Despite effective control of low-density lipoprotein cholesterol, the residual risk of atherosclerotic cardiovascular disease (ASCVD) remains substantial, underscoring the urgent need to identify novel targets to further reduce ASCVD risk. This study aimed to investigate the association between apolipoprotein C-III (APOC3) levels and ASCVD, and further explore the potential impact of APOC3 intervention for reducing ASCVD risk.

We leveraged the 20-year longitudinal data from the Chinese Multi-provincial Cohort Study–Proteomics Project, obtained totaling 5308 APOC3 measurements from 2550 participants, with up to four repeated measurements per participant. The intensity model was employed to estimate the association between time-varying APOC3 and ASCVD, accounting for time-varying potential confounders. The target trial emulation framework was used to emulate the effectiveness of various APOC3-targeted hypothetical interventions on ASCVD risk, with a guideline-directed low-density lipoprotein cholesterol-lowering strategy serving as a positive control.

Of 2550 participants aged 57.5 ± 7.9 years at baseline, and 56% of participants were females. The median level of APOC3 was 5554.8 (interquartile range: 3936.5-7913.8) Relative Fluorescence Units. The level of time-varying APOC3 level were associated with an increased risk of incident ASCVD, and a stronger association was observed in populations with metabolic abnormalities. Furthermore, more intensive reductions in APOC3 produced progressively larger decreases in ASCVD risk, with a maximum estimated reduction of 9.3% observed at a 90% APOC3 reduction.

Our findings suggest that APOC3 may play an important role in ASCVD incidence and that targeting APOC3 may offer additional cardiovascular benefits beyond conventional lipid-lowering strategies.

Hypertension usually clusters with multiple comorbidities. However, the association between cardiometabolic multimorbidity (CMM) and mortality in hypertensive patients is unclear. This study aimed to investigate the association between CMM and all-cause and cardiovascular disease (CVD) mortality in Chinese patients with hypertension.

The data used in this study were from the China National Survey for Determinants of Detection and Treatment Status of Hypertensive Patients with Multiple Risk Factors (CONSIDER), which comprised 5006 participants aged 19–91 years. CMM was defined as the presence of one or more of the following morbidities: diabetes mellitus, dyslipidemia, chronic kidney disease, coronary heart disease, and stroke. Cox proportional hazard models were used to calculate the hazard ratios (HR) with 95% CI to determine the association between the number of CMMs and both all-cause and CVD mortality.

Among 5006 participants [mean age: 58.6 ± 10.4 years, 50% women (2509 participants)], 76.4% of participants had at least one comorbidity. The mortality rate was 4.57, 4.76, 8.48, and 16.04 deaths per 1000 person-years in hypertensive patients without any comorbidity and with one, two, and three or more morbidities, respectively. In the fully adjusted model, hypertensive participants with two cardiometabolic diseases (HR = 1.52, 95% CI: 1.09–2.13) and those with three or more cardiometabolic diseases (HR = 2.44, 95% CI: 1.71–3.48) had a significantly elevated risk of all-cause mortality. The findings were similar for CVD mortality but with a greater increase in risk magnitude.

In this study, three-fourths of hypertensive patients had CMM. Clustering with two or more comorbidities was associated with a significant increase in the risk of all-cause and cardiovascular mortality among hypertensive patients, suggesting more intensive treatment and control in this high-risk patient group.

To describe the duration of the pre-hospital delay time and identify factors associated with prolonged pre-hospital delay in patients with acute myocardial infarction (AMI) in China.

Data were collected from November 2014 to December 2019 as part of the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) project. A total of 33,386 patients with AMI admitted to the index hospitals were included in this study. Two-level logistic regression was conducted to explore the factors associated with the pre-hospital delay and the associations between different pre-hospital delay and in-hospital outcomes.

Of the 33,386 patients with AMI, 70.7% of patients arrived at hospital ≥ 2 h after symptom onset. Old age, female, rural medical insurance, symptom onset at early dawn, and non-use of an ambulance predicted a prolonged pre-hospital delay (all P < 0.05). Hypertension and heart failure at admission were only significant in predicting a longer delay in patients with ST-segment elevation myocardial infarction (STEMI) (all P < 0.05). A pre-hospital delay of ≥ 2 h was associated with an increased risk of mortality [odds ratio (OR) = 1.36, 95% CI: 1.09–1.69, P = 0.006] and major adverse cardiovascular events (OR = 1.22, 95% CI: 1.02–1.47, P = 0.033) in patients with STEMI compared with a pre-hospital delay of < 2 h.

Prolonged pre-hospital delay is associated with adverse in-hospital outcomes in patients with STEMI in China. Our study identifies that patient characteristics, symptom onset time, and type of transportation are associated with pre-hospital delay time, and provides focuses for quality improvement.