Eidan Alrasheid

Background: Premature atherosclerotic cardiovascular disease (ASCVD) represents a growing clinical and public health concern, particularly in regions with a high burden of modifiable risk factors. Whether premature ASCVD reflects a distinct pathophysiological entity or an earlier manifestation of shared risk exposures remains incompletely understood. This study aimed to characterize the clinical profile of premature ASCVD and to examine its relationship with conventional cardiovascular risk factors within a Middle Eastern cohort. Methods: This pooled observational analysis included 2763 adults with established ASCVD derived from multiple cardiovascular registries and a prospective cohort. Premature ASCVD was defined using sex-specific age thresholds (<55 years in men and <65 years in women). Multivariable logistic regression analyses, including sex-stratified models, were performed to evaluate associations between premature presentation and cardiovascular risk factors, including smoking, family history, lipid parameters, and cardiometabolic comorbidities. Results: Among 2763 participants in the pooled clinical cohort, 1335 (48.3%) met the study definition of premature ASCVD. Compared with later-onset disease, premature ASCVD was strongly associated with current smoking, family history of premature cardiovascular disease, and a more atherogenic lipid profile, including higher levels of low-density lipoprotein cholesterol, triglycerides, and non-high-density lipoprotein cholesterol. In contrast, later-onset ASCVD was characterized by a higher prevalence of hypertension and diabetes mellitus. These patterns were consistent across sex-stratified analyses. Despite high rates of secondary prevention therapy use, a substantial residual atherogenic burden was observed among patients with premature ASCVD. Conclusions: In this predominantly coronary cohort, the findings suggest that premature and later-onset ASCVD occur within a broadly overlapping risk-factor landscape, but that the relative distribution of these factors differs according to age at first clinical presentation. The greater prevalence of smoking, family history, and atherogenic lipid abnormalities among younger patients may reflect earlier or greater exposure to these factors, whereas the greater burden of hypertension, diabetes mellitus, and other chronic comorbidities among older patients is consistent with their progressive accumulation with age. These cross-sectional associations should not be interpreted as demonstrating distinct causal mechanisms or age-independent risk profiles.

Aim: This study examined cross-sectional associations between sociodemographic, clinical, behavioral, knowledge-based, and psychological factors and three behavioral scales of heart failure (HF) self-care: Maintenance, Symptom Perception, and Management. Self-Care Confidence was examined as a separate 10-item outcome. Methods: This cross-sectional study recruited 516 consecutive adults with confirmed HF at two tertiary-care HF clinics in northern Jordan between May and November 2025. Self-care was assessed using the SCHFI v7.2, HF knowledge using the AHFKT, and anxiety and depression using the HADS. Separate multivariable ordinary least-squares regression models estimated adjusted associations with Maintenance, Symptom Perception, Management, and Confidence. Association-rule mining was used to identify descriptive co-occurrence profiles. Results: Median SCHFI scores were 50.00 for Maintenance, 43.48 for Symptom Perception, and 51.52 for Management. All four regression models included 516 participants and showed limited explanatory performance (adjusted R² = 0.076–0.127). Each 10-percentage-point increase in the AHFKT percentage-correct score was associated with higher Maintenance (unstandardized coefficient B = 2.02, 95% CI 0.50–3.54), Symptom Perception (B = 2.26, 95% CI 0.78–3.73), and Management (B = 3.81, 95% CI 2.32–5.30). HADS depression was inversely associated with Maintenance (B = −0.94, 95% CI −1.57 to −0.31), Symptom Perception (B = −1.47, 95% CI −2.10 to −0.83), and Management (B = −1.09, 95% CI −1.70 to −0.48). HADS anxiety was positively associated with Symptom Perception (B = 1.37, 95% CI 0.74–2.00) and Management (B = 0.92, 95% CI 0.33–1.51). Elementary and secondary education were associated with lower Maintenance scores. Current smoking (B = −6.69, 95% CI −10.78 to −2.60) and no prior HF admission (B = −4.32, 95% CI −8.21 to −0.42) were separately associated with lower Symptom Perception. Association-rule mining retained 10 exploratory co-occurrence profiles; the highest-lift profile involved male sex, sleeping difficulty, and an HF knowledge score from 50% to <60% for Management scores < 70 (50/51 participants; confidence = 98.0%; lift = 1.25). For the separate Confidence outcome, no profiles met the same final criteria. Conclusions: Most participants had scores below 70 across the three behavioral scales. Higher HF knowledge was associated with higher scores across self-care maintenance, symptom perception, and self-care management, and higher HADS depression was associated with lower self-care confidence, whereas HADS anxiety was positively associated with self-care confidence; education, smoking, and prior HF admission showed further scale-specific cross-sectional associations.

Background: Heart failure (HF) substantially affects health-related quality of life (HRQoL), but evidence across left ventricular ejection fraction (LVEF) categories in Jordan remains limited. Methods: This multicenter cross-sectional study included 516 adults with HF attending outpatient cardiac clinics in northern Jordan between May and November 2025. SF-36 Version 1.0 items were recoded to eight 0–100 domains, and unweighted SF-36 physical and mental four-domain composite scores were analyzed using expanded multivariable ordinary least-squares models with HC3 robust standard errors. A total of 476 participants had complete data for all model variables. Results: The mean SF-36 physical and mental four-domain composite scores were 48.80 (SD 21.14) and 51.88 (SD 20.57), respectively. Both scores differed across EF categories before adjustment (physical p < 0.001; mental p < 0.001), but the adjusted EF omnibus tests were not significant (physical p = 0.111; mental p = 0.613). Lower physical scores were associated with NYHA class II and III, physical inactivity, sleeping difficulty, retirement, and higher anxiety and depression scores, whereas self-care efficacy was positively associated with physical HRQoL. Lower mental scores were associated with NYHA class II and III, physical inactivity, and higher anxiety and depression scores, while self-care efficacy was positively associated with mental HRQoL. Conclusions: In this cross-sectional sample, functional limitation, anxiety and depressive symptoms, physical inactivity, and self-care efficacy were more consistently associated with HRQoL than EF category after adjustment. These findings support multidimensional assessment alongside cardiac measures.