Naji Kholaif

Background: Obesity and unhealthy dietary habits are among the leading modifiable determinants of cardiovascular disease, acting through biological mechanisms that extend far beyond excess body weight. Adipose tissue dysfunction, chronic low-grade inflammation, oxidative stress, endothelial impairment, mitochondrial dysfunction, and gut microbiota dysbiosis contribute to the development and progression of cardiometabolic disease. Consequently, nutrition should be regarded as a key biological modulator of cardiovascular risk, capable of influencing multiple interconnected metabolic and molecular pathways. Methods: This narrative review provides a critical and translational overview of the current evidence linking diet, obesity, and cardiovascular disease. We critically evaluated epidemiological studies, landmark randomized controlled trials, prospective cohort studies, meta-analyses, international guidelines, and relevant mechanistic investigations to examine the impact of major dietary patterns, obesity-related immunometabolic alterations, and emerging precision nutrition strategies on cardiovascular prevention and management. Results: Among currently available dietary models, the Mediterranean diet has one of the most extensive randomized evidence bases for cardiovascular prevention, including trials demonstrating reductions in major adverse cardiovascular events and other clinically relevant cardiovascular outcomes. Other healthy dietary patterns, including the Dietary Approaches to Stop Hypertension (DASH), healthy plant-based, and Nordic diets, consistently improve intermediate cardiometabolic outcomes, although evidence for hard cardiovascular endpoints is less robust. Conversely, Western dietary patterns characterized by high consumption of ultra-processed foods are associated with visceral adiposity, insulin resistance, vascular inflammation, mitochondrial dysfunction, endothelial injury, and increased cardiovascular risk. Conclusions: Contemporary evidence supports nutrition as a cornerstone of cardiovascular prevention and obesity management, with benefits may extend beyond weight reduction through modulation of key biological pathways involved in cardiometabolic disease.

Patients with prior acute myocardial infarction (AMI) generally show low rates of achieving secondary prevention targets. Here we evaluated adherence to guideline-recommended secondary prevention strategies after AMI in Saudi Arabia. This ambispective multicenter cohort study included consecutive patients seen for follow-up visits 6–24 months after hospitalization for AMI. A standardized questionnaire was used to evaluate control of blood pressure (2), physical activity targets, smoking habits, guideline-directed medical therapy (GDMT), and referral to cardiac rehabilitation. Among 108 AMI patients (mean age 58.4 ± 10.9 years; 80.6% male; 76.9% Saudi nationals), 53.7% had uncontrolled blood pressure, ~40% uncontrolled glucose, and 67% above-target LDL-C levels. Most participants were overweight (40.7%) or obese (37%), and 28.7% achieved the physical activity targets. One-third of patients were not receiving all GDMT, 15.7% were current smokers, and 25% had been referred to cardiac rehabilitation. No patient met all guideline-recommended secondary prevention targets. This pilot study highlights gaps in secondary prevention among AMI survivors. Upcoming study phases will aim for national representation and help identify key clinical and demographic drivers to improve secondary prevention efforts across Saudi Arabia.

We report the incidence, patient characteristic with clinical outcomes in patients with homozygous familial hypercholesterolemia (HoFH) in Saudi Arabia. This is a retrospective and prospective, single center study which included 37 patients 14 years and older enrolled and followed up between 2018-2021 for three years. 46% were females, 78% were offspring of consanguineous marriage. LDLR mutation was in 78% and LDL-C/LDLRAP in 3% of patients. Mean LDL-C at the first presentation was 14.2±3.7 mmol/L, average Dutch lipid score was 20.9±6.24. LDL apheresis was performed on 70% of patients. Most patients were on ezetimibe (92%), high-dose statins ( 84%) and PCSK9 inhibitors (32%). 48.6% had aortic stenosis, out of which 30% had severe aortic stenosis. Ten underwent aortic valve surgery (5 mechanical valve, 3 Ross procedure, 1 aortic valve repair, 1 bioprosthetic valve) and one had transcatheter aortic valve implantation (TAVI). Coronary artery bypass surgery (CABG) was performed on 32% and percutaneous intervention (PCI) on 11% of patients. HoFH patients have complex diseases with high morbidity and mortality, and benefit from a highly specialized multidisciplinary clinic to address their clinical needs. Although there are several therapeutic agents on the horizon, early diagnosis, and treatment of HoFH remain critical to optimize patient outcomes.