Association between monocyte lymphocyte ratio and abdominal aortic calcification in US adults: A cross-sectional study

Role of abdominal aortic calcification score in predicting cardiovascular risk in the general population

BACKGROUND

Abdominal aortic calcification (AAC) is closely related to cardiovascular disease. Although its clinical significances have primarily been investigated in patients with chronic kidney disease, its association with cardio-cerebrovascular mortality in the general middle-aged and elderly population has not been sufficiently investigated.

AIMS

To study the association of AAC and cardio-cerebrovascular mortality in both the entire general middle-aged and elderly populations and age subgroups.

METHODS

Data of participants of the National Health and Nutrition Examination Survey (NHANES) 2013-2014 were analyzed. This study included middle-aged and elderly (≥ 40 years old) individuals who underwent dual-energy X-ray absorptiometry. The severity of AAC was assessed by an AAC scoring system (AAC score) with a maximum possible value of 24. Participants were tracked for survival status and major cause of death till 31st December 2019. This study utilized AAC score = 6 as the optimal cut-off according to Harrell's c statistic. Based on AAC scores, participants were trichotomized (0, 0-6, and ≥ 6). Groupwise survival curves and cumulative incidence functions were plotted to reveal the association of AAC and cardio-cerebrovascular mortality. Given results under trichotomization, combination of participants with AAC scores 0 and 0-6 was conducted to reaffirm the association of AAC and adverse prognosis.

RESULTS

Correlation between increased AAC score and poorer survival, higher cumulative incidence of events was revealed. Cox models identified AAC score ≥ 6 as an independent risk factor of cardio-cerebrovascular mortality (AAC score ≥ 6 vs. AAC score = 0: Hazard ratio: 2.38, P = 0.008) after adjusting for cardiovascular risk factors. Results remained significant after regrouping (AAC score ≥ 6 vs. AAC score < 6: Hazard ratio: 2.06, P = 0.016). Subgroup analysis provided no evidence of unparallel change in hazard for the same amount of increase in AAC score among middle-aged (40-65 years old) and elderly (≥ 65 years old) individuals.

CONCLUSIONS

AAC score ≥ 6 independently indicate increased risk of cardio-cerebrovascular death and would be effective in risk stratification among the general middle-aged and elderly population in clinical practice.

Association of Smoking and Alcohol with Abdominal Aortic Calcification in the General Middle-Aged and Elderly Populations

Background

Research results on the association between alcohol consumption and abdominal aortic calcification (AAC) has yielded inconsistent results. There is a paucity of evidence on the association of smoking and alcohol consumption with AAC in the general middle-aged and elderly population, including age subgroups. This study utilizes nationwide survey data to explore these associations.

Methods

Data from middle-aged and elderly National Health and Nutrition Examination Survey (NHANES) 2013-2014 participants receiving dual X-ray absorptiometry were analyzed. AAC severity was assessed using a scoring system with a maximum value of 24. Presence of AAC was defined as an AAC score >0, and severe AAC as an AAC score ≥6. Binary logistic regression was employed for analyzing the association of smoking and alcohol consumption-related indices with the presence of AAC, while cumulative odds logistic regression explored their associations with severe AAC.

Results

Data of 3135 participants were analyzed. Investigation in the entire population found that smoking history was linked to both AAC and severe AAC. In contrast, alcohol consumption history was not linked to AAC or severe AAC. After adjusting for confounders, the findings confirmed a significant association of smoking history with AAC and severe AAC. No significant associations were found for current alcohol consumption with either AAC or severe AAC. Compared with never smokers, former smokers and current smokers experienced increased AAC risk. Former smokers had a significantly lower AAC risk compared to current smokers. Compared with never alcohol consumers, neither former nor current alcohol consumers experienced a different AAC risk. No difference in AAC risk was found between former and current alcohol consumers. Individuals consuming more than 2 drinks of alcohol per day suffered from a significant increase in risk of AAC. Subgroup analyses found elderly ever and current smokers suffered from a significantly elevated AAC risk, as did middle-aged ever smokers. Elderly ever and current alcohol consumers also experienced increased risk of AAC.

Conclusions

Smoking history is significantly associated with both AAC and severe AAC. The cardiovascular benefits associated with smoking cessation primarily manifest as reduction in risk of AAC presence rather than severe AAC. Elderly smokers are exposed to a greater risk of AAC. In contrast, alcohol consumption shows no association with severe AAC. Alcohol consumption is not associated with AAC except in heavy drinking and elderly subpopulations.

The Predictive Value of Perioperative Inflammatory Indexes in Major Arterial Surgical Revascularization from Leriche Syndrome

Objectives: The role of inflammation in the pathophysiology of atherosclerosis is extensive. Our study aims to assess the predictive role of inflammatory indexes regarding in-hospital mortality in major vascular surgery of Leriche syndrome as a convenient, low-cost, and noninvasive prognostic marker to optimize the patient's perioperative course. Methods: Our retrospective single-center study enrolled consecutive patients diagnosed with aortoiliac occlusive disease, Leriche syndrome, who underwent elective major vascular surgery between 2017 and 2023 in a tertiary cardiovascular center. Preoperative, postoperative, and day-one after-surgery data, including systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), aggregate index of systemic inflammation (AISI), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio, and monocyte-lymphocyte ratio, were studied to the endpoint, in-hospital death. We also tested the delta values of the indexes to the endpoint. The indexes were compared to the Revised Cardiac Risk Index (RCRI) and Vascular Surgery Group Cardiac Risk Index (VSG-CRI) for outcome prediction. Results: The tested inflammatory indexes significantly increased from the preoperative to postoperative and, further, to the day-one settings. Preoperative AISI (p = 0.040) emerged as the only independent risk factor regarding in-hospital death occurrence in Leriche patients who underwent major revascularization surgery. While RCRI did not significantly predict the endpoint (AUC = 0.698, p = 0.057), VSG-CRI (AUC = 0.864, p = 0.001) presented the best result in ROC analysis. Postoperative NLR (AUC = 0.758, p = 0.006) was next, followed by NLR postoperative-preoperative (_Preop-_Postop) delta value (AUC = 0.725, p = 0.004), postoperative SIRI (AUC = 0.716, p = 0.016), SIRI_Preop-_Postop delta value (AUC = 0.712, p = 0.016), postoperative SII (AUC = 0.692, p = 0.032), and SII_Preop-_Postop delta value (AUC = 0.631, p = 0.030). Conclusions: Inflammatory indexes are valuable tools for assessing perioperative risk in major vascular surgery, enhancing the value of the already validated risk scores.

The associations of two novel inflammation indexes, systemic immune-inflammation index (SII) and system inflammation response index (SIRI), with periodontitis: evidence from NHANES 2009-2014

OBJECTIVES

The research's goal is to look for any potential relationships between the systemic immune-inflammation index (SII) and the system inflammation response index (SIRI), along with inflammation indicators and the likelihood of periodontitis.

METHODS

Ten thousand two hundred eighty-two individuals in sum were determined to be eligible for this cross-sectional study from the National Health and Nutrition Examination Survey (NHANES) between 2009 and 2014. Multiple logistic regression, generalized additive model, smooth curve fitting, subgroup analysis, and interaction tests were done for analyzing the association between periodontitis and SII, SIRI, and other inflammatory indicators.

RESULTS

The analysis, adjusted for population weighting, revealed that individuals with moderate/severe periodontitis had SII levels of 545.46 (95% CI (529.10, 561.82), P = 0.0044) and SIRI levels of 1.33 (95% CI (1.29, 1.37), P < 0.0001). In a fully adjusted multivariate logistic regression model, SII was not sensibly associated with moderate/severe periodontitis among the continuous and quartile Q1-Q4 groups (OR = 0.97, 95% CI (0.91, 1.02)). The continuous variable of SIRI (OR = 1.11, 95% CI (1.06, 1.17)) and the quartile Q4 group (OR = 1.58, 95% CI (1.28, 1.94)) had a deemed significant positive association with moderate to severe periodontitis. In addition, other inflammatory indicators, especially NLR, PPN, PLR, MLR, PC, NC, and MC were observed to be notably involved moderate/severe periodontist in this research.

CONCLUSION

We explored the association between periodontitis and two novel comprehensive markers of inflammation (SII and SIRI).

CLINICAL RELEVANCE

These inflammatory markers are expected to serve as tools to assist clinicians in diagnosing periodontitis.