Bobrowska B, Rajtar-Salwa R, Zasada W
… +4 more, Zawada M, Pawliński Ł, Waluś-Miarka M, Małecki MT
Pol Arch Intern Med
· 2026 Mar · PMID 41728739
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INTRODUCTION: Familial hypercholesterolemia (FH) is a group of monogenic disorders causing high LDL levels and early cardiovascular diseases (CVD). OBJECTIVES: We present a PCP-initiated FH screening model at University...INTRODUCTION: Familial hypercholesterolemia (FH) is a group of monogenic disorders causing high LDL levels and early cardiovascular diseases (CVD). OBJECTIVES: We present a PCP-initiated FH screening model at University Hospital in Krakow as part of the Kordian CVD prevention program. PATIENTS AND METHODS: Patients without a prior diagnosis of any chronic disease, including CVD, and who had not taken any medications were selected by PCPs as eligible to participate. The study, conducted from 2019 to 2023, involved 4018 patients. From this group, 378 patients (9.4% of the study population) with CVD risk factors were referred by PCPs to the Department of Cardiology for further assessment. RESULTS: Overall, 125 patients (33.1% referred to the Department of Cardiology), including 51 men and 74 women, met the clinical criteria and underwent genetic testing for FH. The mean age was 46.2 years (SD 13.1). Individuals with confirmed pathogenic heterozygous FH mutations accounted for 45.6% (n = 57) of the population selected for genetic testing. Patients with genetically confirmed FH were notably younger (median 41.0 vs 49.0 years, P = 0.002), and had a lower BMI (mean 24.59 vs 27.22 kg/m2, P = 0.009) than those without a genetic diagnosis. Twice as many patients with confirmed FH had relatives with native LDL levels exceeding 190 mmol/l (71.9% vs 27.9%, P <0.001). This factor increased the risk of FH by more than 11 times. CONCLUSIONS: Collaboration between PCPs and specialists with access to genetic testing, guided by a well-designed algorithm, may.
Abu Baker F, Haimi M, Gal O
… +2 more, Hazzan R, Israel A
Pol Arch Intern Med
· 2026 Mar · PMID 41685612
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INTRODUCTION: The Fibrosis‑4 (FIB‑4) index, a widely used noninvasive marker of hepatic fibrosis, shows prognostic value beyond hepatology, yet its broader systemic and health care implications remain unclear. OBJECTIVES...INTRODUCTION: The Fibrosis‑4 (FIB‑4) index, a widely used noninvasive marker of hepatic fibrosis, shows prognostic value beyond hepatology, yet its broader systemic and health care implications remain unclear. OBJECTIVES: We aimed to characterize the systemic disease burden, health care utilization, and long‑term outcomes linked to elevated FIB‑4 score. PATIENTS AND METHODS: We conducted a large‑scale, matched-cohort study using real‑world data from a nationally representative health care provider. Adults aged 40-80 years with available laboratory data were included, comprising 21 540 individuals with FIB‑4 equal to or above 2.67, matched 1:1 to 21 540 controls with FIB‑4 below 1.45 by age, sex, socioeconomic status, and ethnicity. Cross‑sectional and longitudinal analyses assessed clinical characteristics, health care utilization, and long‑term outcomes over median (interquartile range) follow‑up of 6.2 (4.9-7.8) years. RESULTS: The individuals with elevated FIB‑4 exhibited substantially higher baseline rates of cardiovascular disease, autoimmune disorders, and malignancies. Elevated FIB‑4 was associated with greater pharmacologic exposure and higher utilization of multidisciplinary, diagnostic, procedural, and hospital‑based services. Over the follow‑up period, the individuals with FIB‑4 equal to or above 2.67 experienced consistently greater cumulative incidence of systemic diseases and doubled all‑cause mortality (20.2% vs 9.7%; P <0.001). Annual health care expenditures were more than 3‑fold higher in the high-FIB‑4 group, driven by hospitalizations, specialist care, and procedural intensity. CONCLUSIONS: FIB‑4 equal to or above 2.67 robustly identifies individuals with disproportionate systemic morbidity, elevated mortality risk, and substantial health care resource utilization. Beyond staging hepatic fibrosis, FIB‑4 may function as a low‑cost marker of multimorbidity and health care complexity. Its incorporation into multidisciplinary risk stratification frameworks may enable earlier detection of high‑risk patients, inform preventive strategies, and support proactive population health management.
Kozela M, Dziewierz A, Koziara K
… +6 more, Kowalska-Bobko I, Biondi-Zoccai G, Zelek L, Sielski J, Kaziród-Wolski K, Siudak Z
Pol Arch Intern Med
· 2026 Mar · PMID 41685537
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INTRODUCTION: Type 2 diabetes (T2D) represents a major public health challenge in Poland. This study investigated geographic heterogeneity and municipality‑level ecological predictors of a high T2D risk in the Świętokrzy...INTRODUCTION: Type 2 diabetes (T2D) represents a major public health challenge in Poland. This study investigated geographic heterogeneity and municipality‑level ecological predictors of a high T2D risk in the Świętokrzyskie Voivodeship (Poland), a region undergoing rapid socioeconomic transition. OBJECTIVES: We aimed to identify associations between the T2D risk, assessed by the Finnish Diabetes Risk Score (FINDRISC), and socioeconomic and environmental factors. PATIENTS AND METHODS: This cross‑sectional study analyzed data from 252 427 residents of the Świętokrzyskie Voivodeship aged 45-64 years, without diagnosed diabetes, who participated in a regional prevention program (2019-2022). Individual risk, assessed via the FINDRISC questionnaire, was linked with municipality‑level ecological data. We used a logistic regression model with municipality‑clustered standard errors to identify predictors of a high T2D risk (FINDRISC ≥15). RESULTS: Overall, 13.6% of the participants were at a high risk of diabetes (FINDRISC ≥15), with significant geographic variation (P <0.001). Among municipality‑level predictors, higher unemployment rate was significantly associated with increased odds of a high T2D risk (odds ratio [OR], 1.14 per 1% increase; P <0.001), whereas higher proportions of legally disabled residents and higher annual mean concentrations of particulate matter with aerodynamic diameter of 2.5 μm or smaller were inversely associated with the prevalence of a high T2D risk (OR, 0.98; P = 0.03 and OR, 0.92 per 1 μg/m3; P = 0.001, respectively). Results were robust across sensitivity analyses using alternative FINDRISC cutoffs. CONCLUSIONS: Unemployment was a key population‑level determinant of a high T2D risk, whereas other socioeconomic and environmental factors showed null or inverse associations. These findings underscore the importance of considering local context when assessing population‑level health determinants.
Pol Arch Intern Med
· 2026 Mar · PMID 41677222
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INTRODUCTION: Emerging evidence suggests that sodium‑glucose cotransporter 2 inhibitors (SGLT2is) may be associated with a reduced risk of arrhythmias and related complications. OBJECTIVES: We aimed to evaluate the impac...INTRODUCTION: Emerging evidence suggests that sodium‑glucose cotransporter 2 inhibitors (SGLT2is) may be associated with a reduced risk of arrhythmias and related complications. OBJECTIVES: We aimed to evaluate the impact of SGLT2is on atrial fibrillation (AF)-associated adverse outcomes. PATIENTS AND METHODS: All anticoagulated patients with AF diagnosed between January 2014 and December 2020 were identified from a federated electronic medical record database (TriNetX), and followed‑up for 3 years. A 1:1 propensity score matching (PSM) analysis was performed to balance SGLT2i and non‑SGLT2i cohorts. Primary outcomes were bleeding, hospitalizations for AF/atrial flutter (AFl), composite of cardioversion and ablations, and ventricular arrhythmias (VAs) and cardiac arrests. Secondary outcomes included all‑cause mortality, ischemic stroke / transient ischemic attack (TIA), hemorrhagic stroke, incident heart failure (HF), myocardial infarction, and composite of arterial and venous thrombotic events (TEs). Subanalyses were performed on AF‑diabetes and AF‑HF cohorts. RESULTS: As many as 789 758 and 86 249 patients were identified from the non‑SGLT2i and SGLT2i groups, respectively. After PSM, each group had 51 320 patients. The SGLT2i use was associated with a significantly lower risk of bleeding (hazard ratio [HR], 0.669; 95% CI, 0.642-0.697), hospitalization for AF/AFl (HR, 0.826; 95% CI, 0.815-0.837), composite of cardioversion / ablation (HR, 0.652; 95% CI, 0.628-0.678), and VAs and cardiac arrests (HR, 0.779; 95% CI, 0.754-0.805). A lower risk of all‑cause mortality (HR, 0.554; 95% CI, 0.537-0.571), ischemic stroke/TIA (HR, 0.795; 95% CI, 0.768-0.823), hemorrhagic stroke (HR, 0.691; 95% CI, 0.623-0.767), incident HF (HR, 0.856; 95% CI, 0.821-0.893), myocardial infarction (HR, 0.763; 95% CI, 0.736-0.792), and composite of arterial / venous TEs (HR, 0.719; 95% CI, 0.704-0.735) was also observed. CONCLUSIONS: The SGLT2i use was associated with a lower risk of AF‑related complications.
Pajak A, Szafraniec K, Bobak M
… +1 more, Kozela M
Pol Arch Intern Med
· 2026 Mar · PMID 41631483
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INTRODUCTION: Accurate risk prediction in cardiovascular disease (CVD) is crucial for personalized preventive medicine. OBJECTIVES: The study aimed to evaluate the effect of traditional risk factors on CVD mortality, and...INTRODUCTION: Accurate risk prediction in cardiovascular disease (CVD) is crucial for personalized preventive medicine. OBJECTIVES: The study aimed to evaluate the effect of traditional risk factors on CVD mortality, and to validate the prognostic performance of the Systematic Coronary Risk Evaluation 2 (SCORE2) model for the prediction of 18‑year risk of CVD death. PATIENTS AND METHODS: Our cohort study included 6780 residents of Kraków (54% women), free of CVD and diabetes at baseline, recruited between 2002 and 2005. Mean (SD) baseline age was 57.2 (6.9) years for men and 56.6 (6.8) years for women. RESULTS: In 50 246 and 62 906 person‑years of follow‑up in men and women, respectively, cumulative CVD mortality was 9% in men and 5.2% in women, with competing (non‑CVD) mortality of 19.2% and 12%, respectively. Smoking and hypertension were strongly associated with CVD mortality, whereas associations with total cholesterol (TC) and high‑density lipoprotein cholesterol (HDL‑C) levels were weaker. A newly‑derived model including age, smoking, systolic blood pressure, TC, and HDL‑C achieved Harrell C index of 0.693 in men and 0.757 in women. The model including SCORE2 as a continuous variable showed similar discrimination (Harrell C index of 0.718 in men and 0.754 in women), while SCORE2 categories demonstrated poorer predictive performance (Harrell C index of 0.589 and 0.676, respectively). CONCLUSIONS: Smoking and elevated blood pressure were confirmed as major long‑term predictors of CVD mortality. The prognostic performance of SCORE2 as a continuous measure was good and comparable to the derived prediction model including age and traditional risk factors. However, the predictive accuracy of SCORE2 categories was lower, particularly in men.
Lin Q, Janeczko M, Borys M
… +3 more, Pruc M, Szarpak L, Denegri A
Pol Arch Intern Med
· 2026 Mar · PMID 41609353
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Hyponatremia is the most common electrolyte disorder and a frequent trigger for urgent assessment in internal medicine. Beyond classic culprits, such as thiazide diuretics and antidepressants, clinicians increasingly fac...Hyponatremia is the most common electrolyte disorder and a frequent trigger for urgent assessment in internal medicine. Beyond classic culprits, such as thiazide diuretics and antidepressants, clinicians increasingly face hyponatremia in the setting of modern metabolic and oncologic therapies. Sodium‑glucose cotransporter 2 inhibitors (notably empagliflozin and dapagliflozin) promote glucosuria‑driven osmotic diuresis and electrolyte‑free water clearance, and (based on emerging evidence) may mitigate dilutional hyponatremia in selected patients with the syndrome of inappropriate antidiuresis. At the same time, glucosuria can confound urine indices, and the diuretic effect may unmask occult hypovolemia. Immune checkpoint inhibitors (eg, nivolumab, pembrolizumab, ipilimumab) may cause hyponatremia through immune‑related endocrinopathies (secondary or primary adrenal insufficiency, thyroid dysfunction) and through nonendocrine toxicities leading to salt and water losses. In a large real‑world cohort of patients receiving immune checkpoint inhibitors, hyponatremia occurred in roughly two‑thirds, and severe hyponatremia (serum sodium <124 mmol/l) in 6%; endocrine causes accounted for a small but pivotal fraction. Targeted anticancer agents (eg, vascular endothelial growth factor receptor-directed multikinase tyrosine kinase inhibitors and mammalian target of rapamycin inhibitors) add further complexity, often via gastrointestinal toxicity, renal tubular dysfunction, or inappropriate antidiuresis. We provide a bedside diagnostic algorithm and pragmatic monitoring recommendations aimed at preventing neurological harm from overly rapid correction. This narrative review summarizes contemporary mechanisms of drug‑related hyponatremia, highlights therapy‑specific diagnostic pitfalls, and proposes a practical framework for prevention, monitoring, and treatment that prioritizes neurological safety and avoidance of overcorrection.