The relationship between zinc deficiency and incident hypertension remains poorly characterized in humans. We examined the association between zinc deficiency and new-onset hypertension and related complications. This retrospective cohort study utilized the TriNetX Research Network to analyze adult patients with serum zinc measurements between January 2010 and December 2023. The zinc-deficient group had concentrations below 0.7 µg/mL, while controls ranged from 0.70 to 1.20 µg/mL. Following propensity score matching, 47,843 pairs were analyzed over 5 years. The primary outcome was new-onset primary hypertension. Secondary outcomes included secondary hypertension, hypertension-related cardiac and renal complications, and hypertensive crisis. Zinc deficiency was significantly associated with primary hypertension (hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.14-1.25; P < .001), secondary hypertension (HR 1.82, 95% CI 1.45-2.29; P < .001), hypertension-related cardiac and renal complications (HR 1.69, 95% CI 1.49-1.92; P < .001), and hypertensive crisis (HR 1.09, 95% CI 1.01-1.18; P = .028). Dose-response analyses revealed a J-shaped association for primary hypertension, with elevated hazards at both low and high zinc concentrations. The association between zinc deficiency and primary hypertension was significantly stronger in men than in women (HR 1.28 vs 1.13; P for interaction = .021). Zinc deficiency was associated with incident hypertension and related complications, particularly secondary hypertension. Further prospective studies are warranted to determine whether correction of zinc deficiency modifies hypertension risk.

The long-term trend in atrial fibrillation (AF) and atrial flutter (AFL) incidence has rarely been reported from a global perspective. We aimed to explore the past temporal trends (1990-2021) in AF/AFL incidence in group of 20 countries and to predict future trends (2022-2050). Data on yearly AF/AFL incidence by age group and sex were extracted from the global burden of disease study 2021. Age-standardized incidence rates (ASIR) were computed from 1990 to 2021. The number of new cases and incidence rates were predicted to 2050 using the Bayesian age-period-cohort model. The ASIR for AF/AFL exhibited a slight increasing trend on a global scale from 1990 to 2021, with an average annual percent change of 0.5% (95% confidence interval: 0.5-0.5). Canada had the highest ASIR of AF/AFL (97.53/100,000) and showed a significant declining trend from 1990 to 2021, while the USA and Germany showed a clear upward trend and a "wave-like" upward trend, respectively. Notably, Italy experienced a significant increase in the ASIR of AF/AFL during the COVID-19 pandemic (2019-2021), with an annual percent change of 9.3% (95% confidence interval: 6.6-12.0). The ASIR of AF/AFL in developing countries increased more significantly than in developed countries (ASIR change percentage: 4.79% vs 0.20%). The ASIR of AF/AFL is predicted to remain stable or increase in most countries by 2050. AF/AFL remains a significant public health concern, necessitating the development of more precise strategies for prevention, control, and surveillance, particularly among specific populations and endemic countries.

Bivalirudin and heparin are commonly employed anticoagulants in percutaneous coronary intervention (PCI) for patients diagnosed with acute coronary syndrome (ACS). This meta-analysis aimed to compare the safety and efficacy of bivalirudin and heparin in patients with ACS undergoing PCI.

We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) and cohort studies comparing bivalirudin with heparin in patients with ACS undergoing PCI. The outcomes included all-cause mortality, cardiovascular mortality, major bleeding, major adverse cardiovascular events (MACEs), net adverse clinical events, myocardial infarction (MI), stent thrombosis (ST), and stroke.

This study included 11 RCTs and 17 cohort studies, encompassing 584,249 patients. Among in-hospital outcomes, bivalirudin was found to significantly reduce the incidence of all-cause mortality (relative risk [RR] = 0.86, 95% confidence interval [CI]: 0.84-0.88, P < .001, I2 = 0%) and major bleeding (RR = 0.74, 95% CI: 0.62-0.88, P < .001, I2 = 51%) compared with heparin, while there were no significant differences in MACEs, MI, ST, and stroke. Among 30-day follow-up outcomes, bivalirudin was found to significantly reduce the incidence of all-cause mortality (RR = 0.85, 95% CI: 0.76-0.95, P = .006, I2 = 24%), cardiovascular mortality (RR = 0.81, 95% CI: 0.70-0.94, P = .004, I2 = 1%), major bleeding (RR = 0.59, 95% CI: 0.49-0.72, P < .001, I2 = 67%), and net adverse clinical events (RR = 0.79, 95% CI: 0.70-0.89, P < .001, I2 = 55%) compared with heparin, while there were no significant differences in MACEs, MI, ST, and stroke.

This meta-analysis suggests that bivalirudin may offer advantages over heparin in reducing in-hospital and 30-day mortality and major bleeding in patients with ACS undergoing PCI, with no significant differences in ischemic outcomes such as MACEs, MI, ST, or stroke. These findings suggest that bivalirudin may be a reasonable alternative to heparin in selected patients, but more large-scale, long-term RCTs are needed to confirm these results.

Coronary artery disease (CAD) remains a major cause of morbidity and mortality worldwide. Although guideline-directed Western medical therapy improves cardiovascular outcomes, residual symptoms remain common. Integrated traditional Chinese and Western medicine is frequently used as an adjunctive strategy in China, but its real-world, short-term clinical associations require further characterization. This retrospective observational study included 215 patients with CAD treated between January 2022 and December 2024, including 106 patients receiving conventional Western medical therapy alone and 109 receiving adjunctive traditional Chinese medicine based on syndrome differentiation. Symptom status, laboratory parameters, overall clinical response, and documented adverse events were compared between groups. Because treatment allocation was nonrandom and the analyses were unadjusted for potential confounders, all between-group findings were interpreted as associations. No statistically significant differences were observed in the measured baseline demographic, clinical, or laboratory characteristics between the 2 groups. After treatment, the integrated-treatment group had lower rates of residual chest pain, chest tightness, and fatigue and greater changes in total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, fibrinogen, and D-dimer. The observed overall clinical response rate was higher in the integrated-treatment group (90.8% vs 76.4%, P = .004). Documented adverse-event incidence did not differ significantly between groups. In this retrospective real-world cohort, adjunctive traditional Chinese medicine was associated with greater short-term improvement in selected symptoms and laboratory parameters and a higher observed clinical response rate, without a detectable increase in documented short-term adverse events. These unadjusted observational findings are exploratory, do not establish causal superiority or improved cardiovascular prognosis, and are insufficient by themselves to modify current guideline-directed CAD practice.

This study aimed to examine the association between the composite dietary antioxidant index (CDAI) and advanced cardiovascular-kidney-metabolic syndrome (CKM) and characterize its dose-response shape. This cross-sectional study included 23,968 National Health and Nutrition Examination Survey participants aged ≥20 years (2001-2018). Advanced CKM was stages 3 and 4 combined, per the 2023 American Heart Association framework. The CDAI was the sum of sex-specific z-scores for 6 dietary antioxidants (vitamins A, C, and E, carotenoids, zinc, and selenium) from a single 24-hour recall, analyzed in quartiles (Q1-Q4). Multivariable logistic regression assessed the association, and restricted cubic splines tested nonlinearity. Multiple imputation, propensity score matching, survey-weighted models, and subgroup analyses evaluated robustness. Crude prevalence of advanced CKM fell from 33.6% (Q1) to 20.8% (Q4). After full adjustment, odds ratios (ORs) vs Q1 were 0.87 (95% confidence interval 0.78-0.97) for Q2, 0.79 (0.70-0.89) for Q3, and 0.83 (0.72-0.95) for Q4 (P for trend = .002). Splines showed an L-shaped association with a nadir at a CDAI of approximately 0.36; below this threshold each 1-unit increase was associated with marginally lower odds (OR 0.96, 95% confidence interval 0.92-1.00, P = .048), whereas above it the association plateaued. The associations were consistent across age, sex, smoking, alcohol intake, poverty income ratio, and physical activity strata (all P for interaction > .05). After multiple imputation the Q4 OR was 0.77 (0.69-0.85); propensity score-matched and survey-weighted estimates were directionally consistent, with a significant trend in each (P for trend = .045, .039). A higher food-derived CDAI was independently associated with a lower prevalence of advanced CKM, with the inverse association confined to the low-to-moderate intake range. These findings are consistent with dietary guidance emphasizing whole foods rich in diverse antioxidants, although the cross-sectional design precludes causal inference.

Observational studies have suggested a potential association between hypertension and frozen shoulder. This study aims to elucidate the causal dynamics of this relationship using a bidirectional 2-sample Mendelian randomization approach. We analyzed data on hypertension (N = 484,598) and frozen shoulder (N = 627,998) from the IEU Open genome-wide association study database. Instrumental variables were carefully selected to ensure robust correlation and minimize linkage disequilibrium. The primary analysis was conducted using the inverse variance-weighted (IVW) method. Additional analyses, including the Weighted Median, MR-Egger, Simple Model, and Weighted Model, were performed to further assess causal effects. We conducted heterogeneity and pleiotropy tests, along with a leave-one-out analysis, to evaluate the stability of our findings. Our analysis revealed that individuals with hypertension have a significantly increased risk of developing frozen shoulder (IVW: odds ratio = 1.749, 95% CI: 1.275-2.399, P = 5.239*10-4). Conversely, reverse Mendelian randomization analysis showed no significant association between frozen shoulder and the risk of hypertension (IVW: odds ratio = 1.006, 95% CI: 0.991-1.021, P = .426). Our findings confirm that hypertension is associated with an increased risk of frozen shoulder, while the reverse does not hold. Patients with hypertension should be informed of this potential risk and consider preventive strategies against the development of frozen shoulder.

Background: Fulminant myocarditis (FM) is a life-threatening inflammatory cardiac disease in children, frequently triggered by viral infections. Although mechanical circulatory support has improved short-term survival, data on viral etiology and long-term outcomes remain limited, particularly in Asian populations. Methods: We conducted a mixed retrospective-prospective analysis of pediatric FM patients at the Children's Hospital of Fudan University from 2015 to 2025. Clinical data from 2015 to 2023 were collected retrospectively, while data from 2024 onward were collected prospectively. Clinical data, microbiological findings (PCR and metagenomic next-generation sequencing), treatment strategies, and outcomes were extracted from electronic medical records. Follow-up data for survivors were collected through December 2025. Results: A total of 53 children with FM were included. Median age was 91.5 months; 43.4% were male, and 56.6% were female. Common presenting symptoms included fever (64.2%) and vomiting (56.6%). Microbiological evidence was identified in 11 patients (20.8%), with rhinovirus (5.7%) and influenza virus (5.7%) being the most frequent, followed by enterovirus (3.8%) in peripheral specimens. During hospitalization, 79.2% required mechanical ventilation, 64.2% received extracorporeal membrane oxygenation (ECMO), and 45.3% underwent continuous renal replacement therapy (CRRT). Intravenous immunoglobulin (IVIG) was administered to 84.9%. In-hospital mortality was 13.2% (7/53), and 17.0% (9/53) of patients were discharged against medical advice (DAMA). Among 35 followed patients (median 12.4 months), most achieved favorable cardiac recovery; however, persistent conduction abnormalities, structural cardiac changes, and neurological sequelae were observed in a minority. Conclusions: Pediatric FM carries substantial in-hospital morbidity and resource utilization, despite favorable recovery rates in most survivors. The low pathogen detection rate in peripheral blood and the lack of endomyocardial tissue sampling preclude definitive conclusions regarding the underlying etiology, whether active viral replication or immune-mediated injury predominates. Endomyocardial biopsy-based investigations are urgently needed to clarify the underlying pathobiology.

Tuberculosis (TB) is a leading global cause of infectious disease. Growing evidence suggests that TB significantly increases the risk of comorbidity in HIV+ patients, particularly acute ischemic stroke (AIS). Prognosis is often poor, highlighting the need for early prevention and intervention. However, exact mechanisms linking HIV-Mtb coinfection and stroke remain poorly understood. A review of articles from 2016 to 2026 was conducted to study the risk of ischemic stroke and treatment strategies in HIV-Mtb coinfection. Both HIV and Mtb can increase stroke risk, but pathogenesis of the coinfection and relationship between the coinfection and stroke remain as proposals. Antiretroviral therapy (ART) has shown variable success rates; it may increase the risk of stroke or be associated with worse outcomes. Multi-drug-resistant TB (MDR-TB) can be treated with a combination of bedaquiline, linezolid, and pretomanid (BPaL). Steroids and vitamin D supplementation with ART are associated with improved outcomes. For coinfection screening, the monocyte-to-lymphocyte ratio (MLR) and a clinical scoring system for triage may prove useful for early detection, leading to prompt intervention. A clearer understanding of the association between HIV-Mtb coinfection and stroke is essential for developing effective prevention strategies and eliminating transmission. Advancement of current treatments will help improve long-term outcomes in HIV-Mtb coinfection.

Background/Objectives: Elevated white blood cell (WBC) counts and C-reactive protein (CRP) are established inflammatory markers associated with cardiometabolic disease. However, whether elevated WBC remains prognostically important without CRP elevation is unclear. This study aimed to examine whether elevated WBC despite normal CRP would predict incident metabolic syndrome (MetS) and myocardial infarction (MI), and to investigate its genetic basis and dietary modifiability. Methods: This prospective cohort study included 54,744 Korean adults with a mean follow-up of five years. Participants were classified as WBC-Only Elevated (WOE; WBC ≥ 6.2 × 10⁹/L and CRP < 1.0 mg/dL) or normal WBC and CRP (Low Risk) at baseline. Cox proportional hazards models estimated risks of incident MetS and MI. Genome-wide association studies (GWAS) identified genetic variants associated with WOE, from which weighted genetic risk scores (GRS) were constructed and replicated in the UK Biobank (n = 352,394). GRS-diet interactions were evaluated using a validated 106-item semi-quantitative food frequency questionnaire and 24 h dietary recalls. Results: WOE was independently associated with increased risks of MetS (HR = 1.82, 95% CI: 1.57-2.11) and MI (HR = 1.60, 95% CI: 1.25-2.04; both p < 0.001) compared with Low Risk. Immune-related variants at 17q21.1 and 6p21.3 were replicated in the UK Biobank. Among individuals with high genetic risk, adherence to a Korean-style balanced diet and higher overall diet quality attenuated genetic susceptibility to WOE by 16% (p = 0.042) and 30% (p = 0.031), respectively. Conclusions: Elevated WBC despite normal CRP independently predicted incident MetS and MI. These findings suggest that incorporating WBC alongside CRP in inflammatory risk assessment, together with genetic and dietary information, may support more targeted cardiometabolic risk stratification.

Patients with Inborn Errors of Immunity (IEI) are at increased cardiometabolic risk due to inflammation, immune dysfunction, and oxidative stress. Given selenium's essential role in antioxidant defense, this study evaluated plasma selenium concentration in individuals with IEI and its associations with inflammatory and metabolic biomarkers and body mass index (BMI).

A controlled cross-sectional study involved 85 patients, 22 with ataxia-telangiectasia (A-T), 32 with common variable immunodeficiency (CVI) and 31 with juvenile systemic lupus erythematosus (jSLE). The control group comprised 72 age- and sex-matched healthy individuals. Anthropometric, inflammatory, metabolic, and oxidative stress parameters were assessed, including BMI, ultrasensitive C-reactive protein (usCRP), lipid profile, fasting glucose, insulin, plasma Se concentrations, erythrocyte glutathione peroxidase (GPx) activity, and malondialdehyde levels.

Selenium concentrations below the reference value (46 µg/L) were observed in all groups, A-T (41%), CVI (50%), jSLE (48%) and the control group (33%). Low weight was more frequent in the A-T group (41%), whereas excess weight predominated in the CVI (47%) and jSLE (19%) groups. Multiple linear regression showed lower selenium concentrations in the jSLE (β = -10.1 ug/L) and CVI (β = -12.8 µg) groups compared with the controls (p < 0.05). Selenium concentrations were associated with age (β = 0.3 µg/L) and usCRP (p < 0.05). The GPx values were lower among all patient groups (jSLE: β = 3228 U/L, A-T: β = -2030 U/L, and CVI: β = -2060 U/L) (p < 0.05) compared with the controls. The GPx was also influenced by age (β = 56 U/L; p = 0.010).

The present findings suggest alterations in the endogenous antioxidant defense system in patients with IEI, characterized by reduced erythrocyte GPx activity and lower plasma selenium concentrations. The inverse association between selenium and usCRP concentrations suggests a potential link between selenium status and systemic inflammation. However, these findings should be interpreted cautiously, as inflammation may influence circulating selenium concentrations, and the cross-sectional design does not establish causal inferences. Further longitudinal studies are warranted to clarify the relationship between selenium status, inflammation, and antioxidant defense in IEI.