Several studies link cardiovascular diseases (CVD) with unhealthy lifestyles (unhealthy dietary habits, alcohol consumption, smoking, and low levels of physical activity). Therefore, the strong need for CVD prevention may be pursued through an improved control of CVD risk factors (impaired lipid and glycemic profiles, high blood pressure, and obesity), which is achievable through an overall intervention aimed to favor a healthy lifestyle. Focusing on diet, different recommendations emphasize the need to increase or avoid consumption of entire classes of food, with only partly known and only partly foreseeable consequences on the overall level of health. In recent years, the ketogenic diet (KD) has been proposed to be an effective lifestyle intervention for metabolic syndrome, and although the beneficial effects on weight loss and glucose metabolism seems to be well established, the effects of a prolonged KD on the ability to perform different types of exercise and the influence of KD on blood pressure (BP) levels, both in normotensives and in hypertensives, are not so well understood. The objective of this review is to analyze, on the basis of current evidence, the relationship between KD, regular physical activity, and BP.

Exacerbations of chronic obstructive pulmonary disease (COPD) are known to increase the risk of cardiovascular (CV) events and mortality. However, the temporal trend of this risk has not fully elucidated. This systematic review and meta-analysis aims to quantify the risk of CV events after COPD exacerbations over different time periods. To assess the temporal association between CV events, including acute coronary syndrome (ACS), heart failure (HF), acute cereberovascular events, arrhythmia and all-cause mortality after the onset of COPD exacerbations in the following timepoints: 1-30 and 31-180 days; 1-7, 8-14, 15-30, 31-180, 181-365 and >365 days. A comprehensive literature search was conducted in PubMed, Embase, Web of Science and Cochrane databases, identifying observational studies that reported CV outcomes following COPD exacerbations. Studies were included if they enrolled adults diagnosed with COPD and compared CV event rates during exacerbation and non-exacerbation periods (PROSPERO, CRD42024561490). Sixteen studies with over 1.8 million participants were included. Our meta-analysis demonstrated a significantly increased risk of ACS, HF, cerebrovascular events and arrhythmia, with the highest magnitude of risk observed in the period 1-30 days following an exacerbation. This increased risk showed a decline in time points 31-180, 181-365 days and remained persistently higher for ACS even one year after an acute exacerbation. Notably, the risk of HF was found to be greater compared to the other CV outcomes. COPD exacerbations significantly increase the risk of acute CV events, particularly within the first 30 days. Optimal strategies to reduce cardiopulmonary risk are needed.

Background: Current management of COPD is predominantly focused on respiratory aspects. A multidimensional assessment including nutritional assessment, quality of life and disability provides a more reliable perspective of the true complexity of COPD patients. Methods: This was a prospective observational study of 120 elderly COPD patients at high risk of acute exacerbations. The Mini Nutritional Assessment (MNA) was administered in addition to the usual respiratory assessment. The primary outcome was a composite of moderate or severe acute exacerbations during 52 weeks of follow-up. Results: The median MNA Short Form (SF) score was 11 (8–12), 39 participants (32.50%) had a normal nutritional status, 57 (47.5%) were at risk of malnutrition and 24 (20%) were malnourished. Our multivariate linear regression models showed that the MNA score was associated with dyspnea and respiratory symptom severity, assessed by the Modified British Medical Research Council (mMRC) scale and the COPD Assessment Test (CAT) score, with spirometric variables, in particular with the severity of airflow limitation based on the value of FEV1, and with poorer QoL, as assessed by the EQ-5D-3 questionnaire. Competing risk analysis according to nutritional status based on the MNA Total Score showed that COPD participants “at risk of malnutrition” and “malnourished” had a higher risk of moderate to severe acute exacerbations with sub-hazard ratios of 3.08 (1.40–6.80), p = 0.015, and 4.64 (1.71–12.55), p = 0.0002, respectively. Conclusion: Our study confirms the importance of assessing nutritional status in elderly COPD patients and its prognostic value.

Background. Chronic obstructive pulmonary disease (COPD) is a heterogeneous systemic syndrome that often coexists with multiple comorbidities. In highly complex COPD patients, the role of the Cumulative Illness Rating Scale (CIRS) as a risk predictor of COPD exacerbation is not known. Objective. The objective of this study was determine the effectiveness of the CIRS score in detecting the association of comorbidities and disease severity with the risk of acute exacerbations in COPD patients. Methods. In total, 105 adults with COPD (mean age 72.1 ± 9.0 years) were included in this prospective study. All participants at baseline had at least two moderate exacerbations or one leading to hospitalization. The primary outcome was a composite of moderate or severe COPD exacerbation during the 12 months of follow-up. Results. The CIRS indices (CIRS total score, Severity Index and Comorbidity Index) showed a positive correlation with modified Medical Research Council (mMRC), COPD assessment test (CAT) and a negative correlation with forced expiratory volume in the first second (FEV₁), Forced Vital Capacity (FVC), and FEV₁/FVC. The three CIRS indices were able to predict the 12-month rate of moderate or severe exacerbation (CIRS Total Score: Hazard Ratio (HR) = 1.12 (95% CI: 1.08–1.21); CIRS Severity Index: HR = 1.21 (95% CI: 1.12–1.31); CIRS Comorbidity Index = 1.58 (95% CI: 1.33–1.89)). Conclusions. Among patients with COPD, the comorbidity number and severity, as assessed by the CIRS score, influence the risk in moderate-to-severe exacerbations. The CIRS score also correlates with the severity of respiratory symptoms and lung function.

According to “Sepsis-3” consensus, sepsis is a life-threatening clinical syndrome caused by a dysregulated inflammatory host response to infection. A rapid identification of sepsis is mandatory, as the extent of the organ damage triggered by both the pathogen itself and the host’s immune response could abruptly evolve to multiple organ failure and ultimately lead to the death of the patient. The most commonly used therapeutic strategy is to provide hemodynamic and global support to the patient and to rapidly initiate broad-spectrum empiric antibiotic therapy. To date, there is no gold standard diagnostic test that can ascertain the diagnosis of sepsis. Therefore, once sepsis is suspected, the presence of organ dysfunction can be assessed using the Sepsis-related Organ Failure Assessment (SOFA) score, although the diagnosis continues to depend primarily on clinical judgment. Clinicians can now rely on several serum biomarkers for the diagnosis of sepsis (e.g., procalcitonin), and promising new biomarkers have been evaluated, e.g., presepsin and adrenomedullin, although their clinical relevance in the hospital setting is still under discussion. Non-codingRNA, including long non-codingRNAs (lncRNAs), circularRNAs (circRNAs) and microRNAs (miRNAs), take part in a complex chain of events playing a pivotal role in several important regulatory processes in humans. In this narrative review we summarize and then analyze the function of circRNAs-miRNA-mRNA networks as putative novel biomarkers and therapeutic targets for sepsis, focusing only on data collected in clinical settings in humans.

Background and aims: Mechanical thrombectomy (MT) is an effective treatment for acute ischemic stroke due to large vessel occlusion (LVO). Atrial fibrillation (AF) can be known before the stroke (or prevalent AF) or be newly detected after the stroke (post-stroke AF). Inflammation plays a critical role in the pathogenesis of post-stroke AF, making inflammatory markers valuable for early detection of post-stroke AF. This study investigated the predictive value of C-reactive protein (CRP) and other inflammatory biomarkers in predicting post-stroke AF in acute ischemic stroke patients treated with MT. Methods: This observational multicenter retrospective cohort study included 849 patients with anterior circulation LVO treated with MT across four centers from 2016 to 2023. Patients were divided into post-stroke AF and NO-AF groups, excluding those with prevalent AF. Baseline demographics, clinical and procedural variables, and inflammatory biomarkers, including CRP, were collected at admission and 24-h post-procedure. Baseline characteristics were balanced using inverse probability weighting (IPW). Logistic regression and receiver operating characteristic (ROC) analyses assessed the predictive value of CRP for post-stroke AF. Results: The study included 849 patients with a median age of 66 years (interquartile range (IQR) = 54–76) and 477 (56.2%) were female. Post-stroke AF was detected in 186 (21.9%) patients, while 663 (78.1%) did not experience AF during admission. In the weighted population, CRP levels, both admission and 24-h post-procedure, were higher in post-stroke AF patients. In logistic regression analysis, admission and 24-h CRP levels were associated with increased probability of post-stroke AF, respectively (odds ratio (OR) = 1.01; 95% confidence interval (CI) = 1.00–1.03, p < 0.001) and (OR = 1.02, 95% CI = 1.01–1.03, p < 0.001) following MT. We observed that the model combining age, sex, hypertension, heart failure, alcoholism, coronary artery disease, diabetes mellitus, smoking, previous transient ischemic attack (TIA), and ischemic stroke, and admission CRP (area under the curve (AUC) = 0.723, 95% CI = 0.71–0.74) and 24-h CRP (AUC = 0.704, 95% CI = 0.69–0.72) had good predictive accuracy, with optimal cutoff values of 4.25 for admission CRP and 14.69 for 24-h CRP to detect post-stroke AF. Subgroup analysis indicated CRP predictive relevance, particularly in hypertensive patients. Conclusions: Our findings suggest CRP is associated with post-stroke AF in stroke patients due to LVO, highlighting inflammation’s role in AF pathogenesis. Measuring CRP at admission and 24 h may enable early detection and timely anticoagulation. Incorporating CRP into clinical pathways could improve individualized risk assessment, warranting further studies to validate its predictive utility and explore additional markers.