Sarah Zaman

Background: To the best of our knowledge, no previous systematic review has comprehensively quantified cancer prevalence across the broad spectrum of cardiovascular and cardiometabolic conditions included in the present study. We aimed to estimate pooled prevalence of active cancer (primary outcome) and other cancer categories among patients with coronary artery disease (CAD), heart failure (HF), atrial fibrillation (AF), hypertension, Type 2 diabetes mellitus (DM), stroke, peripheral artery disease (PAD), and valvular heart disease (VHD). Methods: PubMed, Web of Science, and Scopus were searched from 2010 to July 2024. Secondary outcomes included prevalence of any, previous, haematological, solid, and metastatic cancer. Prevalence estimates were calculated using one‐step generalized linear mixed models. Results: A total of 676 studies comprising approximately 180 million participants were included. The primary analysis of active cancer included 59 studies (4,759,695 patients). Active cancer prevalence ranged from 4.22% (95% confidence interval [CI] 2.18–5.32) in Type 2 DM to 5.55% (95% CI 3.97–7.01) in AF. The prevalence of any cancer, a secondary outcome with more heterogeneous ascertainment, ranged from 7.04% (95% CI 6.05–8.03) in CAD to 14.10% (95% CI 12.20–15.99) in AF. Conclusion: Cancer represents a substantial comorbidity across cardiovascular and cardiometabolic conditions. Although cancer ascertainment methods varied across studies, particularly for any cancer, the findings provide contemporary estimates of cancer burden that may inform future cardio‐oncology research, healthcare planning, risk stratification, and the design of cardiovascular and cardiometabolic clinical trials. Trial Registration: PROSPERO CRD42023494764

Introduction: Cardiovascular disease is a leading cause of death worldwide, of which coronary artery disease is the most common form. Sudden cardiac death (SCD) is a serious complication following acute myocardial infarction (MI), accounting for the highest percentage of all deaths in this population. Currently implantable cardioverter-defibrillators (ICDs) provide an acceptable method of primary prevention of SCD. However, the current literature is heterogeneous with regard to studies evaluating the benefits of ICDs for the primary prevention of SCD after MI, particularly relating to the timing of ICD implantation, risk stratification of patients for ICD implant selection and reporting non-rhythmic deaths after ICD implantation. Methods and analysis: A meta-analysis will be performed to estimate the pooled effect size of randomised controlled trials (RCTs) examining the relationship between prophylactic transvenous ICD (TV-ICD) implantation and other medical therapies for primary prevention of SCD after MI. A comprehensive literature search and review will be performed using electronic medical databases including Scopus, Ovid MEDLINE, EMBASE (Ovid Platform), Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, ProQuest (Health and Medicine) and CINAHL (EBSCO) from January 1980 to June 2025. The literature search will be limited to peer-reviewed original studies carried out in human subjects and published in English. Type of study design will be limited to RCTs. The systematic review and meta-analysis will be developed according to the Joanna Briggs Institute Manual for Evidence Synthesis (2024 edition) and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines. Data analysis will be performed according to a structured and predetermined analysis plan. The primary outcome of the study will be all-cause-mortality, for which Hazard Ratios (HRs) will be reported as a measure of effect with 95% CI. Based on data availability, subgroup analysis will be carried out. The effect sizes will be reported based on a random effects model. Expected study outcomes and dissemination: This systematic review and meta-analysis will evaluate and provide primary evidence for the effectiveness of prophylactic implantation of TV-ICDs on all-cause mortality in patients who experienced MI, aiming for primary prevention of SCD after MI. The primary prevention of SCD after MI is an important goal to reduce community incidence of out-of-hospital cardiac arrests, improving patient survival rates and their quality of life after MI. Out-of-hospital cardiac arrests currently have a survival rate of less than 10% and could result in long-lasting neurological damage in those who survive. PROSPERO registration: CRD42023456995.

Background: No systematic review has been conducted to pool the existing evidence and quantify cancer prevalence rates in cardiovascular diseases (CVDs). We aimed to estimate pooled cancer prevalence in coronary artery disease (CAD), heart failure (HF), atrial fibrillation (AF), hypertension, type 2 diabetes mellitus (DM), stroke, peripheral arterial disease (PAD), and valvular heart diseases (VHD). Methods: PubMed, Web of Science, and Scopus were searched from 2010 to July 2024. The outcomes were proportions of patients with active, any, previous, blood, solid, and metastatic cancer. The prevalence rates were estimated via one-step generalized linear mixed models. Results: Totally, we retrieved 676 studies with enrollment of roughly 180 million participants. The analysis for active cancer included 59 studies with a population of 4,759,695 patients. The pooled prevalence of active cancer was 4.22% (95% confidence interval (CI) 2.18-5.32), 4.43% (95% CI 2.78-6.38), 4.60% (95% CI 1.72-8.13), 4.61% (95% CI, 2.83-6.97), 4.90% (95% CI 3.84-6.37), and 5.55% (95% CI 3.97-7.01) in patients with type 2 DM, chronic HF, any stroke, CAD, VHD, and AF. For any cancer, prevalence rates ranged from 14.10% (95% CI 12.20-15.99) in AF to 7.04% (95% CI 6.05-8.03) in CAD. Conclusion: Pooled prevalence rates demonstrate a measurable burden of cancer among patients with a wide range of CVDs, highlighting the need for multidisciplinary management in this population. Registration: PROSPERO CRD42023494764

Background: Evidence supporting dietary interventions for heart failure (HF) prevention remains limited. The Dietary Approaches to Stop Hypertension (DASH) diet has been proposed as a cardioprotective dietary pattern, but population-level evidence linking DASH adherence to HF risk is sparse. Aim: To examine the association between adherence to the DASH diet—characterised by high intake of vegetables, fruits and whole grains, and lower consumption of sodium and red and processed meat—with combined risk of HF incidence and death due to HF, as well as its risk factors, namely hypertension and type 2 diabetes mellitus (T2DM). Methods: A prospective cohort analysis was conducted using UK Biobank participants free of HF at baseline (2006–2010), with follow-up to 2024. Dietary intake was assessed using ≥2 instances of 24-hour recall. DASH scores were derived and categorised into quintiles. Fine-Gray competing risks Cox models estimated adjusted HRs (aHRs) and 95% CIs for a primary composite outcome of incident HF or HF-related death, adjusting for sociodemographic factors, deprivation, obesity, smoking, hypertension and T2DM and accounting for all-cause mortality. Secondary outcomes were incident hypertension and T2DM. Results: Among 124 777 participants (mean age 56.1±7.8 years; 56% female; 7% with diabetes; 36% with hypertension), followed for a mean of 12 years, 2931 HF events and 441 HF-related deaths occurred. Compared with the lowest DASH adherence quintile, the highest quintile had a lower risk of HF after adjustment for sociodemographic factors (aHR 0.79, 95% CI 0.70 to 0.89, p<0.001) and comorbidities (aHR 0.89, 95% CI 0.79 to 1.00, p<0.05). Greater DASH adherence was associated with reduced risk of hypertension (aHR 0.91, 95% CI 0.86 to 0.96, p<0.001) and T2DM (aHR 0.82, 95% CI 0.75 to 0.90, p<0.001). Conclusions: Greater adherence to the DASH diet was associated with lower combined risk of HF and death due to HF, as well as hypertension and T2DM, supporting the role of a DASH diet in HF prevention.

Background: Dietary interventions in heart failure (HF) remain limited, with current guidance focused largely on sodium restriction. Ketone metabolism has emerged as a potential therapeutic target in HF, with ketone supplementation shown to improve cardiac function. However, there are currently no studies investigating factors affecting adherence to a ketogenic diet (KD) in HF. Aim: To explore the factors influencing adherence to a KD in patients with HF to inform future dietary interventions. Method: This qualitative study was embedded within the KETO-HF pilot randomised controlled trial, in which participants with HF with reduced ejection fraction undertook a 4-month KD. Consenting participants were invited to complete semi-structured interviews. Interviews were audio-recorded, deidentified and transcribed verbatim. Data were analysed using thematic analysis with a mixed inductive–deductive strategy. Results: Fifteen participants were interviewed. Facilitators of adherence were: (1) personal motivation and self-regulation; (2) improved well-being; (3) interpersonal support and; (4) adaptive strategies and improved nutritional literacy. Barriers included: (1) early-phase physiological and psychological challenges; (2) social and cultural friction; (3) competing family and work demands and; (4) limited availability of suitable foods, particularly difficulty managing social situations and dining out. Conclusions: Adherence to a KD in people with HF is shaped by a combination of individual and social factors. These findings highlight the need for improved education, support, and increased food options to optimise implementation of dietary ketosis in HF.

Background and Objectives: There is limited evidence supporting the incorporation of dietary patterns into heart failure (HF) management. The Dietary Approaches to Stop Hypertension (DASH) diet is linked to cardiovascular disease prevention, but evidence correlating DASH adherence to HF risk is sparse. This study is the first prospective investigation into the relationship between the DASH diet, incident HF and its associated risk factors—hypertension and diabetes mellitus (DM)—in Australian women. Materials and Methods: Survey data (2001–2022) from the Australian Longitudinal Study on Women’s Health (ALSWH) was analysed, where DASH diet scores were calculated from food frequency questionnaire (FFQ) responses and categorised into quintiles. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between DASH adherence and incident HF. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% CIs for secondary endpoints, hypertension and DM, and dietary exposure was modelled as a time-varying covariate. Results: 10 594 women (mean age 52.5 ± 1.45 years) participated and, at 21-year follow-up, there were 136 (1.3%) cases of HF, 2182 (20.6%) and 994 (5.7%) cases of hypertension and DM, respectively. After adjustment for covariates (including age and socioeconomic factors), no association was found between the highest DASH quintile and incident HF [OR 0.73, 95% CI: 0.37–1.43; p = 0.20]. However, adjusted HRs for hypertension and DM—0.73 (95% CI: 0.63–0.84; p < 0.001) and 0.65 (95% CI: 0.53–0.81; p < 0.001), respectively—indicated significant associations. Conclusions: In Australian women, DASH diet adherence was associated with a significantly lower risk of hypertension and DM, both of which are HF risk factors. The finding of no direct statistically significant association between the DASH diet and incident HF might reflect the small incidence of HF in our cohort.