Background To date, >10 million children have been conceived via assisted reproductive technology (ART) globally. However, there are some concerns about potential adverse outcomes associated with ART‐conceived pregnancies, including the risk of congenital heart defects (CHDs). This meta‐analysis aimed to evaluate the association between ART and the risk of major CHDs as well as their specific subtypes. Methods Major electronic databases were screened for studies comparing the incidence of CHD following ART‐conceived pregnancies versus spontaneous conception. The primary end point was study‐defined incidence of CHDs. Secondary end points included incidence of tetralogy of Fallot, transposition of the great arteries, aortic coarctation, ventricular septal defect, atrial septal defect, pulmonary valve atresia, tricuspid valve atresia, and hypoplastic left heart. Pairwise meta‐analyses were performed using frequentist random‐effect models to calculate risk ratios and 95% CIs. Results Thirteen studies, encompassing a total of 45 916 925 subjects (4986 conceived via ART), were included in the quantitative synthesis. ART was significantly associated with a higher risk of major CHD compared with natural pregnancy (risk ratio, 2.35 [95% CI, 1.68–3.28]), with significant heterogeneity across the studies. An increased risk of tetralogy of Fallot, ventricular septal defect, and atrial septal defect following ART‐conceived pregnancies was found, while no difference was found on other CHDs. Prespecified sensitivity analyses were in line with the primary findings of the meta‐analysis. Conclusions Our meta‐analysis shows a potential link between ART and increased risk of major CHDs, particularly on tetralogy of Fallot, ventricular septal defect, and atrial septal defect.
Background Hypertension is a major risk factor for cardiovascular disease. Adoption of the Predicting Risk of Cardiovascular Disease Events risk model in the 2025 American College of Cardiology/American Heart Association guideline may substantially alter the number and characteristics of adults with untreated stage 1 hypertension who are recommended for treatment. We aimed to quantify treatment‐recommendation reclassification among adults with untreated stage 1 hypertension under the 2025 Predicting Risk of Cardiovascular Disease Events–based guideline compared with the 2017 pooled cohort equations–based guideline. Methods This cross‐sectional, nationally representative study used data from NHANES (National Health and Nutrition Examination Survey) 2015 to March 2020. The study population included adults aged 30 to 79 years with stage 1 hypertension, focusing on untreated participants. The exposure was the guideline‐endorse cardiovascular risk assessment framework, pooled cohort equations, and Predicting Risk of Cardiovascular Disease Events, respectively. The primary outcome was recommendation for antihypertensive pharmacotherapy. Results Among 1926 adults with stage 1 hypertension (weighted 32.57 million), 59.59% (19.41 million) were untreated. Under the 2025 guideline, 13.84% (95% CI, 7.06%–20.63%) of untreated adults eligible under the Predicting Risk of Cardiovascular Disease Events threshold (0.42 million) became newly eligible for pharmacotherapy compared with the 2017 guideline. Newly eligible adults were older (mean±SE, 60.48 [0.77] years) and had higher diabetes prevalence (37.74% [95% CI, 15.45%–60.04%]) than those below the treatment threshold. Conclusions The 2025 American College of Cardiology/American Heart Association hypertension guideline recommendations were largely concordant with the prior guideline among adults with untreated stage 1 hypertension, while still newly identifying a subset of individuals with elevated cardiometabolic risk who may benefit from earlier intervention.
Background Severe carotid artery stenosis or occlusion (CASO) is associated with white matter injury and cognitive impairment, but markers of accompanying microvascular dysfunction remain incompletely characterized. We investigated the relationships among retinal microvascular abnormalities on optical coherence tomography angiography, white matter hyperintensities (WMH), and cognitive impairment in severe unilateral CASO. Methods In this multicenter cross‐sectional study, 860 participants were included: 566 patients with severe unilateral CASO without acute cerebral infarction and 294 control participants with similar age and sex distributions. All participants underwent multimodal imaging, including automated WMH segmentation on brain magnetic resonance imaging and macular optical coherence tomography angiography. Cognitive function was assessed using the Montreal Cognitive Assessment. Results Compared with controls, patients with CASO showed lower vessel length density across retinal layers and greater WMH burden. Within the group with CASO , the retina ipsilateral to the stenosis showed lower vessel length density and greater vessel dilation, paralleling the greater burden of deep WMH in the ipsilateral hemisphere (all adjusted P <0.05). Retinal microvascular abnormalities and greater WMH burden were both associated with worse concurrent cognitive performance. Adding optical coherence tomography angiography metrics to clinical and WMH ‐based models provided modest additional discrimination for identifying concurrent cognitive impairment in internal cross‐validation, increasing the area under the curve from 0.652 to 0.695 ( Δarea under the curve , 0.043 [95% CI , 0.021–0.064]). Conclusions In severe unilateral CASO, retinal microvascular abnormalities were associated with ipsilateral white matter injury and lower cognitive performance. Optical coherence tomography angiographymetrics provided modest complementary discriminatory information beyond conventional clinical variables and WMH for identifying concurrent cognitive impairment, although external validation is required. Registration URL: https://www.chictr.org.cn/ . Unique identifier: ChiCTR2300074640.
Background Self‐measured blood pressure (SMBP) monitoring improves long‐term blood pressure (BP) outcomes, but evidence on the acceptability and feasibility of SMBP in refugee populations is limited. Refugees face high cardiovascular risk due to poorly controlled BP. Methods We recruited Iraqi and Syrian refugees living in San Diego, California, through the Family Health Centers of San Diego and enrolled them in a 6‐week single‐arm pilot acceptability and feasibility trial of SMBP with telemonitoring protocol modeled after the TASMIN (Telemonitoring and Self‐Management in Hypertension) SMBP trial in the United Kingdom. Postintervention interviews assessed barriers and facilitators of the intervention. Inductive thematic analysis was performed, and results were organized using the Theoretical Framework of Acceptability. Quantitative participant data were analyzed descriptively. Results A total of 101 refugees participated (80% Iraqi individuals; mean age, 64±9.7; 49% men). Participants generally favored having their BP readings telemonitored and transmitted to their BP providers' office over completing the physical diary. Facilitators of SMBP included increased self‐autonomy, device user friendliness, increased participant confidence, and family support. Barriers included device malfunction, old age, comorbidities, everyday life obligations, diary complexity, and forgetfulness. Participants emphasized for future interventions to promote autonomy, family engagement, and include a streamlined BP tracking method while also integrating provider–patient decision making. Conclusions This is the first study of SMBP among refugees. The intervention was found to be acceptable and feasible. Participants felt valued, self‐autonomous, and confident in SMBP. Future interventions that use technology, family support, team‐based care, and user‐friendly devices may improve BP control in this population.
Background Diagnosing myocardial infarction in patients with prior coronary artery bypass grafting (CABG) remains challenging, primarily because of lower diagnostic accuracy of high‐sensitivity cardiac troponin (hs‐cTn). cMyC (cardiac myosin‐binding protein C), because of its faster release kinetics and greater abundance, may offer improved diagnostic performance in this population. Methods The diagnostic accuracy of cMyC was directly compared with that of hs‐cTnT and hs‐cTnI in a prospective, international, multicenter, diagnostic study enrolling adult patients presenting to the emergency department with acute chest discomfort. Final diagnoses were centrally adjudicated by 2 independent cardiologists using all available clinical and study‐specific data, including imaging and serial hs‐cTnT measurements. Patients were stratified according to the presence or absence of prior CABG. Results Among 4752 patients, 387 (8%) had prior CABG (median age, 75 years; 86% men). The incidence of myocardial infarction was significantly higher in patients with prior CABG (38% versus 16%; P <0.001). In the CABG group, the diagnostic accuracy of cMyC as quantified by the area under the curve was 0.88 (95% CI, 0.85–0.92), which was comparable but not superior to that of hs‐cTnT (0.89 [95% CI, 0.86–0.92]) and hs‐cTnI (0.88 [95% CI, 0.84–0.91]). These findings were consistent across alternative high‐sensitivity cMyC assays. Conclusions In patients with prior CABG, cMyC demonstrated high diagnostic accuracy for myocardial infarction, but not superior to established hs‐cTnT and hs‐cTnI assays. Registration URL: clinicaltrials.gov ; Unique Identifier: NCT00470587.
