2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR)

Physical activity levels and associated biopsychosocial characteristics among attendees to exercise-based cardiac rehabilitation

Aim. Exercise-based cardiac rehabilitation (exCR) reduces morbidity and mortality after acute coronary syndrome (ACS). Little is known about physical activity (PA) levels at exCR program completion and associated demographic, medical, and psychosocial factors. Methods. Cross-sectional data from the ongoing Keep-Up-Going study were used, including 100 participants with recent ACS and ≥80% attendance to 3 months supervised exCR program. Physical activity was assessed by an accelerometer and self-reported psychosocial characteristics were collected at the end of the exCR. Associations between achieving the PA target (>150 min of moderate-to-vigorous-intensity PA/week) and biopsychosocial characteristics were assessed using univariable logistic regression analyses. Results. Mean age was 67 years and 24% were women. Participants achieving the PA target (76%) were more likely to have higher levels of social support, higher outcome expectations for PA, and higher intrinsic regulation (motivation, p < .05 for all). Those not achieving the PA target (24%) had a higher proportion of sedentary time, fewer steps/day, and were more likely to be older, retired, and have reduced left ventricular ejection fraction (LVEF) (p < .05 for all). Conclusions. Although exCR participation provides exercise routines, one-fourth of individuals did not reach the guideline-directed PA targets after an ACS. In addition to higher age and reduced LVEF, lower levels of social support, outcome expectations, and motivation were associated with low levels of PA. Exploring these factors could be of importance to support individuals' behavior change toward increased PA during the exCR period.

Implementation of hypertension guidelines by general practitioner societies and the use of single pill combinations in Europe-results of the survey of the general practitioner nucleus of European society of hypertension

PURPOSE

The implementation of hypertension guidelines into the everyday practice of general practitioners (GPs) have an outmost importance to provide optimal care for patients. The aim of our study was, on the one hand to gain insight about the relationship between hypertension societies and GP societies, and on the other hand, to get feedback about the use of single pill combinations (SPC) in each country, as an indicator of guideline implementation.

MATERIALS AND METHODS

The European Society of Hypertension (ESH) GP Nucleus initiated a survey containing 17 questions about the existence and number of national hypertension and GP societies, the relationship between them and with pharmacists and nurse associations, the authors of national guidelines and the availability of SPCs. The survey was sent to the national hypertension society representatives of ESH. Additionally, data about the number of SPCs sold yearly was also checked using IQVIA database.

RESULTS

Responses were collected from 25 European countries. In most of the countries there is only one hypertension society (23/25) and one GP society (18/25), most of which having a relationship with each other (22/25). Of the countries with national hypertension guidelines most of them are written by the national hypertension society (45%) followed by the GP society (27%) or by public administration (27%). Two thirds of the national hypertension societies (16/25) have relationship with nurse societies and half of them (12/25) with pharmacists. In 65% (15/23) of the guidelines dual SPC therapy is recommended for treatment initiation however, marked differences are present in the number of yearly sold SPCs in different countries.

CONCLUSIONS

National hypertension societies have remarkable impact on GPs for the management of hypertensive patients. However, improvement is needed in the collaboration with nurse and pharmacist societies and in some countries in the use of SPCs for hypertension therapy.

The Nurses' Role in the Cardiac Rehabilitation Team: Data From the Perfect-CR Study

BACKGROUND

Nurses constitute a central profession in the cardiac rehabilitation (CR) team delivering comprehensive CR to individuals with cardiovascular disease. We aimed to identify specific components reflecting the nurses' role in the CR team associated with attainment of risk factor targets post myocardial infarction.

METHODS

Center-level data (n = 78) was used from the Perfect-CR study, in which structure and processes applied at CR centers in Sweden (including details on the nurses' role) were surveyed. Patient-level data (n = 6755) was retrieved from the SWEDEHEART registry. Associations between structure/processes and target achievement for systolic blood pressure (BP) (<140 mm Hg) and low-density lipoprotein cholesterol (LDL-C, <1.8 mmol/L) at 1 year post myocardial infarction were assessed using logistic regression.

RESULTS

Structure and processes reflecting nurses' autonomy and role in the CR team associated with patients achieving systolic BP and/or LDL-C targets included the following: nurses having treatment algorithms to adjust BP medication (odds ratio [95% confidence interval]: systolic BP, 1.22 [1.05-1.42]; LDL-C, 1.17 [1.03-1.34]) and lipid-lowering medication (systolic BP, 1.14 [1.00-1.29]; LDL-C, 1.17 [1.05-1.30]), patients having the same nurse throughout follow-up (systolic BP, 1.07 [1.03-1.11]; LDL-C, 1.10 [1.06-1.14]), number of follow-up hours with a nurse (systolic BP, 1.13 [1.07-1.19]), having regular case rounds to discuss patient cases during follow-up (LDL-C, 1.22 [1.09-1.35]), and nurses having training in counseling methods (systolic BP, 1.06 [1.03-1.10]).

CONCLUSION

Components reflecting CR nurses' autonomy and role in the team are of importance for patients attaining risk factor targets post myocardial infarction. The results could provide guidance for optimizing nurses' competence and responsibilities within the CR team to improve patient care.

Associations between emotional support and cardiovascular risk factors and subclinical atherosclerosis in middle-age

OBJECTIVE

To test the hypothesis of low emotional support being associated with lifestyle and biomedical cardiovascular disease (CVD) risk factors, estimated risk of CVD morbidity and mortality, and subclinical atherosclerosis in middle-aged healthy adults.

METHODS AND MEASURES

Cross-sectional data were obtained from participants aged 40-60 years who had one or more conventional CVD risk factor. They underwent assessment based on questionnaires, clinical examination, blood sampling, and carotid ultrasound of plaque formation and carotid intima-media wall thickness (cIMT). Based on the Interview Schedule for Social Interaction, the participants were categorised as either low in emotional support (n = 884) or as a referent (n = 2570). Logistic regression analyses were conducted to study the associations.

RESULTS

Logistic regression analyses showed that low emotional support was significantly associated with smoking, alcohol consumption and physical inactivity (OR = 1.53 - 1.94), estimated risk of CVD morbidity and mortality (OR = 1.56 - 1.68), and plaque formation (OR = 1.39). No significant associations were found regarding biomedical CVD risk factors or cIMT.

CONCLUSION

The findings suggest that low social support is associated with lifestyle CVD risk factors, estimated risk of CVD morbidity and mortality, and subclinical atherosclerosis in middle-aged healthy adults, encouraging causal evaluation with longitudinal data investigating an impact of emotional support on mechanisms underlying CVD.

Physical Activity in Lower-Extremity Sarcoma Survivors: Specific Recommendations and Program Design

Survivors of lower-extremity sarcoma are at high risk of developing physical performance dysfunctions and impaired quality of life resulting from the sarcoma disease itself and the adverse side effects of the treatments. Therefore, the implementation of safe and effective exercise programs addressing survivors' functionality and life quality is an essential and complementary nonpharmacological intervention in the cancer continuum. The viability and success of physical activity and exercise in lower-extremity sarcoma survivors remains largely unknown, likely due to the heterogeneity of clinical presentation and development of this type of cancer regarding diagnosis, treatment, and prognosis. This study provides specific recommendations for designing an appropriate training program that will help maintain sarcoma survivors' physical activity and improve their quality of life. The main conclusions reported here result from scientific studies and analyses of clinical data both selected from a systematic search in PubMed database. Sarcoma survivors should be advised as soon as the disease is diagnosed to perform a simple program of low-intensity and short-duration exercise prior to surgery (prehabilitation). Later, during clinical treatments and taking into account their psychobiological status, an adapted exercise program may be developed within the hospital environment. Finally, building healthy habits is recommended so as to improve disease-free survival, including regular physical activity, always under the supervision of professionals in this field. Hopefully, these suggestions will contribute to a better professional performance by specialists in the implementation of safe, reliable, and exercise programs in lower-extremity sarcoma survivors.

Atherosclerotic Plaque Progression and Incident Cardiovascular Events in a 10-Year Prospective Study of Patients With Systemic Lupus Erythematosus: The Impact of Persistent Cardiovascular Risk Factor Target Attainment and Sustained DORIS Remission

OBJECTIVE

Cardiovascular disease (CVD) is a leading cause of death in individuals with systemic lupus erythematosus (SLE). We assessed atherosclerotic plaque progression and incident cardiovascular events in patients with SLE over a 10-year follow-up.

METHODS

We prospectively analyzed 738 carotid ultrasound measurements (413 in patients with SLE and 325 in age/sex-matched healthy controls [HCs]) to assess new plaque development from baseline to 3-, 7-, and 10-year follow-up. Multivariate mixed-effects Poisson regression models examined potential predictors of plaque progression, including patient characteristics, Systemic Coronary Risk Evaluation, traditional cardiovascular risk factor (CVRF) target attainment, Definition of Remission in SLE (DORIS), medications, and persistent triple anti-phospholipid antibody (aPL) positivity during follow-up. Ten-year incident cardiovascular events were recorded, and univariate Cox regression analysis assessed potential associations.

RESULTS

Patients with SLE had a 2.3-fold higher risk of carotid plaque progression than HCs (incidence rate ratio [IRR] 2.26, P = 0.002). Plaque progression risk in patients with SLE was reduced by 32% (IRR 0.68, P = 0.004) per each sustainedly attained CVRF target during follow-up, including blood pressure, lipids, smoking, body weight, and physical activity. DORIS achievement ≥75% of follow-up was associated with a 43% decrease in atherosclerosis progression risk (IRR 0.57, P = 0.033). Ten-year risk of incident cardiovascular events was higher in individuals with SLE than HCs (eight versus one event, permutation-based log-rank P = 0.036) and was associated with persistent triple aPL positivity.

CONCLUSION

Patients with SLE experience a 2.3-fold higher 10-year atherosclerosis progression risk than HCs, mitigated by sustained CVRF control and prolonged clinical remission. Persistent triple aPL positivity is associated with increased incidence of CVD events.

Psychological screening in cardiovascular care

Approximately one in three patients with cardiovascular disease experience psychological distress, often with an associated poor prognosis. Early detection and intervention can improve patients' heart and mental health, yet minimal guidance on psychological screening is offered for clinicians working in cardiovascular care. This paper describes a pragmatic approach to conducting psychological screening during routine clinical care, including when and how to screen and what to do in the case of a positive screen. A psychological screening protocol is proposed to enable clinicians to assess and, where necessary, intervene or refer for further evaluation.

The spectrum of eccentric left ventricular hypertrophy in endurance sports disciplines

Endurance sports disciplines largely differ in terms of specific training and event modalities, likely resulting in diverse morpho-functional cardiac changes. Our study aims to assess elite athletes engaged in different endurance disciplines and describe cardiac remodelling in each. We enrolled 282 Olympic athletes (58.5% males, mean age 26.7 ± 4.7) practising long-distance running (57, 20.2%), triathlon (18, 6.4%), canoeing/rowing (76, 26.9%), cycling (65, 23%), long-distance swimming (21, 7.4%), cross-country skiing & biathlon (45, 16%). athletes underwent ECG, echocardiogram and exercise stress-test. Eccentric LV hypertrophy (EH) was present in 73.8% of athletes, without gender differences (p = 0.847), varying greatly among disciplines (p = 0.0005). Triathlon (94.4%) and cycling (87.7%) showed the highest prevalence. The largest LV volumes were observed in triathlon-athletes and cyclists (LVEDVi: males, p = 0.009, females, p = 0.002). The lowest LV dimensions were found in rowing/canoeing (males: p < 0.0001; females: p < 0.0001). Long-distance runners and swimmer presented intermediate extent of LV remodelling. Positive correlation between hours of training and LVMi (p = 0.0004) and LVEDVi (p = 0.048) was observed among cyclists. Indeed, cyclists with the highest EH (i.e., lowest LVMi\LVEDVi ratio) achieved the highest workload at exercise stress-test (p = 0.045) and better athletic achievements. Among endurance athletes, cyclists and triathletes present the most marked extent of LV EH, while canoeists and rowers the lowest degree, with major increase in LV mass. Intra-group analysis showed an association between eccentric hypertrophy and superior exercise capacity and higher athletic performances that may be related to an increased stroke volume and cardiac output, which improve cardiovascular efficiency during endurance exercise. These findings could be useful both for clinicians in identifying potential health issues in athletes and for coaches when assessing athletes' training status.

Predictive Value of Left Ventricular Systolic Dysfunction or Wall Motion Abnormalities for Non-Ischemic Myocardial Injury: A Multicenter Cardiovascular Resonance Study

Background: Left ventricle (LV) systolic dysfunction, defined as a global (LVejection fraction, LVEF < 50%) and/or regional wall motion abnormalities (RWMA), are the major parameters assessed in patients with cardiovascular diseases. The study evaluated the predictive value of LV systolic dysfunction for non-ischemic myocardial injury (presence of myocardial fibrosis/scar) in patients with suspected myocarditis. Methods: This was a multicenter, observational, retrospective study (2018-2021) of stable outpatients with clinically suspected myocarditis referred for a contrast-enhanced CMR. Patients with a history of any other significant cardiovascular disorders were excluded from the study. In each patient, the LV systolic function (LVEF, RWMA) and the presence and severity of late gadolinium enhancement (LGE) were assessed by CMR. Results: A total of 773 consecutive patients were enrolled in the study. The average LVEF was 58 ± 10%, and systolic dysfunction was observed in 95 cases (12%). Subsequently, 456 patients (59%) with confirmed non-ischemic LGE in at least one segment were included in the study group. The average LVEF was 57 ± 11%, with LV systolic dysfunction observed in 126 (28%) individuals with RWMA and 84 (18%) with LVEF < 50%. The median number of LV segments with LGE was 3 (2-5), and the total amount of LGE was 6% (3-10) of the LV mass. The wall motion score index (WMSI) > 1 and LVEF < 56% were the best predictors of non-ischemic injury based on LGE (area under the curve [AUC] 0.62; sensitivity 31%; specificity 94%; p < 0.001 and AUC 0.59; sensitivity 42%; specificity 75%, p < 0.001, respectively). Conclusions: In stable patients with suspected myocarditis, any RWMA and LVEF < 56% had a predictive value for a non-ischemic myocardial injury as assessed by CMR.

A cross-sectional analysis of the association between screen-based sedentary behavior and erectile dysfunction in US adult males

Despite previous studies, the association between screen-based sedentary behavior (SB) and erectile dysfunction (ED) remains unclear. This study aimed to investigate the relationship between screen-based SB and ED using data from the 2001-2004 National Health and Nutrition Examination Survey (NHANES). A total of 4,047 participants were included, of whom 1,192 (29.5%) had ED. Multivariable logistic regression models were used to analyze this association. After adjusting for potential confounders, screen-based SB exceeding 2 h per day was significantly associated with an increased risk of ED (OR = 1.32; 95% CI, 1.12-1.56; p < 0.0001). Subgroup analysis further confirmed a consistent and independent positive association across different population groups (all p for interaction > 0.05). These findings suggest a significant relationship between prolonged screen-based SB and ED in U.S. adult males. Further prospective studies are needed to confirm these results.

Impact of malnutrition on in-hospital outcomes in patients with acute myocardial infarction and no standard modifiable cardiovascular risk factors

BACKGROUND

Individuals who present with acute myocardial infarction (AMI) in the absence of standard modifiable cardiovascular risk factors (i.e. SMuRF-less) seem to have a significantly increased risk of mortality; however, it remains unclear whether the 'SMuRF paradox' would be influenced by patients' baseline nutritional status.

METHODS

We consecutively included patients from a multi-center, prospective registry (NCT05337319) from January 2022 to October 2023. Malnutrition was defined via the Nutritional Risk Index. The primary outcome was in-hospital major adverse cardiovascular events (MACEs), which included mortality, cardiac shock, acute congestive heart failure, reinfarction, and stroke.

RESULTS

A total of 3753 patients with first-presentation AMI were included, of which 10 % were SMuRF-less and over 21 % were malnourished. SMuRF-less malnourished had the highest MACEs (16.1 %), followed by the SMuRF-less nourished (15.5 %), ≥1 SMuRFs malnourished (12.1 %), and ≥1 SMuRFs nourished (5.2 %, p < 0.001). With ≥1 SMuRFs nourished as the reference, SMuRF-less malnourished had the highest increase in MACEs [adjusted OR (95 % CI), 3.385 (2.163-5.298), p < 0.001], followed by SMuRF-less nourished group [adjusted OR (95 % CI), 2.460 (1.214-4.985), p = 0.012], but only a nonsignificant increase in MACEs was observed in the ≥1 SMuRFs malnourished [adjusted OR (95 % CI), 1.297 (0.880-1.911), p = 0.188]. SMuRF-less was not associated with MACEs in the subgroup of malnourished patients [adjusted OR (95 % CI), 1.931 (0.892-4.178), p = 0.095], with a nonsignificant result in interaction analysis (p for interaction = 0.148).

CONCLUSION

Among patients with first-presentation AMI, malnutrition is prevalent, especially in those SMuRF-less. Compared with those with at least one SMuRF, SMuRF-less patients have a significantly higher risk of in-hospital MACEs irrespective of their nutritional status, while the outcome was the most favorable among ≥1 SMuRF and nourished patients.

Primary prevention of cardiotoxicity in cancer patients treated with fluoropyrimidines: a randomized controlled trial

BACKGROUND

Fluoropyrimidines (FP) are the third most used chemotherapeutic drugs administered in solid tumors but have cardiotoxic side effects. We aimed to determine whether pre-chemotherapeutic cardiological assessment and management of cardiovascular risk factors could prevent FP-induced cardiotoxicity and if the coronary artery calcium (CAC) score was predictive of chest pain.

METHODS

This was a randomized, controlled, single center trial of patients with various cancer types who were treated with FP and had no known ischemic heart disease. All patients had CAC score obtained by cardiac CT scan. Patients were randomized to pre-chemotherapeutic cardiological management or standard care. Cardiological management included risk reduction based on electro- and echocardiographic evaluation and blood samples. Primary composite endpoint included hospital admission for chest pain, acute coronary syndrome, coronary angiography intervention, or all-cause mortality. Secondary outcome was chest pain. Follow-up was 6 months. Data were analyzed using Kaplan-Meier survival function with log-rank test and ROC-analyses.

RESULTS

Of the 192 patients included, the primary endpoint occurred in 9/95 (9.5%) patients in the intervention group and 15/97 (15.5%) patients in the control group (log-rank p = 0.19) with an incidence rate ratio (IRR) of 0.57 (95% CI [0.22 - 1.39]). Chest pain occurred in 6/95 (6.3%) patients in the intervention group and 13/97 (13.4%) in the control group, yielding an IRR of 0.44 (95% CI [0.14 - 1.23]). CAC score did not predict chest pain occurrence.

CONCLUSIONS

Cardiological management of cardiovascular risk factors prior to treatment with fluoropyrimidines resulted in half as many cardiotoxic events but the study did not reach statistical significance. Further studies are needed to investigate the optimal strategies to prevent fluoropyrimidine-induced cardiotoxicity in cancer patients.

TRIAL REGISTRATION

ClinicalTrials.gov Identifyer NCT03486340.

Medical Nutrition Therapy in Dermatological Diseases: A Joint Consensus Statement of the Italian Association of Dietetics and Clinical Nutrition (ADI), the Italian Society of Dermatology and Sexually Transmitted Diseases (SIDeMaST), the Italian Society of Nutraceuticals (SINut), Club Ketodiets and Nutraceuticals "KetoNut-SINut" and the Italian Society of Endocrinology (SIE), Club Nutrition, Hormones and Metabolism

Dermatological diseases such as acne, hidradenitis suppurativa (HS), and psoriasis are driven by chronic inflammation and oxidative stress. Emerging evidence highlights the role of nutrition in modulating these conditions, particularly through dietary patterns rich in antioxidants, polyphenols, and unsaturated fatty acids. RECENT FINDINGS: The Mediterranean diet (MedDiet) has demonstrated potential benefits due to its anti-inflammatory and immunomodulatory effects, while very low-energy ketogenic therapy (VLEKT) has shown promise in rapidly improving disease severity. Specific nutrients, including omega-3 fatty acids, probiotics, and micronutrients, may further contribute to disease management. However, the current literature is limited by small-scale studies and the lack of standardized dietary guidelines. PURPOSE OF REVIEW: This Consensus Statement, developed collaboratively by the Italian Association of Dietetics and Clinical Nutrition (ADI), the Italian Society of Dermatology and Sexually Transmitted Diseases (SIDeMaST), the Italian Society of Nutraceuticals (SINut), Club Ketodiets and Nutraceuticals "KetoNut-SINut" and the Italian Society of Endocrinology (SIE), Club Nutrition, Hormones and Metabolism, aimed to establish an evidence-based framework for medical nutrition therapy (MNT) of the most common inflammatory skin diseases, including acne, HS and psoriasis.

Real-world use of guideline-directed therapy for heart failure: Insights from the Danish Heart Failure Registry

AIMS

We aimed to assess real-world implementation of guideline-directed medical therapy (GDMT) for heart failure (HF) with reduced ejection fraction (HFrEF) and its association with mortality and hospitalization.

METHODS

We analysed 46 816 incident HFrEF patients from the Danish Heart Failure Registry (2008-2022). We examined the utilization of GDMT-renin-angiotensin system inhibitors (RASi), beta-blockers, mineralocorticoid receptor antagonists (MRAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2i)-at 4, 8 and 12 weeks of follow-up according to the European Society of Cardiology guidelines within the intervals 2008-2011, 2012-2015, 2016-2020 and 2021-2022. Using Cox regression, we assessed the associations between GDMTs [none (reference), 1-2 GDMTs, and 3-4 GDMTs] initiated at 4, 8 and 12 weeks and 1 and 3 year mortality (all-cause and cardiovascular) and hospitalization (all-cause and HF).

RESULTS

Between 2008-2011 and 2021-2022, RASi utilization at 4 weeks of follow-up was 93.2% and 93.7%, respectively, and at 12 weeks of follow-up, 97.2% and 97.8%, respectively. Beta-blocker use was 81.1% and 78.2% at 4 weeks and 89.6% and 90.4% at 12 weeks of follow-up while MRA utilization was 27.2% and 34.6% at 4 weeks and 32.6% and 52.2% at 12 weeks of follow-up. The SGLT2i use at 4 weeks increased from 0.0% to 21.3%, and at 12 weeks of follow-up from 3.2% to 35.8% between 2016-2020 and 2021-2022. The initiation of GDMTs at 4 weeks of follow-up was associated with lower adjusted hazard ratios (HRs) [95% confidence intervals (CI)] for 1 year all-cause mortality [1-2 GDMTs: 0.73 (95% CI: 0.61-0.86), 3-4 GDMTs: 0.65 (95% CI: 0.55-0.78)], 3 year all-cause mortality [1-2 GDMTs: 0.75 (95% CI: 0.66-0.86); 3-4 GDMTs: 0.67 (95% CI: 0.59-0.76)] and 3 year cardiovascular mortality [1-2 GDMTs: 0.74 (95% CI: 0.62-0.89); 3-4 GDMTs: 0.72 (95% CI: 0.59-0.87)]. Lower adjusted HRs were also observed for 1 year all-cause hospitalization [1-2 GDMTs: 0.80 (95% CI: 0.75-0.86); 3-4 GDMTs: 0.78 (95% CI: 0.73-0.84)] and 3 year all-cause hospitalization [1-2 GDMTs: 0.77 (95% CI: 0.72-0.83); 3-4 GDMTs: 0.77 (95% CI: 0.71-0.82)].

CONCLUSIONS

We demonstrated high use of RASi and beta-blockers and rising use of MRA and SGLT2i, reflecting rapid adaption to guidelines changes in incident HFrEF patients. Early GDMT initiation was associated with lower 1 and 3 year mortality and all-cause hospitalization. Upfront treatment with GDMT, according to the latest guidelines, is crucial.

Dietary Approaches to Stop Hypertension (DASH) for the primary and secondary prevention of cardiovascular diseases

BACKGROUND

The Dietary Approaches to Stop Hypertension (DASH) diet is designed to lower blood pressure and improve cardiovascular health by reducing sodium and unhealthy fats while increasing nutrients, including potassium, calcium, magnesium, and fibre. While evidence supports its benefits for managing cardiovascular risk factors, gaps remain in understanding its long-term impact on preventing cardiovascular disease (CVD), particularly in terms of hard clinical outcomes such as myocardial infarction and stroke.

OBJECTIVES

To assess the effects of the DASH diet for the primary and secondary prevention of cardiovascular diseases.

SEARCH METHODS

We used standard extensive Cochrane search methods. The latest search date was in May 2024.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) comparing a DASH diet intervention to no intervention (including usual care), minimal intervention, or other dietary interventions. In the context of this review, 'minimal intervention' includes brief dietary advice or informational leaflets provided during a medical consultation, without a structured dietary intervention. 'Other dietary interventions' include any other dietary programme besides the DASH diet. Participants were adults with or without CVD. The minimum duration of eligible interventions was eight weeks and the minimum follow-up was three months.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Primary outcomes were myocardial infarction, heart failure, and stroke. Secondary outcomes were the need for coronary revascularisation, carotid revascularisation, peripheral revascularisation, all-cause mortality, cardiovascular mortality, changes in blood pressure, blood lipids, the occurrence of type 2 diabetes, health-related quality of life, and adverse effects. We used GRADE to assess the certainty of evidence for each outcome.

MAIN RESULTS

Five RCTs involving 1397 participants met our inclusion criteria and were included in this review. All five trials contributed at least one intervention arm to one or more of the three prespecified comparisons. In total, 1075 participants across eligible arms were included in the meta-analyses. The difference reflects trial arms that did not meet our prespecified intervention and comparison definitions, and were therefore not analysed, though all participants were randomised within eligible trials and are accounted for in the review total. The trials assessed the DASH diet in a primary prevention setting; none evaluated its effects in secondary prevention. Participants were generally healthy adults aged 18 years or older, without diagnosed cardiovascular disease. The intervention duration ranged from 16 weeks to 12 months, with follow-up periods between 16 weeks and 18 months (medium- and long-term). The trials were conducted in the USA and Poland, with funding from public institutions, including the National Institutes of Health, the National Heart, Lung, and Blood Institute, and the Institute of Cardiology in Poland. DASH diet versus no intervention (including usual care) Myocardial infarction: one trial (144 participants) reported no myocardial infarctions in either group over a one-year follow-up. The GRADE certainty rating was low due to the high risk of performance bias and imprecision. Stroke: one trial (144 participants) reported no strokes in either group over the same follow-up period. The GRADE rating was low for similar reasons. All-cause mortality: one trial (90 participants) reported no deaths over a six-month follow-up. The GRADE rating was very low due to unclear risk of selection bias, high risk of performance bias, and imprecision. No data were available for heart failure or revascularisation needs (coronary, carotid, or peripheral) in this comparison. DASH diet versus minimal intervention Myocardial infarction: two trials (902 participants in total; 629 participants were in trial arms eligible for this comparison, based on our prespecified intervention and comparison definitions) reported limited events, with no clear differences between groups over one year (risk ratio (RR) 2.99, 95% confidence interval (CI) 0.12 to 73.04). The GRADE rating was low due to high risk of performance bias and imprecision. Stroke: two trials (reporting on the same 629 participants) reported no strokes in either group over follow-up periods ranging from six months to one year. The GRADE rating was low due to similar concerns. No data were available for heart failure, revascularisation needs (coronary, carotid, or peripheral), or all-cause mortality in this comparison. DASH diet versus another dietary intervention All-cause mortality: one trial (261 participants) reported no clear difference between the groups over one year (RR 2.98, 95% CI 0.12 to 72.42). The GRADE rating was very low due to multiple risks of bias and imprecision. No data were available for myocardial infarction, stroke, heart failure, or revascularisation needs in this comparison.

AUTHORS' CONCLUSIONS

The effect of the DASH diet on major cardiovascular outcomes - including myocardial infarction, stroke, cardiovascular mortality, and all-cause mortality - remains inconclusive due to a lack of robust long-term evidence. Additionally, no trials have assessed its impact on heart failure or the need for revascularisation procedures, such as coronary, carotid, or peripheral interventions. While the DASH diet may reduce blood pressure, total cholesterol, and triglyceride levels while increasing high-density lipoprotein (HDL) cholesterol compared to no intervention or usual care, it appears to have little to no effect on low-density lipoprotein (LDL) cholesterol. Evidence comparing the DASH diet to a minimal intervention or alternative dietary approaches remains limited. Although the DASH diet has minimal reported adverse effects, the absence of long-term safety data prevents definitive conclusions on its use in individuals with or without cardiovascular disease. The certainty of evidence is low to very low, primarily due to design limitations such as high risk of bias, small sample sizes, and short follow-up periods in the included trials. Most studies focused on cardiovascular risk factors rather than long-term clinical outcomes, and all eligible trials assessed primary prevention, with no data on secondary prevention. Given these uncertainties, well-designed, long-term randomised controlled trials are needed to evaluate the DASH diet's impact on major cardiovascular events, its effectiveness in secondary prevention, and its long-term safety.

Long-Term and Time-Dependent Association of Predictors on Mortality in Patients With Iliofemoral Artery Disease

BACKGROUND

Although several predictors affect long-term mortality in patients with lower extremity artery disease, long-term association of predictors on mortality over time remain unclear.

OBJECTIVES

The aim of this study was to explore the long-term and time-dependent association of baseline characteristics with mortality in patients with iliofemoral arterial disease.

METHODS

This study is a multicenter retrospective analysis of 4,086 consecutive patients (mean age 72 ± 9 years, 74% men) who underwent endovascular therapy for symptomatic de novo iliofemoral arterial disease between January 2004 and December 2011 at 16 cardiovascular centers in Japan.

RESULTS

During the median follow-up of 3.8 years (Q1-Q3: 1.4-7.4 years), 1,100 deaths, and 637 major adverse cardiovascular events (MACE) (defined as death, myocardial infarction, and stroke) were observed. Overall survival and MACE-free rates were estimated to be 56.1% and 50.6% at 10 years. Old age, chronic kidney disease stage, heart failure, the lack of renin-angiotensin-system inhibitor use, chronic limb threatening ischemia (CLTI), decreased ankle-brachial index, femoropopliteal lesion were significantly associated with an increased risk of mortality. while the prognostic impact of CLTI was significantly attenuated afterwards. Old age, chronic kidney disease stage, cerebrovascular disease, coronary artery disease, heart failure, warfarin use, the lack of statin use, and CLTI were significantly associated with an increased risk of MACE, while the prognostic impact of cerebrovascular disease and CLTI was significantly attenuated afterwards.

CONCLUSIONS

This study demonstrated long-term and time-dependent association of predictors on mortality and MACE following endovascular therapy. It highlights the need for continuous management of cardiovascular risk factors in this high-risk population.

Long term outcomes of drug-coated balloons versus drug-eluting stents in patients with small vessel coronary artery disease

OBJECTIVE

Drug-eluting stents (DES) are a normative care of coronary stenosis. However, their efficacy was limited by stent thrombosis and in-stent restenosis especially in small vessel coronary artery disease (SvCAD). The aim of this study was to assess angiographic efficacy and clinical outcomes of drug coated balloons (DCB) as compared with DES in SvCAD setting.

METHODS

A total of 100 SvCAD patients with percutaeous angioplasty of culprit coronary arteries <3 mm diameter and >70 % stenosis were enrolled in this study. The patients were categorized into DES arm and DCB arm. One year clinical outcomes were assessed. The primary endpoint was in-lesion late lumen loss (LLL). The secondary endpoints were vessel thrombosis, major bleeding, all-cause death and major adverse cardiac events (MACEs).

RESULTS

One year clinical follow-up revealed that in-lesion LLL was significantly lower in DCB arm as compared with DES arm (p = 0.004). Composite MACE was significantly higher in DES group compared to DCB group (p < 0.001). Non-fatal myocardial infarction (MI), target lesion revascularization (TLR), and major bleeding in DES group were significantly higher than DCB group (p = 0.04 & p < 0.001 & p = 0.03, respectively). However, there was a numerically; but not significantly, higher incidence of cardiac death (p = 0.65), and vessel thrombosis (p = 0.18) in DES arm compared to DES arm.

CONCLUSION

In SvCAD setting, DCB has favourable angiographic and clinical outcomes; as evidenced by lower LLL and composite MACE at one year follow up, compared to DES.

Determinants of medication adherence in patients with acute coronary syndrome: a secondary analysis of a randomised clinical trial

BACKGROUND

Coronary heart disease (CHD) remains a leading cause of mortality and disability worldwide. Approximately half of the patients who have had a prior hospital admission for CHD will have a recurrent coronary event, with the majority of these occurring within 12 months. Despite well-established evidence-based therapies, medication non-adherence is highly prevalent and reasons for medication non-adherence are poorly understood. This study evaluates factors influencing adherence to secondary prevention medications in people with acute coronary syndrome (ACS).

METHODS

We performed a secondary analysis of TEXT messages to improve MEDication adherence and Secondary prevention after ACS (TEXTMEDS), a single-blind randomised clinical trial of 1424 patients with ACS from 18 hospitals across Australia. The primary outcome was self-reported medication adherence to each of up to five classes of guideline-recommended cardioprotective medications indicated for secondary prevention after ACS. Patients were followed up at 6-month and 12-month time points and were defined as adherent if at both time points, the proportion of indicated medications taken was >80% (>24/30 days in the preceding 1 month) for all five classes if not otherwise contraindicated. Logistic regression analysis and the Least Absolute Shrinkage and Selection Operator regularisation technique were used to assess the effect of sociodemographic and clinical factors on medication adherence.

RESULTS

The analyses included 1379 participants with complete adherence data (mean age 58.5±10.7 years; 1095 (79.4%) men). The following variables were associated with adherence to cardiovascular medications at both 6 and 12 months: greater number of total medications taken (OR: 1.33; 95% CI: 1.25 to 1.42) and attending a cardiac rehabilitation programme (1.47; 95% CI: 1.17 to 1.86). In contrast, female sex (0.67; 95% CI: 0.50 to 0.90) and physical disability (0.43; 95% CI: 0.23 to 0.77) were associated with lower likelihood of medication adherence.

CONCLUSIONS

Sociodemographic and clinical factors may influence medication adherence. Greater awareness, discussion and monitoring of these factors during patient follow-up may help improve medication adherence.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry; URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364448; registration number: ACTRN12613000793718.

The longitudinal association of optimism with quality of life after percutaneous coronary intervention for coronary heart disease; The THORESCI study

BACKGROUND

Positive psychological factors such as optimism are predictive of favorable clinical outcomes in patients with cardiac disease. Evidence suggests that trait optimism can vary over time, especially after a coronary event. We therefore examined whether the level and change in optimism across the one-year time period after percutaneous coronary intervention (PCI) were associated with changes in quality of life (QoL) over time. The analyses were adjusted for negative psychological functioning and health behavior adherence as potential explanatory factors.

METHODS

Patients who underwent PCI (n = 1759, 21 % female, mean age = 64 ± 10 years) filled out a psychological survey including positive (optimism; LOT-R) and negative psychological factors (depression (PHQ9) and anxiety (GAD7)), QoL (WHOQOL-BREF), and health behavior adherence (MOS-GAS) at inclusion and one year later (n = 1474). Data were analyzed using hierarchical linear mixed modeling with time-varying predictors and covariates.

RESULTS

Optimism levels increased from baseline (MeanBL = 7.6 (SD = 2.1) to 1-year follow-up in 43 % of the patients, whereas optimism decreased in 36 %; rintraclass = 0.53). Optimism was associated with a higher level of overall QoL (B = 1.96, se = 0.09, p < .001) and more positive 1-year change in QoL (B = 0.55, se = 0.09, p < .001), adjusting for demographic and clinical covariates, with similar findings for all subdomains. Adding depression and anxiety (both significant negatively correlated with of QoL) explained part of the associations of optimism with physical, psychological and environmental QoL, but not with social QoL. Health behavior adherence was significantly correlated with most QoL components, but adherence did not affect the association between optimism and QoL.

CONCLUSION

These data indicate marked individual differences in the magnitude of changes in optimism following PCI. Both higher levels and increases in optimism were associated with higher and improving QoL. Depression and anxiety, but not health behavior adherence, explained part of this relationship. Optimism might be an important psychological factor to address in cardiac rehabilitation.

Cardiodermatology: the heart of the connection between the skin and cardiovascular disease

The skin and cardiovascular systems are connected in unique and meaningful ways, and many diseases conventionally considered as being limited to one organ system are more closely related than previously believed. Major cardiovascular diseases and phenomena such as infective endocarditis, congestive heart failure, Kawasaki disease and thromboembolism are associated with specific skin findings, and advances in genetics, immunology and clinical epidemiology show that inflammatory dermatological diseases, such as psoriasis, have serious cardiovascular and cardiometabolic consequences. Additionally, commonly used cardiovascular therapies, such as antihypertensive medications, are associated with important cutaneous adverse effects, including photosensitivity, photocarcinogenesis and eczematous skin reactions. Moreover, systemic dermatological therapies, including retinoids, Janus kinase inhibitors and biologics, can alter the risk of cardiovascular and cardiometabolic diseases. In this Review on cardiodermatology, we provide interdisciplinary insights from dermatology and cardiology that will be of practical use to both cardiologists and generalists who manage cardiovascular and cardiometabolic diseases in patients with dermatological findings or histories. We discuss specific skin findings associated with cardiovascular diseases to aid in diagnosis; important cutaneous adverse effects of common cardiovascular therapies, for the purpose of treatment monitoring; and the effect of dermatological diseases and dermatological treatment on cardiovascular risk.

Aortic Remodeling in Patients with Arterial Hypertension: Pathophysiological Mechanisms, Therapeutic Interventions and Preventive Strategies-A Position Paper from the Heart and Hypertension Working Group of the Italian Society of Hypertension

In patient with arterial hypertension the whole aorta is exposed to increased wall stress due to pressure overload. Different blood pressure (BP) components have been reported as main determinant of aortic remodelling. In particular increased diastolic BP has been associated with aortic dilatation across all its segments with smaller increase in aortic root and ascending aorta related to increased systolic BP and pulse pressure. Optimal BP control is crucial to prevent development of aortic aneurysm and acute aortic disease. Many studies have evaluated the role of different antihypertensive drug classes for prevention of adverse aortic remodelling including beneficial effects of ACEIs, ARBs, dihydropyridinic calcium channel blockers and Beta-blockers. The present review discusses pathophysiological mechanisms, therapeutic interventions and preventive strategies for development of aortic remodeling in patients with arterial hypertension.

Automated AI-based coronary calcium scoring using retrospective CT data from SCAPIS is accurate and correlates with expert scoring

OBJECTIVES

Evaluation of the correlation and agreement between AI and semi-automatic evaluations of calcium scoring CT (CSCT) examinations using extensive data from the Swedish CardioPulmonary bio-Image study (SCAPIS).

MATERIALS AND METHODS

In total, 5057 CSCT examinations were performed on one CT system at Linköping University Hospital between October 8, 2015, and June 12, 2018. AI evaluations were compared to semi-automatic CSCT results from expert reader evaluations rendered within SCAPIS. Pearson correlation, intraclass correlation coefficients (ICC), and Bland-Altman analysis were applied for Agatston (AS), volume (VS), mass scores (MS), number of lesions and lesion location. Agreement of Agatston score classifications into cardiovascular (CV) risk categories was evaluated with weighted kappa analysis.

RESULTS

The evaluation included 4567 subjects, 2229 (48.8%) male, 2338 (51.2%) female, 50-64 years of age (mean 57.3 ± 4.4). The AS ranged from 0 to 2871 in the cohort, with 2846 subjects having an AS of 0. Mean and median AS were 51.4 and 0.0, respectively. Total AS, VS, MS and number of lesions ICCs were 0.994, 0.994, 0.994, 0.960 (p < 0.001), respectively. Bland-Altman analyses rendered mean differences ± 1.96 SD upper and lower limits of agreement for AS -0.04, -52.5 to 52.4, VS -0.44, -46.51 to 45.63, and MS -0.07, -9.62 to 9.48. Weighted kappa analysis for CV risk category classifications was 0.913, and overall accuracy was 91.2%.

CONCLUSION

There was excellent correlation and agreement between AI and semi-automatic evaluations for all calcium scores, number of lesions and lesion location. High degrees of agreement and accuracy were found for the CV risk categorization.

KEY POINTS

Question Can AI function as a tool for enhancing the efficiency and accuracy of Coronary Artery Calcium Score (CACS) evaluations in clinical radiology practice? Findings This study confirms the robustness of AI-derived CACS results across extensive datasets, though its generalizability is limited by data acquisition from a single CT system. Clinical relevance This study suggests that AI holds significant promise as a tool for enhancing the efficiency and accuracy of CACS evaluations, with implications for improving patient diagnostics and reducing radiologist workload in clinical practice.

Impact of Home-Based Cardiac Rehabilitation on Physical Function, Outcomes, and Costs

PURPOSE

Cardiac rehabilitation (CR) improves health outcomes in patients with cardiovascular disease (CVD), but referral, participation, and completion rates are low. Home-based CR (HBCR) is a proposed solution, but studies on its efficacy are limited. We report our experience from a Veterans Affairs HBCR program on physical function, costs, and outcomes overlapping with the coronavirus disease-2019 (COVID-19) pandemic.

METHODS

A 12-week HBCR program included case-managed individualized exercise and risk management. Six functional tests were conducted remotely, safety was monitored, and quality of life and costs were quantified. A composite outcome (death, myocardial infarction, stroke, and cardiac-related hospitalization) was compared between 70 HBCR participants, 131 patients referred to Community Care, and 71 patients undergoing usual care (no CR) over a mean follow-up of 2.5 ± 0.90 years.

RESULTS

Among HBCR participants, there were significant improvements in right and left leg balance (145 and 56%, respectively, P < .001), 30-second chair stand (47%, P < .001), 2-minute step performance (41%, P < .001), right and left 30-second arm curl (31 and 30%, respectively, P < .001), 50-foot walk test (20%, P = .002), 8-foot up and go test (28%, P < .001), and steps/day (82%, P < .001). Composite events were lower among patients in the HBCR group versus those referred to Community Care ( P = .002). Health care costs were significantly lower among patients in the HBCR group compared to those in Community Care ($2101 vs $3289/subject, P < .001).

CONCLUSIONS

A HBCR program that included a broad spectrum of patients with CVD and multiple co-morbidities, performed largely during the COVID-19 pandemic, resulted in significant functional and outcome benefits and reduced costs.

Hair cortisol concentration, a stress biomarker, is gradually increasing before an acute myocardial infarction

BACKGROUND

Chronic stress is believed to play a role in the pathophysiology of acute myocardial infarction (AMI). Cortisol is a biomarker associated with stress. We sought to assess stress contribution to AMI using hair cortisol concentration (HCCs) as a surrogate biomarker.

METHODS

HCC was measured in hair segments, corresponding to distinctive periods before hair sampling, in 102 male AMI patients and 50 healthy male controls. Standard baseline variables were collected for both groups, whereas for AMI patients, laboratory and psychological tests were also carried out. Linear mixed models were applied to assess the effect of group and baseline variables on the trend of cortisol before hair sampling.

RESULTS

HCC was significantly higher in AMI patients the last 30 days before hair sampling with an overall higher rate of increase (time-group interaction P  < 0.001). AMI patients with BMI ≥25 kg/m 2 had a slower rate of increase compared with those with BMI <25 kg/m 2 (adjusted P  = 0.008). Among AMI patients, there was no difference in the rate of cortisol increase between STEMI and NSTEMI patients (time-group interaction P  = 0.841). Lower BMI conferred higher rates of cortisol increase irrespectively of AMI type.

CONCLUSION

HCC, a biomarker of stress, showed an increasing trend over a period of 2 months before the occurrence of AMI suggesting a potential role of stress, through cortisol secretion, in the pathophysiology of AMI.

Affective exercise experiences predict physical activity behaviour in cardiac outpatients within a home-based cardiac rehabilitation programme

Home-based cardiac rehabilitation (HBCR) programmes increase exercise capacity but often face poor adherence to physical activity (PA). This study tested the structural validity of the Affective Exercise Experiences Questionnaire (AFFEXX) in a cardiac population and examined the role of the novel construct of affective exercise experiences in predicting exercise behaviour during an HBCR programme. A sample of 177 patients enrolled in a 10-month HBCR programme, completed a moderate-intensity treadmill walking test, and completed the AFFEXX questionnaire and the 7-day Physical Activity Recall at the beginning and end of the programme. Structural equation modelling confirmed the structural validity of the AFFEXX, with a good fit to the data (Comparative Fit Index = 0.97, Tucker-Lewis Index = 0.95, RMSEA = 0.08). Core affective exercise experiences, which were influenced by antecedent appraisals, significantly predicted attraction-antipathy towards exercise. Multiple regression analysis indicated that follow-up PA was significantly predicted by attraction-antipathy towards exercise (b = 0.24, p = 0.001) and baseline PA (b = 0.29, p = 0.001). The model accounted for 31% of the variance in PA. The study highlights the association between attraction towards exercise and adherence to PA in participants enrolled in an HBCR programme, emphasising the importance of this novel construct.

Spanish Working Group in Crohn's Disease and Ulcerative Colitis (GETECCU) position paper on cardiovascular disease in patients with inflammatory bowel disease

Cardiovascular diseases (CVD) are the leading cause of death worldwide. Therefore, it is essential to understand their relationship and prevalence in different diseases that may present specific risk factors for them. The objective of this document is to analyze the specific prevalence of CVD in patients with inflammatory bowel disease (IBD), describing the presence of classical and non-classical cardiovascular risk factors in these patients. Additionally, we will detail the pathophysiology of atherosclerosis in this patient group and the different methods used to assess cardiovascular risk, including the use of risk calculators in clinical practice and different ways to assess subclinical atherosclerosis and endothelial dysfunction. Furthermore, we will describe the potential influence of medication used for managing patients with IBD on cardiovascular risk, as well as the potential influence of commonly used drugs for managing CVD on the course of IBD. The document provides comments and evidence-based recommendations based on available evidence and expert opinion. An interdisciplinary group of gastroenterologists specialized in IBD management, along with a consulting cardiologist for this type of patients, participated in the development of these recommendations by the Spanish Group of Work on Crohn's Disease and Ulcerative Colitis (GETECCU).

Cardiovascular effects after five nights without continuous positive airway pressure for obstructive sleep apnea: a randomized controlled trial

OBJECTIVES

Although continuous positive airway pressure (CPAP) effectively prevents sleep apnea and reduces blood pressure, many patients do not use CPAP every night. This trial investigates cardiovascular effects after sleeping five nights without CPAP.

METHODS

We randomized 100 patients (67 men and 33 women with a mean age 64 ± 9 years) using CPAP treatment for moderate-to-severe sleep apnea to either withdraw treatment for five nights ( n  = 50) or to continue with CPAP ( n  = 50). The primary outcomes were arterial stiffness and 24 h blood pressure.

RESULTS

The 24 h SBP increased by a mean of 2.8 mmHg [95% confidence interval (CI) 0.2-5.4 mmHg] ( P  = 0.035) and DBP increased by a mean of 1.7 mmHg (95% CI 0.1-3.3 mmHg) ( P  = 0.032) in the group without CPAP compared to the CPAP group. There was a significant effect on blood pressure in women but not in men. In women, SBP increased by 5.1 mmHg (95% CI 1.0-9.5 mmHg) ( P  = 0.017) and DBP by 2.9 mmHg (95% CI 0.4-5.6 mmHg) ( P  = 0.029). Arterial stiffness remained unaffected. Secondary outcomes that worsened in patients without CPAP included apnea-hypopnea index, oxygen desaturation index, hemoglobin levels, and daytime sleepiness.

CONCLUSION

Blood pressure is affected after five nights of CPAP interruption, along with a rapid return of sleep apneas, nocturnal hypoxic events, daytime sleepiness and increased hemoglobin levels, but arterial stiffness was not affected. Blood pressure was affected in women only, suggesting a sex-related CPAP effect on blood pressure.

Cardiac serious adverse reactions in donors in France 2010-21

AIM

To study cardiac serious adverse reactions in blood donors (CSARD) reported in the context of whole blood donation (WBD) or apheresis donation (AD) in France. Although potentially serious, they have been poorly studied so far.

METHODS

Retrospective descriptive study of the 125 CSARD (myocardial infarction-MI, acute coronary syndrome-ACS, angina pectoris-AP, rhythm disorder-RD) reported between 2010 and 2021. The studied parameters were age, gender, type of donation, diagnosis, time to onset, imputability, severity (grade), cardiovascular risk factors (CVRF). They were reviewed within the reports by 5 experts, who independently recorded their opinions on each parameter (except age, gender, type of donation). The collegial analysis of the opinions then resulted in a consensus for all cases. The time between the occurrence of CSARD and donation has been extended and limited to 48 h. An additional criterion of imputability was added for the CSARD attributed to causes other than the donation (e.g., coronary atheroma) but Aggravated or Triggered by the donation: AT1 possibly (>24-48 h post-donation), AT2 probably (>12-24 h post-donation) or AT3 certainly (within 12 h or pre-donation start).

RESULTS

Out of 125 reports, 50 were excluded: cardiac qualification of SARD invalidated (8), lack of data (2), absence donation (1), occurrence more than 48 h after the donation (39). The 75 included CSARD (including 5 deaths) comprised 58 coronary events (38 MI, 13 ACS, 7 AP) and 17 RD, and their complementary imputability criterion (AT) was classified respectively as follows 1 (20%), 2 (24%), 3 (56%). The estimated cumulative incidence of CSARD/106 donations is 2.1, significantly higher for AD (5.3) than for WBD (1.6; p < 0.001). The male (M) and female (F) percentages are 81% vs 19%, significantly different from the ones of the standard donor population over 2010-21: 48% M vs 52% F. The median ages, 55 years (30-70) in men, and 47 years (23-68) in women, were significantly higher than the ones of standard donor population 2010-21, respectively 46 (p < 0,001) and 41 (p = 0,04). In the 58 coronary accidents, at least 3 CVRF were noted in 38 cases (66%) and at least 4 CVRF in 20 cases (34%), including 5 with 5 CVRF. In 6/75 cases (8%) pre-existing signs not detected during the pre-donation interview (PDI) would have permanently contraindicated donation.

CONCLUSIONS

A complementary study should assess whether a more formalised consideration of CVRF in the PDI could reduce the frequency of CSARD of coronary type.

Predicting Cardiovascular Risk Factors for Acute Leukemia Patients by Assessing Subclinical Atherosclerosis and Left Ventricular Function Before Chemotherapy

BACKGROUND

Subclinical atherosclerosis is a "silent" cardiovascular disease that can be devastating when combined with other illnesses. Its presence may affect therapy responses but can potentially worsen hematological malignancies due to most chemotherapy regimens' cardiovascular adverse effects. Thus, cardiovascular risk factor (CVRF) assessment is required before chemotherapy. Unfortunately, this rarely happens.

AIM

we aim to examine the impact of CVRFs on hemodynamic parameters of acute leukemia (AL) patients before chemotherapy.

METHODS

Overall, 45 AL patients and 26 controls were included. Intima-media thickness (IMT), ankle brachial index (ABI), pulse wave velocity (PWV), and functional cardiac parameters were used. CVRFs were found in 26 AL patients (36.6%), while 19 AL (26.8%) patients lacked CVRFs. CVRFs were also found in 26 controls (36.6%).

RESULTS

Left ventricular ejection fraction (LVEF) significantly decreased for patients with CVRFs (59.26 ± 5.62) compared to those without CVRFs (64.05 ± 7.43, p < 0.05). Hypertensive and diabetic patients had a significantly higher left IMT (mm) of 0.92 ± 0.01 compared to those without them (0.76 ± 0.03, p < 0.05). Patients with acute myeloid leukemia (AML) with CVRFs had a significantly higher PWV (m/s) of 8.4 ± 0.12 compared to those without CVRFs (6.87 ± 0.66) (p < 0.05).

CONCLUSIONS

AL and cardiovascular risk factors interacted before chemotherapy. To decrease cardiotoxicity, AL patients need cardiovascular risk assessment. Subclinical atherosclerosis and echocardiography help chemotherapy patients to choose a treatment regimen, predict long-term outcomes, and predict cardiovascular issues.

Effects of Nutritional Intervention and Exercise on Anthropometric and Metabolic Parameters in Moroccan Women with Breast Cancer: A Pilot Study

This study examines the effects of a dietary and physical activity intervention on body composition and metabolic parameters in Moroccan women with breast cancer. Conducted as a pilot cohort study, 37 women with breast cancer were recruited between 2017 and 2019 at the Hassan II Regional Hospital Center and the Agadir Regional Oncology Center. Participants completed a 12-month nutrition and physical activity intervention. The mean age was 47.92 ± 8.56 years. At the end of the intervention, participants experienced a mean weight loss of 11%, resulting in a significant reduction in normal weight and obesity rates from 35.14% and 32.43% to 57% and 5%, respectively (p < 0.05). Waist and hip circumferences were reduced by 10%, and there were significant reductions in body fat and visceral fat. Improvements were also seen in metabolic markers, with significant reductions in total cholesterol, LDL-C, blood glucose and HbA1c levels (p < 0.05). Lean mass was preserved and HDL-C showed a significant increase (p < 0.001).

Residual Inflammation in Patients with Psoriasis Treated with Biologic Therapy: Findings from 3 Prospective Observational Cohorts

Psoriasis is associated with a higher cardiovascular disease burden, with systemic inflammation being the root cause of this association. The concept of residual inflammation (RI) was defined in patients with features of high-risk atherosclerosis who had increased inflammatory markers in blood, as characterized by high-sensitivity CRP, despite receiving optimal medical therapy. This study aims to assess RI in patients with psoriasis undergoing biologic therapy, specifically defined as high-sensitivity CRP ≥ 2 mg/l despite achieving a PASI ≤ 2. A prospective observational study was conducted across 3 international cohorts (Spain, United States, and Sweden) comprising 209 patients with psoriasis who achieved a PASI ≤ 2 after stable biologic therapy. RI was observed in 36.3% of patients and was significantly associated with higher body mass index, metabolic dysfunction-associated steatotic liver disease, increased baseline systemic inflammation, and visceral adipose tissue. Female sex was identified as a predictor of RI in the 3 cohorts. The study concludes that RI persists despite optimal skin response and is strongly linked with obesity and fatty liver disease. These conditions are highlighted as critical drivers and treatment targets of inflammation in psoriasis.

Correlation Between SCORE2-Diabetes and Coronary Artery Calcium Score in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study in Vietnam

(1) Background: The SCORE2-Diabetes model has been developed as an effective tool to estimate the 10-year cardiovascular risk in patients with diabetes. Coronary computed tomography angiography (CCTA) and its derived Coronary Artery Calcium Score (CACS) are widely used non-invasive imaging tools for assessing coronary artery disease (CAD). This study aimed to evaluate the correlation between CACS and SCORE2-Diabetes in patients with T2DM. (2) Methods: A cross-sectional study was conducted from October 2023 to May 2024. We included patients aged 40 to 69 years with T2DM who underwent a coronary multislice CT scan due to atypical angina. The correlation between CACS and SCORE2-Diabetes was analyzed using Spearman's rank correlation coefficient. (3) Results: A total of 100 patients met the inclusion criteria, including 71 males and 29 females, with a mean age of 61.9 ± 5.4 years. The differences in CACS and SCORE2-Diabetes among different degrees of coronary artery stenosis were statistically significant (p < 0.05). A statistically significant but weak positive correlation was observed between CACS and SCORE2-Diabetes across all risk categories, with Spearman's rank correlation coefficients ranging from 0.27 to 0.28 (p < 0.01). (4) Conclusions: Despite the weak correlation between CACS and SCORE2-Diabetes, understanding their relationship and independent associations with disease severity is valuable. The combination of these two tools may warrant investigation in future studies to potentially enhance cardiovascular risk assessment in T2DM patients.

The lipid-heart hypothesis from the Seven Countries Study of Cardiovascular Diseases

PURPOSE OF REVIEW

To summarize and comment recent analyses from the Seven Countries Study of Cardiovascular Diseases (SCS) on the role of Atherogenicity (ATI) and Thrombogenicity (THI) indexes (created by combining several types of dietary fatty acids) in predicting major cardiovascular disease (CVD) and mainly coronary heart disease (CHD) mortalities in a long follow-up observation of ecological procedures involving 16 cohorts of middle-aged men.

RECENT FINDINGS

In a chain of steps, a dietary score [Mediterranean Adequacy Index (MAI)] was inversely correlated with the ATI (R = -0.91). ATI directly correlated with serum cholesterol (R = +0.73) and serum cholesterol directly correlated with 50-year CHD mortality (R = +0.78). Moreover, MAI was inversely correlated (R = -0.91) and ATI was directly correlated with CHD mortality (R = +0.93). THI produced comparable results. In 10 cohorts reaching the extinction after 60 years of follow-up, results were similar. The same dietary and metabolic indicators were instead unrelated to other major types of CVD fatalities (heart diseases of uncertain etiology and stroke) or even inverse.

SUMMARY

ATI and THI indices assembled by pooling several types of dietary fatty acids are strongly associated with long-term CHD mortality but not with other major CVD types.

Associations of Glycemic Measures in the Normal Range With All-Cause Mortality in the Absence of Traditional Risk Factors

CONTEXT

The investigation of the association between blood glucose within normal range and all-cause mortality among individuals without traditional risk factors is limited.

OBJECTIVE

To determine the associations of 3 glycemic measures (fasting plasma glucose [FPG], hemoglobin A1c [HbA1c], and 2-hour glucose) in the normal range with all-cause mortality among individuals without traditional risk factors.

METHODS

Retrospective cohort study of US National Health and Nutrition Examination Survey in 1988-1994 and 1999-2018. Nonpregnant adults who had a measurement of 2-hour glucose, FPG, and HbA1c, and absence of traditional risk factors were included. Cox proportional hazard models were performed to examine the associations of normal FPG (n = 5793), normal HbA1c (n = 8179), and normal 2-hour glucose (n = 3404) with all-cause mortality.

RESULTS

A significant association was found between 2-hour glucose within the normal range and all-cause mortality among those without traditional risk factors. Compared with participants with 2-hour glucose <80 mg/dL, participants with a higher normal 2-hour glucose level had a higher risk of all-cause mortality (110-139 mg/dL; HR 1.80, 95% CI 1.03-3.15). In the subgroup analysis, significant associations were also found among people aged ≥60 years and men. No significant associations were found between normal FPG and HbA1c levels and all-cause mortality.

CONCLUSION

Among US adults without traditional risk factors, high normal 2-hour glucose level was positively associated with all-cause mortality. This result highlights the potential importance of maintaining a lower normal level of 2-hour glucose for preventing mortality in individuals who are conventionally considered to be cardiovascular healthy.

No increased arterial stiffness after premenopausal risk-reducing salpingo-oophorectomy (RRSO)

OBJECTIVE

Women at high familial risk of ovarian cancer are recommended to undergo premenopausal risk-reducing salpingo-oophorectomy (RRSO). The procedure leads to immediate surgical menopause, and while early natural menopause is associated with an increase in the risk of cardiovascular disease (CVD), evidence on CVD risk after surgical menopause is inconsistent.

MAIN OUTCOME MEASURES

To investigate the long-term CVD risk after surgical menopause we conducted a cross-sectional study comparing a group of women who underwent a premenopausal RRSO (≤45 years) with a group who underwent postmenopausal RRSO (≥54 years). We assessed arterial stiffness, measured by pulse wave velocity (PWV). Increased PWV has been shown to be an independent predictor for CVD. Age differences between the pre- and postmenopausal RRSO groups were accounted for by restricting analyses to women aged 60-70 at study visit (n = 307). Within the premenopausal RRSO group (n = 461), we also examined the effect of timing of premenopausal RRSO on PWV (RRSO<41 vs RRSO 41-45 years). In addition, we assessed the association between PWV and coronary artery calcium (CAC) in women who underwent premenopausal RRSO.

RESULTS

In women aged 60-70 at study visit, PWV levels were significantly lower in the premenopausal RRSO group compared with the postmenopausal RRSO group (β: -0.87, 95 % CI, -1.45, -0.28 for PWV level; RR: 0.47, 95 % CI, 0.24, 0.93 for being in the upper PWV quintile). The timing of premenopausal RRSO did not influence PWV. Among all women who underwent premenopausal RRSO, having a PWV in the upper quintile was an independent predictor of the presence of CAC (RR 1.32, 95 % CI, 1.04-1.68 for CAC > 0).

CONCLUSION

Our study does not support a long-term adverse effect of premenopausal RRSO on arterial stiffness, but increased arterial stiffness is associated with the presence of CAC in women who have undergone a premenopausal RRSO.

CLINICAL TRIAL REGISTRATION

The pre-registered clinical trial number is .

The Association Between Periodontal Disease and Acute Coronary Syndrome-A Clinical Analysis

Background: This study investigated the association between periodontal disease and acute coronary syndrome (ACS), while examining periodontitis as an independent predictor of STEMI. Materials and Methods: This study included 166 patients with ACS, of whom 103 had a history of periodontal disease. Results: The results showed that patients with periodontal disease were more likely to have a history of tobacco use (78.6%), diabetes (53.1%), and poor oral hygiene (72.8%). This study also found a significant association between periodontal disease and the severity of ACS (STEMI-44.7%, three-vessel/LM disease-30.1%), with patients experiencing more frequent and severe cardiovascular complications (HF-51.6%, valvulopathy and mechanical complications-22.6%, arrhythmias-19.4%). The findings support previous studies suggesting a link between periodontal disease and cardiovascular risk. This study highlights the importance of considering periodontal disease as a potential risk factor for cardiovascular disease and the need for improved access to oral health care to reduce the burden of cardiovascular events. Conclusions: Periodontal disease was identified as an independent predictor of STEMI, highlighting the need for periodontal health assessments as part of routine management in cardiovascular risk stratification. The precise mechanisms continue to be an area of active investigation.

Diabetes and prediabetes among women universally screened for gestational diabetes: a multi-ethnic, population-based, prospective study with eleven years follow-up

BACKGROUND

Gestational diabetes (GDM) is a strong risk factor for later development of diabetes. However, data are scarce on the long-term risk for diabetes or prediabetes diagnosed by HbA1c, in non-selected, multi-ethnic populations universally screened for GDM using the WHO2013 criteria. We aimed to investigate the development of diabetes or prediabetes eleven years after the index pregnancy and identify risk factors in pregnancy or shortly after.

METHODS

A population-based cohort study of 360 women with complete eleven years follow-up data for diabetes (HbA1c ≥ 48 mmol/mol) or prediabetesADA (HbA1c 39-47 mmol/mol). Women were enrolled in gestational week 15 and universally screened with an oral glucose tolerance test in week 28. We performed least absolute shrinkage and selection operator (LASSO) regression to identify predictors of future diabetes or prediabetesADA and constructed a nomogram to predict individual risks.

RESULTS

Diabetes or prediabetesADA combined, was found in 26.9%, and the prevalence was slightly higher in previous GDM compared with non-GDM women (35.6% versus 23.5%; p = 0.019). The relative risk (RR) for developing diabetes or prediabetesADA was moderately elevated in GDM compared with non-GDM women (1.4 [1.0, 1.9], p = 0.035). Seven women (1.9%) had diabetes and all of these except for one, had previous GDM. Hence, the crude prevalence was 5.8% among GDM women vs. 0.4% among non-GDM women. The RR for developing diabetes was substantially higher in GDM vs. non-GDM women (14.8 [2.6, 277.1], p = 0.012). PrediabetesADA was found in 25% and the RR for prediabetesADA was not significantly increased for GDM compared to non-GDM women (1.3 [0.9, 1.8], p = 0.143). Among Europeans, 17.0% had diabetes or prediabetesADA, compared to 43.0% among South Asians (p < 0.001) and 34.4% among other ethnicities (p = 0.002). The most significant predictors identified from the LASSO were HbA1c measured in early pregnancy, ethnicity, and a family history of diabetes.

CONCLUSIONS

The risk for developing diabetes was low, overall and among GDM women. Still GDM represented a strong risk for diabetes, but not for prediabetesADA. HbA1c early in pregnancy, non-European ethnicity, and a family history of diabetes were the strongest risk factors for developing diabetes or prediabetesADA.

TRIAL REGISTRATION

STORK G2 Women and Risk of Diabetes. NCT03870724 (ClinicalTrials.gov). February 27th, 2019.

Longitudinal Association Between the Consumption of Vegetables, Fruits, and Red Meat and Diabetes Disease Burden: An Analysis of Multiple Global Datasets

Background: Dietary factors, such as vegetable, fruit, and red meat consumption, have varying effects on the disease burden of diabetes, the world's third leading health concern. This study aims to evaluate the global impact of vegetable/fruit/red meat consumption on disease burdens. Methods: Diabetes disease burden, vegetable/fruit/red meat consumption, and covariates data were obtained from the Global Burden of Disease Study (GBD) 2021, Food and Agriculture Organization (FAO), and WHO, respectively, and matched by country/region and year. Global vector maps assessed the status of diabetes disease burden and the consumption of three dietary factors in 2021, and their trends from 2010 to 2021 were illustrated through local regression curves. Generalized additive mixed models (GAMMs) were used to analyze relationships, with weights assigned based on log-transformed values relative to the mean population of each country. Results: A comprehensive dataset spanning 2010-2021, encompassing 175 countries/regions, was successfully matched and utilized in the analysis. In 2021, Oceania had the highest diabetes burden, whereas East Asia had a lower one. Globally, the disease burden increased from 2010 to 2021, accompanied by rising per capita vegetable and fruit consumption but declining red meat consumption. Vegetable consumption was inversely correlated with the age-standardized incidence rate (ASIR) and exhibited a "J-shaped" curve with the age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life year (DALY) rate (ASDR) (nadir at approximately 80 kcal/capita/day (kcal/cap/day). Fruit consumption had a "U-shaped" relationship with ASDR (nadir at approximately 100 kcal/cap/day). Red meat consumption was negatively correlated to ASIR and had a "U-shaped" relationship with ASMR and ASDR (nadir at 200 kcal/cap/day). Conclusions: The global diabetes disease burden is heavy, and dietary consumption varies widely. Vegetable-related risks differ between diabetics and non-diabetics. Proper fruit consumption decreases ASDR. Moderate red meat increases can reduce the disease burden, but excessive consumption increases ASMR and ASDR.

Telemedicine-supported lifestyle intervention for glycemic control in patients with CHD and T2DM: multicenter, randomized controlled trial

Patients with coronary heart disease (CHD) and type 2 diabetes mellitus (T2DM) have a substantially increased risk for major cardiovascular events and mortality. Increasing physical activity and improving a healthy diet may effectively reduce cardiovascular risk factors; however, the effects are often transient. In a multicenter, 1:1 randomized controlled trial including 502 patients with combined CHD and T2DM (68 ± 8 years; 84% men), we assessed the effects of a home-based telemedicine-supported lifestyle intervention (exercise training, nutritional recommendations and health literacy training) with regular individualized feedback versus usual care. The study met its primary endpoint of reduced glycated hemoglobin after 6 months in favor of the lifestyle intervention group (mean between-group difference in the complete-case analysis (n = 197 and n = 193), -0.13% (95% confidence interval, -0.25 to -0.01), P = 0.04). When individualized feedback and health literacy training were discontinued after 6 months (while other telemedicine tools were maintained), no statistically significant between-group differences were observed at 12 months. At 12 months, 31 patients (6.2%) had a major adverse cardiovascular event (lifestyle intervention, n = 20 (8.0%); usual care, n = 11 (4.4%); P = 0.15), with the main reason being hospitalization for angina or revascularization (lifestyle intervention, n = 15; usual care, n = 8). There were five deaths (lifestyle intervention, n = 2; usual care, n = 3), none of which were categorized as related to the intervention. However, three events that resulted in hospitalization were categorized as potentially related to the intervention (decompensation of heart failure, vertebral disc prolapse and inguinal hernia). In conclusion, a home-based lifestyle intervention with telemedicine support showed modest effects in patients with CHD and T2DM. ClinicalTrials.gov registration: NCT03835923 .

Relatively independent and complementary roles of family history and polygenic risk score in age at onset and incident cases of 12 common diseases

Few studies have systematically compared the overlap and complementarity of family history (FH) and polygenic risk score (PRS) in terms of disease risk. We here investigated the impacts of FH and PRS on the risk of incident diseases or age at disease onset, as well as their clinical value in risk prediction. We analyzed 12 diseases in the prospective cohort study of UK Biobank (N = 461,220). First, restricted mean survival time analysis was performed to evaluate the influences of FH and PRS on age at onset. Then, Cox proportional hazards model was employed to estimate the effects of FH and PRS on the incident risk. Finally, prediction models were constructed to examine the clinical value of FH and PRS in the incident disease risk. Compared to negative FH, positive FH led to an earlier onset, with an average of 2.29 years earlier between the top and bottom 2.5% PRSs and high blood pressure showing the greatest difference of 6.01 years earlier. Both FH and PRS were related to higher incident risk; but they only exhibited weak interactions on high blood pressure and Alzheimer's disease/dementia, and provided relatively independent and partially complementary information on disease susceptibility, with PRS explaining 7.0% of the FH effect but FH accounting for only 1.1% of the PRS effect for incident cases. Further, FH and PRS showed additional predictive value in risk evaluation, with breast cancer showing the greatest improvement (31.3%). FH and PRS significantly affect a variety of diseases, and they are not interchangeable measures of genetic susceptibility, but instead offer largely independent and partially complementary information. Incorporating FH, PRS, and clinical risk factors simultaneously leads to the greatest predictive value for disease risk assessment.

In-Hospital Outcomes in Patients With Acute Myocardial Infarction and No Standard Modifiable Cardiovascular Risk Factors Across Varying Body Mass Index: Findings From the CCC-ACS Project

BACKGROUND

Individuals who present with acute myocardial infarction in the absence of standard modifiable cardiovascular risk factors (ie, SMuRF-less) seem to have a significantly increased risk of mortality; however, it remains unclear whether the "SMuRF paradox" would be influenced by patients' baseline body mass index (BMI) status.

METHODS

Using data from the CCC-ACS (Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome) project from November 2014 to July 2019, we analyzed patients with acute myocardial infarction with and without SMuRFs and categorized their BMI as underweight (<18.5 kg/m2), normal weight (18.5-24 kg/m2), overweight (24-28 kg/m2), and obese (>28 kg/m2). The primary outcome was in-hospital all-cause mortality. Multivariable logistic regression models were used to estimate BMI-stratified associations between SMuRF-less status and outcomes.

RESULTS

The study included 44 538 patients with first-presentation acute myocardial infarction, of whom 4454 were SMuRF-less. The incidence of SMuRF-lessness declined from 16.2% to 6.5% as BMI increased by category, and it prevailed more frequently among women and older people regardless of their BMI status. Patients who were SMuRF-less had a significant increase in in-hospital mortality than patients with ≥1 SMuRF (adjusted odds ratio [OR], 1.750 [95% CI, 1.057-2.896], P<0.001). The highest mortality rate was observed in the group who were SMuRF-less and underweight (3.5%). Considering patients with ≥1 SMuRF and obesity as the reference group, the group who were SMuRF-less underweight exhibited the highest increase in mortality (adjusted OR, 3.854 [95% CI, 2.130-6.973], P<0.001).

CONCLUSIONS

Among patients with first-presentation acute myocardial infarction, compared with those with ≥1 SMuRF, patients who were SMuRF-less have a significantly higher risk of in-hospital mortality, especially in those underweight, whereas in-hospital survival was the most favorable among patients with ≥1 SMuRF and obesity.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT0230661.

Effectiveness of home-based cardiac rehabilitation interventions delivered via mHealth technologies: a systematic review and meta-analysis

BACKGROUND

Centre-based cardiac rehabilitation (CBCR) is underused due to low referral rates, accessibility barriers, and socioeconomic constraints. mHealth technologies have the potential to address some of these challenges through remote delivery of home-based cardiac rehabilitation (HBCR). This study aims to assess the effects of mHealth HBCR interventions compared with usual care and CBCR in patients with heart disease.

METHODS

We conducted a systematic review and meta-analysis of randomised controlled trials of mHealth HBCR interventions. Four electronic databases (MEDLINE, CENTRAL, CINAHL, and Embase) were searched from inception to March 31, 2023, with no restrictions on language or publication type. Eligible studies were randomised controlled trials of adult patients (age ≥18 years) with heart disease, comparing mHealth interventions with usual care or CBCR. The primary outcome of interest was aerobic exercise capacity, assessed with VO2 peak or 6-min walk test (6MWT). Quality of evidence was assessed using the GRADE system. This review was registered with PROSPERO, CRD42024544087.

FINDINGS

Our search yielded 9164 references, of which 135 were retained for full-text review. 13 randomised controlled trials met eligibility criteria and were included in the systematic review, involving 1508 adults with myocardial infarction, angina pectoris, or heart failure, or who had undergone revascularisation. Intervention duration ranged from 6 weeks to 24 weeks. Random-effects meta-analysis showed that, compared with usual care, mHealth HBCR significantly improved 6MWT (mean difference 24·74, 95% CI 9·88-39·60; 532 patients) and VO2 peak (1·77, 1·19-2·35; 359 patients). No significant differences were found between mHealth HBCR and CBCR. Quality of evidence ranged from low to very low across outcomes due to risk of bias and imprecision (small sample size).

INTERPRETATION

mHealth HBCR could improve access and health outcomes in patients who are unable to attend CBCR. Further research is needed to build a robust evidence base on the clinical effectiveness and cost-effectiveness of mHealth HBCR, particularly in comparison with CBCR, to inform clinical practice and policy.

FUNDING

None.

A Clinical Retrospective Study on the Combined Use of Monocyte-to-Lymphocyte Ratio and Triglyceride-Glucose Index to Predict the Severity of Coronary Artery Disease

Background

Coronary artery disease (CAD) remains a leading cause of morbidity and mortality. Traditional risk models based on factors like age, hypertension, and lipid levels are limited in individualized prediction, especially for high-risk populations. This study evaluates the independent and combined predictive value of the monocyte-to-lymphocyte ratio (MLR) and triglyceride-glucose (TyG) index for assessing CAD severity.

Methods

In this single-center, retrospective study, 678 patients who underwent coronary angiography (CAG) between January 2022 and June 2024 were included. Eligible patients were aged ≥ 40 years with suspected or confirmed CAD. Clinical data and laboratory values were extracted from electronic records. MLR was calculated as the monocyte-to-lymphocyte ratio, and TyG index was derived from fasting triglycerides and glucose. CAD severity was categorized by SYNTAX scores into no CAD, mild, moderate, and severe CAD. Statistical analyses included Spearman correlation, multivariate logistic regression, and receiver operating characteristic (ROC) curve analysis to assess the diagnostic accuracy of MLR and TyG index.

Results

Of the 678 patients, 67.1% had CAD. Both MLR and TyG index were significantly associated with CAD severity, with MLR showing a stronger correlation with SYNTAX scores. Multivariate analysis confirmed MLR (odds ratio (OR) = 2.15) and TyG index (OR = 1.75) as independent predictors of CAD. The combined MLR-TyG model achieved an area under the curve (AUC) of 0.804, surpassing the predictive value of each marker alone. Subgroup analysis indicated high predictive accuracy in diabetic and hypertensive patients.

Conclusions

MLR and TyG index independently and jointly predict CAD severity, with the combined model enhancing diagnostic accuracy. Reflecting both inflammatory and metabolic dysfunction, this dual-marker approach offers a practical tool for CAD risk stratification, particularly in high-risk populations. Further multicenter studies are needed to validate these findings and examine additional biomarker combinations to refine CAD risk models.

Hospital-level variation in cardiac rehabilitation metrics

BACKGROUND

To inform the delivery of cardiac rehabilitation (CR) care nationwide at the hospital level, we described hospital-level variation in CR metrics, overall and stratified by the hospital's tier of cardiac care provided.

METHODS

This retrospective cohort analysis used Medicare fee-for-service (FFS) data (2018-2020), Parts A and B, and American Hospital Association (AHA) data (2018). We included beneficiaries with an acute myocardial infarction (AMI), percutaneous coronary intervention (PCI), or coronary artery bypass graft (CABG) in 2018, aged ≥65 years, and continuously enrolled in a FFS plan. We calculated hospital-level metrics for hospitals with ≥20 CR-qualifying events, which were identified using diagnostic/procedure codes. Claims for CR were identified by Healthcare Common Procedure Coding System (HCPCS) codes. We used multi-level models to examine patient- and hospital-level factors associated with CR metrics. Hospitals were stratified by tier of cardiac care provided (comprehensive, AMI/PCI, AMI-only care).

RESULTS

Across the US, 2,212 hospitals treated individuals aged ≥65 years with a CR-qualifying event in 2018. By tier of cardiac care, 44.4% of hospitals provided comprehensive care, 31.2% provided AMI/PCI care, and 24.4% provided AMI-only care. Across all hospitals, there was substantial variation in CR enrollment (median 19.6%, interquartile range [IQR] = 7.0%, 32.8%). Among hospitals with enrollment (n = 1,866), median time to enrollment was 55.0 days (IQR = 41.0, 71.0), median number of CR sessions was 26.0 (IQR = 23.0, 29.0), and median percent completion was 26.0% (IQR = 10.5%, 41.2%). There was also substantial variation in CR performance metrics among hospitals within each tier of cardiac care (eg, median percent CR enrollment was 30.7% [IQR = 20.7%-41.3%] among comprehensive care hospitals, 18.6% [IQR = 9.5%-27.7%] among AMI/PCI hospitals, and 0.0% [IQR = 0.0%-7.7%] among AMI-only hospitals). In adjusted analyses, characteristics associated with lower odds of CR enrollment included patient-level factors (older age, female sex, non-White race or ethnicity), and hospital-level factors (for-profit ownership, regions other than the Midwest, rural location, medium/large hospital size).

CONCLUSIONS

This is the first national, hospital-level analysis of CR metrics among Medicare beneficiaries. Substantial variation across hospitals, including peer hospitals within the same tier of cardiac care, indicates opportunities for hospital-level quality improvement strategies to improve CR referral and participation metrics.

Decreased gut microbiome-derived indole-3-propionic acid mediates the exacerbation of myocardial ischemia/reperfusion injury following depression via the brain-gut-heart axis

Despite the increasing recognition of the interplay between depression and cardiovascular disease (CVD), the precise mechanisms by which depression contributes to the pathogenesis of cardiovascular disease remain inadequately understood. The involvement of gut microbiota and their metabolites to health and disease susceptibility has been gaining increasing attention. In this study, it was found that depression exacerbated cardiac injury, impaired cardiac function (EF%: P < 0.01; FS%: P < 0.05), hindered long-term survival (P < 0.01), and intensified adverse cardiac remodeling (WGA: P < 0.01; MASSON: P < 0.0001) after myocardial ischemia/reperfusion (MI/R) in mice. Then we found that mice receiving microbiota transplants from chronic social defeat stress (CSDS) mice exhibited worse cardiac function (EF%: P < 0.01; FS%: P < 0.01) than those receiving microbiota transplants from non-CSDS mice after MI/R injury. Moreover, impaired tryptophan metabolism due to alterations in gut microbiota composition and structure was observed in the CSDS mice. Mechanistically, we analyzed the metabolomics of fecal and serum samples from CSDS mice and identified indole-3-propionic acid (IPA) as a protective agent for cardiomyocytes against ferroptosis after MI/R via NRF2/System xc-/GPX4 axis, played a role in mediating the detrimental influence of depression on MI/R. Our findings provide new insights into the role of the gut microbiota and IPA in depression and CVD, forming the basis of intervention strategies aimed at mitigating the deterioration of cardiac function following MI/R in patients experiencing depression.

Associations of the hs-CRP/HDL-C ratio with cardiovascular disease among US adults: Evidence from NHANES 2015-2018

BACKGROUND AND AIMS

Inflammation, lipid signaling, and their interplay are involved in the pathogenesis and development of cardiovascular diseases (CVDs), while the relationships of composite indices combining inflammation and lipids with CVD remained inexplicit.

METHODS AND RESULTS

Our study enrolled 8581 adults from the National Health and Nutrition Examination Survey 2015-2018. Logistic regression model was applied to assess the associations of high-sensitivity C-reactive protein (hs-CRP)-to-high-density lipoprotein cholesterol (HDL-C) ratio with CVD prevalence. Potential mediating effects of hypertension, diabetes, hypercholesterolemia, and obesity on significant associations were explored. Receiver operating characteristic (ROC) curves were generated to compare diagnostic values of the hs-CRP/HDL-C ratio, HDL-C, and hs-CRP. Compared with those in the first quartile of the hs-CRP/HDL-C ratio, participants in the fourth quartile presented higher risks of CVD subtypes and total CVD. Each one-unit increment of the log-transformed hs-CRP/HDL-C ratio was associated with a 25 % increase in CVD risk (95 % confidence interval: 1.11, 1.41) with significant uptrends across the hs-CRP/HDL-C ratio quartiles. Four metabolic disorders significantly mediated associations of the hs-CRP/HDL-C ratio with CVDs. Younger participants were more sensitive to higher hs-CRP/HDL-C ratio with significant interactions in CVD. ROC curves further illustrated the relatively good diagnostic efficacy of the hs-CRP/HDL-C ratio for CVD.

CONCLUSION

The hs-CRP/HDL-C ratio was a significant risk factor for CVD among US adults, in which hypertension, diabetes, hypercholesterolemia, and obesity played important mediating roles. Early attention to people with elevated hs-CRP/HDL-C ratio would be helpful for CVD risk reduction.

Cardiovascular disease risk in patients with psoriasis receiving biologics targeting TNF-α, IL-12/23, IL-17, and IL-23: A population-based retrospective cohort study

BACKGROUND

Psoriasis is associated with various cardiovascular diseases (CVDs). The aim of this study was to compare the risk of CVD in patients with psoriasis who were prescribed biologics or oral therapies, and to assess the association between different classes of biologics and CVD risk.

METHODS AND FINDINGS

This retrospective cohort study utilized the TriNetX Global Collaborative Network (2014-2025). Patients with psoriasis newly prescribed biologics (BIO-cohort) and those newly initiating oral anti-psoriatic drugs without biologic exposure (Non-BIO-cohort) were enrolled. A propensity score-matched analysis was conducted, accounting for age, sex, race, comorbidities, body mass index, serum lipid profile, and inflammatory marker levels. Cardiovascular risk was compared between the BIO- and Non-BIO-cohorts using Cox regression to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). After matching, each cohort comprised 12,732 patients, with approximately 50% being female, a mean age of 57 years, and 55% identifying as White. The 5-year cumulative incidence of any CVDs was significantly lower in the BIO-cohort (10.68%; 95% CI [10.03%, 11.36%]) than in the Non-BIO-cohort (16.17%; 95% CI: [15.34%, 17.05%]) (p < 0.001). The BIO-cohort had attenuated risks of any CVDs (HR 0.621; 95% CI [0.571, 0.676]), cerebrovascular diseases (HR 0.616; 95% CI [0.519, 0.731]), arrhythmias (HR 0.632; 95% CI [0.565, 0.706]), inflammatory heart diseases (HR 0.566; 95% CI [0.360, 0.891]), ischemic heart diseases (HR 0.579; 95% CI [0.465, 0.721]), heart failure (HR 0.637; 95% CI [0.521, 0.780]), non-ischemic cardiomyopathy (HR 0.654; 95% CI [0.466, 0.918]), thrombotic disorders (HR 0.570; 95% CI [0.444, 0.733]), peripheral arterial occlusive diseases (HR 0.501; 95% CI [0.383, 0.656]), and major adverse cardiac events (HR 0.697; 95% CI [0.614, 0.792]). Receiving only anti-tumor necrosis factor (TNF)-α (HR 0.886; 95% CI [0.807, 0.973]), anti-interleukin (IL)-17 (HR 0.724; 95% CI [0.599, 0.875]), or anti-IL-23 (HR 0.739; 95% CI [0.598, 0.914]) was associated with reduced risks of any CVDs, whereas no significant association was observed for only anti-IL-12/23 (HR 0.915; 95% CI [0.742, 1.128]). This risk reduction remained consistent across various subgroups, including age (≤45 or >45 years), sex (male or female), regions of research data (the United States, Europe, Middle East and Africa, and Asia-Pacific), and comorbidities (psoriatic arthritis, hypertension, diabetes, hyperlipidemia, overweight or obesity). Eight sensitivity analyses, such as extending the washout period or tightening medication definitions, validated our findings. The main limitation of our study is the observational design, which can only establish associations, not causation.

CONCLUSIONS

Patients with psoriasis prescribed biologics exhibited a lower risk of CVDs versus those on oral therapy. Anti-TNF-α, anti-IL-17, and anti-IL-23 were associated with decreased cardiovascular hazards, while anti-IL-12/23 was not.