Black tea consumption and the risk of coronary heart disease: a systematic review and meta-analysis of cohort studies.

Considering various confounding factors, the preventive effect of aspirin on pancreatic cancer remains controversial. This study aimed to evaluate the association between aspirin use and the risk of pancreatic cancer in different populations and explore possible influencing factors. A comprehensive search was performed in PubMed, Web of Science, Embase, and Cochrane Library from database inception to 31 March 2025. The primary outcome was pancreatic cancer incidence, assessed using adjusted hazard ratios with 95% confidence intervals (CIs) and prediction intervals. This study was registered in PROSPERO (CRD420251002604). Six cohort studies were included. Pooled analysis showed aspirin use was associated with reduced pancreatic cancer risk (hazard ratio = 0.80, 95% CI: 0.72-0.88, 95% prediction interval: 0.65-0.97, P < 0.001). High heterogeneity ( I ² = 69.9%, τ ² = 0.008) resulted in low Grading of Recommendations, Assessment, Development and Evaluation (evidence‑based grading system for evidence strength). Exploratory subgroup analyses suggested lower risk in diabetes patients (hazard ratio = 0.59, 95% CI: 0.52-0.68, P < 0.001), BMI less than 25 kg/m² (hazard ratio = 0.52, 95% CI: 0.43-0.64, P < 0.001), and nondrinkers (hazard ratio = 0.58, 95% CI: 0.51-0.65, P < 0.001). No significant association was found in women (hazard ratio = 0.74, 95% CI: 0.55-1.00, P = 0.102) or high ‑ dose aspirin users (hazard ratio = 0.82, 95% CI: 0.67-1.00, P = 0.102). Aspirin may be associated with a lower pancreatic cancer risk, but there is considerable heterogeneity. Diabetes, BMI and alcohol consumption may be potential influencing factors and sources of heterogeneity.

Sarcopenia and Mortality, Cardiovascular and Renal Outcomes in Type 2 Diabetes: A Systematic Review and Meta-Analysis.

Iatrogenic colonic perforation is a rare but potentially catastrophic complication of colonoscopy (0.016-0.2% diagnostic; 0.15-5% therapeutic) with reported mortality of 15-25%. Rates may increase with expanding colonoscopy volume and advanced therapeutic interventions. Endoscopic closure is increasingly used, yet comparative outcomes remain uncertain. Registered in PROSPERO (CRD420251233077). We searched six databases from inception to November 2025 for adult observational cohorts comparing endoscopic closure versus surgery. Outcomes included treatment success, mortality, major morbidity, reoperation, length of stay, and fasting duration. Two reviewers independently screened studies, extracted data, and assessed bias using ROBINS-I. Random-effects models pooled risk ratios (RR) and mean differences (MD); GRADE rated certainty. Sensitivity and geographic subgroup analyses assessed robustness and effect modification. Four retrospective cohorts (n = 123; 52 endoscopic, 71 surgical) from Portugal, Korea, and Malaysia were included across care settings. Treatment success showed no clear difference (RR 1.00, 95% CI 0.94-1.06; I2 = 0%; low certainty). Mortality was rare and imprecise (8 events; RR 0.26, 95% CI 0.06-1.16; I2 = 0%; very low certainty). Hospital stay was shorter with endoscopic management (MD - 9.23days, 95% CI - 13.74 to - 4.73; I2 = 43%; low certainty). Fasting duration did not differ significantly and was heterogeneous. No geographic subgroup effect was detected (P = 0.95). Sensitivity analysis supported robustness, except for hospital-stay heterogeneity driven by referred cases in one study. In observational cohorts, endoscopic closure was typically used for immediately recognized, smaller perforations in favorable clinical conditions, whereas surgery was preferentially used for delayed diagnosis, larger defects, or suspected contamination, introducing substantial confounding by indication. Accordingly, the pooled estimates should not be interpreted as evidence of equivalence. In carefully selected patients (immediate recognition, < 2cm, no generalized peritonitis/instability), endoscopic closure appears to be a viable first-line strategy and may reduce length of stay. Prospective multicenter studies with standardized definitions and rigorous confounder adjustment are needed.

To assess the efficacy and safety of uterine artery embolization (UAE) using gelatin sponge (GS) particles through a systematic review and meta-analysis. PubMed, Embase, Scopus, and Google Scholar were searched from inception to April 2024. Prospective and retrospective nonrandomized studies using GS particles for UAE in leiomyoma patients were included. Outcomes included dominant leiomyoma volume reduction and improvement in menorrhagia, dysmenorrhea, and bulk-related symptoms. Six studies with 429 participants were included. Three out of six studies compared GS to another embolic agent. Mean dominant leiomyoma volume reduction was 42.17% at 3months (95% CI 33.65-50.68%), 53.37% at 6months (95% CI 47.89-58.86%), and 58.71% at 12months (95% CI 47.38-70.04%). Menorrhagia improved in 88% (95% CI 85-91%) at 3months, 95% at 6months (95% CI 70-100%), and 98% at 12months (95% CI 92-100%). Dysmenorrhea improved in 90% at 3months (95% CI 53-100%), 96% at 6months (95% CI 66-100%), and 89% at 12months (95% CI 61-100%). Bulk-related symptoms improved in 90% at 3months (95% CI 74-99%) and 99% at 6 (95% CI 92-100%) and at 12months (95% CI 95-100%). Amenorrhea was the most common adverse event. Other adverse events included deep venous thrombosis, groin hematomas, fibroid passage, symptom recurrence, anemia, postembolization syndrome, and elevated liver enzymes. UAE using GS particles is a potentially effective treatment option for managing uterine leiomyoma. It reduces leiomyoma volume and improves menorrhagia, dysmenorrhea, and bulk-related symptoms. Level 2a, Systematic Review & Meta-Analysis of Cohort Studies.

Relationship between hearing loss, cognitive impairment, and dementia; meta-analysis of cohort studies in which the exposure factor is hearing loss measured by audiometry.

Definitive second-line treatment for pediatric Graves' disease (GD) includes radioiodine ablation (RAI) or thyroidectomy. The current treatment practice in pediatric GD patients is a contentious issue as the decision to consider either of the treatment options depends on preferences of patients, physicians, and access to surgical care and radioactive iodine treatment. This systematic review and meta-analysis were performed to compare the cure and relapse rates of RAI versus surgery as definitive therapy in children with Graves' Disease. A comprehensive search on Cochrane library, Embase, PUBMED, MEDLINE (via Pubmed), and ClinicalTrials.gov for English articles published on definitive treatment of GD in children since 1985 to 2023 was performed. The data were extracted and meta-analyzed for efficacy and safety outcomes, risk of bias (ROB), and certainty of evidence summated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) instrument. Twenty-nine (26 retrospective and 3 prospective) studies with a total of 1861 children and a mean age of 13.15years with a mean follow up of 8years were evaluated in the systematic review. Among these, 1061 children received RAI therapy, whereas 800 underwent thyroidectomy and were evaluated in the pooled analysis. 755 were excluded as details pertaining to definite treatment was not available. Studies were of low to moderate risk of bias. The pooled analysis suggests that RAI had significantly lower cure rate in children compared to children who underwent thyroidectomy (RR 0.89; 95% CI 0.81-0.99; p=0.03). In subgroup analysis of patients from 19 studies who underwent surgery, total thyroidectomy (2%) was more effective than subtotal thyroidectomy (13%) in preventing recurrent hyperthyroidism (p=0.001; moderate quality evidence). Hypothyroidism rates after RAI and surgery were similar (RR 0.97; 95% CI 0.67-1.40; p=0.88). There were no significant adverse outcomes reported such as secondary malignancy or quality of life after RAI. Following TT, adverse effects seen were permanent hypoparathyroidism (0.6%) and temporary recurrent laryngeal nerve palsy (5.1%). Thyroidectomy appears to be more effective than RAI in effecting cure in Graves' disease in children following failed remission with antithyroid medication therapy. However, access to thyroidectomy may not be universally available and RAI is an option in these children.

Mortality Risk in Patients with Urological Malignancies and HIV Coinfection: A Systematic Review and Meta-Analysis of Cohort Studies

Several conclusions have emerged regarding the impact of COVID-19 on the male reproductive system. This systematic review and meta-analysis aimed to provide a comprehensive update on the relationship between COVID-19 and male reproductive health. We investigated the effects of SARS-CoV-2 on various semen parameters, including semen volume, sperm concentration, sperm total count, total motility, progressive motility, morphology, and DNA fragmentation index (DFI). A literature review was conducted on all studies evaluating the impact of SARS-CoV-2 infection on male infertility from the beginning of 2019 through December 2023. Main electronic databases such as PubMed, Scopus, Cochrane Library, and Web of Science were used. The research question was based on the PECO framework, focusing on (Population) exposed to SARS-CoV-2 (Exposure), compared to uninfected men (Comparator), with conventional sperm parameters as the measured Outcome. The studies were divided into two groups for analysis: between-group comparisons, which compared sperm parameters of men recovered from COVID-19 to uninfected controls, and within-subject comparisons, which assessed sperm parameters in the same individuals before and after infection. Standardized mean differences (SMD) were calculated as effect sizes with 95% confidence intervals (CI) for each outcome. The DerSimonian-Laird method estimated between-study variance (τ2), while the Jackson method calculated confidence intervals for τ2 and τ. Publication bias was assessed using funnel plots and Egger's test. This meta-analysis included two types of cohort studies: single-arm studies and those with a control group. In the single-arm studies, a statistically significant decrease in semen volume (p=0.0023) was observed. Additionally, in the cohort studies with controls, there were statistically significant reductions in sperm concentration (p<0.0001), total count (p=0.0001), total motility (p=0.0009), progressive sperm motility (0.0391), and DFI (0.04). This is the most up-to-date systematic review and meta-analysis incorporating cohort study data. The findings provide compelling evidence that SARS-CoV-2 infection adversely affects male reproductive health, particularly in terms of semen quality. The analysis reveals significant reductions in key semen parameters, including sperm count, concentration, total motility, and progressive motility. Adult maleand DFI.

Introduction. Excessive screen time is one of the main causes of a sedentary lifestyle in primary school children. Reduced physical activity and, consequently, decreased energy expenditure can lead to excess fat accumulation in children. The aim of this study is to identify the relationship between screen time and obesity in primary school children. Materials and Methods. The authors conducted a systematic search for information consistent with the study objective in the PubMed, Google Scholar, and Epistemonikos databases, as well as clinical trial registries (ClinicalTrials.gov and ISRCTN: the UK’s Clinical Study Registry). The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The methodological quality of the included articles was assessed using the ROBINS-E tool. Bias was assessed using the Egger test and a funnel plot. A random-effects model with inverse variance analysis was used for the meta-analysis. Results. The systematic search revealed 12 studies, 5 of which were included in the subsequent meta-analysis. It was found that children who spent more than 2 hours per day in front of a screen had a 1.34-fold higher relative risk (RR = 1.34; 95% CI: 1.18–1.52, p &lt; 0.0001, I² = 28.1%) of overweight/obesity compared to children who spent less than 2 hours per day in front of a screen. The risk of bias of the included publications ranged from ‘low’ to ‘moderate’. No evidence of publication bias was found. Conclusions. The study found that excessive screen time increases the risk of overweight and obesity in primary school children.

Colorectal cancer is a major global health concern that requires successful surgical treatments. While robotic-assisted surgery (RAS) provides prospective improvements, laparoscopic surgery has proven to yield better results than open surgeries. From 2018 to December 2024, PubMed, Scopus, and Web of Science were used to perform a systematic review and meta-analysis of cohort studies and randomized controlled trials (RCTs). Studies comparing RAS and conventional laparoscopic surgery were included. The primary outcomes assessed were length of hospital stay, conversion to open surgery, postoperative complications, and operating time. Using Comprehensive Meta-Analysis software, statistical analysis was performed, including subgroup analyses by anatomical site (colon, rectum, colorectal). Sensitivity analyses and heterogeneity were conducted. 21 studies involving over 70,000 patients were included. The meta-analysis demonstrated significantly longer operative times with RAS (MD = 0.161-1.049, p < 0.001). RAS was linked to a significantly lower chance of re-operative rates (RR = 0.549, p = 0.023) and a significantly lower risk of conversion to open surgery (RR = 0.412-0.592, p < 0.001). RAS decreased problems in the colorectal group (RR = 0.867, p = 0.023), but overall rectum group complication rates were comparable. Hospital stays were shorter after robotic-assisted surgery (MD = -0.284 to -0.755, p = 0.001). When compared to CLS, RAS has the advantage of lowering conversion and re-operation rates, albeit at the expense of higher operating time. CLS led to shorter hospital stays, but in some circumstances, the complication rates were on level with or lower than those of RAS. According to these results, RAS might be useful in some surgical situations and patient demographics. https://www.crd.york.ac.uk/PROSPERO/view/614084, PROSPERO CRD42024614084.

Loss to follow-up (LTFU) from antiretroviral therapy (ART) remains a major public health concern worldwide, including in Ethiopia. However, nationally representative pooled cohort data on LTFU among adults receiving ART are limited. To address this gap, we conducted a meta-analysis to estimate the incidence and identify predictors of LTFU among adults on ART in Ethiopia. This systematic review and meta-analysis adhered to the PRISMA guidelines. Relevant studies were identified through a comprehensive search of multiple databases, including PubMed, CINAHL, Scopus, EMBASE, and Google Scholar. Data analysis for pooled estimates of incidence and predictors was performed using STATA version 17 with the DerSimonian and Laird random-effects model. Heterogeneity was assessed using Cochrane’s Q-test and the I² statistic, while publication bias was evaluated using funnel plots and Egger’s test. Out of 1,245 studies identified, 24 met the inclusion criteria, comprising a total of 24,637 participants. The pooled incidence rate of LTFU among adults on ART was 8 per 100 person-years (95% CI: 7–10), and the pooled median time to LTFU was 27.77 months (95% CI: 19.22–36.32). Moreover, variation in study sample size (R² = 34.10%) contributed substantially to the high level of heterogeneity among the included studies. Predictors of LTFU included not receiving isoniazid prophylaxis (HR = 1.39, 95% CI: 1.30–1.49), fair or poor ART adherence (HR = 1.56, 95% CI: 1.49–1.64), WHO clinical stages III–IV (HR = 1.29, 95% CI: 1.21–1.38), undisclosed HIV status (HR = 1.34, 95% CI: 1.24–1.45), CD4 count < 200 cells/mm³ (HR = 1.28, 95% CI: 1.19–1.33), BMI < 18.5 kg/m² (HR = 1.34, 95% CI: 1.27–1.43), and age 15–24 years (HR = 1.31, 95% CI: 1.22–1.41). The median time to LTFU among adults on ART in Ethiopia was close to the national target, suggesting the need to enhance retention strategies. Targeted interventions should focus on young adults, undernourished patients, and those with poor adherence. Strengthening adherence support and preventive care, including isoniazid prophylaxis, is essential to improve ART retention outcomes.

Benzodiazepines or related drugs and risk of cardiovascular diseases: a meta-analysis of cohort studies.

BackgroundIt has been shown that fluoroquinolones (FQs) use may be associated with an increased risk of aortic aneurysm (AA) and/or aortic dissection (AD).ObjectivesThe aim of this meta-analysis was to systematically review and summarize the epidemiological evidence on the risk of aortic AA and/or AD following FQs use.DesignSystematic review and meta-analysis.Data Sources and MethodsWe performed a meta-analysis using data from PubMed, Embase, and the Cochrane Library, with research conducted up to March 15, 2025. Cohort studies examining the association between FQs use and AA or AD were included. The quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS). A combined HR with 95% CI was calculated using either a random-effects or fixed-effects model, and robustness was assessed using sensitivity analysis. This meta-analysis was registered with PROSPERO (CRD 420251012072).Results11 studies were included, with 81,976,958 participants. The risk of AA/AD among FQs users was found to be elevated (HR = 1.20, 95% CI: 1.06-1.35). Similar results were found for AA (HR = 1.47, 95% CI: 1.24-1.73) and AD (HR = 1.12, 95% CI: 1.04-1.22). In subgroup analysis, the gender subgroup analysis revealed a higher risk of AA/AD for males (HR = 1.16, 95% CI: 1.06-1.27) compared to females (HR = 1.09, 95% CI: 1.00-1.20). Regionally, the risk was higher in America (HR = 1.47, 95% CI: 1.12-1.93) than Europe (HR = 1.08, 95% CI: 0.98-1.19) and Asia (HR = 0.80, 95% CI: 0.61-1.05). Risk associated with FQs use within 90 days (HR = 1.20, 95% CI: 1.13-1.26) was significantly higher, while no significant increase was observed for ≥365 days (HR = 1.00, 95% CI: 0.90-1.12). The presence of hypertension (HR = 1.24, 95% CI: 1.14-1.36) was associated with a significantly higher risk of AA/AD.ConclusionThis meta-analysis demonstrates that the use of FQs is associated with a significant risk of AA/AD. Clinicians should be aware of this risk in patients prescribed FQs, and further research is needed to elucidate the role of FQs in the development of AA/AD.

The systemic immune-inflammation index (SII) is a newly recognized biomarker of inflammation. Although several studies have suggested that SII may aid in diagnosis of stroke and in predicting treatment outcomes, the findings remain inconsistent, and its relationship with clinical prognosis is still unclear. Therefore, we conducted a comprehensive systematic review and meta-analysis to explore the relationship between SII and clinical outcomes in patients with stroke. We systematically searched four databases (PubMed, Embase, Cochrane Library, and Web of Science). The study adhered strictly to PRISMA guidelines. We assessed the risk of bias across the included studies using the Newcastle-Ottawa Scale. Key outcome indicators included poor functional outcome (modified Rankin Scale, mRS ≥ 2), mortality, stroke severity (National Institutes of Health Stroke Scale, NIHSS >4), and intracranial hemorrhage. A total of 11 cohort studies comprising 24,922 patients with stroke were included. Our results demonstrated that elevated SII was strongly linked to increased mortality (OR = 1.58, 95% CI: 1.23-2.02; p = 0.0003) and poor functional outcome (mRS ≥ 2) (OR = 2.03, 95% CI: 1.63-2.52; p = 0.0001). However, elevated SII was not associated with NIHSS >4 (OR = 3.40, 95% CI: 2.02-5.71; p = 0.80), nor with intracranial hemorrhage (OR = 2.41, 95% CI: 1.59-3.66; p = 0.35). SII appears to have potential value in predicting stroke prognosis and may help clinicians assess outcomes by calculating patients' SII levels. Nevertheless, given the limitations of the available evidence, further research is needed to clarify its practical clinical utility. Larger samples and multicenter clinical trials are required to obtain more robust conclusion. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251163979, identifier PROSPERO (CRD420251163979).

Background and Objectives: Dysglycemia is a major determinant of adverse outcomes in COVID-19, yet the separate contributions of poor glycemic control and glycemic variability (GV) remain incompletely defined. We conducted a systematic review and meta-analysis of observational cohort studies (both prospective and retrospective) to quantify the impact of chronic hyperglycemia and glucose instability on disease severity, intensive care requirements, and mortality in patients with COVID-19. Materials and Methods: We searched PubMed, Scopus, and Web of Science from January 2020 to October 2024 for observational cohort studies reporting clinically relevant COVID-19 outcomes stratified by glycemic control or GV. Dysglycemia definitions varied across studies (HbA1c-based chronic hyperglycemia, fasting glucose, or admission/in-hospital hyperglycemia). GV was assessed using metrics including mean amplitude of glycemic excursions (MAGE), standard deviation (SD), coefficient of variation (CV), or maximum daily glucose difference. Twelve studies met inclusion criteria and were included in qualitative synthesis; five studies were eligible for quantitative synthesis of clinical outcomes. Random-effects DerSimonian-Laird models were applied due to anticipated clinical heterogeneity. Heterogeneity was evaluated using Cochran's Q, τ2, and I2 statistics. Results: Overall, 12 observational studies (9 prospective and 3 retrospective cohorts; n = 1,008,310 patients) were included. In quantitative analyses of five eligible cohorts, poor glycemic control was associated with a significantly increased risk of severe or critical COVID-19 (pooled RR = 1.75, 95% CI: 1.45-2.11; I2 = 29%), ICU admission (RR = 1.54, 95% CI: 1.18-2.01), and mechanical ventilation (RR = 1.72, 95% CI: 1.31-2.26). Three studies evaluating GV demonstrated a strong association with adverse outcomes (pooled RR = 2.07, 95% CI: 1.71-2.50; I2 = 0%); this low heterogeneity should be interpreted cautiously given the limited number of studies. GV remained associated with mortality in multivariable models, indicating that glycemic variability is separately associated with mortality as a clinically relevant prognostic risk marker in hospitalized COVID-19 patients. Conclusions: Both chronic hyperglycemia and elevated glycemic variability are each associated with increased risk of severe COVID-19 outcomes. Glycemic variability appeared to be a consistent, low-heterogeneity prognostic marker of mortality, being separately associated with higher death risk in hospitalized COVID-19 patients, highlighting its potential utility as a dynamic metabolic biomarker. Early identification and targeted management of dysglycemia-especially glucose instability-may improve prognosis in hospitalized COVID-19 patients. PROSPERO: CRD420251250718.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have shown neuroprotective potential. This meta-analysis aimed to compare the effects of SGLT2 inhibitors and dipeptidyl peptidase-4 (DPP-4) inhibitors on dementia risk in patients with type 2 diabetes mellitus (T2DM). A systematic search of PubMed, EMBASE, Cochrane Library, and Web of Science was conducted from inception through May 2025. Cohort studies comparing dementia incidence in T2DM patients treated with SGLT2 inhibitors versus DPP-4 inhibitors were included. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). Data were pooled using a random-effects model in STATA 12.0, with incidence rate ratios (IRRs) and 95 % confidence intervals (CIs) calculated for dementia outcomes. Eight cohort studies (1275,257 participants) were analyzed. SGLT2 inhibitor use was associated with a 33 % lower risk of all-cause dementia compared to DPP-4 inhibitors (I² = 0.0 %, P = 0.816; IRR = 0.666; 95 % CI: 0.484-0.918; P < 0.05). Subgroup analyses indicated non-significant risk reductions for Alzheimer's disease (I² = 0.0 %, P = 0.994; IRR = 0.654; 95 % CI: 0.352-1.212; P = 0.177) and vascular dementia (I² = 0.0 %, P = 0.971; IRR = 0.573; 95 % CI: 0.204-1.605; P = 0.289). SGLT2 inhibitors are associated with a significantly reduced risk of all-cause dementia in T2DM patients compared to DPP-4 inhibitors. While trends favoring SGLT2 inhibitors were observed for dementia subtypes, further long-term studies are needed to confirm these associations.

Complications following hip fracture surgery in end-stage kidney disease patients receiving dialysis: A systematic review and meta-analysis of cohort studies.

Circulating lipids are potentially modifiable risk factors for aortic aneurysm, however, associations between levels of specific lipids and aortic aneurysm are unclear. We analysed associations between blood lipids and aortic aneurysm in the UK Biobank and summarized the available data in a systematic review and meta-analysis of published cohort studies. Up to 429,610 participants aged 38-73 years at baseline in 2006-2010 in UK Biobank were included. Multivariable Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between serum/plasma lipids (total cholesterol, low-density lipoprotein [LDL] cholesterol, high-density lipoprotein [HDL] cholesterol, triglycerides, apolipoprotein A1, apolipoprotein B, and lipoprotein(a)) and risk of aortic aneurysm. PubMed and Embase databases were searched up to November 11th, 2025, to identify relevant cohort studies. Random-effects models were used to estimate summary relative risks (RRs) and 95% CIs for the associations between blood lipid levels and aortic aneurysm risk. In UK Biobank, 2,434 aortic aneurysm cases occurred during 12.3 years of follow-up. Positive associations were observed between the highest vs. lowest quintile of total cholesterol (HR 1.22, 95% CI 1.07-1.41), LDL cholesterol (1.39, 1.21-1.60), apolipoprotein B (1.52, 1.33-1.74), non-HDL cholesterol (1.50, 1.29-1.73), triglycerides (1.23, 1.06-1.42), lipoprotein(a) (1.34, 1.17-1.54) and aortic aneurysm risk, while HDL cholesterol (0.57, 0.48-0.67) and apolipoprotein A1 (0.54, 0.46-0.63) were inversely associated. Eighteen cohort studies were included in the meta-analysis. The summary RR (95% CI) per 1 mmol/L increase was 1.16 (1.10-1.22, I2 = 74%, n = 15) for total cholesterol, 1.11 (1.04-1.19,I2 = 63%, n = 4) for LDL cholesterol, 1.28 (0.98-1.67, I2 = 89%, n = 2) for non-HDL cholesterol, 0.59 (0.50-0.70, I2 = 72%, n = 5) for HDL cholesterol, 1.02 (0.95-1.10, I2 = 55%, n = 7) for triglycerides, and 1.34 (1.17-1.55, I2 = 57%, n = 4) per 50mg/dl incrememt in lipoprotein(a). Additional positive (apolipoprotein B, non-HDL cholesterol) and inverse (apolipoprotein A1) associations were observed in high vs. low meta-analyses. These findings suggest higher levels of total cholesterol, LDL cholesterol, apolipoprotein B, non-HDL cholesterol, lipoprotein(a), and possibly triglycerides are associated with increased risk of aortic aneurysm, while higher levels of HDL cholesterol and apolipoprotein A1 are associated with lower risk.

This study aimed to summarize the observational evidence from prospective cohort studies examining the associations of regular physical activity, sedentary behaviour, and sleep duration with incident dementia among community-dwelling adults aged 35 years and older. Systematic literature searches (1946 to August 2025) of CINAHL, EMBASE, MEDLINE, PSYCINFO, and SPORTDISCUS were performed. Eligible studies included community-dwelling adults aged 35 + years with at least one year of follow-up and valid measures of movement behaviours and dementia outcomes. Studies were excluded if they included participants with baseline dementia, lacked risk estimates for all-cause dementia. Grey literature was excluded. Random effects meta-analysis generated pooled risk ratio (RR) and 95% confidence intervals (CI). Primary exposures were defined using national thresholds for physical activity, sedentary time, and sleep duration. Subgroup analyses were performed by age and follow-up duration. Forty-nine studies with physical activity (n = 2,855,529), 17 studies on sleep duration (n = 1,344,170), and three studies on sedentary duration (n = 295,809) were included. Regular physical activity significantly reduced the risk of incident dementia (pooled RR = 0.75, 95% CI = 0.68 to 0.82), though heterogeneity was substantial and partially explained by subgroup analyses. Prolonged sedentary behaviour (8 + hours/day sitting) increased dementia risk (RR = 1.27, 95% CI = 1.17 to 1.39) with low heterogeneity. Moreover, both short (<7 hours; RR = 1.18, 95% CI = 1.09 to 1.28) and long (>8 hours; RR = 1.28, 95% CI = 1.15 to 1.43) sleep were linked to higher dementia risk compared with 7-8 hours. Heterogeneity was moderate to substantial. Regular physical activity, less sedentary time and appropriate nightly sleep (7-8 h) may be associated with reduced risk of dementia and are potentially modifiable factors in the prevention or delay of dementia. Future studies with middle-aged adults and longer-term follow-up including changes in movement behaviours over time are needed to better understand the relationship between physical activity, sedentary behaviour, and sleep for dementia risk. CRD42021272054.