Piotr Jankowski

Background and Aims: We investigated whether patients with coronary heart disease (CHD) in Europe are achieving the standards set by prevention and rehabilitation guidelines. Variability in achieved standards was also studied: (i) between countries, (ii) between geographical risk regions, and (iii) according to attendance at cardiac rehabilitation (CR). Methods: EUROASPIRE VI is an observational study conducted between September 2024 and February 2026 in 160 hospitals across 27 countries. Geographical risk regions were defined as high, moderate, or low based on World Health Organization cardiovascular mortality data. Results were standardized by age and sex. Results: Among 8590 patients with CHD (23.7% female), 17.1% were current smokers, 32.0% were obese, and 33.5% reported low physical activity. 59.8% were above blood pressure target (systolic ≥130 and/or diastolic ≥80 mmHg), 82.7% were above LDL-cholesterol target (≥1.4 mmol/L), 32.8% had known diabetes of whom 42.2% had HbA1c ≥7%, and 30.6% had chronic kidney disease. Prevalences of these risk factors were all highest in countries from high-risk regions. 29.1% of patients attended at least one CR session, with country variability ranging from 0% to 79% and differing by risk region (55.9% low risk, 29.7% moderate risk and 10.2% high risk; P < .001). Attendance at CR programmes was associated with significantly better lifestyles, risk factor control, and use of cardioprotective drugs. Conclusions: Most European patients are not achieving targets set by prevention guidelines. Despite better outcomes for those attending CR, there is marked variability in CR attendance and evidence of inverse care, with lowest attendance in highest risk regions. These results provide a baseline to inform the challenges for future implementation of the first European Society of Cardiology guideline on CR.

Background: Central systolic blood pressure (cSBP) reflects the pressure experienced by vital organs and may be more closely related to hypertensive cardiac damage than brachial SBP. Twenty‐four–hour ambulatory blood pressure monitoring provides additional insight into cardiovascular load beyond office readings. This study investigated the association of 24‐hour cSBP, measured noninvasively with a validated device, with left ventricular mass index (LVMi) and LV hypertrophy. Methods: We analyzed data from 21 centers worldwide (n=2367; 45.5% women; mean age 49.5 years) participating in the International 24‐Hour Aortic Blood Pressure Consortium. Brachial and central 24‐hour SBPs were recorded using the Mobil‐O‐Graph device, calibrated by either systolic/diastolic (cSBP C1) or mean/diastolic (cSBP C2) pressure; LVMi was derived echocardiographically. BP phenotypes (normotension, isolated diastolic and systolic hypertension, and systolic‐diastolic hypertension) were based on 24‐hour brachial BPs, subdivided by cSBP. Results: LVMi correlated most strongly with 24‐hour cSBP C2 ( P P =0.0045 and <0.001, respectively), without interaction. Discordant classification occurred in 14.4% of participants and was linked to higher LVMi in normotension and lower LVMi in systolic‐diastolic hypertension. Conclusions: Twenty‐four–hour central SBP calibrated with oscillometric mean/diastolic pressure (cSBP C2), is more closely associated with LVMi and LV hypertrophy than brachial SBP. These findings highlight the potential clinical value of incorporating central pressure monitoring into risk assessment and hypertension management.

Background Despite treatment, many hypertensive patients with coronary heart disease (CHD) have blood pressure (BP) that remains above guideline targets. However, less is known about patients in whom on-treatment BP is below target and major European guidelines differ substantially in their recommendations for such patients. Specifically, 2023 European Society of Hypertension (ESH) guidelines provide a Class 3 recommendation to proactively avoid BP below target whereas 2024 European Society of Cardiology (ESC) guidelines do not. Methods Between 2020 and 2023, adults hospitalised in the previous 6–24 months with incident or recurrent CHD were sampled in 14 countries from all six WHO regions and invited for a standardised interview and examination as part of the International Action on Secondary and Primary Prevention by Intervention to Reduce Events (INTERASPIRE) study. We measured seated BP twice using an automated oscillometric device after 5 min of rest. We defined participants as having BP above target (BP ≥130/80 mm Hg), at target (BP 120–129/70-79 mm Hg) or below target (Results Among 4548 participants (21.1% female), the mean age (±SD) was 60.0 (±10.3) years. At a median (IQR) of 1.05 (0.76–1.45) years after index CHD hospitalisation, 10.3% of patients had BP readings within the target range of 120–129/70-79 mm Hg, with 53.9% above target and 35.7% below target. Patients with below-target BP were more likely to have heart failure (13.6% vs 10.0%, p=0.041) and estimated glomerular filtration rate Conclusions More than one-third of INTERASPIRE patients with CHD presented with BP <120/70 mm Hg, which is below target per current European hypertension guidelines. Further research is needed in this population to resolve discordant guideline recommendations and determine whether de-escalation of BP-lowering therapies is beneficial or even harmful in this setting.

Clonal hematopoiesis (CH) is the expansion of clones from a single hematopoietic stem cell (HSC) in the bone marrow. Clonal hematopoiesis of indeterminate potential (CHIP) refers to CH defined by the presence of pre-leukemic driver mutations in at least 2% of alleles in sequenced peripheral blood. This phenomenon is, by definition, associated not only with the future development of acute myeloid leukemia but also with non-malignant conditions, including cardiovascular disease. However, the underlying molecular mechanisms for CH in non-malignant diseases, such as cardiovascular disease, are not fully explained. Certain subtypes of CHIP may give rise to proinflammatory immune cells, which, in turn, may promote atherosclerosis progression. Key subtypes of CHIP include mutations in genes encoding epigenetic regulators DNMT3A (DNA methyltransferase 3A), TET2 (ten-eleven translocation methylcytosine dioxygenase 2), and ASXL1 (associated sex combs-like 1), as well as mutations in the gene encoding hematopoietic cytokine signaling: JAK2 (Janus kinase 2). The aim of this review is to summarize the current knowledge of CHIP and its association with inflammation and cardiovascular risk factors.

Purpose Single Anastomosis Sleeve Ileal (SASI) bypass effectively alleviates GERD symptoms but may increase bile reflux risk. This study evaluates the effects of SASI bypass impact on endoscopic GERD features and GERD-related quality of life. Methods This single-center study is a retrospective analysis of prospectively collected data from patients who underwent SASI bypass between March 2020 and August 2022. Results Esophagitis prevalence significantly decreased from 51.4% preoperatively to 20.0% after SASI bypass, p = 0.010. Notably, esophagitis grade B, present in 17.1% of patients before surgery, was utterly absent postoperatively, p = 0.041. Bile reflux significantly increased from 11.4% preoperatively to 62.9% postoperatively, p < 0.001, with de novo bile reflux occurring in 20 cases. Proton pump inhibitor use increased from 31.4% before surgery to 45.7% after, p = 0.302. An analysis of factors affecting the postoperative quality of life, assessed by the GERD-HRQL General Scale, identified preoperative PPI use as a significant predictor, with users being significantly less likely to achieve a higher postoperative quality of life (OR = 0.07, 95% CI [0.01–0.44]), p = 0.009. Preoperative bile reflux was associated with a 95% lower likelihood of improved postoperative quality of life (OR = 0.05, 95% CI [0.00–0.67]), p = 0.038. Conclusion SASI bypass may be considered a suitable option for selected patients with mild GERD. Although endoscopic bile reflux increased postoperatively, most patients reported minimal reflux symptoms. Preoperative PPI use and bile reflux were associated with reduced postoperative quality of life, emphasizing the importance of appropriate patient selection and close follow-up.

Background: Obesity substantially increases cardiovascular risk and contributes to the accumulation of cardiometabolic risk factors. Achieving optimal control of body weight and guideline-recommended targets is essential in high-risk patients, particularly in secondary prevention following acute coronary events. This study aimed to evaluate treatment strategies and lifestyle modifications undertaken by patients with obesity during long-term follow-up. Methods: This analysis included patients enrolled 6–18 months after acute coronary syndrome or coronary revascularization within the multicentre POLASPIRE II study. Standardized EUROASPIRE methodology was applied to collect clinical, anthropometric, and lifestyle-related data. Results: A total of 788 patients (mean age 65.4 ± 8.9 years; 25.8% women) were included, of whom 40.6% had obesity. No significant association between sex and BMI was observed (β = −0.48; 95% CI −1.30 to 0.31; p = 0.20). Increasing age was associated with lower BMI (β = −0.05; 95% CI −0.09 to −0.0001; p = 0.044), and higher education correlated with lower BMI (β = −1.10; 95% CI −2.00 to −0.22; p = 0.015). With advancing age (OR 1.02; 95% CI 1.002–1.033; p = 0.023) and increasing BMI (OR 1.11; 95% CI 1.076–1.138; p = 0.001), the number of risk factors and comorbidities increased. Higher BMI was associated with poorer control of medical risk factors (OR 1.06; 95% CI 1.03–1.10; p < 0.001), whereas patients with higher BMI demonstrated better control of lifestyle-related risk factors (OR 0.95; 95% CI 0.919–0.983; p = 0.003). Conclusions: Obesity is highly prevalent among high-risk cardiovascular patients and is associated with a greater burden of comorbidities and poorer control of medical risk factors. These findings support the need for strengthened, risk-stratified secondary prevention strategies and more personalized therapeutic approaches in patients with obesity.

Background: The aim of the study was to assess trends in mortality and years of life lost due to acute myocardial infarction (AMI) in Poland between 2000 and 2023. Methods: We analysed aggregated, fully anonymised registry data comprising 431,793 death certificates of Polish residents who died from acute myocardial infarction (AMI). Standardised death rates (SDR) were calculated. Premature mortality was assessed using the Standard Expected Years of Life Lost (SEYLL). Trends were evaluated with joinpoint regression, estimating annual percentage change (APC) and average annual percentage change (AAPC). Results: During the study period, AMI deaths declined from 28,737 in 2000 to 11,328 in 2023, a 2.5-fold reduction. SDR decreased from 115.9 to 31.2 per 100,000, with an overall AAPC of −5.6% (p < 0.05). Declines were greater in men (AAPC −5.7%) than in women (−5.3%). SEYLL decreased from 608,488 years in 2000 to 191,476 years in 2023, representing a >70% reduction, with similar relative declines in men and women. SEYLLd fell from 21.2 to 16.9 years, indicating improved survival and older age at death. A temporary stagnation was observed between 2017 and 2020, followed by renewed steep declines thereafter. Conclusions: AMI mortality and YLL in Poland decreased markedly in the study period, reflecting advances in secondary prevention and public health.