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Objective: Despite robust research endeavors exploring post-play health implications in former NFL players, the impact of former-player status on long-term cardiovascular health has not yet been elucidated. The purpose of this systematic review is to describe the available research on the cardiovascular health in former NFL players., Methods: Relevant studies were included from the PubMed, Scopus, and Embase databases. Studies were evaluated in accordance with PRISMA guidelines. Two independent reviewers conducted the title/abstract screenings and risk of bias determinations. The results of the studies were extracted for inclusion in the review., Results: Sixteen studies met inclusion criteria. Though evidence was discordant among studies, former NFL players appeared to possess more favorable metabolic profiles and decreased mortality compared to community controls. Of note, 90% of former players were found to be overweight or obese., Conclusion: Though cardiovascular disease is the leading cause of death among former NFL players, they possess comparable metabolic and cardiovascular profiles to community controls. Further research is necessary to ascertain the impact of NFL play on cardiovascular health and develop tailored preventative care strategies for former players.

Context/objective: To identify cardiometabolic (CM) measurements that cluster to confer increased cardiovascular disease (CVD) risk using principal component analysis (PCA) in a cohort of chronic spinal cord injury (SCI) and healthy non-SCI individuals., Approach: A cross-sectional study was performed in ninety-eight non-ambulatory men with chronic SCI and fifty-one healthy non-SCI individuals (ambulatory comparison group). Fasting blood samples were obtained for the following CM biomarkers: lipid, lipoprotein particle, fasting glucose and insulin concentrations, leptin, adiponectin, and markers of inflammation. Total and central adiposity [total body fat (TBF) percent and visceral adipose tissue (VAT) percent, respectively] were obtained by dual x-ray absorptiometry (DXA). A PCA was used to identify the CM outcome measurements that cluster to confer CVD risk in SCI and non-SCI cohorts., Results: Using PCA, six factor-components (FC) were extracted, explaining 77% and 82% of the total variance in the SCI and non-SCI cohorts, respectively. In both groups, FC-1 was primarily composed of lipoprotein particle concentration variables. TBF and VAT were included in FC-2 in the SCI group, but not the non-SCI group. In the SCI cohort, logistic regression analysis results revealed that for every unit increase in the FC-1 standardized score generated from the statistical software during the PCA, there is a 216% increased risk of MetS ( P  = 0.001), a 209% increased risk of a 10-yr. FRS ≥ 10% ( P  = 0.001), and a 92% increase in the risk of HOMA2-IR ≥ 2.05 ( P  = 0.01)., Conclusion: Application of PCA identified 6-FC models for the SCI and non-SCI groups. The clustering of variables into the respective models varied considerably between the cohorts, indicating that CM outcomes may play a differential role on their conferring CVD-risk in individuals with chronic SCI.

Background: Although hypertension and diabetes are known to increase cardiovascular disease risk, the influencing and underlying factors remain unclear., Objective: To examine the mediating effect of location of residence and the moderating effects of recommended lifestyle practices in the hypertension/diabetes and cardiovascular disease nexus., Material and Methods: Data were drawn from 4,563 participants in Steps 1 and 2 of the 2020 World Health Organization's STEPS survey in Cabo Verde, with a subsample of 2,436 individuals completing Step 3. A logit regression model was employed to examine the correlations of cardiovascular disease, while structural equation modeling and interaction analysis were used to identify mediators and moderators within the explored relationships., Results: Living with hypertension and diabetes were both observed to increase the likelihood of having a cardiovascular disease [Coeff. (RSE), 0.46, (0.12), p  < 0.001; 1.26, (0.14), p  < 0.001, respectively]. We identify urbanicity as a potential mediator through which hypertension/diabetes leads to a cardiovascular disease and waist circumference as a moderator of hypertension/diabetes-cardiovascular nexus., Conclusion: These findings add to the toolset of public health practitioners and policymakers in formulating policies and interventions aimed at managing cardiovascular diseases, particularly in developing nations.

Using a systematic meta-analysis, we investigated if patients with type 2 diabetes (T2D) and with varying baseline blood pressure (BP) differ in the cardiorenal benefits received from sodium-glucose co-transporter 2 inhibitors (SGLT-2is) and glucagon-like peptide 1 receptor agonists (GLP-1RAs). Design: Randomized, placebo-controlled, cardiovascular outcome trials (CVOTs) of SGLT-2is and GLP-1RAs were identified from MEDLINE, Embase, and the Cochrane Library up to April 2024. Hazard ratios (HRs) with 95% CIs were pooled. The differential treatment effect by baseline BP category within each trial was estimated as the ratio of the HR (RHR) and pooled. Results: Seventeen publications based on 9 unique CVOTs (4 SGLT-2is and 5 GLP-1RAs) were eligible. In participants with normal baseline BP, comparing SGLT-2is with placebo, the HRs (95% CIs) were 0.88 (0.79-0.97) for major adverse cardiovascular events (MACE), 0.73 (0.59-0.91) for heart failure (HF) hospitalization, 0.78 (0.65-0.94) for composite CVD death/HF hospitalization, and 0.55 (0.41-0.73) for composite renal outcome. The corresponding estimates for participants with higher baseline BP were 0.88 (0.81-0.96), 0.67 (0.57-0.79), 0.73 (0.65-0.82), and 0.61 (0.48-0.77), respectively. In participants with normal baseline BP, GLP-RAs had no strong effect on MACE, stroke and nephropathy, but reduced stroke and nephropathy risk in those with higher baseline BP. Estimated RHRs showed no statistical evidence that baseline BP modified the cardiorenal benefits of SGLT-2is and GLP-1RAs. Conclusions: In patients with T2D, the cardiorenal benefits of treatment with SGLT2-Is and GLP1-RAs were similar in patients with normal baseline BP compared to those with a higher baseline BP.

Background: Diabetes and prediabetes are well-recognized risk factors for cardiovascular disease (CVD) and are marked by vascular endothelial dysfunction (ED). However, there is a scarcity of thorough population-based studies examining ED in individuals with diabetes/prediabetes free from manifest CVD. Here, we examined the association between ED assessed by reactive hyperaemia index (RHI) in the finger and diabetes/prediabetes in a large middle-aged population cohort., Methods: Within the Malmö Offspring Study, following the exclusion of participants <30 years and participants with prevalent CVD, 1384 participants had complete data on all covariates. The RHI was calculated using pulse amplitude tonometry. ED was defined as RHI < 1.67. Multivariable logistic and linear regression models were conducted to investigate associations between ED and RHI with diabetes and prediabetes., Results: The study population had a mean age of 53.6 ± 7.6 years (53% women). In study participants with manifest diabetes (n = 121) and prediabetes (n = 514), ED was present in 42% and 25% respectively, compared to 23% in those with normal glucometabolic status. In multivariable logistic regression analyses, prevalent diabetes was significantly associated with ED (OR 1.95; 95%CI 1.57-3.39; p = 0.002), as well as with lower RHI (β-coeff. -0.087; p = 0.002). However, prediabetes showed no association with neither ED nor RHI., Conclusion: In a population free from CVD, vascular endothelial dysfunction was primarily associated with manifest diabetes, but not with prediabetes, implying that finger ED may develop when diabetes is established, rather than being an early sign of glucose intolerance. Further research is needed to explore whether addressing glucose intolerance could potentially delay or prevent vascular ED onset.

Background: In the in-clinic blood pressure (BP) recording setting, a sizable number of individuals with normal BP and approximately 30% of patients with chronic renal disease (CKD) exhibit elevated outpatient BP records. These individuals are known as masked hypertension (MHTN), and when they are on antihypertensive medications, but their BP is not controlled, they are called masked uncontrolled hypertension (MUHTN). The masked phenomenon (MP) (MHTN and MUHTN) increases susceptibility to end-organ damage (a two-fold greater risk for cardiovascular events and kidney dysfunction). The potential extension of the observed benefits of MP therapy, including a reduction in end-organ damage, remains questionable., Aim and Methods: This review aims to study the diagnostic methodology, epidemiology, pathophysiology, and significance of MP management in end-organs, especially the kidneys, cardiovascular system, and outcomes. To achieve the purposes of this non-systematic comprehensive review, PubMed, Google, and Google Scholar were searched using keywords, texts, and phrases such as masked phenomenon, CKD and HTN, HTN types, HTN definition, CKD progression, masked HTN, MHTN, masked uncontrolled HTN, CKD onset, and cardiovascular system and MHTN. We restricted the search process to the last ten years to search for the latest updates., Conclusion: MHTN is a variant of HTN that can be missed if medical professionals are unaware of it. Early detection by ambulatory or home BP recording in susceptible individuals reduces end-organ damage and progresses to sustained HTN. Adherence to the available recommendations when dealing with masked phenomena is justifiable; however, further studies and recommendation updates are required.

Purpose: To describe the process of becoming aware of and acting on personal cardiovascular (CVD) risk in type 2 diabetes (T2D)., Method: A purposive sample of 14 persons living with T2D participated in semi-structured, open-ended, in-dept interviews. The interviews were analysed with grounded theory., Result: The analysis identified the core category "Balancing emotions, integrating knowledge and understanding to achieve risk awareness and act on it." Five categories describe the movement from not being aware of the risk of cardiovascular disease (CVD) to becoming aware of this risk and taking action to reduce it. Persons with T2D need to transform their knowledge and experience of CVD risk and incorporate it in their individual situations. Emotional and existential experiences of CVD risk can lead to awareness about the severity of the condition and contribute to increased motivation for self-management. However, an overly high emotional response can be overwhelming and may result in insufficient self-management., Conclusion: Persons with T2D seemed not to fully grasp their increased risk of CVD or recognize that self-management activities were aimed at reducing this risk. However, their awareness of CVD risk gradually increased as they came to understand the severity of T2D and became more emotionally and existentially engaged.

Purpose: Socioeconomic status has been related to resting blood pressure (BP) levels at different stages of life. However, the association of childhood socioeconomic status (SES) and adulthood exercise BP is largely unknown. Therefore, we studied the association of childhood SES with adulthood maximal exercise BP., Materials and Methods: This investigation consisted of 373 individuals (53% women) participating in the Cardiovascular Risk in Young Finns Study who had data concerning family SES in childhood (baseline in 1980, at age of 6-18 years) and exercise BP response data in adulthood (follow-up in adulthood in 27-29 years since baseline). A maximal cardiopulmonary exercise test with BP measurements was performed by participants, and peak exercise BP was measured., Results: In stepwise multivariable analysis including childhood risk factors and lifestyle factors (body mass index, systolic BP, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, insulin, fruit consumption, vegetable consumption, and physical activity), lower family SES in childhood was associated with higher maximal exercise BP in adulthood (β value ± SE, 1.63 ± 0.77, p  = 0.035). The association remained significant after further adjustment with participants SES in adulthood (β value ± SE, 1.68 ± 0.65, p  = 0.011) and after further adjustment with adulthood body-mass index, systolic BP, maximal exercise capacity, and peak heart rate in exercise (β value ± SE, 1.25 ± 0.56, p  = 0.027)., Conclusions: These findings suggest that lower childhood family SES is associated with higher maximal exercise BP in adulthood.

Objectives: Insulin resistance (IR) is associated with an increased risk of adverse cardiovascular outcomes. The triglyceride-glucose index (TyG index) is a reliable marker of IR. No study has examined the impact of the TyG index on major adverse cardiac and cerebrovascular events (MACCEs) in RTRs. Therefore, this study aimed to investigate the predictive value of the TyG index for MACCEs in RTRs., Materials and Methods: Non-diabetic patients undergoing renal transplantation were retrospectively enrolled. The patients were divided into two groups according to MACCE development. The cut-off value of the TyG index for MACCE was conducted., Results: The mean age of 522 patients was 41 (31-51) years, and 349 (66.9%) were male. During the 5.4-year follow-up, 84 (16%) MACCE were recorded. TyG index was significantly higher in the group that developed MACCE ( p  < 0,001). Cox regression analysis revealed that TyG index [HR: 3.297 (1.228-8.855), p  = 0.018], left ventricle ejection fraction [HR: 0.934 (0.900-0.968), p  < 0.001], cadaveric transplantation [HR: 8.886 (4.764-16.576), p  < 0.001], graft survey [HR: 0.608 (0.542-0.682), p  < 0.001)], and smoking [HR: 1.965 (1.117-3.456), p  = 0.019] were independent predictors of MACCEs in nondiabetic RTRs., Conclusion: TyG index is an independent predictor of MACCEs in non-diabetic RTRs. The widespread use of the TyG index may positively affect long-term treatment costs and survival.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was the main pathogen in the COVID-19 pandemic. This viral infection has been associated with several respiratory and non-respiratory complications contributing to a higher mortality rate, especially in patients with underlying heart diseases worldwide. Once considered a respiratory tract disease, it is now well-known that COVID-19 patients may experience a wide range of cardiac manifestations. Because of its remarkable direct and indirect effects on the cardiovascular system, herein, we examined the published literature that studied the hypothetical mechanisms of injury, manifestations, and diagnostic modalities, including changes in molecular biomarkers with a predictive value in the prognostication of the disease, as well as emerging evidence regarding the long-term cardiac complications of the disease.

Acute exposure to extreme altitude increases arterial stiffness by activation of the sympathetic and endothelin system as well as hypoxia-induced reactive oxygen species production. Beyond a certain individual threshold, these physiological adaptations represent a relevant cardiovascular risk factor. In this pilot study we investigated to what extent temporary exposure to moderate altitude, as present during hiking, skiing or in aeroplanes, leads to changes in vascular tone. Pulse wave parameters of 8 healthy individuals were assessed with a BR-102 plus pulse wave analyser (Schiller, Germany) at baseline (521 m) and after 24 h exposure to moderate altitude (2650 m). We identified a significant increase in heart rate (61 vs. 68/min, p  = 0.021) as well as changes in central (35.6 vs. 41.4 mmHg, p  = 0.024) and peripheral pulse pressure (44.7 vs. 52.6 mmHg, p  = 0.006). Amplitudes of forward (21.6 vs. 25.4 mmHg, p  = 0.012) and backward pulse waves (15.3 vs. 17.6 mmHg, p  = 0.043) were significantly elevated. Pulse wave velocity showed no significant change from 5.8 m/s at baseline to 6.1 m/s at moderate altitude ( p  = 0.056). We show that temporary exposure to moderate altitude leads to mild changes in vascular tone reflected by pulse pressure and pulse wave amplitude in healthy adults. Although the observed effects were mild in our study, it indicates that adaptation capacity is of crucial importance and any restrictions by disease or simply with the process of ageing demand increased awareness, even in moderate altitude.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) and cardiovascular diseases (CVD) commonly co-exist. Outcomes of people living with both conditions are poor in terms of symptom burden, receiving evidence-based treatment and mortality. Increased understanding of the underlying mechanisms may help to identify treatments to relieve this disease burden. This narrative review covers the overlap of COPD and CVD with a focus on clinical presentation, mechanisms, and interventions. Literature up to December 2023 are cited., Areas Covered: 1. What is COPD 2. The co-existence of COPD and cardiovascular disease 3. Mechanisms of cardiovascular disease in COPD. 4. Populations with COPD are at risk of CVD 5. Complexity in the co-diagnosis of COPD in those with cardiovascular disease. 6. Therapy for COPD and implications for cardiovascular events and risk. 7. Cardiovascular risk and exacerbations of COPD. 8. Pro-active identification and management of CV risk in COPD., Expert Opinion: The prospective identification of co-morbid COPD in CVD patients and of CVD and CV risk in people with COPD is crucial for optimizing clinical outcomes. This includes the identification of novel treatment targets and the design of clinical trials specifically designed to reduce the cardiovascular burden and mortality associated with COPD. Databases searched: Pubmed, 2006-2023.

Background: Knowledge about the influence of early developmental factors on cardiometabolic health in the Maya is limited., Aim: To analyse the relationship between birthweight (BW) and cardiometabolic parameters in a sample of rural Maya children from Yucatan, Mexico., Subjects and Methods: We took anthropometric measurements and obtained data on BW and fasting blood samples in a sample of 75 children aged 5-14 years. Dependent variables were: fat mass index (FMI), body mass index (BMI), glucose (G), triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), LDL/HDL and TC/HDL ratios and metabolic index (TGxG/HDL 2 ). Outcomes were transformed to y  = 100 log(e)x and the resulting estimates are interpreted as symmetrical percentage differences. The main independent variable was BW z-score. Multiple linear regression analyses were used to assess the relationship between BW and outcomes., Results: An increase of one standard deviation in BW predicted 6.6% (95% CI [-11.6, -1.6]) decrease in HDL and 11% (95% CI [3.7, 18.4]), 7.8% (95% CI [2.3, 13.2]) and 19.6% (95% CI [3.1, 36]) increases in LDL/HDL, TC/HDL and metabolic index, respectively., Conclusion: Higher birthweights were associated with adverse levels of biochemical parameters in this sample of rural Maya children.

Air travel is widely regarded as the safest mode of transportation, with the United States leading in airline passengers. However, travelers with pre-existing heart conditions face acute cardiovascular risks. Flight pilots and cabin crew are particularly vulnerable to air travel's physiological changes, which can significantly impair their health and performance. Cabin pressure differences and reduced oxygen levels at cruising altitudes of 5000-8000 feet make air travel challenging for individuals with underlying cardiac and pulmonary problems. This, along with dry air, sleep deprivation, missed medication and prolonged sitting, can lead to physiological changes. In-flight and pre-flight stressors contribute to increased health issues, and studies show a rise in medical emergencies during flights. Prolonged exposure to the airplane environment can lead to various health issues for pilots and cabin crew. These changes include impaired judgment, cognitive function and discomfort in the sinuses and ears due to pressure differentials. Therefore, thorough medical screening, skilled instrument use and compliance with safety measures are essential to mitigate these risks. This article reviews the cardiac implications of air travel, discussing the underlying pathophysiology, associated risks and preventive measures to ensure safer flights for individuals with cardiovascular diseases.

Background: Radiation therapy is an integral component of treatment that can predispose to carotid artery stenosis (CAS) and increase the risk of cerebrovascular events for head and neck cancer survivors. The utility of screening for CAS with carotid ultrasound in asymptomatic head and neck cancer survivors is unclear. Methods: In this prospective, cross-sectional pilot study, 60 patients who have no evidence of cancer at least 2 years from completion of RT will undergo screening carotid ultrasound to identify patients with high risk of cardiovascular events. Results: Outcomes will include clinically significant CAS, carotid intima-media thickness, acceptability/feasibility of screening, barriers to care and preliminary data on changes to medical management because of screening. Correlative multi-omics analyses will examine biomarkers of CAS after radiation therapy. Conclusion: The results of this study will provide valuable data on the prevalence of CAS and preliminary patient-centered data that will inform the design of a future large-scale, multi-site clinical trial. Clinical Trial Registration: NCT05490875 (ClinicalTrials.gov).

Aim: Methylation of LDLR , PCSK9 and LDLRAP1 CpG sites was assessed in patients with familial hypercholesterolemia (FH). Methods: DNA methylation of was analyzed by pyrosequencing in 131 FH patients and 23 normolipidemic (NL) subjects. Results:  LDLR , PCSK9 and LDLRP1 methylation was similar between FH patients positive (MD) and negative (non-MD) for pathogenic variants in FH-related genes. LDLR and PCSK9 methylation was higher in MD and non-MD groups than NL subjects ( p  < 0.05). LDLR , PCSK9 and LDLRAP1 methylation profiles were associated with clinical manifestations and cardiovascular events in FH patients ( p  < 0.05). Conclusion: Differential methylation of LDLR , PCSK9 and LDLRAP1 is associated with hypercholesterolemia and cardiovascular events. This methylation profile maybe useful as a biomarker and contribute to the management of FH.

Introduction: The impact of Type II Diabetes mellitus (T2DM) on cardiovascular disease (CVD) is well-established, while lipoprotein(a) [Lp(a)] has recently emerged as a recognized CVD risk factor. The rising prevalence of T2DM resulting from modern lifestyles and the development of specific Lp(a)-lowering agents brought the association between T2DM and Lp(a) in the forefront., Areas Covered: Despite advancements in T2DM treatment, diabetic patients remain at very-high risk of CVD. Lp(a) may, to some extent, contribute to the persistent CVD risk seen in diabetic patients, and the coexistence of T2DM and elevated Lp(a) levels appears to synergistically amplify overall CVD risk. The relationship between T2DM and Lp(a) is paradoxical. On one hand, high Lp(a) plasma concentrations elevate the risk of diabetic microvascular and macrovascular complications. On the other hand, low Lp(a) plasma concentrations have been linked to an increased risk of developing T2DM., Expert Opinion: Comprehending the association between T2DM and Lp(a) is critical due to the pivotal roles both entities play in overall CVD risk, as well as the unique aspects of their relationship. The mechanisms underlying the inverse association between T2DM and Lp(a) remain incompletely understood, necessitating further meticulous research.

Background: Lipid testing for atherosclerotic cardiovascular disease (ASCVD) risk is often performed every 4-6 years, but we hypothesized that the optimum time interval may vary depending on baseline risk., Research Design and Methods: Using lipid values and other risk factors from the National Health and Nutrition Examination Survey (NHANES) ( n  = 9,704), we calculated a 10-year risk score with the pooled-cohort equations. Future risk scores were predicted by increasing age and projecting systolic blood pressure (SBP) and lipid changes, using the mean-percentile age group change in NHANES for SBP ( n = 17,329) and the Lifelines Cohort study for lipids ( n  = 133,540). The crossing of high and intermediate-risk thresholds were calculated by time to determine optimum intervals for lipid testing., Results: Time to crossing risk thresholds depends on baseline risk, but the mean increase in the risk score plateaus at 1% per year for those with a baseline 10-year risk greater than 15%. Based on these findings, we recommend the following maximum time intervals for lipid testing: baseline risk < 15%: 5-years, 16%: 4-years, 17%: 3-years, 18%: 2-years, and 19%: ≤1-year., Conclusions: Testing patients for lipids who have a higher baseline risk more often could identify high-risk patients sooner, allowing for earlier and more effective therapeutic intervention.

Human immunodeficiency virus (HIV) infection is associated with increased cardiovascular diseases (CVDs) even in patients with viral suppression by combination antiretroviral therapy (cART). Arterial stiffness is an independent predictor of CVDs in diseased individuals and the general population. Cardio-ankle vascular index (CAVI) is an index of arterial stiffness that has been shown to predict target organ damage. CAVI is less studied in HIV patients. We compared the levels of arterial stiffness using CAVI and associated factors among cART-treated and cART-naïve HIV patients to those of non-HIV controls. In a case-control design, 158 cART-treated HIV patients, 150 cART-naïve HIV patients and 156 non-HIV controls were recruited from a periurban hospital. We collected data on CVD risk factors, anthropometric characteristics, CAVI, and fasting blood samples to measure plasma glucose, lipid profile, and CD4+ cell counts. Metabolic abnormalities were defined using the JIS criteria. CAVI increased in cART-treated HIV patients compared to cART-naïve HIV patients and non-HIV controls (7.8 ± 1.4 vs 6.6 ± 1.1 vs 6.7 ± 1.4 respectively, p  < 0.001). CAVI was associated with metabolic syndrome in non-HIV controls [OR (95% CI) = 2.14 (1.04-4.4), p  = 0.039] and cART-naïve HIV patients [1.47 (1.21-2.38), p  = 0.015], but not in cART-treated HIV patients [0.81 (0.52-1.26), p  = 0.353]. In cART-treated HIV patients, a tenofovir (TDF)-based regimen (β = -0.46, p  = 0.023) was associated with decreased CAVI and decreased CD4+ cell count (β = -0.23, p  = 0.047) was associated with increased CAVI. In a periurban hospital in Ghana, compared to non-HIV controls or cART-naïve HIV patients, cART-treated HIV patients had increased arterial stiffness measured as CAVI. CAVI is associated with metabolic abnormalities in non-HIV controls and cART-naïve HIV patients, but not in cART-treated HIV patients. Patients on TDF-based regimens had decreased CAVI.

Uncontrolled hypertension drives the global burden of increased cardiovascular disease (CVD) morbidity and mortality. Although high blood pressure (BP) is treatable and preventable, only half of the patients with hypertension undergoing treatment have their BP controlled. The failure of polypharmacy to attain adequate BP control may be due to a lack of physiological response, however, medication non-adherence and clinician inertia to increase treatment intensity are critical factors associated with poor hypertension management. The long-time medication titration, lifelong drug therapy, and often multi-drug treatment strategy are frustrating when the BP goal is not achieved, leading to increased CVD risk and a substantial burden on the healthcare system. Growing evidence indicates that neurohumoral activation is critical in initiating and maintaining elevated BP and its adverse consequences. Over the past decades, device-based therapies targeting the mechanisms underlying hypertension pathophysiology have been extensively studied. Among these, robust clinical experience for hypertension management exists for renal denervation (RDN) and baroreflex activation therapy (BAT), carotid body denervation (CBD), central arteriovenous anastomosis, and to a lesser extent, deep brain stimulation. Future studies are warranted to define the role of device-based approaches as an alternative or adjunctive treatment option to treat hypertension.

Purpose: Individual socioeconomic status is associated with increased arterial stiffness, but limited data are available on the relations of neighbourhood deprivation with this vascular measure. We prospectively examined whether neighbourhood deprivation in childhood and adulthood predicts arterial stiffness indicated by pulse wave velocity (PWV). Materials and methods: The study population comprised 1,761 participants aged 3-18 years at baseline (1980) from the longitudinal Cardiovascular Risk in Young Finns cohort study. PWV was measured in 2007 by whole-body impedance cardiography at ages 30-45 years. Cumulative lifetime neighbourhood deprivation was assessed using data from socioeconomic circumstances in participants' lifetime residential neighbourhoods, categorised as low versus high deprivation. Results: High deprivation in childhood and adulthood was associated with higher PWV in adulthood after adjustment for age, sex, and place of birth (mean difference = 0.57 m/s, 95%CI = 0.26-0.88, P for trend = 0.0004). This association was attenuated but remained statistically significant after further adjustment for childhood parental socioeconomic status and adulthood individual socioeconomic status (mean difference = 0.37 m/s, 95%CI = 0.05-0.70, P for trend 0.048). Also, low individual socioeconomic status in adulthood was associated with higher PWV when adjusted for age, sex, place of birth, parental socioeconomic status in childhood, and lifetime neighbourhood deprivation (mean difference = 0.54 m/s, 95%CI = 0.23-0.84, P for trend 0.0001). Conclusion: These findings suggest that lifetime neighbourhood deprivation and low adulthood socioeconomic status are independent risk factors for increased arterial stiffness in adulthood.

Introduction: Infertility affects 15% of women of reproductive age in the United States. The use of assisted reproductive technology (ART) has been rising globally, as well as a growing recognition of reproductive factors that increase risk for cardiovascular disease (CVD)., Areas Covered: Women with infertility who use ART are more likely to have established CVD risk factors, such as obesity, dyslipidemia, hypertension, and diabetes. They are also more likely to experience adverse pregnancy outcomes, which are associated with both peripartum and long-term cardiovascular complications. ART may lead to increased cardiometabolic demands due to ovarian stimulation, pregnancy itself, and higher rates of multifetal gestation. Preeclampsia risk appears greater with frozen rather than fresh embryo transfers., Expert Opinion: The use of ART and its association with long term CVD has not been well-studied. Future prospective and mechanistic studies investigating the association of ART and CVD risk may help determine causality. Nevertheless, CVD risk screening is critical pre-pregnancy and during pregnancy to reduce pregnancy complications that elevate future CVD risk. This also offers a window of opportunity to connect patients to longitudinal care for early management of cardiometabolic risk profile and initiation of preventive lifestyle and pharmacotherapy interventions tailored toward patient-specific risk factors.

Introduction: Cardiac rehabilitation (CR) is highly effective at reducing morbidity and mortality. However, CR is underutilized, and adherence remains challenging. In no group is CR attendance more challenging than among patients who smoke. Despite being more likely to be referred to CR, they are less likely to enroll, and much more likely to drop out. CR programs generally do not optimally engage and treat those who smoke, but this population is critical to engage given the high-risk nature of continued smoking in those with cardiovascular disease., Areas Covered: This review covers four areas relating to CR in those who smoke. First, we review the evidence of the association between smoking and lack of participation in CR. Second, we examine how smoking has historically been identified in this population and propose objective screening measures for all patients. Third, we discuss the optimal treatment of smoking within CR. Fourth, we review select populations within those who smoke (those with lower-socioeconomic status, females) that require additional research and attention., Expert Opinion: Smoking poses a challenge on multiple fronts, being a significant predictor of future morbidity and mortality, as well as being strongly associated with not completing the secondary prevention program (CR) that could benefit those who smoke the most.

Introduction: E-cigarettes have emerged as a popular alternative to traditional tobacco smoking in recent years. Despite their growing popularity, concerns have arisen regarding the cardiovascular implications of e-cigarette use., Areas Covered: This narrative review aims to highlight the latest evidence on the impact of e-cigarettes on cardiovascular health., Expert Opinion: Numerous studies have demonstrated that e-cigarette use can lead to acute adverse cardiovascular effects. Inhalation of e-cigarette aerosols exposes users to a wide range of potentially harmful substances that have been implicated in critical pathophysiologic pathways of cardiovascular disease, namely endothelial dysfunction, oxidative stress, inflammation, sympathetic overdrive, and arterial stiffness. While long-term epidemiological studies specifically focusing on the cardiovascular effects of e-cigarettes are still relatively scarce, early evidence suggests a potential association between e-cigarette use and an increased risk of adverse cardiovascular events. However, it is essential to recognize that e-cigarettes are relatively new products, and the full extent of their long-term cardiovascular impact has not been fully elucidated. In the meantime, promoting tobacco cessation strategies that are evidence-based and regulated, along with rigorous monitoring of e-cigarette use patterns and associated health outcomes, are essential steps in safeguarding cardiovascular health in the face of this emerging public health challenge.

Background: Several therapies for vasomotor symptoms (VMS) due to menopause are available. Treatment preferences and willingness-to-pay for VMS treatment among US women with VMS were evaluated., Methods: An online survey of women with perimenopausal or postmenopausal VMS was conducted (3/15/21-4/23/21). A discrete choice experiment quantified the impact of 7 treatment attributes on VMS treatment choice: VMS frequency/severity reduction, sleep improvement, risk of breast cancer/cardiovascular events in 6 years, risk of short-term side effects, and out-of-pocket costs. Preference weights (PWs) with 95% confidence intervals (CIs) were estimated and reported., Results: Among 467 women, 86.5% and 87.8% reported moderate to very severe VMS and sleep problems during the preceding month, respectively. Sleep improvement (PW: 0.843; 95% CI: 0.721, 0.965) and reduction in VMS frequency (PW: 0.658; 95% CI: 0.520, 0.796) and severity (PW: 0.628; 95% CI: 0.500, 0.756) most influenced treatment preference; risk of cardiovascular events (PW: 0.150; 95% CI: 0.069, 0.232) or breast cancer (PW: 0.401; 95% CI: 0.306, 0.496) in 6 years had lesser effect. Willingness-to-pay was an additional $35-$46/month for substantially improved sleep, 80% VMS frequency reduction, and reduction from severe to mild VMS., Conclusions: Sleep improvement and reductions in VMS frequency/severity were the most important treatment attributes.

Hypertension is one of the most prevalent medical disorders in the world and is associated with significant cerebrovascular and cardiovascular morbidity. Pre-bout blood pressure (BP) elevation is extremely common, and ringside physicians must accurately assess the accompanying risk of adverse cerebrovascular and cardiovascular events in the decision to allow participation in combat sports. It is strongly recommended that a ringside physician consider disqualifying a combat sports athlete with severe pre-bout hypertension (systolic BP ≥160 mm Hg and/or diastolic BP ≥100 mm Hg, or stage 2 hypertension in children when indexed by gender, age, and height) from that bout, if it persists despite rest and repeated measurement with accurate equipment. This recommendation is congruent with that of the American College of Sports Medicine, the American College of Cardiology, and the American Heart Association, which recommend non-clearance for sports or exercise testing when BP exceeds those thresholds. Severely elevated BP, as defined above, confers markedly increased risk of morbidity and mortality. Exercise further raises BP markedly. The combination of severely elevated blood pressure and cranial trauma during combat sports is a risk factor for intracranial hemorrhage with a direct impact on the morbidity and mortality associated with ringside combat sports events. Combat sports athletes with SBP ≥130 or DBP ≥90 - and their coaches and families, if available and the athlete consents - should be educated on the causes of hypertension, its acute and chronic risks, and the possible future implications for bout clearance, and the athletes should be referred for evaluation and management.

Introduction: There is abundant evidence that elevated lipoprotein(a) [LP(a)] associates with cardiovascular risk. Most lipid modifying therapies don't reduce Lp(a), but new technologies are emerging that act upstream, such as antisense oligonucleotides (ASO) and small interfering RNAs (siRNAs) that inhibit the translation of mRNA for proteins specifically involved in lipid metabolism., Areas Covered: Despite the benefit of therapies for the prevention of atherosclerotic cardiovascular disease (ASCVD), Lp(a) is one of the 'residual risks,' established by observational and Mendelian randomization studies. Although current established lipid modifying therapies targeting low-density-lipoprotein cholesterol, such as statins and ezetimibe, do not lower Lp(a), ASOs and siRNAs demonstrated significant reduction of Lp(a) by -98 to -101% in recent clinical trials. However, we still don't know if specifically lowering Lp(a) reduced cardiovascular events, how much Lp(a) lowering is required to produce clinical benefit, and whether diabetes and inflammation have any impact. This review summarizes Lp(a), the knowns and unknowns about Lp(a), and focus emerging treatments., Expert Opinion: New Lp(a) lowering therapies have the potential to contribute to the personalized prevention of ASCVD.

Introduction: South Asian individuals comprise almost a quarter of the world's population and have an excess risk of atherosclerotic cardiovascular disease (ASCVD) compared to other ethnicities. In part, this can be explained by higher prevalence, earlier onset, and suboptimal control of traditional cardiovascular risk factors, such as insulin resistance, metabolic syndrome, and dyslipidaemia. However, there remains a significant residual excess risk associated with South Asian ethnicity after controlling for traditional risk factors., Areas Covered: In this review, we describe the epidemiology of ASCVD in both native and diaspora South Asian populations. We explore how traditional cardiovascular risk factors, novel cardiovascular risk factors, and social determinants of health may contribute to the excess ASCVD risk seen in South Asian populations., Expert Opinion: There should be increased awareness of the relative importance of South Asian ethnicity and related social determinants of health, as risk factors for ASCVD. Systematic screening processes should be tailored to this population, and modifiable risk factors should be treated aggressively. Further research is required to quantify determinants of the excess ASCVD risk seen in South Asian populations and to develop targeted interventions to address these factors.

Introduction: For a long time, metformin has been the first-line treatment for glycemic control in type 2 diabetes; however, the results of recent cardiovascular outcome trials of sodium-glucose co-transporter 2 inhibitors and glucagon-like peptide 1 receptor agonists have caused many to question metformin's position in the guidelines. Although there are several plausible mechanisms by which metformin might have beneficial cardiovascular effects, for example, its anti-inflammatory effects and metabolic properties, and numerous observational data suggesting improved cardiovascular outcomes with metformin use, the main randomized clinical trial data for metformin was published over 20 years ago. Nevertheless, the overwhelming majority of participants in contemporary type 2 diabetes trials were prescribed metformin., Areas Covered: In this review, we will summarize the potential mechanisms of cardiovascular benefit with metformin, before discussing clinical data in individuals with or without diabetes., Expert Opinion: Metformin may have some cardiovascular benefit in patients with and without diabetes, however the majority of clinical trials were small and are before the use SGLT2 inhibitors and GLP1-RAs. Larger contemporary randomized trials, with metformin evaluating its cardiovascular benefit are warranted.

Introduction: Hypertension is a well-established risk factor for cardiovascular (CV) events in patients with chronic kidney disease (CKD), heart failure, obesity, and diabetes. Despite the usual prescribed antihypertensive therapies, many patients fail to achieve the recommended blood pressure (BP) targets., Areas Covered: This review summarizes the clinical BP-lowering data presented in major CV and kidney outcome trials for sodium-glucose cotransporter-2 (SGLT2) inhibitors, as well as smaller dedicated BP trials in high-risk individuals with and without diabetes. We have also highlighted potential mechanisms that may contribute to the antihypertensive effects of SGLT2 inhibitors, including natriuresis and hemodynamic changes, a loop diuretic-like effect, and alterations in vascular physiology., Expert Opinion: The antihypertensive properties of SGLT2 inhibitors are generally modest but may be larger in certain patient populations. SGLT2 inhibitors may have an additional role as an adjunctive BP-lowering therapy in patients with hypertension at high risk of CV disease or kidney disease.

Objectives: Type-2 Diabetes mellitus (T2DM) increases both the patient risk of cardiovascular disease (CVD) and renal outcomes, such as chronic kidney disease (CKD). Recent clinical trials of the glucose-lowering drug-class of sodium-glucose co-transporter-2 inhibitors (SGLT2is) have shown benefits in preventing CVD events and progression of CKD, leading to an update of the Dutch T2DM treatment guideline for patients at risk. The aim of this study is to assess the health and economic impact of the guideline-recommended utilization of SGLT2is in the Netherlands., Methods: The patient population at risk was determined by multiplying Dutch T2DM prevalence rates with the total numbers of inhabitants of the Netherlands in 2020. Subsequently, two analyses, comparing a treatment setting before and after implementation of the new guideline for SGLT2is, were conducted. Clinical and adverse event rates in both settings as well as direct healthcare costs were sourced from the literature. Total costs were calculated by multiplying disease prevalence, event rates and costs associated to outcomes. One-time disutilities per event were included to estimate the health impact. The potential health and economic impact of implementing the updated guideline was calculated., Results: Using a 5-year time horizon, the guideline-suggested utilization of SGLT2is resulted in a health impact equal to 4835 quality adjusted life years gained (0.0031 per patient per year) and €461 million cost-savings. The costs of treatment with SGLT2is were €813 million. Hence the net budget impact was €352 million for the total Dutch T2DM population, which translated to €0,57 per patient per day., Conclusion: SGLT2is offer an option to reduce the number of CVD and CKD related events and associated healthcare costs and health losses in the Netherlands. Further research is needed to include the benefits of improved T2DM management options from a broader societal perspective.HighlightsThe glucose-lowering drug-class of sodium-glucose co-transporter-2 inhibitors (SGLT2is) has shown benefits in preventing cardiovascular events and progression of kidney disease in patients with type-2 diabetes leading to a revision of the respective Dutch treatment guideline.The 5-year budget impact of the adoption of SGLT2is in the new treatment guideline was equal to €352 million or €0.57 per patient per day, with a total of 4385 quality adjusted life years gained.The introduction of SGLT2is for Dutch type-2 diabetes patients has the potential to substantially reduce the number of cardiovascular as well as renal disease events and related healthcare costs while also delivering a health benefit.

Purpose: COVID-19, a novel infection, presented with several complications, including socioeconomical and reproductive health challenges such as erectile dysfunction (ED). The present review summarizes the available shreds of evidence on the impact of COVID-19 on ED. Materials and methods: All published peer-reviewed articles from the onset of the COVID-19 outbreak to date, relating to ED, were reviewed. Results: Available pieces of evidence that ED is a consequence of COVID-19 are convincing. COVID-19 and ED share common risk factors such as disruption of vascular integrity, cardiovascular disease (CVD), cytokine storm, diabetes, obesity, and chronic kidney disease (CKD). COVID-19 also induces impaired pulmonary haemodynamics, increased ang II, testicular damage and low serum testosterone, and reduced arginine-dependent NO bioavailability that promotes reactive oxygen species (ROS) generation and endothelial dysfunction, resulting in ED. In addition, COVID-19 triggers psychological/mental stress and suppresses testosterone-dependent dopamine concentration, which contributes to incident ED. Conclusions: In conclusion, COVID-19 exerts a detrimental effect on male reproductive function, including erectile function. This involves a cascade of events from multiple pathways. As the pandemic dwindles, identifying the long-term effects of COVID-19-induced ED, and proffering adequate and effective measures in militating against COVID-19-induced ED remains pertinent.

Purpose: We investigated whether blood pressure (BP) control measures, visit-to-visit BP variability, and time in therapeutic range (TTR) are associated with future cardiovascular outcomes in hypertensive patients., Materials and Methods: Among 1,408 hypertensive patients without cardiovascular disease, we prospectively evaluated the incident major cardiovascular events over 6 years. In newly diagnosed patients, antihypertensive drug treatment was initiated. We estimated two markers of on-treatment BP control, (1) visit-to-visit BPV as the coefficient of variation of office systolic BP (BP-CV), and (2) TTR calculated as the percentage of office systolic BP measurements within 120-140mmHg across visits., Results: The hypertensive cohort (672 males, mean age 60 years, 31% newly diagnosed) had a mean systolic/diastolic BP of 142/87 mmHg. The mean number of visits was 4.9 ± 2.6, while the mean attained systolic/diastolic BP during follow-up was 137/79 mmHg using 2.7 ± 1.1 antihypertensive drugs. The BP-CV and TTR were 9.1 ± 4.1% and 45 ± 29%, respectively, and the incidence of the composite outcome was 8.3% ( n  = 117). After adjustment for relevant confounders and standardization to z-scores, BP-CV and TTR were associated with a 43% (95% CI, 27-62%) increase and a 33% (95% CI, 15-47%) reduction in the outcome. However, the joint evaluation of TTR and BP-CV in a common multivariable model indicated that a standardized change of TTR was associated with the outcome to a greater extent than BP-CV (mean hazard ratios of 30% vs. 24%, respectively). When combined with the higher BP standardized-CV quartile, the lower TTR quartile predicted the outcome by 2.3 times (95% CI, 1.1-5.4) compared to the inverse TTR and BP-CV quartile pattern., Conclusion: High BP-CV or low TTR was associated with future cardiovascular events in a cohort of treated hypertensive patients. As a determinant, the extent of TTR value appears greater than BP-CV when these measures are considered in the same multivariable model.

Background: Some migraine treatments are contraindicated for patients with cardiovascular disease (CVD) or risk factors (CVRFs). We report safety and efficacy of lasmiditan, a new oral acute migraine treatment with no cardiovascular contraindication, in Japanese patients with CVRFs., Research Design and Methods: MONONOFU was a multicenter, randomized, double-blind, placebo-controlled, phase 2 study of Japanese patients with migraine (met International Headache Society criteria, Migraine Disability Assessment score ≥11, disabling migraine for ≥1 year). Eligible patients were randomized (7:3:7:6) to placebo or lasmiditan 50, 100, 200 mg. This prespecified analysis described CVDs, CVRFs, and cardiovascular treatment-emergent adverse events (TEAEs). Efficacy (proportion pain-free, experienced pain relief, most bothersome symptom-free, or disability-free 2 hours post-dose) was evaluated within CVRF subgroups (≤1, ≥2)., Results: Of 846 randomized patients, 691 were analyzed (CVRF≤1: 375; CVRF≥2: 316). The proportion of lasmiditan-treated patients with ≥1 TEAE was not related to CVRF numbers. Eighteen (3.8%) lasmiditan-treated and three (1.4%) placebo-treated patients reported likely cardiovascular TEAEs. Lasmiditan was more effective than placebo at relieving pain, symptoms, and disability in both CVRF subgroups. There was no consistent relationship between CVRF subgroups and efficacy., Conclusions: Lasmiditan was well tolerated and effective in Japanese patients with migraine and CVRFs., Trial Registration: ClinicalTrials.gov: NCT03962738.

Introduction: Psoriasis is an inflammatory disease nowadays considered not only as a cutaneous but as a systemic disease. Among the numerous comorbidities, psoriatic arthritis (PsA), depression, obesity, and cardiovascular disease (CVD) are considered the most frequent. In addition, metabolic syndrome (MetS), which involves hypertension, dyslipidemia, obesity, and atherosclerosis, has presented a higher prevalence in recent years, especially in psoriatic patients., Areas Covered: The mechanism linking anti-tumor necrosis factor (TNF) to MetS and CVD has been widely explained, while there are unknowns about inhibitors of interleukin (IL)-17 and -23. Considering the growing incidence of CVD in the world's population and in particular the strict correlation in patients with psoriasis, it is important to identify therapeutic options able to avoid a negative impact on patients with both conditions. The aim of this paper is to perform a review of the scientific literature with a focus on the pathogenetic mechanism linking psoriasis to CVD and MetS., Expert Opinion: The scientific evidence currently available allows us to consider and support the use of anti-IL-17 and anti-IL-23 as a first-line therapy choice in psoriatic patients with high risk of CVDs or MetS.

Diffuse large B-cell lymphoma is an aggressive disease occurring primarily in elderly patients. Despite high curative rates with doxorubicin-containing treatment, some elderly patients receive less intensive treatments, mainly due to advanced age, comorbidities, and concerns of cardiotoxicity from doxorubicin-containing regimens. We analyzed 1009 patients aged 75 years or older and 10,090 age- and sex-matched comparisons. We aimed to evaluate long-term cardiovascular side effects in elderly patients treated with doxorubicin. Approximately, 64% of patients received doxorubicin-containing treatment. These patients had a persistently increased risk of new-onset heart failure with a hazard ratio of 1.5 and 1.7 when conditioning on survival without heart failure to 6 and 24 months, respectively. Moreover, we observed an increased risk of venous thromboembolism during the first six months following the lymphoma diagnosis. On the contrary, no difference in risk of developing ischemic heart disease or stroke following doxorubicin-containing treatment was observed.

Context: Waist-to-height ratio (WHtR) is a controversial evaluation index of cardiovascular risk factors (CVRFs) in children and adolescents., Objective: To assess the accuracy of WHtR as a measure to screen for clusters of at least one CVRF (CVRF 1 ), two CVRFs (CVRF 2 ), and three CVRFs (CVRF 3 ) in different ages, sexes, regions and cut-offs., Methods: The PubMed, Web of Science, EBSCOhost, Springer, Taylor & Francis Online, Wiley Online Library, Wanfang, and CNKI databases were searched for eligible publications up to June 2021. The QUADAS-2 checklist was used to assess the methodology of the included studies., Results: Twenty-two studies that evaluated 85281 children and adolescents aged 5-19 years were included in the meta-analysis. The AUSROC values were 0.56 (95% CI: 0.54-0.57), 0.82 (95% CI: 0.81-0.83), and 0.89 (95% CI: 0.89-0.90) for CVRF 1 , CVRF 2 , and CVRF 3 , respectively. Higher AUSROC values were found for adolescents (12-19 years), that is, 0.91 (95% CI: 0.88-0.93), 0.90 (95% CI: 0.87-0.92) for males, and 0.91 (95% CI: 0.90-0.91) for a cut-off of ≥ 0.51 in the identification of CVRF 3 ., Conclusion: WHtR can be used as an accurate screening tool for CVRF 3 and CVRF 2 in children and adolescents, and it is recommended to select different cut-offs according to different ages, sexes, and regions.

Objective: To investigate the effects of an 8-week walking training program on glycemic control, lipid profile, and inflammatory markers in individuals with chronic spinal cord injury (SCI)., Design: A pilot, single-group, pretest-posttest study., Setting: A neuromuscular research laboratory., Participants: Eleven participants with chronic SCI., Intervention: An 8-week walking training program using a treadmill, a body weight-supported system, and an assistive gait training device., Outcome Measures: Levels of glycated hemoglobin (HbA 1c ), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), C-reactive protein (CRP), and interleukin-6 were assessed before and after the walking training., Results: Following the walking training, there was a statistically significant decrease in HbA 1c level ( P <0.01) of uncertain clinical significance. The lipid profile improved after training, as shown by a statistically and clinically significant increase in HDL-C level ( P <0.01) and a statistically significant decrease in LDL-C level ( P <0.1) of no clinical significance. The ratio of LDL-C to HDL-C was significantly reduced ( P <0.01). In regard to inflammatory markers, concentrations of IL-6 showed a significant reduction after training ( P =0.05) of unknown clinical significance, while those of CRP trended to decrease ( P =0.13)., Conclusion: The findings of this pilot study suggest that an 8-week walking training program may produce favorable changes in risk markers of cardiovascular disease in individuals with chronic SCI as shown by clinically meaningful improvements in HDL-C, and small changes in the right direction, but uncertain clinical significance, in HbA1c, LDL-C and IL-6. A randomized controlled trial is needed to compare the effects of walking training on these outcome measures with those of other exercise modalities suitable for this population, and to see if more prolonged exercise exposure leads to favorable parameters of significant size to justify the exercise modality.

Introduction: The recent COVID-19 pandemic has induced an increase in anxiety, stress, and depression in the world population, prompting a reevaluation of these well-known risk factors on cardiovascular burden., Areas Covered: This short report analyzes the impact of the pandemic on stress and depression, highlighting how the phenomenon has particularly affected women and highlights the strategies that can be undertaken after the pandemic to reduce stress and depression. We have analyzed the pandemic because it has completely changed the scenario of cardiovascular risk factors with an important increase in socio-economic stressors., Expert Opinion: It is still difficult to assess the damage produced on cardiovascular risk just as it is almost impossible to predict how the overwhelming and important increase in Long-Covid Syndromes will impact the population. Strong action is needed to support critical situations and to implement social campaigns aimed at restoring healthy lifestyles. Physical activity can be an easy and inexpensive tool to help cope with stress and depression.

Introduction: FIFA World Cup represent one of the world's greatest phenomena. The spectators watch the matches of national teams with great emotional involvement. It is well documented fact that emotional stress can be a trigger of unwanted cardiovascular (CV) event., Aim: The aim of this retrospective study was to determine whether there had been an increase in the number of the emergency admissions for CVD in the Emergency Room and Clinic for Cardiovascular Diseases of the Sestre milosrdnice University Hospital Centre during and after the matches that the Croatian national team played in the FIFA World Cup 2018., Methods: The hospital's database was examined for the dates when Croatia played its matches, plus two more days after each match. An unexposed period that included the same dates in 2017 and 2019 was formed., Results: 1093 cases were assessed. The incidence of CV admissions during the exposed period was 1.15 (95% confidence interval [CI]; 1.02 to 1.31) times higher than during the unexposed period. There was a 1.30 (95% CI; 1.1 to 1.54) times higher incidence in women compared to the unexposed period. Arrhythmias and angina pectoris were the CVDs that occurred more frequently in the exposed period., Conclusion: This study showed that watching Croatian national team's matches and cheering represented an additional risk for a CV incident, especially in women.

Introduction: Dyslipidemia therapeutics have primarily focused on lowering levels of low-density lipoprotein cholesterol. However, many patients continue to experience cardiovascular events, despite effective lowering of LDL-C. This has prompted efforts to target additional risk factors to achieve more effective prevention of cardiovascular disease. Emerging evidence suggests that triglyceride rich lipoproteins play a causal role in atherosclerosis, highlighting the potential for specific therapeutic lowering., Areas Covered: (1) Evidence to support the causal role of triglyceride rich lipoproteins in atherosclerotic cardiovascular disease. (2) Use of existing lipid modifying therapies to target triglyceride rich lipoproteins. (3) Development of novel therapeutic agents that target triglyceride rich lipoproteins and their potential impact on cardiovascular risk., Expert Opinion/commentary: Evidence from preclinical, observational and genetic studies highlight the role of triglyceride rich lipoproteins in the causal pathway of atherosclerotic cardiovascular disease. A number of existing agents have the potential to reduce residual cardiovascular risk associated with hypertriglyceridemia. However, emerging agents have the potential to substantially and preferentially lower triglyceride levels beyond contemporary therapeutics. How they will modulate cardiovascular risk will ultimately be determined by large clinical outcomes trials. They do provide the opportunity to substantially influence the way we target dyslipidemia in the prevention of cardiovascular disease.

Background: A body shape index (ABSI) has been proven to be related to a population's CVD incidence. However, the application of this indicator has produced different results., Aim: This study aimed to evaluate the applicability of the ABSI in predicting the incidence of CVD in rural Xinjiang, China, and compare it with waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and body mass index (BMI)., Subjects and Methods: 5375 people aged 18 years or older were included in the study. We used the Cox proportional hazard model to evaluate the relationship between WC, WHR, WHtR, BMI, and ABSI and the incidence of CVD, the area under the curve (AUC) to evaluate the predictive power of each anthropometric index for the incidence of CVD, and restricted cubic splines are used to analyse the trend relationship between anthropometric indicators and the incidence of CVD., Results: After multivariate adjustment, standardised WC, WHR, WHtR, BMI, and ABSI all positively correlated with the incidence of CVD. WC had the highest HR (95% CI) value, 1.64 (1.51-1.78), and AUC (95% CI) value, 0.7743 (0.7537-0.7949). ABSI had the lowest HR (95% CI) value, 1.21(1.10-1.32), and AUC (95% CI) value, 0.7419 (0.7208-0.7630). In the sex-specific sensitivity analysis, the predictive ability of traditional anthropometric indicators for the incidence of CVD is higher than that of ABSI., Conclusions: In the rural areas of Xinjiang, the traditional anthropometric indicators of WC had better ability to predict the incidence of CVD than ABSI.

Background: A healthy lifestyle should be adopted by young people to maintain cardiometabolic health., Aim: To verify the prevalence and the integrated role of lifestyle habits in cardiometabolic risk factors according to sex in adolescents., Subjects and Methods: Cross-sectional study developed with 1502 adolescents, aged 10-17 years. Lifestyle habits included physical activity, screen time and sleep duration evaluated through a questionnaire. Cardiometabolic risk score (CMRS) was calculated by summing z -scores, divided by 6. For statistical analyses, multivariable binary and multinomial logistic regression models were used., Results: 80.7% of the boys classified with adverse CMRS presented physical inactivity, compared to normal CMRS. In girls, 42.6% showed inadequate sleep compared to normal CMRS. Boys classified as inactive showed higher odds for obesity, as well as altered triglycerides (TGs), and systolic blood pressure, risk for cardiorespiratory fitness (CRF), high waist circumference, and CMRS, compared to the active. A prolonged screen time increased the odds for altered glucose and decreased the odds for altered TGs. In girls, inadequate sleep duration presented higher odds for overweight, obesity, risk for CRF, and high CMRS, compared to adequate sleep., Conclusion: Physical activity for boys and sleep duration for girls are important to maintain healthy metabolic health amongst youth.

Background: Cardiorespiratory fitness (CRF) is considered a beneficial effect of physical activity (PA). PA and excessive screen time have implications for cardiometabolic risk., Objective: To verify the association between screen time and CRF grouped by cardiometabolic risk factors., Subjects and Methods: Cross-sectional study evaluated 1,253 schoolchildren (54.2% girls) aged seven to 17 years from southern Brazil. The outcomes were body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), and diastolic (DBP), glucose, and lipid profile. Exposure was a combined variable of self-reported screen time (television, video game, computer) and CRF., Results: The main result is that CRF had a more consistent association with anthropometric factors than with metabolic variables. Low CRF students, regardless of screen time, showed a 15% increase in the risk of elevated WC ( p  < 0.001) and a 24% (<2 h screen time) and 19% (≥2 h) higher risk of overweight ( p  < 0.001). Second, the increase in SBP was associated with a combination of the two risk factors, ≥2 h screen time/low CRF was associated with a 7% increase in elevated SBP ( p  = 0.025)., Conclusion: Low CRF was a risk factor for elevated BMI and WC, regardless of screen time. High screen time and low CRF were associated with higher SBP values.

Introduction: In recent decades, life expectancy has increased considerably. The cardiovascular effects of Obstructive Sleep Apnea (OSA) in the elderly lead to patient disability and high resource consumption. Intermittent nocturnal hypoxia leads to hemodynamic stress and adrenergic activation, which promotes cardiovascular disease. However, chronic intermittent hypoxia may protect elderly patients from cardiovascular events (CVE) due to biological adaptation., Areas Covered: OSA patients are at increased risk of cardiovascular events. The severity of OSA increases cardiovascular risk, and this association also exists in the elderly. This article reviews the association between OSA, CPAP treatment, and CVE, particularly stroke and coronary heart disease (CHD), in the elderly. MEDLINE and the Cochrane Collaboration databases were searched from inception to July 2021., Expert Commentary: Although a positive association between OSA and the incidence of cardiovascular disease in the elderly has been established, the role of sleep apnea in certain cardiovascular events remains controversial. Most authors agree that untreated OSA is a risk factor for stroke or worse stroke prognosis. However, the association between OSA and CHD is usually less pronounced than between OSA and stroke, especially in the elderly.

Objectives: To evaluate the association of meat consumption with prevalent depressive symptomatology and cardiovascular disease (CVD) incidence in apparently healthy individuals. Methods: ATTICA study was conducted during 2001-2012 including n  = 1514 men and n  = 1528 women (aged >18 years old) from the greater Athens area, Greece. At baseline, depressive symptomatology through Zung Self-Rating Depression Scale (range 20-80) and meat consumption (total meat, red, white and processed meat) through validated semi-quantitative food frequency questionnaire were assessed. Follow-up (2011-2012) was achieved in n  = 2020 participants ( n  = 317 cases); n  = 845 participants with complete psychological metrics were used for the primary analysis. Results: Ranking from 1st to 3 rd total meat consumption (low to high) tertiles, participants assigned in 2 nd tertile had the lowest depressive-symptomatology scoring ( p<0.001 ). This trend was retained in multiadjusted logistic regression analysis; participants reporting moderate total and red meat consumption had ∼20% lower likelihood to be depressed (i.e. Zung scale<45) compared with their 1st tertile counterparts (Odds Ratio (OR) total meat 0.82, 95% Confidence Interval (95%CI) (0.60, 0.97) and OR red meat 0.79 95%CI (0.45, 0.96)). Non-linear associations were revealed; 2-3 serving/week total meat and 1-2 servings/week red meat presented the lowest odds of depressive symptomatology (all ps<0.05 ). These U-shape trends seemed to attenuate the aggravating effect of depressive symptomatology on CVD hard endpoints. All aforementioned associations were more evident in women (all ps for sex-related interaction<0.05 ). Discussion: The present findings generate the hypothesis that moderate total meat consumption and notably, red meat may be more beneficial to prevent depressed mood and in turn hard CVD endpoints.