Prediction of coronary heart disease (CHD) risk through standard equations relying on laboratory-based clinical markers has proven challenging and needs advancement. This study aims to derive and cross-validate novel CHD-risk prediction models based on lifestyle behaviours including wearables and polygenic risk scores (PRS), with comparison to the established Pooled Cohort Equations (PCE) and Systematic COronary Risk Evaluation 2 (SCORE2). This study included 291,151 white British individuals of UK Biobank. Cox regression was applied to derive Lifestyle-Based Model (LBM) for CHD-risk prediction incorporating age, sex, body mass index, dietary intake score (0-3; derived from self-reported food types), smoking status, and physical activity (wearable-device-derived Euclidean Norm Minus One). Weighted PRS for CHD was calculated based on 300 genetic variants. Over a median 13.8-year follow-up, 13,063 CHD incidence cases were ascertained. The C-index (indicative of discrimination) of the LBM, PCE and SCORE2 was 0.713 (95% Confidence Interval [CI]: 0.703-0.722), 0.714 (95% CI: 0.705-0.724) and 0.709 (95% CI: 0.700-0.719). Adding PRS to LBM, PCE and SCORE2 increased the C-index to 0.733 (95% CI: 0.724-0.742), 0.726 (95% CI: 0.716-0.735) and 0.721 (95% CI: 0.711-0.730). The LBM with and without PRS both demonstrated good calibration, demonstrating by p-values of 0.997 and 0.999. The addition of PRS to LBM marginally improved calibration, with the slope increasing from 0.981 to 0.983. Integrating PRS rendered a positive categorical net reclassification improvement (cut-off point: 7.5%) of 4.30% for LBM. The non-laboratory-based LBM, integrating wearable-based and anthropometric data, demonstrated moderate cardiovascular risk prediction accuracy, though external validations remain to be explored.

Cardiovascular diseases (CVDs) have been the leading cause of death in China. Depression and anxiety are recognized as significant risk factors for poor prognosis and disability among Chinese CVD patients. However, these mental health conditions have received limited clinical attention in the context of CVD management. To date, comprehensive national epidemiological data on the prevalence of depression and anxiety in cardiovascular clinics (CVCs) in China are lacking. The present study aims to describe the prevalence, recognition and therapeutic inequity in CVCs so as to improve the overall health outcomes of CVD patients. A multicenter, cross-sectional study was conducted across secondary and tertiary hospitals in China (January 2021 to December 2022), enrolling 1049 CVD patients from CVCs consecutively. Depression and anxiety symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), respectively. Sociodemographic and clinical data were collected via standardized questionnaires. Risk factors were analyzed by multivariable logistic regression, meanwhile recognition rates and treatment inequities were systematically evaluated. The pooled prevalence of depression and anxiety were 61.4% and 53.4% respectively, with 23.9% exhibiting moderate-to-severe symptoms. The multivariable logistic regression analyses disclosed that residing in South Central China, usual activities impairment, as well as experiencing pain or discomfort in daily life were associated with the presence of both depression and anxiety among patients in CVCs. Alarmingly, only 41.5% of depressed patients and 44.1% of anxious patients were recognized; and fewer than 50% accessed guideline-recommended interventions (psycho-education or medications). Patients residing in South Central China, having moderate or severe mental symptoms and having anxiety and depression comorbidity were more likely to be recognized and treated by cardiologists. This first national study to demonstrate the "high burden-low care" paradox in Chinese CVCs highlights systemic gaps in mental health integration. Urgent implementation of collaborative care models is warranted, prioritizing standardized screening protocols and equity-focused interventions for vulnerable subgroups. These findings provide pivotal evidence for advancing Chinese CVD clinical guidelines to address the mental health crisis in cardiology.Trial registration: The trial was registered with ClinicalTrials.gov under the identifier NCT03225586 (Registration Date: 2017-07-19).

Patients with in-stent restenosis have an increased risk of recurrence of major adverse cardiovascular events. Achievement of an adequate acute luminal gain is essential to minimize such recurrence. We compared the effect of utilization of Super-high pressure OPN balloon in patients with In-stent restenosis. This is an investigator-initiated single-centre observational study done at SRIHER, India. The primary outcome was procedural success, defined by intravascular ultrasound (IVUS). In addition, we intended to study the in-hospital clinical outcomes. We studied 30 patients, with 73.4% male and a median age of 66.5 years. Diabetes was present in 83%, hypertension in 60%, and chronic kidney disease in 20%. Left ventricular dysfunction (EF < 45%) was observed in 43.3%. In-stent restenosis (ISR) cases presented as chronic coronary syndrome (43.3%), NSTEMI (36.7%), and unstable angina (20%). Among 49 lesions, 48.97% were in the LAD, followed by the RCA (28.57%), LCx (20.4%), and LM (2.04%). OPN was used for pre-dilatation in 14 patients and post-dilatation in 13 patients while it was used for both pre- and post-dilatation in 3 patients. Regarding final treatment, drug-eluting stents (DES) was used in 21 cases (36 lesions), a covered stent in 1 case (2 lesions), drug-coated balloons (DCB) in 6 cases (9 lesions), and plain old balloon angioplasty (POBA) in 2 cases (2 lesions). Procedural success was obtained in all but one patients. (n = 47 lesions) One patient had coronary perforation that was managed by a covered stent. At a median follow-up of 31 months (IQR-22), 4 (13.3%) patients had died; 1 due to potential stent thrombosis and 3 due to non-cardiovascular causes, and there was no MI or repeat revascularization. In our image-guided study, we found that OPN usage may be a safe and effective in patients with ISR lesions leading to a very good acute luminal gain.

Data on cardiorespiratory fitness (CRF) in psoriatic arthritis (PsA) are scarce. This study aimed to determine the CRF level in patients with PsA and to examine the relation between CRF and disease parameters, cardiometabolic risk profile as well as patient-reported outcome measures (PROMs).

In this cross-sectional study, CRF was measured as peak oxygen uptake (VO₂peak) during an incremental maximal cardiopulmonary exercise test and compared with reference charts of the general population using the one-sided t-test. Multivariable linear regression models were built to evaluate the associations between VO₂peak (mL/min/kg, log-transformed) and disease parameters, cardiometabolic risk parameters and PROMs. Statistical significance was defined as p<0.05 with application of Holm-Bonferroni correction in regression analysis (expressed as p*).

In 80 patients with PsA (41% females, mean age 51 years (SD=11)), mean VO₂peak was 26.03 mL/min/kg (SD=7.56) and significantly decreased compared with the physically active reference population (mean 74.01% (SD=19.19), p<0.001) with 41% having an impaired CRF. In the final multivariable linear regression model, adjusted for age and sex, disease activity (Psoriatic Arthritis Disease Activity Score: β=-0.2757, p*=0.009), waist-hip ratio (β=-0.4193, p*<0.001), patient-reported disease impact (Psoriatic Arthritis Impact of Disease 12-item questionnaire: β=-0.2385, p*=0.015), and moderate-to-vigorous physical activity during commuting and leisure time (minutes/week: β=0.1702, p*=0.015) were significantly associated with VO₂peak (adjusted R²=0.71).

The CRF level of patients with PsA was significantly decreased compared to a physically active population with 41% having an impaired CRF. A lower CRF level was substantially associated with impaired disease control, unfavourable body composition, lower self-reported physical activity as well as with higher patient-reported disease impact.

This study aims to investigate the relationship between waterpipe smoking, polycythaemia and cardiac risk factors, including blood pressure and obesity.

Cross-sectional Study conducted in 2022.

An-Najah National University (ANNU) in the West Bank, Palestine.

A total of 954 university students participated in the study.

A questionnaire used to assess smoking behaviours and other substance practices and patterns. Anthropometric and clinical measurements were measured and recorded, and complete blood counts (CBC) were obtained using an automated haematology analyser. Descriptive statistics were used to characterise the sample. Logistic regression models were applied to assess associations between smoking and polycythaemia. Also, there is a link between polycythaemia and high systolic and diastolic blood pressure.

Out of 954 participants, 60% were females, 18.5% smoked cigarettes (57.1% daily), 31.1% smoked waterpipes (20.5% daily), 6.5% smoked e-cigarettes (18.2% daily), 18.8% had polycythaemia and 17.6% were obese. After adjusting for gender, obesity and other confounders, waterpipe smoking was associated with polycythaemia (OR=1.70, p=0.023), male gender (OR=87.89, p<0.001) and obesity (OR=3.82, p=0.014). Polycythaemia was associated with higher systolic blood pressure (OR=2.00, p=0.016) and higher diastolic blood pressure (OR=1.98, p=0.007).

The study findings indicated significant associations between high blood pressure and polycythaemia, tobacco smoking, obesity and male gender. These findings underscore the importance of addressing tobacco hazards and their potential impact on cardiometabolic health, particularly among young adults.

To understand why patients with chronic kidney disease (CKD) may not be treated according to international guidelines for myocardial infarction (MI).

Multicentre qualitative interview study. Interviews were analysed using reflexive thematic analysis approach as outlined by Braun and Clarke to generate themes associated with MI treatment decision-making for, and by, patients with CKD.

Four National Health Service hospital centres in the UK (February 2022 to July 2024).

A purposive sample of 46 participants (patients and clinicians). Clinicians (n=32) were senior doctors-in-training or consultants in cardiology, nephrology, acute or emergency care or cardiac surgery. Patient participants (n=14) had CKD, defined as an estimated glomerular filtration rate <60 mL/min/1.73 m², or receipt of kidney replacement therapy (KRT).

Despite expressing strong views regarding their health priorities, patients reported minimal involvement in treatment decision-making. Decision-making by clinicians was driven by the desire to avoid causing harm to patients by 'active' treatment initiation. In general, despite the concept of evidence-based medicine being widely accepted, there remained scepticism of guidelines or epidemiological data, especially in the light of personal adverse experiences or anecdotes. Clinicians described how, in the absence of collaborative decision-making and a clinical safety-net for managing treatment complications, they tended to make conservative treatment decisions for patients with CKD.

Interventions to foster teamworking between specialists and ensure adequately resourced specialist clinical service safety-nets may improve access to treatments for MI for people with CKD. Intervention development and evaluation should follow to determine if outcomes for people with CKD and MI can be improved.

Out-of-hospital cardiac arrest (OHCA) has low survival rates with worse outcomes at night due to delayed emergency medical services (EMS) response, resource limitations and workforce fatigue. Since randomised trials are unfeasible, all-comers registries provide essential data to bridge evidence gaps and improve EMS protocols.

Retrospective observational study using propensity score matching.

National EMS registry and death registry data from Poland, cases from September to November 2022.

Of 2388 eligible patients, cases were grouped by time of cardiac arrest (on-hours: 7:00-18:59; off-hours: 7:00-18:59 AM) and matched 1:1 using propensity scores, yielding 1194 pairs.

Primary: return of spontaneous circulation (ROSC) and 30-day survival.Secondary: EMS response time.

Our findings revealed significant disparities in OHCA outcomes between day and night shifts. ROSC rates were notably lower at night (20.9% vs 34.8%; p=0.01); however, no difference in 30-day survival was observed (8.3% vs 8.1%; p=0.94). Furthermore, EMS response times were significantly longer during nighttime hours (median and IQR): 12.4 (7.4-14.6) versus 11.2 (6.2-13.5) (minutes); p=0.01.

Patients with OHCA during off-hours experienced longer EMS response times and significantly lower rates of ROSC as compared with daytime hours. No difference in 30-day survival was observed between groups. Potential contributors include reduced staffing, fatigue and logistical delays. System-level changes in EMS scheduling and workforce planning might help to reduce time-of-day-related disparities in OHCA outcomes.

Clinical Trials ID: NCT03130088; Post results.

To develop a model for cardiovascular disease (CVD) risk, combining polygenic risk score (PRS) with traditional risk factors while assessing the added value of PRS in two cohorts of biobank participants.

Data of 128 209 participants from the Estonian Biobank recruited between 2002-2017 and 2018-2022 without prevalent cardiovascular disease, was included. Hazard ratios (HR) for polygenic risk versus conventional risk factors were estimated with Cox proportional hazards models, cumulative incidence was assessed with Aalen-Johansen curves. Predictive performance was tested using a split-sample approach and competing risk modelling. Age at CVD event served as the outcome, and the impact of the PRS was evaluated by age group (25-59 vs. 60+), sex, and recruitment period, using HRs, Harrell's C-index, and net reclassification indices (NRI).

The estimated HR per one standard deviation (SD) of PRS ranged from 1.1, 95% CI 1.06-1.15 (age 60 + , earlier cohort) to 1.36, 95% CI 1.24-1.49 (men 25-59, later cohort). Adding PRS to the conventional risk factors in the age group 25-59 increased the C-statistic by 0.028 (p < 0.0001) for men. In the age group 60 + , the increase was 0.016 (p = 0.0002) across all. In the independent validation set, the continuous NRI was 19.1% (95% CI 13.3%-24.9%) in the 25-59 group and 13.9% (95% CI 8.1%-19.6%) in the 60 + group.

In a high-risk population, PRS is a strong independent risk factor for CVD and should be considered in routine risk assessment, starting at a relatively young age.

Primary brainstem hemorrhage (PBSH) is a life-threatening neurological condition associated with high mortality and disability rates. Stereotactic hematoma aspiration surgery has been explored as a treatment option, and postoperative brainstem function monitoring is considered important for patient management.

This study aimed to evaluate the integration of minimally invasive stereotactic aspiration surgery with quantitative electroencephalography (qEEG) and transcranial Doppler (TCD) monitoring to assess brain function and improve predictive models for clinical outcomes in PBSH patients.

We conducted a retrospective analysis of 34 PBSH patients admitted between December 2022 and October 2023. After applying exclusion criteria, 25 eligible patients underwent stereotactic aspiration surgery within 24-48 hours of symptom onset. Both qEEG and TCD monitoring were performed preoperatively and within 24 hours postoperatively. Changes in qEEG parameters and TCD-derived hemodynamic indices were analyzed to assess surgical safety and efficacy.

Stereotactic surgery was associated with higher rates of favorable outcomes at 90 days compared with the non-surgical group (68.75% vs. 11.11%, p = 0.01). Postoperative TCD parameters improved significantly, indicating better hemodynamic stability, though no correlation with mRS scores was found. qEEG analysis showed significant correlations between RBP δ% and mRS scores (ρ = 0.480, p = 0.015), and RBP α% (ρ = -0.456, p = 0.022). aEEG also correlated strongly with 90-day mRS scores (ρ = 0.544, p = 0.004). The combined model of hematoma volume, RBP α%, and aEEG showed the highest predictive accuracy (AUC = 0.865).

This study suggests the prognostic value of qEEG and explores the utility of combining neurophysiological monitoring with stereotactic aspiration surgery. The integration of these tools may assist in prognostic assessment for PBSH patients; however, validation in larger prospective studies is required before clinical adoption.

Heart rate variability biofeedback (HRVB) is a self-regulation intervention that targets autonomic nervous system activity through guided breathing and visualization. Investigating its effects on cardiovascular responses to psychological stress may clarify its therapeutic potential for patients with coronary artery disease (CAD).

To examine the effects of HRVB on myocardial blood flow (MBF) changes during a mental stress challenge in individuals with CAD.

This single-center pilot randomized clinical trial included participants aged 30 to 79 years with CAD recruited in a university hospital setting and enrolled from March 30 to November 9, 2016 (data were analyzed from January to August 2025 for final reporting). Participants were followed up for 2 months.

Six weeks of HRVB training and prescribed daily practice vs usual care (standard medical care with the intervention received after study completion).

Myocardial blood flow changes after an arithmetic mental stress challenge, as measured by rubidium-82 positron emission tomography at baseline and again after 8 weeks. Linear mixed models examined the effects of HRVB on mental stress myocardial flow reserve (MFR), which is the ratio of MBF with mental stress to MBF at rest, while adjusting for baseline flow levels.

Data were analyzed from 21 participants (12 HRVB, 9 usual care) with mean (SD) age of 65 (6) years; 13 (61.9%) were male. In the HRVB group, the mean MFR with mental stress at baseline was 1.07 (95% CI, 0.94-1.22) and after the intervention was 1.16 (95% CI, 1.06-1.26). In the usual care group, the mean MFR with mental stress at baseline was 1.20 (95% CI, 1.05-1.38) and at the follow-up visit was 1.15 (95% CI, 0.94-1.40). While the within-group changes were not statistically significant, between-group difference in change from baseline to follow-up was significant. Specifically, the change in MFR in the HRVB group was 0.10 (95% CI, 0.01-0.19) units greater than the change in the usual care group (P = .03).

In this randomized clinical trial of participants with CAD, HRVB resulted in an increased MFR with mental stress compared with usual care. These results suggest potential benefits of HRVB during periods of mental stress and support the need for larger clinical trials to further investigate the efficacy of HRVB in cardiovascular disease prevention.

ClinicalTrials.gov Identifier: NCT02657382.