Background The clinical significance of isolated diastolic hypertension (IDH), particularly in relation to subclinical vascular changes, remains unclear and may vary across age groups. This study evaluated the age-stratified association between IDH and carotid intima-media thickness (IMT).
Methods This cross-sectional study included 6,759 Korean adults aged 30–64 years from the Cardiovascular and Metabolic Diseases Etiology Research Center (CMERC) cohort. Participants with a history of cardiovascular disease or use of antihypertensive medication were excluded. Blood pressure was classified according to the 2017 American College of Cardiology/American Heart Association guidelines into four categories: no hypertension, IDH, isolated systolic hypertension, and systolic diastolic hypertension. Carotid IMT was measured by B-mode ultrasonography, and vascular thickening was defined as IMT ≥0.857 mm (75th percentile). Multivariable logistic regression analyses were performed with age stratification.
Results Among participants younger than 50 years, IDH was significantly associated with carotid IMT thickening after adjustment for age, sex, body mass index, educational attainment, physical activity, smoking, diabetes, total cholesterol, high-density lipoprotein cholesterol, lipid-lowering drug use, C-reactive protein, and study site (odds ratio [OR], 1.57; 95% confidence interval [CI], 1.10–2.26). No significant association was observed in participants aged 50 years or older (OR, 0.89; 95% CI, 0.72–1.09). Both isolated systolic hypertension and systolic diastolic hypertension were associated with carotid IMT thickening in all age groups.
Conclusions IDH was associated with subclinical vascular changes in younger adults but not in older adults. These findings highlight the age-specific nature of the association of IDH with cardiovascular risk.
Low-density lipoprotein cholesterol (LDL-C) is a causal and modifiable risk factor for atherosclerotic cardiovascular disease, and intensive reduction of LDL-C is central to prevention strategies. Meta-analyses have shown that each 1 mmol/L (approximately 38.7 mg/dL) decrease in LDL-C confers about a 22% relative risk reduction in major vascular events, independent of baseline LDL-C levels. Despite the proven efficacy of statins and ezetimibe, many patients fail to reach recommended LDL-C targets due to inadequate response, intolerance, or poor adherence to daily therapy. The development of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors has transformed lipid management, providing substantial LDL-C reduction. Recently, next-generation agents with extended dosing intervals have emerged, including recaticimab, a fully human monoclonal antibody, and inclisiran, a small interfering RNA therapy. Recaticimab binds circulating PCSK9, preventing degradation of the low-density lipoprotein receptor, and achieves sustained LDL-C reductions of about 50% with dosing every 8 to 12 weeks. Inclisiran employs N-acetylgalactosamine (GalNAc)-mediated hepatocyte delivery to silence PCSK9 messenger RNA, producing comparable LDL-C reductions with twice-yearly maintenance dosing after an initial loading dose. Their extended dosing schedules offer potential benefits in adherence and long-term lipid control, particularly for high-risk patients who struggle with frequent dosing or have statin intolerance. As outcome data accumulate, these therapies may further reduce residual atherosclerotic cardiovascular disease risk and become increasingly important in comprehensive prevention strategies.
Cardiovascular disease (CVD) remains the leading cause of mortality worldwide, highlighting the need for effective preventive strategies. This consensus statement emphasizes the critical role of regular physical activity, including aerobic and muscle- strengthening exercises, in reducing key CVD risk factors such as hypertension, dyslipidemia, obesity, and insulin resistance. Recommendations are provided for the general adult population as well as specific subgroups, including older adults, pregnant and postpartum women, individuals with CVD, and those with physical limitations. The importance of reducing sedentary behavior and integrating physical activity into daily life is also addressed. Recommendations should focus on tailored interventions, supportive environments, and evidence-based policies that encourage active lifestyles. Further research specific to the Korean population will enhance the development of evidence-based, population-tailored guidelines for more effective CVD prevention in Korea.
Background Cardiovascular disease (CVD) is the second most common cause of death in Korea. We investigated the incidence rate of CVD in the Korean adult population using the Korean National Health Insurance Service database.
Methods This cohort included individuals aged 20 years and older who participated in the National Health Screening Program in 2012, and longitudinal follow-up data were collected through December 2022. The incidence of CVD, myocardial infarction, ischemic stroke, and cardiovascular mortality was evaluated. The incidence of CVD in relation to key cardiovascular risk factors was also analyzed.
Results A total of 4,737,616 participants were included in the final analysis. The mean age was 47.9 years, with a slight male predominance (54.1%). Older age, male sex, and current smoking were consistently associated with higher risk across all CVD outcomes. The overall adjusted incidence rate was 288.9 per 100,000 person-years for CVD. The 1.6-fold higher incidence of CVD in individuals with type 2 diabetes mellitus, 1.5-fold higher incidence in those with hypertension, and 1.4-fold in those with metabolic syndrome clearly demonstrate the cumulative risk conferred by these comorbidities. The most pronounced increase in cardiovascular mortality was observed in individuals with chronic kidney disease, reaching a 2.0-fold higher rate.
Conclusions CVD and its comorbidities in the Korean adult population represent a significant health burden. Prompt and aggressive lifestyle modification and management of risk factors should be actively emphasized.
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Background Although retinal imaging–based artificial intelligence (AI) tools have recently been introduced for cardiovascular disease (CVD) risk assessment, little is known about the distribution of these AI-derived scores across the full age spectrum or their associations with traditional cardiometabolic risk factors at different ages.
Methods We analyzed data from 138,745 participants who underwent routine health examinations at two health screening centers in Seoul, Korea. The AI-based retinal CVD risk score (Dr.Noon CVD), as well as anthropometric, hemodynamic, and metabolic indices and cardiometabolic disease status, were compared across ages 16 to 96 years. In a subgroup of 13,182 individuals who underwent coronary artery calcium scoring (CACS) by cardiac computed tomography, we evaluated the performance of the Dr.Noon CVD score in detecting CACS using receiver operating characteristic curve analysis.
Results Mean Dr.Noon CVD scores rose steadily with age from 14.2±2.9 (<30 years) to 46.3±6.5 (≥70 years), closely mirroring the increase in traditional cardiovascular risk factors with age. Additional analysis using CACS demonstrated that the Dr.Noon CVD score achieved an area under the curve of 0.80 (95% confidence interval, 0.80–0.81) for detecting any coronary calcification, defined as CACS >0, and an area under the curve of 0.82 (95% confidence interval, 0.81–0.83) for identifying significant calcification burden, defined as CACS >100.
Conclusions Dr.Noon CVD scores were consistently correlated with age, conventional risk factors, and CACS, suggesting a potential role in broad-based cardiovascular risk stratification and in guiding personalized prevention strategies.
Despite being the leading cause of mortality among women, cardiovascular disease remains underrecognized and undertreated due to sex-related differences in clinical presentation, risk factors, and healthcare delivery. Women are often excluded from clinical trials, undergo fewer diagnostic evaluations, and are less likely to receive guideline-directed therapies. Additionally, female-specific risk factors, such as pregnancy-related disorders, early menopause, and autoimmune diseases, are frequently overlooked. Addressing these disparities through sex-specific risk assessment, increased clinician awareness, and inclusion of women in research is imperative to optimize prevention and treatment strategies and reduce cardiovascular disease-related morbidity and mortality in women.
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Sodium-glucose cotransporter 2 (SGLT2) inhibitors have transformed the treatment of both cardiovascular and renal diseases. Although originally developed for glycemic control in type 2 diabetes mellitus, these agents have demonstrated significant benefits by reducing cardiovascular events and slowing the progression of kidney disease, even in patients without diabetes. Landmark trials, including EMPA-REG OUTCOME, CANVAS, DECLARE-TIMI 58, and DAPA-HF, consistently demonstrated reductions in heart failure hospitalizations and renal deterioration among patients at high cardiovascular risk. However, many of these studies excluded patients with advanced chronic kidney disease (CKD), limiting the generalizability of their findings for this population. More recent investigations, such as CREDENCE, DAPA-CKD, and EMPA-KIDNEY, have focused on patients with CKD and confirmed that SGLT2 inhibitors offer significant renal and cardiovascular protection regardless of diabetic status. This review summarizes key clinical trials, outlining their design and outcomes with a particular emphasis on inclusion and exclusion criteria and the implications for CKD populations. Further, it discusses the practical application and safety considerations of SGLT2 inhibitors in nephrology, underscoring their emerging role as a fundamental therapeutic strategy in CKD management.
Lipoprotein(a) (Lp(a)), is not a new entity; however, it has become an increasingly discussed and studied risk factor for atherosclerotic cardiovascular disease (CVD) and aortic valve stenosis. Recent guidelines recommend measuring Lp(a) levels throughout the lifetime in patients at high risk for CVD, as Lp(a) can serve as a signature marker for identifying individuals at elevated risk for CVD. Numerous genetic and epidemiological studies have underscored the significant causal role of Lp(a) in the incidence of CVD. Individuals with high Lp(a) levels face an increased risk for CVD, even with optimal low-density lipoprotein cholesterol lowering. Furthermore, Lp(a) levels are primarily determined by genetics and are not significantly reduced by lifestyle changes or certain medications. This review will discuss the characteristics, genetic factors, and epidemiological properties of Lp(a) in relation to CVD.
This review explores the complex relationship between diabetic neuropathy and cardiovascular disease (CVD). Neuropathy, a common complication of type 1 and type 2 diabetes, is divided into autonomic and peripheral types, each impacting cardiovascular health. Cardiovascular autonomic neuropathy, a form of autonomic neuropathy, is associated with various CVD complications, including arrhythmias, impaired nocturnal blood pressure regulation, and increased mortality. The prevalence of cardiovascular autonomic neuropathy varies depending on the type and duration of diabetes and is influenced by factors like glycemic control and metabolic stress. Peripheral polyneuropathy, which is often linked to diabetic foot disease, is also correlated with elevated CVD risk; research suggests shared pathophysiological mechanisms between peripheral neuropathy and cardiovascular conditions. Screening for neuropathies using tools like the Michigan Neuropathy Screening Instrument and heart rate variability analyses can facilitate early detection of CVD risk. Additionally, emerging technologies, like deep learning models, have demonstrated promise in detecting early cardiovascular patterns associated with autonomic neuropathy through electrocardiogram analysis. These findings underscore the value of integrating novel diagnostic approaches for early intervention. As CVD represents a leading cause of death among patients with diabetes, this article emphasizes the need for thorough assessment and proactive management of neuropathy to mitigate cardiovascular risk. The review recommends a multidisciplinary approach to diabetes care, including early screening, accurate risk stratification, and targeted therapeutic strategies to prevent or slow the progression of CVD in patients with autonomic and peripheral neuropathies. Further research is warranted to clarify the optimal intervention strategies for reducing CVD risk in these populations.
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Cardiovascular disease is a leading cause of global mortality, necessitating effective strategies for prevention and treatment. The cardiovascular disease continuum concept highlights the progression from risk factors such as hypertension and diabetes mellitus to advanced stages, including heart failure (HF) and death. Sodium-glucose cotransporter 2 (SGLT2) inhibitors, initially developed to manage diabetes, have emerged as effective therapies across all stages of the cardiovascular disease continuum. Numerous cardiovascular outcome trials demonstrate that SGLT2 inhibitors significantly reduce major adverse cardiovascular events and hospitalizations for HF in patients with and without established atherosclerotic cardiovascular disease. Notably, SGLT2 inhibitors have shown remarkable benefits in reducing HF risk, even in patients without diabetes, including those with HF and preserved ejection fraction. Furthermore, recent studies in post–myocardial infarction patients suggest potential benefits in reducing hospitalizations for HF. Despite their widespread use, the precise mechanisms by which SGLT2 inhibitors confer cardiovascular protection remain unclear, suggesting the need for further investigation. In conclusion, SGLT2 inhibitors have revolutionized cardiovascular disease management, offering significant therapeutic potential across a broad spectrum of patients, and are expected to play an increasingly prominent role in both the prevention and treatment of cardiovascular disease.
Background Cardiovascular disease continues to be a leading cause of death among young people globally. This cross-sectional study was designed to assess the health behaviors, knowledge, and attitudes regarding cardiovascular disease risk factors among young adults in Erbil, Iraq.
Methods Data were collected using the WHO STEPS Instrument for Chronic Disease Risk Factor Surveillance and the Heart Disease Fact Questions.
Results Ninety percent of participants demonstrated moderate to high knowledge and exhibited a positive attitude. Multiple linear regression analysis revealed that while a history of smoking, a lack of knowledge, and the absence of formal education negatively impacted knowledge levels, being aged 38 to 45 years, recognizing the importance of consuming less salt, walking for at least 10 minutes on 5 or more days per week, and regularly checking blood sugar levels positively contributed to knowledge. Unwillingness to change lifestyle had the most significant negative influence on knowledge.
Conclusions Establishing effective educational interventions may increase knowledge and promote more positive attitudes.
Background The COVID-19 pandemic and the implementation of social distancing have been reported to negatively impact cardiovascular-related health behaviors. However, the effects of lifting social distancing restrictions on these health behaviors remain unclear. This study investigated public awareness and behavioral changes related to cardiovascular disease prevention after the end of social distancing.
Methods Between June 5 and June 12, 2023, 2,000 adults participated in the 2023 Cardiovascular Disease Prevention Awareness Survey in Korea. The survey comprehensively addressed sociodemographic factors, cardiometabolic disease history, cardiovascular disease concern, prevention awareness, and behavioral changes after the end of social distancing. Logistic regression analyses were performed to assess the associations between behavioral changes and sociodemographic factors.
Results Cardiovascular disease ranked as the second most feared disease (most feared, 18.0%; second most feared, 26.3%) after cancer (most feared, 42.3%; second most feared, 21.7%). Among nine cardiovascular disease prevention recommendations, stress management, being physically active, and maintaining a healthy diet were perceived as the most challenging recommendations. After the end of social distancing, there were more positive changes than negative changes in smoking, alcohol consumption, dietary habits, physical activity, and healthcare service use, whereas stress management more frequently changed negatively (40.0%) than it changed positively (19.5%).
Conclusions Positive changes in cardiovascular-related health behaviors, except for stress management, were observed after the end of social distancing. Further research is necessary to fully comprehend the impact of discontinuing social distancing practices.
The global response to the COVID-19 pandemic has led to rapid vaccine development and distribution. As vaccination efforts continue, concerns have arisen regarding potential adverse events associated with COVID-19 vaccination. This article examines emerging evidence on adverse events, including myocarditis, pericarditis, and thrombotic complications, in relation to COVID-19 vaccination. Reports of myocarditis and pericarditis cases following messenger RNA vaccines have sparked interest, with discussions revolving around potential mechanisms and genetic predispositions. The contrasting findings on pericarditis risk postvaccination highlight the complexity of studying this phenomenon. Thrombotic events, particularly vaccine-induced thrombotic thrombocytopenia, have garnered attention, prompting investigations into antibody responses and mechanisms. This article underscores the importance of ongoing research, collaboration, and data analysis for accurately understanding adverse events. While the COVID-19 vaccination campaign may have ended, it is still vital to maintain vigilance, collect comprehensive data and foster interdisciplinary collaboration to uphold vaccine safety and steer public health strategies in the upcoming period.
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Hypertension is a common condition among older adults, and blood pressure (BP) control is effective for preventing cardiovascular morbidity and mortality even among the oldest-old adults. However, the optimal target BP for older patients with hypertension has been a subject of debate, with previous clinical trials providing conflicting evidence. Determining the optimal target BP for older adults is a complex issue that requires considering comorbidities, frailty, quality of life, and goals of care. As such, BP targets should be individualized based on each patient's unique health status and risk factors, and treatment should be closely monitored to ensure that it is effective and well-tolerated. The benefits and risks of intensive BP control should be carefully weighed in the context of the patient's overall health status and treatment goals. Ultimately, the decision to pursue intensive BP control should be made through shared decision-making between patients and their healthcare providers.
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Community health worker-led interventions for hypertension Suning Mao, Liu Liu, Tianyi Wang, Yubin Cao Cochrane Database of Systematic Reviews.2025;[Epub] CrossRef
Background The COVID-19 pandemic has been the most pressing health challenge in recent years. Meanwhile, prevention for other diseases, such as cardiovascular disease (CVD) has been less prioritized during the pandemic. COVID-19, a novel infectious disease, both had a direct impact on public health and provoked changes in health-related behaviors, including those for CVD prevention. This study sought to examine changes in CVD-related health behaviors during the COVID-19 pandemic and related sociodemographic factors.
Methods We used data from the Cardiovascular Disease Prevention Awareness Survey conducted in Korea in June 2022. A total of 2,000 adults across Korea’s 17 provinces completed a structured questionnaire online or on a mobile device. Self-reported changes in CVD-related health behaviors were investigated. We used unadjusted and adjusted logistic regression models to explore the associations between negative changes and sociodemographic factors.
Results In smoking, drinking, and healthcare service use, the proportion of those with positive changes surpassed the proportion of respondents who reported negative changes. In contrast, negative changes predominated for diet, exercise, and stress. Most individuals (52.6%) reported a deterioration of psychological distress. These negative changes were significantly associated with age, sex, marital status, and the presence of cardiometabolic disease.
Conclusions The COVID-19 pandemic has affected CVD-related health behaviors. Based on these changes, CVD prevention should be encouraged with appropriate and prioritized strategies.
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Changes in cardiovascular-related health behaviors after the end of social distancing: the 2023 Cardiovascular Disease Prevention Awareness Survey Jaeyong Lee, Eunji Kim, Won-Young Lee, Eun-Jung Rhee, Hyeon Chang Kim Cardiovascular Prevention and Pharmacotherapy.2024; 6(2): 57. CrossRef
Cardiovascular-related health behavior changes: lessons from the COVID-19 pandemic and post-pandemic challenges Inha Jung, Won-Young Lee Cardiovascular Prevention and Pharmacotherapy.2023; 5(4): 99. CrossRef