BACKGROUND: Over the past decade, advancements in awareness, diagnosis, and new treatment options for transthyretin amyloid cardiomyopathy (ATTR-CM) have likely influenced the characteristics of patient populations enrol...BACKGROUND: Over the past decade, advancements in awareness, diagnosis, and new treatment options for transthyretin amyloid cardiomyopathy (ATTR-CM) have likely influenced the characteristics of patient populations enrolled in clinical trials. This systematic review aims to assess temporal trends in baseline characteristics of patients enrolled in ATTR-CM clinical trials. METHODS: Systematic literature searches were conducted on September 25, 2024, using Embase, MEDLINE, and Cochrane databases via Ovid and were supplemented by gray literature searches. Overall, 58 publications on 13 clinical trials enrolling patients with ATTR-CM during 2008-2022 were included. Baseline characteristics of participants enrolled in these trials and key clinical outcomes, including all-cause mortality were analyzed. RESULTS: Key baseline characteristics - including the proportion of participants with variant ATTR-CM; New York Heart Association class; N-terminal pro-B-type natriuretic peptide and troponin levels; and estimated glomerular filtration rate - varied according to enrollment year. All-cause mortality in placebo groups at 12 months decreased from 9.0% in ATTR-ACT (2013-2015) to 6.9% in ATTRibute-CM (2019-2020), 5.6% in APOLLO-B (2019-2021), and 4.3% and 5.5% in HELIOS-B (overall and monotherapy populations, respectively; 2019-2021). CONCLUSIONS: Patients enrolled in more recent clinical trials exhibited baseline characteristics consistent with less advanced ATTR-CM than earlier clinical trials. These descriptive findings are consistent with a temporal shift toward earlier identification and enrollment of patients with ATTR-CM, occurring alongside advances in diagnostic techniques and availability of disease-modifying treatments. These observations highlight the importance of evaluating the relevance of clinical outcomes and trial design in evolving patient populations and therapeutic landscapes.
PURPOSE: The digital transformation of healthcare is creating new opportunities to enhance access, engagement, and outcomes in exercise, fitness, cardiovascular disease (CVD) prevention, and rehabilitation. This review s...PURPOSE: The digital transformation of healthcare is creating new opportunities to enhance access, engagement, and outcomes in exercise, fitness, cardiovascular disease (CVD) prevention, and rehabilitation. This review synthesizes current evidence on digital health technologies across the cardiovascular care continuum, emphasizing their role in promoting physical activity in both primary and secondary prevention. METHODS: A narrative review was conducted examining mobile health applications, wearable devices, artificial intelligence, remote monitoring platforms, and emerging technologies including virtual reality, 5G connectivity, and large language models. Applications were evaluated in the context of CVD prevention, rehabilitation, and behavior change. RESULTS: Digital tools can personalize exercise prescriptions, monitor physiologic metrics, and support remote supervision in clinical and community settings. Wearables and mobile platforms demonstrate utility in improving adherence, fitness, and CVD risk. AI-driven systems enable adaptive programming, patient monitoring, and predictive modeling, while virtual and augmented reality offer immersive options for home-based rehabilitation. Persistent barriers include digital literacy, inequitable access, and data privacy concerns. CONCLUSION: Digital health technologies are reshaping exercise-based cardiovascular care. When coupled with behavior change strategies and ethical implementation, they can extend the reach and impact of physical activity interventions. Further research is needed to guide clinical integration, long-term evaluation, and equitable adoption.
Aleksova A, Janjusevic M, Marketou M
… +11 more, Beltrami AP, Dozio E, Vanin G, Zandonà L, Chicco A, Beltrame D, Perone F, Barbati G, Giustina A, Sinagra G, Fluca AL
BACKGROUND: Insulin-like growth factor-1 (IGF-1) and vitamin D are crucial for overall health. Imbalances in these markers are increasingly recognized as pivotal contributors to cardiovascular and residual risks followin...BACKGROUND: Insulin-like growth factor-1 (IGF-1) and vitamin D are crucial for overall health. Imbalances in these markers are increasingly recognized as pivotal contributors to cardiovascular and residual risks following acute myocardial infarction (AMI). This study evaluated the prognostic value of IGF-1 and vitamin D levels for CAD severity and long-term outcomes in AMI survivors. METHODS: We included 681 AMI patients admitted to the University Hospital of Trieste between 2014 and 2023. RESULTS: Mean age was 66.3 years; 73.2% were male, and 71.9% had STEMI. The median IGF-1 level was 539 pg/ml and it was found to decline with ageing and with worsening kidney function. 56.1% of patients had hypovitaminosis D (HypoD), which was associated with higher levels of inflammation (CRP, IL-1β) and lower IGF-1 concentrations. Both low and high IGF-1 levels independently predicted severe CAD, indicating a U-shaped association. Over a median 51-month follow-up, 265 patients reached the composite endpoint and IGF-1 levels were lower in patients with events. Furthermore, continuous hazard ratio analysis revealed that IGF-1 levels below the median were linearly associated with adverse outcomes. Patients with the dual burden of low IGF-1 and HypoD exhibited higher probability of the composite endpoint. This combination independently predicted adverse outcomes (HR 1.43), alongside traditional risk factors such as age, LVEF, elevated HbA1C, CAD severity and impaired renal function. CONCLUSION: Low IGF-1 levels were associated with severe CAD and worse prognosis. This risk was further increased in patients with co-existing HypoD, thus additional studies are needed to determine how these biomarkers can be integrated into the clinical management of the patients.
Maliha M, Abdelaziz A, Satish V
… +11 more, Halder S, Modak V, Inshyna D, Castagna F, Agalliu I, Filtz A, Lorenzatti D, Weissler-Snir A, Slipczuk L, Garcia MJ, Schenone AL
BACKGROUND: The association between OSA and sudden cardiac death (SCD) risk in patients with hypertrophic cardiomyopathy (HCM) is poorly defined. We hypothesized that OSA may be associated with the risk of cardiac arrest...BACKGROUND: The association between OSA and sudden cardiac death (SCD) risk in patients with hypertrophic cardiomyopathy (HCM) is poorly defined. We hypothesized that OSA may be associated with the risk of cardiac arrest and ventricular fibrillation (CA-VF) in HCM patients. METHODS: We conducted a retrospective analysis of the National Inpatient Sample (2016-2020), including adults with HCM without prior history of SCD. Patients were stratified by the presence of OSA. The primary outcome was a composite of CA-VF. Multivariate logistic regression and propensity score matching (PSM) assessed the association between OSA and outcomes, adjusting for age, gender, family history of SCD, CIHD, AF, use of ICD, syncope, and LVEF<50%. Mediation analysis was performed to assess whether AF, a known outcome of OSA and predictor of SCD in HCM, mediates the association between OSA and the composite endpoint. RESULTS: Of 52,106 HCM admissions, 8848 (16.98%) had OSA. In a multivariate model excluding AF, OSA was associated with CA-VF (OR 1.16, 95% CI 1.10-1.27, p = 0.002). However, after adjusting for AF, this association was no longer significant (OR 1.001, 95% CI 0.91-1.10, p = 0.97). Mediation analysis showed a significant average causal mediation effect (ACME, p < 0.001), with AF accounting for approximately 98.5% of the total effect of OSA on CA-VF. CONCLUSION: In this large cohort of HCM patients, the association between OSA and CA-VF appeared to be predominantly mediated by AF, with no significant independent direct effect observed. These findings suggest that OSA may contribute to arrhythmic risk in HCM primarily through its relationship with AF and should be considered hypothesis-generating.
Heart failure (HF) due to left ventricular systolic dysfunction (LVSD) remains a major clinical challenge, particularly among patients with chronic total occlusions (CTO). CTO are present in up to 30% of patients with LV...Heart failure (HF) due to left ventricular systolic dysfunction (LVSD) remains a major clinical challenge, particularly among patients with chronic total occlusions (CTO). CTO are present in up to 30% of patients with LVSD undergoing coronary angiography and are independently associated with worse outcomes. Although advances in interventional techniques have increased success rates of CTO percutaneous coronary intervention (CTO-PCI), high-quality evidence supporting this procedure in patients with LVSD remains limited. Observational studies report potential benefits, including improved survival, alleviation of HF symptoms, and recovery of left ventricular ejection fraction (LVEF). However, randomized controlled trials (RCTs) have largely excluded patients with LVEF <35% and those with advanced, complex coronary artery disease (CAD), including CTO, thereby restricting generalizability. Assessment of myocardial viability remains central to patient select for CTO-PCI, its prognostic value for hard clinical endpoints has not been definitively established. The use of mechanical circulatory support (MCS) during high-risk CTO-PCI is increasing, particularly in patients with reduced LVEF and complex coronary anatomy; available data provides inconsistent evidence regarding its impact on clinical outcomes and appears to be largely influenced by individual patient characteristics. Finally, in the setting of acute coronary syndromes (ACS), the effect of CTO revascularization on clinical endpoints and arrhythmic risk is unclear, with conflicting observational data. Future research should prioritize this underrepresented high-risk cohort and be conducted in experienced centers within an integrated multidisciplinary care framework.
Sleep is increasingly recognized as a modifiable factor for cardiovascular diseases (CVDs), yet the roles of specific sleep stages, particularly rapid eye movement (REM) sleep, and the utility of wearable-derived sleep p...Sleep is increasingly recognized as a modifiable factor for cardiovascular diseases (CVDs), yet the roles of specific sleep stages, particularly rapid eye movement (REM) sleep, and the utility of wearable-derived sleep parameters for CVD prediction remain unknown. Therefore, we aimed to investigate the associations of sleep with CVD risk and to develop multimodal prediction models for incident CVD. Using data from the All of Us Research Program, 23,413 adults who consented to share both Fitbit and electronic health record data between May 2018 and October 2023 were included in the analysis. Sleep data were obtained from Fitbit wearable devices, including sleep duration and stage-specific information such as REM sleep. Incident CVD was defined as occurring at least six months after the initiation of Fitbit monitoring. Cox proportional hazards models were applied to estimate adjusted hazard ratios (aHR) with 95% confidence intervals (CIs) for sleep duration and REM sleep in association with CVD. For the prediction of CVD within six years, two modeling strategies were implemented, including a non-invasive multimodal model using demographic, self-reported, and wearable-derived data and an invasive multimodal model that additionally incorporated laboratory measures. To compare real-world model performance, we applied and compared several conventional risk prediction models, including SCORE2, the Framingham Risk Score, AutoPrognosis 2.0, and the Pooled Cohort Equations. Among 23,413 participants (mean [standard deviation] age, 56.7 [15.5] years; 70.9% female), both short (<7 h) and long (≥9 h) sleep durations were associated with higher risk of CVDs compared with 7 to 9 h of sleep (short sleep: aHR, 1.16 [95% CI, 1.07 to 1.27]; long sleep: aHR, 1.32 [95% CI, 1.10 to 1.58]), with U-shaped relationship. Individuals with less than 20% REM sleep had a greater risk of CVDs (aHR, 1.31 [95% CI, 1.18 to 1.45]) compared with those with 20% to 25% REM sleep. These associations were consistent across CVD subtypes. In prediction analyses, soft-voting ensemble models with LightGBM and XGBoost integrating wearable, clinical, and laboratory data achieved high performance (AUROC of non-invasive models, 0.748; AUROC of invasive models, 0.782), outperforming conventional risk scores (SCORE2, the Framingham Risk Score, AutoPrognosis 2.0, and the Pooled Cohort Equations: AUROC range, 0.649 to 0.685). Short and long sleep durations, as well as reduced REM sleep, were associated with increased risk of CVD. We also derived and validated a multimodal model to predict the incidence of CVD within six years. These findings support the potential value of integrating objective sleep-stage measures and multimodal digital health data into future cardiovascular prevention strategies and guideline development.
BACKGROUND: Management of valvular heart disease (VHD) has shifted from predominantly surgical approaches to widespread use of transcatheter interventions, including transcatheter aortic valve replacement (TAVR), mitral...BACKGROUND: Management of valvular heart disease (VHD) has shifted from predominantly surgical approaches to widespread use of transcatheter interventions, including transcatheter aortic valve replacement (TAVR), mitral transcatheter edge-to-edge repair (M-TEER), transcatheter mitral valve replacement (TMVR), and emerging tricuspid transcatheter valve intervention (TTVI). Although ESC/EACTS and ACC/AHA guidelines recognize frailty as a major determinant of mortality, complications, and recovery, they offer limited guidance on how to modify frailty before intervention. CONTENT: Frailty is highly prevalent in VHD, particularly among transcatheter candidates, and represents a dynamic, potentially reversible syndrome driven by sarcopenia, deconditioning, malnutrition, inflammation, and psychological vulnerability. It influences symptoms, procedural selection, and recovery, exerting prognostic effects beyond valve anatomy. Prehabilitation offers a strategy to convert the preprocedural interval from passive waiting into a therapeutic opportunity. Evidence from cardiac surgery and hemodynamic interventions shows that multimodal prehabilitation (including aerobic and resistance exercise, respiratory training, nutritional optimization and psychological support) can improve functional capacity, reduce pulmonary complications, and shorten hospitalization. In TAVR candidates, early data suggest that even short programs may enhance functional performance, mitigate frailty and reduce major adverse cardiovascular events. In contrast, dedicated trials for M-TEER, TMVR and TTVI remain limited, and current practice depends on evidence from other procedural settings. Ongoing studies are testing exercise-based, nutritional, and psychological interventions, including telemedicine-supported and home-based models, while incorporating objective measures of frailty reversal. SUMMARY: As procedural risk declines, patients' physiological reserve becomes the principal barrier to long-term benefit. Prehabilitation may provide a scalable strategy to bridge anatomical correction with meaningful functional recovery.
BACKGROUND: Preoperative cardiac risk assessment is critical in patients undergoing intermediate- to high-risk non-cardiac surgery. While both treadmill testing (TMT) and coronary computed tomography angiography (CTA) ar...BACKGROUND: Preoperative cardiac risk assessment is critical in patients undergoing intermediate- to high-risk non-cardiac surgery. While both treadmill testing (TMT) and coronary computed tomography angiography (CTA) are widely used, the incremental prognostic value of combining these modalities remains unclear. OBJECTIVES: To evaluate the additive predictive value of coronary CTA when performed after TMT in patients scheduled for non-cardiac surgery. METHODS: In this prospective multicenter cohort study conducted at two tertiary hospitals (Changwon Gyeongsang National University Hospital and Gyeongsang National University Hospital), 447 patients undergoing non-cardiac surgery were enrolled between January 2018 and April 2025. All patients underwent both TMT and coronary CTA prior to surgery. The primary endpoint was 30-day major adverse cardiac events (MACE), defined as a composite of cardiac death, nonfatal myocardial infarction, myocardial injury after noncardiac surgery, pulmonary edema with heart failure, clinically significant arrhythmias requiring urgent intervention, and prophylactic coronary revascularization. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC), and incremental prognostic value was evaluated using net reclassification improvement (NRI) and integrated discrimination improvement (IDI). RESULTS: Forty-five patients (10.1%) experienced MACE. Significant coronary stenosis (≥50%) and a high coronary artery calcium score (CACS ≥203) on CTA were strong independent predictors of perioperative events. Among patients with positive TMT results, the addition of CTA significantly improved risk prediction. Importantly, even among TMT-negative patients, CTA findings provided meaningful discriminatory value. Conversely, TMT contributed modest incremental prognostic information in patients with significant coronary stenosis identified on CTA. Overall, models integrating both anatomic and functional assessments demonstrated the best predictive performance. CONCLUSIONS: Coronary CTA provides incremental prognostic value beyond TMT for predicting 30-day perioperative MACE in patients undergoing non-cardiac surgery. A combined strategy incorporating both anatomic and functional testing may enhance perioperative risk stratification and support more informed clinical decision-making.
Atherosclerotic cardiovascular disease remains the leading cause of death and disability worldwide. Its major clinical outcomes, myocardial infarction, stroke, vascular dementia, and cognitive decline, reflect a shared v...Atherosclerotic cardiovascular disease remains the leading cause of death and disability worldwide. Its major clinical outcomes, myocardial infarction, stroke, vascular dementia, and cognitive decline, reflect a shared vascular foundation. Recognizing subclinical atherosclerosis early is essential to preventing these interrelated cardiovascular and neurological consequences. Coronary artery calcium (CAC), quantified by non-contrast CT, is a well-validated and reproducible marker of total atherosclerotic burden. Although primarily applied to the heart, CAC also reflected systemic vascular injury. Findings from large prospective cohorts, including the Rotterdam Study and AGES-Reykjavik Study, demonstrate that higher CAC scores independently predict ischemic stroke, dementia, and accelerated cognitive decline. Individuals with CAC ≥100 Agatston units have roughly three times the risk of ischemic stroke and cognitive decline compared with those with CAC = 0, even after adjusting for shared vascular risk factors. Extra-coronary arterial calcification, involving the aorta and intra- and extra-cranial arteries, has been associated with cerebral small-vessel disease, white-matter hyperintensities, and cortical atrophy, highlighting the systemic nature of vascular atherosclerosis. Detecting both coronary and extra-coronary calcification enables earlier, targeted intervention through lipid-lowering, blood pressure, and glycemic control, and lifestyle modifications. Integrating arterial calcification imaging across vascular beds into clinical risk assessment may therefore enhance the prevention of both cardiovascular and neurovascular events. Imaging of arterial calcification provides a practical and scalable assessment of systemic atherosclerosis. Its predictive value extends beyond coronary outcomes to encompass stroke, dementia, and cognitive decline, highlighting the common vascular pathways that link cardiovascular disease with vascular cognitive impairment.
BACKGROUND: Gout and cardiovascular disease (CVD) are globally widespread diseases, yet evidence on their association in the Chinese population remains limited. We aimed to investigate the association between gout and th...BACKGROUND: Gout and cardiovascular disease (CVD) are globally widespread diseases, yet evidence on their association in the Chinese population remains limited. We aimed to investigate the association between gout and the incident risk of CVD in a Chinese population. METHODS: A register-based cohort study was conducted based on a city-wide health information platform in Shenzhen, China (2016-2022). We included individuals diagnosed with gout and free of CVD at baseline, and used the propensity score to select a 5-fold number of matched controls without gout. Electronic medical records and death registration were used to identify gout patients and CVD events. Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) between gout and the incident risk of CVD, including ischemic heart disease (IHD), stroke, and heart failure (HF). RESULTS: We included 230,339 CVD-free gout patients and matched 1,055,509 controls. During a maximum follow-up of 5.7 years, a total of 5108 and 16,621 incident CVD in gout patients and the controls were recorded, with incidence rates of 9.82 and 6.24 per 1000 person-years, respectively. Compared with the controls, gout patients had a higher risk (HR: 1.27, 95% CI: 1.24 to 1.29) for the total CVD incidence. Subgroup analyses showed that women and younger patients (aged 18 to 44 years) with gout had higher relative risks of CVD than their counterparts (P for interaction ≤ 0.001). CONCLUSION: We provide evidence that gout is associated with incident CVD risk, emphasizing the need for effective prevention and management strategies to mitigate CVD burden.
The management of symptomatic obstructive hypertrophic cardiomyopathy remains a therapeutic clinical challenge. Surgical septal myectomy has long been established as the gold-standard intervention for patients with persi...The management of symptomatic obstructive hypertrophic cardiomyopathy remains a therapeutic clinical challenge. Surgical septal myectomy has long been established as the gold-standard intervention for patients with persistent symptoms despite optimal medical therapy, offering durable symptom relief with low perioperative risk in experienced centers. Recently, the introduction of cardiac myosin inhibitors, such as mavacamten and aficamten, has reshaped the treatment paradigm for obstructive hypertrophic cardiomyopathy. By selectively inhibiting cardiac myosin ATPase activity, these agents reduce hypercontractility and improve myocardial energetic efficiency. Randomized, placebo-controlled trials such as EXPLORER-HCM and SEQUOIA-HCM have demonstrated the efficacy of cardiac myosin inhibitors in reducing left ventricular outflow tract gradients, alleviating symptoms, and enhancing functional capacity in patients with obstructive hypertrophic cardiomyopathy. The growing clinical use of cardiac myosin inhibitors raises critical questions regarding their role relative to surgical intervention. While cardiac myosin inhibitors offer an effective and less invasive alternative for many patients, they do not fully replace surgical myectomy across all clinical settings. This review articles explores the evolving therapeutic landscape of obstructive hypertrophic cardiomyopathy, focusing on the comparative advantages and limitations of cardiac myosin inhibitors and surgical myectomy.
Sheikh S, Khoja A, Naeem U
… +21 more, Fayyaz M, Junaid V, Hoodbhoy Z, Khan U, Fatmi Z, Zavala GA, Almas A, Iqbal R, Samad Z, Chauhadry IA, Nisar MI, Hussain A, Iqbal J, Ngugi AK, Slipczuk L, Al Kindi S, Merchant AT, Abubakar A, Jehan F, Soofi SB, Virani SS
Prog Cardiovasc Dis
· 2026 · PMID 41570966
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Full text
OBJECTIVE: LIFECARD is a community-based longitudinal cohort in Pakistan investigating how anthropometric, environmental, and mental health factors (anxiety and depression) and lifestyle behaviors in low middle income co...OBJECTIVE: LIFECARD is a community-based longitudinal cohort in Pakistan investigating how anthropometric, environmental, and mental health factors (anxiety and depression) and lifestyle behaviors in low middle income country settings influence cardiovascular -kidney-metabolic (CKM) syndrome risk trajectories in individuals aged 10 to 45 years old. METHODS AND ANALYSIS: This 10-year longitudinal study will enroll approximately 4000 participants: 2000 adolescents (10-20 years) and 2000 young adults (21-45 years) from Karachi (peri-urban) and Matiari (rural) districts of Sindh. A multistage sampling design will be employed. Clusters of 200 households will be selected first in each area, followed by random selection of 75 households per cluster. One eligible participant per household will be enrolled to minimize clustering. Baseline assessments include sociodemographic data, clinical and family history, obstetric history (married women aged 15-45), tobacco/alcohol consumption, anxiety and depression screening, dietary intake, physical activity, and air quality measurements (personal, indoor, and outdoor). Anthropometric measurements and laboratory investigations (HbA1c, lipid profile) will be performed. These baseline variables will be captured every 2 years. Blood specimens will be bio-banked for future biomarkers and genomic analyses. Carotid intima-media thickness (cIMT) and plaque assessment via ultrasound will be conducted at baseline and every 5 years. CONCLUSION: LIFECARD will be Pakistan's first cohort investigating contextual risk factors for premature CKM from early adolescence (10 years) through adulthood (45 years). These insights will identify critical windows for early interventions to prevent disease initiation and progression.