BACKGROUND:Suboptimal blood pressure (BP) control remains a major cardiovascular disease risk factor. Whether genetically predicted BP independently predicts long-term BP control is unknown. We examined the associations of BP polygenic scores (PGSs) with long-term BP control and treatment-resistant hypertension. METHODS:We identified 22 456 Mass General Brigham Biobank participants with hypertension. Longitudinal BP control was defined as the percentage of time above-target systolic BP (SBP) ≥130 mm Hg or diastolic BP (DBP) ≥80 mm Hg over 5 years. Using multivariable regression, we assessed the associations of BP PGS with duration above-target BP and lifetime treatment-resistant hypertension incidence. Incremental prognostic utility of BP PGSs was assessed based on the discrimination C-index, Brier score, and net reclassification index. Validation was performed in the population-based UK Biobank cohort using the SBP/DBP ≥140/90 mm Hg threshold. RESULTS:Among 10 853 (48.3%) were female, the mean SBP/DBP (SD) at index date was 132 (18)/75 (11) mm Hg, and 4126 (18.4%) developed treatment-resistant hypertension over lifetime. In reference to the low (<20th percentile) PGS group, the high (≥80th percentile) BP PGS was associated with 8.01 (95% CI, 6.68%-9.34%) longer duration with above-target SBP and 6.19 (95% CI, 5.05%-7.33%) with high DBP. Each high SBP and DBP PGS conferred 2.36 (95% CI, 2.07-2.68) and 1.75 (95% CI, 1.55-1.99)-fold higher odds of treatment-resistant hypertension. Adding BP PGSs to traditional risk factors improved treatment-resistant hypertension prediction from C-index (95% CI), 0.74 (0.73-0.75) to 0.78 (0.77-0.79). BP PGSs consistently predicted longitudinal BP management to a comparable extent in the UK Biobank. CONCLUSIONS:Harnessing BP PGSs may inform anticipated trends in BP control to warrant vigilant monitoring and augment prioritization of intensive therapy.

BACKGROUND:Cardiovascular disease mortality among Asian American subgroups has worsened in recent decades. One understudied contributor is the role of discrimination and its impact on lifestyle risk factors that influence cardiovascular health. This scoping review synthesizes the literature on the associations between interpersonal discrimination and three key lifestyle risk factors that are crucial to cardiovascular health: smoking, exercise, and sleep. METHODS:We searched four databases (PubMed/Embase/CINAHL Complete/PsycINFO) for studies published prior to 2/13/2026, supplemented by hand-searching reference lists of included articles. Eligible studies explored the association between interpersonal discrimination and smoking, exercise, or sleep among Asian Americans. RESULTS:Our search returned 1,935 studies, of which 1,912 were excluded. We conducted a full-text review with 23 articles, yielding 16 eligible studies. Five studies examined discrimination and smoking, three examined discrimination and exercise, and 10 examined discrimination and sleep health. Many of the included studies had small samples, varied methods, and high risk of bias. Among these risk factors, most of the evidence suggests poor sleep health is related to discrimination against Asian Americans. CONCLUSION:Interpersonal discrimination is linked to adverse lifestyle risk factors, especially poor sleep health, highlighting underrecognized contributors to cardiovascular health disparities among Asian Americans. Larger studies that disaggregate Asian American subgroups with validated assessments of discrimination and related risk behaviors are needed, along with more language-concordant surveys to better capture the experiences of those with limited English proficiency. Healthcare professionals, public health officials, and researchers must work collaboratively to address discrimination and reduce its harmful downstream effects.

BACKGROUND:Atrial cardiopathy often precedes atrial fibrillation (AF) and has emerged as an independent risk factor for cardiovascular outcomes. However, previous studies have been limited in size and have overlooked the right atrium. METHODS:In 51 693 UK Biobank participants without prevalent AF, we assessed biatrial volumes and emptying fraction from cardiac magnetic resonance imaging using deep learning segmentation. We evaluated associations with new-onset AF, ischemic stroke, heart failure, and dementia, conducted a genome-wide association study, and evaluated causal associations using Mendelian randomization. RESULTS:Among 51 693 adults, the mean (SD) age was 65 (7.7) years, and 24 584 (48%) were male. During the 4-year follow-up, 964 (1.9%) developed AF, 266 (0.5%) developed ischemic stroke, 365 (0.7%) developed heart failure, and 72 (0.1%) developed dementia. After adjustment for clinical risk factors, both left and right atrial measures were associated with new-onset AF (left atrial minimal volume; hazard ratio, 1.55 [95% CI, 1.48-1.62]), ischemic stroke, and heart failure, with stronger associations in women. Left atrial minimal volume was also associated with dementia. Our genome-wide association study identified 51 (27 novel) genetic associations with atrial measures, many of which do not overlap with established AF loci. Genetic correlations revealed that each atrium had varying correlations with cardiometabolic risk factors, and Mendelian randomization demonstrated that left atrial measures had direct causal effects on AF and stroke risk. However, the stroke associations were attenuated after accounting for AF variants. CONCLUSIONS:In this largest assessment of biatrial structure and function to date, both left and right atrial cardiopathies were independently associated with increased risk of adverse cardiovascular events. We identified several novel genetic loci for atrial traits and observed unique genetic correlations between left and right atrial traits and cardiovascular phenotypes, providing insight into chamber-specific remodeling. Several of these measures are likely to be causal determinants of cardiovascular complications previously attributed to AF.

Background Asian Americans represent the fastest-growing group in the United States. Yet the relationship between neighborhood socio-economic status (NSES) and cardiometabolic health has not been thoroughly examined. The study goal is to determine the association between NSES with obesity, hypertension, and diabetes among Asian American subgroups. Methods Data from 4557 self-identified Chinese, Asians from the Indian sub-continent, or Other Asian participants of the 2017-2020 New York City Community Health Survey were analyzed. Each participant was geo-coded into one of 55 community districts and a NSES factor score was calculated and categorized into low, medium, or high NSES. Overweight/obesity, hypertension, and diabetes were self-reported. Hierarchical multivariable adjusted regression models were used to evaluate the association between NSES and cardiometabolic health. Results Compared with high NSES, residing in a neighborhood of medium NSES was associated with higher odds of obesity (OR: 2.70, 95% CI: 1.43, 5.13) among Other Asians and higher odds of overweight/obesity among “All Asians” (OR: 1.41, 95% CI: 1.06, 1.89), Chinese (OR: 1.25, 95% CI: 1.01, 1.62), and “other Asians” (OR: 3.04, 95% CI: 1.39, 6.69). Conclusions Lower compared with higher NSES was associated with overweight/obesity among Asian Americans in NYC.

Background: Cardiovascular disease burden and risk factors have been shown to differ across Asian American subgroups, with notably high prevalence of elevated cholesterol and diabetes in Southeast Asians. Cardiovascular health (CVH) and its associations with demographic and sociocultural factors in Southeast Asians in the US are incompletely understood. We hypothesized that lower socioeconomic position, greater psychological stressors, and differences in sociocultural beliefs in Southeast Asians would be associated with lower CVH. Methods: Adults who self-identified as Southeast Asian were surveyed with standardized, validated questionnaires. CVH was assessed by calculating the composite LE8 score as per the AHA guidelines. The association of LE8 score with demographic, social, psychological, and cultural beliefs was evaluated with the Wilcoxon Rank Sum test. Results: Of 34 Southeast Asian adults surveyed (n=22 women, n=12 men, mean age 43 years, SD 15.8 years), the average LE8 score was 82.3 (SD 12.2). The most suboptimal LE8 component scores were BMI (mean 73, SD 30) and blood glucose (mean 69.2, SD 33.9). The most optimal LE8 component score was nicotine avoidance (mean score 94.6, SD 18.9). Overall, a lower LE8 score was significantly associated with birth outside the United States, education attainment lower than a Bachelor's, annual household income lower than $75,000, and less symptoms of anxiety (p<0.01 all). Of note, strength of cultural beliefs was not significantly associated with a higher LE8 score. Conclusions: This pilot study is the first to characterize CVH in Southeast Asians in association with demographic, sociocultural, and psychological factors. Preliminary data highlights various factors that could contribute to a higher LE8 score in this population, such as nicotine avoidance, more physical activity, and healthcare-seeking behaviors.

Cardiovascular disease is the leading cause of death worldwide, with certain racial/ethnic groups facing higher risks. Global clinical guidelines for the prevention of cardiovascular disease vary in their approach to addressing racial/ethnic differences among patients. The authors compare the American Heart Association’s 2024 PREVENT (Predicting Risk of Cardiovascular Disease Events) equations, the European Society of Cardiology’s 2021 Systematic Coronary Risk Evaluation 2 model, and the Singapore-modified Framingham risk score, with a focus on their differing approaches to race and ethnicity. The PREVENT model removes race and ethnicity as a factor, instead incorporating the Social Deprivation Index to address social determinants of health. SCORE2 introduces multiplier factors for different ethnicities, while the Singapore-modified Framingham risk score retains ethnicity as a variable. Race-neutral models such as PREVENT aim to avoid reinforcing race as a biological construct while still accounting for social determinants of health that are highly correlated with race. In Asia, the path toward race-neutral risk prediction begins with strengthening data infrastructure and increasing participation in clinical trials to ensure adequate representation.

Objectives We aim to compare cardiac CT characteristics of epicardial adipose tissue (EAT), coronary plaque, and perivascular adipose tissue (PVAT) among East, South and Southeast Asian coronary artery disease (CAD) patients. Methods This retrospective, cross-sectional study analyzed data from 2702 stable CAD patients, including 2078 East (56.4 ± 11.2 years, 59.5% male), 310 South (53.2 ± 10.4 years, 62.4% male), and 314 Southeast Asian (52.9 ± 11.2 years, 60.6% male) patients. From this clinical cohort, available imaging subsets were analyzed: 1090 patients with analyzable non-contrast computed tomography for EAT assessment and 751 patients with coronary computed tomography angiography for plaque and PVAT characterization. Results Compared to East Asian patients, South Asian patients exhibited higher EAT attenuation and high-density EAT volume ratio but lower EAT volume (difference: +1.45HU, 95% CI [0.05, 2.84], p = 0.042; +2.79% [0.76, 4.83], p = 0.007; -33.54cm3 [-41.79, -25.29], p < 0.001). No significant differences were found in plaque volumes or compositions and PVAT mean attenuation across the three groups (p > 0.05). Despite higher diabetes prevalence and family history of CAD in South Asian patients, these factors were not independently associated with EAT differences. Conclusions In a multi-ethnic Asian cohort of stable CAD patients, South Asians showed a distinct pro-inflammatory EAT profile, including higher EAT attenuation and high-density volume ratio, independent of traditional risk factors, despite having similar coronary plaque burden, composition, and PVAT characteristics as other Asian groups. This finding suggests that ethnic-specific cardiovascular pathophysiology may operate through mechanisms beyond traditional cardiovascular risk factors.

BACKGROUND:The incidence of type 2 diabetes mellitus among young adults has been increasing over the past few decades. There are limited data on contemporary national cardiovascular mortality rates in young adults with diabetes mellitus (DM). METHODS:We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database for patients aged 15 to 44 years from 1999 to 2019 in the primary analysis. A secondary analysis included data from 2020 to 2022 to examine the effect of the COVID-19 pandemic. We analysed patients in whom cardiovascular diseases (CVD) were listed as the main cause of death and DM as a contributing cause of death. In calculating age-adjusted mortality rates (AAMR) per 100 000 individuals, we used CVD mortality in young adults with comorbid diabetes as the numerator and the overall population as the denominator. We determined temporal trends by estimating the average annual percent change (AAPC) using the Joinpoint regression program. RESULTS:Among 3 309 079 individuals aged 15-44 years who died, 30 978 deaths were due to CVD with comorbid DM listed as a contributing cause. The overall AAMR increased from 1.08 per 100 000 individuals in 1999 to 1.23 per 100 000 individuals in 2019, with an average APC of 0.75 (95% CI, 0.31-1.20). Compared with 1999, the percentage increase in CVD deaths in 2019 among young adults with comorbid DM was +6.2%, whereas a decrease of 19.9% was observed among those without comorbid DM. Males had a higher AAMR than females (1.60 vs. 0.97). Non-Hispanic Black individuals and non-Hispanic American Indian/Alaska Native individuals had the highest AAMRs of 2.99 and 2.89, respectively. The AAMR was higher in rural regions compared to urban areas (1.63 vs. 1.23). The overall AAMR increased markedly from 1.23 in 2019 to 1.60 in 2022, with a similar pattern observed across demographic subgroups. CONCLUSION:Our study reveals a rising trend in CVD mortality in young adults with DM as a contributing cause. Males, non-Hispanic Black individuals, and individuals from rural regions had higher AAMR than their counterparts. This warrants the development of specific healthcare policies aimed at these at-risk populations. LAY SUMMARY:Our study shows that cardiovascular disease (CVD) deaths are increasing in young adults with diabetes mellitus listed as a contributing cause.