Various studies have suggested the possible cardiovascular (CV) protective effects of the pneumococcal vaccine (PV). Therefore, we conducted a meta-analysis to assess the association between recipients of PV with mortality and CV outcomes among patients with and without established cardiovascular disease. We performed a systematic literature search in PubMed, Embase, and Scopus for studies evaluating the effect of PV on mortality and CV outcomes. A total of 15 studies with 347,444 patients were included in the meta-analysis: 111,784 patients received PV (32%) and 235,660 patients were in the unvaccinated group (68%). Recipients of PV were associated with decreased all-cause mortality (HR, 0.76 (95% CI: 0.66 to 0.87), p < 0.001). PV was associated with a decrease in the incidence of myocardial infarction (MI) (HR, 0.73 (95% CI: 0.56–0.96), p = 0.02), without significant reduction in CV mortality (HR, 0.87 (95% CI: 0.72–1.07), p = 0.18) and stroke (HR, 1.01 (95% CI: 0.93–1.10), p = 0.82). Our study found PV was associated with decreased risk of all-cause mortality and MI. Future RCTs will be necessary to confirm benefits associated with receipt of PV.

Purpose of review: This review critically examines the evolving role of C-reactive protein (CRP) in cardiovascular disease (CVD), addressing its pathogenesis and relationship with various CVDs including coronary artery disease (CAD), heart failure, and atrial fibrillation. Recent findings: CRP is mechanistically implicated in endothelial dysfunction, oxidative stress, and plaque destabilization. Recent studies demonstrate that lipid-lowering agents (statins, bempedoic acid) and anti-inflammatory therapies (canakinumab, colchicine) reduce CRP levels and improve outcomes in CAD. In heart failure, elevated CRP predicts adverse events, though evidence on phenotypes varies, and novel therapies (glucagon-like peptide-1 agonists, sodium-glucose cotransporter-2 inhibitors) lower CRP independently of weight loss. For atrial fibrillation, CRP correlates with postoperative incidence and recurrence postablation, though data remain inconsistent. Guidelines offer differing opinion with the American College of Cardiology and the American Heart Association (ACC/AHA) guidelines cautiously endorsing CRP for risk stratification in intermediate-risk individuals, while European guidelines advise against its routine use for primary prevention, reflecting unresolved questions about CRP's additive value. Summary: CRP remains a pivotal inflammation biomarker in CVD, yet its causal role and clinical applicability require clarification. While CRP-guided therapies show promise, discrepancies in guidelines highlight the need for robust trials to determine whether targeting CRP directly improves outcomes. Future research should focus on CRP's pathophysiological mechanisms and validate its utility in personalized CVD management.

Background: Cannabis use has been steadily rising in the United States and can have multiple adverse effects, including cannabis-induced acute pancreatitis. This study aims to collate and highlight the significant demographics, clinical presentation, and outcomes in patients with cannabis-induced acute pancreatitis. Method: A systematic literature search of electronic databases for peer-reviewed articles was conducted. After an initial search, we found 792 articles through different electronic databases. After manually removing duplicates and articles that did not meet the criteria, 25 articles were included in our review. Results: A total of 45 patients were studied, 35 (78%) cases were male and 10 (22%) cases were female, showing male predominance. The mean age of all participants was 29.2 ± 10.3 years. The most common presenting symptoms were abdominal pain 21 of 21 (100%), nausea 17 of 21 (81%), and vomiting 12 of 20 (60%). Ultrasound was normal in the majority of patients, with findings of mild pancreatitis. Computerized tomography scans revealed pancreatic edema and inflammation in 7 of 20 (35%) patients, and findings of necrotizing pancreatitis and complex fluid collection were visualized in 3 of 20 (15%) patients. Dilatation of intrahepatic or extrahepatic biliary ducts was not seen in any patients. The overall prognosis was good, with reported full recovery. Conclusions: Cannabis should be included in the differential diagnosis for the etiology of acute pancreatitis, which would help in early intervention and treatment for the mitigation of the rapidly progressive disease.

Objective: We aim to study the clinical characteristics and outcomes of acute ischemic stroke (AIS) in patients with and without systemic lupus erythematosus (SLE). Methods: We conducted a retrospective cohort study using the National Inpatient Sample (2016–2021) to analyze AIS hospitalizations among patients with and without SLE. Outcomes included in‐hospital mortality (primary) and secondary endpoints such as mechanical ventilation, intracerebral hemorrhage, acute kidney injury (AKI), blood transfusion, length of stay, and hospitalization costs. Propensity score matching was performed to adjust for baseline characteristics, and multivariable logistic regression assessed outcome associations, incorporating stroke severity (NIH Stroke Scale). Results: Among 3 678 244 AIS hospitalizations, 18 975 (0.52%) involved SLE patients. SLE patients were younger (mean age 58.1 vs. 69.8 years, p < 0.001), predominantly female (86.7% vs. 49.4%, p < 0.001), and had higher rates of chronic kidney disease and anemia but lower rates of atrial fibrillation and hyperlipidemia. Unadjusted analysis showed lower in‐hospital mortality in SLE patients (5.85% vs. 6.67%, p = 0.04), which persisted after propensity matching (adjusted OR 0.70, 95% CI 0.60–0.82). However, adjusting for NIHSS attenuated this association (OR 0.96, 95% CI 0.67–1.38), suggesting the mortality benefit was largely driven by less severe strokes in the SLE group. Conclusions: While SLE patients hospitalized for AIS exhibited lower in‐hospital mortality, this was primarily attributable to lower stroke severity at presentation. Further research is needed to validate these findings.

Background: Chronic steroid (CS) therapy was reportedly linked to increased vascular complications following percutaneous coronary intervention. However, its association with vascular complications after transcatheter aortic valve replacement (TAVR) remained uncertain, with conflicting results being reported. Objective: The authors aimed to compare the rate of vascular complications and outcomes between patients with and without CS use after TAVR. Methods: The authors conducted a comprehensive literature search in PubMed, Embase, and Cochrane databases from their inception until 18th April 2022 for relevant studies. Endpoints were described according to Valve Academic Research Consortium-2 definitions. Effect sizes were pooled using DerSimonian and Laird random-effects model as risk ratio (RR) with 95% CI. Results: Five studies with 6136 patients undergoing TAVR were included in the analysis. The included studies were published between 2015 and 2022. The mean ages of patients in both study groups were similar, with the CS group averaging 80 years and the nonsteroid group averaging 82 years. Notably, a higher proportion of patients in the CS group were female (56%) compared to the nonsteroid group (54%). CS use was associated with a significantly higher risk of major vascular complications (12.5 vs. 6.7%, RR 2.32, 95% CI: 1.73–3.11, P<0.001), major bleeding (16.8 vs. 13.1%, RR 1.61, 95% CI: 1.27–2.05, P<0.001), and aortic annulus rupture (2.3 vs. 0.6%, RR 4.66, 95% CI: 1.67–13.01, P<0.001). There was no significant difference in terms of minor vascular complications (RR 1.43, 95% CI: 1.00–2.04, P=0.05), in-hospital mortality (2.3 vs. 1.4%, RR 1.86, 95% CI: 0.74–4.70, P=0.19), and 30-day mortality (2.9 vs. 3.1%, RR 1.14, 95% CI: 0.53–2.46, P=0.74) between both groups. Conclusion: Our study showed that CS therapy is associated with increased major vascular complications, major bleeding, and annulus rupture following TAVR. Further large multicenter studies or randomized controlled trials are warranted to validate these findings.