To explore the relationship between B vitamins and blood pressure across distinct age groups.

We analyzed 3654 participants aged ≥20 years after excluding pregnant/lactating individuals and those with incomplete data. B-vitamin intake was calculated from two 24-hour dietary recalls and supplement surveys. Exposure variables included 7 kinds of B vitamins intake, while outcomes comprised hypertension prevalence, systolic and diastolic pressure. The covariates include basic demographics, lifestyle factors, chronic Comorbidities, and nutrient intake. Based on the cross-sectional study, the statistical analyses incorporated NHANES sampling weights. Weighted logistic regression evaluated hypertension association, while linear regression assessed systolic/diastolic pressure differences. RCS model explored nonlinear dose-response relationships.

Weighted logistic regression and RCS model revealed age-specific and nonlinear characteristics in the b vitamin-blood pressure relationship. Vitamin B1 was negatively correlated with hypertension in ≥60 years old (Q4: Q1 OR (95%CI) =0.27 (0.08, 0.91)). Vitamin B2 was negatively correlated with hypertension in total population at Q4 (OR (95%CI) =0.39 (0.15, 0.99)), and in aged 40-59 years, OR (95%CI) =0.52 (0.33, 0.83). Choline was positively correlated with hypertension in the total population (OR (95%CI) =1.30 (1.08, 1.58)) but negatively correlated with ≥60 years old (OR (95%CI = 0.73 (0.56, 0.95)). Vitamin B12 shown positive associations with hypertension in the total population, 20-39 years old and ≥60 years old OR (95%CI) =1.39 (1.13, 1.71), 1.82 (1.23, 2.69), and 1.63 (1.04, 2.54), respectively. For diastolic pressure, vitamin B1, B2, niacin, B6, and folate displayed significant negative associations in the total population and ≥60 years old. Vitamin B2 was also negatively associated in 40-59 years old. Vitamin B12 exhibited a negative association with diastolic pressure in ≥60 years old. Weight RCS analysis revealed the linear or nonlinear relationships between specific B vitamins and hypertension and systolic/diastolic pressure, with age stratification improving the discernment of these associations.

Associations between B vitamins intake and hypertension/blood pressure exhibited age-dependent variations. Age-specific considerations are essential for optimizing B vitamins supplementation or restriction.

Cardiovascular disease (CVD) remains a global health challenge and contributes substantially to mortality burden in sub-Saharan Africa (SSA) in particular. Several factors, including particular blood group types in the ABO system, have been associated with CVD risk. However, the direction of the association of ABO blood groups with CVD remains controversial. This review looked at the studies that investigated the association of ABO blood groups and CVD and its risk in SSA and people of African ancestry.

The review included all observational studies that investigated ABO blood groups and their association with CVD and CVD risk in Africans and people of African descent and were published in English between 1960 and 2023. The data were extracted from Pubmed, Google Scholar, ScienceDirect, Web of Science, Scopus, African Wide and Medline. A total of 24 publications were reviewed following the inclusion criteria. The protocol for this systematic review was registered with PROSPERO (ID#: CRD42023495721).

A total of 24 studies were included in the review with most of them being cross-sectional in design. The mean age of participants was 44 years with an age range of 1-89 years. The most common blood group in SSA was blood group O. The review showed that 11 out of the 24 studies indicated non-O groups association with CVD and CVD risk and 4 studies indicated blood group O association with CVD risk. The most common CVD risk markers studied were body mass index (BMI) and blood pressure (BP). The CVDs investigated were ischaemic disease, intracranial aneurysm, peripheral artery disease and coronary artery disease.

There is no conclusive evidence showing a particular blood group, in the ABO system, being cardioprotective or more susceptible to CVD risk. The varying ABO associations with CVD risk among Africans and African ancestry underscore the importance of targeted and localised interventions aimed at curbing CVD against the backdrop of ABO profiling.

Healthy diet plays an important role in the prevention of cardiovascular disease (CVD), which is the second leading cause of death in Canada. In 2019, Health Canada released an updated Canada's Food Guide (CFG) which is accompanied with supportive evidence of Canada's Dietary Guidelines (CDG) to reflect the latest evidence of the relationship between diet and prevention of chronic diseases including CVD. The Canadian Cardiovascular Society recommends the use of the Framingham risk score (FRS) to estimate the 10-year CVD risk and heart age in individuals aged 30 and older, aiding in CVD prevention interventions such as lifestyle modifications. However, the relationship between the intake of dietary choices aligned with 2019 CFG/CDG and CVD risk among Canadians was not studied. This study aims to examine the association between dietary choices assessed by a Food Choices Assessment Score (FCAS) according to 2019 CFG/CDG and 10-year CVD risk and heart age among Canadian adults. This cross-sectional study was conducted using the national Canadian Health Measures Survey (CHMS) (2016-2019) and included Canadian adults (≥ 30 years) without heart disease (n = 5,111). The 2019 CFG/CDG FCAS was calculated using the CHMS food frequency questionnaire. Canadians in the highest quintile (healthiest) of the FCAS had 55% lower odds (OR) of having high risk (≥ 20%) of estimated 10-year CVD risk (OR: 0.45; 95%CI: 0.23, 0.90) (P trend = 0.011), and 47% lower odds of having unhealthy heart age difference (heart age > chronological age) (OR: 0.53; 95%CI: 0.30, 0.92) (P trend = 0.02), compared to those in the first quintile (unhealthy) of the FCAS. This study indicates a strong inverse association of dietary choices as measured by the 2019 CFG/CDG FCAS with high 10-year CVD risk (≥ 20%) and unhealthy heart age (older than chronological age), estimated with the FRS.

Aortic dissection (AD) is a life-threatening condition. We developed an artificial intelligence (AI) algorithm capable of robust, accurate, and automated AD detection and sub-classification.

Based on 2010-2023 data from Mannheim University Medical Centre, heterogeneous internal training cases with confirmed AD (n = 70) were manually segmented and, together with non-AD cases (n = 87), used for training of a convolutional neural network (CNN; U-Net architecture) configured using the nnU-Net framework. Internal test dataset was composed of 106 cases. The external test was performed on a public dataset: 100 AD cases from ImageTBAD, Guangdong Provincial People's Hospital, China, and 38 non-AD cases from the AVT dataset (multiple sources). Model performance was evaluated by area under the receiver operating characteristic curve (AUROC), area under the precision-recall curve (AUPRC), sensitivity, specificity, precision, and F1-score, and by investigating performance on different subsets of cases. Confidence intervals were determined using DeLong's method and bootstrapping.

The best-performing algorithm achieved an AUROC of 98.7% (95% CI: 96.1-100.0%) and an AUPRC of 98.9% (96.0-100.0%) on the internal test dataset, 97.0% (94.7-99.3%) and 99.06% (98.0-99.7%) on the external test datasets, respectively. In the internal test dataset, of 15 unsuspected AD cases, 14 (93.3%) were successfully detected by the algorithm. On the external test dataset, sensitivity, specificity, precision, and F1-score were 92.0%, 100.0%, 100.0%, and 95.8%, respectively.

The developed AI pipeline highlighted the capability of optimized CNNs to reliably detect AD across heterogeneous multicenter datasets. The resulting tool will be made publicly available for further scientific evaluation.

Artificial Intelligence demonstrated promising potential to detect AD on heterogeneous thoracic CT imaging data.

Early detection of aortic dissection (AD) is crucial for timely treatment. A modern convolutional neural network (CNN) achieved 93.5% sensitivity and 100.0% specificity for AD detection on multicenter, heterogeneous CT data. These results demonstrate the potential of streamlined, optimized CNNs for robust AD detection on CT, supporting fast clinical response.

Habitual sleep positions might influence cardiovascular function, but its association with cardiovascular risk in the general population remains unknown. This study aimed to examine the relationship between the supine sleep position and the frequency of angina pectoris (angina), a common symptom of ischemic heart disease, and to explore whether body mass index (BMI) or sex moderate this relationship.

Data from the Sleep Heart Health Study (SHHS) were used. Supine sleep position was quantified as the percentage of total sleep duration spent in the supine position, measured by unattended home polysomnography (PSG) during the first SHHS visit. Angina frequency was defined by the number of episodes over a 15-year follow-up period. Multiple Poisson regression was conducted, adjusting for various conventional cardiovascular disease (CVD) risk factors.

The study included 5,804 participants (52% female), with a mean age of 63 years and an average BMI of 28.16 kg/m². The average time spent in the supine position was 32.4%, and the mean number of angina episodes was 0.48. Longer time in the supine sleep position was independently associated with an increased risk of angina (IRR = 1.003, p < .0001); a 10% increase in supine sleep time was associated with a 3% increase in angina risk. BMI (p = .189) and sex (p = .117) did not significantly moderate this association.

Sleeping in the supine position was significantly associated with more angina episodes. The study lacked information on other sleep positions. Identifying optimal sleep positions to support cardiovascular health could significantly contribute to CVD prevention.

Generating real-world evidence on individuals living with severe overweight or obesity in Italy, focusing on their characterization and management from general practitioners (GPs) perspective.

This was a non-interventional longitudinal observational cohort study using data from the Italian IQVIA Longitudinal Patient Database (LPD), conducted in collaboration with a working group from the 'Società Italiana di Obesità'. The study included individuals with body mass index (BMI) ≥ 27 kg/m² during 'January 2018-June 2022'. Data on clinical conditions, GP interventions (including drug prescriptions, and referrals for laboratory tests, instrumental examinations, and specialist visits), and hospitalizations were collected during the year preceding (baseline) and following BMI recording. Data were analyzed according to time (follow-up versus baseline) and BMI thresholds.

The final cohort consisted of 134,776 individuals: 44.9% with severe overweight, 36.7% with class I, 12.9% with class II, and 5.6% with class III obesity. Overall mean age was 59.9 years and men accounted for 52.9%. Mean age and male proportions decreased across increasing BMI categories. Most frequently recorded conditions during follow-up were hypertension (51.4%), cardiovascular disease (27.5%), and type-2 diabetes (25.1%). Proportions of subjects presenting with clinical conditions and of individuals requiring clinical interventions were higher during follow-up compared to baseline. The likelihood of presenting with most of clinical conditions and interventions increased with BMI.

Patients living with overweight or obesity experience a significant worsening of their health status which increases healthcare resources utilization. Public health interventions could benefit from supporting GPs with training and resources to enhance obesity management and improve patient outcomes.

Level III: Evidence obtained from well-designed cohort or case-control analytic studies.

Higher blood pressure is strongly related to an increased risk of cardiovascular disease. There has been interest in riboflavin (vitamin B₂) as a potential intervention to lower blood pressure, particularly for those with a common genetic polymorphism in the methylene tetrahydrofolate reductase enzyme (MTHFR).

To assess the benefits and harms of riboflavin supplements compared to placebo or no additional treatment for lowering systolic and diastolic blood pressure.

We searched the Cochrane Hypertension Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Ovid Embase, Clarivate Web of Science, Clarivate Food Science & Technology Abstracts and two clinical trials registries. There were no restrictions on language, publication year, or publication status. The latest search date was 24 October 2024. We also handsearched the reference lists of included studies.

We included randomised controlled trials (RCTs) conducted in adults that evaluated oral riboflavin supplements compared with an inactive control (e.g. placebo or no additional treatment) and measured at least one of the critical outcomes. We did not include trials that evaluated multivitamins containing riboflavin. Participants in both the intervention and control groups were able to receive standard medical therapy for hypertension prior to and during the trial.

The critical outcomes were systolic blood pressure and diastolic blood pressure. The important outcomes were antihypertensive medication, adverse events and biomarkers of riboflavin status.

We used the Cochrane RoB 2 tool to assess the risk of bias in included studies for the following outcomes: systolic blood pressure, diastolic blood pressure, antihypertensive medication and adverse events.

We used standard Cochrane methods. For the critical outcomes, which were continuous, we calculated mean differences (MD) and 95% confidence intervals (CIs). We used a fixed-effect meta-analysis to pool data for each outcome where possible. We conducted subgroup analyses, including by MTHFR C677T genotype.

We included four RCTs, which contributed 374 total participants for quantitative synthesis, although the number of participants included for each outcome varied. Most included studies for most outcomes had an overall high risk of bias.

The evidence is very uncertain about the effect of riboflavin on systolic blood pressure (MD -1.94 mmHg, 95% CI -5.74 to 1.86 mmHg; P = 0.32; 3 studies, 320 participants; very low-certainty evidence) and diastolic blood pressure (MD -3.03 mmHg, 95% CI -5.97 to -0.09 mmHg; P = 0.04; 2 studies, 271 participants; very low-certainty evidence). No RCTs reported data on changes in dose or number of antihypertensive medications. One RCT (54 participants) reported data on adverse events by intervention group; there were two adverse events in the riboflavin group and one in the control group. Low-certainty evidence suggests that riboflavin may result in little to no difference in adverse events.

The evidence for the effect of oral riboflavin supplements on systolic and diastolic blood pressure is very uncertain. The evidence comes from four RCTs, three of which had an overall high risk of bias. Large, well-conducted trials are needed for high-certainty evidence of the effect of riboflavin for blood pressure lowering.

KEB was supported by a Sir Charles Hercus Health Research Fellowship from the Health Research Council (Grant number: 19/110) and a Senior Heart Foundation fellowship from the Heart Foundation of New Zealand, supported in part by the GR Winn Trust (Grant number: 3728679).

Protocol (2023): DOI: 10.1002/14651858.CD015464.

To study the clinical characteristics of pediatric Behçet syndrome (BS).

A retrospective review was conducted on the medical records of children hospitalized in the Department of Pediatrics at the Second Hospital of Hebei Medical University between December 2014 and December 2024 who met diagnostic criteria for BS.

Among 45 children with BS, 26 (58%) were male. Oral aphthous ulcers were the most common manifestation (43/45, 96%), followed by genital ulcers (23/45, 51%) and gastrointestinal involvement (18/45, 40%). Genital ulcers were more frequent in girls, whereas ocular involvement was more common in boys (P<0.05). The pathergy test was positive in 10 (22%), and HLA-B51 was positive in 13 (29%). Fecal calprotectin (FC) was elevated in 16 (36%); gastrointestinal involvement was more frequent in children with elevated FC than in those with normal FC (P<0.05). According to the respective criteria, 17 (38%) patients met the International Study Group criteria (1990), 33 (73%) met the International Criteria for Behçet Disease (2014), and 13 (29%) met the Pediatric Behçet Disease criteria (2015).

Pediatric BS shows marked clinical heterogeneity. HLA-B51 is associated with disease susceptibility.

Most troubling of painless gastrointestinal endoscopy is hypoxia and hypotension. Esketamine has sympathomimetic and respiratory protection, which combined with midazolam and propofol may reduce these troubles. So, this study aims to explore the efficacy and safety of this regimen.

In total, 318 patients who received painless gastrointestinal endoscopy from November 2022 to April 2023 were included and randomly divided into two groups at 1:1: 0.1 µg/kg sufentanil (Suf) or 0.15 mg/kg esketamine (Esk) group. Except for analgesics, all patients were given midazolam and propofol. The incidence of hypotension and hypoxia (SPO₂ < 93%) during the examination was observed.

Compared with the Suf, the Esk group reduced the incidence of hypotension (12.8% vs 36.2%, 95% confidence interval (CI) 13.20-33.09, P < 0.001), respiratory depression (apnea > 30 s) (2.1% vs 15.4%, 6.47-20.52, P < 0.001), and hypoxia (7.1% vs 16.1%, 1.07-16.92, P = 0.018), but may increase the incidence of coughing (P < 0.001) and increased secretions (P = 0.032). There was no significant difference in the examination and recovery time (P > 0.05).

Esketamine, midazolam, and propofol for painless gastrointestinal endoscopy can achieve opioid-free sedation and reduce the occurrence of hypotension and hypoxia. However, the dosages of this regimen need to be further explored to avoid coughing and increased secretions.

This study has been registered in the Chinese Clinical Trial Center ( https://www.chictr.org.cn/index.html , Date: November 3, 2022, No: ChiCTR2200065379).

In Sweden, most out-of-hospital cardiac arrests (OHCAs) occur in private residences and nursing homes. Although studies suggest that nursing home staff appear hesitant to start cardiopulmonary resuscitation (CPR) before ambulance staff arrive, it is unknown whether treatment and outcomes among those who suffer OHCA in nursing homes differ from private residences. The aim of the study was to describe OHCA occurrence, treatment, and 30-day survival in people aged 65 years or older in Swedish nursing homes, in comparison with private residences.

This retrospective registry study utilized data from the Swedish Register of Cardiopulmonary Resuscitation from 1992 to 2022. The study included 59 459 OHCAs. Data were analyzed using descriptive and inferential statistics, complemented with generalized linear models.

The number of OHCAs was 56 379 in private residences and 3 080 in nursing homes. While the occurrence of OHCA increased in private residences it remained stable in nursing homes. The overall survival rate in people suffering OHCA in living facilities was 4.4% during the 31-year study period. There was an advantage of 1.0% in 30-days survival for private residences in the unadjusted analyses (p < 0.001), while the adjusted longitudinal model displayed a positive trend in annual survival odds in both private residences (5.6%) and in nursing homes (3.5%), with no difference between the groups (p = 0.207).

In this registry study, 30-day survival in nursing homes and private residences was similar and improved in both settings. These findings suggest that the location of OHCA is not the primary determinant of survival. Resuscitation decisions should be guided by careful consideration of the patient's medical condition, frailty, and personal preferences. Future initiatives might include strengthening emergency preparedness in nursing homes while supporting ethically justified and patient-centred shared decision-making.

Not applicable.