Cardiovascular diseases remain the leading global cause of mortality and morbidity, necessitating continuous advancement in secondary prevention strategies. Cardiac rehabilitation (CR), a cornerstone of comprehensive cardiovascular care, has been significantly enhanced by innovations in exercise medicine, evolving towards more personalized and accessible paradigms. This review synthesizes the current frontiers in exercise‐based CR, focusing on the synergistic integration of three transformative domains: technological innovation, precision medicine, and population‐specific strategies. We first delineate the established physiological benefits and evidence‐based efficacy of exercise therapy within CR frameworks. Subsequently, we examine the application of digital and intelligent technologies—including wearable devices, remote monitoring, artificial intelligence (AI), and big data analytics—which enable dynamic, data‐driven patient management and remote care delivery. The paper further explores the paradigm of precision exercise prescription, guided by biomarkers, genetic profiling, and other individual biological data, to tailor interventions for optimal safety and therapeutic yield. Special emphasis is placed on addressing the heterogeneous needs of key patient populations, such as the elderly, women, and those with specific comorbidities like heart failure or arrhythmias, by outlining individualized strategies that improve engagement and effectiveness. Finally, we discuss future directions, highlighting multimodal technology platforms and in‐depth precision medicine applications as key drivers for the next generation of CR, while critically evaluating the evidence readiness of emerging technologies and addressing implementation barriers. This review aims to inform clinical practice and guide future research towards developing more personalized, technology‐enabled, and equitable cardiac rehabilitation models.
Background & Aim Cardiovascular disease (CVD) represents a major global health crisis, accounting for a significant fraction of overall morbidity and mortality rates. While growing evidence indicates that poor cardiovascular health may be associated with higher loneliness, studies on this association within the Middle Eastern context, particularly in Saudi Arabia, are limited. Given the unique social and cultural characteristics of Saudi Arabia, this study aimed to examine the association of myocardial infarction (MI) and loneliness among adults in the country. Methods This comparative analytical study, using questionnaires, was conducted at King Khaled University Hospital in Riyadh. We recruited 173 Saudi adult patients aged between 18 and over 70 years with a confirmed diagnosis of MI and compared them with 446 Saudi adult healthy participants without CVD. Participants completed the validated Arabic translation of the De Jong Gierveld Loneliness Scale. Sociodemographic, behavioral, clinical, and treatment‐related data were also collected. Bivariate and multivariable logistic regression analyses were used to identify the association between high loneliness and MI (score ≥ 3). Results A high loneliness score was reported by 28.4% of all participants. Multivariable analysis identified statistically significant associations between loneliness and the presence of heart disease, younger age, physical inactivity, and smoking (OR = 4.88, 95% CI 2.46–9.67, p < 0.001). In cardiac patients, higher physical activity and better diabetes management were correlated with lower loneliness scores, whereas chronic kidney dysfunction significantly increased loneliness scores ( p = 0.03). Conclusions We found that, within the highly culturally and socially oriented population of Saudi Arabia, MI in adults was associated with greater loneliness compared to healthy participants. Loneliness is also significantly associated with smoking, physical inactivity, and comorbidities in MI patients. These findings highlight the need for culturally tailored interventions that integrate psychosocial support into cardiac care, particularly for vulnerable subgroups.
Background Cardiovascular disease (CVD) remains the leading cause of mortality worldwide, with its burden continuing to rise. Environmental cadmium (Cd) exposure has emerged as a potential risk factor for CVD. This study aimed to investigate the associations between Cd exposure and CVD risk, and to explore cross‐sectional associations and a potential inflammatory pathway using exploratory mediation analysis. Methods This study utilized data from the National Health and Nutrition Examination Survey. Logistic regression models were used to identify factors influencing CVD risk. Dose–response relationships were evaluated using restricted cubic splines (RCS). Exploratory mediation analysis was conducted to assess the potential mediating role of NLR in the association between Cd exposure and CVD risk. Results Individuals with CVD had significantly higher levels of blood Cd, urinary Cd, and NLR than controls ( p < 0.05) in both sexes. In males, the highest quartile (Q4) of blood Cd (OR = 3.06, 95% CI: 1.45‐6.46, p = 0.004) and urinary Cd (OR = 3.02, 95% CI: 1.52–6.02, p = 0.002) were significantly associated with higher CVD prevalence. Conversely, no significant association was observed in females for blood Cd ( p = 0.505), and the association for urinary Cd ( p = 0.046) was notably weaker and less robust than that in males. Interaction analyses confirmed sex‐specific differences (p‐interaction < 0.05). NLR showed significant exploratory mediating effects (indirect effects), accounting for 9.4% (95% CI: 3.5%–15.2%) of the blood Cd–CVD link and 5.0% (95% CI: 1.9%–8.1%) of the urinary Cd–CVD link in males. Similar significant mediation was observed in the general population for blood Cd: 7.2% (95% CI: 2.2%–12.2%), and for urinary Cd: 6.4% (95% CI: 2.8%–10.0%). Conclusions This cross‐sectional study identified significant sex‐specific and dose‐dependent associations between Cd exposure and CVD risk. Inflammatory responses, particularly those reflected by elevated NLR, were cross‐sectionally associated with the observed Cd–CVD link, suggesting a potential pathway that warrants prospective validation, especially in males.
Myocardial angiogenesis contributes to the maintenance of myocardial perfusion and cardiac function. Resistance training (RT) induces cardiovascular adaptations, but the myocardial transcriptional responses to acute RT (ART) and chronic RT (CRT) remain incompletely understood. This study compared the expression of angiogenesis- and metabolic adaptation–related genes in the left ventricle following a single RT bout and 8 weeks of repeated RT in healthy male Wistar rats. Twenty-four rats were randomized to three groups: sedentary control (CON) (n = 8), ART (one ladder-climbing session), or CRT (ladder-climbing 5 days/week for 8 weeks). RT was performed on a 1-m ladder inclined at 80° using progressive loads attached to the tail. Left-ventricular tissue was collected 1 h after the exercise bout in ART and 1 h after the final training session in CRT. Compared to CON, ART showed significantly higher HIF-1α and FSTL1 expression, whereas PGC-1α and VEGF did not differ significantly. CRT also showed significantly higher HIF-1α and FSTL1 expression than CON, together with significantly higher PGC-1α and VEGF expression. No significant differences were observed between ART and CRT for any of the genes examined. These findings demonstrate distinct myocardial transcriptional profiles following ART versus CRT, characterized by an HIF-1α- and FSTL1-associated response after a single bout and a PGC-1α- and VEGF-associated response following CRT.
Background Both trimethylamine‐N‐oxide (TMAO) and Helicobacter pylori ( H. pylori ) have been linked to atherosclerosis and carotid plaque development. This study examined the associations of H. pylori infection and plasma TMAO levels with carotid plaque in a health screening population. Methods Between October 2022 and September 2023, 1779 participants undergoing routine health examinations, including carotid ultrasonography and H. pylori testing, were enrolled. Multivariable logistic regression was used to evaluate the association between H. pylori infection and carotid plaque. Inverse probability weighting (IPW) was applied to address selection bias in the TMAO subgroup, followed by weighted logistic regression analyses. Results Carotid plaque was more prevalent among H. pylori ‐seropositive participants than among seronegative participants (53.96% vs. 40.37%, p < 0.001). In multivariable logistic regression analyses, H. pylori seropositivity remained significantly associated with carotid plaque after adjustment for demographic characteristics and cardiovascular risk factors, with odds ratios ranging from 3.099 to 3.392 across the adjusted models (all p < 0.001). Higher TMAO levels were associated with carotid plaque in unadjusted analyses and remained associated after adjustment for demographic and conventional cardiovascular risk factors; however, these associations were attenuated and became statistically non‐significant after further adjustment for age. No significant association was observed between H. pylori seropositivity and plasma TMAO levels. Conclusions H. pylori infection was associated with carotid plaque in this cross‐sectional study. The association between TMAO and carotid plaque appeared to be largely explained by age. Given the cross‐sectional design, causal relationships cannot be inferred, and further prospective studies are warranted.
