Carotid artery stenosis is a major cause of ischemic stroke, with prevalence increasing with age and vascular risk factors. Targeted diagnosis in patients with acute cerebrovascular disease and high-risk populations, combined with consistent conservative management, is essential to significantly reduce stroke risk. This article reviews current diagnostic strategies, including duplex ultrasound as the cornerstone of non-invasive assessment, and discusses pharmacological and non-pharmacological treatment approaches. Medical therapy-including antiplatelet therapy, statins, and vascular risk factor control-is crucial across all stenosis stages and may suffice even in some cases traditionally considered for revascularization. Current research focuses on individualized therapy guided by risk stratification to identify patients for whom conservative management alone provides optimal stroke prevention. Interdisciplinary decision-making is essential to tailor treatment strategies.

Ischemic stroke (IS) accounts for 87% of all strokes and is a leading cause of disability worldwide. Women face higher lifetime IS risk and worse functional outcomes, yet predictive biomarkers remain limited. Moreover, inflammation is increasingly recognized as a contributor to IS pathogenesis, with inflammatory markers such as C-reactive protein (CRP) positively associated with IS. Yet, the metabolic pathways linking chronic inflammation to IS risk are poorly understood. We aimed to identify a metabolomic signature reflecting systemic inflammation and evaluate its association with incident IS in women.

This study used nested case-control designs within the Nurses' Health Study (NHS), a prospective cohort of US female registered nurses aged 30-55 at enrollment. Using elastic net regression in a derivation cohort with inflammatory biomarker (high-sensitive CRP, interleukin 6, tumor necrosis factor receptor 2, adiponectin) and metabolomic data, we developed a metabolomic signature index of inflammation (i-MSI). The i-MSI's association with incident IS was examined in an independent NHS nested case-control study using conditional logistic regression, adjusting for cardiovascular risk factors. Generalizability to atherosclerotic disease was evaluated in a coronary heart disease (CHD) nested case-control study from the Women's Health Initiative (WHI).

The derivation cohort included 1,699 women (mean age 58 years, 94% White). The i-MSI comprised 102 metabolites, with lysophosphatidylcholine species-promoters of endothelial activation, vascular inflammation, and plaque instability-contributing most significantly. In the independent IS case-control study (454 cases, 454 controls; mean age 66 years), women in the highest compared with lowest i-MSI quartile had a multivariable-adjusted odds ratio (OR) of 1.76 (95% CI 1.02-3.03) for IS, whereas each 1-SD increase in the i-MSI was associated with an OR of 1.35 (95% CI 1.09-1.67). In the WHI study (793 cases, 795 controls; mean age 67 years), each SD increase in the i-MSI was associated with an OR of 1.20 (95% CI 1.05-1.37) for CHD.

An inflammatory metabolomic signature was associated with higher IS risk, independent of traditional cardiovascular disease risk factors, with consistent findings for CHD. Future studies should replicate these findings in other populations and evaluate whether these metabolites can improve risk stratification and serve as biomarkers for atherosclerotic cardiovascular diseases.

The frequency and cognitive trajectory of cerebral amyloid angiopathy (CAA) in patients from memory clinics is uncertain. We aimed to determine whether patients with CAA have an increased risk of dementia in nondemented individuals presenting with a cognitive complaint.

We retrospectively analyzed data of the MEMENTO prospective cohort that enrolled outpatients from 26 centers in France presenting with a cognitive complaint and a Clinical Dementia Rating (CDR) scale score ≤0.5. Participants aged >50 years who had interpretable baseline brain MRI were eligible for this study and followed every 6 months for 5 years with systematic assessment of dementia. Based on MRI analysis, participants were classified into 4 categories using the Boston criteria V2.0 and V1.5: probable CAA, possible CAA, deep/mixed small vessel disease (SVD), or controls (without imaging markers of SVD). The primary outcome was the progression to dementia (Diagnostic and Statistical Manual of Mental Disorders, Fourth Revision criteria) evaluated by an expert committee. Cox proportional hazards models were used to determine hazard ratios (HRs) and CIs for the primary outcome.

Of 2,323 MEMENTO participants, 2,136 (92%) were included in this study. The mean age (SD) at baseline was 71.3 (7.9) years and 1,320 (62%) were women. Probable CAA was diagnosed in 413 (19.3%) patients using the Boston criteria V2.0, and 144 (7.0%) using the Boston criteria V1.5. During a median follow-up of 5.0 years (interquartile range 3.1-5.1), 307 participants developed dementia. Compared with controls, patients with probable CAA according to the Boston criteria V2.0 (HR 1.73, 95% CI 1.23-2.42) and V1.5 (HR 2.23, 95% CI 1.56-3.20) had increased risk of dementia. After adjusting for age, sex, baseline Mini-Mental State Examination score and hippocampal volume, patients with probable CAA per Boston criteria V1.5 but not V2.0 had an increased risk of dementia compared with controls. This association was not significant when further adjusting with APOE ε4.

CAA is a common condition in outpatients with mild cognitive symptoms. Patients with probable CAA according to the Boston criteria V1.5 but not V2.0 have increased risk of dementia. Further studies are required to externally validate these findings and evaluate potential mediation effect of APOE genotype.

Being overweight and obese are major health concerns worldwide, contributing to lifestyle-related diseases such as hypertension, dyslipidemia, type 2 diabetes, and cardiovascular disease. Increasing physical activity is an effective strategy for weight management. However, earlier step count studies have remained limited to small populations, short-term measurements of 1-2 weeks, and mainly cross-sectional comparisons of average step counts. The effects of long-term step count changes on weight loss remain unclear.

This study was conducted to assess the effects of long-term patterns of step counts on weight loss using data from the "Asmile" mobile health app in Japan. We hypothesized that participants with continuously increasing step counts over time would have a higher likelihood of significant weight reduction than participants who show steady or fluctuating patterns, even if their average step counts were similar.

We analyzed data of 2778 Asmile users aged 40-74 years with BMI ≥25 kg/m² who underwent a specific health checkup during fiscal years 2019-2023 and who had valid step count records for 10-14 months. Step count trajectories, reflecting long-term trends in physical activity, were classified using a latent class mixed model into four patterns: UP (increasing), FLAT (steady), DOWN (decreasing), and UP/DOWN (increasing then decreasing). Logistic regression was applied to estimate odds ratios for achieving ≥3% weight loss, with step trajectory as the explanatory variable and weight loss as the outcome.

Among participants, 1601 (57.6%) were men and 1177 (42.4%) were women, with respective mean ages of 65.8 (SD 7.9) and 64 (SD 8.2) years. Step count trajectories were distributed as 28.5% UP, 36.2% FLAT, 20.1% DOWN, and 15.2% UP/DOWN. Compared with the FLAT group, participants in the UP group had a significantly higher likelihood of achieving ≥3% weight loss (adjusted odds ratio 2.45, 95% CI 1.78-3.38).

Long-term tracking of step counts using the Asmile app revealed distinct activity patterns. Continuous increases in step counts were associated with the greatest likelihood of weight loss, emphasizing the importance of sustained physical activity. These findings support the use of long-term step monitoring to guide interventions for obesity and lifestyle-related disease prevention.

Understanding the multifactorial drivers of cardiovascular disease (CVD) risk in LGBTQ+ populations is critical to advancing equitable cardiovascular care.

To evaluate and synthesize empirical evidence on factors influencing CVD risk among sexual minority populations.

A systematic review was conducted following PRISMA guidelines. Five databases (PubMed, Scopus, MEDLINE, ScienceDirect and ProQuest) were searched for studies published between 2019 and 2024 that examined CVD risk factors among LGBTQ+ adults. Eligible studies were appraised using the Joanna Briggs Institute critical appraisal tool, and findings were synthesized using a convergent integrated approach.

Twenty studies met the inclusion criteria, most of which were cross-sectional and conducted in high-income countries. Identified CVD risk factors were classified into six domains: behavioural (e.g., nicotine use, health behaviours, substance use), blood biomarker (e.g., lipid or total cholesterol, HbA1c, C-reactive protein), physical (e.g., BMI, blood pressure, age), comorbidities (e.g., metabolic syndrome, COPD, HIV), psychological (e.g., positive and negative factors) and social (e.g., discrimination, loneliness, marital status). Bisexual, lesbian and gay individuals were most frequently represented. Across studies, minority stress and adverse social determinants were consistently associated with elevated CVD risk.

Sexual minority populations face disproportionate cardiovascular risk shaped by behavioural, biological and psychosocial stressors. These findings highlight the need for inclusive, culturally competent nursing practice and identity-informed screening strategies.

Nurses should integrate sexual orientation and gender identity into cardiovascular risk assessments, adopt trauma-informed and resilience-promoting approaches, and advocate for policies that reduce structural barriers to equitable care.

No patients or members of the public were directly involved in the design, conduct or reporting of this systematic review.

Optimal cardiovascular health during pregnancy and postpartum is critical for reducing maternal morbidity and mortality. Although lifestyle interventions effectively promote cardiovascular health, strategies are needed to reach the maternal populations with the highest prevalence of cardiovascular disease risk factors. Evidence-based home visiting programs, though not initially developed to address cardiovascular health, offer a promising platform for reaching pregnant and postpartum women at high risk for later cardiovascular disease. This study explored home visitor perspectives on integrating cardiovascular health content into home visitation. Guided by the Social Ecological Model, semi-structured interviews (n = 10) and focus groups (n = 8) were conducted with home visitors, supervisors, and program managers (N = 33) from agencies in California and Rhode Island. Thematic analysis identified broad support for including heart health content, with participants emphasizing the value of culturally relevant, engaging, and flexible curricula that could be tailored to family needs. Organizational challenges included staff burden, training gaps, and funding for intervention sustainability. At the community level, strong relationships with healthcare providers and aligned messaging across systems were identified as key facilitators. Findings provide practical insights for the design and implementation of cardiovascular health interventions within home visiting and highlight the importance of addressing multi-level factors to support successful integration.

Vascular aging is a central determinant of healthy life span, not only influencing the susceptibility to cardiovascular diseases but also shaping the risk of systemic decline across multiple organs. It is driven by a variety of age-related factors, including cellular senescence, chronic inflammation, loss of proteostasis, mitochondrial dysfunction, genomic instability, epigenetic remodeling, and stem cell exhaustion. These processes interact with the unique mechanical and metabolic environment of the vasculature to create a distinctive pathological trajectory, manifested in part as arterial stiffening, impaired barrier integrity, and dysregulated vasomotor control. Recent advances in single-cell omics and cross-organ molecular clocks have revealed the heterogeneity and organ specificity of aging, underscoring the need for integrative frameworks that connect vascular biology with overall health. Meanwhile, the development of diverse therapeutic strategies-ranging from senolytic and immune-mediated clearance to metabolic and mitochondrial interventions-highlights the translational potential of targeting the aging vasculature. Looking ahead, multimodal biomarkers and precision medicine may transform vascular aging from an inevitable process into a modifiable determinant of health span.

Early-stage diagnosis of paroxysmal atrial fibrillation (PAF) is challenging owing to its asymptomatic nature. However, the genetic factors underlying PAF and predictive utility of polygenic risk scores (PRSs) for PAF in Asian populations remain elusive. We aimed to explore the PAF-associated genetic variants in a Japanese cohort and evaluate the predictive performance of PAF-specific PRSs. This study included 2,604 participants. Following exclusion, quality control, and genotype imputation, a genome-wide association study (GWAS) was conducted. The predictive performance of 30 sets of PRS models constructed across various thresholds was evaluated using three machine learning methods. Model performance was assessed using area under the curve (AUC) and SHapley Additive exPlanations (SHAP). The GWAS using 1,038 PAF cases and 744 controls identified 82 genome-wide significant variants (P < 5 × 10-8), all on chromosome 4q25. Of these, 80 variants clustered upstream of PITX2, and two were located in LINC01438. Fine mapping identified two independent intergenic signals, with rs2200732 as the lead single-nucleotide polymorphism. The best PRS-only model achieved an AUC of >0.70, which was improved up to 0.737 in additive models incorporating both PRS and clinical variables. SHAP analysis consistently ranked PRS as the most influential predictor among the clinical variables included in this study. These results suggest that genetic risk, particularly at the established 4q25/PITX2 locus, contributes substantially to PAF susceptibility in this Japanese cohort and that PRS may improve early risk stratification when integrated with clinical risk factors.

Spasticity is a frequent neuromuscular impairment associated with cerebral palsy, stroke, and spinal cord injury, commonly assessed using subjective clinical scales. This exploratory pilot study aimed to develop and preliminarily validate a multimodal instrument for the objective quantification and stratification of spasticity in nine individuals (3 female, 6 male) with upper-limb spasticity due to cerebral palsy (n = 5) or stroke (n = 4). A wearable system integrating surface electromyography, inertial measurement units, and force sensing resistors was designed to simultaneously capture muscle activation, joint kinematics, and generalized resistance force during standardized passive mobilizations. Simple indicators six area under the curve-based indicators were derived: force, sEMG, and angular velocity under two conditions (R1, R2) and given distinct weights depending on their contribution. Principal component analysis revealed that three latent components accounted for 83.86% of the total variance observed across participants. Based on these indicators, a Composite Index was constructed using min-max normalization and weighted linear aggregation. Within the pilot study, the Composite Index could differentiate between spasticity severity levels (F = 6.38, p = 0.0327, η² = 0.68), with sEMG activity during slow stretch (AUC sEMG R2) the most influential contributor indicators. The proposed multimodal instrument demonstrates preliminary feasibility as a non-invasive and portable approach for objective spasticity quantification, warranting further validation in larger cohorts.

Transcutaneous auricular vagus nerve stimulation (ta-VNS) involves applying electrical stimulation via electrodes to the auricular concha. This activates vagal afferent fibers, initiating an ascending pathway from the periphery to the brainstem, which ultimately stimulates central vagal projections and promotes neural plasticity. Previous studies have demonstrated that combining ta-VNS with motor training offers synergistic benefits for motor recovery after stroke. However, these combined approaches typically employ open-loop stimulation with fixed parameters, lacking real-time closed-loop responsiveness to dynamic neural activity. To address this limitation, we developed a novel closed-loop ta-VNS system synchronized with electroencephalography (EEG)-triggered brain-computer interface (BCI) motor training. This system was designed to enhance corticospinal coupling and promote synaptic plasticity. We established a standardized protocol for applying this closed-loop ta-VNS system synchronized with BCI-based motor training in stroke patients. Using EEG-based functional assessment, we compared the effects of the closed-loop ta-VNS system synchronized with BCI-based motor training to those of sham ta-VNS synchronized with BCI-based motor training. This work provides the methodological and theoretical groundwork for the clinical application of this approach in stroke rehabilitation.