Background: Although low-density-lipoprotein cholesterol (LDL-C) remains the primary target of lipid-lowering therapy, many patients with atherosclerotic cardiovascular disease (ASCVD) continue to experience cardiovascular events. This residual risk suggests that LDL-C alone does not fully capture the total atherogenic burden. Alternative lipid measures, including non-high-density lipoprotein cholesterol (non-HDL-C) and cholesterol ratios, may provide a more comprehensive risk assessment, particularly in populations with a high prevalence of metabolic disorders. This study assessed the prevalence and clinical determinants of elevated non-HDL cholesterol and adverse cholesterol ratios among Middle Eastern patients with established ASCVD. Methods: This pooled cross-sectional analysis included 2763 adults with confirmed ASCVD from the Jordan SMuRF-less Study and six cardiovascular registries across the Middle East. Patients were stratified by standard modifiable cardiovascular risk factors (SMuRFs). Demographic, clinical, treatment, and lifestyle data were harmonized and analyzed using multivariable regression models. Results: Elevated non-HDL-C was observed in 54% of patients. Those with elevated non-HDL-C were younger (55.0 vs. 59.9 years) and more frequently current smokers (52.6% vs. 43.1%). Hypertension (64.2% vs. 51.0%) and heart failure (25.0% vs. 15.4%) were more common among patients with lower non-HDL-C, whereas dyslipidemia (90.8% vs. 75.8%) and acute coronary syndrome (88.1% vs. 83.7%) were more prevalent in the elevated group. Elevated non-HDL-C was associated with higher baseline LDL-C levels measured prior to the initiation of lipid-lowering therapy (141.3 vs. 81.1 mg/dL) and higher triglycerides (221.4 vs. 140.9 mg/dL). In multivariable analyses, age > 60 years (OR = 0.45), hypertension (OR = 0.74), and heart failure (OR = 0.61) were inversely associated with elevated non-HDL-C. Conclusions: Elevated non-HDL cholesterol is common among Middle Eastern patients with ASCVD, particularly younger individuals, reflecting early metabolic risk and increased atherogenic burden. Non-HDL-C is a valuable marker of residual cardiovascular risk, supporting earlier screening and region-specific prevention strategies.

Background/Objectives: The clinical impact of antipsychotics on the human body remains inadequately investigated, hence we aimed to compere the effects olanzapine (OLZ) and Clozapine (CLZ) on different body systems. Methods: 48 patients and 24 healthy individuals were involved, and followed over six months. PANSS, metabolic, cardiovascular, inflammatory, and neuronal transmitter parameters were determined. Results: No significant difference was found between the effects of the two drugs on blood mineral and cardiovascular parameters, except for CK-MB, which showed a greater increase in the OLZ group than in the CLZ group. Both drugs increased the lipid profile and HbA1C levels, with the effect of CLZ being more prominent. Both drugs increased the patients’ body weights, with no significant difference between their effects. Regarding renal and hepatic functions, OLZ had a more notable effect on creatinine and albumin levels than CLZ, while AST and ALT showed markedly greater increases in the CLZ-treated group than in the OLZ-treated group. Regarding the effects on neurotransmitters and inflammatory mediators, both drugs increased serotonin and ghrelin levels, in addition to decreasing leptin concentrations, and decreased the inflammatory mediators IL-1β, IL-6, and –TNF-α, with the effect of OLZ being more prominent. Regarding therapeutic efficacy, CLZ was more effective at reducing general and negative symptoms than OLZ. Conclusions: The present study revealed that CLZ had a greater impact on metabolic parameters and better therapeutic efficacy in attenuating both general and negative symptoms, whereas OLZ had more detectable anti-inflammatory effects, aid determining the appropriate treatment for schizophrenic patients.

Background: Metabolic syndrome (MS), characterized by a constellation of interrelated cardiometabolic abnormalities, markedly amplifies cardiovascular risk. Despite the high prevalence of atherosclerotic cardiovascular disease (ASCVD) in the Middle East, evidence regarding the burden and determinants of MS in this high-risk population remains limited. This study aimed to estimate the prevalence of MS and identify its independent predictors among Middle Eastern patients with established ASCVD. Methods: This comprehensive analysis integrated data from two complementary sources: a prospective cohort derived from the Jordan SMuRF-less Study, which enrolled adults (≥18 years) with confirmed ASCVD across nine centers in Jordan, and a pooled retrospective dataset from six regional cardiovascular registries. Standardized case report forms were used to collect demographic, clinical, and laboratory data. Participants were stratified according to the number of standard modifiable risk factors (SMuRFs) into three categories (0, 1–2, and 3–4 SMuRFs). Multivariable logistic regression analysis was conducted to determine independent predictors of MS. Results: Among 1016 patients with ASCVD, MS was present in 42.7% of the cohort. The prevalence of MS demonstrated a significant graded increase with higher SMuRF burden, rising from 2.2% in patients without SMuRFs to 28.3% in those with one to two SMuRFs and 62.2% in those with three to four SMuRFs (p < 0.001). Patients with MS were significantly older and exhibited higher body mass index and triglyceride levels, lower high-density lipoprotein cholesterol, and a greater prevalence of hypertension, diabetes mellitus, dyslipidemia, chronic kidney disease, and heart failure (all p < 0.001). Independent predictors of MS included advanced age, diabetes mellitus, hypertension, chronic kidney disease, heart failure, elevated body mass index, and increased triglyceride levels. In contrast, higher HDL cholesterol and smoking were inversely associated with MS. Conclusions: MS is highly prevalent among Middle Eastern patients with ASCVD and is strongly associated with cumulative SMuRF burden in a graded manner. These findings highlight the urgent need for targeted, region-specific strategies focusing on early identification and comprehensive management of cardiometabolic risk in this vulnerable population.

Background: Heart failure (HF) substantially affects health-related quality of life (HRQoL), but evidence across left ventricular ejection fraction (LVEF) categories in Jordan remains limited. Methods: This multicenter cross-sectional study included 516 adults with HF attending outpatient cardiac clinics in northern Jordan between May and November 2025. SF-36 Version 1.0 items were recoded to eight 0–100 domains, and unweighted SF-36 physical and mental four-domain composite scores were analyzed using expanded multivariable ordinary least-squares models with HC3 robust standard errors. A total of 476 participants had complete data for all model variables. Results: The mean SF-36 physical and mental four-domain composite scores were 48.80 (SD 21.14) and 51.88 (SD 20.57), respectively. Both scores differed across EF categories before adjustment (physical p < 0.001; mental p < 0.001), but the adjusted EF omnibus tests were not significant (physical p = 0.111; mental p = 0.613). Lower physical scores were associated with NYHA class II and III, physical inactivity, sleeping difficulty, retirement, and higher anxiety and depression scores, whereas self-care efficacy was positively associated with physical HRQoL. Lower mental scores were associated with NYHA class II and III, physical inactivity, and higher anxiety and depression scores, while self-care efficacy was positively associated with mental HRQoL. Conclusions: In this cross-sectional sample, functional limitation, anxiety and depressive symptoms, physical inactivity, and self-care efficacy were more consistently associated with HRQoL than EF category after adjustment. These findings support multidimensional assessment alongside cardiac measures.

Background: Immune checkpoint inhibitors (ICIs) have become an integral component of cancer treatment across multiple solid and hematologic malignancies. Although these agents can produce durable clinical responses, they are also associated with immune-related adverse events that may lead to emergency department (ED) visits. However, real-world data describing ED utilization among patients receiving ICIs in Saudi Arabia remain limited. Objectives: This study aimed to describe all-cause ED utilization among patients with cancer receiving immune checkpoint inhibitors, characterize immune-related and non-immune-related ED presentations, and explore factors associated with ED use. Methods: This retrospective observational cohort study included adult patients with cancer who received at least one immune checkpoint inhibitor at King Abdullah Medical City, Makkah, Saudi Arabia, between January 2019 and December 2023. Patients were followed for a predefined 24-week period after the first documented administration of an ICI. The primary outcome was the occurrence of at least one all-cause ED visit. Secondary outcomes included ED visits attributed to irAEs, documented toxicity patterns, management, hospitalization, and exploratory factors associated with ED utilization. Logistic regression analyses were exploratory and not intended to establish causal associations. Results: A total of 288 patients were included. The mean age was 58.4 ± 13.69 years, and most patients were male. The most common cancer types were non-small cell lung cancer, renal cell carcinoma, and urothelial carcinoma. Pembrolizumab was the most frequently used immune checkpoint inhibitor. During the 24-week observation period, 162 patients (56.3%) had at least one ED visit, whereas 25 patients (8.7% of the total cohort) had an ED visit attributed to an irAE. Gastrointestinal, dermatologic, and endocrine toxicities were the most frequently documented irAE categories. Most toxicities were graded as grade 1 or 2. In exploratory regression analyses of all-cause ED utilization, treatment-cycle count, alanine aminotransferase, and total bilirubin were statistically associated with ED visits. These associations should be interpreted cautiously because treatment-cycle count was not a fixed baseline exposure, laboratory timing could not be fully standardized retrospectively, and residual confounding may remain. Conclusions: ED utilization was common among patients receiving ICIs, whereas only a minority of patients had ED visits attributed to irAEs. These findings primarily characterize real-world acute healthcare utilization in a Saudi tertiary oncology setting. Associations identified in exploratory analyses should not be interpreted as causal or as specific predictors of immune-mediated toxicity. Further prospective studies are needed to evaluate structured approaches for assessing acute presentations in patients receiving ICIs.

Objective: To compare the efficacy, safety, weight reduction and treatment adherence of oral versus subcutaneous semaglutide in adults with uncontrolled T2DM and obesity. Methods: A multicenter retrospective cohort study was conducted between January 2023 and January 2024. Adult patients (≥18 years) with T2DM (HbA1c ≥ 7%) and obesity (BMI ≥ 30) who received either oral or subcutaneous semaglutide were included. Demographic, clinical, and biochemical variables including body weight, BMI, HbA1c, side effects, and adherence were extracted from electronic medical records. Adverse effects were categorized by severity. Comparative analyses between groups used Chi-square and Mann Whitney U tests, with p0.05). The severity of adverse effects predominantly gastrointestinal symptoms such as nausea, vomiting, constipation, and diarrhea did not differ significantly between groups (p=0.994). However, dizziness was significantly more frequent in the subcutaneous group (p = 0.04). Adherence was markedly higher with oral semaglutide (p<0.05), with cost identified as the primary barrier among oral users, while subcutaneous users more frequently cited side effects, forgetfulness, and limited weight loss. Weight reduction was comparable at 3 months (p=0.23), but significantly greater with oral semaglutide at 6, 9, and 12 months (all p<0.01). Conversely, HbA1c reduction favored subcutaneous semaglutide at 3 and 6 months (p=0.03 and 0.02), although baseline glycemic control was similar. Conclusions: This study demonstrates that while subcutaneous semaglutide may provide a faster early HbA1c decline, oral semaglutide offers superior long-term weight reduction and significantly better adherence, likely attributable to easier administration. Both formulations exhibited comparable safety profiles.