Aldona Kubica

Out-of-hospital cardiac arrest remains associated with high mortality and neurological disability. Mild therapeutic hypothermia has been questioned after large trials failed to demonstrate superiority over controlled normothermia with fever prevention. In this expert viewpoint, we argue that these neutral findings should not be interpreted as proof of biological futility in every patient and setting. The clinical effect of hypothermia may depend on patient phenotype, timing of initiation, cooling technique, temperature-control quality, and integration with contemporary post-resuscitation care. This may be particularly important in patients undergoing percutaneous coronary intervention, in whom hypothermia can impair the pharmacokinetics and antiplatelet effects of oral P2Y12 inhibitors. Current evidence does not support routine hypothermia in all comatose survivors. However, uncertainty remains regarding its value in selected patients. Patients with an intermediate degree of ischemic brain injury may represent a plausible target for neuroprotection, but this remains an unproven hypothesis. Future trials should investigate whether injury severity modifies the effects of early, precisely delivered hypothermia, using standardized protocols, active normothermia as the comparator, and prespecified antithrombotic and post-resuscitation strategies.

Heart failure (HF) remains a major global health burden despite substantial therapeutic advances. Vericiguat, an oral soluble guanylate cyclase (sGC) stimulator, represents a distinct pharmacological strategy targeting impaired nitric oxide–sGC–cyclic guanosine monophosphate (NO–sGC–cGMP) signaling, a pathway closely linked to endothelial dysfunction, vascular stiffness, myocardial fibrosis, and adverse remodeling. This narrative review synthesizes the current evidence on the efficacy, safety, and clinical positioning of vericiguat across the heart failure spectrum, with a particular focus on worsening heart failure with reduced ejection fraction (HFrEF), while integrating recent trial data, updated guideline recommendations, and emerging real-world evidence to define its contemporary role in clinical practice. Randomized trials, subgroup analyses, and contemporary meta-analyses indicate that vericiguat provides a modest but clinically relevant reduction in HF-related outcomes, especially in high-risk patients with recent decompensation. However, its overall effect appears smaller than that of foundational therapies such as angiotensin receptor–neprilysin inhibitors and sodium–glucose cotransporter 2 inhibitors. Recently published data from the VICTOR program further refine the role of vericiguat in compensated outpatients with chronic HFrEF, showing a neutral primary outcome but providing supportive hypothesis-generating signals across a broader risk continuum while confirming a favorable safety profile. Overall, vericiguat should be regarded not as a replacement for cornerstone therapy but as a mechanistically complementary, risk-targeted adjunct for selected patients with persistent residual risk despite guideline-directed medical therapy.

The cardiovascular–kidney–metabolic (CKM) syndrome has emerged as an integrated framework linking obesity, type 2 diabetes, chronic kidney disease (CKD), and heart failure with preserved or mildly reduced ejection fraction through shared mechanisms including inflammation, oxidative stress, endothelial dysfunction, and fibrosis. Persistent mineralocorticoid receptor overactivation plays a central role in this continuum, contributing to progressive cardiac and renal injury despite optimized renin–angiotensin system blockade. Finerenone, a selective non-steroidal mineralocorticoid receptor antagonist, has therefore gained increasing attention as a targeted strategy to reduce residual cardiorenal risk. This narrative review summarizes the mechanistic rationale and clinical evidence supporting finerenone across the CKM spectrum. Experimental data indicate that finerenone attenuates inflammation, fibrosis, myocardial hypertrophy, and adverse remodeling, while proteomic and translational analyses suggest biological complementarity with sodium–glucose cotransporter 2 inhibitors. Clinically, pivotal randomized trials have demonstrated that finerenone reduces kidney disease progression and major cardiovascular events in patients with CKD and type 2 diabetes, while the FINEARTS-HF trial extended these benefits to patients with heart failure with mildly reduced or preserved ejection fraction by reducing worsening heart failure events. Additional subgroup, pooled, and meta-analytic data reinforce the consistency of these effects across a broad range of cardiorenal phenotypes. Taken together, current evidence positions finerenone as an important component of contemporary CKM management, particularly in patients with diabetic CKD and selected heart failure phenotypes. Its principal value lies in targeting residual inflammatory and fibrotic risk beyond conventional hemodynamic and metabolic control. Future progress will depend on earlier phenotype recognition, improved implementation and adherence, and wider adoption of pathway-oriented combination therapy across the cardiorenal continuum.

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: Kidney function is critical for cardiovascular health, and its appropriate assessment entails proper determination of prognosis in patients with chronic coronary syndromes (CCSs). However, assessment of the urinary spot albumin to creatinine ratio (uACR) is often overlooked, whereas it is crucial for determination of chronic kidney disease (CKD). This study assesses the prevalence of impaired kidney function in patients with CCS based on their eGFR and albuminuria. Methods and results: This study comprised a total of 1957 patients from seven regions in Poland, aged ≤ 80 years, who, 6–18 months earlier, were hospitalized for acute coronary syndrome or elective myocardial revascularization. Complete uACR and eGFR data were obtained from 1152 patients (median age was 67 years, and 71.23% of participants were male). The finding of albuminuria reclassified the CKD in 17% (200) patients, suggesting that a patient’s risk cannot be ascertained only based on their eGFR result. CKD reclassification by albuminuria was observed in older (p < 0.001) patients with higher BPs (p = 0.008), BPd (p = 0.038), HR (p < 0.001), fasting glucose (p < 0.001), and HbA1c (p < 0.001) and decreased HDL concentration (p = 0.001); hence, this is the population where uACR assessment is particularly valuable. Conclusions: In a notable percentage of patients with CCS, their kidney function classification is changed based on their albuminuria. Therefore, it is important to include albuminuria in the routine assessment of patients with cardiovascular disease.

According to the ESC guidelines, cangrelor may be considered in P2Y12-inhibitor-naïve acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). The aim of this review is to summarize available evidence on the optimal maintenance therapy with P2Y12 receptor inhibitor after cangrelor. Transitioning from cangrelor to a thienopyridine, but not ticagrelor, can be associated with a drug-drug interaction (DDI); therefore, a ticagrelor loading dose (LD) can be given any time before, during, or at the end of a cangrelor infusion, while a LD of clopidogrel or prasugrel should be administered at the time the infusion of cangrelor ends or within 30 minutes before the end of infusion in the case of a LD of prasugrel. Administration of any oral antiplatelet agent at the end of a cangrelor infusion will also result in a transient period of increased platelet reactivity. The inter-individual variability of this period is difficult to predict because it depends on many factors related to the patient and the treatment. In addition, experimental studies indicate that cangrelor may exert a cardioprotective effect beyond the blockade of platelet aggregation. Considering the available data, the potential use of cangrelor in ACS patients goes well beyond the current indications. Furthermore, we believe that it might be prudent to avoid use of thienopyridines during and soon after a cangrelor infusion until conclusive data on the effect of the DDI on the clinical outcome are available. On the other hand, ticagrelor seems to be an optimal oral agent for continuation of P2Y12 inhibition in patients receiving cangrelor infusion. Keywords: antiplatelet therapy cangrelor ticagrelor P2Y12 receptor inhibition

Background: A chronic disease occurring in a person’s life is a stressor, disrupting every aspect of their life. Objectives: This study aims to assess the relationship between functioning in chronic illness and quality of life with the prevalence of symptoms of depression and anxiety in patients with high cardiovascular risk. Material and methods: This study included 200 patients (aged 18–80 years) under the care of a primary care physician, diagnosed with hypertension and/or hypercholesterolemia, and/or diabetes between 6 and 24 months before the enrollment. The presented analysis assessed the symptoms of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS); and the quality of life of patients with cardiovascular disease using the Heart Quality of Life (HeartQoL) questionnaire and functioning in chronic illness using the Functioning in Chronic Illness Scale (FCIS). Results: The HADS scores amounted to 4.34 ± 3.414 points for the HADS-Anxiety subscale and 3.20 ± 2.979 points for the HADS-Depression subscale. The score indicative of functioning in chronic illness assessed with the FCIS was 98.32 ± 13.89 points. The independent predictors of HADS-anxiety were HeartQoL Emotional and FCIS Global, while HeartQoL Global and FCIS Global were the independent predictors for HADS-depression. Better functioning in chronic illness (FCIS Global) was associated with less frequent symptoms of anxiety and depression based on the HADS: HADS-Anxiety (R Spearmann = −0.3969; p < 0.0001) and HADS-Depression (R Spearmann = −0.5884; p < 0.0001). Higher HeartQoL scores, both globally, as well as in emotional and physical dimensions, were associated with a lower severity of anxiety and depression assessed with the HADS: HADS-Anxiety (R Spearmann = −0.2909; p = 0.0001) and HADS-Depression (R Spearmann = −0.2583; p = 0.0002). Conclusions: The quality of life and functioning in chronic illness are connected with symptoms of depression and anxiety. When assessing the severity of the depression symptoms in relation to the individual aspects of functioning in chronic illness, the areas requiring supportive-educational intervention can be identified. The assessment of both functioning in a chronic disease and the severity of the depression symptoms should be included in a standard nursing diagnosis and further supportive and educational intervention.

Background: Elevated lipoprotein (a) [Lp(a)] concentrations are linked mainly to genetic factors. The relationship between Lp(a) and other lipid disorders or cardiovascular (CV) risk factors has been less investigated. The aim of this study was to assess the occurrence of lipid disorders and other CV risk factors according to Lp(a) concentrations. Methods: A cross-sectional analysis of 200 primary-care patients who had not been diagnosed with CV disease was conducted. The following risk factors were assessed: older age, history of hypertension, diabetes mellitus or dyslipidemia, smoking, lack of physical activity, body mass index (BMI), and waist circumference. The following lipid parameters were measured: total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), and small, dense LDL (sdLDL-C). Patients were divided into two groups based on their Lp(a) concentrations: p = 0.04), with no significant differences regarding the other analyzed lipid disorders (p > 0.05). Both in the low- and high-Lp(a) group, most patients had two other abnormal lipid factors (45.0% and 60.0%, respectively). The distribution of impaired lipid parameters (p = 0.41) and other CV risk factors (p = 0.16) was similar in both groups. There was a lower rate of patients >60 years old (15.0% vs. 32.9%, p = 0.01) and with a BMI ≥ 25 kg/m² (46.7% vs. 63.6%, p = 0.026) in the high-Lp(a) group, and previously diagnosed hyperlipidemia was more prevalent in this group (65.0% vs. 47.1%, p = 0.02). The occurrence of other cardiovascular risk factors did not differ significantly between the Lp(a) groups (p > 0.05). In the high-Lp(a) group, the highest proportion (25.0%) had two CV risk factors, and in the low-Lp(a) group, 31.4% had four CV risk factors. Conclusions: An elevated Lp(a) concentration is not related to the number of conventional CV risk factors or other impairment major lipid parameters.

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.