Aims: It is unclear whether the future risk of cardiovascular events in breast cancer (Bc) survivors is greater than in the general population. This meta-analysis quantifies the risk of cardiovascular disease development in Bc patients, compared to the risk in a general matched cancer-free population, and reports the incidence of cardiovascular events in patients with Bc. Methods and results: We searched PubMed, Scopus, and Web of Science databases (up to 23 March 2022) for observational studies and post hoc analyses of randomized controlled trials. Cardiovascular death, heart failure (HF), atrial fibrillation (AF), coronary artery disease (CAD), myocardial infarction (MI), and stroke were the individual endpoints for our meta-analysis. We pooled incidence rates (IRs) and risk in hazard ratios (HRs), using random-effects meta-analyses. Heterogeneity was reported through the I2 statistic, and publication bias was examined using funnel plots and Egger’s test in the meta-analysis of risk. One hundred and forty-two studies were identified in total, 26 (836 301 patients) relevant to the relative risk and 116 (2 111 882 patients) relevant to IRs. Compared to matched cancer-free controls, Bc patients had higher risk for cardiovascular death within 5 years of cancer diagnosis [HR = 1.09; 95% confidence interval (CI): 1.07, 1.11], HF within 10 years (HR = 1.21; 95% CI: 1.1, 1.33), and AF within 3 years (HR = 1.13; 95% CI: 1.05, 1.21). The pooled IR for cardiovascular death was 1.73 (95% CI 1.18, 2.53), 4.44 (95% CI 3.33, 5.92) for HF, 4.29 (95% CI 3.09, 5.94) for CAD, 1.98 (95% CI 1.24, 3.16) for MI, 4.33 (95% CI 2.97, 6.30) for stroke of any type, and 2.64 (95% CI 2.97, 6.30) for ischaemic stroke. Conclusion: Breast cancer exposure was associated with the increased risk for cardiovascular death, HF, and AF. The pooled incidence for cardiovascular endpoints varied depending on population characteristics and endpoint studied. Registration: CRD42022298741.

Background: Bridging the gap between laboratory discoveries and patient care relies heavily on the physician-scientist workforce, which has historically served as a cornerstone in advancing biomedical sciences. However, the past decade has witnessed a remarkable decline in the number of emerging physician-scientists, raising concerns about the future of this vital community. This study aimed to evaluate the current state of early career physician-scientists on a national scale and explore challenges that hinder its growth, thereby limiting potential scientific innovation and progress. Methods: A survey was conducted in the United States and distributed to 110 nationally representative institutions using an online platform (SurveyMonkey), targeting physician-scientists at their late stage of clinical training (residents/fellows) and graduates of training programs within the past 10 years. 265 submitted results but after filtering for incomplete responses, a total of 230 survey results were used in the analysis. The survey evaluated scientific career trajectories, challenges encountered, and top priorities. Statistical analyses, including Chi-square and Fisher’s exact tests, were used to compare differences between groups. Results: A total of 230 physician-scientists completed the survey. The respondents were predominantly assistant professors (46%), while 27% were still enrolled in career training programs. Nearly half of the participants reported considering leaving their research career within the next two years. The primary reasons cited for this included burnout and unhappiness (35%), stress (35%), and lack of funding (30%). The most frequently reported career challenges were achieving a balance between clinical and educational responsibilities (63%) and maintaining work-life balance (53%), followed by insufficient research funding (41%). Additionally, participants underscored key factors they prioritize when seeking employment, including hybrid research-clinical opportunities (67%), work-life balance (52%), and financial security (26%). Conclusion: This national survey provides an overview of the current state of early-career physician-scientists. It examines the factors contributing to the inclination to leave the scientific track and identifies the primary career challenges faced by this vulnerable community. Furthermore, it highlights key priorities of physician-scientists and gaps that require attention, offering valuable insights into strategies for retaining and supporting this critical workforce.

Objective: To investigate the association between health-related quality of life (HRQoL) and major adverse cardiovascular and cerebrovascular events (MACCE) in individuals with ischaemic heart disease (IHD). Methods: Medline(R), Embase, APA PsycINFO and CINAHL (EBSCO) from inception to 3 April 2023 were searched. Studies reporting association of HRQoL, using a generic or cardiac-specific tool, with MACCE or components of MACCE for individuals with IHD were eligible for inclusion. Risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale to assess the quality of the studies. Descriptive synthesis, evidence mapping and random-effects meta-analysis were performed stratified by HRQoL measures and effect estimates. Between-study heterogeneity was assessed using the Higgins I² statistic. Results: Fifty-one articles were included with a total of 134 740 participants from 53 countries. Meta-analysis of 23 studies found that the risk of MACCE increased with lower baseline HeartQoL score (HR 1.49, 95% CI 1.16 to 1.93) and Short Form Survey (SF-12) physical component score (PCS) (HR 1.39, 95% CI 1.28 to 1.51). Risk of all-cause mortality increased with a lower HeartQoL (HR 1.64, 95% CI 1.34 to 2.01), EuroQol 5-dimension (HR 1.17, 95% CI 1.12 to 1.22), SF-36 PCS (HR 1.29, 95% CI 1.19 to 1.41), SF-36 mental component score (HR 1.18, 95% CI 1.08 to 1.30). Conclusions: This study found an inverse association between baseline values or change in HRQoL and MACCE or components of MACCE in individuals with IHD, albeit with between-study heterogeneity. Standardisation and routine assessment of HRQoL in clinical practice may help risk stratify individuals with IHD for tailored interventions. PROSPERO registration number: CRD42021234638.

Venous thromboembolism (VTE) is one of the leading causes of post-operative morbidity and mortality. Over previous decades, heparin and warfarin were the predominant therapeutic options for post-operative thromboprophylaxis. However, their use is limited by drawbacks including a narrow therapeutic range, numerous food and drug interactions, and the need for regular monitoring for dose adjustments. Recently, direct oral anticoagulants (DOACs), such as dabigatran etexilate (a direct thrombin inhibitor) and apixaban, rivaroxaban and edoxaban (direct factor Xa inhibitors), have been developed to overcome these issues. DOACs have shown promising results in Phase III clinical trials for post-operative VTE prophylaxis. This review summarises the pharmacological profile of DOACs and highlights the use of DOACs in post-operative VTE prophylaxis based on the available clinical trial data.