Ischemic heart disease (IHD) remains a leading cause of global morbidity and mortality despite advances in prevention, diagnosis, and therapy. Traditional clinical risk scores and biomarkers often fail to fully capture the complex molecular processes underlying atherosclerosis, myocardial infarction, and ischemic cardiomyopathy, leaving substantial residual risk. MicroRNAs have emerged as promising regulators and biomarkers of cardiovascular disease, among which microRNA-21 (miR-21) has attracted particular attention. MiR-21 is deeply involved in key pathophysiological mechanisms of IHD, including endothelial dysfunction, vascular inflammation, vascular smooth muscle cell proliferation, plaque development and vulnerability, cardiomyocyte survival, and myocardial fibrosis. Accumulating clinical evidence suggests that circulating miR-21 holds diagnostic value across the ischemic continuum, from stable coronary artery disease to acute coronary syndromes, myocardial infarction, and ischemic heart failure. Moreover, miR-21 demonstrates prognostic relevance, correlating with plaque instability, adverse remodeling, heart failure progression, and long-term cardiovascular outcomes. Preclinical studies further indicate that miR-21 represents a double-edged therapeutic target, offering cardio protection in acute ischemic injury while contributing to fibrosis and maladaptive remodeling if dysregulated. This narrative review summarizes current evidence on the diagnostic, prognostic, and therapeutic utility of miR-21 in IHD, highlighting its clinical promise as well as key limitations and future translational challenges.

Objective: The aim of this study was to evaluate the impact of chronic kidney disease (CKD) on clinical presentation, laboratory parameters, ECG, and echocardiographic features of patients with chronic heart failure (CHF). Methods: This retrospective cross-sectional study included 2227 patients hospitalized in a tertiary care center due to CHF. Patients were divided into two groups based on the presence of CKD, defined as eGFR < 60 mL/min/1.73 m². Demographic, clinical, laboratory, and echocardiographic data were collected for all patients. Comparative analyses were performed to assess differences in cardiovascular risk factors, comorbidities, laboratory parameters, and echocardiographic findings between the two groups. Results: The proportion of men was significantly higher in the non-CKD group, whereas women predominated in the CKD group (p < 0.001). Dyspnea, orthopnea, leg swelling, claudication, and expectoration were significantly more frequent in patients with CKD, while chest pain and palpitations were more common in the non-CKD group (all p < 0.05). A significant difference in the distribution of NYHA functional classes was observed between the groups (p < 0.001), with NYHA class IV being more prevalent in the CKD group and classes II and III more frequent in the non-CKD group. Levels of CRP and NT-proBNP were significantly higher in the CKD group (p < 0.001). In-hospital mortality was 2.5-fold higher in patients with CKD (28.6% vs. 11.1%; p < 0.001). Conclusions: Coexistence of CKD was associated with a more severe clinical presentation, advanced functional limitation, and a distinct laboratory and echocardiographic profile in CHF patients.

Background: Psychological distress is common among patients with cardiovascular disease and adversely affects secondary prevention. We investigated whether depressive and anxiety symptoms, identified by guideline-recommended ultra-brief screening instruments, were associated with blood pressure (BP) control after hospital discharge, with particular attention to sex. Data in very high-risk populations remain limited. Methods: In this prospective observational single-center study, 305 consecutive hospitalized cardiovascular patients (mean age 63.9 years, 62.6% men, 79.3% at very high cardiovascular risk) underwent screening for depressive and anxiety symptoms using the Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder-2 (GAD-2). BP control was assessed at discharge and at routine follow-up after a median of 36.0 (32.5–39.5) days using ambulatory or home BP monitoring. Clinical, echocardiographic and psychosocial characteristics were analyzed. Results: Depressive and anxiety symptoms were identified in 31.1% and 29.2% of patients, respectively. Depressive symptoms were more prevalent in women. BP target achievement declined from 78.4% at discharge to 49.5% during follow-up. PHQ-2 ≥ 3 was independently associated with lower odds of achieving BP targets (OR 0.12, 95% CI 0.06–0.23; p < 0.001), together with overweight/obesity (OR 0.20, 95% CI 0.09–0.42; p < 0.001), while male sex was independently associated with better BP control (OR 2.06, 95% CI 1.12–3.77; p = 0.02). Female sex, overweight/obesity, chronic kidney disease, loneliness, and poor sleep quality were associated with PHQ-2 ≥ 3. Conclusions: Female sex and depressive symptoms were independently associated with a lower likelihood of achieving guideline-recommended BP targets during early post-discharge follow-up. These findings highlight the potential utility of brief psychological screening to identify patients at increased risk after discharge.