The management of hypertension has been shaped by decades of evolving guidelines that progressively lower the threshold at which treatment of elevated systolic blood pressure (SBP) is recommended. While these changes are presented as advances in patient care and longevity, they raise a legitimate and underexplored question: do current guidelines genuinely reflect patient benefit, or do they partly reflect the commercial interests of an expanding antihypertensive drug market ? The trend toward stricter SBP thresholds is well documented. Over recent decades, the boundary defining hypertension has shifted downward considerably, enlarging the population eligible for pharmacological treatment. This shift coincides with a growing market for antihypertensive agents, and the convergence of clinical recommendation and commercial opportunity deserves honest scrutiny. The concern is not that treatment is ineffective, but that the threshold for when it becomes necessary may be set too low for man...

Mykola Iabluchanskyi and Pavlo Garkaviy Abstract Lipoprotein(a) [Lp(a)] has moved from the periphery of cardiovascular medicine to a position of growing clinical and conceptual importance. It is now recognized as a causal, largely genetically determined risk factor for atherosclerotic cardiovascular disease and calcific aortic valve stenosis , while broader testing recommendations and emerging targeted therapies are reshaping its practical relevance. Yet the significance of Lp(a) may extend beyond its role as an additional inherited biomarker. This commentary argues that Lp(a) should be reconsidered as a marker and mediator of a distinct disorder of lipid homeostasis, one that links atherogenesis, vascular inflammation, thrombogenicity, and calcific remodeling into a recognizable vascular phenotype. From this perspective, the clinical importance of Lp(a) lies not only in its capacity to refine cardiovascular risk, but in its potential to reorganize diagnostic reasoning and therap...

Health technology assessment , or HTA , has become one of the most important tools for modern healthcare systems. As countries face growing pressure from rising costs, rapid innovation, aging populations, and increasing expectations for access to new treatments, they need a structured way to decide which technologies truly improve health and deserve adoption. HTA was created to serve exactly that purpose.  In simple terms, HTA is a systematic and multidisciplinary process used to evaluate the value of a health technology. A health technology may be a medicine, a medical device, a diagnostic test, a surgical procedure, a rehabilitation technology, a digital tool, or even a model of care delivery. HTA examines not only whether a technology works, but also whether it is safe, cost-effective , feasible to implement, and meaningful for patients and the health system as a whole.  How HTA was born HTA emerged from a practical need in healthcare: scientific innovation was moving ...

A new r andomized clinical trial in JAMA Cardiology reported that two years of menaquinone-7, or MK-7, may slow calcification in noncalcified plaques among patients with symptomatic coronary artery disease . The authors were appropriately cautious: the clinical significance of this finding for plaque stability remains uncertain. Yet the study raises a larger question that should not be confined too narrowly to the coronary arteries alone. If atherosclerosis is truly a systemic disease, why should we think about this result only in coronary terms?  That question is not rhetorical. It goes to the conceptual core of atherosclerosis. As argued in our Atherosclerosis: Bridging Genetics, Inflammation, and Clinical Realities, atherosclerosis is not merely a local lesion of one favored vascular territory but a chronic systemic inflammatory disease expressed in different arterial beds according to local conditions, timing, and clinical visibility. Coronary, carotid, femoral, aortic, an...

When people think about fat, they usually imagine the fats they eat. Yet the more important story begins after food enters the intestine. Dietary fats are not simply transferred unchanged into body stores. In the intestine, they are emulsified by bile acids , broken down by pancreatic and intestinal enzymes into fatty acids and monoglycerides, absorbed by enterocytes, repackaged into chylomicrons, and then delivered into circulation. From there, tissues take up, burn, remodel, store, or transform these lipid fragments according to the body’s own metabolic priorities. This is why fat biology cannot be reduced to dietary fat alone. The human body is an active lipid-producing and lipid-regulating system. It does not merely receive fats from food; it rebuilds them, synthesizes new ones, and uses them for energy storage, membrane formation, signaling, hormone production, and thermal regulation. In healthy conditions, this endogenous fat production is essential for life. In unhealthy condit...

In a long cardiology career, one remembers not only drugs but slogans. Few therapies have lived through more reversals than digitalis : first as a breakthrough, then as habit, then as controversy, then almost as an embarrassment, and now again as a subject of serious reconsideration. The lesson is not merely about one old drug. It is about how medicine repeatedly confuses fashion with truth, and how often certainty must be revised when physiology, evidence, and clinical context are brought back into the same frame.  The story properly begins with William Withering , whose 1785 account of foxglove transformed a traditional remedy into a recognizable medical therapy. He did more than “discover” a plant effect; he observed, classified, and disciplined its use, linking clinical benefit with careful dosing and warning against toxicity. In that sense, the digoxin story began not with therapeutic bravado but with clinical humility: an effective medicine, yes, but one requiring judgment...