Background: Patients with coronary artery disease or heart failure (HF) face heightened COVID‐19 and cardiovascular risk, yet the long‐term cardiac effects of COVID‐19 vaccination in this population remain uncertain. Methods: We performed a retrospective, propensity‐matched cohort study using the TriNetX US Collaborative Network (December 2020–December 2022). Adults with coronary artery disease or HF were matched 1:1, creating 74 236 vaccinated and 74 236 calendar‐aligned unvaccinated patients. Outcomes included mortality, acute myocardial infarction, stroke, HF hospitalization, deep vein thrombosis/pulmonary embolism, atrial fibrillation hospitalization, myocarditis, pericarditis, percutaneous coronary intervention, and coronary artery bypass grafting at 1‐year and 2‐year follow‐ups. Results: Vaccination was associated with a dose‐dependent reduction in all‐cause mortality. Landmark hazard ratios (HRs) remained favorable, 0.92 (95% CI, 0.89–0.95), 0.99 (95% CI, 0.96–1.02), and 0.72 (95% CI, 0.70–0.74), confirming robustness across time periods. Vaccination was also associated with fewer HF hospitalizations (2‐year HR, 0.90 [95% CI, 0.87–0.94]) and lower revascularization rates (percutaneous coronary intervention HR, 0.87; coronary artery bypass grafting HR, 0.80), while showing no significant association with acute myocardial infarction, stroke, or venous thromboembolism. Although the study was underpowered to definitively assess rare safety events, a small increase in myocarditis was observed (2‐year HR, 1.36), representing a potential safety signal that warrants further investigation; pericarditis was not significantly elevated. Conclusions: COVID‐19 vaccination was associated with a graded reduction in mortality that persisted after landmark adjustment, as well as lower rates of HF admissions and revascularizations. Findings support the use of complete vaccination, including boosters, as part of secondary prevention, pending confirmation in prospective studies.

Background: Diabetes mellitus (DM) significantly increases the risk of cerebrovascular disease (CeVD), a major cause of mortality and long‐term disability. Despite improvements in healthcare, disparities in CeVD‐related mortality among diabetic populations in the United States persist. Methods: We conducted a retrospective analysis using the CDC WONDER database from 1999 to 2020 to assess mortality trends related to CeVD among adults aged ≥ 45 years with DM. Deaths were identified using ICD‐10 codes I60–I69 (CeVD) and E10–E14 (DM). Age‐adjusted mortality rates (AAMRs) were calculated, and trends were analysed using Joinpoint regression, stratified by age, race/ethnicity, geography, urbanisation, and place of death. Results: A total of 689,846 CeVD‐related deaths occurred in diabetic individuals. AAMR decreased from 36.9 in 1999 to 29.3 in 2020, with an average annual percentage change (AAPC) of −1.41%. However, a sharp rise was observed from 2018 to 2020 (APC 14.87%), indicating a concerning reversal in progress. The highest crude mortality rates were in the 75–84 age group, and the lowest in the 45–54 group. Black and Hispanic populations, rural residents, and those in the Southern United States had the highest mortality rates. The Northeast and Asian populations had the lowest, reflecting persistent disparities in access to care and preventive services. Conclusion: While CeVD mortality in diabetics declined over two decades, the recent reversal highlights emerging challenges, possibly due to healthcare disruptions and socioeconomic disparities. These findings underscore the need for targeted public health interventions to address inequities and improve outcomes in high‐risk populations.

Dual antiplatelet therapy is a standard treatment after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS), but the optimal monotherapy agent post-dual antiplatelet therapy remains unclear. Clopidogrel and aspirin are widely used, yet their comparative effectiveness and safety in this patient population have not been fully established. This systematic review and meta-analysis compared the efficacy and safety of clopidogrel and aspirin monotherapy following PCI in patients with ACS. A comprehensive search of PubMed, Embase, and Web of Science was conducted from inception to March 31, 2025. Randomized controlled trials (RCTs) comparing clopidogrel and aspirin monotherapy in adult ACS patients post-PCI were included. Primary outcomes were all-cause death, myocardial infarction (MI), and ischemic stroke. Secondary outcomes included target-vessel and target-lesion revascularization, cardiovascular and noncardiovascular death, and stent thrombosis. The risk of bias was assessed using the Cochrane RoB 2 tool, and the GRADE methodology was applied to evaluate the certainty of evidence. Three RCTs involving 16,056 patients (clopidogrel: 8103; aspirin: 7953) were included. Clopidogrel significantly reduced MI (risk ratio = 0.71; 95% confidence interval: 0.55–0.92; P = 0.01) and target-vessel revascularization (risk ratio = 0.77; 95% confidence interval: 0.60–0.97; P = 0.03). No significant differences were found in all-cause death, ischemic stroke, or other secondary outcomes. Sensitivity analysis suggested a potential reduction in noncardiovascular death favoring clopidogrel. Clopidogrel monotherapy after PCI may offer superior protection against MI and target-vessel revascularization compared with aspirin, with no increased risk of death or stroke.