BACKGROUND: Out-of-hospital cardiac arrest (OHCA) has high mortality, and bystander cardiopulmonary resuscitation (CPR) improves outcomes. The comparative effectiveness of chest compression-only CPR (CCO) versus standard...BACKGROUND: Out-of-hospital cardiac arrest (OHCA) has high mortality, and bystander cardiopulmonary resuscitation (CPR) improves outcomes. The comparative effectiveness of chest compression-only CPR (CCO) versus standard CPR (sCPR) with ventilation remains uncertain. METHODS: We systematically searched PubMed, Scopus, Web of Science, Embase, Google Scholar, and Cochrane Library for randomized controlled trials (RCTs) and observational cohorts of adult OHCA comparing bystander CCO and sCPR. Primary outcomes were survival to hospital discharge and favourable neurological outcome; secondary outcomes were prehospital return of spontaneous circulation (ROSC), survival to hospital admission, 24 h survival, and one-month mortality. RESULTS: Eighteen studies (5 RCTs, 13 observational cohorts) including 232,655 OHCA cases (CCO n = 152,632; sCPR n = 80,023). Survival to hospital discharge was similar (OR 0.85; 95% CI 0.61-1.19). Favourable neurological outcome at discharge did not differ (OR 0.87; 95% CI 0.64-1.20). Prehospital ROSC (OR 1.06; 95% CI 0.89-1.27) and survival to admission (OR 1.12; 95% CI 0.79-1.49) were similar. For 24 h mortality (OR 0.92; 95% CI 0.83-1.01), sensitivity analyses suggested lower survival with sCPR (OR 0.87-0.90). One-month mortality was similar overall (OR 1.26; 95% CI 0.98-1.62), but higher after CCO in sensitivity analyses (OR 1.32; 95% CI 1.02-1.71). CONCLUSION: In adult OHCA, CCO and sCPR yield similar survival and neurological outcomes; CCO remains effective, simple strategy that may enhance bystander CPR delivery.
BACKGROUND: Systemic lupus erythematosus and type 2 diabetes mellitus are chronic inflammatory diseases that impact kidney function. Glucagon-like peptide-1 receptor agonist (GLP-1 RA), have shown benefits in several inf...BACKGROUND: Systemic lupus erythematosus and type 2 diabetes mellitus are chronic inflammatory diseases that impact kidney function. Glucagon-like peptide-1 receptor agonist (GLP-1 RA), have shown benefits in several inflammatory diseases. However, their role in systemic lupus erythematosus, particularly in lupus nephritis, and disease flare are not well understood. We explored the hypothesized association between exposure to GLP-1 RA and renal and inflammatory outcomes in patients with systemic lupus erythematosus and type 2 diabetes mellitus. METHODS: This retrospective cohort study utilized a global database of electronic health records from approximately 141 million patients. After propensity score matching, the study included 9,386 systemic lupus erythematosus patients with type 2 diabetes mellitus, stratified by GLP-1 RA exposure. RESULTS: Among 9,386 systemic lupus erythematosus patients with type 2 diabetes mellitus, the average age in the GLP-1 RA-exposed group was 61.6 years. The relative risk of lupus nephritis was comparable (RR 0.57, 95% CI: 0.26-1.25, P = 0.15) at one-month follow-up; however, GLP-1 RA exposure was associated with a lower risk of lupus nephritis at one year (RR 0.59, 95% CI: 0.40-0.86, P < 0.01) compared to the control group. Secondary outcomes, including systemic lupus erythematosus flare, all-cause mortality, acute myocardial infarction, and hospitalization rate were observed less frequently in the GLP-1 RA group at one-year follow-up. The ischemic stroke risk was similar between the two groups at one month, however, GLP-1 RA exposure was associated with a lower risk of ischemic stroke at one year CONCLUSION: GLP-1 RA exposure in systemic lupus erythematosus patients with type 2 diabetes mellitus is associated with reduced risks of lupus nephritis, and systemic lupus erythematosus flares.
BACKGROUND: Celiac disease is an immune-mediated enteropathy increasingly recognized as a systemic disorder with potential cardiovascular involvement. Prior studies suggested a modestly higher risk of atrial fibrillation...BACKGROUND: Celiac disease is an immune-mediated enteropathy increasingly recognized as a systemic disorder with potential cardiovascular involvement. Prior studies suggested a modestly higher risk of atrial fibrillation and cardiovascular disease, though traditional risk factors such as hypertension, hyperlipidemia, and obesity are less common in this population. We aimed to evaluate the independent association between celiac disease and cardiovascular outcomes using a large real-world database. METHODS: We used the TriNetX Global Collaborative Network, comprising anonymized electronic health records (EHR) from over 150 million individuals worldwide. Adults (≥18 years) with celiac disease (ICD-10 K90.0) were compared with controls without celiac disease. Propensity-score matching (1:1) was applied on demographics, comorbidities, laboratory parameters, and cardiovascular medications. Outcomes included all-cause death, acute myocardial infarction, ischemic stroke or thromboembolism, incident atrial fibrillation, ventricular tachycardia, ventricular fibrillation, or cardiac arrest, incident heart failure, acute pulmonary edema or cardiogenic shock, myocarditis, and pericarditis. RESULTS: After propensity-score matching, 41,071 patients per cohort were followed for a mean of 4.2 ± 1.5 years. Compared with matched controls, patients with celiac disease had lower risks of all-cause death (HR 0.75, 95% CI 0.71-0.80), acute myocardial infarction (HR 0.76, 95% CI 0.67-0.88), and incident heart failure (HR 0.91, 95% CI 0.85-0.98). There were no significant differences between groups for ischemic stroke or thromboembolism, atrial fibrillation, tachycardia/ventricular fibrillation or cardiac arrest, acute pulmonary edema or cardiogenic shock, myocarditis or pericarditis. CONCLUSION: In this large, contemporary EHR-based analysis, celiac disease was not associated with excess cardiovascular risk after adjustment for comorbidities and risk factors, suggesting that prior associations likely reflected residual confounding rather than a direct pathogenic link.
Coronary artery disease has reached epidemic proportions in the United States and remains the number one cause of death of both adult men and women. This review focuses on the importance of treating all positive coronary...Coronary artery disease has reached epidemic proportions in the United States and remains the number one cause of death of both adult men and women. This review focuses on the importance of treating all positive coronary artery calcium (CAC) scores with aggressive anti-atherogenic therapy. The reasons for this approach include: 1) atherosclerosis is a preventable, fatal disease, 2) CAC scores increase with time, 3) the response to statin therapy improves with shorter duration of exposure to atherogenic cholesterol, 4) myocardial infarctions occur at all CAC scores, 5) myocardial infarctions cause great family stress, and 6) CAC testing and treatment are cost effective. A positive CAC score almost always represents cholesterol plaques in the coronary arteries which have been increasing for many months. Treatment with rosuvastatin and ezetimibe has been shown to be effective at reducing and preventing cardiovascular disease with minimal adverse effects. Reducing the incidence of myocardial infarctions in the United States (600,000 per year) requires aggressive prevention of all atherosclerotic disease in the coronary arteries and should not be delayed.
BACKGROUND: This study investigated the effects of a four-year exercise program on 49 men aged 60 to 82 years, previously naïve to exercise. Participants chose between a combined resistance and aerobic exercise group or...BACKGROUND: This study investigated the effects of a four-year exercise program on 49 men aged 60 to 82 years, previously naïve to exercise. Participants chose between a combined resistance and aerobic exercise group or a resistance training only group. METHODS: The combined group (n = 25, age 66 ± 7 years) engaged in a weekly resistance programme featuring seated chest press, seated pull down, and leg press at 60%-70% of one repetition maximum, followed by approximately 30 minutes of aerobic exercise at 70%-90% maximum heart rate. The resistance training only group (n = 24, age 65 ± 5 years) followed a similar resistance programme but included only multi-joint and single-joint exercises, without an aerobic component. Each session lasted 50-60 minutes. RESULTS: Over four years, both groups exhibited significant increases in strength for chest press and leg press (P < .05) with no group differences. Body fat decreased similarly in both groups (P < .001). The combined group showed an increase in relative maximal oxygen uptake (P < .01), whereas the resistance training group experienced a decline (P < .001). Leg power improved in both groups (P < .05) with no significant differences. Grip strength remained unchanged in either group. CONCLUSIONS: The study demonstrated that combined resistance and aerobic training, as well as resistance training alone, are equally effective for enhancing upper and lower body muscle strength in older men. However, the combined training approach is more time-efficient and superior for improving aerobic fitness.
Sodium-glucose cotransporter (SGLT) inhibitors have transformed cardiovascular therapeutics beyond glycemic control. Both selective SGLT2 and dual SGLT1/2 inhibitors demonstrate robust reductions in heart failure hospita...Sodium-glucose cotransporter (SGLT) inhibitors have transformed cardiovascular therapeutics beyond glycemic control. Both selective SGLT2 and dual SGLT1/2 inhibitors demonstrate robust reductions in heart failure hospitalization (∼30%), cardiovascular mortality (13%-15%), and all-cause mortality across ejection fraction spectra, independent of diabetes status. Landmark trials including DAPA-HF, EMPEROR, and DELIVER established SGLT2 inhibitors as foundational therapy alongside RAAS inhibition, β-blockers, and mineralocorticoid receptor antagonists. Dual SGLT1/2 inhibition shows comparable heart failure benefits with potential stroke reduction (∼25%). Mechanisms involve natriuresis, improved myocardial energetics via NHE1 inhibition and ketone utilization, endothelial function improvement, and anti-inflammatory effects, transcending glucose lowering. Common adverse effects include genitourinary infections, mild hypovolemia, and rarely euglycemic ketoacidosis. Current guidelines provide Class I recommendations for SGLT2 inhibitors across heart failure phenotypes. However, despite robust evidence, implementation remains suboptimal and <50% prescription rates remain a challenge. We performed a systematic appraisal of landmark trials, real-world studies, and clinical guidelines to provide a comprehensive review of SGLT inhibitors in heart failure and diabetes.
Socioeconomic disadvantage, reflected by low income, limited education, and neighborhood deprivation, is increasingly recognized as a determinant of cardiovascular outcomes. This systematic review synthesized evidence fr...Socioeconomic disadvantage, reflected by low income, limited education, and neighborhood deprivation, is increasingly recognized as a determinant of cardiovascular outcomes. This systematic review synthesized evidence from 29 studies (2015-2025) on the association between socioeconomic indicators and mortality, hospital readmissions, and recurrent events in adults with established cardiovascular disease (CVD). Across diverse populations, socioeconomic disadvantage was consistently associated with significantly higher mortality (hazard ratios, 1.20-2.23) and increased hospitalizations or readmissions, independent of traditional risk factors. Disparities were observed across health systems and specific conditions, such as neighborhood deprivation leading to 63% higher 30-day mortality in valvular heart disease. Behavioral risk factors only partially accounted for the gradients. Socioeconomic disadvantage is a robust, independent predictor of adverse CVD outcomes, underscoring the need to integrate social determinants into risk assessment and treatment planning.
Yin Y, Morgan CJ, Costello RB
… +21 more, Fonarow GC, Cheng Y, Tekle S, Faselis C, Lam PH, Sheriff HM, Rosanoff A, Anker SD, Raman VK, Moore HJ, Vargas JD, Patel SS, Sen S, Liu S, Zullo A, Heidenreich PA, Gottlieb SS, Deedwania P, Wu WC, Zeng-Treitler Q, Ahmed A
BACKGROUND: Magnesium is essential for myocardial function and rhythm. Although typically well-regulated, patients with heart failure are prone to magnesium deficiency. Most clinical laboratories define normal serum magn...BACKGROUND: Magnesium is essential for myocardial function and rhythm. Although typically well-regulated, patients with heart failure are prone to magnesium deficiency. Most clinical laboratories define normal serum magnesium as 1.6-2.6 mg/dL, but this range may include chronic latent magnesium deficiency. The Magnesium Global Network (MaGNet) recommends 2.1-2.3 as optimal. We examined outcomes in heart failure patients across and outside these ranges. METHODS: Using ambulatory serum magnesium levels, we categorized 627,349 Veterans with heart failure (2001-2023) into <1.6 (6%), 1.6-1.7 (11%), 1.8-2.0 (39%), 2.1-2.3 (34%; reference) and >2.3 (10%) mg/dL. Cox models estimated multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for one-year mortality. Restricted cubic spline models assessed nonlinear associations between serum magnesium as a continuous variable, using two reference values: the lower limits of the current clinical reference range (1.6-2.6 mg/dL) and the MaGNet range (2.1-2.3 mg/dL). RESULTS: All-cause mortality occurred in 15.4%, 13.3%, 11.6%, 11.5%, and 16.2% of the patients with serum magnesium <1.6, 1.6-1.7, 1.8-2.0, 2.1-2.3, and >2.3 respectively. Corresponding adjusted HRs (95% CIs) were 1.36 (1.32-1.41), 1.23 (1.20-1.26), 1.07 (1.05-1.09), 1.00 (reference), and 1.23 (1.20-1.26), respectively. When the lower limit of current clinical reference range (1.6-2.6 mg/dL) was used as the reference, restricted cubic spline analysis revealed a U-shaped association, with the lowest HR between 1.6 and 2.6 mg/dL, with significantly higher risks outside these ranges. CONCLUSIONS: In US Veterans with heart failure, ambulatory serum magnesium levels showed an independent U-shaped association with one-year mortality, with the lowest risk observed between 1.6 and 2.6 mg/dL, consistent with the current clinical reference range, and higher risks at both lower and higher levels.
BACKGROUND: The physician white coat has traditionally been symbolic of patients' trust in their physicians. Recently, use of surgical scrubs has expanded as an alternative to traditional physician attire. We sought to e...BACKGROUND: The physician white coat has traditionally been symbolic of patients' trust in their physicians. Recently, use of surgical scrubs has expanded as an alternative to traditional physician attire. We sought to evaluate whether patient trust is influenced by traditional physician attire versus surgical scrubs. METHODS: This is a prospective quasi-experimental study utilizing the Modified Trust in Physician Scale (TIPS) survey administered to 274 hospitalized English and Spanish speaking patients aged 18-80 years at the time of patient discharge or upon completion of physician shift. Five full-time hospitalist physicians alternated their weekly attire: one week wearing traditional attire with white coat and the following week surgical scrubs without white coat. Other variables examined included patients' age, gender, ethnicity, level of education and duration of time attended by the physician. RESULTS: After a mean of 3 hospital days, there was no difference in patient trust in physicians wearing traditional attire with a white coat (TIPS mean score 2.00, 95% CI 1.90-2.09) versus those wearing surgical scrubs (TIPS = 2.08, 95% CI 1.95-2.21, P = 0.26). CONCLUSION: When evaluating the impact of physician attire in the setting of an inpatient patient encounter, we found no association between patient trust and physicians wearing traditional attire with a white coat and surgical scrubs without a white coat.