European Journal of Internal Medicine最新文献

{"title":"Comparative analysis of obesity indices in discrimination and reclassification of cardiovascular disease risk: The ATTICA study (2002–2022)","authors":"Sofia-Panagiota Giannakopoulou ,&nbsp;Fotios Barkas ,&nbsp;Christina Chrysohoou ,&nbsp;Evangelos Liberopoulos ,&nbsp;Petros P. Sfikakis ,&nbsp;Christos Pitsavos ,&nbsp;Costas Tsioufis ,&nbsp;Demosthenes Panagiotakos","doi":"10.1016/j.ejim.2025.02.007","DOIUrl":"10.1016/j.ejim.2025.02.007","url":null,"abstract":"<div><h3>Background</h3><div>Despite the established link between obesity and cardiovascular disease (CVD), the optimal anthropometric index for risk prediction remains uncertain.</div></div><div><h3>Aims</h3><div>This prospective cohort study aimed to compare various anthropometric indices for their association with 20-year atherosclerotic cardiovascular disease (ASCVD) risk in a healthy adult population and to assess their incremental predictive value.</div></div><div><h3>Methods</h3><div>In 2002, <em>n</em> = 3,042 adults free of CVD, residing in Athens metropolitan area, in Greece, were recruited. A 20-year follow-up was conducted in 2022, comprising <em>n</em> = 2,169 participants, of which <em>n</em> = 1,845 had complete data on both CVD occurrence and anthropometric measures.</div></div><div><h3>Results</h3><div>Almost all the studied anthropometric measures were significantly associated with 20-year ASCVD incidence. However, after full adjustment, none of these measures retained a significant association. The inclusion of any individual obesity index within the SCORE2 model enhanced the model's discriminatory power, while the continuous NRI exhibited positive values, suggesting improved risk reclassification. The indices linked to adipose tissue dysfunction exhibited greater efficacy in distinguishing and reclassifying CVD risk beyond SCORE2. Stratified analysis according to obesity and metabolic health status revealed that the optimal obesity index varies according to individual obesity and metabolic health profiles.</div></div><div><h3>Conclusion</h3><div>Obesity indices are strongly associated with long-term risk of ASCVD, underscoring the major role of excessive body fat in the pathogenesis of this condition. The inclusion of an obesity index in a CVD risk model significantly enhances its predictive accuracy and reclassification of risk, emphasizing the importance of these indices in refining CVD risk assessment among the general population.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"134 ","pages":"Pages 96-103"},"PeriodicalIF":5.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypertensive heart disease in older patients: considerations for clinical practice","authors":"Miguel Camafort ,&nbsp;Alexandros Kasiakogias ,&nbsp;Enrico Agabiti-Rosei ,&nbsp;Stefano Masi ,&nbsp;Panagiotis Iliakis ,&nbsp;Athanase Benetos ,&nbsp;Jin-Ok Jeong ,&nbsp;Hae-Young Lee ,&nbsp;Maria Lorenza Muiesan ,&nbsp;Isabella Sudano ,&nbsp;Costas Tsioufis ,&nbsp;European Society of Hypertension Working Group on Hypertension and the Heart","doi":"10.1016/j.ejim.2024.12.034","DOIUrl":"10.1016/j.ejim.2024.12.034","url":null,"abstract":"<div><div>Appropriate management of older people with hypertension is essential to reduce the burden of hypertensive heart disease and further cardiovascular sequelae but there may be challenges given the presence of concurrent senescent changes, comorbidities and impairment in functionality. It is recommended that frailty level and functional status are assessed periodically to understand patient needs and to guide treatment decisions. Office blood pressure should be measured with an appropriate cuff as per standard guidelines. There should be a high index of suspicion for orthostatic hypotension and white coat/masked hypertension, both common in older individuals. Cardiac imaging often identifies age-related changes that may not result from hypertension alone, including smaller ventricular volumes, a sigmoid septum and non-ischaemic fibrosis. Diastolic dysfunction is common and other pathologies, including cardiac amyloidosis, may need to be considered in the presence of red flags. Screening for atrial fibrillation during blood pressure evaluation is advised. Decisions for blood pressure management should follow current recommendations and take into consideration the patient's age and tolerance. There is limited evidence regarding heart failure management in older patients, however, disease-modifying therapy as per guidelines should be pursued. Sufficient outcome data are lacking for this patient group and a multidisciplinary approach is often needed to design optimal therapy.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"134 ","pages":"Pages 75-88"},"PeriodicalIF":5.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atrial fibrillation screening: The importance of the patient perspective","authors":"Jacopo Francesco Imberti ,&nbsp;Davide Antonio Mei ,&nbsp;Giuseppe Boriani","doi":"10.1016/j.ejim.2025.02.028","DOIUrl":"10.1016/j.ejim.2025.02.028","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"134 ","pages":"Pages 28-30"},"PeriodicalIF":5.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143505287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse effects of late sleep on physical health in a large cohort of community-dwelling adults","authors":"Renske Lok ,&nbsp;Lara Weed ,&nbsp;Joseph Winer ,&nbsp;Jamie M. Zeitzer","doi":"10.1016/j.ejim.2024.12.031","DOIUrl":"10.1016/j.ejim.2024.12.031","url":null,"abstract":"<div><h3>Aims</h3><div>Sleep timing, influenced by chronotype, behavior, and circadian rhythms, is critical for human health. While previous research has linked chronotype to various health outcomes, the impact of aligning sleep timing with chronotype on physical health remains underexplored. The objective of this study is to investigate the association between chronotype, actual sleep timing, and their alignment with a spectrum of physical health outcomes.</div></div><div><h3>Methods</h3><div>Objective sleep timing (actigraphy, categorized as early, intermediate, or late) and chronotype (self-reported, categorized as morning, intermediate, or evening types) were derived from the UK Biobank (n=73,888 middle-aged and older adults) and used in cross-sectional and longitudinal analyses. Physical health outcomes included metabolic disorders, diabetes, obesity, hypertension, circulatory disorders, digestive disorders, respiratory disorders, and all-cause cancer based on ICD10 codes. Analyses were adjusted for demographic factors, sleep duration and sleep timing stability.</div></div><div><h3>Results</h3><div>As compared to morning types with early behavior (aligned), morning types with late behavior (misaligned) had an increased risk of all included physical health disorders (p's&lt;0.001). As compared to evening-types with late behavior (aligned), however, evening-types with early behavior (misaligned) had a decreased risk of diabetes, obesity, hypertension, circulatory disorders, and respiratory disorders (p &lt; 0.01). Longitudinal analyses, in which the likelihood of developing <em>de novo</em> physical health disorders was associated with chronotype, behavioral timing, and alignment between the two, confirmed cross-sectional findings.</div></div><div><h3>Conclusion</h3><div>Late sleep timing across chronotypes was consistently associated with adverse physical health outcomes. These findings underscore the importance of going to sleep early, regardless of preference.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"134 ","pages":"Pages 66-74"},"PeriodicalIF":5.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-flow nasal oxygen therapy in patients with hypercapnic respiratory failure: A systematic review and meta-analysis","authors":"Lili Guan ,&nbsp;Jianyi Niu ,&nbsp;Qiaoyun Huang ,&nbsp;Shanshan Zha ,&nbsp;Zhenfeng He ,&nbsp;Jieying Hu ,&nbsp;Shengchuan Feng ,&nbsp;Luqian Zhou ,&nbsp;Rongchang Chen","doi":"10.1016/j.ejim.2025.02.015","DOIUrl":"10.1016/j.ejim.2025.02.015","url":null,"abstract":"<div><h3>Background</h3><div>Noninvasive ventilation (NIV) is recommended as the first-line respiratory support method for patients with hypercapnic respiratory failure (HRF). However, the need for well-trained operators and the occurrence of treatment discomfort may limit its efficacy. High-flow nasal oxygen therapy (HFNO) is a convenient respiratory support with user-friendly operation, high comfort, and good compliance. This systematic review and meta-analysis was performed to compare the therapeutic effects of HFNO and other noninvasive respiratory support methods [NIV or conventional oxygen therapy (COT)] in patients with acute HRF (AHRF) or chronic HRF (CHRF).</div></div><div><h3>Methods</h3><div>We searched the PubMed, Web of Science, Embase, and Cochrane Library databases from inception to May 2024 to identify randomized clinical trials comparing the impact of HFNO and NIV/COT in adults with HRF.</div></div><div><h3>Results</h3><div>Sixteen studies (1630 patients) were included. Compared with NIV, HFNO did not improve the primary outcome of PaCO₂ in patients with AHRF or CHRF [AHRF: MD = −0.81, 95 % CI = −3.40 to 1.77; CHRF: MD = 1.82, 95 % CI = 0.44 to 3.20]. However, HFNO showed advantages over COT (AHRF: MD = −2.03, 95 % CI = −3.48 to −0.59; CHRF: MD = −2.64, 95 % CI = −4.24 to −1.03).</div></div><div><h3>Conclusions</h3><div>The evidence of its clinical efficacy in hypercapnic patients remains inconclusive. Further studies are needed to generate more evidence for the application of HFNO in patients with HRF and to determine the subset of patients for whom may be preferable.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"134 ","pages":"Pages 119-129"},"PeriodicalIF":5.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validating ChatGPT's role in systematic reviews and meta-analyses: A case study on GLP-1 receptor agonists and all-cause mortality","authors":"Lefteris Teperikidis ,&nbsp;Paschalis Karakasis ,&nbsp;Dimitrios Patoulias ,&nbsp;Aristi Boulmpou ,&nbsp;Dimitrios Kouzoukas ,&nbsp;AIMES – AI for Meta-Analysis and Evidence Synthesis","doi":"10.1016/j.ejim.2024.10.017","DOIUrl":"10.1016/j.ejim.2024.10.017","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"134 ","pages":"Pages 145-147"},"PeriodicalIF":5.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of betablockers in post-myocardial infarction patients in a real-world setting","authors":"Marta Baviera ,&nbsp;Anna Zanovello ,&nbsp;Luisa Ojeda-Fernández ,&nbsp;Mauro Molteni ,&nbsp;Claudio Cimminiello","doi":"10.1016/j.ejim.2024.12.005","DOIUrl":"10.1016/j.ejim.2024.12.005","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"134 ","pages":"Pages 157-159"},"PeriodicalIF":5.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reevaluating hypoxia and cancer as determinants of prognosis in COPD and Takotsubo syndrome","authors":"Gonzalo García-Martí ,&nbsp;Ravi Vazirani ,&nbsp;Hernán Mejía-Rentería ,&nbsp;Iván J. Núñez-Gil","doi":"10.1016/j.ejim.2025.01.001","DOIUrl":"10.1016/j.ejim.2025.01.001","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"134 ","pages":"Page 142"},"PeriodicalIF":5.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is new in the management of coeliac disease?","authors":"Mohamed G Shiha ,&nbsp;David S Sanders","doi":"10.1016/j.ejim.2025.01.028","DOIUrl":"10.1016/j.ejim.2025.01.028","url":null,"abstract":"<div><div>Coeliac disease is the most common immune-mediated enteropathy, affecting approximately 1 % of the population worldwide. Currently, the vast majority of individuals remain undiagnosed. Coeliac disease is triggered by gluten ingestion in genetically predisposed individuals carrying the human leukocyte antigen (HLA) genes; HLA-DQ2 and HLA-DQ8. Patients with coeliac disease present with a wide spectrum of gastrointestinal and extraintestinal manifestations and, in some cases, without any symptoms. The diagnosis of coeliac disease in adults is based on a combination of clinical suspicion, positive serological markers and histological evidence of small intestinal atrophy on duodenal biopsies. The only effective treatment is a strict, lifelong gluten-free diet. However, up to 20 % of patients report persistent or recurrent symptoms. In this review, we provide a comprehensive update on coeliac disease, focusing on its relevance to the different medical specialities and highlighting the need for a multidisciplinary approach to its diagnosis and management. Clinicians practicing internal medicine have a unique opportunity to diagnose this multisystem autoimmune disease. By doing so, they would avoid delays in diagnosis for these patients. A low threshold for serological testing is recommended.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"134 ","pages":"Pages 1-8"},"PeriodicalIF":5.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterization of ischemic etiology in heart failure with reduced ejection fraction randomized clinical trials: A systematic review and meta-analysis","authors":"Marco Canepa ,&nbsp;Gianluca Anastasia ,&nbsp;Pietro Ameri ,&nbsp;Rocco Vergallo ,&nbsp;Christopher M. O'Connor ,&nbsp;Gianfranco Sinagra ,&nbsp;Italo Porto","doi":"10.1016/j.ejim.2025.02.004","DOIUrl":"10.1016/j.ejim.2025.02.004","url":null,"abstract":"<div><h3>Aims</h3><div>We investigated how ischemic etiology has been assigned in heart failure with a reduced ejection fraction (HFrEF) randomized controlled trials (RCTs).</div></div><div><h3>Methods and results</h3><div>We performed a systematic review and meta-analysis of definitions, rates of ischemic etiology and of each ischemic definition component: i) coronary artery disease (CAD), ii) myocardial infarction (MI), iii) coronary revascularization, and iv) prior/current angina. A total of 145 HFrEF RCTs were selected, of which 133 (91.7 %) enrolling both ischemic and non-ischemic patients (629 patients/study on average, median age 64.8 years and ejection fraction 28.2 %). The majority of these RCTs (84.2 %) lacked of clear ischemic etiology definition. Rate of ischemic etiology was 57.8 % (122 RCTs, 169,855 patients), of CAD 53.8 % (25 RCTs, 18,756 patients), of prior MI 46.7 % (57 RCTs, 80,582 patients), of prior revascularization 39.9 % (32 RCTs, 30,730 patients), and of prior/current angina 25.5 % (22 RCTs, 25,572 patients). In studies presenting both variables, prior MI showed the strongest correlations with assigned ischemic etiology (<em>β</em> = 0.84, <em>p</em> &lt; 0.0001, 49 RCTs), followed by prior/current angina (<em>β</em> = 0.84, <em>p</em> &lt; 0.0001, 20 RCTs), prior revascularization (<em>β</em> = 0.30, <em>p</em> = 0.006, 28 RCTs), whereas CAD had no significant correlation (<em>β</em> = 0.29, <em>p</em> = 0.162, from 17 RCTs). Rate of prior MI decreased over time (1986–2007: 51.4 ± 11.6 %; 2008–2016: 48.2 ± 8.8 %; 2017–2023: 41.4 ± 16.6 %; <em>p</em> = 0.057), whereas the one of prior revascularization increased (28.3 ± 11.2 %; 40.7 ± 19.6 %; 49.3 ± 19.4 %; <em>p</em> = 0.048).</div></div><div><h3>Conclusions</h3><div>An accurate definition of ischemic etiology is mostly lacking in HFrEF RCTs, and primarily assigned based on investigators clinical judgment, sometimes in the presence of a prior MI, although the rate of this component showed a decline over time.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"134 ","pages":"Pages 51-58"},"PeriodicalIF":5.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143410998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}