Dyslipidaemia remains a leading cause of death in Germany despite an improving therapeutic landscape, with many patients not achieving guideline-recommended low-density lipoprotein cholesterol (LDL-C) goals. Bempedoic acid, an adenosine triphosphate citrate lyase inhibitor, is a recent addition to the therapeutic landscape with proven efficacy in randomised controlled trials; however, its use varies between centres. We aimed to assess the short-term, real-world effectiveness of bempedoic acid in lowering LDL-C levels in patients in Germany.

This retrospective, observational study was conducted using data from patients with primary hypercholesterolaemia or mixed dyslipidaemia, collected before and approximately 3 months after initiating bempedoic acid in 7 specialised lipid outpatient clinics in Germany.

Data were analysed from a total of 641 patients, with a mean age (standard deviation [SD]) of 63.2 (11.3) years. The addition of bempedoic acid significantly reduced LDL-C levels from a mean of 133.6 mg/dL at baseline to 101.8 mg/dL after 3 months (p < 0.001). The mean within-patient LDL-C reduction was 31.8 mg/dL and the mean patient-level percentage change was -17.5%. Mean patient-level changes were -4.9% for HDL-C and -12.0% for total cholesterol; triglycerides did not change significantly. At 3 months, patients not receiving any lipid-lowering therapy (LLT) other than bempedoic acid had a mean patient-level LDL-C reduction of 27.1%; corresponding mean reductions were 23.7% with ezetimibe, 20.3% with PCSK9 inhibitor therapy, 9.0% with statin therapy and 6.1% with statin plus ezetimibe. Suspected adverse events were documented in 218/641 patients (34.0%), and 171/641 (26.7%) had discontinued bempedoic acid by follow-up. Myalgia was the most commonly reported adverse event in patients discontinuing treatment (75 cases).

Findings from this real-world, multicentre study conducted in Germany show that bempedoic acid may present an effective treatment option for patients with hypercholesterolaemia who are already receiving LLT, in addition to being an effective option for patients not receiving/tolerating other LLTs. The magnitude of LDL-C reduction differed across background treatment strategies, while suspected adverse events and treatment discontinuation were common in this specialist-care cohort.

Stroke is one of the leading causes of death and disability in China and imposes a substantial disease burden. Population aging has further increased the challenges of stroke prevention and control among middle-aged and older adults. Although environmental relative humidity (RH) is considered an important environmental determinant of health, existing evidence regarding its association with stroke remains inconsistent, with prospective evidence from Chinese populations being particularly limited. This study aims to investigate the association between environmental RH and the risk of incident stroke among middle-aged and older adults in China and to assess the mediating role of frailty and potential gender differences in this association.

A dynamic-entry cohort was constructed using data from the 2011, 2013, 2015, and 2018 waves of the China Health and Retirement Longitudinal Study (CHARLS), with a total of 19 582 participants ultimately included. Participants were followed from the date of the first interview at which they met the eligibility criteria until the first report of incident stroke, loss to follow-up, or the end of follow-up in 2020. Hourly RH at each participant's place of residence was obtained from ERA5 reanalysis dataset, and the mean RH during the year preceding enrollment was calculated. Participants were categorized into low-, moderate-, and high-humidity groups according to tertiles, with the low-humidity group serving as the reference. Incident stroke was defined as the first self-reported physician diagnosis of stroke during follow-up. Cox proportional hazards models were used to estimate HR and 95% CI, with sequential adjustment for sociodemographic characteristics, health behaviors, mean temperature during the year preceding enrollment, and other potential confounders. Gender-stratified analyses were also performed. Counterfactual-based mediation analysis was conducted to assess the mediating effect of the frailty index (FI), and nonparametric bootstrap resampling with 5 000 repetitions was used to estimate the proportion mediated by FI and its uncertainty.

During a median follow-up of 7 years, 1 235 participants (6.31%) developed incident stroke. Cox regression analyses showed that, compared with the low-humidity group, both the moderate- and high-humidity groups had increased risks of incident stroke. In the fully adjusted model, the HR was 1.119 (95% CI 1.033 to 1.213) for the moderate-humidity group and 1.279 (95% CI 1.227 to 1.331) for the high-humidity group (both P<0.01), with effect estimates progressively attenuated as the degree of model adjustment increased. Gender-stratified analyses showed that the association was more pronounced in men. In the fully adjusted model, the HRs among men were 1.145 (95% CI 1.031 to 1.272) for the moderate-humidity group and 1.352 (95% CI 1.268 to 1.442) for the high-humidity group. Among women, the risk was also elevated in the high-humidity group (HR=1.186, 95% CI 1.092 to 1.288), whereas the association for the moderate-humidity group was attenuated and not statistically significant (HR=1.082, 95% CI 0.954 to 1.227). Mediation analysis indicated that the total effect of environmental RH on incident stroke risk was statistically significant (P<0.01). RH was associated with frailty level (β=0.22, P<0.01), and frailty mediated 22.0% of the association between RH and incident stroke risk.

Higher environmental RH is associated with an increased risk of incident stroke among middle-aged and older adults in China, and this association may be partially mediated through frailty. Gender differences were observed, with the association being more pronounced in men. These findings suggest that exposure to high-humidity environments should be considered in primary stroke prevention and healthy aging management, with enhanced risk identification and health guidance for potentially high-risk subgroups, particularly individuals with frailty and men.

It remains unclear whether the degree of fragmentation modifies the adverse health outcomes associated with prolonged sedentary behavior. This study aims to investigate the associations of objectively measured sedentary patterns with incident cardiovascular disease (CVD), mortality, and life expectancy.

This prospective cohort study included 89 010 UK Biobank participants (median age 63.5 years, 56.5% women) who provided 3 to 7 valid days of wrist accelerometer data. Daily sedentary time and number of sedentary breaks were the metrics of interest. Four overall sedentary behavior patterns were identified by joint classification of sedentary time and number of sedentary breaks. Outcomes were all-cause mortality, CVD incidence and mortality, CVD-free life expectancy, and total life expectancy. Multivariable Cox proportional hazards models were used to evaluate the associations of sedentary behavior metrics with all-cause mortality and CVD incidence, whereas Fine-Gray competing-risk models were used to evaluate their associations with cardiovascular mortality, with non-CVD death treated as a competing event. Restricted cubic splines were used to assess potential nonlinear associations. Multi-state survival analyses were performed to estimate CVD-free life expectancy. Isotemporal substitution models were used to estimate the effects of replacing sedentary time with moderate-to-vigorous physical activity (MVPA).

During a median follow-up of 8.0 years, 3 730 deaths occurred, including 1 223 CVD deaths and 8 883 incident CVD cases. Total sedentary time showed J-shaped dose-response associations with all-cause and cardiovascular mortality and a linear association with increased CVD incidence. The number of sedentary breaks showed L-shaped associations with risks of all-cause mortality and CVD mortality. Compared to the least sedentary group, participants with prolonged sedentary time (≥10 h/d) and a low degree of fragmentation (sedentary break <12 bouts/d) had a 51.5% higher risk of all-cause mortality [hazard ratio (HR)=1.515, 95% confidence interval (CI) 1.380 to 1.663], a 55.3% higher risk of cardiovascular mortality (subdistribution HR=1.553, 95% CI 1.325 to 1.820), and a 10.0% higher risk of incident CVD (HR=1.100, 95% CI 1.030 to 1.174). At age 50, the loss of life expectancy was primarily observed in CVD-free years (men: -2.770 years, 95% CI -3.392 to -2.148; women: -3.113 years, 95% CI -3.794 to -2.432). Notably, a higher frequency of sedentary breaks attenuated the increased mortality risk and the loss of CVD-free life expectancy associated with prolonged sedentary time. Nevertheless, replacing sedentary behavior with MVPA reduced the risk of mortality and CVD incidence among all sedentary participants, regardless of levels of fragmentation.

Prolonged sedentary time and its uninterrupted accumulation patterns are associated with greater risks of mortality and CVD, alongside reductions in CVD-free life expectancy. The increased mortality risk and the loss of CVD-free years may be mitigated by frequent interruptions to sedentary behavior.

Objective: To explore the related factors of patients with primary aldosteronism (PA) developing into stage 4 of cardiovascular-renal-metabolic syndrome (CKM). Methods: A total of 397 patients diagnosed with PA from January 2016 to December 2024 were retrospectively enrolled. According to the CKM staging criteria, the patients were divided into the early stage group (stages 0-2), stage 3 group and stage 4 group. To analyze the differences in each indicator among the three groups. Multivariate logistic regression models were applied to analyze the correlation between each indicator and the occurrence of CKM stage 4 via stepwise adjustment for confounding factors. Subgroup analyses were further conducted by gender, age (≤50 years and >50 years) and PA subtypes [idiopathic hyperaldosteronism (IHA) and aldosterone-producing adenoma]. Results: Among the 397 PA patients, 231 were males and 166 were females, with a confirmed diagnosis age of (51.1±10.9) years. There were 179 patients in the early CKM stage group (including 1 case in stage 0, 7 cases in stage 1, and 171 cases in stage 2), 107 patients in the CKM stage 3 group, and 111 patients in the CKM stage 4 group. There were statistically significant differences among the 3 groups in age, gender, PA subtype, body mass index, diastolic blood pressure, systolic blood pressure, hypertension duration, proportion of dyslipidemia, proportion of diabetes, proportion of atherosclerosis, proportion of chronic kidney disease, proportion of cerebral infarction, and proportion of coronary heart disease (all P<0.05). In terms of laboratory indicators, there were statistically significant differences among the 3 groups in fasting blood glucose, total cholesterol, low-density lipoprotein cholesterol, γ-glutamyl transferase, blood potassium, serum creatinine, urinary albumin/creatinine ratio (UACR), estimated glomerular filtration rate (eGFR), supine aldosterone, and aldosterone 2 hours after the captopril test (all P<0.05). Multivariate logistic regression showed that after adjusting for a series of influencing factors including gender, age, BMI, metabolic indicators, disease history and medication history, 2 h post-captopril aldosterone remained independently and positively correlated with the occurrence of CKM stage 4 in PA patients (OR=1.003, 95%CI: 1.001-1.005). Subgroup analyses revealed that the correlation between 2-hour post-captopril aldosterone and CKM stage 4 was more significant in the male subgroup (OR=1.005, 95%CI: 1.002-1.008),the subgroup aged ≤50 years (OR=1.006, 95%CI: 1.002-1.010) andthe IHA subgroup (OR=1.005, 95%CI: 1.002-1.008). Conclusions: High aldosterone level is a factor associated with progression of CKM to the clinical event phase (CKM stage 4). Among aldosterone-related indicators, 2 h post-captopril aldosterone has the most stable predictive value, and this correlation presents heterogeneity across populations with different genders, ages and PA subtypes.

Objective: To investigate the incidence characteristics and influencing factors of metabolic syndrome (MS) among rural residents in southern Xinjiang Uygur Autonomous Region, to provide scientific evidence for early prevention of MS. Methods: A rural population cohort of 12 813 permanent residents aged 18 and above in southern Xinjiang Uygur Autonomous Region was established in 2016. Latent Class Analysis (LCA) was conducted in the total population and new-onset MS population to explore phenotypic distribution characteristics. Chi-square tests and Cox proportional hazards regression models were used to analyze MS risk factors. Results: The incidence density of MS was 32.06 per 1 000 person-years. Male incidence density (37.25 per 1 000 person-years) exceeded that of females (27.89 per 1 000 person-years). Age >30 years, overweight/obesity, abnormal LDL-C, abnormal gamma-glutamyl transferase (GGT), high triglyceride-high waist circumference, and hypertension-high waist circumference phenotype were risk factors for MS (all HR>1.00, all P<0.05). Stratified analysis indicated that abnormal LDL-C,abnormal GGT, high triglyceride-high waist circumference phenotype, and hypertension-waist circumference phenotype were risk factors for MS in the 31-60 age group. In men, abnormal GGT and high triglyceride-high waist circumference phenotypes carried higher MS risk; in women, abnormal LDL-C, overweight/obesity, and hypertension-high waist circumference phenotypes were associated with higher MS risk; those with a secondary school education or above had a lower risk of MS. Conclusions: The incidence density of MS was relatively high in rural areas of southern Xinjiang Uygur Autonomous Region, with gender and age differences in risk factors. It was recommended to focus on individuals aged 31-60 years with hypertension-high waist circumference and high triglyceride-high waist circumference phenotypes. Men should strengthen lipid and liver function monitoring, while women should enhance weight, blood pressure, and waist circumference management.

Objective: To investigate the association of novel high-density lipoprotein cholesterol (HDL-C) metabolic phenotypes-metabolic HDL-C (mHDL-C) and its residual (mHDL-CΔ)-with all-cause and cardiovascular disease (CVD) mortality risks in community-dwelling older adults in Beijing. Methods: Based on the Beijing Healthy Aging Cohort Study, a total of 8 578 older adults (≥60 years) with complete baseline data were included and followed for survival outcomes. A random forest regression model was constructed to obtain mHDL-C and mHDL-CΔ. Cox proportional hazards regression models were used to analyze the associations of HDL-C, mHDL-C, and mHDL-CΔ with mortality risk. Predictive performance was evaluated using the net reclassification improvement (NRI), integrated discrimination improvement, and time-dependent area under the receiver operating characteristic curve. Results: In the follow up as of March 31, 2021, a total of 1 162 all-cause deaths occurred (the median survival: 2 257.50 days), including 558 CVD deaths. After adjusting for confounders, both HDL-C and mHDL-C levels were negatively associated with the all-cause mortality (HR=0.84, 95%CI: 0.79-0.91; HR=0.84, 95%CI: 0.76-0.91) and CVD mortality (HR=0.73, 95%CI: 0.65-0.81; HR=0.70, 95%CI: 0.61-0.80). In contrast, mHDL-CΔ was positively associated with both types of mortality (all-cause: HR=1.28, 95%CI: 1.17-1.40; CVD: HR=1.42, 95%CI: 1.25-1.61). mHDL-CΔ showed the best reclassification of all-cause mortality (NRI=0.122). Conclusions: In the older adults in communities in Beijing, the novel metabolic phenotypes mHDL-C and mHDL-CΔ were significantly associated with all-cause and CVD mortality risks. These indicators can reveal metabolic heterogeneity and residual mortality risk which cannot be detected by traditional HDL-C concentration, suggesting their potential as auxiliary predictors for mortality risk and as tools for cardiovascular risk stratification and precision prevention in this population.

BACKGROUND Cardiac implantable electronic device (CIED) infections are usually caused by gram-positive bacteria, whereas gram-negative pathogens are uncommon. CASE REPORT We report a case of pacemaker pocket infection caused by Campylobacter jejuni in an immunocompromised patient. The patient underwent uncomplicated dual-chamber pacemaker implantation for sick sinus syndrome. At the first scheduled follow-up, after receiving a diagnosis of primary central nervous system diffuse large B-cell lymphoma and beginning chemotherapy with corticosteroids, swelling and subcutaneous fluid accumulation over the device pocket were observed. There were no local inflammatory signs; the patient had no systemic symptoms or recent history of diarrhea, abdominal pain, nausea, vomiting, or other gastrointestinal symptoms. Inflammatory markers were mildly elevated. Device pocket aspiration yielded straw-colored serous fluid; cultures of pocket fluid and blood grew C. jejuni, prompting a change from empirical amoxicillin-clavulanate to targeted macrolide therapy (intravenous clarithromycin) based on antimicrobial susceptibility testing. Transesophageal echocardiography showed no vegetations on the leads. The entire pacing system (generator and leads) was extracted, and temporary pacing was provided. Inflammatory markers became normalized during continued antibiotic therapy. After clinical stabilization, a new dual-chamber pacemaker was implanted contralaterally. The patient was discharged without signs of persistent infection and remains under regular outpatient follow-up. CONCLUSIONS This case emphasizes that subtle pocket changes in immunocompromised patients may indicate CIED infection, even in the absence of systemic symptoms. The absence of gastrointestinal symptoms suggests silent Campylobacter bacteremia with secondary seeding of the device pocket. Early microbiological sampling, pathogen-directed antimicrobial therapy, and complete device removal remain essential for cure.

Lung transplantation is conventionally performed through clamshell thoracosternotomy or sternotomy, approaches associated with pain, impaired wound healing, and chronic neuralgia. Robotic assistance has reached transplantation only recently. We systematically reviewed the clinical experience with robotic-assisted lung transplantation. Following PRISMA 2020 and PRISMA-S, we searched MEDLINE, Embase, Scopus, Web of Science, and Cochrane CENTRAL from inception to 15 August 2026, with trial registries, conference abstracts, and Chinese-language sources, without language restriction. Human robotic lung transplant reports with at least one clinical outcome were eligible. Because only one comparative cohort existed, synthesis was narrative; no meta-analysis was performed. Certainty was graded by outcome. PROSPERO: CRD420261479535. Out of 393 database records and 7 from other methods, six reports from five reporting centers (27 unique recipients) were included. No randomized trial or prior full-length systematic review was identified. In the only comparative cohort (robotic n = 21 vs. direct-vision minimally invasive n = 90), one-year survival was 95.0% versus 95.5% (log-rank P = 0.84) and grade-3 primary graft dysfunction at 72 h 4.8% versus 8.9% (odds ratio 0.51, 95% CI 0.06-4.34), despite longer ischemic times (486 vs. 408 min; P = 0.02). Every robotic versus direct-vision confidence interval included unity. Certainty was very low for all outcomes. Robotic lung transplantation is technically feasible across five reporting centers. Comparative evidence rests on one clinically selected, non-randomized cohort in which no difference was statistically detectable; this establishes neither equivalence nor absence of harm. Multicenter prospective evaluation with standardized outcomes is required.Registration: The protocol was registered with PROSPERO (CRD420261479535).

Current stroke guidelines consider a previous acute ischemic stroke (AIS) within 3 months a relative contraindication to intravenous thrombolysis (IVT) because of the perceived risk of symptomatic intracranial haemorrhage (sICH). The recommendation is largely based on expert consensus, while growing evidence suggests repeated IVT (RIVT) may be feasible in selected patients.

To systematically review the efficacy and safety of RIVT for recurrent AIS within 90 days of a previous IVT-treated stroke.

We performed a systematic review and individual-patient data meta-analysis, including 28 reports (63 patients), with individual patient data available for 44 cases. Overall, 66.7% of patients achieved a favorable outcome, with a 7.5 days median interval between treatments. Meta-analysis showed a non-significant trend toward better functional outcomes after RIVT (pooled OR = 1.52, 95% CI 0.97-2.39; I² = 0%) and no significant increase in functional deterioration between stroke episodes (pooled OR = 1.28, 95% CI 0.75-2.19; I² = 0%). Outcomes were not influenced by treatment interval, age, sex, stroke etiology, vascular territory, or onset-to-treatment time. No sICH occurred after RIVT. Asymptomatic intracranial or systemic haemorrhages were reported in 15.9% of patients, while fatal events (5%) were unrelated to neurological complications. Haemorrhagic and fatal events occurred predominantly in patients with cardioembolic and more severe strokes.

RIVT within 90 days is a rare event and its efficacy is understudied. It may be a reasonable reperfusion strategy in carefully selected patients with recurrent AIS, suggesting that the interval from the previous stroke should not be considered an isolated exclusion criterion for IVT.

To develop and internally validate a nomogram for predicting long-term survival in patients with infective endocarditis (IE), focusing on microbiological characteristics and surgical treatment.

We retrospectively analyzed 210 patients with IE. Clinical characteristics, laboratory data, echocardiographic findings, microbiological profiles, and treatment information were collected. LASSO regression was used for variable selection, followed by multivariable Cox regression to identify independent prognostic factors and construct the nomogram. Model performance was evaluated using time-dependent ROC curves, concordance index, calibration curves, and decision curve analysis. Internal validation was performed using bootstrap resampling.

Among 210 patients (67.1% male; median age, 55 years), 125 (59.5%) underwent surgery. Seven independent prognostic factors identified from 11 LASSO-selected candidates were incorporated into the nomogram. The model showed good discrimination, with AUCs of 0.872, 0.840, and 0.846 for 1-, 3-, and 5-year survival prediction, respectively. The concordance index was 0.826. Calibration and decision curve analyses demonstrated good predictive accuracy and clinical utility. Blood culture-negative IE and Gram-negative bacterial infection were associated with poorer survival, whereas surgical treatment predicted improved outcomes.

We developed and internally validated a nomogram integrating clinical, microbiological, and treatment-related variables to predict long-term survival in IE patients, which may support individualized risk assessment and prognostic stratification.