Iatrogenic menopause is common, but its long-term cardiovascular consequences remain uncertain, particularly by age at menopause.

To quantify associations between iatrogenic menopause and cardiovascular morbidity and mortality and evaluate whether age at iatrogenic menopause is a modifier.

In this systematic review and meta-analysis, Scopus, MEDLINE, PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, and PsycINFO were searched from January 2004 to March 2026.

Observational studies and randomized clinical trials reporting cardiovascular morbidity or mortality among women with iatrogenic menopause before natural menopause age compared with naturally menopausal or age-matched controls were included.

Data were extracted in duplicate by 2 independent reviewers, with consensus resolution. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline.

Primary outcomes were cardiovascular morbidity, cardiovascular and all-cause mortality, and a composite of cardiovascular morbidity and cardiovascular mortality, quantified as random-effects pooled hazard ratios (PHRs) with 95% CIs, irrespective of heterogeneity and with age at menopause as a moderator. Meta-regression estimates were clustered by source cohort.

Of 14 409 records, 36 studies were included with 2 617 942 women (mean [SD] age, 55.52 [12.41] years for the iatrogenic menopause cohort and 45.58 [16.02] years for comparators); median follow-up was 16.0 years (range, 4.8-36.0 years). Iatrogenic menopause vs comparators was associated with higher risk of all-cause mortality (PHR, 1.08; 95% CI, 1.01-1.16), cardiovascular events (PHR, 1.25; 95% CI, 1.12-1.39), coronary heart disease (PHR, 1.48; 95% CI, 1.07-2.03), and stroke (PHR, 1.22; 95% CI, 1.15-1.28). Mortality excesses were confined to iatrogenic menopause before age 45 years (cardiovascular mortality: PHR, 1.20 [95% CI, 1.04-1.37]; all-cause mortality: PHR, 1.15 [95% CI, 1.06-1.25]), with null estimates at or after age 45 years (cardiovascular mortality: PHR, 0.95 [95% CI, 0.81-1.11]; all-cause mortality: PHR, 0.99 [95% CI, 0.89-1.09]). In a post hoc meta-regression on the composite outcome, each increasing 5-year increment in age at iatrogenic menopause was associated with lower risk (HR, 0.89; 95% CI, 0.83-0.97) based on 37 estimates from 11 independent populations.

In this study, iatrogenic menopause was associated with higher cardiovascular morbidity, most consistently stroke, and with cardiovascular and all-cause mortality excesses before age 45 years at menopause. Older age at iatrogenic menopause was associated with progressively lower risk of cardiovascular morbidity and mortality, supporting a period of elevated risk before age 45 years rather than a single threshold age.

Inflammation contributes to cerebrovascular disease, but prospective studies of broad immune marker panels and incident stroke are limited. We aimed to identify plasma immune markers independently associated with incident stroke. Stroke-free Northern Manhattan Study participants aged ≥ 50 years had 60 plasma immune-related proteins measured by Luminex. Least absolute shrinkage and selection operator (LASSO) Cox regression selected markers associated with incident all-cause stroke. Selected markers were tested in Cox models of stroke risk sequentially adjusted for vascular risk, cardiac comorbidities, interleukin-6, interleukin-1β, tumor necrosis factor-α, and white matter hyperintensity volume (WMHV). Ischemic stroke was a secondary outcome, and bootstrap resampling provided internal validation. Among 1175 participants (mean age 70 ± 9 years; 60% women; 67% Hispanic), 130 strokes, 101 (78%) ischemic, occurred over a median of 14 years. LASSO selected only C-X-C motif chemokine ligands 9 and 10 (CXCL9 and CXCL10). Each 1-standard deviation greater CXCL10 was associated with 20% greater all-cause stroke risk after adjustment for vascular risk, cardiac comorbidities, and inflammatory cytokines (HR 1.20; 95%CI 1.04-1.38). The association persisted after WMHV adjustment (HR 1.18; 95%CI 1.02-1.37), was similar for ischemic stroke (HR 1.19; 95%CI 1.01-1.41), and was stable across bootstrap resamples. CXCL9 was not independently associated with stroke. In a multiethnic urban aging cohort followed prospectively for over a decade, baseline plasma CXCL10, also known as interferon-γ-induced protein 10 (IP-10), was independently associated with incident stroke. CXCL10 may mark interferon-γ-responsive immune activity linked to cerebrovascular vulnerability. Whether CXCL10 signals a modifiable pathway for stroke prevention warrants investigation.

Hypertrophic cardiomyopathy (HCM) carries substantial risk of major adverse cardiovascular events (MACE), yet current tools do not fully exploit quantitative myocardial texture from routine echocardiography. We retrospectively studied 413 patients with HCM from two tertiary centers to develop and externally validate a deep survival model integrating transthoracic echocardiographic texture radiomics with clinical and conventional echocardiographic variables. Patients from one center (n = 308) were used for development and internal testing and those from the other (n = 105) for external validation. The best-performing model was selected by cross-validated Harrell C-index and interpreted using Shapley additive explanations. During median follow-up of 30.7 and 35.6 months, 83 patients (20.1%) experienced a first MACE. The Combined model showed the highest concordance and net clinical benefit, with age, RadScore, left atrial diameter, and maximal wall thickness as leading contributors. This model may provide an accessible approach to individualised MACE risk stratification in HCM.

Sleep disturbances before stroke have been associated with stroke risk and severity, but the relationships between habitual pre-stroke sleep symptoms and subsequent neurological and functional outcomes remain unclear. We examined associations between self-reported pre-stroke sleep symptoms and stroke outcomes at admission and follow-up.

This exploratory secondary analysis included data from two prospective stroke cohorts conducted at Copenhagen University Hospital Rigshospitalet, Denmark. Adults with ischaemic stroke or intracerebral haemorrhage who completed a 16-item sleep questionnaire at admission and follow-up were included. Regression models were adjusted for age, sex, previous stroke or transient ischaemic attack, and depression; follow-up models were additionally adjusted for the corresponding admission outcome.

Among 133 participants, the median age was 70 years, 36.8% were women, and 90.2% had ischaemic stroke. Median follow-up was 167 days. Pre-stroke unintended leg movements during sleep, sleep-maintenance insomnia, and nocturia were associated with higher follow-up NIHSS (adjusted β 1.27, 95% confidence interval [CI] 0.41-2.12; β 0.93, 95% CI 0.21-1.66; and β 0.98, 95% CI 0.25-1.72, respectively). Hypnagogic hallucinations were associated with higher admission NIHSS (adjusted β 2.22, 95% CI 0.61-3.83), lower admission BI (adjusted β -17.83, 95% CI -27.98 to -7.69), NIHSS > 4 (adjusted odds ratio 3.06, 95% CI 1.40-6.67), and BI < 80 (adjusted odds ratio 2.18, 95% CI 1.03-4.65).

Several self-reported pre-stroke sleep symptoms were associated with neurological and functional outcomes after stroke. These pre-stroke symptoms may identify vulnerability phenotypes warranting further investigation.

Hypertension has significant socioeconomic consequences and adversely affects the health-related quality of life (HRQOL) of people living with hypertension. In Cameroon, although one-third of adults have hypertension, no study has previously examined its impact on the HRQoL of individuals. This study aimed to assess the effect of hypertension on the HRQoL of people living with hypertension followed up in three health facilities in the Dschang Health District.

We carried out a comparative analytical cross-sectional study to compare people with a confirmed diagnosis of hypertension (exposed group) with age-, sex-, and location-matched participants without hypertension (unexposed group). Data were collected through face-to-face interviews via a standardized questionnaire including the Health Utilities Index Mark 3 (HUI3) to assess HRQoL. Data were analysed using SPSS software, and the significance threshold was set at 5%. Comparisons between the two groups were performed using multivariable linear regression for continuous HUI3 scores and logistic regression for binary HRQoL outcomes.

A total of 196 participants were enrolled in this study, with 98 in each group. The median age of the subjects was 66 years (IQR: 60-73.25), and most of the participants were females (62.2%). Among chronic comorbidities, diabetes was significantly more common among participants with hypertension (OR = 30.961 [6.87-139.51], p value = 0.001). Compared with those without hypertension, people with hypertension had significantly poorer HRQoL (a difference of 0.2017 in the overall mean HUI score, p < 0.001), and this difference was more than 6 times greater than the clinically important difference of 0.03. Neither a longer duration of hypertension since diagnosis nor the overall burden of comorbidities was associated with a reduction in HRQoL.

These findings underscore the importance of integrating routine HRQoL assessment and comprehensive management of hypertension into hypertension care programs. They also support continued investment in health promotion and primary prevention strategies aimed at reducing the burden of hypertension and diabetes in Cameroon and other low- and middle-income settings.

Cerebral edema (CED) is a common complication of acute ischemic stroke, associated with increased mortality and poor functional outcomes. While infarct size is a known predictor, the role of sodium homeostasis remains unclear. This study evaluated risk factors for CED and its impact on outcomes.

We prospectively enrolled 178 patients with acute non-lacunar ischemic stroke. Cerebral edema was assessed and graded using the SITS-MOST edema scale over the first seven days. Sodium concentration and variability were monitored daily. Risk factors for CED were identified through multivariate logistic regression, and the impact of CED on mortality, functional outcomes, hemorrhagic transformation, and seizures was analyzed.

CED occurred in 38.2% of patients and was associated with larger infarcts (> 3 cm), higher NIHSS, lower ASPECTS, lack of reperfusion, and multi-territory involvement. No differences were observed in demographics or cardiovascular risk factors. Sodium levels were higher on days 3 and 5 in CED patients, with greater variability, while baseline levels were not predictive. Infarct size and day 3 sodium were independent predictors. CED was linked to worse outcomes, including higher 1-month mortality (23.5% vs. 1.8%), increased hemorrhagic transformation, and reduced functional independence. No association with seizures was found.

Infarct size remains the strongest risk factor for cerebral edema after ischemic stroke. Baseline sodium levels were not determining CED development. CED worsens outcomes but is not linked to seizure risk. These findings underscore the importance of early imaging and suggest a potential role for targeted anti-edema therapies in patients with larger strokes.

This study aimed to assess the association between grandparental age and the risk of Down syndrome and evaluate the relationship between paternal age and congenital heart disease (CHD) among affected children in Peru. A retrospective case-control study was conducted at a national pediatric referral center in Peru, including 290 participants (145 cases with free trisomy 21 and 145 controls without genetic disorders). Logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs). Parental ages were higher in cases than in controls, but there were no significant differences in grandparental ages. Maternal age was the strongest risk factor for Down syndrome (OR = 1.16 per additional year; 95% CI: 1.09-1.23). No significant association was found between maternal grandmother's age and Down syndrome (OR = 0.96 per additional year; 95% CI: 0.91-1.02). Paternal age ≥ 32.6 years (categorical analysis based on the Liu-derived cut-off) was associated with an increased risk of congenital heart disease in the presence of FT21, compared with a reference group combining FT21 without CHD and healthy controls (aOR = 3.64; 95% CI: 1.96-6.77).

In this Latin American cohort, maternal age remains the primary risk factor for Down syndrome, with no evidence supporting an effect of maternal grandmother's age at the birth of the mother. Notably, advanced paternal age was independently associated with higher odds of congenital heart disease among children with Down syndrome. These findings warrant confirmation in independent populations before being considered for clinical application.

• Advanced maternal age is the main established risk factor for Down syndrome. • The maternal grandmother's age at the birth of the mother remains uncertain, with inconsistent evidence. The contribution of paternal age to congenital heart disease in affected individuals has been insufficiently studied.

• In this case-control study from a Latin American population, the maternal grandmother's age at the birth of the mother was not associated with DS • Advanced paternal age was independently associated with higher odds of congenital heart disease among children with Down syndrome.

Associations between plasma proteomic profiles and left atrial strain (LAS) may provide insights into biological processes that underly variations in atrial function in adults without overt cardiovascular disease (CVD).

We aimed to assess the associations between circulating proteins and phasic LAS, and explore the potential influence of cardiometabolic factors on these relationships.

Study participants included individuals from the population of the Bialystok PLUS (Bialystok Polish Longitudinal University Study), examined between 2018 and 2024, including adults aged 35-70 years who had complete echocardiographic data and plasma samples available for proteomic profiling. Individuals with overt cardiovascular, inflammatory, neoplastic, or neurodegenerative disease were excluded. LA reservoir (LASr), conduit (LAScd), and contraction (LASct) strains were assessed on speckle‑tracking echocardiography. Plasma proteomic profiling was performed using the Olink Reveal platform. The associations between 1034 proteins and LAS parameters were analyzed using age‑adjusted linear models with false discovery rate (FDR) correction (q ≤0.1). Additional analyses evaluated the influence of cardiometabolic risk factors and overlap with conventional echocardiographic parameters.

The study included 414 adults at a median (interquartile range) age of 51 (43-61) years; 47.3% were men. After age adjustment, significant associations were observed exclusively for LAScd, with 30 proteins meeting the FDR threshold, whereas no proteins showed associations with LASr or LASct. The proteins linked to LAScd were mainly involved in metabolic regulation, inflammation, cellular stress responses, and tissue remodeling. The proteomic signature of LAScd showed only partial overlap with conventional echocardiographic phenotypes. After further adjustment for cardiometabolic risk factors, no associations remained significant after FDR correction.

In adults without overt CVD, LAScd was the only component of LAS associated with a distinct age‑adjusted plasma proteomic profile. The observed associations were substantially influenced by cardiometabolic risk factors, suggesting that the identified proteomic patterns primarily reflect underlying cardiometabolic processes. Further longitudinal studies are needed to determine the clinical significance of these findings.

Many inequities exist in the global access of heart and lung transplantation. Few studies have identified global strategies to implement equitable access to heart or lung transplantation.

Members of the International Society for Heart and Lung Transplantation (ISHLT) developed a consortium to identify strategic priorities to improve global access to heart and lung transplantation according to the Capability, Opportunity, Motivation- Behavior Change Wheel Model (COM-B/ BCW), an implementation science framework. Initial workshops were held at the ISHLT Scientific Sessions and refined with follow-up focus group meetings of consortium members from 2025 through 2026.

Focus 1 was to improve quality of transplant data for access and outcomes; prioritized behavior included: 1) improving collection of social determinants of health, race, and ethnicity data, and 2) collecting data on patients referred but not listed. Focus 2 was to improve transplant access to diverse racial and ethnic populations; prioritized behavior included: 1) increasing transparency regarding candidacy and allocation, and 2) improving awareness regarding diverse patient and community needs for transplant consideration. Focus 3 was to improve access with patient-centered approaches; prioritized behavior included: individualizing a comprehensive patient assessment and plan. Focus 4 was to develop transplant programs in under-resourced countries; prioritized behaviors included: 1) developing a national or regional heart and lung transplant infrastructure and workforce plan, and 2) identifying and designating transplant capable centers as pilot hubs or consortium nodes.

An ISHLT consortium developed and prioritized strategies for behavior change to improve global access to heart and lung transplantation. These strategies may form the basis of global quality improvement and implementation research studies for transplantation equity.

Bartonella infective endocarditis (IE) is a rare cause of initially blood culture-negative IE, classically associated with cat flea exposure in Bartonella henselae infection or body lice infestation among individuals experiencing homelessness or alcoholism in Bartonella quintana infection. We report the case of an 84-year-old man with severe calcific aortic stenosis who was undergoing evaluation for pre-transcatheter aortic valve implantation (TAVI). Cardiac computed tomography (CT) unexpectedly revealed a peri-annular cavity consistent with a drained or healed peri-annular abscess, despite the absence of fever or other clinical features of IE. Initial blood cultures were negative, and TAVI was planned following multidisciplinary discussion, pending serological results. However, a subsequently reported high-titer Bartonella serology prompted readmission, and TAVI was ultimately deferred after the diagnosis was confirmed. Prolonged incubation of blood cultures subsequently identified B. quintana, while brain magnetic resonance imaging (MRI) revealed a lesion suspicious for an intracranial infectious aneurysm. Definite IE was established according to the 2023 Duke-International Society for Cardiovascular Infectious Diseases (Duke-ISCVID) criteria based on two major criteria: high-titer Bartonella serology and imaging evidence of a peri-annular abscess. No classical epidemiological risk factors for Bartonella infection were identified. Despite targeted antimicrobial therapy, the patient experienced progressive clinical deterioration, and multiple comorbidities precluded surgical intervention. He ultimately died of multiorgan failure. This case highlights the diagnostic challenge of occult B. quintana IE incidentally identified during pre-TAVI evaluation, including in patients without classical epidemiological risk factors or overt manifestations of infection. It also emphasizes that unexpected peri-annular abnormalities detected during pre-TAVI evaluation should prompt a thorough investigation for IE, even in clinically unsuspected cases, with direct implications for procedural planning.