Background Emerging evidence suggests associations between air pollution, multimorbidity, and atrial fibrillation (AF), but their interplay remains unclear. We evaluated these relationships in a prospective cohort. Methods We retrieved a total of 480 344 individuals from the UK Biobank. The quantification of air pollutants (particulate matter with a diameter ≤2.5 μm (PM2.5), particulate matter with a diameter ≤10 μm (PM10), nitrogen oxides (NOx) and nitrogen dioxide (NO2)) was conducted at the geocoded residential locations of each participant. Multimorbidity clusters were determined using latent class analysis using 35 long-term conditions (LTCsc. Three latent classes were identified: non-cardiovascular disease (non-CVD) multimorbidity, mental health multimorbidity and cardiometabolic multimorbidity. These were compared with no LTCs and singular LTCs. Cox models examined the effects of air pollution and multimorbidity status on AF incidence. Counterfactual analyses were performed to c

Background Mobility limitation is prevalent in patients with heart failure (HF), but the dose-response relationship between its severity and adverse outcomes remains unquantified. Methods We conducted a patient-level pooled analysis of two prospective Japanese cohort studies, including 2103 hospitalised patients with HF with no exclusion criteria. Mobility limitation at discharge was categorised into four levels: category I (independent outdoor walking), category II (indoor independence but requiring outdoor assistance), category III (requiring indoor assistance) and category IV (unable to walk). The primary endpoint was a 2-year composite of HF rehospitalisation or all-cause mortality. Adjusted analyses accounted for age, sex, comorbidities, biomarkers and medications. Results Among 2820.7 person-years of follow-up, 998 composite outcomes occurred. Incidence rates per 100 person-years for the primary outcome increased with mobility limitation severity: 24.9 (category I), 47.0 (II), 59

Background Guideline recommendations for the prevention of cardiovascular (CV) events in patients with coronary artery disease (CAD) are predominantly one-size-fits-all. Clinically identifiable phenotypes needing specific considerations might exist. The purpose of this study is to identify such clinical phenotypic clusters in patients with CAD and assess their relationship with the risk of recurrent CV events. Methods Unsupervised machine learning through latent class analysis was performed in patients with CAD from the Swedish Web‐System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) registry (n=88 894) and Utrecht Cardiovascular Cohort-Second Manifestations of Arterial Disease (UCC-SMART) cohort (n=5506). Characteristics for clustering were based on availability, missingness and clinical relevance. Clustering was performed in SWEDEHEART and validated in UCC-SMART. Association between clusters and the c

Background Bicuspid aortic regurgitation (AR) is common in younger patients who often do not meet guideline-based criteria for aortic valve (AV) surgery at diagnosis. However, identifying early predictors of disease progression may aid in risk stratification and surgical timing. Methods From a single-centre registry of 1927 patients with bicuspid AV, we identified 335 patients with moderate or severe AR, excluding those with severe aortic stenosis (AS), endocarditis or other major valvular diseases. Among them, 199 patients (mean age 52±14.0 years; 80% male) did not initially meet the surgical criteria and were included in the final analysis. Clinical data and echocardiographic parameters, including speckle-tracking-derived strain measurements, were analysed. The primary outcome was progression to AV surgery during follow-up. Results Over a mean follow-up of 4.9 years, 41 patients (21%) underwent AV surgery, primarily for symptom onset or left ventricular (LV) enlargement. In multivari

Background The relationship between objectively measured hearing ability and the risk of incident heart failure (HF) remains unclear. This study aimed to assess this association, explore potential modifying factors, and examine whether psychological factors mediate this relationship. Methods We included 164 431 participants from the UK Biobank without HF at baseline. Speech-in-noise hearing ability was measured using the Digit Triplets Test and quantified by the speech-reception-threshold (SRT). Incident HF was identified through hospital admission and death records. Mediation analyses assessed the role of social isolation, psychological distress, and neuroticism. Results Over a median follow-up of 11.7 years, 4449 (2.7%) participants developed incident HF. Higher SRT levels were associated with an increased risk of HF (adjusted HR per SD increment 1.05, 95% CI 1.02 to 1.08). Compared with those with normal hearing, participants with insufficient hearing, poor hearing, or hearing aid u

Background Patients with diabetes mellitus (DM) have an elevated risk of late events after percutaneous coronary intervention (PCI). The Second-generation Drug-eluting Stents in Diabetes (SUGAR) trial ([NCT03321032][1]) compared amphilimus-eluting stents (AESs) and onyx-zotarolimus-eluting stents (O-ZESs) in this population. Objectives To report the co-primary endpoint comparing target lesion failure (TLF) between AES and O-ZES at 2 years and the extended follow-up at 3 years. Methods The SUGAR trial enrolled 1175 patients with DM across 23 centres in a randomised (1:1 AES (Cre8EVO) or O-ZES (Resolute Onyx)) assessor-blinded design. The primary endpoint, assessed with a Cox proportional hazards model, was TLF (a composite of cardiac death, target vessel myocardial infarction or ischaemia-driven target lesion revascularisation). Secondary endpoints included all-cause mortality, stent thrombosis and major adverse cardiac events. Results At 2 years, TLF occurred in 60 (10.4%) patients in