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Background Inadequate preventive dental care may contribute to inflammatory conditions such as periodontitis, increasing cardiovascular disease risk. Artificial intelligence–enabled electrocardiography (AI‐ECG) algorithms accurately estimate cardiovascular disease risk. We investigated the association between inadequate preventive dental care and the AI‐ECG–estimated risk of atrial fibrillation, aortic stenosis, low ejection fraction, cardiac amyloid, cardiovascular aging, and all‐cause mortality. Methods We retrospectively analyzed 266 637 Mayo Clinic patients (2018–2024) who completed a Social Determinants of Health Survey and had an ECG performed within 1 year of survey completion. AI‐ECG algorithms generated continuous risk scores (0 or 1) for atrial fibrillation, aortic stenosis, low ejection fraction, and amyloid. Cardiac aging was assessed by delta age, calculated as AI‐ECG–estimated physiological age minus the chronological age. Associations with preventive dental care were analyzed using logistic regression. Cox regression evaluated dental care predictiveness on all‐cause mortality. Results Among 266 637 individuals (mean age, 59.5±16.4 years; 51.1% women), 49 918 (18.7%) reported inadequate preventive dental care. These individuals had higher delta age and increased AI‐ECG–predicted risks of atrial fibrillation, aortic stenosis, amyloid, and reduced ejection fraction (all P <0.001). In multivariable logistic regression models including all AI‐ECG scores, inadequate preventive dental care was associated with higher probabilities of low ejection fraction (odds ratio [OR], 1.80 [95% CI, 1.69–1.91]), atrial fibrillation (OR, 1.10 [95% CI, 1.04–1.17]), aortic stenosis (OR, 1.90 [95% CI, 1.64–2.20]), amyloid (OR, 1.18 [95% CI, 1.12–1.25]), and higher delta age (OR, 1.03 [95% CI, 1.02–1.03]) (all P <0.001). Inadequate preventive dental care predicted all‐cause mortality after adjusting for demographics, risk factors, and AI‐ECG algorithms (HR, 1.45 [95% CI, 1.38–1.53], P <0.001). Conclusions Inadequate preventive dental care is associated with subclinical cardiovascular disease. AI‐ECG algorithms may facilitate cardiovascular risk stratification among individuals with limited preventive dental care access.

Abstract Background Atherosclerotic cardiovascular disease (ASCVD) develops over a prolonged latent period, progressing from subclinical ASCVD to major cardiovascular events due to plaque accumulation. Subclinical ASCVD is a valid subrogate to assess potential risk factors or ASCVD. Dietary patterns are known to contribute to or prevent ASCVD. Dairy consumption has been associated with lower rates of obesity, hypertension, and diabetes, while saturated fats, present in most dairy products, have been associated with ASCVD. Studies assessing the association between subclinical ASCVD and dairy consumption have shown mixed results but have not been systematically analyzed Purpose This study aimed to systematically review and synthesize the existing evidence on the association between dairy product consumption and subclinical ASCVD Methods The study protocol was registered in the International Prospective Register of Systematic Reviews and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. We conducted a comprehensive search of PubMed, EMBASE, Scopus, Cochrane Central Register, Google Scholar, and Web of Science to identify experimental and observational studies that examined the association of dairy product consumption with measures of subclinical ASCVD assessed through coronary artery calcium (CAC) scanning, intima-media thickness (IMT), pulse pressure (PP) or pulse wave velocity (PWV), from inception to July 9, 2024. Titles and abstracts were screened in duplicate, followed by a full-text review and data abstraction from articles that met the study criteria. Dairy products were classified as: a) Dairy, according to the United States Department of Agriculture, encompassing milk, yogurt, cheese, lactose-free milk, and fortified soy milk/yogurt; and b) Dairy+, which further included higher fat content products such as cream cheese, sour cream, cream, and butter Results A total of 973 articles were identified; 22 met inclusion criteria representing 20 studies; being predominantly cross-sectional (55%) conducted in North America (50%); food frequency questionnaires were the most implemented tool for dietary assessment (86%), and 41% used PWV for subclinical ASCVD assessment; Fig. 1. Total Dairy and Dairy+ exhibited predominantly neutral effects with a trend toward a beneficial effect, similar to yogurt intake. Milk and cheese demonstrated contrasting effects, with studies reporting protective, neutral, and harmful associations, particularly for PWV and IMT. Limited data on CAC suggested no strong relationship with dairy consumption; Table 1 Conclusion Available evidence on the association between dairy consumption and subclinical ASCVD is complex with mixed effects across dairy products. No consistent evidence of harm or benefit was found; future research is needed to clarify the role of different dairy components in the development of subclinical ASCVD and incidence of cardiovascular eventsFig1.Summary of studies characteristics Table 1.Summary of effects

Abstract Background Coronary flow augmentation occurs through the simultaneous interaction and regulation of both endothelium-dependent and endothelium-independent mechanisms. A decrease in coronary flow reserve (CFR) secondary to either mechanism is associated with poor prognosis. However, at the individual level, the integrated impact of these two mechanisms has not been thoroughly investigated. Purpose This study investigated the prognostic implications of an integrated metric, CFRsum, combining endothelium-dependent and -independent CFR. Methods A total of 1441 patients with angina with non-obstructive coronary artery (ANOCA) undergoing coronary reactivity testing were studied. Endothelium-independent CFR was measured during adenosine-induced hyperemia, and endothelium-dependent CFR during intracoronary acetylcholine infusion. CFRsum was calculated by summing these components. Cardiovascular event was defined as composite of cardiovascular death, myocardial infarction, heart failure, and cerebral infarction. Results Our patients had a median age of 51.7 years, 69.0% of whom were female, and their CFRsum was 4.57 [3.88, 5.37]. Patients were divided into three tertile-based groups, and Cox proportional hazards analysis demonstrated that all CFR classes were independent predictors of prognosis, with CFRsum providing the best model fit (Likelihood ratio: 54.62, degrees of freedom: 7, P &lt; 0.001). The Kaplan-Meier curve (Figure) demonstrated a stepwise deterioration in prognosis across CFRsum tertile groups, with lower CFRsum being associated with progressively worse outcomes (p &lt; 0.001). Stratification by follow-up duration (3 years) revealed that patients with middle-range CFRsum exhibited comparable outcomes to those with the highest CFRsum during the early phase (&lt;3y) but significantly worse outcomes in the late phase (≥3y) (P = 0.459 and P &lt; 0.001, respectively). Conclusion CFRsum showed superior prognostic value over traditional CFR metrics in patients with ANOCA, identifying a compensated group with time-varying outcomes. This novel metric improves the assessment of microvascular function and supports better clinical management.

BACKGROUND: Cardiac radioablation is emerging as a treatment modality for refractory ventricular tachycardia. This study aimed to evaluate the effects of radiation on the coronary arteries in a swine model of proton beam cardiac radioablation. METHODS: Eighteen swine underwent single-fraction 30 to 40 Gy pencil-beam scanning proton therapy targeting the left ventricle and were euthanized 12 to 40 weeks later. Treatment planning was performed without restricting the dose to the coronary arteries. The maximum point dose (D max ) to the epicardial coronary arteries was calculated. In secondary analyses, the mean (D mean ) and minimum dose received by the highest irradiated 0.01 cm 3 (D 0.01 ) of each coronary artery were also calculated. Coronary artery segments were harvested from the D max sites for histological analysis, and the D max was correlated with stenosis severity. RESULTS: Ninety-six coronary arteries were analyzed. No stenoses were observed by computed tomography imaging preirradiation. By histological analysis posteuthanasia, 25/96 (26%) coronaries sampled at their D max sites had ≥75% stenosis. The median D max was 4.7 Gy for the <75% stenosis group and 29.7 Gy for the ≥75% stenosis group ( P <0.001). The AUC-ROC for the association between D max and stenosis ≥75% was 92.2%. A D max value of 20.1 Gy best predicted stenosis ≥75%, with sensitivity 92.3% and specificity 87.1%. The AUC-ROCs for the associations of D mean and D 0.01 with stenosis ≥75% were 84.8% and 91.6%, respectively. In histopathologic analysis, intimal hyperplasia was the most common coronary artery abnormality at the D max sites, and it was present in 61.5% of all arteries and in 93.9% of arteries with D max ≥20 Gy. CONCLUSIONS: In this preclinical model of proton beam cardiac radioablation, coronary stenoses occurred in a dose-dependent manner, with D max showing the closest correlation with stenosis ≥75%. These data provide for the first time a framework for dose constraint considerations for the coronary arteries during treatment planning for cardiac radioablation and thoracic malignancy radiation.

Advances in cancer therapies have transformed many malignancies into chronic or manageable conditions, but have been linked to adverse, including cardiovascular, events. Vascular toxicities associated with cancer treatment range from abnormal vasoreactivity to accelerated atherosclerosis, arterial thrombotic events, vasculitis, and arterial aneurysms or dissections. 5-fluorouracil and VEGF (vascular endothelial growth factor) inhibitors are the agents most commonly linked to abnormal vasoreactivity, whereas BCR-ABL (breakpoint cluster region–Abelson murine leukemia viral oncogene homolog) inhibitors and immune checkpoint inhibitors have been associated with accelerated atherosclerosis. Arterial thrombotic events are seen with VEGF and BCR-ABL inhibitors as well as platinum drugs. Vasculitis emerged with the use of immune checkpoint inhibitors, and arterial aneurysms and dissections with VEGF inhibitors. Radiation therapy can lead to several of the outlined vascular toxicities. This review comprehensively explores the mechanisms of vascular complications associated with chemotherapy, targeted therapies, immunotherapies, and radiation therapy. Key contributors include endothelial injury and dysfunction, oxidative stress, and inflammation. An understanding of the mechanisms of vascular toxicities may facilitate optimal treatment and preventive strategies in patients with cancer.

Background α‐Klotho is a multifunctional protein implicated in vascular aging. Declining Klotho levels are associated with arterial stiffness, endothelial dysfunction, and vascular calcification. We investigated the associations between circulating klotho, aortoiliac calcification, endothelial progenitor cells, and 10‐year survival. Methods In this retrospective cohort, blinded clinicians scored calcification on computed tomography (0–10 scale: aorta 6 points, iliac 4 points). Plasma klotho was measured by ELISA; endothelial progenitor cell subsets were quantified via flow cytometry. Mortality data were obtained from the Minnesota Death Registry. Results This study included 148 participants (mean age 72.4±9.6 years; 41% female). Median calcification score was 3 (interquartile range, 1–5). Patients with low calcification had higher Klotho levels (669 [567–841] versus 556 [457–678] pg/mL; P <0.01), with Klotho inversely correlated with calcification (r=−0.315, P <0.01). Stratified by calcification location and severity, the highest Klotho levels were seen in patients without aortic or iliac calcification ( P =0.015). Over 10 years, low Klotho was independently associated with higher mortality (hazard ratio [HR], 3.056 [95% CI 1.288–7.878]; P =0.014). Klotho inversely correlated with mature osteocalcin‐positive EPCs; B=−0.16 (95% CI, −0.29 to −0.02; P =0.027). Immunohistochemistry and immunofluorescence confirmed endothelial Klotho expression in internal mammary artery. Conclusions Lower circulating Klotho levels are associated with increased aortoiliac calcification and higher 10‐year mortality, supporting a role for Klotho in vascular aging.

Background: Coronary microvascular dysfunction (CMD) is a common cause of angina with non-obstructive coronary arteries (ANOCA), but its role in patients with a history of myocardial infarction with non-obstructive coronary arteries (MINOCA) is much less understood. We investigated the incidence of major adverse cardiac and cerebrovascular events (MACCE) in patients undergoing invasive assessment for CMD, divided into patients with MINOCA versus patients with ANOCA. We hypothesized that CMD would be common in both groups. Methods: Serial patients undergoing invasive coronary provocation testing between 2012 and 2022 were divided into MINOCA (n=76) or ANOCA (n=561). Doppler study was performed in the left anterior descending artery. CMD was defined as either coronary flow reserve (CFR) <2.5 with adenosine or <50% increase in flow with acetylcholine. Patients were followed prospectively through 2025. Incidence of MACCE (cardiac death, non-fatal MI, hospitalization for heart failure, urgent revascularization, and stroke) was compared between MINOCA and ANOCA and further analyzed by CMD status. Kaplan-Meier curves were constructed and Cox proportional hazards models were used to estimate hazard ratios (HRs). Results: Among patients with MINOCA, 53 of 76 (70%) had CMD, compared to 363 of 561 (65%) with ANOCA. Invasive provocation testing was performed a median of 163 days (IQR 13 – 255 days) after the MI in the MINOCA group. Patients were then followed for a median of 4.4 years (IQR 3.0 – 6.9 years). MACCE-free survival was significantly lower in patients with MINOCA compared to those with ANOCA (HR = 3.57, p < 0.001; Figure 1). The major contributor to MACCE was non-fatal MI in MINOCA (24%) and heart failure hospitalization in ANOCA (6%). The presence of CMD was associated with worse prognosis in both MINOCA (HR = 3.76, p = 0.02) and ANOCA (HR = 8.35, p < 0.001; Figure 2). Conclusions: Patients with MINOCA experience significantly higher long-term risk of major adverse events compared to those with ANOCA. CMD is common in both groups and is independently associated with worse outcomes. Specifically, patients with CMD had higher rates of MACCE over time, regardless of whether they presented with MINOCA or ANOCA. Invasive assessment of CMD in patients with myocardial infarction and non-obstructive coronary arteries may improve risk stratification and inform management strategies in these understudied populations

Introduction: Blood pressure (BP) is a complex physiological marker. Cuffless devices, often based on photoplethysmography (PPG), enable frequent or continuous BP monitoring without arterial occlusion, enhancing comfort and usability in both inpatient and outpatient settings. Various devices have received regulatory clearance, but they are not yet included in clinical guidelines due to evolving validation standards. Aim: To evaluate accuracy of the Biobeat WP613 device for continuous BP monitoring using invasive intra-arterial pressure (IAP) monitoring in ICCU patients. Methods: This prospective, single-center study enrolled adults undergoing cardiac surgery at Chaim Sheba Medical Center (June 2020–January 2023) who had radial artery catheters for standard BP monitoring. Severe shock patients were excluded. Demographics and Fitzpatrick skin tone were recorded. ClinicalTrials.gov NCT04071015. Post-op, patients were simultaneously monitored with the standard IAP system and the Biobeat device. Continuous BP and HR were collected for up to five days. Data analyzed post hoc. Tested device The WP613 (Biobeat, Israel) is FDA-cleared, chest-worn, PPG-based device that uses multi-wavelength light and a sensor to monitor vital signs. It wirelessly transmits data to a cloud based algorithms to measure BP, cardiac output, stroke volume, and more. It also records a single-lead ECG and has a 5-day battery life. Results: A total of 96 patients were enrolled, with 88 included in the final BP analysis after excluding 8 due to technical issues. Of those, 80 received inotropic support. The average age was 63.2±12.2 years, with 33% female. Monitoring lasted an average of 25.6±17.2 hours, yielding over 78000 readings for each BP parameter and over 92000 HR readings (Fig 1) . Patients represented the full range of skin tones, classified using the Fitzpatrick scale I–VI. The Biobeat device showed excellent correlation with IAP monitoring: r=0.959 for SBP, 0.973 DBP, and 0.962 HR. Bland-Altman showed minimal bias (e.g., 0.1±4.8 for SBP) (Fig 2) . Correlation remained strong across BP ranges and skin tones. Heatmaps and representative cases confirmed close tracking between Biobeat and IAP (Fig 3) . Conclusion: The tested cuffless device (Biobeat) offers a high level of accuracy and agreement for BP and HR compared to data obtained by IAP monitoring in post-cardiac surgery patients. Further studies are needed to validate these findings in various populations and clinical settings.