Cardiovascular diseases (CVDs) are currently the leading cause of mortality worldwide, with coronary heart disease being the primary cause. The Mediterranean Diet (MD) has been highlighted for its potential in providing greater protection against CVDs. This study aims to present an updated systematic review that examines the impact of MD on mortality and CVDs, both in the general population and in patients with a prior CVD, while also considering the potential influence of gender. We conducted a systematic review. After the selection process, 24 studies met the inclusion criteria. The findings from these studies consistently demonstrate that higher adherence to the MD is associated with a reduced risk of overall mortality, both in the general population and in patients with previous CVDs. Moreover, evidence suggests that following this dietary pattern likely decreases the risk of CVDs such as heart attacks, various types of coronary artery disease, stroke, and cardiovascular mortality. While some studies have identified differences in the benefits of the MD between men and women, it is important to note that these disparities may be attributed to lower event rates and a generally lower cardiovascular risk profile in women. Thus, the observed variations in outcomes should be interpreted in the context of these factors. Adherence to the MD has the potential to improve survival rates and reduce the risk of CVDs in both the general population and individuals with a prior CVD. Further research is needed to explore the specific mechanisms underlying the protective effects of this dietary pattern and to better understand the role gender-related differences in its outcomes. Nevertheless, promoting the adoption of the MD could be an effective strategy for mitigating the burden of CVDs globally.

Objective Left atrial appendage (LAA) thrombus has heretofore been considered a contraindication to percutaneous LAA closure (LAAC). Data regarding its management are very limited. The aim of this study was to analyse the medical and invasive treatment of patients referred for LAAC in the presence of LAA thrombus. Methods This multicentre observational registry included 126 consecutive patients referred for LAAC with LAA thrombus on preprocedural imaging. Treatment strategies included intensification of antithrombotic therapy (IAT) or direct LAAC. The primary and secondary endpoints were a composite of bleeding, stroke and death at 18 months, and procedural success, respectively. Results IAT was the preferred strategy in 57.9% of patients, with total thrombus resolution observed in 60.3% and 75.3% after initial and subsequent IAT, respectively. Bleeding complications and stroke during IAT occurred in 9.6% and 2.9%, respectively, compared with 3.8% bleeding and no embolic events in the direct LAAC group before the procedure. Procedural success was 90.5% (96.2% vs 86.3% in direct LAAC and IAT group, respectively, p=0.072), without cases of in-hospital thromboembolic complications. The primary endpoint occurred in 29.3% and device-related thrombosis was found in 12.8%, without significant difference according to treatment strategy. Bleeding complications at 18 months occurred in 22.5% vs 10.5% in the IAT and direct LAAC group, respectively (p=0.102). Conclusion In the presence of LAA thrombus, IAT was the initial management strategy in half of our cohort, with initial thrombus resolution in 60% of these, but with a relatively high bleeding rate (~10%). Direct LAAC was feasible, with high procedural success and absence of periprocedural embolic complications. However, a high rate of device-related thrombosis was detected during follow-up.

BACKGROUND: The optimal antithrombotic treatment after transcatheter left atrial appendage closure (LAAC) remains to be determined. The objective of this trial was to compare anticoagulation and antiplatelet therapy for preventing device-related thrombosis (DRT) after LAAC. METHODS: This was a prospective multicenter international randomized trial comparing 2 different antithrombotic strategies for preventing DRT after LAAC in patients with nonvalvular atrial fibrillation. Patients were randomized (1:1) to receive direct oral anticoagulants (DOACs) or dual antiplatelet therapy (DAPT; aspirin+clopidogrel) for 60 days. Patients underwent transesophageal echocardiography at 60 days, and the images were analyzed in a central echocardiography laboratory by experienced echocardiographers blinded to the allocated treatment. The primary outcome was DRT as determined by transesophageal echocardiography 60 days after LAAC in patients receiving the allocated treatment at the time of transesophageal echocardiography (per-protocol analysis). The safety outcome included all-cause mortality, stroke, bleeding, or site-reported DRT within 60 days after LAAC in all randomized patients (intention-to-treat analysis). RESULTS: A total of 510 patients (mean age 77±9 years, 35% women) were included between October 2018 and May 2025, and 253 and 257 patients were randomized to the DOAC and DAPT groups, respectively. Of these, 399 patients underwent transesophageal echocardiography and were receiving the allocated treatment at 60 days after LAAC. The primary outcome occurred in 3 patients (1.5%) in the DOAC group compared with 8 patients (4.1%) in the DAPT group (difference, −2.7% [95% CI, −6.0% to 0.6%]; P =0.110). The safety outcome occurred in 52 patients (22.5%) in the DOAC group compared with 82 patients (34.9%) in the DAPT group (difference, −12.4% [95% CI, −20.6% to −4.2%]; P =0.003), and differences were mainly driven by a lower rate of bleeding events in the DOAC group (44 patients [17.4%] versus 64 patients [24.9%]; difference, −7.5% [95% CI, −14.6% to −0.4%]; P =0.038). CONCLUSIONS: The use of DOACs after LAAC failed to reduce DRT compared with DAPT, but it was associated with an improved safety profile. The results of this study should be interpreted with caution because of statistical power issues related to the narrower-than-expected between-group differences and will need confirmation in future larger studies. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03568890.

BACKGROUND: Effective risk communication is essential in managing cardiovascular disease, the leading cause of global mortality. Clear communication between patients and physicians supports informed decision-making, yet comprehension gaps persist. We aimed to assess the quality of risk communication during hospital admissions for cardiovascular events, from patient and physician perspectives, and identify discrepancies in risk perception and associated factors. METHODS: The HARIPA study (Heart Risk Perception and Communication Inpatient) by the Spanish Society of Cardiology was a multicenter, cross-sectional analysis conducted in 28 hospitals across Spain from October 2022 to March 2023. It included consecutive cardiology inpatients (urgent or scheduled), aged ≥18 years, who could complete structured questionnaires. Participating physicians also completed parallel questionnaires. These assessed admission diagnosis, perceptions of future cardiovascular risk, and communication about potential procedural complications. Agreement between responses was evaluated using kappa indices (weighted for ordinal variables), and multivariable logistic regression was used to examine the impact of demographic and clinical factors (odds ratios with 95% CIs). RESULTS: We included 943 patients (mean age, 68.2 years; 29.4% women). The most frequent reason for admission was ischemic heart disease (41.3%). Responses resulted in a substantial agreement, with a kappa index of 0.72. Concordance between patients and physicians regarding future cardiovascular risk was low (weighted kappa: 0.29), with patients often underestimating their risk. And for assessment about procedural potential complications was moderate (kappa: 0.34). Although 76.9% of patients reported feeling adequately informed about procedural risks, 69.3% of those who experienced complications (n=208) stated they had not been warned about them. CONCLUSIONS: This study reveals significant gaps in risk communication in cardiovascular care, particularly regarding future risks and complications. As well-informed patients are more likely to adhere to preventive therapies, tailoring communication strategies to individual patient characteristics could improve understanding and align perceptions with clinical realities, enhancing health outcomes.

La hemofilia A adquirida es un trastorno infrecuente de la coagulación debido a autoanticuerpos frente al factor VIII. Se debe sospechar en caso de sangrado espontáneo y prolongación del TTPA. Presentamos el caso de un varón de 85 años con hematoma retroperitoneal. En los análisis de laboratorio destacaba TTPA prolongado. Se determinó la actividad del factor VIII, que se encontraba significativamente disminuida. El paciente inició tratamiento, con excelente respuesta clínica. Este caso clínico es un ejemplo ilustrativo de esta enfermedad desconocida, que puede ayudar a su mejor comprensión y a un mejor manejo de estos pacientes.