Diabetic patients are highly susceptible to cardiovascular and renal diseases. As a newly updated comprehensive index for assessing cardiovascular health (CVH), Life's essential 8 (LE8) has the potential to serve as a practical tool for evaluating the risk of diabetic kidney disease (DKD). We are committed to exploring the relationship between LE8 and its subscales with DKD in diabetic patients, aiming to provide preliminary evidence for the formulation of clinical strategies.

A total of 3,715 NHANES participants were included in this study, representing 18.9 million non-institutionalized residents of the United States. The mean age of all subjects was 59.72 years, and the weighted prevalence of DKD among diabetic patients was 36.39%. After adjusting for potential confounding factors, it was found that compared to the low LE8 group, the risk of developing DKD was significantly lower in the moderate LE8 group (OR: 0.54, 95% CI: 0.43-0.66) and the high LE8 group (OR: 0.18, 95% CI: 0.08-0.42). A similar trend was observed across the subscales of the LE8 score. The results of the fully adjusted restricted cubic spline regression analysis revealed a linear relationship between LE8 and its subscales with DKD. The findings remained consistent in subgroup and sensitivity analyses, with no significant interactions observed between subgroups.

Higher scores on the LE8 and its subscales were associated with a lower risk of developing DKD. However, the long-term causal relationship between LE8 and DKD risk necessitates further validation and exploration through large-scale, rigorously designed prospective studies.

The study analyzed the association of area-level socioeconomic status (SES) with the risk of all-cause dementia, Parkinson's Disease (PD), and all-cause mortality using a multistate approach. Data from the UK Biobank were used (N = 363,663 50+y individuals, ≤15y follow-up), and Cox proportional hazards and multistate parametric models including Weibull regression were conducted, while cardiovascular health was tested as a potential mediator. In multistate models, socioeconomic area-level deprivation, measured by the Townsend Deprivation Index (TDI) z-score, was positively associated with the hazard of going from healthy into the 3 states of PD, dementia, and all-cause mortality (i.e. transitions 1: HR = 1.06, 95 % CI:1.02-1.10, P = 0.005, 2: HR = 1.19, 95 % CI: 1.16-1.22, P < 0.001 and 3: HR = 1.19, 95 % CI: 1.18-1.21, P < 0.001), with no association detected for transitions 4 (PD→Dementia), 5 (PD→Death), or 6 (Dementia→Death). Cardiovascular health did not mediate these associations. Socioeconomic area-level deprivation was directly associated with reduced survival rates from Healthy into Dementia, PD and Death.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is linked to cognitive decline and dementia risk. We aimed to investigate the association between MASLD and brain ageing and explore the role of low-grade inflammation.

Within the UK Biobank, 30 386 chronic neurological disorders-free participants who underwent brain magnetic resonance imaging (MRI) scans were included. Individuals were categorised into no MASLD/related SLD and MASLD/related SLD (including subtypes of MASLD, MASLD with increased alcohol intake [MetALD] and MASLD with other combined aetiology). Brain age was estimated using machine learning by 1079 brain MRI phenotypes. Brain age gap (BAG) was calculated as the difference between brain age and chronological age. Low-grade inflammation (INFLA) was calculated based on white blood cell count, platelet, neutrophil granulocyte to lymphocyte ratio and C-reactive protein. Data were analysed using linear regression and structural equation models.

At baseline, 7360 (24.2%) participants had MASLD/related SLD. Compared to participants with no MASLD/related SLD, those with MASLD/related SLD had significantly larger BAG (β = 0.86, 95% CI = 0.70, 1.02), as well as those with MASLD (β = 0.59, 95% CI = 0.41, 0.77) or MetALD (β = 1.57, 95% CI = 1.31, 1.83). The association between MASLD/related SLD and larger BAG was significant across middle-aged (< 60) and older (≥ 60) adults, males and females, and APOE ɛ4 carriers and non-carriers. INFLA mediated 13.53% of the association between MASLD/related SLD and larger BAG (p < 0.001).

MASLD/related SLD, as well as MASLD and MetALD, is associated with accelerated brain ageing, even among middle-aged adults and APOE ɛ4 non-carriers. Low-grade systemic inflammation may partially mediate this association.

Healthy lifestyle behaviors play a significant role in promoting cardiovascular health. Primary care clinicians (PCCs) are tasked with promoting cardiovascular health through the assessment of lifestyle behaviors and the use of behavior change counseling. However, PCCs face several barriers including a lack of training in counseling techniques. We propose a framework to guide the development of a patient-centered digital communication bundle that can aid PCCs in helping their patients create and sustain feasible lifestyle changes. Our framework proposes that this digital communication bundle contains the following features: assess and analyze an individual's cardiovascular health status; communicate personalized information in a health-literacy-friendly, visual format; assess behavioral components of change (e.g., motivation) that can inform the PCC's approach in guiding behavior change; provide PCCs with brief, behavior change counseling prompts that are grounded in motivational interviewing; and assess and address potential structural, socioeconomic, and environmental barriers, thereby fostering resilience in patients' lifestyle change efforts. We highlight the available research to support the need for such a tool and its potential ability to guide PCCs while also promoting behavior change in a patient-centered manner.

Although it is known that caregiver dietary behaviors influence child eating patterns, a gap remains in addressing the diet of a caregiver as much as their child in pediatric practice. A dyadic (caregiver-child) dietary approach would enhance the promotion of healthy eating patterns in children (and their caregivers) and achieve the population health goal of healthy eating across demographic groups. This study aimed to understand factors influencing dyadic dietary patterns (concordance, discordance) and contexts. Twenty professionals who provide nutrition-related expertise for families were recruited via maximum variation sampling. Qualitative thematic analysis of semi-structured interviews revealed 3 themes: (1) variable professional perspectives on what constitutes "healthy eating," (2) eating patterns of a child in the setting of variable caregiver eating practices, and (3) challenges to the promotion of a healthy caregiver-child dyadic diet within a social context. The results offer insight for future interventions that promote positive intergenerational transmission of health.

This study aimed to explore the association between dietary fiber intake and the risk of metabolic dysfunction-associated steatotic liver disease (MASLD), as well as liver fat content, while considering genetic predispositions of MASLD, gut microbial abundance, and butyrate levels. This study analyzed data from 190,276 participants in the UK Biobank. Dietary fiber intake was assessed using 24-h dietary recall. MASLD cases were diagnosed through hospital admission records and death registries, and liver fat content was measured via magnetic resonance imaging. The genetic predispositions of MASLD, gut microbial abundance, and butyrate levels were evaluated using single nucleotide polymorphisms. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95 % confidence intervals (CIs). Over a median follow-up of 10.49 years, 1423 MASLD cases were recorded. Elevated dietary fiber intake was associated with a reduced risk of MASLD (HR: 0.72; 95 % CI: 0.58, 0.90) and a lower level of liver fat content (β: -0.97; 95 % CI: -1.21, -0.73) (all P for trend <0.05). Restricted cubic spline analyses further confirmed the linear inverse associations between fiber intake and the risk of MASLD. Notably, the negative associations between dietary fiber intake and both MASLD and liver fat content were consistent across different genetic predispositions of gut microbial abundance and butyrate levels. Moreover, the inverse association between dietary fiber intake and liver fat was strengthened by high genetic susceptibility of MASLD and elevated body mass index (both P for interaction <0.05). Overall, increased dietary fiber consumption was associated with a lower MASLD risk and decreased liver fat content regardless of genetic predispositions of gut microbial abundance and butyrate levels.

This study aimed to evaluate whether higher moderate- to vigorous-intensity physical activity (MVPA) and lower sedentary behavior (SB) are related to better cardiovascular health (CVH) after pregnancy.

In the nuMoM2b Heart Health Study cohort, Life's Essential 8 health factors (body mass index [BMI], blood pressure, glucose, and lipids) were assessed in the first trimester of pregnancy and 2-7 yr later ( n = 3985). The four health factors were scored with Life's Essential 8 criteria (0 = poorest; 100 = ideal) and averaged to calculate a CVH health factor score (CVH hf) . Self-reported leisure MVPA and SB were assessed at follow-up. Linear regression evaluated associations of MVPA levels and SB quartiles with follow-up CVH hf after adjustment for first trimester CVH hf and covariates. Analyses were repeated after stratification by history of hypertensive disorders of pregnancy (HDP) or gestational diabetes (GDM).

Over follow-up (mean 3.2 yr after delivery), CVH hf declined from 85.6 to 81.6 points (-4.0 points, P < 0.001). The decline was greatest in lipid (-8.4 points, P < 0.001) and BMI scores (-5.6 points, P < 0.001). Healthier activity profiles (higher MVPA level and lower SB quartile) were each associated with higher CVH hf at follow-up: 0.7 points higher per level of MVPA, P < 0.001; 0.5 points lower per quartile of SB, P = 0.0042. Higher MVPA level associated with healthier BMI, glucose, and lipid scores; lower SB quartile associated with healthier BMI and blood pressure scores ( P < 0.05). Although HDP/GDM history was associated with lower CVH hf , patterns of CVH hf across healthier leisure MVPA levels and SB quartiles were similar in those with and without HDP or GDM.

Higher MVPA and lower SB during leisure could help to maintain CVH health factors in the years after pregnancy, including among those who experienced HDP or GDM.

In 2022, the previously American Heart Association (AHA) life's simple 7 score (range 0 to 14) measuring cardiovascular health (CVH) has been updated by adding sleep health and providing more granularity to the score (range 0 to 100) to measure the so-called Life's Essential 8 (LE8) score. However, the distribution of the LE8 score in nationwide representative US and non-US populations is scarce. The present study quantifies LE8 score distribution and identifies determinants of high CVH (80-100 points) in French adults.

CONSTANCES is a nationwide French cohort study that randomly recruited participants aged 18 to 69 years in 24 participating health examination centers in 21 French "départements" in different regions of France between 2012 and 2019. Design weights for age class, sex, socio economic status, and examination center/region were applied to represent the source population. LE8 score was quantified using inclusion data on eight CVH metrics. The prevalence estimates were age-standardized directly using the 2022 EU 28 population. Mixed effects multivariable linear and logistic regression models identified key LE8 score determinants.

The study included 191,335 participants free of prior cardiovascular disease, with an average age of 46.48 years (SD 13.41) and 54 % women, representing 45.17 million individuals aged 18-69 in France. The overall mean LE8 score was 66.11 (68.92 in women vs. 62.79 in men, p = 6.875e-7), 13.21 %, 76.81 %, and 9.43 % achieved high (≥ 80 points), moderate (50-79 points), and poor (< 50 points) LE8 levels, respectively. Diet had the lowest mean score (41.50), while blood glycemia had the highest mean score (95.50). Mixed effects multivariable regression models identified younger age, womanhood, high educational attainment, self-employment, or managerial positions, not living with a partner, fewer depressive symptoms, lower alcohol consumption, rural residence, less socioeconomic deprivation, and absence of CVD family history as predictors of higher LE8 scores.

Only 13.21 % of adults in France achieved a high LE8 score (≥ 80 points), and disparities related to individual and contextual socio-demographic factors and mental health were identified. The findings further underscore the importance of timely implementation of effective and personalized primordial prevention strategies.

The ideal cardiovascular health (CVH) construct has recently been updated to ¨ Life's Essential 8¨(LE8).

to determine LE8's prevalence and its association with sociodemographic and socioeconomic determinants in a Latino women cohort in Santiago de Chile.

Cross-sectional study on 619 women between 35 and 70 years old, representing 1.359.509 women (after expansion factors). LE8 was assessed through a survey on demographic and CV risk factors, as well as anthropometric, blood pressure, and biochemical measurements. The overall LE8 score was estimated for all participants, ranging from 0 to 100 (≥80 points, high CVH and < 50 points, low CVH). Besides, the score for each metric was determined. A descriptive analysis was performed with sample weights for the overall sample, and stratified by age, education, family income level and civil status. A regression analysis was performed adjusted by age group, family income and education level to determine the association of sociodemographic variables with LE8 score.

The mean overall LE8 score was 62.7 points. Only 11.5 % had a high LE8, while 18.2 % had a low score. The best-accomplished metrics were blood glucose and physical activity (PA); the worst were diet and nicotine exposure. The adjusted regression analysis showed significantly higher scores for younger age (+3.2 points for <45yo, p < 0.05) and higher education level (+5 points, p < 0.01 and +12 points, p = 0.000,1 for high school and tertiary education, respectively). Higher LE8 scores in women with high education level were significantly driven by improvements in 5 metrics (lipids, blood pressure, body mass index, diet and PA).

Nearly 1 out of 9 women from Santiago had an ideal LE8 score. Years of education are crucial determinants in the fight to get an ideal CVH.

MAFLD is highly prevalent among overweight and obese individuals. Recently, the American Heart Association proposed a new measure of cardiovascular health (Life's Essential 8). This study investigated the relationship between the Life's Essential 8 (LE8) and MAFLD, all-cause and cardiovascular mortality in these populations, exploring the mediating role of inflammation and insulin resistance. This retrospective study used data from the National Health and Nutrition Examination Survey (NHANES, 2007-2018), including 6,885 overweight and obese individuals. LE8 scores were categorized into low, medium, and high groups. Weighted logistic regression and Cox proportional hazards models assessed the relationships between LE8, MAFLD, and mortality. Mediation analyses explored the roles of inflammation and insulin resistance, and weighted restricted cubic spline (RCS) regression examined potential nonlinear associations. Kaplan-Meier survival analysis evaluated survival rates across LE8 groups, and subgroup analyses assessed interactions with demographic characteristics. Additionally, ROC curves were used to explore the predictive accuracy of various inflammation and insulin resistance biomarkers. In model 3, compared to the low LE8 group, the prevalence of MAFLD in the highest LE8 group was reduced by 89% (OR = 0.11; 95% CI: 0.06, 0.20). HOMA-IR mediated 72.26% of the mediation effect. Various inflammation markers, including CRP, hs-CRP, SII, and SIRI indices, mediated effects ranging from 3 to 12%. Compared to the low LE8 group, the highest LE8 group had a 58% reduction in all-cause mortality and a 90% reduction in cardiovascular mortality. Kaplan-Meier analysis showed that the higher LE8 groups had significantly higher survival rates than the low LE8 group. Inflammatory markers mediated 5-17% of the mediation effects. Restricted cubic spline (RCS) curves revealed a non-linear relationship between LE8 and MAFLD. Age interacted with LE8 in several subgroup analyses. ROC curves showed that HOMA-IR had strong predictive accuracy for MAFLD, while SIRI demonstrated potential advantages in predicting mortality risk. In overweight/obese populations, LE8 scores were negatively associated with the prevalence of MAFLD, and risk of mortality. These findings emphasize the importance of maintaining high levels of LE8 scores for primary prevention in overweight/obese populations.

Social disparities in health persist in Israel despite universal health care. Few studies have focused on the impact of neighborhood disadvantage on health in a representative sample of the Israeli population while accounting for multiple socioeconomic factors. The objective of this study was to assess the independent association between perceived neighborhood disadvantage and self-reported poor chronic health.

Self-reported poor chronic health was defined as (1) reported not very good/poor health, and (2) having a chronic health/physical problem for > = 6 months disrupting daily life activities. Neighborhood disadvantage was based on self-reported measures of residential environment (scale of dissatisfaction with transportation, parks, cleanliness, waste removal, noise, pollution, safety, and walkability) and social problems (dissatisfaction related to neighbors, and neighbors interacting to improve the environment). High levels of neighborhood problems were defined as top 25th percentile of dissatisfaction scales. Logistic regression models included incremental adjustment for sex, age, ethnicity/religion, immigration status, peripheral region and then income, education and employment status.

A total of n = 7,020 participants with non-missing data were included. High levels of neighborhood environmental and social problems were independently associated with poor chronic health even after adjustment for sex, age, ethnicity/religion, immigration status, and peripheral region, and remained statistically significant after additionally adjusting for income, education, employment and lifestyle factors (odds ratio (OR) 1.5, 95% confidence interval (CI) 1.2-1.9 for environmental problems; OR 1.3, 95% CI 1.1-1.6 for social problems).

Living in areas of perceived disadvantage conferred health risks beyond those related to ethnicity or socioeconomic status. These findings suggest that neighborhood-level factors contribute significantly to health disparities in Israel and should be included in national efforts to evaluate and minimize these health disparities. Future research is needed to also consider objective measures of neighborhood disadvantage, in order to determine the more salient neighborhood measures with respect to health outcomes and to effectively develop targeted interventions to reduce area-level health disparities.

Plant-based diets are associated with favourable cardiovascular health markers. Although increasingly consumed among younger demographics, it is unclear how plant-based diet quality tracks from adolescence to young adulthood, and how this impacts cardiovascular health later in life. Thus, this study aimed to explore trajectories of plant-based dietary patterns from adolescence to young adulthood and investigate associations with cardiometabolic health markers in young Australian adults.

Longitudinal data from 417 participants from the Raine Study were included. Semi-quantitative food frequency questionnaires conducted at 14, 20, and 27 years of were used to derive three plant-based diet quality index scores: an overall plant-based diet (PDI), a healthy plant-based diet (hPDI), and a less healthy plant-based diet (uPDI). Markers of cardiometabolic health included waist circumference, blood lipids, and blood pressure obtained at 14 and 28 years of age. Group-based trajectory modelling was used to describe plant-based diet quality trajectory groups from adolescence to young adulthood. Multivariate linear regression models were used to investigate associations with cardiovascular health markers.

Plant-based diet quality trajectory groups were different by sex, but remained relatively stable over the life stages, with participants remaining either above or below average diet quality at all time points. Associations with cardiovascular health outcomes differed between the sexes, with the hPDI having the greatest number of associations for females, and the uPDI for males. Being female with a higher hPDI score was associated with lower insulin (β = -1.11 (95% CI -2.12, -0.09)), HOMA-IR (β = -0.25 (95% CI -0.48, -0.01)), systolic blood pressure (β = -2.75 (95% CI -5.31, -0.19)), and hs-CRP (β = -1.53 (95% CI -2.82, -0.23)), and higher HDL-cholesterol (β = 0.13 (95% CI -0.03, 0.23)) compared to females with lower hPDI scores. Being male in the higher scoring uPDI group was associated with higher waist circumference (β = 3.12 (95% CI 0.61, 5.63)), waist-to-height ratio (β = 0.02 (95% CI 0.01, 0.03)), insulin (β = 1.54 (95% CI 0.33, 2.76)), HOMA-IR (β = 0.35 (95% CI 0.07, 0.63)), and hypertension status (β = 6.60 (95% CI 1.04, 42.00)) when compared to the lower scoring uPDI group.

This study provides new insights into how plant-based diets track across adolescence into adulthood, impacting on cardiometabolic risk factors differently for males and females. Findings highlight the importance of early sex-specific interventions in adolescence to reduce future risk of cardiovascular-disease.

Objective: We studied whether cardiovascular health promotion via mHealth intervention was effective in a sample of adults entering college. Participants: 301 Freshmen at a Northwestern University were cluster randomized by residence hall. Methods: We compared 2 conditions delivered via custom smartphone apps: (1) Cardiovascular Health, an intervention addressing behaviors related to cardiovascular disease risk; or (2) Whole Health, an active control addressing behaviors unrelated to cardiovascular disease. The primary outcome was the AHA's Life's Simple Seven (LSS) composite score. Outcomes were assessed in-person at baseline, 1 and 2 years. Linear mixed models were used to compare the groups on the composite score. Results: We found no significant group, time, or group by time differences in LSS. Participants were relatively healthy at baseline and stable over time. Cholesterol increased by 5.24 mg/dL from Baseline to Year 1 and by 7.39 mg/dL from Baseline to Year 2 in both groups. Conclusions: mHealth interventions focused on cardiovascular health did not show appreciable difference from those addressing more general health behaviors. Low engagement in the intervention could have contributed to the null findings and future research is needed to determine if mHealth strategies could be improved as an intervening modality.

Environmental pollution, sedentary lifestyles and unhealthy dietary patterns have been hypothesized as the main modifiable factors of human semen quality decline.

To assess associations between a-priori defined Mediterranean diet (MedDiet) adherence and semen quality parameters or medically assisted reproductive (MAR) outcomes in men.

A systematic review was conducted with studies from PUBMED,EMBASE or SCOPUS databases until October 2024. A-priori defined MedDiet adherence was considered as exposure and conventional semen quality parameters as the primary outcomes. Secondary outcomes included MAR outcomes, reproductive hormone levels and sperm DNA fragmentation. A quality assessment was performed using the NHLBI tool. Meta-analysis was conducted following Cochrane guidelines. A subgroup analysis was done for healthy participants and those from fertility clinics separately. A sensitivity analysis was performed to check the influential studies.

A qualitative analysis was performed on 11 eligible articles (n=2,558 individuals). Data from 9 observational studies showed a positive association between the adherence to MedDiet and semen volume (1/9), sperm concentration (5/9 studies), count (5/9), total motility (5/9), progressive motility (4/9), vitality (1/9), normal morphology (2/9), or follicular stimulating hormone (1/9). Among these, the links between MedDiet adherence and MAR outcomes were prospectively explored only in one study, that reported no association. A total of 8 studies were eligible for meta-analysis (n=1,835 individuals). Total MedDiet adherence showed a significant positive association with sperm count (24.37 M spz.; 1.30 to 47.44, I2=89%), total motility (8.81%; 2.26 to 15.37, I2=88%), progressive motility (7.49%; 1.47 to 13.50, I2=86%) and normal morphology (1.02%, 0.21 to 1.82, I2=77%). Evidence from two randomized clinical trial evaluating the effect of MedDiet on semen parameters aligns with the primary results.

Evidence from observational studies and clinical trials show potential benefit of adhering to a MedDiet in terms of seminal quality parameters, but not with fertility outcomes.

PROSPERO (ID: CRD42024584003) STATEMENT OF SIGNIFICANCE: This SRMA is the most updated and first article with the specific association of a-priori MedDiet on the male semen quality and medically assisted reproductive outcomes, including latest RCTs and also with meta-analysed data for observational studies.

BackgroundThe extent to which hypertension-related excess risk of dementia can be mitigated or eradicated through lifestyle factor modification remains unclear.ObjectiveTo explore the association between lifestyle behaviors and hypertension-related excess risk of dementia.MethodsIn this prospective cohort study using data from the UK Biobank, participants were enrolled from 2006 to 2010 and followed up until December 2022. A healthy lifestyle score was constructed by assigning one point for each of the seven selected healthy lifestyle factors. The association of dementia risk in individuals with hypertension according to the healthy lifestyle score was compared to individuals without hypertension.ResultsThis study included 337,378 individuals. During a median follow-up of 13.6 years, 5390 participants developed dementia. A higher healthy lifestyle score was associated with a gradual decrease in the excess risk of dementia for individuals with hypertension compared to individuals without hypertension. Excess dementia risk was not detected among individuals with hypertension who adopted at least six healthy lifestyle factors (hazard ratio (HR) = 1.05 (95% confidence interval (CI): 0.96-1.14)) for six scores; HR = 0.93 (95% CI: 0.82-1.06 for seven scores). The protective association between adhering to all seven healthy lifestyle factors and dementia was significantly stronger for individuals <60 years old than for individuals ≥60 years old.ConclusionsFor individuals with hypertension who adopted at least six healthy lifestyle factors had no hypertension-related excess risk of dementia.

Comprehensive longitudinal data in healthy populations on cardiometabolic determinants of arterial intima-media thickness (IMT), especially aortic IMT, in adolescence are lacking. We aimed to examine in detail how cardiometabolic risk factors associate with aortic and carotid intima-media thickness (IMT) in adolescence.

Participants (n = 522) were healthy individuals from Special Turku Coronary Risk Factor Intervention Project. IMT of the abdominal aorta and common carotid artery was measured repeatedly with ultrasonography at the age of 11, 13, 15, 17 and 19 years. Data on cardiometabolic risk markers were available beginning from early childhood.

Between ages 11 and 19 years, body mass index (BMI), waist circumference, systolic and diastolic blood pressure, serum total cholesterol, non-HDL-cholesterol, and apolipoprotein B levels, insulin and insulin resistance indicated by homeostasis model of insulin resistance (HOMA-IR), C-reactive protein, and smoking associated directly with aortic IMT. For carotid IMT, a direct association was found with BMI, waist circumference, systolic blood pressure and smoking. In multivariate analyses, BMI(β = 5.49, SE = 1.01, P < 0.0001) and HOMA-IR (β = 16.79, SE = 7.45, P = 0.02) remained as determinants of aortic IMT. Correspondingly, BMI(β = 1.78, SE = 0.42, P < 0.0001) and systolic blood pressure (β = 0.38, SE = 0.10, P = 0.0001) determined carotid IMT. Participants with longitudinal aortic or carotid IMT above/equal the 80th percentile had higher BMI measured from infancy than their peers with longitudinal IMT below the 80th percentile.

In adolescence, several cardiometabolic risk factors associate with aortic IMT while these links are less evident for carotid IMT. Aortic IMT may serve as a more sensitive marker than carotid IMT of early vascular remodeling.

Individuals with cardiovascular diseases (CVD) tend to have decreasing cardiorespiratory fitness (CRF), muscle strength, and quality of life (QoL). Because of its multiple benefits, participation in an exercise-based cardiac rehabilitation (CR) program was highly recommended for CVD patients. Currently, there is a trend of increasing the use of resistance exercises (RE) in CR and treatment of CVD, including coronary artery disease (CAD), peripheral arterial disease, and stroke. The application of RE in CVD patients also raises concerns for physicians due to adverse events related to cardiovascular responses. Therefore, this review aimed to explore the effect of RE on cardiovascular responses, cardiovascular risk factors, muscle strength, CRF, and the QoL, including its safety in CAD patients. Articles published in the last ten years were searched using PubMed, Science Direct, Research Gate, and Google Scholar databases using relevant keywords. Studies found that the administration of RE in CAD patients was proven safe when prescribed properly. Some literature showed that RE affected CVD risk factors by improving blood pressure, blood sugar, lipid profile, and body composition. In addition, systemic vascular resistance change led to vasodilatation and reduced blood pressure. Fatal and non-fatal myocardial infarction and mortality also decreased after progressive RE. High-intensity RE was proven to be better at increasing muscle strength compared to low-intensity because it produced a greater increase in the number of myofibrils and neural adaptation. Subsequently, aerobic exercise (AE) combined with RE caused a better increase in CRF. An increase in muscle strength and CRF, as well as diminished symptoms and controlled risk factors obtained from RE administration, increased QoL. To conclude, RE was a safe modality for QoL improvement in CAD patients through controlling risk factors and improving muscle strength and CRF.

Autoimmune diseases are closely linked to cardiovascular diseases. This study aimed to assess the relationship between cardiovascular health (CVH) defined by Life's Essential 8 (LE8), genetic predisposition, and the risk of 19 autoimmune disorders.

A total of 247 660 participants without prior autoimmune diseases from the UK Biobank were included. CVH was assessed using LE8 scores, categorized into low, moderate, and high. Cox proportional hazards models estimated the association between CVH, genetic susceptibility, and autoimmune disorder risk. Over 13.2 years of follow-up, 11 422 incident autoimmune disorders occurred. Higher CVH levels were associated with reduced risks of overall autoimmune disorders (hazard ratio, 0.68 [95% CI, 0.62-0.74]) and specific conditions, including Graves disease, inflammatory bowel disease, polymyalgia rheumatica, psoriasis, rheumatoid arthritis, and type 1 diabetes. Dose-response analyses revealed a linear negative relationship between continuous LE8 scores and the risks of Graves disease, inflammatory bowel disease, polymyalgia rheumatica, psoriasis, rheumatoid arthritis, and type 1 diabetes (Pnonlinear>0.05). Genetic predisposition to autoimmune disorders (including ankylosing spondylitis, celiac disease, Graves disease, inflammatory bowel disease, polymyalgia rheumatica, psoriasis, rheumatoid arthritis, Sjögren syndrome, systemic lupus erythematosus, systemic sclerosis, and type 1 diabetes) significantly modified these associations (Pinteraction<0.05), with protective effects more pronounced in women, participants aged <65 years, and those with low genetic risk.

LE8 scores inversely and linearly predicted autoimmune disease incidence. Prioritizing CVH optimization through LE8 adherence may reduce the global autoimmune disease burden.

The growing morbidity, mortality, and health care costs related to heart failure (HF) underscore the urgent need to prioritize its primary prevention. Whereas a risk-based approach for HF prevention remains in its infancy, several key opportunities exist to actualize this paradigm in clinical practice. First, the 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America HF guidelines provided recommendations, for the first time, on the clinical utility of multivariable risk equations to estimate risk of incident HF. Second, the American Heart Association recently developed the PREVENT (Predicting Risk of Cardiovascular Disease Events) equations, which not only enable prediction of incident HF separately, but also include HF in the prediction of total cardiovascular disease. Third, the predominant phenotype of HF risk has emerged as the cardiovascular-kidney-metabolic syndrome. Fourth, the emergence of novel therapies that prevent incident HF (eg, sodium-glucose cotransporter-2 inhibitors) and target multiple cardiovascular-kidney-metabolic axes demonstrate growing potential for risk-based interventions. Whereas the concept of risk-based prevention has been established for decades, it has only been operationalized for atherosclerotic cardiovascular disease prevention to date. Translating these opportunities into a conceptual framework of risk-based primary prevention of HF requires implementation of PREVENT-HF (Predicting Risk of Cardiovascular Disease Events-Heart Failure) equations, targeted use of cardiac biomarkers (eg, natriuretic peptides) and echocardiography for risk reclassification and earlier detection of pre-HF, and definition of therapy-specific risk thresholds that incorporate net benefit and cost-effectiveness. This scientific statement reviews the current evidence for accurate risk prediction, defines strategies for equitable prevention, and proposes potential strategies for the successful implementation of risk-based primary prevention of HF.

Cardiovascular health (CVH) is closely linked to cardiovascular disease (CVD)-specific mortality, yet research on Life's Essential 8 (LE8), a new CVH indicator, and its association with CVD risk is limited.

This study aims to explore the association between LE8 and CVD risk in US adults.

A total of 22,298 participants were included in this cross-sectional study from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018. LE8 scores were categorized into low, moderate, and high groups. Multivariate logistic regression and restricted cubic spline (RCS) models were employed to examine the association between LE8 scores and CVD risk.

In the multivariate-adjusted model, individuals with moderate and high LE8 scores exhibited a 53% (odds ratio [OR] = 0.47, 95% confidence interval [CI]: 0.41-0.54) and 77% (OR = 0.23, 95% CI: 0.18-0.30) reduction in total CVD risk compared to those with low LE8 scores. RCS analyses revealed an inverse dose-response relationship between LE8 scores and total CVD risk. A consistently negative association was observed between LE8 scores and the risk of CVD subtypes, including congestive heart failure, coronary heart disease, angina pectoris, heart attack, and stroke. Subgroup analyses indicated a more pronounced inverse association between LE8 scores and total CVD risk among participants under 50 years old and with a family history of CVD.

These findings suggest a strong inverse relationship between LE8 and CVD risk. Improving CVH through adherence to LE8 guidelines has significant potential to reduce the burden of CVD.

Definition and staging rationale of cardiovascular-kidney-metabolic syndrome were developed. The utility of cardiovascular-kidney-metabolic construct in risk stratification and target strategies of health and behavior modifications needs to be addressed. The study aims to investigate the individual and combined associations of cardiovascular-kidney-metabolic stage and cardiovascular health (CVH) by Life's Essential 8 (LE 8) with incident cardiovascular events (CVD), and determine the distribution and contribution of domain-specific CVH across cardiovascular-kidney-metabolic stages.

The study included 100,727 individuals in the China Cardiovascular Disease and Cancer Cohort with complete data on cardiovascular-kidney-metabolic factors and LE 8 metrics, with a median follow-up of 10.1 years. Cardiovascular-kidney-metabolic stages and CVH metrics (nicotine exposure, diet, physical activity, sleep, body mass index, blood lipids, blood pressure, blood glucose) were defined according to Presidential Advisory from the American Heart Association. Incident CVD events including cardiovascular death, myocardial infarction, and stroke were validated. The Fine-Gray hazard model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of CKM stages or CVH status associated with CVD.

Compared with cardiovascular-kidney-metabolic stage 0, the adjusted competing HRs and 95% CIs of CVD events were 1.20 (0.95-1.51), 2.45 (1.97-3.04), 4.43 (3.53-5.58), and 5.95 (4.75-7.45) from stage 1 to stage 4, respectively. Optimal CVH status and each optimal CVH metric presented a significantly decreased risk of CVD events. Variation was observed in the association between cardiovascular-kidney-metabolic stage and CVD events with different CVH status or numbers of optimal CVH metrics. Compared with those in stage 0, Participants in stage 1 or 2 with optimal CVH no longer had elevated risks for incident CVD events. Suboptimal health factor contributed larger population attributable fractions to CVD events in cardiovascular-kidney-metabolic stage 0-2 (51.2%) than in stage 3-4 (25.2%), whereas suboptimal health behavior exhibited larger contribution in advanced stages (13.1% in stage 0-2 and 18.2% in stage 3-4).

The study indicated that cardiovascular-kidney-metabolic stage was associated with cardiovascular events, and optimal cardiovascular health could attenuate this risk. Health factor contributed predominantly at the early-stage, whereas health behavior exhibited consistent and slightly increased contribution along the spectrum. These findings support the utility of cardiovascular-kidney-metabolic construct and highlight the importance of target health improvement based on LE 8 framework.

Cardiovascular disease (CVD) risk factors, including poor diet, lack of physical activity (PA), smoking, and obesity, are associated with unhealthy lifestyle choices and contribute significantly to the global disease burden. This study aims to investigate the prevalence of behavioral risk factors associated with overweight/obesity, PA, smoking, and eating habits among Saudi students and explores how these vary by region, age, gender, relationship status, and income. A total of 968 participants (285 males and 681 females), aged 18-50, were recruited from bachelor's, master's, doctoral, and other university programs across the Eastern, Riyadh, and Western provinces. Each participant completed the Saudi Food Frequency Questionnaire (SFFQ). The risk of CVD was assessed by summing individual risk factors related to BMI, tobacco use, PA level, glycemic load (GL) of ingested foods, and consumption of saturated fats (SF), processed meats, oily fish, nuts, and cereal fiber (CF). Participants were classified into minimal, medium, or high-risk categories based on their total scores. A high prevalence of CVD risk factors was observed, with 93.6% of participants having three or more risk factors. After adjusting for demographic variables, living in Riyadh was associated with a 12% lower probability of CVD risk. Conversely, students aged 46-50 showed a five- to nine-fold increase in CVD risk. Significant factors influencing CVD risk included BMI (Exp(β) = 11.70), smoking status (Exp(β) = 6.54), PA (Exp(β) = 7.61), SF intake (Exp(β) = 4.79), GL (Exp(β) = 7.00), CF intake (Exp(β) = 24.58), and oily fish consumption (Exp(β) = 2.99). Low CF intake and high BMI were the most prominent risk factors. Lifestyle interventions targeting overweight/obesity, physical inactivity, smoking, high GL and SF intake, and promoting CF and oily fish consumption could improve CV health among participants. Addressing these modifiable risk factors is essential for effective prevention.

This research aims to elucidate the gender differences in the association between cardiovascular disease (CVD) prevalence and Life's Essential 8 (LE8), a recently updated measure of cardiovascular health (CVH).

This study included participants from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018.The scores of LE8, health behavior, health factor and each metric based on diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipid, blood glucose, and blood pressure were classified as low (0-49 points), moderate (50-79 points), and high (80-100 points). The scores of LE8, health behavior and health factor as continuous variables were also used for dose-response analysis. The main outcomes included the prevalence of CVD. The definition of CVD based on self-reported history of coronary heart disease or stroke.

A total of 23,307 individuals were included in this analysis. Participants with CVD had significantly lower LE8 scores compared to those without CVD, and females demonstrated higher CVH levels compared to males including total LE8 scores and the scores of diet, nicotine exposure, blood lipid, blood glucose, and blood pressure (P < 0.05). Moreover, the LE8 score demonstrated a non-linear association with CVD in both males and females (all P-values for non-linearity were < 0.001). Furthermore, compared to the low LE8 level, a high LE8 level was associated with a 78% decreased risk of CVD in males (HR: 0.22, 95% CI: 0.16-0.31) and an 83% decreased risk in females (HR: 0.17, 95% CI: 0.11-0.26). Consistently, compared to low levels of health behaviors and health factors, higher levels were significantly associated with a decreased risk of CVD in both males and females (All P < 0.001). Additionally, the area under the curve (AUC) for the total LE8 score in CVD discrimination was significantly higher in females than in males (P < 0.001).

Higher CVH scores were associated with a lower risk of CVD, especially in females. These findings highlight the need for gender-specific preventive strategies in CVH promotion, with a particular focus on improving LE8 scores in high-risk populations.

Cardiovascular health (CVH) is a key determinant of mortality, but the comparative effectiveness of different CVH metrics remains uncertain. Life's Simple 7 (LS7) evaluates seven domains: smoking, body mass index, physical activity, total cholesterol, blood pressure, fasting glucose, and diet. Life's Essential 8 (LE8) adds sleep health, while Life's Crucial 9 (LC9) further includes mental health. This study aimed to assess whether the additional components in LE8 and LC9 enhance mortality prediction compared to LS7.

Data from 22,382 participants in the NHANES 2005-2018 were analyzed. Cox proportional hazards regression models were used to evaluate the associations between the scores of these metrics and all-cause, cardio-cerebrovascular disease (CCD), and CVD mortality. The predictive performance of each metric was assessed via receiver operating characteristic (ROC) curves and area under the curve (AUC) values.

The participants had a mean age of 45.23 ± 0.23 years, and 51.53% were female. During a median follow-up of 7.75 (4.42-11.08) years, there were 1,483 all-cause deaths, 405 CCD deaths, and 337 CVD deaths. Compared with participants with LS7 scores ≤ 4, those with scores ≥ 11 had a 65% (HR = 0.35 [0.25-0.50]) lower risk of all-cause mortality, a 66% (HR = 0.34 [0.16-0.73]) lower risk of CCD mortality, and a 61% (HR = 0.39 [0.18-0.85]) lower risk of CVD mortality. Similar trends were observed for LE8 and LC9. The AUC for LS7 (0.68 [0.66-0.70]) was slightly greater than that for LE8 (0.67 [0.65-0.69], P = 0.007) and LC9 (0.67 [0.65-0.69], P = 0.019) in predicting all-cause mortality at 5 years; however, the overall predictive performance was nearly identical across all three metrics. Furthermore, the addition of LS7 (AUC = 0.84 [0.82-0.86], P < 0.001), LE8 (AUC = 0.84 [0.82-0.86], P < 0.001), and LC9 (AUC = 0.84 [0.83-0.86], P < 0.001) to the baseline model (AUC = 0.83 [0.82-0.85]) significantly improved all-cause mortality predictions at 5 years; however, the actual gains in predictive performance were marginal.

LS7, LE8, and LC9 all predict mortality effectively. Given its simpler scoring and fewer components, LS7 demonstrates comparable predictive performance to LE8 and LC9, making it a more practical tool for clinical and public health applications.

Our study aimed to investigate the association of phenotypic aging, lifestyle, and genetic risk with the risk of incident atrial fibrillation (AF).

A large prospective cohort study.

This study included 327,122 participants from the UK Biobank.

PhenoAge acceleration (PhenoAgeAccel) was calculated by regressing phenotypic age (PhenoAge) on chronological age. Two key stratification tools were derived from previous research: the Healthy Lifestyle Score (HLS) based on smoking, body mass index (BMI), physical activity, and diet, to assess participants' lifestyles; and the polygenic risk score (PRS) based on 104 AF-associated SNPs and their effect sizes identified in a GWAS to evaluate genetic risk. Cox proportional hazards models were employed to assess both independent and combined effects of PhenoAgeAccel, HLS, and PRS with AF risk.

At a median follow-up of 10.84 (10.08-11.56) years, 15,997 cases of AF were identified. Each standard deviation (SD) increase in PhenoAgeAccel was associated with a 30% higher AF risk (HR 1.30, 95% CI 1.28-1.31). Participants biologically older (PhenoAgeAccel>0) had a significantly higher risk of AF (HR 1.47, 95% CI 1.42-1.51) compared to those biologically younger (PhenoAgeAccel≤0), whereas ideal HLS was significantly associated with a lower risk of AF (HR 0.52, 95% CI 0.49-0.56 vs. poor HLS), and high genetic risk was significantly associated with a higher risk of AF (HR 2.30, 95% CI 2.21-2.39 vs. low genetic risk). Joint effects and multiplicative/additive interactions were noted between PhenoAgeAccel and HLS (or genetic risk). When combined PhenoAgeAccel and genetic risk, participants biologically older and in high genetic risk had the highest AF risk (HR 3.52, 95% CI 3.31-3.74). When combined PhenoAgeAccel and HLS, participants who were biologically older and had a poor lifestyle had the highest AF risk (HR 2.42, 95% CI 2.23-2.62). Further analysis categorized PhenoAgeAccel into quartiles based on its population distribution, and the associations remained consistent.

Increased PhenoAgeAccel is significantly associated with increased risk of AF. When combined with a poor lifestyle or high genetic risk, the risk is further increased. These findings highlight the importance of integrating phenotypic aging, genetic risk, and lifestyle factors into AF prevention strategies.

Evidence linking noise pollution and brain health, particularly at mid-to-late life, remains scarce. We investigated the associations between long-term exposure to road and railway traffic noise and incident dementia in the UK Biobank cohort.

Participants with available data for dementia incidence and linked traffic noise exposure during follow-up were included. Residential road traffic noise from both minor and major roads were calculated in accordance with CNOSSOS-EU framework; railway noise estimates were created by Extrium, with the raster datasets representing noise contributions from major railway corridors. Cox regression was used to quantify the associations between transport noise and incident dementia (incl. its subtypes), adjusting for potential confounders, air pollution and greenness.

Of the full cohort (n = 502,416), 7668 participants had incident dementia during a median follow-up period of 9.67 years. No associations were found between all cause dementia incidence and road or railway noise. However, a 10-dB (dB) higher exposure in annual mean road traffic noise (Lden) was significantly associated with incident Alzheimer's disease (HR:1.150, 95 % CI: 1.022-1.294). The effect estimate was slightly higher when participants were exposed to night-time road noise above 45 dB (HR:1.188, 95 % CI:1.012-1.394) and this was mediated by the cardiovascular health profile. Railway noise (Lden) was significantly associated with incident Parkinson's disease related dementia (HR:1.042, 95 % CI:1.005-1.081), however, the effect estimate was slightly reduced after further adjustment of air pollution and residential greenness (HR:1.037, 95 % CI:0.998-1.077).

Distinct associations between different traffic noise exposures and incident dementia subtypes were found in this large UK prospective cohort study.

The Life's Essential 8 (LE8) is a composite metric including 4 health behaviors (diet, physical activity, nicotine exposure, and sleep) and 4 health factors (body mass index, nonhigh-density lipoprotein cholesterol, blood glucose, and blood pressure). This study aimed to describe the cardiovascular health (CVH) metrics promoted by LE8 in nonagenarians and to investigate their relationship with mortality at 5 and 10 years.

This study was conducted within the framework of the Mugello Study, a longitudinal survey on nonagenarians living in the Mugello area (Tuscany, Italy). One-hundred and fifty-seven subjects (42 males and 115 females, median age 92 years) were administered a series of validated questionnaires and underwent instrumental examinations and blood withdrawal. CVH metrics were calculated according to LE8 guidelines. Physical activity and sleep duration were quantitatively estimated using a monitor device.

In the male group, after 5 and 10 years of follow-up, a higher Health Behavior score was associated with a lower risk of all-cause mortality (HR: 0.963, p = .005 and HR: 0.972, p = .020; after 5 and 10 years). Differently, in the female group, no significant association was observed between the LE8 total score and subscores and different risk of mortality after 5 and 10 years from the interview.

These findings highlight the importance of potentially modifiable behaviors in improving survival. They support resource investments to address the needs of individuals in this stage of life and encourage them to be empowered and actively engage in health-promoting behaviors.

Updated criteria pertaining to the diagnosis of Alzheimer's disease (AD) have sparked debate over the reliance on biomarkers-particularly amyloid-β and phosphorylated tau. While biomarkers promise earlier detection and standardized criteria, the potential extension and interpretation of their use in asymptomatic individuals remains controversial. Many individuals with abnormal biomarker profiles never experience cognitive decline, raising concerns about overdiagnosis, unintended negative psychosocial consequences and the blurring line between risk and definitive diagnosis. We, and others, argue that biomarker positivity should be reframed not as a definitive diagnosis but rather as an indicator of elevated risk, particularly in the absence of cognitive symptoms. Doing so better aligns with current evidence, preserves clarity in diagnosis, and avoids unintended psychosocial consequences. Crucially, the role of cognitive reserve-influenced by education, other life experiences and structural inequities-must be considered, particularly among racially and ethnically diverse populations historically underrepresented in AD research. Biomarker thresholds (as well as neuropsychological tools) derived from predominantly non-Hispanic white cohorts may not generalize across groups, risking misclassification and inequity. As the field moves towards precision medicine and AI-driven risk models, inclusive data and culturally valid frameworks are essential. Ultimately, embracing a risk-based, multifactorial approach respects the complexity of AD and promotes equitable care. This perspective calls for interdisciplinary collaboration to refine diagnostic strategies that are scientifically grounded, socially conscious and responsive to the lived realities of diverse populations. Only then can we responsibly integrate biomarkers into practice without sacrificing nuance.

Sleep disordered breathing, represented by sleep apnea syndrome, not only significantly reduces the quality of daily life but is also known to contribute to the development of various cardiovascular diseases. Since 2000, sleep apnea syndrome has become widely recognized by the general public. However, the number of suspected patients who seek medical consultation remains low, and even fewer receive a proper diagnosis and treatment. One reason for this is the lack of information that apnea is linked to cardiovascular disease, even among individuals experiencing typical sleep apnea syndrome symptoms such as daytime sleepiness and general fatigue. Additionally, healthcare providers may not be effectively guiding patients while providing sleep hygiene education. Furthermore, the limited number of medical facilities and technicians capable of conducting overnight polysomnography tests for diagnosing sleep disordered breathing is another factor preventing more patients from benefiting from treatment. This article explores the relationship between sleep disordered breathing and the onset of cardiovascular diseases, as well as the latest treatment approaches.

To determine the impact of body roundness index (BRI) on the 10-year risk of cardiovascular disease (CVD) and all-cause mortality in Chinese adults.

We utilized data from a nationwide prospective cohort of 165 785 Chinese adults (aged ≥40 years, free of CVD and cancer at baseline), which was extracted from the China Cardiometabolic Disease and Cancer Cohort (4C). Cox regression and restricted cubic splines quantified BRI-outcome associations and identified optimal BRI cutoffs.

During a median follow-up of 10.1 years, we documented 10 538 CVD events and 8679 deaths. A monotonic increasing dose-response association was observed between BRI and CVD risk, while BRI and all-cause mortality exhibited a U-shaped relationship (p for non-linear <0.001), with the nadir at a BRI of 3.9. Gender differences indicated that increased CVD risk was associated with higher BRI in men. As age increases, the excess risk of CVD and mortality associated with BRI diminishes, with a significant harmful effect of low BRI observed on mortality in individuals aged ≥75 years. Moreover, the inclusion of BRI in the model significantly enhanced the C-statistic for CVD prediction by 0.00412 (p <0.001) and for mortality prediction by 0.00045 (p = 0.0097).

Our findings indicate a positive association between BRI and CVD and a U-shaped association between BRI and mortality. These findings underscore the importance of the BRI in assessing the risk of CVD and all-cause mortality, particularly when considering different genders and age groups.

Intracranial atherosclerotic stenosis (ICAS)-related mortality may vary according to race/ethnicity, but information about this association in diverse populations is limited. We aimed to assess mortality according to ICAS severity in stroke-free older adults of indigenous ancestry living in Ecuador.

We invited stroke-free individuals ≥60 years old enrolled in the population-based Atahualpa Project cohort to undergo time-of-flight brain MRA. Participants were followed to ascertain mortality (as the primary outcome) during the observation period. Luminal stenosis in 11 large intracranial arteries was calculated to reflect the stenosis score. We categorized prevalent ICAS as a stenosis score ≥3 points or as the presence of moderate-to-severe stenosis (≥50 %). Cox proportional hazards models were fitted to estimate mortality risk according to ICAS severity.

Analysis included 358 participants (mean age: 67.5 ± 6.9 years; 57 % women) followed on average for 10.1 ± 2.9 years. Seventy-four (21 %) participants had a stenosis score ≥3 points, and 37 (10 %) had moderate-to-severe stenosis. In adjusted analysis, mortality risk was higher in participants with a ICAS score ≥3 points (HR: 2.38; 95 % C.I.: 1.49-3.80; p < 0.001) and among those with moderate-to-severe stenosis (HR: 1.96; 95 % C.I.: 1.12-3.43; p = 0.018). Thirty-five (10 %) participants had incident strokes. Overall, 97 (27 %) participants died during the follow-up, including 11/35 who developed an incident stroke and 86/323 who did not (31 % versus 27 %; p = 0.544).

The burden of asymptomatic ICAS is high in older adults of indigenous Ecuadorian ancestry and is significantly associated with mortality. Incident strokes do not influence mortality in this population.

Poor cardiovascular health (CVH) is linked to Alzheimer's disease and dementia; however, its association with neurocognitive trajectories earlier in life remains underexplored.

We included 3224 participants with information on CVH at early midlife (mean age 45.0 ± standard deviation 3.4) an cognitive assessments, and neuroimaging 5, 10, and 15 years later including white matter hyperintensities (WMHs), total gray matter (GM), and hippocampal volume. CVH was operationalized according to the American Heart Association's (AHA) "Life's Essential 8" (LE8) guidelines. The association between LE8 and cognitive and neuroimaging measures was examined using mixed linear regression adjusting for age, sex, race, and education.

Worse LE8 score was associated with steeper decline in cognition, higher accumulation of WMHs, and steeper decline in total GM and hippocampal volume.

Poor CVH is related to accelerated brain aging across midlife, highlighting the need to screen for and improve CVH earlier to prevent adverse cognitive outcomes.

Poor cardiovascular health in early midlife is associated with faster decline in cognition across 10 years overall and in specific domains. Poor and intermediate cardiovascular health was associated with higher accumulation of white matter hyperintensities across midlife. Poor cardiovascular health was associated with faster atrophy in total gray matter volume and hippocampal volume.

Dietary carbohydrate quality is inversely associated with risks of chronic disease and all-cause mortality. However, limited evidence exists regarding the role of carbohydrate quality and dietary carbohydrate types in promoting healthy aging.

To evaluate the long-term role of dietary carbohydrate intake and carbohydrate quality in healthy aging.

This prospective cohort study used data from the Nurses' Health Study (NHS) from January 1984 to December 2016 and included participants aged younger than 60 years in 1984. Data were analyzed from January 2023 to February 2025.

Intakes of total carbohydrates; refined carbohydrates; high-quality carbohydrates from whole grains, fruits, vegetables, and legumes; dietary fiber; and the dietary glycemic index (GI) and glycemic load (GL).

Nutrient intakes were derived from 1984 and 1986 food frequency questionnaires. The primary outcome was healthy aging, defined as the absence of major chronic diseases, lack of cognitive and physical function impairments, and having good mental health, according to 2014 or 2016 NHS questionnaire data. Multivariate logistic regression was used to calculate associations of each carbohydrate variable with healthy aging.

Among 47 513 participants (mean [SD] baseline age, 48.5 [6.2] years), 3706 (7.8%) met our healthy aging definition. Every 10%-calorie increment in intakes of total carbohydrates (odds ratio [OR], 1.17; 95% CI, 1.10-1.25) and high-quality carbohydrates (OR, 1.31; 95% CI, 1.22-1.41) was positively associated with healthy aging. Refined carbohydrates were associated with lower odds of healthy aging (OR, 0.87; 95% CI, 0.80-0.95). Intakes of carbohydrates from fruits, vegetables, and whole grains were positively associated with odds of healthy aging (ORs ranging from 1.11; 95% CI, 1.07-1.15 to 1.37; 95% CI, 1.20-1.57 per 5% energy increment). Additionally, intakes of total dietary fiber and fiber from fruits, vegetables, and cereals were associated with higher odds of healthy aging (ORs ranging from 1.07; 95% CI, 1.03-1.11 to 1.17; 95% CI, 1.13-1.22 per 1-SD increment). GL was positively associated with healthy aging, which was attenuated by dietary fiber adjustment. A higher GI (OR, 0.76; 95% CI, 0.67-0.87) and carbohydrate-to-fiber ratio (OR, 0.71; 95% CI, 0.62-0.81) were inversely associated with healthy aging when comparing extreme quintiles. There were positive associations for isocaloric replacements of refined carbohydrates, animal protein, total fat, or trans fats with high-quality carbohydrates (ORs ranging from 1.08; 95% CI, 1.01-1.16 to 1.16; 95% CI, 1.11-1.21).

In this cohort study of women, intakes of high-quality carbohydrates and dietary fiber were associated with positive health status in older adulthood, suggesting that dietary carbohydrate quality may be an important determinant of healthy aging.