Lipoprotein(a) [Lp(a)] promotes atherosclerotic plaque vulnerability through pro-inflammatory and thrombogenic pathways, while the CatLet© angiographic score quantifies coronary lesion complexity. We hypothesized that their integration would improve prognostication in acute myocardial infarction (AMI) after emergency percutaneous coronary intervention (ePCI).

In this retrospective cohort, 307 AMI patients undergoing successful ePCI (2020-2022) were stratified by 1-year major adverse cardiovascular/cerebrovascular events (MACCE). Serum Lp(a) and troponin I were measured post-admission. CatLet© and Gensini scores were assessed by blinded analysts. Multivariable logistic regression and ROC analyses evaluated predictive performance.

MACCE patients (n = 78) exhibited higher Lp(a) (135.99 ± 33.07vs. 123.35 ± 42.70nmol/L, P = 0.0178) and CatLet© scores (33.58 ± 9.04vs. 30.80 ± 8.24, P = 0.0012) versus controls. Lp(a) (OR=2.339,95%CI:1.519-3.603, P <  0.001) and CatLet© score (OR=1.092, 95%CI:1.027-1.161, P = 0.005) independently predicted MACCE. The combined model Lp(a)≥70.70 nmol/L + CatLet© ≥ 18.6) significantly outperformed individual markers (AUC 0.862 [95%CI:0.83-0.96] vs. 0.780/0.833; DeLong's test confirmed the superiority of the combined model over individual predictors (P = 0.0089, Z = 2.64 vs. Lp(a); P = 0.034, Z = 2.12 vs. CatLet© score), with 88% sensitivity and 83% specificity.

The Lp(a)-CatLet© synergy enhances MACCE risk stratification in ePCI-treated AMI, reflecting complementary pathobiological (Lp(a)-driven plaque vulnerability) and anatomical (CatLet©-quantified complexity) pathways. This dual-parameter approach could support post-PCI risk stratification and follow-up planning.

The impact of changes in leisure time physical activity (LTPA) is not well-documented, especially when considering occupational physical activity (OPA). This study examines the effects of LTPA changes in workers with varying physical activity demands.

Part of the OPERA study, we tracked morbidities for over 20 years (P1, from 1993 to 2014) and mortality for over 8 years (P2, from 2014 to 2021-2022) with 599 participants. They were categorized into four LTPA groups ("sedentary," "started," "quit," "active") and two OPA groups ("office workers" and "occupationally physically active").

Maintaining regular LTPA was associated with lower incidence of hypertension, diabetes and metabolic syndrome (p-values 0.007, < 0.001 and <0.001 respectively). Non-fatal cardiovascular disease (CVD) events were more common (p = 0.006, HR 1.99, CI95% 1.22-3.26) in the "quit" group during P1, especially among "occupationally physically active" (p < 0.001, HR 2.29, CI95% 1.23-4.29). During P2, fatal CVD events were associated with being in the "sedentary" group (p = 0.042, HR 2.67, CI95% 1.04-7.03). This association was particularly evident among "office workers," where belonging to the "sedentary" and "quit" groups was associated with a higher risk of fatal CVD events (p = 0.017, HR 5.45, CI95%1.36-21.91, and p = 0.025, HR 4.55, CI95% 1.21-17.19, respectively). Furthermore, total mortality was associated with being in the "sedentary" or "quit" groups (p = 0.029, HR 3.69, CI95% 1.14-11.93, and p = 0.009, HR 4.61, CI95%1.47-14.49, respectively).

Stopping LTPA in middle age was associated to higher risk for non-fatal CVD events in "occupationally physically active" individuals. Fatal CVD events were associated with a sedentary lifestyle in whole study population. Among "office workers," both a sedentary lifestyle and stopping regular LTPA were associated with higher risks of fatal CVD events and all-cause mortality.

Loneliness, a significant social determinant of health, has been increasingly recognized for its potential to influence cardiovascular disease (CVD) risk. This study aimed to delineate the relationship between loneliness and the incidence of CVD, specifically heart disease and stroke, among Chinese adults aged 45 and older. Utilizing data from the China Health and Retirement Longitudinal Study (CHARLS), loneliness was assessed using a validated single-item measure. Incident CVD events, including heart disease and stroke, were ascertained through standardized interviews. We employed Cox proportional hazards models to calculate hazard ratios (HRs), adjusting for a comprehensive set of covariates. A longitudinal analysis of 8,046 participants initially free of CVD was conducted. During a 7-year follow-up period, 1,033 participants experienced incident CVD events. Loneliness was found to be an independent risk factor for CVD, with individuals reporting loneliness exhibiting a 42.9% higher risk of developing CVD (adjusted HR: 1.429; 95% CI, 1.251-1.632). Specifically, the risk of heart disease was elevated by 44.7% (adjusted HR: 1.447; 95% CI, 1.229-1.703), and the risk of stroke was increased by 27.9% (adjusted HR: 1.279; 95% CI, 1.035-1.580). This association was particularly pronounced among those without a history of hypertension, where the risk of CVD was elevated by 58.2% (adjusted HR: 1.582; 95% CI, 1.317-1.900). Our findings indicate that loneliness is significantly associated with an increased risk of CVD, specifically heart disease and stroke, among Chinese adults aged 45 and older. These results highlight the need to consider psychosocial factors in CVD prevention strategies.

In the Region of the Americas, particularly in low- and middle-income countries such as Peru, cardiovascular disease (CVD) remains one of the leading causes of mortality. A positive association has also been described between body fat percentage and CVD risk.

To evaluate the association between obesity, defined by Relative Fat Mass (RFM, an anthropometric indicator that estimates total body fat), and 10-year cardiovascular risk estimated by the Framingham risk score.

A cross-sectional study was conducted using data from the Food and Nutrition Surveillance by Life Stages survey (2017-2018) in Peru. Obesity was the exposure variable defined by RFM. The RFM was also analyzed both as a continuous and categorical variable. Generalized linear models of the gamma family with a logarithmic link were applied and stratified by sex.

Data from 651 adults were analyzed. The prevalence of obesity was 78.2% in women and 42.7% in men. After adjusting for age, poverty, fruit and vegetable consumption, and altitude of residence, obesity defined by RFM was associated with higher estimated Framingham risk scores in both sexes (Women: β: 0.48; 95% CI: 0.32-0.63; Men: β: 0.39; 95% CI: 0.23-0.56. Similar results were observed when RFM was analyzed as a continuous variable and in tertiles.

Obesity defined by RFM was positively associated with estimated 10-year cardiovascular risk in both sexes, with stronger association in women. These results suggest that RFM may serve as a useful tool for assessing estimated 10-year cardiovascular risk, with implications for the design of public health interventions in Peru.

The present study evaluated the effectiveness of transcranial alternating current stimulation (tACS) treating patients with post-stroke anomia using a picture-naming task and a Single-Case Experimental Design (SCED). A right-handed 38-year-old woman with a left-hemisphere stroke and a left-handed 54-year-old man with a right-hemisphere stroke underwent an eight-week treatment program. Specifically, they participated in a picture-naming task three times a week, alternating between sessions with and without tACS stimulation every two weeks. Electroencephalography (EEG) measurements were taken at the end of each two-week period, and behavioral data were collected before, during and after the treatment. EEG and behavioral assessments were also conducted at one- and three-month follow-ups. Picture-naming performance was significantly faster during tACS sessions compared to sessions without tACS. By the end of the intervention, both participants demonstrated improved accuracy and speed, with positive effects also observed in behavioral measures. EEG analysis showed that post-treatment brain activity resembled that of healthy individuals performing similar tasks. Patients' improvements in picture-naming and behavioral tests showed that the positive effects remained stable even after three months. Thus, preliminary data suggest that tACS might be a promising intervention for anomia, with lasting effects. Large-scale studies are needed to confirm these findings.

Although previous studies have suggested a relationship between subclinical congestion and poor dietary intake, evidence on this topic remains limited. This study aimed to evaluate whether subclinical congestion is associated with inadequate dietary intake in patients with heart failure (HF). A cross-sectional study was conducted in 122 ambulatory patients at the Heart Failure Clinic of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán between April 2023 and January 2025. Subclinical congestion was assessed using the Venous Excess Ultrasound Score (VExUS) and bioelectrical impedance vector analysis (BIVA). Dietary intake was evaluated through three nonconsecutive 24 h dietary recalls. Inadequate dietary intake was defined as consumption below 60% of the standard energy requirement (25-30 kcal/kg) and a protein intake below 1.2 g/kg/day. Patients with subclinical congestion showed significantly lower total energy intake (1098.42 vs. 1478 kcal, p = 0.001) and protein intake (0.84 vs. 1.44 g/kg, p = 0.001), alongside a higher carbohydrate intake (64.3% vs. 49.1%, p < 0.001) and lower fiber intake (10.90 g vs. 16.83 g, p = 0.008), particularly soluble fiber (0.53 vs. 3.01 g, p < 0.001). Subclinical congestion was strongly associated with inadequate dietary intake (odds ratio [OR] = 10.04; 95% confidence interval [CI]: 1.03-97.75; p = 0.047). Additionally, lack of appetite emerged as an independent risk factor for insufficient intake (OR = 11.37; 95% CI: 2.14-60.30; p = 0.004). In conclusion, subclinical congestion in HF patients was associated with significantly lower energy and protein intake, higher carbohydrate consumption, and reduced fiber intake. These findings highlight the potential role of nutritional assessment in the early identification and management of subclinical congestion in HF.

Frailty is common in acute myocardial infarction (AMI), but evidence gaps may cause care disparities and worse outcomes. We examined the prevalence of frailty, its impact on care and its long-term effects.

We analysed adults hospitalised with AMI in England and Wales (2005-19) using linked registries. Frailty was classified by the Secondary Care Administrative Records Frailty (SCARF) index as fit, mild, moderate or severe. The primary outcome was 1-year all-cause mortality; secondary outcomes included cardiovascular death, Major adverse cardiovascular events (MACE), heart failure readmission, reinfarction and bleeding.

Of 931 133 patients (median age 70 years, 34% female), 13% had severe frailty, 22% moderate frailty, 36% mild frailty and 29% were classified as fit. Compared with fit patients, those with severe frailty were less likely to receive coronary angiography (44.8% vs. 69.3%), dual antiplatelet therapy (75.5% vs. 93.4%) or referral for cardiac rehabilitation (71.8% vs. 89.7%). Frailty demonstrated a graded association with 1-year mortality: aHR:3.01 (95% CI:2.93-3.10) for severe frailty, 2.33 (95% CI:2.27-2.40) for moderate and aHR:1.65 (95% CI:1.61-1.7) for mild frailty. Similar dose-response patterns were seen for cardiovascular death (aHR:2.82, 95% CI:2.70-2.94; 2.03, 95% CI:1.88-2.20; and 1.12, 95% CI:1.08-1.16), MACE (aHR:2.56, 95% CI:2.51-2.60; 1.84, 95% CI:1.80-1.89; and 1.17, 95% CI:1.15-1.19), heart failure readmission (aHR:3.74, 95% CI:3.61-3.88; 2.79, 95% CI:2.69-2.89; and 1.79, 95% CI:1.73-1.85) and major bleeding (aHR:1.85, 95% CI:1.78-1.92; 1.59, 95% CI:1.51-1.67; and 1.27, 95% CI:1.20-1.34).

In this national cohort, over one-third of AMI patients had moderate or severe frailty, which was associated with reduced use of evidence-based care and worse outcomes.

PurposeIndobufen, an alternative to aspirin in acute coronary syndrome (ACS) patients with gastrointestinal damage undergoing percutaneous coronary intervention (PCI), has limited data on its efficacy and safety in long-term use. This study compared indobufen-based dual antiplatelet therapy (DAPT) to aspirin-based DAPT in such patients.MethodsWe retrospectively analyzed 255 PCI patients with a history of gastrointestinal damage, divided into indobufen (n = 90) and aspirin (n = 165) groups. We defined the composite of major adverse gastrointestinal events as a composite endpoint event of dyspepsia, peptic ulcer disease and gastrointestinal hemorrhage. Concurrently, the composite of clinically significant adverse gastrointestinal events has been designated as a composite endpoint comprising peptic ulcer disease and gastrointestinal hemorrhage.ResultsIndobufen significantly reduced the incidence of the composite of major adverse gastrointestinal events (25.6% vs 39.4%, HR = 0.58, 95% CI:0.36-0.94, P = 0.026) and the composite of clinically significant adverse gastrointestinal events (18.9% vs 33.3%, HR = 0.53, 95% CI:0.30-0.90, P = 0.020) compared to aspirin. There was no significant difference in major adverse cardiovascular events (MACE) incidence between the two groups (4.4% vs 6.7%, P = 0.400).ConclusionIn conclusion, compared with aspirin, the use of indobufen-based DAPT was associated with a lower incidence of the composite of major adverse gastrointestinal events, which was mainly driven by a reduction in the clinical symptoms and an improvement in quality of life.

Cardiovascular disease affects millions of people, resulting in significant rates of morbidity and mortality. Inadequate healthcare systems, combined with costly treatments, impose a high economic burden, with growing challenges in the public healthcare arena. The demand for equitable access to specialised services is high in a country where most of the population relies on public healthcare services.

This study investigated the shortcomings and possible solutions to expedite referral for appropriate diagnosis and therapy.

In a sub-analysis performed on 2 523 first-time echocardiography referrals to a tertiary-care hospital, cardiac abnormalities were diagnosed in 74% of patients. Most significant were valvular disorders (33%) and secondary pulmonary hypertension (19%). More than a third of patients presented with severe valvular disease, indicative of progressive heart disease and late referral. Almost a half (44%) of patients with cardiomyopathy presented with severely impaired left ventricular systolic function at first referral (left ventricular ejection fraction <30%), suggesting missed diagnosis and/or late referral.

The study demonstrated a high demand for echocardiographic services from secondary regional and district hospitals in central South Africa. Late referrals can be attributed to long travelling distances and the number of regional hospitals. The availability of echocardiographic screening could fill the void in the current healthcare system to expedite diagnosis and effective referral.

Selection of patients with a bicuspid aortic valve and aortopathy for prophylactic aortic surgery remains challenging. In thoracic aortopathy, aortic medial elastin fiber fragmentation initially leads to microcalcification but later declines with progressive loss of elastin content and reduced structural integrity.

To determine whether aortic microcalcification detected using fluorine F 18-labeled [18F]-sodium fluoride positron emission tomography (PET) is associated with future aortic diameter expansion.

This prospective longitudinal cohort study was conducted in tertiary care centers across Scotland from April 4, 2019, to September 15, 2023. Participants included patients with a bicuspid aortic valve. Data analysis was performed from May 21, 2024, to March 4, 2025.

Hybrid [18F]-sodium fluoride PET and computed tomography.

Baseline ascending aortic [18F]-sodium fluoride uptake was measured as mean tissue to background ratio. The primary outcome was ascending aortic diameter expansion during 24 months on cardiac magnetic resonance imaging (MRI).

Seventy-six patients with a bicuspid aortic valve (mean [SD] age, 52.6 [7.5] years; 57 [75.0%] male) underwent baseline [18F]-sodium fluoride PET and MRI. Fifty-six patients underwent follow-up MRI after a median of 723 (IQR, 515-787) days. There was an inverse correlation between baseline ascending aortic [18F]-sodium fluoride uptake and annual change in diameter (Pearson r = -0.37; P = .005), which remained after adjustment for confounders in multivariable regression analysis. Ascending aortic [18F]-sodium fluoride was not correlated with baseline diameter (Pearson r = 0.08; P = .50) but was moderately correlated with baseline ascending aortic stiffness index (Pearson r = 0.38; P < .001).

In this cohort study of patients with a bicuspid aortic valve, the most rapid aortic growth was seen in those with low [18F]-sodium fluoride ascending aortic uptake, indicating reduced aortic wall integrity. High ascending aortic [18F]-sodium fluoride uptake was associated with a stiffer and slow-growing ascending aortic phenotype. These findings suggest that [18F]-sodium fluoride PET imaging represents a promising new noninvasive approach to identify a microcalcified disease phenotype in thoracic aortopathy among patients with a bicuspid aortic valve.