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Inter-arm blood pressure differences (IABPDs) can be caused by atherosclerosis. We investigated 29 921 men and women aged 50-64 years from the nationwide population-based Swedish CArdio Pulmonary bioImage Study (SCAPIS) to evaluate if IABPD is related to risk factors for atherosclerosis and can be used as a marker of atherosclerosis as evaluated by coronary artery calcium score, arterial segment involvement score on computed tomography, carotid ultrasound, and ankle-brachial index (ABI).

The overall prevalence of systolic IABPD at least 10 mmHg was 2110/29 921 (7.1%). Individuals with IABPD at least 10 mmHg were significantly ( P  < 0.001) older, more often women, had higher BMI, nonhigh-density lipoprotein cholesterol, triglycerides, SBP and DBPs, and were more likely to have diabetes. In unadjusted analyses, IABPD at least 10 mmHg was associated with presence of coronary atherosclerosis, with more carotid arteries with plaque, and with pathological ABI. These associations were largely attenuated after adjustment for cardiovascular risk factors (age, sex, nonhigh-density lipoprotein cholesterol, systolic BP, smoking, diabetes, and the use of BP lowering drugs). Only ABI retained significance after these adjustments.

In conclusion, a systolic IABPD of at least 10 mmHg in middle aged men and women is common in the general population, and can be used as a screening tool for subclinical atherosclerotic changes in coronary, carotid, and lower extremity arteries. However, these relationships were largely explained by correlations between IABPD and traditional cardiovascular risk factors.

Rationale & Objective: The association between body mass index (BMI) and chronic kidney disease (CKD) is well established in middle-aged and older adults. Here, we assess the association of BMI in late adolescence with CKD, kidney failure, and acute kidney injury (AKI) later in life.

Study Design, Setting & Participants: Population- based cohort study including data from the Swedish Conscription Database, the National Patient Register, the Cause of Death Register, and Statistics Sweden. Conscripts with no history of diabetes, cardiovascular, kidney, or rheumatic diseases enlisted between 1969 and 1997 were followed until December 31, 2019.

Main Outcomes & Exposures: The study examined the impact of BMI on kidney outcomes. The primary outcome was incident chronic kidney disease. Secondary outcomes were stage 5 chronic kidney disease, end-stage kidney disease, and acute kidney injury.

Analytical Approach: Patients were stratified into the quintiles of BMI at conscription, and followed until events, death, or censoring, using Cox proportional hazards model, adjusted for baseline systolic and diastolic blood pressure, proteinuria, and socioeconomic factors.

Results: In total, 1,321,481 male participants with a mean age of 18.3 years and a mean BMI of 21.6 kg/m2 were followed for an average of 35.6 years, generating a total of 47 million person-years of follow-up. During this period, the incidence of CKD-based on diagnosis codes was 5,590, whereas 2,357 subjects were diagnosed with end-stage kidney disease and 8,023 with AKI, respectively. The risk for CKD was increased for the fourth and fifth highest BMI quintile relative to the lowest (adjusted hazard ratio [aHR] 1.23; 95% confidence interval [CI], 1.13-1.35 for BMI 21.9-23.5 kg/m2; aHR 2.09; 95% CI, 1.93-2.26 for BMI >23.5 kg/m2). Patterns were similar for stage 5 CKD and end-stage kidney disease, whereas the risk for AKI was evident at the third and higher quintiles (aHR 1.14; 95% CI, 1.061.23 for BMI 20.7-21.9 kg/m2; aHR 1.31; 95% CI, 1.22-1.41 for BMI 21.9-23.5 kg/m2; and aHR 1.92; 1.79-2.05 for BMI >= 23.5 kg/m2).

Limitations: A retrospective observational study of male Swedish adolescents.

Conclusions: The findings of this study indicate that, for prevention of kidney disease, the optimal BMI in adolescence with reference to kidney outcomes is likely in the low-normal range.

Objective: To examine the association between adolescent cardiorespiratory fitness and risk of type 2 diabetes in late adulthood, including the potential influence of unobserved familial confounding on the association.

Design: Nationwide sibling controlled cohort study.Setting Swedish Military Service Conscription Register, Sweden, 1972-95, with Multi-Generation Register for identifying full siblings. National Patient Register and Prescribed Drug Register for data on diagnoses of type 2 diabetes, deaths from National Cause of Death Register, and Statistics Sweden for emigration and socioeconomic data.

Participants: 1 124 049 Swedish men who participated in mandatory military conscription examinations with completed standardised cardiorespiratory fitness testing. Participants were followed up until 31 December 2023.Main outcome measures Type 2 diabetes, defined as a composite endpoint of diagnosis in inpatient or specialist outpatient care and dispensation of antidiabetic drug treatment, until 31 December 2023.

Results: 1 124 049 men, including 477 453 full siblings, with a mean age of 18.3 (standard deviation 0.7) years at baseline were included. During follow-up, 115 958 men (10.3%) and 48 089 full siblings (10.1%) had a first type 2 diabetes event at a median age of 53.4 (interquartile range 47.6-59.3) years. Cardiorespiratory fitness was categorised into deciles (referred to as groups, with group 1 being the lowest fitness level and group 10 the highest). In a cohort analysis, the adjusted hazard ratio in fitness group 2 versus fitness group 1 was 0.83 (95% confidence interval (CI) 0.81 to 0.85), with a difference in the standardised cumulative incidence at age 65 years of 4.3 (95% CI 3.8 to 4.8) percentage points, decreasing to a hazard ratio of 0.38 (0.36 to 0.39; incidence difference 17.8 (17.3 to 18.3) percentage points) in fitness group 10. When comparing full siblings, and thus controlling for all unobserved shared behavioural, environmental, and genetic confounders, the association was replicated, but with a reduction in magnitude. The hazard ratio in fitness group 2 was 0.89 (95% CI 0.85 to 0.94; incidence difference 2.3 (1.3 to 3.3) percentage points) and 0.53 (0.50 to 0.57; incidence difference 10.9 (9.7 to 12.1) percentage points) in fitness group 10. Hypothetically moving all participants in fitness group 1 to fitness group 2 was estimated to prevent 7.2% (95% CI 6.4% to 8.0%) of events at age 65 years in the cohort analysis versus 4.6% (2.6% to 6.5%) in the full sibling analysis, whereas hypothetically moving all participants to fitness group 10 was estimated to prevent 35.6% (34.1% to 37.0%) versus 24.3% (20.5 to 28.0) of events. Indications of effect modification by overweight status were found, where the association was smaller in those with overweight than in those without overweight, particularly in the full sibling analysis.

Conclusions: The findings indicate that adolescent cardiorespiratory fitness could be important in the development of type 2 diabetes in late adulthood, but conventional observational analysis might give biased estimates of the magnitude of the effect.

Aims: Low Carbohydrate High Fat (LCHF) diets are popular for weight loss or glucose control. The main source of energy in such diets is fat but the composition of nutrients varies. This study aims to investigate dietary variations in a real-world LCHF population and its associations with cardiovascular risk factors.

Methods: We recruited 100 volunteers who considered themselves adherent to a LCHF diet. Their last 14 days of dietary intake was assessed using diet history interviews. Validation of energy intake against expenditure was made using activity monitors. Predictive variables for the linear regression models were selected using stepwise bidirectional assessment of Akaike information criterion (AIC).

Results: Energy intake (E%) from carbohydrates was low, 8.7 E%, and fat was the main replacement. Dietary cholesterol was associated with higher total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL). Dietary sodium intake was associated with higher blood pressure. Protein intake was associated with lower diastolic blood pressure but also with lower HDL. The intake of dietary fibre was associated with lower LDL and total cholesterol but with higher hemoglobin A1c (HbA1c). The intake of carbohydrates and saturated fatty acids (SFA) was not associated with any of the outcome variables.

Conclusion: In this LCHF population, variations in intake of carbohydrates and saturated fatty acids could not predict any aspects of the cardiovascular risk profile. Lower fibre intake and higher cholesterol and sodium intake predicted a less favorable cardiovascular risk profile.

Recent studies have renewed the debate over optimal systolic blood pressure (SBP) targets in hypertensive patients, particularly those at increased cardiovascular (CV) risk and with type 2 diabetes mellitus (T2DM). The Effects of Intensive Systolic Blood Pressure Lowering Treatment in Reducing Risk of Vascular Events (ESPRIT) and Blood Pressure Control Target in Diabetes (BPROAD) randomized controlled trials, both conducted in Chinese populations, offer new insights into intensive versus standard SBP-lowering strategies. ESPRIT enrolled 11,255 patients with high CV risk (including 38.7% with T2DM), while BPROAD included 12,821 hypertensive patients with T2DM and elevated CV risk. Both trials compared intensive SBP lowering (< 120 mmHg) with standard treatment (< 140 mmHg). Results from both studies showed that intensive treatment significantly reduced the incidence of major adverse cardiovascular events (MACE). ESPRIT reported a hazard ratio (HR) of 0.88 for MACE, along with notable reductions in CV and all-cause mortality. BPROAD similarly found a HR of 0.79 for MACE, although it did not demonstrate a statistically significant benefit in all-cause mortality. However, intensive treatment in both trials was associated with higher—though relatively low—absolute rates of adverse events, including hypotension, syncope, and renal impairment. When considered alongside previous trials, our meta-analysis suggests a consistent reduction in MACE risk with intensive SBP control. Nevertheless, concerns remain regarding the safety profile and generalizability of these findings, particularly given that both ESPRIT and BPROAD were limited to ethnically Chinese cohorts and reported unusually low adverse event rates compared to Western studies. In summary, the cumulative evidence suggests that an SBP target < 140 mmHg may be suboptimal. However, whether a target < 120 mmHg is superior to the current guideline-recommended range of 120–129 mmHg remains uncertain. No trials have directly compared < 120 mmHg with < 130 mmHg. Therefore, future research should determine whether the additional benefits of more aggressive SBP lowering outweigh potential risks, especially in diverse populations with and without diabetes.

Objective: This systematic review and meta-analysis aims to estimate the prevalence of high blood pressure (BP) and hypertension among European children and adolescents (1990–present).

Methods: We included population-based cross-sectional and cohort studies reporting BP in children (≤18 years) from European countries, excluding studies from electronic health records or specialist care referrals. PubMed was searched on 27 January 2025. Risk of bias was assessed with the Hoy et al tool, and data were pooled using random-effects meta-analysis. The main outcomes were pooled prevalence of high BP and hypertension.

Results: We analysed 56 studies (n=179 279, mean age, 12 years) from 18 European countries. The prevalence of high BP was 8% (95% CI 7% to 10%), higher in boys (7%, 95%CI 6% to 9%) than in girls (5%, 95%CI 4% to 7%). Among children with obesity, prevalence was 23% (95% CI 18% to 29%) vs 6% (95% CI 4% to 9%) in children without obesity. Prevalence was highest in 10–13 years old (8% (95% CI 5% to 13%) compared with 6% (95% CI 4% to 8%) and 6% (95% CI 3% to 9%) in 3–9 years old and 14–19 years old, respectively. The prevalence of hypertension was 4% (95% CI 3% to 5%). Risk of bias was judged to be moderate or high for most studies, with variability in BP measurement methods.

Conclusions: The prevalence of high BP and hypertension among European children and adolescents is considerable, particularly among those with obesity, where one-fourth has high BP. It is more common in boys and peaks during puberty. These findings should be interpreted with caution due to methodological limitations of the included studies.

Objective: The objective was to investigate 10-year mortality, causes of death and cardiovascular comorbidity in idiopathic normal pressure hydrocephalus (iNPH) and to evaluate their mutual associations.

Methods: This prospective cohort study included 176 CSF-shunted iNPH patients, and 368 age- and sex-matched controls. At inclusion, participants were medically examined, had blood analyzed and answered a questionnaire. The vascular comorbidities investigated were smoking, diabetes, body mass index, blood pressure (BP), hyperlipidemia, kidney function, atrial fibrillation and, cerebro- and cardiovascular disease.

Results: Survival was observed for a mean period of 10.3 ± 0.84 years. Shunted iNPH patients had an increased risk of death compared to controls (hazard ratio (HR) = 2.5, 95% CI 1.86–3.36; p < 0.001). After 10 years, 50% (n = 88) of iNPH patients and 24% (n = 88) of the controls were dead (p < 0.001). The risk of dying from cardiovascular disease, falls and neurological diseases were higher in iNPH (p < 0.05). The most common cause of death in iNPH was cardiovascular diseases (14% vs 7% for controls). Seven out of nine iNPH dying from falls had subdural hematomas. Systolic BP (HR = 0.985 95% CI 0.972–0.997, p = 0.018), atrial fibrillation (HR = 2.652, 95% CI 1.506–4.872, p < 0.001) and creatinine (HR = 1.018, 95% CI 1.010–1.027, p < 0.001) were independently associated with mortality for iNPH.

Discussion: This long-term and population-matched cohort study indicates that in spite of CSF-shunt treatment, iNPH has shorter life expectancy. It may be important to treat iNPH in supplementary ways to reduce mortality. Both cardiovascular comorbidities and lethal falls are contributing to the excess mortality in iNPH and reducing these preventable risks should be an established part of the treatment plan.