Patients with prior coronary artery bypass grafting (CABG) presenting with an acute coronary syndrome (ACS) constitute a subgroup at high cardiovascular risk and have a poor prognosis even after percutaneous coronary intervention (PCI). The stress hyperglycemia ratio (SHR) is a novel marker reflecting acute hyperglycemia adjusted for chronic glycemic status, but its prognostic value in this specific population remains unknown. This study aimed to investigate the association of SHR with long-term adverse cardiovascular outcomes in ACS patients with prior CABG.

The SHR was calculated using the following formula: admission fasting blood glucose (AFBG)/[1.59 × glycosylated hemoglobin A1c (HbA1c) - 2.59]. The primary endpoint was the long-term incidence of major adverse cardiovascular and cerebrovascular events (MACCE), a composite of all-cause death, non-fatal stroke, non-fatal myocardial infarction, or unplanned revascularization.

A total of 1,208 ACS patients with prior CABG who underwent PCI were included in the final analysis. During a median follow-up of 1,291 days, 368 (30.5%) patients developed at least one primary endpoint event. Kaplan-Meier analysis revealed a graded, positive relationship between the SHR tertiles and the follow-up incidence of MACCE (log-rank P < 0.001). In multivariate Cox proportional hazards regression analysis adjusted for GRACE risk score and other confounders, compared with those in the lowest SHR tertile, patients in the middle and highest tertiles had a higher risk of MACCE (adjusted hazard ratio [HR]: 1.557, 95% confidence interval [CI] 1.166-2.079, P = 0.003, and 1.943, 95% CI 1.476-2.557, P < 0.001, respectively). Similar results were obtained when SHR was analyzed as a continuous variable (adjusted HR per unit increase 1.276, 95% CI 1.105-1.474, P = 0.001). The addition of SHR to the baseline reference prediction model including GRACE risk score improved model predictive performance markedly (C-statistic: increased from 0.559 to 0.626, P = 0.002; cNRI: 0.580, P = 0.016; IDI: 0.133, P = 0.010).

In ACS patients with prior CABG undergoing PCI, an elevated SHR was a strong and independent predictor of long-term MACCE. This simple metric provides potent prognostic information, potentially enhancing risk stratification and guiding management in this high-risk patient population.

Antihistamines have been reported to be linked with new-onset osteoarthritis (NOO). However, the effect of these drugs on NOO is unclear in patients with autoimmune disease. In this study, we aimed to investigate the effects of an antihistamine on NOO in patients with autoimmune disease.

We conducted a retrospective population-based cohort study involving patients who received antihistamines therapy and patients who did not receive antihistamines therapy. The outcome was the risk of NOO. We used multivariable Cox proportional hazard models to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between antihistamines use and NOO.

Overall, 49,078 patients who received antihistamines therapy and 196,312 patients who did not receive antihistamines therapy were matched for age, sex, and index date at a ratio of 1:4 between 2012 and 2022. During a follow-up of 9 years, 12,761 and 47,982 NOO events occurred in antihistamine users and nonusers, respectively. Antihistamine use was associated with a significantly higher risk of NOO (adjusted HR 1.05, 95% CI: 1.03-1.07, P < 0.0001). We confirmed the robustness of these results through a propensity score 1:1 matching analysis.

In this population-based cohort study, we found that antihistamine use was associated with a significantly increased risk of osteoarthritis in patients with autoimmune disease. Further efforts are needed to minimize the potential population drawbacks of these therapies in high-risk groups.

food insecurity is increasing at an alarming rate, contributing to gender variation in illness and undermining the 2030 nutrition goals. Evaluating its components could aid interventions aimed at addressing gender-specific diseases such as hypertension. This study assessed gender differences in food insecurity and its association with elevated blood pressure (EBP) in Ondo State, Nigeria.

this community-based cross-sectional study used a four-stage systematic random sampling to select 769 adults aged 18 years and older. Food insecurity experience scale survey module components (Worried, Healthy, Fewfoods, Skipped, Ateless, Ranout, Hungry, and Wholeday) were defined, and participants were categorized into: food secure (0 point) and food insecure (≥1 point). Obesity and abdominal adiposity were determined by body mass index (≥30kg/m²) and waist-height ratio (≥0.5), respectively. The EBP was defined as BP≥140/90mmHg. Multivariable logistic regression was performed at p<.05.

a proportion of 54.9% men and 45.1% women participated in the study. Their mean ages and monthly incomes (±standard deviation) were 32.3±11.6 years, 33.9±11.7 years, and $51.1±41.0, $46.9±37.3, respectively. Women were more food insecure (44.1%, 35.8%) and experienced Worried (34.9%, 23.9%), Healthy (34.3%, 25.8%), Fewfoods (22.8%, 18.0%), Skipped (36.0%, 26.3%), Ateless (25.4%, 20.4%), Ranout (14.4%, 10.2%), Hungry (11.8%, 10.1%) and Wholeday (5.8%, 4.5%) than men, respectively. Men (9.2%) had EBP more than women (8.6%). The EBP was associated with marital status (aOR=2.53, CI=1.09, 5.87, p=.03), worried (aOR=6.33, CI=2.25, 17.78, p=<.001), ranout (aOR=5.98, CI=1.02, 35.01, p=.04) and abdominal adiposity (aOR=2.44, CI=1.38, 5.31, p=.03) among men, but occupation (aOR=1.41, CI=1.04, 1.91, p=.03) and physical inactivity (aOR=3.63, CI=1.04, 14.30, p=0.04) among women.

gender difference was observed in food insecurity, which significantly contributed to EBP among men, while occupation and physical inactivity predisposed women to EBP. Interventions in controlling hypertension should incorporate schemes that address lack and inadequate access to food, and maintain a healthy body weight through a quality diet and physical exercise among Nigerian adults.

The population of adult patients with congenital heart disease (ACHD) is rapidly growing thanks to advances in diagnostics and therapeutics. However, these patients now encounter new clinical and healthcare challenges. The 'New perspectives in ACHD management' session at the ACHD 2025 Congress highlighted the key areas of innovation aimed at improving prognosis and quality of life. The aging ACHD population places substantial demands on geriatric medicine, with significant implications for the healthcare system. Similarly, the increasing arrhythmic burden, in particular atrial fibrillation, requires specific preventive and therapeutic strategies, including ablation procedures tailored to the anatomical peculiarities of ACHD patients. Pulmonary hypertension is a major contributor to morbidity and mortality in ACHD, requiring precision medicine approaches, dedicated risk stratification, and multidisciplinary approach. A central role is played by adequate prevention of acquired cardiovascular diseases, whose incidence is higher and occur earlier than in the general population. Specific risk stratification tools and an integrated approach of lifestyle modification and innovative pharmacological therapy are necessary. Telemedicine offers new opportunities for remote monitoring, access to specialized expertise, and comprehensive support, particularly for frail patients or those living in remote areas. Lastly, emerging technologies such as 3D printing, virtual reality, computational modelling, and artificial intelligence are transforming treatment planning and enabling personalized care. A multidisciplinary and technologically advanced approach is essential for shifting the focus from merely prolonging survival to truly improving the quality of life of ACHD patients.

Racial disparities have been reported in the management of cardiovascular diseases. Transcatheter aortic valve replacement (TAVR) volume continues to increase with evolving indications and practice changes.

This study aims to provide insight regarding procedure access and outcomes to evaluate for potential racial disparities in the contemporary era of TAVR.

TAVR patients (aged ≥18) were identified in the National Inpatient Sample from 2016 to 2019 and grouped by race. Baseline characteristics and in-hospital outcomes were compared between White and non-White patients before and after propensity-score matching. Primary outcomes were in-hospital mortality and a composite outcome. The individual components of the composite outcome served as secondary outcomes.

Of 42,877 total TAVR patients, 37,319 were White and 5558 were non-White. Annual procedure volume in both groups increased significantly (Ptrend < 0.001 for both). The proportions of White and non-White patients remained steady over time (12.5%-13.5% non-White, Ptrend = 0.117). The characteristics of White and non-White patients differed significantly. There was no difference in in-hospital mortality (1.5% vs 1.6%, P = 0.585) or composite outcome (23.8% vs 24.6%, P = 0.316). Non-White race was associated with higher rates of acute renal failure (odds ratio [OR]:1.21, 95% confidence interval [CI]:1.10-1.33, P < 0.001), transfusion (OR:1.18, 95%CI:1.05-1.32, P = 0.006), and vascular complications (OR:1.62, 95%CI:1.29-2.04, P < 0.001), but lower rates of permanent pacemaker implantation (OR:0.83, 95%CI:0.75-0.93, P = 0.001).

TAVR remains safe in both White and non-White patients with comparable in-hospital mortality and overall outcomes. Differences in baseline characteristics and individual complications indicate the presence of racial disparities in procedure accessibility and outcomes.Meeting presentation: Presented at the Transcatheter Cardiovascular Therapeutics (TCT) 2024, October 27-30, 2024, Washington D.C.

Although previous research has explored the involvement of the choroid in the pathogenesis of non- arteritic anterior ischaemic optic neuropathy (NAION), the relationship between optical coherence tomography angiography (OCTA) findings and choroidal features remains unclear. An understanding of this relationship may help clarify the vascular mechanisms underlying this disease. The aim of this study was to investigate the relationships between OCTA and choroidal parameters in patients with NAION during the post-acute phase, after the resolution of optic disc oedema.

This retrospective analysis included the affected eyes of patients with unilateral NAION, their unaffected fellow eyes, and the eyes of age- and sex-matched healthy controls. The three groups were compared with regard to OCTA and choroidal parameters. Retinal imaging was conducted approximately 2 months after NAION occurrence to allow for the spontaneous resolution of characteristic optic disc oedema.

A total of 75 eyes were included in the final analysis: 25 NAION-affected eyes, 25 fellow eyes, and 25 control eyes (13 women and 12 men). Age and sex distributions were similar across groups. The peripapillary vessel density (pVD), flow area (FA), retinal nerve fibre layer (RNFL) thickness, and choroidal vascularity index (CVI) in all quadrants were significantly lower in NAION eyes than in unaffected and control eyes. Unaffected eyes also demonstrated significantly lower radial peripapillary capillary (RPC) mean, RPC temporal, and RPC FA values than did the healthy controls. A moderate correlation was observed between RPC pVD and the mean RNFL thickness in NAION eyes and between RPC FA and the mean RNFL thickness in both NAION and unaffected eyes. The strong relationship between RPC perfusion and RNFL thinning could not be statistically confirmed after false discovery rate correction; thus, a direct cause-and-effect relationship could not be validated.

There were no significant correlations between OCTA and choroidal parameters across all groups. These findings suggest that the retina and choroid are affected through distinct mechanisms in NAION. However, reductions in OCTA parameters, including CVI, were evident in NAION eyes. Overall, the study findings underscore the potential of OCTA as a non-invasive tool for identifying risk factors and monitoring disease progression in NAION.

One of the challenges encountered when extracting transvenous leads with long dwell times is the presence of dense calcifications encasing the leads. This is the most likely reason for failure to advance a laser extraction sheath. The Shockwave intravascular lithotripsy (IVL) device is an angioplasty balloon that delivers intravascular lithotripsy and fractures calcified lesions in the vasculature, approved for use in coronary and arterial angioplasty. It has also been reported as an adjunctive tool in transvenous lead extraction.

To report the Vanderbilt University Medical Center experience using Shockwave(r) Lithotripsy in the extraction of very old leads.

We report procedural outcomes in this retrospective single-center series of 24 patients in whom IVL was performed for pretreatment before lead extraction. To use the shockwave balloon, one must have venous access along the path of the leads. In some cases, there was venous access, and in others, a lower-risk lead was extracted first to allow for the passage of the Shockwave balloon. After IVL pretreatment, leads were extracted using conventional laser and, when necessary, mechanical tools.

Forty-nine total leads were extracted, with a median of 2 leads per patient and median dwell time of 16 years with a range of 4-36 years. All transvenous leads were successfully removed, and there were no significant complications. An excimer laser system (Philips, Inc.) was utilized for extraction in all cases, with a median sheath size of 14 Fr. Despite long dwell times, mechanical extraction tools were only required in 6 (12%) of the leads.

Our experience contributes to the growing body of data supporting the use of Shockwave IVL as an adjunctive measure during extraction of calcified leads with long dwell time.

Psoriasis and obesity often occur together, with up to 50% of patients with psoriasis being classified as obese. This increases systemic inflammation, cardiovascular risk, and disease severity while reducing the efficacy of biologic treatments. Despite this overlap, dermatology lacks obesity-specific guidance. This review evaluates lifestyle, pharmacological (glucagon-like peptide 1 receptor agonists [GLP-1 RAs] and tirzepatide) and surgical strategies, as well as clinic-level algorithms, to inform dermatological practice.

We performed a narrative synthesis of epidemiology, randomized trials, real-world studies, and guideline recommendations. Our focus was on the pathophysiology and the efficacy of GLP-1 RAs and tirzepatide, providing a practical algorithm pathway for triage, pharmacotherapy escalation, and referral criteria to a multidisciplinary unit.

Although there are no psoriasis-specific guidelines for obesity treatment, the strong link between the two conditions and the poorer therapeutic response observed in obese patients make addressing excess weight essential for people with psoriasis. The proposed algorithms emphasize universal lifestyle counseling and dermatology-led management for patients with a BMI (body mass index) < 35 kg/m² and without major metabolic complications. GLP-1 RAs are considered the first-line treatment, given the available scientific evidence about their efficacy in terms of weight loss and management of comorbidities, as well as their safety profile. If weight loss with these drugs is insufficient, the next proposed treatment step is tirzepatide. Bariatric surgery, including bypass procedures, should be reserved for patients with a BMI ≥ 40 kg/m², or with a BMI ≥ 35 kg/m² when earlier measures have failed and/or comorbidities are not adequately controlled.

Dermatologists should integrate obesity assessment and patient-centered interventions into psoriasis care. A structured, multidisciplinary approach could meaningfully enhance dermatological, metabolic, and cardiovascular outcomes in patients with psoriasis and obesity.

Clarifying the critical lesion regions of poststroke cognitive impairment (PSCI) could improve the understanding of how anatomical locations and functional networks jointly influence the manifestation of cognitive deficits. Lesion-symptom and lesion network analyses are performed to identify the anatomical sites and functional networks related to specific cognitive functions. The multidomain cognitive statuses and the focal brain lesions of 83 patients with PSCI were recorded during the acute poststroke period (< 2 weeks). Multivariate lesion-symptom mapping was performed to identify risk regions, i.e., lesion sites associated with worse cognitive deficits; functional lesion network mapping was performed to identify risk networks, i.e., brain networks connected to risk regional peaks. Lesion-symptom mapping analysis identified several brain regions where lesions were significantly correlated with neurological deficit, general cognitive impairment, visuospatial dysfunction, and executive dysfunction. Various types of cognitive deficits presented diverse risk region distribution patterns with different peaks. Functional lesion network mapping demonstrated that networks connected to peak risk regions for neurological deficit and general cognitive impairment were mostly similar to the default network (DN), whereas the risk network for visuospatial and executive dysfunctions was the somatomotor network (SN). Functional imaging measurements directly from PSCI patients revealed that intranetwork functional connections within the limbic network, which is functionally similar to the DN, were stably reduced in all patients, and intranetwork functional connections in the SN exhibited the same pattern. Although the decreases did not present the network preference observed in lesion network mapping, these results still support the concept that lesions to specific nodes of the DN or SN are associated with the cognitive deficits that constitute PSCI.

Metabolic diseases, cardiovascular diseases (CVD), and chronic kidney disease (CKD) often coexist. To understand the complex relationships between these conditions, the American Heart Association first proposed the concept of cardiovascular-kidney-metabolic (CKM) syndrome in 2023. This syndrome is recognized by pathophysiological interplays among metabolic risk factors, CKD, and CVD, which results in multi-organ disorders and increased adverse cardiovascular outcomes. The core effect of the liver in metabolism has been revealed gradually. Sharing extensive overlapping pathological mechanisms with metabolic syndrome (MS), metabolic dysfunction-associated steatotic liver disease (MASLD) is the hepatic component of MS. The risk of developing CVD and CKD is considerably elevated in patients with MASLD. Therefore, from the perspective of endocrinologists, the concept of metabolic associated liver-cardiovascular-kidney syndrome (MALCKS) more accurately describes the impairment to vital organs caused by metabolic abnormalities. By examining the implications of CKM syndrome and its relationship with MASLD, this article elucidates the mechanisms linking MASLD to metabolic syndrome and cardiorenal diseases, and demonstrates that MASLD is associated with cardiovascular, renal, and endocrine metabolic disorders, thereby expanding the concept of CKM syndrome to MALCKS. Furthermore, multidisciplinary managements under the MALCKS framework are advocated to improve patient prognosis. Nevertheless, its formal adoption as a clinical syndrome will require clear operational definitions, validation through robust cohort studies, demonstration of unique clinical utility, and multidisciplinary consensus.