The relationship between Neuromyelitis optica spectrum disorder (NMOSD) and specific cardiovascular outcomes, particularly macrovascular events such as peripheral artery disease (PAD) and venous thromboembolism (VTE), has not been examined in a population-based study. The current study investigated the association between NMOSD and the risks of PAD and VTE.

This retrospective cohort study used data from the Taiwan National Health Insurance Research Database. Patients with new-onset NMOSD between 2003 and 2020. Patients with previous PAD or VTE were excluded. Each patient was matched to five general patients for comparison using propensity score matching. In total, the study included 2,027 patients with NMOSD and 10,135 matched general population controls. A Cox proportional hazards model was used to investigate PAD and VTE risk, with relevant variables controlled for. NMOSD was stratified by severity to further verify the association between disease severity and macrovascular event risk. The control variables considered in this study were sex, age, insured salary, urbanization, Charlson comorbidity index (CCI), and related comorbidities.

The average follow-up of all participants was 7.01 person-years. After adjustments for relevant variables, patients with NMOSD had significantly higher risks of PAD (adjusted hazard ratio [aHR] = 1.40; 95% confidence interval [CI]: 1.02-1.92) and VTE (aHR = 4.81; 95% CI: 3.08-7.52). The risk of vascular events was strongly associated with disease severity. Severe NMOSD was associated with markedly increased risks of PAD (aHR = 2.26; 95% CI: 1.41-3.61) and VTE (aHR = 11.69; 95% CI: 6.86-19.90), whereas mild and moderate disease did not significantly increase PAD risk.

NMOSD is a significant risk factor for PAD and VTE. These findings highlight the importance of proactive vascular risk assessment and preventive management in patients with NMOSD.

Transgender individuals represent a marginalised population, often exposed to unique psychosocial stressors, limited healthcare access, and social exclusion, all of which may contribute to an increased risk of cardiovascular disease (CVD). However, evidence focusing exclusively on the cardiovascular outcomes in this group remains limited. This systematic review and meta-analysis aimed to estimate the pooled prevalence of major cardiovascular morbidities among transgender adults.

A systematic search of five databases (PubMed, PubMed Central, Embase, Scopus, and Google Scholar) was conducted to identify observational studies reporting cardiovascular outcomes in transgender individuals aged ≥18 years. The study protocol was registered with PROSPERO (CRD42022383213). The inclusion criteria were cross-sectional, cohort, and case-control studies published in English. Data extraction and quality assessment were independently performed by two reviewers using standardised tools. A meta-analysis was conducted using a random-effects model, and publication bias was assessed using funnel plots and Egger's test.

10 eligible studies that focused on transgender individuals were included in the final analysis. The pooled prevalence rates were hypertension 21% (95% CI: 12-36; I ² = 99.0%), stroke/CVA 5% (95% CI: 3-8; I ² = 84.3%), coronary artery disease (CAD) 3% (95% CI: 1-19; I ² = 98.8%), and myocardial infarction (MI) 7% (95% CI: 6-9; I ² = 75.5%). Funnel plots indicated a symmetrical distribution for hypertension and stroke, suggesting low publication bias, whereas asymmetry was noted for CAD and MI.

This review revealed a substantial burden of cardiovascular morbidity among transgender individuals, warranting routine screening and targeted preventive strategies in this population. Policymakers and healthcare providers should consider inclusive approaches to reduce cardiovascular risk. Further longitudinal studies and comparative analyses of cisgender populations are essential for guiding evidence-based interventions.

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022383213, identifier: CRD42022383213.

While prolonged sedentary behavior is an established contributor to hemorrhoidal disease, the precise quantitative impact of dietary fiber within sedentary occupational cohorts remains to be fully elucidated. This study aimed to characterize the dose-response relationship between fiber consumption and hemorrhoid prevalence among professionals in sedentary roles.

In this cross-sectional investigation of 421 sedentary professionals, dietary patterns were evaluated via validated instruments, and hemorrhoid status was determined through a combination of clinical assessment and symptom-based screening. We utilized multivariable logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Furthermore, restricted cubic spline (RCS) analysis, adjusted for age, BMI, exercise habits, and sedentary duration, was employed to model the dose-response landscape.

The cohort exhibited a hemorrhoid prevalence of 38.95%. Multivariable-adjusted models revealed a significant inverse correlation between total fiber intake and hemorrhoid risk (P for trend < 0.001). Compared with the lowest energy-adjusted intake group (< 13.1 g/d), participants in the highest quartile (>18.5 g/d) had lower odds of hemorrhoids (adjusted OR: 0.56; 95% CI: 0.32-0.98). RCS regression identified a non-linear "L-shaped" association (P for non-linearity = 0.024). The curve showed visual flattening near 25 g/d, which should be interpreted as a descriptive pattern rather than a statistically validated threshold.

Higher dietary fiber intake was independently associated with lower hemorrhoid prevalence among sedentary workers. Because of the cross-sectional design, these findings should not be interpreted as evidence of causality. Prospective studies are needed to clarify temporality and to determine whether increasing dietary fiber intake can reduce future hemorrhoid occurrence.

Oral frailty among coronary heart disease (CHD) patients is prevalent and harmful. CHD patients have encountered serious physical and psychological health issues. Social support is a crucial protective factor in chronic disease management. There is a paucity of evidence regarding the specific association among CHD patients. Depressive symptoms and nutritional risk have been demonstrated to be associated with oral frailty, but the mediating role between them under the influence of social support remains to be further explored. This study aimed to investigate the chain mediating effect of depressive symptoms and nutritional risk between social support and oral frailty among CHD patients.

This is a cross-sectional study involving 500 hospitalized CHD patients, conducted from September 2025 to January 2026. The assessment tools used included a demographic characteristics, the Social Support Rating Scale (SSRS), the PHQ-9 Depression Screening Scale (PHQ-9), the Nutritional Risk Screening 2002(NRS 2002), and the Oral Frailty Index-8 (OFI-8). Pearson correlation analysis was used to examine relationships among variables, and the Bootstrap method (with 5,000 repeated samples) was employed to test for mediating effects.

The prevalence of oral frailty among CHD patients was 57.60%. The mean scores for social support, depressive symptoms, nutritional risk, and oral frailty were (37.67 ± 8.15), (13.41 ± 3.47), (1.12 ± 1.13), and (4.80 ± 2.86), respectively. Correlation analysis revealed that oral frailty was negatively correlated with social support and positively correlated with depressive symptoms and nutritional risk. Mediation analysis indicated that social support not only directly influences oral frailty but also indirectly influenced it through depressive symptoms, nutritional risk, and the chain path between depressive symptom and nutritional risk; the chain mediation effect accounted for 15.57% of the total effect. After adjusting for covariate, the mediation effects remained statistically significant.

The study showed that social support can predict oral frailty through depressive symptoms and nutritional risk. It is recommended that healthcare professionals provide comprehensive interventions to enhance social support for CHD patients and actively manage their depressive symptoms and nutritional risks to prevent the progression of oral frailty.

To systematically evaluate the effects of exercise interventions on post-stroke depression (PSD) and to clarify the dose-response relationship between physical activity dosage and depressive symptoms in individuals with PSD.

A structured and comprehensive search was conducted in PubMed, Web of Science, Embase, Scopus, and the Cochrane Library. Restricted cubic spline models were applied to examine the dose-response association between physical activity dosage and depressive symptoms in PSD.

A total of 27 publications comprising 31 randomized controlled trials were included, involving 2,247 participants. The meta-analysis indicated that exercise intervention was associated with a modest improvement in depressive symptoms among patients with PSD [SMD = -0.15, 95% CI (-0.23, -0.07), p < 0.01], with moderate heterogeneity (I ² = 41.9%). Dose-response analysis revealed a non-linear association between exercise dosage and symptom improvement, with the greatest apparent benefit observed at approximately 801 MET-min/week. Subgroup analyses suggested that more favorable improvements were more commonly observed in interventions characterized by resistance training [SMD = -0.55, 95% CI (-0.85, -0.25)], a frequency of 1-2 sessions per week [SMD = -0.41, 95% CI (-0.67, -0.15)], a session duration of ≤30 min [SMD = -0.44, 95% CI (-0.70, -0.19)], and an intervention duration of 9-12 weeks [SMD = -0.16, 95% CI (-0.27, -0.05)].

Moderate-dose exercise intervention, approximately 801 MET-min/week, was associated with a modest improvement in post-stroke depressive symptoms. These findings provide a reference for optimizing exercise dosage and informing individualized prescription strategies for patients with PSD.

https://www.crd.york.ac.uk/PROSPERO/view/CRD420251167322, identifier (CRD420251167322).

Cardiovascular disease (CVD) risk assessment based on single-time-point measurements may inadequately capture the dynamic interplay of obesity, metabolic dysfunction, and chronic inflammation. Understanding their long-term co-evolution may improve CVD risk stratification.

We conducted a prospective cohort study using data from the China Health and Retirement Longitudinal Study. Participants aged ≥ 45 years with repeated measurements of body mass index (BMI), triglyceride-glucose (TyG) index, and high-sensitivity C-reactive protein (hsCRP) between 2011 and 2015 were included. Joint trajectories of these obesity-metabolic-inflammatory markers were identified using the KmL3D clustering algorithm. Incident CVD (heart disease or stroke) was ascertained during follow-up from 2015 to 2020. Cox proportional hazards models were applied to evaluate associations between trajectory groups and CVD risk after adjustment for demographic, lifestyle, and clinical covariates.

Among 4483 participants (mean age 57.8 years; 52.6% women), four distinct joint trajectory patterns were identified: a sustained low-risk profile (46.8%), an obesity-predominant profile (26.7%), a metabolic-obesity-driven profile (17.1%), and an inflammation-dominant profile (9.4%). During a median follow-up of 5.0 years, 592 incident CVD events occurred. Compared with the low-risk profile, all adverse trajectory groups were associated with significantly higher CVD risk, with hazard ratios ranging from 1.35 to 1.46 after full adjustment. Associations were more pronounced for stroke, particularly among individuals with a metabolic-obesity-driven trajectory. Findings were robust across sensitivity analyses.

Distinct dynamic co-evolution patterns of obesity, metabolic dysfunction, and inflammation identify population subgroups with substantially different risks of incident CVD.

Acute coronary syndromes (ACS) represent one of the leading causes of cardiovascular mortality and morbidity, with a substantial clinical, organizational, and economic impact on the Italian National Health Service (NHS). On behalf of the National Center for Clinical Excellence, Quality and Safety of Care of the Italian National Institute of Health (Istituto Superiore di Sanità, ISS), the Italian Association of Hospital Cardiologists (ANMCO) promoted the development of consensus-based recommendations for good clinical practice (RBPCA) for the diagnosis and management of ACS, with the aim of integrating and contextualizing the most recent European Society of Cardiology guidelines within the Italian healthcare setting. The recommendations were developed through a multidisciplinary Consensus Conference, according to the ISS methodological framework, addressing 16 clinical and organizational issues of major relevance related to the diagnostic and therapeutic pathway of ACS. The RBPCA aim to reduce variability in clinical management, promote appropriateness and uniformity of care, and improve clinical outcomes for patients with ACS within the context of the Italian NHS.

Cardiogenic shock is a critical condition with a short-term mortality rate of around 40-50%, which has remained unchanged over the years despite therapeutic advances in acute cardiac diseases. In this context, the use of microaxial flow pumps is increasing and in the DanGer Shock trial it reduced the 6-month mortality in patients with cardiogenic shock due to acute myocardial infarction compared to standard therapy. The aim of this study was to evaluate how the use of microaxial flow pump in our population of patients with cardiogenic shock impacted survival and short- and mid-term outcomes.

We retrospectively collected data from 78 patients with cardiogenic shock treated with microaxial flow pump and admitted to the Cardiac Intensive Care Unit of Ospedali Riuniti of Ancona, Italy, between April 2014 and December 2024. The primary end-point was the assessment of independent predictors of in-hospital mortality, while the secondary end-point was a composite end-point (all-cause death, rehospitalization for heart failure, acute coronary syndrome, arrhythmias, heart transplantation, or ventricular assist device implantation at 12-month follow-up).

Mean age of the population was 59.3 years, predominantly of male sex. The mean left ventricular ejection fraction at admission was 24.2%, mean serum lactate level at admission was 5.8 mmol/l. In 17 patients, Impella mechanical circulatory support represented an escalation therapy from intra-aortic balloon pump. In-hospital mortality was 32.1%, and variables such as age, left ventricular ejection fraction at intensive care unit admission, and the presence of right ventricular dysfunction were associated with higher in-hospital mortality. The secondary end-point occurred in 7 patients (8.9%): 3 patients died and 4 patients were rehospitalized for cardiovascular causes within 12 months after discharge.

Impella circulatory support is a device capable of "resting" the ventricular myocardium while ensuring adequate cardiac output. In our observational evaluation, the use of Impella was associated with a reduction in in-hospital mortality. However, optimal timing of implantation remains to be clarified to maximize its benefit and avoid futile use.

In recent years, catheter ablation for atrial fibrillation (AF), particularly pulmonary vein isolation, has become an increasingly used and evidence-based treatment aimed primarily at improving symptoms and quality of life. In this context, the management of oral anticoagulation (OAC) after the procedure has become a major topic of discussion within the scientific community. Current guidelines recommend continuing OAC based on the thromboembolic risk profile assessed by the CHA2DS2-VA score, regardless of the apparent success of the ablation. However, in recent years several research groups have explored the possibility of discontinuing anticoagulation after successful ablation in patients without documented arrhythmia recurrence. In particular, two recent randomized trials, ALONE-AF and OCEAN, have investigated strategies of anticoagulation discontinuation or de-escalation in the post-ablation setting, contributing to renewed debate regarding the necessity of long-term anticoagulation in selected patients. In parallel, the OPTION trial evaluated an alternative strategy based on left atrial appendage occlusion as a means to avoid long-term anticoagulant therapy. The aim of this review is to summarize and critically discuss the most recent evidence regarding antithrombotic management after AF ablation, focusing on clinical implications, methodological limitations, and potential future directions toward more individualized therapeutic strategies.

There are no data on the implementation of shock teams (ST) or their impact on cardiogenic shock (CS) in Spain.

We conducted a retrospective observational study including episodes of CS (2016-2022) from hospitals within the Spanish National Health System with availability of an Interventional Cardiology Unit. The population was divided into a) patients hospitalized in centers with ST (CS-ST) and b) patients hospitalized in centers without ST (CSNST). Furthermore, the availability of a cardiac intensive care unit (CICU), cardiac surgery, heart transplant program, and volume of CS cases at each center were recorded. The outcome variable was the in-hospital mortality rate.

A total of 15,879 episodes were analyzed, 32% (5,095) of which corresponded to the CS-ST group. The proportion of  enters with ST availability increased progressively from 7% in 2016 to 39% in 2022. Patients from the CS-ST group were younger (68 vs 71 years, P < .001) and more frequently underwent mechanical ventilation, renal replacement therapy, and circulatory support (P < .001), showing a higher rate of acute kidney failure and stroke and longer lengths of stay (12 days vs 9 days, P < .001). Care in centers with ST (OR, 0.86; 95% CI, 0.77-0.96; P = .005) and CICU (OR, 0.82; 95% CI, 0.69-0.98; P < .033) was significantly associated with a lower mortality rate.

The availability of ST has expanded in our setting. Patients admitted to centers with ST are managed more invasively, with a lower in-hospital mortality rate despite a higher rate of complications.