Gianluigi Cuomo

Tirzepatide, a dual GLP-1/GIP receptor agonist, is increasingly used for the treatment of type 2 diabetes and obesity. While gastrointestinal side effects such as nausea and diarrhoea are common, reports of ischemic colitis potentially associated with tirzepatide are extremely rare. Understanding potential mechanisms is critical for early recognition and management. We report the case of a 77-yearold woman with type 2 diabetes, severe obesity, and cardiovascular comorbidities, who developed acute onset abdominal pain and rectal bleeding two days after her second dose of tirzepatide. On admission, laboratory evaluation showed leucocytosis and elevated Creactive protein. Abdominal CT demonstrated segmental left-sided colitis with diverticulosis. Rectosigmoidoscopy revealed hyperaemic, oedematous, friable mucosa with superficial ulcerations in the sigmoid colon. Histology was consistent with erosive colitis with features suggestive of ischemic injury. Infectious workup was negative. The patient was promptly started on intravenous metronidazole, fluid resuscitation, and pantoprazole. Clinical symptoms resolved over the subsequent days, and laboratory markers improved. This case highlights a potential association between tirzepatide therapy and ischemic colitis. Mechanisms may include delayed gastrointestinal motility, increased intraluminal pressure, relative hypovolemia, and possible neuroenteric microvascular modulation. Clinicians should be aware of this rare but serious complication, particularly in patients with cardiovascular comorbidities.

Peripheral artery disease (PAD) is a pervasive atherosclerotic condition affecting well over 100 million adults worldwide and associated with major functional limitations, reduced quality of life, and elevated risks of myocardial infarction, stroke, limb events, and mortality. Exercise therapy—preferably supervised or delivered through structured, monitored home-based programs—is a first-line, guideline-endorsed therapy that improves walking performance and patient-reported outcomes and contributes to comprehensive secondary prevention. This review synthesizes mechanistic underpinnings (endothelial, angiogenic, metabolic, and autonomic) and appraises the comparative effectiveness, safety, and implementation models of supervised exercise therapy (SET), structured home-based and hybrid programs, and alternative modalities in PAD. Finally, we summarize policy aspects and persistent gaps to guide clinical practice and future research.

Peripheral artery disease (PAD) is a pervasive atherosclerotic condition affecting well over 100 million adults worldwide and associated with major functional limitations, reduced quality of life, and elevated risks of myocardial infarction, stroke, limb events, and mortality. Exercise therapy—preferably supervised or delivered through structured, monitored home based programs—is a first line, guideline endorsed therapy that improves walking performance and patient reported outcomes and contributes to comprehensive secondary prevention. This review synthesizes mechanistic underpinnings (endothelial, angiogenic, metabolic, autonomic) and appraises the comparative effectiveness, safety, and implementation models of supervised exercise therapy (SET), structured home based and hybrid programs, and alternative modalities in PAD. Finally, we summarize policy aspects and persistent gaps to guide clinical practice and future research.

Background: Return to work (RTW) after acute coronary syndrome (ACS) or acute heart failure (HF) is a pivotal outcome reflecting functional recovery and quality of life (QoL). While survival after cardiac events has improved through reperfusion and guideline-directed pharmacotherapy, sustainable RTW depends on an integrated set of clinical, psychological, social, and occupational determinants. Objective: This study aimed to synthesize and expand the evidence on predictors of RTW, delineate practical workload-matching rules using METs and CPET, and position multidisciplinary cardiac rehabilitation (CR) as the bridge from clinical recovery to durable vocational reintegration. Key findings: Beyond left ventricular ejection fraction (LVEF), depression, anxiety, illness perceptions, and RTW self-efficacy are robust predictors of vocational outcomes. CPET-guided exercise prescriptions and MET-based job matching ensure adequate metabolic reserve; sustained task demand should remain at ≤35–40% of maximal capacity, with peak capacity ≥2× average job demand. CR (Class IA in the 2023 ESC ACS Guidelines) improves exercise tolerance, medication adherence, psychosocial well-being, and deployment of vocational support, including stepwise reintegration plans and ergonomic adaptations. Telerehabilitation extends monitoring and counseling into the workplace and maintains adherence after RTW. Conclusions: Comprehensive CR that integrates exercise training, psychosocial counseling, lifestyle modification, and vocational interventions offers the most effective pathway to stable RTW, improved QoL, and reduced socio-economic burden. Early identification of vulnerable subgroups and personalized, digitally supported follow-up are essential for long-term job retention.

Background: Return to work (RTW) after acute coronary syndrome (ACS) or acute heart failure (HF) is a pivotal outcome reflecting functional recovery and quality of life (QoL). While survival after cardiac events has improved through reperfusion and guideline-directed pharmacotherapy, sustainable RTW depends on an integrated set of clinical, psychological, social, and occupational determinants. Objective: To synthesize and expand the evidence on predictors of RTW, delineate practical workload-matching rules using METs and CPET, and position multidisciplinary cardiac rehabilitation (CR) as the bridge from clinical recovery to durable vocational reintegration. Key findings: Beyond left ventricular ejection fraction (LVEF), depression, anxiety, illness perceptions, and RTW self-efficacy are robust predictors of vocational outcomes. CPET-guided exercise prescriptions and MET-based job matching ensure adequate metabolic reserve; sustained task demand should remain ≤35–40% of maximal capacity, with peak capacity ≥2× average job demand. CR (Class IA in the 2023 ESC ACS Guidelines) improves exercise tolerance, medication adherence, psychosocial well-being, and deployment of vocational support, including stepwise reintegration plans and ergonomic adaptations. Telerehabilitation extends monitoring and counseling into the workplace and maintains adherence after RTW. Conclusions: Comprehensive CR that integrates exercise training, psychosocial counseling, lifestyle modification, and vocational interventions offers the most effective pathway to stable RTW, improved QoL, and reduced socio-economic burden. Early identification of vulnerable subgroups and personalized, digitally supported follow-up are essential for long-term job retention.

Background: Serum albumin is a well-known marker of nutritional and inflammatory status and has been associated with adverse outcomes in heart failure (HF). However, its predictive value for length of hospital-stay and short-term mortality in elderly HF patients remains underexplored. Objectives: To investigate the association between serum albumin levels at hospital admission and length of stay, as well as post-admission mortality, in a cohort of elderly patients hospitalized for HF. Methods: We conducted a retrospective analysis of 56 consecutive patients aged ≥65 years admitted for HF. Comorbidities were assessed using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), and inflammatory status was measured via C-reactive protein (CRP). Negative binomial regression with robust confidence intervals was employed to evaluate the relationship between serum albumin and length of hospital-stay, adjusting for age, comorbidity burden, and CRP. Cox proportional hazards models were used to assess mortality at 6 months and 1 year, adjusting for age, comorbidity, CRP, and HF subtype, with Kaplan–Meier curves illustrating unadjusted survival differences according to albumin levels and HF subtype. Results: Mean age was 78.6 ± 7.5 years, with 69.6% female patients. Mean serum albumin at admission was 3.58 ± 0.60 g/dL, and mean length of stay was 14.8 ± 10.1 days. Each 1 g/dL increase in albumin was associated with a 32% reduction in length of stay (adjusted IRR = 0.68; 95% CI: 0.54–0.85; p = 0.01), independently by age, inflammatory status and comorbidity. Serum albumin was independently associated with reduced risk of death at 6 months (HR 0.30; 95% CI: 0.11–0.82; p = 0.019) and 1 year (HR = 0.41; 95% CI: 0.17–0.96; p = 0.041). Conclusions: Serum albumin at hospital admission independently predicts length of stay and short-term mortality in elderly patients with HF. Albumin measurement, simple, cheap and universally available biomarker, is helpful for early risk stratification and may guide clinical management in this vulnerable population.

Although shown to be effective in improving survival and quality of life in patients with cancer, some treatments are well-known causes of cardiotoxicity, such as anthracyclines, monoclonal antibodies against human epidermal growth factor receptor 2 (HER2) and radiotherapy. To prevent cardiovascular disease (CVD) in patients living with cancer, cardiologists and oncologists promoted the development of cardio-oncology, an interdisciplinary field which aims to further improving life expectancy in these patients. Cardio-oncology rehabilitation (CORE), through correction of risk factors, prescription of drug therapies and structured exercise programs, tries to improve symptoms, quality of life, cardiorespiratory fitness (CRF) and survival in patients with cancer. Different imaging modalities can be used to evaluate the real effectiveness of exercise training on cardiac function. Among these, the global longitudinal strain (GLS) has recently aroused interest, thanks to its high sensitivity and specificity for cardiac dysfunction detection due to advanced ultrasound programs. This review summarizes the evidence on the usefulness of GLS in patients with cancer undergoing cardiac rehabilitation programs.

Cardiovascular disease is the most important cause of death worldwide in recent years; an increasing trend is also shown in organ transplant patients subjected to immunosuppressive therapies, in which cardiovascular diseases represent one of the most frequent causes of long-term mortality. This is also linked to immunosuppressant-induced dyslipidemia, which occurs in 27 to 71% of organ transplant recipients. The aim of this review is to clarify the pathophysiological mechanisms underlying dyslipidemia in patients treated with immunosuppressants to identify immunosuppressive therapies which do not cause dyslipidemia or therapeutic pathways effective in reducing hypercholesterolemia, hypertriglyceridemia, or both, without further adverse events.

Dyslipidemia is a widespread risk factor in solid organ transplant patients, due to many reasons, such as the use of immunosuppressive drugs, with a consequent increase in cardiovascular diseases in this population. PCSK9 is an enzyme mainly known for its role in altering LDL levels, consequently increasing cardiovascular risk. Monoclonal antibody PCSK9 inhibitors demonstrated remarkable efficacy in the general population in reducing LDL cholesterol levels and preventing cardiovascular disease. In transplant patients, these drugs are still poorly used, despite having comparable efficacy to the general population and giving fewer drug interactions with immunosuppressants. Furthermore, there is enough evidence that PCSK9 also plays a role in other pathways, such as inflammation, which is particularly dangerous for graft survival. In this review, the current evidence on the function of PCSK9 and the use of its inhibitors will be discussed, particularly in transplant patients, in which they may provide additional benefits.