Cardiovascular disease (CVD) commonly coexists with multiple long-term conditions (MLTC), including diabetes, chronic kidney disease, obesity, and mental health disorders. This clustering creates a syndemic burden associated with poorer outcomes, polypharmacy, high treatment burden, and rising healthcare costs. Fragmented, single-disease care models are ill-suited to address this complexity.The WHF roadmap for integrated care in people living with – or at risk of – CVD and MLTC provides a structured framework to support the design, implementation, and scale-up of person-centred, coordinated care models globally. Drawing on current evidence, expert consensus, case studies, and stakeholder surveys, the Roadmap outlines the epidemiological and systemic challenges of MLTC and identifies practical strategies adaptable across high-, middle-, and low-income settings.This Roadmap emphasises multidisciplinary teamwork, aligned financing, digital health infrastructure, workforce development, patient partnership, and robust monitoring and evaluation. By shifting from siloed care to integrated, capacity-sensitive approaches, health systems can improve clinical outcomes, enhance quality of life, reduce avoidable hospitalisations, and build resilience in the face of growing multimorbidity.

Despite clear guidelines for lipid-lowering therapies (LLT) for patients with high and very-high atherosclerotic cardiovascular disease (ASCVD) risk, a significant gap persists between recommended low-density lipoprotein cholesterol (LDL-C) management and actual clinical practice, leaving a large proportion of patients without adequate treatment. Patient age is one of several factors that may play a role in this gap. We characterized LLT prescription patterns among middle-aged and older adults with high and very-high ASCVD risk and estimated the effect of age in achieving LDL-C control. This cohort study used electronic health records of a Portuguese healthcare institution from January 2012 to December 2022. Middle-aged (40-69 years) and older (70-85 years) patients with high and very-high ASCVD risk were analysed. Exposure consisted of LLT prescriptions. LLT prescriptions were characterized in six dynamic patterns based on statin intensity (high, moderate, low) and the addition of ezetimibe. Risk for LDL-C control at 150 and 360 days was compared between the two age cohorts using multivariate Cox regressions. A total of 36,866 patients were identified, accounting for 407,500 LLT prescriptions. High-intensity statins were more frequently prescribed to middle-aged patients (12.0% vs. 8.6% older), whereas older patients more often received low-intensity statins (8.6% vs. 5.9% middle-aged). The use of statin-ezetimibe combinations was low across all age groups (0.1-1.4%). At 150 and 360 days of follow-up, LDL-C targets were achieved in 2,661 (0.7%) and 14,047 (3.8%) prescriptions, respectively. Older patients had a 32% higher rate of reaching LDL-C goals at 150 days (HR = 1.32, 95% CI = 1.19-1.45) and 27% at 360 days (HR = 1.27, 95% CI = 1.19-1.35). LDL-C control remains low in high- and very-high-risk patients from a Portuguese integrated health care unit, with particularly low achievement rates among middle-aged adults, despite their higher use of high-intensity LLT. These findings highlight the need for optimized treatment strategies, including age-specific approaches.

Evidence has shown that lipoprotein(a) (Lp[a]) is an independent, causal, genetic risk factor for cardiovascular disease (CVD) that promotes the progression of high-risk, vulnerable atherosclerotic plaque phenotypes. Systems biology integrates multiomics datasets to study linear and nonlinear relationships to enhance understanding of the molecular patterns of disease. One such example is the Genetic Loci and the Burden of Atherosclerotic Lesions (GLOBAL) study, which utilizes multiomics profiling to unravel the molecular signatures of Lp(a)-driven CVD. Using deep phenotyping of coronary atherosclerosis by coronary computed tomography angiography, whole-genome sequencing for genetic analysis, and evaluation of thousands of omics measurements and circulating biomarkers, it is possible to describe the atherogenic milieu associated with Lp(a)-driven CVD. By leveraging the multiomic evaluation of Lp(a)-driven coronary phenotypes, we can begin to translate these findings into real-world strategies for earlier recognition of distinct Lp(a)-driven CVD, which may contribute to improved risk mitigation strategies in clinical practice.

Equitable representation in clinical trials (CTs) is essential for the validity, generalizability, and ethical integrity of medical research. However, participation from low- and middle-income countries (LMICs) remains disproportionately low, particularly in the Middle East and North Africa (MENA) region. Iraq, despite a substantial disease burden, has minimal participation in global clinical research, and patient-level determinants of CT engagement remain largely unexplored. Understanding patient perceptions in these settings is essential to enhance recruitment in CTs. To assess awareness, willingness, motivators, and concerns regarding CT participation among Iraqi patients, and to identify demographic and perceptual factors associated with willingness to participate. A multi-center, cross-sectional study was conducted using a validated 16-item interviewer-administered survey among patients attending five major teaching hospitals in Baghdad, Iraq, between October 2023 and February 2024. The survey assessed demographic characteristics, awareness of CTs, prior participation, perceived motivators and barriers, and willingness to participate under different trial scenarios (invasive, non-invasive, digital, and drug safety contexts). If a respondent reported lack of knowledge of the term 'clinical trial,' the investigator explained the meaning in simple Arabic to enable the respondent to participate. Descriptive statistics, univariate and multivariate analyses were performed to examine associations between participant characteristics and willingness to participate. A total of 631 patients (mean age 41.7 ± 16.2 years; 60.1% women) with generally low educational attainment (30.1% primary education; 14.4% no formal education) participated. Awareness of CTs was extremely limited, as 90.6% of participants had never heard of CTs and only 1.1% reported prior participation. More than half (51.3%) expressed concerns regarding participation, with safety being the predominant concern (85.9%), followed by family obligations that could limit trial adherence (55.8%), and fears of being experimented upon. Despite these concerns, altruistic motivations were prominent, with advancing medical science (86.4%) and helping other patients (85.4%) cited most frequently. If invited to participate in a CT, 40.1% of respondents indicated willingness, whereas 51.3% would decline and 8.6% were uncertain. Willingness varied substantially by trial characteristics: only 28.8% were willing to participate in trials involving invasive procedures, compared with the 61.2% who would participate in non-invasive studies, including educational interventions, telemedicine, or digital applications. Perceived drug safety was a key determinant, with willingness increasing to 70.8% when investigational drugs had confirmed safety, but declining sharply when safety was uncertain, with 85.9% declining willingness. Overall, educational level, prior awareness of CTs, and safety-related concerns were strongly associated with willingness to participate. In multivariable analysis, higher education (college/postgraduate) was independently associated with greater willingness to participate (OR 2.06, 95% CI 1.15-3.68), whereas having concerns about CTs was associated with reduced willingness (OR 0.42, 95% CI 0.27-0.66). Iraqi patients demonstrate profound gaps in awareness of CTs and substantial safety-related concerns, yet exhibit strong altruistic motivations and openness to non-invasive and digital research models. These findings underscore the need for culturally tailored public education, transparent communication regarding trial safety, and innovative trial designs to enhance participation. Addressing these barriers is critical to improve equitable representation of LMIC populations in general and of the MENA region in particular in global clinical research, and to strengthen the external validity of CT evidence.

Introduction:Unhealthy lifestyle habits, including high-calorie diets and physical inactivity, increase the risk of cardiovascular disease (CVD). Chronic conditions such as hypertension, diabetes, and kidney disease frequently precede cardiovascular events. This study aimed to characterize the sociodemographic and clinical profiles of individuals who have experienced such events and to provide updated evidence on the prevalence of cardiovascular risk factors in the Mexican adult population.Methods:Data were obtained from adults aged ≥ 20 years with chronic diseases who participated in the 2018 National Health and Nutrition Survey. Biomarkers were measured from fasting (8 h) blood samples. The survey used a cross-sectional, probabilistic design with national representativeness. The prevalence of major cardiovascular risk factors was estimated by sex and CVD diagnosis. Logistic regression analyses yielded adjusted odds ratios, identifying significant associations between key risk factors and CVD.Results:Women exhibited a greater prevalence of obesity (38.6%), diabetes (17.4%), dyslipidemia (88.5%), and a personal history of myocardial infarction (19.5%) in comparison to men; similarly, women and individuals aged 50–59 years demonstrate the presence of more than two concurrent risk factors. The prevalence of obesity, dyslipidemia and hypertension in women was associated with an increased likelihood of a CVD diagnosis, adjusted odds ratio (aOR) = 2.6[95% CI: 1.5, 4.5].Conclusion:The prevalence of cardiovascular events was similar between sexes; however, different risk factor profiles were identified. The pharmacological treatment alone has not been sufficient to achieve therapeutic goals.

Central obesity, as indicated by waist circumference (WC), is a major risk factor for coronary artery disease (CAD). However, the independent causal role of WC in CAD remains underexplored, particularly after adjusting for metabolic comorbidities such as hypertension and diabetes. This study aims to evaluate the causal relationship between WC and CAD using a two-pronged approach: propensity score-matched observational analysis and Mendelian randomization (MR) analysis. Data from the National Health and Nutrition Examination Survey (NHANES) 1999-2023 were used for cross-sectional analysis, while genetic instrumental variables associated with WC were sourced from genome-wide association studies (GWAS). We performed inverse variance weighted (IVW) MR analysis and sensitivity tests including MR-Egger and leave-one-out analysis. Propensity score matching showed that WC was significantly higher in the CAD group compared to controls (p < 0.001). MR analysis confirmed a causal relationship between increased WC and CAD risk, with an estimated causal effect size of 0.02884 (95% CI: 0.016, 0.041; p = 0.00000883). Sensitivity analyses validated the robustness of these findings. Our results provide strong genetic and observational evidence linking increased WC with a higher risk of CAD. These findings highlight the need for targeted interventions to reduce central obesity and prevent CAD, especially in populations prone to metabolic disorders.

Cardiovascular diseases (CVDs) still represent a major cause of mortality, with inflammation playing a key role in their pathogenesis. Thus, elucidating the possible effects of disease-modifying antirheumatic drugs (DMARDs) on CVD risk in the general population may hold considerable clinical implications. Genetic instruments were employed to proxy the pharmacological effects of seven DMARD classes, including sulfasalazine, cyclosporine, leflunomide, IL-6 inhibitors, TNF-alpha inhibitors, abatacept, rituximab, and JAK inhibitors. To investigate their potential causal associations with 11 CVD outcomes, a comprehensive framework incorporating two-sample Mendelian randomization (TSMR), summary-data-based MR (SMR), and colocalization analysis was developed. Lastly, several sensitivity analyses were undertaken to verify the robustness of our findings. In the primary TSMR results, sulfasalazine targeting PLA2G1B was linked to reduced risks of heart failure (OR: 0.86, 95% CI: 0.80-0.94), total cholesterol (OR: 0.89, 95% CI: 0.83-0.95), high-density lipoprotein cholesterol (OR: 0.88, 95% CI: 0.82-0.94), and aortic stenosis (OR: 0.72, 95% CI: 0.62-0.84). Sulfasalazine targeting RELB exhibited similar protective associations, whereas RELA exhibited the opposite associations. Moreover, IL-6R was robustly associated with increased risks of atrial fibrillation (OR: 1.29, 95% CI: 1.16-1.44), coronary artery disease (OR: 1.38, 95% CI: 1.23-1.56), myocardial infarction (OR: 1.27, 95% CI: 1.11-1.44), ischemic stroke (OR: 1.34, 95% CI: 1.22-1.48), and aortic stenosis (OR: 1.75, 95% CI: 1.46-2.09). Genetically higher IL-6R expression was associated with increased CVD risk, suggesting that IL-6 inhibition may confer cardiovascular benefit. SMR analysis further validated the associations of RELA, CD80, and IL-6R with one or more cardiovascular phenotypes. Finally, colocalization analyses for IL-6R and RELB provided strong evidence supporting their involvement in multiple CVDs. Overall, this study presents evidence supporting a causal association between DMARDs and several CVDs. Nevertheless, further clinical investigations are necessary to validate our findings.

ST-elevation myocardial infarction (STEMI) is a life-threatening, time-sensitive emergency. Cardiovascular diseases, including STEMI, are increasing on the African continent. Improving optimal outcomes for these patients requires a system-wide approach as the existing literature is unclear. To describe and summarise the African literature on STEMI Systems of Care (STEMI SOC). This scoping review was designed following the PRISMA-ScR guidelines. An a priori search strategy was applied to EbscoHost, PubMed, and Google Scholar databases. A total of 671 articles were identified. Following the exclusion of 619 articles, 52 articles were eligible for inclusion. STEMI patients in Africa are generally younger than their Western counterparts, present late to healthcare facilities, have insufficient healthcare insurance, and are non-adherent to discharge medication. Emergency medical services are lacking, there is a shortage of percutaneous coronary intervention (PCI) facilities, and emergency departments are disorganised. STEMI reperfusion times are delayed, data collection and quality assurance initiatives are inadequate, and STEMI referral networks and registries are underdeveloped. In addition, there is a deficiency of ECG and telemetry, a shortage of healthcare workers, a lack of adherence to guideline-recommended therapy, and a perceived hesitancy of medical personnel to administer fibrinolytics. These findings suggest a need for more clinical education. A myriad of barriers, as well as potential facilitators in the implementation of these networks, have been reported in this scoping review. The coordination and introduction of a STEMI SOC in African settings potentially holds great advantages, as has been witnessed in other low- and middle-income countries (LMICs) and high-income countries (HICs).

Acute myocardial infarction (AMI) remains a major global health problem, being the leading cause of both morbidity and mortality. We aim to present the temporal trends, demographic, clinical characteristics and risk factors of AMI in Kosovo. We conducted a retrospective, single-center observational study at the Clinic of Cardiology, University Clinical Center of Kosovo, having analyzed all patients admitted with AMI between January 2014 and December 2024. STEMI and NSTEMI cases were diagnosed according to ESC criteria. Patient's risk factors, biomarkers, PCI, and outcome data were extracted from hospital clinical records. Latent class analysis identified patient subgroups based on risk profiles. Temporal trends and projections of AMI incidence (per 100,000 population) were analyzed using polynomial and Joinpoint regression models. Statistical comparisons employed Chi-squared, t-tests, or Mann-Whitney U tests. Over the course of 11 years, 13,099 AMI patients (mean age 63.8 years; 29% female) were admitted; 55% had STEMI and 45% NSTEMI. Annual Age-standardized incidence increased from 23.5 to 86.4 per 100,000 (2014-2021) then fell to 71.3 in 2024. Hypertension (66%), smoking (47%), diabetes (34%) and dyslipidemia were highly prevalent. Latent class analysis identified four distinct patient clusters with varying combinations of smoking, diabetes, hypertension and family history of cardiovascular disease (CVD) (p < 0.001). STEMI patients were younger, more often male and smokers, while NSTEMI patients were older with higher rates of diabetes, hypertension and prior LBBB. In-hospital mortality was 9.15%, higher for STEMI (~12%) than NSTEMI (~6%), and declined markedly over time (19.3% in 2014 vs 7-10% in 2022, p < 0.001). In a developing country, Kosovo, STEMI was more frequent than NSTEMI, affecting younger male patients. The leading risk factors included arterial hypertension, smoking, diabetes mellitus, and a family history of CVD. The decline in acute MI related mortality over recent years, can be explained by the increasing use of myocardial reperfusion procedures. Furthermore, the rates of acute MI related complications are not different from neighboring countries.