Association between ankle-brachial blood pressure index with all-cause and cardiovascular mortality in adults without arterial stiffness.

PURPOSE: To explore the relationship between ankle-brachial blood pressure index (ABPI) and all-cause or cardiovascular mortality in adults without arterial stiffness. METHODS: A total of 6784 participants without arterial stiffness were enrolled from National Health and Nutrition Examination Survey 1999-2004. The hazard ratio (HR) and 95% confidence interval (CI) of ABPI associating with the risk of all-cause and cardiovascular mortality was calculated by Cox proportional regression models adjusted for demographic and traditional risk factors. Dose-response relationship was explored with restricted cubic spines. RESULTS: After an average follow-up of 12.1 years, 1844 all-cause deaths and 299 cardiovascular deaths occurred. Compared with the lowest ABPI quartile, the second quartile was associated with the lowest risk of all-cause mortality (HR 0.89, 95%CI 0.79-0.98; p = 0.036) and cardiovascular mortality (HR 0.75, 95%CI 0.56-0.98; p = 0.048). Besides, dose-response analysis revealed that ABPI was nonlinearly correlated to all-cause mortality (p for nonlinearity < 0.001) and linearly correlated to cardiovascular mortality (p for nonlinearity = 0.459). CONCLUSIONS: The relationship between ABPI and all-cause and cardiovascular mortality followed a L-shape curve. A lower ABPI was independently associated with an increased risk of all-cause and cardiovascular mortality in adults without arterial stiffness.

The triglyceride glucose index was U-shape associated with all-cause mortality in population with cardiovascular diseases.

BACKGROUND: The triglyceride and glucose (TyG) index has been considered a simple surrogate marker of insulin resistance, related to a high risk of mortality. However, few studies have investigated the specific relationship between the TyG index and all-cause mortality among population with cardiovascular diseases. METHODS: 2,072 participants with cardiovascular diseases were enrolled from the National Health and Nutrition Examination Survey (NHANES) 1999-2014. The TyG index was calculated as log [fasting triglycerides (mg/dL) x fasting glucose (mg/dL)/2]. Outcomes were all-cause mortality and cardiovascular mortality. The baseline levels of TyG associated with the risk of mortality were evaluated on a continuous scale (restricted cubic splines) and by a priori defined quantile categories with Cox regression models. RESULTS: After a follow-up of 16.8 years, 791 all-cause deaths and 184 cardiovascular deaths occurred. Restricted cubic splines showed that the association between levels of TyG index and the risk of all-cause mortality was non-linear (p < 0.001) and the TyG index associated with the lowest risk of all-cause mortality ranges 8.83 to 9.06 in individuals with cardiovascular diseases. Compared with the reference quartile of 8.84 ~ 9.29, the multivariate-adjusted hazards ratios and 95% confidence intervals were 1.40 (1.13-1.74; p = 0.002) in the lowest quartile and 1.08 (0.88, 1.32; p = 0.475) in the highest quartile for all-cause mortality. However, TyG was not associated with cardiovascular mortality. CONCLUSIONS: TyG index was U-shape associated with the risk of all-cause mortality in participants with cardiovascular diseases and the level associated with the lowest risk ranged 8.83 to 9.06.

Corrigendum: Cost-effectiveness of adding empagliflozin to the standard therapy for Heart Failure with Preserved Ejection Fraction from the perspective of healthcare systems in China.

[This corrects the article DOI: 10.3389/fcvm.2022.946399.].

Environmental protection tax and the labor income share of companies: evidence from a quasi-natural experiment in China.

There is no conclusion on whether green development can symbiotically coexist with shared development, and the effect of environmental protection tax on labor share provides new evidence to answer this question. This paper presents a theoretical analysis of change in labor share in the exogenous impact of the enforcement of the Environmental Protection Tax Law of China, and proposes relevant hypotheses. At the same time, empirical data of listed firms on the main board from 2013 to 2019 are collected. A difference-in-differences model is constructed to test the hypotheses empirically. The study found that the reform of environmental protection fee to tax reduced the labor share of high-polluting firms by an average of about 1.43%. However, it did not significantly reduce the share of corporate executives' income. The reform of environmental protection fee to tax reduces the labor share of high-polluting firms through the crowding-out effect and the substitution effect of production technology. The heterogeneity study revealed that the reform of environmental protection fee to tax has more substantial negative impacts on firms with high financing constraints, low market concerns, and low government subsidies. There is no significant difference between the impact on state-owned and private firms. The reform of environmental protection fee to tax has a more substantial negative impact on the firms in Central and Western China than those in more economically developed Eastern China.

Emission reduction effects of vertical environmental regulation: Capacity transfer or energy intensity reduction? Evidence from a quasi-natural experiment in China.

There is insufficient research on how to reduce the destructive effects of command-based environmental regulation through institutional design. The implementation of the National Key Monitoring Enterprises provides new evidence to assess the effects of vertical monitoring. This study integrates and matches three types of micro databases in China: industrial, pollution, and patent, and constructs firm-level panel data from 2004 to 2010. The empirical evidence shows that the policy reduces the energy use intensity of monitored enterprises by about 10.4% and sulfur dioxide emission intensity by about 23.9%. The mechanism test shows that this effect is achieved by means of energy structure optimization, process innovation, and end-of-pipe treatment, but the effect on total factor productivity is not significant. Among them, the positive impact is stronger for high-profit and emerging firms. Further, we quantify the policy-induced capacity transfer and technology spillovers from monitored enterprises to non-monitored enterprises. In terms of scale, the policy leads to a simultaneous increase in output and pollution emissions of unmonitored firms in the same industry. However, in terms of efficiency, the policy reduces the energy use intensity and pollution emission intensity of enterprises in the same industry.

Cost-effectiveness of adding empagliflozin to the standard therapy for Heart Failure with Preserved Ejection Fraction from the perspective of healthcare systems in China.

Background: The Empagliflozin Outcome Trial in Patients with Chronic Heart Failure with Preserved Ejection Fraction (EMPEROR-Preserved) is the first randomized controlled trial to provide promising evidence on the efficacy of adding empagliflozin to the standard therapy in patients with Heart Failure with Preserved Ejection Fraction (HFpEF), but the cost-effectiveness of add-on empagliflozin treatment remains unclear. Method: A Markov model using data from the EMPEROR-Preserved trial and national database was constructed to assess lifetime costs and utility from a China healthcare system perspective. The time horizon was 10 years and a 5% discount rate was applied. Incremental cost-effectiveness ratio (ICER) against willingness to pay (WTP) threshold was performed to evaluate the cost-effectiveness. A series of sensitivity analyses was applied to ensure the robustness of the results. Results: Compared to standard therapy, the increased cost of adding empagliflozin from $4,645.23 to $5,916.50 was associated with a quality-adjusted life years (QALYs) gain from 4.70 to 4.81, projecting an ICER of $11,292.06, which was lower than a WTP threshold of $12,652.5. Univariate sensitivity analysis revealed that the parameters with the largest impact on ICER were cardiovascular mortality in both groups, followed by the cost of empagliflozin and the cost of hospitalization for heart failure. Probabilistic sensitivity analysis indicated that when the WTP threshold was $12,652.5 and $37,957.5, the probability of being cost-effective for adding empagliflozin was 52.7% and 67.6%, respectively. Scenario analysis demonstrated that the cost of empagliflozin, the cost of hospitalization for heart failure, NYHA functional classes, and time horizon had a greater impact on the ICER. Conclusion: At a WTP threshold of $12,652.5, the add-on empagliflozin treatment for HFpEF was cost-effective in healthcare systems in China, which promoted the rational use of empagliflozin for HFpEF.

Cost-Effectiveness of Adding SGLT2 Inhibitors to Standard Treatment for Heart Failure With Reduced Ejection Fraction Patients in China.

Objective: To evaluate the economics and effectiveness of adding dapagliflozin or empagliflozin to the standard treatment for heart failure (HF) for patients with reduced ejection fraction (HFrEF) in China. Methods: A Markov model was developed to project the clinical and economic outcomes of adding dapagliflozin or empagliflozin to the standard treatment for 66-year-old patients with HFrEF. A cost-utility analysis was performed based mostly on data from the empagliflozin outcome trial in patients with chronic heart failure and a reduced ejection fraction (EMPEROR-Reduced) study and the dapagliflozin and prevention of adverse outcomes in heart failure (DAPA-HF) trial. The primary outcomes were measured via total and incremental costs and quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER). Results: In China, compared to the standard treatment, although adding dapagliflozin to the standard treatment in the treatment of HFrEF was more expensive ($4,870.68 vs. $3,596.25), it was more cost-effective (3.87 QALYs vs. 3.64 QALYs), resulting in an ICER of $5,541.00 per QALY. Similarly, adding empagliflozin was more expensive ($5,021.93 vs. $4,118.86) but more cost-effective (3.66 QALYs vs. 3.53 QALYs), resulting in an ICER of $6,946.69 per QALY. A sensitivity analysis demonstrated the robustness of the model in identifying cardiovascular death as a significant driver of cost-effectiveness. A probabilistic sensitivity analysis indicated that when the willingness-to-pay was $11,008.07 per QALY, the probability of the addition of dapagliflozin or empagliflozin being cost-effective was 70.5 and 55.2%, respectively. A scenario analysis showed that the cost of hospitalization, diabetes status, and time horizon had a greater impact on ICER. Conclusion: Compared with standard treatments with or without empagliflozin, adding dapagliflozin to the standard treatment in the treatment of HFrEF in China was extremely cost-effective.

[Circulating microRNA expression in children with idiopathic short stature].

OBJECTIVE: To study the role of circulating microRNAs (miRNA) in the pathogenesis of idiopathic short stature (ISS) through detecting miRNA expression profile in plasma of children with ISS. METHODS: Plasma miRNA expression was determined by microarray in 20 children with ISS and 20 healthy children. Altered microRNAs were verified by real-time PCR. The online miRNA target gene prediction software was used to predict and screen miRNA differentially expressed target genes. RESULTS: According to the microarray, there were 40 differentially expressed miRNAs in the ISS group compared with the control group, including 24 up-regulated miRNAs and 16 down-regulated miRNAs. Real-time PCR verified two up-regulated (miR-185and miR-574-5p) and two down-regulated miRNAs (miR-497and miR-15a) and confirmed that plasma miR-185 expression was significantly up-regulated (P<0.05) and miR-497 expression was significantly down-regulated (P<0.05) in children with ISS. CONCLUSIONS: Plasma miRNA expression levels in children with ISS are significantly different from healthy controls, suggesting that plasma miRNA is associated with the pathogenesis of ISS.