effect of poor community conditions on health, such as improving local amenities and transport connectivity, providing building paths for walking, running and cycling., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

A Myocardial Infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to the coronary artery of the heart, causing damage to the heart muscle. This investigation is a pioneering effort to depict the scientific output of myocardial infarction research especially in China using the data downloaded from Scopus database for a period from 2001 to 2020. The study proved that Chinese scholars are interested in collaborative research rather than solo research. The study deviates Bradford's law of scattering. The highest productive journal in this field, as chosen by Chinese scholars is Chinese Medical Journal followed by International Journal of Cardiology (United States) and Medicine (United States). Wang, Y ranks first with 922 publications followed by Zang, Y and Li, Y having 849 and 739 publications respectively. More than one third of the references are of less than 5 years old. [ABSTRACT FROM AUTHOR]

Ethnopharmacological Relevance: Fructus Choerospondiatis is the dried and mature fruit of Choerospondias axillaris (Roxb.) Burtt et Hill. It has been used for a long time in Tibetan and Mongolian medicine, first recorded in the ancient Tibetan medicine book "Medicine Diagnosis of the King of the Moon" in the early 8th century. Fructus Choerospondiatis shows multiple pharmacological activities, especially in treating cardiovascular diseases., Aim of This Review: This paper reviews the progress in research on the botanical characteristics, traditional uses, chemical constituents, pharmacological activity, clinical studies, and quality control of Fructus Choerospondiatis. This review aims to summarize current research and provide a reference for further development and utilization of Fructus Choerospondiatis resources., Method: The sources for this review include the Pharmacopeia of the People's Republic of China (2020), theses, and peer-reviewed papers (in both English and Chinese). Theses and papers were downloaded from electronic databases including Web of Science, PubMed, SciFinder, Scholar, Springer, and China National Knowledge Infrastructure.The search terms used were "Choerospondias axillaris", "C. axillaris", "Choerospondias axillaris (Roxb.) Burtt et Hill", "Fructus choerospondiatis", "Guangzao", "Lapsi", and "Lupsi"., Results: Fructus Choerospondiatis contains polyphenols, organic acids, amino acids, fatty acids, polysaccharides, and other chemical components. These ingredients contribute to its diverse pharmacological activities such as antioxidant activity, protection against myocardial ischemia-reperfusion injury, anti-myocardial fibrosis, heart rhythm regulation, anti-tumor, liver protection, and immunity enhancement. It also affects the central nervous system, with the ability to repair damaged nerve cells., Conclusion: Fructus Choerospondiatis, with its various chemical compositions and pharmacological activities, is a promising medicinal resource. However, it remains under-researched, particularly in pharmacodynamic material basis and quality control. These areas require further exploration by researchers in the future., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Aims: The aim of this study was to examine main risk factors of undocumented Chinese migrants living in Italy when compared with Chinese migrants registered with National Health Service (NHS)., Methods: A cohort of 3435 Chinese first-generation immigrants living in Prato underwent blood pressure (BP) measurement and blood tests. Hypertension was diagnosed for BP ≥ 140/90 mmHg at 2 visits, and/or antihypertensive drug use; type 2 diabetes (T2DM) for fasting glucose ≥ 126 mg/dL at 2 visits, and/or use of hypoglycemic drugs; hypercholesterolemia (HC) for cholesterol ≥ 240 mg/dL and/or statins use. Subjects diagnosed with hypertension, T2DM, or HC unaware of their condition were considered newly diagnosed. Comparisons were performed using multivariable adjusted logistic regression analysis., Results: A large proportion of Chinese migrants were undocumented (1766, 51 %); newly diagnoses of risk factors were performed especially among undocumented migrants; registration with NHS was associated with higher level of awareness for hypertension and T2DM and with 6 times higher rate of treatment for T2DM. Only a small minority of subjects with high cholesterol were treated with statins., Conclusions: Undocumented immigrants had high prevalence of risk factors with lower levels of awareness than migrants registered with the NHS. Health policies targeting this hard-to-reach population needs to be improved., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Although sleep duration and depression were correlated, their temporal sequence and how the sequence influence on future risk of cardiovascular disease (CVD) remained undetermined. This study aimed to explore the temporal relationship between sleep duration and depression, and its association with future CVD risk., Methods: We included 10,629 middle-aged and elderly participants with repeated measurements of sleep duration and depressive symptoms (measured by Center for Epidemiological Studies-Depression scale [CESD]) at the first two visits from the China Health and Retirement Longitudinal Study. Cross-lagged analysis and mediation analysis were used to examine the temporal relationship between sleep duration and depression and its impact on future risk of CVD., Results: The adjusted cross-lagged path coefficient from baseline sleep duration to follow-up CES-D (β 1  = -0.191; 95 % confidence interval [CI], -0.239 to -0.142) was significantly greatly than that from baseline CES-D to follow-up sleep duration (β 2  = -0.031; 95 % CI, -0.031 to -0.024) (P difference  < 0.0001). Similarly, the path coefficient from baseline sleep duration to annual changes in CES-D was significantly greater than that from baseline CES-D to annual changes in sleep duration (β 1  = -0.093 versus β 2  = -0.015, P difference  < 0.0001). The path coefficient from baseline sleep duration to follow-up CES-D in CVD group was significantly greater than that in those without CVD (P difference of β 1  = 0.0378). Furthermore, 27.93 % of the total association of sleep duration with CVD was mediated by depression symptoms., Conclusions: The findings provide evidence that decrease in sleep duration probably precedes the increased in depressive symptoms, and depression partially mediated the pathway from sleep duration to incident CVD., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Background: Data on the relationship between short-term exposure to air pollution and cardiovascular diseases (CVDs) and the potential modifying factors are limited and inconsistent., Objective: To explore the relationship between short-term exposure to air pollution and CVD risk, and potential modification effect factors., Method: A time series study was conducted on 52,991 hospital admissions for CVD from 2015 to 2019 in Xiangyang City, China. Air pollution data from four national fixed monitoring stations were collected to estimate exposure level in Xiangyang City. A quasi-Poisson generalized additive model incorporating a distributed lag nonlinear model was applied to evaluate the association between air pollution and CVD risk. The potential modification effect of sex, age, and season on the above associations was also evaluated., Results: CVD risk was positively associated with air pollution. Peak associations in single lag day structures were observed for particulate matter ≤10 μm in aerodynamic (PM 10 ; RR: 1.040, 95 % CI: 0.996-1.087), PM 2.5 (1.025, 1.004-1.045), nitrogen dioxide (NO 2 ; 1.074, 1.039-1.111), and sulfur dioxide (SO 2 ; 1.079, 1.019-1.141) at Lag 0 and ozone (O 3 ; 1.018, 1.004-1.031) at Lag 4. In cumulative lag day structures, the highest RRs were 1.225 (1.079,1.392) for PM 10 at Lag 06, 1.054 (1.013, 1.098) for PM 2.5 at Lag 03, 1.200 (1.119, 1.287) for NO 2 at Lag 04, and 1.135 (1.025, 1.257) for SO 2 at Lag 02. Moreover, the association between air pollution and CVD risk was modified by sex and age (P < 0.05). Females and individuals aged ≤65 years were more vulnerable to NO 2 and had a higher CVD risk., Conclusion: Short-term exposure to air pollution was positively associated with CVD risk. Moreover, sex and age could modify the effect of air pollution on CVD risk. Females and individuals aged ≤65 years had a higher NO 2 exposure-induced CVD risk., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Cardiovascular diseases (CVDs) become a major public health concern. Evidence concerning the effects of outdoor artificial light at night (ALAN) on CVD in adults is scarce. We aimed to investigate the extent to which outdoor ALAN could affect the risk of CVD over a exposure range. Data from the China Health and Retirement Longitudinal Study, a population-based longitudinal study, launched in 2011-2012 and follow up till 2018, covering 28 provinces, autonomous regions and municipalities across mainland China. This study included 14,097 adults aged ≥45 years. Outdoor ALAN exposure (in nanowatts per centimeters squared per steradian) within 500 m of each participant's baseline residence was obtained from satellite image data. CVD was defined from medical diagnosis. The population was divided into three groups based on outdoor ALAN exposure from low to high. Cox regression model was used to estimate the association between outdoor ALAN exposure and incident CVD with hazard ratios (HRs) and 95 % confidence intervals (CIs). The mean (SD) age of the cohort was 57.6 (9.1) years old and 49.3 % were males. Outdoor ALAN exposure of study participants ranged from 0.02 to 39.79 nW/cm 2 /sr. During 83,033 person-years of follow-up, 2190 (15.5 %) cases of CVD were identified. Both low (HR: 1.21; 95 % CI: 1.02-1.43) and high (HR: 1.23; 95 % CI: 1.04-1.46) levels of outdoor ALAN exposure group were associated with higher risk of CVD compared with intermediate levels of outdoor ALAN exposure group. Body mass index was a significant effect modifier in the association between outdoor ALAN and risk of CVD, with stronger effects among those who was overweight or obese. The findings of this study suggest that low and high outdoor ALAN exposure were associated with a higher risk for CVD. More attention should be given to the cardiovascular effects associated with outdoor ALAN exposure., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Objectives: We aimed to seek accurate assessments of the glomerular filtration rate (GFR) in a Chinese hypertensive population to identify individuals at high risk for chronic kidney disease (CKD) progression. Then, the risk of cardiovascular disease (CVD) and all-cause death due to kidney injury were further investigated under appropriate GFR-estimation equations., Methods: In this prospective follow-up cohort study of 10,171 hypertensive patients, we compared the discrimination power of a trio of GFR-estimation equations using Harrell's C-index, measuring the model fit by calculating the Akaike information criterion. Univariate and multivariable logistic regression analyses were respectively used to calculate the hazard ratio (HR) and 95% confidence interval [CI] values for CKD progression. In addition, we also assessed the risk of CVD and all-cause death with impaired renal function using multivariable-adjusted Cox regression models., Results: The Modification of Diet in Renal Disease (MDRD) equation showed the highest C-index range for the predicted probability of CKD progression in the fully adjusted model. During MDRD analysis, a low eGFR (60-89 mL/min/1.73m 2 or < 60 mL/min/1.73m 2 ) was an independent risk factor for CVD, especially stroke (1.28 [95% CI, 1.05-1.55] and 1.89 [95% CI, 1.08-3.31]), as well as all-cause mortality (1.28 [95% CI, 1.09-1.50] and 1.68 [95% CI, 1.01-2.78])., Conclusions: The MDRD equation seems to be more suitable for screening CKD progression in Chinese hypertensive populations, targeting potential risk factors for effective prevention to reduce renal impairment so as to further limit CVD morbidity and mortality., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

This study aimed to explore the separate and joint effects of long-term ambient air pollution and household air pollution exposure on 10-year high cardiovascular disease (CVD) risk among postmenopausal women. A total of 4679 postmenopausal women from the China Health and Retirement Longitudinal Study (CHARLS) were included in this study. Information of fuel type was collected by standard questionnaires and use of solid fuel was considered as a proxy for household air pollution. Data of ambient air pollutants (PM 1 , PM 2.5 , PM 10 , SO 2 , NO 2 , CO, O 3 ) were obtained from the ChinaHighAirPollutants (CHAP) datasets. Logistic regression models were performed to assess the separate and joint effects of long-term exposure to ambient air pollution and use of solid fuel on 10-year high CVD risk. We found use of solid fuel and its duration and ambient air pollutants (PM 1 , PM 2.5 , PM 10 , SO 2 , NO 2 ) were all positively associated with 10-year high CVD risk among postmenopausal women (P < 0.05). Compared to those used clean fuel and exposed to low ambient air pollution levels, odds ratios (ORs) and 95% confidence intervals (CIs) for participants using solid fuels and exposed to high ambient air pollution levels (PM 1 , PM 2.5 , PM 10 , SO 2 , NO 2 , CO, O 3 ) were 1.66 (1.35, 2.05), 1.66 (1.35, 2.04), 1.49 (1.22, 1.83), 1.28 (1.05, 1.57), 1.67 (1.34, 2.07), 1.28 (1.04, 1.57), 1.46 (1.18, 1.80), respectively. Moreover, significant additive interactions of solid fuel use with PM 1 and PM 2.5 on 10-year high CVD risk were observed, with approximately 18% and 23% of 10-year high risk of CVD attributable to the interaction. Overall, indoor and outdoor air pollution had separate and joint effects on 10-year high CVD risk among postmenopausal women. Therefore, simultaneously improving indoor and outdoor air quality are of great importance and could have a joint impact on prevention of CVD and improved health among postmenopausal women., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Cardiovascular diseases (CVDs) are the leading cause of deaths among adult populationinChina, whose incidence and mortality rates continue rising with a trend towards youngerages. Although numerous drugs are used to prevent and treat CVDs, the long-termprognosisof patients with CVDs is still not very satisfactory. Therefore, there is an urgent needtoexplore new safe and effective drugs for CVDs in clinical practice. As a traditional medicinein China, Ginkgo biloba has a history of more than 2,000 years in clinical practice experience, meanwhile its therapeutic role in CVDs has been revealed in more and more clinical studies. As a living fossil of traditional Chinese medicine, Ginkgo biloba, a deciduous tree plant of theGinkgo family and genus, contains active medicinal ingredients in its leaves, kernels, outerskins and roots. Ginkgo biloba leaves are the main medicinal part, which are mild innature, sweet, bitter and astringent in taste. Ginkgo biloba activates the circulation of blood, relievespains, and lowers lipids, which is mainly used to treat chest obstruction and heartaches, stroke hemiplegia, and asthma, as well as hyperlipidemia, etc. This paper aims to reviewthemedicinal properties of Ginkgo biloba and its active ingredients in the treatment of CVDs, with emphasis on the antioxidant, apoptosis-inhibiting, anti-inflammatory mechanismandother mechanisms, so as to provide a scientific basis for their clinical application as well asfurther development and utilization. [ABSTRACT FROM AUTHOR]

Background: Increasing evidence indicates that the gut microbiota (GM) is linked to cardiovascular disease (CVD). Many studies on the GM in CVD have been published in the last decade. However, bibliometric analysis in this field is still lacking. Methods: On 30 September 2022, a search of the Web of Science™ (WoS; Clarivate™, Philadelphia, PA, USA) yielded 1,500 articles and reviews on the GM and CVD. Microsoft Excel and CiteSpace and VOSviewer software were used to analyze publication trends and research hotspots in this field. Results: Our search generated 1,708 publications on the GM in CVD published between 2004 and 2022, and 1,500 articles and review papers were included in the final analysis. The number of publications relating to the GM in CVD increased from 1 in 2004 to 350 in 2021. China (485 publications, 9,728 non-self-citations, and an H-index of 47) and the USA (418 publications, 24,918 non-self-citations, and an H-index of 82) contributed 32.31%, and 27.85%, respectively, of the total number of publications. Examination of the number of publications (Np) and number of citations, excluding self-citations (Nc), of individual authors showed that Y. L. Tian (Np: 18, Nc: 262, and H-index: 12), from China, is the most productive author, followed by R. Knight (Np: 16, Nc: 3,036, and H-index: 15) and M. Nieuwdorp (Np: 16, Nc: 503, and H-index: 9). The Chinese Academy of Medical Sciences and Peking Union Medical College accounted for the largest number of publications (Np: 62, Nc: 3,727, and H-index: 13, average citation number (ACN): 60.11). The journal Nutrients had the most publications (Np: 73, Nc: 2,036, and ACN: 27.89). The emerging keywords in this field were "monooxygenase 3" (strength 3.24, 2020-2022), "short-chain fatty acid" (strength 4.63, 2021-2022), "fatty liver disease" (strength 3.18, 2021-2022), "metabolic disease" (strength 3.04, 2021-2022), "Mediterranean diet" (strength 2.95, 2021-2022), "prevention" (strength 2.77, 2021-2022), and "intestinal barrier" (strength 2.8, 2021-2022). Conclusion: Publications on the GM in CVD rapidly increased in the last decade. The USA was the most influential country in publications in this field, followed by China. The journal with the most publications was Nutrients. Monooxygenase-3, short-chain fatty acids, fatty liver disease, metabolic disease, the Mediterranean diet, intestinal barrier, and prevention are the current hotspots or potential hotspots for future study. [ABSTRACT FROM AUTHOR]

Background: Particulate matter (PM) exposure has been linked with cardiovascular disease (CVD) and metabolic syndrome (MetS), the latter characterized by concurrent multiple metabolic disorders. As a result, the mechanisms assumption from PM to CVD through MetS have emerged, thus requiring further epidemiological evidence. This cohort study aimed to assess whether MetS mediates the associations of PM with CVD risk., Methods: This study included 14,195 participants from the Chengdu cohort of the China Multi-Ethnic Cohort (CMEC) study in 2018. The primary outcome of incident CVD diagnoses was identified using matched hospital records from the Health Information Center of Sichuan Province. Residence-specific levels of PM with aerodynamic diameters of ≤ 1 µm (PM 1 ), ≤ 2.5 µm (PM 2.5 ), and ≤ 10 µm (PM 10 ) were estimated by spatiotemporal models. Causal mediation analyses were applied to evaluate the indirect effect of MetS., Results: Increased exposure levels to PM were significantly associated with MetS and CVD. Mediation analyses indicated that the associations between PM exposure and CVD were mediated by MetS, with the proportion of multiple mediations being 19.3%, 12.1%, and 13.5% for PM 1 , PM 2.5 , and PM 10 , respectively. Further moderated mediation analyses suggested that male, overweight individuals, alcohol drinkers, and those suffering from indoor air pollution may experience more significant adverse effects from PM exposure on CVD via MetS than others., Conclusions: Our findings suggest that MetS partially mediates the association between long-term exposure to PM and CVD. These mediation effects appear to be amplified by demographic characteristics and unhealthy lifestyles., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Interoceptive awareness (perception of body conditions and processes) and heart rate variability are connected physiologically in cardiovascular disease (CVD) patients. At present, there is no specific evaluation model for the perception of the physical state and processes of CVD patients in China., Objectives: The objective of this study is to examine the reliability and validity of the Chinese Interoceptive Awareness Questionnaire (C-IAQ) for Chinese CVD patients., Methods: 160 CVD patients were recruited from a hospital in Hubei province using a convenient sampling method. A standard "forward-backward" translation method was applied to convert the C-IAQ into Mandarin. Split-half reliability and internal consistency were conducted by using reliability tests. Validity testing was conducted on the content, structure, and criterion-related validity. Criterion-related validity was assessed by using the Anxiety Sensitivity Index-III (ASI-III)., Results: The research results indicate that the dual factor structure of the original C-IAQ has 19 items, including attention to unpleasant sensations (9 items) and awareness of neutral body sensations (10 items). Moreover, C-IAQ is positively correlated with ASI-III (r = 0.48, P<0.01). The entire scale has a Cronbach's α value of 0.85 and split-half dependability of 0.77., Conclusion: The C-IAQ has favorable psychometric feature. Hence, it can be used to measure the interoceptive awareness of CVD patients., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Inc.)

Background: Cardiovascular diseases are the top cause of death in China. Manual segmentation of cardiovascular images, prone to errors, demands an automated, rapid, and precise solution for clinical diagnosis., Objective: The paper highlights deep learning in automatic cardiovascular image segmentation, efficiently identifying pixel regions of interest for auxiliary diagnosis and research in cardiovascular diseases., Methods: In our study, we introduce innovative Region Weighted Fusion (RWF) and Shape Feature Refinement (SFR) modules, utilizing polarized self-attention for significant performance improvement in multiscale feature integration and shape fine-tuning. The RWF module includes reshaping, weight computation, and feature fusion, enhancing high-resolution attention computation and reducing information loss. Model optimization through loss functions offers a more reliable solution for cardiovascular medical image processing., Results: Our method excels in segmentation accuracy, emphasizing the vital role of the RWF module. It demonstrates outstanding performance in cardiovascular image segmentation, potentially raising clinical practice standards., Conclusions: Our method ensures reliable medical image processing, guiding cardiovascular segmentation for future advancements in practical healthcare and contributing scientifically to enhanced disease diagnosis and treatment.

Short-term exposure to ambient high temperature (heat) could increase the risk of cardiovascular disease (CVD). However, available evidence on the burden of daytime and nighttime heat on CVD is limited and vulnerable populations remain unknown so far. We aimed to examine and differentiate the impact of daytime and nighttime heat on CVD in China. Data on daily outpatient visits for CVD were collected from 15 Chinese cities spanning multiple geographical regions, climates, and socio-economic conditions. The population-weighted temperature was used to calculate excess heat exposure in warm seasons (June-September) from 2011 to 2015. Hot day excess (HDE) and hot night excess (HNE), the sum of temperature above the heat threshold during daytime and nighttime respectively, were used to represent daytime and nighttime excess heat. A distributed lag non-linear model was employed to estimate the city-level association between HDE/HNE and daily CVD cases. The city-level association was then pooled by multivariate meta-analysis. We further estimated the disease burden of CVD attributable to HDE and HNE by geographical regions, gender, and age. A total of 729,409 cases of CVD were included in this study. Both HDE and HNE were associated with an increased risk of CVD, with greater effects from nighttime heat (relative risk (RR): 1.38; 95% confidence interval (CI): 1.18-1.61) than daytime heat (RR: 1.10; 95% CI: 1.05-1.15). The proportion of CVD cases attributable to HNE was 15.7%, which was almost three times as high as HDE (4.6%, p for difference <0.05). Males, people living in northern cities, and those aged less than 45 years were more vulnerable to HNE. Our findings for the first time revealed an intra-day difference in the heat effect on CVD, with a greater impact from nighttime heat exposure, which should be considered to protect vulnerable populations on hot days., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

With the aggravation of population aging, the health of the elderly has become an important issue in the aging society. The Mediterranean diet (MD) contributes to healthy aging by changing dietary patterns to delay and prevent disease onset. This paper summarizes the concepts related to the MD pattern and its relationship with cardiovascular diseases, cognitive dysfunction, depression, chronic inflammation and other brain and heart comorbidity in the elderly, so as to provide thinking and reference for the optimization and upgrading of the elderly, and contribute to the development of healthy China. [ABSTRACT FROM AUTHOR]

Abstract: Background: Evidence‐based nursing has been highlighted and highly developed in recent decades in mainland China. Nevertheless, little is known about its overall development. Aims: To gain insights on the overall development of evidence‐based nursing in the most recent 5 years and to inform future evidence‐based nursing research in mainland China. Method: Four Chinese and four English databases were searched with the search terms “evidence‐based practice,” “nurse or nursing,” and “China or Chinese” from 2012 to 2016. Bibliometric and co‐word cluster analysis were conducted with the final included publications. Results: A total of 9036 papers published by 13 808 authors in 606 journals were included. Publication numbers were increasing. None of the top ten journals publishing evidence‐based nursing papers were core nursing journals. The research hot spots on evidence‐based nursing in the recent five years were cardiovascular disease, mental health, and complication prevention. However, little attention has been paid to education for evidence‐based nursing. Conclusion: Evidence‐based nursing has penetrated into various nursing branches in mainland China and become a well‐recognized and relatively mature research domain. More importance should be attached to the study design, methodological, and reporting quality of evidence‐based nursing projects. [ABSTRACT FROM AUTHOR]

Ambient ozone (O 3 ) pollution has been associated with an increased risk of cardiovascular diseases. However, few studies have addressed the effect of O 3 exposure on electrocardiogram (ECG) abnormalities, a subclinical indicator of early damage to the cardiovascular system. This study aimed to examine the association between short-term exposure to O 3 and ECG abnormalities. We included 102,027 visits of 47,290 participants over 40 years old who had a normal ECG at baseline and then visited again at least once from the China National Stroke Screening Survey (CNSSS). Short-term ozone exposure concentrations were measured as averages of maximum daily 8-h O 3 concentrations over the two weeks prior to ECG measurements. The generalized estimation equations models were used to evaluate the association between O 3 exposure and ECG abnormalities. For every 10 µg/m 3 increment in short-term O 3 concentration, the odds ratio of any ECG abnormality was 1.055 (95% confidence interval [CI] 1.045-1.064). For ECG-diagnosed cardiac arrhythmia, the odds ratio was 1.062 (95% CI 1.052-1.072). A nonlinear analysis showed a sublinear relationship between O 3 exposure and risk for ECG abnormalities. The association between O 3 exposure and ECG abnormalities varied by subpopulation. Our study provided new epidemiological evidence on the association between short-term O 3 exposure and ECG abnormalities. There is an urgent need to control ambient O 3 pollution to prevent cardiovascular events., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)