Beta-blockers have long been a foundational pharmacotherapy in cardiovascular care across many disease conditions. However, the emergence of contemporary randomized trials and large population analyses has reshaped our understanding of their appropriate use. This review highlights well established indications, such as chronic heart failure with reduced ejection fraction and angina, while also examining recent studies that have questioned routine use in certain scenarios such as myocardial infarction in patients with preserved ejection fraction, stable coronary artery disease, heart failure with preserved ejection fraction, first-line antihypertensive therapy, and perioperative management. Evolving data suggest that benefits are more nuanced than previously recognized and must be individualized based on underlying pathology, ventricular function, and symptomatic burden. This article provides a practical, indication-focused framework and identifies areas where further evidence is needed to refine prescribing and deprescribing practices.

This study aimed to develop an end-to-end intelligent decision support system, NeurAneuNet, to automate the selection of Pipeline Embolization Device (PED) size and landing zones for intracranial aneurysm treatment, thereby reducing reliance on operator experience and improving planning consistency.

NeurAneuNet integrates multimodal deep learning with knowledge enhancement. The system processes three-dimensional rotational angiography (3DRA) images using a dual-path attention U-Net++ for aneurysm segmentation, extracts knowledge-augmented geometric and clinical features, fuses five feature modalities via tensor decomposition, and predicts optimal PED sizing and landing zones with a high-order Kolmogorov-Arnold Network (KAN). A dataset of 600 aneurysms (including 210 PED-treated cases) was used for model development and validation, with an independent clinical cohort of 21 cases employed to assess real-world utility.

NeurAneuNet achieved a Dice coefficient of 0.874 ± 0.03 for aneurysm segmentation, a PED size classification accuracy of 91.8%, and a diameter prediction error of 0.24 ± 0.10 mm. In the independent test, its primary recommendation agreed with the expert consensus in 95.2% of cases. When assisting clinicians, the system reduced planning time by 44.8% and significantly lowered subjective cognitive workload, as assessed by the National Aeronautics and Space Administration Task Load Index (NASA-TLX) score (from 33 ± 8 to 21 ± 5).

NeurAneuNet demonstrates clinically relevant accuracy and efficiency in automating PED treatment planning, providing robust, intelligent support for intracranial aneurysm interventions. The system provides a promising foundation for developing a generalizable AI-driven decision support framework in complex medical scenarios.

Serious non-AIDS events (SNAEs), including non-AIDS malignancies, cardiovascular disease, and hepatic complications, remain major causes of mortality in treated HIV infection. These outcomes are driven by persistent immune activation, systemic inflammation, and metabolic dysfunction despite effective viral suppression with antiretroviral therapy (ART). To investigate mechanisms underlying SNAE pathogenesis, we performed a cross-site multi-omic analysis integrating plasma proteins, plasma metabolites, and mucosal microbiomes in 82 ART-treated people with HIV (PWH) and 10 people without HIV from the United States and Mexico. Geography was the dominant source of variation, particularly across lipid classes. However, individuals at high risk for SNAEs, defined by low CD4+ T cell counts and low CD4/CD8 ratios, shared a consistent signature of systemic inflammation, mitochondrial dysfunction, and microbial dysbiosis, including elevated plasma IL-6 and ω-oxidation products (adipic and suberic acids) and depletion of short-chain fatty acid-producing commensals in the gut mucosa, including Akkermansia muciniphila, Bacteroides uniformis, and Ruminococcus. A. muciniphila abundance correlated with lower IL-6 levels, fewer HIV RNA-producing cells in lymph nodes, and higher CD4/CD8 ratios. These findings identify a shared inflammatory and metabolic phenotype in PWH and implicate A. muciniphila as a potential microbiome-based target to mitigate immune activation and SNAE risk in treated HIV.

Chronic cerebral hypoperfusion drives the progression of intracranial atherosclerotic stenosis (ICAS) and increases ischemic risk. Endothelial angiogenic adaptation initially preserves cerebral perfusion but deteriorates with disease progression. We investigated whether the HCG11/QKI5 axis represents a regulatory node with therapeutic potential in cerebral hypoperfusion.

Circulating hypoxia- and angiogenesis-related biomarkers were compared between asymptomatic and symptomatic ICAS patients to reflect different progression stages. Endothelial function was assessed in oxygen-glucose deprivation models following HCG11 overexpression or QKI5 knockdown. A rat model of chronic cerebral hypoperfusion was used to evaluate temporal changes in vivo.

Pro-angiogenic factors were elevated in asymptomatic ICAS but reduced in symptomatic patients, indicating progressive impairment of vascular compensation. HCG11 overexpression enhanced endothelial proliferation and tube formation, whereas QKI5 silencing attenuated these responses. These effects were associated with modulation of HIF-1α/VEGF signaling. In vivo, early hypoperfusion activated QKI5 and angiogenic pathways, followed by a gradual decline during sustained hypoperfusion.

Progressive attenuation of the HCG11/QKI5-mediated angiogenic program may underlie endothelial adaptive failure in cerebral hypoperfusion. Targeting this RNA-regulatory axis may represent a potential therapeutic strategy to preserve vascular compensation and mitigate disease progression in ICAS.

to map the scientific evidence on the use of educational avatars for patients with cardiovascular diseases.

a scoping review was conducted according to the Joanna Briggs Institute guidelines, with no time limit. The search was conducted in eight databases, in the gray literature, and reverse citation searching. Data extraction and description followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews.

a total of 1,405 publications were identified, of which 14 studies were included, all published in English. The studies pointed to good acceptance of avatars by patients for self-management of their health condition, understanding, treatment adherence, promotion of self-care, and improvement in health literacy levels. Methodological diversity was observed, along with important gaps, such as the lack of description of avatar development processes and the scarcity of information on the profile and selection criteria of experts involved in the validation process.

educational avatars have the potential to complement clinical practice and the promotion of cardiovascular health. Further studies are needed in different contexts to ensure effective, accessible, and patient-centered tools.

Tribulus terrestris (Zygophylaceae) has been used by traditional medicine as tonic, aphrodisiac and diuretic agent, as well as to treat cardiovascular diseases. However, the vascular effect of Tribulus terrestris fruits is poorly explored. Thus, the aim of this study is to assess effect of Tribulus terrestris fruit preparations on rat aortae. Dried crude ethanol deriving from Tribulus terrestris fruit extract (CE) was partitioned to produce hexane (HEX), dichloromethane (DCM), ethyl acetate (EtOAc), butanol (BuOH) and methanol/water-soluble (MWS) fractions. These preparations had their phytochemical profile assessed though UPLC-ESI-MS. Concentration-response curves plotted for CE, or for its fractions, were built in precontracted vessels with, or without, intact endothelium. Cumulative addition of both CE and its fractions (0.1-1,000 µg/mL) to a phenylephrine-induced precontracted vessel (10-7 M) promoted vasorelaxant effect in a concentration-dependent manner, and it did not depend on the vascular endothelium. EtOAc (1,000 µg/mL) applied to endothelium-denuded rings has fully inhibited phenylephrine-induced contractions. Likewise, EtOAC (1,000 µg/mL) added to nominally Ca2+-free depolarizing solution inhibited CaCl2-induced contractions. UPLC-ESI-MS analyses have indicated that EtOAC is rich in cinnamic acid amide derivatives. Altogether, the herein analyzed data suggest that the vasorelaxant effect of EtOAc can likely be attributed to the blockage of voltage-gated calcium channels.

Mitral valve prolapse (MVP) may increase ventricular arrhythmic burden.

To assess prevalence, clinical significance, risk factors of arrhythmic MVP (aMVP) of the Polish MVP population.

454 adult MVP patients were enrolled into MITPROL AR-PL (Mitral Valve Prolapse Polish Registry). Patients with proarrhythmic comorbidities and severe mitral regurgitation were excluded. The study population was divided according to EHRA (European Heart Rhythm Association) 2022 consensus into aMVP, non-arrhythmic MVP (non-aMVP). Demographics, symptoms, electrocardiogram and MVP morphology were analyzed.

The aMVP was diagnosed in 61 (13.5%, mean age 45.0 years, females: 46/75%) and non-aMVP in 215 (47.4%, mean age 47.9 years, females: 157/73%) patients. Differences regarding symptoms were not recorded. Comparison between aMVP and non-aMVP showed a more frequent presence of Barlow's disease (52.5 vs. 25.1%, P < 0.001), bileaflet prolapse (75.4 vs. 47.9%, P < 0.001), Pickelhaube sign (41.0 vs. 21.4%, P = 0.002), mitral annulus disjunction (MAD; 73.8 vs. 48.8%, P < 0.001), inferior leads T-wave inversion (26.2 vs. 13.5%, P = 0.0001) in the aMVP. MAD length (8.4 vs. 8.0 mm, P = 0.04), maximum prolapse depth (5.7 vs. 4.6 mm, P < 0.001), leaflet thickness (5.5 vs. 4.6 mm, P = 0.001) were higher in the aMVP. Multivariable logistic regression showed predictors for aMVP: maximum prolapse depth (OR, 1.21; CI, 1.02-1.45, P = 0.02), leaflet thickness (OR, 1.51, CI, 1.17-1.94, P = 0.001).

The aMVP is rare. Maximum prolapse depth,leaflet thickness are independent aMVP risk factors. Screening for aMVP is reasonable in the MVP population regardless of arrhythmic symptoms with advanced prolapse, without well-recognized proarrhythmic factors.

Recent clinical trials have underscored the importance of early initiation of heart failure (HF) guideline-directed medical therapy (GDMT), with growing emphasis on rapid sequencing, particularly after hospitalization for acute HF (AHF). Despite the proven short-term benefit of this approach, few patients receive this therapy at discharge. In patients with AHF, we evaluated whether treatment at discharge with dual sodium-glucose co-transporter-2 inhibitors (SGLT2i)-mineralocorticoid receptor antagonist (MRA) therapy or four-class GDMT was associated with short-term mortality and incremental risk reduction.

We analysed two prospective registries of AHF: the China HF-CAP (n = 441 320; main cohort) and the Swedish HF Registry (SwedeHF) (n = 2367; external validation cohort). We assessed the association between discharge prescription of dual therapy SGLT2i and MRA versus neither, and four-class GDMT vs none, with 90-day cardiovascular (CV) and all-cause mortalities, further stratified by baseline serum potassium levels and left ventricular ejection fraction (LVEF) categories.

In the main cohort, for dual SGLT2i and MRA therapy (n = 71 154) vs neither (n = 81 793) therapy, adjusted odds of 90-day CV and all-cause death were 0.320 [0.283-0.361] and 0.504 [0.472-0.539], respectively. In the external validation cohort, results were directionally consistent. Association between dual SGLT2i and MRA therapy and short-term survival was consistent irrespective of hyperkalaemia and across HF phenotypes. Further, in the main cohort, adjusted odds of 90-day CV death of four-class GDMT (n = 36 301) were 0.122 (0.106-0.14) vs no therapy (n = 18 374).

After AHF, early initiation of dual SGLT2i and MRA therapy was associated with lower short-term mortality, irrespective of LVEF or potassium levels. Four-class GDMT conferred the lowest risk, emphasizing the importance of timely implementation after AHF.

This review discusses the implications of frameworks leveraging genetic admixture and multiomics data for advancing gene discovery in cardiovascular and kidney disease research. By broadening gene discovery efforts to additional populations that have a disproportionately high risk of disease and leveraging genetic diversity in admixed populations, studies can identify population-enriched risk variants that traditionally have been missed in genome-wide association studies. The use of multiomics approaches, including the transcriptome, proteome, and metabolome, advances a mechanistic understanding of disease beyond associations. As single-cell omics technologies continue to improve, their integration into gene discovery may help uncover cell-type-specific regulatory pathways and more precise biological contexts. The full potential of these approaches depends on sustained investment in diverse, well-characterized omics data sets, methodological innovation in multiancestry statistical approaches, and interdisciplinary collaboration bridging genomics, epidemiology, and clinical medicine. These efforts will need to be translated into clinically actionable insights, including ancestry-informed risk stratification and targeted therapeutics, to improve outcomes for cardiovascular and kidney diseases.

Primary aldosteronism (PA) is a common and treatable cause of hypertension, yet data on the durability of medical treatment response beyond the first year are limited. Using the PA medical treatment outcomes framework, we evaluated long-term biochemical and clinical outcomes and factors associated with treatment response.

We conducted an international, multicenter, observational cohort study across 27 centers on 4 continents. Adults with PA treated with mineralocorticoid receptor antagonists and epithelial sodium channel blockers between 2016 and 2021 were included if follow-up data were available at ≥12 months. Biochemical and clinical responses were classified as complete, partial, or absent using PA medical treatment outcomes criteria. Ordinal logistic regression identified determinants of a favorable treatment response.

The cohort included 1292 patients (47.5% women, mean age 52 years) with a median follow-up of 34 months (interquartile range, 21-51). At ≥12 months, 58.3% achieved a complete biochemical response, and 20.8% achieved a complete clinical response, with only 5% showing no response. Determinants of a favorable biochemical response included lower aldosterone and lateralization index, and higher renin and potassium levels at baseline. In those taking spironolactone, a higher daily dose was also associated with a favorable biochemical response. Determinants of a favorable clinical response included female sex, lower body mass index, shorter duration of hypertension, and absence of hypertension-mediated organ damage.

Targeted medical therapy for PA can deliver sustained biochemical and clinical benefits. Early disease detection and adequate dose titration are highly actionable determinants of long-term treatment success.