Guidelines on rehabilitation and a focus on lifestyle-related cardiovascular prevention

For the podcast associated with this article, please visit https://academic.oup.com/eurheartj/pages/Podcasts. This Issue starts with an ESC Guidelines article entitled ‘2026 ESC Guidelines on cardiac rehabilitation’, by Maria Bäck from the University of Gothenburg, Sweden, and colleagues.1 These updated practical guidelines establish a comprehensive, patient-centred framework for cardiac rehabilitation, an important form of treatment frequently underutilized in daily clinical practice.2–4 The Issue continues with a focus on Epidemiology, prevention, and healthcare policies. Pregnancy represents a critical period during which the maternal cardiovascular (CV) system adapts to profound haemodynamic and metabolic demands. When these adaptive mechanisms are impaired, adverse pregnancy outcomes (APOs)—including hypertensive disorders of pregnancy, gestational diabetes, pre-term birth, small-for-gestational-age birth, and pregnancy loss—occur.5–8 In a State of the Art Review article entitled ‘Adverse pregnancy outcomes and long-term cardiovascular risk: lifelong connections’, Veronica Giorgione Nunes from St George's University Hospitals NHS Foundation Trust in London, UK, and colleagues summarize current evidence with four aims: (i) to quantify the magnitude of CV risk after specific APOs; (ii) to outline shared pathophysiology linking APOs and CV disease (CVD); (iii) to chart the temporal course of the CV legacy from early post-partum CV findings to later organ damage; and (iv) to translate these insights into pragmatic strategies for prevention, covering optimal fourth-trimester care and the system gaps that impede its delivery.9 Extensive epidemiological evidence demonstrates that APOs are not isolated obstetric events but early clinical markers of cardiometabolic dysfunction that identify women at increased risk of coronary artery disease (CAD), heart failure, stroke, chronic kidney disease (CKD), and premature CV mortality. Shared mechanisms include endothelial dysfunction, inflammation, and insulin resistance, establishing a continuum between obstetric complications and later CVD. Early post-partum studies reveal persistent hypertension, adverse cardiac remodelling, and metabolic abnormalities that mediate much of the long-term excess CV risk. These findings redefine the ‘fourth trimester’ as a preventive window in which timely blood pressure surveillance, metabolic screening, and lifestyle optimization can yield durable CV benefit. Integrated cardio-obstetric care models, digital follow-up, and systematic transition to primary care are crucial for maintaining long-term prevention. Addressing persistent gaps in limited provider awareness, fragmented follow-up, and disparities across socially disadvantaged populations remains critical. Recognizing pregnancy complications as indicators of underlying CV vulnerability offers an opportunity to shift prevention upstream and promote lifelong CV health for women. A construct is only as actionable as the diagnostic pathway that supports it. Recent patient-led advocacy and policy initiatives—including the designation of March as Endometriosis Awareness Month—have strengthened public and professional recognition of this debilitating disease and promoted earlier clinical evaluation. In a Viewpoint article entitled ‘Endometriosis as a cardiovascular risk enhancer’, Benjamin Marchandot and Oliver Morel from the University Hospital of Strasbourg, France, aim to highlight endometriosis as a potential CV risk factor in women and propose a practical approach for incorporating it into atherosclerotic CVD (ASCVD) risk assessment and prevention.10 Endometriosis is a chronic, systemic neuroinflammatory disorder affecting an estimated ∼190 million people worldwide (∼1 in 10 women of reproductive age). Convergent epidemiological and mechanistic evidence links endometriosis to increased risk of ASCVD, yet contemporary risk frameworks rarely capture this contribution, and prevention pathways remain inconsistent. In parallel, the diagnostic landscape is shifting; alongside imaging and specialist centres, non-invasive molecular signature-based assays may compress the diagnostic interval from years to days, opening a practical window for earlier CV risk profiling. This viewpoint reframes endometriosis as a sex-specific, non-communicable CV risk enhancer and sets out a pragmatic, testable two-step prevention pathway. Step 1 prioritizes systematic identification and consistent documentation of endometriosis in symptomatic individuals, with explicit risk tagging to trigger CV assessment. Step 2 activates a guideline-aligned prevention strategy: structured baseline assessment; use of existing risk estimation tools with endometriosis documented as a risk enhancer; guideline-based management of traditional and lifestyle-related risk factors; and timed reassessment with escalation where warranted. A coordinated research agenda, spanning phenotypic stratification, risk prediction modelling, pragmatic intervention trials, and health-economic evaluations is outlined to test clinical benefit and scalability before guideline-level adoption. Ambient PM2.5 exposure is a known potent CV risk factor.11–13 Myocardial infarction with non-obstructive coronary arteries (MINOCA) represents a subtype of acute MI (AMI) distinct from myocardial infarction with obstructive coronary disease (MI-CAD). In a Clinical Research article entitled ‘Air pollution before and during the COVID-19 pandemic: changes in risk of acute myocardial infarction’, Masanobu Ishii from Kumamoto University, Japan, and colleagues investigate changes in the association between short-term exposure to PM2.5 and AMI subtypes following the COVID-19 pandemic.14 Public health measures during the COVID-19 pandemic may have altered exposure patterns, offering a natural experiment. Using data from the nationwide JROAD-DPC database, this study analysed ∼270 000 first-admission AMI patients, including ∼23 000 with MINOCA, betwee