搜索结果：Cardiovascular diagnosis and therapy

Familial hypercholesterolemia (FH) is a common monogenic lipid disorder, characterized by lifelong elevated low-density lipoprotein cholesterol (LDL-C) and a markedly increased risk of atherosclerotic cardiovascular disease (ASCVD). Although the genetic prevalence of FH does not differ between sexes, women with FH face unique challenges across their lifespan that contribute to their cardiovascular risk. This review synthesizes current evidence on the trajectory of FH in women, with a focus on disparities in diagnosis, treatment, and cardiovascular outcomes across the female lifespan. Current evidence highlights a substantial gender gap in FH care. Compared with men, women are typically diagnosed 3-7 years later, are 26% less likely to receive lipid-lowering therapy (LLT), and are 37% less likely to achieve guideline-recommended LDL-C targets. Childbearing years are a major vulnerable period, as LLT is usually interrupted during pre-conception, pregnancy, and lactation, resulting in a median loss of 2.3 years of statin-treatment per woman. These treatment-gaps contribute to a disproportionately greater cumulative LDL-C burden in younger women with FH than men. Although premenopausal women retain lower absolute ASCVD risk than men with FH, their excess risk relative to the general female population exceeds the corresponding male disadvantage, and both LDL-C and ASCVD risk rise further after menopause. Women with FH face distinct diagnostic and therapeutic challenges requiring sex-specific care. Improving equity in FH care in women necessitates early diagnosis, appropriate LLT intensification, dedicated management across the childbearing years, and expanded research into LLT safety in pregnancy to reduce cumulative LDL-C exposure and long-term ASCVD burden.

Chronic obstructive pulmonary disease (COPD) is a systemic inflammatory disorder frequently followed by cardiovascular disease and diabetes mellitus (DM) that may increase the risk of major adverse cardiovascular events (MACE). Dipeptidyl peptidase-4 inhibitors (DPP-4i) are widely used antidiabetic agents with potential anti-inflammatory and cardiovascular protective effects beyond glycemic control. This study investigated the association between DPP-4i use and the risk of MACE in patients with COPD and comorbid DM. This nationwide retrospective cohort study used data from Taiwan's National Health Insurance Research Database between 2016 and 2021. Patients aged &#x2265;40 years with at least one hospitalization for COPD and a diagnosis of DM were included. DPP-4i users were identified by prescription records (ATC code A10BH*), and non-users were defined as patients receiving other antidiabetic agents without DPP-4i. The primary outcome was MACE, defined as a composite of cardiovascular death, myocardial infarction, and stroke. Cox proportional hazards analysis was used to estimate hazard ratios (HRs) of MACE with 95% confidence intervals (CIs), adjusting for demographic characteristics, comorbidities, and overall disease burden. A total of 24,215 patients with COPD and DM were included, of whom 5737 (23.7%) were DPP-4i users and 18,478 (76.3%) were non-users. During follow-up, DPP-4i users had a significantly lower incidence of MACE compared with non-users (17.88% vs 26.34%, p < 0.0001). Non-DPP-4i use was associated with a higher risk of MACE (adjusted HR: 1.56; 95% CI: 1.46-1.67; p < 0.0001) compared with DPP-4i use. The association of DPP-4i was consistent across sex, age groups, and patients with prior myocardial infarction, stroke, or hypertension. In this nationwide retrospective cohort study, DPP-4i use was associated with a lower risk of MACE among patients with COPD and comorbid DM. These findings suggest that DPP-4i may provide cardiovascular benefits beyond glycemic control in this high-risk population. However, given the observational design, causal relationships cannot be established, and the findings should be interpreted with caution due to potential residual confounding and selection bias. Further randomized controlled trials are warranted to confirm findings.

The association between breast cancer diagnosis and treatment and the risk of incident ischemic stroke remains unclear. We investigated ischemic stroke risk among breast cancer survivors and evaluated associations by age, follow-up duration, and type of cancer treatment. We conducted a nationwide, retrospective, matched cohort study using the Korean National Health Insurance Service database. Women aged 18 years and older with newly diagnosed breast cancer who underwent breast cancer surgery between January 2010 and December 2016 and had no prior stroke were identified. Each was matched 1:3 by birth year to cancer-free women. The primary outcome was first ischemic stroke, defined as hospitalization with International Classification of Disease, Tenth Revision codes I63/I64 plus inpatient brain CT or MRI. Subdistribution hazard ratios (sHRs) and 95% CIs were estimated using Fine-Gray models that accounted for death as a competing risk and adjusted for sociodemographic factors and cardiovascular and non-CV comorbidities. We analyzed 107,606 breast cancer surgery survivors (mean age, 50.0 years) and 322,818 matched cancer-free women. Over a mean 7.2-year follow-up, ischemic stroke occurred in 1,155 survivors (1.07%). Stroke risk was elevated shortly after breast cancer diagnosis (1-year sHR 1.59; 95% CI 1.34-1.89; 3-year sHR 1.17; 95% CI 1.05-1.30) compared with cancer-free women, with stronger associations at 3 and 6 months after diagnosis across all age groups. Over the long term, survivors had a slightly lower risk of stroke (sHR 0.94; 95% CI 0.88-1.00), and in a 1-year landmark analysis including only event-free individuals, the risk was lower (sHR 0.87, 95% CI 0.81-0.93). Among survivors, anthracycline use (sHR 1.25) and combined tamoxifen-aromatase inhibitor therapy (sHR 1.49) were associated with increased risk of stroke, whereas radiation therapy was associated with decreased risk (sHR 0.84). These associations attenuated and became nonsignificant beyond 1 year. Stroke risk was also higher among survivors with low income, hypertension, diabetes, or current smoking. The association between breast cancer and ischemic stroke risk is time dependent, with a short-term increase after diagnosis and treatment followed by a gradual decline over time. These findings highlight the need for proactive stroke risk management, including early CV assessment and ongoing monitoring for thromboembolic events during survivorship.

Medical nutrition therapy (MNT) serves as the foundational intervention in the clinical management of gestational diabetes mellitus (GDM) management. However, inadequate supportive care often hinders patients' ability to sustain dietary modifications and self-management behaviors, particularly for complex regimens. Flexible online interventions are thus gaining interest as adjuncts to clinical care, with the potential to improve the outcomes of GDM self-management. This study sought to evaluate the benefits of WeChat-delivered medical nutrition therapy (WeMNT), a WeChat-delivered MNT intervention, for patients with GDM. A parallel-group, single-blind randomized controlled trial (with outcome assessor blinding) was implemented at a university hospital's obstetric clinic. Eligible participants were those with a 24- to 28-week singleton pregnancy, a GDM diagnosis confirmed by the 75 g oral glucose tolerance test, no requirement for insulin therapy, and the ability to use a smartphone and WeChat, as well as to communicate in Chinese. Participants were randomized 1:1 to the intervention (n=47, 50%) or control group (n=47, 50%) using a random number table. The WeMNT intervention was designed per the behavior change wheel framework: (1) analyze capability-, opportunity-, and motivation-based barriers related to MNT adherence; (2) formulate targeted intervention functions; and (3) select evidence-based behavior change techniques. Three WeChat mini-programs served as the core delivery platform to implement the multifaceted intervention functions. The primary outcomes measured in this study included fasting blood glucose, 2-hour postprandial glucose (2hPG), hemoglobin A1c (HbA1c), and gestational weight gain (GWG). The secondary outcomes assessed included obstetric complications and neonatal parameters. Intention-to-treat analysis using adjusted generalized linear mixed models was conducted to evaluate the effects of the intervention. From March 2023 to October 2023, a total of 94 participants were enrolled in this study. Among the participants, 88 (93.62%) individuals (mean age 32.18, SD 5.04 years) successfully completed the study, 44 (46.81%) in the intervention group and 44 (46.81%) in the control group. Approximately 68.18% (30/44) of the participants in the intervention group demonstrated sustained adherence, as expected, adhered to the diet plan &#x2265;60% of the days. Compared with the control group, the intervention group showed a significantly greater decrease in GWG over time (group&#xd7;time interaction: &#x3b2;=-1.96, 95% CI -3.58 to -0.34; P=.02), with no significant effects on fasting blood glucose. Conversely, significant decreases in 2hPG (&#x3b2;=-0.12, 95% CI -0.19 to -0.04; P<.001) and HbA1c (&#x3b2;=-0.49, 95% CI -0.74 to -0.23; P<.001) were noted in the intervention group. No unexpected maternal adverse events occurred, and no significant effects on other health outcomes were detected. As a WeChat-delivered, behavior change wheel-informed intervention, WeMNT successfully reduced 2hPG, HbA1c, and GWG in GDM management. Its integrated self-management model yields robust evidence, validating this patient-centered tool as a viable option for clinical adoption.

Atherosclerotic cardiovascular disease (ASCVD), particularly myocardial infarction (MI), is the leading cause of mortality and morbidity worldwide. The pathophysiology of MI involves atherosclerotic plaque rupture with thrombus formation, interrupting myocardial blood supply with subsequent myocardial necrosis. Despite advances in primary prevention and acute revascularization strategies for MI, recurrent ischemic events and stent thrombosis continue to pose challenging issues for clinicians. Consequently, effective secondary prevention, specifically antiplatelet therapy (aspirin and P2Y12 inhibitors), is the cornerstone of the prevention of recurrent ischemia and cardiovascular death to improve long-term prognosis. However, the optimal choice and duration of antiplatelet therapy should be individualized depending on risk factors and comorbidities. This review will explore the mechanisms of thrombosis in MI, the role of antiplatelet therapy in secondary prevention after MI, and the clinical evidence supporting various antiplatelet agents, focusing on their pharmacological profiles, efficacy, safety considerations, guideline recommendations, and application in special populations based on available clinical trial data while highlighting key controversies, knowledge gaps, and emerging strategies such as biomarker-guided and genotype-guided therapy.

Blood pressure-related deaths from cardiovascular disease are higher in rural than in urban areas in the Unites States, especially in southeastern states. However, the barriers and potential solutions to hypertension care are inadequately understood. We interviewed 62 local community and health systems key informants in 2 rural (Pamlico and Robeson) counties in North Carolina. Probes based on the Consolidated Framework for Implementation Research were used to identify contextual barriers and facilitators affecting existing resources and services for improving hypertension care. Data were analyzed using hybrid deductive and inductive approaches, and organized into themes and subthemes with illustrative quotations. The prominent barriers of hypertension care emerged across outer setting (economic constraints, insufficient health insurance, food insecurity, wide accessibility of processed food, lack of transportation, digital connectivity gap, limited awareness of partnership and resources, and mistrust), inner setting (provider shortage, weak communication, rural food culture, and mistrust of health systems), and individual level (low health literacy, chronic stress, and a sense of hopelessness). The most cited facilitators were codesigning task-sharing approaches to hypertension care with community outreach that are tailored for rural settings, targeted subsidies for healthy food and health care, and trust building with the community, preferably led by faith-based leaders. Our findings based on consultations with diverse community and health systems partners show key challenges and highlight potential solutions to improve blood pressure control and cardiovascular health in rural communities in the United States. Concerted efforts to codesign hypertension care programs that are multisectoral, build on local resources, and include community outreach and trust building efforts are likely to be acceptable, effective, and sustainable.

The "2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome" retires, replaces, and expands upon the "2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults." The primary intended audience for this guideline is clinicians who care for patients across the spectrum of cardiovascular-kidney-metabolic syndrome, an interrelated condition characterized by the interconnections among metabolic risk factors (including obesity and type 2 diabetes), chronic kidney disease, and cardiovascular disease. A comprehensive literature search was conducted from October 29, 2024, to April 14, 2025, to identify clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human subjects that were published since 2015 in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. The focus of this clinical practice guideline is to create a living, working document that provides current knowledge in the field of cardiovascular-kidney-metabolic syndrome aimed at all practicing cardiologists, endocrinologists, nephrologists, and primary care and specialty clinicians who manage these patients.

Rapid initiation and up-titration of guideline-directed medical therapy (GDMT) are critical for improving outcomes in heart failure with reduced ejection fraction (HFrEF), yet initiation is frequently delayed and target doses are often not achieved in routine clinical care. We assessed whether a predefined standardised home-based titration strategy supported by telemonitoring enhances GDMT optimisation compared with standard of care. This study compared the TELEmonitored FAst Standardized Titration for Efficient Response in Heart Failure with reduced ejection fraction (TELEFASTER-HF) cohort (n=60) that underwent standardised, home-based GDMT titration with a contemporaneous standard-of-care cohort (n=65). Groups were balanced using inverse probability of treatment weighting. Outcomes included time to optimal medical therapy (OMT), comparative attainment of GDMT doses at 8&#x2009;weeks and GDMT persistence up to 12 months after the study index. The time to OMT was substantially shorter in TELEFASTER-HF patients compared with the standard-of-care cohort (median 48 vs 321 days, HR 16.1, 95%&#x2009;CI 8.3 to 31.2, p<0.001). Compared with standard-of care, TELEFASTER-HF care was associated with higher GDMT dose categories and achievement of higher rates of GDMT target doses across all drug classes needing titration at all follow-up time points. Exploratory analyses showed no heart failure hospitalisations in the TELEFASTER-HF group during 12 months from index compared with 26 events in the control cohort. A standardised, telemonitored, home-based GDMT titration strategy was associated with faster, more comprehensive and more durable optimisation of GDMT in patients with HFrEF compared with standard of care. This approach may help address persistent GDMT implementation gaps.

Arterial disease of the lower extremities is a common form of atherosclerosis associated with an increased risk of cardiovascular disease and mortality. Arterial disease of the lower extremities tends to progress from asymptomatic forms to intermittent claudication and critical ischemia. Sulodexide therapy in patients with PH allows for increased pain-free walking distance. At the same time, the scientific literature has not fully documented how long-term sulodexide therapy affects the quality of life of patients with arterial disease of the lower extremities. The aim of the study was to evaluate the effect of sulodexide on the quality of life of patients with arterial disease of the lower extremities. The multicenter prospective observational study of ANDANTE included patients with PH stage IIa-IIb according to the classification of A.V. Pokrovsky receiving sulodexide therapy. During the 6-month follow-up, 4 visits were conducted, during which the quality of life was analyzed based on a subjective assessment of physical and mental health using the SF-36 questionnaire. Pain-free walking distance, ankle-shoulder index, self-assessment of erection retention, WELCH walking ability scale scores, and Hasegawa dementia scale scores were also evaluated for men. In this article, we have considered only the dynamics of patients' quality of life in terms of physical and mental health on the SF-36 scale as the primary endpoint of the study. In the future, data on other criteria for the treatment of patients will be presented. The study included 229 patients aged 37 to 90 years (on average, 65.0&#xb1;9.9 years). Men prevailed among the patients - 159 (69.4%) patients. There were 118 (51.5%) smokers and 111 (48.5%) non-smokers. The average duration of the disease from the moment of diagnosis of arterial disease of the lower extremities to inclusion in the study was 6.0&#xb1;6.3 years. In addition to OCD, 72.5% of patients were diagnosed with hypertension, 28.4% with cerebrovascular disease, 26.6% with coronary heart disease, 25.3% with diabetes mellitus, and 19.7% with erectile dysfunction. At the time of inclusion in the study, 61.6% of patients were taking antiplatelet agents, 10.9% were taking direct oral anticoagulants, and 46.3% of patients were taking lipid-lowering therapy. At the time of inclusion in the study, 147 (64.2%) patients followed the recommendations on physical activity. Revascularization before inclusion in the study was performed in 19.2%, and 80.8% were treated conservatively. The study did not record any adverse events during sulodexide therapy. Compliance with therapy was high and averaged 4.6 points on a 5-point scale. The indicators of the physical aspect of the quality of life on the SF-36 scale significantly increased (p<0.01) after 6 months of treatment with sulodexide from 35.7&#xb1;8.3 points on the first visit, to 44.6&#xb1;7.2 points on the fourth. At the same time, the indicator increased by 8.9 (24.9%) points. The mental aspect of the quality of life during treatment also significantly improved from 45.4&#xb1;9.9 to 51.6&#xb1;6.7 points, an increase of 6.2 (13.6%) points. ANDANTE's study showed an improvement in subjective physical by 24.9% and mental by 13.6% aspects of quality of life on the background of sulodexide therapy in patients with ZANK.

Nonrheumatic valvular heart disease is an increasing public health concern. This study assessed the burden and quality of care for nonrheumatic valvular heart disease in Asia and at the global level from 1990 to 2021, and projected trends to 2050 using data from the GBS (Global Burden of Disease Study) 2021. Incidence, age-standardized incidence rate, deaths, age-standardized mortality rate, disability-adjusted life years, and age-standardized disability-adjusted life years rate were analyzed. A time-series model (autoregressive integrated moving average was used for forecasting future trends. A quality-of-care index was constructed through principal component analysis, and future quality-of-care index trends were projected using a Bayesian age-period-cohort model. From 1990 to 2021, both incident nonrheumatic valvular heart disease cases and age-standardized incidence rate increased globally and in Asia, whereas age-standardized mortality rate and age-standardized disability-adjusted life years rate declined. Projections suggest that incident cases will continue to rise through 2050, with age-standardized incidence rate decreasing globally but remaining relatively stable in Asia. Although Asia has lower age-standardized rates than the global average, its projected age-standardized incidence rate increase is greater. Disease burden varied by age and sex, with incidence peaking at 70 to 74&#x2009;years. Mortality exceeded that of men among women after age 70 to 74. Nonrheumatic aortic valve disease contributed to the greatest burden. Quality-of-care index improved markedly from 1990 to 2021 globally and in Asia, but recent gains have slowed, suggesting a plateau in care improvement. Nonrheumatic valvular heart disease burden is rising, especially in aging Asian populations. Despite declining mortality and improved care quality, increasing incidence and slowing quality-of-care index gains may intensify future health system pressures.

The optimal antithrombotic regimen for peripheral artery disease, balancing thromboembolic and bleeding risks, remains uncertain. This study aimed to compare the efficacy and safety of antithrombotic regimens in patients with peripheral artery disease. We reviewed randomized controlled trials evaluating antithrombotic therapies for peripheral artery disease, including aspirin, P2Y12 inhibitors, cilostazol, and rivaroxaban. The primary outcome was major adverse cardiac events, defined as a composite of cardiovascular death, myocardial infarction, and stroke. The secondary outcomes included major adverse limb events, defined as a composite of acute limb ischemia, revascularization, and amputation. The safety outcome was major bleeding, primarily assessed using the Thrombolysis in Myocardial Infarction criteria. We performed a network meta-analysis to compare antithrombotic regimens. Seventeen randomized controlled trials involving 44&#x2009;532 participants were included. Compared with aspirin monotherapy, the following were associated with lower risks of major adverse cardiac events: clopidogrel, 75 mg/d, plus cilostazol, 200 mg/d (hazard ratio [HR], 0.37 [95% CI, 0.20-0.72]), clopidogrel, 75 mg/d, monotherapy (HR, 0.80 [95% CI, 0.67-0.96]), aspirin plus low-dose rivaroxaban, 2.5 mg twice daily (HR, 0.81 [95% CI, 0.72-0.92]), and aspirin plus ticagrelor, 60 to 90 mg twice daily (HR, 0.81 [95% CI, 0.69-0.96]). Aspirin plus rivaroxaban or ticagrelor showed a lower risk of major adverse limb events compared with aspirin alone. Rivaroxaban monotherapy, 5 mg twice daily, and aspirin plus rivaroxaban or clopidogrel were associated with a higher risk of major bleeding. Clopidogrel plus cilostazol or clopidogrel monotherapy might be a balanced strategy in patients with peripheral artery disease.

With guidelines recommending earlier advanced therapy (AT) use after 5-ASA failure for patients with moderately-to-severely active ulcerative colitis (UC), it is important to explore treatment preferences at the point of escalation to first-line AT. A web-based discrete choice experiment (DCE) survey was administered to AT-na&#xef;ve patients with moderately-to-severely active UC and gastroenterologists in 5 European countries. Treatment attributes included time until symptom improvement, probability of remission and corticosteroid-free remission, risks of cancer, serious infection, and major adverse cardiovascular events (MACE), and mode of administration. Preference weights, relative attribute importance (RAI), and maximum acceptable risk were estimated. A latent class analysis explored preference heterogeneity. Probability of remission at 1&#xa0;year was the most important attribute for patients (N&#xa0;=&#xa0;514; RAI&#xa0;=&#xa0;45.3%) and gastroenterologists (N&#xa0;=&#xa0;397; RAI&#xa0;=&#xa0;48.5%). Five-year cancer risk was the second most important attribute for patients (RAI&#xa0;=&#xa0;11.8%) and third for gastroenterologists (RAI&#xa0;=&#xa0;10.9%). RAI of MACE was higher for patients than gastroenterologists (10.6% vs. 6.8%). Both were willing to accept risks for increased probability of remission. Latent class analysis identified 4 groups of patients and 2 groups of gastroenterologists with distinct preferences. The relative importance of efficacy was higher compared with safety in latent classes representing 80% of patients. Clinical remission was most important to patients and gastroenterologists, and both were willing to accept some risk in exchange for the benefits of AT. However, some heterogeneity in preferences was observed. To support patient-centered, guideline-concordant care, gastroenterologists should discuss escalation to AT with patients not well-controlled on conventional therapy, incorporating individual preferences through shared decision-making.

Socioeconomic development is gradually reducing in the prevalence of hypertension (HT) and associated risk factors between urban and rural areas. To update data for the Democratic Republic of the Congo by examining differences in the prevalence and control of HT and other cardiovascular risk factors between urban and rural populations of Congolese adults. During the May Measurement Month campaigns in 2023 and 2024, 4,012 participants aged &#x2265;&#xa0;30 years (1,036 residing in the city of Bukavu and 2,976 in the rural areas of Kaziba and Katana) were interviewed and underwent measurements of blood pressure, weight, and height. HT was defined as blood pressure &#x2265;&#xa0;140/90mmHg and/or current use of antihypertensive medication. Compared with urban participants, rural participants had a significantly higher prevalence of HT (33.4% vs. 27.8%; P=0.001), age >60 years (29.4% vs. 20.4%; P<0.0001), and smoking (27.6% vs. 14.0%; P<0.0001). Conversely, overweight (32.9% vs. 23.2%; P<0.0001), obesity (12.3% vs. 5.3%; P<0.0001), physical inactivity (32.9% vs. 11.8%; P<0.0001) and a history of diabetes mellitus (5.3% vs. 3.5%; P=0.01) were significantly more significantly more common in urban areas. Multivariate analysis indicated that rural residence (adjusted OR=1.55; P<0.0001) was an independent predictor of HT after adjustment for age, sex, BMI, smoking, diabetes mellitus, and physical inactivity. The findings suggest that the rural Congolese environment may contribute to hypertension due to an older age structure, the adoption of unhealthy behaviors, and low detection rates of HT. Enhanced awareness of HT diagnosis and promotion of healthy lifestyles are essential in these settings to mitigate this major cardiovascular risk factor.

With the rise in older population globally, the optimal blood pressure (BP) target for antihypertensive therapy in those aged 60 and above remains to be evaluated in the real-world practice. This study evaluated the effectiveness and safety of standard versus lower BP targets in old (aged 60-79) and very old (aged &#x2265;80) patients with hypertension in real-world clinical settings. We emulated a target trial using electronic medical records from the Hong Kong Hospital Authority, including patients aged 60&#xa0;years or above with a diagnosis of hypertension, uncontrolled BP and records of antihypertensives adjustments from 2008 to 2013. Patients were first categorized into 3 age groups (60-69, 70-79, &#x2265; 80) and then assigned to BP targets of either 130-140/80-90&#xa0;mmHg or below 130/80&#xa0;mmHg. Outcomes included major cardiovascular disease (CVD), end-stage renal disease, all-cause mortality and major adverse events related to antihypertensive treatment. Of 132 430 eligible patients identified, 52&#x2009;553, 28&#x2009;661 and 7106 patients aged 60-69, 70-79 and&#x2009;&#x2265;&#x2009;80&#xa0;years had BP targets of 130-140/80-90&#xa0;mmHg, respectively; 11&#x2009;148, 5636 and 1203 of patients in the same age groups had targets below 130/80&#xa0;mmHg. Lower BP target was associated with reduced overall CVD and all-cause mortality: aged 60-69&#xa0;years (CVD HR: 0.91 [95% CI, 0.85-0.96]; all-cause mortality: 0.89 [0.81-0.98]), aged 70-79&#xa0;years (CVD: 0.87 [0.82-0.93]; all-cause mortality: 0.84 [0.78-0.91]), and aged&#x2265;80&#xa0;years (CVD: 0.77 [0.69-0.86]; all-cause mortality: 0.80 [0.72-0.89]). No significant increase in major adverse events was observed in any age group. Results were consistent across all subgroups. Lowering BP of below 130/80&#xa0;mmHg in old and very old patients was associated with better cardiovascular and mortality outcomes without increased adverse events. These findings suggest that a lower BP target may be beneficial and safe for older patients with hypertension.

HIV remains a significant public health challenge despite highly effective prevention and treatment strategies. Screening for HIV infection is recommended for individuals ages 15 to 65 years. The status neutral approach to care includes preexposure prophylaxis for HIV-negative patients and antiretroviral therapy for patients with HIV. The preexposure prophylaxis options approved by the US Food and Drug Administration include oral and injectable formulations, which reduce HIV acquisition risk by 99% when taken consistently. Same-day antiretroviral therapy initiation is the standard of care for patients diagnosed with HIV infection, with integrase strand transfer inhibitor-based regimens preferred for treatment-naive patients. Key clinical considerations in primary care require modified management approaches for patients with HIV. All patients 40 to 75 years of age with HIV infection and 10-year atherosclerotic cardiovascular disease risk scores between 5% and less than 20% should be prescribed a moderate-intensity statin, and those with risk scores of 20% or greater should receive a high-intensity statin. In addition to standard age-appropriate vaccines, adults with HIV should receive hepatitis A and B (if not immune), meningococcal, pneumococcal, and herpes zoster vaccines. Cancer screening for patients with HIV includes lifelong cervical cancer screening. Anal cancer screening should start at age 35 for men who have sex with men and transgender women, and at age 45 for all other patients. Family physicians are uniquely positioned to deliver comprehensive care that addresses HIV-specific needs and whole person primary care.

Despite accounting for a quarter of all UK deaths, atherosclerotic cardiovascular disease (ASCVD) is frequently undertreated in non-specialist hospital care due to the perceived complexity of modern lipid management. This review aims to bridge the gap between evolving guidelines and routine clinical practice. We examine the advances in lipid testing, including lipoprotein (a), apolipoproteins and genetic testing, which have allowed improved and personalised risk assessment. While statins remain the foundation of lipid-lowering therapy, the treatment options have expanded and we discuss the role of ezetimibe, proprotein convertase subtilisin/kexin type 9 (PCSK9) monoclonal antibodies, inclisiran, and bempedoic acid. We also look ahead to gene-editing strategies and lipoprotein (a) lowering therapies currently in clinical trials. By simplifying these recent advances, this review aims to provide hospital clinicians with a practical approach to identify high-risk patients, optimise their therapy and reduce cardiovascular disease burden.

Background Studies have demonstrated that large language models (LLMs) can perform differential diagnosis based on textual radiologic findings; however, it is unclear how variations in reader-generated inputs affect LLM performance and clinical utility. Purpose To evaluate how reader experience influences the diagnostic benefit of LLM assistance in brain MRI differential diagnosis. Materials and Methods In this retrospective multireader study, neuroradiologists (n = 4), radiology residents (n = 4), and neurology/neurosurgery residents (n = 4) provided textual radiologic findings and their top three differential diagnoses for brain MRI scans with confirmed diagnoses obtained between January 2009 and April 2024 from a single academic center. Confirmed diagnoses were established histopathologically or through consensus of at least two neuroradiologists. Three LLMs (GPT-4.1 [OpenAI], Gemini 2.5 Pro [Google DeepMind], and DeepSeek-R1 [Hangzhou DeepSeek Artificial Intelligence Basic Technology Research]) generated differential diagnoses based on reader-provided findings. Readers revised their diagnoses after reviewing the suggestions of GPT-4.1. A cumulative link mixed model was fitted to evaluate the association between reader experience and diagnostic benefit, with change in diagnostic result as an ordinal outcome, reader experience as a predictor, and random intercepts for rater and patient. Results Forty brain MRI scans (mean patient age, 50 years &#xb1; 18 [SD]; 23 female) were included. LLM-generated diagnoses achieved the highest top-three accuracy based on imaging findings from neuroradiologists (78.8%-83.8% across LLMs), followed by radiology residents (71.8%-77.6%) and neurology/neurosurgery residents (63.2%-67.1%). Mean absolute gains in top-three accuracy with LLM assistance diminished with increasing experience: +19.4% for neurology/neurosurgery residents (from 43.2% to 62.6%), +14.7% for radiology residents (from 59.6% to 74.4%), and +4.4% for neuroradiologists (from 83.1% to 87.5%). Models demonstrated a negative association between reader experience and diagnostic benefit from LLM assistance (&#x3b2; = -0.10; P = .005) and a positive association of reader experience with correctness (&#x3b2; = 0.11; P < .001) and completeness (&#x3b2; = 0.18; P = .002) of imaging findings. Conclusion With increasing reader experience, LLM accuracy with reader-generated input improved, whereas accuracy gains from LLM assistance diminished. &#xa9; RSNA, 2026 Supplemental material is available for this article. See also the editorial by McMillan in this issue.

Thoracic and cardiac surgical procedures are associated with significant postoperative pain. Intercostal nerve cryoablation (INC) is a non-opioid adjunctive pain management strategy. The objective of this study was to comprehensively review published outcomes of INC during non-pectus repair thoracic and cardiac surgeries to inform clinical practice and guideline development. A literature search was conducted in PubMed, Embase, Google Scholar, and using manual approaches to identify comparative studies of patients undergoing non-pectus repair thoracic or cardiac procedures with INC versus standard of care (SOC) without INC. Meta-analyses were performed to quantitively evaluate opioid consumption and hospital length of stay (LOS). Secondary outcomes were summarized qualitatively. Twenty-four studies were included encompassing 18465 patients, of whom 10.6% (n&#x2009;=&#x2009;1954) received INC. INC was applied during surgical stabilization of rib fractures, thoracotomy, pulmonary resections, lung transplants, aortic aneurysm repair, and cardiac procedures. Meta-analyses of adult studies demonstrated a significant reduction in inpatient opioid consumption by 102 morphine milligram equivalents (MME) (95% CI: -180.00, -23.87) and a non-significant reduction in opioid consumption after discharge by 89 MME (95% CI: -182.00, 4.56) with INC. Sub-group analysis demonstrated the largest effect size in inpatient opioid reduction for bilateral thoracotomy or thoracosternotomy for lung transplants. Meta-analysis demonstrated no significant difference in hospital stay for adult patients treated with INC. The results of this systematic review and meta-analysis provide evidence to support the association between INC and reduced inpatient opioid consumption in non-pectus repair thoracic and cardiac procedures.

Approximately one million individuals live with heart failure in the UK, and clinicians diagnose around 200 000 new cases each year. Although lifesaving treatments such as heart transplantation (HTx) and left ventricular assist device (LVAD) therapy exist, healthcare providers perform only about 325 of these procedures annually across the UK and Ireland. This gap suggests that many eligible patients do not receive appropriate referrals for HTx or LVAD. The Transplant Cardiology Working Group conducted the inaugural UK and Ireland National Advanced Heart Failure Audit Report 2024 to promote quality improvement in caring for patients with advanced heart failure (AHF). This first international multicentre audit specifically examined referral patterns for HTx and LVAD therapies to the seven adult heart transplant centres across the UK and Ireland. The audit identified approximately 100 referrals per month for transplant or LVAD assessment. Adjusting for age eligibility, referral rates varied significantly by region, with some areas showing high referral levels and others substantially lower. The audit also found that a considerable number of referred patients had contraindications to HTx or LVAD therapy. Importantly, neither distance to the nearest transplant centre nor the deprivation level of the patient's postcode influenced referral likelihood, indicating that factors such as clinician awareness or local referral culture may drive variation. Additionally, women remain under-referred, comprising only one in three patients assessed for AHF therapies. This audit provides the first concrete evidence of widespread potential inequity in access to AHF therapies across the UK and Ireland. These findings have important implications for national healthcare planning, including workforce development and allocation of public health resources. Further work is required to investigate barriers to referral, enhance clinician awareness and optimise care pathways for patients in need of both life-prolonging and supportive therapies.