A study published in the Journal of the American Heart Association (J Am Heart Assoc) by Zhang et al. (2025) highlights how malnutrition significantly worsens cardiovascular outcomes in patients with acute coronary syndrome (ACS) who also have obstructive sleep apnea (OSA). The findings reveal that the coexistence of these two conditions greatly amplifies the risk of major cardiovascular and cerebrovascular events. While malnutrition is an often-overlooked factor in cardiac care, this research underscores its critical role in disease progression and prognosis, especially among patients already burdened by obstructive sleep apnea-related metabolic stress. The researchers analyzed data from a large cohort of patients diagnosed with acute coronary syndrome and evaluated the relationship between their nutritional status and long-term outcomes. They found that moderate-to-severe malnutrition was a key predictor of poor prognosis in individuals with obstructive sleep apnea, while this association was not evident in patients without obstructive sleep apnea. The combined presence of obstructive sleep apneaand malnutrition likely intensifies systemic inflammation, oxidative stress, and endothelial dysfunction, creating a biological environment conducive to recurrent cardiovascular events. This interaction highlights how nutritional deficiencies can exacerbate the cardiometabolic strain caused by repeated oxygen deprivation during sleep, resulting in impaired recovery and increased mortality risk. The authors concluded that nutritional assessment should become an integral part of clinical management for acute coronary syndromepatients, particularly those with known or suspected obstructive sleep apnea. Routine nutritional screening and early intervention may help identify high-risk patients who could benefit from dietary optimization or targeted nutritional support. Integrating nutritional therapy alongside conventional cardiovascular and sleep apnea treatments could improve overall outcomes and quality of life. The study provides a strong rationale for adopting multidisciplinary care models that include cardiologists, sleep specialists, and dietitians in the long-term management of acute coronary syndrome patients. Keywords: Acute coronary syndrome, Obstructive sleep apnea, Malnutrition, Cardiovascular outcomes, Inflammation, Nutritional assessment, Risk stratification Reference: Zhang, Y., Liu, J., Chen, X., Li, H., Wang, Q., & Zhao, L. (2025). Malnutrition drives worse outcomes in acute coronary syndrome with obstructive sleep apnea. Journal of the American Heart Association. [https://doi.org/10.1161/JAHA.125.043885](https://doi.org/10.1161/JAHA.125.043885)