(1) Background: Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide. The aim of the study was to examine the existing published results of the association between elevated serum phosphate concentrations and cardiovascular mortality, along with the CVD incidence and subclinical coronary atherosclerosis, in primary prevention among non-selected samples of the general population. (2) Methods: A systematic review and meta-analysis were carried out using literature obtained from PubMed, SCOPUS, and the Web Of Science until March 2024 and following the PRISMA guidelines. Relevant information was extracted and presented. Random and fixed effects models were used to estimate the pooled odds ratio (OR) and hazard ratio (HR) with their 95% coefficient interval (CI), and I² was used to assess heterogeneity. (3) Results: Twenty-five studies met our inclusion criteria and were included in the meta-analysis (11 cross-sectional and 14 cohort studies). For cardiovascular mortality, which included 7 cohort studies and 41,764 adults, the pooled HR was 1.44 (95% CIs 1.28, 1.61; I² 0%) when the highest versus the reference level of serum phosphate concentrations were compared. For CVDs, which included 8 cohort studies and 61,723 adults, the pooled HR was 1.12 (95% CIs 0.99, 1.27; I² 51%). For subclinical coronary atherosclerosis, which included 11 cross-sectional studies and 24,820 adults, the pooled OR was 1.44 (95% CIs 1.15, 1.79; I² 88%). (4) Conclusions: The highest serum phosphate concentrations were positively associated with a 44% increased risk of cardiovascular mortality and subclinical coronary atherosclerosis.

Background/Objectives: Phthalates are endocrine-disrupting chemicals that are commonly used in plastic consumer products and food packaging, with growing evidence suggesting that they have a potential role in obesity. This study aimed to investigate the association between urinary concentrations of phthalate metabolites and both general and abdominal obesity among adult males in Spain. Methods: We analysed data from 1124 male participants of the Aragon Workers’ Health Study (AWHS) collected between 2011 and 2014 in Zaragoza, Spain. Eleven urinary phthalate metabolites were measured and adjusted for creatinine levels. Multivariate logistic regression models were used to evaluate associations between phthalate exposure and general and abdominal obesity, controlling for dietary and lifestyle factors. Dose–response relationships were explored using restricted cubic spline models. Results: Higher urinary concentrations of di(2-ethylhexyl) phthalate (∑DEHP) and two of its metabolites—mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP) and mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP)—were significantly associated with general obesity. The adjusted odds ratios were: ∑DEHP [OR = 1.26; 95% CI: 1.01, 1.58], MEOHP [OR = 1.24; 95% CI: 1.00, 1.53], and MEHHP [OR = 1.26; 95% CI: 1.03, 1.55]. In contrast, mono-isobutyl phthalate (MiBP) was inversely associated with abdominal obesity [OR = 0.73; 95% CI: 0.57, 0.93]. Conclusions: These findings suggest a positive association between exposure to DEHP and its metabolites and general obesity. This highlights the potential importance of environmental exposures as modifiable factors in obesity prevention and supports the need for further investigation in nutritional and public health contexts.

Context: The recommendation of a low-sugar diet to prevent cardiovascular disease (CVD) has led to the popularity of artificial sweeteners (AS). Although their consumption is considered mostly safe, their potential associations with cardiovascular health remain controversial. Objectives: The aim of this study was to review the existing published evidence on the association between AS and CVD, specifically excluding artificially sweetened beverages, which have been studied more recently. Data Sources: Articles were retrieved from the PubMed, Web of Science, and Scopus databases from inception to February 2025. Data Extraction: Study characteristics related to AS and CVD meeting the inclusion criteria were extracted by 2 independent reviewers. Relevant information was extracted and presented according to PRISMA guidelines. A random-effects model was used to estimate the pooled hazard ratio with its 95% CI, and I2 was used to assess heterogeneity. Funnel plots and Egger’s tests were used to evaluate publication bias. Data Analysis: A total of 11 articles were identified (6 for serum/plasma measurements of AS and 5 for dietary consumption). The meta-analysis showed a positive association for serum/plasma polyols, with a 26% higher risk of cardiovascular events when comparing extreme categories. However, there was high heterogeneity and suspicion of publication bias. Second, the systematic review of AS consumption found mixed results for CVD mortality, although most estimates for cardiovascular events were positive. However, the number of included articles was relatively small and based on specific foods, making it difficult to draw conclusions. Conclusion: Elevated serum/plasma polyols are positively associated with a higher presence of cardiovascular events. However, total AS consumption was not clearly associated with CVD mortality or cardiovascular events. Future research is needed to better establish the association between AS and CVD. Systematic Review Registration: PROSPERO registration no. CRD42025644601.

Background: Physical activity (PA) intensity could play a key role in atherosclerosis risk, but the existing literature shows controversial results. The aim of this study was to analyze the association of different PA levels with the presence of subclinical atherosclerosis in femoral and carotid arteries. Methods: A cross-sectional analysis was conducted of 449 middle-aged men belonging to the Aragon Workers’ Health Study. Demographic, anthropometric, and clinical data were obtained during the annual medical examination. Ultrasonography was used to assess the presence of atheroma plaques in femoral and carotid territories. Accelerometry was used to assess habitual PA. Participants were categorized into vigorous PA (VPA) groups (0 min/week, >0–60 min/week, >60 min/week), and into moderate to vigorous PA (MVPA) groups using terciles as cut-offs. Results: Compared with participants who completed 0 min/week of VPA, those participants who completed >60 min/week of VPA had fully adjusted odds of subclinical atherosclerosis of 0.47 (95%CI: 0.22, 0.99, p < 0.05) and 0.35 (95%CI: 0.17, 0.73, p < 0.05) for femoral and any territory (femoral and/or carotid) respectively. No significant differences were observed in the prevalence of atheroma plaques in any vascular territory between the different MVPA groups. Conclusions: Performing more than 60 min/week of VPA is associated with reduced odds for subclinical atherosclerosis in femoral or any vascular territory in adult men.

Background/Objectives: Emerging approaches aim to protect both human and environmental health. Therefore, we hypothesise that adherence to the Healthy and Sustainable Dietary Recommendations for the Spanish Population Index (HS-DRSI) is inversely associated with the occurrence of Metabolic Syndrome (MetS) and promotes environmental sustainability. Methods: A cross-sectional analysis was performed with 2286 middle-aged men, with no previous cardiovascular disease and belonging to the Aragon Workers’ Health Study (AWHS). Diet was collected with a 136-item food-frequency questionnaire. Adherence to the recommendation was assessed with the HS-DRSI, which assigns one point for each of 19 food categories. The National Cholesterol Education Programme-Adult Treatment Panel III (NCEP-ATP III) definition was used to define MetS. Logistic regressions were used to estimate the association between adherence to the HS-DRSI and presence of MetS. Environmental assessment was calculated based on the 2016 European database. Results: Higher adherence to the HS-DRSI was inversely associated with MetS and elevated waist circumference. The odds ratio (OR) of having MetS for participants in the highest (8–13 points) vs. lowest (1–5 points) quartile of adherence to the diet score was 0.72 (95% CI, 0.52–0.99) and the OR of elevated waist circumference was 0.69 (95% CI, 0.48–0.99), with consistent results per 1 SD increase (2 points). In addition, greenhouse gas emissions (GHGE) decreased progressively across adherence quartiles (from 6.10 to 5.70 kg CO₂-eq/day). Conclusions: Adherence to the HS-DRSI was associated with a lower risk of MetS and may contribute to lower GHGE production.

(1) Background: Atherosclerosis is a leading cause of vascular death worldwide. High urinary phosphate has recently been identified as a cardiovascular risk factor, but its role has not been fully established. The aim of this study was to investigate the association between urinary phosphate and subclinical atherosclerosis in the carotid, femoral as well as coronary territories; (2) Methods: We performed a cross-sectional analysis of a sample of 1169 middle-aged men, aged 50.9 years (SD 3.7), without previous cardiovascular disease, belonging to the Aragon Workers Health Study (AWHS). Urinary phosphate was analyzed in urine samples using the Fiske-Subbarow method. The presence of carotid plaque and femoral plaque was assessed by ultrasound and coronary artery calcium score (CACS) by computed tomography. Demographic, anthropometric and clinical data were collected at annual medical examinations. Logistic regression models were used to estimate the prevalence of adjusted atherosclerosis in the different vascular arteries; (3) Results: A significant inverse association was observed between urinary phosphate and subclinical atherosclerosis in the carotid [OR 95% CI 0.69 (0.49–0.99)] and coronary (CACS > 200) [OR 95% CI 0.46 (0.23–0.88)] arteries; however, no statistically significant association was found between urinary phosphate and the presence of atheroma plaques in the femoral territory [OR 1.02 (0.72–1.45)]; (4) Conclusions: In middle-aged men, a higher urinary phosphate concentration is associated with a lower prevalence of subclinical carotid and coronary atherosclerosis compared with those with a lower urinary phosphate concentration.