Hungarian Archives of Internal Medicine

In memory of Endre Kelemen

Pal Peter Bucsky — Tue, 03 Mar 2026 09:14:05 +0000

Advances in lipidology

Mariann Harangi, Biborka Nadro, Agnes Dioszegi, Gyorgy Paragh — Tue, 03 Mar 2026 12:56:02 +0000

Lipid metabolism disorders represent one of the most significant risk factors for cardiovascular diseases. In 2025, the European Society of Cardiology released an update to the 2019 European Guidelines for the Management of Dyslipidemias, incorporating recent clinical trial data and recommending several key modifications. Among the most important changes is the replacement of the previously used SCORE risk estimation system with SCORE2 for individuals under 70 years of age and SCORE2-OP for those between 70 and 89 years. The updated guidelines also introduce the consideration of subclinical atherosclerosis – as evidenced by markers such as elevated coronary artery calcium score – as a risk-modifying factor. Another important addition is the recommendation of bempedoic acid, which is not yet available in Hungary, as a lipid-lowering therapy for patients with statin intolerance, as well as in combination with maximally tolerated statin and/or ezetimibe in high- and very high-risk patients. A significant modification in the management of acute coronary syndromes is the recommendation for early intensification of LDL-C lowering therapy, with the goal of achieving aggressive lipid reduction during the index hospitalization. The update also emphasizes that lipoprotein(a) levels above 50 mg/dL are considered an independent cardiovascular risk factor in all adults, and it is therefore recommended that lipoprotein(a) be measured at least once during a patient’s lifetime. Furthermore, the guidelines highlight that high dose icosapentethyl therapy should be considered in hypertriglyceridemic patients at high or very high cardiovascular risk, particularly when statin therapy alone is insufficient to achieve desired lipid goals. Importantly, the LDL-C target values and cardiovascular risk categories remain fundamentally unchanged compared to the 2019 guidelines. The intensity of LDL-C lowering should still be guided by the individual’s overall cardiovascular risk level. However, the update also acknowledges the role of emerging therapeutic options in certain specific patient populations. These include volanesorsen for familial chylomicronemia syndrome, evinacumab for homozygous familial hypercholesterolemia, and evidence supporting the efficacy of statin therapy in primary prevention among HIV-infected individuals and in cancer patients undergoing chemotherapy. In conclusion, therapeutic options for the management of dyslipidemia are expanding significantly, but their proper implementation in everyday clinical practice remains crucial.

The hypertension in the light of the new guidelines

Ipoly Szauder — Tue, 03 Mar 2026 14:46:04 +0000

We present the optimal diagnostics and therapy of hypertension based on the latest Hungarian and European (ESH, ESC) hypertension guidelines. After the novelties and differences of the guidelines, we critically consider the relevant randomized, non-randomized, observational clinical trials, and describe what is not included or not included in this way in the guidelines based on the literature and practical experience, supplemented by the most common errors in domestic practice. We highlight the ones that are rarely used in diagnostics: the importance of the pulse, heart sounds, palpitations and panic disorder, the recognition of hypertension-induced silent ischemia, and echocardiographic abnormalities suggestive of hypertension. In blood pressure measurements, in addition to the importance of simultaneous blood pressure and ECG monitoring, we describe the sources of error in monitoring and the most effective telemedicine home measurements. In the treatment of hypertension, we follow a newly recommended strategy in the guidelines. When emphasizing individual risk assessment treatment, we highlight the risk markers of hypertension-mediated organ damage, the new, non-traditional risk factors. When individualizing antihypertensive treatment, we present the advantages and disadvantages of fixed combinations, the importance and application of chronopharmacotherapy, and the aspects of beta-blocker selection with the margin of errors.

Recent biological and clinical findings in geroscience prolonging healthy lifespan

Aliz Holczbauer, Alexandra Kalmar, Gabor Valcz, Istvan Takacs, Bela Molnar — Wed, 04 Mar 2026 10:39:29 +0000

Aging is a biologically determined process influenced by both intrinsic traits and environmental factors, characterized by a gradual decline in the physiological functions of tissues and organs. Simultaneously, the underlying mechanisms of aging increase the body's vulnerability to stressors and the development of chronic diseases. While aging was once considered an irreversible, unidirectional process, recent research has revealed a high degree of plasticity in aging. In this work, we present the cellular and organ-level changes associated with aging and their potential application in determining the biological age of a specific organ or the entire organism. We place particular emphasis on cellular senescence, a key event in aging, as a promising target for therapeutic intervention. We also summarize ongoing efforts to slow, halt, or reverse aging and outline the potential clinical translation of these strategies.

Pharmacokinetic alterations in cachexia and sarcopenia

Patricia Vincze-Harmat, Lajos Botz — Wed, 04 Mar 2026 11:15:10 +0000

Cachexia is a weight loss syndrome that causes body composition and functional abnormalities and is caused by an underlying chronic disease. Sarcopenia is a loss of muscle mass and strength, its prevalence increasing with advancing age. Both are complex pathophysiological processes, resulting in significant body composition and functional alterations, which modify pharmacokinetic and pharmacodynamic parameters of drugs. Currently, there is no available generally accepted and applied guideline to recommend drug therapy modifications in cachectic or sarcopenic patients. The manuscript summarizes the crucial aspects for appropriate, safe and effective drug therapy, based on available literature. It also aims to draw attention to the importance of monitoring nutritional status of patients, with effective use of supportive therapeutic modalities, like nutritional therapy applied in timely manner.

Abdominal resistance and anemia without malignancy - a misleading clinical picture

Attila Szucs, Agnes Bereczki, Eva Farkas, Marta Varga — Wed, 04 Mar 2026 13:08:24 +0000

The authors present a 46-year-old male patient with coeliac disease who did not follow a glutenfree diet. Abdominal resistance, weight loss, and anemia are alarming signs that would initially suggest a malignant disease. During tumor investigation, computed tomography of the chest, abdomen and pelvis revealed retroperitoneal and mesenteric lymphadenopathy, but the pathologist saw only reactive abnormalities in the histological sample. The patient then followed a gluten-free diet, and few months later, a follow-up computed tomography showed no lymphadenopathy but described chronic thrombosis of the superior mesenteric vein as an incidental finding. Due to the atypical location of the thrombosis, examinations were requested tests for antiphospholipid syndrome and thrombophilia, which confirmed combined thrombophilia. Based on the results so far, there is no correlation between novum heart disease and coeliac disease. The patient has since been receiving anticoagulant treatment, following a gluten-free diet, and attending regular medical check-ups.

Medisan polyclinic

Ipoly Szauder — Wed, 04 Mar 2026 13:19:57 +0000

In memoriam János Bezerédi dr. (1954–2025).

I limp

Miklós Szathmári — Wed, 04 Mar 2026 13:46:33 +0000

The work was written by Dezső Kosztolányi (1885-1936) in 1931.

Mor Jokai

Miklós Szathmári — Wed, 04 Mar 2026 14:03:19 +0000

On the occasion of the 200th anniversary of the birth of Mór Jókai (1825–1904), we are publishing this article, which originally appeared in the Pesti Hírlap Emlékkönyve (Pesti Hírlap Memorial Book).