Kardiologia polska最新文献

Background: The pathomechanism of myocardial infarction with non-obstructive coronary arteries (MINOCA) is diverse and not fully explained. One of the factors for cardiovascular risk evaluation is smoking. Nevertheless, "smoker's paradox" is a controversial phenomenon in patients with myocardial infarction which can imply better outcomes in smokers than non-smokers.

Aims: This study aimed to assess the association between smoking and clinical outcomes in MINOCA patients.

Methods: In this study 6045 patients hospitalized with a working diagnosis of MINOCA were evaluated. 4808 of these (79.5%) were non-smokers. Our analysis included baseline characteristics, outcomes and readmission rates during a 36‑month follow‑up.

Results: Smoking patients were significantly younger (59 [52-66] vs. 70 [60-78] years; P <0.001) than non-smokers. There were more male patients in smoking (64.92% vs. 40.95%) than in the non-smoking group. Smokers were less likely to have traditional risk factors, more frequently had symptoms of angina (89.29% vs. 86.87%; P = 0.03) and had lower mortality during hospitalization (0.81% vs. 1.75%; P = 0.02), after 12 months (8.08% vs. 11.69%; P <0.001) and after 36 months (13.34% vs. 16.95%; P = 0.002), as compared with non-smokers. Nevertheless, multivariable analysis showed smoking was one of the independent risk factors for 36‑month mortality (hazard ratio, 1.23; 95% confidence interval, 1.03-1.47; P = 0.02).

Conclusions: This study showed that lower 36‑month crude rates of death among the smokers (comparing to non-smokers) may be explained by a significantly lower burden of traditional risk factors and younger age of smokers. After adjusting for baseline differences, tobacco use remained an independent risk factor for 36‑month mortality.

Testosterone replacement therapy (TRT) is an effective treatment for male hypogonadism of defined etiology, yet its safety profile continues to prompt clinical and regulatory scrutiny. Beyond major adverse cardiovascular events (MACE), attention has shifted toward clinically important non‑MACE outcomes, notably atrial fibrillation (AF), acute kidney injury (AKI), and venous thromboembolism, including pulmonary embolism (PE). The landmark TRAVERSE randomized safety trial in men with hypogonadism and established or high cardiovascular risk demonstrated non‑inferiority of TRT vs. placebo for MACE, but reported higher event rates of AF, AKI and PE in the testosterone group. Observational datasets suggest a possible early venous thromboembolism risk window after TRT initiation (often within the first 3-6 months), although estimates vary and residual confounding remains a major limitation. In February 2025, the US Food and Drug Administration updated testosterone product labeling: the boxed warning for major cardiovascular events was removed, while a class‑wide warning regarding blood pressure increases was added based on ambulatory blood pressure monitoring data. This narrative review integrates randomized and real‑world evidence on TRT‑associated AF, AKI and PE, translates these signals into practical guidance for patient selection and safety monitoring, and outlines key methodological and mechanistic priorities for future research. In contemporary practice, the objective is precision: select the right patient, aim for stable exposure, and follow a protocolized safety plan.