Archives of Medical Science最新文献

This state-of-the-art review surveys the rapidly advancing field of triglyceride-lowering therapies as of 2025, positioning hypertriglyceridemia (HTG) as both a residual driver of atherosclerotic cardiovascular disease (ASCVD) and a key precipitant of acute pancreatitis. After outlining the pathophysiological role of elevated triglycerides - via remnant lipoproteins, inflammation and endothelial dysfunction, often within the lipid triad of low high-density lipoprotein-cholesterol (HDL-C) and small, dense low-density lipoprotein (LDL) - we evaluate established and emerging pharmacologic options. Fenofibrate, a PPAR-α activator, remains a cornerstone for mixed dyslipidemia, improving micro- and macrovascular outcomes in diabetes. Purified eicosapentaenoic acid (icosapent ethyl) is highlighted for its robust reduction of major adverse cardiovascular events despite neutral triglyceride thresholds, albeit with a modest increase in atrial fibrillation risk. Novel agents targeting apolipoprotein C-III (volanesorsen, olezarsen, plozasiran) achieve profound triglyceride declines and substantially mitigate pancreatitis in familial chylomicronemia syndrome (FCS), while angiopoietin-like 3 (ANGPTL3) inhibitors and fibroblast growth factor 21 (FGF21) agonists demonstrate early promise in broad atherogenic-lipid reduction and metabolic modulation. The paper emphasizes the importance of genetic testing to differentiate FCS from multifactorial chylomicronemia syndrome, guiding personalized therapy. Current guidelines endorse icosapent ethyl and fenofibrate for high-risk HTG, with apoC-III inhibitors poised to become first-line for FCS as access improves. Ongoing trials of ANGPTL3 inhibitors, FGF21 agonists and gene-editing approaches may soon redefine lifelong lipid management.

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in Poland. Lipoprotein(a) [Lp(a)] constitutes an independent, causal risk factor for ASCVD and aortic valve stenosis. Elevated Lp(a) is found in approximately 20% of the Polish population. Lp(a) measurements have been recommended in all adult patients to improve cardiovascular risk stratification. As the testing rate remains insufficient, there is a need to facilitate the incorporation of Lp(a) into routine patient care. This clinically oriented review outlines (i) up-to-date evidence on the role of Lp(a) in cardiovascular diseases, (ii) recent real-world data on the characteristics of Polish patients with elevated Lp(a), and (iii) strategies for Lp(a) testing and management in light of the current national recommendations and the latest 2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidemias.

Lung cancer, the leading cause of cancer-related deaths globally and in Poland, accounts for 25% of all cancer-related deaths, with smoking being its predominant cause. While primary prevention through smoking cessation is crucial, the effectiveness of lung cancer screening (LCS) with low-dose computed tomography in reducing mortality has gained international recognition. This expert consensus, developed through multidisciplinary collaboration, proposes a comprehensive framework for smoking cessation interventions within LCS. Key recommendations include providing participants with educational materials, cognitive-behavioral counseling, and pharmacotherapy. Proactive follow-up, biochemical addiction validation, and teleconsultations are essential to ensure long-term cessation. Besides, participants should be discouraged from using alternative nicotine products, such as heated tobacco or electronic cigarettes due to their limited efficacy, highly probable health risks and potential for nicotine addiction. By integrating evidence-based cessation methods, LCS programs can serve as a model for broader smoking cessation strategies in healthcare.

In recent years, the relationship between microbiota and various aspects of health has become a focal point for scientific investigation. The complex interplay between microbial communities and the development, progression, and treatment of gynaecological malignancies is a burgeoning field not yet fully understood. Recent research indicates that gut, vaginal, and uterine microbiota play a critical role in the response to treatments of ovarian cancer, and particularly in chemotherapy, anti-angiogenic therapy, and PARP inhibitors. Microbiota and microbial metabolites can modulate immune responses, drug metabolism, and angiogenesis, affecting the outcomes of therapy. This review explores the relationship between microbiota and anticancer therapies, and discusses the connection between dysbiosis and treatment resistance, highlighting the potential of microbiota as biomarkers and therapeutic targets in ovarian cancer treatment.

Introduction: Given insulin resistance's (IR) critical role in metabolic pathophysiology, this study aims to identify optimal coffee consumption patterns by timing and dose to improve population health.

Material and methods: Multivariate logistic regression and restricted cubic splines assessed associations between coffee timing, dosage, and IR (measured by estimated glucose disposal rate) from NHANES data (1999-2018). Interaction and subgroup analyses explored variations across population segments.

Results: We analysed 21,138 participants, of whom 46.79% were non-consumers. Among consumers, 76% primarily drank coffee in the morning. Morning consumption at the lowest quartile (Q1) showed significant improvement in IR (odds ratio [OR] = 1.37, 95% confidence interval [CI]: 1.16-1.62), although this benefit diminished with higher consumption levels (p < 0.05). While the "all-day" pattern overall showed a non-significant trend toward improved insulin resistance (OR = 1.20, 95% CI: 0.83-1.73), higher consumption within this pattern (Q3: OR = 1.46, 95% CI: 1.13-1.89; Q4: OR = 1.34, 95% CI: 1.11-1.63) proved significantly more beneficial than lower intake. Comparative analysis revealed that morning consumption tended to be more advantageous for low-to-moderate intake (Q1-Q2), whereas all-day distribution showed potential benefits at higher consumption levels (Q3-Q4). The observed benefits were primarily associated with caffeinated coffee, attenuated by sugar addition, and varied across subgroups based on age, sex, and comorbidities.

Conclusions: Both morning and all-day coffee intake improve IR. For moderate consumption (1-2 cups/day), morning intake provides optimal improvement in insulin sensitivity. For higher intake (≥ 3 cups/day), distributed consumption is more effective. These findings support chrono-nutrition principles for optimising metabolic health through coffee consumption.