BACKGROUND:Obesity is linked to heart failure, particularly with preserved ejection fraction, but is associated with lower natriuretic peptide levels, potentially leading to underdiagnosis. AIMS:To examine the association between adiposity measures-body mass index, waist circumference, and waist-to-height ratio-and N-terminal pro-B-type natriuretic peptide levels, and to determine if lower cut-offs should be used to rule out heart failure in individuals with obesity. METHODS:PORTHOS is a 2023 population-based study in Portugal including adults aged 50 years or older. Participants underwent N-terminal pro-B-type natriuretic peptide screening, followed by clinical and echocardiographic assessment in those with levels >= 125 pg/mL, self-reported heart failure, or a 5% random sample with levels <125 pg/mL. RESULTS:Among 2498 participants, obesity prevalence range from 25% using body mass index ≥30 kg/m² to >70% using waist-to-height ratio ≥0.6. Body mass index showed a strong inverse association with N-terminal pro-B-type natriuretic peptide, with approximately 50 pg/mL lower levels per 5 kg/m² increase. Individuals with obesity and peptide levels < 125 pg/mL had higher odds of heart failure symptoms (odds ratio 1.97, 95% confidence interval 1.15-3.38) and echocardiographic abnormalities (odds ratio 3.63, 95% confidence interval 1.27-10.4) than lean participants with levels >= 125 pg/mL, despite being 9 years younger and having fourfold lower median peptide levels (59 vs 235 pg/mL). CONCLUSIONS:Obesity is associated with lower N-terminal pro-B-type natriuretic peptide levels despite a higher burden of symptoms and structural abnormalities. Fixed cut-offs do not reliably exclude heart failure in individuals with obesity.
BACKGROUND AND AIMS:Heart failure (HF) is a major global health burden, yet its true prevalence remains uncertain due to heterogeneous study designs and evolving diagnostic criteria. The Portuguese Heart Failure Prevalence Observational Study (PORTHOS) aimed to estimate the prevalence and phenotypic distribution of HF in community-dwelling adults aged ≥50 years in mainland Portugal. METHODS:PORTHOS was a cross-sectional, population-based study with a two-stage design. Stage 1 randomly selected community-dwelling individuals aged ≥50 years via structured interviews and point-of-care N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing. Individuals with NT-proBNP ≥125 pg/mL and/or a self-reported HF diagnosis, plus a random 5% of screen-negatives, proceeded to stage 2. This confirmatory stage included clinical assessment, electrocardiogram, and echocardiography. HF diagnosis required the presence of symptoms, NT-proBNP ≥125 pg/mL, and echocardiographic criteria. HF was defined as per the 2021 ESC and HFA-PEFF guidelines. RESULTS:Of 6189 participants, 2249 screened positive and 1136 were diagnosed with HF. The estimated HF prevalence was 16.54%, increasing with age (from 4.01% in 50-59 years old to 30.68% in those ≥70) and higher in females than males (21.00% vs 10.47%). Notably, 93.4% had HF with preserved ejection fraction (HFpEF), and 90% were previously undiagnosed. HFpEF was independently associated with older age, female sex, type 2 diabetes, atrial fibrillation, and dyslipidaemia. CONCLUSIONS:HF affects approximately one in six Portuguese adults aged ≥50 years, with HFpEF accounting for over 90% of cases, most previously undiagnosed. These findings support NT-proBNP-based screening combined with echocardiographic evaluation to improve early HF detection in ageing populations.
In the security printing industry, high complexity stimuli‐responsive functional inks have been used to develop anti‐counterfeit elements, such as authentication markers and encrypted patterns. Through these applications, they create more reliable products, reduce economic losses, help retain brand identity, and assist in identifying counterfeit products. Thermochromic inks, owing to their temperature‐responsive color‐shifts, have gained considerable interest in the last decade as functional inks in a variety of fields. Here, we outline the different types of thermochromic materials, their properties, development scales, and how they have been previously applied, with a focus on their use as security inks for anti‐counterfeit elements. Despite promising functional properties, thermochromic materials are hindered from use by low stability, generally high toxicity, and a lack of printing optimization. In recent years, however, efforts have been made to enhance their durability and sustainability, along with an improved understanding of their thermochromic transitions and novel ink formulations, granting great promise for more diverse and specialized applications. Additionally, their integration alongside other functional materials has promoted the development of multilevel high‐security elements with potential for future anti‐counterfeit technologies. In this review, we highlight recent advancements in property enhancement, sustainable development, and scalability of thermochromic security inks.
