Direct oral anticoagulants (DOAC) were developed as an alternative to vitamin K antagonists in the treatment of NVAF. Statins are frequently prescribed drugs for the prevention of atherosclerotic cardiovascular disease. A potential interaction between DOACs and statins has been described, suggesting that their concomitant use may increase the risk of major bleeding (MB).

To estimate the risk of MB associated with concomitant use of DOACs and statins to assess potential safety issues.

A case-control study nested in a cohort of new users of DOACs was performed in BIFAP. Cases were defined as MB events and matched to four controls by risk-set sampling. Treatment episodes were built to define the participants' exposure according to their use at index date as current, recent, past, or no use. Exposure was also assessed in relation to its continuity and duration. Variables were created based on the concomitant use of DOACs and statins to study the interaction, using conditional logistic regression to estimate the risk of MB.

aOR (95% CI) for current use of DOAC or statin use were 1.35 (0.96-1.9) and 0.72 (0.59-0.88). aOR for their concomitant use was 1.31 (0.83-2.07) compared to nonuse of either of them. DOAC continuous use (1.27; 0.8-2.03) and long-term (1.11; 0.67-1.81) treatment was associated with smaller risks than noncontinuous (1.40; 0.85-2.32) and short-term treatment (1.43; 0.94-2.45). Analyses by individual DOACs and statins showed similar results except for edoxaban, which had low numbers.

There was no evidence to suggest an interaction between DOACs and statins and the risk of MB. Regular use of DOACs is important to minimize their impact on MB onset.

Dementia is a major global health challenge and lifestyle modification is a key prevention strategy. Cardiovascular disease (CVD) is hypothesized to mediate lifestyle-dementia relationships, but empirical evidence is unclear. Mediation analysis offers insight into causal mechanisms beyond traditional associations. This scoping review synthesizes the limited available studies applying mediation analysis to examine whether CVD mediates associations between lifestyle factors (smoking, alcohol use, diet, physical activity) and cognitive outcomes in adults aged 45 and older. Of 1309 records screened, five studies met the inclusion criteria, reflecting a small, heterogeneous evidence base. Most examined physical activity (n = 4), with two reporting partial mediation by composite CVD risk scores. Evidence for diet (n = 2) and alcohol (n = 1) was inconclusive, and no studies assessed smoking. Overall, evidence for CVD as a mediator remains tentative, sparse, and inconsistent, highlighting major methodological gaps and an urgent need for robust studies to clarify whether cardiovascular health underpins lifestyle-related dementia risk. HIGHLIGHTS: Five studies were identified that used mediation analysis to explore the role of cardiovascular disease in the relationship between lifestyle risk factors and dementia. Cardiovascular disease may partially mediate the impact of physical activity on brain health. Diet and alcohol consumption showed no clear mediation effects by cardiovascular disease on cognition. Longitudinal, well-powered studies with robust mediation frameworks are urgently needed to evaluate vascular pathways and optimize dementia prevention strategies targeting modifiable lifestyle factors.

Due to the higher rates of cardiovascular disease (CVD), the "Honoring the Gift of Heart Health" CVD risk factor educational program was developed specifically for American Indian communities. However, the effectiveness of educational program materials may change overtime and updates may be required to influence community health behaviors. Therefore, the aim of this project was to work with American Indians to provide recommendations on updating the "Honoring the Gift of Heart Health" CVD risk factor curriculum. To achieve this aim, we used a qualitative research design and a narrative inquiry approach. We used snowball sampling to recruit American Indian community stakeholders from the Oklahoma communities that participate in the Strong Heart Study, a study of CVD among American Indians. Throughout 2022, we conducted 3 focus group discussions, with 12 total participants. Two researchers transcribed the focus group audio recordings and conducted a content analysis to identify themes and patterns. American Indian participants provided recommendations regarding educational material format, topics, and incorporating culture into learning. On average, participants spent the highest percentage of time discussing themes related to nutrition (46%), followed by educational material format, risk factors, special groups, and new recommendations. In conclusion, this project was the first step in working with American Indian communities to update an educational intervention to address the persistent public health issue of CVD.

The role of gut microbiota-modulating diets in cardiovascular-kidney-metabolic (CKM) syndrome progression is poorly understood. This study investigated associations between the dietary index for gut microbiota (DI-GM) and advanced CKM risk, with a focus on inflammatory mediation. Cross-sectional data from 12,068 NHANES participants (2007-2020) were analyzed. Advanced CKM stages (3-4) were classified using American Heart Association (AHA) criteria. DI-GM scores were derived from 14 dietary components, and inflammatory biomarkers (e.g., dietary inflammatory index [DII], neutrophil to lymphocyte ratio [NLR], systemic inflammation response index [SIRI]) were assessed. Multivariable logistic regression, mediation analysis, and machine learning (XGBoost, SHAP) evaluated associations and predictive performance. High DI-GM adherence (≥6) was associated with a 25% reduction in advanced CKM risk, while each unit increase was associated with a 7% lower risk. Inflammatory biomarkers mediated 42.88% (DII) to 5.59% (neutrophils) of this association. XGBoost identified coffee, refined grains, and fat as top risk predictors. This cross-sectional study underscores the protective role of DI-GM against CKM progression, mediated substantially by inflammation suppression. While these results highlight promising associations, the cross-sectional design necessitates caution in inferring causality. Machine learning underscores the importance of dietary synergy over isolated components, advocating for integrated dietary-microbiota interventions in precision CKM management. PRACTICAL APPLICATIONS: What is currently known about this topic? Cardiovascular-kidney-metabolic (CKM) syndrome, formally defined in 2023, affects over 25% of US adults, yet evidence linking gut microbiota-targeted dietary patterns to advanced CKM risk remains limited. What is the key research question? Higher dietary index for gut microbiota (DI-GM) scores-characterized by fiber-rich, fermented, and plant-based components-are inversely associated with advanced CKM risk, particularly in males sedentary and hypertension subgroups. How might this study influence clinical practice? Inflammatory biomarkers mediate 42.88% of the association between DI-GM and CKM progression, with machine learning identifying coffee, refined grains, and dietary fat as key contributors to risk stratification, supporting microbiota-driven precision nutrition strategies.

BACKGROUND Tenecteplase (TNK), a recombinant tissue plasminogen activator administered as a single intravenous bolus, is increasingly used in acute ischemic stroke (AIS) thrombolysis owing to its ease of administration and comparable efficacy to alteplase. Patients with AIS often have cardiovascular comorbidities, including coronary atherosclerosis and aortic disease, which can predispose to abdominal aortic aneurysm (AAA). This report presents the case of a 77-year-old man treated with TNK fibrinolysis for AIS, in whom an incidental AAA was later identified, highlighting its potential impact on hemorrhagic risk. CASE REPORT A 77-year-old man presented 4 h after onset of acute left-sided weakness, with a National Institutes of Health Stroke Scale score of 12. Initial head computed tomography (CT) excluded hemorrhage, and intravenous TNK (0.25 mg/kg, 21.25 mg) was administered, resulting in partial neurological improvement. Several hours later, he developed groin pain, diaphoresis, and hemodynamic instability. Aortic CT angiography revealed an infrarenal AAA measuring 41 mm, with mural thrombus and penetrating ulceration. The AAA had been previously noted as measuring 34 mm on imaging 5 years earlier. That evening, he experienced sudden neurological deterioration, and follow-up CT demonstrated thalamic and cerebellar hemorrhages. Laboratory findings showed systemic inflammation and coagulopathy. Although TNK reversal strategies were proposed, the family declined further aggressive interventions, and the patient died within hours. CONCLUSIONS This case highlights that undisclosed AAA can increase hemorrhagic risk following TNK thrombolysis in AIS. Careful vascular history-taking, individualized risk assessment, and early recognition of vascular warning signs are essential to optimize safety and clinical outcomes.

Erythritol, a widely used nonnutritive sweetener, has been linked to increased cardiovascular risk in observational studies. However, whether erythritol causally contributes to arterial and venous thrombotic diseases remains unclear. We performed a 2-sample Mendelian randomization (MR) study using 60 independent single nucleotide polymorphisms strongly associated with erythritol from a genome-wide association study of 8167 European individuals. Summary statistics for coronary heart disease, ischemic stroke, venous thromboembolism (VTE), pulmonary embolism (PE), and deep vein thrombosis (DVT) were obtained from the FinnGen consortium. The inverse-variance weighted method was the primary analysis, supplemented by MR-Egger, weighted median, and mode-based sensitivity analyses. Pleiotropy and heterogeneity were assessed. Genetically predicted higher erythritol levels were significantly associated with increased risks of coronary heart disease (odds ratio [OR] = 1.077, 95% confidence interval [CI]: 1.060-1.090) and ischemic stroke (OR = 1.157, 95% CI: 1.135-1.179), with consistent findings across sensitivity analyses and no evidence of pleiotropy. A suggestive association was observed for DVT (OR = 1.117, 95% CI: 1.077-1.158); however, causal effect directions for VTE and PE were inconsistent across MR methods. Additionally, MR-Egger intercept tests indicated potential horizontal pleiotropy for DVT, VTE, and PE. Our study suggests a potential role of erythritol in increasing the risk of coronary heart disease, ischemic stroke, and venous thromboembolism, which warrants further investigation.

Given the emerging evidence suggesting a link between schizophrenia (SCZ) and tachyarrhythmias, this study utilized a bidirectional Mendelian randomization (MR) approach to explore the causal relationship between SCZ and several common tachyarrhythmias, including tachycardia, atrial flutter (AFL), atrial fibrillation (AF), and supraventricular tachycardia (SVT). Stringent selection criteria were applied to identify instrumental variables, followed by 5 MR analyses grounded in different hypotheses to evaluate the causal relationship between SCZ and tachycardia, SVT, and "AFL and AF." Inverse variance weighted (IVW) was the primary MR analysis method used. Additionally, several sensitivity analyses were performed, including the MR pleiotropy residual sum and outlier global test, Cochran Q test, MR-Egger intercept test, leave-one-out sensitivity analysis, and bias risk assessment. The bidirectional MR analysis revealed that SCZ is a risk factor for both SVT and "AFL and AF." Specifically, SCZ was found to significantly impact SVT [PIVW = .038, odds ratio = 1.001, 95% confidence interval: 1.000-1.002] and "AFL and AF" (PIVW = .005, odds ratio = 1.001, 95% confidence interval: 1.000-1.002). All studies were free of significant pleiotropy as well as genetic heterogeneity, the results of the studies were independent of individual genetic variant, and the selection of instrumental variables was unbiased. In a bidirectional MR analysis, we found that SCZ is a risk factor for SVT as well as "AFL and AF," and that early intervention in patients with SCZ associated with tachyarrhythmias may be the key to improving their survival.

To conduct a bibliometric analysis of heart failure (HF) omics research from 2008 to 2024 using CiteSpace, exploring research hotspots and the latest advancements in this field.

Literature on HF omics research published between January 2008 and December 2024 was retrieved from the web of science core collection. Microsoft Excel 2019 was used to calculate publication volume and growth trends, while CiteSpace 6.2.R4 was employed to generate visual maps and conduct visual analyses of authors, institutions, countries, journals, references, and keywords.

A total of 282 articles were included for bibliometric analysis. The results indicate a gradual increase in the number of publications on HF omics research over the past 16 years. The leading research countries in this field are the United States, China, the United Kingdom, Germany, and Italy. Authoritative research institutions include the German Center for Cardiovascular Research, Harvard University, and Brigham and Women's Hospital. The representative researcher is Zannad, Faiez. Key research keywords include biomarkers, coronary heart disease (CHD), pathways, receptors, acute myocardial infarction (AMI), and atrial fibrillation (AF).

Omics Research in the Field of HF has been steadily increasing year by year. In terms of research directions, hotspots often involve studies related to CHD, AMI, AF, and other associated conditions. Regarding research objectives, the primary focuses include identifying biomarkers, achieving precision medicine, and elucidating gene expression mechanisms.

The aim of this study was to investigate the relationship between serum ultrasensitive C-reactive protein (hs-CRP) levels and stroke incidence and to assess its potential role in decision-making for thrombolytic therapy in stroke. Given that hs-CRP is a well-recognized marker of inflammation, its association with cardiovascular disease makes this area of research significant. Using NHANES data (3144 participants, including 239 stroke cases), we analyzed associations between inflammatory markers and stroke via bivariate correlation, restricted cubic spline regression, and neural network modeling. Model performance was evaluated by receiver operating characteristic curves and confusion matrices. Stroke patients exhibited significantly higher hs-CRP (3.1 mg/L) and ferritin (133 μg/L) but lower granulocyte-to-lymphocyte ratio (GLR) (P <.05). Hs-CRP >2 mg/L markedly increased stroke risk (HR >1.0, P <.05). Correlation analysis confirmed hs-CRP (R = 0.050) and ferritin (R = 0.052) as positive risk factors, while GLR was protective (r=-0.054). The neural network model prioritized ferritin (importance = 0.257) and hs-CRP (0.246), achieving 88.7% accuracy. Additional risk factors included depression (OR = 2.12), smoking, and advanced age. Elevated hs-CRP (≥2 mg/L) and ferritin are robust predictors of stroke risk and may indicate adverse outcomes post-thrombolysis. Combined with GLR, these markers support personalized thrombolytic therapy decisions. Further validation in prospective cohorts is warranted.

This study aimed to evaluate the advantage of intravascular ultrasound (IVUS) in optimizing the outcome of stent implantation for stenosis proximal to myocardial bridge (MB).

A total of 117 patients with stenosis proximal to MB were randomly divided into angiography guided stent implantation (AGSI, n = 61) group and IVUS guided stent implantation (IGST n = 56). Major adverse cardiac events (MACE) were followed up to 12 months. Coronary angiography and IVUS were performed at 12 months follow up. Lumen diameter, cross section area and lumen loss was calculated. We constructed Kaplan-Meier curves to compare MACE between 2 groups, differences were assessed with the aid of the log-rank test. Cox's proportional hazards regression modeling was used to assess clinical outcomes.

At 12 months after stent implantation, angiography and IVUS follow up were performed in 90.16% patients in AGSI group (55/61), and 94.64% in IGSI group (53/56). In AGSI group, there were 32.73% (18/55) of the patients for whom the stent was extruded into MB while no patient was found in IGSI group (P < .01). In AGSI group, there were 16.36% (9/55) of the patients for whom the stent did not fully cover the stenosis lesion while no patient was found in IGSI group (P < .05). Totally, 49.09% (27/55) of the patients' stents were not positioned exactly. However, the stent was positioned exactly in all patients in IGSI groups. The incidence of MACE was higher in AGSI group than that in IGSI group (18.0% vs 5.4% P < .05). The incidence of target lesion revascularization was higher in AGSI group than that in IGSI group (8.2% vs 0.0% P < .05). Kaplan-Meier survival curves showed that IGSI decreased the risk of 12-mouth MACE ((χ2 = 8.427, Plog-rank = .004). There was a significant correlation between IGSI and MACE events in COX analysis before and after multifactor correction (P < .05).

IVUS guiding leads to shorter stent length, less diameter stenosis, more accurate stent positioning and less MACE and thus optimizes the stent implantation for stenosis proximal to MB.