Kounis syndrome (KS) describes the occurrence of acute coronary syndromes precipitated by allergic, hypersensitivity, or anaphylactic reactions and represents a unique intersection between immunologic activation and cardiovascular disease. The epidemiology of KS is likely underestimated due to diagnostic overlap with other cardiac and allergic conditions and limited awareness across medical specialties. This narrative review focuses on the distinctive features of KS in special populations, emphasizing how patients’ age, comorbidities, immune status, and vascular substrate modify presentation, diagnosis, and outcomes. In elderly patients, polypharmacy, increased plaque vulnerability, and endothelial dysfunction favor Type II and III KS. Pediatric cases, although rare, are predominantly Type I and strongly associated with food allergies, insect stings, vaccines, and antibiotics, with under-recognition driven by diagnostic bias and ethical concerns surrounding invasive testing. Patients with coronary stents, cardiac devices, chronic kidney disease, and those receiving dialysis exhibit heightened susceptibility due to chronic inflammation, foreign-body hypersensitivity, and prothrombotic states. Pregnancy and the peripartum period represent a unique immuno-hemodynamic milieu in which Th2 immune shift, increased coronary vasoreactivity, and obstetric triggers can compromise both maternal and fetal perfusion. Additional risk modulation is observed in atopic individuals, asthmatics, patients with autoimmune, inflammatory, oncologic, psychiatric, and neurodevelopmental conditions, as well as in COVID-19 and post-infectious states. We propose a host-modified framework for KS that complements traditional classification by integrating immune phenotype and vascular substrate, enabling improved risk stratification and personalized preventive strategies.

Cardiovascular disease remains one of the most common and influential causes of death worldwide, as the heart plays a key role in the human body. Energetic cardioprotective therapy of the myocardium is an important protective factor, regulating the synthesis and use of energy by myocardial cells, while having a little effect on heart rate, blood pressure, and blood supply. Phosphocreatine plays an important role in the intracellular energy buffering and transport system, ensuring energy transfer from the site of production to the site of use to meet the high and variable demands of the heart. Research shows that phosphocreatine can have a positive effect on patients with coronary heart disease, heart failure, and those who have undergone cardiac surgery. The accumulated information confirms the prospects of using phosphocreatine in clinical practice to improve treatment outcomes in patients with heart diseases.

Cardiovascular diseases (CVDs) remain the foremost cause of morbidity and mortality worldwide, accounting for a substantial burden on healthcare systems, e

Cardiovascular–kidney–metabolic (CKM) syndrome is driven by the interplay of visceral adiposity, insulin resistance, chronic inflammation, oxidative stress, and progressive kidney dysfunction. These mechanisms generate a distinct atherogenic dyslipidaemic phenotype characterised by elevated triglycerides (TG), reduced high-density lipoprotein-cholesterol (HDL-C), increased apolipoprotein B (apoB)-containing lipoproteins, remnant cholesterol (RC) accumulation, small dense low-density lipoprotein (LDL) particles, and frequently elevated lipoprotein(a) [Lp(a)]. Such lipid abnormalities contribute to accelerated atherosclerosis and early renal deterioration. In turn, kidney dysfunction further amplifies lipid abnormalities. These pathways underscore the need for a timely and comprehensive lipid assessment using apoB, non-HDL-C, RC, and Lp(a) within the CKM framework. Effective lipid management is crucial for CKM syndrome treatment, with the potential to reduce residual cardiovascular and renal risk and improve long-term clinical outcomes. In this narrative review, we examine current evidence on the pathophysiological mechanisms underlying CKM-related dyslipidaemia and provide a practical framework for its assessment and management. Management requires a multimodal approach tailored to the patient’s lipid phenotype and overall cardiovascular risk, incorporating a range of lipid-lowering strategies including statins, ezetimibe, PCSK9 inhibitors, bempedoic acid, fibrates, icosapent ethyl, and emerging therapies targeting apoC-III, ANGPTL3, and Lp(a). Beyond lipid lowering, lifestyle interventions and cardiometabolic therapies such as glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter 2 inhibitors, and finerenone may provide complementary cardiometabolic and renal protection.

Background. The aim of the work is a comprehensive assessment of the meldonium effect on the functional state of the central nervous and cardiovascular system in patients with stage 1-2 dyscirculatory encephalopathy (DЕ) and type 2 diabetes. Materials and methods. A comprehensive clinical and neurological study involved 25 patients (14 women, 11 men) with atherosclerotic DE of stage 1-2, 10 of them had of type 2 diabetes. The average age of the study group was 58.3±3.4 years. Before and after the meldonium treatment course all patients underwent a comprehensive clinical, neurological and neuropsychological examination, including: the test “Remembering 10 words” by A. R. Luria; the Munsterberg test – assessment of selectivity of attention; biochemical analysis of blood, lipidogram, coagulogram; EEG; study of cerebral blood flow using ultrasound duplex scanning of extra- and intracranial sections of the main arteries of the head and neck; electrocardiography with assessment of heart rate variability (HRV). All patients received meldonium at a dose of 5 ml (100 mg/ml) intravenously in a jet 1 time per day for 10 days. Results. In patients with stage 1-2 DE and type 2 diabetes mellitus, meldonium treatment course improved the subjective state: complaints of headaches, a dizziness, a pain in the heart area decreased and a sleep was normalized, a short-term, a long-term verbal memory improved, attention level increased. The meldonium treatment course of improves a cerebral blood flow as a result of improved LSSK against the background of a decrease in peripheral resistance in individual vessels of the carotid and vertebro-basilar pools, causes a positive reorganization of the structure of the bioelectric activity of a brain: it reduces the intensity level in the range of slow rhythms (theta) and increases by 2 hemisphere intensity in the range of Alpha- and Beta-rhythms. According to spectral and temporal analysis of HRV, the meldonium harmonizes the sympatho-parasympathetic relationship in patients with stage 1-2 DE and type 2 diabetes mellitus. Conclusions. The positive effect of the meldonium on the clinical and neurological state, neuro-psychological functions, a cerebral blood flow, bioelectric activity of a brain and a heart rate variability suggests that this drug should be included in the complex treatment regimen for patients with stage 1-2 DE.