To investigate the link between serum 25-hydroxyvitamin D [25(OH)D] and obesity in postmenopausal women, and to evaluate the potential mediating effect of the atherogenic index of plasma (AIP).

In this cross-sectional analysis, data from 3386 postmenopausal women were extracted from the National Health and Nutrition Examination Survey (2011-2018). Participants were stratified by vitamin D status: deficient (< 50 nmol/L), insufficient (50-75 nmol/L), and sufficient (≥ 75 nmol/L). Adjusted weighted regression models assessed associations with body mass index (BMI) and obesity (BMI ≥ 30 kg/m²), while mediation analysis quantified the role of AIP.

After comprehensive covariate adjustment, a significant inverse relationship was observed between serum 25(OH)D and BMI (β = -2.36, 95% CI: -3.16, -1.55). Vitamin D deficient women exhibited a mean BMI increase of 1.98 units (95% CI: 0.96, 3.00) and an elevated odds of obesity (OR = 1.81, 95% CI: 1.30, 2.50) relative to the sufficient group. These findings were robust across demographic and clinical subgroups. Mediation analysis indicated AIP accounted for 9.53% of the association with BMI and 9.40% with obesity (both p < 0.001).

This study demonstrates a significant inverse association between vitamin D status and obesity in postmenopausal women, with lipid metabolism, as reflected by AIP, partially mediating this relationship. Further longitudinal research is required to establish causality.

Pulmonary vein stenosis (PVS) is a rare and aggressive condition in infants and children, characterized by progressive neointimal proliferation, multivessel involvement, and high early mortality. Despite historically poor outcomes, a growing body of evidence supports the use of catheter-based interventions as a cornerstone of modern multimodal treatment strategies. Balloon angioplasty, and bare-metal or drug-eluting stents are used to restore vessel patency, often as part of serial procedures. However, recurrent stenosis remains common, necessitating frequent reintervention. Reintervention is associated with improved survival, particularly when paired with early diagnosis, aggressive surveillance, and systemic medical therapies. When transcatheter interventions are applied as part of a multidisciplinary approach, they contribute to meaningful improvements in survival and quality of life. Ongoing innovation in device technology and biologic modulation will be critical in further advancing outcomes for this high-risk population.

Single ventricle congenital heart disease (SVCHD) remains a high-risk pathology for transplantation-free survival and quality of life. While medical and surgical advancements have significantly improved attrition through palliation and ultimately survival following the Fontan operation, Fontan candidacy evaluation remains a critical component to insuring optimal outcomes for patients with SVCHD. While the initial 10 Commandments proposed by Choussat and colleagues provided pioneering insights and supported early success of the Fontan operation, advancements in care have shifted the focus of Fontan candidacy determination to be patient- and center-specific, seeking to maintain both Fontan and transplantation candidacy across all risk categories. Herein, we present a focused review of the current state of Fontan candidacy determination while also offering a multidisciplinary perspective within this evolving and nuanced aspect of care for patients with SVCHD.

Infants with complex congenital heart disease represent a vulnerable subset of pediatric patients who experience unacceptably high mortality while awaiting cardiac allotransplantation. The limited availability of size-matched donor organs and the unsuitability of existing mechanical circulatory support in this patient population compels the development of alternative bridging strategies. Cardiac xenotransplantation using genetically modified porcine donors represents a potential solution to this complex clinical issue. In this review, we describe the scientific and clinical landscape of pediatric cardiac xenotransplantation, summarize the key findings from a preclinical baboon model of orthotopic cardiac xenotransplantation as a bridge to allotransplantation, and discuss future directions required to bring this concept to clinical implementation.

To identify and synthesise evidence pertaining to 'health check' programmes for the assessment of cardiovascular risk factors and disease delivered to adult populations in countries with universal healthcare.

A systematic umbrella review was undertaken. The protocol for this systematic umbrella review was registered on the PROSPERO registry and was undertaken based on Cochrane guidance and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline.

Medline, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), the Cochrane Database of Systematic Reviews, Scopus, Google Scholar and Health Management Information Consortium (HMIC) were searched. These searches identified records published between January 2009 and February 2025.

The inclusion criteria for the review were as follows: population-adults aged ≥18 years; intervention-health checks including the assessment of cardiovascular risk factors and disease; comparators-non-recipients, variations of health checks and within-person pre/post assessments; outcomes-uptake and diagnosis rates, cardiovascular disease (CVD) and related clinical and behavioural risk factors, referral changes, and barriers and facilitators to uptake. Studies published prior to 2009 (when NHS Health Checks were introduced) and those from countries without universal healthcare provision were excluded. Screening was performed independently by two reviewers and conflicts were resolved via discussion or adjudication by a third reviewer.

Data extraction and quality appraisal were performed independently by a single reviewer and checked by a second reviewer. The quality of included reviews was assessed using the Risk of Bias in Systematic Reviews (ROBIS) (for quantitative evidence) and the Swedish Agency for Medical and Social Evaluation tool (for qualitative evidence). The results of this systematic umbrella review were synthesised narratively.

Results from meta-analyses reported by the included systematic reviews showed that the effects of health checks on cardiovascular and total mortality, stroke and coronary heart disease were mixed and generally non-significant. Conversely, health checks generally showed significant, positive effects (reductions) in CVD risk factors including blood pressure, body mass index and cholesterol levels. Non-significant reductions in smoking were found in two meta-analyses. Health checks were generally cost-effective; however, it was found that the cost-effectiveness of health checks could be improved through targeting towards 'high risk' populations defined based on socioeconomic factors, obesity and family history of CVD. Health check attendance versus non-attendance was related to demographic, attitudinal, socioeconomic and practical factors. The effectiveness of health checks was influenced by factors including social support to make changes to health behaviours and the availability and accessibility of referral options.

Overall, health checks had a positive impact on the detection of and improvement in the levels of cardiovascular risk factors. There was limited evidence of impact on the occurrence of longer term CVD events, which could reflect the limitations of onward treatment for CVD. Cardiovascular health checks could be more effective and cost-effective if targeted towards high-risk groups. The ability to access appointments at convenient times and venues and increased opportunities for social support may increase health check uptake, and increased availability and accessibility of referral options may improve their effectiveness.

CRD42024487529.

This scoping review aimed to examine the impact of climate change on the health of older adults and to evaluate existing interventions targeting this population.

The review followed Arksey and O'Malley's framework and the PRISMA-ScR guidelines. A comprehensive search was conducted across PubMed, Google Scholar, Scopus, and Web of Science. Eligible studies included those focusing on adults aged 60 years and older that examined the physical and mental health impacts of climate change across any geographic setting or level of care. Descriptive and thematic analyses were performed to identify key findings and knowledge gaps.

Climate change adversely affects the physical and mental health of older adults through increased exposure to infectious diseases, extreme temperatures, and poor air and water quality. Older adults are particularly vulnerable to heat-related illnesses, cardiovascular events, and respiratory conditions, with women and individuals with comorbidities at higher risk. Climate change is also associated with increased anxiety, insomnia, and other mental health concerns in this population. Social support and targeted interventions-such as community awareness programs and subsidized cooling costs-are associated with reduced risk. Community-based initiatives have demonstrated potential in reducing mortality and enhancing resilience among older adults during extreme weather events.

Healthcare professionals should be educated about climate-related health outcomes affecting older adults. Protecting this vulnerable population requires urgent, inclusive, and targeted strategies, including education, improved healthcare access, and tailored interventions.

The aim of this study was to compare the accuracy, scientific quality, and clarity of responses generated by GPT-4o and Gemini to frequently asked patient questions related to carotid artery disease and carotid endarterectomy.

In total, 40 unique carotid endarterectomy-related questions were compiled from online sources and clinical experience. Each was entered into separate new sessions with GPT-4o and Gemini 2.5 Flash in Turkish, and responses were collected without modification. Notably, four blinded cardiovascular surgeons independently rated each answer (1-5 Likert scale) in three domains: Accuracy, Scientific Quality, and Clarity. Mean response lengths and domain scores were compared using appropriate paired tests.

GPT-4o produced longer responses than Gemini (258.1±101.6 vs. 193.2±43.7 words; p<0.001). Overall, GPT-4o had higher Accuracy scores (4.33±0.39 vs. 4.16±0.33; p=0.04), with no significant differences in Scientific Quality or Clarity (p=0.377 and p=0.154, respectively). In rater-level analyses, Gemini scored higher in Clarity for one rater, whereas GPT-4o was superior in Accuracy and Scientific Quality for another. Overall mean scores were comparable (4.17±0.36 vs. 4.13±0.31; p=0.636). Physician referral was recommended in 62.5% of GPT-4o and 52.5% of Gemini (p=0.366).

Both GPT-4o and Gemini provided "good"-quality responses to carotid endarterectomy patient questions, with GPT-4o showing a modest accuracy advantage, with no difference in other domains. Explicit disclaimers on both platforms underscore their supportive, not definitive, role in patient education. Physicians should remain the primary source for individualized decisions, and AI-generated information should always be verified.

The aim of the study was to determine the association between low muscle mass and abnormal fluid distribution with in-hospital mortality in patients with acute heart failure.

In a prospective cohort study at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran in Mexico City, patients with acute heart failure who underwent thoracic or abdominal computed tomography within 72 h before or after admission between September 2017 and July 2024 were included. The exclusion criteria were an illegible computed tomography scan, an incorrect bioimpedance analysis lecture, the presence of cancer, COVID-19, chronic kidney disease with renal replacement therapy, or dismissal of a diagnosis of acute heart failure. Bioelectrical impedance analysis was performed within the first 24 h of hospitalization to measure phase angle and impedance ratio for evaluating hydration status. The skeletal muscle area was measured using a single axial slide at L3 for abdominal computed tomography and the T4 level for thoracic computed tomography.

This study included 134 patients, with an overall hospital survival rate of 83.6%. The mortality group had a lower abdominal skeletal muscle area (86.5 vs. 111 cm2, p=0.024), smaller pectoral skeletal muscle area (18.9 vs. 26 cm2, p=0.005), lower phase angle (3 vs. 3.9, p=0.010), increased impedance ratio (0.89 vs. 0.86, p=0.002), greater prevalence of reduced pectoral muscle mass (40.9 vs. 12.5%, p<0.001), and abnormal fluid distribution according to impedance ratio (86.4 vs. 57.1%, p=0.016). In survival analyses, the interaction effect of pectoral skeletal muscle area and increased impedance ratio had the lowest survival probability (log-rank test, p<0.001).

Low skeletal muscle mass and abnormal fluid distribution are associated with in-hospital mortality in patients with acute heart failure.

The prognosis of nonobstructive coronary artery disease (CAD) is not well established. Comparative data between coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) are limited.

To compare CCTA- and ICA-derived information in nonobstructive CAD regarding detection and clinical outcomes.

We followed 4,004 adult patients who underwent either ICA (n = 2,355) or CCTA (n = 1,649) for a median of 9 years. The primary endpoint was a composite of all-cause mortality, acute coronary syndrome/acute myocardial infarction, and stroke. Propensity score matching was performed to compare outcomes between groups. The significance level was set at 5%.

The overall event rate was 6.9%. ICA was associated with worse outcomes than CCTA (hazard ratio [HR] 0.54; 95% CI 0.42-0.68; p < 0.001). Patients with nonobstructive CAD had worse outcomes than those without CAD (HR 1.73; 95% CI 1.32-2.27; p < 0.001). Normal coronary findings on CCTA were associated with better outcomes than normal findings on ICA (HR 0.39; 95% CI 0.24-0.62; p < 0.001). Event rates increased proportionally with plaque burden. In 1,187 matched pairs, CCTA was associated with improved survival (HR 0.57; 95% CI 0.42-0.78; p < 0.001).

CCTA more closely reflects clinical outcomes than ICA. Nonobstructive CAD carries a substantial risk regardless of imaging modality.

Atrial cardiomyopathy (AC) is a condition detectable by electrocardiogram (ECG) that may play a significant role in the pathophysiology of the etiology of strokes, independently of atrial fibrillation (AF).

To evaluate the association between ECG markers of AC (prolonged P-wave duration >120 ms and P-terminal force in V1 (PTFV1) >4,000 µV·ms) as well as the occurrence of mortality and hospitalization due to stroke.

This retrospective cohort study included patients from Belo Horizonte who underwent ECGs between 2006 and 2018. Patients aged ≥40 years, in sinus rhythm, and without a previous history of stroke at baseline ECG were included. Clinical and ECG data were linked to mortality (SIM) and hospitalization (SIH) public databases. Cox regression was used to calculate hazard ratios (HRs), and incremental adjustment models for age, sex, cardiovascular risk factors, and left ventricular hypertrophy were employed. Statistical significance was set at p<0.05.

245,588 patients were included. 26.3% had prolonged P-wave duration >120 ms, and 10.1% had elevated PTFV1 >4,000 µV·ms. Mean follow-up duration was 3.5 years. AC was associated with mortality and hospitalization due to stroke (HR 1.24; 95% CI, 1.12-1.36 for P-wave duration >120 ms; p<0.001; HR 1.20; 95% CI, 1.05-1.38 for PTFV1 >4,000 µV·ms; p<0.001).

ECG markers of AC are associated with death or hospitalization due to stroke, as well as cardiovascular mortality and incident AF in a large, representative Brazilian cohort, highlighting their prognostic value.