Social risk factors contribute to cardiovascular, kidney, and metabolic disease; however, their associations with advanced cardiovascular-kidney-metabolic (CKM) syndrome and variation across demographic subgroups remain unclear.

To examine the association between individual social risk factors and advanced CKM syndrome and to assess whether these associations vary by age group, sex, and race and ethnicity.

This is a cross-sectional study of adults aged 30 years or older from the National Health and Nutrition Examination Survey 2005 to 2018 cycles. Data analysis was conducted from July to October 2025. Analyses incorporated survey weights to generate nationally representative estimates.

Five social risk domains: economic instability, poor neighborhood environment, limited education, limited health care access, and poor social and/or community context.

The primary outcome was advanced CKM syndrome (stages 3-4) defined using American Heart Association criteria. Following tests for interactions by age, race and ethnicity, and sex, weighted logistic regression tested associations between social risks and advanced CKM syndrome, stratified by race and ethnicity and sex.

Among 28 218 participants (representing 165.8 million US adults; mean [SD] age, 52.6 [14.2] years; 14 402 female participants [52.0%]), 12 614 (44.7%) had advanced CKM syndrome. No significant interactions were found for age. Economic instability was associated with higher odds of advanced CKM syndrome among non-Hispanic Black (odds ratio [OR], 1.27; 95% CI, 1.08-1.50) and non-Hispanic White adults (OR, 1.22; 95% CI, 1.08-1.37). Poor neighborhood environment was significant for non-Hispanic Black adults (OR, 1.20; 95% CI, 1.03-1.38). Limited education was associated with advanced CKM syndrome among non-Hispanic White adults (OR, 1.29; 95% CI, 1.13-1.48). Poor social and/or community context was associated across all groups, with the highest OR among Hispanic adults (OR, 1.72; 95% CI, 1.43-2.08). By sex, social risks were more associated with advanced CKM syndrome in women, with associations for men less prevalent and limited to economic instability, poor neighborhood environment, and poor social and/or community context.

In this cross-sectional study of US adults, multiple social risks factors were associated with advanced CKM syndrome, with meaningful variation by race and ethnicity and sex. Integrating social risk screening into CKM syndrome prevention and tailoring interventions to high-risk subgroups may help reduce disparities and slow CKM syndrome progression.

Maternal adult congenital heart disease (ACHD) has been associated with increased offspring congenital heart disease (CHD), but evidence from resource-limited regions remains scarce. The association between maternal acquired heart disease (AHD) and offspring CHD is unknown.

To quantify the overall and subtype-specific CHD risk in offspring associated with maternal ACHD and AHD, examine the association of maternal ACHD and AHD with outcomes in offspring with CHD, and identify maternal factors that may modify the associations between maternal cardiac diseases and offspring CHD risk.

This prospective birth cohort study enrolled pregnant women receiving prenatal care between August 1, 2011, and December 31, 2021, at a major cardiac referral center in China. Participants included pregnant women with ACHD, with AHD, or without cardiac disease and were followed up through delivery; their offspring were followed up until 1 year of age. All follow-ups were completed by December 15, 2023. Data were analyzed from April 1, 2024, through April 31, 2025.

Maternal ACHD and AHD, confirmed via the center's electronic medical records.

The main outcome was offspring CHD, which was diagnosed using echocardiography. Log-binomial regression was used to estimate relative risks (risk ratios [RRs]) and 95% CIs. Adverse outcomes were compared using pairwise tests. Stratification analyses identified potential effect modifiers.

A total of 14 336 pregnant women with 15 677 offspring (8480 males [54.1%]) were included. The mean (SD) maternal age and gestational age at enrollment were 31.4 (4.5) years and 16.4 (6.4) weeks, respectively. Both maternal ACHD and AHD were associated with higher CHD risk in offspring (RR, 1.71 [95% CI, 1.26-2.31] and 1.38 [95% CI, 1.02-1.87], respectively). Minor CHDs, particularly septal defects, were the subtypes with the greatest magnitude of associations with maternal ACHD (RR, 2.95; 95% CI, 1.97-4.43) and AHD (RR, 2.28; 95% CI, 1.50-3.45). Right ventricular outflow tract obstruction (RR, 6.17; 95% CI, 3.59-10.60) and valvular heart disease (RR, 1.65; 95% CI, 1.11-2.45) were the key contributors to offspring CHD risk. Preterm birth had higher rates among offspring with CHD and mothers with ACHD as well as offspring with CHD and mothers without ACHD compared with offspring without CHD and mothers without cardiac disease (12 of 39 [30.8%] and 121 of 780 [15.5%] vs 1287 of 14 088 [9.1%]; all P < .001). Higher rates of chromosomal (5 of 39 [12.8%] and 38 of 780 [4.9%] vs 75 of 14 088 [0.5%]; all P < .001) and genetic aberrations (3 of 39 [7.7%] and 16 of 780 [2.1%] vs 57/14 088 [0.4%]; all P < .001) were found among offspring with CHD and mothers with AHD as well as offspring with CHD and mothers without AHCD compared with offspring without CHD and mothers without cardiac disease. Associations between maternal cardiac disease and offspring CHD were robust in primiparous women (ACHD: RR, 2.15 [95% CI, 1.48-3.11], P for interaction < .001; AHD: RR, 1.73 [95% CI, 1.17-2.56], P for interaction = .02) and those with periconceptional exposure to hazardous substances (ACHD: RR, 2.22 [95% CI, 1.56-3.16], P for interaction < .001; AHD: RR, 1.57 [95% CI, 1.05-2.36], P for interaction = .02).

In this cohort study, maternal ACHD and AHD were associated with increased risks and adverse outcomes of offspring CHD. Targeted modification of identified maternal factors could help mitigate offspring CHD risk in this high-risk population.

Intravascular lithotripsy (IVL) utilizes high-energy sonic waves to create controlled fractures in calcified plaques, facilitating vessel preparation and improving stent apposition.

The study was designed to evaluate the safety and efficacy of IVL in a patient population that included individuals with acute myocardial infarction (MI). A total of 201 consecutive patients who underwent percutaneous coronary intervention (PCI) using IVL [Shockwave C2 or C2+ (Shockwave Medical Inc, Santa Clara, CA, US)] from April 2020 onward were included in this single-center registry. The study population comprised 76 patients with acute MI (Group 1) and 125 patients with non-MI (Group 2).

Left ventricular ejection fraction was lower (46.0% ± 13.1% vs. 50.9% ± 10.5%; p = 0.022), while SYNTAX Score was significantly higher (20.0 ± 11.3 vs. 16.5 ± 10.2; p = 0.059) in Group 1 than in Group 2 (46.0% ± 13.1% vs. 50.9% ± 10.5%; p = 0.022). The overall IVL success rate and procedure success rate were very high (97.5% and 99.5%, respectively). A mean increase in lumen area was observed in Group 1 and Group 2: 5.9 ± 3.7 mm2 vs. 4.5 ± 2.2 mm2 and 237% vs. 239%, respectively. In the long-term follow-up there was no difference in all-cause mortality between Group 1 and Group 2 (9.0% vs. 8.1%; p = 0.997), cardiac death (p = 0.340), repeat MI (p = 0.986) and major adverse cardiovascular events [MACE; cardiac death, myocardial infarction, stroke] (16.8% vs. 9.8%; p = 0.501). Prior chronic kidney disease (CKD), post rota-atherectomy debulking, prior coronary artery bypass graft (CABG) and longer lesions were independent predictors of long-term all-cause mortality.

Intravascular lithotripsy is an effective treatment for the modification of calcified atherosclerotic lesions, with a high success rate and few periprocedural complications. The long-term outcomes achieved in this complex population are satisfactory.

According to traditional Chinese medicine theory, acute myocardial infarction (AMI) is primarily associated with qi stagnation and blood stasis. Simiao Yong'an (SMYA) decoction is a well-known prescription that clears heat, detoxifies, and promotes blood circulation. SMYA has been used in the treatment of ischemic heart diseases (IHD). However, further analysis is required to clarify the specific mechanisms through which SMYA improves AMI and to determine its therapeutic effects at different time points during the acute phase of myocardial infarction.

This study is aimed at investigating the protective effects of SMYA against AMI at various time points and to explore its underlying mechanisms.

The active ingredients in SMYA were identified through ultraperformance liquid chromatography-quadrupole-time-of-flight mass spectrometry (UPLC-Q-TOF/MS). An integrated in silico approach was employed to predict potential targets of these compounds, and target-pathway associations were established by aligning the data with relevant databases. A cardiac ischemia/reperfusion (I/R) model in rats was created by ligating the left coronary artery, inducing ischemia for 45 min, and allowing for 24 h of reperfusion. SMYA treatment was administered for 7 days. Cardiac function was evaluated at different time points during the acute phase of myocardial infarction using echocardiography. Serum biochemical indexes were measured using a biochemical kit, and western blotting (WB) was used to analyze AKT, p-AKT, PI3K, p-PI3K, BAX, Bcl-2, and caspase-3 proteins.

UPLC-Q-TOF/MS identified 25 components in SMYA, which were considered potential effective ingredients. Network analysis identified 161 key targets and 167 Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways associated with SMYA, with the PI3K-Akt pathway being notably prominent. Experimental validation demonstrated that SMYA significantly reduced the levels of creatine kinase isoenzyme (CK-MB) and lactate dehydrogenase (LDH) in serum and improved left ventricular ejection fraction (LVEF) and fractional shortening (FS) after myocardial I/R injury in rats. Additionally, SMYA reduced myocardial cell apoptosis and activated the PI3K-AKT pathway in a dose-dependent manner. Molecular docking confirmed binding between SMYA components and AKT/BCL-2.

This study elucidates the mechanisms underlying AMI and the molecular action of SMYA. SMYA alleviates I/R-induced AMI in rats by activating the PI3K-AKT pathway, suggesting its potential as a therapeutic target for myocardial remodeling. The dose- and time-dependent protective effects of SMYA suggest that the PI3K-AKT pathway and its downstream target BCL-2 constitute promising therapeutic targets for novel interventions in AMI.

Background Increasing evidence shows that intermuscular adipose tissue (IMAT) and lean muscle mass (LMM) influence cardiometabolic health; however, their independent and/or combined associations with cardiovascular risk in individuals without pre-existing conditions remain unclear. Purpose To assess whether IMAT and LMM are associated with cardiometabolic risk factors in individuals without pre-existing conditions. Materials and Methods A total of 11 348 participants (6460 [56.9%] men; median age, 43.0 years; IQR, 33.5-52.5 years) without any known pre-existing conditions underwent whole-body 3-T MRI as part of a prospective multicenter population study (German National Cohort, or NAKO). LMM and IMAT were quantified on MRI-based paraspinal muscle segmentations with a deep learning model. Cardiometabolic risk factors (hypertension, dysglycemia, and atherogenic dyslipidemia) were defined on the basis of laboratory test results and clinical examinations. Age- and sex-corrected z scores of LMM and IMAT were calculated. Associations of LMM and IMAT percentage with physical activity and cardiometabolic risk factors were examined with univariable and multivariable analyses. Results The percentage of IMAT increased with age and was greater in women, whereas LMM decreased with age and was lower in women. After adjustments for age, sex, and study site, increased IMAT was associated with increased odds of hypertension (odds ratio [OR], 1.67; 95% CI: 1.49, 1.86; P < .001), atherogenic dyslipidemia (OR, 1.82; 95% CI: 1.65, 2.00; P < .001), and dysglycemia (OR, 0.51; 95% CI: 0.35, 0.76; P = .009) in both sexes, whereas increased LMM was associated with decreased odds of all risk factors (dysglycemia: OR, 0.51; 95% CI: 0.35, 0.76; P = .009; atherogenic dyslipidemia: OR, 0.49; 95% CI: 0.39, 0.62; P < .001; hypertension: OR, 0.34; 95% CI: 0.24, 0.48; P < .001) in male participants only. Across z score combinations, participants with higher IMAT and lower LMM showed the highest prevalence of cardiometabolic risk factors. Conclusion IMAT and LMM, assessed on MRI scans, were independently associated with cardiometabolic risk factors in individuals without pre-existing conditions. © RSNA, 2026 Supplemental material is available for this article. See also the editorial by Hu in this issue. See also the editorial by Mohajer and Bari in this issue.

Background Body composition (BC) is associated with cardiometabolic risk. However, using BC to predict future disease risk is challenging, as it may reflect body size or age instead of poor health. Purpose To calculate age-, sex-, and height-normalized BC metrics from MRI scans in over 66 000 individuals from the general population and to assess the prognostic value of these metrics for cardiometabolic outcomes beyond traditional risk factors. Materials and Methods In this retrospective study, age-, sex-, and height-specific BC z-scores derived from whole-body MRI scans were calculated using an open-source fully automated deep learning framework. Data were sourced from the UK Biobank (UKB) and German National Cohort between April 2014 and May 2022, including subcutaneous adipose tissue, visceral adipose tissue (VAT), skeletal muscle (SM), SM fat fraction, and intramuscular adipose tissue (IMAT) to provide an open-source web-based z-score calculator, evaluated against reference-standard radiologist labels. Multivariable Cox regression was used to assess the prognostic value of z-score categories (low: z < -1; middle: z = -1 to 1; high: z > 1) for incident diabetes, major adverse cardiovascular events, and all-cause mortality beyond cardiometabolic risk factors in the UKB. Results Age-, sex-, and height-specific BC z-scores were calculated using data from 66 608 individuals (mean age, 57.7 years ± 12.9 [SD]; 34 443 male; mean body mass index [calculated as weight in kilograms divided by height in meters squared], 26.2 ± 4.5). In multivariable-adjusted Cox regression, z-score risk categories had hazard ratios of up to 2.26 for incident diabetes (high VAT category), 1.54 for incident major adverse cardiovascular events (high IMAT), and 1.44 for all-cause mortality (low SM) compared with middle categories. Conclusion Whole-body MRI-derived BC z-scores were used to identify at-risk individuals and predict cardiometabolic outcomes and mortality beyond traditional risk factors. An open-source age-, sex-, and height-adjusted z-score calculator is available at https://circ-ml.github.io. © RSNA, 2026 Supplemental material is available for this article. See also the editorial by Ghosh and Chernyak in this issue.

To examine national trends and disparities in cardiovascular mortality associated with systemic connective tissue disorders (CTDs) in the United States from 1999 to 2020.

We analyzed mortality data from the CDC WONDER database. Deaths were included where CTD (ICD-10: M05, M06, M30-M35) was the underlying cause and cardiovascular disease was a contributing cause. Age-adjusted mortality rates (AAMRs) per 1 000 000 were calculated using the 2000 US Standard Population. Joinpoint regression identified annual and average annual percentage changes. Analyses were stratified by sex, race/ethnicity, census region, and urbanization. Disease subgroup and state-level analyses were performed.

Between 1999 and 2020, 47 752 cardiovascular deaths occurred among individuals with systemic CTDs. The national AAMR declined from 14.4 to 8.2 per 1 000 000 (AAPC: -2.68%, 95% CI: -2.89 to -2.47, p < 0.001). Females had consistently higher mortality than males (average AAMR: 13.5 vs. 5.9 per 1 000 000; p < 0.001). Non-Hispanic Black individuals had the highest rates (average AAMR: 14.9 per 1 000 000), with widening disparities after 2008. Rural areas had higher mortality than urban areas (average AAMR: 11.4 vs. 9.9 per 1 000 000; p = 0.01). Subgroup analyses revealed heterogeneous trends across CTD subtypes, with SLE showing the slowest improvement (AAPC: -1.87%) and dermatomyositis the steepest decline (AAPC: -4.98%). State-level AAMRs ranged 2.2-fold, from 6.3 (District of Columbia) to 13.6 (Montana) per 1 000 000.

Cardiovascular mortality associated with systemic CTDs has declined significantly over two decades; however, persistent racial disparities, urban-rural differences, heterogeneous disease-specific trends, and substantial geographic variation underscore the need for targeted, equitable interventions in this high-risk population.

Sudden cardiac death remains a major clinical and social challenge. The number of cases still remains higher in Italy, both involving patients suffering from overt heart disease and those otherwise healthy. The heterogeneous mechanisms leading to cardiac arrest call for a comprehensive preventive strategy plan that combines clinical assessment, advanced diagnostic tools, and public health initiatives. The need for counteracting a transient period of elevated risk - as in post-infarction - forces to the use of a wearable cardioverter-defibrillator as it provides temporary protection while awaiting definitive reassessment. On the contrary, when cardiac arrest affects young and apparently healthy individuals, preventive efforts necessarily extend to their families to identify inherited conditions that would otherwise remain unrecognized. In the out-of-hospital setting, survival largely depends on the actions taken within the first few minutes. Therefore accessible defibrillators, widespread community training, and the active involvement of law enforcement agencies and schools can significantly enhance the response to out-of-hospital cardiac arrest. This paper ultimately outlines a roadmap that integrates clinical risk stratification, the expansion of territorial networks, broad training initiatives, and consistent institutional coordination. The goal is to establish a coherent national framework that can reduce regional disparities, enhance the early identification of at-risk individuals, and improve survival rates after cardiac arrest.

Primary cardiovascular prevention was one of the main topics discussed during the 2025 ANMCO General States. The focus on this theme is due to the evidence that, although in high-income countries cardiovascular mortality has declined over the decades, the downward trend has slowed in the last years. Cardiovascular disease remains a leading cause of death worldwide, and a substantial proportion of cardiovascular events, including deaths, occurs in individuals with no previous history of disease. In this paper, the initiatives that ANMCO implements with the Heart Care Foundation to spread the culture of primary prevention are presented: from days dedicated to cardiovascular disease screening to training campaigns in schools and information and awareness campaigns through various digital tools (web pages, social media). Another aspect that ANMCO focuses on to foster cardiovascular prevention is the implementation of the One Health approach promoted by the World Health Organization. A healthy diet like the Mediterranean diet represents not only a lifestyle that promotes cardiovascular prevention but also an approach to health that respects and protects the environment. In addition, there are the "silent killers", environmental factors such as air pollution, noise and light pollution, and chemical pollution of land and water, all emerging risk factors that should be considered as targets of a One Health approach.

Preventing the development and progression of atherosclerotic cardiovascular disease is a challenge that is part of the mission of many clinicians, particularly those working in cardiology. Given the demonstrated cumulative effect of risk factors, early recognition of these factors and the implementation of both pharmacological and non-pharmacological interventions allows for more effective prevention of cardiovascular events. The purpose of this ANMCO position paper is to guide clinicians in the early identification of conditions that increase the risk of developing cardiovascular events and to provide guidance on the most appropriate interventions. The paper briefly reviews the evidence supporting the cumulative impact of traditional risk factors over time. The role of risk stratification tools such as SCORE2, SCORE2-OP, and SCORE2-Diabetes, as well as emerging biomarkers, is discussed. For risk factors such as hypertension, dyslipidemia, and diabetes, the recommended targets and current therapeutic options are illustrated. The pharmacological interventions currently available for managing obesity-associated cardiovascular risk and the indications for antiplatelet treatment in the context of primary prevention are also discussed. Overall, early diagnosis and primary prevention are the foundation of an efficient and economically sustainable healthcare system.