Despite the availability of numerous lipid-lowering agents, the treatment of lipid disorders remains a public health challenge. A substantial portion of patients, especially those with severe dyslipidemia or familial hypercholesterolemia (FH), fail to achieve the LDL-C goal. The leading causes of suboptimal LDL-C control include underprescription and poor adherence; however, in rare cases, it may result from an unusual biological response to treatment. In the presented case, a 78-year-old female with a history of transient ischemic attack and myocardial infarction was diagnosed with a heterozygous variant of FH and true statin intolerance following trials of simvastatin, rosuvastatin and pitavastatin. Initially, inclisiran was added to ezetimibe, leading to an unexpected increase in LDL-C. Due to the patient’s refusal of another statin re-challenge and the unavailability of bempedoic acid, nutraceuticals were introduced. After 6 months, inclisiran was discontinued because only a 22% reduction in LDL-C was achieved, likely attributable to the nutraceutical’s effect. Another PCSK9 inhibitor, evolocumab, was subsequently initiated. Shortly after the treatment onset, the patient complained of paraesthesia in the upper extremities and discontinued therapy. LDL-C levels increased by 7% after one month of treatment with evolocumab. The patient refused treatment with lipid apheresis. Possible causes of poor response to PCSK9 inhibitors include elevated lipoprotein(a) and FH.

Background: Respiratory infections were found to be connected with the incidence of acute coronary syndrome (ACS). The proposed pathway of this connection includes inflammation, oxidative stress, pro-coagulation, and atherosclerotic plaque destabilization. This can cause rapture and thrombus formation, leading to ACS. Our study aimed to assess the risk factors for coronary artery thrombosis as a manifestation of ACS and for lower respiratory tract infections (LRTIs) in patients with ACS. Methods: The study included 876 patients with ACS from January 2014 to December 2018. Both the clinical data and air pollution data were analyzed. Statistical tests used for analysis included Student’s t-test, the Mann–Whitney U-test, the Chi-squared test, and the odds ratio Altman calculation. Results: LRTIs were found in 9.13% patients with ACS. The patients with LRTI had a higher risk of coronary artery thrombosis (OR: 2.4903; CI: 1.3483 to 4.5996). Moreover, they had increased values of inflammatory markers, were older, had a lower BMI, and a higher rate of atrial fibrillation. The average atmospheric aerosols with a maximum diameter of 2.5 μm (PM_2.5 concentration) from three consecutive days before hospitalization for ACS were higher in patients with LRTI. Conclusions: The occurrence of coronary artery thrombosis was higher among the patients with LRTI during ACS. PM_2.5 exposition was higher in the three consecutive days before hospitalization in patients with LRTI during ACS.

Background/Objectives: Stroke and arteriosclerotic diseases remain the main challenge for global healthcare. Carotid artery procedures aim to restore blood flow through the carotid arteries to prevent embolic events. The most common techniques include carotid endarterectomy (CEA) and carotid artery stenting (CAS). The choice of intervention depends on the severity of stenosis, the patient’s overall condition and the presence of comorbidities. The personalized approach, which includes sex-related differences, is crucial in optimizing the outcome. Methods: Sex-related differences in atherosclerosis risk factors and early carotid artery stenting treatment outcomes were evaluated in 271 patients. The goal of the study was to asses sex-related differences in early outcome of CAS, including success rate and complications. Results: The only significant difference in classical arteriosclerosis risk factors included a higher occurrence of smoking among males. The technical success rate of carotid artery stenting was high (94.46%). The sex-related differences in CAS involve using smaller sizes of implanted stents in females. There was a high incidence of complications (mostly minor), predominantly among females. They had a significantly higher frequency of bleeding and hypotension. Blood pressure and BMI significantly influenced the odds of complications. Conclusions: Females undergoing CAS have a higher complication risk with a similar success rate.

Echocardiography remains a vital part of the initial assessment and monitoring of oncological patients. It allows for proper treatment selection but can also reveal life-threatening complications, including impaired left ventricular function or thromboembolism. It can rarely detect intracardiac masses that require further investigation. In the presented case, a 51-year-old female patient with left-sided breast cancer, who had undergone neoadjuvant chemotherapy, was hospitalised due to a right atrial mass identified via routine transthoracic echocardiography (TTE). Initial anticoagulation therapy showed no clinical improvement. Follow-up TTE revealed a 12 × 19 mm hyperechogenic, mobile mass in the right atrium (RA). Computed tomography angiography (CTA) ruled out pulmonary embolism and revealed that the mass was located close to the tip of the vascular access port. Transoesophageal echocardiography showed that the lesion was not connected to the vascular port. Based on location and mobility, the lesion was most consistent with a cardiac myxoma. After the Heart Team made a decision, endovascular intervention using a vacuum-assisted device was performed without complications. Histopathological examination excluded thrombosis and myxoma, revealing a fibro-inflammatory lesion. A multimodality approach is necessary to assess RA masses. However, even an extensive evaluation could be misleading, so treatment options should always be subject to the Heart Team’s decision.