Cardiology Plus最新文献

{"title":"Low-dose aspirin for the prevention of atherothrombosis across the cardiovascular risk continuum","authors":"Jaqui Walker","doi":"10.1097/cp9.0000000000000017","DOIUrl":"https://doi.org/10.1097/cp9.0000000000000017","url":null,"abstract":"Professor Junbo Ge welcomed speakers and attendees both present (25, 600) and virtual (120,000) to the International Aspirin Foundation (IAF) Symposium at the Oriental Congress of Cardiology (OCC). He introduced aspirin as the cornerstone of antiplatelet therapy with evidence for its efficacy and safety in cardiovascular disease (CVD) prevention accumulating since the 1970s. Aspirin works by irreversibly inactivating the cyclooxygenase (COX) activity of the ubiquitous bifunctional enzyme, prostaglandin (PG)G/H-synthase, which catalyzes the conversion of arachidonic acid to PGG 2 (through its COX activity) and PGH 2 (through its peroxidase activity) 1 . PGH 2 is a common intermediate in the biosynthesis of different prostanoids (e.g., PGE 2 , thromboxane [TX] A 2 and prostacyclin [PGI 2 ]), through the action of tissue-specific isomerases and synthases. three clinical case studies to illustrate his perspectives on aspirin’s role in the prevention of cardiovascular events using data from both primary and secondary prevention trials. For secondary prevention of CVD, in those with known atherosclerotic disease prior myocardial infarction the that risk of in serious thrombotic atrial clear benefits for low-dose aspirin. Two of Professor Gaziano’s case studies illustrated the types of people benefiting from aspirin for the secondary prevention of CVD. There are over 13.7 million new strokes worldwide each year, with individuals having a lifetime risk of 20%. TIA and minor stroke comprise 70% of all acute cerebrovascular events and often herald an impending major stroke, with seven-day risk of major stroke as high as 10% 1,2 . However, urgent medical assessment and treatment are very effective in preventing early recurrent major stroke. The EXPRESS study showed urgent investigation/treatment after TIA and minor stroke reduced the 90-day risk of major recurrent stroke by about 80% - one of the most effective interventions in medicine 3,4 . This benefit was achieved by changing care from non-urgent general practice prescribing to urgent assessment and treatment using existing medications. Other studies show similar feasibility and results 5 . However, the EXPRESS Study intervention was multifactorial, including aspirin, other antiplatelet drugs in high-risk patients, BP-lowering drugs and statins, and it was uncertain which component had reduced stroke risk. Aspirin was given to all patients, but the effect of aspirin on recurrent stroke risk had long been considered modest, based on trials in acute major stroke and in long-term prevention after TIA/minor stroke. By detailed re-analysis of individual patient data from these trials, it was shown the acute benefits of aspirin in TIA/minor stroke had been considerably underestimated, showing that aspirin alone reduced 90-day risk of disabling recurrent stroke by 80% and of all stroke by 60% 6 . Despite patients given benefits of aspirin. this, Professor Rothwell has with guideline writers recommend low-dose ","PeriodicalId":52908,"journal":{"name":"Cardiology Plus","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42428058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of hybutimibe on primary hypercholesterolemia: a randomized, double-blinded, placebo and positive–controlled, parallel phase II study","authors":"L. Qi, Shu-Lian Zhao, Jiyan Chen, Mei Zhang, Xiaodong Li, Yugang Dong, Xiaomei Guo, Kaikai Huang, Fang Wang, Y. Huo, J. Ge","doi":"10.1097/CP9.0000000000000012","DOIUrl":"https://doi.org/10.1097/CP9.0000000000000012","url":null,"abstract":"Abstract Background and purpose: Hybutimibe is proved to be safe in healthy adults by a phase I study. A multi-center, randomized, double-blind phase II clinical trial evaluated its effectiveness and safety of Hybutimibe in the treatment of primary hypercholesterolemia. Methods: A total of 244 patients between August 2014 and August 2015, with primary hypercholesterolemia from 15 centers in China were enrolled and randomly assigned to receive placebo, ezetimibe, or hybutimibe 5, 10, or 20 mg/day in a 1:1:1:1:1 ratio. The primary outcome was evaluated from the change rate of low-density lipoprotein cholesterol (LDL-C) at week 8 from baseline, whereas secondary outcomes were evaluated from the change rates of LDL-C, TC, TG, HDL-C, non-HDL-C, APO-B, APO-A1 at weeks 1, 2, 4, and 8 from baseline. Results: After 8 weeks of treatment, the average decrease rate of LDL-C was −20.01% for ezetimibe, −10.84% (95% CI: −14.67, −7.00) for hybutimibe 5 mg/day, −17.06% (95% CI: −20.83, −13.29) for hybutimibe 10 mg/day, and −17.04% (95% CI: −20.30, −13.79) for hybutimibe 20 mg/day, respectively. The change rates of TC, non-HDL-C, and APO-B levels were significantly improved in all treatments compared with placebo (P < 0.05), whereas changes in the above lipid profiles of hybutimibe 20 mg/day were similar with ezetimibe. In terms of safety, the most common adverse events were elevation in ALT, gastrointestinal reaction, dizziness, and headache. Conclusions: This clinical study found that hybutimibe with the least dose of 5 mg/day effectively improved the LDL-C, TC, non-HDL-C, and APO-B levels in patients with primary hyperlipidemia with good tolerance and safety with no significant effect on TG levels.","PeriodicalId":52908,"journal":{"name":"Cardiology Plus","volume":"7 1","pages":"77 - 84"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41895719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Familial hypercholesterolemia in China requires greater efforts","authors":"Jianjun Li","doi":"10.1097/CP9.0000000000000013","DOIUrl":"https://doi.org/10.1097/CP9.0000000000000013","url":null,"abstract":"Familial hypercholesterolemia (FH) is one of the most common genetic disorders characterized by a predominant elevation in plasma low-density lipoprotein (LDL) cholesterol (LDL-C) concentration and higher incidence of premature atherosclerotic cardiovascular disease (ASCVD). It has been reported that the long-term coronary artery disease (CAD) and ASCVD risk in the US adults with the FH phenotype are up to approximately five-fold higher than that in the general population.[1] It has also been estimated that there is an important longterm burden of ASCVD in phenotypic but undiagnosed FH patients in the US, with the acceleration of CAD risk by 20–30years.[1] In recent years, the features of underdiagnosis and under-treatment of FH patients has attained an intensive attention worldwide.[2] This increased risk is age dependent, with the highest relative risk in younger index ages. Notably, several atherosclerosisrelated international academic organizations or societies have issued statements or guidelines consequently, which call for the actions to improve the diagnosis and treatment of this unique, treatable disease globally.[3–6] In the Asia Pacific region, FH is estimated to affect at least 15 million people.[7] Among them, China alone may account for more than half of the FH patients as it is the world’s most populous country. The general knowledge regarding FH is not very unfamiliar for medical professionals. Premature ASCVD is a great concern in FH patients due to the extremely high plasma LDL-C concentration. If homozygous FH (HoFH) is left untreated, tendon xanthomas may usually be detected.[2] Since the 1950s, FH patients have been divided into heterozygous FH (HeFH) and HoFH, and diagnosing HeFH and HoFH based on the phenotypic features of ASCVD or xanthomas has frequently been difficult without the DNA analysis of FH genes.[3] With the development of genetic testing technology, multiple studies revealed that a severe defect in the ability to bind and internalize LDL particles was caused by mutations in both alleles of the","PeriodicalId":52908,"journal":{"name":"Cardiology Plus","volume":"7 1","pages":"61 - 63"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44149927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Omega-3 Index necessary for fish oil supplements for CVD risk prevention?","authors":"Chen Luo, Zhenyue Chen","doi":"10.1097/CP9.0000000000000015","DOIUrl":"https://doi.org/10.1097/CP9.0000000000000015","url":null,"abstract":"Abstract Several large prospective cohort studies demonstrated an association between higher cardiovascular disease (CVD) risk with low blood level of omega-3 fatty acids as well as low Omega-3 Index [<4% eicosapentaenoic acid (EPA)+ docosahexaenoic acid (DHA) to total fatty acids in red blood cell membrane]. However, randomized controlled trials of omega-3 fatty acids as either primary or secondary prevention have yielded controversial results. In this review, we summarize the evidence that supports or argues against the use omega-3 fatty acids, with a focus on the underlying mechanisms for the observed discrepancies (eg, differences in dosage, comparators and EPA levels or Omega-3 Index). Omega-3 Index is an independent risk factor for cardiovascular risk. The baseline Omega-3 Index can be used as a reference for whether and how much fish oil should be supplemented. To some degree, it can be used to explain why there are so much inconsistencies in clinical trials. Omega-3 Index could be a promising treatment target in clinical practice and in public health settings although there are still some barriers. This review summarizes current evidences from both epidemiological studies and randomized controlled trials of omega-3 fatty acids as primary and secondary prevention of CVD, and aims to provide a comprehensive overview of fish oil supplements on risk for CVD, and Omega-3 Index as a tool to identify subjects at high risk as well as a treatment target in CVD prevention.","PeriodicalId":52908,"journal":{"name":"Cardiology Plus","volume":"7 1","pages":"70 - 76"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46445527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elevated plasma homocysteine level is associated with poor ST-segment resolution in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention at high altitude","authors":"Bei Liu, Shujuan Yang, Lixia Yang, Bin Zhang, R. Guo","doi":"10.1097/CP9.0000000000000016","DOIUrl":"https://doi.org/10.1097/CP9.0000000000000016","url":null,"abstract":"Abstract Background and purpose: Poor ST-segment resolution (STR) is strongly associated with poor prognosis in patients with ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). previous studies suggested higher HCY level in the people who live in high altitudes, so a retrospective analysis is conducted to examine the potential relationship between elevated serum HCY and poor STR after PPCI at high altitudes. Methods: This retrospective analysis included 308 high-altitude dwelling patients (1800-2200 meters elevation from the sea level) undergoing PPCI for STEMI during a period from September 2021 to March 2022. Clinical data were collected and statistically analyzed. Results: In comparison to the patients with normal plasma homocysteine (≤15 mmol/L; n = 155), patients with elevated homocysteine (>15 mmol/L) had higher percentage of men (92.81% vs. 80.00%; p = 0.001) and smoker (79.08% vs. 63.87%; p = 0.003), but no difference in other key baseline characteristics. The rate of complete ST-segment resolution after PPCI (≥ 70%) was 83.23% in the control group and 49.67% in the elevated HCY group (p ≤ 0.001). In multivariable regression analysis, poor ST-segment resolution (<70%) was independently associated with longer pain-to-balloon time (OR 0.832; 95%CI: 0.775–0.894), lower uric acid (OR 1.003; 95%CI: 1.000-1.005), and elevated HCY (OR 0.957 vs. normal HCY; 95%CI: 0.937–0.977). Conclusion: Elevated plasma HCY level was associated with poor ST segment resolution in patients undergoing PPCI STEMI at high altitude.","PeriodicalId":52908,"journal":{"name":"Cardiology Plus","volume":"7 1","pages":"92 - 96"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48473235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Four aces of heart failure therapy: systematic review of established and emerging therapies for heart failure with reduced ejection fraction","authors":"E. Ruffino, M. Gori, E. D’Elia, E. Sciatti, V. Shi, M. Senni","doi":"10.1097/CP9.0000000000000007","DOIUrl":"https://doi.org/10.1097/CP9.0000000000000007","url":null,"abstract":"Abstract Heart failure with reduced ejection fraction (HFrEF) is a common disease requiring multi-drug therapy. Moreover, it is associated with a poor prognosis, with increasing prevalence in the community. In the last decade, two major drug classes were introduced to the heart failure (HF) specialist's arsenal: angiotensin receptor neprilysin inhibitors (ARNIs) and sodium-glucose-cotransporter 2 inhibitors (SGLT2is). The current paradigm of sequential drug therapy is changing, favoring a multi-drug combination therapy upfront, including four “pillar” classes: beta-blockers, mineralcorticoid receptor antagonists (MRAs), ARNIs, and SGLT-2is. Recent putative placebo analyses of large-scale randomized clinical trials compared a combination of all four drug classes with a standard of care and was in favor of the multi-drug combination revealing a hazard ratio for cardiovascular (CV) death and HF hospitalization of 0.5 and 0.32, respectively. We reviewed the approval landmark trials for the four drug classes and have subincluded a short comment about the implications and impact of each study in clinical practice. Moreover, we present more detailed trials concerning the use of these drugs in different settings (eg, acute phase, in-hospital, and outpatient) and more data about the clinical, biochemical, functional, and echographic remodeling effects of the molecules. The results of the meta-analyses and putative placebo analyses in the literature we reviewed suggest the benefit of offering all the best therapy available upfront. This approach ensures maximal life expectancy gain, especially in younger patients, and cuts the costs of rehospitalizations. Thus, this review underlines the importance of the four-drug approach to HFrEF therapy, as recently stated in the ESC guidelines.","PeriodicalId":52908,"journal":{"name":"Cardiology Plus","volume":"7 1","pages":"20 - 28"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48294937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sacubitril-valsartan therapy in a patient with heart failure due to isolated left ventricular noncompaction: a case report and literature review","authors":"Yawei Yang, Jun Yuan, Jing-Fen Xing, M. Fan","doi":"10.1097/CP9.0000000000000003","DOIUrl":"https://doi.org/10.1097/CP9.0000000000000003","url":null,"abstract":"Abstract Background: Left ventricular noncompaction (LVNC) is a rare type of cardiomyopathy. The core clinical feature is heart failure that responds poorly to treatments. Case presentation: A 58-year-old woman received various treatments (including metoprolol, benazepril, torasemide, spirolactone, and digoxin) for 4 years for LVNC, but responded poorly. Upon presentation, transthoracic echocardiogram (ECHO) showed 26% left ventricular ejection fraction (LVEF) and class IV diastolic dysfunction. Upon cardiac magnetic resonance imaging (CMRI), the ratio of noncompacted versus compacted myocardium was 3.9. She received guideline-recommended treatments that included sacubitril-valsartan (100 mg/day) in addition to β-blocker, torasemide, spirolactone, digoxin, and isosorbide. Symptoms and signs improved rapidly, and she was discharged 1 week later. Sacubitril-valsartan dosage was adjusted to 200 mg/day 4 weeks later. She remained in relatively good health thereafter. At the last follow-up 16 months later, LVEF was 51% on ECHO. CMRI showed the significantly reduced ratio of 2.8 in noncompacted versus compacted myocardium. Conclusions: Sacubitril-valsartan therapy may result in reverse remodeling and improve long-term outcomes in LVNC patients.","PeriodicalId":52908,"journal":{"name":"Cardiology Plus","volume":"7 1","pages":"56 - 59"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41676095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing residual inflammatory risk in atherosclerotic cardiovascular disease: another piece of the puzzle?","authors":"Y. Dai, J. Ge","doi":"10.1097/cp9.0000000000000005","DOIUrl":"https://doi.org/10.1097/cp9.0000000000000005","url":null,"abstract":"","PeriodicalId":52908,"journal":{"name":"Cardiology Plus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43142371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of MELD-XI and MELD-Albumin scores in double valve replacement","authors":"Yu-Juan Yu, Y. Tse, Siyun Yu, L. Lam, K. Li, Yan Chen, Mei-Zhen Wu, Q. Ren, S. Yu, P. Wong, H. Tse, K. Yiu","doi":"10.1097/CP9.0000000000000009","DOIUrl":"https://doi.org/10.1097/CP9.0000000000000009","url":null,"abstract":"Abstract Background: Patients who undergo concomitant aortic and mitral double valve replacement (DVR) have poor postoperative clinical outcomes. The modified Model for End-Stage Liver Disease excluding international normalized ratio (MELD-XI) score and the modified Model for End-Stage Liver Disease score with albumin replacing international normalized ratio (MELD-albumin) score have been reported as predictors of adverse events in hepato-cardiac diseases. The objective of this study was to assess the clinical prognostic value of the two modified Model for End-Stage Liver Disease (MELD) scores in patients undergoing DVR. Methods: A total of 210 patients undergoing DVR were evaluated. Baseline clinical and laboratory parameters were recorded, and EuroSCORE II was calculated for each patient. The outcome of interest was the composite of heart failure hospitalization and cardiovascular mortality. Results: Patients undergoing DVR had a high prevalence of hepato-renal dysfunction. During a median follow-up of 71 months, the MELD-XI and MELD-Albumin scores independently predicted adverse outcomes (hazard ratio [95% confidence interval] = 1.09 [1.03–1.16] and 1.11 [1.06–1.16], P < 0.01, respectively). Kaplan–Meier analysis demonstrated that high MELD-XI and MELD-Albumin scores were associated with an increased risk of adverse events. MELD-Albumin provided incremental prognostic value to clinical parameters and EuroSCORE II (net reclassification index [NRI] = 0.34; P < 0.01). Conclusions: Both the MELD-XI score and MELD-Albumin score can provide useful information to predict adverse outcomes in patients undergoing DVR. The present study supports the monitoring of modified MELD scores to improve preoperative risk stratification for these patients.","PeriodicalId":52908,"journal":{"name":"Cardiology Plus","volume":"7 1","pages":"39 - 47"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43026756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aldehyde dehydrogenase 2-associated metabolic abnormalities and cardiovascular diseases: current status, underlying mechanisms, and clinical recommendations","authors":"Lei Xu, X. Cui, Zhang‐wei Chen, L. Shen, Xiu-Fang Gao, Xiao-Xiang Yan, Cong-Rong Wang, Xiao-kai Zhang, K. Hu, Jun-bo Ge, Ai-Jun Sun","doi":"10.1097/cp9.0000000000000002","DOIUrl":"https://doi.org/10.1097/cp9.0000000000000002","url":null,"abstract":"","PeriodicalId":52908,"journal":{"name":"Cardiology Plus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44128948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}