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.

ObjectivePatients with a prior history of coronary artery bypass grafting (CABG) presenting with non-ST-elevation acute coronary syndrome (NSTE-ACS) represent a high-risk population in whom revascularization decisions are frequently individualized in real-world practice. Objective biomarkers capable of supporting treatment selection in this setting remain limited. The Naples Prognostic Score (NPS), a composite index integrating inflammatory and nutritional parameters, may reflect overall clinical vulnerability.MethodsIn this retrospective, single-center observational cohort study, the association between NPS and treatment strategy selection was evaluated in 367 patients with prior CABG presenting with NSTE-ACS between January 2019 and October 2025. NPS was calculated at admission prior to coronary angiography using total cholesterol, neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and serum albumin levels. Patients were categorized into low (0-2) and high (3-4) NPS groups. Treatment strategies were determined through routine multidisciplinary clinical assessment and were not influenced by study investigators. Multivariable logistic regression and prespecified stratified sensitivity analyses were performed.ResultsRevascularization was selected in 169 patients (46.0%), including 164 percutaneous coronary interventions and 5 redo CABG procedures. Patients undergoing revascularization had significantly lower NPS values. High NPS was independently associated with a lower likelihood of being selected for revascularization (OR 0.28, 95% CI 0.17-0.48; p < 0.001). Procedural success rates following PCI were similar between NPS groups (89.0% overall; p = 0.161). Results remained consistent across stratified sensitivity analyses according to clinical presentation, chronic kidney disease status, and age categories.ConclusionsHigher NPS values were associated with a lower likelihood of revascularization without affecting procedural success. NPS appears to reflect disease burden and clinical vulnerability rather than treatment benefit. It may also capture acute inflammatory status and should be considered a complementary, not decisive, clinical marker.

Extracellular vesicles (EVs), encompassing exosomes, microvesicles, and apoptotic bodies, are pivotal mediators of intercellular communication, facilitating the transfer of nucleic acids, proteins, and lipids between cells and thereby influencing a wide range of physiological and pathological processes. Their inherent biocompatibility, nanoscale size, and ability to reflect the molecular signatures of their parental cells have positioned EVs as promising therapeutic agents for various diseases, including neurological, cardiovascular, hepatic, and pulmonary disorders, for which conventional therapies often provide limited or nonspecific benefits. Notably, EVs can traverse biological barriers such as the blood-brain barrier, enhancing their clinical applicability by enabling drug delivery to anatomically protected sites. Furthermore, patient-derived EVs exhibit distinct molecular profiles compared with healthy controls, underscoring their potential as diagnostic biomarkers and modulators of disease pathogenesis, with growing evidence demonstrating their ability to distinguish disease subtypes, predict prognosis, and monitor therapeutic responses. Accumulating evidence also indicates that EVs regulate immune responses, angiogenesis, and tissue remodeling, thereby contributing to both physiological homeostasis and pathological processes. Engineered EVs further offer innovative drug delivery solutions by improving therapeutic precision while minimizing adverse effects associated with conventional systems, and they hold considerable promise for future personalized- medicine strategies. This review summarizes current knowledge on the diverse roles of EVs across major organ diseases, highlights their translational potential as both therapeutic agents and biomarkers, and discusses emerging challenges that must be addressed for successful clinical translation. By providing a comprehensive overview, this study aims to advance the clinical translation of EVs in precision medicine.

BACKGROUND Cardiovascular disease remains the leading cause of morbidity and mortality in kidney transplant (KT) recipients. Stress echocardiography (STE) is frequently used in pretransplant risk stratification, but its prognostic value in predicting posttransplant outcomes is uncertain. This retrospective study from a single center aimed to evaluate pretransplant STE findings in 354 KT recipients and their association with posttransplant major adverse cardiovascular events (MACE). MATERIAL AND METHODS We included KT recipients from our Midwest academic institution between January 2015 and January 2024 who underwent pretransplant STE. STEs were classified as positive (ischemic EKG changes or new wall motion abnormalities) or negative. MACE was defined as cardiovascular death, acute coronary syndrome, heart failure hospitalization, fatal arrhythmia, or stroke. Kaplan-Meier survival curves and Cox regression models were constructed to assess the associations between STE parameters and outcomes. RESULTS Among 354 KT recipients, 58 (16.3%) had a positive STE. Over a mean follow-up of 54±19 months, 67 patients (18.9%) experienced MACE. In unadjusted analyses, age, diabetes, and coronary artery disease were associated with higher MACE risk; however, positive STE was not significantly associated with outcomes. In multivariable models, abnormal STE remained unassociated with MACE or the composite outcome. Kaplan-Meier survival analysis confirmed no difference in MACE-free survival between groups. CONCLUSIONS In this contemporary single-center cohort of KT recipients, abnormal pretransplant STE was not independently associated with posttransplant cardiovascular events. These findings suggest the need to re-evaluate the role of traditional stress testing targeted toward detecting myocardial ischemia in pre-KT evaluation.