Kardio-reno-metabolické kontinuum: návrat k integrující roli vnitřního lékařství

prof. MUDr. Michal Vrablík, Ph.D.

Vnitr Lek 2026, 72(6):356  

SGLT2 inhibitors in cardiology, nephrology, and diabetes care: who should take them, how to start treatment, and when to discontinue

Jan Škrha

Vnitr Lek 2026, 72(6):360-363 | DOI: 10.36290/vnl.2026.068  

SGLT2 inhibitors, also known as gliflozins, were originally developed as oral antidiabetic agents with mild diuretic and glycosuric effects; they have gradually become a cornerstone of treatment for heart failure and chronic kidney disease, regardless of the presence of diabetes. This article aims to summarize the current status of SGLT2i across internal medicine specialties, define the optimal patient for their use, and provide practical guidance for their safe management, with particular emphasis on perioperative care.

The role of SGLT2 inhibitors in outpatient cardiology practice

Petra Buděšínská

Vnitr Lek 2026, 72(6):364-372 | DOI: 10.36290/vnl.2026.069  

The article discusses the beneficial effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors (gliflozins) on the kidneys and the heart, thereby slowing the progression of pathophysiological processes underlying heart failure and chronic kidney disease, which may ultimately lead to cardiorenal syndrome. Early diagnosis of these processes through interdisciplinary cooperation among internal medicine specialties, with a focus on biomarkers of heart failure and renal impairment, including NT-proBNP, eGFR, and albuminuria, enables timely initiation of treatment with these drugs.

GLP-1 receptor agonists in obesity treatment: where we are today and what can we expect?

Dita Pichlerová

Vnitr Lek 2026, 72(6):374-381 | DOI: 10.36290/vnl.2026.070  

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) represent a major breakthrough in the treatment of obesity and type 2 diabetes. Their ability to reduce body weight is well documented, and the outlook for new anti-obesity drugs in the near future is more than positive. Along with a reduction of up to 15-22% of baseline weight with semaglutide and tirzepatide, evidence is growing for a wide range of metabolic, cardiovascular, liver, kidney, and neurobiological effects that are independent of weight loss itself. This review article summarizes current clinical and preclinical knowledge about the pleiotropic effects of GLP-1 RAs, with a focus on the...

Dyslipidemia in cardio-reno-metabolic syndrome

David Karásek

Vnitr Lek 2026, 72(6):382-387 | DOI: 10.36290/vnl.2026.071  

Cardio-reno-metabolic (CRM) syndrome is a complex disease resulting from the interaction of metabolic disorders, cardiovascular impairment and chronic kidney disease. The basic pathogenetic mechanism is adipose tissue dysfunction leading to insulin resistance, chronic inflammation and vascular dysfunction. A typical laboratory manifestation is atherogenic dyslipidemia characterized by hypertriglyceridemia, reduced HDL-cholesterol and increased small dense LDL particles, often with only slightly increased LDL-cholesterol. Postprandial lipoproteins and residual cholesterol represent a significant cardiovascular risk. The basal therapy of dyslipidemia...

Sequencing and combination of therapies in the cardiovascular-kidney-metabolic syndrome: GLP-1 RA, SGLT2 inhibitors, lipid-lowering drugs and mineralocorticoid receptor antagonists

Michal Dubský

Vnitr Lek 2026, 72(6):388-394 | DOI: 10.36290/vnl.2026.072  

Cardiovascular-kidney-metabolic (CKM) syndrome is a concept introduced by the 2023 consensus statement of the American Heart Association (AHA). It describes an interconnected complex of obesity, type 2 diabetes mellitus (T2DM), dyslipidemia, chronic kidney disease (CKD), and cardiovascular (CV) disease, including heart failure (HF). Current evidence from large randomized trials supports early sequencing and, in appropriately selected patients, combination of several therapeutic classes: SGLT2 inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), lipid-lowering therapies (statins, ezetimibe, PCSK9 inhibitors, inclisiran, bempedoic acid),...

Modern treatment of hereditary angioedema due to C1 inhibitor deficiency: from attack control to complete disease control

Roman Hakl, Jan Baroš, Jiří Litzman

Vnitr Lek 2026, 72(6):396-400 | DOI: 10.36290/vnl.2026.073  

Hereditary angioedema due to C1 inhibitor deficiency (HAE-C1-INH) is a rare, potentially life-threatening disorder characterized by recurrent episodes of bradykinin-mediated angioedema. In recent years, major advances have been achieved in both the diagnosis and treatment of HAE-C1-INH, particularly due to the development of targeted biological and molecular therapies. The updated 2025 WAO guidelines emphasize an individualized approach, the availability of effective on-demand therapy for all patients, and a treatment strategy aimed at achieving complete disease control. This review article summarizes current therapeutic options for HAE-C1-INH, including...

Cushing's syndrome: current view

Michal Kršek

Vnitr Lek 2026, 72(6):402-411 | DOI: 10.36290/vnl.2026.074  

Cushing's syndrome is a rare endocrine disorder that significantly affects patients and is associated with significantly increased morbidity and mortality, mainly due to cardiovascular disorders and complications. Increased morbidity and mortality persist even many years after the successful cure. Therefore, early diagnosis and treatment are of eminent importance. It is necessary to state that diagnosis and differential diagnosis of Cushing's syndrome belong to the most difficult ones in clinical endocrinology mainly for variable aetiology and also not sufficiently good performance of diagnostic tests. That also pays for the treatment that often has...

Hematoncology treatment toxicity

Simona Pavúková, Roman Králik, Juraj Payer, Ľuboš Drgoňa

Vnitr Lek 2026, 72(6):E11-E15 | DOI: 10.36290/vnl.2026.078  

Modern anticancer therapy, including conventional chemotherapy, targeted biological treatment, and immunotherapy, has significantly improved survival rates for patients with hematological and oncological malignancies. However, despite their high therapeutic efficacy, these modalities impose a substantial burden on the organism and are associated with a wide spectrum of adverse effects. Among the most frequent and clinically significant complications are hematotoxicity, organ toxicities - particularly cardiotoxicity, pneumotoxicity, and nephrotoxicity - and specific immune-related adverse events. Understanding the underlying mechanisms of these complications,...

Changes in diabetes care assessed from the number of HbA1c assays performed during COVID pandemic in Slovakia

Martin Jankovsky, Jozef Lacka, Viktor Oliver Rácz, Petra Ištokovičová, Elena Tibenská, Peter Jackuliak

Vnitr Lek 2026, 72(6):E1-E5 | DOI: 10.36290/vnl.2026.077  

Introduction: In Slovakia during the first two years of COVID-19 pandemic a significant increase of mortality in diabetic patients occurred, which returned near to the initial values in its last stage (2022). Patients with diabetes mellitus need regular assessment of HbA1c. The aim of this study was evaluation of the effect of pandemic on the number of HbA1c measurements performed before (2019), during (2020; 2021), and in the last stage (2022) of pandemic. Methods: 382 803 HbA1c measurements from Medirex Inc. laboratory chain and 23 779 assays from a local laboratory (Cumulus Inc.) were evaluated. Results: The number of HbA1c measurements...

Carotid Plaque Score and the Risk of Coronary Artery Disease in Patients with Arterial Hypertension

Danka Škultétyová, Slavomíra Filipová, Ján Postulka

Vnitr Lek 2026, 72(6):E6-E10 | DOI: 10.36290/vnl.2026.076  

Introduction: Cardiovascular diseases (CVD) are the most common cause of death in Europe. 2023 European Society of Hypertension Guidelines for the management of arterial hypertension (AH) recommend looking for hypertension-mediated organ damage. Aim: We investigated whether carotid plaque score (CPS) may be useful in diagnostics of coronary artery disease. We analyzed relationships between CPS and the coronary artery calcium score (CACS), as well as with coronary computed tomography angiography (CCTA). Patients and methods: We examined 50 high risk hypertensive patients with an average age of 67±8 years with suspected or confirmed coronary artery...

Thiamine deficiency syndromes - case report and overview

Jiří Müller, Jaroslav Raděj, Lenka Valešová, Miroslav Kříž, Roman Pavlík, Alena Vondráková, Martin Matějovič

Vnitr Lek 2026, 72(6):413-419 | DOI: 10.36290/vnl.2026.075  

Thiamine (vitamin B1) is a water-soluble vitamin that plays a pivotal role as a cofactor for enzymes involved in energy metabolism. Its deficiency can result in the development of heterogeneous and complex syndromes, primarily characterised by impaired nervous and cardiovascular system. Timely diagnosis and treatment of these potentially life-threatening conditions are often delayed due to the incomplete or atypical clinical presentation and the lack of accessible and reliable methods for determining vitamin B1 levels. The objective of this case report, which details a critically ill female patient with advanced central nervous system involvement,...

Aprocitentan - a dual endothelin receptor antagonist for the treatment of resistant arterial hypertension

Jitka Mlíková Seidlerová

Vnitr Lek 2026, 72(6):E16-E20 | DOI: 10.36290/vnl.2026.079  

Aprocitentan is a dual endothelin receptor inhibitor and a new drug approved in both the U.S. and Europe for the treatment of resistant hypertension. It is distinctive in that it targets a pathophysiological mechanism that is not affected by any existing antihypertensive medications. Unlike first-generation endothelin receptor blockers, it is not metabolized by CYP450 or BcRP, which means a lower risk of drug interactions. Current evidence demonstrates a significant reduction in blood pressure, both clinical and 24-hour, including sustained reductions during the night. In the PRECISION study, the difference in blood pressure reduction in patients treated...