Women with hypertension are more likely than men to have ineffective treatment where blood pressure (BP) is treated but not controlled. The aim of this study was to investigate whether a quadpill based strategy differs between males and females. A secondary analysis of The Quadruple UltrA-low-dose tReaTment for hypErTension (QUARTET); randomized controlled trial. In this analysis the primary outcome was sex differences in unattended office systolic BP at 12 weeks. The QUARTET study recruited 591 participants (40% female) with mean age 59 (standard deviation 12) years [male 57 (12); female 62 (11)]. Males and females recorded a similar reduction in unattended systolic BP at 12 weeks with no interaction between group allocation and sex [male:mean difference (MD) in mmHg -6.95 (95% CI -9.53 to -4.38), female: MD -6.34 (95% CI -9.50 to -3.18), interaction P  = 0.77]. The quadpill strategy was similarly effective in men and women. Initiating BP control with a quadpill in women presents a promising approach to achieving similar BP control levels to men.

Postmenopausal women may be susceptible to unhealthy eating and physical activity behaviors and increased cardiometabolic risk.

This study examined the effectiveness of a community-based lifestyle behavioral intervention in modifying eating and physical activity behaviors, their behavioral determinants, and cardiometabolic risk factors in community-dwelling postmenopausal women.

A 2-arm, parallel-group, randomized controlled trial was conducted with 46 postmenopausal women recruited from churches and universities in Seoul, South Korea. Participants were randomly assigned to either the intervention (n = 23) or control (n = 23) group. The intervention group underwent a 12-week behavioral intervention designed theoretically to modify behavioral determinants with individual- and group-based sessions using cognitive-behavioral strategies, while the control group received a single general counseling session. Assessments were conducted at baseline, after 12 weeks, and at the 24th week. These included measurements of eating and physical activity behaviors, their determinants (ie, attitude, subjective norm, behavioral control, intention, and planning, based on the extended theory of planned behavior), waist circumference, blood pressure, and fasting glucose.

Compared with the control group, the intervention group showed significant improvements in eating behaviors (F = 5.08, P = .008), physical activity behaviors (F = 15.56, P < .001), and all behavioral determinants (P < .05 for all) over 24 weeks. The intervention group also experienced a significant reduction in waist circumference compared with the control group (F = 5.03, P = .009) over the same period.

The community-based behavioral intervention may be effective in promoting behavioral outcomes and waist circumference among postmenopausal women.

Korea Clinical Trial Registry (KCT006349).

Thrombotic and bleeding risks differ between sexes, partly in relation to distinct biology and hormonal status, but also due to differences in age, comorbidities, and body size at presentation. Women experience frequent fluctuations of prothrombotic and bleeding status related to menstrual cycle, use of oral contraceptives, hormone replacement therapy, or menopause. Although clinical studies tend to underrepresent women, available data consistently support sex-specific differences in the baseline thrombotic and haemorrhagic risks. Compared with men, women feature an increased risk of in-hospital bleeding related to invasive procedures, as well as long-term out-of-hospital bleeding events. In addition, the inappropriate dosing of antithrombotic drugs, which is not adapted to body weight or renal function, is more frequently associated with an increased risk of bleeding in women compared to men. While acute coronary syndrome (ACS) studies support similar antithrombotic drug efficacy, irrespective of sex, women may receive delayed treatment due to bias in their referral, diagnosis, and invasive treatment decisions. The current clinical consensus statement highlights the need for an increased awareness of sex-specific risks and biases in ACS management, with a focus on sex-specific bleeding mitigation strategies, antithrombotic management in special conditions (e.g., myocardial infarction with non-obstructive coronary arteries), and barriers to female representation in cardiovascular trials. This manuscript aims to provide expert opinion, based on the best available evidence, and consensus statements on optimising antithrombotic therapy according to sex, which is critical to improve sex-based disparities in outcome.

Female patients are at an increased risk of experiencing severe postoperative pain and developing chronic pain after cardiac surgery. However, the impact of sex on postoperative opioid administration is underexplored.

This single-centre retrospective cohort study included adults undergoing coronary artery bypass grafting, valve surgery, or a combined procedure at a quaternary referral hospital, between November 2012 and June 2021. Patients were classified as female or male based on biological sex. Opioid doses were converted to oral morphine equivalent daily doses (oMEDDs) to enable comparisons. Energy balancing was used to adjust for baseline differences, including body weight and other confounders. Sex differences in gabapentinoid and antipsychotic drug administration were also evaluated. The aim of this study was to evaluate the association of patient sex and perioperative opioid administration after cardiac surgery.

We studied 3188 patients: 825 (25.9%) females and 2363 (74.1%) males. After adjusting for body weight and other confounders, female patients received significantly less opioid analgesia on postoperative day 1 (oMEDD difference: -5.70 mg [95% confidence interval {CI}: -3.15 to -8.25], p < 0.0001), day 2 (oMEDD difference: -9.06 mg [95% CI: -5.05 to -13.08], p < 0.0001), and day 3 (oMEDD difference: -4.50 mg [95% CI: -0.52 to -8.47], p < 0.03). Female patients were also more likely to be prescribed a gabapentinoid (odds ratio: 1.47 [95% CI: 1.02 to 2.13], p = 0.04) but less likely to be prescribed an antipsychotic (odds ratio: 0.63 [95% CI: 0.46-0.86], p = 0.004).

In a single-centre cohort study involving over 3000 cardiac surgery patients, female sex was associated with the administration of significantly lower doses of postoperative opioid. Providers involved in the care of cardiac surgery patients should be aware of the potential for implicit bias, and further studies are required to identify mechanisms for the observed disparities.

Statin therapy is recommended for secondary prevention of atherosclerotic vascular disease (ASCVD) based on randomized trials, which enrolled mostly men with coronary artery disease (CAD), whereas women and patients with cerebrovascular (CVD) and peripheral artery disease (PAD) were under-represented. We analyzed the effectiveness of statin therapy uptake in a nation-wide cohort of women hospitalized for ASCVD.

Women hospitalized for CAD, CVD, or PAD, including aortic disease, between 2015 and 2021 were retrospectively identified by linking the national hospital database, medicines reimbursement claims, and national mortality registry. The association of statin uptake within 30 days post-discharge with clinical outcomes (all-cause mortality and cardiovascular hospitalizations) was assessed by Kaplan-Meier curves and Cox proportional hazards regression model with propensity score-derived inverse probability of treatment weights and a 30-day landmark period.

We included 24,665 women with ASCVD - 14,419 with CAD, 5,427 with CVD, and 4,819 with PAD. Overall, the median age was 73 (64-81) years. The rates of statin uptake were 50 % for women with CAD, 60 % for CVD and 28 % for PAD. Statin therapy uptake was associated with a reduction in all-cause mortality and cardiovascular hospitalizations across all three major types of ASCVD: hazard ratio (HR) 0.88, 95 % confidence interval (CI) 0.83-0.93, p = 0.001 for CAD, HR 0.87, 95 % CI 0.80-0.94, p = 0.006 for PAD, and HR 0.72, 95 % CI 0.66-0.78, p < 0.001 for CVD.

Statin therapy is associated with reduced all-cause mortality and cardiovascular hospital readmissions in women with all major types of ASCVD.

Cardiovascular diseases (CVDs) remain the leading cause of mortality worldwide, necessitating innovative approaches for early detection and personalized interventions. Lipidomics, leveraging advanced mass spectrometry techniques, has become instrumental in deciphering lipid-mediated mechanisms in CVDs. This review explores the application of lipidomics in identifying biomarkers for myocardial infarction, heart failure, stroke, and calcific aortic valve stenosis (CAVS). This review examines the technological advancements in shotgun lipidomics and LC/MS, which provide unparalleled insights into lipid composition and function. Key lipid biomarkers, including ceramides and lysophospholipids, have been linked to disease progression and therapeutic outcomes. Integrating lipidomics with genomic and proteomic data reveals the molecular underpinnings of CVDs, enhancing risk prediction and intervention strategies. This review positions lipidomics as a transformative tool in reshaping cardiovascular research and clinical practice.

The growing interest of the public in healthy food products with adequate nutritional quality has triggered a search for novel sources of protein. This review discusses scientific evidence on the available sources, processing, and biological properties of plant-based protein and bioactive peptides, with a particular emphasis on pulses, as these are some of the most important sources of protein and peptides displaying a wide range of health benefits. Processing plant-based proteins and derived peptides require standardized methods ensuring the improvement of their nutritional quality to counteract limiting factors affecting their evenness to other protein sources. If protein and bioactive peptides can be produced as functional ingredients, the industry releases patents, making them highly marketable to develop functional food products. Current research supports that plant-based food products constitute a nutritious part of a healthy diet by preventing chronic non-communicable diseases, but more studies, particularly clinical trials, are needed to demonstrate these effects fully.

This meta-analysis investigates the sex differences in mortality risk between the acute coronary syndrome (ACS) population without standard modifiable risk factors (SMuRF-less) and those with at least one standard modifiable risk factor (SMuRF), and analyses mortality rates between males and females within the SMuRF-less cohort.

The MEDLINE and Embase databases were searched for cohort studies with sex-stratified outcomes for SMuRF-less versus SMuRF patients with ACS till 15 December 2023. The analysis of variables reported in proportions was carried out by utilizing a meta-analysis with a generalized linear mixed model while continuous variables were analyzed by a meta-analysis of means, using an inverse variance method.

Eight studies were included in the current paper, with 82,395 SMuRF-less ACS patients and 607,558 SMuRF ACS patients. Excess in-hospital mortality found in SMuRF-less ACS, compared to those with SMuRFs, were only observed in females (RR 1.56, 95%CI 1.08-2.25, p = 0.029), but not in males (RR 1.59, 95%CI 0.90-2.80, p = 0.088). On longer follow-up, the 1- and 2-year post-ACS mortality rates were similar across the SMuRF-less and SMuRF cohorts, for both sexes. The subgroup analysis of SMuRF-less ACS individuals revealed that SMuRF-less females had higher in-hospital (RR 1.52, 95%CI 1.30-1.78, p = 0.002), 1-year (RR 1.51, 95%CI 1.34-1.71, p = 0.005) and 2-year mortality risks (RR 1.40, 95%CI 1.13-1.75, p = 0.016) compared to the SMuRF-less male counterparts.

Paradoxical excess mortality in SMuRF-less ACS, compared to those with SMuRFs, was only observed in females. Females without cardiovascular risk factors are at the highest risk of short- and medium-term mortality following ACS.

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.

To evaluate cardiovascular safety outcomes in estetrol 15 mg/drospirenone 3 mg users with cardiovascular risk factors.

We performed a secondary analysis of two open-label contraceptive phase-3 trials that enrolled participants 16 to 50 years to use estetrol/drospirenone for up to 13 cycles. Study exclusion criteria included >35 years and smoking, body mass index >35 kg/m2, and baseline blood pressure (BP) >140/90 mmHg. We compared adverse event rates in participants with and without cardiovascular risk factors and assessed discontinuation rates for cardiovascular adverse events.

Of 3417 participants, 1410 (41.3%) had one or more, and 309 (9.0%) had two or more cardiovascular risk factors. We found no difference in discontinuation for any adverse events in participants with and without cardiovascular risk factors. Six (0.18%) participants discontinued for a cardiovascular complaint including four with risk factors: three (0.09%) due to hypertension (all had baseline BP ≥130/85 mmHg and one or more additional risk factors) and one due to venous thrombosis (BP ≥130/85 mmHg). Of 375 participants with baseline BP ≥130/85 mmHg, 0.8% (95% CI 0%-1.7%) discontinued for hypertension while among the 192 participants with baseline BP ≥130/85 mmHg and one or more additional cardiovascular risk factors, 1.6% (95% CI 0%-3.3%) discontinued for hypertension.

Among >1400 study participants with cardiovascular risk factors using estetrol/drospirenone, only three (0.2%) discontinued for hypertension, all of whom had high-normal baseline BP and at least one other risk cardiovascular risk factor.

Estetrol/drospirenone use demonstrates excellent cardiovascular tolerance in study participants with normal and high-normal blood pressure, even in those with cardiovascular risk factors. The very low rate of hypertension, even when cardiovascular risk factors were present, provides evidence to warrant clinical trials of estetrol/drospirenone in patients with hypertension desiring contraception.

Approximately 30% of women with a history of preeclampsia develop chronic hypertension within 10 years of pregnancy. This systematic review summarizes risk factors before, during, and immediately after pregnancy for the development of chronic hypertension 5 years after preeclampsia. Databases were searched with terms 'preeclampsia' and 'postpartum hypertension' or 'cardiovascular disease' up to 30th October 2023. Observational studies reporting chronic hypertension more than 5 years after preeclampsia were included. Quality was assessed using the Newcastle-Ottawa scale. Wherever possible, a meta-analysis was conducted. Twenty-one cohort and five case-control studies, with a median quality score of 8/10, were included, involving 197 793 patients and reporting 32 risk factors. Preeclampsia in a subsequent pregnancy is associated with chronic hypertension [risk ratio (RR) 2.26, 95% confidence interval (CI) 1.59-3.22, n  = 45 626]. Other significant risk factors include early-onset of preeclampsia (<34 weeks gestation), maternal BMI, blood pressure, diabetes, and family history of hypertension.

A cardiac digital twin is a virtual replica of a patient-specific heart, mimicking its anatomy and physiology. A crucial step of building a cardiac digital twin is anatomical twinning, where the computational mesh of the digital twin is tailored to the patient-specific cardiac anatomy. In a number of studies, the effect of anatomical variation on clinically relevant functional measurements like electrocardiograms (ECGs) is investigated, using computational simulations. While such a simulation environment provides researchers with a carefully controlled ground truth, the impact of anatomical differences on functional measurements in real-world patients remains understudied. In this study, we develop a biventricular statistical shape model and use it to quantify the effect of biventricular anatomy on ECG-derived and demographic features, providing novel insights for the development of digital twins of cardiac electrophysiology. To this end, a dataset comprising high-resolution cardiac CT scans from 271 healthy individuals, including athletes, is utilized. Furthermore, a novel, universal, ventricular coordinate-based method is developed to establish lightweight shape correspondence. The performance of the shape model is rigorously established, focusing on its dimensionality reduction capabilities and the training data requirements. The most important variability in healthy ventricles captured by the model is their size, followed by their elongation. These anatomical factors are found to significantly correlate with ECG-derived and demographic features. Additionally, a comprehensive synthetic cohort is made available, featuring ready-to-use biventricular meshes with fiber structures and anatomical region annotations. These meshes are well-suited for electrophysiological simulations.

Rationale: Randomized controlled trials (RCTs) of lung cancer (LC) screening (LCS) using computed tomography (CT) documented LC mortality reductions between 7.2% and 29.2%, compared with a chest radiograph (CXR). Women appear to have a greater reduction than men. Objectives: We sought to determine why women appear to have better outcomes from LCS compared with men. Methods: We used a secondary analysis of the National Lung Screening Trial, an RCT comparing CXR with CT among screen-eligible individuals ages 55-74 years. Descriptive statistics and a competing risk proportional hazards model that included an interaction between sex and screening arm were used to examine differences in screening outcomes by sex. Results: Of 31,530 men and 21,922 women, 648 (2.1%) and 373 (1.7%) died of LC during the study, respectively. Overall mortality was higher in men: 2,771 (8.8%) versus 1,198 (5.5%). In an adjusted competing cause of death analysis, the LC mortality subdistribution hazard ratio (sHR) favoring CT was significant in women (sHR = 0.74; 95% confidence interval [CI] = 0.6-0.9; P = 0.003) but not men (sHR = 0.91; 95% CI = 0.78-1.06; P = 0.24). The interaction between screening arm and sex was not significant (P = 0.1). Chronic obstructive pulmonary disease and heart disease, which are more prevalent in men, were independently associated with LC death. LC deaths were consistently greater in the CT arm (vs. the CXR arm), for preexisting COPD and diabetes mellitus in men, but not women. Of those with LC, women in the CT arm had 53.7% prevalence of adenocarcinoma (AD) histology, whereas women in the CXR arm and men in both arms had approximately 36-41% AD prevalence. However, there was no overall difference between sexes in the screening difference for AD lethality. Conclusion: Women in the National Lung Screening Trial had a greater reduction in LC mortality that, although not statistically significant, could be the result of more prevalent comorbid disease in men, which contributed to greater all-cause and LC mortality.

Despite being a leading cause of female morbidity and mortality, female-specific cardiovascular disease (CVD) is understudied, underdiagnosed and undertreated. Pregnancy complications involving the placenta, including pre-eclampsia, pregnancy-induced hypertension and foetal growth restriction, are thought to reflect global maternal vascular derangements that indicate a twofold to eightfold increased risk of future CVD. This calls for a better understanding of female cardiovascular pathophysiology to allow development of targeted screening and prevention strategies.Acute atherosis is a placental vascular lesion, which histologically resembles systemic atherosclerosis. The PlacEntal Acute atherosis RefLecting Subclinical atherosclerosis study investigates the association between placental acute atherosis lesions and subclinical systemic atherosclerosis up to 20 years postpartum.This study will improve our understanding of the relationship between pregnancy complications and CVD to identify potential prevention targets and treatments. In addition, it could determine whether the placenta can improve identification of young women at high risk of CVD. These women could benefit from risk-reducing interventions.

This longitudinal prospective cohort study will include women who are either currently pregnant or from a historical cohort. Both groups will have placental histopathology and a single postpartum CVD assessment. The CVD assessment will include medical history taking, blood tests, electrocardiography and echocardiography. Additionally, coronary CT angiography focusing on the presence of atherosclerotic plaques and calcium score will be carried out.The currently pregnant women will either have a pre-eclamptic pregnancy (pre-eclamptic group) or an uncomplicated normotensive pregnancy (uncomplicated group), and their placenta will be collected prospectively. The single CVD assessment will be carried out 6-36 months postpartum.Women from the historical cohort had a pre-eclamptic pregnancy 10-20 years ago. Placental tissue is available for reanalysis. The single CVD assessment will take place immediately and corresponds with 10-20 years postpartum.Exclusion criteria are contraindications to diagnostic assessment necessities: iodinated contrast, beta-blockers or glyceryl trinitrate. Women with uncomplicated pregnancies will be excluded if they have a pre-existing auto-immune condition, chronic hypertension or diabetes mellitus. In the pre-eclamptic group, there are no additional exclusion criteria.

Ethical approval was granted by the Medical Ethics Committee in Maastricht University Medical Centre+ (NL52556.068.15/METC152019). Participants will give written informed consent. Results will be shared in peer-reviewed journals and conference presentations.

NCT05500989; ClinicalTrials.gov Identifier.

Background and objective: Menopause is a significant physiological milestone in a woman's life, coinciding with increased cardiovascular disease (CVD) risk due to various health-related changes. This narrative review focuses on cardiovascular health-related alterations during menopause and their implications on vascular function. Methods: An electronic database search was performed, drawing from sources such as PubMed and Google Scholar. Publications were included if they addressed CVD risk in peri- and postmenopausal women, and examined the impact of hormonal changes, traditional risk factors (e.g., hypertension, hyperlipidemia, diabetes), or lifestyle factors (e.g., diet, physical activity) on CVD. Results: Estrogen deficiency is pivotal, leading to adverse effects such as endothelial dysfunction, increased arterial stiffness, and lipid profile deterioration. Characteristics of menopause, including the age at onset, type or stage of menopause, and severity of symptoms, further modulate CVD risk. Additionally, the impact of traditional risk factors is amplified during this period. Strategies for the prevention of CVD in menopausal women are critically assessed, with a focus on lifestyle modifications, dietary interventions, and physical activity. Conclusions: This narrative review describes the potential benefits and risks of hormone therapy, alongside lipid-lowering therapies. Emphasis is placed on individualized risk assessment and management, highlighting the need for regular cardiovascular screenings and proactive management of risk factors.

Background and Objectives: To examine individual-level sex differences in traditional and non-traditional risk factors and their potential effects on the severity of coronary artery disease (CAD). Materials and Methods: A cross-sectional analysis was performed on 208 patients with a low-to-intermediate pretest probability of CAD, referred to a Coronary CT angiography (CCTA) at the Department of Radiology, Maribor University Medical Centre, from January 2022 to January 2024. CCTA-derived EAT (epicardial adipose tissue) attenuation and CAC (coronary artery calcification) values were measured. The association between CAD, EAT, and risk factors was analyzed by sex, using correlation analysis and multivariate regression. Results: In the results obtained using the univariate logistic regression model, age (OR 1.122, p < 0.001) and hypertension (OR 4.087, p = 0.048) were significantly associated with the presence of obstructive CAD in women, while in men, age (OR 1.052, p = 0.008), hypercholesterolemia (OR 3.765, p = 0.042), and EAT attenuation (OR 1.053, p = 0.011) were significant factors. In results obtained using the multivariable logistic regression analysis model, EAT attenuation was found to be significantly associated with the presence of obstructive CAD in men (OR 1.087, p = 0.012), and age was a significant factor in women (OR =1.108, p = 0.033), while hypertension, body mass index (BMI), diabetes, hypercholesterolemia, angina pectoris, and smoking were not. Conclusions: In the sex-specific multivariable logistic regression analysis model, EAT attenuation was significantly associated with obstructive CAD in men, while in women, it was associated with age. EAT may function as a beneficial alternative indicator in identifying patients with CAD.

Cardiovascular disease (CVD) remains the leading cause of mortality among people with type 1 diabetes (T1D), with cardiovascular mortality rates 2-5 times higher than in the general population. A concerning sex disparity exists within this high-risk population, as the cardioprotective advantage typically observed in women without diabetes appears attenuated or eliminated in individuals with T1D. This disparity is evident across the CVD spectrum, including coronary artery disease, stroke, heart failure, and cardiovascular mortality, with women consistently experiencing an excess burden of disease. These differences are particularly pronounced in women with early-onset T1D, leading to a substantial loss of life-years-approximately 18 years for women compared to 14 for men. Several factors may contribute to this sex disparity. First, the effect of hyperglycemia on CVD appears to have a sex-based differential impact and women with T1D often demonstrate more difficulties to achieve optimal glycemic control. Second, although women with T1D generally exhibit a more favorable CVD risk factor profile than men with T1D, the presence of hypertension, smoking or diabetic kidney disease seem to have a strong impact on CVD in women. Diabetes also appears to diminish sex-based differences in lipid metabolism, and a trend towards increased obesity rates among women with T1D has been observed. Lastly, female-specific factors, which are more prevalent in T1D, exacerbate cardiovascular risk. These include premature menopause, pregnancy-related disorders (such as preeclampsia), polycystic ovary syndrome, and autoimmune diseases, which disproportionately affect women. This narrative review examines the epidemiological evidence highlighting the aspects regarding the excess risk of CVD in women with T1D and evaluates sex disparities in both traditional and female-specific risk factors. Finally, we include a sex-based analysis from the Catalan Registry, which highlights the critical need for greater awareness and enhanced early detection and management of CVD risk factors in this population.

Thrombotic and bleeding risks differ between sexes, partly in relation to distinct biology and hormonal status, but also due to differences in age, comorbidities, and body size at presentation. Women experience frequent fluctuations of prothrombotic and bleeding status related to menstrual cycle, use of oral contraceptives, hormone replacement therapy, or menopause. Although clinical studies tend to underrepresent women, available data consistently support sex-specific differences in the baseline thrombotic and haemorrhagic risks. Compared with men, women feature an increased risk of in-hospital bleeding related to invasive procedures, as well as long-term out-of-hospital bleeding events. In addition, the inappropriate dosing of antithrombotic drugs, which is not adapted to body weight or renal function, is more frequently associated with an increased risk of bleeding in women compared to men. While acute coronary syndrome (ACS) studies support similar antithrombotic drug efficacy, irrespective of sex, women may receive delayed treatment due to bias in their referral, diagnosis, and invasive treatment decisions. The current clinical consensus statement highlights the need for an increased awareness of sex-specific risks and biases in ACS management, with a focus on sex-specific bleeding mitigation strategies, antithrombotic management in special conditions (e.g., myocardial infarction with non-obstructive coronary arteries), and barriers to female representation in cardiovascular trials. This manuscript aims to provide expert opinion, based on the best available evidence, and consensus statements on optimising antithrombotic therapy according to sex, which is critical to improve sex-based disparities in outcome.

Cardiovascular disease (CVD) remains the leading cause of death globally, despite significant public health efforts. The identification and targeting of modifiable risk factors - including hypertension, dyslipidemia, diabetes mellitus, smoking and obesity - have led to significant improvements in patient outcomes over the past 60 years. However, current strategies based on this model have been shown to underestimate CVD risk in women and they are less frequently targeted compared to men. In addition, female-specific biological differences known to contribute to CVD are frequently understudied or excluded from risk stratification efforts. This review explores the unique epidemiological burden, pathobiology and outcomes of CVD in women; the influence of traditional and sex-specific risk factors; and both diagnostic and therapeutic strategies that may improve clinical outcomes in the future.

Individuals with severe mental illnesses (SMI) like schizophrenia, bipolar disorder (BD), and major depressive disorder (MDD) have an increased risk for cardiovascular diseases (CVD), but the causal relationship remains unclear.

Mendelian randomization (MR) was used to investigate the potential causal relationship between SMI and CVD and its five subtypes of disease, coronary heart disease, myocardial infarction, stroke, heart failure, and atrial fibrillation. Subsequently, the MR results of SMI with CVD and its subtypes were meta-analyzed separately. To assess the robustness of the findings, Cochran's Q test, MR-Egger intercept test, MR-PRESSO, and leave-one-out analysis were used. Select single nucleotide polymorphisms (SNPs) related to SMI and CVD and their five subtypes (coronary heart disease, myocardial infarction, stroke, heart failure, and atrial fibrillation). Use univariable Mendelian randomization (UVMR) and multivariate Mendelian randomization (MVMR) to assess the causal relationship between these conditions. Conduct a meta-analysis of the MR results of SMI and CVD and their subtypes. Use MR mediation analysis to evaluate the mediating effect of BMI between BD and CVD. Use Cochran's Q test, MR-Egger intercept test, MR-PRESSO, and leave-one-out analysis to enhance the robustness of the study.

MR analyses have revealed correlations between schizophrenia and BD with CVD and their subtypes in certain datasets. No significant evidence of an association between MDD and CVD or its subtypes was observed in our MR analyses. After MVMR and MR meta-analysis, no basis for genetically predicted SMI increasing CVD and their subtypes was found. The MR mediation analysis showed that the reduced risk of certain CVDs in BD was partially related to BMI to some extent.

Our MR study did not provide conclusive evidence for a causal association between genetic predisposition to SMI and CVD. Based on the available evidence, it would be more appropriate to consider SMI as potential risk markers for CVD and its subtypes rather than definitive risk factors.

Background: Postmenopausal women face increased risk of developing metabolic syndrome (MetS) and cardiovascular disease (CVD) due to hormone changes during menopause. Life's Essential 8 (LE8), a relatively new cardiovascular health assessment index by the American Heart Association, may impact MetS diagnostics and potential treatment strategies. This study investigated the association between LE8 and MetS among postmenopausal women. Methods: National Health and Nutrition Examination Survey (NHANES) data were extracted (2011-2020). LE8 comprised eight health behaviours and factors (score of 0-100) classified into low (0-49), moderate (50-79), and high (80-100) cardiovascular health status. MetS was defined as metabolic dysfunctions comprising insulin resistance, central obesity, dyslipidaemia, impaired glucose metabolism, and hypertension. Complex survey-adjusted regression models were used. Effect modification by race and female hormone use were investigated. Results: 5402 postmenopausal women were included (mean age: 63.0 y), and 3152 (58.3%) met MetS criteria. LE8 scores for those with and without MetS were 58 ± 13.8 and 70 ± 14.1 (p < 0.001), respectively (mean ± SD). Higher LE8 scores were associated with lower odds of having MetS (Odds ratio (OR) for a 10-score increase: 0.53, 95% CI: [0.48, 0.57], p < 0.001). Nicotine exposure score was inversely associated with the likelihood of having MetS (0.52 [0.34, 0.80], p = 0.022). The association between LE8 status and odds of MetS differed by race (p-interaction = 0.01); 'moderate' or 'high' cardiovascular health status lowered odds of MetS in all races except other/multi-racial. Conclusions: The inverse relationship between LE8 scores and MetS suggests that integrating LE8 components into management strategies may help prevent CVD in postmenopausal women.

There are no studies on the burden of ischemic heart disease (IHD) among women of childbearing age (WCBA) in China. This study aims to describe the IHD burden among WCBA in China from 1990 to 2021, predict the trends over the next 15 years, and identify the contributing factors associated with IHD-related deaths.

The data was extracted from the Global Burden of Disease Database 2021. The Direct age-standardized method was used to estimate the age-standardized (AS) prevalence rate (ASPR), mortality rate (ASMR), incidence rate (ASIR), and disability-adjusted life years rate (ASDR) of IHD among WCBA. Joinpoint regression analysis was used to analyze the Annual Percent Change and Average Annual Percent Change from 1990 to 2021. The Autoregressive Integrated Moving Average model was used to predict the trend over the next 15 years.

From 1990 to 2021, the ASPR and ASIR increased by 17.44% and 25.83%, culminating in 616.50 (95% UI, 498.42-762.38) and 79.93 (95% UI, 49.43-113.88) cases per 100,000 individuals. Conversely, the ASMR and ASDR declined to 5.17 (95% UI, 4.14-6.33) and 261.24 (95% UI, 212.03-318.03) cases per 100,000 individuals. Over the next 15 years, the ASPR is projected to increase by 25.74%, culminating in 775.20 (95% UI, 637.98-912.42) cases per 100,000 individuals. The main contributor to increased IHD-related deaths among WCBA in China was high low-density lipoprotein.

Despite the significant decline in the ASMR and ASDR of IHD among WCBA in China over the last 30 years, the ASPR and ASIR continue to increase. Additionally, the ASPR is projected to rise over the next 15 years. These findings emphasize that effective measures and timely interventions are needed to reduce the disease burden.

High body mass index (BMI) and hypertension are quite prevalent in women of childbearing age (WCBA) and are also common risk factors for ischemic heart disease (IHD). However, there are few studies globally evaluating the burden of IHD of WCBA attribute to high BMI and hypertension.

The DALYs (Disability-adjusted life years), Deaths, YLDs (Year lived with disabilitys), YLLs (Year of life losts) of IHD in WCBA attributable to high BMI and hypertension were analyzed by age, sex, year, and geographical location and Socio-demographic Index (SDI). To assess the contribution of epidemiological changes, population growth, and population ageing, a decomposition analysis was used. Exponential Smoothing (ES) modeling and the Autoregressive Integrated Moving Average (ARIMA) model were used to predict the global ASDR (age-standardized DALYs rate), ASMR (age-standardized mortality rate) attributed to the 2 risk factors from 2022 to 2050. The cluster analysis was used to evaluate the changing pattern of burden across GBD regions.

In 2021, the number of global deaths attribution to high BMI was 9,865,138 (95% UI: 3,845,800-15,976,196), and the corresponding ASMR was 216.05 (95% UI: 84.26-349.49) per 100000 population. In various age groups, the largest increase occurred in 20-24 years group (EAPC = 1.26 (95% CI:1.13-1.39)). The number of DALYs of IHD in WCBA attribution to hypertension is 2,158,633 (95% UI:1,725,994-2,538,752) with a corresponding ASMR 46.05 (95% UI: 36.87-54.15) per 100,000 population. The number of DALYs of IHD in WCBA attribution to hypertension is 37,920,567 (95% UI: 30,389,745-44,641,339), and the corresponding ASDR is 817.79 (95% UI: 655.74-962.67) per 100000 population. The largest number of Deaths and DALYs of IHD in WCBA was found between 45-49 years. From 1990 to 2021, ASMR and ASDR attributable to high BMI and hypertension led to a sustained upward trend in Low and Low-medium SDI regions. In addition, the ASMR and ASDR for high BMI and hypertension are highest in the Low-middle SDI regions. Globally, from 1990 to 2021, the overall changes in ASMR and ASDR indicate a relatively stable trend in IHD in WCNA attribute to high BMI. Meanwhile, ASMR and ASDR showed an overall downward trend for hypertension. The number of DALYs, deaths, YLLs, and YLDs of IHD in WCBA attribution to high BMI and hypertension based on the ES and ASMIR models are all increasing from 2022 to 2050.

Over the past 30 years, the ASMR and ASDR of IHD in WCBA has continued to rise. Countries need to remain vigilant about the increasing burden of IHD in WCBA attribute to high BMI and hypertension. It requires proactive prevention strategies, strict control of risk factors, and increased medical coverage to alleviate the burden of IHD. Each region should develop more proactive and effective strategic measures.

Among all the published risk scores, the Harborview Risk Score (HRS) is the only one that relies exclusively on preoperative variables that can be easily assessed at the bedside (age >76 years, creatinine concentration >2.0 mg/dL, systolic blood pressure ever <70 mm Hg and pH < 7.2 or international normalized ratio >1.8). This study has the aim of retrospectively evaluating the population of the ASST Grande Ospedale Metropolitano Niguarda (Milan) the accuracy of the HRS in Italy and of the modified Harborview Risk Score (mHRS) for the first time in Italy.

A single-center, retrospective, observational study was performed. Information on patients treated for ruptured abdominal aortic aneurysms (rAAAs) between January 2002 and March 2024 at the ASST Grande Ospedale Metropolitano Niguarda, Milan (Italy) were collected.

Of the 180 patients treated for rAAA in our hospital during the 22-year study period, 158 met inclusion criteria for the HRS and 145 for the mHRS. Observed 30-day mortality using the HRS was 8.3%, 24.1%, 47%, 54.5%, and 100%, respectively, for a score from 0 to 4 (P value < 0.001). For the mHRS the 30-day mortality observed was 13.2%, 26.7%, 36.4%, 58.8%, and 100%, respectively, for a score from 0 to 4 (P value < 0.001). Receiver operating characteristic analysis revealed a slightly higher ability of the HRS to predict 30-day death (area under the curve = 0.732) than the mHRS (area under the curve = 0.682).

The HRS can accurately predict 30-day mortality after repair of rAAAs, with a higher accuracy for the HRS than the mHRS. These scores represent valuable tools that may guide the clinical decision-making process and help predict futility in the preoperative setting for this morbid disease.

Genetic testing is widely recommended in the diagnosis and management of breast cancer. This study aimed to investigate the knowledge, attitude, and practice (KAP) toward genetic testing in Chinese patients with breast cancer. This multicenter cross-sectional study enrolled breast cancer patients in seven public hospitals in Shanghai, China, between November 2022 and January 2023. A self-administered web-based questionnaire was used to collect the participants' demographic information and their KAP regarding genetic testing. A total of 592 valid questionnaires were collected in this study; 145 (24.49%) patients underwent genetic testing, and 20.61% of the patients never learned about genetic testing. The knowledge, attitude, and practice scores were 4.59 ± 4.49 (22.95%, possible range: 0-20), 16.72 ± 2.92 (83.60%, possible range: 0-20), and 23.67 ± 5.18 (73.97%, possible range: 0-32), respectively. Multivariable logistic regression showed that knowledge (OR = 1.21, 95%CI: 1.51-1.28, P < 0.001), attitude (OR = 1.10, 95%CI: 1.01-1.19, P = 0.027), Jiangsu Province (OR = 0.40, 95%CI: 0.19-0.84, P = 0.016), monthly income of 5000-10,000 CNY (OR = 0.46, 95%CI: 0.25-0.86, P = 0.015), disease duration of 5-10 years (OR = 0.50, 95%CI: 0.27-0.94, P = 0.030) and disease duration of ≥ 10 years (OR = 0.26, 95%CI: 0.11-0.60, P = 0.002), triple-negative subtype (OR = 3.45, 95%CI: 1.51-7.85, P = 0.003) were independently associated with patients' behavior of undergoing genetic testing. The structural equation modeling showed that knowledge directly positively influenced attitude (β = 0.343, P < 0.001), while attitude directly positively influenced practice (β = 0.942, P < 0.001). Chinese patients with breast cancer demonstrated poor knowledge, positive attitude, and suboptimal practice toward genetic testing. More education and counseling on genetic testing for patients are necessary.

For the management of acute coronary syndrome, literature shows lower healthcare providers' guideline adherence for women than for men. Since less is known about the management of chronic coronary syndrome (CCS), this study investigated patient-related sex differences in providers' guideline adherence for invasive coronary angiography (CA) performed in patients with suspected CCS.

Using data from the German ENLIGHT-KHK trial, patients with suspected CCS who underwent a CA were analysed. To assess the association between patient sex and physicians' adherence to the German National Disease Management Guideline "Chronic coronary artery disease" of 2019, binary logistic regression models were developed. Covariates included age, symptoms, risk factors, comorbidities, and non-invasive testing and its results. To examine sex differences in predictors of guideline adherence, models were run separately for women and men.

Two hundred seventy-three women and three hundred eighty-six men were included (aged 67 ± 10 years). Physicians' guideline adherence for CA was lower for women than for men (19.4% vs. 30.1%, p = 0.002). CAs were less likely to be guideline-adherent for women with suspected CCS than men (OR 0.4, p < 0.05). Guideline adherence predictors differed between women and men. For example, men's predictors included non-invasive testing and its results, age, typical angina and smoking; of these, only a positive non-invasive test result had an impact for women.

Our results indicate a less guideline-adherent diagnostic workup of CA for women with suspected CCS than men. This might reflect a limited awareness of CCS in women and insufficiently sex-specific guideline recommendations.

German Clinical Trials Register DRKS00015638, Registered February 19, 2019; Universal Trial Number (UTN): U1111-1227-8055.

Heart disease is the leading cause of death (LCOD) for women in the United States. However, despite decades of public health campaigns, awareness of heart disease among women, especially those with racial/ethnic minority backgrounds and young women, significantly declined from 2009 to 2019.

The aim of this study was to compare the differences in heart disease awareness as the LCOD among Black, Hispanic, White, and Asian/Other women groups.

In this cross-sectional, online survey study, 422 community-dwelling women were analyzed. Heart disease as the LCOD was categorized as the correct answer. We implemented log-linear models via a Poisson regression to estimate unadjusted and adjusted relative risks [RRs] of race in predicting correct knowledge of LCOD.

The mean age was 41.2 (±12.9) years. The sample represents 39.8 % Hispanic, 28.4 % White, 19.9 % Black, 11.9 % Asian/others. After adjusting for age and cardiovascular disease risks, Black and Hispanic women, as compared to White women, had significantly lower awareness of heart disease as the LCOD [(Adjusted RR=0.69, 95 % CI: 0.52, 0.92); (Adjusted RR= 0.78, 95 % CI: 0.78 -0.94), respectively]. Additionally, physical inactivity and hypertension medication intake were significantly associated with this level of awareness (P < 0.5).

Lower heart disease awareness in Black and Hispanic women persists. It is crucial to develop more effective approaches to close this disparity. Testing new methods, such as applying artificial intelligence to send more culturally appropriate and personalized messages, is urgently needed to raise women's awareness of their heart disease risk.

Exposure to certain chemicals in disinfectants has been associated with vascular dysfunction in toxicological studies, but the association between disinfectant exposure and clinical cardiovascular disease (CVD) remains unclear.

The aim of this study was to evaluate the association between occupational exposure to disinfectants and subsequent risk of CVD among US nurses.

We included 75,675 participants from The Nurses' Health Study II who maintained a nursing job and reported data on occupational disinfectant exposure. We estimated hazard ratios (HR) and 95% confidence intervals (CIs) of incident CVD, including coronary heart disease (CHD) and stroke, using Cox proportional hazard models comparing job types and general disinfection tasks between participants. We also used a job-task-exposure matrix to evaluate the risk of CVD by frequency of cleaning/disinfection tasks and exposure levels of seven specific disinfectants (formaldehyde, glutaraldehyde, hypochlorite bleach, hydrogen peroxide, alcohol, quaternary ammonium compounds, and enzymatic cleaners).

During 10 y of follow-up (2009-2019), we documented 726 incident cases of CVD. In fully adjusted models, the hazard ratio of CVD among nurses who worked in operating rooms was 1.72 [95% confidence interval (CI): 1.25, 2.36], in comparison with those working as educators or administrators. A similar pattern of associations was found when we separately assessed the risk for CHD and stroke [HR = 1.69 (95% CI: 1.11, 2.58) and HR = 1.69 (95% CI: 1.05, 2.74), respectively] among operating room nurses, in comparison with those working as educators or administrators. Those who used disinfectants weekly had modest elevations in CVD risk (HR = 1.21 ; 95% CI: 1.04, 1.40), in comparison with women who never used disinfectants. The highest CVD risk was observed among nurses using disinfectants or spray or aerosol products 4-7 d/wk and those exposed to the highest levels of the seven specific disinfectants listed above.

Exposure to disinfectants in real-world health care settings was associated with a higher risk of CVD, including CHD and stroke, among US nurses. https://doi.org/10.1289/EHP14945.

Circadian Syndrome (CircS) was recently recognized as a novel predictor of cardiovascular disease (CVD) risk, with reproductive factors playing an important role in CVD risk. Yet, studies linking reproductive factors to CircS remain sparse. Data on middle-aged and elderly women were extracted from three nationally representative surveys: the China Health and Retirement Longitudinal Study (CHARLS) and the English Longitudinal Study on Ageing (ELSA) provided the training set, and the National Health and Nutrition Examination Survey (NHANES) constituted the validation set. We employed logistic regression to evaluate the association between self-reported reproductive factors and CircS risk, with inverse probability of treatment weighting (IPTW) and subgroup analyses conducted to verify the stability. A total of 11,721 participants were analyzed. CircS prevalence differed significantly across countries, with 51.40 % in China and 20.19 % in the United Kingdom. Early menarche (age <12 years) correlated with increased CircS risk in CHARLS (OR 1.38 [95 % CI 0.99-1.92]; p = 0.061), ELSA (OR 1.64 [95 % CI 1.36-1.98]; p < 0.001), and NHANES (OR1.52 [95 % CI: 1.21-1.89]; p < 0.001). Premature menopause (age <40 years) was associated with a roughly 30 % higher CircS risk. A shorter reproductive lifespan was significantly linked to CircS, with this relationship emerging at a reproductive lifespan of ≥40 years in CHARLS (OR1.39 [95 % CI: 1.04-1.84]; p = 0.024). The aforementioned correlations retained significance following IPTW and subgroup analyses. Early menarche, premature menopause, and abbreviated reproductive lifespans may negatively affect CircS. Public health strategies should incorporate menstrual cycle-related reproductive health into primary CircS prevention.

Homozygous familial hypercholesterolemia (HoFH) is characterized by extremely high plasma low-density lipoprotein cholesterol (LDL-C) levels and high premature atherosclerotic cardiovascular disease risk. During pregnancy LDL-C levels increase, while limited therapeutic options are available. This international study documented current approaches of healthcare professionals (HCPs) to family planning, pregnancy, and breastfeeding in HoFH.

An online HCP survey was distributed among the HoFH International Clinical Collaborators (HICC, NCT04815005). Responses were analyzed according to HCPs' gender, medical specialty, country income status, and world region.

In total, 87 HCPs (39.1 % women) from 48 countries participated (64.4 % practicing in high-income countries). Most HCPs (79.3 %) always discuss family planning with patients with HoFH. Most (72.4 %) recommend contraception, with intrauterine devices (50.8 %) and oral contraceptives (49.2 %) being most commonly recommended. One in three HCPs would advise against pregnancy if ASCVD risks were deemed too high. Except for lipoprotein apheresis and colesevelam, most HCPs would recommend discontinuing LLT during the conception, pregnancy, and breastfeeding periods. However, approximately 30 % advise continuation or reinitiation of statins and/or ezetimibe during pregnancy and breastfeeding despite labelled restrictions on use during pregnancy and breastfeeding. Nearly half (48.3 %) of HCPs would recommend that women with HoFH shorten the breastfeeding period to resume LLT earlier, with HCPs from high-income countries significantly more likely to do so (51.8 % vs. 41.9 %; p = 0.008).

This study highlights significant variability in the management of HoFH in women of childbearing age, especially concerning LLT use during conception, pregnancy, and breastfeeding. The findings underscore the need for further research to establish global evidence-based guidelines tailored to individual needs, to improve cardiovascular risk management and reproductive health outcomes for women with HoFH worldwide.

Although continuous positive airway pressure (CPAP) effectively prevents sleep apnea and reduces blood pressure, many patients do not use CPAP every night. This trial investigates cardiovascular effects after sleeping five nights without CPAP.

We randomized 100 patients (67 men and 33 women with a mean age 64 ± 9 years) using CPAP treatment for moderate-to-severe sleep apnea to either withdraw treatment for five nights ( n  = 50) or to continue with CPAP ( n  = 50). The primary outcomes were arterial stiffness and 24 h blood pressure.

The 24 h SBP increased by a mean of 2.8 mmHg [95% confidence interval (CI) 0.2-5.4 mmHg] ( P  = 0.035) and DBP increased by a mean of 1.7 mmHg (95% CI 0.1-3.3 mmHg) ( P  = 0.032) in the group without CPAP compared to the CPAP group. There was a significant effect on blood pressure in women but not in men. In women, SBP increased by 5.1 mmHg (95% CI 1.0-9.5 mmHg) ( P  = 0.017) and DBP by 2.9 mmHg (95% CI 0.4-5.6 mmHg) ( P  = 0.029). Arterial stiffness remained unaffected. Secondary outcomes that worsened in patients without CPAP included apnea-hypopnea index, oxygen desaturation index, hemoglobin levels, and daytime sleepiness.

Blood pressure is affected after five nights of CPAP interruption, along with a rapid return of sleep apneas, nocturnal hypoxic events, daytime sleepiness and increased hemoglobin levels, but arterial stiffness was not affected. Blood pressure was affected in women only, suggesting a sex-related CPAP effect on blood pressure.

According to international guidelines, lowering LDL-cholesterol is the cornerstone of atherosclerotic cardiovascular disease (ASCVD) prevention. However, observational studies have identified current gaps in the implementation of lipid-lowering therapy (LLT). This whole-population study aimed to evaluate the prevalence and determinants of LLT use in ASCVD patients.

Using the national health data system, all French adults with established ASCVD between 2012 and 2021 were identified using specific ICD-10 and/or procedure codes. LLT use was defined as ≥1 dispensing in the last quarter of 2021. Logistic regression was used to identify factors associated with the absence of LLT use.

In 2021, 2,206,305 individuals (4.89 % among 45,082,270 adults) had established ASCVD (mean age: 72.2 years; 36.9 % women), including 56.1 % with coronary artery disease, 40.4 % with cerebrovascular disease, and 14.5 % with revascularized peripheral artery disease (PAD). Among the 2,056,354 patients alive on 31st December 2021, 32.5 % did not receive any LLT, while 64.8 % received a statin (27.0 % a high-intensity statin), 13.0 % a combination of statin and ezetimibe, and 0.25 % a PCSK9 inhibitor. The absence of LLT use was significantly associated with female sex (adjusted odds ratio [aOR]:1.42, 95 %CI, 1.41-1.43); lowest/highest ages: < 50 years (aOR (/65-74 years): 2.23, 95 %CI 2.20-2.27) and ≥ 85 years (aOR: 2.10, 95 %CI 2.08-2.13); and stroke and PAD, compared to myocardial infarction (aOR: 2.21, 95 %CI 2.19-2.23 and 1.88, 95 %CI 1.86-1.91, respectively).

In real life, one-third of French ASCVD patients was not regularly treated with LLT, highlighting the urgent need to develop implementation strategies for lipid management.

Developing durable anticoagulant coatings for cardiovascular implants remains a major research challenge. Heparin, the current gold-standard anticoagulant, faces challenges due to rapid elution from coated surfaces. This article reports a new heparin-alternative anticoagulant coating system engineered through rational design of a dual-functional chondroitin sulfate derivative (methacrylated/aldehyde-modified chondroitin sulfate, CSMAO) and sulfonated chitosan (SCS). The hierarchical architecture was constructed via sequential layer-by-layer (LbL) assembly on polydopamine (PDA)-functionalized 316 L stainless steel substrates. The material characterization methods included Fourier transform infrared (FTIR) spectroscopy, nuclear magnetic resonance (NMR), and X-ray photoelectron spectroscopy (XPS). The grafting rate of glycidyl methacrylate was 20.05 %, with an aldehyde substitution degree of 48.61 %, and the sulfonation degree of SCS reached 46.96 %. The composite coating exhibited excellent biocompatibility and anticoagulant properties. Coagulation profiling indicated comparable extrinsic pathway regulation to that of heparin controls along with superior intrinsic pathway inhibition (P < 0.01). This rationally designed coating system shows translational promise for improving the hemocompatibility of cardiovascular implants.

Cardiovascular disease (CVD) is the leading cause of death among women.

Adverse pregnancy outcomes, such as stillbirth and recurrent pregnancy loss, are sex-specific risk factors for CVD. Little research investigates CVD preventive healthcare following bereavement.

To describe women's preferences and experiences regarding CVD preventive healthcare after bereavement and identify their questions to inform future research and intervention design.

A participatory, qualitative approach was adopted, involving a Lived Experience Expert Group to plan, conduct and interpret focus groups with women who experienced stillbirth or recurrent pregnancy loss. Focus groups involved facilitated group discussion, and a nominal group technique activity to prioritise questions about CVD risk. Focus group transcripts were analysed thematically.

Sixteen women participated, all previously unaware of the association between their bereavement and increased CVD risk. Two major themes emerged: women have unmet needs for supportive care after bereavement, and a cautious desire for information about CVD risk. The 'top ten' questions focussed on improving bereavement care, preventing CVD, and concerns beyond CVD.

Although women valued information about CVD risk, they were concerned about adding to the burden of bereaved women, especially in the context of inadequate bereavement care.

Gaps in bereavement care have an enduring impact on women after early pregnancy loss and stillbirth. Beyond improving women's experiences and mental health outcomes, improving bereavement care may also support uptake of long-term CVD preventive healthcare.