Statins, renin-angiotensin system inhibitors (RASIs) and beta-blockers are guideline-recommended cardiovascular medications post-myocardial infarction (MI) for secondary prevention, but evidence for people with dementia is scarce.

To evaluate the association between post-MI cardiovascular medication use and the risk of cardiovascular outcomes and mortality, focusing on people with dementia.

Large retrospective cohort study using data from Australia, Finland, Taiwan, the UK and the USA.

People with and without dementia.

Seven exposure groups were assigned using one or combinations of the three guideline-recommended medication classes-(i) statin, RASI and beta-blocker, (ii) statin and beta-blocker, (iii) statin and RASI, (iv) RASI and beta-blocker, (v) statin only, (vi) beta-blocker only and (vii) RASI only, based on medication records during a 60-day landmark period post-MI. Recurrent MI, major adverse cardiovascular event (MACE) and all-cause mortality were evaluated as outcomes. Jurisdiction-specific results were pooled together using meta-analyses.

A total of 28 122 people with dementia and 260 360 people without dementia were included. Among people with dementia, using any single or two medications carried a similar risk of recurrent MI and MACE as using all three guideline-recommended medications, except that using RASI and a beta-blocker without a statin was associated with a lower risk of recurrent MI (HR 0.85; 95% CI, 0.75-0.96). Using a statin and RASI without beta-blockers resulted in similar all-cause mortality to using all three (HR 1.16; 95% CI, 0.97-1.39), while all the remaining single- or dual-medication regimens were associated with higher risks of all-cause mortality.

For people with dementia, using one or two guideline-recommended medications appeared sufficient to protect against recurrent MI and MACE. Beta-blockers may not provide additional survival benefits over statins and RASIs.

Ginger (Zingiber officinale L.) contains bioactive compounds with vasodilatory properties that may benefit blood pressure (BP) regulation. However, findings from studies remain inconsistent. This systematic review and meta-analysis aimed to evaluate the effect of ginger supplementation on BP in adults.

The literature was systematically searched in PubMed, Web of Science, and Scopus from database inception through May 1, 2026, to identify eligible randomized controlled trials (RCTs) evaluating systolic and diastolic blood pressure (SBP, DBP). Pooled effect estimates were calculated as weighted mean differences (WMDs) using a random-effects model. Subgroup and sensitivity analyses, publication bias assessments, and both linear and nonlinear dose-response analyses were conducted. The risk of bias was evaluated using the RoB 2 tool, and the certainty of the evidence was assessed according to the GRADE framework.

Twelve unique RCTs contributed 13 effect sizes for SBP and 12 effect sizes for DBP. Ginger supplementation significantly reduced SBP (WMD: -5.03 mmHg, 95% CI: -8.49, -1.57; p = 0.004) and DBP (WMD: -2.03 mmHg, 95% CI: -3.90, -0.15; p = 0.034). Subgroup-specific reductions were observed in trials enrolling participants with elevated baseline BP, using doses ≥ 2000 mg/day, including both sexes, and enrolling participants with obesity. Nonlinear dose-response analyses confirmed a significant inverse association between ginger dose and BP, whereas intervention duration had no meaningful influence. Findings remained robust in sensitivity analyses, and no evidence of publication bias was detected. GRADE assessment rated the certainty of the evidence as low, downgraded only for inconsistency.

Ginger supplementation was associated with modest reductions in BP, with potentially greater effects in higher-risk populations and at doses ≥ 2000 mg/day. However, substantial heterogeneity, short trial durations, and limited robustness of the DBP findings reduce confidence in these estimates. Further high-quality, long-term RCTs are needed before definitive clinical or dosing recommendations can be made.

The precise association between the atherogenic index of plasma (AIP) and its derived anthropometric indicators and the future risk of liver diseases and alcoholic liver disease among Chinese middle-aged and elderly adults remains unclear. The study population was derived from the China Health and Retirement Longitudinal Study. Incident liver disease cases were identified based on self-reported questionnaire information. The AIP and its related indicators were calculated using laboratory results from participants blood samples. We employed Cox regression to assess the associations between cumulative and categorical AIP, as well as related indicators, and the occurrence of liver disease. Additionally, restricted cubic splines were used to examine potential nonlinear relationships between cumulative AIP and liver disease risk. The mean age of the 9027 participants was 61.20 ± 9.54 years, and 438 (4.85%) subjects developed liver disease during a median follow-up duration of 7 years. After full adjustment for confounders, each 1-standard deviation increase in AIP was associated with a 15% higher risk of liver disease (HR = 1.15; 95% confidence intervals: 1.02-1.30; P = .020). Similarly, higher levels of AIP-BMI, AIP-WC, and AIP-BRI were associated with increased liver disease risk. restricted cubic splines analyses visually confirmed a positive dose-response relationship between AIP and its related indicators and liver disease risk, with no significant nonlinear trends. Additionally, subgroup analyses and sensitivity analyses confirmed that higher levels of AIP are associated with a higher risk of liver disease. In this national cohort, higher AIP was associated with an increased risk of self-reported liver disease. Long-term monitoring of AIP may help identify individuals for further hepatic assessment. However, confounding from unmeasured factors including viral hepatitis cannot be ruled out.

This study aimed to analyze the global disease burden, temporal trends of ischemic stroke (IS) in adults aged 20 to 54 years (1990-2021), and temporal disparities in attributable risk factors. Using Global Burden of Disease 2021 data, we extracted estimates with 95% uncertainty intervals for IS prevalence, incidence, mortality, and disability-adjusted life years (DALYs) among adults aged 20 to 54 years. Trends were assessed globally and locally, stratified by sex and age subgroup. Age-period-cohort models estimated age, period, and cohort effects on prevalence and incidence, and population-attributable fractions were used to evaluate temporal changes in risk factor contributions. In 2021, adults aged 20 to 54 years had 16,301,644 prevalent IS cases and 1,324,743 incident cases worldwide, with rates of 432.46 and 35.14 per 100,000 population, respectively. IS caused 105,859 deaths and 6,967,488 DALYs, corresponding to mortality and DALY rates of 2.81 and 184.84 per 100,000 population. From 1990 to 2021, prevalence and incidence increased, whereas mortality and DALYs declined. Prevalence was higher among females, while incidence, mortality, and DALYs were higher among males. Marked heterogeneity was observed across socio-demographic index regions, Global Burden of Disease, Injuries, and Risk Factors Study regions, and countries. Greater burdens were concentrated in high-middle socio-demographic index regions, Eastern Europe, Central Asia, and parts of North Africa and the Middle East, while East Asia experienced the largest increase in incidence. Joinpoint regression showed fluctuating but overall increasing trends in prevalence and incidence, alongside sustained declines in mortality and DALY rates after the early 2000s. Age-period-cohort analysis indicated that the risks of IS prevalence and incidence increased with age, particularly after 35 years. Period effects peaked in 2017 to 2021, whereas cohort effects declined progressively from the 1942 to 1946 to the 1997 to 2001 birth cohorts. High low-density lipoprotein cholesterol, high systolic blood pressure, particulate matter pollution, smoking, and high body mass index were the leading contributors to IS-related DALYs. From 1990 to 2021, the population-attributable fractions of particulate matter pollution, smoking, and high-sodium diet decreased, whereas those of metabolic risks increased, particularly high systolic blood pressure and high body mass index. IS imposes a heavy global burden on young and middle-aged adults with an upward trend driven by metabolic, environmental, and lifestyle factors. Early screening and targeted risk management are critical.

The association between the modified cardiometabolic index (MCMI) and stroke risk remains unclear. This study aimed to investigate the relationship between MCMI and incident stroke. A total of 8167 participants from the China Health and Retirement Longitudinal Study (baseline 2011) were included. MCMI was calculated as ln[triglycerides × fasting blood glucose/ high-density lipoprotein cholesterol] × waist circumference/ height. Incident stroke was defined as self-reported physician-diagnosed stroke during follow-up through 2020. Cox proportional hazards regression, restricted cubic spline (RCS) modeling, and subgroup analyses were performed to examine the association. Time-dependent receiver operating characteristic (ROC) analysis was used to compare the predictive performance of MCMI with that of the cardiometabolic index (CMI). Over 9 years of follow-up, higher MCMI levels were associated with increased stroke risk (hazard ratio [HR] = 1.32, 95% confidence interval [CI]: 1.20-1.46). Quartile analyses confirmed this trend, with the highest quartile showing the greatest risk compared with the lowest (HR = 2.30, 95% CI: 1.80-2.94). RCS analysis revealed a nonlinear relationship (P for nonlinearity = 0.002). Subgroup analyses suggested potential heterogeneity across marital status and residential location. ROC analysis showed that the MCMI consistently yielded higher AUC values than the CMI at 3 years (0.72 vs 0.70), 5 years (0.75 vs 0.73), 7 years (0.77 vs 0.75), and 8 years (0.72 vs 0.70), with all DeLong's test P-values < 0.05. Higher MCMI levels were positively associated with stroke risk. Although MCMI demonstrated slightly better predictive performance than CMI, the improvement was limited. These findings support an association rather than direct clinical applicability. Additional large-scale prospective studies and validation analyses are required before its routine use in clinical risk stratification can be considered.

Depression and anxiety are prevalent among patients with cardiovascular disease (CVD) and detrimentally affect their health-related quality of life (HRQoL). Although current guidelines recommend screening for both conditions, the mechanisms underlying the association between depression and HRQoL, particularly through the anxiety subdomains of fear, attention, and avoidance, remain unclear. This study investigates how anxiety-related factors mediate the relationship between depression and HRQoL in patients with CVD. This cross-sectional study analyzed 204 CVD outpatients from a tertiary hospital in South Korea. Each patient completed the Patient Health Questionnaire-9 to assess depression, the Cardiac Anxiety Questionnaire to evaluate anxiety subdomains, and the 12-Item Short Form Health Survey to measure HRQoL. Serial multiple mediation analyses were conducted to examine the direct and indirect associations between depression and HRQoL. This approach allowed the potential pathways of mediators to be simultaneously tested, particularly the sequential path from fear to attention to avoidance. Higher depression scores showed a significant negative association with HRQoL (total effect: β = -0.5449, P < .001). Moreover, indirect pathways were observed: increased depression was associated with heightened levels of fear, attention, and avoidance. The direct association between depression and HRQoL remained significant when the indirect pathways were controlled (β = -0.3888, P < .001), supporting a partial mediation model. The overall mediation model explained 18% of the variance in HRQoL. Our findings suggest that a complex interplay between depression and anxiety subdomains influences quality of life among patients with CVD. Therefore, future prospective or interventional studies are needed to evaluate whether interventions targeting depressive symptoms and maladaptive anxiety responses can improve HRQoL in this population.

This study aimed to investigate the association between weekend catch-up sleep (WCS) and stroke among US adults. Data from the 2017 to 2020 and 2021 to 2023 cycles of the National Health and Nutrition Examination Survey were analyzed, including 11,134 participants aged ≥20 years. Sleep duration and stroke status were obtained from self-reported questionnaires. WCS was calculated as the difference between weekend and weekday sleep duration. Participants were categorized into 4 groups: ≤0 hours, 0 to <2 hours, 2 to <3 hours, and ≥3 hours. Multivariable logistic regression models, subgroup analyses, interaction tests, and restricted cubic spline analyses were performed to evaluate the association between WCS and stroke. In the fully adjusted model, participants with WCS > 0 hours had a lower likelihood of stroke compared with those with WCS ≤ 0 hours (adjusted odds ratio = 0.78, 95% confidence interval: 0.62-0.97, P = .0268). Among the categorized groups, only WCS of 2 to <3 hours was significantly associated with a lower likelihood of stroke (odds ratio = 0.60, 95% confidence interval: 0.39-0.94, P = .0251). Subgroup analyses showed that this association remained significant among women, individuals aged 36-64 years, and those with a history of alcohol consumption. A significant interaction was observed for age (P for interaction = .0385). WCS was associated with a lower likelihood of stroke among US adults, particularly when WCS duration was between 2 and 3 hours.

The interconnections between hearing loss, tinnitus, and atherosclerotic cardiovascular disease (ASCVD) remain incompletely elucidated. This study sought to investigate the associations of ASCVD prevalence with hearing loss and tinnitus. We analyzed data from the National Health and Nutrition Examination Survey (2015-2018), encompassing 19,225 US adults aged 20 years and older in this cross-sectional study. Multivariable logistic regression models were employed to examine potential links between ASCVD and both hearing loss and tinnitus. Moreover, we performed subgroup analyses and interaction tests to explore if the relationship was stable in different subgroups. Among 4320 adults included in this study (mean age, 49.8 ± 17.5 years), 452 (10.5%) had ASCVD and 3868 (89.5%) did not have ASCVD. Compared with participants without hearing loss, those with hearing loss had a higher prevalence of ASCVD (unadjusted odds ratio [OR] = 3.62, 95% confidence interval [CI] = 2.96-4.42, P < .001; adjusted OR = 1.49, 95% CI = 1.18-1.88, P < .001). Similarly, tinnitus was independently associated with higher odds of ASCVD (unadjusted OR = 2.40, 95% CI = 1.92-2.99, P < .001; adjusted OR = 1.63, 95% CI = 1.27-2.09, P < .001). This study of US adults revealed robust associations between hearing loss, tinnitus, and ASCVD prevalence.

Poststroke insomnia is often associated with poor recovery. Acupuncture (Acu) and related therapies offer have notable advantages as effective and safe treatment for poststroke insomnia. This systematic review evaluated the therapeutic effect of various Acu interventions on poststroke insomnia.

Two researchers independently screened literature and extracted data from 8 databases for randomized controlled trials of Acu and related therapies for poststroke insomnia. The risk of bias was assessed using the "bias risk assessment tool" recommended by the Cochrane Library. R version 4.4.1 and Stata 18.0 were used to conduct a network meta-analysis of relevant outcomes.

A total of 107 articles were included, involving 8062 patients and 14 Acu related therapies. Network meta-analysis revealed that in terms of Pittsburgh Sleep Quality Index total score, Acu related therapies were superior to western medicine and conventional rehabilitation therapy. The combined therapy, Acu + auriculotherapy + electroacupuncture had the best outcomes. Acu alone, Acu + auriculotherapy + point embedding and Acu + western medicine had better effects on prolonging sleep duration and shortening sleep latency. For subjective sleep quality, point embedding achieved the best outcomes. Warm acupuncture demonstrated the best results in improving daily functional dysfunction, while Acu ranked the as the best in reducing the degree of sleep disorder.

Acu and related therapies have a positive effect in ameliorating poststroke insomnia, with the combined therapy having a more significant effect. However, different Acu regimens should be considered for poststroke insomnia patients with different clinical manifestations. More standardized clinical trials are needed to provide higher quality evidence and optimal treatment regimen.

Reduced muscle strength, also known as dynapenia, is common in metabolic dysfunction-associated steatotic liver disease (MASLD), but its prognostic value remains unclear. This study aimed to examine the associations between dynapenia, defined by knee extensor strength, and mortality in United States adults with MASLD. Data were drawn from 1019 adults (mean age 61.75 years; 52.23% men) aged ≥ 50 years from the 1999-2002 National Health and Nutrition Examination Survey. Dynapenia was assessed by measuring quadriceps isokinetic strength. Participants were followed-up for all-cause and cardiovascular disease (CVD) mortality. Cox proportional hazard regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). During a median follow-up of 212 months, 446 participants died, including 154 from CVD. Compared to non-dynapenic participants, those with dynapenia had increased all-cause (HR = 2.73, 95% CI: 2.24-3.34) and CVD mortality (HR = 2.63, 95% CI: 1.65-4.18). Population-attributable fraction analysis estimated that 23.4% of all-cause deaths and 29.7% of CVD deaths were theoretically attributable to dynapenia. Stratified analysis showed that the associations between dynapenia and all-cause (P for interaction < .001) and CVD mortality (P for interaction = .01) were stronger in non-diabetic participants. The receiver-operating characteristic curve showed that adding dynapenia significantly improved predictive discrimination and offered significant net reclassification improvement. Knee extensor dynapenia is an independent predictor of all-cause and CVD mortality in US adults with MASLD, especially those without comorbid diabetes. Thus, routine assessment of knee extensor strength may guide risk stratification and inform clinical management in patients with MASLD.