Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating stroke subtype. In the acute phase (< 72 h), stent-assisted coiling (SAC) carries a substantial risk of ischemic events (IEs). Early identification of high-risk patients is critical to improving outcomes. We developed and validated a practical risk score for predicting IEs, to support individual risk stratification. This prospective registry (SANE registry) included patients with aSAH at 33 advanced stroke centers across China from April 2021 to April 2024. Demographic, radiological and procedural variables collected at hospitalization were screened using Least Absolute Shrinkage and Selection Operator (LASSO) and logistic regression to construct a predictive risk score (FLATS). Model discrimination was assessed by the area under the receiver operating characteristic curve (AUC). An independent external validation cohort was derived from a single tertiary hospital, comprising patients treated between January 2011 and December 2020. The derivation cohort included 1,469 patients (median age: 57 years; 71.0% females) and 196 patients (13.3%) developed IEs. From 18 potential predictors, 5 variables were independent predictive factors and were included in the risk score: age, modified Fisher Scale, aneurysm size and location, and time to surgery. The FLATS score demonstrated good discriminative, with an AUC of 0.808. In external validation (n = 439), the AUC was 0.853. For risk stratification, a FLATS score > 15 was defined as high risk and a score < 10 indicated as lower risk. The FLATS score is an easily applicable aid for risk stratification of IEs after SAC for acute aSAH.  TRIAL REGISTRATION: ChiCTR2000032657 (chictr.org.cn, registered by Beijing Tiantan Hospital on May 5, 2020).

May-Thurner Syndrome (MTS) is an underrecognized anatomic cause of left-sided deep vein thrombosis (DVT) resulting from compression of the left common iliac vein by the overlying right common iliac artery. Although it accounts for approximately 2-5% of DVT cases, it may be overlooked when other provoking risk factors are present, leading to incomplete treatment and risk of recurrence. We report a 61-year-old woman with no prior history of venous thromboembolism who presented with one week of progressive left lower extremity swelling and pain following recent femoral venous catheterization during a prior hospitalization. Imaging demonstrated extensive proximal iliofemoral DVT involving the left external iliac, common femoral, and superficial femoral veins. Despite initiation of intravenous anticoagulation, the significant clot burden prompted aspiration mechanical thrombectomy. Post-procedural venography revealed persistent residual stenosis of the left common iliac vein, raising suspicion for underlying iliac vein compression. The distribution of thrombosis and focal stenosis was consistent with MTS. Balloon venoplasty was unsuccessful, and definitive management was achieved with placement of a 16 mm × 80 mm venous stent, resulting in restoration of inline venous flow. The patient was transitioned to oral anticoagulation with dual antiplatelet therapy and experienced clinical improvement without complications. This case highlights MTS as an important and potentially underdiagnosed cause of extensive left-sided DVT, particularly when thrombus burden appears disproportionate to apparent provoking factors. Recognition of this anatomic variant is essential, as anticoagulation alone may be insufficient and endovascular intervention is often required to prevent recurrence and long-term venous morbidity.

Cognitive impairment is a major geriatric health issue with significant public health burdens. Emerging evidence suggests blood pressure variability (BPV), particularly its dynamic fluctuations, may contribute to cognitive impairment pathogenesis through cerebrovascular damage. This study aims to investigate the prospective association between BPV, and cognitive impairment based on a cohort of community-dwelling older adults from Hong Kong. Based on a prospective cohort study with data collection of regular blood pressure (BP) measurements and health surveys in Hong Kong, participants older than 55 years were included and cognitive function was evaluated with the Montreal Cognitive Assessment. Demographic, social, and disease history information were adjusted. BPV was defined as standard deviation (SD) and categorized as high, medium, and low by a machine learning method. Logistic and quantile regression was conducted to explore the association between cognitive function and BPV. 573 participants with a mean age of 72 years, 96.2% of whom were women, with a mean follow-up of approximately eight months and a mean of 19 BP measurements. After adjustment, higher systolic BPV was associated with an increased risk of MCI (OR: 1.16; 95% CI: 1.03-1.31), but not diastolic BPV. Participants classified as having a high level of BPV showed a 5.6-fold risk for MCI compared with low BPV participants, especially among participants with lower cognitive levels. Higher systolic BPV was independently associated with an increased risk of MCI in older adults. Incorporating BPV assessment into routine monitoring could enhance early detection of cognitive decline in older adult populations.

Beyond serving as a structural organ, the skeleton undergoes continuous remodeling and functions as an endocrine organ by secreting bioactive factors that regulate the physiology of distant tissues. Indeed, the concept of a "bone-vascular axis" has long been recognized, supported by epidemiological evidence linking osteoporosis and low bone mass to increased cardiovascular morbidity and mortality. Emerging findings now extend this paradigm to the brain, suggesting that bone- and bone marrow-derived signals influence cerebrovascular structure, function, and aging. Given that cerebrovascular dysfunction is a central driver of age-related cognitive decline, dementia, and neurodegenerative diseases, understanding this "bone-cerebrovascular axis" may offer novel opportunities for prevention and intervention. Here, we outline the cellular and molecular mechanisms underlying age-associated neurovascular impairment and summarize the biology of major bone and bone marrow cell populations, with emphasis on age-related alterations in their secretome. A central focus of this Review is the emerging evidence that age-related skeletal alterations exert systemic effects on the cerebrovasculature, highlighting how bone- and bone marrow-derived factors shape neurovascular health and pathology, which may subsequently contribute to CNS aging and neurodegeneration. A deeper understanding of these systemic interactions reframes brain aging within a whole-body context and may uncover innovative biomarkers and therapeutic strategies to mitigate neurodegeneration and other age-associated disorders.

Colchicine has emerged as a promising anti-inflammatory option for secondary prevention in coronary artery disease, but its role in routine practice remains uncertain. Evidence from randomised trials suggests a more consistent benefit in chronic coronary syndromes and selected post-myocardial infarction populations. In contrast, results in acute coronary syndromes and PCI-related settings have been less convincing. This review summarises the main limitations and unresolved challenges of colchicine use in coronary artery disease, including heterogeneity across trials, lack of biomarker-guided patient selection, uncertainty regarding timing and duration of therapy, and concerns about tolerability, safety, and drug interactions. Current data suggest that colchicine may be useful in selected patients rather than as a universal treatment strategy. Further studies are needed to define its optimal clinical use better and to support a more personalised anti-inflammatory approach.

Glucocorticoids (GCs) are widely used as first-line therapy in rheumatoid arthritis (RA) due to their rapid onset of action and strong efficacy. However, inappropriate use is associated with significant adverse effects. Long-term treatment with low doses has been considered relatively safe for most RA patients, although its cardiovascular (CV) impact remains controversial.

A systematic literature review was conducted using PubMed to evaluate the CV effects of long-term (≥12 months) low-dose GC therapy (<7.5 mg/day prednisone equivalent) in RA patients. Studies published between 2010 and 15 March 2026 were screened independently by two reviewers. Study quality was assessed using the Newcastle-Ottawa Scale for observational studies and the Cochrane Risk of Bias 2 tool for randomised controlled trials. A meta-analysis was performed to estimate pooled hazard ratios (HRs) with 95% confidence intervals.

Ten studies were included in the review, of which five provided adjusted HRs suitable for meta-analysis. Long-term GC exposure even to low doses was associated with an increased risk of CV events (pooled HR 1.37; 95%CI 1.03-1.81; p=0.01). Substantial heterogeneity was observed among studies. Egger's test did not indicate significant publication bias.

Current evidence suggests that while short-term low-dose GC therapy may be relatively safe in selected RA patients, prolonged use and higher cumulative doses are associated with a slight increased CV risk, particularly in individuals with existing risk factors or comorbidities.

Exposure to hydrocarbons, including polycyclic aromatic hydrocarbons (PAHs) and volatile organic compounds (VOCs), represents an escalating public health concern. These compounds induce systemic inflammation, oxidative stress, and endothelial dysfunction, driving cardiovascular disease (CVD) pathogenesis. This systematic review evaluates the association between hydrocarbon exposure and CVD risk, focusing on specific metabolite biomarkers. A comprehensive search of PubMed, Embase, and Web of Science was conducted up to June 10, 2025. Observational studies evaluating correlations between hydrocarbon exposure and CVD outcomes-including coronary heart disease (CHD), stroke, and myocardial infarction (MI)-were selected for narrative synthesis. Eleven studies met the inclusion criteria. Included studies were of moderate to high quality with a low overall risk of bias. The PAH metabolites 1-hydroxynaphthalene (6 studies), 2-hydroxynaphthalene (7 studies), 2-hydroxyfluorene (6 studies), 3-hydroxyfluorene (5 studies), and 1-hydroxypyrene (5 studies) were consistently associated with elevated risks of CHD, stroke, and MI. Similarly, exposure to BTEX components (benzene, toluene, ethylbenzene, and xylene) evaluated in one study significantly correlated with heightened CVD incidence. These associations appeared more pronounced in highly exposed populations, particularly occupational cohorts, although effect sizes varied across studies because of study design differences and residual confounding factors such as smoking. Overall, the available evidence suggests an association between hydrocarbon exposure and increased CVD risk. Further prospective longitudinal studies are needed to confirm these findings and clarify the underlying toxicological mechanisms.

Objective: To investigate the association between triglyceride-glucose (TyG)-body shape index (BSI) and all-cause and cause-specific mortality in the elderly population. Methods: Data were derived from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2018, and a total of 8 093 adults aged ≥60 years were included. Fasting blood glucose, triglycerides, waist circumference, height, and body mass index were used to calculate TyG, BSI, and TyG-BSI (the product of TyG and BSI). Participants were divided into four groups based on TyG-BSI quartiles. Outcomes included all-cause, cardiovascular, and non-cardiovascular mortality. Cox proportional hazards models and restricted cubic spline analyses were employed to assess the association between TyG-BSI and mortality risk. Survival differences across TyG-BSI quartiles were compared using Kaplan-Meier curves. Receiver operating characteristic (ROC) curves were used to evaluate the predictive performance of TyG-BSI for mortality, and the net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were calculated to assess its incremental predictive value over traditional metabolic indices (TyG, TyG-waist circumference, and TyG-waist-to-height ratio). Results: The average age of the study population was 69.6 years (95%CI 69.3-69.8), with 46.0% (95%CI 44.9%-47.1%) males. Over a median follow-up of 8.3 years, 2 874 (35.5%) all-cause deaths occurred, including 949 (11.7%) cardiovascular deaths and 1 925 (23.8%) non-cardiovascular deaths. Cox regression analysis showed that after adjusting for age, sex, race, and other covariates, compared with the lowest TyG-BSI quartile, the highest TyG-BSI quartile was associated with significantly higher risks of all-cause mortality (HR=1.34, 95%CI 1.14-1.57), cardiovascular mortality (HR=1.41, 95%CI 1.08-1.85), and non-cardiovascular mortality (HR=1.31, 95%CI 1.07-1.61). Restricted cubic spline analysis revealed a linear positive association between TyG-BSI and mortality risk. Kaplan-Meier survival curves demonstrated a decreasing survival trend with increasing TyG-BSI quartiles. The ROC analysis yielded area under the curve values of 0.577, 0.591, and 0.550 for predicting all-cause, cardiovascular, and non-cardiovascular mortality, respectively. TyG-BSI provided incremental predictive value over traditional metabolic indices (both NRI and IDI0). Conclusions: TyG-BSI is positively associated with all-cause and cause-specific mortality in elderly populations, offering incremental predictive value for mortality beyond that of traditional metabolic indicators. While TyG-BSI can be used as an additional indicator for the initial screening of mortality risk in the elderly, its discriminative performance is limited when used alone and it should be combined with traditional clinical risk factors for comprehensive assessment.

Objective: To investigate the predictive value of pulmonary vein antrum anatomy for recurrence after radiofrequency catheter ablation (RFCA) in patients with paroxysmal atrial fibrillation (PAF). Methods: This was a retrospective cohort study. Patients with PAF who underwent successful first-time RFCA at the First Affiliated Hospital of Zhengzhou University from June 2019 to March 2021 were enrolled. All patients underwent cardiac CT angiography before ablation to measure left atrial diameter, as well as the circumference and area of bilateral pulmonary vein antrum orifices. The circularity parameters of bilateral pulmonary vein antrum orifices were calculated and denoted as pulmonary vein antrum-e (PVA-e), with left and right values recorded as LPVA-e and RPVA-e, respectively. All patients were followed up at 3, 6, 9, and 12 months after ablation by outpatient visit or telephone follow-up, and a standard electrocardiogram or Holter monitoring was performed at each follow-up. Recurrence of atrial fibrillation within 1 year after ablation was defined as the endpoint. Patients were divided into recurrence and non-recurrence groups according to whether recurrence occurred. Baseline characteristics were compared between the two groups, and Cox regression analysis was performed to identify independent predictors of recurrence after ablation. Receiver operating characteristic curves were used to evaluate the predictive performance of left atrial diameter, LPVA-e, and RPVA-e for post-ablation recurrence and to determine their optimal cutoff values. Kaplan-Meier curves were generated according to the optimal cutoff values of LPVA-e and RPVA-e, and differences in atrial fibrillation-free rate between groups were compared using the log-rank test. Results: A total of 188 patients with PAF (age (59.0±11.1) years, 76 (40.43%) females) were included. During the 1-year follow-up, 40 patients (21.28%) experienced recurrence after ablation. The left atrial diameter, LPVA-e, and RPVA-e were greater in the recurrent group compared to the non-recurrent group (P0.05). Multivariate Cox regression analysis showed that the left atrial diameter (HR=1.65, 95%CI: 1.07-2.56, P=0.025), LPVA-e (HR=1.13, 95%CI: 1.05-1.21, P0.001), and RPVA-e (HR=1.11, 95%CI: 1.01-1.22, P=0.031) were independent predictors of recurrence after RFCA. Receiver operating characteristic curve analysis showed that the area under the curve for LPVA-e was 0.737 (95%CI: 0.663-0.811), and the optimal cutoff value was 0.902, with a sensitivity of 82.5% and a specificity of 60.8%. The area under the curve for RPVA-e was 0.701 (95%CI: 0.610-0.791), and the optimal cutoff value was 0.927, with a sensitivity of 80.0% and a specificity of 55.4%. According to the optimal cutoff value, the bilateral PVA-e was divided into high and low groups. Kaplan-Meier curve analysis showed that atrial fibrillation-free rate was significantly lower in the high LPVA-e group than in the low LPVA-e group (log-rank P0.001), and similarly lower in the high RPVA-e group than in the low RPVA-e group (log-rank P0.001). Conclusion: Left atrial diameter, LPVA-e and RPVA-e are independent predictors of recurrence after RFCA in patients with PAF.

Background: Abdominal aortic aneurysm (AAA) remains an important cause of cardiovascular mortality in the United States despite advances in screening, surveillance, and aneurysm repair. Contemporary national analyses evaluating long-term AAA mortality trends across demographic and geographic subgroups remain limited, particularly following the COVID-19 pandemic period. Objective: To evaluate temporal trends in AAA-related mortality among U.S. adults aged ≥ 65 years from 1999 to 2024 and characterize demographic and geographic disparities. Methods: A retrospective population-based study was conducted using the CDC WONDER Multiple Cause of Death database. AAA-related deaths were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes I71.3 and I71.4. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated using the 2000 U.S. standard population. Mortality trends were stratified by sex, age, race/ethnicity, census region, and urbanization status. Joinpoint regression analysis was used to estimate annual percent change (APC) and average annual percent change (AAPC). Results: Between 1999 and 2024, a total of 208,476 AAA-related deaths among U.S. adults aged ≥ 65 years were recorded. Overall AAMR declined significantly from 32.61 per 100,000 population in 1999 to 12.17 per 100,000 population in 2024 (AAPC -3.86%; 95% confidence interval [CI]: -4.43 to -3.30; p < 0.001). Mortality rates remained consistently higher among males, adults aged ≥ 85 years, non-Hispanic White individuals, residents of the Midwest, and non-metropolitan populations. Joinpoint analysis demonstrated sustained declines across most demographic groups. Although several subgroups exhibited a temporary plateau in declining mortality trends during the pandemic era, these trend changes did not reach statistical significance. Following 2021, mortality rates resumed a significant downward trend. Conclusions: AAA-related mortality among U.S. adults aged ≥ 65 years declined substantially between 1999 and 2024; however, important demographic and geographic disparities persist. Continued efforts aimed at risk factor reduction, equitable screening access, and preventive vascular care remain essential to further reduce AAA-related mortality among older adults.