Vauterin D, Van Vaerenbergh F, Grymonprez M
… +3 more, Hawkins NM, Fabbri LM, Lahousse L
Eur J Intern Med
· 2026 May · PMID 41833474
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RATIONALE: Real-world effectiveness of cardiovascular and LABA/LAMA treatment in patients with heart failure (HF) during hospitalized exacerbation of COPD (ECOPD) is limited. OBJECTIVES: To investigate associations of gu...RATIONALE: Real-world effectiveness of cardiovascular and LABA/LAMA treatment in patients with heart failure (HF) during hospitalized exacerbation of COPD (ECOPD) is limited. OBJECTIVES: To investigate associations of guideline-directed medical therapy (GDMT) during hospitalization with in-hospital and post-discharge all-cause mortality and readmission risk. METHODS: HF patients aged ≥18 years hospitalized for ECOPD were included in this Belgian nationwide observational cohort between 2017-2022. HF GDMT was defined as use of at least beta-blockers in combination with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers or angiotensin receptor-neprilysin inhibitors following 2016 ESC guidelines, whereas COPD GDMT was defined as use of at least LABA+LAMA following 2017 GOLD report. Multivariable adjusted logistic regression and time-to-event analyses were used to investigate the associations. MAIN RESULTS: Among 14,582 patients (mean age 76.8 years, 40.7% females), GDMT was dispensed for HF only (20.4%), COPD only (23.6%) or both HF and COPD (11.9%). During hospitalization, 14.1% (2,058/14,582) died: 18.1% (no GDMT), 11.1% (HF GDMT), 11.0% (COPD GDMT) and 7.9% (both GDMT), respectively. HF GDMT was significantly associated with a 38% lower in-hospital mortality odds (aOR 0.62, 95%CI 0.55-0.70), while COPD GDMT was independently associated with a 40% lower odds (aOR 0.60, 95%CI 0.53-0.67). HF GDMT, alone (aHR 0.83, 95%CI 0.77-0.88) or combined with COPD GDMT (aHR 0.82, 95%CI 0.75-0.89), was associated with a significantly lower post-discharge mortality risk, whereas no significant associations between GDMT and readmission were observed. CONCLUSIONS: These results highlight the importance of HF GDMT, alongside optimised COPD management during hospitalization, to reduce in-hospital and post-discharge mortality risk.
Eur J Intern Med
· 2026 May · PMID 41833473
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Incretin-based therapies, including mono-, dual-, and emerging triple-agonists, have transformed the pharmacological management of obesity by inducing substantial and sustained weight loss together with marked improvemen...Incretin-based therapies, including mono-, dual-, and emerging triple-agonists, have transformed the pharmacological management of obesity by inducing substantial and sustained weight loss together with marked improvements in cardiometabolic risk factors. However, growing evidence from randomized withdrawal trials and meta-analyses demonstrates that discontinuation of these agents is consistently followed by rapid and clinically meaningful weight regain, often approaching two-thirds of the initial weight loss within one year, alongside early deterioration of cardiometabolic parameters. These observations reinforce the concept of obesity as a chronic, relapsing disease that generally requires long-term pharmacological management rather than time-limited treatment. This Opinion article examines the biological, clinical, and health-system factors that complicate discontinuation of incretin-based therapies, including adaptive neuroendocrine responses to weight loss, interindividual variability in treatment response, persistence of "obesity memory" at the adipose tissue level, and real-world challenges related to adherence, tolerability, and cost. We discuss emerging strategies aimed at mitigating post-withdrawal weight regain, such as dose de-escalation, low-dose maintenance, extended dosing intervals, and intensive lifestyle interventions, while highlighting the current lack of robust randomized evidence supporting these approaches. Finally, we propose reframing the concept of precision medicine in obesity toward a "precision physician-patient relationship," emphasizing individualized, longitudinal decision-making to guide treatment continuation, tapering, or discontinuation in the absence of reliable predictive biomarkers.
INTRODUCTION: Retinal vascular alterations were reported in patients with SSc suggesting a potential role for OCTA in the evaluation of SSc-related microangiopathy. The aim of the study is to evaluate the microangiopathi...INTRODUCTION: Retinal vascular alterations were reported in patients with SSc suggesting a potential role for OCTA in the evaluation of SSc-related microangiopathy. The aim of the study is to evaluate the microangiopathic alterations in the retina of patients with SSc and to evaluate their correlation with the clinical manifestations of the disease and the capillaroscopic findings MATERIALS AND METHODS: This is a case-control study comparing SSc patients to healthy controls. OCTA acquisition consisted on scans of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) of both the macula and the optic nerve, performed using Canon OCT. Vascular density (VD), vascular length density (VLD), foveal avascular zone (FAZ) and retinal thickness in the fovea and in the perifoveal region were obtained using dedicated software. RESULTS: 41 SSc patients (11 were VEDOSS) were compared with 20 healthy controls. SSc patients showed reduced VD and VLD values in all areas evaluated both in the SCP and DCP (p < 0.001 for both). At the optic nerve level, both VD and VLD values were reduced at the SCP (p < 0.001 for both) and DCP levels (p = 0.009 and p < 0.001). Retinal thickness in the parafoveal region was increased in SSc patients (p = 0.013) and correlated with blood flow at nailfold videocapillascopy (p = 0.030). VD and VLD at the foveal level in DCP were associated with the presence of avascular areas (p = 0.018 and p = 0.019) and neoangiogenesis (p = 0.023 and p = 0.025). CONCLUSION: Ocular microangiopathy is present in scleroderma patients since the early stages of the disease and is correlated with capillaroscopic alterations.
Rigutini AG, Paciaroni M, Mosconi MG
… +10 more, Cancelloni V, Urbini C, Marvardi M, Rapuano C, Gaboni A, Bufi A, Bucci T, Becattini C, Lip GYH, Caso V
BACKGROUND: Acute stroke is frequently complicated by new-onset cardiac or thromboembolic events, referred to as Stroke-Heart Syndrome (SHS). The role of stroke subtype and lesion location in determining SHS risk remains...BACKGROUND: Acute stroke is frequently complicated by new-onset cardiac or thromboembolic events, referred to as Stroke-Heart Syndrome (SHS). The role of stroke subtype and lesion location in determining SHS risk remains underexplored. METHODS: We conducted a retrospective analysis of data from the hospital-based Perugia Stroke Registry (March 2005-September 2019). Patients with acute neurological symptoms were classified as ischaemic stroke (IS) or haemorrhagic stroke (HS) based on neuroimaging. Logistic regression identified predictors of stroke subtype and in-hospital complications. Subgroup analyses compared first-ever versus recurrent strokes, and lesion location (lacunar, non-lacunar anterior, or non-lacunar posterior for IS; typical versus atypical for HS). The primary outcome was a composite of all-cause death, cardiac events and venous thromboembolic events during Stroke Unit stay. Secondary outcomes were each component. RESULTS: Among 2080 patients (mean age 72.8 ± 12.5 years; 57% male), 1788 (86%) had IS and 292 (14%) HS. During Stroke Unit stay (median 8 days, IQR 5-14), HS patients had higher rates of the composite outcome (26% vs 14%) and all-cause death (21.2% vs 8.8%) than IS. In IS, non-lacunar posterior and anterior strokes were associated with increased risk of composite outcome (OR 1.97, 95%CI 1.10-3.63; OR 1.61, 95%CI 0.96-2.81) and all-cause death (OR 3.35, 95%CI 1.35-9.51; OR 2.90, 95%CI 1.28-7.79) versus lacunar strokes. Among HS, atypical lesions increased risk of composite outcome (OR 2.51, 95%CI 1.24-5.22) and all-cause death (OR 2.80, 95%CI 1.31-6.17). CONCLUSIONS: Lesion location is a key determinant of SHS. Non-lacunar posterior stroke and atypical HS predict higher mortality and cardiovascular complications.
BACKGROUND AND AIM: The role of exercise testing in the follow up of patients with persistent dyspnea after pulmonary embolism (PE) is currently limited, with cardiopulmonary exercise test (CPET) mainly recommended in pa...BACKGROUND AND AIM: The role of exercise testing in the follow up of patients with persistent dyspnea after pulmonary embolism (PE) is currently limited, with cardiopulmonary exercise test (CPET) mainly recommended in patients with a low probability of pulmonary hypertension (PH) at rest. METHODS: We conducted a comprehensive systematic review of studies retrieved from EMBASE and MEDLINE. When appropriate, meta-analysis was conducted. RESULTS: Twenty-eight studies were included. At CPET, pooled VE/VCO₂ slope was lower in CTEPD without PH compared to chronic thromboembolic pulmonary hypertension (CTEPH) (mean difference = 12.34, 95% CI =17.19 to 7.48, I² =76%). CPET parameters indicated more severe cardiopulmonary impairment in CTEPH than in pulmonary arterial hypertension (PAH), with a lower pooled Peak VO₂ (mean difference=-0.57 mL·kg⁻¹·min⁻¹, 95% CI=-0.94 to -0.20, I²=0%), higher VE/VCO₂ slope (mean difference=8.44, 95% CI=3.31 to 13.57, I²=19%), lower peak PETCO₂ (mean difference=-3.55 mmHg, 95% CI=-4.75 to -2.34 mmHg, I²=0%), and lower PETCO₂ at anaerobic threshold (mean difference=-3.55 mmHg, 95% CI=-4.75 to -2.34 mmHg, I²=0%). In CTEPH, peak VO2 correlated with mPAP and survival: in two studies, different VO2 thresholds were associated with survival differences of 30% and 35%, respectively. The prevalence of exercise-induced PH, assessed by exercise right heart catheterization (exRHC), was reported as 50% and 45% in two studies. DISCUSSION: CTEPH is associated with worse CPET profile compared with both CTEPD without PH and PAH. Peak VO₂ and ventilatory efficiency may have prognostic value in CTEPH, while evidence in CTEPD without PH remains largely exploratory and hypothesis-generating.
BACKGROUND: Liver cirrhosis is associated with an increased risk of infections, but it is unknown when infection rates start to increase. This study aims to investigate the risk of infection before, and after, cirrhosis...BACKGROUND: Liver cirrhosis is associated with an increased risk of infections, but it is unknown when infection rates start to increase. This study aims to investigate the risk of infection before, and after, cirrhosis diagnosis. METHODS: All patients diagnosed with cirrhosis in Sweden between 1997 and 2020 were retrospectively identified from National Patient Register, from which incident infections were also ascertained. Conditional Poisson regression was used to compare the incidence rate [IR] of infections during the diagnostic period (±3 months from cirrhosis diagnosis) to a pre-diagnostic period (the same six-months-span four years prior) among the same patients. RESULTS: 21,187 (50.4%) patients with decompensated, and 20,880 (49.6%) with compensated cirrhosis were identified. Alcohol-related liver disease (44.8%) and viral hepatitis (18.1%) were the most common etiologies. A total of 824 infections were observed in the pre-diagnostic, and 9892 in the diagnostic period. Compared to the pre-diagnostic period, the IR ratio during the diagnostic period was 15.7-fold higher (95%CI=14.7-16.9) for all patients, 17.2-fold higher (95%CI=15.6-19.0) in decompensated cirrhosis and 14.2-fold higher (95%CI=14.7-16.9) in compensated cirrhosis. Patients with ascites had the greatest increase in infection risk. Sepsis and peritonitis showed the highest increase in risk during the diagnostic period. CONCLUSION: Infection risk increases several years prior to cirrhosis and peaks around the time of cirrhosis diagnosis, although estimates may reflect detection bias. The progressive increase in infection risk four years proceeding cirrhosis suggests that infections may serve as clinical indicators of underlying cirrhosis, and highlights the importance of infection prevention, especially in decompensated cirrhosis.
Vogelmeier CF, Böhm M, Hurst JR
… +9 more, Kahnert K, Lange TJ, Taube C, Trinkmann F, Watz H, Rabe KF, Stolz D, Gediga M, Fabbri LM
Eur J Intern Med
· 2026 May · PMID 41802970
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Patients with chronic obstructive pulmonary disease (COPD) frequently suffer from other chronic conditions, with cardiovascular disease being especially common. The presence of cardiovascular disease in patients with COP...Patients with chronic obstructive pulmonary disease (COPD) frequently suffer from other chronic conditions, with cardiovascular disease being especially common. The presence of cardiovascular disease in patients with COPD complicates overall disease management and is associated with worse morbidity and high mortality. Furthermore, patients who are hospitalised due to a COPD exacerbation are at an increased risk of death not only during hospitalisation but also for at least one year post-discharge, with the coexistence of cardiovascular comorbidities being key predictors of poor medium-term outcomes. Importantly, cardiovascular disease is often undiagnosed in patients with COPD - and even if diagnosed, medical care during and after hospitalisation often focuses on a single condition without structured coordination between hospital- and office-based physicians. This narrative review aims to provide practical guidance to primary and (non-specialist) secondary care physicians who are caring for patients with COPD and cardiovascular comorbidities, including the discharge process and the post-hospitalisation period. Limited data are available to support some of these recommendations, and the content therefore represents expert consensus based on collective experience and practice.
Johnson R, Gruev I, Yotov Y
… +17 more, Jackuliak P, Borghi C, Domienik-Karłowicz J, Tykarski A, Filipiak KJ, Jaguszewski MJ, Narkiewicz K, Barylski M, Mamcarz A, Wolf J, Jarai Z, Becer D, Vrablik M, Vinereanu D, Wełnicki M, Widecka K, Litwin M
BACKGROUND: Hyperuricemia has traditionally been viewed primarily as a cause of gout; however, accumulating evidence indicates that elevated serum uric acid (sUA) is also associated with increased cardiovascular and rena...BACKGROUND: Hyperuricemia has traditionally been viewed primarily as a cause of gout; however, accumulating evidence indicates that elevated serum uric acid (sUA) is also associated with increased cardiovascular and renal risk. Recent epidemiological studies suggest that adverse outcomes may occur at sUA levels well below the classic crystal-based thresholds, particularly in patients with high cardiovascular risk. METHODS: This expert consensus document was developed by a multidisciplinary European panel of cardiology, internal medicine, nephrology, and hypertension specialists. The recommendations are based on a critical narrative review of the literature published, including large cohort studies, meta-analyses, randomized controlled trials, and contemporary European guidelines (ESC, ESH, KDIGO, EULAR). Particular emphasis was placed on outcome-driven serum urate thresholds and clinically applicable risk stratification. RESULTS: Hyperuricemia is common and increasingly prevalent, especially among individuals with hypertension, chronic kidney disease, obesity, diabetes, and established cardiovascular disease. Elevated sUA is independently associated with cardiovascular mortality, heart failure, stroke, and faster progression of chronic kidney disease. However, randomized trials have not shown clear cardiovascular or renal benefit from routine urate-lowering therapy in patients with asymptomatic hyperuricemia. Based on current evidence, this consensus proposes a risk-based, individualized approach to hyperuricemia management and presents a pragmatic six-rung therapeutic ladder integrating lifestyle measures, optimization of comorbidities, and pharmacological urate-lowering therapy when clinically indicated. CONCLUSIONS: Hyperuricemia should be recognized as a relevant cardiovascular and renal risk factor rather than a benign biochemical finding. Serum urate measurement can improve risk stratification in selected high-risk populations. While routine treatment of asymptomatic hyperuricemia cannot be universally recommended, targeted urate-lowering strategies may be appropriate in patients with high cardiovascular risk, symptomatic disease, or very high sUA levels. Future randomized trials are needed to define whether urate-lowering therapy can improve hard cardiovascular and renal outcomes in these populations.