According to epidemiological data from Hungary, cardiovascular diseases cause the greatest loss of health among the population and are responsible for a significant proportion of premature deaths. This reinforces the health policy position that cardiovascular prevention, including improving medication adherence, must be given top priority in patient care. Long-term survival in patients who have experienced acute coronary syndrome depends heavily on medication adherence, particularly regarding statins and anticoagulants; however, domestic surveys indicate deficiencies in the use of preventive medications. The aim of our study was to compare the attitudes and beliefs regarding antiplatelet agents and cholesterol-lowering drugs among patients in the secondary prevention group who underwent percutaneous coronary intervention and those in the primary prevention control group, using the Beliefs about Medicines Questionnaire (BMQ). A cross-sectional, questionnaire-based study included 162 secondary prevention patients and 136 primary prevention patients who had undergone percutaneous coronary intervention. Medication attitudes were measured using the specific and general dimensions of the BMQ, and SPSS 27.0 was used for statistical analysis. Among patients in the secondary prevention group, both drug groups were characterized by lower levels of concern and more accepting attitudes, whereas in the primary prevention group, sceptical (p<0.05) and ambivalent attitudes were more common (p<0.001). Based on the analysis of respondents by attitude group and the examination of the BMQ's general subscales, percutaneous coronary intervention significantly influenced beliefs regarding medications. This change was clinically significant in terms of treatment adherence (p<0.001) Discussion and conclusion: Patients who have undergone percutaneous coronary intervention have more favourable attitudes toward medication, which highlights the role of targeted education and psychoeducation in improving adherence in the non-intervention population. However, adherence in the secondary prevention group cannot be considered optimal either, therefore further targeted education is warranted in this patient group as well. Orv Hetil. 2026; 167(31): 1238-1247. Bevezetés: Magyarországi epidemiológiai adatok alapján a cardiovascularis betegségek okozzák a legnagyobb egészségveszteséget a lakosság körében, és az idő előtti halálozás jelentős részéért is felelősek. Ez megerősíti azt az egészségpolitikai álláspontot, hogy a cardiovascularis prevenciónak, beleértve a gyógyszeres terápiahűség javítását, kiemelt prioritást kell kapnia a betegellátásban. Az akut coronaria szindrómán átesett betegek hosszú távú túlélése nagymértékben függ a gyógyszeres terápiahűségtől, különösen a sztatinok és véralvadásgátlók tekintetében, ugyanakkor hazai felmérések a preventív gyógyszerek szedésének hiányosságaira utalnak. Célkitűzés: Vizsgálatunk célja a percutan coronariaintervención átesett másodlagos prevenciós és a kontrollcsoportba tartozó elsődleges prevenciós betegek thrombocytaaggregáció-gátlókkal és koleszterinszint-csökkentőkkel kapcsolatos hozzáállásának és hiedelmeinek összehasonlítása volt a Beliefs about Medicines Questionnaire (BMQ) segítségével. Módszerek: Keresztmetszeti, kérdőíves vizsgálatban 162 percutan coronariaintervención átesett másodlagos prevenciós és 136 elsődleges prevenciós beteg vett részt. A gyógyszerattitűdök mérése a BMQ speciális és általános dimenziói mentén történt, a statisztikai elemzéshez az SPSS 27.0 programcsomagot alkalmaztunk. Eredmények: A másodlagos prevenciós betegek esetében elmondható, hogy mindkét gyógyszercsoport esetében kisebb aggodalomszint és elfogadóbb hozzáállás volt jellemző, míg az elsődleges prevenciós csoportban gyakoribb volt a szkeptikus (p<0,05) és az ambivalens hozzáállás (p<0,001). A válaszadók attitűdcsoportok szerinti elemzése, valamint a BMQ általános alskáláinak vizsgálata alapján a percutan coronariaintervencióhoz társulóan szignifikáns különbségek voltak megfigyelhetők a gyógyszerekkel kapcsolatos hiedelmeket illetően. Ez a változás a gyógyszeres terápiahűséggel összefüggő attitűdök szempontjából jelentős volt (p<0,001). Megbeszélés és következtetés: A percutan coronariaintervención átesett betegek kedvezőbb gyógyszerattitűdökkel rendelkeznek, ami kiemeli a célzott edukáció és pszichoedukáció szerepét a nem intervención átesett populáció terápiahűségének javításában. Ugyanakkor a terápiahűség a másodlagos prevenciós csoportban sem tekinthető optimálisnak, ezért ebben a csoportban is indokolt a további célzott betegoktatás alkalmazása. Orv Hetil. 2026; 167(31): 1238–1247.
We compared the predictive performance of SLECRISK, an SLE-specific 10-year CVD risk model, to the new PREVENT (Predicting Risk of cardiovascular disease EVENT) model in our SLE cohort. Adult SLE patients meeting ACR 1997 and/or EULAR criteria were included. PREVENT and SLECRISK models were used to predict 10-year risk of myocardial infarction, stroke, or cardiac death. Discrimination and model performance were compared. Among 1,243 patients, SLECRISK and PREVENT yielded similar discrimination (AUC 0.74 vs. 0.76; p = 0.64). Using a 7.5% threshold for predicted 10-year MACE risk, SLECRISK demonstrated higher sensitivity (0.74 vs. 0.29), identifying more patients who subsequently developed MACE. 581 patients (46.7%) were classified as moderate/high risk by either model: 490 by SLECRISK only and 91 by PREVENT only or by both PREVENT and SLECRISK. Patients classified by SLECRISK alone were younger (mean 42.5 vs. 57.2 years, p < 0.001) and had lower systolic BP (122.0 vs. 145.0 mmHg, p < 0.001) and creatinine (0.91 vs. 2.63 mg/dL, p < 0.001), while showing higher prevalence of anti-dsDNA (85.7% vs. 73.6%) and anti-RNP (56.1% vs. 28.6%). Although overall discrimination was similar, SLECRISK demonstrated better agreement between predicted and observed cardiovascular events and higher sensitivity for identifying patients who developed MACE. In SLE, where younger patients may develop cardiovascular events without many traditional risk factors, failure to identify at-risk individuals may carry greater clinical consequences than overestimating risk. These findings suggest a role for SLECRISK as a diseasespecific tool for cardiovascular risk stratification in SLE.
Patients with atherosclerotic cardiovascular disease (ASCVD) and systemic inflammation (SI) or chronic kidney disease (CKD) have poorer outcomes than those without SI or CKD. This study evaluated the impact of both SI and CKD on major adverse cardiovascular events (MACE), healthcare costs, and healthcare resource utilization (HCRU) in patients with ASCVD. This retrospective cohort study examined the association between SI and revised MACE, healthcare costs, and HCRU among adult patients with ASCVD from the Komodo Healthcare Map®. CKD stage 3-4 was determined from claims or laboratory data. SI was defined as ≥ 1 high-sensitivity C-reactive protein (hsCRP) value of 2-10 mg/l (without SI, all hsCRP values < 2 mg/l). The primary endpoint, revised MACE, was defined as a composite of nonfatal myocardial infarction, nonfatal stroke, and all-cause mortality. Of 74,884 patients with ASCVD and ≥ 1 eligible hsCRP value, 8.5% had CKD stage 3-4, and 49.2% had SI. Patients with SI had a higher comorbidity index and a greater prevalence of obesity, hypertension, and type 2 diabetes than those without SI. Compared with patients with ASCVD without CKD or SI, SI alone was associated with a 24% higher risk (hazard ratio [HR] 1.24; 95% CI 1.15-1.34), CKD stage 3-4 with a 33% higher risk (HR 1.33; 95% CI 1.16-1.51), and both SI and CKD stage 3-4 with a 62% higher risk (HR 1.62; 95% CI 1.45-1.82) of revised MACE. In patients with ASCVD without CKD, total healthcare costs were $18,002 PPPY with SI vs. $15,070 PPPY without SI. In patients with ASCVD with CKD stage 3-4, costs were $26,089 PPPY with SI vs. $20,753 PPPY without SI. Across groups, SI was associated with higher HCRU. SI is associated with increased risk of MACE and higher total healthcare costs and HCRU in patients with ASCVD with or without CKD. Inflammation usually happens when the body needs to heal an injury or infection. Inflammation that keeps happening in your body over a long time is called sustained systemic inflammation. Systemic inflammation can cause harm instead of healing. We looked at the effect of systemic inflammation in almost 75,000 people with atherosclerotic cardiovascular disease (ASCVD). Some of these people also had chronic kidney disease (CKD). We found that people with ASCVD and systemic inflammation were more likely to have a heart attack, stroke, or die sooner. These people who had systemic inflammation also needed to visit doctors and hospitals more often and had higher doctor and hospital costs. Patients who also had CKD had an even higher risk of a heart attack, stroke, or dying sooner, as well as higher healthcare costs than patients who did not have CKD, and the additional presence of systemic inflammation increased that risk further. These results suggest that we should aim to develop and test treatments to lower inflammation in patients with ASCVD and CKD, an often understudied population, to determine if these therapies improve the patients’ health.
Cardiovascular diseases (CVDs) remain a leading cause of global mortality and impose a substantial health and economic burden worldwide. Exosomes, as promising endogenous nanocarriers, have emerged as a powerful tool for the prevention and treatment of CVDs. In particular, advanced functionalization strategies have largely enhanced exosomal therapeutic efficacy in vivo. Notably, Traditional Chinese Medicine (TCM) and its bioactive components exert profound regulatory effects on exosomes. In this review, we systematically summarize exosome-based therapeutic strategies for CVDs, along with state-of-art functionalization approaches to optimize exosomal cargo loading and targeted delivery. We further provide a comprehensive overview of TCM-mediated exosomal regulation. We found that TCM and TCM-derived chemicals can optimize exosomal cargo loading, especially the loading of microRNAs (miRNAs) and bioactive chemicals. More importantly, TCM and chemicals can promote exosomal secretion, which provides new avenues for exosomal-scale production. Besides, there are synergistic effects between exosomes and TCM when co-administered. Collectively, exosome-based systems hold great promise for CVD therapy, and TCM provides novel strategies for exosomal functionalization, which substantially enhances exosomal-mediated therapeutic efficacy for CVDs.
The association between endogenous sex hormones and Cardiovascular-kidney-metabolic (CKM) syndrome remains incompletely elucidated. We performed a cohort study using clinical data from the National Health and Nutrition Examination Survey (NHANES) 2013-2016. Restricted cubic spline Cox proportional hazards models and stratified analyses were employed to analyze the relationships between sex hormone-binding globulin (SHBG), free androgen index (FAI), testosterone-to-estradiol ratio (T: E), and mortality. In a cohort of 2,545 patients with CKM (mean age 51.84 years; 63.65% male) followed for a mean of 4.78 years, stage 2 disease was the most prevalent (56.96%). A significant inverse correlation between advancing CKM stages and serum levels of testosterone-related parameters (all P < 0.05) was observed, alongside reduced estradiol and elevated SHBG. After multivariable adjustments, the association between FAI and all-cause mortality remained significant (HR = 0.46, 95% CI: 0.30-0.69, P < 0.001), whereas the effects of SHBG and the T: E ratio were diminished (P > 0.05). However, for CVD mortality, no significant results were observed in multivariable adjustments. In men aged > 60 years, elevated FAI (> 25.91 nmol/L) and T: E ratio (> 1.55) were each independently associated with reduced all‑cause mortality, with adjusted HRs of 0.24 (P = 0.02) and 0.51 (P = 0.01), respectively. Cox proportional hazards analysis demonstrated an inverse relationship between serum FAI and all-cause mortality in the overall, postmenopausal and men (> 60 years) CKM subgroup. In addition, a higher T: E ratio was inversely associated with all‑cause mortality specifically in men aged > 60 years with CKM.
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Children and young people (CYP) with life-limiting conditions (LLCs) comprise a clinically heterogeneous population with diverse disease trajectories and survival patterns. However, studies evaluating long-term survival according to disease group and sociodemographic characteristics remain limited. We assessed long-term survival patterns among CYP with LLCs and evaluated differences in mortality outcomes according to disease group and selected sociodemographic characteristics. Cohort study. Using the Korean National Health Insurance database, we identified individuals aged 0-24 years who were newly diagnosed with LLCs between 2011 and 2013. Patients were followed from the date of diagnosis until death or December 31, 2020. Kaplan-Meier survival analyses and Cox proportional hazards models were used to evaluate long-term mortality outcomes according to disease groups and sociodemographic indicators, including insurance premium-based income categories and residential area. In total, 175,813 CYP with LLCs were included. Survival patterns differed significantly across disease groups, age groups, and income levels. Disease group distribution varied by age, with premature and neonatal conditions predominating in infancy. Survival probabilities were lowest among children aged < 1 year and among medical aid beneficiaries. Premature and neonatal disorders and cardiovascular diseases were associated with the shortest observed survival durations. Male patients demonstrated a higher hazard of death from cancer (hazard ratio [HR] 1.83), metabolic diseases (HR 1.61), and neurologic and neuromuscular diseases (HR 1.33) compared to female patients. Higher hazard ratios among medical aid beneficiaries were observed primarily in patients with metabolic, neurologic and neuromuscular diseases, whereas residence-related differences in survival were observed among patients with cardiovascular diseases. Distinct survival trajectories exist across disease groups among CYP with LLCs. Early mortality predominates in premature and neonatal disorders and cardiovascular diseases, whereas more prolonged survival patterns are observed in cancer and neurologic disorders. These findings may inform the development of disease-specific integrated treatment strategies, long-term care planning, and supportive care policies for CYP with LLCs and their families. Children and young people with life-limiting conditions often live with severe illnesses that require ongoing medical care and support. These conditions include cancer, neurologic disorders, heart disease, respiratory disease, metabolic disorders, and severe neonatal conditions. Some children die soon after diagnosis, while others survive for many years with complex healthcare needs. Understanding these survival patterns is important for planning treatment, supportive care, and pediatric palliative care services. In this study, we used national health insurance data from Korea to examine long-term survival among 175,813 children and young people aged 0–24 years who were diagnosed with life-limiting conditions between 2011 and 2013. We followed patients for up to 10 years after diagnosis. Survival differed greatly depending on the type of disease. Children with premature and neonatal conditions or cardiovascular diseases had the shortest survival times, with many deaths occurring within the first year after diagnosis. In contrast, children with neurologic disorders and cancer often survived for longer periods after diagnosis. Survival was also lower among infants younger than 1 year and among children from lower-income families receiving medical aid support. In some disease groups, boys had a higher risk of death than girls. Regional differences were generally small, although children with cardiovascular diseases living outside metropolitan areas had poorer survival outcomes. These findings show that children and young people with life-limiting conditions have different healthcare and support needs depending on their disease and social circumstances. The results may help improve long-term care planning, supportive services, and healthcare policies for affected children and their families.
Albuminuria is one of the most important biomarkers of chronic kidney disease and also a target that can be influenced by treatment. The amount of albumin excreted in the urine is an independent predictor of declining kidney function, cardiovascular events, and all-cause mortality. It is most easily determined based on the albumin-to-creatinine ratio (ACR) measured in the first morning urine sample; in the vast majority of cases, 24-hour urine collection is not required. The pathophysiology of albuminuria centers on damage to the glomerular filtration barrier - particularly podocytes - hemodynamic hyperfiltration, inflammation associated with tubular protein reabsorption, and activation of the renin-angiotensin-aldosterone system (RAAS). Modern four-pillar pharmacotherapy - RAS inhibitors (ACE inhibitors/ARBs), SGLT2 inhibitors, non-steroidal mineralocorticoid receptor antagonists (finerenone), and GLP1 receptor agonists in type 2 diabetes - acts on these processes through complementary mechanisms. When tailored to the degree of albuminuria and eGFR, this treatment significantly slows the progression of chronic kidney disease and reduces cardiovascular risk. Measuring and monitoring albuminuria must therefore be an essential part of daily clinical practice. Orv Hetil. 2026; 167(31): 1231-1237. Az albuminuria a krónikus vesebetegség egyik legfontosabb biomarkere és egyben terápiásan befolyásolható célpont. A vizelettel ürülő albumin mennyisége a vesefunkció-romlás, a cardiovascularis események és az összmortalitás önálló prediktora. Meghatározása a legegyszerűbben a reggeli első vizeletmintából meghatározott albumin/kreatinin hányados (ACR) alapján történik; az esetek túlnyomó hányadában nincs szükség 24 órás vizeletgyűjtésre. Az albuminuria patofiziológiájának középpontjában a glomerularis filtrációs barrier – különösen a podocyták – sérülése, a hemodinamikai hiperfiltráció, a tubularis fehérjereabszorpcióhoz kapcsolódó gyulladás és a renin-angiotenzin-aldoszteron rendszer (RAAS) aktivációja áll. A modern négypilléres farmakoterápia – RAS-gátló (ACE-gátló/ARB), SGLT2-gátló, nemszteroid mineralokortikoidreceptor-antagonista (finerenon) és 2-es típusú diabetesben GLP1-receptor-agonista – egymást kiegészítő mechanizmusokon keresztül hat ezekre a folyamatokra. A kezelés az albuminuria mértékéhez és az eGFR-értékhez igazítva érdemben lassítja a krónikus vesebetegség progresszióját, és csökkenti a cardiovascularis rizikót. Az albuminuria mérése és monitorozása ezért a mindennapi klinikai (egyben háziorvosi) gyakorlat elengedhetetlen része kell, hogy legyen. Orv Hetil. 2026; 167(31): 1231–1237.
Immune checkpoint inhibitors (ICIs) have transformed cancer therapy but are associated with a growing spectrum of cardiovascular immune-related adverse events. Among these, arrhythmias represent a rare yet potentially life-threatening complication. ICI-induced arrhythmias encompass a wide clinical spectrum, including atrial arrhythmias, conduction disturbances and malignant ventricular arrhythmias. This review summarizes the current evidence on the incidence, clinical presentation, pathophysiological mechanisms and management of ICI-associated arrhythmias. We discuss the limitations of available data, which are largely derived from case reports, small series and retrospective registries, and highlight the implications for clinical practice. Improved understanding of ICI-induced arrhythmias is essential to balance oncological efficacy with cardiovascular safety in this, rapidly expanding, patient population.
Takotsubo syndrome is an acute, transient ventricular dysfunction that frequently mimics acute coronary syndrome. Patients with cancer may be particularly vulnerable because malignancy-related stress and cancer therapies converge with cardiovascular susceptibility. This narrative review examines sex-related susceptibility and acuity, cancer-related stressors, implicated therapy classes, diagnostic differentiation, management, and treatment rechallenge. PubMed/MEDLINE was searched from January 2000 through June 2026 using combinations of terms for Takotsubo syndrome, cancer, cardio-oncology, sex, specific antineoplastic agents, imaging, outcomes, and rechallenge; reference lists of relevant consensus statements and reviews were also screened. Evidence is predominantly derived from registries, retrospective cohorts, case series, and case reports. Sex should be treated as a risk modifier rather than a stand-alone determinant. A cumulative vulnerability framework integrating patient susceptibility, cancer-related stress burden, and treatment exposure may support earlier recognition and multidisciplinary decisions, but prospective validation and standardized sex-stratified reporting are required.
International morbidity and mortality are led by cardiovascular disease, specifically arrhythmias. The integration of artificial intelligence (AI) can promote earlier identification and, therefore, provide personalized clinical judgments sooner, which can avert these consequences. AI is mainly used in diagnostics, prognostics, and decision support through test interpretations (electrocardiographs (ECGs) and MRI scans) and computing hidden characteristics to utilize a personalized plan rather than a population-based one. While such technology is available in hospitals, some functions are also being integrated into smart wearable devices. These wearable devices allow for continuous monitoring rather than limiting it to in-hospital settings, thus making it easier to enable an earlier diagnosis. However, certain arrhythmias, such as asymptomatic arrhythmias, can go unnoticed by AI. Additionally, there are questions regarding data transparency, privacy, and the financial burden of utilizing and managing AI in medical settings.
Coronary calcification is a prevalent pathology and strong cardiovascular indicator. However, its progression drivers remain poorly defined. With limited clinical samples, it is unclear if simple traditional machine learning can effectively predict progression, challenging risk assessment and individualized treatment. We assembled a serial CCTA dataset of 2,579 patients from West China Hospital. Using Random Forest, Gradient Boosting Decision Trees, XGBoost, and Logistic Regression with SHAP analysis, we identified key features of coronary artery calcification progression and built predictive models, then compared them with traditional clinical models. The Random Forest (RF) model achieved an AUC of 0.81 (95% CI: 0.78-0.84) vs. 0.64 (0.59-0.68) for the traditional model. Baseline CACS, plaque burden, and other CCTA features were key predictors, with critical thresholds determined. A coronary artery calcification progression prediction score (CACPPS) was derived to quantify personalized progression risk. The RF model also showed acceptable calibration (Brier score = 0.169; Hosmer-Lemeshow p = 0.415), favorable decision-curve net benefit, and an optimal CACPPS threshold of 0.566. In patients with suspected or confirmed CAD, a traditional yet interpretable machine learning model can predict CACS progression and generate CACPPS to support treatment decisions and dynamic individualized management, mitigating black-box concerns through indirect interpretability.
Uric acid is the end product of purine metabolism and plays a dichotomous role in the human body. On one hand, it exerts antioxidant and neuroprotective effects; on the other hand, chronic hyperuricemia has been strongly associated with diseases beyond gout, affecting the cardiovascular, renal, metabolic, autoimmune, and central nervous systems (CNS). Excess uric acid promotes oxidative stress, endothelial damage, neurodegeneration, inflammasome activation, and impairs energy metabolism. It exacerbates autoimmune diseases, such as Systemic Lupus Erythematosus (SLE) and antiphospholipid syndrome (APS), by increasing inflammatory and oxidative damage, leading to greater end-organ damage. The British Society for Rheumatology, European League Against Rheumatism, American College of Rheumatology, and National Institute for Health and Care Excellence (NICE) have all established a "treat-to-target" approach for hyperuricemia with serum urate levels below 6 mg/dL and below 5 mg/dL in severe cases. Allopurinol and Febuxostat, xanthine oxidase inhibitors, are used as first-line pharmacological therapies for the treatment of hyperuricemia, whereas uricosurics and Interleukin-1 (IL-1) inhibitors are preferred in cases of refractory hyperuricemia. Lifestyle modifications, such as the Dietary Approaches to Stop Hypertension (DASH) diet, weight reduction, and smoking cessation, are also recommended for the long-term management of the disease. Sodium-Glucose Cotransporter 2 (SGLT2) inhibitors, selective urate transport inhibitors, and plant-derived anti-inflammatory compounds have emerged as new treatments with promising responses. This review synthesizes the current literature on the multifaceted role of uric acid and emphasizes its systemic implications in chronic diseases. It also outlines the already established management options and new innovative therapies for managing this disease. Understanding this dichotomous role is essential for adopting a precise management approach that balances the protective and pathological effects of uric acid.
Population-based analyses usually classify smoking status at survey enrollment, which combines people who quit before disease recognition with those who continued smoking through diagnosis and quit afterward. This study evaluated whether smoking cessation after a self-reported cardiopulmonary disease diagnosis was associated with subsequent all-cause and cause-specific mortality among adults reconstructed as smoking at diagnosis. This secondary analysis pooled ten cross-sectional National Health and Nutrition Examination Survey (NHANES) cycles from 1999-2000 through 2017-2018 and linked survey records to mortality follow-up through 2019. Adults aged ≥40 years with self-reported cardiovascular or chronic lung disease were included when self-reported smoking initiation, diagnosis, cessation, and current-smoking information permitted classification as smoking at diagnosis. Survey-weighted Cox models compared post-diagnostic quitters with persistent smokers. Models were unadjusted, demographic-adjusted, and fully adjusted for prespecified demographic, disease-history, smoking-history, and survey-cycle covariates. Among 2319 participants, 975 were post-diagnostic quitters, and 1344 were persistent smokers. During a median follow-up of 6.33 years, 999 all-cause, 272 heart-disease, and 244 cancer deaths occurred. In the fully adjusted model, post-diagnostic quitting was associated with lower heart-disease mortality (adjusted hazard ratio, AHR=0.59; 95% CI: 0.42-0.82; p=0.001). Associations with all-cause mortality (AHR=0.90; 95% CI: 0.74-1.09; p=0.276) and cancer mortality (AHR=0.72; 95% CI: 0.49-1.06; p=0.100) were not statistically significant. Findings for heart-disease mortality were consistent across landmark, overlap-weighted, smoking-burden-adjusted, disease-restricted, quit-age reconstruction, and leave-one-covariate-out analyses. Among adults retrospectively classified as smoking when cardiopulmonary disease was diagnosed, post-diagnostic cessation was associated with lower subsequent heart-disease mortality. The findings are observational and remain susceptible to survivor selection, reverse causation, recall and social-desirability bias, exposure changes after enrollment, mortality misclassification, and residual confounding.
Statins are the primary treatment for hypercholesterolemia and a cornerstone of atherosclerotic cardiovascular disease prevention. Although generally safe, serious adverse effects may occur in selected patients, particularly when statins are used at high doses or without medical supervision. We describe a 66-year-old man with hypertension and hyperlipidemia who developed syncope after self-adjusting atorvastatin from 20 mg daily to 80 mg daily for two weeks. On admission, electrocardiography showed sinus arrest with a ventricular escape rhythm, accompanied by acute hepatic and renal dysfunction, electrolyte abnormalities, coagulation abnormalities, and elevated inflammatory markers. Common reversible causes, including thyroid dysfunction, structural heart disease, acute myocarditis, Lyme disease, and the use of negative chronotropic drugs, were not supported by the clinical evaluation. After temporary pacing and supportive treatment, liver and kidney function, electrolytes, and coagulation function returned to normal; however, symptomatic sinus arrest persisted, and a permanent pacemaker was implanted. During follow-up, the electrocardiogram showed recovery of sinus rhythm. Pacemaker interrogation at 1 year showed a pacing burden of approximately 80% when the lower rate limit was programmed at 70 beats per minute; after the lower rate limit was reduced to 50 beats per minute, the pacing burden decreased to approximately 20% at the subsequent follow-up. This finding suggests partial recovery of intrinsic sinus rhythm but persistent or intermittent sinus node dysfunction. The case supports a cautious interpretation of possible atorvastatin-associated severe bradyarrhythmia mediated by multiorgan dysfunction rather than definitive direct statin-induced sinus node injury. Clinicians should carefully educate patients not to self-adjust statin doses and should monitor for serious adverse events when high-dose statin exposure is suspected.
Anaphylaxis during pregnancy is uncommon but remains one of the most critical emergencies in obstetric medicine because maternal deterioration and fetal hypoxia evolve simultaneously. Despite established treatment recommendations, diagnostic uncertainty and persistent concerns regarding epinephrine use continue to contribute to jeopardize preventable morbidity/mortality. This review examines recent advances in the recognition, management, and prevention of pregnancy-associated anaphylaxis, with emphasis on emerging concepts that may improve maternal-fetal safety. Physiological pregnancy-related cardiovascular and respiratory adaptations can obscure classic manifestations of anaphylaxis, creating important diagnostic blind spots and increasing the risk of delayed recognition. Growing evidence indicates that maternal hypotension and hypoxemia represent the main threats to fetal wellbeing. Epinephrine hesitancy remains common in clinical practice. New insights into mast cell disorders, hereditary alpha-tryptasemia, and MRGPRX2-mediated reactions are refining risk stratification and expanding understanding of severe and perioperative anaphylaxis. Recent epidemiological studies also highlight the predominance of drug-related and cesarean-associated triggers and support the implementation of multidisciplinary care pathways, allergy evaluation, and targeted prevention strategies. Maternal anaphylaxis should be viewed as a time-critical obstetric emergency in which prompt recognition and immediate epinephrine administration are essential to optimize maternal and fetal outcomes. Future progress will depend on pregnancy-adapted diagnostic approaches, improved risk identification, systematic prevention efforts, and coordinated multidisciplinary management across obstetric, anesthetic, emergency, and allergy services.
COVID-19 is linked to diverse cardiovascular complications, including myocarditis, new-onset heart failure, and ventricular arrhythmias. Although premature ventricular contractions and bigeminy are recognized, the specific pattern of quadrigeminy remains rarely documented in this setting. A 57-year-old male with untreated hypertension presented with acute exertional chest pressure, dyspnea, and nocturnal wheezing over two weeks. On arrival, BP was 176/100 mmHg, HR was 101 bpm, and O2 saturation was 93% on room air. ECG showed sinus tachycardia with bigeminy and trigeminy, without QT or QTc prolongation. Lab results showed troponin 0.04 ng/mL, B-type natriuretic peptide (BNP) 241 pg/mL, and the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) was positive. Chest CT revealed pulmonary edema, and echocardiogram showed a left ventricular ejection fraction (LVEF) of 40-45% with myocardial speckling. Telemetry showed runs of bigeminy, trigeminy, and quadrigeminy. He was diagnosed with acute hypoxic respiratory failure and COVID-19 myocarditis complicated by heart failure with mildly reduced ejection fraction (HFmrEF) and ventricular arrhythmias. Long-term follow-up is ongoing. This single-case report is based on comprehensive clinical, laboratory, electrocardiographic, telemetry, and imaging data from a community hospital admission. However, the limitations of this report are that this was a single case without cardiac MRI or biopsy confirmation. Hence, causality cannot be definitively established. To conclude, COVID-19 infection can cause myocarditis complicated by HFmrEF with rare arrhythmias, including quadrigeminy. Careful evaluation and individualized treatment are critical for optimal outcomes.
Obesity is a chronic relapsing disease leading to weight-related health risks for disorders such as cardiovascular diseases, type 2 diabetes, osteoarthritis, and depression. Many studies focus on these weight-related health risks. However, research on current self-reported social impacts and health complaints is limited. This study aims to investigate self-reported social impact and health complaints, received care aiming at lifestyle change, and perceived effectiveness of this care, by children with obesity and their parents. Secondarily, differences concerning sex, age, obesity-severity and frequency of received care were studied. Questionnaires were collected from children and adolescents aged 0-18 years visiting Obesity Center CGG. Data were analyzed regarding their social impacts, health complaints, received care, and perceived care effectiveness (0-10 scale). Children were categorized into sex, age, BMI, and care categories. Descriptive statistics were performed using chi-square tests and post hoc analyses to examine differences between categories. 86.8% of the patients self-reported experiencing social impact and 92.3% reported health complaints. Most frequently reported social impacts were difficulty to find fitting clothes (70.1%), problems in mobility and sports (63.7%), and bullying (41.6%); most reported health complaints were abdominal pain (38.8%), headache (34.8%), and musculoskeletal pain (34.1%). The dietician (64.1%) was most frequently reported as received care, and effectiveness scores ranged between 0 and 4 out of 10.  A substantial percentage of patients experience social impacts and health complaints affecting their well-being and quality of life. Low perceived effectiveness of interventions calls for a more innovative and comprehensive care framework incorporating these children's needs. • Children with overweight and obesity face a wide range of adverse health consequences and social challenges. • However, the number and types of health issues experienced by children themselves and studying per range of age, BMI-stage or care trajectory have not been systematically investigated. • A high percentage of children experience social impacts (87%) and health complaints (70%) aff ecting their well-being and quality of life, and perceived eff ectiveness of lifestyle interventions is low. The main reported healthcomplaints abdominal pain, headache, musculoskeletal pain and snoring loudly were mostly observed in girls withobesity aged 12-18 years, who received three or more care types. • The study demonstrated that perceived treatment effectiveness by children and parents declined with increasingobesity severity.
CART (combined aerobic and resistance training) has shown important results in exercise-based cardiovascular rehabilitation. However, there are little data concerning the effects of CART on the exercise capacity, muscle strength, health-related quality of life (HRQoL), and mortality of coronary heart disease (CHD) patients. Therefore, the aim of this study was to analyze the published randomized controlled trials (RCTs) that investigated the effects of CART on exercise capacity [peak oxygen consumption (peak VO2) and 6-min walking distance (6MWD)], muscle strength [1-repetition maximum (1-RM), peak torque and handgrip strength], HRQoL, and mortality in patients with CHD. We search for references in MEDLINE/PubMed, Scopus, Cochrane Central Register of Controlled Trials, and EMBASE databases to find RCTs that evaluated the effects of CART for CHD. Mean difference (MD), standardized mean difference (SMD), risk ratio (RR), and 95% confidence intervals (CIs) were calculated. CART improved relative peak VO2 of 2.20 ml/kg/min (P < 0.0001), peak torque of 16.69 N.m (P < 0.0001), handgrip strength of 4.68 kgf (P < 0.0001), and HRQoL of 1.00 (P < 0.00001) and reduced mortality (RR = 0.40; P = 0.002) compared to non-exercising usual care. CART improved (relative and absolute) peak VO2 by 0.28 (P < 0.002), 6MWD by 21.98 m (P = 0.004), 1-RM by 0.61 kg (P < 0.0001), peak torque by 4.03 N.m (P = 0.002), and HRQoL by 0.50 (P < 0.0004) compared to aerobic training. CART improved relative peak VO2 by 1.91 ml/kg/min (P < 0.00001) compared to resistance training. CART was efficient in improving peak VO2, peak torque, handgrip strength, HRQoL, and lower mortality events compared to non-exercising usual care in patients with CHD. CART appears superior to aerobic training in improving peak VO2, 6MWD, 1-RM, peak torque, and HRQoL in patients with CHD. Furthermore, CART was more effective than resistance training for peak VO2 in patients with CHD. CART should be considered as a method in the rehabilitation of patients with CHD.
Children who suffer from undernutrition would grow rapidly to catch-up-growth after improvement in nutrition intake. However, this rapid growth during early life might have harmful effects on children's long-term health. Rapid growth, which is too fast, increases the risk of cardiovascular disease and obesity. To determine the prevalence and analyze the risk of rapid growth in children, particularly who experienced undernutrition in 1000 first days of life, compared to well-nourished children. This cohort study used data from the second and third waves of the Indonesia Family Life Survey (1997 and 2000). A total of 671 children aged 0 to 23 months in 1997 and 3 to 5 years in 2000 were included in this study. Rapid growth was determined as a change in length- or height-per-age and weight-per-age z-score greater than 0.67, based on WHO Child Growth Standard between years of follow-up. The anthropometric measurements were conducted by trained health workers. Children with history of low birth weight, stunting, underweight, and/or wasting were categorized as undernourished children. We used a logistic regression model to identify the risk of rapid growth in children among undernourished and well-nourished children, adjusted by characteristics of children, parents, and the household socioeconomic status. The prevalence of rapid growth in length/height and weight in undernourished children was 44.56% and 35.2%, respectively. The odds of undernourished children to grow rapidly in length/height compared to well-nourished children was 6.36 (95% CI 3.94,10.26; p = 0.000) after being controlled by socio-demographic characteristics. There was a higher odd 5.7 (95% CI 3.4, 9.5; p = 0.000) of rapid growth in weight in undernourished children. The odds of rapid growth in height increased significantly in children aged 12 to 23 months and children with mothers who had lower education levels. Furthermore, the odds of rapid growth in weight-for-age increased significantly in all children whose fathers had lower education levels. This study adds to the evidence that there is an increased risk for rapid growth in length/height and weight in undernourished children and the risk was higher among older children aged 12 to 23 months. The study also found that maternal education was related to the risk of rapid growth in height and paternal education was strongly related to the risk for rapid growth in weight.