2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Perimenopausal combined hormonal contraception: focus on sexual function

Age alone should not be an absolute contraindication for any contraceptive methods. However, medical eligibility criteria for combined hormonal contraception (CHC) use must be taken into consideration when choosing an appropriate contraceptive method. Women should be counseled on the benefits and risks of CHC while in their 40s. If there are no contraindications, women may use CHC for contraception up until the age of 50 years. Loss of libido is a common symptom during the late 40s. While women associate this with hormone levels, libido is multifactorial and is influenced by family and work stress, tiredness, self-image, medications and the physical changes in their partner. During this stage, women might experience urogenital issues such as vaginal dryness, dyspareunia and bladder problems, which can further affect the woman's sexual function. Before attributing the cause of sexual dysfunction to CHC use, a complete gynecologic examination and a full biopsychosocial assessment of the woman and her partner should be conducted to define other potential causes. When CHC-related female sexual dysfunction is suspected, using an oral CHC with a higher estrogen dose, a vaginal contraceptive ring or a transdermal contraceptive patch, or switching to a progesterone-only pill or non-hormonal method, might be suggested.

Metabolic outcomes in women 6 months and 2 years after preeclampsia versus normotensive pregnancy: A P4 study

Preeclampsia is associated with an increased risk of long-term cardiometabolic disease; however, little is known regarding metabolic factors in the early postpartum years potentially contributing to these health disparities. This study aimed to compare body composition, serum biochemical parameters, energy balance and diet 6 months and 2 years after normotensive pregnancy versus preeclampsia. This is the longitudinal metabolic sub-study of the Postpartum Physiology, Psychology and Paediatric cohort study. Women were assessed 6 months and 2 years after normotensive pregnancy (n = 118) and preeclampsia (n = 47). Metabolic measures included anthropometry, body composition via bioelectrical impedance analysis, serum biochemical parameters, diet via a food recall diary, and 24-h energy expenditure using SenseWear Armbands. Two years postpartum, women after preeclampsia continued to have significantly higher weight (median 67.1 kg vs. 63.1 kg, p = .04) compared to normotensive pregnancies, in addition to higher LDL cholesterol levels (2.7 ± 0.8 mmol/L vs. 2.4 ± 0.6 mmol/L, p = .03). These women were also more likely to have an elevated HOMA-IR score ≥2.08 (44% vs. 19%, p = .01). For all women in our study, waist-to-hip ratio, percent fat mass and activity-associated energy expenditure improved overtime. However, HDL cholesterol levels deteriorated, and excess saturated fat and sodium intake persisted from 6 months postpartum. Therefore, two years after preeclampsia, women remain at greater metabolic risk than their normotensive counterparts, with greater weight, LDL cholesterol and markers of insulin resistance, potentially contributing to long-term cardiovascular morbidity and requiring early intervention.

[Stroke in octogenarians]

Stroke is one of the most common causes of disability in older adults. It remains a common cause of death and permanent functional limitation in individuals who are older than 80 years. Approximately 50% of all strokes occur in people over the age of 75, and 30% in those over 85. Top priorities in primary stroke prevention include the treatment of hypertension, anticoagulation for patients with atrial fibrillation, and lifestyle modifications such as smoking cessation.

Coronary computed tomography angiography improves assessment of patients with acute chest pain and inconclusively elevated high-sensitivity troponins

OBJECTIVES

To determine whether coronary computed tomography angiography (CCTA) can improve the diagnostic work-up of patients with acute chest pain and inconclusively high-sensitivity troponins (hs-troponin).

METHODS

We conducted a prospective, blinded, observational, multicentre study. Patients aged 30-80 years presenting to the emergency department with acute chest pain and inconclusively elevated hs-troponins were included and underwent CCTA. The primary outcome was the diagnostic accuracy of ≥ 50% stenosis on CCTA to identify patients with type-1 non-ST-segment elevation acute coronary syndrome (NSTE-ACS).

RESULTS

A total of 106 patients (mean age 65 ± 10, 29% women) were enrolled of whom 20 patients (19%) had an adjudicated diagnosis of type-1 NSTE-ACS. In 45 patients, CCTA revealed non-obstructive coronary artery disease (CAD) or no CAD. Sensitivity, specificity, negative predictive value (NPV), positive predictive value and area-under-the-curve (AUC) of ≥ 50% stenosis on CCTA to identify patients with type 1 NSTE-ACS, was 95% (95% confidence interval: 74-100), 56% (45-68), 98% (87-100), 35% (29-41) and 0.83 (0.73-0.94), respectively. When only coronary segments with a diameter ≥ 2 mm were considered for the adjudication of type 1 NSTE-ACS, the sensitivity and NPV increased to 100%. In 8 patients, CCTA enabled the detection of clinically relevant non-coronary findings.

CONCLUSION

The absence of ≥ 50% coronary artery stenosis on CCTA can be used to rule out type 1 NSTE-ACS in acute chest pain patients with inconclusively elevated hs-troponins. Additionally, CCTA can help improve the diagnostic work-up by detecting other relevant conditions that cause acute chest pain and inconclusively elevated hs-troponins.

CLINICAL RELEVANCE STATEMENT

Coronary CTA (CCTA) can safely rule out type 1 non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in patients presenting to the ED with acute chest pain and inconclusively elevated hs-troponins, while also detecting other relevant non-coronary conditions.

TRIAL REGISTRATION

Clinicaltrials.gov (NCT03129659). Registered on 26 April 2017 KEY POINTS: Acute chest discomfort is a common presenting complaint in the emergency department. CCTA achieved very high negative predictive values for type 1 NSTE-ACS in this population. CCTA can serve as an adjunct for evaluating equivocal ACS and evaluates for other pathology.

Aspirin does not confer protection against major ischemic vascular events in patients diagnosed with rheumatoid arthritis

OBJECTIVE

Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease characterized by inflammatory arthritis and extra-articular involvement. Patients with RA are at increased risk of developing cardiovascular diseases. This retrospective cohort study aimed to determine whether acetylsalicylic acid (aspirin [ASA]) protects against major ischemic vascular events in patients diagnosed with RA.

METHODS

Patients with RA were recruited from a population of 118, 500 participants who were enrolled into the Kailuan Cohort Study between 2014 and 2016. Information regarding demographic characteristics, anthropometric measures, and medical histories were documented. Patients with RA who underwent ASA therapy were propensity score matched at a ratio of 1:4 with patients with RA who did not receive ASA. The risk of ischemic vascular events (myocardial infarction and ischemic stroke) was examined. The relationship between ASA therapy and major ischemic vascular events was analyzed by Cox proportional hazards regression.

RESULTS

A total of 939 patients with RA were included (189 who received ASA and 750 who did not). During the 3.3-year follow-up, six and 35 major ischemic vascular events occurred in the ASA and non-ASA groups, respectively, with no significant between-group difference in the cumulative incidence of such events. Cox proportional hazards regression analysis showed that ASA therapy was not associated with major vascular ischemic events and its subtypes.

CONCLUSIONS

ASA did not confer protection against major ischemic vascular events in patients diagnosed with RA.

Artificial Intelligence in Ischemic Heart Disease Prevention

PURPOSE OF REVIEW

This review discusses the transformative potential of artificial intelligence (AI) in ischemic heart disease (IHD) prevention. It explores advancements of AI in predictive modeling, biomarker discovery, and cardiovascular imaging. Finally, considerations for clinical integration of AI into preventive cardiology workflows are reviewed.

RECENT FINDINGS

AI-driven tools, including machine learning (ML) models, have greatly enhanced IHD risk prediction by integrating multimodal data from clinical sources, patient-generated inputs, biomarkers, and imaging. Applications in these various data sources have demonstrated superior diagnostic accuracy compared to traditional methods. However, ensuring algorithm fairness, mitigating biases, enhancing explainability, and addressing ethical concerns remain critical for successful deployment. Emerging technologies like federated learning and explainable AI are fostering more robust, scalable, and equitable adoption. AI holds promise in reshaping preventive cardiology workflows, offering more precise risk assessment and personalized care. Addressing barriers related to equity, transparency, and stakeholder engagement is key for seamless clinical integration and sustainable, lasting improvements in cardiovascular care.

The effect of bedtime snacks on morning fasting blood glucose in gestational diabetes mellitus: a randomized controlled trial

IMPORTANCE

While guidelines recommend bedtime snacks for women with gestational diabetes mellitus (GDM), there is insufficient evidence championed those recommendation.

OBJECTIVE

To evaluate if bedtime snacking is effective in preventing high fasting blood glucose incidence among women with GDM.

DESIGN

An open-label, parallel-group, randomized controlled trial was conducted from December 2023 to July 2024 at Ma'anshan Maternal and Child Health Care Center, Anhui, China.

INTERVENTIONS

A total of 62 GDM cases at the nutrition clinics were enrolled, and were randomly and equally allocated to groups of bedtime snacks (25 g nuts, intervention group) and no bedtime snacks (control group). The intervention was lasted for 8 weeks, during which fasting blood glucose was measured 3 times per week, 1-hour postprandial glucose and 2-hour postprandial glucose 2 times per week with a home glucometer. In the late pregnancy (approximately at 34 weeks), the glycated haemoglobin, high-density lipoprotein, low-density lipoprotein, triglycerides, total cholesterol were measured in the laboratory and birth outcomes information (birth weight, gestational weeks at delivery, delivery mode) were collected.

MAIN OUTCOMES AND MEASURES

The primary outcomes were the level of fasting blood glucose and the hyper-fasting blood glucose incidence during 8-week duration. The secondary outcomes were the level of the glycated haemoglobin, high-density lipoprotein, low-density lipoprotein, triglycerides and total cholesterol in the late pregnancy. Generalized estimating equations and analysis of covariates were conducted for the analysis of the primary outcomes. The multivariate linear regression was conducted for the analysis of the secondary outcomes. Post-hoc analysis was also conducted for the indicators of 1-hour postprandial glucose, 2-hour postprandial glucose and perinatal outcomes applying generalized estimating equations, analysis of covariates, the multivariate linear regression and logistics regression.

RESULTS

After adjusting for maternal age, pre-pregnancy body mass index, mid-pregnancy glucose, mid-pregnancy blood lipids and diet in late pregnancy, neither the average fasting blood glucose (control group: 4.90 mmol l-1, intervention group: 4.96 mmol l-1) (β = 0.05, [95%CI-0.22 to 0.31], P = 0.720) nor hyper-fasting blood glucose incidence (control group: 0.19, intervention group:0.26) (β = 0.07, [95%CI-0.07 to 0.20], P = 0.335) were significant different between the two groups. And we found low-density lipoprotein level were higher in the intervention group (3.21 mmol l-1) compared to the control group (2.52 mmol l-1) (β = 0.70, [95%CI0.07 to 1.34], P = 0.031). Additionally, post-hoc analysis showed that the incidence of elevated 1-hour postprandial glucose was significantly higher in the intervention group (0.42) than in the control group (0.28) (β = 0.14, [95%CI0.01 to 0.27], P = 0.036). No difference was found regarding any perinatal outcomes between the two groups.

CONCLUSIONS

Bedtime snack did not reduce the risk of morning hyperglycaemia and adverse perinatal outcomes in women with gestational diabetes mellitus, but exacerbated lipid markers and the 1-hour postprandial glucose profile. Our study did not support clinicians and relevant guidelines to recommend bedtime snacking as a form of glycaemic control in women with GDM. Clinical trial identification number: ChiCTR2300078399. URL of the registration site: https://www.chictr.org.cn/bin/project/edit?pid=210400 .

Analysis of 26 Studies of the Impact of Coconut Oil on Lipid Parameters: Beyond Total and LDL Cholesterol

Coconut oil (CNO) is often characterized as an "artery-clogging fat" because it is a predominantly saturated fat that ostensibly raises total cholesterol (TChol) and LDL cholesterol (LDL-C). Whereas previous analyses assessed CNO based on the relative effects on lipid parameters against other fats and oils, this analysis focuses on the effects of CNO itself. Here, we review the literature on CNO and analyze 984 lipid profile data sets from 26 CNO studies conducted over the past 40 years. This analysis shows considerable heterogeneity among CNO studies regarding participant selection, the amount consumed, and the study duration. The analysis reveals that, overall, CNO consumption gives variable TChol and LDL-C values, but that the HDL-cholesterol (HDL-C) values increase and triglycerides (TG) decrease. This holistic lipid assessment, together with the consideration of lipid ratios, shows that CNO does not pose a health risk for heart disease. Because the predominantly medium-chain fatty acid profile of CNO is significantly different from that of lard and palm oil, studies using these as reference materials do not apply to CNO. This paper concludes that the recommendation to avoid consuming coconut oil due to the risk of heart disease is not justified.

Age-stratified comparison of heart age and predicted cardiovascular risk in 370 000 primary care patients

BACKGROUND

Cardiovascular disease (CVD) preventive medications are recommended for patients at high short-term CVD risk. As most younger people with multiple raised CVD risk factors levels have low short-term risk, they could be falsely reassured to take no action. Heart age-the chronological age of a hypothetical person with the same short-term absolute CVD risk as the patient being assessed, but with an 'ideal' risk profile-is a complementary relative CVD risk metric developed to encourage these younger patients to make long-term lifestyle changes. However, clinicians sometimes use heart age to inform medication decisions. We assessed the appropriateness of this practice by comparing heart age and short-term CVD risk.

METHODS

New Zealand primary care patients are recruited to the PREDICT cohort when their CVD risk is assessed. PREDICT is an ongoing prospective study in one-third of New Zealand general practices, designed to derive CVD risk prediction algorithms. Five-year CVD risk was calculated for 35-74-year-old PREDICT participants using published equations. Heart age was calculated using non-smoking, systolic blood pressure of 120 mm Hg and total cholesterol/high-density lipoprotein ratio of 3.5, as the 'ideal' risk profile. CVD risk and heart age gaps (difference between chronological age and heart age) were compared.

RESULTS

Among 371 676 PREDICT participants, 5-year CVD risk increased with age, approximately doubling every 10 years, whereas heart age gaps decreased with increasing age, approximately halving between 35 and 44-year olds and 65-74-year olds. There were 5-40-year heart age gap differences between groups with similar 5-year CVD risks, but different ages.

CONCLUSION

Short-term CVD risk and heart age are not interchangeable risk metrics. Short-term risk increases with increasing age whereas heart age gaps generally decline, with major differences between younger and older people with similar short-term risk. If heart age is used to inform medication decisions rather than encourage long-term lifestyle changes, older people at high short-term risk could be undertreated and younger people at low short-term risk could be unnecessarily medicated.

The effect of sarpogrelate compared to aspirin in high- or very-high-risk diabetes for primary prevention

The benefit of aspirin in primary prevention for atherosclerotic cardiovascular diseases (ASCVD) is questionable due to bleeding complications. We analyzed the Korean National Health Insurance data to compare the efficacy and overall bleeding of sarpogrelate, an antiplatelet agent with lower bleeding risk, versus aspirin in high-/very-high-risk diabetic populations without prior ASCVD. The primary endpoint was net adverse clinical events (NACE), defined as a composite of efficacy and overall bleeding. The efficacy was a composite of all-cause death, myocardial infarction (MI) and stroke, whereas overall bleeding included intracranial hemorrhage (ICH) and gastrointestinal (GI) bleeding. A total of 10,778 high-/very-high-risk diabetic patients (9550 on aspirin, 1228 on sarpogrelate) were analyzed. After propensity score matching, sarpogrelate was linked to a lower incidence of NACE (HR:0.71; 95% CI 0.57-0.88), mainly driven by 62% reductions in overall bleeding (0.38; 0.17-0.81), a composite of 64% and 72% lower rate of GI bleeding and ICH, respectively. Additionally, there was no significant differences in MI or stroke between groups. In high- or very-high-risk diabetic patients without ASCVD, sarpogrelate use was associated with net clinical benefit mainly due to the reduction of significant reduction in overall bleeding events.

Physical activity during summer and recognition of heatstroke prevention among patients with cardiovascular disease in an urban area of Japan: a descriptive study

OBJECTIVE

Patients with cardiovascular disease are considered a high-risk population for heat-related illnesses. This study aimed to describe the difference in physical activity between summer and fall among patients with cardiovascular disease and their recognition of heatstroke prevention in an urban area with high temperature conditions.

RESULTS

We enrolled 56 outpatients who participated in cardiac rehabilitation in the summer of 2022 (median age, 75 years [interquartile range, 68-80]). Physical activity level for each patient was assessed using the International Physical Activity Questionnaire at baseline in summer (August) and follow-up in fall (October). Changes in exercise habits and frequency of going outside during the study period and the patients' recognition of heatstroke prevention were assessed using questionnaires. The prevalence of low physical activity was higher in summer than in fall (57.1% vs. 37.5%, p = 0.013). Of the patients involved in self-exercise before summer, 33.9% answered that their exercise habits decreased in summer. Of them, 47.4% felt that their exercise habits remained decreased in fall. Regarding the frequency of going outside, 82.1% went outside less in summer. Most participants were highly interested in heatstroke prevention.

The impact of dietary patterns on gut microbiota for the primary and secondary prevention of cardiovascular disease: a systematic review

BACKGROUND

Previous studies found that it is promising to achieve the protective effects of dietary patterns on cardiovascular health through the modulation of gut microbiota. However, conflicting findings have been reported on how dietary patterns impact gut microbiota in individuals either established or at risk of cardiovascular disease (CVD). Our systematic review aimed to explore the effect of dietary patterns on gut microbiota composition and on risk factors for CVD in these populations.

METHODS

We systematically searched seven databases, including PubMed/MEDLINE, MEDLINE (Ovid), Embase (Ovid), CINHAL (EBSCO), Web of Science, CNKI (Chinese), and Wanfang (Chinese), covering literature from inception to October 2024. Studies were included if they focused on adults aged 18 years and older with CVD or at least two CVD risk factors, implemented dietary pattern interventions, and incorporated outcomes related to microbiome analysis. The risk of bias for included studies was assessed using the revised Cochrane risk of bias tool (RoB2) for randomized trials and the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) for non-randomized studies. Changes in the relative abundance of the gut microbiome were summarized at various taxonomic levels, including phylum, class, order, family, genus, and species. Random-effects meta-analysis was conducted to analyze the mean difference in cardiometabolic parameters pre- and post-intervention.

RESULTS

Nineteen studies were identified, including 17 RCT and two self-controlled trails. Risk of bias across the studies was mixed but mainly identified as low and unclear. The most frequently reported increased taxa were Faecalibacterium (N = 8) with plant-rich diets, Bacteroides (N = 3) with restrictive diets, and Ruminococcaceae UCG 005 and Alistipes (N = 9) with the polyphenol-rich diets. The most frequently reported decreased taxa were Parabacteroides (N = 7) with plant-rich diets, Roseburia (N = 3) with restrictive diets, and Ruminococcus gauvreauii group (N = 6) with the polyphenol-rich diets. Plant-rich diets showed a significant decrease in total cholesterol (TC) with a mean difference of -6.77 (95% CI, -12.36 to -2.58; I2 = 84.7%), while restrictive diets showed a significant decrease in triglycerides (TG) of -22.12 (95% CI, -36.05 to -8.19; I2 = 98.4%).

CONCLUSIONS

Different dietary patterns showed distinct impacts on gut microbiota composition. Plant-rich diets promoted the proliferation of butyrate-producing bacteria, suggesting promising prospects for modulating gut microbiota and butyrate production through dietary interventions to enhance cardiovascular health. Further research is warranted to investigate the long-term effects of dietary patterns on clinical endpoints, such as CVD events or mortality.

REVIEW REGISTRATION

Registration number: CRD42024507660.

Lipid Lowering Therapy Utilization and Lipid Goal Attainment in Women

PURPOSE OF REVIEW

The purpose of this review is to provide an overview of the current status of lipid-lowering therapy utilization and lipid goal attainment in women. We focus on lipid-lowering therapy in individuals with and without established atherosclerotic cardiovascular disease, as well as familial hypercholesterolemia. Additionally, this review aims to explore the underlying mechanisms driving these sex differences and to identify existing knowledge gaps in this area.

RECENT FINDINGS

Despite the proven efficacy of lipid-lowering therapy in both sexes, real-world studies indicate that women with comparable risk profiles are less likely than men to receive these treatments. Furthermore, women who are prescribed statins typically receive lower-intensity regimens than men and are less likely to achieve guideline-recommended low-density lipoprotein cholesterol goals. Despite advancements in lipid-lowering therapies, women compared to men, are systematically undertreated. This difference is influenced by patient-related, physician-related, and societal factors.

Chronic disease prevalence and preventive care among Ontario social housing residents compared with the general population: a population-based cohort study

BACKGROUND

Older adults living in social housing report poor health and access to healthcare services. This study aimed to estimate the prevalence of chronic diseases, influenza vaccination and cancer screenings among social housing residents versus non-residents in Ontario, Canada.

METHODS

We conducted a population-based cohort study for all health-insured Ontarians alive and aged 40 or older as of 1 January 2020. Social housing residents were identified using postal codes. Validated health administrative data case definitions were used to identify individuals with diabetes, hypertension, chronic obstructive pulmonary disease, asthma, congestive heart failure and cardiovascular disease. Influenza vaccination and mammography, Pap and colorectal cancer screenings were identified among screen-eligible residents using health administrative data.

RESULTS

The prevalence of all chronic diseases was higher among social housing residents across all age groups: 40-59, 60-79 and 80+ years. Influenza vaccination rates in 2018-2019 were lower among social housing residents aged 60-79 and 80+ years. Mammography rates for women aged 50-69 years in 2018-2019 were 10-11% lower among social housing residents across all age groups compared with non-residents. Pap screening rates for women aged 40-69 in 2018-2019 were 6-8% lower among social housing residents. The percentage of colorectal screening in both women and men aged 52-74 was lower (9-10% in men and 6-7% in women) in social housing compared with the general population in 2019-2020.

CONCLUSION

There is a higher prevalence of chronic diseases and lower cancer screening rates among the growing population of older adults in social housing in Ontario, Canada.

Global trends in the burden of ischemic heart disease based on the global burden of disease study 2021: the role of metabolic risk factors

BACKGROUND

Ischemic heart disease (IHD) remains a leading cause of mortality and morbidity globally. This study aims to evaluate the trends in IHD burden across different socioeconomic regions using data from the Global Burden of Disease Study 2021 (GBD 2021) and to understand the impact of the metabolic risk factors on these trends.

METHODS

Data from GBD 2021 was analyzed to evaluate the global age-standardized death rates (ASDR) and disability-adjusted life years (ASRDALYs) linked to IHD. Key metabolic risk factors evaluated included high systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDLc), fasting plasma glucose (FPG), and body mass index (BMI). Temporal trends were assessed using estimated annual percentage changes (EAPCs), with further analysis by age, sex and socio-demographic index (SDI).

RESULTS

Resource-abundant regions showed notable reductions in ASDR and ASRDALYs, largely due to effective management of SBP and LDLc, resulting in an EAPC of -3.43 (95% CI: -3.32, -3.53). In contrast, resource-limited regions, particularly among males, experienced stagnation or even increases in IHD burden. The EAPC of ASDR in low-, low-middle-, and middle-SDI regions ranged from - 0.12 (95% CI: -0.04, -0.19) to 0.16 (95% CI: 0.09, 0.23). Among males, the values ranged from 0.22 (95% CI: 0.14, 0.29) to 0.55 (95% CI: 0.47, 0.62). The increase in IHD burden in these regions was primarily driven by rising levels of FPG and BMI. Younger populations (15-49 years) were disproportionately affected, showing increasing exposure to these metabolic risks.

CONCLUSION

Regional disparities in IHD burden persist, primarily driven by metabolic risk factors. Resource-abundant regions have benefitted from effective control of SBP and LDLc, whereas resource-limited regions face growing challenges, especially related to FPG and BMI. The use of secondary data from the GBD 2021 database provides a comprehensive global perspective but may not fully capture local variations in disease burden. Targeted public health strategies and early interventions are essential to reduce the growing IHD burden in these vulnerable populations.

Updates on CAD risk assessment: using the coronary artery calcium score in combination with traditional risk factors

BACKGROUND

Coronary artery disease (CAD) is the third leading cause of death worldwide, so prevention and early diagnosis play important roles to reduce mortality and morbidity. Traditional risk-score assessments were used to find the at-risk patients in order to prevent or early treatment of CAD. Adding imaging data to traditional risk-score systems will able us to find these patients more confidently and reduce the probable mismanagements.

MAIN TEXT

Measuring the vascular calcification by coronary artery calcium (CAC) score can prepare valuable data for this purpose. Using CAC became more popular in recent years. The most applicable method to evaluate CAC is Agatston scoring using computed tomography (CT) scanning. Patients are classified into several subgroups: no evidence of CAD (score 0), mild CAD (score 1-10), minimal CAD (score 11-100), moderate CAD (score 101-400), and severe CAD (score > 400) and higher than1000 as the extreme risk of CVD events.

CONCLUSIONS

CAC assessment was recommended in the patients older than 40 years old with CAD risk factors, the ones with stable angina, borderline-to-intermediate-risk group, etc. According to the results of the CAC the patients may be candidate for further evaluation for needing revascularization, medical treatment, or routine follow-up. Adding artificial intelligence (AI) to CAC will prepare more data and can increase the reliability of our approach to the patients promising a bright future to improve this technology.

Prevalence of Lp(a) in a real-world Portuguese cohort: implications for cardiovascular risk assessment

BACKGROUND

Cardiovascular disease (CVD) is a major cause of mortality worldwide, necessitating more refined strategies for risk assessment. Recently, lipoprotein(a) [Lp(a)] has gained attention for its distinctive role in atherosclerosis, yet its prevalence and impact for cardiovascular risk assessment are not well-documented in the Portuguese population. This study aimed to characterize Lp(a) levels in a real-world Portuguese cohort, investigating its prevalence and association with CVD risk.

METHODS

Retrospective and cross-sectional study of adults who underwent serum Lp(a) analysis in a Portuguese hospital between August 2018 and June 2022. Demographic and anthropometric data, laboratory values, relevant comorbidities and lipid-lowering medication were collected.

RESULTS

Of 1134 participants, 28.7% had elevated Lp(a) levels (> 125 nmol/L). A higher prevalence was observed in those with atherosclerotic cardiovascular disease (ASCVD) (45.9%) or a family history of premature CVD (41.9%). Additionally, a significant association was found between elevated Lp(a) levels and traditional CVD risk factors, including hypertension, dyslipidemia, and diabetes mellitus. Among those classified as having low-to-moderate CVD risk by (Systematic COronary Risk Evaluation 2) SCORE2, 55.7% exhibited high Lp(a) levels (> 75 nmol/L), suggesting a potential higher risk of CVD disease.

CONCLUSIONS

The prevalence of elevated Lp(a) in Portugal, notably among those with ASCVD or premature CVD history, is concerning. This study underscores the potential of Lp(a) assessment for a more comprehensive approach to cardiovascular risk assessment. This could improve the stratification of CVD risk and identify individuals who could benefit from early intensive management of their risk factors, ultimately reducing the burden of CVD and cardiovascular-related mortality.

Cardiovascular risk profiling among South Asian adults in Hong Kong: a latent class analysis

BACKGROUND

South Asians living in urbanized settings are facing disproportionate cardiovascular burden largely attributable to modifiable risk factors. Given the rapid surge in South Asian population in Hong Kong, this study aims to identify and distinguish clusters of cardiovascular risk profiles among community-dwelling South Asian adults.

METHODS

Between June 2022 and December 2023, 1181 South Asian adults were recruited through territory-wide outreach health assessments on lifestyle, psychological distress, obesity, clinical cardiovascular conditions, and sociodemographic factors. Latent class analysis was performed to classify the cardiovascular profiles, followed by multinomial logistic regression to identify the sociodemographic characteristics across classes.

RESULTS

Five latent classes were identified: low risk (19.6%), lifestyle risk plus distress (8.9%), obesity risk (33.4%), lifestyle risk plus distress with obesity (26.6%), and high clinical risk (11.4%). Apart from the higher clinical risk in older adults, women tended to cluster into classes with obesity, while men and the economically active were more likely in classes with poorer lifestyles and stress. Pakistani and Nepalese consistently exhibited higher risks compared to Indians, whereas the less educated tended to cluster into the high clinical risk class.

CONCLUSION

This study revealed distinct cardiovascular risk patterns and sociodemographic features within the South Asian community in Hong Kong. The heavy burden on obesity especially in women, lifestyle and psychological risks especially in men, and low overall physical activity level may be translated into a tremendous cardiovascular disease burden in the forthcoming decades, in particular among Pakistani and Nepalese as well as the socioeconomically disadvantaged.

Correlation between metabolic dysfunction-associated steatotic liver disease and subclinical coronary atherosclerosis in eastern China

BACKGROUND

Metabolic dysfunction-associated steatotic liver disease (MASLD) is characterized by the presence of at least one cardiovascular disease (CVD) risk factor, underscoring its potential to elevate CVD risk in affected individuals. However, evidence linking MASLD to subclinical coronary atherosclerosis remains scarce, and further investigations are necessary to elucidate the independent role of varying MASLD severities as a CVD risk factor.

METHODS

This study analyzed 7,507 participants aged ≥ 40 who underwent comprehensive health evaluations at the Shanghai Health and Medical Center. Logistic regression analysis was utilized to explore the relationship between MASLD severity and the presence of coronary artery calcification (CAC). Correlation analysis was performed to assess the association between MASLD severity and CAC staging.

RESULTS

After adjusting for established CVD risk factors, MASLD showed a significant association with CAC, which intensified with increasing MASLD severity. Among individuals with hypertension, MASLD was markedly correlated with CAC. In contrast, in non-hypertensive participants, only moderate and severe MASLD were significantly associated with CAC, while mild MASLD demonstrated no notable link, even after adjustment for CVD risk factors. Moreover, correlation analysis revealed a positive association between MASLD severity and CAC staging, indicating that higher MASLD severity aligned with more advanced CAC stages.

CONCLUSION

This study highlighted that MASLD severity was independently associated with subclinical atherosclerosis, irrespective of traditional CVD risk factors, in an urban eastern Chinese population without a prior history of coronary atherosclerosis. The strongest associations were observed in individuals with severe MASLD, emphasizing the importance of assessing MASLD severity in CVD risk stratification.

Acute Coronary Syndrome in Brazil: Registration of Predisposing Factors and Population Profile in a National Public Reference Cardiological Institute

BACKGROUND

Acute coronary syndrome (ACS) is one of the leading causes of mortality worldwide. Knowing the predisposing factors is essential for preventing it.

OBJECTIVES

To describe the etiological and epidemiological characteristics of the population with ACS admitted to an emergency room in the State of São Paulo.

METHODS

The prospective cohort study, based on electronic medical records from a public cardiology institute located in the state of São Paulo, Brazil, describes 5,580 patients hospitalized with ACS between August 2018 and October 2022. The main epidemiological characteristics, the association between confirmed ACS and risk scores, and adverse events during hospitalization and in the 30-day follow-up after hospital discharge were evaluated. The significance level was set at 5%.

RESULTS

The main factors associated with ACS were hypertension (80.38%), obesity or overweight (72.47%), and previous coronary artery disease (CAD) (59.11%). In the GRACE score, 65.10% were considered low risk, while 81.34% in the TIMI and 71.16% in the HEART were identified as moderate risk. Catheterization represented 84.93% of the diagnostic methods. Clinical treatment was the strategy adopted in 46.47% of the cases. In the 30-day evolution, 3.10% presented major bleeding, 7.86% infarction/reinfarction, 5.55% stroke, and 2.53% evolved to death.

CONCLUSION

The results of the largest Brazilian ACS registry to date highlight the impact of potentially modifiable risk factors on the occurrence of ischemic events in the local population. The findings may contribute to the development of public policies aimed at preventing and controlling the burden of ischemic disease in the country.

Moderate-intensity interval exercise exacerbates cardiac lipotoxicity in high-fat, high-calories diet-fed mice

Physical exercise is a cornerstone for preventing diet-induced obesity, while it is unclear whether physical exercise could offset high-fat, high-calories diet (HFCD)-induced cardiac dysfunction. Here, mice were fed with HFCD and simultaneously subjected to physical exercise. As expected, physical exercise prevented HFCD-induced whole-body fat deposition. However, physical exercise exacerbated HFCD-induced cardiac damage. Further metabolomic analysis results showed that physical exercise induced circulating lipid redistribution, leading to excessive cardiac lipid uptake and lipotoxicity. Our study provides valuable insights into the cardiac effects of exercise in mice fed with HFCD, suggesting that counteracting the negative effect of HFCD by simultaneous physical exercise might be detrimental. Moreover, inappropriate physical exercise may damage certain organs even though it leads to weight loss and overall metabolic benefits. Of note, the current findings are based on animal experiments, the generalizability of these findings beyond this specific diet and mouse strain remains to be further explored.

Rosuvastatin-based combination treatment with acetylsalicylic acid or ezetimibe in the management of patients at high and very high cardiovascular risk. Expert opinion paper of the Polish Lipid Association 2025

Lipid disorders are the most common risk factor for atherosclerotic cardiovascular disease (ASCVD) in Poland, where it is responsible for up to 200,000 deaths per year, with the number of myocardial infarctions and strokes reaching 80,000 annually and 25% of people dying within 3 years after a myocardial infarction. Despite the availability of effective drugs, the level of control of low-density lipoprotein cholesterol (LDL-C) is low, at only about 20% among high- and very high-risk patients, who often require combination lipid-lowering therapy (LLT) with a potent statin (e.g. rosuvastatin) and ezetimibe. Moreover, in Poland, several million patients require concomitant lipid-lowering and antiplatelet (acetylsalicylic acid) therapy based on their risks and indications. Single pill combinations (SPCs) improve adherence to treatment as well as the achievement of therapeutic goals and allow a greater reduction in cardiovascular incidents and mortality. This expert opinion paper, endorsed by the Polish Lipid Association (PoLA), provides practical recommendations for more effective treatment of patients with indications for LLT and antiplatelet therapy using available rosuvastatin-based combination therapies (with ezetimibe or acetylsalicylic acid).

Cardiovascular-Liver-Metabolic Health: Recommendations in Screening, Diagnosis, and Management of Metabolic Dysfunction-Associated Steatotic Liver Disease in Cardiovascular Disease via Modified Delphi Approach

There is a new awareness of the widespread nature of metabolic dysfunction-associated steatotic liver disease (MASLD) and its connection to cardiovascular disease (CVD). This has catalyzed collaboration between cardiologists, hepatologists, endocrinologists, and the wider multidisciplinary team to address the need for earlier identification of those with MASLD who are at increased risk for CVD. The overlap in the pathophysiologic processes and parallel prevalence of CVD, metabolic syndrome, and MASLD highlight the multisystem consequences of poor cardiovascular-liver-metabolic health. Metabolic dysfunction and associated insulin resistance, together with the predilection for ectopic fat deposition in the liver and surrounding tissues, are associated with elevated risk of endothelial dysfunction, systemic inflammatory response, and ectopic fat deposition in the epicardium. This complex pathophysiology can accelerate atherogenic dyslipidemia, atherogenesis, diastolic dysfunction, valvular calcification, and cardiac arrhythmias. Despite the mounting evidence of mechanistic pathways underpinning MASLD and CVD, current recommendations have not clearly focused upon MASLD as a risk factor or target for intervention in CVD. We have brought together a diverse range of international experts committed to promoting cardiovascular-liver-metabolic health and related outcomes across the globe. The overarching goal of this document is to offer a construct for clinicians in the cardiovascular field with regards to (1) diagnosis and screening of MASLD through the use of noninvasive serum and imaging tests; (2) screening for CVD in all individuals with MASLD regardless of established atherosclerotic risk factors; and (3) the approach to management of MASLD with respect to prevention of CVD through lifestyle, as well as pharmacologic and surgical strategies. To achieve this, the modified Delphi method was applied and a series of evidence-based quality standard recommendations have been identified.

Atherosclerotic Cardiovascular Disease Risk Scores are Associated with Carotid Intima-Media Thickness

Atherosclerotic cardiovascular disease (ASCVD) risk calculators estimate the 10-year incident risk of myocardial infarction (MI), coronary artery disease (CAD) death, or stroke; however, they lack comprehensiveness and accuracy. Carotid intima-media thickness (CIMT) is a surrogate marker that may improve risk estimation acumen. The objective of this study was to derive ASCVD risk scores from historical data and determine whether these risk scores are associated with the history of subclinical CAD and CIMT. This retrospective cross-sectional study used an existing dataset of individuals with prediabetes. Subclinical CAD history was defined as the history of CAD, coronary plaque, or coronary revascularization without a history of MI. The online ASCVD Risk Estimator Plus calculator was used to derive individual risk scores. Chi-square or Fisher's exact tests for categorical variables and ANOVA for continuous variables detected differences among ASCVD risk categories. Linear regression of CIMT measurements on ASCVD risk scores ascertained ASCVD risk scores' utility in predicting CIMT measurements. The sample included 86 participants, 28% with a history of CAD, 60% male, and 95% White. No differences in risk scores existed between participants with or without CAD. Individuals with higher ASCVD risk scores were older (p ≤ .001) and had higher systolic blood pressure (p ≤ .001), CIMT arterial age (p = .003), mean IMT common (p ≤ .001), mean IMT maximum (p ≤ .001), and plaque burden (p = .02) measurements. ASCVD risk scores were significantly associated and moderately correlated with CIMT measurements. ASCVD risk scores were not associated with CAD history but were associated with CIMT measurements. While risk calculators provide a starting point for ASCVD risk estimation, physical tools like CIMT can diagnose ASCVD, categorize plaque quality, and track intervention efficacy. CIMT may be used for more direct ASCVD risk estimation. Risk scores are easily imputed from existing records but are only intended for incident risk, and their accuracy relies on the variables' availability and validity and the boundaries of the calculators.

A novel machine learning-based cancer-specific cardiovascular disease risk score among patients with breast, colorectal, or lung cancer

BACKGROUND

Cancer patients have up to a 3-fold higher risk for cardiovascular disease (CVD) than the general population. Traditional CVD risk scores may be less accurate for them. We aimed to develop cancer-specific CVD risk scores and compare them with conventional scores in predicting 10-year CVD risk for patients with breast cancer (BC), colorectal cancer (CRC), or lung cancer (LC).

METHODS

We analyzed adults diagnosed with BC, CRC, or LC between 2005 and 2012. An machine learning (ML) Extreme Gradient Boosting algorithm ranked 40-50 covariates for predicting CVD for each cancer type using SHapley Additive exPlanations values. The top 10 ML-predictors were used to create predictive equations using logistic regression and compared with American College of Cardiology (ACC)/American Heart Association (AHA) Pooled Cohort Equations (PCE), Predicting Risk of cardiovascular disease EVENTs (PREVENT), and Systematic COronary Risk Evaluation-2 (SCORE2) using the area under the curve (AUC).

RESULTS

We included 10 339 patients: 55.5% had BC, 15.6% had CRC, and 29.7% had LC. The actual 10-year CVD rates were: BC 21%, CRC 10%, and LC 28%. The predictors derived from the ML algorithm included cancer-specific and socioeconomic factors. The cancer-specific predictive scores achieved AUCs of 0.84, 0.76, and 0.83 for BC, CRC, and LC, respectively, and outperformed PCE, PREVENT, and SCORE2, increasing the absolute AUC values by up to 0.31 points (with AUC ranging from 0 to 1). Similar results were found when excluding patients with cardiac history or advanced cancer from the analysis.

CONCLUSIONS

Cancer-specific CVD predictive scores outperform conventional scores and emphasize the importance of integrating cancer-related covariates for precise prediction.

Deep-learning prediction of cardiovascular outcomes from routine retinal images in individuals with type 2 diabetes

BACKGROUND

Prior studies have demonstrated an association between retinal vascular features and cardiovascular disease (CVD), however most studies have only evaluated a few simple parameters at a time. Our aim was to determine whether a deep-learning artificial intelligence (AI) model could be used to predict CVD outcomes from routinely obtained diabetic retinal screening photographs and to compare its performance to a traditional clinical CVD risk score.

METHODS

We included 6127 individuals with type 2 diabetes without myocardial infarction or stroke prior to study entry. The cohort was divided into training (70%), validation (10%) and testing (20%) cohorts. Clinical 10-year CVD risk was calculated using the pooled cohort equation (PCE) risk score. A polygenic risk score (PRS) for coronary heart disease was also obtained. Retinal images were analysed using an EfficientNet-B2 network to predict 10-year CVD risk. The primary outcome was time to first major adverse CV event (MACE) including CV death, myocardial infarction or stroke.

RESULTS

1241 individuals were included in the test cohort (mean PCE 10-year CVD risk 35%). There was a strong correlation between retinal predicted CVD risk and the PCE risk score (r = 0.66) but not the polygenic risk score (r = 0.05). There were 288 MACE events. Higher retina-predicted risk was significantly associated with increased 10-year risk of MACE (HR 1.05 per 1% increase; 95% CI 1.04-1.06, p < 0.001) and remained so after adjustment for the PCE and polygenic risk score (HR 1.03; 95% CI 1.02-1.04, p < 0.001). The retinal risk score had similar performance to the PCE (both AUC 0.697) and when combined with the PCE and polygenic risk score had significantly improved performance compared to the PCE alone (AUC 0.728). An increase in retinal-predicted risk within 3 years was associated with subsequent increased MACE likelihood.

CONCLUSIONS

A deep-learning AI model could accurately predict MACE from routine retinal screening photographs with a comparable performance to traditional clinical risk assessment in a diabetic cohort. Combining the AI-derived retinal risk prediction with a coronary heart disease polygenic risk score improved risk prediction. AI retinal assessment might allow a one-stop CVD risk assessment at routine retinal screening.

Impact of smoking status on incident hypertension in a Japanese occupational population

Hypertension and tobacco smoking pose independent risks for cardiovascular diseases, but their association is unclear especially in Japanese. We investigated the impact of smoking status on the risk of new-onset hypertension in male and female Japanese workers. We evaluated 5439 subjects without hypertension who participated in medical check-ups in 2007-2018. The outcome was the development of hypertension (blood pressure ≥140/90 mmHg or initiation of antihypertensive drugs). Cox's proportional hazards models were used to assess the association between smoking status and the hypertension incidence. During the average 6.0-year follow-up, 1395 individuals (25.6%) developed hypertension. The crude incidence rates of hypertension (per 100 person-years) were: current non-smokers (n = 3033), 3.4; quitters (n = 445), 4.2; and sustained smokers (n = 1961), 5.7. The multivariable-adjusted hazard ratio was 1.34 (1.20-1.50) for sustained smokers and 1.03 (0.86-1.24) for quitters compared to current non-smokers (P for trend <0.01). In stratified analyses, the risk of incident hypertension was significantly higher in the sustained smokers with lower blood pressure or without diabetes at baseline versus the current non-smokers. A significant risk reduction of hypertension development due to smoking cessation was revealed in the subjects with higher blood pressure levels at baseline or without body weight gain after smoking cessation. Smoking was an independent risk factor for incident hypertension. Smoking cessation reduced the risk of hypertension development compared to sustained smoking, especially among the subjects with higher blood pressure levels. Maintaining one's body weight after smoking cessation would also help prevent hypertension development.

Clinical and Genomic Prediction of Coronary Artery Disease Subtypes

BACKGROUND

Coronary artery disease (CAD) is a complex, heterogeneous disease with distinct etiological mechanisms. These different etiologies may give rise to multiple subtypes of CAD that could benefit from alternative preventions and treatments. However, so far, there have been no systematic efforts to predict CAD subtypes using clinical and genetic factors.

METHODS

Here, we trained and applied statistical models incorporating clinical and genetic factors to predict CAD subtypes in 26 036 patients with CAD in the UK Biobank. We performed external validation of the UK Biobank models in the US-based All of Us cohort (8598 patients with CAD). Subtypes were defined as high versus normal LDL (low-density lipoprotein) levels, high versus normal Lpa (lipoprotein A) levels, ST-segment-elevation myocardial infarction versus non-ST-segment-elevation myocardial infarction, occlusive versus nonocclusive CAD, and stable versus unstable CAD. Clinical predictors included levels of ApoA, ApoB, HDL (high-density lipoprotein), triglycerides, and CRP (C-reactive protein). Genetic predictors were genome-wide and pathway-based polygenic risk scores (PRSs).

RESULTS

Results showed that both clinical-only and genetic-only models can predict CAD subtypes, while combining clinical and genetic factors leads to greater predictive accuracy. Pathway-based PRSs had higher discriminatory power than genome-wide PRSs for the Lpa and LDL subtypes and provided insights into their etiologies. The 10-pathway PRS most predictive of the LDL subtype involved cholesterol metabolism. Pathway PRS models had poor generalizability to the All of Us cohort.

CONCLUSIONS

In summary, we present the first systematic demonstration that CAD subtypes can be distinguished by clinical and genomic risk factors, which could have important implications for stratified cardiovascular medicine.

Haematological setpoints are a stable and patient-specific deep phenotype

The complete blood count (CBC) is an important screening tool for healthy adults and a common test at periodic exams. However, results are usually interpreted relative to one-size-fits-all reference intervals1,2, undermining the precision medicine goal to tailor care for patients on the basis of their unique characteristics3,4. Here we study thousands of diverse patients at an academic medical centre and show that routine CBC indices fluctuate around stable values or setpoints5, and setpoints are patient-specific, with the typical healthy adult's nine CBC setpoints distinguishable as a group from those of 98% of other healthy adults, and setpoint differences persist for at least 20 years. Haematological setpoints reflect a deep physiologic phenotype enabling investigation of acquired and genetic determinants of haematological regulation and its variation among healthy adults. Setpoints in apparently healthy adults were associated with significant variation in clinical risk: absolute risk of some common diseases and morbidities varied by more than 2% (heart attack and stroke, diabetes, kidney disease, osteoporosis), and absolute risk of all-cause 10 year mortality varied by more than 5%. Setpoints also define patient-specific reference intervals and personalize the interpretation of subsequent test results. In retrospective analysis, setpoints improved sensitivity and specificity for evaluation of some common conditions including diabetes, kidney disease, thyroid dysfunction, iron deficiency and myeloproliferative neoplasms. This study shows CBC setpoints are sufficiently stable and patient-specific to help realize the promise of precision medicine for healthy adults.

The Impact of Physical Activity in Patients With Type 2 Diabetes

Most patients with type 2 diabetes (T2DM) do not meet guideline-driven exercise recommendations. Physical activity (PA) is any form of bodily movement via skeletal muscle contraction. It can include walking, gardening, leisure activity, exercise, or movement for transportation or an occupation. Aerobic and resistance exercise have been well studied and are known to improve glycemic control in patients with T2DM. While data is less substantial, low-intensity PA such as walking, yoga, tai-chi, qigong, and activity for household tasks have also been shown to be effective methods of reducing hyperglycemia. Additionally, PA to break up sedentary behaviors can also have glycemic benefits. Healthcare providers should encourage patients to increase their PA as a more sustainable means of meeting guideline-directed exercise and activity recommendations. Discussing these changes with patients involves identifying motivators, setting goals, removing barriers, monitoring progress, and understanding the patient's social support and environment.

5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2025

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Relationship Between Coronary Artery Calcium Score and Vulnerability of Culprit Plaque Assessed by OCT in Patients With Established Coronary Artery Disease

BACKGROUND

Coronary artery calcium score (CACS) is widely used for risk stratification. However, in patients with established coronary artery disease, its clinical implication and relationship with plaque vulnerability are unclear. We sought to correlate the CACS and plaque vulnerability assessed by optical coherence tomography.

METHODS

Patients with coronary artery disease who had CACS and optical coherence tomography before percutaneous coronary intervention were included. Patients were divided into 5 groups based on CACS: CACS of 0, 1 to 99, 100 to 399, 400 to 999, and ≥1000. Optical coherence tomography-derived vulnerable features in culprit plaque were compared between the groups.

RESULTS

In 460 patients, the prevalence of lipid-rich plaque, macrophage, and cholesterol crystal significantly differed among the 5 groups, being lowest in the patients with a CACS of 0. The prevalence of thin-cap fibroatheroma tended to be lower in those with a CACS of 0. No significant difference in vulnerable features was observed between the 4 groups with CACS >0. In the 2-group comparison between the group with a CACS of 0 and the other 4 groups combined, the prevalence of lipid-rich plaque (60.5% versus 85.9%; P<0.001), macrophage (48.8% versus 74.1%; P<0.001), thin-cap fibroatheroma (16.3% versus 35.0%; P=0.013), and cholesterol crystal (11.6% versus 32.9%; P=0.004) was significantly lower in the patients with CACS of 0. CACS of 0 was independently negatively associated with lipid-rich plaque, macrophage, thin-cap fibroatheroma, and cholesterol crystal after adjustment for patient characteristics.

CONCLUSIONS

Patients with a CACS of 0 have a significantly lower prevalence of vulnerable plaque features compared with those with CACS >0 in patients with established coronary artery disease.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT04523194.

The Rise of Type 2 Diabetes in Children and Adolescents: An Emerging Pandemic

AIM

This review explores the increasing prevalence of Type 2 Diabetes Mellitus (T2DM) in children and adolescents, focusing on its etiology, risk factors, complications, and the importance of early detection and management. It also highlights the need for a multidisciplinary, family-centered approach in managing T2DM in pediatric populations, with an emphasis on nutrition, exercise, and lifestyle interventions.

MATERIALS AND METHODS

A literature review was conducted using PubMed, Google Scholar, and Scopus to incorporate studies from 2015 to 2024 on T2DM in youths/adolescents/children, focusing on epidemiology, risk factors, and prevention strategies. Studies on Type 1 Diabetes Mellitus (T1DM) or adult populations were excluded.

RESULTS

T2DM is a complex metabolic disorder with various societal, behavioral, environmental, and genetic risk factors. It accounts for one in three new childhood diabetes cases, with rising incidence among American Indian/Alaska Native, Black, and Hispanic/Latino children. The increase in T2DM incidence correlates with growing childhood obesity rates. Early onset significantly raises the risk of complications like retinopathy, nephropathy, neuropathy, cardiovascular diseases, nonalcoholic fatty liver disease, and obstructive sleep apnea. Early detection, screening, and treatment can prevent or delay these complications. A family-centered, multidisciplinary approach is essential for effective management, including lifestyle and behavioral support.

CONCLUSIONS

T2DM in children is a growing health concern with severe implications. Early detection and management, including nutrition and exercise counseling, are critical in reducing long-term complications. A multidisciplinary approach is vital for improving outcomes and minimizing morbidity and mortality.

10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes-2025

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Changing the paradigm in heart failure: shifting from treatment to prevention

Heart failure (HF) poses a major global health challenge with rising prevalence, significant morbidity and mortality, and substantial associated healthcare costs. With aging of the population and an increasing burden of comorbidities, the complex interplay between cardiovascular, kidney, and metabolic risk factors have been thrust into the spotlight and have broadened the traditional focus from HF treatment to an increased emphasis on prevention. In recognition of the evolving HF landscape, the American Heart Association released the PREVENT models which are comprehensive risk assessment tools that estimate 10- and 30-year risk of incident cardiovascular disease and its subtypes, including atherosclerotic cardiovascular disease (ASCVD) and, for the first time, HF. While it is an accurate risk estimation tool and represents a step forward in improving risk stratification for primary prevention of HF, there remain several limitations and unknowns like model performance across disaggregated racial and ethnic groups, the role of traditional ASCVD vs. HF-specific risk factors, HF prediction among those with known ASCVD, and the use of traditional regression techniques in lieu of potentially more powerful machine learning-based modeling approaches. Furthermore, it remains unclear how to optimize risk estimation in clinical care. The emergence of multiple novel pharmacological therapies that prevent incident HF, including sodium-glucose co-transporter 2 (SGLT2) inhibitors, glucagon-like peptide 1 (GLP1) receptor agonists, and nonsteroidal mineralocorticoid receptor antagonists (MRAs), highlights the importance of accurate HF risk prediction. To provide HF prevention with these effective but costly therapies, we must understand the optimal strategy in sequencing and combining these therapies and prioritize patients at highest risk. Such implementation requires both accurate risk stratification and a better understanding of how to communicate risk to patients and providers. This state-of-the-art review aims to provide a comprehensive overview of recent trends in HF prevention, including risk assessment, care management strategies, and emerging and novel treatments.

A Comprehensive Review of the Manifestation of Cardiovascular Diseases in HIV Patients

The increasing lifespan of people living with HIV (PLWH) due to advancements in antiretroviral therapy (ART) has shifted mortality patterns from AIDS-related to non-AIDS-related causes, notably cardiovascular diseases (CVDs). This review investigates how HIV and ART contribute to vascular endothelial dysfunction, myocardial fibrosis, and hypercoagulation, which significantly exacerbate cardiovascular risk. Mechanistic insights include chronic inflammation and immune dysregulation due to persistent HIV infection and ART-specific effects such as protease inhibitors causing dyslipidemia and zidovudine inducing mitochondrial toxicity leading to cardiomyopathy. ART, while lifesaving, has been implicated in promoting subclinical atherosclerosis and increasing the risk of acute myocardial infarction, further highlighting the need for tailored approaches. The manuscript addresses pressing obstacles, including disparities in healthcare access and the lack of standardized cardiovascular screening guidelines specific to PLWH. It emphasizes the integration of advanced imaging techniques and emerging biomarkers, such as coronary artery calcium scoring and soluble ST2, to detect early subclinical cardiovascular abnormalities. The review also identifies challenges in ART selection to balance virologic control and cardiovascular safety. What sets this review apart is its holistic and detailed approach to the intersection of HIV and cardiovascular health. It not only elucidates complex pathophysiological mechanisms but also offers actionable insights into how current clinical guidelines fall short. This manuscript underscores the urgency of implementing proactive cardiovascular screening protocols tailored for PLWH and refining ART regimens to mitigate CVD risks. By addressing these gaps, this work aims to expand our understanding of HIV-related cardiovascular manifestations and provide a foundation for targeted interventions, thereby improving long-term health outcomes for PLWH. This comprehensive perspective is poised to transform clinical practice by fostering greater awareness among physicians and encouraging the development of more effective strategies for managing cardiovascular risks in the HIV population.

3. Prevention or Delay of Diabetes and Associated Comorbidities: Standards of Care in Diabetes-2025

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Association of relative fat mass (RFM) index with diabetes-related mortality and heart disease mortality

Although studies have examined the association of the Relative Fat Mass (RFM, a novel anthropometric index used as a surrogate for whole-body fat percentage) with all-cause mortality, the association of RFM with diabetes-related mortality and heart disease mortality has not been thoroughly investigated. In addition, no study has compared the associations of RFM and waist circumference (a surrogate for intra-abdominal fat) with cause-specific mortality and all-cause mortality. In the present study, we addressed these knowledge gaps. We used data from the US National Health and Nutrition Examination Survey (NHANES) 1999-2018. NHANES III was used for validation. Analyses included 46,535 adults (mean age 46.5 years). During a median follow-up time of 9.7 years, 6,101 participants died (743 from diabetes; 1,514 from heart disease). Compared with BMI and WC, RFM was more strongly associated with diabetes-related mortality in both women and men, adjusting for age, ethnicity, education, and smoking status. All anthropometric measures were similarly strongly associated with heart disease mortality and all-cause mortality. RFM showed greater predictive discrimination of mortality. Similar results were found in NHANES III (n = 14,448). In conclusion, RFM is strongly associated with diabetes-related mortality, heart disease mortality, and all-cause mortality, and outperforms conventional adiposity measures for prediction of mortality.

Identifying predictors of nosocomial pneumonia in trauma patients admitted to a level-1 trauma center

BACKGROUND

Nosocomial pneumonia is common in trauma patients and associated with an adverse prognosis. We recently externally validated and recalibrated an existing formula to predict nosocomial pneumonia risk. Identifying more potential predictors could aid in a more accurate prediction of nosocomial pneumonia risk in level-1 trauma patients. This study aims to identify predictors of nosocomial pneumonia in level-1 trauma patients available in the emergency department or shortly after, and examine their added predictive value to an existing prediction model by Croce.

METHODS

This retrospective cohort study included all consecutive trauma patients (≥ 16 years) admitted for > 24 h to our level-1 trauma center in 2017. Excluded were patients with active infection upon admission, transfer from another hospital, or in-hospital mortality < 48 h. Multiple imputations were used for missing values. Multivariable logistic regression analysis and Ridge penalization were performed to assess the association of predictors with nosocomial pneumonia and evaluate predictor stability. The predictive performance in addition to the existing prediction model was evaluated as well.

RESULTS

The study included 809 patients [median age 51 (IQR 32-68) years, 66.9% male, median ISS 10 (5-17), median GCS score 15 (14-15)]. Pneumonia incidence was 10.6% (n = 86). Age (OR 1.03 per year), ISS (OR 1.10 per point), GCS score (OR 0.91 per point), pulmonary contusion (OR 2.77), male sex (OR 1.36), hypertension (OR 1.86), diabetes (OR 1.20), number of rib fractures (OR 1.05 per fractured rib), and thoracic spine fracture (OR 1.51) were found to be predictors of nosocomial pneumonia. All variables showed added predictive value in addition to the existing model.

CONCLUSION

Patient history, injury severity, thoracic trauma, and traumatic brain injury are essential components of nosocomial pneumonia prediction and add to the predictive value of an existing model. Our results further build a basis for more accurate prediction.

LEVEL OF EVIDENCE

Level III, prognostic/epidemiological.

Evaluating the Role of Aspirin in Liver Disease: Efficacy, Safety, Potential Benefits and Risks

The rise in liver disease incidence and prevalence has led to increasing morbidity and mortality worldwide. Persistent hepatic inflammation drives disease progression by increasing fibrosis, advancing to cirrhosis, and potentially developing into hepatocellular carcinoma (HCC). Addressing these complications is essential to reduce liver-related mortality. Recent studies suggest that non-steroidal anti-inflammatory drugs, particularly aspirin, may play a beneficial role in managing liver disease. Aspirin's anti-inflammatory and chemoprotective effects contribute to slowing disease progression and reducing the risks associated with chronic liver disease (CLD). This review highlights the current literature on the effects of aspirin in CLD, with a focus on patients with metabolic-associated steatotic liver disease (MASLD) and hepatitis B and C. We will examine aspirin's potential ability to mitigate fibrosis, reduce the incidence of HCC, and lower liver-related mortality. Additionally, we will discuss its potential side effects and safety considerations, particularly in the context of liver disease, where there is an increased risk of bleeding.

Research on rheumatic heart disease from 2013 to early 2024: a bibliometric analysis

OBJECTIVES

The aim of this bibliometric analysis was to highlight potential future areas for the practical application of research on rheumatic heart disease (RHD), considering past and current research efforts.

METHODS

A systematic search was conducted in the WoSCC to find articles and reviews focused on RHD published between 2013 and 2024. Microsoft Excel 2019 was used to chart the annual productivity of research relevant to RHD, while ArcGIS (version 10.8) was employed to visualize the global distribution of publications. Analysis tools such as CiteSpace (version 6.1.R6) and VOSviewer (version 1.6.18) were utilized to identify the most prolific countries or regions, authors, journals, and resource-, intellectual-, and knowledge-sharing in RHD research, and to perform co-citation analysis of references and keywords. Additionally, the Bibliometrix R Package was used to analyze topic dynamics.

RESULTS

From the search, a total of 2,428 publications were retrieved. In terms of countries or regions, the United States was the most productive country (566, 23.31%). As for institutions, most publications have been contributed by the University of Cape Town (149, 6.14%). Regarding authors, Jonathan R. Carapetis produced the most published works, and he received the most co-citations. The most prolific journal was identified as the International Journal of Cardiology (70, 2.88%). The study published in Circulation received the most co-citations. Keywords with ongoing strong citation bursts included "surgical treatment" and "valvular heart disease".

CONCLUSION

Despite the rapid advancements in the field of RHD research, future efforts should prioritize strengthening collaboration among national institutions to facilitate information dissemination. Current research on RHD mainly focuses on prognosis of patients. While, the emerging research trends in RHD encompass treatment strategies for complications, including atrial fibrillation (AF), heart failure (HF), and infective endocarditis, as well as screening strategies for RHD and surgical interventions for patients with rheumatic mitral valve disease.

Status of diabetes mellitus in different regions of KSA and update on its management

BACKGROUND

Complications of diabetes and its associated comorbidities can cause rapid progression of type II diabetes mellitus (T2DM). It comes at high costs and affects a patient's quality of life. We aim to assess T2DM in KSA, including the demographics, medications, complications, and comorbidities, as it remains an integral part of Vision 2030.

METHODS

Observational retrospective study was designed spanning five administrative regions of KSA. A total of 638 patients' records were randomly selected from general hospitals and diabetes centers from 2017 to 2020, and the collected were statistically analyzed.

RESULTS

Most (77%) selected patients had uncontrolled diabetes, showing a statistically significant correlation between regions and diabetes control. The Northern, Central, and Southern regions had the highest uncontrolled percentage with less than 20% control, while Western and Eastern regions' control percentages were around 40% of subjects. Eighty percent of the uncontrolled BP patients had uncontrolled diabetes contrasting the 68% of the BP-controlled patients. Biguanides, DPP-4 inhibitors, GLP-1 agonists, Insulin, and SGLT-2 inhibitors are the most common diabetes medications. Metformin was the most prescribed in all regions, followed by DPP4. Results showed that patients used one to four non-diabetes drugs on average. Dispensing of vitamin B complex and statins were higher in diabetes centers than in hospitals. Retinopathy and peripheral neuropathy were the most common complications, while hypertension and ASCVD were the most common comorbidities.

CONCLUSION

Results showed a poor glycemic control situation in the kingdom that necessitates implementing stricter measures to hinder disease progression and reduce complications and comorbidities. Increasing awareness, training, and monitoring programs with larger sample sizes and broader distribution is highly recommended nationally.

Unravelling the cardio-renal-metabolic-foot connection in people with diabetes-related foot ulceration: a narrative review

Diabetes-related foot ulceration (DFU), a serious but preventable complication of diabetes, is a leading cause of hospitalisation, lower extremity amputation and disability worldwide. People with DFU have a greater burden of cardiovascular risk factors, heart failure and chronic kidney disease, resulting in over two-fold higher risk of cardiovascular death compared with people with diabetes without DFU. Here, we propose a "cardio-renal-metabolic-foot" connection in people with diabetes based on shared pathophysiological mechanisms linking DFU with cardiovascular and renal disease. Whilst these mechanistic links remain to be fully elucidated, systemic inflammation and infection in the context of DFU are postulated as key mediators in the development, and progression of, cardiovascular and renal disease. However, cardiovascular and renal disease are also implicated in the pathogenesis of DFU, highlighting the multi-directional interplay between conditions. The impact of screening, prevention, and early management of cardiovascular complications associated with DFU requires further research. Multi-modality cardiac imaging could play a role in unravelling disease mechanisms leading to novel therapeutic strategies, as well as facilitating personalised risk assessment and management. Recent clinical trials have transformed the therapeutic landscape for people with type 2 diabetes, by demonstrating that sodium glucose co-transporter 2 inhibitors, glucagon-like peptide-1 agonists and non-steroidal mineralocorticoid receptor antagonists improve cardiovascular and renal outcomes. Although dedicated research in people with DFU is warranted, these therapies could target multiple facets of the "cardio-renal-metabolic-foot" connection. The holistic, person-centred approach to managing DFU should incorporate new multidisciplinary models of care focusing on the prevention and management of cardiovascular and kidney disease.

Integrated safety analysis of tofacitinib from Phase 2 and 3 trials of patients with ankylosing spondylitis

OBJECTIVES

Describe tofacitinib safety from an integrated analysis of randomized controlled trials (RCTs) in patients with ankylosing spondylitis (AS).

METHOD

Pooled data from Phase 2 (NCT01786668; 04/2013-03/2015)/Phase 3 (NCT03502616; 06/2018-08/2020) RCTs in AS patients were analyzed (3 overlapping cohorts): 16-week placebo-controlled (tofacitinib 5 mg twice daily [BID] [n = 185]; placebo [n = 187]); 48-week only-tofacitinib 5 mg BID (n = 316); 48-week all-tofacitinib (≥ 1 dose of tofacitinib 2, 5, or 10 mg BID; n = 420). Baseline 10-year atherosclerotic cardiovascular disease (ASCVD) risk was determined in patients without history of ASCVD (48-week cohorts). Adverse events (AEs)/AEs of special interest were evaluated/compared with findings from other tofacitinib programs (16 Phase 2/Phase 3 rheumatoid arthritis [RA]; 2 Phase 3 psoriatic arthritis [PsA] RCTs) and a real-world cohort of AS patients initiating biologic disease-modifying antirheumatic drugs (US MarketScan).

RESULTS

Most patients (> 75%; 48-week cohorts) without history of ASCVD had low baseline 10-year ASCVD risk. One patient (tofacitinib 5 mg BID; in all 3 cohorts) had a serious infection (aseptic meningitis). Herpes zoster (non-serious) occurred in the 48-week only-tofacitinib 5 mg BID (n = 5 [1.6%]) and all-tofacitinib (n = 7 [1.7%]; one multi-dermatomal [tofacitinib 10 mg BID]) cohorts. No deaths, opportunistic infections, tuberculosis, malignancies, major adverse cardiovascular events, thromboembolic events, gastrointestinal perforations occurred.

LIMITATIONS

short RCT durations/low patient numbers within cohorts.

CONCLUSION

Tofacitinib 5 mg BID was well tolerated to 48 weeks in AS patients; safety profile was consistent with RA/PsA clinical programs and a cohort of AS patients from US routine clinical practice.

CLINICAL TRIAL REGISTRATION NUMBERS

NCT01786668 (2013-02-06); NCT03502616 (2018-04-11).

The association of HDL-cholesterol levels with incident major adverse cardiovascular events and mortality in 0.6 million individuals with type 2 diabetes: a population-based retrospective cohort study

BACKGROUND

High levels of high-density lipoprotein cholesterol (HDL-C) are previously considered protective against cardiovascular diseases (CVD), but recent studies suggest an increased risk of adverse events at very high HDL-C levels in the general population. It remains to be elucidated such a relationship in diabetes, a condition with high cardiovascular risks. We examined the association of HDL-C levels with the risk of major adverse cardiovascular events (MACE) and mortality in type 2 diabetes.

METHODS

This retrospective cohort study identified individuals with type 2 diabetes who had HDL-C records (2008-2020) from the electronic health record database of the Hong Kong Hospital Authority. They were classified into three groups based on their first-recorded HDL-C levels following diabetes diagnosis: low (≤ 40 mg/dL), medium (> 40 and ≤ 80 mg/dL) and high HDL-C (> 80 mg/dL) groups. The primary outcome was incident MACE (composite of myocardial infarction, stroke, heart failure, and cardiovascular mortality). Cox regression model and restricted cubic spline analysis were employed to assess the relationship between HDL-C and adverse outcomes.

RESULTS

Among 596,943 individuals with type 2 diabetes included, 168,931 (28.30%), 412,863 (69.16%), and 15,149 (2.54%) were classified as low HDL-C, medium HDL-C, and high HDL-C groups, respectively. Over a median follow-up of 79.5 months, both low and high HDL-C groups had higher risk of incident MACE compared to the medium HDL-C group (HR 1.24, 95% CI 1.23-1.26, P < 0.001; HR 1.09, 95% CI 1.04-1.13, P < 0.001). The spline curves revealed a U-shaped association between HDL-C levels and incident MACE (non-linear p < 0.001). Similar U-shaped relationship was observed for all-cause and non-cardiovascular mortality.

CONCLUSIONS

Our study demonstrated a U-shaped association between HDL-C levels and incident MACEs and all-cause and non-cardiovascular mortality in individuals with type 2 diabetes, highlighting the need for mechanistic studies on the adverse outcomes seen at high HDL-C levels in type 2 diabetes.

Association between erectile dysfunction and the predicted 10-year risk for atherosclerosis cardiovascular disease among U.S. men: a population-based study from the NHANES 2001-2004

Background

Erectile dysfunction (ED) is considered the tip of the iceberg for cardiovascular disease (CVD). However, there is still conflicting evidence regarding their relationship. Recently, a validated tool for the Atherosclerotic Cardiovascular Disease (ASCVD) risk score has provided a key opportunity to delve deeper into the relationship between ED and CVD. Therefore, we intended to assess the relationship between ED and 10-year ASCVD risk score.

Methods

Complete data of 1207 participants from the 2001-2004 National Health and Nutrition Examination Survey (NHANES) were used in the study. Various weighted logistic and linear regression models were employed to investigate the effect of the presence of ED on the higher 10-Year ASCVD risk score or high risk of 10-Year ASCVD. Conversely, logistic regression models were repeated to explore the effect of continuous or categorical ASCVD risk score on the prevalence of ED. Sensitivity analyses were also conducted, focusing on severe ED with a more stringent definition. Additionally, we supplemented our study with subgroup analyses, restricted cubic spline (RCS) analysis, and receiver operating characteristic (ROC) analysis to enhance the robustness of our results.

Results

Participants with ED had higher ASCVD risk scores and a higher risk of ASCVD, which corresponded to a greater prevalence of ED or severe ED. When considering the presence of ED as the exposure, our results indicated that the presence of ED increased the ASCVD risk score (Model 3: β [95%CI]: 2.09 [1.12, 3.06]) in Model 3, as well as the high risk of ASCVD (OR [95%CI]: 2.27 [1.13, 4.59]). Conversely, a continuous increase in the ASCVD risk score was also associated with an increased prevalence of ED (OR [95%CI]: 1.04 [1.02,1.06]). Additionally, those in the borderline ASCVD risk group (OR [95% CI]: 2.95 [1.60, 5.44]), intermediate ASCVD risk group (OR [95% CI]: 4.53 [2.35, 8.73]), and high ASCVD risk group (OR [95% CI]: 7.62 [3.19, 18.19]) exhibited progressively increasing ED risk when compared to the low-risk group. Furthermore, the RCS analysis demonstrated a linear relationship between ED prevalence and the continuous ASCVD risk score, with the latter showing high efficacy in predicting ED (AUC [95%CI]: 0.794 [0.768, 0.821]).

Conclusions

The presence of ED may precede the onset of ASCVD by some years. Consequently, timely and dynamic evaluation of the cardiovascular status provides an earlier opportunity to identify and implement effective prevention strategies to promote cardiovascular health for ED patients.

Metabonomic Biomarkers of Plaque Burden and Instability in Patients With Coronary Atherosclerotic Disease After Moderate Lipid-Lowering Therapy

BACKGROUND

Contemporary risk assessment in patients with coronary atherosclerotic disease (CAD) often relies on invasive angiography. However, we aimed to explore the potential of metabolomic biomarkers in reflecting residual risk in patients with CAD after moderate lipid-lowering therapy.

METHODS AND RESULTS

We analyzed serum metabolomic profile among 2560 patients with newly diagnosed CAD undergoing moderate lipid-lowering therapy, through nuclear magnetic resonance spectroscopy and quantified 175 metabolites, predominantly lipoproteins and their components. CAD severity was evaluated using Gensini score for plaque burden and circulating cardiac troponin T levels for plaque instability. The association of metabolites with CAD severity was examined using multivariate linear regression, and the underlying potential causality was explored using a 2-sample Mendelian randomization approach. Two composite metabolomic indices were constructed to reflect CAD severity using least absolute shrinkage and selection operator linear regression, and their associations with risk of major adverse cardiac events during a median follow-up of 3.8 years were evaluated using Cox models. Our investigation revealed that triglycerides and apolipoprotein B in low-density lipoprotein particles displayed stronger associations with CAD severity compared with the clinically used low-density lipoprotein cholesterol marker. In large high-density lipoprotein, components like cholesterol, cholesterol esters, triglyceride, apolipoprotein A1/A2 showed inverse associations with CAD severity. Certain metabolites, including apolipoprotein B and dihydrothymine, showed a putative causal link with Gensini score. Notably, per standard deviation increase in Gensini score-based metabolomic index was associated with 14.8% higher major adverse cardiac event risk (hazard ratio, 1.148 [95% CI, 1.018-1.295]) independent of demographic factors, medication use, and disease status.

CONCLUSIONS

Our findings highlight the potential of nuclear magnetic resonance-based metabolomics in identifying novel biomarkers of plaque burden and instability. Metabolites related to plaque burden may facilitate noninvasive assessment of CAD prognosis.