Amid the cardiovascular-kidney-metabolic (CKM) syndrome public health crisis, this study aimed to explore differential pathological associations with established versus advanced CKM status and assess its consistency across Chinese and U.S. adults.

This cross-sectional study analyzed data from two independent sources: a community survey in Shaanxi, China (n=2, 100) and the U.S. National Health and Nutrition Examination Survey (NHANES) (2011-2018; n=5, 359). Associations between three pathological axes-visceral adiposity (VA), insulin resistance/dyslipidemia pathological score (IRD-PS), and systemic low-grade inflammation pathological score (SLI-PS)-and two key CKM outcomes (established: Stages 2-4 vs. 0-1; advanced: Stages 3-4 vs. 0-2) were evaluated using Firth's penalized logistic regression to address potential quasi-complete separation in the outcome data.

IRD-PS exhibited the strongest association with established CKM status in both populations (Shaanxi: OR = 2.49, 95% CI 2.18, 2.86; NHANES: OR = 2.52, 95% CI 2.24, 2.82). In contrast, SLI-PS was significantly and consistently correlated with advanced CKM status (Shaanxi: OR = 1.11, 95% CI 1.03, 1.19; NHANES: OR = 1.07, 95% CI 1.01, 1.14). Statistical exploratory decomposition analysis revealed IRD-PS largely attenuated the association between VA and established CKM status, statistically accounting for 67.1% of the effect in Shaanxi and 64.5% in NHANES. In the NHANES, significant racial/ethnic heterogeneity was observed in the IRD-PS-established CKM status association (P for interaction < 0.001), with the strongest association in non-Hispanic Asian people (OR = 3.96) and the weakest in non-Hispanic Black people (OR = 2.03). These cross-sectional associations should be interpreted with caution.

Our findings support a conceptual model of CKM syndrome in which metabolic dysregulation is the primary correlate of the established (Stage 2+) CKM status and in which systemic inflammation is a more prominent correlate of advanced (Stage 3+) CKM status. These findings may primarily generalize to the analyzed subsamples rather than broader general populations. Given the cross-sectional design, all findings are strictly hypothesis-generating, and the proposed stage-specific pathological pattern requires formal validation in future longitudinal cohorts.

The landscape of epidemiological research is experiencing a technological transformation, driven by the rapid expansion of big data and advancements in artificial intelligence (AI) and machine learning (ML). This workshop explored the opportunities and challenges associated with integrating diverse data sources into population-based research at different levels, including electronic health records (EHRs), genomic and omics data, imaging, wearable device data, and social determinants of health measures, among others. AI/ML tools present powerful capabilities for analyzing these vast datasets, offering advancements in health risk prediction, disease pattern identification, and the development of personalized interventions. However, the integration of big data introduces technical barriers related to data heterogeneity, privacy and security concerns, and the potential to exacerbate health disparities through algorithmic biases. In September 2023, the National Institutes of Health's (NIH) National Heart, Lung, and Blood Institute (NHLBI), in collaboration with the National Cancer Institute (NCI) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), hosted a workshop to address these challenges and discuss the integration of big data into epidemiology and population-based studies. Key themes from the workshop emphasized interdisciplinary collaboration, data standardization, and the development of robust ethical frameworks, as well as the importance of advancing data governance, implementing transparent consent processes, and employing privacy-preserving techniques to maintain public trust. Additionally, the workshop highlighted the transformative potential of digital health technologies, such as wearable devices, which, when integrated with EHRs, enhance data granularity, facilitate early disease detection, and strengthen public health surveillance. Ethical, legal, and social issues (ELSI) are central to responsibly leveraging big data and AI in research, unbiased algorithms, the use of diverse datasets in AI training, and continuous human oversight to mitigate risk and ensure validity. The workshop also emphasized the need for workforce training and education in data science and bioinformatics to prepare researchers for utilizing these technologies effectively. The workshop concluded by recognizing the need for a balanced approach that addresses data integration challenges while harnessing AI/ML to improve healthcare outcomes. By fostering interdisciplinary collaboration, prioritizing privacy, and embracing data-driven methodologies, epidemiological research can unlock the full potential of big data to transform public health and clinical practice.

This study aimed to analyze the risk factors of coronary artery lesions (CAL) in patients with Kawasaki disease (KD) and establish predictive models for CAL in patients with KD.

This retrospective cohort study included KD patients admitted to Shengjing Hospital of China Medical University, collecting data on 41 demographic, clinical, and laboratory parameters. LASSO regression identified key predictive variables. The dataset was split into 70% training and 30% validation. Ten models were trained using 10-fold cross-validation, with the training set balanced through ROSE oversampling. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy.

The CatBoost algorithm achieved the best results: AUC, 0.953; sensitivity, 0.908; specificity, 0.860; and accuracy, 0.883. Internal validation results were as follows: AUC, 0.874; sensitivity, 0.721; specificity, 0.848; accuracy, 0.837. External validation results were as follows: AUC, 0.876.sensitivity, 0.894; specificity, 0.954.

We present a machine-learning model that predicts the risk of CAL in patients with KD in China, aiding doctors in creating personalized treatment strategies to improve outcomes.

The soluble form of cellular prion protein (PrP^C) in plasma has been investigated as a biomarker in multiple conditions, yet its relationship with ischemic stroke severity remains unclear. Soluble PrP^C is also implicated in immune-cell activation and inflammatory regulation. Here, we examined whether plasma soluble PrP^C is associated with stroke severity and circulating CD4⁺ T cell immune responses in patients with acute ischemic stroke.

In this single-center prospective cohort study, we consecutively enrolled patients with acute ischemic stroke admitted to the Department of Neurology, The First Hospital of Jilin University (Changchun, China) between June 2023 and October 2024 within 48 h of symptom onset (for wake-up stroke, onset was defined as the last known well). Fasting venous blood was collected the morning after admission. Stroke severity was categorized by admission NIHSS as mild (≤6) or moderate-to-severe (>6), and volunteers from the Health Examination Center served as controls. Circulating CD4⁺ T cells and Th1/Th2/Th17 subsets were quantified by flow cytometry, and soluble PrP^C concentrations in plasma were measured by ELISA.

Plasma soluble PrP^C concentrations were higher in patients with ischemic stroke than in controls (1.16 [0.74, 1.99] ng/mL vs 0.54 [0.36, 0.65] ng/mL; P < 0.0001) and were further increased in the moderate-to-severe subgroup (1.91 [1.10, 3.18] ng/mL vs 0.86 [0.58, 1.40] ng/mL; P < 0.01). Plasma soluble PrP^C was independently associated with admission NIHSS (B = 2.085, 95% CI 1.176-2.994; P < 0.001). Among stroke patients, plasma soluble PrP^C was positively associated with Th2 proportion (ρ = 0.73; P < 0.001) and negatively associated with the Th1/Th2 ratio (ρ = -0.66; P < 0.001); both associations remained significant after covariate adjustment (Th2: B = 1.504, 95% CI 1.166-1.841; Th1/Th2: B = -2.374, 95% CI -3.427--1.322; both P < 0.001).

Plasma soluble PrP^C is elevated early after ischemic stroke and is associated with stroke severity and a Th2-skewed circulating CD4⁺ T-cell profile. These findings support plasma soluble PrP^C as a candidate acute-phase marker linked to post-stroke immune dysregulation.

Rheumatic and musculoskeletal diseases (RMDs) confer an increased cardiovascular risk beyond traditional factors, with peripheral artery disease (PAD) being an important source of morbidity and disability in these patients. This review summarizes current evidence on PAD across RMDs, including rheumatoid arthritis, systemic lupus erythematosus, antiphospholipid syndrome, systemic sclerosis, polymyalgia rheumatica, psoriatic arthritis, and primary Sjögren's syndrome. Physiopathological mechanisms involved include persistent inflammation, immune dysregulation, and the presence of pathogenic autoantibodies. Protective humoral responses have also been linked to reduced CV risk and may serve as future biomarkers. Clinical studies reveal variable PAD prevalence across diseases but consistent high underdiagnosis. Optimal management requires aggressive CV risk control, including lipid-lowering, immunomodulatory, and biologic therapies. This review underscores PAD as a distinct and clinically relevant manifestation of systemic autoimmunity, calling for targeted screening and prevention strategies in rheumatic populations.

Pregnancy in women with cardiovascular disease (CVD) represents a distinct clinical condition, as the physiological adaptations of pregnancy may interact with underlying cardiac pathology in variable and sometimes unpredictable ways. Consequently, maternal and foetal risk cannot be assumed a priori and requires structured, patient- and disease-specific assessment. The new ESC guidelines on cardiovascular disease and pregnancy incorporate updated evidence following the 2018 version. The contents span from models of multidisciplinary care (the Pregnancy Heart Team, PHT), pre-pregnancy counselling, and pregnancy-related risk assessment, to novel recommendations that are both shared by all pregnancies in women with CVD and specific to each distinct disease. Due to limited prospective or randomized studies largely prevented by ethical reasons, most recommendations are based on evidence level C. This document provides a concise synthesis of innovations in shared management strategies and disease-specific pathways in pregnancy of women with known CVD. It also acknowledges that not all clinical scenarios can be fully captured by guideline-based recommendations. Beyond guidelines, and primarily because approximately 50% of recommendations are Level C evidence, there is considerable decision-making margin for cardiovascular specialists to adhere recommendations. For rare unpredictable complications/events the limited available evidence does not allow recommendations to be made. Looking to the future, the expectation is that AI, which is already generating data and models of care in pregnancy, can help support widespread access to PHT, both in hospitals equipped with the necessary requirements and remotely to all healthcare facilities serving pregnant women with CVDs.

Agomelatine and mirtazapine are antidepressants with complementary pharmacological profiles. However, this combination is rarely reported in clinical practice. We report a case of a 54-year-old man with ischemic heart disease, diabetes, and hypothyroidism, who achieved early full remission of major depressive disorder and chronic insomnia following treatment with agomelatine and mirtazapine. By the four-week follow-up, the patient reported sleeping 8-9 hours/night with normalized mood and cognitive function. He sustained full remission for over three months, with no adverse effects. Serial lab investigations and ECGs remained stable throughout. No arrhythmic events or QTc prolongation were observed during follow-up. While not commonly reported together in routine care, the combination was well tolerated and appeared to support both mood improvement and sleep restoration, without notable side effects, despite the presence of multiple cardiovascular and metabolic comorbidities. This case adds to the expanding literature and suggests that this combination may be a useful off-label option for select patients with depression and insomnia who are at risk of cardiovascular or metabolic complications.

Spontaneous coronary artery dissection (SCAD) has emerged as a critically important non-atherosclerotic cause of acute coronary syndrome that disproportionately affects women, yet contemporary data on non-pregnancy-associated SCAD remain limited, particularly regarding treatment patterns and disparities in care delivery. We conducted a retrospective cohort study using the 2022 National Inpatient Sample, identifying adult hospitalizations with a primary diagnosis of SCAD using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. To ensure a homogeneous non-obstetric cohort, we applied strict exclusion criteria, removing pregnancy-related admissions, peripartum cardiomyopathy, obstetric complications, and patients under 18 years of age. All statistical analyses were performed using STATA version 18.0 (StataCorp LLC, College Station, TX), incorporating survey weights to generate nationally representative estimates. Multivariable logistic regression analysis was performed to identify predictors of in-hospital mortality and treatment utilization. A total of 4,563 hospitalizations met the inclusion criteria, with a mean age of 52.4 ± 11.8 years and 72.6% (n = 3,313) female patients. The overall in-hospital mortality rate was 3.2% (n = 146). Women were significantly less likely to undergo percutaneous coronary intervention compared to men, with rates of 28.4% (n = 941) versus 36.9% (n = 483), respectively, despite having similar rates of cardiogenic shock (9.1% (n = 301) vs. 8.0% (n = 96)). Racial disparities were evident, as Black patients demonstrated higher adjusted odds of mortality compared to White patients, with an adjusted odds ratio of 1.42 (95% CI: 1.08-1.86). Independent predictors of mortality included cardiogenic shock, which increased the odds of death nearly sixfold, chronic kidney disease, and increasing age. Notably, percutaneous coronary intervention was not independently associated with reduced in-hospital mortality. In this nationally representative cohort, non-pregnancy-associated SCAD was associated with low but clinically significant mortality. Marked sex- and race-based disparities in treatment and outcomes persist, underscoring the urgent need for standardized management strategies and equitable cardiovascular care delivery.

Patients with abdominal aortic aneurysms (AAAs) have poor survival rates after aneurysm repair compared with the general population, potentially due to increased cardiovascular risk. This systematic review and meta-analysis aimed to assess the long-term incidence of all-cause and cardiovascular mortality after elective, infrarenal AAA repair.

The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed (PROSPERO ID: CRD42022344547). Studies published in PubMed, Web of Science, and COCHRANE databases between January 2013 and May 2023 with a mean follow-up time of ≥5 years were included. A weighted linear regression analysis was performed to determine the annual incidence of all-cause and cardiovascular mortality five years after AAA repair. A random effects model calculated the overall incidence rates per 1000 person-years (PY). Endovascular aneurysm repair (EVAR) and open surgical repair (OSR) were compared.

Nineteen studies with 84 212 patients (mean follow-up: 68.9 [±13.3] months) were included. Common preoperative cardiovascular comorbidities included hypertension (74.4%), dyslipidemia (43.6%), and coronary artery disease (27.6%). At five years, the mean all-cause mortality was 29.78%, and cardiovascular mortality was 11.98%, with an annual increase of 6.59% and 2.46%, respectively (R²=0.809, p<0.001 and R²=0.824, p<0.001). The random effects model showed an all-cause mortality rate of 62.99 events (95% CI=57.53-68.96; I²=93%) per 1000 PY and a cardiovascular mortality rate of 24.19 events per 1000 PY (95% CI=21.69-26.98; I²=66%). Patients undergoing an EVAR had a significant higher incidence of all-cause and cardiovascular mortality than patients undergoing an OSR (B-coefficient 4.10 and 2.39, both p<0.001, respectively).

The long-term all-cause and cardiovascular mortality remain high following elective, infrarenal AAA repair. These findings highlight a much needed optimization and emphasis of cardiovascular risk management, to minimize the long-term incidence of cardiovascular mortality in patients with AAA following surgical intervention.Clinical ImpactThis study evaluated the long-term outcomes of cardiovascular and all-cause mortality rates following elective repair of the infrarenal abdominal aortic aneurysm. The results of this systematic review and meta-analysis emphasizes the suboptimal cardiovascular risk profile observed in this patient population. Futhermore, it highlights the importance of optimization and emphasis of cardiovascular risk management, including in the long-term after surgical intervention.

The optimal perioperative oxygen regimen remains clinically debated. As preclinical studies implicate oxidative pathways in cardiovascular pathophysiology, an evaluation of the oxygen, oxidative stress and cardiac outcome triad is therefore crucial for perioperative oxygen treatment.

A meta-analysis based on RCTs was conducted to reveal the impact of hyperoxia on oxidative stress indicators and cardiac complications compared with normoxia. Two-sample mendelian randomization (MR) analysis was conducted to investigate the influence of oxidative stress on cardiac complications. Trial sequential analysis (TSA) was performed to ascertain the necessary sample size and evaluate the reliability for definitive conclusions.

The meta-analysis revealed no significant differences in cardiac complications between hyperoxia and normoxia groups, including atrial fibrillation (AF; RR 1.06, 95% CI 0.89-1.27), myocardial infarction (MI; RR 0.73, 95% CI 0.45-1.20), myocardial injury (RR 1.02, 95% CI 0.81-1.28), arrhythmia (RR 0.92, 95% CI 0.72-1.26), and low cardiac output syndrome (LCOS; RR 0.84, 95% CI 0.49-1.44). Perioperative hyperoxia significantly increased intraoperative plasma total oxidant status (TOS; SMD 0.86, 95% CI 0.42-1.30) and F2-isoprostane levels (SMD 0.71, 95% CI 0.05-1.38). MR analysis demonstrated that uric acid (UA) was positively associated with MI (OR 1.0021, 95% CI 1.0009-1.0033), cardiovascular disease (CVD; OR 1.0012, 95% CI 1.0005-1.0020), and ischemic heart disease (IHD; OR 1.001, 95% CI 1.000-1.002), while CAT and GST showed negative associations with CVD (OR 0.97, 95% CI 0.95-0.99) and AF (OR 0.96, 95% CI 0.96-0.99), respectively. False discovery rate (FDR) adjustment confirmed causal links for UA with MI and CVD, and TSA validated adequate sample size for AF and MI conclusions. No significant differences were found on other complications.

Based on the comprehensive evidence presented, including the equivalent safety profile of perioperative normoxia across organ systems, the significant increase in systemic oxidative stress associated with hyperoxia, and the MR-confirmed causal links between oxidative stress biomarkers and cardiovascular risks, is recommend as the preferred oxygenation strategy in perioperative care​due to the safety and potential cardiovascular benefits.