Acute myocardial infarction,nicotine dependence,smoking cessation,tobacco control

Heart failure is an increasing public health issue with substantial morbidity and mortality rates. This study aimed to evaluate the efficacy, safety, and long-term outcomes of angiotensin receptor neprilysin inhibitor (ARNi) in the treatment of heart failure with reduced ejection fraction (HFrEF) 5 years after treatment initiation. This retrospective study analyzed a cohort of 75 patients diagnosed with HFrEF over a period of 5 years after the initiation of ARNi therapy. The initial clinical condition, laboratory and echocardiographic measurements including left ventricular ejection fraction (LVEF), New York Heart Association functional classes (NYHA-FC) and the prognostic nutritional index were compared to the corresponding values obtained after a 5-year period of ARNi therapy. In addition, the number of annual hospitalizations, mortality rates and any history of adverse effects during the follow-up period were recorded. The N-terminal pro-brain natriuretic peptide (NT-proBNP) level, LVEF, and NYHA-FC values demonstrated significant improvement at the end of the 5-year follow-up period (all parameters, P < .001). Although the observed increase in the prognostic nutritional index was not statistically significant (P = .077), it is worth noting. A significant reduction in daily diuretic doses and hospitalizations due to heart failure was observed following the use of ARNi (all comparisons, P < .001). The prevalence of hypotension was around 16% (being symptomatic in 4%), making it the most frequently observed adverse event. The 5-year cardiovascular mortality rate was 17.3%. The use of ARNi in HFrEF patients was associated with a notable improvement in NYHA-FC, LVEF, and NT-proBNP levels in the long-term, while also leading to a better nutritional status and reduced need for diuretics and annual hospitalization. Additionally, ARNi usage has been associated with improved nutritional status, decreased reliance on diuretics, and reduced frequency of annual hospitalizations. These effects were associated with a lack of significant increase in adverse effects. These results may contribute to a better understanding of ARNi’s long-term effects on patient outcomes.

The evaluation of the metabolic and autonomic predictors of cardiovascular diseases in relation to prostatic hyperplasia symptoms

Aims: Beyond the acute phase of the COVID-19 disease, many patients experience persistent symptoms, collectively termed "post-COVID syndrome," which includes autonomic dysfunction. Heart rate variability (HRV) is a well-established method to assess autonomic nervous system (ANS) function. This study aimed to investigate the long-term impact of COVID-19 on autonomic function through evaluating the changes in HRV. Methods: This retrospective study included 225 participants divided into two groups: 117 post-COVID patients and 108 age and gender matched controls. HRV was assessed using 24-hour Holter monitoring. Time-domain and frequency-domain indices were analyzed, including standard deviation of normal-to-normal intervals (SDNN), root mean square of successive RR interval differences (RMSSD), and low frequency (LF)/high frequency (HF) ratio. Statistical comparisons were performed using independent t-tests, Mann-Whitney U tests, and correlation analyses. Results: Post-COVID patients exhibited significantly lower HRV indices compared to controls. Time-domain metrics such as SDNN (135.7±39.5 ms vs 149.1±34.2 ms, p=0.007) and RMSSD (32.7±13.7 ms vs 37.5±14.7 ms, p=0.012) were reduced in the COVID-19 group. Frequency-domain indices, including total power (TP) and HF power, were also diminished. Correlation analysis revealed no significant association between the duration of time post-COVID (one-year follow-up) and most HRV parameters. Conclusion: Post-COVID patients experience significant autonomic dysfunction, marked by reduced parasympathetic activity and increased cardiovascular risks, with some evidence of partial recovery during sleep. Routine HRV monitoring and targeted interventions, alongside further research with larger cohorts, are crucial for better understanding of the long-term effects and improving patient outcomes.