Exploring the role of uterine fibroids in promotion of cardiovascular diseases by diabetes exposure: Findings from national health and nutrition examination survey 1999-2006

Blood Pressure, Cardiometabolic Traits, and Cardiovascular Events in Women With Uterine Fibroids: A Genetic Correlation and Mendelian Randomization Study

BACKGROUND

Uterine fibroids (UFs) are understudied uterus neoplasms, mainly affecting women of reproductive age and often leading to hysterectomy. Clinical series suggest impaired cardiometabolic features in UFs. We investigated potential genetic links between blood pressure (BP), several cardiometabolic traits, and UFs.

METHODS AND RESULTS

We used summary statistics of genome-wide association studies for UFs and 18 traits related to BP, obesity, lipids, and main vascular diseases. We applied linkage disequilibrium score regression to estimate genetic correlations and Genome-Wide Complex Trait Analysis-multitrait-based conditional and joint analysis to perform adjusted correlations. Univariate and bidirectional Mendelian randomization verified potential causal associations with UFs. We found UFs to significantly correlate with systolic BP (genetic correlation coefficient [rg]=0.08, P=8.7×10-5) and diastolic BP (rg=0.12, P=8.2×10-8), including after adjustment for body mass index. UFs also positively corelated with body mass index (rg=0.11, P=4.1×10-4), waist-to-hip ratio (rg=0.09, P=7.3×10-3), type 2 diabetes (rg=0.15, P=1.9×10-5), and triglycerides (rg=0.17, P=7.6×10-7). We identified a negative correlation with sex hormone-binding globulin (rg=-0.16, P=3×10-4), a marker of bioavailability of sex steroids. No evidence for shared genetic basis with vascular diseases was observed, except with migraine (rg=0.08, P=5.8×10-7). Mendelian randomization analyses confirmed higher body mass index to increase UF risk (beta-per-kg/m2=0.033, P=6.1×10-5), as did waist-to-hip ratio (beta-per-unit=0.193, P=3.3×10-5) and triglycerides (bet-per-mmol/L=0.163, P=1.9×10-5). Higher sex hormone-binding globulin decreased UF risk (beta-per-nmol/L=0.005, P=2.5×10-3). No causal effect was found for BP.

CONCLUSIONS

Our study shows that UFs share substantial genetic basis with traits related to BP, obesity, diabetes, and migraine, a predominantly female vascular disease. We provide Mendelian randomization-based evidence for central obesity, visceral fat traits, and sex-steroid bioavailability as relevant risk factors for UFs.

Association between systemic immune-inflammation index and diabetes: a population-based study from the NHANES

Background

Systemic Immune-Inflammation Index (SII) has been reported to be associated with diabetes. We aimed to assess possible links between SII and diabetes.

Methods

Data were obtained from the 2017-2020 National Health and Nutrition Examination Survey (NHANES) database. After removing missing data for SII and diabetes, we examined patients older than 20 years. Simultaneously, the relationship between SII and diabetes was examined using weighted multivariate regression analysis, subgroup analysis, and smooth curve fitting.

Results

There were 7877 subjects in this study, the average SII was 524.91 ± 358.90, and the prevalence of diabetes was 16.07%. Weighted multivariate regression analysis found that SII was positively associated with diabetes, and in model 3, this positive association remained stable (OR = 1.04; 95% CI: 1.02-1.06; p = 0.0006), indicating that each additional unit of SII, the possibility of having diabetes increased by 4%. Gender, age, BMI, regular exercise, high blood pressure, and smoking did not significantly affect this positive link, according to the interaction test (p for trend>0.05).

Discussion

Additional prospective studies are required to examine the precise connection between higher SII levels and diabetes, which may be associated with higher SII levels.

Systemic immune-inflammation index within the first postoperative hour as a predictor of severe postoperative complications in upper abdominal surgery: a retrospective single-center study

Background

Systemic pro-inflammatory factors play a critical role in mediating severe postoperative complications (SPCs) in upper abdominal surgery (UAS). The systemic immune-inflammation index (SII) has been identified as a new inflammatory marker in many occasions. The present study aims to determine the association between SII and the occurrence of SPCs after UAS.

Methods

Included in this study were 310 patients with upper abdominal tumors who received UAS and subsequently were transferred to the anesthesia intensive care unit between November 2020 and November 2021 in Nanjing Drum Hospital. SPCs, including postoperative pulmonary complications (PPCs), major adverse cardiac and cardiovascular events, postoperative infections and delirium, were recorded during the hospital stay. The clinical features of the patients with and without SPCs were compared by Student’s t-test or Fisher’s exact test as appropriate. Risk factors associated with SPC occurrence were evaluated by univariable and multivariable logistic regression analyses. Receiver operating characteristic (ROC) curve analysis was used to establish a cut-off level of SII value to predict SPCs.

Results

Of the 310 patients receiving UAS, 103 patients (33.2%) presented at least one SPC, including PPCs (n = 62), adverse cardiovascular events (n = 22), postoperative infections (n = 51), and delirium (n = 5). Both preoperative SII and 1-h postoperative SII in patients with SPCs were significantly higher than those in patients without SPCs. Multivariate analysis showed that 1-h postoperative SII was an independent predictor for SPC occurrence (OR = 1.000, 95% CI 1.000–1.000, P = 0.007), together with postoperative C-reactive protein, postoperative arterial lactate, postoperative oxygenation-index and older age. The ROC curve showed that the optimal cutoff value of 1-h postoperative SII to predict SPCs was 754.6078 × 10⁹/L, with an 88.3% sensitivity and a 29% specificity. Multivariate analysis also confirmed that 1-h postoperative SII > 754.6078 × 10⁹/L was associated with increased SPC occurrence (OR = 2.656, 95% CI 1.311–5.381, P = 0.007).

Conclusion

Our findings demonstrated an association between the higher level of 1-h postoperative SII and SPCs, suggesting that 1-h postoperative SII, especially categorized 1-h postoperative SII using cutoff value, may be a useful tool for identifying patients at risk of developing SPCs.