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Background/Objectives: Estrogen deficiency is strongly related to osteoporosis, but its role in the development of atherosclerotic cardiovascular disease (CVD), particularly in postmenopausal women, is unclear. The aim of this study was to assess the relationship between osteopenia and subclinical atherosclerosis in asymptomatic non-diabetic postmenopausal women.

Methods: This prospective study included 117 consecutive postmenopausal women (mean age 59 ± 7 years) referred from the outpatient Rheumatology Clinic of the University Clinical Centre of Kosovo, recruited between September 2021 and December 2022. Clinical, biochemical, bone mineral density (BMD), carotid ultrasound and coronary CT angiography data were analyzed. Subclinical atherosclerosis was diagnosed as the presence of carotid plaques and/or increased intima-media thickness (CIMT) > 1.0 mm.

Results: Of the 117 studied women, 83 (71%) had osteopenia or osteoporosis (T-score < −1 SD), who had higher prevalence of carotid artery plaques (27.7 vs. 8.8%, p = 0.019), compared to those with normal BMD. They were, also, older (p < 0.001), had a longer duration of menopause (p = 0.004) and higher CAC scores (p < 0.019), compared to those without plaques. In multivariate analysis [odds ratio 95% confidence interval], age [1.244 (1.052–1.470), p = 0.001], osteoporosis [0.197 (0.048–0.806), p = 0.024] and CAC score > 10 HU [0.174 (0.058–0.806), p = 0.006] were independently associated with the presence of carotid plaques.

Conclusions: Reduced BMD is highly prevalent in asymptomatic non-diabetic postmenopausal women and is associated with a high prevalence of subclinical carotid atherosclerosis. Age, osteoporosis and CAC score > 10 HU were independently associated with atherosclerotic carotid plaque formation. These findings highlight the potential pathophysiological link between osteoporosis and subclinical atherosclerosis.

Introduction: Non-invasive assessment of coronary artery disease (CAD) in patients with hypertensive heart disease is still a major clinical challenge. The aim of this meta-analysis was to evaluate the diagnostic accuracy of different non-invasive techniques in detecting significant (> 50%) CAD in hypertensive patients.

Material and methods: We systematically searched selected electronic databases from inception until February 27(th) 2024. The main clinical endpoint was the diagnostic accuracy of non-invasive investigations including exercise electrocardiography test (EET), stress echocardiography (SE) and myocardial perfusion imaging (MPI). Random effects summary receiver operating characteristic analysis was performed.

Results: Twenty-five papers with a total of 3812 patients with systemic hypertension and suspected or known significant CAD were finally included in the meta-analysis. The diagnostic accuracy of SE was the highest compared to the two other investigations (85%, 72%, 53%, p < 0.05 for all). SE had higher sensitivity 85% (83-87%) and specificity 81% (79-83%) compared to MPI (sensitivity 81% (77-83%), specificity 64% (59-68%)) and EET (sensitivity: 53% (50-65%) and specificity 51% (47-54%)). All three tested investigations had higher accuracy in patients with multivessel disease compared to those with single-vessel disease (p < 0.05 for all). The diagnostic accuracy of SE and MPI was not significantly impacted by left ventricular hypertrophy (p > 0.05 for both) compared to EET, which was lower in patients with hypertrophy compared to those without (41% vs. 58%, p = 0.03). These results were consistent irrespective of the stress echo modality, physical, exercise or pharmacological (p > 0.05).

Conclusions: This meta-analysis reveals the powerful diagnostic value of stress echocardiography in detecting significant coronary artery disease in hypertension patients.

Aims; Heterozygous familial hypercholesterolaemia (HeFH) is one of the most frequent monogenic disorders in the world, leading to premature atherosclerotic cardiovascular diseases. The aim of this meta-analysis was to evaluate the efficacy and safety of lipid-lowering therapy (LLT) and achievement of low density lipoprotein cholesterol (LDL-C) goal in children with HeFH.

Methods and results: The main endpoint was efficacy of goal achievement for LDL-C and other lipid parameters: total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), apolipoprotein B, and lipoprotein(a), and the LLT safety [adverse events (AEs), including endocrine function, and growth indices]. The secondary endpoint was an effect of LLT on attainment of LDL-C goal treatment (<3.5 mmol/L/130 mg/dL). A total of 41 studies with 4667 paediatric patients at mean age 12.08 ± 2.4 years were included. Seventeen reported the efficacy and safety of LLT therapy compared to control, while the remaining assessed LLT through pre- and post-treatment. At median follow-up of 18.8 months, the group on LLT had significantly higher mean reductions of TC, LDL-C, TG, and increased HDL-C compared to control [−1.75 mmol/L (−67.7 mg/dL), −1.84 mmol/L (−71.2 mg/dL), −0.11 mmol/L (−9.74 mg/dL), 0.08 mmol/L (3.1 mg/dL), respectively, P < 0.001 for all]. In the subgroup analysis according to different types of LLT, we observed a significantly higher mean reduction of LDL-C by statin combined with ezetimibe treatment, followed by statins in monotherapy, PCSK9 inhibitors, and monotherapy with ezetimibe [−2.48 mmol/L (−95.9 mg/dL), −2.16 mmol/L (−83.5 mg/dL), −2.03 mmol/L (−78.5 mg/dL), and −1.50 mmol/L (−58 mg/dL), respectively, test for overall effect: P < 0.001]. The pooled LDL-C was reduced by 33.44% [−2.14 mmol/L (−82.8 mg/dL), P < 0.001] and failed to reach the goal treatment (<3.5 mmol/L) by 12.6% (95% CI, 12.4-12.9%). A total of 38.7% of children achieved the LDL-C goal, 23.9% fell short by up to 10%, 10.7% experienced moderate failure (were over the LDL-C target between >10% and 20%), and 26.7% failed by more than 20% to reach the LDL-C target. When comparing different regions, only Sweden and Greece achieved the LDL-C goal < 3.5 mmol/L in the follow-up. Netherlands, Norway, Poland, USA, UK, France, Spain, Belgium, and Austria required 2.2%, 3.4%, 3.5%, 8.9%, 10.2%, 11.2%, 11.2%, 15%, and 19.4% additional reduction in LDL-C respectively to achieve the LDL-C goal of < 3.5 mmol/L. All other countries required over 20% additional reduction in LDL-C to achieve the LDL-C goal. For other investigated countries, over 20% mean LDL-C reduction was required. All parameters related to endocrine function and demographic indices were unaffected by LLT therapy (P > 0.05). The AEs were not reported significantly higher when compared to the control, and the prevalence of therapy discontinuation was only 0.8%.

Conclusion: Despite the efficacy of LLT in children with HeFH and the low occurrence of discontinuation-related adverse events, achieving LDL-C treatment goals was relatively rare, with large differences between the investigated countries. These results underscore the importance of considering early combination therapy of statins and ezetimibe, and PCSK9 inhibitors (if available) to attain LDL-C goals effectively.

Background: Heart failure (HF) is a complex clinical syndrome that is associated with high morbidity and mortality. The prognosis of chronic HF in Kosovo has never been objectively assessed and compared with other countries. Thus, this study aimed to investigate the long-term prognostic value of clinical and cardiac function parameters in predicting the mortality of patients in Kosovo with chronic HF.

Methods: This study included 203 consecutive patients with chronic HF who were followed up for a mean of 86 ± 40 months. The primary outcome of the study was all-cause mortality.

Results: During the follow-up period, there were 94 deaths (46.3%). Deceased patients were older (p < 0.001), commonly in New York Heart Association (NYHA) class ≥III (p < 0.001), had lower 6-minute walk distances (p = 0.014), higher prevalence of type 2 diabetes mellitus (T2DM) (p = 0.018), raised creatinine (p = 0.001), and lower hemoglobin (p = 0.004). Moreover, these patients often had left bundle branch block (p = 0.001), lower left ventricular (LV) ejection fraction (EF) (p < 0.001), larger left atrium (LA) (p < 0.001), lower lateral and septal mitral annular plane systolic excursion (MAPSE) values (p = 0.001 and p < 0.001, respectively), and tricuspid annular plane systolic excursion (TAPSE) (p = 0.009), reduced lateral systolic myocardial velocity (s’) (p = 0.018), early diastolic myocardial velocity (e’) (p = 0.011) and late diastolic myocardial velocity (a’) (p = 0.010) velocities, reduced septal e’ (p < 0.001) and a’ (p = 0.032) velocities, and had higher E/e’ (p = 0.021), compared to survivors. Multivariate analysis identified NYHA class ≥III (odds ratio (OR) = 5.573, 95% CI 1.688–18.39; p = 0.005), raised creatinine (OR = 1.027, 95% CI 1.006–1.047; p = 0.011), advanced age (OR = 1.069, 95% CI 1.011–1.132; p = 0.020), enlarged LA (OR = 3.279, 95% CI 1.033–10.41; p = 0.044), and left ventricular ejection fraction (LVEF) ≤45% (OR = 3.887, 95% CI 1.221–12.38; p = 0.022), as independent predictors of mortality.

Conclusions: In medically treated patients with chronic HF from Kosovo, worse functional NYHA class, impaired kidney function, age, compromised LV systolic function, and enlarged LA were independently associated with increased risk of long-term all-cause mortality.

BACKGROUND AND AIM: Cardiovascular disease progresses after menopause. Conventional risk factors, particularly diabetes, for atherosclerosis are well-established predictors of phenotypic arterial disease. The aim of this study is to assess the predictors of subclinical atherosclerosis in asymptomatic non-diabetic postmenopausal women.

METHODS: This prospective study included 117 consecutive postmenopausal women (mean age 59 ± 7 years) referred from the outpatient Rheumatology Clinic of the University Clinical Centre of Kosovo, recruited between September 2021 and December 2022. Clinical, biochemical, carotid ultrasound and coronary CT angiography data were analysed. Subclinical atherosclerosis was diagnosed when plaque and/or carotid intima-media thickness >1.00 mm were present.

RESULTS: Women who had subclinical atherosclerosis had higher erythrocyte sedimentation (p = 0.022), higher total cholesterol (p = 0.013), higher CAC score (p = 0.017), and higher prevalence of CAC > 100 HU and CAC > 400 HU (p = 0.017 and p = 0.034, respectively) compared to those without subclinical atherosclerosis. Women who had mild coronary calcification (CAC score ≥10 HU) were older (p = 0.005), in longer menopause (p = 0.005), had thicker CIMT (p = 0.008) with higher prevalence (p = 0.03) compared to those with CAC score <10 HU. Women with moderate coronary calcification (CAC score ≥100 HU) had higher triglycerides, worse CIMT (p = 0.005) with higher prevalence (p = 0.039) compared to those with CAC score <100 HU. In multivariate analysis [odds ratio 95% confidence interval], age [1.101 (1.032-1.174), p = 0.037] and cholesterol [2.020 (1.225-3.331), p = 0.006] independently predicted the presence of subclinical atherosclerosis.

CONCLUSIONS: In addition to the impact of age, hypercholesterolaemia is an important predictor of subclinical atherosclerosis in non-diabetic postmenopausal women.

Background and Aims: Myocardial infarction (MI) is a major cause of mortality worldwide, irrespective of its presentation as non-ST-segment elevation MI (NSTEMI) or ST-segment elevation MI (STEMI). The objective of this study was to assess national results of management and clinical outcome of acute MI patients in Kosovo.

Methods: This cross-sectional descriptive study, conducted at the Clinic of Cardiology of the University Clinical Center of Kosovo, in Prishtina, included all patients hospitalized with acute MI over a period of 7 years (2014-2020). The primary outcome of the study was in-hospital mortality.

Results: Among 7353 admitted patients with acute MI (mean age 63 ± 12 years, 29% female) and according to the final diagnosis, 4436 (59.4%) patients had STEMI, and 2987 (40.6%) NSTEMI. More patients with STEMI received primary percutaneous intervention (PPCI) than those with NSTEMI (50% vs. 41%, p < 0.001). In-hospital mortality was higher in no PPCI patients compared to PPCI both in NSTEMI (10.7% vs. 2.6%, p < 0.001) and STEMI (20.9% vs. 6.8%, p < 0.001). Age ≥65 years [0.399 (0.267–0.597), p ˂ 0.001], hemoglobin level [0.889 (0.815–0.970), p = 0.008], STEMI [0.491 (0.343–0.704), p ˂ 0.001], lack of PPCI [2.636 (1.798–3.866), p ˂ 0.001], cardiogenic shock [0.002 (0.001–0.006), p < 0.001], reduced left ventricular ejection fraction (LV EF) [0.966 (0.951–0.980), p < 0.001], and heart rate at admission [1.009 (1.000–1.017), p = 0.047], independently predicted mortality. In STEMI, cardiogenic shock (p ˂ 0.001), lack of PPCI (p = 0.006), female gender (p = 0.01), and low LV EF (p = 0.04) predicted mortality but age ≥65 years (p = 0.02), female gender (p = 0.02), low LV EF (p = 0.007), and low hemoglobin (p = 0.04) predicted mortality in NSTEMI.

Conclusion: Between 2014 and 2020, half of patients with acute MI were not treated with PPCI, who had high mortality, particularly when presenting with STEMI. Age, cardiogenic shock, anemia, low LV EF, STEMI and no PPCI independently predicted mortality. Cardiogenic shock and lack of PPCI independently predicted mortality, only in STEMI.

Dual antiplatelet therapy (DAPT) remains the gold standard in patients who underwent percutaneous coronary intervention (PCI). This meta-analysis aims to evaluate the clinical safety of 1-month DAPT followed by aspirin or a P2Y12 receptor inhibitor after PCI with drug-eluting stents (DES). We searched PubMed, MEDLINE, Embase, Scopus, Google Scholar, Cochrane Central Registry, and ClinicalTrials.gov databases and identified 5 randomized controlled trials with 29,831 patients who underwent PCI with DES and compared 1-month versus >1-month DAPT. The primary end point was major bleeding, and the co-primary end point was stent thrombosis. The secondary end point included all-cause mortality, cardiovascular death, myocardial infarction, stroke, and major adverse cardiovascular or cerebrovascular events. Compared with >1-month DAPT, the 1-month DAPT was associated with a lower rate of major bleeding (odds ratio [OR] 0.66, 95% confidence interval [CI] 0.45 to 0.97, p = 0.03, I2 = 71%), whereas stent thrombosis had a similar rate in both study groups (OR 1.08, 95% CI 0.81 to 1.44, p = 0.60, I2 = 0.0%). The study groups had similar risks for all-cause mortality (OR 0.89, 95% CI 0.77 to 1.04, p = 0.14, I2 = 0.0%), cardiovascular death (OR 0.84, 95% CI 0.59 to 1.19, p = 0.32, I2 = 0.0%), myocardial infarction (OR 1.04, 95% CI 0.89 to 1.21, p = 0.62, I2 = 0.0%), and stroke (OR 0.82, 95% CI 0.64 to 1.05, p = 0.11, I2 = 6%). The risk of major adverse cardiovascular or cerebrovascular events was lower (OR 0.86, 95% CI 0.76 to 0.97, p = 0.02, I2 = 25%) in the 1-month DAPT compared with >1-month DAPT. In conclusion, in patients who underwent PCI with DES, 1-month DAPT followed by aspirin or a P2Y12 receptor inhibitor reduced major bleeding with no risk of increased thrombotic risk compared with longer-term DAPT.

Background: Myocardial infarction (MI), presented as ST-segment elevation MI (STEMI) and non-ST-segment elevation MI (NSTEMI), is influenced by atherosclerosis risk factors. Aim: The aim of this study was to assess the patterns of presentation of patients with acute MI in Kosovo. Methods: This was a cross-sectional study conducted at the University Clinical Center of Kosovo, which included all patients hospitalized with acute MI over a period of 7 years. Results: Among the 7353 patients admitted with acute MI (age 63 ± 12 years, 29% female), 59.4% had STEMI and 40.6% had NSTEMI. The patients with NSTEMI patients less (48.3% vs. 54%, p < 0.001), but more of them had diabetes (37.8% vs. 33.6%, p < 0.001), hypertension (69.6% vs. 63%, p < 0.001), frequently had a family history of coronary artery disease (CAD) (40% vs. 38%, p = 0.009), and had more females compared to the patients with STEMI (32% vs. 27%, p < 0.001). The patients with NSTEMI underwent less primary percutaneous interventions compared with the patients with STEMI (43.6% vs. 55.2%, p < 0.001). Smoking [1.277 (1.117–1.459), p ˂ 0.001] and high triglycerides [0.791 (0.714–0.878), p = 0.02] were independent predictors of STEMI. Conclusions: In Kosovo, patients with STEMI are more common than those with NSTEMI, and they were mostly males and more likely to have diabetes, hypertension, and a family history of CAD compared to those with NSTEMI. Smoking and high triglycerides proved to be the strongest predictors of acute STEMI in Kosovo, thus highlighting the urgent need for optimum atherosclerosis risk control and education strategies.

In the recent years, there has been a burgeoning interest in Takotsubo syndrome (TTS), which is renowned as a specific form of reversible myocardial dysfunction. Despite the extensive literature available on TTS, clinicians still face several practical challenges associated with the diagnosis and management of this phenomenon. This potentially results in the underdiagnosis and improper management of TTS in clinical practice. The present paper, the first part (part-1) of the consensus report, aims to cover diagnostic and therapeutic challenges associated with TTS along with certain recommendations to combat these challenges.