Search Results (3,663)

Systemic arterial hypertension (SAH) is a multifaceted condition marked by sustained elevations in arterial blood pressure. Its occurrence is closely related to alterations in target organs, such as the liver. Non-pharmacological treatments have been proposed for these effects. Thus, the aim of this study was to investigate the effects of açaí supplementation and resistance training, applied individually or in combination, on blood pressure and liver structural parameters. An experimental, quantitative, and longitudinal study was conducted using young Wistar rats (~60 days old) and spontaneously hypertensive rat (SHR) strains. Fifty rats were divided into five experimental groups: Wistar Control (C), Hypertensive Control (H), Hypertensive Trained (HT), Hypertensive Açaí-Supplemented (HA), and Hypertensive Trained plus Açaí Supplementation (HAT). Each group consisted of ten animals. Subsequently, analyses were performed for the antioxidant capacity and proximate composition of the açaí pulp, systolic blood pressure assessment, and histological evaluation of the liver. The açaí used exhibited high antioxidant capacity. At the end of the experimental period, the trained groups increased their maximal load carried, along with a reduction in systolic blood pressure in all treated groups. Açaí supplementation resulted in lower relative liver mass compared with the H group. The hypertensive condition promoted extracellular matrix expansion and a reduction in hepatocyte proportion. Both interventions attenuated these effects, and the combined treatment (HAT) produced the greatest improvement, indicating an additive response. Hypertension also elevated hepatic glycogen concentration, and the treatments reduced this alteration. It is concluded that açaí supplementation and resistance training could promote positive adaptations in the liver of hypertensive animals. Full article

Myxomatous mitral valve disease (MMVD) is the most common acquired cardiac disease in small-breed dogs and shows particularly high prevalence and early onset in Cavalier King Charles Spaniels (CKCS). Although MMVD is considered a complex, polygenic disease, the clinical relevance of individual genetic variants remains incompletely understood. The angiotensin-converting enzyme (ACE) gene variant rs850683722 has previously been associated with altered ACE activity and differences in renin–angiotensin–aldosterone system-related responses in dogs with MMVD. The aim of this study was to determine the prevalence of rs850683722 in a Polish population of CKCS dogs and to assess whether this variant is associated with the clinical course of MMVD. A total of 105 CKCS dogs were included in the study. All dogs underwent standardized cardiovascular evaluation, including echocardiography, electrocardiography, and systolic blood pressure measurement. MMVD diagnosis and staging were performed according to current ACVIM consensus criteria. Genotyping of the rs850683722 variant was performed using Sanger sequencing for 95 dogs, while next-generation sequencing data was obtained for 10 dogs. Genotype distribution, allele frequencies, conformity with the Hardy–Weinberg equilibrium (HWE), sex-related differences, and associations between genotype and age at progression to selected MMVD stages or the primary clinical endpoint were assessed statistically. The most frequent genotype was AA, detected in fifty-nine dogs, followed by GG in thirty-seven dogs and AG in nine dogs. When dogs carrying at least one A allele were considered variant-positive, the overall prevalence of the variant-positive genotype was 64.8%. The calculated allele frequencies were 0.605 for the A allele and 0.395 for the G allele. The observed genotype distribution deviated markedly from the Hardy–Weinberg equilibrium, mainly because of a pronounced deficit of heterozygous dogs. No significant association was detected between genotype and sex. Genotype was also not significantly associated with age at progression to stage B2 or stage C. A statistically significant difference in age of death was demonstrated by genotype, but this difference was not reflected in the survival analysis. The rs850683722 variant was highly prevalent in the studied Polish CKCS population, with a frequency comparable to previously reported data for this breed. Despite its documented biological association with ACE activity and RAAS-related responses, the variant was not significantly associated with the clinical progression of MMVD in this cohort. These findings suggest that rs850683722 alone seems unlikely to be a reliable marker for predicting the severity or rate of MMVD progression in Polish CKCS dogs. Further studies including larger cohorts, longer follow-up, pedigree information, and the direct assessment of RAAS activity may help clarify whether this variant has stage-dependent or treatment-related clinical relevance. Full article

Background: We previously reported that consuming a Mediterranean-style healthy dietary pattern (MED-HDP) with lower vs. higher glycemic index foods differentially changed indices of postprandial glucose control and daily glycemic variability but did not influence improvements in cardiovascular health indices. Methods: Fifty-two adults (31 females, 21 males; aged 49 ± 11 y, BMI 31 ± 3.1 kg/m², mean ± SD) with two or more features of metabolic syndrome participated for 12 weeks in the randomized, controlled trial with all foods provided. At dinner only, participants could select from protocol-approved foods, including unprocessed chicken breast, unprocessed lean beef, and unprocessed salmon and shrimp (seafood). Objective: Herein, we retrospectively assessed whether the frequency of consuming different sources of meat (i.e., the exposures) was associated with MED-HDP-induced changes in cardiovascular health indices (i.e., the outcomes). Results: Among all participants, consuming the MED-HDP foods (88% adherence) reduced fasting systolic (SBP) and diastolic (DBP) blood pressures and serum total cholesterol (TC), triglycerides (TGs), and HDL. More frequent consumption of chicken at dinner, in place of beef and seafood, was associated with greater reductions in SBP (p = 0.034 and p = 0.047 for replacing beef and seafood, respectively) and DBP (p = 0.021 and p = 0.043, respectively). Frequency of chicken, beef, and seafood intakes at dinner did not associate with the reductions in serum TC, TG, HDL, or LDL. Conclusions: These results support that adoption of a MED-HDP improved multiple cardiovascular risk factors among middle-aged and older adults at elevated cardiovascular risk. The observed modest associations between more frequent consumption of unprocessed chicken at dinner and greater blood pressure reductions, which do not mean that eating more chicken at dinner causes lower blood pressure, warrant independent replication. Full article

Background: Cardiovascular disease (CVD) remains the leading cause of mortality worldwide, with over 75% of deaths occurring in low- and middle-income countries, where conventional risk models often demonstrate poor calibration and limited generalizability. Objective: This study aimed to develop an interpretable, pharmacotherapy-informed machine learning model for cardiovascular risk prediction using national electronic health record (EHR) data from Jordan. Methods: A retrospective cohort study was conducted using approximately 600,000 individuals from the national Hakeem EHR system (2018–2022). Demographic, clinical, blood pressure, laboratory, and medication data were integrated to construct three datasets reflecting varying levels of feature completeness. Multiple machine learning models were benchmarked, followed by optimization, hybrid modeling, and probability calibration. Model interpretability was assessed using SHAP analysis. Results: The national cohort demonstrated a high cardiometabolic burden, with prevalence of hypertension (50.2%), hyperlipidemia (54.9%), and diabetes (47.9%). Antihypertensive and lipid-lowering therapies were more frequently used among CVD patients (56.9% and 49.6%, respectively). Treatment patterns were dominated by amlodipine (19.9%) and atorvastatin (74.4%). The final calibrated seed-bagged gradient boosting model achieved robust performance (ROC-AUC 0.844; PR-AUC 0.813) with consistent generalization across datasets. Key predictors included antihyperlipidemic therapy, systolic blood pressure variability, age, and sex. Conclusions: This study presents JoRisk, a calibrated and interpretable machine learning framework that integrates pharmacotherapy and clinical data for short-term cardiovascular risk prediction. The model demonstrates strong performance using routinely available EHR variables and offers a scalable decision-support tool for risk stratification in resource-constrained healthcare systems. Full article

Conventional ultrasound-based assessment of aortic stiffness relies on two-point distension metrics using maximum and minimum vessel diameters within a cardiac cycle, which may not fully reflect time-resolved aortic wall dynamics. This retrospective pilot study investigated the feasibility and clinical relevance of a time-series-based stiffness parameter, termed pulsatile stiffness-β, derived from automated segmentation of archived aortic M-mode ultrasound images. Seventy-nine cases with available aortic M-mode images were analyzed. Automated image processing was used to segment the anterior and posterior aortic walls and reconstruct diameter waveforms. Conventional stiffness-β, pulsatile stiffness-β, and wall asymmetry-related parameters were calculated and compared with demographic, tonometry-derived, hemodynamic, coronary burden, cardiovascular risk, and echocardiographic variables. Conventional and pulsatile stiffness-β were strongly correlated and showed directionally consistent associations with established vascular functional parameters, including systolic blood pressure, pulse pressure, augmentation pressure, age, and cardiovascular risk burden. Pulsatile stiffness-β demonstrated association patterns broadly comparable to conventional stiffness-β, suggesting its role as a waveform-informed extension rather than a superior alternative. Wall asymmetry-related parameters were associated with the Syntax score. Automated analysis of archived aortic M-mode images may provide feasible time-resolved vascular biomarkers for stiffness and wall motion assessment. Full article

Hypertension is among the most important modifiable risk factors associated with heart failure with preserved ejection fraction (HFpEF) development and progression, yet guideline-directed blood pressure (BP) targets (<130/80 mmHg) and sodium–glucose co-transporter 2 inhibitor (SGLT2i) therapies lack dedicated randomized controlled trials (RCTs) in this specific group of patients. This narrative review synthesizes 2024 ESC/ESH and 2025 JSH meta-analyses, discussing the proposed pathophysiological framework linking hypertension-associated remodeling with HFpEF. Post hoc analyses from landmark trials (EMPEROR-Preserved, DELIVER) demonstrate consistent heart failure (HF) event reductions with SGLT2i (pooled HR 0.79, 95% CI 0.67–0.93), complemented by modest systolic BP lowering (−2.3 mmHg) and biomarker insights. Soluble ST2 and N-terminal pro-B-type natriuretic peptide (NT-proBNP) may contribute to risk stratification in HFpEF populations when interpreted in conjuction with imaging findings and clinical context; however, neither biomarker is specific for hypertension-mediated remodeling. Critical evidence gaps persist: heterogeneous BP thresholds across international guidelines, limited device therapy data (renal denervation showing −8.5 mmHg sustained reduction), and real-world implementation barriers among elderly/comorbid Europeans (adherence < 50%, polypharmacy risks). Hellenic HF Registry data highlight frailty prevalence (68% in patients > 75 years) complicating aggressive BP management. The review addresses phenotype-specific challenges through precision medicine approaches incorporating phenomapping and multi-biomarker panels (NRI 0.28 improvement). We advocate for dedicated HFpEF RCTs evaluating intensive vs. standard BP targets, SGLT2i sequencing with antihypertensives, and European real-world registries to bridge the translational gap. These strategies aim to transform guideline recommendations into optimized, patient-centered care for the rapidly expanding hypertensive HFpEF population. Full article

Background/Objectives: Cardiovascular disease (CVD) burden decreased in the North Africa and Middle East (NAME) region between 1990 and 2019. This study used Global Burden of Disease (GBD) 2023 data to examine whether trends in mortality, disability-adjusted life years (DALYs), incidence, and prevalence continued through 2023 across all 21 NAME countries. Methods: We analysed age-standardised CVD mortality, incidence, prevalence, and DALY rates from 1990 to 2023. Joinpoint regression identified changes in temporal trends and calculated the annual percent change (APC) and average annual percent change (AAPC) with 95% confidence intervals (CIs). Results: Age-standardised CVD mortality decreased from 579.6 per 100,000 in 1990 to 358.2 in 2023 (AAPC: −1.42%; 95% CI: −1.48 to −1.35). However, no significant reduction occurred between 2019 and 2023 (APC: −0.33%; 95% CI: −1.37 to 1.75). DALY, incidence, and prevalence rates followed similar patterns, with no significant decline in the final years of this study. Egypt was the only country with a long-term increase in CVD mortality, which accelerated after 2020 (APC: +5.20%; 95% CI: 1.20 to 12.87). High systolic blood pressure, dietary risks, lead exposure, and air pollution were the leading modifiable risk factors. Conclusions: The earlier decline in CVD burden in the NAME region did not clearly continue after 2019. The region is currently off track to meet Sustainable Development Goal 3.4 by 2030. Future progress may depend on improved blood pressure control, lipid management, dietary habits, and environmental risk reduction. Full article

Background and Objectives: Pulmonary sequestration (PS) is a rare congenital lung anomaly with anomalous systemic arterial supply. Surgical resection is the standard treatment, but some children have contraindications. Endovascular embolization (EE) is an established alternative; published pediatric experience is limited, particularly in neonates. We report a two-centre experience with extended follow-up and quantitative hemodynamic data. Methods: Six pediatric patients (five male; median age 6 months, range 11 days to 4 years and 8 months) underwent EE for PS at two centres in Gdańsk, Poland, between 2020 and 2025. Contraindications to surgery were severe pulmonary arterial hypertension, high-output cardiac failure, low body weight with comorbidity, complex extralobar anatomy or refused parental consent. Procedures were performed under general anesthesia via right common femoral arterial access; device strategy was tailored to vessel anatomy. Results: Technical success was 100% with no procedural complications. Median feeding-artery diameter was 3.4 mm (range 2.1 to 5.3 mm). An Amplatzer-family vascular plug was used in five patients (83.3%), pushable platinum coils in two (33.3%) and Onyx-18 in one (16.7%); two had hybrid combinations and one underwent planned staged two-step embolization. Median procedural duration was 51 min. At median follow-up of 50 months (range 11 to 68), all patients showed sequester regression on imaging. Reverse cardiac remodelling occurred within five weeks in the patient with pre-procedural left ventricular dilation (Z-score +2.45 returning to normal); systolic pulmonary artery pressure fell from 35 to 40 to 17 mmHg within six weeks in the neonate treated at 11 days of life for high-output cardiac failure. No patient required surgical resection. Conclusions: Endovascular embolization is safe and effective in pediatric patients with pulmonary sequestration and contraindications to surgery, including neonates with comorbidity. Documented reverse cardiac remodelling and rapid hemodynamic improvement support its use in selected cases. Full article

Background: Hemodynamic depression, characterized by bradycardia and hypotension, is a common complication of carotid artery stenting (CAS) and is primarily attributed to carotid sinus baroreceptor stimulation. While prophylactic atropine is often used in high-risk patients, predictors of unexpected hemodynamic depression among patients initially deemed low-risk remain incompletely defined. Objective: To identify clinical, anatomical, and procedural predictors of hemodynamic depression in patients undergoing CAS without prophylactic atropine. Methods: We performed a retrospective, single-center observational study of consecutive patients undergoing CAS between January 2015 and May 2024. Patients who received prophylactic atropine for low baseline heart rate (HR) were excluded. Hemodynamic depression was defined as a >20% reduction in HR from baseline. Absolute bradycardia (HR <50 bpm) and hypotension (>40% reduction in systolic blood pressure) were recorded descriptively. Results: A total of 158 patients underwent CAS, of whom 33 (20.9%) were excluded due to prophylactic atropine administration for low pre-procedural heart rates (<60 bpm). Among 125 included patients, 62 (49.6%) experienced significant HR reduction during CAS. In multivariable analysis, a shorter distance between the stenotic lesion and the carotid bifurcation was independently associated with hemodynamic depression (OR 0.90 per mm increase; 95% CI 0.82–0.99; p = 0.023). Greater intraprocedural reductions in systolic and mean arterial pressure were also associated with HR depression. Traditional clinical risk factors, including age, sex, comorbidities, degree of stenosis, calcification severity, anesthesia type, and procedure urgency, were not independently predictive. Conclusions: Hemodynamic depression remains frequent during CAS even among patients classified as low risk. Lesion proximity to the carotid bifurcation is a key anatomical predictor of autonomic instability, highlighting the limitations of standard risk stratification and supporting a lesion-specific approach to periprocedural hemodynamic management. Full article

Background/Objectives: Patients with chronic kidney disease (CKD) often present with peripheral arterial stiffness (PAS), which is associated with an increased cardiovascular risk. This study assessed the association between circulating osteoprotegerin (OPG), a known mediator of vascular calcification, and PAS, measured as brachial–ankle pulse wave velocity (baPWV), in patients with CKD. Methods: This cross-sectional investigation engaged 200 individuals with non-dialysis CKD. Serum OPG concentrations were measured using a commercial enzyme-linked immunosorbent assay. Participants were classified as having PAS when either left or right baPWV was greater than 18.0 m/s; those with baPWV values of 18.0 m/s or lower were assigned to the control group. Results: Eighty-six patients (43.0%) had PAS. In comparison to controls, PAS patients were older (p < 0.001) and had higher proportions of diabetes mellitus (p = 0.023) and hypertension (p = 0.010); systolic blood pressure was higher (p < 0.001), urine protein-to-creatinine ratio was elevated (p = 0.004), and serum OPG was markedly greater (p < 0.001), whereas estimated glomerular filtration rate was lower (p = 0.003). After full adjustment, OPG levels, in addition to older age and diabetes mellitus, demonstrated an independent association with PAS (odds ratio: 1.008; 95% confidence interval: 1.002–1.015; p = 0.010). The OPG level was positively associated with bilateral baPWV by Spearman’s correlation analysis (p < 0.001). Conclusions: Circulating OPG level showed an independent association with PAS and baPWV in CKD patients not yet on dialysis. Hence, OPG can be a potential marker of vascular risk in this patient population. Full article

Background/Objectives: Nutrition plays a core role in chronic disease management, and there is growing interest in the health impact of plant-based diets (PBDs) in people with overweight or obesity. We conducted this systematic review and meta-analysis to summarize the evidence on the health effect of PBDs compared to omnivorous diets in overweight or obese individuals. Methods: We searched the databases Cochrane Central Register of Controlled Trials, MEDLINE, Embase, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform from inception to 3 January 2024. Two review authors independently screened studies for eligibility, extracted data, evaluated the risk of bias, and rated the certainty of the evidence using GRADE. This study is registered with PROSPERO, CRD42021225525. We used random-effects meta-analysis to analyze data. Results: Of 2664 records identified, 10 randomized controlled trials (RCTs) and six ongoing studies met the inclusion criteria. The available evidence suggests little to no difference between plant-based and omnivorous diets for body weight, systolic blood pressure, diastolic blood pressure, serum glucose, serum insulin, insulin sensitivity, total cholesterol, triglyceride, HDL cholesterol and body fat mass. Plant-based diets may slightly reduce LDL cholesterol. They may also reduce BMI and HbA1c, although the certainty of the evidence is very low. Longer-duration dietary interventions (14 weeks or more) showed greater improvements in BMI, LDL cholesterol and HbA1c. Conclusions: Plant-based diets may represent a dietary option for people with overweight or obesity and may support modest improvements in selected cardiometabolic outcomes, although the available evidence is limited and uncertain. Most outcomes showed little or no difference between PBDs and comparison diets, while the observed effects on BMI and HbA1c were supported by very low certainty evidence. Full article

Watercress (Nasturtium officinale R.Br.) is a cruciferous vegetable rich in bioactive compounds that may improve cardiovascular disease (CVD) risk factors. However, clinical evidence regarding its direct impact on CVD risk remains limited. This study evaluated the efficacy of watercress consumption on cardiovascular parameters, oxidative stress biomarkers, and estimated CVD risk in middle-aged Thai adults with low-to-moderate risk. Twenty-five participants completed the randomized, placebo-controlled pilot study. The watercress group (n = 12) consumed 16 dried watercress capsules daily for four weeks, while the placebo group (n = 13) received a placebo. Physical examinations, arterial stiffness, lipid profiles, and biochemical biomarkers were analyzed at baseline and the end of treatment. The 10-year CVD risk was estimated using the Framingham equation. Following the intervention, the watercress group showed significant reductions in both systolic and diastolic blood pressure compared to the placebo group. Within the watercress group, significant improvements from baseline to post-intervention were observed in oxidized LDL, antioxidant capacity (ABTS), and estimated 10-year CVD risk score. However, these three parameters did not reach statistical significance when compared to the placebo group. In conclusion, daily watercress consumption significantly lowers blood pressure and demonstrates a potential dietary option for supporting cardiovascular health. Nevertheless, larger and longer-term clinical trials remain necessary. Full article

Transcatheter edge-to-edge repair (TEER) is a recent minimally invasive method of managing mitral regurgitation (MR) in dogs with myxomatous mitral valve disease (MMVD). As the goal of intervention is to minimize MR severity, this study aimed to determine the association between reduced MR and changes in myocardial work indices after TEER in dogs. Ten client-owned dogs with moderate-to-severe MR were enrolled in the study, and all underwent TEER with multimodal imaging guidance. Myocardial work was analyzed before and after the procedure, and the MR severity, transmitral pressure gradients, left atrial and ventricular measurements, and index of myocardial work (GWI: the total myocardial work during systole; GCW: work contributing to LV ejection; GWW: ineffective work that contributes to no forward displacement; and GWE: ratio of constructive work to total work) were calculated. TEER significantly reduced MR severity in the majority of dogs, and this MR decrease was associated with a greater efficiency of myocardial work, more constructive work, and less wasted energy. No significant negative associations of moderate post-procedure gradients with short-term clinical outcomes emerged. TEER-mediated reduction in MR improves myocardial function in dogs. However, long-term studies are also needed to examine the effects of residual MR and transmitral gradients on cardiac function and clinical outcome. Full article

Background: Continuous-flow left ventricular assist devices (LVADs) generate non-pulsatile circulation, rendering conventional oscillometric blood pressure measurements unreliable. Accurate monitoring is critical to prevent complications including stroke, pump thrombosis, and aortic regurgitation. Doppler-based measurement is widely used as a non-invasive alternative, yet its accuracy relative to invasive arterial pressure remains insufficiently characterized. Methods: In this prospective single-centre study, 32 adult continuous-flow LVAD patients underwent simultaneous invasive radial artery and Doppler blood pressure measurements twice daily over three consecutive days (192 paired readings; Day 3: n = 27 due to technical recording issues). Pulsatility was assessed by means of peripheral pulse palpation and transthoracic echocardiography. Spearman’s rho, Wilcoxon signed-rank test, and Bland–Altman analysis were applied. Results: Median invasive MAP was 73.0 [IQR 66–80] mmHg and median Doppler pressure was 75.0 [IQR 70–80] mmHg. Doppler measurements demonstrated strong-to-excellent correlation with invasive MAP across all time points (r = 0.78–0.91, p < 0.001), with no significant paired differences (all p > 0.05). Bland–Altman analysis revealed a bias of −0.35 mmHg with limits of agreement of −9.10 to +8.40 mmHg, within the accepted ±10 mmHg threshold. Correlation with systolic pressure was lower (r = 0.66–0.89, p < 0.001), with a positive bias of +13.47 mmHg and wide limits of agreement (+1.28 to +25.67 mmHg), indicating clinically unacceptable agreement. Conclusions: Doppler-derived blood pressure may provide a reliable estimate of invasive MAP in continuous-flow LVAD patients, whereas its utility for systolic pressure estimation appears limited. Doppler measurement represents a practical, non-invasive tool for routine MAP monitoring in both inpatient and outpatient settings. Full article

Background: The impact of overweight and obesity on blood pressure and cardiac remodelling in pediatric congenital heart disease (CHD) remains incompletely defined, particularly across different ventricular physiologies and cardiac anatomies. Aim: To assess the association of overweight and obesity with arterial blood pressure and cardiac remodelling in pediatric and young adult patients with CHD, according to ventricular physiology and cardiac anatomy. Methods: In this observational study, pediatric CHD patients undergoing clinical and echocardiographic evaluation were classified by weight status and ventricular physiology, with additional stratification by cardiac anatomy. Associations between body mass index (BMI), arterial hypertension, and echocardiographic parameters were analyzed. Results: A total of 451 patients were included (mean age 13.1 ± 3.9 years; 74 univentricular, 377 biventricular). Overall, 16% were overweight and 7% obese. Hypertension was present in 16% and increased across BMI categories (14%, 26%, and 50%). BMI was associated with blood pressure category (p < 0.001), higher systolic blood pressure (p < 0.001), and increased left ventricular (LV) mass (p = 0.007), interventricular septal thickness (p < 0.001), and posterior wall thickness (p < 0.001), without evidence of systolic dysfunction. In adjusted models, overweight/obesity remained associated with worse blood pressure classification, both as a three-category outcome (OR 2.1, 95% CI 1.4–3.2; p < 0.001) and as a binary outcome (OR 2.3, 95% CI 1.5–3.7; p < 0.001), as well as with higher systolic blood pressure (β = 5.1 mmHg, 95% CI 2.4–7.8; p < 0.001), left ventricular mass index (LVMI) (β = 10.0, 95% CI 4.3–15.8; p < 0.001), interventricular septal thickness at end-diastole (IVSd) (p < 0.001), and left ventricular posterior wall in diastole (LVPWd) (p < 0.001), but not with diastolic blood pressure or systolic function. No significant associations were observed in univentricular patients, whereas in biventricular circulation higher BMI was consistently associated with worse blood pressure and remodeling, without systolic dysfunction. Conclusions: Excess body weight is independently associated with adverse blood pressure status and early LV structural remodelling in pediatric and young adult patients with CHD, despite preserved systolic function. These findings support early cardiovascular risk surveillance and preventive strategies targeting overweight and obesity in CHD care. Full article