搜索结果：International heart journal

There is increasing evidence that arteriovenous fistulas (AVFs) might alter cardiac function. Upper arm AVFs are associated with higher access flow, and their use is increasing. It has been hypothesized that the creation of upper arm AVFs would lead to a higher incidence of heart failure compared with forearm AVFs. Retrospective cohort study. All patients who received a hemodialysis access between 2013 and 2022 in Sweden. Patients with prevalent heart failure or previous hemodialysis were excluded. Type of hemodialysis access and access flow. New-onset heart failure. Cox proportional hazards regression for type of access and restricted cubic splines for access flow. Comorbid conditions were included as covariates in both models. In total, 10,170 patients were included. Of those, 6,579 patients with a total of 11,238 accesses remained after excluding patients with prevalent heart failure or prevalent hemodialysis. The risk of new-onset heart failure was comparable between forearm and upper arm AVF (P = 0.57). Access flow was highest in upper arm AVF (P < 0.001), but there was a substantial overlap. The risk of heart failure development depending on access flow was nonlinear (P < 0.001) with increased risk in patients with lowest as well as the highest flow. Reliance on International Classification of Diseases (ICD)-10 codes is a limitation because of potential underascertainment and misclassification. The findings may not be generalizable to settings where upper arm AVF are used more liberally than in Sweden. Upper arm AVFs were not associated with the development of heart failure. Comorbid conditions such as ischemic heart disease, heart valve disease, and diabetes as well as age were more important factors for the development of heart failure than access type. The association between access flow and new-onset heart failure is U-shaped. Hemodialysis requires access to the bloodstream, most often through an arteriovenous fistula. Fistulas created in the upper arm are increasingly used and usually have higher blood flow than those created in the forearm. This has raised concerns that they might cause heart failure. We studied all patients in Sweden who received a hemodialysis access between 2013 and 2022 and did not have heart failure beforehand. We found no increased risk of heart failure with upper arm fistulas. Patients with very low or very high blood flow had the highest risk. Development of heart failure was mainly related to the presence of heart and vascular disease rather than fistula type. These findings support personalized decision making based on patient health.

Rheumatic heart disease (RHD) remains a leading cause of cardiovascular morbidity and maternal mortality in pregnancy worldwide. Despite near-eradication in high-income countries, RHD continues to disproportionately affect young women in low- and middle-income regions, where delayed diagnosis, limited access to preventive care, and constrained availability of cardiac interventions contribute to adverse maternal and fetal outcomes. To present contemporary evidence on the global burden, pathophysiology, detection, surgical and interventional management, of maternal and fetal outcomes of rheumatic heart disease in pregnancy, with principal emphasis on low-resource and endemic settings. We conducted a structured narrative review of the existing literature using PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library, identifying observational cohorts, multicenter registries, randomized trials, systematic reviews, international clinical guidelines, and expert reviews published between January 2005 and May 2026. Studies were included if they reported on RHD epidemiology, screening and prophylaxis strategies, cardiac or obstetric outcomes, surgical or transcatheter interventions, valve prosthesis selection, anticoagulation management, or intrapartum and postpartum care during pregnancy. Evidence was narratively synthesized and organized by thematic domains relevant to pregnancy-associated risk. RHD accounts for the majority of acquired heart disease in pregnancy across endemic regions, with contemporary registries reporting that 30%-70% of cardiac disease complicating pregnancy is rheumatic in origin. Mitral stenosis predominates and is associated with high rates of maternal heart failure, arrhythmia, thromboembolism, and postpartum decompensation. Maternal adverse cardiac events occur in approximately 15%-40% of pregnancies, with mortality ranging from 1%-10% depending on lesion severity, rhythm status, and access to care. Fetal complications, including preterm birth, low birth weight, and pregnancy loss, are common and are exacerbated by severe stenotic disease and prosthetic valves. Screening studies demonstrate that many women with RHD are unaware of their diagnosis prior to pregnancy, while randomized evidence supports echocardiographic screening coupled with secondary antibiotic prophylaxis to reduce disease progression in early-stage RHD. Surgical and interventional management during pregnancy remains high-risk, particularly in women with mechanical heart valves, underscoring the importance of preconception optimization and multidisciplinary care. Rheumatic heart disease in pregnancy confers substantial and preventable risk to both mother and fetus, particularly in low-resource settings where disease is often advanced at presentation. Improved strategies for early detection, primary and secondary prophylaxis, preconception counseling, and timely referral for valve intervention are essential to reducing maternal and fetal morbidity and mortality. Strengthening health systems to deliver integrated cardio-obstetric care remains central to improving outcomes for women with RHD worldwide.

This study aimed to appraise clinical practice guidelines relevant to physical activity in patients with coronary heart disease (CHD) and summarize consensus and discrepant recommendations. The websites of organizations that develop guidelines, including those of cardiovascular and medical sports associations, were searched in addition to 9 literature databases from January 2014 to November 2024. The included guidelines were published in English or Chinese, labeled as a recommendation guideline, position paper, practice parameter, or consensus statement; and addressed physical activity for patients with coronary heart disease. Two authors independently extracted recommendations. Three reviewers independently assessed guideline quality using the AGREE II instrument. A total of 32 guidelines were included, with the Scottish Intercollegiate Guidelines Network and the American Heart Association deemed to have the highest methodological quality. A total of 26 consensus recommendations were identified, including general recommendations, principles for early in-hospital rehabilitation, and the FITT-VP principles for outpatient rehabilitation exercise prescriptions, of which 4 were classified as having moderate consensus and 22 as having low consensus. The guidelines have developed consensus recommendations for routine physical activity in patients with coronary heart disease. However, inconsistencies in exercise prescriptions indicate a need to develop core FITT standards that are applicable across various clinical settings and can be flexibly adapted to individual needs. Furthermore, international collaboration and standardization efforts should be pursued to enhance the applicability of evidence-based guidelines, and implementation frameworks should be introduced to bridge the gap between clinical practice and guideline recommendations.

Background and objective Heart failure (HF) is a leading cause of morbidity and mortality worldwide and is broadly classified into heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF), which differ in pathophysiology, clinical profile, and outcomes. This study aimed to compare the demographic characteristics, clinical profile, comorbidity burden, and short-term clinical outcomes, including in-hospital mortality, length of hospital stay, and 30-day readmission, between patients with HFpEF&#xa0;and HFrEF, and to identify independent predictors of adverse clinical outcomes. Methodology This retrospective comparative observational study was conducted at Shalamar Hospital, Lahore, Pakistan, from March 2023 to March 2026. A total of 305 patients with confirmed heart failure were included using non-probability consecutive sampling. Patients were categorized into HFrEF (left ventricular ejection fraction (LVEF) < 40%) and HFpEF (LVEF &#x2265; 50%) groups. Data were extracted from medical records using a structured proforma. Results Of 305 patients, 182 (59.7%) had HFrEF and 123 (40.3%) had HFpEF. Patients with HFpEF were significantly older and had a higher prevalence of hypertension, diabetes mellitus, and obesity (p < 0.05). HFrEF patients more commonly had ischemic heart disease and presented with more advanced symptoms (p < 0.05). In-hospital mortality was higher in HFrEF compared to HFpEF (26, 14.3% vs. 10, 8.1%), although the difference was not statistically significant (p = 0.089). HFrEF was associated with longer hospital stay (7.6 &#xb1; 3.2 vs. 5.9 &#xb1; 2.7 days, p = 0.001) and higher 30-day readmission rates (50, 27.5%&#xa0;vs. 23, 18.7%, p = 0.045). Conclusions HFrEF is associated with worse short-term clinical outcomes, including prolonged hospitalization and higher readmission rates, whereas HFpEF is associated with a greater burden of comorbid conditions.

Post-myocardial infarction inflammation and maladaptive remodeling are major drivers of heart failure, but the role of cathepsin B (CTSB) in quercetin-associated cardioprotection remains unclear. In this study, public bulk transcriptomic and single-cell RNA sequencing datasets were re-analyzed to characterize CTSB expression across cardiac cell populations and heart failure phenotypes. Network pharmacology and molecular docking were used to explore a potential association between quercetin and CTSB. In lipopolysaccharide-stimulated RAW264.7 macrophage-neonatal rat ventricular myocyte (NRVMs) co-cultures, quercetin reduced nitric oxide production, suppressed inflammatory cytokine expression, promoted a shift toward CD206-positive macrophages, and decreased CTSB expression at both messenger RNA and protein levels. CTSB knockdown reproduced part of the anti-inflammatory phenotype, whereas CTSB overexpression partially attenuated the suppressive effects of quercetin on inflammatory cytokines, supporting CTSB as a functionally relevant mediator contributing to quercetin responsiveness. In a mouse left anterior descending coronary artery ligation model, quercetin improved cardiac functional parameters, reduced infarct-related histopathological injury, decreased myocardial CTSB protein expression, and lowered pro-inflammatory cytokine levels. Molecular docking suggested a potential interaction between quercetin and CTSB, although direct biochemical target engagement was not examined. These findings identify CTSB as a macrophage-associated inflammatory candidate in post-myocardial infarction heart failure and indicate that quercetin exerts anti-inflammatory and cardioprotective effects in association with reduced CTSB expression.

Adverse pregnancy outcomes (APOs) confer long-term cardiovascular risk, yet population-level temporal trends in heart failure (HF) burden among APO-exposed women in the United States remain uncharacterized. We used the TriNetX U.S. Collaborative Network (64 U.S. health care organizations; n = 979,178 women aged 15-60 years with &#x2265;1 documented APO at delivery) to calculate annual HF incidence proportion and period prevalence from 2013 through 2023, stratified by 5-year age band and self-reported race/ethnicity. HF was identified by International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) code I50; a prewindow lookback distinguished the incident from prevalent cases. HF incidence proportion rose 2.70-fold (0.782-2.110 per 1,000), and prevalence increased 3.20-fold (0.39-1.26%) from 2013 to 2023. By 2023, women aged 15-19 years had an HF incidence of 1.529 per 1,000, exceeding the 2013 incidence of women a decade older (30-34 years: 0.916 per 1,000) (7.7-fold increase). Incidence declined 10.7% in 2020, whereas prevalence continued to rise (0.74-0.81%), before incidence rebounded 31.1% in 2021. AI/AN women maintained the highest absolute incidence throughout (5.845 per 1,000 in 2013; 5.467 per 1,000 in 2023). Black/AA women showed a 2.1-fold increase (1.673-3.534 per 1,000), maintaining a 2.0- to 3.2-fold excess over White women at all time points. Native Hawaiian/Other Pacific Islander women had the largest incidence-prevalence divergence: a 5.8-fold prevalence increase (0.40-2.33%) against a near-stable incidence proportion. HF burden increased substantially across all age groups and racial categories among APO-exposed U.S. women from 2013 to 2023.

Congenital heart diseases (CHDs) are closely associated with malnutrition and impaired growth. This study assessed growth patterns and identified risk factors for malnutrition in children with CHD. This retrospective cohort study included 3838 children with CHD who underwent corrective intervention. For long-term growth analysis, 966 children aged <12 years with a minimum 2 years follow-up were included. Nutritional status was evaluated using World Health Organization (WHO)&#xa0;z-scores standards. Wasting was determined from Body Mass Index-for-Age (BAZ), underweight from Weight-for-Age (WAZ), and stunting from Height-for-Age (HAZ) (z-score&#x2009;<&#x2009;-2). Growth trends were assessed across age groups and CHD subtypes. Logistic regression was performed to identify pre and post-interventional risk factors of malnutrition. At baseline, 53.6% of children were underweight, 45.0% stunted, and 39.9% wasted. Significant post-intervention catch-up growth was observed, particularly for HAZ during follow-up (P&#x2009;<&#x2009;0.001), indicating sustained linear growth recovery with the greatest improvement seen among infants (0-1 year) in BAZ and WAZ. Subtype analysis showed sustained improvement in ventricular septal defect (P&#x2009;<&#x2009;0.001). Pre-intervention malnutrition was significantly associated with frequent fainting (syncope), paternal addiction, low socioeconomic status, and cyanosis (P&#x2009;<&#x2009;0.001). Younger age at intervention was associated with higher odds of persistent early post-interventional malnutrition. Malnutrition is highly prevalent among Indian children with CHD but improves substantially following early corrective intervention.

Inflammation plays a critical role in the pathogenesis of acute decompensated heart failure (ADHF), and circulating inflammatory cytokines have been implicated in heart failure pathophysiology and progression. However, their association with clinical outcomes in patients with ADHF remains incompletely understood.A total of 872 patients with ADHF who completed 1 year of follow-up were included. Clinical characteristics and inflammatory cytokine levels were compared between patients with and without major adverse cardiovascular events (MACE). Multivariable Cox regression analyses were performed to identify factors independently associated with 1-year MACE. The incremental prognostic information of IL-2 beyond the established clinical risk factors was assessed using net reclassification improvement (NRI) and integrated discrimination improvement (IDI).Serum interleukin-2 (IL-2) levels were significantly higher in patients with MACE than in those without MACE (0.24 pg/mL versus 0.21 pg/mL, P < 0.05). Multivariable Cox regression showed that log2-transformed IL-2 was independently associated with 1-year MACE (HR = 1.212, 95% CI: 1.080-1.359, P = 0.001). Addition of IL-2 to the established clinical risk model significantly improved NRI (0.245, 95% CI: 0.015-0.370, P = 0.032) and IDI (0.019, 95% CI: 0.002-0.043, P = 0.028) for 1-year MACE. Elevated circulating IL-2 levels were independently associated with adverse 1-year clinical outcomes in patients with ADHF and provided incremental prognostic information beyond conventional risk factors. IL-2 may have potential utility for risk stratification in ADHF.

Coronary artery bypass grafting (CABG) is a common but invasive operation traditionally performed through a median sternotomy. Minimally invasive cardiac surgery (MICS) CABG via small thoracotomy might improve postoperative recovery, but randomised evidence has been scarce. We aimed to compare patient-reported recovery after MICS CABG versus sternotomy CABG in patients with multivessel coronary artery disease and to describe clinical and safety outcomes. MIST was an investigator-initiated, international, open-label, randomised controlled trial done at seven centres (four academic hospitals and three community hospitals) in Canada, India, China, Germany, the USA, and Japan. Patients referred to participating surgeons for CABG were eligible if they were aged 18 years or older; had angiographically confirmed multivessel coronary artery disease, defined as lesions of at least 70% stenosis in at least two major epicardial vessels and at least two separate coronary artery territories (left anterior descending artery, left circumflex artery, or right coronary artery) or left main coronary stenosis of 50% or more; and were suitable for coronary surgery both with sternotomy CABG and MICS CABG. Patients who were haemodynamically compromised, had contraindications to either approach, had had previous cardiac surgery, or required concomitant procedures were excluded. Eligible patients were randomly assigned (1:1) to MICS CABG or sternotomy CABG by a central, web-based system, stratified by centre, with block sizes of four and six. The primary endpoint was patient-reported physical recovery at 1 month, assessed by the 36-item Short Form Health Survey Physical Component Summary (SF-36 PCS) score. The primary analysis was by intention to treat; safety analyses were done according to treatment received. Missing 1-month questionnaire data were handled by multiple imputation. The trial was registered with ClinicalTrials.gov (NCT03447938), and is closed to recruitment. Between Aug 24, 2018, and Nov 26, 2024, 176 patients were enrolled, 170 of whom were randomly assigned to MICS CABG (n=86) or sternotomy CABG (n=84). The median age of patients was 67&#xb7;0 years (IQR 61&#xb7;0-72&#xb7;0), 154 (91%) patients were male, and 16 (9%) were female. At 1 month after surgery, SF-36 PCS scores were significantly higher in the MICS CABG group than in the sternotomy CABG group (mean 45&#xb7;1 [SD 8&#xb7;0] vs 42&#xb7;2 [9&#xb7;1]; mean difference 2&#xb7;9 [95% CI 0&#xb7;3-5&#xb7;5]; p=0&#xb7;031). Clinical and safety follow-up at 1 month was complete in all patients; 12-month clinical and safety follow-up was complete in all except three patients in the sternotomy CABG group. Up to 12 months after surgery, there were no deaths or strokes in either group; one major adverse cardiac or cerebrovascular event occurred in the MICS CABG group before 1 month and none in the sternotomy CABG group. For selected patients with multivessel coronary artery disease, MICS CABG performed by experienced teams improved patient-reported physical recovery at 1 month compared with sternotomy CABG, with no apparent safety penalty through to 12 months. These findings support consideration of MICS CABG in appropriately selected patients treated by experienced teams, and further studies of implementation, recovery pathways, and long-term outcomes. Medtronic.

Heart failure (HF) is a common complication of diabetes, associated with a high mortality rate and a substantial healthcare burden. Residual HF risk persists despite achieving current treatment targets, suggesting a role for additional mechanisms beyond conventional risk factors. We sought to prospectively assess HF incidence and independent risk factors in individuals with new-onset diabetes. We used a prospective inception cohort (ANDIS, n=19,892) that included all individuals with newly diagnosed diabetes from southern Sweden between 2008 and 2021. Baseline clinical, biochemical and questionnaire data were linked to the Region Scania Care Database to obtain data on cardiovascular events and to the National Diabetes Registry to gather further data on cardiovascular risk factors that were not collected in the ANDIS study protocol. All-cause HF included all cases of HF regardless of underlying aetiology, whereas non-ischaemic HF was defined as HF occurring in individuals without prior acute myocardial infarction at baseline or during follow-up before the HF diagnosis. Cardiovascular disease incidence was estimated using the Kaplan-Meier method, and the associations with risk factors and incident HF were assessed using Cox proportional hazards regression. The median age of the overall population was 62.5 years (IQR 52.6-70.3), while the median age among individuals who developed incident all-cause HF was 69.8 years (IQR 62.7-76.7). A total of 819 individuals (4.1%) with prevalent HF were excluded. During up to 14 years of follow-up (median 5.0), the cumulative incidence of HF was 4.8%, exceeding that of myocardial infarction (3.0%). No individuals with type 1 diabetes developed HF, but the incidence was similar across those with type 2 diabetes, latent autoimmune diabetes in adults, and secondary diabetes. A lower eGFR and higher HOMA2-IR, were associated with increased risk of all-cause and non-ischaemic HF, independently of the presence of conventional risk factors. Insulin resistance predicted all-cause HF independently of the established SCORE2-Diabetes risk score. The hazard ratio (HR) per 1&#xa0;SD increase in HOMA2-IR was highest in the low-risk group (HR 1.89; 95% CI 1.02, 3.48; p=4.3&#xa0;&#xd7;&#xa0;10-2), with concordant results observed for non-ischaemic HF. The HF incidence was high, with approximately 1 in 20 individuals developing HF within 5 years after diagnosis of diabetes other than type 1, highlighting a notably high risk of developing HF soon after diabetes diagnosis. Beyond conventional risk factors, higher HOMA2-IR and lower renal function, but not hyperglycaemia or autoantibodies, were independent risk factors for HF. Measuring HOMA2-IR also provided prognostic information in addition to that provided by the SCORE2-Diabetes risk score, supporting its value in HF risk stratification.

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Chagas disease, caused by Trypanosoma cruzi, remains a health concern worldwide. Its most severe clinical outcome, chronic Chagas cardiomyopathy (CCC), is marked by progressive cardiac dysfunction. Biological mechanisms underlying the differential development of CCC remain unclear. We hypothesized that alterations in the host DNA methylation and its influence on gene expression may contribute to this differential disease progression. We analyzed whole-blood methylation data from 42 CCC patients and 23 individuals with the indeterminate form, followed by an integrated transcriptomic analysis in a 22 individuals subset. We performed transcription factor (TF) and functional enrichment analyses to identify biological mechanisms underlying CCC severity. Severe CCC patients exhibited higher methylation variability, particularly in immune regulation genes. Integrated analysis revealed dysregulation of genes regulating cardiac development, morphogenesis, and ion homeostasis, with GATA5 as a key TF regulating cardiac pathways. TF activity inferred from peripheral blood resembled cardiac signatures previously described, with RUNX TFs, key drivers of Th1 immune polarization, correlating strongly with disease severity. Our findings highlight a systemic epigenetic signature in blood that reflects cardiac pathology in CCC. These insights advance our understanding of CCC pathogenesis and facilitate novel blood-based biomarkers and therapeutic targets aimed at preventing disease progression.

Left ventricular (LV) hypertrabeculation, formerly termed LV noncompaction, is a heterogeneous myocardial entity linked to adverse cardiovascular outcomes. This study evaluated embolic risk in patients with dilated cardiomyopathy (DCM) according to the presence of hypertrabeculation and examined its prevalence and prognostic relevance across DCM genotypes. Clinical data from 1160 patients with DCM evaluated by cardiac magnetic resonance imaging and genetic testing (n=997 [86%]) were collected from 22 international centers. End points included embolic events, advanced heart failure events, and major ventricular arrhythmias. LV hypertrabeculation was identified in 354 patients (30.5%) by fractal analysis and in 343 (29.7%) according to Petersen criteria, with good concordance. After a median follow-up of 5.1 years (interquartile range, 2.8-7.4), embolic events occurred in 37 patients (3.2%), advanced heart failure in 62 (5.3%), and major ventricular arrhythmias in 136 (11.7%). Hypertrabeculation was not associated with increased embolic risk (hazard ratio, 1.5 [95% CI, 0.75-3.00]), even among patients in sinus rhythm with LV ejection fraction &#x2264;40% (hazard ratio, 1.89 [95% CI, 0.7-5.5]). In contrast, atrial fibrillation and reduced LV ejection fraction were associated with embolic events (both P<0.01). LV hypertrabeculation was not associated with an increased risk of major ventricular arrhythmias or advanced heart failure; genotype, LV ejection fraction, and late gadolinium enhancement emerged as the main predictors of adverse outcomes. The prevalence of LV hypertrabeculation varied across genotypes, with the highest prevalence observed in patients with sequence variants in motor sarcomeric genes (58%), TTN (38%), and genotype-negative status (33%), and the lowest prevalence observed among those with variants in cytoskeletal/Z-disk (7%) and nuclear envelope (5%) genes. Hypertrabeculation was not associated with adverse outcomes within any genotype. Although LV hypertrabeculation is common in DCM, it is not associated with worse outcomes and should not prompt differential clinical management. The embolic risk in patients with DCM and hypertrabeculation is low, including in those with reduced LV ejection fraction without atrial fibrillation, and does not support prophylactic anticoagulation in these patients.

Post-COVID syndrome (PCS) is an ongoing legacy of the SARS-CoV-2 pandemic. Defined as symptoms persisting beyond 12 weeks following SARS-CoV-2 infection unexplained by an alternative diagnosis, many individuals continue to experience symptoms for months post-infection. Fatigue, breathlessness, cognitive difficulties and sleep disturbances are all commonly reported, frequently impairing daily functioning and quality of life. Acceptance and commitment therapy (ACT), which enhances psychological flexibility and supports values-based behaviour change, has shown effectiveness across long-term health conditions. This protocol describes the evaluation of Balance-ACT as a novel, adapted ACT-based intervention to address the complex physical and psychological needs of people with PCS. A randomised controlled trial (RCT), co-developed with people with PCS, will evaluate the efficacy and cost-effectiveness of Balance-ACT for PCS. A total of 196 adults with PCS will be recruited from specialist long COVID services within secondary care across NHS organisations in England and randomised 1:1 to Balance-ACT or treatment as usual (TAU). Balance-ACT consists of 10 therapist-delivered sessions delivered over 13 weeks. TAU comprises brief educational videos and a self-help leaflet for COVID-19 recovery. Outcomes will be assessed at 7, 14 and 20&#x2009;weeks post-randomisation. The primary outcome is health-related quality of life, measured using the SF-36 Physical Component Score at 14 weeks post randomisation. Secondary outcomes include physical health-related quality of life at 20 weeks, perceived fatigue, clinical global improvement, sleep disturbance, cognitive functioning, depressive symptoms, anxiety symptoms, post-exertional malaise, breathlessness, muscle strength, muscle fatigue and heart-rate variability. Mediation analyses will examine whether the intervention leads to changes in psychological flexibility, fear-avoidance beliefs, damage beliefs, embarrassment-avoidance, symptom focusing, muscle strength and physical activity and whether these changes are associated with physical health outcomes. We will also conduct a nested qualitative study to explore participants' views of the intervention. Cost-effectiveness will be assessed by comparing health and social care service costs and quality of life outcomes between Balance-ACT and TAU at 20 weeks. Ethical approval has been granted by the NHS Camberwell St Giles Research Ethics Committee (reference 23/LO/0941). The study results will be disseminated in peer-reviewed journals and presented at international conferences. NCT06231238.

Large commercial laboratories serve millions of patients and generate billions of test results annually. The objective of our study was to assess the potential use of commercial laboratory lipid testing for population health monitoring. Lipid levels from commercial laboratory testing of adult patients in Dallas County, TX, were compared with those from DHS-2 (Dallas Heart Study Phase-2)-a population-based cohort study in Dallas County-over the same period (September 2007-September 2009). Sensitivity analysis excluded those with International Classification of Diseases-Tenth Revision codes listing diabetes or cardiovascular disease as the indication for testing. The associations between abnormal lipid levels (high-density lipoprotein cholesterol <50 mg/dL in women and <40 mg/dL in men, low-density lipoprotein cholesterol &#x2265;130 mg/dL, triglycerides &#x2265;150 mg/dL) and residency in any of 76 ZIP codes was assessed in the commercial laboratory population using logistic regression adjusting for age and sex. The distribution plots of high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides were broadly similar in a commercial laboratory population (n=59&#x2009;419; median age [interquartile range], 48 [33-58] years; 56% women) and DHS-2 (n=3147; median age [interquartile range], 50 [42-58] years; 60% women). Median high-density lipoprotein cholesterol was 1 mg/dL lower (95% CI 0.6-2), low-density lipoprotein cholesterol was 5 mg/dL lower (95% CI 3-6), and triglycerides were 12 mg/dL higher (95% CI 9-14) in the commercial laboratory population versus DHS-2. Similar results were observed in a sensitivity analysis that excluded those with diabetes or cardiovascular disease. Higher probabilities of abnormal levels of all 3 lipids were observed for 5 ZIP codes (odds ratios [95% CI] ranged from 1.07 [1.001-1.15] to 1.84 [1.48-2.28]). Within the same geographic region, the differences between lipids observed in commercial laboratory testing and in a population-based cohort were negligible (high-density lipoprotein cholesterol) to moderate (low-density lipoprotein cholesterol, triglycerides). This proof-of-concept study suggests that commercial laboratory testing may be useful for monitoring population lipid levels and assessing regional and temporal variation.

Prostate cancer (PCa) is one of the most common cancers affecting men worldwide and its prevalence is rising in India. The disease primarily affects older men, with incidence increasing with age, and a substantial proportion present with advanced or metastatic disease at diagnosis. Simultaneously, cardiovascular disease (CVD) remains highly prevalent in the Indian population, representing a major cause of non-cancer mortality. The intersection of PCa, its treatment, and cardiovascular comorbidities presents a complex clinical challenge, particularly as therapies such as androgen deprivation therapy (ADT) and androgen receptor pathway inhibitors (ARPIs) improve overall survival but carry cardiometabolic risks. The Prostate Cancer Cardiovascular (PCCV) Risk Expert Panel, consisting of urologists, oncologists, and cardio-oncologists from India with guidance from an international expert, developed practical, India-specific recommendations using a modified Delphi methodology. Evidence on the cardiovascular effects of ADT and ARPIs was reviewed and contextualized for Indian clinical practice. Consensus was defined as &#x2265;75% agreement among panelists. The panel recommended comprehensive baseline lifestyle and cardiometabolic assessment, use of simplified cardiovascular risk checklists, baseline ECG and metabolic profiling, and risk stratification into low, intermediate, or high cardiovascular risk. GnRH antagonists were preferred for high-risk patients, with referral to cardiologists for those at intermediate or high risk. Ongoing cardiometabolic monitoring, lifestyle interventions, and integration of the ABCDE (A - Awareness and Aspirin: Identify risk factors and consider prophylactic aspirin if appropriate, B - Blood Pressure: Monitor and manage hypertension, C - Cholesterol/Cigarettes: Manage cholesterol and avoid smoking, D - Diet/Diabetes: Promote a heart-healthy diet and control blood sugar, E - Exercise: Encourage regular physical activity). Cardio-Oncology framework were emphasized. A multidisciplinary care model involving oncologists, urologists, cardiologists, and primary care providers was strongly recommended. With increasing use of ADT and ARPIs and the high burden of cardiovascular comorbidities in Indian men with PCa, proactive cardiovascular risk assessment, individualized treatment selection, and coordinated multidisciplinary management are essential. This expert consensus provides actionable, India-specific guidance to balance oncologic efficacy with cardiovascular safety and improve long-term outcomes and quality of life for patients.

Deubiquitinating enzymes (DUBs) are critically involved in diabetic cardiomyopathy (DCM), yet the function of OTU domain-containing protein 7B (OTUD7b), a recently identified DUB, in DCM remains unknown. Here, we identified that OTUD7b expression was significantly elevated in cardiomyocytes from both type 1 and type 2 diabetic mouse hearts. Cardiomyocyte-specific deletion of OTUD7b ameliorated cardiac dysfunction, hypertrophy, and fibrosis in diabetic mice, without affecting systemic hyperglycemia. Mechanistically, combining ubiquitinome and interactome analyses, we identified transforming growth factor &#x3b2;-activated kinase 1 (TAK1) as a direct substrate of OTUD7b in cardiomyocytes. Under diabetic conditions, OTUD7b binds to TAK1 via its zinc finger domain and catalyzes K48-linked deubiquitination at the K346 of TAK1, thereby enhancing TAK1 protein stability. This OTUD7b-mediated stabilization increased the levels of both TAK1 and p-TAK1, which led to hyperactivation of the TAK1-MAPK (JNK/p38) axis, subsequently promoting extrinsic apoptosis and inflammatory responses in cardiomyocytes. Crucially, cardiomyocyte-specific reconstitution of a deubiquitination-resistant TAK1-K346R mutant in diabetic mice completely abolished the cardioprotective effects of OTUD7b deficiency, confirming that OTUD7b drives DCM primarily through deubiquitinating TAK1 at K346. Taken together, our study unveils a novel OTUD7b-TAK1 axis in cardiomyocytes driving diabetic heart injury and positions OTUD7b as a promising therapeutic target for DCM.

Blood proteins may play causal roles in cardiovascular diseases (CVDs) such as heart failure (HF) and peripheral artery disease (PAD). Proteome-wide Mendelian randomization (MR) has been widely used to prioritize drug targets for CVD in European populations, but its application to non-European populations remains limited. We conducted a proteome-wide MR analysis to evaluate the potential causal effects of 2,922 plasma proteins on five CVDs-atrial fibrillation (AF), coronary artery disease (CAD), HF, ischemic heart disease (IHD), and PAD. Analyses were performed across African (n&#x2009;=&#x2009;931), East Asian (n&#x2009;=&#x2009;262), and European (n&#x2009;=&#x2009;10,840) populations using genetic instrument data from the UK Biobank cohort. Significant associations were further examined with genetic colocalization to strengthen causal inference. Using MR and colocalization analyses, we identified 53 significant protein-CVD associations across multi-populations, including 16 in African, six in East Asian, and 31 in European populations, respectively. Cross-population comparisons revealed four protein-CVD associations unique to African population and another four specific to East Asian population. Integration with clinical trial data prioritized 14 protein-disease pairs as promising candidates for therapeutic development or drug repurposing. Our findings highlight the value of proteome-wide MR in evaluating drug target applicability across populations. Several protein-disease associations were population-specific, emphasizing the need for inclusive genetic research to inform precision medicine in CVD prevention and treatment.

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice, and its prevalence is increasing in aging populations. It is a leading cause of acute stroke, heart failure, and other cardiovascular morbidities. AF is often asymptomatic and is frequently diagnosed late, typically after a patient presents with acute stroke. Early detection and treatment can prevent such life-threatening events, making AF screening a public health priority. However, diagnosing asymptomatic AF remains challenging. While international guidelines recommend AF screening, Qatar lacks documented prevalence data and formal screening programs. This study aimed to assess the feasibility of an AF screening program for older adults in Qatar. A cross-sectional study was conducted among individuals aged &#x2265;65 years registered with the Primary Health Care Corporation (PHCC)-Qatar, which serves approximately 70% of Qatar's population. A simple random sample of 139 to 385 individuals was determined to ensure a sampling error of 5% to 3%, assuming a 10% AF prevalence. The participants underwent screening via standard ECG tracing that were reviewed independently by both the family physicians and a cardiologist. The prevalence of AF among the study population was 5.4%. Newly diagnosed cases accounted for 2% of the 249 participants screened. All newly detected patients had CHA2DS2-VA scores indicating the need for anticoagulant therapy to reduce stroke risk. Furthermore, compared with cardiologists, the family physicians in primary care successfully identified 75% of AF cases through ECG. If implemented nationally among individuals aged &#x2265;65 years, the screening program could identify 747 undiagnosed AF cases among the 37,371. AF screening for individuals aged &#x2265;75 years appears to provide an effective strategy for reducing the cost and supporting the implementation of a targeted screening strategy in Qatar.