Vasilios Kotsis

Background/Objectives: Patient safety incidents can adversely affect healthcare professionals, but relationships between leadership and organizational responses, clinician recovery, professional consequences, and safety-related outcomes remain incompletely synthesized. This review examined contemporary quantitative evidence on these relationships and the extent to which directly measured safety behaviors and patient-safety outcomes have been evaluated. Methods: This PROSPERO-registered systematic review (CRD420261453278) followed PRISMA 2020 and PRISMA-S. PubMed and Scopus were searched as the primary bibliographic databases, supplemented by Europe PMC and OpenAlex and by forward citation searching in Scopus and the Web of Science Core Collection, for English-language studies published from January 2021 through July 2026. Two reviewers independently screened records and extracted data; design-specific JBI appraisal judgments were agreed by two reviewers. Heterogeneity precluded meta-analysis, and findings were synthesized narratively using SWiM-informed structured reporting. Results: Of 6838 records, 44 studies were included. Distress/recovery was assessed in 40 studies (90.9%), professional consequences in 21 (47.7%), other safety-related outcomes or indicators in five (11.4%), and disclosure-related behavior in one (2.3%). No study prospectively evaluated incident or near-miss reporting or speaking up as a principal exposure-linked outcome. Supportive organizational responses, just and non-punitive cultures, learning-oriented safety climates, and structured support were generally associated with less distress, more favorable recovery, and fewer negative professional outcomes. Structured-support evaluations suggested feasibility, acceptability, and favorable short-term signals but did not establish intervention effectiveness. Conclusions: Contemporary evidence is substantially stronger for clinician recovery and professional functioning than for safety behavior or patient outcomes. Predominantly cross-sectional, self-reported, and uncontrolled evidence precludes causal conclusions. Direct evaluation of reporting, disclosure, speaking up, verified workforce outcomes, and patient-safety effects remains a major research priority.

The May Measurement Month (MMM) 2023 global blood pressure (BP) screening campaign was conducted in Greece aiming to raise hypertension awareness and control in the general population. Volunteers aged ≥18 years were recruited through opportunistic screening in 11 cities. Each participant was assessed with triplicate seated BP measurements using validated automated upper-arm cuff devices and a standardized questionnaire on medical history. These data were submitted online through a custom-designed app of the global MMM campaign. Hypertension was defined as BP ≥140/90mmHg (average of second-third measurement) and/or use of antihypertensive drugs. A total of 5,437 individuals were analysed (mean age 53±17.1 years, 46.2% men, 27.8% current smokers, 10.9% with diabetes, 6.7% with cardiovascular disease) and 41.7% were hypertensive. The prevalence of hypertension was higher in men compared to women and in older compared to youngers individuals. Among hypertensives, 73.9% were unaware of their diagnosis, 69.9% were on antihypertensive drugs, and 47.6% were treated and controlled (BP <140/90mmHg). These data suggest that in Greece a high prevalence of hypertension persists, and often is undiagnosed, untreated, and uncontrolled. Global BP screening campaigns such as MMM are important and need to be complemented by public health initiatives at a national level for improving hypertension diagnosis and control.

Background: Estimated pulse wave velocity (ePWV), an easy to calculate proxy of carotid to femoral PWV (cfPWV), can be derived from 24-hour blood pressure monitoring (24h-BPM). Its role in acute ischemic stroke (AIS) has not previously been investigated in large multinational datasets. Methods: A pooled individual patient data analysis from 13 cohorts across seven countries was conducted, including 2933 AIS patients who underwent 24h-BPM during the hyperacute to subacute phase. ePWV was calculated using a validated equation. Associations with clinical characteristics, stroke severity, etiologic subtypes, and outcomes were assessed with logistic regression. The primary outcome was poor functional outcome at 90 days, defined as a modified Rankin Scale (mRS) >2. Results: Patients with higher ePWV presented with more severe strokes (median NIHSS 7 vs. 3, P < .001) and had poorer outcomes both at 90 days (63.7% vs. 23.7%, P < .001) and discharge (61.9% vs 29.1%, P < .001). ePWV was associated with poor outcome at 90 days (aOR: 1.24, 95% CI: 1.05-1.45) and discharge (aOR: 1.26, 95% CI: 1.12-1.42), per 1 m/s increase in ePWV, after adjustment for conventional risk factors and stroke severity. In patients ≤50 years, ePWV was highest in those with small vessel disease (SVD), who also had more cardiovascular risk factors than other stroke subtypes. Conclusions: ePWV derived from 24h-BPM is a simple, widely applicable measure of vascular aging that is associated with functional outcome after AIS. The higher ePWV observed in young patients with SVD underscores a potential early arteriosclerotic burden in this subgroup.

Introduction Super Normal Vascular Aging (SUPERNOVA) describes individuals whose vascular system remains protected, despite exposure to cardiovascular risk factors. Understanding the determinants of arterial stiffness in this population may provide valuable insights into protection mechanisms. Aim This study aims to investigate the key features of SUPERNOVA individuals and examine factors associated with carotid-femoral pulse wave velocity (cf-PWV) across different age subgroups. Methods This cross-sectional study included individuals referred to a Hypertension Center for blood pressure (BP) evaluation. SUPERNOVA status was defined based on cf-PWV values lower than the age-expected averages derived from European population. Clinical, laboratory, and ambulatory BP measurements were recorded. Results From a total cohort of 829 participants, 37.2% (n = 308) met the SUPERNOVA criteria. The mean age was 42.7 ± 25years (57.9% females). The population present normal BP parameters during day, night and 24 h, almost in all age decades. The mean cf-PWV presented the lowest value (5.2 ± 0.5 m/s) for the youngest age group (< 30years) and the highest (9.3 ± 1.0 m/s) for the older (≥ 70years). The prevalence of hypertension, obesity, smoking, and dyslipidemia was lower among elderly SUPERNOVA individuals (≥ 70years) compared to younger groups. Multivariate analysis revealed that age (B: 0.06, p < 0.001), LDL cholesterol (B: 0.009, p = 0.001), and 24-hour systolic BP (B: 0.031, p = 0.005) were independently associated with higher cf-PWV, whereas 24-hour diastolic BP (B: − 0.047, p = 0.003) was inversely associated among SUPERNOVA patients. Conclusion This study highlights key characteristics of SUPERNOVA individuals and suggests that LDL cholesterol and 24-hour systolic BP are crucial factors influencing arterial stiffness. These findings may help identify strategies to preserve vascular health and delay arterial aging.

1. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors – evolocumab and alirocumab– have been approved by the US Food and Drug Administration and the European Union for the treatment o...

Rheumatoid arthritis (RA) is characterized by immune-mediated inflammation resulting in excess cardiovascular disease (CVD) risk. Increased sodium, decreased potassium intake and their ratio have been acknowledged as CVD risk modifiers, while pathophysiological studies suggest a role in autoimmunity and inflammation. We aimed to review in a systematic manner the literature regarding the effects of dietary sodium, potassium intake and their ratio, on cardiovascular and disease-related outcomes in patients with RA. We performed a systematic literature search in Medline and Cochrane. Our research concluded to 1,283 patients (8 studies). Although not all studies coincide, most agree that increased dietary sodium and reduced dietary potassium intake are adversely associated with disease related (rheumatic and immunologic) outcomes. The ratio between sodium and potassium emerges a potential indicator of autoimmunity state that needs to be further balanced. Only 4 studies reported associations with cardiovascular outcomes in RA, particularly hypertension, although not consistently and none with hard CVD endpoints. These findings support that interventions promoting a poor in sodium and rich in potassium diet in RA may have beneficial effects in terms of autoimmunity regulation, suppression of inflammation and improvement in cardiovascular health.

Background: Early vascular aging (EVA) reflects accelerated arterial stiffening and is closely linked to cardiovascular and renal target organ damage. The Early Vascular Aging Ambulatory score (EVAAs) estimates EVA using ambulatory blood pressure monitoring (ABPM) and routinely available clinical parameters. We aim to investigate the association between EVAAs-defined early vascular aging and markers of kidney involvement—particularly albumin-to-creatinine ratio (ACR)—in a hypertensive population. Methods: Fifty treated hypertensive adults undergoing 24 h ABPM were enrolled. All participants underwent laboratory evaluation, including serum electrolytes and 24 h urine collection for albumin, creatinine, sodium, and potassium. EVAAs was calculated using ABPM-derived parameters and established cardiovascular risk factors. Results: EVAAs was positively correlated with ACR (r = 0.276, p = 0.049). In addition, inverse correlations were observed between EVAAs and serum potassium (r = −0.290, p = 0.038) and serum sodium (r = −0.284, p = 0.046). Participants with moderately increased albuminuria tended to exhibit higher EVAAs values, although this difference did not reach statistical significance. Conclusions: EVAAs is associated with early markers of renal involvement in hypertensive patients, supporting its potential role as a non-invasive indicator of subclinical target organ damage. Larger studies are warranted to confirm these findings and to further validate EVAAs as a clinically useful marker of EVA.

There is cumulative evidence that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) can offer cardiovascular protection extending beyond glucose-lowering and weight reduction, but the underlying mechanisms contributing to these effects remain incompletely understood. Modulation of platelet function might contribute to the aforementioned benefits. In the current literature review article, we synthesized available preclinical and clinical data evaluating the effects of GLP-1 RAs on platelet activation and function. Preclinical data indicate that GLP-1 RAs might decrease platelet activation via both GLP-1 receptor-dependent and -independent mechanisms with the involvement of cyclic adenosine monophosphate signaling, increase in nitric oxide bioavailability, and suppression of thromboxane-mediated pathways, particularly under inflammatory or shear-stress conditions. Additionally, clinical studies, despite being limited and heterogeneous, support a reduction in platelet activation markers, even independently of glycemic control or weight loss. However, most of them are characterized by small sample sizes and significant heterogeneity among them. In summary, existing evidence suggests that GLP-1 RAs exhibit potential antiplatelet effects that could contribute to their cardioprotective profile. Larger, well-designed clinical studies are crucial to better understand the clinical importance of platelet modulation by GLP-1 RAs and their potential implications for cardiovascular risk reduction.

Obesity is a key contributor to heart failure, driving increased morbidity, mortality, and healthcare costs. This association is supported by multiple pathophysiological mechanisms and consistent epidemiological evidence, particularly not only in heart failure with preserved ejection fraction (HFpEF), but also in heart failure with reduced ejection fraction (HFrEF). Given the rising prevalence of both diseases, integrated management strategies are essential. This review outlines current management options in patients with heart failure and obesity, from lifestyle modification to pharmacological and surgical treatment, and explores emerging treatments aimed at mitigating this growing burden.

Background/Objectives: Several studies in the literature support that endovascular aortic repair (EVAR) could exert a harmful effect on heart function, causing myocardial injury. The aim of this study is to investigate the correlation of high-sensitivity cardiac troponin I (hs-cTnI) levels during the immediate postoperative period after EVAR with various factors. Methods: A total of 104 patients were enrolled from February to December 2024 prospectively and consecutively. Patient demographics, cardiovascular comorbidities, laboratory tests, including hemoglobin and hs-cTnI levels, EVAR procedure duration and type of anesthesia were recorded. A generalized linear mixed model with a Gamma distribution and log link was fitted to analyze postoperative hs-cTnI concentrations across three time points (6 h, 24 h, and 48 h). Results: The mean age of patients was 71.6 ± 7.3 years, the mean transverse AAA diameter was 5.7 ± 1.1 cm and the mean preoperative hemoglobin was 14.2 ± 1.64 g/dL. In total, 72 patients received general anesthesia and 32 patients regional anesthesia. A total of 18 patients presented myocardial injury. Patients under general anesthesia had significantly higher mean hs-cTnI than those under regional anesthesia (p < 0.01). Older age, longer operations, and higher baseline hs-cTnI all predict higher follow-up hs-cTnI. Meanwhile higher preoperative hemoglobin predicts lower hs-cTnI. Conclusions: General anesthesia compared to regional anesthesia, older age, longer surgery, and higher baseline hs-cTnI are associated with higher postoperative hs-cTnI levels, while higher preoperative hemoglobin predicts lower hs-cTnI levels. Understanding the factors that are related to myocardial injury during EVAR could contribute to the improvement in procedures in order to minimize the harmful effect of EVAR on heart function.