Suboptimal prepregnancy metabolic health predisposes women to hypertensive disorders of pregnancy (HDP). Prevention of HDP starts with prepregnancy metabolic health optimization. If hypertension is present during pregnancy, adequate blood pressure control becomes crucial. Pregnancy and lactation safety should be considered when selecting an antihypertensive medication regimen. Aspirin prophylaxis is recommended for women at risk of preeclampsia. HDPs and other APOs increase the risk of future maternal cardiovascular events. Therefore, continued surveillance, screening, and cardiometabolic health optimization after pregnancy are essential to improving long-term health.

Folate, along with the metabolically-related B vitamins (B12, B6 and riboflavin), play essential roles in human health throughout life. Notably, recent UK Biobank evidence implicates folate deficiency in hypertension, the major risk factor contributing to mortality worldwide. An estimated 15% of pregnancies are affected by hypertension, which contributes to serious adverse maternal and offspring outcomes, a greater risk of stroke later in life in the mother and long-term disease risk in the child. Clinical and genome-wide association studies link the C677T polymorphism in the gene encoding the folate-metabolizing enzyme methylenetetrahydrofolate reductase (MTHFR) with an increased risk of hypertension. Riboflavin (as flavin adenine dinucleotide; FAD) is required as a cofactor for MTHFR, and randomized trials show that intervention with riboflavin lowers blood pressure, specifically in individuals with the MTHFR 677TT genotype, independently of antihypertensive medications. The health implications of this gene-nutrient interaction are important, especially for populations worldwide with the highest frequencies of the variant TT genotype in MTHFR, including Guatemala (up to 66%), Mexico (32-44%), and Northern China (24%). Further investigation is required to elucidate the mechanisms linking folate-mediated one-carbon metabolism with blood pressure and how riboflavin alleviates the excess genetic risk of hypertension in affected individuals. Riboflavin deficiency is highly prevalent worldwide, particularly in women, but is typically overlooked in health and research settings. This review highlights the roles of folate and riboflavin in blood pressure and the opportunity for a precision nutrition approach to reduce hypertension in at-risk individuals by addressing riboflavin deficiency and thus optimizing folate metabolism.

Introduction and objectives This report presents the 2025 activity of the Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC). Methods All interventional cardiology laboratories in Spain were invited to complete an online survey. Data were analyzed by an external company and subsequently reviewed and presented by the ACI-SEC board. Results A total of 125 hospitals participated, compared with 118 in the previous year. The number of diagnostic procedures and coronary angiograms increased by 4% and 4.5%, respectively, both reaching record highs. Percutaneous coronary interventions (PCI) increased by 3.3%. The trend toward lower relative stent use was confirmed, with a marked increase in the use of drug-coated balloons, both as a standalone strategy and as part of hybrid strategies. The use of intracoronary imaging and coronary physiology techniques increased, reaching record absolute numbers. Interventional treatment of myocardial infarction increased by 3.6%, with primary PCI accounting for 98% of procedures. Structural heart interventions continued to expand: transcatheter aortic valve implantation (+10.1%), percutaneous mitral interventions (+25.2%), tricuspid interventions (+7.9%), and left atrial appendage closure (+8.4%). Renal denervation procedures, interventional treatment of acute pulmonary embolism, and interventions for chronic thromboembolic pulmonary hypertension increased significantly. Conclusions The 2025 Spanish cardiac catheterization and interventional cardiology registry shows overall growth in both coronary and structural activity. Full English text available from: www.revespcardiol.org/en.

Long-term outcomes after kidney re-transplantation in patients with childhood-onset kidney replacement therapy (KRT) are poorly characterized. Using European Renal Association Registry data, we studied 12,623 patients who started KRT before age 20 years and received one (n = 11,078), two (n = 2,962) or three (n = 718) kidney transplants (KTs) between 1978 and 2019. In this descriptive study, 5-, 10- and 15-year patient survival was 97, 94 and 90 % after first, 97, 95, 94 % after second and 96, 94, 92 % after third KT; corresponding graft survival was 79, 63, 50 %, 69, 52, 38 %, and 67, 51, 38 %, respectively. After first KT, mortality and graft failure risks were lower after pre-emptive transplantation (adjusted hazard ratio: 0.66 [95% CI 0.54-0.80] and 0.89 [0.82-0.97], respectively) and after living donor (LD) transplantation (0.71 [0.61-0.83] and 0.76 [0.70-0.81], respectively). Additionally, graft failure risk was higher between ages 10-24 years, and for patients with glomerulonephritis, metabolic diseases or recurrent nephropathies, and females. In re-transplants, LD and pre-emptive KTs (particularly for second KT) and prior graft survival > 5 years were associated with reduced graft failure. Overall, LD, pre-emptive transplantation, and durable prior grafts were associated with the best outcomes.