Improving Outcomes in Cardiovascular Diseases: A Review on Vorapaxar
Antiplatelet agents are the standard of practice in the management of atherosclerosis and acute coronary syndrome. In contrast to the available antiplatelet agents, vorapaxar represents a novel mechanism of action. It is an antagonist of the platelet protease-activated receptor-1 and inhibits thrombin-induced and thrombin receptor agonist peptide-induced platelet aggregation. The Thrombin Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events-Thrombolysis in Myocardial Infarction 50 (TRA 2°P-TIMI 50) trial led to the approval of vorapaxar by the Food and Drug Administration and European Medicines ...
Source: Cardiology in Review - August 17, 2022 Category: Cardiology Tags: Review Articles Source Type: research
Clinical Implications and Debates on the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches Trial
The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) was eagerly awaited study in the field of ischemic heart disease. Following the presentation and publication of ISCHEMIA, multiple opinions and viewpoints get complicated. The ongoing debates have been including the relevance of coronary revascularization, noninvasive diagnostic methods, and invasive ischemic testing in patients with stable ischemic heart disease (SIHD). Prior to ISCHEMIA, observational studies indicated the potential of coronary revascularization for improving clinical outcomes, while the randomized...
Source: Cardiology in Review - August 17, 2022 Category: Cardiology Tags: Review Articles Source Type: research
Cardiac Resynchronization Therapy With or Without Defibrillation: A Long-Standing Debate
Cardiac resynchronization therapy (CRT) was shown to improve cardiac function, reduce heart failure hospitalizations, improve quality of life and prolong survival in patients with severe left ventricular dysfunction and intraventricular conduction disturbances, mainly left bundle branch block, on optimal medical therapy with ACE-inhibitors, β-blockers and mineralocorticoid receptor antagonists up-titrated to maximum tolerated evidence-based doses. CRT can be achieved by means of pacemaker systems (CRT-P) or devices with defibrillation capabilities (CRT-D). CRT-Ds offer an undoubted advantage in the prevention of arrhythmi...
Source: Cardiology in Review - August 17, 2022 Category: Cardiology Tags: Review Articles Source Type: research
Inclisiran: Small Interfering Ribonucleic Acid Injectable for the Treatment of Hyperlipidemia
Elevated plasma lipid levels, especially low-density lipoprotein, are correlated with atherosclerotic cardiovascular disease (ASCVD) and increased risk of ischemic heart disease and stroke. Statins are first-line agents for reducing low-density lipoprotein cholesterol (LDL-C) and the risk of major cardiovascular events, but patients with a genetic susceptibility or established ASCVD oftentimes remain subtherapeutic on statin therapy alone. Biotechnological advancements in medication therapy have led to the development of inclisiran, a recently approved twice-yearly injectable agent to help patients with heterozygous famili...
Source: Cardiology in Review - June 10, 2022 Category: Cardiology Tags: Review Articles Source Type: research
Genetic Risk Assessment for Atherosclerotic Cardiovascular Disease: A Guide for the General Cardiologist
Genetic testing for cardiovascular (CV) disease has had a profound impact on the diagnosis and evaluation of monogenic causes of CV disease, such as hypertrophic and familial cardiomyopathies, long QT syndrome, and familial hypercholesterolemia. The success in genetic testing for monogenic diseases has prompted special interest in utilizing genetic information in the risk assessment of more common diseases such as atherosclerotic cardiovascular disease (ASCVD). Polygenic risk scores (PRS) have been developed to assess the risk of coronary artery disease, which now include millions of single-nucleotide polymorphisms that ha...
Source: Cardiology in Review - June 10, 2022 Category: Cardiology Tags: Review Articles Source Type: research
Contemporary Mechanical Circulatory Support With Continuous-Flow Biventricular Assist Devices: A Systematic Review
As the incidence of heart failure increases, so too has that of biventricular failure. While transplantation remains the gold standard therapy for end-stage heart failure, the limited organ supply has increased the need for durable mechanical circulatory support. We therefore sought to conduct a systematic review of continuous-flow ventricular assist devices in a biventricular configuration (CF-BiVAD). An electronic search of PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases was performed using the keyword “BIVAD.” Studies were reviewed to identify discrete variables, including impl...
Source: Cardiology in Review - June 10, 2022 Category: Cardiology Tags: Review Articles Source Type: research
Systemic and Coronary Hemodynamic Effects of Tobacco Products on the Cardiovascular System and Potential Pathophysiologic Mechanisms
Tobacco product usage is the single most preventable cause of death in the United States. Smoking promotes atherosclerosis, producing disease in the coronary arteries, the aorta, the carotid and cerebral arteries and the large arteries in the peripheral circulation. The cardiovascular consequences of tobacco products have been the subject of intensive study for several decades. Despite the overwhelming epidemiologic association between smoking and vascular disease, the pathophysiologic mechanisms by which smoking exerts its deleterious effects remain incompletely understood. This review addresses the acute and long-term sy...
Source: Cardiology in Review - June 10, 2022 Category: Cardiology Tags: Review Articles Source Type: research
Conduction Disturbances and Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: Predictors and Prevention
Conduction disturbances and permanent pacemaker implantation (PPMI) remain a frequent and important consequence of transcatheter aortic valve replacement (TAVR). Understanding risk factors for TAVR-related conduction disturbances could improve patient selection, procedural techniques, and periprocedural efforts for monitoring and treatment of heart block. Several studies have identified patient-related and procedural factors associated with new-onset left bundle branch block, high-degree atrioventricular block, and the need for PPMI after TAVR. Notable patient-related predictors include preexisting right bundle branch bloc...
Source: Cardiology in Review - June 10, 2022 Category: Cardiology Tags: Review Articles Source Type: research
Exercise, Physical Activity, and Cardiometabolic Health: Insights into the Prevention and Treatment of Cardiometabolic Diseases
Physical activity (PA) and exercise are widely recognized as essential components of primary and secondary cardiovascular disease (CVD) prevention efforts and are emphasized in the health promotion guidelines of numerous professional societies and committees. The protean benefits of PA and exercise extend across the spectrum of CVD, and include the improvement and reduction of risk factors and events for atherosclerotic CVD (ASCVD), cardiometabolic disease, heart failure, and atrial fibrillation (AF), respectively. Here, we highlight recent insights into the salutary effects of PA and exercise on the primary and secondary ...
Source: Cardiology in Review - June 10, 2022 Category: Cardiology Tags: Review Articles Source Type: research
Part 2: Disease of the Heart and Liver: A Relationship That Cuts Both Ways
Diseases known to affect both the heart and liver include a variety of infectious, autoimmune, and metabolic disorders, as well as toxins: most commonly alcohol. As damage to both the heart and liver progresses, transplantation is a reasonable therapeutic option. Heart failure patients with underlying congestive hepatopathy receiving cardiac transplant have demonstrated improved liver enzyme levels posttransplant. Patients with severe end-stage liver disease requiring a liver transplant must undergo careful preoperative evaluation as surgical stress exposes the myocardium to high levels of catecholamines. Clinicians must c...
Source: Cardiology in Review - June 10, 2022 Category: Cardiology Tags: Review Articles Source Type: research
C. Walton Lillehei—His Life and Legacy
No abstract available (Source: Cardiology in Review)
Source: Cardiology in Review - June 10, 2022 Category: Cardiology Tags: Editorial Source Type: research
Comprehensive Review of Cardiovascular Complications of Coronavirus Disease 2019 and Beneficial Treatments
We present the most up-to-date literature summary to explore the incidence of new-onset cardiac complications of coronavirus and their role in predicting the severity of COVID-19. We review the association of elevated troponin with the severity of COVID-19 disease, which includes mild compared to severe disease, in nonintensive care unit compared to intensive care unit patients and in those discharged from the hospital compared to those who die. The role of serum troponin levels in predicting prognosis are compared in survivors and non-survivors. The association between COVID-19 disease and myocarditis, heart failure and c...
Source: Cardiology in Review - April 7, 2022 Category: Cardiology Tags: Review Articles Source Type: research
Exercise, Physical Activity, and Cardiometabolic Health: Pathophysiologic Insights
Physical activity and its sustained and purposeful performance—exercise—promote a broad and diverse set of metabolic and cardiovascular health benefits. Regular exercise is the most effective way to improve cardiorespiratory fitness, a measure of one’s global cardiovascular, pulmonary and metabolic health, and one of the strongest predictors of future health risk. Here, we describe how exercise affects individual organ systems related to cardiometabolic health, including the promotion of insulin and glucose homeostasis through improved efficiency in skeletal muscle glucose utilization and enhanced insulin sensitivity...
Source: Cardiology in Review - April 7, 2022 Category: Cardiology Tags: Review Articles Source Type: research
Extracorporeal Membrane Oxygenation in Patients With COVID-19
In this study, we review the indications, challenges, complications, and clinical outcomes of ECMO utilization in critically ill patients with COVID-19-related ARDS. Most of these patients required venovenous ECMO. Although the risk of mortality and complications is very high among patients with COVID-19 requiring ECMO, it is similar to that of non-COVID-19 patients with ARDS requiring ECMO. ECMO is a resource-intensive therapy, with an inherent risk of complications, which makes its availability limited and its use challenging in the midst of a pandemic. Well-maintained data registries, with timely reporting of outcomes a...
Source: Cardiology in Review - April 7, 2022 Category: Cardiology Tags: Review Articles Source Type: research
Coronavirus Disease 2019 and Cardiometabolic Disease
Cardiometabolic disease describes a combination of metabolic abnormalities that increases the risk of type 2 diabetes and cardiovascular diseases, including pathological changes such as insulin resistance, hyperglycemia, dyslipidemia, abdominal obesity, and hypertension, and environmental risk factors such as smoking, sedentary lifestyle, poor diet, and poverty. As the number of coronavirus disease 2019 (COVID-19) patients continues to rise, type 2 diabetes, cardiovascular disease, hypertension, and obesity, all components of, or sequelae of cardiometabolic disease, were identified among others as key risk factors associat...
Source: Cardiology in Review - April 7, 2022 Category: Cardiology Tags: Review Articles Source Type: research
