Do the Gender and the Number of Comorbidities and the Use of Tertiary Prevention Play a Role in the Severity of Anxiety and Depression in Patients with Coronary Artery Disease? A POLASPIRE II Study.

Background/Objectives: The need to conduct research on anxiety and depression in patients with coronary artery disease in connection with factors such as gender or implemented tertiary prevention is very important for drawing practical conclusions and, consequently, implementing new recommendations and procedures. The aim of the study was to attempt to answer the question whether gender and the number of comorbidities, as well as the application of tertiary prevention principles, play a role in the severity of anxiety and depression in the studied group of patients with coronary artery disease. Material: The study involved 765 patients from 11 Polish cardiology centers. The presented material is part of the multicenter POLASPIRE II study. Methods: All patients completed The Hospital Anxiety and Depression Scale (HADS) questionnaire, and a medical interview was conducted with them. Conclusions: Although the intensity of anxiety and depression in the studied group of patients was low, gender differentiated them, which, however, did not influence undertaking tertiary prevention activities. In the study group of patients, the number of comorbidities and cardiac incidents/procedures after the event qualifying for the study, as well as preventive actions undertaken, were not associated with the severity of anxiety and depression. In the studied group of patients with coronary heart disease, there was still a large group of people who did not take preventive measures. Therefore, there is a need for systematic education regarding the benefits of implementing them to prevent the progression of the disease and premature death.

May Measurement Month 2021: an analysis of blood pressure screening results from Poland.

May Measurement Month 2021 (MMM21) is the fourth edition of the global initiative in Poland initiated by the International Society of Hypertension (ISH) and aimed at raising awareness of hypertension and the need for blood pressure (BP) screening. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in 132 sites - between May and September 2021. Blood pressure was measured in 1699 subjects (mean age: 40.8 ± 17.0 years; 68.8% females). After multiple imputation, the age and sex standardized systolic and diastolic BP was 126.6/78.7 mmHg for the entire group, 133.8/81.9 mmHg in individuals on antihypertensive medication, and 125.4/78.6 mmHg in those not taking antihypertensive drugs. The proportion of subjects with high BP (≥140/90 mmHg) were: 30.9% for the entire group, 40.4% in subjects taking antihypertensive drugs, and 17.9% in those not taking antihypertensive drugs. Of all participants, 33.9% were in the age range of 18-29 years and we observed higher BP levels and more frequent BP elevation in males in this age group. These data provide unique insights into the hypertension rates during the COVID-19 pandemic. Due to the associated restrictions, only limited data could be obtained for older adults. Interestingly, among young Polish participants, the rate of hypertension and the level of BP were higher in males compared to females, suggestive perhaps of a higher susceptibility of males to experience a rise in BP during specific circumstances associated with a pandemic.

Quality of Life in Patients with Coronary Artery Disease-Multicenter POLASPIRE II Study.

Background: The quality of life of patients with coronary heart disease is extremely important for their treatment. The aim of the study was to assess the quality of life of patients with coronary artery disease, considering education and compliance with medical recommendations regarding lifestyle changes, as well as the presence of selected cardiovascular risk factors. Methods: The study involved 763 patients from 11 Polish cardiology centers. The presented material is part of the multicenter POLASPIRE II study. Patients completed a standardized questionnaire EuroQol 5D-5Lm. A medical interview was conducted with each patient. All patients had their body weight and height measured and BMI determined. Results: The quality of life of patients was better in men, younger people, those with lower body weight and those who followed preventive recommendations and intensified their physical activity. Most of the examined patients complied with the medical recommendations regarding lifestyle changes after a cardiac incident, but they mainly concerned dietary modifications. There was still a large group of patients who did not comply with the recommendations, e.g., regarding increasing physical activity. Conclusions: The assessment of quality of life depended on many factors, such as gender, body weight and compliance with medical recommendations. The health education of patients in the presented study group was not sufficient. Therefore, there is a need for better education regarding the benefits of following medical recommendations in terms of leading a healthy lifestyle, which consequently improves its quality and duration.

Anemia and iron metabolism disorders after single anastomosis sleeve ileal (SASI) bypass. Is it a real problem?

PURPOSE: SASI (single anastomosis sleeve ileal) bypass can lead to nutritional deficiencies, including disorders of iron metabolism and anemia. This study aims to evaluate the effect of SASI bypass on weight loss, anemia, and iron deficiency in patients with obesity during the follow-up period. METHODS: This study is a retrospective analysis of prospectively collected data from patients who underwent SASI bypass at our hospital between January 2020 and February 2022. RESULTS: The mean age of the patients was 42 years (range 22-58). The average duration of the follow-up period was 26 months. The mean percentage of excess weight loss (%EWL) was 90.1%, and total weight loss (%TWL) was 30.5%. During the postoperative observation period, anemia was identified in ten patients (25%), comprising 70% with normocytic anemia, 10% with microcytic anemia, and two macrocytic anemia cases (20%). Iron deficiency was observed in two patients (5%). CONCLUSION: SASI bypass is an effective bariatric procedure in weight loss outcomes. However, there may be an increased risk of anemia and iron metabolism disruptions associated with this procedure. The common limb length (250 vs. 300 cm) did not significantly impact hemoglobin, iron, TIBC, ferritin levels, or anemia incidence among patients undergoing SASI bypass. The decrease in postoperative ferritin levels signifies a depletion in tissue iron reserves, thereby emphasizing the necessity for surveillance of iron homeostasis parameters following SASI bypass.

Blood pressure measurement and assessment of arterial structure and function: an expert group position paper.

Measuring blood pressure (BP) and investigating arterial hemodynamics are essential in understanding cardiovascular disease and assessing cardiovascular risk. Several methods are used to measure BP in the doctor's office, at home, or over 24 h under ambulatory conditions. Similarly, several noninvasive methods have been introduced for assessing arterial structure and function; these methods differ for the large arteries, the small ones, and the capillaries. Consequently, when studying arterial hemodynamics, the clinician is faced with a multitude of assessment methods whose technical details, advantages, and limitations are sometimes unclear. Moreover, the conditions and procedures for their optimal implementation, and/or the reference normality values for the parameters they yield are not always taken into sufficient consideration. Therefore, a practice guideline summarizing the main methods and their use in clinical practice is needed. This expert group position paper was developed by an international group of scientists after a two-day meeting during which each of the most used methods and techniques for blood pressure measurement and arterial function and structure evaluation were presented and discussed, focusing on their advantages, limitations, indications, normal values, and their pragmatic clinical application.

Incidence and prevalence of registered hypertension in Poland.

INTRODUCTION: Hypertension is a major factor related to morbidity and mortality in middle- and high­income countries. OBJECTIVES: The aim of the study was to assess the incidence and prevalence of registered hypertension in Poland in the years 2018-2022. PATIENTS AND METHODS: We used the public payer claims database to assess incidence and prevalence of registered hypertension. Definition of hypertension was based on the International Classification of Diseases, 10th Revision codes from I10 to I15. RESULTS: The number of registered hypertension cases during the analyzed period varied from 10.9 to 11 million. The prevalence was 0.5%, 0.5%, 0.5%, 0.4%, and 0.4% (P <0.001) in children (age <18 years) and 34.4%, 34.8%, 34.9%, 35.2%, and 35.2% (P <0.001) among adults in 2018, 2019, 2020, 2021, and 2022, respectively. In 2022, the mean (SD) age of persons with registered hypertension was 66.2 (14.1) years in women and 60.8 (14.8) years in men (P <0.001). The highest incidence of registered hypertension was found in men aged 55-59 years and in women aged 50-54 years. In the population aged up to 54 years, the registered prevalence of hypertension was higher among men, while in older age groups it was higher in women, reaching 94% and 87% in the oldest groups of women and men, respectively. CONCLUSIONS: In 2022, the number of patients with registered hypertension in Poland was close to 11 million, while the prevalence was 35.2% in adults and 0.4% in children. In the population under the age of 55 years, hypertension is more common in men, while women predominate in the older age groups.

Triglicerydes/high-density lipoprotein ratio as a risk factor of post-Covid-19 sinus tachycardia: A retrospective study.

Inappropriate sinus tachycardia (IST) is one of the manifestations of the post-COVID-19 syndrome (PCS), which pathogenesis remains largely unknown. This study aimed to identify potential risk factors for IST in individuals with PCS. The 1349 patients with PCS were included into the study. Clinical examination, 24H Holter ECG, 24H ambulatory blood pressure monitoring and biochemical tests were performed 12-16 weeks after the COVID-19 in all participants. IST was found in 69 (3.5%) individuals. In the clinical assessment IST patients were characterized by a higher age (p < 0.001) and lower prevalence of the diagnosed hypertension (p = 0.012), compared to remaining patients. Biochemical testing showed higher serum triglycerides (1.66 vs. 1.31 pmol/L, p = 0.007) and higher prevalence of a low high-density lipoprotein (HDL) cholesterol (24.6% vs. 15.2%, p = 0.035) in the IST group. Subsequently, the triglicerydes (TG)/HDL ratio, an indicator of insulin resistance, was significantly higher in the IST individuals (3.2 vs. 2.4, p = 0.005). 24H monitoring revealed a significantly higher minimum diastolic, maximum systolic and mean arterial blood pressure values in the IST group (p < 0.001 for all), suggesting a high prevalence of undiagnosed hypertension. A multivariate analysis confirmed the predictive value TG/HDL ratio >3 (OR 2.67, p < 0.001) as predictors of IST development. A receiver operating characteristic curve analysis of the relationship between the TG/HDL ratio and the IST risk showed that the predictive cut-off point for this parameter was 2.46 (area under the ROC curve = 0.600, p = 0.004). Based on these findings, one can conclude that insulin resistance seems to be a risk factor of IST, a common component of PCS.

Association between Blood Parameters of Nutritional Status and Functional Status in Extreme Longevity.

BACKGROUND: The relationship between functional and nutritional status in the geriatric population remains an issue of debate and there is a gap in the knowledge regarding this field in long-lived individuals. AIM: The main aim of this study was to assess the association between selected blood parameters of nutritional status and functional status in extreme longevity. METHODS: The inclusion criteria were centenarians above 100 years of age who were examined at their homes, and blood samples were collected. The study group consisted of 170 individuals (25 men and 145 women, median age 100.75 years [100.29-101.58]). RESULTS: Total protein and albumin serum concentration was significantly lower in long-lived individuals with severe functional decline compared to individuals with preserved functional status, p = 0.000001 and p = 0.0000, respectively. Iron serum level was significantly higher in the group with preserved functional status, p = 0.04. Preserved functional status was positively correlated with total protein serum concentration (p = 0.000), albumin concentration (p = 0.000), and iron serum level (p = 0.029). A negative correlation was stated between c-reactive protein (CRP) and functional status (p = 0.032). Univariable logistic regression analysis showed that the functional status of long-lived individuals depends on total protein (OR 2.89, CI 95% [1.67-5.0]) and albumin concentrations (OR 2.34, CI 95% [1.39-3.92]). Multivariable backward stepwise logistic regression analysis showed that a total protein concentration was the only variable independently related to the preserved functional status (OR 3.2, 95% Cl [1.8-5.67]). CONCLUSIONS: In long-lived individuals, the total serum protein and albumin levels are lower in centenarians with severe functional decline, and they correlate with functional status. Total protein serum concentration is the only factor independently related to the preserved functional status in extreme longevity.

How to Enhance the Diagnosis of Early Stages of Chronic Obstructive Pulmonary Disease (COPD)? The Role of Mobile Spirometry in COPD Screening and Diagnosis-A Systematic Review.

COPD is the third leading cause of death worldwide. Its diagnosis can be made with spirometry, which is underused due to its limited accessibility. Portable spirometry holds promise for enhancing the efficacy of COPD diagnoses. The study aimed to estimate COPD prevalence diagnosed with a portable spirometer in high-risk patients and compare it with COPD prevalence based on data from conventional, on-site spirometry. We also evaluated the strategy of a proactive approach to identify COPD in high-risk individuals. We conducted a systematic review of original studies on COPD targeted screening and diagnosis with portable and conventional spirometers selected from 8496 publications initially found in three databases: Cochrane, PubMed, and Embase. The inclusion criteria were met by 28 studies. COPD prevalence evaluated with the use of portable spirometers reached 20.27% and was lower compared to that estimated with the use of conventional spirometers (24.67%). In 11 included studies, postbronchodilator tests were performed with portable spirometers, which enabled a bedside COPD diagnosis. Portable spirometers can be successfully used in COPD targeted screening and diagnosis and thus enhance the detection of COPD at early stages.

Revisional one-anastomosis gastric bypass for failed laparoscopic sleeve gastrectomy.

The study aimed to evaluate the mid-term weight loss outcomes and complications of revisional one-anastomosis gastric bypass (OAGB) following failed laparoscopic sleeve gastrectomy (LSG). A total of 586 patients underwent LSG from January 2010 to February 2018. Revisional OAGB (rOAGB) was performed in 22 (3.8%) patients. A retrospective analysis of prospectively collected data from 20 patients with at least 12 months of follow-up after the revisional OAGB was carried out. The indications for revisional surgery were as follows: insufficient weight loss-4 (20%), weight regain-13 (65%), weight regain and symptoms of gastroesophageal reflux disease (GERD)-2 (10%), and dysphagia with gastroesophageal reflux-1 (5%). The mean interval between the LSG and rOAGB was 35.3 ± 15.4 months (range 4-64). The mean follow-up time after rOAGB was 45.5 ± 17.1 months (range 12-54). At the end of the follow-up after rOAGB, %TWL was 26.4 ± 8.9%, and %EWL was 58.5 ± 21.6%, based on pre-LSG body weight. In all three patients with intractable GERD, the clinical symptoms of reflux retreated after revisional OAGB. The overall complication rate was 20%. In conclusion, the main indications for revision after LSG are weight regain, insufficient weight loss, and intractable GERD. Revisional OAGB emerges as a viable surgical alternative for unsuccessful LSG, presenting notable weight loss outcomes; however, it may be linked to an increased incidence of complications.

Cardio-ankle vascular index for predicting cardiovascular morbimortality and determinants for its progression in the prospective advanced approach to arterial stiffness (TRIPLE-A-Stiffness) study.

BACKGROUND: The cardio-ankle vascular index (CAVI) measure of arterial stiffness is associated with prevalent cardiovascular risk factors, while its predictive value for cardiovascular events remains to be established. The aim was to determine associations of CAVI with cardiovascular morbimortality (primary outcome) and all-cause mortality (secondary outcome), and to establish the determinants of CAVI progression. METHODS: TRIPLE-A-Stiffness, an international multicentre prospective longitudinal study, enrolled >2000 subjects ≥40 years old at 32 centres from 18 European countries. Of these, 1250 subjects (55% women) were followed for a median of 3.82 (2.81-4.69) years. FINDINGS: Unadjusted cumulative incidence rates of outcomes according to CAVI stratification were higher in highest stratum (CAVI > 9). Cox regression with adjustment for age, sex, and cardiovascular risk factors revealed that CAVI was associated with increased cardiovascular morbimortality (HR 1.25 per 1 increase; 95% confidence interval, CI: 1.03-1.51) and all-cause mortality (HR 1.37 per 1 increase; 95% CI: 1.10-1.70) risk in subjects ≥60 years. In ROC analyses, CAVI optimal threshold was 9.25 (c-index 0.598; 0.542-0.654) and 8.30 (c-index 0.565; 0.512-0.618) in subjects ≥ or <60 years, respectively, to predict increased CV morbimortality. Finally, age, mean arterial blood pressure, anti-diabetic and lipid-lowering treatment were independent predictors of yearly CAVI progression adjusted for baseline CAVI. INTERPRETATION: The present study identified additional value for CAVI to predict outcomes after adjustment for CV risk factors, in particular for subjects ≥60 years. CAVI progression may represent a modifiable risk factor by treatments. FUNDING: International Society of Vascular Health (ISVH) and Fukuda Denshi, Japan.

The Course of COVID-19 and Long COVID: Identifying Risk Factors among Patients Suffering from the Disease before and during the Omicron-Dominant Period.

SARS-CoV-2 has acquired many mutations that influence the severity of COVID-19's course or the risk of developing long COVID. In 2022, the dominant SARS-CoV-2 variant was Omicron. This study aimed to compare the course of COVID-19 in the periods before and during the dominance of the Omicron variant. Risk factors for developing long COVID were also assessed. This study was based on stationary visits of patients after COVID-19 and follow-up assessments after 3 months. Clinical symptoms, comorbidities, and vaccination status were evaluated in 1967 patients. Of the analyzed group, 1308 patients (66.5%) were affected by COVID-19 in the period before the Omicron dominance. The prevalence of long COVID was significantly lower among patients of the Omicron group (47.7% vs. 66.9%, p < 0.001). The risk of long COVID was higher for women (OR: 1.61; 95% CI: 1.31, 1.99]) and asthmatics (OR: 1.46; 95% CI: 1.03, 2.07]). Conclusively, infection during the Omicron-dominant period was linked to a lower risk of developing long COVID. Females are at higher risk of developing long COVID independent of the pandemic period. Individuals affected by COVID-19 in the Omicron-dominant period experience a shorter duration of symptoms and reduced frequency of symptoms, except for coughing, which occurs more often.

The Effect of Sex on the Risk of Long-COVID and Cardiovascular Complications in Healthy Patients without Comorbidities: Data from a Polish Long-COVID Cardiovascular (PoLoCOV-CVD) Study.

Background: The prevalence of long-COVID (LC) presents a significant challenge to healthcare systems globally. There are still some discrepancies on the role of sex as an independent risk factor of LC complications. Thus, we aimed to determine the differences in clinical and cardiovascular complications between males and females without comorbidities after COVID-19. Methods: Clinical data on the course of the disease with the accompanying symptoms and post-COVID-19 symptoms were compiled from both male and female subjects with a minimum 12-week interval after COVID-19 recovery. Next, the patients were followed for 12 months. ECG, echocardiography, 24 h ECG monitoring, 24 h ambulatory blood pressure monitoring (ABPM), and selected biochemical tests were performed. LC was diagnosed based on the World Health Organization (WHO) definition. To reduce the impact of confounders, i.e., body mass index (BMI) and age, on the results of the study, the nearest neighbour (NN) propensity score matching (PSM) method with a 1:1 ratio was used. Results: The results were obtained following the removal of cases with comorbidities from the database consisting of 1237 males and 2192 females, and PSM of the new database included 886 cases (443 males and 443 females). At both the 3-month and 1-year post-recovery marks, females consistently reported a higher frequency of LC symptoms compared to males (p < 0.001 for both comparisons). Moreover, after 1 year of follow-up, females exhibited a higher prevalence of LC compared to males, with rates of 14% versus 8.3%, respectively (p = 0.013). The symptoms that significantly differed between females and males in the 12-month follow-up were hair loss (5.4 vs. 0.7%, p < 0.001), memory and concentration disturbances (8.4 vs. 4.3%, p = 0.013), and headaches (4.3 vs. 1.4%, p = 0.008). Females presented lower mean arterial pressure (MAP) [89 (83-95) mmHg versus (vs.) 94 (89-100); p < 0.001] and lower pulse pressure (PP) [46 (42-52) mmHg vs. 51 (48-57); p < 0.001] in 24 h ABPM and more elevated heart rates (HRs) in 24 h ECG monitoring as well as arrhythmia (p < 0.001 and p = 0.018, respectively). Males had a higher occurrence of ECG abnormalities such as QRS >= 120 ms, ST-T changes, T inversion, arrhythmia, and QRS fragmentation (27.3% vs. 19.2%; p = 0.004). No significant differences were observed between males and females concerning physical activity levels, stress, fatigue, alcohol consumption, and smoking habits. Conclusions: One year post-COVID-19 recovery, regardless of age and BMI, healthy females more often suffered from LC symptoms than males. They had lower MAP and PP in 24 h ABPM, more often had higher HRs and arrhythmia in 24 h ECG monitoring, and fewer ECG abnormalities than males.

Theory cracks old data: Rovibrational energy levels of orthoH2-CO derived from experiment.

Measurements of rovibrational spectra of clusters provide physical insight only if spectral lines can be assigned to pairs of quantum states, and further insight is obtained if one can deduce the quantitative energy-level pattern. Both steps can be so difficult that some measured spectra remain unassigned, one example is orthoH2-CO. To extend the scope of spectroscopic insights, we propose to use theoretical information in interpretation of spectra. We first performed high accuracy, full-dimensional calculations of the orthoH2-CO spectrum, at the highest practically achievable levels of electronic structure theory and quantum nuclear dynamics. Then, an iterative, theory-guided method developed here allowed us to fully interpret the spectrum of orthoH2-CO, extending the range of van der Waals clusters for which spectroscopy can provide physical insights.

Recommendations of the Experts of the Polish Cardiac Society (PCS) and the Polish Lipid Association (PoLA) on the diagnosis and management of elevated lipoprotein(a) levels.

Lipoprotein(a) [Lp(a)] is made up of a low-density lipoprotein (LDL) particle and a specific apolipoprotein(a). The blood concentration of Lp(a) is approximately 90% genetically determined, and the main genetic factor determining Lp(a) levels is the size of the apo(a) isoform, which is determined by the number of KIV2 domain repeats. The size of the apo(a) isoform is inversely proportional to the blood concentration of Lp(a). Lp(a) is a strong and independent cardiovascular risk factor. Elevated Lp(a) levels ≥ 50 mg/dl (≥ 125 nmol/l) are estimated to occur in more than 1.5 billion people worldwide. However, determination of Lp(a) levels is performed far too rarely, including Poland, where, in fact, it is only since the 2021 guidelines of the Polish Lipid Association (PoLA) and five other scientific societies that Lp(a) measurements have begun to be performed. Determination of Lp(a) concentrations is not easy due to, among other things, the different sizes of the apo(a) isoforms; however, the currently available certified tests make it possible to distinguish between people with low and high cardiovascular risk with a high degree of precision. In 2022, the first guidelines for the management of patients with elevated lipoprotein(a) levels were published by the European Atherosclerosis Society (EAS) and the American Heart Association (AHA). The first Polish guidelines are the result of the work of experts from the two scientific societies and their aim is to provide clear, practical recommendations for the determination and management of elevated Lp(a) levels.

First-year follow-up costs of myocardial infarction management in Poland from the payer's perspective.

BACKGROUND: Myocardial infarction (MI) remains a major burden for healthcare systems. Therefore, we intended to analyze the determinants of cost management of patients hospitalized for MI in Poland. METHODS: Data on patients hospitalized and discharged with the diagnosis of acute MI were derived from the public payer claims database. Adult patients, reported between October 1, 2017 and December 31, 2019, were included. Costs of hospitalization for acute MI and cumulative one-year follow-up were analyzed. RESULTS: The median (IQR) of the total direct cost was €3804.7 (2674.1-5712.7) per patient and 29% (€1113.6 [380.5-2490.4]) of these were costs related to the use of post-hospitalization healthcare resources. The median cost of cardiovascular disease management was €3624.7 (2582.1-5258.5), and 26% of this sum were follow-up costs. The analysis of the total cost for individual years showed a slight increase in median costs in subsequent years: €3450.7 (2407.8-5205.2) in 2017, €3753.8 (2642.6-5681.9) in 2018, and €3944.9 (2794.8-5844.4) in 2019. Male sex, heart failure, atrial fibrillation, diabetes, kidney disease, chronic obstructive pulmonary disease, and history of stroke in addition to hospitalization in a department other than cardiology or internal disease were independently related to the cost of MI patient management. CONCLUSIONS: The high cost of management of MI patients was independently related to sex, heart failure, atrial fibrillation, diabetes, kidney disease, chronic obstructive pulmonary disease, and history of stroke as well as hospitalization in other than cardiology or internal disease department.

Clinical and electrocardiographic correlates of myocardial dysfunction after COVID-19 in nonhospitalised patients in long-term follow-up. Data from the polish long-covid cardiovascular study.

Clinical evidence indicates that COVID-19 is a multiorgan disease that significantly impacts the cardiovascular system. However, little is known about the predictors of myocardial dysfunction after SARS-CoV-2 infection. Therefore, this research aimed to evaluate the clinical and electrocardiographic correlates of myocardial dysfunction after SARS-CoV-2 infection in nonhospitalised patients without previously diagnosed cardiovascular disease. This observational study included 448 patients selected from the database of 4142 patients in the Polish Long-Covid Cardiovascular study. All patients underwent a 12-lead electrocardiogram (ECG); 24-h Holter ECG monitoring, 24/7 ambulatory blood pressure monitoring, echocardiography, and cardiac magnetic resonance imaging. According to the results of diagnostic tests, patients were divided into two groups depending on the occurrence of myocardial dysfunction after COVID-19. Group 1-without myocardial dysfunction after COVID-19-consisted of 419 patients, with a mean age of 48.82 (SD ± 11.91), and Group 2 (29 patients)-with myocardial dysfunction after COVID-19, with a mean age of 51.45 (SD ± 12.92). When comparing the analysed groups, there were significantly more men in Group 2 (p = 0.006). QRS (corresponds to the time of ventricular contraction in an electrocardiographic examination) fragmentation (p = 0.031), arrhythmias (atrial fibrillation, supraventricular extrasystole, ventricular extrasystole) (p = 0.008), and male gender (p = 0.007) were independently associated with myocardial dysfunction after COVID-19. The study showed that myocardial damage after COVID-19 affects men more often and is independent of typical clinical factors and the severity of the disease course. The QRS fragmentation and arrhythmias observed in the ECG indicate the possibility of myocardial dysfunction in patients after COVID-19, which may be a valuable marker for physicians.

Risk factors for cardiovascular diseases: the focus on primary prevention.

Views on the etiopathogenesis of atherosclerosis are subject to evolution. In addition to the classic well-known risk factors, new ones related to mental state, social life and environment are being discovered. Both acute and chronic stress stimulate inflammatory processes. Due to the change in lifestyle and eating habits, the accumulation of risk factors in childhood is an increasing problem. Knowledge of risk factors allows for effective primary prevention of cardiovascular diseases. The effectiveness of prevention increases when the activities cover the largest possible part of the society, and access to a doctor is easy. Therefore, government programs are being implemented offering patients easier access to diagnostics of cardiovascular diseases at the level of primary health care, which enables faster identification of people at the greatest cardiovascular risk. Easier access to primary care and a good doctor-patient relationship improve patient compliance. In this situation, the importance of the family doctor as a key link in the diagnosis, prevention and treatment of cardiovascular diseases is increasing.

The role of pneumococcal vaccination in reducing cardiovascular risk in cardiac patients: Expert opinion of the Prevention Committee of the Polish Cardiac Society supported by the Polish Vaccinology Society.

Respiratory diseases have been the fourth most common cause of death in Poland in recent years. Respiratory infection, especially pneumonia, can lead to exacerbation of chronic cardiovascular disease.Streptococcus pneumoniae is the most common bacterial pathogen causing community-acquired pneumonia. Pneumococci are also the most common pathogen complicating the course of infection with the influenza virus. Pneumonia, especially invasive pneumococcal disease, is associated with risk of death in the course of respiratory failure or sepsis and also with worsening of the prognosis for existing cardiovascular disease. Despite those facts, recommendations for pneumococcal vaccination are still not well established in cardiovascular guidelines. This expert opinion aims to summarize current knowledge on the importance of preventing invasive pneumococcal disease in cardiac patients.

Intensive Statin Therapy Versus Upfront Combination Therapy of Statin and Ezetimibe in Patients With Acute Coronary Syndrome: A Propensity Score Matching Analysis Based on the PL-ACS Data.

Background We aimed to compare statin monotherapy and upfront combination therapy of statin and ezetimibe in patients with acute coronary syndromes (ACSs). Methods and Results The study included consecutive patients with ACS included in the PL-ACS (Polish Registry of Acute Coronary Syndromes), which is a national, multicenter, ongoing, prospective observational registry that is mandatory for patients with ACS hospitalized in Poland. Data were matched using the Mahalanobis distance within propensity score matching calipers. Multivariable stepwise logistic regression analysis, including all variables, was next used in propensity score matching analysis. Finally, 38 023 consecutive patients with ACS who were discharged alive were included in the analysis. After propensity score matching, 2 groups were analyzed: statin monotherapy (atorvastatin or rosuvastatin; n=768) and upfront combination therapy of statin and ezetimibe (n=768 patients). The difference in mortality between groups was significant during the follow-up and was present at 1 (5.9% versus 3.5%; P=0.041), 2 (7.8% versus 4.3%; P=0.019), and 3 (10.2% versus 5.5%; P=0.024) years of follow-up in favor of the upfront combination therapy, as well as for the overall period. For the treatment, rosuvastatin significantly improved prognosis compared with atorvastatin (odds ratio [OR], 0.790 [95% CI, 0.732-0.853]). Upfront combination therapy was associated with a significant reduction of all-cause mortality in comparison with statin monotherapy (OR, 0.526 [95% CI, 0.378-0.733]), with absolute risk reduction of 4.7% after 3 years (number needed to treat=21). Conclusions The upfront combination lipid-lowering therapy is superior to statin monotherapy for all-cause mortality in patients with ACS. These results suggest that in high-risk patients, such an approach, rather than a stepwise therapy approach, should be recommended.