Getting healthy sleep was recognized in 2022 by the American Heart Association as a key health behavior of Life’s Essential 8 based on growing evidence of its impact on cardiovascular health. American Heart Association guidelines recommend that adults aged ≥20 years get on average 7 to 9 hours of sleep per night, based on self-reported measures. However, many adults report getting inadequate sleep duration, a trend expected to worsen through 2050. For these reasons, the relationship between sleep, including its multidimensional components (eg, timing, efficiency, regularity, and architecture), and cardiovascular disease must be evaluated further. In this review, we summarize the current evidence on the association of multidimensional sleep with heart disease and stroke risk. In addition, we discuss the advantages and limitations of various sleep assessments from self-report to direct measurement via novel digital health technologies.

Lifestyle scores have emerged as a practical tool to assess the risk of major non-communicable diseases (NCDs). However, most of them are primarily developed for single NCDs. Given the common risk factors for some of the major NCDs, we conducted a systematic review to evaluate the potential of existing lifestyle scores in predicting the risk of multiple NCD-related endpoints. PubMed, Web of Science, the Cochrane Library, Embase, and Google Scholar were searched from inception to October 2024. We included observational studies assessing the association between lifestyle scores and the risk of morbidity or mortality of multiple NCDs, including type 2 diabetes (T2D), cardiovascular disease (CVD), and cancer. Of 16,138 unique records identified by the search, 56 eligible studies were included in the systematic review, consisting of 48 cohort studies, 5 case-control studies, 2 case-cohort studies, and 1 cross-sectional study from 16 countries. 15 lifestyle scores were identified to estimate the risk of 32 NCDs, with HLIBMI being the most reported score (14/56, 25.0

Background: Cardiac rehab (CR) is a critical but underused secondary prevention program. Hybrid CR programs have the potential to improve patient access by enabling home CR sessions alongside traditional in-center sessions. However, representation and retention of patients who enroll in hybrid CR remain a knowledge gap. Methods: The mTECH-Rehab trial evaluated a 12-week hybrid CR program (center and home-based), recruiting from four inpatient sites, with outpatient delivery at affiliated and unaffiliated centers based on patient preference. We integrated strategies informed by early pilot data to facilitate representative enrollment and retention. These included remote recruitment with electronic consent, a pre-randomization run-in period, and human-centered design paired with digital engagement workflows. Participants in the intervention arm received necessary devices (smartphones, smartwatches, blood pressure monitors) to mitigate digital access barriers. Trained tech coaches ran personalized onboarding guided by a structured protocol, with on-demand participant support throughout the trial. A 4-week run-in period ensured continued interest and digital readiness. Weekly metrics included screening, enrollment, dropout, and randomization to inform adaptive outreach (Fig. 1 ). Results: Of 6,170 patients screened, 1,252 (19%) met eligibility criteria; 969 (77%) were contacted, and 259 (27%) enrolled (mean [SD] age 65 [11.7] years). Among those enrolled, 202 (78%) were randomized, and 167 (83%) of these were retained and completed follow-up. Representation by age, sex, and race remained stable across all phases (mean [SD] age = 64 [12] years enrolled and retained; 32% women enrolled, 31% retained; 9% African Americans enrolled, 10% retained), suggesting that access-related barriers did not lead to attrition ( Fig 2) . Reasons for dropout included unavailability for clinical visits (25%), insurance or logistical issues (22%), loss of contact (19%), unreliable follow-up (19%), withdrawal of consent (9%), and health issues (7%). Conclusion: In our trial, despite low enrollment of racial and ethnic groups, demographic retention and representation in hybrid CR by age, sex, and race were stable. This is an encouraging result achieved through a multifaceted strategy that included a run-in phase, digital device provision, supportive onboarding, and on-demand technology support. Whether such stability can be achieved in a real-world implementation requires further investigation.

BACKGROUND:Digital health technologies provide a scalable, efficient approach to implementing guideline-recommended risk factor modification in the care of patients with atrial fibrillation (AF). OBJECTIVES:This study aimed to evaluate the feasibility of a 12-week, multicomponent, virtual AF management program using a smartphone application, connected devices, and virtual coaching calls for risk factor modification. METHODS:Patients with AF were enrolled from outpatient clinics. Patients were randomized in a 1:1 ratio to either usual care only or the virtual program. The study objectives were to assess feasibility, with the goal of achieving at least 60% participant retention at 12 weeks, intervention engagement, and participant satisfaction. RESULTS:Among 61 patients enrolled (76% of those approached), the mean age was 65 ± 8 years, and 36% were women. A total of 89% of all participants were retained by 12-week follow-up. In the intervention group, at 12-weeks, 88% continued using the smartphone application, 73% continued participation in virtual coaching calls, and 80% reported being satisfied with the program. CONCLUSIONS:The mTECH Afib (Patient Centered mobile health TECHnology Enabled Atrial Fibrillation Management) trial demonstrates feasibility of conducting a randomized controlled trial using an innovative digital health technology-enabled intervention with broad patient engagement and acceptance of the program components. Large-scale clinical trials powered for health outcomes will be necessary to establish intervention efficacy.

Numerous simple lifestyle scores have been developed for specific non‐communicable diseases (NCDs). This research aimed to investigate and compare the associations of various lifestyle scores with the incidence and mortality of NCDs. In 76,399 participants from the UK Biobank, we investigated the associations of 13 lifestyle scores with the incidence and mortality of cancer, cardiovascular disease (CVD), type 2 diabetes (T2D), and a composite of these NCDs. Cox proportional‐hazards regression models were used to estimate hazard ratios (HRs) for associations between lifestyle scores and NCD outcomes. During a median follow‐up time of 10.5 years, 12,214 incident NCD cases and 2250 NCD deaths were documented. Higher lifestyle scores were generally associated with a reduced risk of overall NCDs (HRs ranging from 0.65 to 0.89) and NCD mortality (0.51–0.92). Cancer (HRs ranging from 0.72 to 0.98) and CVD (0.55–0.87) risk were less dependent on lifestyle behaviors than T2D (0.18–0.74). Notably, the top three scores associated with cancer outcomes included smoking as a component, and those for T2D included body mass index (BMI). For overall NCD outcomes, lifestyle scores including both smoking and BMI showed the strongest associations. Healthy Lifestyle Score and the Chronic Disease Risk Index were the overall best‐performing scores to predict NCD risk and mortality. These findings suggest that the use of lifestyle scores designed for a single disease group can be extended for predicting multiple NCDs and mortality. Both smoking and BMI should be included in lifestyle scores aiming to predict overall NCD risk and mortality for future research and recommendations.

Traditional cohort studies, relying on periodic visits, may introduce bias by capturing data largely when participants feel well. Wearables enable continuous data collection, potentially mitigating this bias, but low adoption among older adults could result in data gaps. Fitbit Charge 6 devices were used to collect long-term health data among Atherosclerosis Risk in Communities Neurocognitive Study (ARIC NCS) participants with a smartphone in 2024-2025. Staff provided Fitbit setup and training, encouraging daily wear and regular syncing, with ongoing technology support. Fitbit wear time, measured by heart rate data, was calculated as a percentage. Mann-Whitney U tests assessed differences in wear time by age, sex, and race. Approximately one-third of eligible participants offered a Fitbit chose to enroll. A total of 309 ARIC NCS participants (84.0±3.2 years [36% ≥85 years], 60% women, 82% White, 45% ≤high school/vocational school) contributed a median of 125 (IQR: 148) days of Fitbit data (∼4.2 months). In this sample of older adults aged 79-95 years, the median wear time was 99% (IQR: 3%). A Mann-Whitney U test revealed a significant difference (z=-4.08, p < 0.001) in median wear time between Black (98%, IQR: 10%) and White (99%, IQR 3%) older adults, indicating greater variability in wear time among Black adults. These findings suggest that with the proper onboarding and ongoing technology support, wearable devices can be used to collect long-term data among adults 80 years and older. Future research could examine potential reasons for greater wear time variability among Black adults, including digital literacy and sensor accuracy.

The American Heart Association recommends 7-9 hours of sleep per night, based primarily on self-reported data, to promote cardiovascular and cognitive health. Due to limited objective, long-term sleep data in adults aged 80 years and older, we sought to objectively characterize sleep in this group. Fitbit Charge 6 devices were used to collect long-term data on sleep among Atherosclerosis Risk in Communities Neurocognitive Study (ARIC NCS) participants with a smartphone in 2024-2025. Nighttime sleep (8 pm-8 am) with ≥8 hours of heart rate data, ensuring consistent Fitbit wear, was analyzed to assess sleep duration and efficiency. Multiple linear regression was used to assess independent predictors of sleep efficiency, including age, sex, and race. A total of 301 ARIC NCS participants (84.0±3.2 years [36% ≥85 years], 60% women, 82% White) contributed a median of 112 (IQR: 144) nights of sleep data (∼3.7 months). This sample of older adults aged 79-95 years spent a median of 301 (IQR: 115) minutes asleep (∼5 hours) and 450 (IQR: 104) minutes in bed (∼7.5 hours) per night. Median sleep efficiency was 68% (IQR: 15), with 85% having fair or poor sleep (efficiency <80%). Men (-4.28%; 95% CI: -7.11%, -1.45%) and Black adults (-5.40%; 95% CI: -9.01%, -1.80%) had significantly lower sleep efficiency compared to women and White adults. In conclusion, adults 80 years and older, particularly Black adults and men, experience poor sleep. Future research could examine long-term sleep variability in this population and reasons for sleep deficits among Black older adults and men.

Background: Hybrid cardiac rehabilitation (HCR) is an emerging approach to increase participation in cardiac rehabilitation, which targets improvements in functional status and broader risk factor modification including lipid management. However, long-term lipid control trends of patients engaging in HCR remain unexplored. Methods: Using data from a quality improvement program initiated during COVID-19, we conducted a retrospective analysis of 68 adults eligible for HCR from Jan 2021 to Feb 2023 at the Johns Hopkins Health System (Baltimore, MD), utilizing the Corrie digital health platform. This multi-component platform combines expert knowledge with gamified education and virtual coaching to deliver HCR. Patients hospitalized for cardiovascular events qualifying for HCR were recruited for a pilot study of a randomized controlled trial (mTECH REHAB; NCT05238103). We modeled trends in low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non-HDL-C, and triglycerides via mixed-effects regression. Results: Among 68 eligible adults, 41 participated in HCR, with a mean age of 60.1 years, 78.1% male, 24.3% Black, and 14.6% Asian/Mixed. HCR participation was significantly associated with being married (61% vs 33%, p=0.044) or employed (63% vs 26%, p=0.015). On average, 2.3 lipid panels were assessed per person over a median of 12 months (max 30 months) post-discharge. During this period, LDL-C levels decreased from 84.6 mg/dL (95% CI: 75.0-94.1) to 53.0 mg/dL (95% CI: 34.3-71.8) (p for trend = 0.003). Non-HDL-C decreased from 105.9 mg/dL (95% CI: 95.7-116.1) to 74.2 mg/dL (95% CI: 54.1-94.3) (p for trend = 0.005). Levels of HDL-C and triglycerides showed no significant changes (p for trend = 0.724 and 0.607). Among 34 participants with ≥2 lipid panels, the proportion of LDL-C <70 mg/dL increased from 41.2% at hospitalization to 64.7% at the most recent check, and LDL-C <55 mg/dL increased from 14.7% to 38.2%. Conclusion: Improvements in atherogenic lipid levels, in particular LDL-C and non-HDL-C, were observed in adults participating in HCR after a cardiovascular event. Our findings highlight the potential of HCR to support optimal lipid management in adults with cardiovascular disease.

BACKGROUND:Prior studies have shown that cardiovascular disease (CVD) can be effectively managed through telehealth. However, there are little national data on the use of telehealth in people with CVD or CVD risk factors. We aimed to determine the prevalence of telehealth visits and visit modality (video versus audio-only) in people with CVD and CVD risk factors. We also assessed their rationale and satisfaction with telehealth visits. METHODS AND RESULTS:A nationally representative sample of 6252 participants from the 2022 Health Information National Trends Survey 6 was used. We defined the CVD risk categories as having no self-reported CVD (coronary heart disease or heart failure) or CVD risk factors (hypertension, diabetes, obesity, or current smoking), CVD risk factors alone, and CVD. Multivariable logistic regression, adjusting for major sociodemographic factors, assessed the relationship between CVD risk and telehealth uptake. The weighted prevalence of using telehealth was 50% (95% CI, 44%-56%) for individuals with CVD and 40% (95% CI, 37%-43%) for those with CVD risk factors alone. Individuals with CVD had the highest odds of using any telehealth (audio-only or video) (adjusted odds ratio [OR], 2.02 [95% CI, 1.39-2.93]) when compared with those without CVD or CVD risk factors. Notably, 21% (95% CI, 16.3%-25.6%) of patients with CVD used audio-only visits (adjusted OR, 2.38 [95% CI, 1.55-3.64]) compared with patients without CVD or CVD risk factors. CONCLUSIONS:In a nationally representative survey, there was high prevalence of any (video or audio-only) telehealth visits in people with CVD, and audio-only visits comprised a significant proportion of telehealth visits in this population.

Objective Elevated lipoprotein(a) [Lp(a)] is an independent, genetically determined risk factor for atherosclerotic cardiovascular disease (ASCVD). We evaluated the frequency of testing for elevated Lp(a) and subsequent management at the Johns Hopkins Hospital, a large academic medical center, over a 5-year period. Methods The Johns Hopkins Hospital (JHH) electronic medical record was queried to identify patients with an encounter between 2017 and 2021, either with established ASCVD or at increased risk, defined as being on any lipid lowering medication or having LDL-C ≥ 190 mg/dL. The frequency of Lp(a) testing and of elevated levels were identified for each year. Results Among 111,350 unique adult patients, 2,785 (2.5 %) had at least one Lp(a) test. Patients with Lp(a) testing, compared to those without testing, were younger (mean age 56 years vs. 66 years), more often female (49 % vs. 44 %), Black (24.7 % vs. 24.6 %) or “other” race/ethnicity (12 % vs 10 %), and had higher LDL-C levels (median 118 vs. 91 mg/dL; p < 0.001). The number and frequency of Lp(a) testing increased from 167 (0.57 %) in 2017 to 1155 (5.67 %) in 2021. Lp(a) levels were abnormal in 43.4 % of patients (moderate [75–125 nmol/L]: 10.3 %, high [126–600 nmol/L]: 32.2 %, severe [>600 nmol/L]: 0.9 %). Among 920 patients with high or severe Lp(a) levels, 200 (22 %) had a subsequent referral to cardiology or lipid specialist, and 180 (20 %) had a new lipid-lowering medication prescribed in the subsequent 18 months. Conclusion Based on a single-center experience, the frequency of incident Lp(a) testing among increased-risk patients was low but increased significantly over 5-years, likely due to Lipid Clinic referrals with reflex Lp(a) testing and greater awareness about this risk factor. Future work should target appropriate population based Lp(a) testing strategies and clinical decision-making regarding risk management once Lp(a) elevation is diagnosed.

Background Cardiac rehabilitation (CR) is an evidence‐based, guideline‐recommended intervention for patients recovering from a cardiac event, surgery or procedure that improves morbidity, mortality, and functional status. CR is traditionally provided in‐center, which limits access and engagement, most notably among underrepresented racial and ethnic groups due to barriers including cost, scheduling, and transportation access. This study is designed to evaluate the Corrie Hybrid CR, a technology‐based, multicomponent health equity‐focused intervention as an alternative to traditional in‐center CR among patients recovering from a cardiac event, surgery, or procedure compared with usual care alone. Methods The mTECH‐Rehab (Impact of a Mobile Technology Enabled Corrie CR Program) trial will randomize 200 patients who either have a diagnosis of type 1 myocardial infarction or who undergo coronary artery bypass grafting surgery, percutaneous coronary intervention, heart valve repair, or replacement presenting to 4 hospitals in a large academic health system in Maryland, United States, to the Corrie Hybrid CR program combined with usual care CR (intervention group) or usual care CR alone (control group) in a parallel arm, randomized controlled trial. The Corrie Hybrid CR program leverages 5 components: (1) a patient‐facing mobile application that encourages behavior change, patient empowerment, and engagement with guideline‐directed therapy; (2) Food and Drug Administration‐approved smart devices that collect health metrics; (3) 2 upfront in‐center CR sessions to facilitate personalization, self‐efficacy, and evaluation for the safety of home exercise, followed by a combination of in‐center and home‐based sessions per participant preference; (4) a clinician dashboard to track health data; and (5) weekly virtual coaching sessions delivered over 12 weeks for education, encouragement, and risk factor modification. The primary outcome is the mean difference between the intervention versus control groups in distance walked on the 6‐minute walk test (ie, functional capacity) at 12 weeks post randomization. Key secondary and exploratory outcomes include improvement in a composite cardiovascular health metric, CR engagement, quality of life, health factors (including low‐density lipoprotein‐cholesterol, hemoglobin A1c, weight, diet, smoking cessation, blood pressure), and psychosocial factors. Approval for the study was granted by the local institutional review board. Results of the trial will be published once data collection and analysis have been completed. Conclusions The Corrie Hybrid CR program has the potential to improve functional status, cardiovascular health, and CR engagement and advance equity in access to cardiac rehabilitation. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT05238103.

BACKGROUND: Despite the well-established benefits of cardiac rehabilitation (CR) for secondary prevention of cardiovascular disease, participation remains low due to limited supply and access barriers. We built a hybrid CR program that combines in-person and home-based CR (with smartphone app (Corrie Health), smartwatch, Bluetooth blood pressure monitor, and health coaching delivered over 12 weeks). We assessed this novel CR program in a pilot study at Johns Hopkins Hospital and applied the lessons learned to launch a randomized controlled trial (mTECH REHAB; NCT05238103) of hybrid versus traditional CR. METHODS: We examined pilot data from Nov 2022 to Feb 2023 for electronic health record (EHR) screening, bedside enrollment, technology onboarding, access to CR, and weekly health coaching. We identified barriers in the enrollment process which we then used to guide trial design and team organization. RESULTS: EHR screening yielded 1,270 candidates, among which 209 (16.5%) were eligible following chart review. Our team approached 106 (50.7%) at bedside and 20 (9.6%) were enrolled into the pilot study. Ten (50.0%) were lost to follow up, with reasons of: loss of interest (3), post-procedural complication (3), frailty requiring acute CR (1), no insurance coverage (1), follow up in external CR (1), and technology challenges (1). These findings informed trial design as follows: 1) pre-specified filters for cardiovascular procedures/surgeries were added to EHR screening; 2) remote enrollment pathway was added; 3) a 2-week run-in period was added to verify insurance and continued interest following hospital discharge; and 4) standardized workflows and specialized teams were developed for patient recruitment, technology onboarding, and health coaching. The mTECH REHAB trial was launched in Apr 2023. In the first 9 weeks, 851 patients were screened, 157 (18.4%) were eligible, 148 (94.2%) were able to be reached at bedside or via telephone, 41 (27.7%; 16 bedside, 25 remote) were enrolled, and 5 (12.2%) were lost to early follow up because of: loss of interest (3), post-procedural complication (1), and patient relocation (1). CONCLUSIONS: A pilot study can inform and improve the enrollment process in a multi-component digital health trial.

To investigate the correlation the correlation between residual cholesterol (RC) and increased carotid intima-media thickness(cIMT) in non-diabetic individuals. This study included 1786 non-diabetic individuals who underwent carotid ultrasound. RC was calculated based on total cholesterol (TC), LDL-C, and high density lipoprotein cholesterol (HDL-C). The subjects were divided into the cIMT thickening group (cIMT ≥ 0.1 cm) and non-thickening group (cIMT < 0.1 cm) groups based on cIMT, binary logistic regression with different models and receiver operating characteristic (ROC) curves were adopted to evaluate the predictive ability of RC in cIMT. Of the research participants , their median age was 55 (49–51) years, 1121 (63

Background Understanding current trends in cholesterol screening, lipid levels, and lipid management therapies may inform health policy and practice. Methods and Results In 50 928 US adult National Health and Nutrition Examination Survey (NHANES) participants, trends were assessed in cholesterol screening, mean levels of total cholesterol, triglycerides, low‐density‐lipoprotein cholesterol, and lipid‐lowering medication use from 1999 through 2018. Point estimates were also calculated using the 2017 to March 2020 prepandemic data set. The age‐ and sex‐adjusted proportion of having cholesterol screened within 5 years increased from 63.2% (95% CI, 60.0–66.3) in 1999 to 2000 to 72.5% (95% CI, 69.5–75.3) in 2017 to 2018 ( P <0.001 for linear trend). Mean total cholesterol decreased from 203.3 mg/dL (95% CI, 201.0–205.7) in 1999 to 2000 to 188.4 mg/dL in 2017 to 2018 (95% CI, 185.4–191.5) ( P <0.001 for nonlinear trend). The mean triglyceride level decreased from 121.3 mg/dL (95% CI, 116.4–126.4) in 1999 to 2000 to 91.4 mg/dL (95% CI, 88.4–94.6) in 2017 to 2018 ( P <0.001 for nonlinear trend). Low‐density lipoprotein cholesterol decreased from 127.9 mg/dL (95% CI, 125.3–130.5) in 1999 to 2000 to 111.7 mg/dL (95% CI, 109.0–114.4) in 2017 to 2018 ( P <0.001 for nonlinear trend). Among statin‐eligible US adults, the proportion of statin use increased from 14.9% (95% CI, 12.2–17.9) in 1999 to 2000 to 27.8% (95% CI, 23.0–33.2) in 2017 to 2018 ( P <0.001 for nonlinear trend). Statin use increased in adults with diabetes aged 40 to 75 years from 21.4% in 1999 to 2000 to 51.9% in 2017 to 2018 ( P <0.001 for overall linear trend). Statin use plateaued in all other groups. The proportions of using ezetimibe and proprotein convertase subtilisin/kexin type 9 inhibitors were 3.7% (95% CI, 1.3–9.8) and 0.03% (95% CI, 0.01–0.15) in 2017 to March 2020, respectively. Conclusions From 1999 through 2018, cholesterol screening increased while mean total cholesterol, triglycerides, and low‐density lipoprotein cholesterol levels decreased, with a modest increase in statin use and low uptake of nonstatin therapy in the US population.