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Cardiovascular outcome trials suggest that glucagon-like peptide-1 receptor agonists (GLP-1RAs) reduce major adverse cardiovascular events in individuals with type 2 diabetes (T2DM), but the magnitude of benefit, including recent evidence from the landmark SOUL trial and oral formulations, remains uncertain. We performed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (International Prospective Register of Systematic Reviews ID: CRD420251034652), searching PubMed, Embase, Cochrane CENTRAL, Scopus and ClinicalTrials.gov on 6 May 2025 for randomised controlled trials comparing GLP-1RAs with placebo or usual care in adults with T2DM and established atherosclerotic cardiovascular disease. Seven trials, including 56 191 participants (mean follow-up: 3.5 years), were analysed. GLP-1RAs reduced major adverse cardiovascular events by 11% [hazard ratio: 0.89, 95% confidence interval (CI): 0.83-0.96], all-cause mortality by 11% (hazard ratio: 0.89, 95% CI: 0.82-0.97) and hospitalisation for heart failure by 7% (hazard ratio: 0.93, 95% CI: 0.89-0.98), all with high-certainty evidence. Overall, GLP-1RAs - available in subcutaneous and oral formulations - provide clinically meaningful cardiovascular benefits in high-risk adults with T2DM.
The comparative cardiovascular effectiveness of different renin-angiotensin system (RAS) inhibitors in patients receiving maintenance hemodialysis remains uncertain, and current guideline recommendations largely assume therapeutic equivalence between angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB). Using the TriNetX multi-institutional database, we identified adults with ESKD who newly initiated ARB or ACEI therapy from 2006 to 2025. An active-comparator new-user design and 1:1 propensity score matching were applied. The primary outcome was 1-year major adverse cardiovascular events (MACE: myocardial infarction [MI], stroke, or all-cause mortality). Secondary outcomes included individual MACE components and hyperkalemia. Hazard ratios (HRs) were estimated using Cox models, and negative-control analyses assessed residual confounding. After matching, 55,894 patients were included. ARB was associated with a lower risk of MACE compared with ACEI users (30.3% vs. 35.0%; HR 0.85; 95% CI 0.83-0.88). Stroke (HR 0.90; 95% CI 0.86-0.94) and all-cause mortality (HR 0.75; 95% CI 0.71-0.78) were also associated with a lower risk, while MI risk was similar (HR 0.99; 95% CI 0.94-1.03). Hyperkalemia rates were comparable. Subgroup findings consistently favored ARBs across age, sex, diabetes, heart failure, CAD, and PAD strata. Negative-control outcomes showed no significant associations. In this large real-world cohort of patients receiving maintenance hemodialysis, initiation of ARB was associated with lower risks of major adverse cardiovascular events, stroke, and all-cause mortality compared with ACEI. These findings suggest a potential difference in observed cardiovascular outcomes between ARBs and ACEIs in the hemodialysis population; however, causal inference is limited by the observational design.
Cardiovascular diseases (CVDs) are becoming more prevalent worldwide each year, contributing to the leading cause of mortality in both men and women. Awareness of CVD is low, particularly in developing countries. This study aimed to identify key variables that determine CVD awareness among young adults. This study used a cross-sectional, descriptive correlational design and was conducted in accordance with STROBE guidelines. Data were collected across Indonesia via social media from late November 2022 to February 2023. CVD awareness was assessed using the Attitude-Belief-About-Cardiovascular-Disease (ABCD) Risk Questionnaire. Data were analyzed using univariate, bivariate (Fisher's, Wilcoxon, Spearman, and Kruskal-Wallis), and regression (ordinary least squares and robust) analyses. 270 respondents participated in this study, with average age of 26.88 (SD = 5.55). The mean CVD awareness score was 55.27 (SD = 5.85). Gender, educational background, and body mass index (BMI) all played a role in CVD awareness. Female sex was associated with lower awareness (OLS: B = -1.99, p < 0.001; robust: B = -1.62, p < 0.01), while university attendance was associated with higher awareness (robust: B = 1.64, p = 0.03). Higher BMI was the strongest and most consistent predictor of CVD awareness across models (OLS: B = 0.19, p < 0.001; robust: B = 0.18, p < 0.001). Young adults (aged ≥ 18-39) in Indonesia demonstrated adequate knowledge of CVD risk factors; however, females, those with lower educational attainment, and individuals with normal weight showed lower levels of CVD awareness. Targeted health education and CVD screening programs are needed for these groups. Nurses play a pivotal role in bridging these awareness gaps by implementing tailored health education initiatives and proactive, community-based screening programs that specifically address the needs of these high-risk subgroups to promote early detection and long-term cardiovascular health.
Cardiovascular disease (CVD) remains a leading cause of death in China. Systemic inflammation (SI) is an emerging risk factor in atherosclerotic CVD (ASCVD) and chronic kidney disease (CKD). High-sensitivity C-reactive protein (hsCRP) is increasingly recognised for prognostication. The SPARK-CVD China survey assessed Chinese cardiologists' and nephrologists' awareness and perceptions of SI and hsCRP in patients with both ASCVD and CKD. A nationwide cross-sectional survey was conducted (September to December 2024) across 31 provinces in China mainland among physicians with ≥3 years of clinical experience and managing ≥20 adult patients with both ASCVD and CKD per month. Descriptive and comparative statistics were used. Among 1500 respondents, SI was used more to aid treatment than diagnosis (65.2% vs 45.5%). Although 73.3% viewed SI as a key determinant of cardiovascular events, only 35.2% discussed SI as a risk factor with patients. Non-testers cited no expected impact on decisions (71.3%), lack of guideline direction (44.0%), and limited treatments (37.2%). A knowledge-practice gap for hsCRP was observed: 29.7% identified hsCRP unprompted versus 87.7% when prompted; perceived diagnostic thresholds varied widely. Fewer than 1/4 of ASCVD and/or CKD patients would be prescribed colchicine; barriers included limited experience (55.2%), potential contraindications (54.1%), and side effects (47.1%). Cardiorenal benefits of GLP-1 receptor agonists were widely recognised (97.9%), with 76.5% attributing benefits partly to anti-inflammatory effects. SI is acknowledged but inconsistently operationalised domestically. Targeted professional education, explicit guideline recommendations, and further evidence for risk-stratified, inflammation-guided care may help refine treatment pathways for ASCVD with CKD.
Macrophages play a crucial role in coronary artery plaque development and can be quantified as circumferential arc features via optical coherence tomography (OCT). However, the prognostic implications of macrophage arc characteristics remain underexplored. In this multicentre, retrospective study, consecutive patients with coronary artery disease (CAD) undergoing OCT between January 2017 and April 2023 were enrolled. The macrophage arc was evaluated using maximum arc, mean arc, and mean arc score (MAS) in the target vessel. Among 1025 patients (1173 vessels), 61 (5.9%) experienced major adverse cardiovascular events (MACEs). Receiver operating characteristic analysis identified optimal predictive thresholds: maximum arc ≥ 157.5°, mean arc ≥ 97.88°, and MAS ≥ 2.27 (all P < 0.001). Elevated mean arc [hazard ratio (HR) = 7.628, P < 0.0001], maximum arc (HR = 6.902, P < 0.0001), and MAS (HR = 6.704, P < 0.0001) were independently associated with MACEs. When combined with thin-cap fibroatheroma (TCFA) status, these parameters demonstrated enhanced predictive power: mean arc ≥ 97.88° + TCFA (HR = 8.779, P < 0.0001), maximum arc ≥ 157.5° + TCFA (HR = 8.149, P < 0.0001), and MAS ≥ 2.27 + TCFA (HR = 7.509, P < 0.0001). Notably, among TCFA-negative patients, a mean arc ≥ 97.88° showed markedly improved predictive capacity for MACEs (HR = 6.685, P < 0.001), as did maximum arc ≥ 157.5° (HR = 4.490, P < 0.001) and MAS ≥ 2.27 (HR = 5.126, P < 0.001). Macrophage arc parameters are strongly associated with long-term cardiovascular risk, serving as novel OCT-derived biomarkers for patients with CAD.
The association between thyroid hormones and cardiovascular disease (CVD) has been widely examined; however, the role of biological aging in this relationship remains unclear. This study systematically investigates the mediating role of phenotypic age acceleration (PhenoAgeAccel) in the relationship between thyroid hormones and CVD. The data were sourced from the 2007-2010 cycles of the National Health and Nutrition Examination Survey (NHANES). Analyses included logistic regression, linear regression, restricted cubic splines, subgroup analyses, and mediation analysis to assess the role of PhenoAgeAccel. Among participants aged ≥ 60 years, elevated free triiodothyronine (FT3) concentrations were linked to a reduced risk of CVD (adjusted odds ratio [aOR] = 0.483; 95% CI: 0.273-0.856; p = 0.013). Similarly, total triiodothyronine (TT3) levels were associated with a decreased CVD risk in those aged 60 and above (aOR = 0.988; 95% CI: 0.980-0.995; p = 0.013). Mediation analysis showed that PhenoAgeAccel mediated 21.13% of the FT3-CVD association and 23.41% of the TT3-CVD association in older adults. This study identifies an age-dependent relationship between FT3, TT3, and CVD and reveals that PhenoAgeAccel partially mediates this association. These findings suggest that interventions targeting thyroid function and biological aging may offer novel strategies for CVD prevention and management in older populations.
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Aortic valve disease in young adults remains challenging due to long life expectancy and the need for durable, anticoagulation-free solutions. The Ross procedure offers excellent hemodynamics and long-term durability but is underutilized in Latin America because of its technical complexity and limited homograft availability. We conducted an observational study including all adult patients undergoing the Ross procedure between July 2024 and April 2026 at Hospital Clínico UC-Christus. Demographics, clinical history, surgical indications, operative details, complications, and echocardiographic follow-up were analyzed. 29 consecutive patients were included (13.8% female; range: 21-61). Main surgical indications were severe aortic stenosis (34.5%), mixed lesions (34.5%) and severe aortic regurgitation (27.6%); 86.2% had bicuspid aortic valves. Associated procedures were performed in 24.1% of cases. Median cross-clamp and cardiopulmonary bypass times were 205 and 230 min, respectively. Early complications included perioperative stroke in 3 patients (10.3%; all ischemic, two recovered with mRS: 0-1 and one with mRS: 3). Early echocardiography follow-up showed no neoaortic regurgitation in 18 patients, trivial in 9, and mild in 2, with a median neoaortic gradient of 4.0 mmHg and neopulmonary gradient of 2.0 mmHg. No patient developed severe autograft or homograft regurgitation. During a median follow-up of 295 days (range: 30-662), no deaths were observed. There was 1 reintervention due to homograft endocarditis. Implementation of a dedicated Ross program in a high-complexity Latin American center is feasible and was associated with acceptable early postoperative outcomes. These findings support feasibility and short-term safety only; longer follow-up and larger cohorts are required before conclusions can be drawn regarding durability or wider safety.
Mitral valve prolapse (MVP) is a prevalent and traditionally benign heart valve disease; however, mounting evidence identifies a subset of patients at risk for malignant ventricular arrhythmias and sudden cardiac death. This narrative review critically examines the role of multimodality imaging in arrhythmic MVP, with an integrative overview of transthoracic echocardiography, cardiac magnetic resonance (CMR), computed tomography, and positron emission tomography. Particular attention is given to the complementary contribution of these modalities to structural, functional, and myocardial tissue characterization, while acknowledging their different levels of evidence and current clinical applicability. The specific added value of this review lies in organizing these imaging findings within a pathophysiological framework that links valve morphology and annular biomechanics to myocardial injury, diffuse fibrotic remodeling, focal replacement fibrosis, and arrhythmic vulnerability, rather than presenting each modality as an isolated diagnostic tool. Advanced CMR techniques, including native T1 and T2 mapping and extracellular volume quantification, are discussed as promising tools for detecting diffuse fibrosis and myocardial tissue characterization that may contribute to early myocardial remodeling. Genetic susceptibility is also considered as a potential modifier of phenotypic heterogeneity rather than as a routine component of current risk stratification. Overall, the reviewed literature supports an evolving framework for phenotypic characterization and mechanistic interpretation in arrhythmic MVP, while highlighting the need for further standardization, prospective validation, and cautious integration of advanced imaging biomarkers into clinical pathways.
Chronic kidney disease (CKD) is a common and progressive disorder in dogs characterized by irreversible loss of renal function over time. It is frequently observed in geriatric dogs and may present with nonspecific clinical signs that require careful diagnostic evaluation for confirmation. An 11-year-old male mixed-breed dog weighing 17.9 kg presented with a history of lethargy and anorexia for three consecutive days. On physical examination, the dog had a body temperature of 37.9°C, heart rate of 60 beats per minute (bradycardia), and respiratory rate of 24 breaths per minute (within normal range). Physical examination and clinical laboratory testing, including hematology and serum biochemistry, were performed to evaluate renal function. The results of these investigations, along with the clinical signs, were consistent with CKD. This case highlights the clinical presentation and diagnostic process of CKD in a geriatric mixed-breed dog. Early recognition and appropriate diagnostic evaluation are essential for the accurate diagnosis and management of CKD in dogs.
Immune checkpoint inhibitors (ICIs) have transformed oncologic practice, but their expanding use has heightened concern about potentially fatal cardiovascular toxicity. This bibliometric study mapped the global research landscape and temporal evolution of ICI-associated cardiotoxicity from 2016 to 2025. Records were retrieved from the Web of Science Core Collection on January 1, 2026. After excluding letters, conference abstracts, editorials, and other non-research items, 1,127 original articles and reviews were analyzed. A thesaurus file standardized synonyms, abbreviations, spelling variants, and singular-plural forms before keyword co-occurrence analysis. VOSviewer and CiteSpace were used to evaluate publication trends, collaboration networks, citation structures, keyword clusters, temporal patterns, and burst terms. The corpus involved 67 countries, 2,430 institutions, and 8,842 authors. Annual output increased from 9 publications in 2016 to 236 in 2025, representing a 26.2-fold rise and a compound annual growth rate of 43.8%; cumulative publication output was well fitted by a quadratic polynomial model (R2 = 0.9973). China produced the most publications, whereas the United States achieved the highest citation count. The University of Texas MD Anderson Cancer Center, Javid Moslehi, and Frontiers in Oncology were the leading institution, author, and journal, respectively; The New England Journal of Medicine was the most frequently co-cited journal. Keyword mapping delineated three domains: immune-mediated cardiovascular phenotypes, PD-1/PD-L1-related mechanisms, and multidisciplinary risk management. Temporal and burst analyses indicated a shift from toxicity recognition toward mechanistic elucidation, diagnostic standardization, risk stratification, and cardiovascular outcome assessment. Emerging low-frequency but rapidly strengthening terms highlight growing attention to combination-regimen safety, patient-level risk assessment, evidence synthesis, and long-term cardiovascular outcomes.
Neuromuscular blocking agents are widely used in veterinary anesthesia to facilitate tracheal intubation and provide optimal surgical conditions. Quantitative neuromuscular monitoring enables accurate evaluation of neuromuscular effects while ensuring cardiovascular safety in anesthetized dogs. This study aimed to quantify the neuromuscular effects, therapeutic effectiveness, and cardiovascular safety of rocuronium and atracurium during quantitative neuromuscular monitoring of dogs under ambulatory anesthesia. A total of 18 healthy adult dogs were randomly divided into two groups. One group received 0.6 mg/kg IV of rocuronium, and the other received 0.5 mg/kg IV of atracurium after the induction of isoflurane anesthesia, with each group consisting of nine dogs. Neuromuscular transmission was quantified using calibrated train-of-four (TOF) acceleromyography. Onset time, duration of action, and recovery time to a TOF ratio ≥ 0.9 were measured concurrently with continuous monitoring of heart rate, mean arterial pressure, and oxygen saturation. The use of rocuronium resulted in a significantly faster onset of neuromuscular block compared with atracurium (p < 0.001), enabling rapid tracheal intubation. No significant differences were found between the two groups regarding the duration of action and recovery time. During the anesthesia period, cardiovascular parameters remained stable and comparable between the groups, and only one dog in the atracurium group experienced a minor, transient adverse effect. The results suggest that both drugs are potent and do not harm dogs. In addition, rocuronium is a better option for quick procedures, whereas atracurium can be used in situations where it is not anticipated that the patient will be able to respond to reversal agents or has compromised organ function, due to its predictably less discomfort during the recovery phase.
Protein-bound uremic toxins, including indoxyl sulfate and p-cresyl sulfate, are poorly removed by conventional dialysis and contribute to cardiovascular, inflammatory, and neurological complications in end-stage kidney disease. Although postfilter hemodiafiltration enhances middle molecule clearance, its availability is limited. We evaluated whether combining medium cut-off dialysis with HA130 hemoadsorption achieves protein-bound uremic toxin removal comparable with that of optimized postfilter hemodiafiltration. Prospective, single-center, parallel-group, single-session comparative study. Twenty anuric adult patients undergoing maintenance hemodialysis treated at a tertiary dialysis center were allocated to medium cut-off dialysis with hemoadsorption (n = 10) or postfilter hemodiafiltration (n = 10). Expanded hemodialysis using a medium cut-off membrane combined with HA130 hemoadsorption versus postfilter hemodiafiltration. Corrected reduction ratios of protein-bound uremic toxins (indoxyl sulfate, p-cresyl sulfate, carboxymethyllysine, and protein carbonyls) and middle molecules (β2-microglobulin, free light chains, prolactin, parathyroid hormone, soluble receptor for advanced glycation end-products). Predialysis and postdialysis plasma concentrations were measured, and corrected reduction ratios were calculated after adjusting for hemoconcentration. Between-group comparisons were performed using nonparametric tests. Corrected reduction ratios for key protein-bound uremic toxins were similar between medium cut-off dialysis with hemoadsorption and hemodiafiltration. Indoxyl sulfate corrected reduction ratios were 28.0% (IQR, 21.6-41.7) with medium cut-off dialysis with hemoadsorption and 26.0% (IQR, 22.5-37.9) with hemodiafiltration, while p-cresyl sulfate corrected reduction ratios were 31.8% (IQR, 23.9-37.4) versus 36.5% (IQR, 23.9-39.7), respectively (all P > 0.05). Carboxymethyllysine and protein carbonyl removal did not differ between modalities. In contrast, hemodiafiltration achieved higher corrected reduction ratios for conventional middle molecules, including β2-microglobulin and free light chains. Reduction of soluble receptor for advanced glycation end-products was modest and comparable across treatments. Small sample size, single-session design, and reliance on plasma reduction ratios without direct dialysate mass measurements. In this exploratory study, medium cut-off dialysis with hemoadsorption achieved protein-bound uremic toxin removal similar to that of optimized postfilter hemodiafiltration, despite lower clearance of conventional middle molecules. Hybrid strategies integrating diffusion, convection, and adsorption may expand protein-bound uremic toxin removal options, particularly where hemodiafiltration is not feasible. Patients with kidney failure requiring dialysis accumulate uremic toxins that are inadequately removed by conventional dialysis techniques. Among these, protein-bound uremic toxins are particularly difficult to eliminate and have been implicated in cardiovascular, vascular, and neurological complications. Although hemodiafiltration enhances the clearance of several uremic solutes, its availability remains limited in many dialysis centers. In this study, we investigated whether the combination of a medium cut-off dialysis membrane with a hemoadsorption cartridge could represent a feasible alternative strategy. We observed that this hybrid approach achieved comparable removal of protein-bound uremic toxins to hemodiafiltration, although it was less effective for certain middle-molecular-weight solutes. These findings suggest that hybrid dialysis strategies may help expand treatment options when hemodiafiltration is not available.
Loneliness, distinct from social isolation, is a subjective sense of social disconnection exacerbating a public health crisis among older adults. Affecting ~33% of community-dwelling individuals aged 50-80 years post-COVID-19, it rivals smoking in mortality risk and drives cognitive, cardiovascular, and mental health declines. This review synthesises evidence to inform clinical strategies. A critical review of per-reviewed meta-analyses, RCTs, and prospective cohorts literature (2019-2025) was conducted for adults aged 50 years and above. Studies were selected using validated loneliness or social isolation measures, with quality appraised via AMSTAR-2, Cochrane RoB 2, and Newcastle-Ottawa Scale; 34 studies met eligibility criteria from an initial yield of 1,847 records. Prevalence of loneliness stands at 29% isolation by 2024, highest among those with poor health (53%-75%), unemployment (52%), solitary living, and ages 50-64. Loneliness elevates all-cause mortality (32%), dementia (50%-59%), cardiovascular events (29%-32%), depression (40%), and anxiety (35%). Mechanisms include increased inflammation (↑CRP, IL-6), HPA dysregulation, immune compromise, hippocampal atrophy, and behavioural lapses. Interventions like CBT/reminiscence therapy, multicomponent programs, animal therapy, exercise, and digital platforms have been shown to reduce loneliness, though primary care implementation lags due to screening/referral barriers. Tools such as the UCLA Loneliness Scale enable feasible assessment. Loneliness as a geriatric syndrome demands mandated screening, provider education, and reimbursement reforms. Coordinated healthcare-community efforts could avert substantial morbidity/mortality, addressing gaps in long-term outcomes and cost-effectiveness research.
Long-term survival has improved in the current era of pediatric heart transplantation (HT). The impact of elevated filling pressures [EFP; defined as pulmonary capillary wedge pressure (PCWP) > 15 mmHg and/or right atrial pressure (RAP) > 12 mmHg in the absence of biopsy-confirmed rejection] on long-term outcomes beyond 10 years remains poorly characterized. We assessed whether EFP during the early years after HT are associated with poor graft survival and cardiovascular adverse events (AE). We retrospectively analyzed 114 pediatric HT grafts (1986-2020) with available PCWP and/or RAP measurements 7 months to 5 years post-transplant (grouping period), representing a landmark cohort of 5-year survivors. Associations of EFP with graft survival and AE were evaluated. Fourteen grafts (12%) had EFP during the grouping period. Grafts with EFP had significantly worse long-term survival (44% vs. 85% at 10 years; log-rank p < 0.001), and higher risk of graft loss (overall HR 6.04, 95% CI [2.01-16.85]). The incidence of AE was numerically higher in grafts with EFP (26.6 [15.2-43.2] vs. 11.9 [9.4-14.9] per 100 person-years), but should be interpreted as exploratory. EFP within the early years post-transplant are associated with poor graft survival and may indicate cardiovascular complications.
Hypertension remains one of the most prevalent and consequential cardiovascular risk factors worldwide and is a leading cause of heart disease. Hypertensive heart disease may manifest in alterations in left ventricular (LV) geometry, including concentric remodeling, concentric hypertrophy, and eccentric hypertrophy, representing adaptive responses to chronic pressure or volume overload that may progress to maladaptive remodeling and heart failure. LV geometric patterns, defined by LV mass and relative wall thickness, carry important diagnostic and prognostic implications independent of blood pressure levels. This review provides a comprehensive and contemporary overview of the relationship between hypertension and LV geometry. We summarize key determinants of hypertensive LV remodeling, including cumulative blood pressure exposure, sex differences, metabolic comorbidities, obesity, pericardial adiposity, and obstructive sleep apnea. We discuss current approaches to screening and diagnosis, highlighting the strengths and limitations of electrocardiography, echocardiography, and cardiac magnetic resonance imaging. We review emerging applications of artificial intelligence in electrocardiographic and echocardiographic assessment, with particular attention to their potential to improve detection, phenotypic differentiation, and prognostication. We further examine the prognostic significance of LV remodeling in hypertension and review evidence supporting regression of LV hypertrophy through intensive blood pressure control, management of comorbidities, and lifestyle interventions. Early identification and reversal of hypertensive LV remodeling may offer a critical opportunity to prevent progression to heart failure and reduce long-term cardiovascular morbidity and mortality. See also the graphical abstract(Fig. 1).
We investigated whether individuals who likely developed type 2 diabetes (T2D) through predominantly genetic, adverse intrauterine, or lifestyle aetiologies have different clinical presentations and complications. In this Danish nationwide combined cross-sectional and registry-based follow-up study, we included 7867 individuals with newly diagnosed T2D from the DD2 cohort, enrolled during 2010-2023 through general practices and hospital outpatient clinics across Denmark. Participants were required to have available genotyping and birthweight data; those with GAD antibody levels >30 were excluded. Individuals were grouped by presumed predominant aetiologies: genetic (highest-quartile T2D genetic risk score (GRS), birthweight above lowest quartile; n = 1435); intrauterine (lowest-quartile birthweight, GRS below highest quartile; n = 1195); and lifestyle (birthweight above lowest quartile, GRS below highest quartile; n = 4380). Baseline characteristics at diagnosis were examined using linear and log-binomial or robust Poisson regression. The main follow-up outcomes were standardised 10-year risks of major adverse cardiovascular events and microvascular complications after DD2 enrolment, estimated using the Aalen-Johansen method. Compared with the genetic group (18%), intrauterine (15%) and lifestyle (56%) aetiologies both showed -6.9% lower Homeostatic Model Assessment-2 (HOMA2) insulin sensitivity, higher triglycerides (+6.6% and +5.3%), higher HOMA2 beta-cell function (+8.9% and +9.6%), and higher high-sensitivity C-reactive protein (+14.8% and +24.1%). Age at T2D diagnosis was 1.2 years lower (intrauterine) and 2.3 year higher (lifestyle). The 10-year risk of major adverse cardiovascular events was 14.8% (intrauterine), 13.2% (lifestyle), and 11.5% (genetic), corresponding to absolute risk differences (RDs) of +3.3% (95% confidence interval [CI] 0.6, 6.0) for intrauterine, and +1.7% (95% CI -0.3, 3.6) for lifestyle, vs. genetic aetiology. The 10-year risk of microvascular complications was 25.9% (intrauterine), 25.4% (lifestyle), and 21.8% (genetic), yielding RDs of +4.1% (95% CI 0.7, 7.5) for intrauterine and +3.5% (95% CI 1.0, 6.1) for lifestyle aetiology. Individuals who developed T2D with predominant intrauterine or lifestyle rather than genetic aetiology exhibited distinct characteristics including higher long-term complication risks. Future studies should validate this framework in more diverse populations and assess whether these proxy-based aetiological domains can improve risk stratification and guide treatment. This work was funded by Danish Agency for Science, the Danish Health and Medicines Authority, the Danish Diabetes Association, the Region of Southern Denmark, the Swedish Research Council, the Novo Nordisk Foundation, the Swedish ALF for Region Skåne, the Crafoord Foundation, and the Swedish Diabetes Association.
Elderly patients with coronary heart disease (CHD) are prone to psychological disorders during treatment. Strengthening psychological well-being can improve rehabilitation outcomes. This study aimed to explore the effects of recording positive events on anxiety, psychological capital, treatment compliance, and major adverse cardiovascular events (MACE) in elderly CHD patients with anxiety symptoms. A total of 309 elderly CHD patients with anxiety were enrolled and randomly assigned to an intervention group (n=154) and a control group (n=155). After the intervention, assessments were conducted using the Self-Rating Anxiety Scale (SAS), the Positive Psychological Capital Questionnaire (PPQ), and a treatment compliance scale, along with collection of clinical indicators and data on MACE. Primary outcomes were changes in anxiety and treatment compliance behaviors. Secondary outcomes included changes in the positive psychological capital scores, clinical indicators, and incidence of MACE. The intervention group showed significantly lower anxiety scores than the control group at the end of the intervention (3 months after discharge) and the end of follow-up period (6 months after discharge) (p<0.05). Additionally, the intervention group scored significantly higher on the PPQ and CHD Treatment Compliance Behavior Scale (p<0.05). Improvements in clinical indicators (except systolic blood pressure) were significantly greater in the intervention group (p<0.05). Furthermore, the incidence of MACE was significantly lower in the intervention group (12 cases vs. 36 cases, p<0.05), and compared with the control group, the relative risk (RR) of adverse cardiovascular events was 0.33 (95% confidence interval: 0.18-0.61, p = 0.025). Recording positive events can alleviate anxiety, enhance psychological capital and treatment compliance, reduce the occurrence of MACE, and effectively improve rehabilitation outcomes in elderly CHD patients.
Accurate assessment of arterial blood pressure (BP) and vascular stiffness is critical for diagnosing and monitoring cardiovascular disease. Arterial tonometry (AT) enables direct pulse wave acquisition and has been widely explored for noninvasive, continuous, wearable BP estimation. However, tonometry-based approaches typically rely on generalized arterial biomechanical parameters that exhibit substantial intersubject variability and can limit accuracy, particularly in pathological conditions. To address this limitation, we present a hybrid sensing framework that integrates shear wave elastography (SWE) with arterial tonometry to enable patient-specific biomechanical parameterization. The proposed device simultaneously acquires arterial stiffness metrics and pulse pressure waveforms, which are incorporated into a validated physics-driven model for continuous BP estimation. By combining elastography-derived mechanical priors with direct pulse wave measurements, this approach improves personalization and physiological fidelity of noninvasive, continuous BP monitoring. The proposed hybrid system demonstrates the potential for more accurate, patient-specific, and continuous blood pressure assessment, with implications for wearable cardiovascular monitoring and precision diagnostics.
Interest in intermittent fasting regimens has expanded substantially due to its reported metabolic effects. However, whether such dietary patterns are safe for individuals living with chronic heart failure remains unclear. This issue is particularly relevant for patients who fast for religious observance, including Ramadan. We therefore performed a systematic review to evaluate the clinical safety and physiological implications of intermittent fasting regimens in stable heart failure populations. The review protocol adhered to established reporting standards for systematic reviews. Multiple electronic databases were systematically searched from inception through December 2025 to identify studies evaluating intermittent fasting regimens in adults with chronic heart failure. Both randomized and observational designs were considered eligible. Key outcomes included clinical deterioration, cardiovascular events, New York Heart Association functional status, left ventricular systolic performance, and natriuretic peptide levels. Where data allowed, pooled analyses were conducted; otherwise, findings were summarized narratively. Five observational studies fulfilled inclusion criteria, three of which provided comparable data for quantitative synthesis, comprising 1345 participants. Across studies, fasting was not associated with increased rates of heart failure decompensation, major cardiovascular events, or mortality relative to non-fasting periods. Functional status remained generally stable, with a tendency toward improved symptom classification among fasting participants. Measures of systolic function and natriuretic peptides showed no clinically meaningful worsening. In clinically stable individuals with chronic heart failure, intermittent fasting regimens, including Ramadan fasting, were not linked to short-term adverse clinical outcomes based on currently available observational evidence.