Coexistence of chronic kidney disease (CKD) in the case of acute coronary syndromes (ACS) significantly worsens the outcomes. The aim of our study was to assess renal function impact on mortality a...

Previous studies conducted in highly polluted areas have reported associations between air pollution and daily mortality. The Green Lungs of Poland are characterized by unique natural features and a moderate pollution level. We aimed to assess the short-term impact of air pollution on cardiovascular (CVD)-, acute coronary syndrome (ACS)-, and cerebrovascular-related (CbVD) mortality. An analysis with 4,500,000 person-years and a time-stratified case-crossover design was performed. The interquartile range increase in the PM_2.5 (OR 1.036, 95% CI 1.016–1.056, p < 0.001) and PM₁₀ concentration (OR 1.034, 95% CI 1.015–1.053, p < 0.001) was associated with increased CVD mortality on lag 0, and this effect persisted on the following days. The effects of PMs were expressed more in association with ACS-related mortality (PM_2.5-OR = 1.045, 95% CI 1.012–1.080, p = 0.01; PM₁₀-OR = 1.044, 95% CI 1.010–1.078, p = 0.01) and CbVD mortality (PM₁₀-OR = 1.099, 95% CI 1.019–1.343, p = 0.02). We also noted a higher CVD mortality OR in the cold season for PM₁₀ in cities with area-source domination: Białystok (p = 0.001) and Suwałki (p = 0.047). The short-term impact of PMs on cardiovascular mortality is also observed in moderately polluted areas. This adverse health effect was more apparent in CbVD- and ACS-related mortality, and in the cold season. Further research focusing on the adverse health effects of “Polish smog” is sorely needed.

Aims: Air pollution remains the single largest environmental health risk factor, while atrial fibrillation (AF) is the most prevalent arrhythmia globally. The study aimed to investigate the relationship between short-term exposure to air pollution and acute AF admissions. Methods and results: Individual data on AF hospitalization in the years 2011–20 were collected from the National Health Fund in Poland (ICD-10: I48.XX). To obtain high-resolution data on air pollution, we applied a modelling method using the GEM-AQ model. Associations between air pollution exposure and acute AF admissions were estimated using generalized additive models with Poisson regression. Over the analysed period, we recorded 252 566 acute admissions due to AF. Each 10 µg/m3 increment of particulate matter with diameters ≤2.5 (PM2.5) and nitrogen dioxide (NO2) concentration, 1 µg/m3 of sulfur dioxide and 10 ng/m3 of benzo(a)pyrene (BaP) concentration on the day of exposure resulted in 1.13% (0.70−1.55%), 1.65% (1.05−2.26%), 0.11% (0.01−0.21%), and 0.3% (0.04−0.55%) increases in acute AF admissions, respectively. The estimates are larger for women and older people. Stronger associations between PM2.5 and BaP concentrations and AF admissions in poorly urbanized areas were noted. Areas with high gross domestic product levels were more affected by the increase in NO2 concentrations, resulting in a 0.2% (1.001–1.003) increase in AF admissions. Exposure-response functions show steeper slopes of the pollutant-outcome associations in the lower ranges of exposures, far below World Health Organization (WHO) air quality guideline norms. For the zero-emission scenario, we estimate avoidable AF admissions—5873 for PM2.5 (95% confidence interval 3679 to 8047) and 3295 for NO2 (2108–4477). Conclusion: Air pollution acts as a triggering factor and can be associated with acute AF hospitalizations. PM2.5 and NO2 have an impact on AF even at concentrations levels below WHO air quality guideline norms.

Hypertension remains a global threat to public health, affecting the worldwide population. It is one of the most common risk factors for cardiovascular disease. Today’s treatments focus on creating a hypotensive effect. However, there is a constant search for additional factors to reduce the potential of developing hypertension complications. These factors may act as a parallel treatment target with a beneficial effect in specific populations. Some studies suggest that uric acid may be considered such a factor. This study investigated the potential effect of uric acid concentrations over 5 mg/dL on the incidence of hypertension complications among patients with very high cardiovascular risk. A total of 705 patients with hypertension and very high cardiovascular risk were selected and included in the analysis. The patients were divided and compared according to serum uric acid levels. The study showed a higher occurrence of heart failure (OR = 1.7898; CI: 1.2738–2.5147; p = 0.0008), atrial fibrillation (OR = 3.4452; CI: 1.5414–7.7002; p = 0.0026) and chronic kidney disease (OR = 2.4470; CI: 1.3746–4.3558; p = 0.0024) among individuals with serum uric acid levels over 5 mg/dL, males and those with a BMI > 25 kg/m². These findings suggest that even serum uric acid concentrations over 5 mg/dL may affect the prevalence of hypertension-related complications among patients with very high cardiovascular risk.

Aims: The impact of the external exposome and mental health on cardiovascular diseases (CVDs) is well documented. However, the interactions between these factors remain poorly understood. This study aims is to assess the long-term impact of the exposome on cardiovascular and mental health and to explore the interactions between them. Methods and results: This nationwide analysis encompassed 400 million person-years of observation, using individual health data. Environmental and socioeconomic status (SES) data were derived from environmental monitoring stations, satellite-based remote sensing, and national registries. Negative binomial regression was employed. Environmental and SES were assessed as modifiers using interaction terms and stratified analyses. The association between long-term exposure to air pollution (AP) and mortality was expressed as relative risks (RRs) with 95% confidence intervals (CIs), per 10 µg/m³ annual increase in particulate matter with diameter < 2.5 μm (PM₂.₅), nitrogen dioxide (NO₂), and carbon monoxide (CO) and per 1 µg/m³ for sulfur dioxide (SO2). Between 2011 and 2020, 4 010 521 all-cause deaths were recorded, including 1 706 111 CVD-related deaths (42.5%), median age 81 (71–87), and 53.6% were female. Annual increases in AP concentrations were associated with CVD mortality: PM₂.₅ (RR, 1.023; 95% CI, 1.012–1.035), NO₂ (RR, 1.111; 95% CI, 1.072–1.151), SO₂ (RR, 1.081; 95% CI, 1.030–1.134), and CO (RR, 1.018; 95% CI, 1.013–1.023); all P < 0.001. Exposure to ambient pollutants was linked to higher rates of mental services (RR range, 1.003–1.053; all P < 0.05). Five per cent increase in forestation index (RR, 0.967; 95% CI, 0.955–0.979; P < 0.001) and recreational green spaces (RR, 0.967; 95% CI, 0.952–0.982; P < 0.001) were directly associated with lower CVD mortality. With increasing rates of psychiatric hospitalizations and depression-related services, there was weaker association between exposure to AP and mortality, while greenness exposure and SES indicators showed a mixed modifying effect depending on the pollutant, but were generally associated with risk reduction. Conclusion: The findings indicate multidimensional interactions between AP exposure, mental health, and SES conditions in shaping mortality risk. Greater access to mental health services modified the effects of environmental exposures, attenuating the associated risk. Socioeconomic status and greenness exposure might be associated with heterogeneous modifying effects, but seem predominantly to reduce risk. Our study highlights the necessity for context-specific urban planning strategies that consider local environmental and health determinants. Registration: ClinicalTrials.gov: NCT05198492 Lay summary:

Summary: Patients with preoperative atrial fibrillation (AF) undergoing cardiac surgery face a heightened risk of complications and reduced survival. Concomitant surgical ablation (SA) has shown promise in mitigating the arrhythmic burden, prompting guideline upgrades by major scientific societies. However, SA remains underutilized, with performance rates varying between 22% and 48%, depending on the type of procedure. The goal of this narrative review is to summarize current evidence to aid physicians in decision making regarding AF management during cardiac surgery. This review examines existing literature on the prevalence, management and outcomes of AF in cardiac surgery. We assess epidemiological data, summarize trends in clinical practice and review the rationale and techniques for treating AF surgically. Emerging challenges, including barriers to implementation and novel therapeutic advancements, are also discussed. Evidence underscores the detrimental impact of preoperative AF on perioperative and long-term outcomes, including higher mortality, morbidity and thromboembolic risk. Concomitant SA, particularly the Cox-maze IV procedure, significantly improves sinus rhythm restoration, reduces mortality and mitigates complications like stroke. However, the procedure remains underperformed due to concerns about complexity, prolonged operative time and training gaps. Emerging hybrid techniques, novel mapping systems and technologies like pulsed field ablation may enhance outcomes and broaden SA adoption. Concomitant SA is an effective yet underutilized therapy that can improve survival and reduce AF-related complications in cardiac surgery patients. Addressing implementation barriers and integrating advancements in technology and surgical approaches are key to optimizing patient outcomes.