ASIDE Cardiovascular Journal is a peer-reviewed, open-access journal published and owned by PubPorta Publishing LLC, 16192 Coastal Highway, Lewes, Delaware 19958, USA. Academic oversight and scholarly guidance are provided by the American Society for Inclusion, Diversity, and Equity in Healthcare (ASIDE). The journal is dedicated to advancing cardiovascular medicine through the publication of high-quality scholarly work across cardiovascular disease, vascular medicine, preventive cardiology, cardiac imaging, electrophysiology, heart failure, interventional cardiology, cardiac surgery, and related disciplines. It promotes diversity, equity, inclusion, and accessibility in healthcare by highlighting disparities in cardiovascular outcomes, inclusive clinical approaches, the role of social determinants of health, and strategies to improve access to timely diagnosis, evidence-based treatment, and long-term cardiovascular care for underserved and marginalized populations. It serves as an international platform for clinicians, researchers, educators, and public health professionals to share knowledge that strengthens patient care, supports education, and advances more equitable cardiovascular practice and policy.
Copyright and Licensing All articles published in ASIDE Cardiovascular are open access and freely available online immediately upon publication, without embargo. This journal applies the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0). Under this license, anyone may copy, redistribute, remix, transform, and build upon the material for any purpose, even commercially, provided that proper credit is given to the original author(s), a link to the license is provided, and any changes made are indicated. License link: https://creativecommons.org/licenses/by/4.0/ Machine-readable license metadata is embedded in each article and its DOI record. Copyright Holder Copyright in all articles remains with the author(s). By submitting a manuscript, authors agree to grant the publisher (American Society for Inclusion, Diversity, and Equity in Healthcare – ASIDE) a non-exclusive license to publish and distribute the work under the terms of the CC BY 4.0 license. Third-party Material Any material (e.g., images, figures, or tables) not covered by CC BY 4.0 will be clearly indicated in the article. Users must obtain permission directly from the copyright holder for reuse of such third-party material. Author Rights and Self-Archiving Authors are permitted to deposit all versions of their work (preprint, author’s accepted manuscript, and version of record) in institutional or subject repositories of their choice immediately upon publication, without embargo, provided that the DOI and license information are included.
Ac-SDKP Maintains Coronary Microvascular Barrier Function and Prevents Radiation-induced Cardiac Injury
Background: Radiation‑induced cardiomyopathy is a significant late complication in cancer survivors treated with thoracic radiation, with few preventive options. Early injury is characterized by coronary microvascular endothelial dysfunction and increased vascular permeability. Claudin‑1 (Cldn1), a tight junction protein in endothelial cells, plays a key role in maintaining vascular barrier integrity. This study investigated whether the endogenous tetrapeptide N‑acetyl‑Ser‑Asp‑Lys‑Pro (Ac‑SDKP) preserves cardiac microvascular barrier function and mitigates early radiation‑associated cardiac injury in preclinical models. Methods: Human coronary microvascular endothelial cells (HMVECs) were exposed to ionizing radiation (IR) with preventive Ac‑SDKP treatment. Endothelial barrier function was assessed using FITC‑dextran permeability and transendothelial electrical resistance (TEER). In vivo, mice received fractionated left thoracic irradiation (3 Gy/day, 5 days/week; total 45 Gy). Ac‑SDKP (3.2 mg/kg/day) was administered via subcutaneous osmotic minipump starting one day prior to irradiation and continued throughout the study. Cardiac vascular leakage was measured by Evans blue extravasation at early and chronic time points, and left ventricular (LV) function was evaluated by cardiac MRI. Results: IR decreased Cldn1 expression, increased endothelial permeability, and reduced TEER in HMVECs. Preventive Ac‑SDKP preserved Cldn1 expression and significantly reduced IR‑induced permeability, although TEER recovery was partial. In mice, irradiation reduced cardiac Cldn1 levels, increased vascular leakage, and impaired LV function. Ac‑SDKP reduced early leakage and improved selected functional measures, with no significant effect on chronic permeability. Conclusion: Preventive Ac‑SDKP attenuates radiation‑related cardiac microvascular dysfunction and partially preserves cardiac function, likely through maintenance of endothelial barrier integrity and Cldn1 expression suggesting potential vascular protective pathways.
Copyright (c) 2026 Sarmila Nepali, Badri Karthikeyan, Swati D Sonkawade, Supriya D Mahajan, Joseph Spernyak, Umesh C Sharma, Saraswati Pokharel https://creativecommons.org/licenses/by/4.0
Cardiogenic Shock and Sepsis-Related Mortality in the United States, 1999-2025: National Trends, Disparities, and Forecasts to 2040
Background: Cardiogenic shock (CS) complicated by sepsis is a life-threatening condition marked by circulatory collapse and systemic inflammation, with persistently high mortality despite critical care advances. National trends and disparities remain unclear. This study aimed to evaluate temporal mortality trends from 1999 to 2025 and project rates through 2040. Methods: We conducted a population-based study using U.S. mortality data (1999–2025) from the CDC WONDER database. Deaths among adults aged ≥25 years with CS and sepsis were identified using ICD-10 codes. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated. Joinpoint regression estimated annual percent change (APC) and average annual percent change (AAPC). Forecasting models projected mortality trends through 2040. Results: From 1999 to 2025, 71,726 deaths occurred; 97.09% in medical facilities. Overall, AAMR rose from 0.65 to 2.16 (AAPC 5.01%, p < 0.001) and is projected to reach 3.62 by 2040. Men had higher mortality than women (2025: 2.78 vs 1.65; AAPC 5.06% vs 4.91%). In 2025, AAMR was 3.75 among NH Black individuals, 1.98 among NH White individuals, and 2.01 among Hispanic individuals. Adults ≥65 years had the highest CMR (7.50 in 2025; AAPC 4.63%), with the largest relative increase in ages 25–44 (AAPC 7.19%). Conclusion: CS with sepsis mortality increased significantly from 1999 to 2025, particularly among men, NH Black individuals, and adults ≥65 years. Although recent trends have stabilized, projections indicate continued increases through 2040, highlighting persistent and widening demographic disparities in the mortality burden.
Copyright (c) 2026 Karim Othman Abdelnaim, Alaa Eldeeb, Alyaa Ahmed Ibrahim, Raveen Mujeeb, Mohammad Rayyan Faisal, Amro Ali, Salem K. Qupp, Bassam Hegazy, Amr Ibrahim, Ibtissam ElGhazzani, Mohamed Zabady, Sihame ElGhazzani, Walid Bechibchi, Ilhame ElGhazzani, Mahdi Ahmed, Abdelrhman H. Mohamed, Mohamed Fawzi Hemida https://creativecommons.org/licenses/by/4.0
Trends and Disparities of CVD Underlying-Cause Deaths with Pneumonia and Influenza Mentioned on the Death Certificate in the United States: A CDC WONDER Analysis.
Background: Pneumonia and influenza (P&I) may precipitate cardiovascular decompensation, yet long-term U.S. mortality patterns of P&I co-mention at death among cardiovascular disease (CVD) deaths are not well described across sociodemographic and geographic strata. Methods: Using CDC WONDER multiple-cause-of-death data, we identified deaths with CVD as the underlying cause (ICD-10 I00–I99) and P&I (J09–J18) mentioned anywhere on the death certificate. We calculated crude and age-adjusted mortality rates (AAMR, per 100,000; 2000 U.S. standard), assessed 1999–2023 trends with Joinpoint regression, selected descriptive subgroup and interstate mapping summaries used 1999–2020. Results: AAMR declined from 29.58 (1999) to 8.45 (2023) (-71.4%), with joinpoints in 2005, 2009, and 2019 and a plateau after 2019. Mortality increased with age; adults ≥85 years accounted for 47.3% of deaths and the highest crude rate (277.9 per 100,000). In 2023, AAMR was higher in males than in females (10.69 vs 6.73). Rates were higher in Black than White decedents (10.7 vs 9.5 per 100,000) and highest in rural areas, with marked interstate heterogeneity. Conclusions: AAMRs declined during 1999–2023 but plateaued after 2019, with heterogeneity by age, geography, and race/ethnicity. These descriptive co-mention patterns highlight higher-rate groups and areas that may warrant prioritization for further investigation and prevention planning; they do not establish causal pathways or quantify the impact of structural determinants.
Copyright (c) 2026 Ahmed A. Badawi, Amjad S. Ibrahim, Mohammad A. Badawi, Aseel M. Shalalfeh, Ameen M. Bsharat, Maram M. Abukhalil, Anwar Zahran, Mohammad Bdair https://creativecommons.org/licenses/by/4.0
Long-Term Mortality Trends in Atrial Fibrillation and Renal Disease in the United States, 1999–2023: A Retrospective Analysis
Background: The coexistence of atrial fibrillation (AF) and renal disease is a significant contributor to mortality and morbidity. However, comprehensive national mortality trends for AF among older adults with renal disease, including demographic and geographic variations, remain largely unexamined. Methods: We performed a retrospective analysis of U.S. adult deaths (≥65 years) from 1999 to 2023 using the CDC WONDER Multiple Cause of Death database. Deaths were included when atrial fibrillation and kidney disease appeared in any mention field of the death certificate, regardless of the underlying cause of death. We calculated crude and age-adjusted mortality rates (CMR, AAMR) per 100,000 population, and temporal trends were assessed using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC). Results: A total of 372,652 deaths were attributed to both AF and renal disease in older adults. The national AAMR increased more than threefold, from 16.67 in 1999 to 54.45 per 100,000 in 2023 (AAPC: 5.10; p < 0.001). Men had higher absolute mortality, but women experienced a slightly steeper increase in AAMR. Non-Hispanic White individuals had the highest absolute mortality, while all racial/ethnic groups showed significant increases. The South reported the most deaths, the Northeast had the highest AAMR, and non-metropolitan areas consistently showed higher AAMR than metropolitan areas. Most deaths occurred in medical facilities (54.55%). Conclusions: Mortality from AF and renal disease has substantially risen over the past 25 years, with marked disparities by sex, race/ethnicity, geography, and urbanization.
Copyright (c) 2025 Mohamed Fawzi Hemida, Alyaa Ahmed Ibrahim, Muhammad Raza Sarfraz, Anika Goel, Mirna Hussein, Mohammad Rayyan Faisal, Mahmoud Tablawy, Krish Patel, Noha Hammad, Maryam Saghir , Eshal Saghir, Aamer Ahmad, Muhammad Faizan Ali, Amro Ali, Ahmad M. Abdelkhalek, Raheel Ahmed (Author) https://creativecommons.org/licenses/by/4.0
Hypoxemia After Inferior Atrial Septal Defect Repair Due to Iatrogenic Diversion of Inferior Vena Cava to Left Atrium: A Case Report
Iatrogenic diversion of the inferior vena cava (IVC) into the left atrium (LA) is a rare but serious complication of surgical atrial septal defect (ASD) repair, particularly in inferior or low-lying defects. When echocardiography is inconclusive, cross-sectional imaging can be critical for diagnosis. A 17-year-old girl with a history of surgical closure of a low-lying ASD at 15 years of age presented with exertional dyspnea and mild oxygen desaturation of 90%-94%. Transthoracic echocardiography showed an intact atrial septal patch. Still, it could not clearly demonstrate the relationship of the inferior vena cava to the right atrium or assess the inferior margin of the repair. Contrast-enhanced CT angiography demonstrated direct drainage of the IVC into the LA with exclusion of the IVC orifice from the right atrium by the atrial septal patch, confirming iatrogenic diversion of the IVC. The patient was referred for surgical re-exploration and corrective re-repair. However, the details of the revision surgery are not available. Iatrogenic diversion of the IVC should be suspected in postoperative ASD patients presenting with unexplained desaturation when echocardiography is inconclusive. CT angiography provides definitive delineation of caval drainage and patch anatomy, enabling accurate diagnosis. This case also underscores the importance of careful intraoperative identification of the inferior rim and confirmation of IVC drainage during repair of low-lying ASDs to prevent this complication.
Copyright (c) 2026 Amit Kumar Paliwal, RK Patel, Debraj Sen, Rachit Sharma, Saurabh Maheshwari https://creativecommons.org/licenses/by/4.0
Cardiac Arrest and Cardiomyopathy Related Mortality in the United States, 1999-2025: Trends and Disparities
Background: Cardiac arrest and cardiomyopathy are major contributors to cardiovascular mortality and sudden death. However, long-term national mortality trends and demographic disparities remain unclear. This study aimed to evaluate U.S. mortality trends from 1999 to 2025 and assess differences by sex, race/ethnicity, and age. Methods: We conducted a cross-sectional analysis of U.S. mortality data from 1999–2025 using the CDC WONDER Multiple Cause-of-Death database. Deaths among adults aged ≥25 years were identified using ICD-10 codes I42 (cardiomyopathy) and I46 (cardiac arrest), including cases where these codes appeared as underlying or contributing causes of death. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated. Temporal trends were assessed using Joinpoint regression and expressed as average annual percent change (AAPC), stratified by sex, race/ethnicity, and three age groups (25–44, 45–64, and ≥65 years). Results: Between 1999 and 2025, 237,958 deaths from cardiac arrest and cardiomyopathy occurred among U.S. adults ≥25 years. Overall, AAMR declined from 6.33 to 2.41 (AAPC −3.83; 95% CI: −4.18 to −3.57). Males had higher mortality than females (AAMR 5.82 vs 2.71) with declines from 9.13 to 3.28 and 4.36 to 1.62, respectively. Non-Hispanic (NH) Black individuals had the highest AAMR (7.42), followed by Hispanics (4.62). Mortality was highest among those aged ≥65 years (CMR 14.74), declining from 23.88 to 7.88 between 1999 and 2025. Conclusion: Mortality from cardiac arrest and cardiomyopathy declined significantly from 1999–2025. However, substantial disparities persisted, with higher mortality among males, NH Black individuals, and adults ≥65 years, highlighting ongoing inequities in cardiovascular outcomes.
Copyright (c) 2026 Mahdi Ahmed, Alaa Eldeeb, Maryam Saghir, Alyaa Ahmed Ibrahim, Mohammad Rayyan Faisal, Raveen Mujeeb, Bassam Hegazy, Mohamed Zabady, Amr Ibrahim, Karim Othman Abdelnaim, Walid Bechibchi, Humam Al-Machtomi, Ehsanullah Alokozay, Mohaimen Mohammed Al-Machtomi, Irfan Ullah, Mohamed Fawzi Hemida https://creativecommons.org/licenses/by/4.0
Mortality Trends and Disparities in Hypertensive Heart and Renal Disease: A 25-Year Analysis (1999–2023) Using the CDC WONDER Database
Background: Hypertensive heart and renal disease remain major contributors to mortality in the United States. Tracking long-term mortality patterns is essential for identifying high-risk populations and guiding public health strategies. Methods: We conducted a nationwide ecological time-trend analysis using CDC WONDER underlying cause-of-death data for Hypertensive Heart and Renal Disease (ICD-10 I13) from 1999–2023. Age-adjusted mortality rates (AAMR) for all ages were examined by sex, race/ethnicity, census region, and urbanization level. Temporal changes were assessed using joinpoint regression with annual percent change (APC) and average annual percent change (AAPC). Results: AAMR increased from 1.2 (95% CI: 1.2–1.3) per 100,000 in 1999 to 4.2 (95% CI: 4.2–4.3) in 2023. After relative stability in the early years, a marked rise began around 2011, with the South and Midwest showing the steepest increases. From 2013–2023, the AAPC was not statistically significant for females (AAPC = 6.26%; p = 0.1678) but was significant for males (AAPC = 10.67%; p = 0.000117). Males(with AAMR of 4.7 vs 3.9 in females in 2023), older adults, and Black individuals consistently exhibited the highest mortality, while American Indian or Alaska Native groups experienced the most rapid recent increases. A modest decline from 2021–2023 was observed; potential explanations include shifts in healthcare access, reporting, or coding practices. Conclusions: Rising mortality from hypertensive heart and renal disease from 1999 to 2023 highlights persistent demographic and geographic disparities requiring targeted interventions.
Copyright (c) 2026 Ahmad Jalil, Fatima Rajab, Bisal Naseer, Aleena Mujahid, Mohsan Ali, Hadia Rajab, Justin May https://creativecommons.org/licenses/by/4.0