Links between chronic exposure to outdoor air pollution and cardiovascular diseases: a review.

Acute exposure to air pollution is associated with an increasing risk of death and cardiovascular disorders. Nonetheless, the impact of chronic exposure to air pollution on the circulatory system is still debated. Here, we review the links of chronic exposure to outdoor air pollution with mortality and most common cardiovascular diseases, in particular during the coronavirus disease 2019 event (COVID-19). We found that recent studies provide robust evidence for a causal effect of chronic exposure to air pollution and cardiovascular mortality. In terms of mortality, the strongest relationship was noted for fine particulate matter, nitrogen dioxide, and ozone. There is also increasing evidence showing that exposure to air pollution, mainly fine particulate matter and nitrogen dioxide, is associated with the development of atherosclerosis, hypertension, stroke, and heart failure. However, available scientific evidence is not strong enough to support associations with cardiac arrhythmias and coagulation disturbances. Noteworthy, for some pollutants, the risk of negative health effects is high for concentrations lower than the limit values recommended by the European Union and Word Health Organization. Efforts to diminish exposure to air pollution and to design optimal methods of air pollution reduction should be urgently intensified and supported by effective legislation and interdisciplinary cooperation.

Prognostic significance of atherogenic index of plasma, atherogenic coefficient and lipoprotein combined index among elderly patients with non-ST-segment elevation myocardial infarction in 1-year follow-up.

OBJECTIVES: Coronary artery disease (CAD) remains a leading cause of death in elderly patients. Recently, novel lipoproteins- Atherogenic Index of Plasma (AIP), Atherogenic Coefficient (AC) and Lipoprotein Combine Index (LCI) have been suggested as CAD risk factors; their clinical usefulness, however, remains unknown. The aim of the study was to assess the predictive value of AIP, AC and LCI concerning incidence of major adverse cardiovascular events (MACE) and all-cause mortality in 1-year follow-up. METHODS: For the study, 1,083 patients, aged 60 or older, with NSTEMI were enrolled and divided into two groups: young-old and old-old. RESULTS: MACE occurred in 11.8 % of the patients; LCI showed a borderline significance, but only in univariate analysis. Analysis in groups revealed ambiguous results. None of the examined indices was a predictor of MACE in the young-old group whereas all three of them were significant, but negative predictors in the old-old group. Finally, all-cause mortality at follow-up was 14.9 %. AC predicted 1-year mortality in the whole study population (OR = 1.1 (95% CI: 1-1.2; p = 0.02), but was insignificant in the multivariable model. Additionally, it was an independent predictor in the old-old group, but with borderline significance (OR = 1.14 (95% CI: 1-1.3, p = 0.036). CONCLUSIONS: AIP, AC and LCI should not be used as predictors of MACE and 1-year mortality among elderly patients with NSTEMI (Tab. 5, Ref. 23).

Prognostic value of non-traditional lipid parameters: Castelli Risk Index I, Castelli Risk Index II, and triglycerides to high-density lipoprotein cholesterol ratio among patients with non-ST-segment elevation myocardial infarction during 1­year follow-up.

Aim    Concentrations of classical lipoproteines have a well-established role in non-invasive cardiology. The efficacy of the Castelli Risk Index I (CRI I), Castelli Risk Index II (CRI II), and triglycerides to high-density lipoprotein cholesterol (TG / HDL-C) ratio in clinical practice are currently under evaluation. The study aimed to assess the predictive value of CRI I, CRI II and TG / HDL-C for the incidence of Major Adverse Cardiovascular Events (MACE) and for all-cause mortality during 1­year follow-up of patients with non-ST-segment elevation myocardial infarction (NSTEMI).Material and Methods    1,301 patients were enrolled in the study. Associations between CRI I, CRI II, TG / HDL-C and occurrence of MACE and 1­year mortality were studied. Moreover correlations between CRI I, CRI II, and TG / HDL-C and the severity of coronary artery disease (CAD) were assessed.Results    MACE occurred in 10.9 % (142) of patients, and 1­year mortality was 13.4 % (174). None of the evaluated indices appeared to be an independent predictor of MACE in either the entire population or subpopulations, as divided according to the presence of diabetes or CAD diagnosed prior to admission. Furthermore, no dependence between 1­year mortality and the examined indices was found. Additionally, only a weak correlation between CAD severity and CRI I was observed (R=0.08, p=0.02). No significant correlations for CRI II (p=0.07) and TG / HDL-C (p=0.6) were detected.Conclusions    CRI I, CRI II and TG / HDL-C should not be used as predictors of MACE or all-cause mortality among patients with NSTEMI. Moreover, these indices do not reflect CAD severity.

Blood Plasma's Protective Ability against the Degradation of S-Nitrosoglutathione under the Influence of Air-Pollution-Derived Metal Ions in Patients with Exacerbation of Heart Failure and Coronary Artery Disease.

One of the consequences of long-term exposure to air pollutants is increased mortality and deterioration of life parameters, especially among people diagnosed with cardiovascular diseases (CVD) or impaired respiratory system. Aqueous soluble inorganic components of airborne particulate matter containing redox-active transition metal ions affect the stability of S-nitrosothiols and disrupt the balance in the homeostasis of nitric oxide. Blood plasma's protective ability against the decomposition of S-nitrosoglutathione (GSNO) under the influence of aqueous PM extract among patients with exacerbation of heart failure and coronary artery disease was studied and compared with a group of healthy volunteers. In the environment of CVD patients' plasma, NO release from GSNO was facilitated compared to the plasma of healthy controls, and the addition of ascorbic acid boosted this process. Model studies with albumin revealed that the amount of free thiol groups is one of the crucial factors in GSNO decomposition. The correlation between the concentration of NO released and -SH level in blood plasma supports this conclusion. Complementary studies on gamma-glutamyltranspeptidase activity and ICP-MS multielement analysis of CVD patients' plasma samples in comparison to a healthy control group provide broader insights into the mechanism of cardiovascular risk development induced by air pollution.

Artificial neural network identifies nonsteroidal anti-inflammatory drugs exacerbated respiratory disease (N-ERD) cohort.

BACKGROUND: To date, there has been no reliable in vitro test to either diagnose or differentiate nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (N-ERD). The aim of the present study was to develop and validate an artificial neural network (ANN) for the prediction of N-ERD in patients with asthma. METHODS: This study used a prospective database of patients with N-ERD (n = 121) and aspirin-tolerant (n = 82) who underwent aspirin challenge from May 2014 to May 2018. Eighteen parameters, including clinical characteristics, inflammatory phenotypes based on sputum cells, as well as eicosanoid levels in induced sputum supernatant (ISS) and urine were extracted for the ANN. RESULTS: The validation sensitivity of ANN was 94.12% (80.32%-99.28%), specificity was 73.08% (52.21%-88.43%), and accuracy was 85.00% (77.43%-92.90%) for the prediction of N-ERD. The area under the receiver operating curve was 0.83 (0.71-0.90). CONCLUSIONS: The designed ANN model seems to have powerful prediction capabilities to provide diagnosis of N-ERD. Although it cannot replace the gold-standard aspirin challenge test, the implementation of the ANN might provide an added value for identification of patients with N-ERD. External validation in a large cohort is needed to confirm our results.

Prostaglandin E2 decrease in induced sputum of hypersensitive asthmatics during oral challenge with aspirin.

BACKGROUND: A special regulatory role for prostaglandin E2 (PGE2 ) has been postulated in nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (NERD). OBJECTIVE: To investigate the effect of systemic aspirin (acetylsalicylic acid) administration on airway PGE2 biosynthesis in induced sputum supernatant (ISS) among subjects with NERD or aspirin-tolerant asthma with chronic rhinosinusitis with nasal polyposis (ATA-CRSwNP), as well as healthy controls (HC). METHODS: Induced sputum (IS) was collected from patients with NERD (n = 26), ATA-CRSwNP (n = 17), and HC (n = 21) at baseline and after aspirin challenge. Sputum differential cell count and IS supernatant (ISS) levels of prostanoids, PGE2 , 8-iso-PGE2 , tetranor-PGE-M, 8-iso-PGF2 α, and leukotriene C4 , D4 , and E4 , were determined using mass spectrometry. Urinary excretion of LTE4 was measured by ELISA. RESULTS: NERD subjects had elevated sputum eosinophilic count as compared to ATA-CRSwNP and HC (median NERD 9.1%, ATA-CRSwNP 2.1%, and HC 0.4%; P < 0.01). Baseline ISS levels of PGE2 were higher in asthmatics as compared to HC at baseline (NERD vs HC P = 0.04, ATA-CRSwNP vs HC P < 0.05). Post-challenge ISS levels of PGE2 compared to baseline significantly decreased in NERD and HC (P < 0.01 and P = 0.01), but not in ATA-CRSwNP. In NERD, a similar decrease in PGE2 as in HC resulted from 2.8 times lower dose of aspirin. CONCLUSION: Aspirin-precipitated bronchoconstriction is associated with a decrease in airway PGE2 biosynthesis. These results support the mechanism of PGE2 biosynthesis inhibition as a trigger for bronchoconstriction in NERD.

Treatment with high-dose n-3 PUFAs has no effect on platelet function, coagulation, metabolic status or inflammation in patients with atherosclerosis and type 2 diabetes.

BACKGROUND: Despite numerous studies on cardioprotective effects of omega-3 polyunsaturated fatty acids (n-3 PUFAs), there is limited evidence for n-3 PUFA-mediated effects, especially at its higher dose, on cardiovascular risk in patients with type 2 diabetes (DM2) and established atherosclerosis. PURPOSE: To investigate the effect of daily treatment with a higher dose (2 g) of n-3 PUFAs on platelet function, coagulation parameters, fibrin clot properties, markers of systemic inflammation and metabolic status, in patients with atherosclerotic vascular disease and DM2 who receive optimal medical therapy. METHODS: We conducted a prospective, double-blind, placebo-controlled, randomized, double-center study, in which thrombin generation (plasma thrombogenic potential from automated thrombogram), fibrin clot properties (plasma fibrin clot permeability; lysis time), platelet aggregation (light transmission aggregometry with adenosine diphosphate and arachidonic acid used as agonists), HbA1c, insulin level, lipid profiles, leptin and adiponectin levels, as well as markers of systemic inflammation (i.e., hsCRP, IL-6, TNF-α, ICAM-1, VCAM-1, and myeloperoxidase) were determined at baseline and at 3 months after treatment with 2 g/day of n-3 PUFAs (n = 36) or placebo (n = 38). Moreover, we assessed serum fatty acids of the phospholipid fraction by gas chromatography both at baseline and at the end of the study. RESULTS: Majority of patients were treated with optimal medical therapy and achieved recommended treatment targets. Despite higher serum levels of eicosapentaenoic acid (EPA) (by 204%; p < 0.001) and docosahexaenoic acid (DHA) (by 62%; p < 0.0001) in n-3 PUFA group at the end of treatment no changes in platelet aggregation, thrombin generation, fibrin clot properties or markers of systemic inflammation were observed. No intergroup differences in the insulin, HbA1c and lipid levels were found at the end of the study. There was no change in adiponectin and leptin in interventional group, however leptin increased in control group (p = 0.01), therefore after study period leptin levels were lower in the interventional group (p = 0.01). Additionally, resolvin D1 did not differ between interventional and control group. CONCLUSIONS: In conclusion, our study demonstrated that in patients with long-standing, well-controlled DM2 and atherosclerotic disease the treatment with a high dose of n-3 PUFAs (namely, 1 g/day of EPA and 1 g/day of DHA for 3 months) does not improve coagulation, metabolic, and inflammatory status when measured with the specified tests. The study was registered in ClinicalTrials.gov; identifier: NCT02178501. Registration date: April 12, 2014.

Trauma-induced acute myocardial infarction due to delayed dissection of the left anterior descending coronary artery.

Acute myocardial infarction is a very rare, life-threatening complication of blunt chest trauma. A 27-year-old man with no previous medical history was admitted to the emergency department due to multiple trauma following a car accident. After 48h following the accident, the patient's condition rapidly deteriorated, with severe dyspnea at rest, tachycardia, and increasing chest pain. A 12-lead ECG showed a sinus tachycardia at 120bpm with significant ST-segment elevation in leads V1 to V5, pathologic Q wave in I, aVL, and QS complex in leads V1 to V4. Bedside echocardiography disclosed akinesis of the anterior and lateral walls, apex, and anterior septum with severely decreased left ventricular ejection fraction of 30%. Urgent coronary angiography revealed an occlusive dissection of the proximal left anterior descending coronary artery. Primary percutaneous coronary intervention with a Biolimus A9™-eluting stent implantation were successfully performed. The further course was uneventful. At 12-month follow-up, the patient has remained asymptomatic with no recurrence of cardiovascular symptoms.

Influence of the recurrent syncope episodes on neurocognitive functions in patients with vasovagal syncope.

The aim of study was to evaluate an influence of recurrent syncope episodes on the neurocognitive functions (NCF) in patients with suspected VVS. AIM: The aim of study was to evaluate an influence of recurrent syncope episodes on the neurocognitive functions (NCF) in patients with suspected VVS. MATERIALS AND METHODS: Study population: 24 pts. (16 women) aged 17-70 yrs (mean age 40 years), with suspected VVS, referred to HUTT (head-up tilt test). All pts. underwent initial evaluation regarding to the number and circumstances of the syncopal and/or presyncopal spells. All pts performed HUTT with Westminster protocol. Basing on the syncope history and HUTT results, two groups of pts were distinguished: gr. I - 18 pts with at least 2 syncopal spells and positive HUTT, and gr. II 6 pts with only presyncopal status without complete loss of consciousness and negative HUTT. All pts underwent the evaluation of NCF with computer-assisted Vienna Test System battery, consisted of the following tests: DAUF - evaluation of long-term selective attention and concentration; COG - assessment of attention and concentration; STROOP - registration of the color-word interference tendency, CORSI - estimation of visual short-term memory capacity and implicite visuo-spatial learning. Values of the measured parameters were compared between both groups of pts. RESULTS: Patients without syncope (gr. II) had higher number of correctly reproduced sequences (11,0 vs 8,38 p<0,01) and Reliable Spatial Span score (5,50 vs 4,46,p<0,02) in CORSI test, in relation to pts with syncope history (gr. I). This suggests possible influence of the recurrent syncope episodes on the short-term memory capacity in pts with VVS. There were no significant differences between groups, comparing results of the other tests. CONCLUSIONS: Repeated syncope episodes may lead to impairment of short-term memory capacity in patients with vasovagal syndrome. Syncope episodes may have potentially negative influence on neurocognitive functions in patients with vasovagal syndrome.

[Biochemical predictors of anthracyclin and trastuzumab induced cardiotoxicity in early diagnostics of cardiomyopathy]. / Biochemiczne predyktory kardiotoksycznosci indukowanej przez antracykliny i trastuzumab we wczesnej diagnostyce uposledzenia czynnosci serca.

The treatment based on athracyclines and trastuzumab may lead to heart failure in oncological setting. Assessment of the heart function is conducted using radiological examinations, especially echocardiography. Biochemical diagnostics enables to depict clinically silent cardiac dysfunction at an earlier stage. Biomarkers that showed to be the most promising in predicting the development of deterioration of systolic and/or diastolic function in course of chemotherapy are troponins and NT-pro-BNP. However, no cut-off point had been yet determined, especially in terms of cardiotoxicity induced by oncological therapy. Biomarkers serum level may be dependent on many conditions, mostly comorbidities, what makes the interpretation of the results difficult. Trials involving mikro RNA particles, which depict the molecular level of the pathological changes, also those involved in the development of cardiomyopathy, are underway.

[Diagnostic imaging methods of cardiac dysfunction caused by cardiotoxicity of oncological therapy]. / Rola wolnych rodników tlenowych w patogenezie zaburzen rytmu serca.

Cardiotoxicity of chemotherapy is a serious complication of oncological treatment. Assessment of cardiac function before, during and after cardiotoxic chemotherapy course should be a standard procedure in oncology. There are several methods for evaluation of the changes in myocardium such as: electrocardiography, radiology techniques (RTG, CT, MRI, PET-CT, PET-MRI), echocardiography, radioisotope imaging techniques (scyntygraphy, MUGA, PET), and ultra-structure evaluation in biopsy samples. Nevertheless, there is a continuous need for new diagnostic methods of cardiac dysfunction of great predictive and prognostic importance. Unfortunately advanced imaging techniques are still not available in many oncological centers in Poland. Nowadays to evaluate potential cardiotoxicity of drugs in oncology it is postulated to perform serial echocardiographic examinations as a basal imaging method. Thus constant cooperation between cardiologist and oncologist plays crucial role during chemotherapy.

[Induced sputum supernatant prostaglandin E2 during oral aspirin challenge of asthmatic patients with and without aspirin hypersensitivity and healthy controls--pilot study]. / Wplyw dawki prowokacyjnej aspiryny na poziom prostaglandyny E2 w plwocinie indukowanej u chorych na astme z i bez nadwrazliwosci na aspiryne oraz u osób zdrowych--badanie pilotazowe.

The aim of this pilot study was to evaluate changes in the concentration of prostaglandin E2 (PGE2) in induced sputum supernatant in 3 groups: sub- jects with NSAID-exacerbated respira- tory disease (NERD), aspirin tolerant asthma (ATA) and healthy controls (HC), before and after oral aspirin chal- lenge test. The study was conducted in the years 2014-2015 at the Clinical Department of the Pulmonology Clinic at the University Hospital in Cracow. 43 patients were enrolled in the study (NERD - n = 15, ATA - n = 15 and HC - n = 13). All of them underwent a placebo-controlled oral aspirin challenge. Sputum was induced 24 hours before the challenge and immediately after the test. Induced sputum was processed in order to obtain cystospin slides to depict inflammatory cell patterns and supernatants, in which PGE2 was measured. The concentration of PGE2 was determined using mass spectrometry coupled with gas chromatography (gas chromatography/mass spectrometry - GC/MS). After aspirin challenge, the concentration of PGE2 in induced sputum supernatant decreased in both asthmatics hypersensitive to aspirin (p = 0.01) and those who tolerated aspirin well (p = 0.17). The change in the healthy control group was not statistically significant. These results support the cyclooxygenase theory of PGE2 inhibition by aspirin. However, the mechanism of bronchoconstriction after aspirin administration alone in patients with NSAID-exacerbated respiratory disease remains unclear.

Clinical and biochemical factors for response to aspirin desensitization in aspirin-induced asthma patients ­ pilot study.

Aspirin desensitization is considered to be an effective and well-tolerated therapy for patients with Non-steroidal anti-inflammatory(NSAIDs)-Exacerbated Respiratory Disease (NERD). The aim of the present study was to investigate the influence of aspirin desensitization on inflammatory cell count in induced sputum and nasal lavage in fifteen NERD individuals subjected to one-year aspirin therapy. The decrease in induced sputum count of eosinophils and macrophages was observed. Clinical efficacy of aspirin therapy in improving nasal symptoms and quality of life in NERD patients was also confirmed.

Polyunsaturated omega-3 fatty acids reduce lipoprotein-associated phospholipase A(2) in patients with stable angina.

BACKGROUND AND AIMS: Increased consumption of omega-3 polyunsaturated fatty acids (PUFA) together with lifestyle measures and medications is recommended for the prevention of cardiovascular diseases. However, the exact mechanisms underlying observed benefits are not well defined. To this aim, we evaluated the effects of omega-3 PUFA in stable coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI) on lipoprotein associated phospholipase A2 (Lp-PLA2) mass and activity and their relation to oxidized low-density lipoproteins (oxy-LDL). METHODS AND RESULTS: In a prospective, double-blind, placebo-controlled, randomized study Lp-PLA2, oxy-LDL, myeloperoxidase and interleukin-6 were determined at baseline, 3-5 days and 30 days during administration of omega-3 PUFA 1 g/day (n = 30) or placebo (n = 24). Treatment with omega-3 PUFA resulted in reduction of Lp-PLA2 mass by 10.7%, activity by 9.3 (p = 0.026 for both) and oxy-LDL by 10.9% (p = 0.014) at 30 days, with no change in myeloperoxidase and interleukin-6. Compared with placebo, patients receiving omega-3 PUFA had lower Lp-PLA2 mass by 9.42%, activity by 9.2 (p = 0.041 for both) and oxy-LDL by 12.3% (p = 0.10) after one month, but not at 3-5 days. There were no correlations between Lp-PLA2 and both myeloperoxidase and oxy-LDL throughout the study. The multivariate model showed that only treatment with omega-3 PUFA and baseline myeloperoxidase levels were independent predictors of Lp-PLA2 mass changes at one month (R(2) = 0.37, P = 0.005). CONCLUSIONS: Administration of omega-3 PUFA can decrease Lp-PLA2 in patients with stable angina undergoing PCI. This novel effect may contribute to the benefits derived from omega-3 PUF.

[Association of common cyclooxygenase-2 (COX-2) gene polymorphisms with clinical and angiographic characteristics of patients with coronary artery disease]. / Ocena zwiazku czestych polimorfizmów genu cyklooksygenazy-2 (COX-2) z obrazem klinicznym choroby niedokrwiennej serca i zaawansowaniem zmian miazdzycowych w tetnicach wiencowych.

BACKGROUND: Chronic inflammation of the arterial wall plays a crucial role in the pathogenesis of atherosclerosis. Cyclooxygenase-2 (COX-2) is a key enzyme in the synthesis of proinflammatory prostanoids. At least two of the common genetic polymorphisms of the COX-2 gene have phenotypic effects: G-765C (rs20417) and T8473C (rs5275). AIM: To assess the relation of G-765C and T8473C COX-2 polymorphisms to clinical and angiographic characteristics of patients with coronary artery disease (CAD). MATERIAL AND METHODS: The study comprised 186 consecutive patients with angiographically defined CAD (> or =70% stenosis of > or =1 coronary artery). The study population were divided into two groups: A-123 patients with stable angina (mean age, 62.6 +/- 11.2 years; 30.1% women), and B-63 patients with unstable angina (mean age, 64.0 +/- 10.8 years; 19.0% women). The controls comprised 70 individuals without symptoms of CAD (mean age, 37.6 +/- 9.9 years; 57.1% women). Results: No significant differences were observed in -765C and 8473C allele frequencies between the patients with CAD and control subjects. In CAD patients, the studied COX-2 polymorphisms were not significantly associated with the age of the onset of symptoms and clinical presentation of CAD. In the B group, a difference was observed within the frequency of significant (>50%) left main coronary artery stenosis (LMCAS) and/or three-vessel CAD (3-CAD) between the -765C allele carriers and 765G 765G homozygotes (14.3% vs. 49.0%; p=0.044). In the CAD patients (group A and group B) the prevalence of LMCAS and/or 3-CAD was significantly lower among 365C allele carriers (22.8% vs. 40.3%: CONCLUSIONS: There were no significant differences in -765C and 8473C allele frequencies between patients with CAD and subjects without symptoms of CAD; In patients with CAD, COX-2 G-765C and T8473C polymorphisms had no significant association with the age of the onset of symptoms and clinical presentation of ischaemic heart disease; The G-765C COX-2 polymorphism is associated with less frequent occurrence of multivessel CAD in the studied population. p=0.021

Predictive value of metabolic score for insulin resistance and triglyceride glucose-BMI among patients with acute myocardial infarction in 1-year follow-up.

BACKGROUND: Recently two indicators - metabolic score for insulin resistance (METS-IR) and triglyceride glucose-BMI (TyG-BMI) have been proposed as surrogate markers of IR and potential cardiovascular risk factors. The aim of the study was to assess the predictive value of METS-IR and TyG-BMI concerning the incidence of major adverse cardiovascular events (MACE) and all-cause mortality in 1-year follow-up among patients admitted with acute myocardial infarction (AMI). METHODS: Two thousand one hundred fifty-three patients with a median age of 68 years were enrolled in the study. Patients were divided into two groups according to the type of AMI. RESULTS: MACE occurred in 7.9% of the patients in the ST-segment elevation myocardial infarction (STEMI) group and in 10.9% of the non-STEMI (NSTEMI) group. No significant difference in median MACE-IR and TyG-BMI between patients with and without incidence of MACE was found in both groups. None of the examined indices were predictors of MACE in the STEMI and NSTEMI groups. Moreover, both of them did not predict MACE in subgroups of patients classified according to the presence of diabetes. Finally, METS-IR and TyG-BMI were significant predictors of 1-year morality, however with low prognostic value and only in univariate regression analysis. CONCLUSION: METS-IR and TyG-BMI should not be used in predicting MACE among patients with AMI.

Biomarkers of Trastuzumab-Induced Cardiac Toxicity in HER2- Positive Breast Cancer Patient Population.

Trastuzumab-induced cardiotoxicity (TIC) can lead to early treatment discontinuation. The aim of this study was to evaluate: N-terminal brain natriuretic peptide (NT-proBNP), creatine kinase-MB (CK-MB), myoglobin, and selected biochemical and clinical factors as predictors of TIC. One hundred and thirty patients with HER2-positive BC receiving adjuvant trastuzumab therapy (TT) were enrolled. Measurement of cardiac markers and biochemical tests as well as echocardiography were performed prior to TT initiation and every three months thereafter. Cardiotoxicity leading to treatment interruption occurred in 24 patients (18.5%). While cardiotoxicity caused early treatment discontinuation in 14 patients (10.8%), the TIC resolved in 10 (7.7%) and TT was resumed. The most common complication was a decrease in left ventricular ejection fraction of more than 10% from baseline or below 50% (7.7%). In patients with TIC, there was no increase in the levels of NT-proBNP, myoglobin, and CK-MB. BMI, hypertension, ischemic heart disease, diabetes, age, cancer stage, type of surgery, use of radiotherapy, chemotherapy, and hormone therapy were shown to not have an effect on TIC occurrence. NT-proBNP, myoglobin, and CK-MB are not predictors of TIC. There is an ongoing need to identify biomarkers for TIC.

Monocyte exposure to fine particulate matter results in miRNA release: A link between air pollution and potential clinical complication.

Chronic exposure to PM2.5 contributes to the pathogenesis of numerous disorders, although the underlying mechanisms remain unknown. The study investigated whether exposure of human monocytes to PM2.5 is associated with alterations in miRNAs. Monocytes were exposed in vitro to PM2.5 collected during winter and summer, followed by miRNA isolation from monocytes. Additionally, in 140 persons chronically exposed to air pollution, some miRNA patterns were isolated from serum seasonally. Between-season differences in chemical PM2.5 composition were observed. Some miRNAs were expressed both in monocytes and in human serum. MiR-34c-5p and miR-223-5p expression was more pronounced in winter. Bioinformatics analyses showed that selected miRNAs were involved in the regulation of several pathways. The expression of the same miRNA species in monocytes and serum suggests that these cells are involved in the production of miRNAs implicated in the development of disorders mediated by inflammation, oxidative stress, proliferation, and apoptosis after exposure to PM2.5.

Adjuvant combined therapy with trastuzumab in patients with HER2­ positive breast cancer and cardiac alterations: implications for optimal cardio­oncology care.

INTRODUCTION: Recently, the prognosis of patients with HER2­positive breast cancer (BC) has improved significantly owing to the use of combined treatment modalities. However, systemic treatment is as-sociated with increased risk of cardiotoxicity. OBJECTIVES: We aimed to assess subclinical cardiac alterations during the final stage of adjuvant com-bined therapy, that is, trastuzumab therapy (TT), as potential predictors of late cardiac complications in patients with HER2­positive BC. PATIENTS AND METHODS: We enrolled 251 patients with HER2­positive BC treated with a radical local therapy, adjuvant chemotherapy (anthracyclines or anthracyclines + taxanes), and immunotherapy (trastuzumab). Patients underwent 6 echocardiographic examinations: at baseline, during TT, and after TT, with assessment of left ventricular ejection fraction (LVEF), degree of valvular regurgitation, and cardiac chamber diameters. RESULTS: Valvular fibrosis (28.4% of patients) was associated with older age, hypertension at baseline, and a higher degree of regurgitation during TT. Reduced LVEF, greater regurgitation, and larger cardiac chamber diameters were noted during TT. The patients who received higher anthracycline doses showed a greater degree of aortic insufficiency and a larger right ventricular diameter. Reduced LVEF during TT was associated with radiotherapy or chemotherapy and the degree of valvular regurgitation. Significantly larger diameters were observed in older patients and in those with comorbidities at baseline, high body mass index, and regurgitation. CONCLUSIONS: Asymptomatic subclinical cardiac alterations during TT may predict late cardiac complica-tions; however, longer follow­up is necessary to confirm this hypothesis. Patients with HER2­positive BC should be closely monitored for possible cardiac alterations during and after therapy to ensure optimal care and guide therapeutic decision­making.

Prevention of coronary heart disease in primary medical care in Poland: results from the LIPIDOGRAM study.

AIMS: To determine: (1) achievement of cholesterol therapy goals in patients receiving lipid-lowering drugs in Polish primary care between the years 2004 and 2006; (2) the characteristics of patients that are associated with attainment of these goals. DESIGN: Cross-sectional study in randomly selected Polish primary care practices. METHOD: 5248 patients aged over 30 years in 2004 and 5386 patients in 2006, who were taking cholesterol-lowering treatment took part in the study. Physicians recorded demographic and medical history data using a standardized questionnaire, including weight and height, and collected blood samples of patients to determine their cholesterol level. RESULTS: 18.5% of patients attained their optimal goals of therapy (total cholesterol, TC; low-density lipoprotein cholesterol, LDL-C) in 2004 compared to 25.2% in 2006 (p < 0.001). In both 2004 and 2006, more patients achieved their target levels for LDL-C than for TC and statins were the most commonly used medication (85% and 91%, respectively). Male sex, smoking, and higher education were the strongest correlates of the therapeutic outcome. The odds ratio of achieving cholesterol therapy goals in men, non-smokers, and university graduates was estimated at 1.51, 0.70, 1.38 in 2004 and 1.50, 0.73, 1.34 in 2006, respectively. CONCLUSION: There was a measurable improvement in the effectiveness of hypercholesterolaemia treatment between 2004 and 2006 but the majority of patients remain inadequately treated, with goals not being achieved. There is a need to raise the standard of lipid-lowering management in Poland.