Asma Malwi Alshahrani

Cardiovascular disease (CVD) remains a major global cause of morbidity and mortality, with substantial interindividual variation in disease risk, treatment response, and susceptibility to adverse effects. Precision cardiovascular medicine incorporates patient-level information to refine cardiovascular prevention, diagnosis, risk stratification, and treatment. This structured narrative review is based on a structured literature search, with 213 publications included in the synthesis. This review synthesizes evidence on four complementary domains: pharmacogenomics, biomarkers, artificial intelligence (AI), and real-world evidence (RWE), and examines their potential integration in cardiovascular care. Pharmacogenomics has established applications in selected gene–drug pairs, including CYP2C19–clopidogrel, CYP2C9/VKORC1–warfarin, and SLCO1B1–statin-associated muscle toxicity, although implementation varies according to evidence, accessibility, and clinical infrastructure. Biomarker research extends beyond cardiac troponins to markers of myocardial stress, fibrosis, inflammation, and molecular regulation, including soluble ST2, galectin-3, GDF-15, and microRNAs. AI and machine learning provide approaches for analyzing multimodal cardiovascular data and have been investigated for risk assessment, phenotyping, imaging, ECG analysis, and clinical decision support. RWE complements randomized evidence by providing information on treatment utilization, safety, effectiveness, and outcomes in routine-care populations, while challenges include data quality, confounding, and incomplete ascertainment. Across coronary artery disease, heart failure, atrial fibrillation, hypertension, dyslipidemia, and inherited cardiovascular diseases, increasing opportunities exist to integrate these domains. However, clinical translation remains influenced by validation, interpretability, generalizability, cost, regulation, data governance, and health equity. Future research should emphasize prospective evaluation, diverse-population validation, interoperable infrastructure, and assessment of clinical utility to support the responsible integration of precision approaches into cardiovascular care.

Mental health disorders such as depression, anxiety, and stress are prevalent in the general population, with various socio-demographic factors potentially influencing their prevalence. This study aimed to assess the prevalence of Depression, Anxiety, and Stress Scale – 21 Items and identify associated risk factors within the general population in Asir, Saudi Arabia. This cross-sectional study, conducted from April 27, 2025, to September 28, 2025, assessed depression, anxiety, and stress using the Depression, Anxiety, and Stress Scale – 21 Items and identified risk factors in the Asir region of Saudi Arabia. Data from 392 participants were collected through an anonymous online survey and analyzed using descriptive statistics and logistic regression. The study included 392 participants, with 55.1% females and 44.9% males. The largest age group was 18 to 30 years (27.3%). Most participants were nonsmokers (84.2%), 46.7% were employed, and 52% had graduate-level education. A majority were married (61.5%), and 32.9% earned P = .011) and those with 3 to 5 children (OR = 2.232, P = .060). Anxiety was higher in divorced/widowed individuals (OR = 3.828, P = .016) and the unemployed (OR = 2.033, P = .017). Stress was more prevalent in single (OR = 6.304, P = .007) and divorced/widowed individuals (OR = 2.994, P = .094), and those with 3 to 5 children (OR = 3.417, P = .030). Females had lower odds of anxiety (OR = 0.543, P = .021). Age, education, smoking, and income showed limited or nonsignificant associations with mental health outcomes. The study found high levels of depression, anxiety, and stress, with unemployment, being single or divorced, and having more children as significant risk factors. These findings highlight the need for targeted mental health interventions, accessible services, stigma reduction, and preventive strategies addressing social and economic influences on mental well-being.

A cornerstone of treatment for chronic obstructive pulmonary disease (COPD) is inhalation therapy. However, incorrect use of inhalers can increase the risk of exacerbations. Adherence to inhaled medications and patient satisfaction are interrelated and play critical roles in achieving optimal symptom control. This study aimed to evaluate patient satisfaction with and adherence to inhalers among individuals with COPD. A prospective single-center observational study was conducted in a South Indian hospital, assessing inhaler adherence using the Test of Adherence to Inhalers and patient satisfaction using the Feeling of Satisfaction with Inhaler (FSI-10) questionnaire. A logistic regression model was used to identify factors associated with high inhaler satisfaction. Among 377 COPD patients (mean age = 61.8 ± 10.7 years), 57.3% reported high inhaler satisfaction (FSI-10 ≥ 43), which was associated with older age, male sex, longer disease duration, fewer current smokers, comorbidities, milder disease (global initiative for chronic obstructive lung disease I–II), dry powder inhaler use, single-inhaler therapy, long-acting beta ₂ -agonist/long-acting muscarinic antagonist regimens, and fewer exacerbations (all P < .05). Good adherence (Test of Adherence to Inhalers [10-item questionnaire] = 50) was observed in 32.9%, associated with adequate inhaler knowledge, absence of forgetfulness or fear, single-inhaler use, and higher satisfaction (all P < .001). In multivariable analyses, high satisfaction was independently associated with age >60 years (Adjusted Odds Ratio [aOR] = 3.84; confidence interval [CI] = 2.12–6.97), comorbidities (aOR = 1.67; CI = 1.04–2.68), whereas multiple inhaler use (aOR = 0.62; 95% CI = 0.39–0.99) and global initiative for chronic obstructive lung disease III to IV (GOLD III to IV) (aOR = 0.48; 95% CI = 0.29–0.79) were associated with lower satisfaction.. Good adherence was independently associated with higher education (aOR = 3.12; CI = 1.94–5.02), inadequate inhaler knowledge (Adjusted aOR = 0.31; CI = 0.14–0.69), and higher FSI-10 scores (aOR per unit = 1.18; CI = 1.11–1.26). Satisfaction and adherence were moderately correlated (r = 0.46; P < .001). This study found that high inhaler satisfaction was common among patients with COPD, whereas full adherence was less frequent. Satisfaction and adherence were associated with age, disease severity, inhaler regimen complexity, education, and inhaler knowledge. The moderate positive correlation between satisfaction and adherence suggests a potential relationship that warrants further investigation in longitudinal or interventional studies.

Type 2 diabetes mellitus (T2DM) has been linked to several types of cancer, including breast cancer. Glycated hemoglobin (HbA1c) serves as an indicator of long-term blood sugar control, and elevated levels may contribute to the development of breast cancer. This study aims to evaluate the association between elevated HbA1c levels and breast cancer risk in women with T2DM attending a tertiary care hospital in South India, and to compare HbA1c levels between diabetic women with and without breast cancer. A retrospective case-control study was conducted at Kovai Medical Center from 2014 to 2016 among women with T2DM. Breast cancer was histopathologically confirmed. Data on HbA1c (P < .05. The study included 182 women with T2DM and breast cancer and 197 age-matched controls without breast cancer. Poor glycemic control (HbA1c ≥ 7.0%) was more prevalent among cases and significantly associated with breast cancer in multivariable logistic regression adjusting for age, body mass index, menopausal status, diabetes duration, and insulin use (adjusted OR = 2.98, 95% CI: 1.08–8.21, P < .0001). Additional risk factors included postmenopausal status (OR = 4.52, 95% CI: 1.36–15.00), age 50 to 59 years (OR = 8.30, 95% CI: 2.80–19.32), and insulin use (OR = 2.57, 95% CI: 1.04–3.21). Most cases were estrogen receptor and progesterone receptor negative, with 63% diagnosed at stage I. Advanced stages (II/III), triple-negative breast cancer (OR = 2.78, 95% CI: 1.05–3.65), and higher Ki-67 index (intermediate: OR = 1.91, high: OR = 3.00) were linked to more aggressive disease. In this retrospective case-control study, higher HbA1c levels (≥7.0%) were associated with breast cancer presence and more advanced tumor stages among women with T2DM, although the odds ratio for HbA1c should be interpreted cautiously. Postmenopausal status and insulin use were more common among cases, while metformin use showed a nonsignificant inverse trend. triple-negative breast cancer status and higher Ki-67 index were also more frequent in advanced disease.

Clinical pharmacists play a critical role in cardiology by optimizing pharmacotherapy and improving patient outcomes. However, despite their growing importance, standardized quality indicators to evaluate their impact in clinical practice remain lacking. This study aimed to develop and validate a set of cardiology-specific Quality Indicator Drug Therapy Problems (QI-DTPs) defined as medication-related quality indicators focused on identifying, preventing, and resolving drug therapy problems—using a modified Delphi technique in Saudi Arabia. Twenty-three candidate QI-DTPs were developed based on a comprehensive review of current cardiology guidelines and evidence-based literature, refined by an expert advisory group. A panel of sixteen experienced clinical pharmacists with cardiology expertise from Saudi Arabia evaluated these indicators using a modified Delphi approach conducted over three iterative rounds. Each indicator was rated on a nine-point Likert scale (1 = strong disagreement to 9 = strong agreement). Indicators achieving ≥75% consensus were considered validated. Sixteen expert clinical pharmacists participated (69% male, 31% female), most of whom had completed a pharmacy residency and had cardiology-related clinical experience. High levels of agreement were achieved across the Delphi rounds, and all 23 proposed QI-DTPs met the predefined ≥75% consensus threshold, demonstrating strong agreement regarding their relevance, clarity, and applicability in cardiology practice. The study successfully identified and validated 23 QI-DTPs, reflecting strong consensus among clinical pharmacists in Saudi Arabia. Implementation of these indicators in clinical practice could enhance the quality of cardiovascular care, reinforce pharmacist-led interventions, and promote medication safety. Future research should assess the direct impact of these quality metrics on patient outcomes.

Cardiovascular disease (CVD) is increasingly recognized as a significant comorbidity in people living with HIV (PWH), contributing to increased morbidity and mortality. Epidemiological studies indicate that PWH have a 1.2–2-fold higher risk of myocardial infarction (MI) and other CVD events compared to HIV-negative individuals. While the mechanisms underlying HIV-associated CVD are not fully understood, they are likely to include a combination of cardiovascular-related adverse effects of HIV medications, vascular dysfunction caused by HIV-induced monocyte activation, and cytokine secretion, in addition to existing comorbidities and lifestyle choices. This comprehensive review examines the complex relationship between HIV infection and CVD, highlighting key pathophysiological mechanisms such as chronic immune activation, inflammation, endothelial dysfunction, and the role of antiretroviral therapy (ART) in promoting cardiovascular risk. Alongside conventional risk factors such as smoking, hypertension, and dyslipidemia, HIV-specific elements, especially metabolic abnormalities associated with ART, significantly contribute to the development of CVD. Prevention strategies are crucial, focusing on the early identification and management of cardiovascular risk factors as well as optimizing ART regimens to minimize adverse metabolic effects. Clinical guidelines now recommend routine cardiovascular risk assessment in PWH, emphasizing aggressive management tailored to their unique health profiles. However, challenges exist in fully understanding the cardiovascular outcomes in this population. Future research directions include exploring the role of inflammation-modulating therapies and refining sustainable prevention strategies to mitigate the growing burden of CVD in PWH.

Background: Prostate cancer (PCa) is one of the most common malignancies among men in Saudi Arabia and contributes significantly to cancer-related morbidity and mortality. The objective of this survey was to evaluate community awareness and screening practices related to PCa among men in the Asir region of Saudi Arabia. Method: A cross-sectional study was conducted from 5 October to 25 December 2024 among men aged 40 and above in the Asir region, excluding those with a prior PCa diagnosis. Using convenience sampling, 399 participants were recruited via social media and community outreach. Data were collected through a self-administered online questionnaire covering demographics, medical history, PCa knowledge, information sources, prevention, screening awareness, and barriers. Informed consent was obtained from all participants. Results: The study comprised 399 male participants, with 37.09% aged 40–50, 36.34% aged 51–60, and 26.56% over 60. Most participants (363; 90.97%) were married, 245 (61.4%) had a university education, 282 (70.67%) lived in urban areas, and 180 (45.11%) were employed. Over half of the participants, 222 (55.63%), had a personal history of prostate problems. Additionally, 272 (68.17%) had health insurance, and 153 (38.34%) reported a monthly income between 10,000 and 14,999 SAR. The study found that 329 (82.5%) participants had good knowledge of PCa but only 197 (49.4%) had good awareness of screening methods. Key predictors of good awareness of PCa screening included a personal history of prostate problems (odds ratio—OR = 4.791, p = 0.000, confidence interval—CI 2.727–8.418) and health insurance (OR = 0.359, p = 0.000, CI 0.203–0.636). Common barriers to screening were affordability, n = 116 (29.07%), and perceived good health, n = 201 (50.37%). Additionally, 154 participants (38.59%) found screening uncomfortable, while 156 (39.59%) believed the Digital Rectal Exam (DRE) was harmful or embarrassing. Significant differences in perceived barriers were found based on age (F = 11.449, p < 0.001), education (F = 2.608, p = 0.051), occupation (F = 3.668, p = 0.026), family history (F = 17.407, p < 0.001), and income (F = 5.148, p = 0.006). Conclusions: The study highlights a significant gap between general knowledge and specific awareness of prostate cancer (PCa) screening among men in the Asir region. Although 82.5% demonstrated good overall knowledge, only 49.4% were aware of screening methods, and just 44.36% had undergone PSA testing. Common barriers included perceived good health, fear of diagnosis, embarrassment, and financial concerns. However, due to the use of convenience sampling, online distribution, and geographic restriction to the Asir region, the findings may not be generalizable to the broader male population in Saudi Arabia, particularly older men and those in rural areas. Addressing these gaps requires targeted education, empowerment of healthcare providers, and coordinated public health strategies to enhance early detection and reduce the PCa burden.

Background and Objectives: Coronary artery disease (CAD) significantly impacts health-related quality of life (HRQoL), with lifestyle factors and comorbidities influencing various dimensions of well-being. This study aimed to assess HRQoL and its association with sociodemographic and lifestyle factors in CAD patients. Materials and Methods: A cross-sectional study was conducted at the Rajiv Gandhi Co-operative Multispecialty Hospital, South India, from July 2022 to April 2023, where lifestyle factors were assessed, and HRQoL was measured using the EQ-5D-3L. The differences and associations of sociodemographic and lifestyle factors with HRQoL were analyzed using the chi-square test and multivariate regression. Results: A total of 212 CAD patients were included in this study. Female gender and comorbid disease were more likely to be associated with reported problems in mobility (89.7%, 78.8%) and anxiety/depression (97.4%, 92.7%) (p < 0.05). Factors such as age ≥ 50 years, family history of CAD, current smoking, comorbid disease, and a moderate- to high-risk diet significantly influenced anxiety/depression (p < 0.05). Patients with comorbid disease and moderate- to high-risk dietary intake were significantly associated with all five dimensions (p < 0.05). Gender, educational level, alcohol intake, and sleep duration did not show a significant association with all dimensions (p > 0.05). Conclusions: This study found that CAD patients undergoing treatment for secondary prevention exhibited inadequate HRQoL, particularly in terms of mental health. Factors such as comorbid disease and moderate- to high-risk dietary intake were significantly associated with reduced HRQoL. Older age, family history of CAD, current smoking habit, comorbid disease, and a moderate- to high-risk diet were significantly associated with anxiety/depression.

Background: Hypertension significantly impacts the health-related quality of life (HRQoL) of patients. This study evaluates the influence of sociodemographic, economic, and clinical features on HRQoL among hypertensive patients using the 36-Item Short Form Survey (SF-36). Method: A cross-sectional study was conducted at a public health center in Khamis Mushayt, Saudi Arabia, where 209 adult hypertensive patients were surveyed using simple random sampling. Data were collected through a structured questionnaire covering sociodemographic and clinical details, and multiple linear regression was used to analyze the associations between variables and the SF-36 domains. Results: Of the 209 participants, 122 (58.4%) were female and 87 (41.6%) were male. Complications and multiple antihypertensive medications were linked to poorer physical functioning and general health (p < 0.05). Salt restriction improved physical functioning (B = 12.339, p = 0.008), and exercise reduced body pain (B = −8.487, p = 0.038). Middle-income patients had higher vitality (B = 7.632, p = 0.038) and social functioning (B = 16.465, p = 0.035). Higher-income individuals showed lower social functioning (B = −12.323, p = 0.022). Conclusions: Age, income, marital status, and complications were key determinants of HRQoL in hypertensive patients. Lifestyle interventions like exercise and salt restriction improve physical functioning and reduce pain, while psychological and social support are vital for mental health. Tailored interventions addressing clinical and psychosocial support are crucial for optimizing HRQoL in this population.

Natural products have been pivotal in drug discovery, offering a wealth of bioactive compounds that significantly contribute to therapeutic developments. Despite the rise of synthetic chemistry, natural products continue to play a crucial role due to their unique chemical structures and diverse biological activities. This study reviews and evaluates the potential of natural products in drug discovery and development, emphasizing the integration of traditional knowledge with modern drug discovery methodologies and addressing the associated challenges. A comprehensive literature search was conducted across PubMed/MedLine, Scopus, Web of Science, Google Scholar, and Cochrane Library, covering publications from 2000 to 2023. Inclusion criteria focused on studies related to natural products, bioactive compounds, medicinal plants, phytochemistry, and AI applications in drug discovery. Data were categorized into source, extraction methods, bioactivity assays, and technological advances. The current review underscores the historical and ongoing importance of natural products in drug discovery. Technological advancements in chromatographic and spectroscopic techniques have improved the isolation and structural elucidation of bioactive compounds. AI and machine learning have streamlined the identification and optimization of natural product leads. Challenges such as biodiversity sustainability and development complexities are discussed, alongside innovative approaches like biosynthetic engineering and metagenomics. Natural products remain a vital source of novel therapeutic agents, providing unique chemical diversity and specific biological activities. Integrating traditional knowledge with modern scientific methods is essential for maximizing the potential of natural products in drug discovery. Despite existing challenges, ongoing research and technological advancements are expected to enhance the efficiency and success of natural product-based drug development.