Prediabetes is defined as a state of impaired glucose metabolism with hemoglobin A1c (HbA1c) levels that precede those of a diabetic state. There is increasing evidence that suggests that hyperglycemic derangement in prediabetes leads to microvascular and macrovascular complications even before progression to overt diabetes mellitus. We aim to identify the association of prediabetes with acute cardiovascular events. We utilized the National inpatient sample 2018-2020 to identify adult hospitalizations with prediabetes after excluding all hospitalizations with diabetes. Demographics and prevalence of other cardiovascular risk factors were compared in hospitalizations with and without prediabetes using the chi-square test for categorical variables and the t-test for continuous variables. Multivariate regression analysis was further performed to study the impact of prediabetes on acute coronary syndrome, acute ischemic stroke, intracranial hemorrhage, and acute heart failure. Hospitalizations with prediabetes had a higher prevalence of cardiovascular risk factors like hypertension, hyperlipidemia, obesity, and tobacco abuse. In addition, the adjusted analysis revealed that hospitalizations with prediabetes were associated with higher odds of developing acute coronary syndrome (OR-2.01; C.I:1.94-2.08; P<0.001), acute ischemic stroke (OR-2.21; 2.11-2.31; p<0.001), and acute heart failure (OR-1.41; C.I.: 1.29-1.55; p<0.001) as compared to hospitalizations without prediabetes. Our study suggests that prediabetes is associated with a higher odds of major cardiovascular events. Further prospective studies should be conducted to identify prediabetes as an independent causative factor for these events. In addition, screening and lifestyle modifications for prediabetics should be encouraged to improve patient outcomes.

Cocaine has been linked to both myocardial infarction (MI) and pulmonary embolism (PE), with the latter occasionally mimicking acute coronary syndrome. We report a 54‐year‐old man with polysubstance abuse who was found unresponsive and revived with naloxone. He developed chest pain with electrocardiogram showing ST‐segment elevation in V2–V3 and elevated troponin, suggestive of anteroseptal ST‐elevation MI (STEMI). Bedside echocardiography revealed right ventricular dilation and dysfunction without left ventricular abnormalities, prompting computed tomography angiography (CTA), which demonstrated large bilateral pulmonary emboli with right heart strain. He was anticoagulated and later discharged on a direct oral anticoagulant; coronary angiography revealed only mild nonobstructive disease. This case underscores the diagnostic challenge of distinguishing PE from STEMI in patients with cocaine use and highlights the utility of point‐of‐care echocardiography in avoiding unnecessary invasive procedures. Clinicians should consider PE in the differential diagnosis of chest pain with ST elevation.

Longevity is not solely determined by the absence of risk factors but often reflects the balance between harmful exposures and protective adaptations. We introduce the framework of epigenetic resilience as a counterbalancing mechanism by which favorable environmental and lifestyle factors can potentially offset detrimental influences such as tobacco use. Tobacco is a well-established accelerator of biological aging through adverse epigenetic reprogramming, yet populations such as Andorra paradoxically exhibit both high smoking prevalence and some of the longest life expectancies worldwide. This observation underscores the potential role of resilience factors—including diet, physical activity, psychosocial cohesion, and environmental context—that may buffer or counteract the negative epigenetic imprints of smoking. By highlighting this paradox, we emphasize the importance of understanding how protective influences reshape DNA methylation landscapes to sustain healthspan despite harmful exposures. Recognizing and enhancing epigenetic resilience might offer a path toward targeted interventions that could mitigate the consequences of tobacco and other stressors, ultimately informing strategies to promote healthy aging at both individual and population levels.

Aims: Mental health disorders (MHDs) are common in acute myocardial infarction (AMI) and have been associated with less intensive cardiac care. We examined trends in five MHDs and their adjusted associations with in-hospital mortality, mechanical circulatory support (MCS), and coronary revascularization. Methods and results: We analysed the National Inpatient Sample, 2016–23, including adult hospitalizations with a principal diagnosis of AMI [ICD-10-CM I21.x/I22.x, excluding type 2 myocardial infarction (MI)]; five MHDs were identified from secondary diagnoses. Survey-weighted logistic regression produced adjusted odds ratios (aORs), adjusting for demographics, hospital characteristics, MI type, and 19 comorbidities, with all five MHDs entered simultaneously. Sensitivity analyses were restricted to hospitalizations without prior MI, percutaneous coronary intervention, or coronary artery bypass grafting. Among 970 969 AMI hospitalizations, prevalence rose for every MHD except schizophrenia/psychotic disorders, most steeply for PTSD (Post-traumatic stress disorder). Schizophrenia/psychotic disorders had the lowest adjusted odds of revascularization [aOR, 0.56; 95% confidence interval, 0.53–0.60] and invasive management (0.52; 0.49–0.55), followed by bipolar disorder (revascularization 0.81; 0.78–0.85); MCS associations were attenuated after adjustment. Restricted to those without prior coronary disease, the schizophrenia deficit was larger (0.54; 0.50–0.57) than among those with prior coronary disease (0.67; 0.60–0.74; interaction P < 0.001). Depression, anxiety, bipolar disorder, and PTSD were associated with lower adjusted in-hospital mortality (all P < 0.001); schizophrenia/psychotic disorders showed no significant difference (1.11; 0.98–1.26; P = 0.09). Conclusion: Schizophrenia and other psychotic disorders were consistently associated with markedly lower odds of invasive evaluation and coronary revascularization after AMI, with the largest deficit at first presentation. These findings highlight a potentially modifiable gap in cardiovascular care.