Psychosocial and work stress, socioeconomic status, and environmental health directly impact the onset and progression of cardiovascular diseases, irrespective of sex or conventional cardiovascular risk factors (cCRFs). On the other hand, the impact of cCRFs on health-related quality of life (HRQoL) is not well known, and the psychological socioeconomic environmental somatic health interaction is often neglected. Accordingly, we aimed to: (i) compare the self-reported HRQoL using the WHOQOL-BREF questionnaire between healthy subjects and those with cCRFs; and (ii) evaluate the interplay between HRQoL, cCRFs, and cardiovascular treatment adherence. We prospectively included 90 working adults (46 healthy and 44 with cCRFs age- and sex-matched adults) evaluated by clinical examination, 12-leads electrocardiography, and transthoracic echocardiography as part of a cardiovascular diseases screening program, that also filled in the WHOQOL-BREF questionnaire. Subjects with CRFs were less satisfied with their own individual health. The presence and the number of CRFs, as well as the need for cardiovascular treatment and the number of drugs taken correlated with reduced scores at the majority of HRQoL domains. The results in the social relationships domain were the best predictor of cardiovascular treatment adherence. Finally, the results of all HRQoL domains were strongly correlated to each other demonstrating the psychological socioeconomic environmental somatic health interaction.

Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as the most prevalent chronic liver disease globally and is now recognized as a key cardiometabolic disorder. Beyond hepatic involvement, MASLD is independently associated with increased risks of coronary artery disease, stroke, arrhythmias, and heart failure, even after adjusting for traditional cardiovascular risk factors. Its pathophysiology involves insulin resistance, visceral adiposity, systemic inflammation, and oxidative stress, which collectively contribute to both hepatic fibrosis and cardiovascular disease (CVD). Diagnostic strategies have evolved to include non-invasive tools—such as the Fibrosis-4 Index and Enhanced Liver Fibrosis test, transient elastography, NT-proBNP, coronary artery calcium scoring, and echocardiography—to facilitate early identification of patients at dual hepatic and cardiovascular risk. Complementing these efforts, a novel pathophysiological staging framework for systemic metabolic disorder has been proposed to stratify disease severity and personalize treatment approaches. Management is increasingly multidimensional, combining lifestyle intervention with pharmacologic therapies such as GLP-1 receptor agonists, SGLT2 inhibitors, statins, and novel agents like resmetirom. Given the shared pathophysiological mechanisms between MASLD and CVD, integrated care approaches across hepatology, cardiology, and endocrinology are essential. Recognizing MASLD as a systemic disease enables earlier interventions that may prevent both hepatic progression and adverse cardiovascular outcomes.

Background/Objectives: Atrial fibrillation (AF) may cause functional mitral regurgitation (MR) and tricuspid regurgitation (TR) through atrial remodeling and annular dilation. However, the prevalence and structural characteristics of combined MR/TR in AF are not well defined. We aimed to determine the prevalence, clinical profile, and factors associated with combined clinically significant MR and TR in AF patients. Methods: In this prospective observational study (REMO-FIB), 175 consecutive AF patients underwent comprehensive transesophageal echocardiography with three-dimensional mitral valve analysis. After excluding organic MR and significant aortic valve disease, 125 patients were analyzed. Patients were classified into four groups according to the presence of moderate/severe MR and/or TR. Multivariable logistic regression evaluated factors associated with the combined phenotype. Results: Among 125 patients, 53 (42.4%) had no significant MR/TR, 33 (26.4%) had isolated MR, 11 (8.8%) had isolated TR, and 28 (22.4%) had combined MR/TR. Compared with patients without regurgitation, those with combined MR/TR had higher symptom burden (EHRA class, p = 0.036), more heart failure (92.9% vs. 67.9%, p = 0.048), larger left (47.0 vs. 42.0 mm, p = 0.002) and right atria (42.0 vs. 38.0 mm, p < 0.001), higher pulmonary artery pressure (40.0 vs. 28.0 mmHg, p = 0.004), and lower left ventricular ejection fraction (47.5% vs. 55.0%, p = 0.006). Three-dimensional analysis showed larger mitral annular perimeter (129.0 vs. 121.0 mm, p = 0.009), greater annular area (12.7 vs. 11.1 cm², p = 0.014), longer anterior leaflet length (26.5 vs. 24.0 mm, p < 0.001), and greater tenting area (2.1 vs. 1.4 cm², p = 0.002). Factors independently associated with the combined phenotype were female sex (OR 4.60, p = 0.015), lower ejection fraction (OR 0.47 per SD, p = 0.005), and larger right atrial diameter (OR 1.85 per SD, p = 0.037). Model discrimination was good (AUC 0.81). Conclusions: Combined moderate/severe MR and TR affects over one-fifth of AF patients without organic valve disease and is associated with advanced biatrial remodeling, adverse symptoms, and heart failure. Comprehensive assessment of both atrioventricular valves should be considered in AF.