Search Results (1,662)

Ischemic heart disease (IHD) remains a leading cause of global morbidity and mortality despite advances in prevention, diagnosis, and therapy. Traditional clinical risk scores and biomarkers often fail to fully capture the complex molecular processes underlying atherosclerosis, myocardial infarction, and ischemic cardiomyopathy, leaving substantial residual risk. MicroRNAs have emerged as promising regulators and biomarkers of cardiovascular disease, among which microRNA-21 (miR-21) has attracted particular attention. MiR-21 is deeply involved in key pathophysiological mechanisms of IHD, including endothelial dysfunction, vascular inflammation, vascular smooth muscle cell proliferation, plaque development and vulnerability, cardiomyocyte survival, and myocardial fibrosis. Accumulating clinical evidence suggests that circulating miR-21 holds diagnostic value across the ischemic continuum, from stable coronary artery disease to acute coronary syndromes, myocardial infarction, and ischemic heart failure. Moreover, miR-21 demonstrates prognostic relevance, correlating with plaque instability, adverse remodeling, heart failure progression, and long-term cardiovascular outcomes. Preclinical studies further indicate that miR-21 represents a double-edged therapeutic target, offering cardio protection in acute ischemic injury while contributing to fibrosis and maladaptive remodeling if dysregulated. This narrative review summarizes current evidence on the diagnostic, prognostic, and therapeutic utility of miR-21 in IHD, highlighting its clinical promise as well as key limitations and future translational challenges. Full article

Lipodystrophy is a rare group of metabolic disorders characterized by the abnormal distribution of body fat, which can lead to various metabolic complications due to the body’s inability to adequately process carbohydrates and fat. We report the case of a female, aged 53 years, who was admitted as an outpatient for progressive weight loss of the upper part of the body (face, neck, arms, and chest), dyspeptic complaints, fatigue, mild insomnia, and anxious behavior. Her medical history was characterized by the presence of dyslipidemia, hypertension, and a minor stroke episode. However, she denied any family-relevant medical history. Although the clinical perspective suggested a possible late onset of partial acquired lipodystrophy, due to the imaging exam that revealed an enlarged liver with inhomogeneous structure with multiple nodular lesions, scattered over both lobes, a lot of lab work-ups and complementary studies were performed. Eventually, a liver biopsy was performed by a laparoscopic approach during cholecystectomy, the histology consistent with metabolic disease-associated steatohepatitis (MASH). In conclusion, given their heterogeneity and rarity, lipodystrophies may be either overlooked or misdiagnosed for other entities. Barraquer–Simons syndrome (BSS) may be associated with liver disease, including cirrhosis and liver failure. Liver lipodystrophy in BSS may sometimes feature steatosis with a focal, multi-nodular aspect, multiplying the diagnostic burden. Liver lipodystrophy may manifest as asymptomatic fat accumulation but may progress to severe conditions, representing one of the major causes of mortality in BSS, apart from the cardio-vascular comorbidities. Given the potential of severe outcomes, it is mandatory to correctly assess the stage of liver disease since the first diagnosis. Full article

Prediabetes is a serious and major global problem afflicting approximately 21% of the world’s population. It is the intermediate stage between normal glucose levels and type 2 diabetes mellitus (T2DM). Prediabetes is associated with major complications including the development of T2DM and increased cardiovascular disease (CVD). It can be easily diagnosed with an inexpensive plasma glucose level and/or a hemoglobin A1c (HbA1c) measurement. The mainstay of treatment is intensive lifestyle (ILS) intervention, including reduction in calories, especially saturated fats, refined carbohydrates, etc., coupled with regular physical activity of 150 min per week since ILS changes, with at least a 5% weight loss, have been shown to reduce progression to T2DM in multiple studies globally. Also, metformin therapy has been shown to prevent the progression to T2DM. In conclusion, serious consideration by guideline committees to classify prediabetes as a disease is highly recommended based on its global burden, easy and cost-effective diagnosis, association with serious conditions of diabetes and CVD, and effective ILS intervention. Therapy targeting those at an especially high risk for T2DM, such as persons with impaired glucose tolerance (IGT), impaired fasting glucose (IFG) with values ≥ 110 mg/dL (6.1 mmol/L), and/or HbA1c ≥ 6.0% (42 mmol/mol) coupled with overweightness or obesity. Full article

Background: Glaucoma is an age-related optic neuropathy frequently accompanied by systemic comorbidities. Vitamin D deficiency (VDD) has been associated with cardiovascular and renal diseases in the general population, yet its relationship with long-term systemic outcomes in glaucoma remains unclear. This study evaluated the association between baseline vitamin D status and subsequent mortality and cardiorenal events in patients with primary glaucoma. Methods: We conducted a retrospective cohort study using deidentified electronic health records from the TriNetX U.S. Collaborative Network, a federated network of participating healthcare organizations. Adults (≥18 years) with incident primary glaucoma (2005–2020) and a serum 25-hydroxyvitamin D (25(OH)D) test within 12 months prior to diagnosis were categorized as VDD (<30 ng/mL) or vitamin D adequacy (VDA; ≥30 ng/mL). After 1:1 propensity score matching across 47 demographic, clinical, medication, and laboratory variables, 11,855 patients per group were followed for up to 5 years. Outcomes included all-cause mortality, major adverse cardiovascular events (MACE), acute kidney injury (AKI), and renal function decline (eGFR < 60 mL/min/1.73 m²). Analyses incorporated Kaplan–Meier curves, Cox models, landmark tests, sensitivity analyses, and competing risk methods. Results: Among the 35,100 eligible patients, the matched cohorts demonstrated higher 5-year risks associated with VDD for all-cause mortality (HR 1.104; 95% CI 1.001–1.217), MACE (HR 1.151; 95% CI 1.078–1.229), and AKI (HR 1.154; 95% CI 1.056–1.261), whereas the risks of renal function decline did not differ (HR 0.972; 95% CI 0.907–1.042). Risk divergence emerged within the first year of follow-up and persisted through the 5-year observation period. Conclusions: In patients with primary glaucoma, vitamin D deficiency was associated with higher long-term risks of mortality and cardiorenal complications, but not renal function decline. Taken together, the results are consistent with vitamin D status serving as a marker of broader systemic vulnerability in glaucoma and highlight the need for prospective studies to further clarify its prognostic significance. Full article

Osteoporosis and chronic conditions such as type 2 diabetes mellitus, cardiovascular disease, heart failure, and chronic kidney disease share several common biological mechanisms, including chronic inflammation, oxidative stress, hormonal dysregulation, and metabolic alterations. In this context, multimorbidity presents an increasing clinical challenge, particularly in older populations, where osteoporosis remains frequently underdiagnosed and undertreated. This review aims to explore the complex interplay between skeletal fragility and cardiometabolic diseases, emphasizing the role of nutritional deficiencies (such as iron and vitamin C), shared molecular pathways (advanced glycation end-products, Renin–Angiotensin–Aldosterone System, RANK Ligand, RANK), and the systemic impact of chronic inflammation and tissue hypoperfusion. The review also addresses the effects of various drug classes—antidiabetics, antihypertensives, anticoagulants, and anti-osteoporotic agents—on bone metabolism and cardiovascular risk. Special focus is given to the implementation of integrated and personalized care models, particularly multidisciplinary team-based approaches, which have demonstrated significant reductions in mortality and refracture rates, despite their still limited adoption in clinical practice. In conclusion, this review highlights the shared mechanisms between osteoporosis and cardiometabolic conditions in the context of multimorbidity, underscoring persistent clinical challenges related to diagnosis, drug interactions, and care fragmentation that warrant further research into integrated care models. Full article

The early diagnosis and treatment of civilizational diseases remain a significant challenge worldwide. Although advances in medical technology have led to the introduction of more screening options over time, these measures are still insufficient to effectively reduce mortality from deadly diseases such as lung cancer (LC), cardiovascular diseases (CVD), diabetes, and chronic obstructive pulmonary disease (COPD). These conditions pose a major public health burden, underlying the urgent need for more comprehensive and efficient prevention strategies. Recently, the concept of ‘multiscreening’ has emerged as a promising approach. Multiscreening involves the simultaneous screening for multiple diseases using integrated diagnostic methods, potentially improving early detection rates and optimizing resource utilization. In 2024, Rzyman W. et al. launched the MULTIPREVENT epidemiological study, which aims to develop and validate a low-dose computed tomography (LDCT)-based screening test for civilizational diseases. This study represents a step forward in the pursuit of more effective, minimally invasive diagnostic tools that could facilitate earlier intervention and improve patient outcomes. To better understand the potential of multiscreening approaches and their clinical utility, it is essential to evaluate the existing predictive models used for identifying individuals at high risk for these diseases. This narrative review focuses primarily on lung cancer risk prediction models used in LDCT screening while situating these approaches within the broader conceptual framework of the MULTIPREVENT project, aimed at future integration of multi-disease prevention strategies. With this analysis, we aim to provide insights that will guide the development of more accurate, integrative screening tools that could reduce the global burden of these diseases. Full article

Heart failure (HF) remains a major cause of morbidity and mortality worldwide, with its prevalence continuing to rise due to an aging population and the increasing burden of cardiometabolic diseases. Advances in understanding HF pathophysiology—neurohormonal, inflammatory, and metabolic mechanisms—have led to significant improvements in diagnosis and management, emphasizing earlier detection and patient-centered approaches. Novel biomarkers have the potential to enhance risk assessment beyond traditional natriuretic peptides. Imaging advances can enhance structural and functional assessment, enabling more accurate phenotyping, disease characterization, and risk stratification. Recent advances and real-world data have been used to implement and optimize guideline-directed medical therapy (GDMT) for HF to reduce HF hospitalizations and cardiovascular mortality across the spectrum of HF etiologies. Adjunctive therapies are reserved for select patients with persistent symptoms or high-risk features despite optimal GDMT. Device- and transcatheter-based interventions include established and emerging technologies that address persistent symptoms, structural abnormalities, and hemodynamic abnormalities despite optimal GDMT, thereby expanding treatment options for high-risk patients. Collectively, these advancements highlight a paradigm shift toward precise, personalized approaches to HF management, thereby improving long-term outcomes across the spectrum of HF etiologies. Full article

Acute pancreatitis (AP) is an inflammatory condition with varying severity, ranging from mild self-limiting episodes to life-threatening complications. The incidence, clinical presentation, and outcomes of AP differ significantly across age groups, with elderly patients demonstrating distinct challenges. Biliary pancreatitis is more prevalent in older adults, whereas alcohol-induced AP dominates in younger populations. Elderly patients frequently present with atypical or less pronounced abdominal symptoms, which may delay diagnosis. Comorbidities such as kidney failure, cardiovascular disease, diabetes mellitus and arterial hypertension are significantly more common in the elderly and are associated with increased risk of organ dysfunction, systemic complications such as organ failure, multiple organ dysfunction syndrome (MODS), and prolonged hospitalization. The higher incidence of intensive care unit admissions and mortality is noted in the elderly, particularly in those over 80 years, in particular. Evidence on age-related differences in local pancreatic complications is inconsistent, with a possible trend toward lower rates in older adults. Early identification and individualized treatment planning are essential. Abundant fluid administration should be limited in older patients due to frequent cardiac insufficiency but should be carefully monitored due to the present or threatening renal insufficiency. Pain control with opioids may cause severe CNS complications for elderly patients. In contrast, ERCP, when indicated, is usually well tolerated in older patients. Personalized management in elderly patients is strongly recommended. Full article

Background: Obesity is a worldwide public health problem, affecting organs and systems. It is also a cardiovascular risk factor, which facilitates the development of diseases, such as arterial hypertension, dyslipidemia, and diabetes, which are used as criteria for the diagnosis of metabolically unhealthy obesity. Objective: To analyze the association between blood pressure and metabolic health factors, stress level, and nutrient intake in overweight and obese university students through mediation analysis. Methods: A quantitative, non-experimental, cross-sectional, correlational, and quantitative study was conducted in a sample of 230 obese/overweight university students selected by a multistage mass random sampling method. To evaluate habitual dietary intakes, a CFCA food frequency questionnaire was applied; a DASS-21 scale was used to evaluate stress; blood pressure and anthropometric data were collected; insulin levels, lipid profile, and glucose were determined using fasting blood samples. Statistical analysis was performed using univariate methods (frequencies, trend, and dispersion measures) and a mediational model. Results: The majority were young people aged 18 years (18.7%), with morning and afternoon shifts (60%), overweight (76.1%), and obese (23.9%). Not all obese people have arterial hypertension; however, an increase in BMI increases the risk of suffering from this disease. Model 1 showed that certain types of stress and sex at birth have an important relationship with diastolic blood pressure, mediated in some cases by weight. In Model 2, weight is a significant mediator in the relationship between moderate stress and systolic BP, and between sex at birth and systolic BP, thus allowing us to contribute to the understanding of how these variables are interrelated. Conclusions: This suggests that severe stress and sex at birth not only affect BP directly, but also do so through their effect on weight. Thus, both pathways contribute to understanding the relationship between stress, sex at birth, and diastolic and systolic blood pressure. Nevertheless, the results of this study provide empirical knowledge to design evidence-based prevention and treatment strategies. Full article

Cardiovascular disease (CVD) remains the leading cause of mortality among hemodialysis (HD) patients, underscoring the need for reliable biomarkers for early diagnosis and management. Serum intercellular adhesion molecule-1 (ICAM-1) has been investigated for years as a potential CVD marker but has yet to establish clinical utility. In a cohort of 142 HD patients, we examined the potential of serum ICAM-1 as a CVD biomarker and evaluated whether confounding factors, including low-grade inflammation and chronic kidney disease–mineral bone disorder (CKD-MBD), limit its diagnostic value. In addition to serum ICAM-1, routine biochemical parameters, bone alkaline phosphatase (bALP), and nitric oxide (NO) were measured. Serum levels of ICAM-1, bALP, and NO did not differ between patients with and without CVD, defined by a positive history of coronary heart disease, stroke, or peripheral arterial disease. Serum ICAM-1 concentrations were higher in HD patients with inflammation, as indicated by C-reactive protein levels >1 mg/dL. ICAM-1 showed no correlation with NO, a marker of endothelial dysfunction, but was positively correlated with bALP, a marker of CKD-MBD. In conclusion, serum ICAM-1 is not a reliable biomarker of CVD in HD patients. Its diagnostic utility appears confounded by inflammation and disturbances in bone turnover. Full article

Objectives: Emerging evidence suggests that bilirubin, beyond being a metabolic byproduct, may exert protective effects against metabolic and cardiovascular diseases due to its antioxidant properties. However, its relationship with hyperlipidemia remains unclear. This study investigated the relationship between hyperbilirubinemia and hyperlipidemia in a large, community-based cohort. Methods: Data from 8464 participants in the Jidong Community Cohort were analyzed using a cross-sectional design. Hyperbilirubinemia was defined as serum total bilirubin (STB) ≥ 17.1 μmol/L, whereas hyperlipidemia was determined based on a prior diagnosis or elevated lipid profile. Results: Of all participants, 31.6% had hyperbilirubinemia and 51.8% had hyperlipidemia. Multivariable logistic regression revealed a significant inverse association between hyperbilirubinemia and hyperlipidemia [odds ratio (OR) = 0.764, 95% confidence interval (CI) = 0.686–0.851]. This association was significant in participants aged <65 years (OR = 0.762, p < 0.0001) but not in those aged ≥65 years. Stratified analysis by smoking status further revealed a 29% reduced risk of hyperlipidemia among never-smokers (OR = 0.708, p < 0.001), but not among current (OR = 0.831, p = 0.087) or former smokers (OR = 0.685, p = 0.175). Hyperbilirubinemia was also negatively associated with TC (p < 0.0001), TGs (p < 0.0001), LDL-C (p = 0.0061), very LDL-C (VLDL-C; p = 0.0043), and apolipoprotein B (ApoB; p < 0.0001) levels, as well as the ApoB/apolipoprotein A1 (ApoA1) ratio (p = 0.0003). Restricted cubic spline analysis revealed an inverse relationship of high STB levels with the TC, TG, LDL-C, VLDL-C, and ApoB levels, as well as the ApoB/ApoA1 ratio. Moreover, elevated STB levels were inversely linked to obesity (OR = 0.747, p < 0.0001), arterial stenosis (OR = 0.806, p = 0.0462), and metabolic syndrome (OR = 0.784, p = 0.0008). Conclusions: hyperbilirubinemia may be an independent factor protective against hyperlipidemia and related lipid abnormalities; these results provide insights for the prevention and management of lipid-related diseases. Full article

Background/Objectives: The postoperative implications of a history of coronavirus disease 2019 (COVID-19) in patients undergoing spinal surgery remain inadequately defined. This study investigated whether a history of COVID-19 is associated with increased postoperative complication risk and assessed how surgical timing after infection influences outcomes. Methods: Patients who underwent spinal surgery in 2020 were identified. Individuals with a confirmed history of COVID-19 were matched 1:3 by age and sex to uninfected controls. Patients were categorized by the interval between COVID-19 diagnosis and the index surgical date (≤1 month, >1–≤3 months, or >3–≤6 months). Postoperative pulmonary, cardiovascular, thromboembolic, infectious, and mortality outcomes were evaluated. Cumulative risks were estimated using Kaplan–Meier analysis, and adjusted hazard ratios (HRs) were determined using multivariable Cox proportional hazards models controlling for demographic and clinical factors. Results: Surgery performed ≤1 month after COVID-19 diagnosis was associated with significantly higher risks of pneumonia within 3 months (HR 3.91; p = 0.031) and 6 months postoperatively (HR 3.12; p = 0.049). Patients undergoing surgery >1–≤3 months after COVID-19 demonstrated increased risk of spinal and implant-related infections within 3 months (HR 2.12; p = 0.040), and this elevated risk persisted when surgery occurred >3–≤6 months after infection (HR 2.00; p = 0.022). No significant differences were observed in cardiovascular, thromboembolic, or mortality outcomes. Conclusions: A history of COVID-19 infection was associated with postoperative pneumonia and spinal and implant-related infections following spinal surgery. These findings suggest that prior COVID-19 infection may be a relevant consideration in perioperative risk assessment and surgical planning. Full article

The increasing prevalence of obesity-related primary arterial hypertension (PAH) in the pediatric population emphasizes the need to develop new biomarkers that can aid in clinical practice for prevention or early diagnosis of the cardiovascular disease. The objective of the present study was to evaluate the relationship between selected adipokines, cytokines, and blood pressure (BP) values in children with obesity. A total of 78 children participated in the study: 60 children with obesity (study group) and 18 children with normal weight (control group). Blood pressure was measured according to guidelines. Serum levels of metabolic and inflammatory markers, including leptin, adiponectin, resistin, ghrelin, interleukin 6 (IL-6), interleukin 10 (IL-10), tumor necrosis factor α (TNF-α), vascular endothelial growth factor (VEGF), and insulin were determined using multiplex immunoassays. Statistical analysis included correlation and ROC tests to identify potential predictors of PAH. The study group had significantly higher systolic and diastolic BP compared to the control group (p < 0.0001). Serum levels of leptin, IL-6, VEGF, insulin, and resistin were increased in the study group. Leptin, IL-6 and resistin correlated positively with BP values (p < 0.05), while ghrelin and adiponectin correlated negatively. ROC analysis identified leptin, IL-6, and VEGF as the most promising biomarkers for predicting PAH. The results confirm the role of adipokines and cytokines in the pathogenesis of PAH. The assessment of adipokine and cytokine profiles complements traditional anthropometric parameters such as BMI in assessing cardiovascular risk. Leptin, IL-6, and VEGF presented the strongest correlation with hypertension, suggesting their potential in future diagnostic and preventive strategies. Full article

The objectives of our study were to determine the mortality rates, causes, and risk factors of people living with HIV in the modern antiretroviral therapy era, in a major HIV center in Israel. We retrospectively collected data from 1547 patients treated during 2001–2021. We used the Shapiro–Wilk test, Fisher’s exact test, Student’s t test, and chi-square to compare between patients who died and those who did not, and between patients who died from AIDS-related and non-AIDS-related causes. In total, 206 (13.3%) patients died. The causes of death were AIDS-defining diseases (33.5%), cardiovascular diseases (21.8%), non-AIDS infections (16%), and hepatic disorders (7%). The annual mortality rate was 1.31 ± 0.3%. Despite an increase in age (35 ± 13.2 in 2001, 49 ± 13.6 years in 2021; p < 0.001), the mortality rate decreased (2.12% during 2005–2008, 0.71% during 2018–2021; p = 0.0001). AIDS-defining diseases caused 75% of deaths during 2001–2002, and only 25% during 2019–2021. The proportion of cardiovascular deaths increased (8.3% in 2001–2003, 33.3% in 2019–2021; p < 0.001). Low CD4 and high viral load at diagnosis, male gender, non-MSM HIV acquisition (heterosexual transmission and people who inject drugs), and inability to achieve viral suppression because of non-compliance were risk factors for mortality. Mortality rates decreased during 2001–2021; however, the proportion of non-AIDS deaths increased. Early cardiovascular comorbidity screening and targeted adherence interventions in non-MSM populations and in patients with low CD4 are needed. Full article

Background/Objectives: Endometriosis is a chronic inflammatory disease affecting up to 10–15% of women of reproductive age and is frequently associated with pelvic pain and infertility. Non-invasive biomarkers remain insufficient for accurate diagnosis, often necessitating laparoscopic confirmation. The fibrinogen-to-albumin ratio (FAR), a composite marker of systemic inflammation, has been proposed in both oncological and cardiovascular disease but has not yet been evaluated in endometriosis. Methods: We conducted a retrospective monocentric study including 390 women who underwent laparoscopy between January 2015 and December 2021 at the Medical University of Vienna. Of these, 218 had histologically confirmed endometriosis and 172 had benign ovarian cysts. Preoperative laboratory data was collected, and FAR was calculated. Group comparisons were performed using the Mann–Whitney U test. ANOVA was used to compare FAR across revised American Society for Reproductive Medicine (rASRM) stages, and Spearman’s rank correlation assessed associations with disease severity. Subgroup analyses were performed for adenomyosis and deep infiltrating endometriosis (DIE). Results: FAR was significantly higher in women with endometriosis than in controls (median 0.0679, IQR 0.0588–0.0778 vs. 0.0641, IQR 0.0559–0.716; p = 0.0035). Across rASRM stages I–IV, FAR values were comparable (means 0.0691–0.0709) and did not differ significantly (p = 0.822, ANOVA). Spearman’s correlation confirmed no significant association with disease stage (ρ = 0.085, p = 0.24). In exploratory analyses, women with adenomyosis (n = 35) showed a non-significant trend toward a higher median FAR compared to those without adenomyosis (0.0707 vs. 0.0669; p = 0.073, one-sided). No difference in FAR was observed between women with deep infiltrating endometriosis (DIE; n = 144) and those without (0.0680 vs. 0.0672; p = 0.389, one-sided). Conclusions: Although FAR alone cannot replace surgical confirmation, the difference observed between the groups may reflect the systemic inflammatory aspect of endometriosis and should be investigated further in future studies. Given its accessibility and cost-effectiveness, FAR may support the development of non-invasive, personalized diagnostic approaches when combined with other clinical and molecular markers. Full article