Antza C, Anyfanti P, Poutachidis A
… +3 more, Poulis D, Belančić A, Kotsis V
Pol Arch Intern Med
· 2026 Feb · PMID 41589430
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Hypertension is a leading global cause of morbidity and mortality, increasingly prevalent among young adults with obesity. This epidemiologic shift is particularly concerning, as early‑onset hypertension confers an incre...Hypertension is a leading global cause of morbidity and mortality, increasingly prevalent among young adults with obesity. This epidemiologic shift is particularly concerning, as early‑onset hypertension confers an increased lifetime risk of cardiovascular disease. Obesity and hypertension share pathophysiological mechanisms, including sympathetic nervous system overactivation, leptin resistance, chronic low‑grade inflammation, renal fat deposition, endothelial dysfunction, and genetic predisposition. Dietary factors, sedentary lifestyle, poor sleep, psychosocial stress, and environmental exposures further exacerbate the risk. Hence, effective management requires an integrated approach targeting both obesity and blood pressure. Lifestyle interventions play a key role in therapy but are often hindered by poor adherence in younger populations. Pharmacological therapies have shown substantial efficacy in reducing weight and blood pressure, with emerging cardiovascular benefits. Bariatric surgery remains an alternative, achieving sustained weight loss and remission of hypertension in a significant proportion of patients. Early, multifaceted interventions tailored to this population can reduce premature cardiovascular disease, lower health care costs, and improve quality of life.
Kralisz P, Nowak K, Kuźma Ł
… +8 more, Prokopczuk P, Gugała K, Mężyński G, Dubicki A, Kożuch M, Stachurski Ł, Bachórzewska-Gajewska H, Dobrzycki S
Pol Arch Intern Med
· 2026 Feb · PMID 41589427
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INTRODUCTION: Severe coronary calcification remains one of the major challenges in percutaneous coronary intervention (PCI). Rotational atherectomy (RA) facilitates calcium modification, improving stent delivery and expa...INTRODUCTION: Severe coronary calcification remains one of the major challenges in percutaneous coronary intervention (PCI). Rotational atherectomy (RA) facilitates calcium modification, improving stent delivery and expansion, and may therefore enhance both procedural and long‑term outcomes. OBJECTIVES: We aimed to evaluate the temporal trends, procedural performance, and short- and long‑term clinical outcomes of RA in patients with heavily calcified coronary artery disease treated with PCI over a 15‑year period in a single high‑volume center. PATIENTS AND METHODS: Baseline characteristics, procedural outcomes, in‑hospital complications, and follow‑up were assessed. The primary end point was procedural and clinical success; the secondary end point included major adverse cardiovascular and cerebrovascular events (MACCEs; cardiovascular death, myocardial infarction, target vessel revascularization, stroke) at 24 months. RESULTS: Among 1060 patients (median [interquartile range] age, 74 [66-80] y), diabetes and chronic kidney disease were present in 42% and 31.1%, respectively, and 63.8% had prior PCI. Multivessel disease was diagnosed in 36.4%, and 29.4% had the SYNTAX I value equal to or above 32. Technical and clinical success were 97.6% and 86.2%, respectively. Thirty‑day MACCE rate was 10.9%, while at 24 months the MACCE rate was 38.3% and all‑cause mortality rate was 19.4% (cardiovascular, 14.2%). Estimated glomerular filtration rate below 30 ml/min/1.73 m² (subdistribution hazard ratio [sHR], 1.61; 95% CI, 1.11-2.35; P = 0.01) and each 10‑point increase in the SYNTAX I score (sHR, 1.13; 95% CI, 1.04-1.23; P = 0.005) predicted higher MACCE rate, whereas higher left ventricular ejection fraction was protective (sHR, 0.984 per 5% increase; P <0.001). Isolated postprocedural troponin rise was not independently associated with outcomes (sHR, 1.22; P = 0.07). CONCLUSIONS: RA provides high procedural success even in the most complex lesions and remains an essential tool in contemporary PCI.
Navarese EP, Kereiakes DJ, Henry TD
… +5 more, Isgender M, Talanas G, Kubica J, Farkouh ME, Andreotti F
Pol Arch Intern Med
· 2026 Feb · PMID 41562391
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INTRODUCTION: The optimal antithrombotic regimen for chronic coronary artery disease (CAD) requiring long‑term anticoagulation remains uncertain. OBJECTIVES: We aimed to determine the effects of oral anticoagulation (OAC...INTRODUCTION: The optimal antithrombotic regimen for chronic coronary artery disease (CAD) requiring long‑term anticoagulation remains uncertain. OBJECTIVES: We aimed to determine the effects of oral anticoagulation (OAC) monotherapy in comparison with OAC plus single antiplatelet therapy (OAC+SAPT) on cardiovascular mortality in chronic CAD. The secondary objective was to assess the effects of both antithrombotic approaches on major bleeding, nonfatal ischemic events, and all‑cause death. PATIENTS AND METHODS: We searched PubMed, Embase, and Cochrane CENTRAL (up to August 2025) for randomized trials comparing OAC alone vs OAC+SAPT in chronic CAD. Fixed‑effects models were used when heterogeneity was low (I² <50%); otherwise, random‑effects models were applied. Prespecified sensitivity analyses included a Bayesian meta‑analysis and trial sequential analysis (TSA). The primary outcome was cardiovascular death; secondary outcomes were all‑cause death, major bleeding, nonfatal myocardial infarction, and ischemic stroke. RESULTS: Five trials (AFIRE, AQUATIC, EPIC‑CAD, OAC‑ALONE, and PRAEDO AF; n = 4964; follow‑up range, 12-30 mo) met the eligibility criteria. Cardiovascular death occurred in 2.7% of the patients on OAC alone vs 3.8% on OAC+SAPT (hazard ratio [HR], 0.69; 95% CI, 0.5-0.96; P = 0.02). The Bayesian analysis confirmed the result (HR, 0.75; 95% credible interval, 0.61-0.93). TSA crossed the efficacy boundary, supporting firm evidence for cardiovascular mortality reduction with OAC alone. All‑cause mortality was numerically, but not significantly, lower on OAC alone (4.9% vs 6.7%; HR, 0.79; 95% CI, 0.5-1.24; P = 0.3). Major bleeding was reduced on OAC alone (3.3% vs 6.4%; HR, 0.51; 95% CI, 0.39-0.66; P <0.001). Myocardial infarction and ischemic stroke incidence did not differ significantly in the treatment arms. CONCLUSIONS: In chronic CAD requiring anticoagulation, OAC monotherapy vs OAC+SAPT reduced cardiovascular mortality and major bleeding without an excess in nonfatal thrombotic events, generally supporting OAC alone as the preferred long‑term strategy in this patient population.
Sibiak R, Iciek R, Gastolek K
… +3 more, Chudzynska E, Meek C, Wender-Ozegowska E
Pol Arch Intern Med
· 2026 Feb · PMID 41562177
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INTRODUCTION: Gestational diabetes mellitus (GDM) is one of the most common metabolic disorders in pregnancy, and its prevalence has been rising worldwide in parallel with increasing maternal age and obesity. OBJECTIVES:...INTRODUCTION: Gestational diabetes mellitus (GDM) is one of the most common metabolic disorders in pregnancy, and its prevalence has been rising worldwide in parallel with increasing maternal age and obesity. OBJECTIVES: We aimed to describe nationwide 10-year trends in GDM prevalence, management, and perinatal outcomes. PATIENTS AND METHODS: We conducted a retrospective, population‑based cohort study including all deliveries recorded in the Polish National Health Fund database from 2015 to 2024. GDM and complications were identified based on the International Classification of Diseases, Tenth Revision codes. GDM was diagnosed according to the International Association of Diabetes and Pregnancy Study Groups / World Health Organization 2013 criteria. Maternal age was categorized into 5 groups (<18, 18-24, 25-34, 35-44, and 45-54 y). We calculated the prevalence of GDM, assessed temporal trends, and estimated odds ratios for key maternal and neonatal complications. RESULTS: The cohort comprised 3 729 871 deliveries. Over the 10‑year study period, the total annual number of deliveries in Poland declined by 25%, while GDM prevalence rose from 6.1% to 10.6%. Women with GDM were on average older, and the proportion of individuals with insulin‑dependent GDM increased modestly. GDM was consistently associated with higher risks of hypertensive disorders, cesarean delivery, macrosomia, congenital malformations, and neonatal hypoglycemia, among other complications. DISCUSSION: GDM prevalence in Poland nearly doubled from 2015 to 2024, partly reflecting delayed childbearing. Pregnancies affected by GDM showed substantially greater maternal and neonatal morbidity.
Pol Arch Intern Med
· 2026 Jan · PMID 41538277
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Direct oral anticoagulants (DOACs) have transformed venous thromboembolism (VTE) treatment by offering predictable pharmacokinetics and eliminating routine monitoring requirements. Despite robust clinical trial evidence...Direct oral anticoagulants (DOACs) have transformed venous thromboembolism (VTE) treatment by offering predictable pharmacokinetics and eliminating routine monitoring requirements. Despite robust clinical trial evidence supporting their efficacy, real‑world implementation continues to present challenges in special populations. This review synthesizes recent evidence on DOAC usage in VTE patients, with emphasis on current challenges encountered in everyday clinical practice, including special populations, treatment adherence, bleeding management, and emerging dosing strategies. A literature search was conducted across PubMed, MEDLINE, and Cochrane databases for peer‑reviewed articles published in the last 5 years using the following search terms: "direct oral anticoagulants," "DOACs," "venous thromboembolism," "VTE," "deep vein thrombosis," and "pulmonary embolism." Inclusion criteria prioritized randomized controlled trials, meta‑analyses, systematic reviews, and observational studies. Current evidence demonstrates DOACs as first‑line therapy for most VTE patients, with clinical challenges remaining in patients with obesity, severe renal impairment, cancer‑associated thrombosis, and unusual site thrombosis. Network meta‑analyses reveal comparable efficacy among DOACs, with apixaban demonstrating favorable bleeding profiles. Adherence significantly impacts outcomes, with consistently high adherence reducing recurrent VTE risk. Reversal agents have improved management of DOAC‑associated bleeding. DOACs represent the standard of care for VTE treatment, with increasing real‑world evidence supporting their safety and efficacy. Clinicians must navigate persistent challenges in special populations through individualized risk‑benefit assessment. Encouraging physicians to focus both on patient education to optimize adherence and on provider awareness of emerging evidence on dose modifications and reversal strategies is imperative to proper and effective implementation of DOACs in these groups.