Aim: To develop a prognostic model and identify risk factors that may lead to cognitive decline 5-7 years after coronary artery bypass surgery.
Materials and methods. The observational prospective study included 146 patients with an average follow-up period of 6.4 years. The patients underwent general clinical, neurological, and instrumental examinations 3-5 days before and 5-7 years after surgery. Neuropsychological testing included assessment of psychomotor and executive functions, attention, and short-term memory. The method of binary logistic regression was used to build a predictive model.
Results. Cognitive decline, characterized by a≥20% decrease in postoperative cognitive indicators compared to the preoperative level in ≥20% of the total test battery, was detected 5-7 years after surgery in 67 (45.9%) patients. Neurodynamic disorders occurred in 60% of patients, while violations of verbal and symbolic short–term memory occurred in 20-25% of cases. It was found that the presence of carotid artery stenosis (CA), smoking, low ejection fraction, and high triglyceride levels are associated with the development of cognitive decline 5-7 years after CABG. With the initial cut-off threshold (0.5), the most effective ratio of sensitivity (0.61) and specificity (0.82) was selected, which ensures the successful determination of both the presence and absence of cognitive decline and indicates the good quality of the predictive model.
Conclusion. Five to seven years after CABG surgery, 46% of patients experience a decrease in cognitive functions, manifested in the form of neurodynamic disorders, as well as deterioration of short-term memory. The factors included in the prognostic model were CA stenosis, low left ventricular ejection fraction, and high triglyceride levels, as well as smoking in patients. This indicates the need to improve approaches to postoperative follow-up of patients who have undergone cardiac surgery to minimize adverse neurological consequences.

Background and aim. The relationship between coronary artery disease (CAD) and cognitive impairment (CI) has been established, but the neural mechanisms that underlie this interaction have yet to be identified. CAD patients may exhibit specific manifestations of CI, underscoring the importance of early diagnosis. EEG activity changes are a valuable diagnostic tool to detect brain pathology. The study aimed to investigate the effects of CAD on EEG activity with intact cognitive status and CI.

Methods. The study involved 132 patients with stable coronary artery disease (CAD) aged 45 to 75 years. According to the Montreal Cognitive Assessment Scale (MoCA) results, the patients were divided into two groups: those without CI (no CI), with MoCA scale sum scores ranging from 27 to 30 (n = 37), and those with CI, with MoCA scale sum scores ranging from 20 to 26 (n = 95). The group of practically healthy elderly subjects consisted of 63 individuals aged 43 to 78 years. All patients and healthy participants underwent an EEG study. The mean values of the spectral power density were calculated in the frequency band of 4-30 Hz for the electrode areas symmetrically located in the left and right hemispheres: frontal, central, temporal, parietal, and occipital.

Results. Theta and alpha 2 power values were lower for the healthy elderly group compared to CAD patients, both with and without CI. Furthermore, CAD patients without CI had higher alpha 2 power values than the CI group. The topographic features of the differences in the theta 1 rhythm between the practically healthy elderly group and CAD patients were related to the frontal and temporal areas in patients without CI, as well as to the frontal, temporal, and occipital areas of the brain in the CI group.

Conclusion. The study's data can be used to develop diagnostic tools for identifying cognitive impairment in patients with coronary heart disease at early stages.

Background:
Hypertension is one of the leading contributors to cardiovascular and renal disease worldwide, and its burden is particularly concerning in low-resource settings such as Yemen. The dual impact of heart disease (HD) and kidney disease (KD) places patients at an even higher risk of adverse outcomes. Despite the high prevalence of hypertension, there remains a gap in understanding the interplay of demographic, clinical, and lifestyle-related risk factors in the Yemeni population.

Objective:
This study aimed to identify factors associated with hypertension among HD and KD patients in Sana’a, thereby providing evidence to guide targeted prevention and management strategies.

Methods:
A cross-sectional study was conducted between March and August 2024 involving 300 patients (200 men, 100 women) aged 35–70 years. Sociodemographic and clinical data, including age, sex, body weight, smoking history, Qat chewing habits, comorbid diabetes, and adherence to antihypertensive medications, were collected through structured interviews and clinical records. Blood pressure was measured using a standardized sphygmomanometer. Logistic regression analysis was performed to estimate odds ratios (ORs) with 95% confidence intervals (CIs) for variables associated with hypertension.

Results:
Hypertension was significantly associated with increasing age (OR: 1.08; 95% CI: 1.02–1.11), obesity (OR: 2.42; 95% CI: 1.23–4.75), smoking (OR: 1.88; 95% CI: 1.05–3.35), type 2 diabetes (OR: 2.87; 95% CI: 1.56–4.55), and irregular use of antihypertensive medication (OR: 3.21; 95% CI: 1.45–7.11). Notably, all participants reported regular Qat chewing (100%), reflecting its entrenched cultural presence.

Conclusion:
Age, obesity, smoking, diabetes, and poor medication adherence emerged as major predictors of hypertension among Yemeni HD and KD patients. The universal irregularity in medication use and widespread Qat chewing highlight systemic healthcare challenges and cultural influences. Strengthening adherence support, promoting healthier lifestyles, and improving healthcare delivery are urgently required to reduce hypertension-related complications in this high-risk population.

Background:
The use of statins for cardiovascular disease prevention is widespread, yet their safety in the elderly, particularly those aged ≥75 years, remains under scrutiny due to polypharmacy, altered pharmacokinetics, frailty, and age-related physiological changes. Evidence is further limited because older adults are frequently underrepresented in randomized trials, leaving uncertainty regarding long-term tolerability, functional outcomes, and interactions with commonly prescribed medications. This systematic review aims to assess the safety of statin use in elderly populations.

Methods:
We conducted a systematic review in accordance with the PRISMA 2020 guidelines. Databases searched included PubMed and Cochrane CENTRAL (last search conducted in July 2025). We included studies reporting adverse outcomes of statin therapy in patients aged ≥65 years. Data on study design, population characteristics, and reported adverse effects were extracted for review and analysis. The risk of bias was assessed using the Cochrane RoB2 and Newcastle–Ottawa tools.

Results:
Of the 248 initial articles, 7 studies (4 RCTs, 2 cohort studies, 1 meta-analysis) met the inclusion criteria. Across these studies, statins were generally well-tolerated. Myopathy and elevated liver enzymes were reported, but had a low incidence. No consistent increase in serious adverse events (e.g., rhabdomyolysis, cognitive decline) was observed in elderly cohorts compared to younger groups. One observational study noted a higher discontinuation rate in adults ≥80 years, largely due to patient preference or comorbidities rather than toxicity.

Conclusion:
Statins appear to have an acceptable safety profile in the elderly populations, including the very elderly, though individualized risk-benefit assessments remain essential. Future studies should explore safety in frail subpopulations and clarify long-term tolerability, particularly regarding drug–drug interactions, multimorbidity, and functional outcomes. These findings may support more confident prescribing in age groups that have been historically underrepresented in trials and guide geriatric-focused clinical decision-making.

Background

Sepsis and chronic kidney disease (CKD) are major causes of mortality in the U.S. However, national trends in mortality involving both conditions remain poorly defined.

Methods

This cross-sectional study analyzed CDC WONDER data (1999–2023) to examine mortality trends related to CKD–sepsis (ICD-10: N18, A40, A41) among U.S. adults aged 45 years or older. Age-adjusted and crude mortality rates (AAMRs, CMRs) were calculated per 100,000 population and stratified by gender, age, race, urbanization, region, state, place of death, and ICD-10 subcodes. Annual and average annual percentage changes (APCs, AAPCs) in trends were assessed using Joinpoint regression.

Results

CKD–sepsis mortality remained stable from 1999 to 2023, with AAMR rising from 7.5 to 9.0 per 100,000 by 2019 (APC = 0.60%, 95% CI: -0.21 to 1.51), then declining from 10.3 in 2020 to 9.7 in 2023 (APC = -2.6%, 95% CI: -6.96 to 1.81). Of 270,746 CKD–sepsis-related deaths, 51.5% were male, with consistently higher AAMRs and a significant rise through 2019. Black individuals consistently had the highest AAMRs throughout the study. From 1999 to 2019, rates declined across all racial groups except Whites. By 2023, Black AAMR (21.1) remained over twice that of Whites (8.0), Asian/Pacific Islanders (8.3), and Hispanics (10.4). The CMR gap between the 45-54 and ≥85 groups widened from a 9-fold to a 23-fold difference over the study period. DC had the highest AAMR (22.5), while Montana had the lowest (4.1). AAMRs in medium-sized and small, as well as non-metropolitan areas, rose significantly, surpassing those in large metropolitan areas. Regionally, the South had the highest AAMR throughout, increasing from 8.8 to 10.7. The majority (92.91%) of deaths were attributed to unspecified septicemia.

Conclusion

CKD–sepsis-related mortality remained relatively stable from 1999 to 2023, though certain populations, particularly males, older adults, Black individuals, and residents of the South, experienced consistently higher mortality rates.

Abstract

Background: Since the efficacy and safety of endovascular thrombectomy (EVT) in patients with acute ischemic stroke with a large infarct area is still inconclusive, we sought to compare functional and neurological outcomes with the use of endovascular thrombectomy versus medical care alone.

Methods: We searched MEDLINE (via PubMed), Embase, Cochrane Library, ClinicalTrials.gov, and the International Clinical Trials Registry Platform (ICTRP) to retrieve all the relevant randomized controlled trials (RCTs) on this topic. Review Manager (RevMan) was used to perform meta-analyses using a random-effect model. Dichotomous outcomes were pooled using risk ratios (RR) with 95% confidence intervals (CIs).

Results: Our meta-analysis included 6 RCTs with a total of 1665 patients. Most studies included patients with an ASPECTS score of 3-5. Our results demonstrate that endovascular thrombectomy significantly increased the rates of functional independence (mRS ≤ 2) (RR, 2.49; 95% CI, 1.89-3.29) and moderate neurological outcome (mRS ≤ 3) (RR, 1.90; 95% CI, 1.50-2.40) at 90 days. The benefit of EVT for these outcomes remained unchanged at the 1-year follow-up. Endovascular thrombectomy was associated with increased rates of early neurological improvement (RR, 2.22; 95% CI, 1.53-3.22), excellent neurological recovery (mRS ≤ 1) (RR, 1.75; 95% CI, 1.02-3.03), and decreased rate of poor neurological recovery (mRS 4-6) (RR, 0.81; 95% CI, 0.76-0.86). No significant difference was found between the two groups regarding all-cause mortality (RR, 0.86; 95% CI, 0.72-1.02), decompressive craniectomy (RR, 1.32; 95% CI, 0.89-1.94), and the incidence of serious adverse effects (RR, 1.39; 95% CI, 0.83-2.32) between the two groups. Endovascular thrombectomy significantly increased the rates of any intracranial hemorrhage (relative risk [RR], 1.94; 95% confidence interval [CI], 1.48-2.53) and symptomatic intracranial hemorrhage (RR, 1.73; 95% CI, 1.11-2.69).

Conclusion: Endovascular thrombectomy (EVT) significantly improves neurological and functional outcomes in patients who present within 6 hours of stroke onset with ICA and proximal M1 occlusions, and ASPECTS scores ranging from 3 to 5, compared to medical therapy alone, with an increased risk of symptomatic intracranial hemorrhage.