Cardiac MRI and Ischemic Heart Disease: Role in Diagnosis and Risk Stratification
Abstract Cardiac magnetic resonance imaging (CMRI) has been under development for the past four decades and has more recently become an essential tool in the evaluation of ischemic heart disease (IHD). It is the reference standard for quantification of both right and left ventricular volume and function and, after landmark work published in the New England Journal of Medicine in 2000, has proven effective in identifying hibernating myocardium, or hypokinetic myocardium that will recover after revascularization. More recent literature continues to support both delayed enhancement imaging and CMRI stress perfusion ...
Source: Current Atherosclerosis Reports - March 15, 2016 Category: Cardiology Source Type: research

Obesity and Cardiovascular Disease: a Risk Factor or a Risk Marker?
Abstract In the USA, 69 % of adults are either overweight or obese and 35 % are obese. Obesity is associated with an increased incidence of various cardiovascular disorders. Obesity is a risk marker for cardiovascular disease, in that it is associated with a much higher prevalence of comorbidities such as diabetes, hypertension, and metabolic syndrome, which then increase the risk for cardiovascular disease. However, in addition, obesity may also be an independent risk factor for the development of cardiovascular disease. Furthermore, although obesity has been shown to be an independent risk factor for ...
Source: Current Atherosclerosis Reports - March 14, 2016 Category: Cardiology Source Type: research

Approach to Statin Use in 2016: an Update
Abstract Statin therapy is the pharmacologic foundation of cholesterol treatment and the most common class of medication prescribed in the USA. The clinical benefits of statins and their favorable side effect profile have been well established for atherosclerotic cardiovascular disease prevention. With new guidelines on the treatment of dyslipidemia being published in the last several years, a greater percentage of the population now appears eligible for statin therapy. In this review, we discuss the updated American College of Cardiology/American Heart Association and National Lipid Association guidelines on lip...
Source: Current Atherosclerosis Reports - March 14, 2016 Category: Cardiology Source Type: research

Niacin Alternatives for Dyslipidemia: Fool’s Gold or Gold Mine? Part II: Novel Niacin Mimetics
Abstract Two cardiovascular outcome trials established niacin 3 g daily prevents hard cardiac events. However, as detailed in part I of this series, an extended-release (ER) alternative at only 2 g nightly demonstrated no comparable benefits in two outcome trials, implying the alternative is not equivalent to the established cardioprotective regimen. Since statins leave a significant treatment gap, this presents a major opportunity for developers. Importantly, the established regimen is cardioprotective, so the pathway is likely beneficial. Moreover, though effective, the established cardioprotective re...
Source: Current Atherosclerosis Reports - March 1, 2016 Category: Cardiology Source Type: research

Gemfibrozil in Combination with Statins—Is It Really Contraindicated?
Abstract Gemfibrozil is a lipid-modifying agent that belongs to the fibric acid derivative class. Fibric acid derivatives activate peroxisome proliferator activated receptor α (PPAR-α). The primary role of these agents in clinical practice is for the management of hypertriglyceridemia. Triglycerides may be reduced by as much as 74 % in some patients. In addition to lowering triglycerides, these agents can also decrease very low-density lipoprotein cholesterol (VLDL-C) and low-density lipoprotein cholesterol (LDL-C) as well as raise high-density lipoprotein cholesterol (HDL-C). Based on the 2013 A...
Source: Current Atherosclerosis Reports - March 1, 2016 Category: Cardiology Source Type: research

Testosterone Replacement Therapy and the Cardiovascular System
Abstract As testosterone replacement therapy (TRT) has emerged as a commonly prescribed therapy for symptomatic low testosterone, conflicting data have been reported in terms of both its efficacy and potential adverse outcomes. One of the most controversial associations has been that of TRT and cardiovascular morbidity and mortality. This review briefly provides background on the history of TRT, the indications for TRT, and the data behind TRT for symptomatic low testosterone. It then specifically delves into the rather limited data for cardiovascular outcomes of those with low endogenous testosterone and those w...
Source: Current Atherosclerosis Reports - March 1, 2016 Category: Cardiology Source Type: research

Metformin: an Old Therapy that Deserves a New Indication for the Treatment of Obesity
Abstract Metformin is not currently used for weight loss or diabetes prevention because it lacks an FDA indication for obesity and/or pre-diabetes treatment. Based on the evidence, metformin has been shown to decrease the incidence of type 2 diabetes, and compares favorably to other weight-loss medications in terms of efficacy as well as safety. Thus, metformin should be considered for a treatment indication in patients with these conditions. (Source: Current Atherosclerosis Reports)
Source: Current Atherosclerosis Reports - February 18, 2016 Category: Cardiology Source Type: research

Epigenetics and Peripheral Artery Disease
Abstract The term epigenetics is usually used to describe inheritable changes in gene function which do not involve changes in the DNA sequence. These typically include non-coding RNAs, DNA methylation and histone modifications. Smoking and older age are recognised risk factors for peripheral artery diseases, such as occlusive lower limb artery disease and abdominal aortic aneurysm, and have been implicated in promoting epigenetic changes. This brief review describes studies that have associated epigenetic factors with peripheral artery diseases and investigations which have examined the effect of epigenetic modi...
Source: Current Atherosclerosis Reports - February 18, 2016 Category: Cardiology Source Type: research

Thyroid Hormone Mimetics: the Past, Current Status and Future Challenges
Abstract The association between thyroid hormone status and plasma levels of low-density lipoprotein cholesterol has raised the awareness for the development of thyroid hormone mimetics as lipid-lowering agents. The discovery of the two main types of thyroid hormone receptors (α and β) as well as the development of novel combinatorial chemistry providing organ specificity has drastically improved the selectivity of these compounds. In the past decades, several thyroid hormone mimetics have been investigated with the purpose of lowering low-density lipoprotein cholesterol levels. However, until now, non...
Source: Current Atherosclerosis Reports - February 17, 2016 Category: Cardiology Source Type: research

Troponin in Cardiovascular Disease Prevention: Updates and Future Direction
Abstract Cardiac troponin has been well described as the preferred biomarker for diagnosis of myocardial infarction due to the high sensitivity and specificity for myocardial injury. Numerous other conditions apart from acute coronary syndrome can also lead to small elevations in troponin levels. However, the use of cTn as prognostic biomarker for the primary assessment of cardiovascular risk in asymptomatic patient has only recently been described. And with the development of newer generations of high-sensitivity cardiac troponin assays that can detect 10-fold lower concentrations of troponin, the potential valu...
Source: Current Atherosclerosis Reports - February 15, 2016 Category: Cardiology Source Type: research

Niacin Alternatives for Dyslipidemia: Fool’s Gold or Gold Mine? Part I: Alternative Niacin Regimens
Abstract Niacin was the first drug demonstrating lowered cholesterol prevents coronary heart disease (CHD) events, with two clinical CHD outcome studies establishing a cardioprotective niacin regimen: 1 g thrice daily with meals. Though cardioprotective, skin toxicity limits niacin’s use, fostering several variations to improve tolerability. One of these, an extended-release (ER) alternative, proved immensely successful commercially, dominating clinical practice despite departing from the established regimen in several critical ways. Hence, improved tolerability may have come at the cost of diminished ...
Source: Current Atherosclerosis Reports - February 15, 2016 Category: Cardiology Source Type: research

An Update on the Utility of Coronary Artery Calcium Scoring for Coronary Heart Disease and Cardiovascular Disease Risk Prediction
We describe the MESA CHD risk calculator, a recently developed CAC-based 10-year CHD risk estimator, which can help guide preventive therapy allocation by better identifying both high- and low-risk individuals. In closing, we discuss calcium density, regional distribution of CAC, and extra-coronary calcification, which represent the future of CAC and CVD risk assessment research and may lead to further improvements in risk prediction. (Source: Current Atherosclerosis Reports)
Source: Current Atherosclerosis Reports - February 15, 2016 Category: Cardiology Source Type: research

Cardiac Rehabilitation in Patients with Established Atherosclerotic Vascular Disease: New Directions in the Era of Value-Based Healthcare
Abstract Exercise-based cardiac rehabilitation (CR) is associated with significant improvements in coronary disease outcomes, but has been underutilized. However, new developments within the field, some spurred by healthcare reform and the transition to more accountable and coordinated care, offer hope for closing the large CR treatment gap. This review presents new CR-related research, policy, and analyses, and discusses how evolving eligibility criteria, referral processes, performance measures, care models, and delivery and payment options could increase CR utilization over the next decade and enable this life...
Source: Current Atherosclerosis Reports - January 23, 2016 Category: Cardiology Source Type: research

Ethnic Minorities and Coronary Heart Disease: an Update and Future Directions
Abstract Heart disease remains the leading cause of death in the USA. Overall, heart disease accounts for about 1 in 4 deaths with coronary heart disease (CHD) being responsible for over 370,000 deaths per year. It has frequently and repeatedly been shown that some minority groups in the USA have higher rates of traditional CHD risk factors, different rates of treatment with revascularization procedures, and excess morbidity and mortality from CHD when compared to the non-Hispanic white population. Numerous investigations have been made into the causes of these disparities. This review aims to highlight the recen...
Source: Current Atherosclerosis Reports - January 20, 2016 Category: Cardiology Source Type: research

The Role of Ezetimibe in the Treatment of Cardiovascular Disease
Abstract Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide. Despite the success of treatment of CVD with statin therapy, a number of patients remain at high risk for CVD. Ezetimibe is a non-statin agent that inhibits intestinal cholesterol absorption, leading to reductions in low-density lipoprotein cholesterol (LDL-C). A number of clinical studies evaluating the use of ezetimibe therapy have resulted in discordant data regarding its safety and efficacy. In this review, we discuss the findings from these studies as well as potential indications for the use of ezetimibe for LDL...
Source: Current Atherosclerosis Reports - January 20, 2016 Category: Cardiology Source Type: research

Cardiometabolic Effects of Glucagon-Like Peptide-1 Agonists
Abstract Cardiovascular disease is the leading cause of death among adults in the USA. Both type 1 (T1DM) and type 2 diabetes mellitus (T2DM) are known risk factors for cardiovascular disease. Despite the development of numerous effective anti-glycemic therapies, we have been unable to completely mitigate cardiovascular risk with glucose lowering alone, and prevention of cardiovascular disease in patients with diabetes is primarily achieved with the use of medications that address other risk factors such as anti-hypertensives or statins. Glucagon-like peptide-1 (GLP-1) is a key hormone in the pathophysiology of d...
Source: Current Atherosclerosis Reports - January 19, 2016 Category: Cardiology Source Type: research

Women Versus Men: Is There Equal Benefit and Safety from Statins?
Abstract Coronary heart disease (CHD) is the leading cause of death in the United States. CHD risk differs between genders, with coronary events lagging behind ten years for women in comparison to men. Low-density lipoprotein cholesterol lowering with statin therapy is a major target for cardiovascular risk reduction. The benefit of statin therapy has been well established in men, for both primary and secondary prevention. However, the same has not been shown for women. While studies have demonstrated benefit in women for secondary prevention, their role in primary prevention of cardiovascular disease remains con...
Source: Current Atherosclerosis Reports - January 18, 2016 Category: Cardiology Source Type: research

Dual Antiplatelet Therapy in Patients with Stable Ischemic Heart Disease
Abstract Dual antiplatelet therapy (DAPT) is the use of a P2Y12 receptor antagonist (clopidogrel, prasugrel, or ticagrelor) in combination with aspirin. Recommendations for its use are primarily in patients who have experienced acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI) in the preceding 12 months. There is a growing body of evidence, however, investigating the use of long-duration DAPT in patients with stable ischemic heart disease (SIHD). SIHD is defined as clinical evidence of ischemic heart disease, without an ACS event in the preceding 12 months, and includes patients ...
Source: Current Atherosclerosis Reports - January 12, 2016 Category: Cardiology Source Type: research

Aspirin for the Primary Prevention of Cardiovascular Disease: In Need of Clarity
Abstract Aspirin remains one of the most extensively studied cardiovascular medications in the history of medicine. However, despite multiple, well-designed, large randomized controlled trials evaluating the potential of aspirin to prevent cardiovascular events in individuals without known cardiovascular disease (CVD), the role of aspirin in primary prevention is currently unclear. The initial aspirin trials included largely low-risk individuals with primary outcomes mostly focused on myocardial infarction (MI) and stroke, and showed a significant reduction in these CVD outcomes, especially MI. The more recently ...
Source: Current Atherosclerosis Reports - January 11, 2016 Category: Cardiology Source Type: research

The Link Between Inflammatory Disorders and Coronary Heart Disease: a Look at Recent Studies and Novel Drugs in Development
Abstract Inflammation is a critical component in the development of coronary heart disease (CHD), specifically in the process of atherogenesis. Human translational and preclinical studies have demonstrated that inflammation contributes to the development, sustainment, and progression of atherosclerosis, and epidemiological studies demonstrate that human diseases associated with increased systemic inflammation increase the risk of CHD-related events. Therefore, over the last decade, multiple clinical studies were designed to target the inflammatory cascade in order to reduce the risk of CHD and to identify which p...
Source: Current Atherosclerosis Reports - January 6, 2016 Category: Cardiology Source Type: research

HDL Cholesterol Efflux Capacity: Cardiovascular Risk Factor and Potential Therapeutic Target
Abstract Low high-density lipoprotein cholesterol (HDL-C) levels are associated with incident cardiovascular events; however, many therapies targeting increases in HDL-C have failed to show consistent clinical benefit. Thus, focus has recently shifted toward measuring high-density lipoprotein (HDL) function. HDL is the key mediator of reverse cholesterol transport, the process of cholesterol extraction from foam cells, and eventual excretion into the biliary system. Cholesterol efflux from peripheral macrophages to HDL particles has been associated with atherosclerosis in both animals and humans. We review the me...
Source: Current Atherosclerosis Reports - December 29, 2015 Category: Cardiology Source Type: research

The Link Between Obstructive Sleep Apnea and Cardiovascular Disease
Abstract Obstructive sleep apnea (OSA) is common in the general population and highly prevalent in patients with cardiovascular disease. In this paper, we review (1) the pathophysiological mechanisms of OSA that may causally contribute to cardiovascular disease; (2) current evidence regarding the association between OSA and hypertension, stroke, ischemic heart disease, heart failure, atrial fibrillation, and cardiovascular mortality; and (3) the impact of continuous positive airway pressure (CPAP) treatment on cardiovascular risk factors and outcomes. We emphasize the importance of obesity as a comorbidity of OSA...
Source: Current Atherosclerosis Reports - December 28, 2015 Category: Cardiology Source Type: research

All-Cause and Cause-Specific Mortality Associated with Bariatric Surgery: A Review
Abstract The question of whether or not nonsurgical intentional or voluntary weight loss results in reduced mortality has been equivocal, with long-term mortality following weight loss being reported as increased, decreased, and not changed. In part, inconsistent results have been attributed to the uncertainty of whether the intentionality of weight loss is accurately reported in large population studies and also that achieving significant and sustained voluntary weight loss in large intervention trials is extremely difficult. Bariatric surgery has generally been free of these conflicts. Patients voluntarily unde...
Source: Current Atherosclerosis Reports - October 26, 2015 Category: Cardiology Source Type: research

Novel Approaches to Targeting Visceral and Hepatic Adiposities in HIV-Associated Lipodystrophy
Abstract Visceral and hepatic adiposities have been associated with both cardiovascular and liver disease and are of concern in HIV-infected persons in the modern era of combination antiretroviral therapy (ART). The development of therapeutic targets to reduce visceral and hepatic adiposities in HIV-infected persons has been slow, because of early reports that attributed the excess adiposity to specific antiretroviral drugs. Visceral adiposity was initially thought to occur as part of a protease inhibitor-induced “HIV-associated lipodystrophy syndrome.” Subsequent studies show that visceral adiposity ...
Source: Current Atherosclerosis Reports - October 22, 2015 Category: Cardiology Source Type: research

Advances in the Detection and Monitoring of Atrial Fibrillation for Patients with Cryptogenic Ischemic Stroke
Abstract Atrial fibrillation (AF) is a significant etiologic cause of acute ischemic stroke (AIS) that leads to disabling deficits as well as significant morbidity and mortality in this population. Approximately 25 % of AIS is considered to be cryptogenic with no etiology ascertained at the time of the index event. Recent advances from the EMBRACE and CRYSTAL-AF trial have improved detection and treatment of AF and subsequently lead to changes in guidelines. However, with improved detection rates, the duration and frequency cutoffs for treating AF are currently being investigated to ensure optimization of pa...
Source: Current Atherosclerosis Reports - October 21, 2015 Category: Cardiology Source Type: research

Role of Ezetimibe in Lipid-Lowering and Cardiovascular Disease Prevention
Abstract With the goal of decreasing low-density cholesterol (LDL-C) to mitigate risk of both primary and secondary cardiovascular outcomes, statins have been the cornerstone of therapy, significantly reducing the incidence of coronary atherosclerotic vascular disease. Previous studies suggest that adding other non-statin LDL-lowering agents may further lower LDL-C without negative side effects. Recent guidelines support the hypothesis that driving the LDL-C level below previously recommended targets may have a beneficial effect. Ezetimibe, a cholesterol absorption blocker that inhibits the Niemann-Pick C1-Like 1...
Source: Current Atherosclerosis Reports - October 21, 2015 Category: Cardiology Source Type: research

MicroRNA Biomarkers for Coronary Artery Disease?
Abstract MicroRNA (miRNA, miR) measurements in patients with coronary heart disease are hampered by the confounding effects of medication commonly used in cardiovascular patients such as statins, antiplatelet drugs, and heparin administration. Statins reduce the circulating levels of liver-derived miR-122. Antiplatelet medication attenuates the release of platelet-derived miRNAs. Heparin inhibits the polymerase chain reactions, in particular the amplification of the exogenous Caenorhabditis elegans spike-in control, thereby resulting in an artefactual rise of endogenous miRNAs. As these limitations have not been ...
Source: Current Atherosclerosis Reports - October 21, 2015 Category: Cardiology Source Type: research

Statin Intolerance: the Clinician’s Perspective
Abstract Muscle problems and other adverse symptoms associated with statin use are frequent reasons for non-adherence and discontinuation of statin therapy, which results in inadequate control of hyperlipidemia and increased cardiovascular risk. However, most patients who experience adverse symptoms during statin use are able to tolerate at least some degree of statin therapy. Given the profound cardiovascular benefits derived from statins, an adequate practical approach to statin intolerance is, therefore, of great clinical importance. Statin intolerance can be defined as the occurrence of myalgia or other adver...
Source: Current Atherosclerosis Reports - October 21, 2015 Category: Cardiology Source Type: research

Fibrinolysis for Acute Care of Pulmonary Embolism in the Intermediate Risk Patient
Abstract Controversy over the role of fibrinolysis in patients with intermediate-risk pulmonary embolism (PE) has persisted because of the lack of adequately sized trials. The PEITHO study now allows a more precise estimate of the risk to benefit ratio of fibrinolysis in these patients. This trial enrolled patients with intermediate-risk PE who were randomized to receive heparin with either tenecteplase or placebo. Fibrinolysis was associated with a significant reduction in the combined end-point of death or hemodynamic decompensation, but also with a significant increase in the risk of major bleeding. The primar...
Source: Current Atherosclerosis Reports - October 20, 2015 Category: Cardiology Source Type: research

Paroxysmal Atrial Fibrillation in Cryptogenic Stroke: an Overlooked Explanation?
Abstract Approximately one third of ischemic strokes are labeled cryptogenic because the etiology is unknown despite a thorough evaluation. Paroxysmal atrial fibrillation carries the same risk of ischemic stroke as persistent atrial fibrillation and has increasingly gained attention as a potential source of cryptogenic stroke. Recent trials utilizing long-term cardiac monitoring devices have demonstrated high rates of previously undetected paroxysmal atrial fibrillation in patients with cryptogenic stroke. Newly detected atrial fibrillation has subsequently changed treatment and increased the use of oral anticoag...
Source: Current Atherosclerosis Reports - October 20, 2015 Category: Cardiology Source Type: research

Surgical Strategies for Management of Mitral Regurgitation: Recent Evidence from Randomized Controlled Trials
Abstract In contrast to mitral regurgitation (MR) caused by structural abnormality of the valve (“primary” MR), about which there is increasing consensus regarding treatment, there is increasing controversy around the management of functional or “secondary” MR, of which “ischemic mitral regurgitation” (IMR) is a common cause. While the trend in the management of primary MR is increasingly aggressive, with wide agreement on the preference for repair over replacement such that debate centers on earlier and earlier repair even among asymptomatic patients, the situation is reversed...
Source: Current Atherosclerosis Reports - October 20, 2015 Category: Cardiology Source Type: research

Role of Endovascular Closure of the Left Atrial Appendage in Stroke Prevention for Atrial Fibrillation
Abstract The pathophysiologic mechanism of thromboembolic stroke in the setting of non-valvular atrial fibrillation (AF) resides in the left atrial appendage (LAA). In this setting, approximately 90 % of all strokes originate from this structure. Percutaneous left atrial appendage occlusion (LAAO) therapy has recently emerged as an important strategy for prevention of stroke and systemic embolism in patients with non-valvular AF. Systemic anticoagulation therapy in this AF population, while effective, is associated with a significant bleeding risk, drug compliance issues, and limited reversal strategies. In ...
Source: Current Atherosclerosis Reports - September 26, 2015 Category: Cardiology Source Type: research

Spironolactone for Management of Heart Failure with Preserved Ejection Fraction: Whither to After TOPCAT?
Abstract Mineralocorticoid receptor antagonists (MRAs) represent an attractive class of drugs for the treatment of heart failure with preserved ejection fraction (HFpEF) because of the deleterious cardiovascular effects of aldosterone and because MRAs combat myocardial fibrosis and improve cardiac structure/function and vascular health. Recently, the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) study, a randomized, double-blind clinical trial of spironolactone versus placebo, was conducted in 3445 patients with symptomatic HFpEF. Although considered by some to be a...
Source: Current Atherosclerosis Reports - September 26, 2015 Category: Cardiology Source Type: research

Continuation of Dual-Antiplatelet Therapy Following Percutaneous Revascularization with a Drug-Eluting Stent: What Duration Is Optimal?
Abstract Dual-antiplatelet therapy (DAPT) is required after percutaneous coronary intervention with drug-eluting stents (DESs) to prevent thrombotic complications, particularly stent thrombosis (ST). However, there is still disagreement regarding the optimal duration of DAPT post-DES placement. Compared to bare metal stents, DESs are known to reduce restenosis and target vessel revascularization but may be more prone to late and very late ST due to delayed endothelialization. Several trials have suggested that longer (>12 months) DAPT reduces ischemic events but does so at the cost of increased bleeding. ...
Source: Current Atherosclerosis Reports - September 23, 2015 Category: Cardiology Source Type: research

Impact of Continuous Positive Airway Pressure on Cardiovascular Risk Factors in High-Risk Patients
Abstract Cardiovascular disease remains the leading cause of morbidity and mortality in developed countries. Obstructive sleep apnea is a highly prevalent condition characterized by repetitive upper airway collapse during sleep. A large body of evidence suggests that obstructive sleep apnea is associated with the development of cardiovascular disease and increased cardiovascular morbidity and mortality. Continuous positive airway pressure (CPAP) is the current gold standard for the treatment of obstructive sleep apnea. CPAP devices maintain upper airway patency using a pneumatic splint, thereby ameliorating the r...
Source: Current Atherosclerosis Reports - September 14, 2015 Category: Cardiology Source Type: research

Changes in Reward after Gastric Bypass: the Advantages and Disadvantages
Abstract Gastric bypass surgery is an effective long-term weight loss intervention. Key to its success appears a putative shift in food preference away from high-energy-density foods associated with a reduced appetitive drive and loss of neural reactivity in the reward system of the brain towards food. Post-prandial exaggerated satiety gut hormone responses have been implicated as mediators. Whilst the positive impact of bariatric surgery on both physical and psychological outcomes for many patients is clearly evident, a subset of patients appear to be detrimentally affected by this loss of reward from food and b...
Source: Current Atherosclerosis Reports - September 10, 2015 Category: Cardiology Source Type: research

ApoA-I-Directed Therapies for the Management of Atherosclerosis
Abstract Several recent reports have raised doubts about the atheroprotective role of high-density lipoprotein cholesterol (HDL-C). Nevertheless, a substantial body of work supports the validity of pharmacological interventions able to enhance HDL function, as opposed to raising HDL-C levels per se. In this article, we briefly review the development of pharmacological interventions that target apoA-I and HDL function as a means of reducing atherosclerotic risk: small molecule pharmaceuticals, small HDL mimetic peptides, and infusion of apoA-I-containing particles. (Source: Current Atherosclerosis Reports)
Source: Current Atherosclerosis Reports - September 3, 2015 Category: Cardiology Source Type: research

Clinical Management of Type 2 Diabetes Mellitus after Bariatric Surgery
Abstract Bariatric surgery has emerged as an effective treatment for type 2 diabetes in the setting of obesity, with recent clinical trials demonstrating biochemical remission (i.e., euglycemia) in up to 40 % of subjects at 3 years post-surgery. Conversely, these trials also highlight that a significant proportion of individuals undergoing bariatric surgery experience residual diabetes (i.e., they do not achieve remission or experience diabetes recurrence). The management of residual diabetes following surgery requires personalized attention, yet limited evidence exists on which to base clinical decisio...
Source: Current Atherosclerosis Reports - August 24, 2015 Category: Cardiology Source Type: research

The Obese Brain—Effects of Bariatric Surgery on Energy Balance Neurocircuitry
Abstract Obesity is a highly prevalent disease in the world and with a major impact on global health. While genetic components are also involved in its pathogenesis, in recent years, it has shown a critical role of the innate and adaptive immune cell response in many tissues triggered by excess of nutrients such as lipids and glucose. Free fatty acids and other nutrient-related signals induce damage such as insulin resistance in the peripheral tissues but also in the brain. Specifically in the hypothalamus, these metabolic signals can trigger significant changes in the control of energy balance. Recent studies ha...
Source: Current Atherosclerosis Reports - August 24, 2015 Category: Cardiology Source Type: research

Metabolic Surgery in Type 2 Diabetes: Roux-en-Y Gastric Bypass or Sleeve Gastrectomy as Procedure of Choice?
Abstract In recent years, a marked increase in the relative use of sleeve gastrectomy (SG) has occurred. However, long-term head-to-head comparison of the impact of this bariatric surgery (BS) procedure with the still considered “gold standard” Roux-en-Y gastric bypass (GBP) in subjects with type 2 diabetes mellitus (T2DM) is surprisingly low. The aim of this review manuscript is to appraise current evidence on the potential of GBP and SG as long-term therapeutic tool for subjects with T2DM. In our opinion, unfortunately, review of current literature does not allow to properly answer which of the two ...
Source: Current Atherosclerosis Reports - August 24, 2015 Category: Cardiology Source Type: research

Catheter-based Renal Artery Denervation for Resistant Hypertension: Promise Unfulfilled or Unsettled?
Abstract Resistant hypertension affects approximately 10–15 % of the hypertensive population and is associated with an increased occurrence of adverse cardiovascular outcomes. Recently, renal denervation (RDN) has emerged as a novel, non-pharmacologic therapy for resistant hypertension that is designed to ablate the sympathetic nerves distributed around the renal arteries, thus diminishing sympathetic nervous system activity and its influence on hypertension. RDN appeared to have a powerful BP-lowering effect in early clinical trials. However, a pivotal follow-up trial, SYMPLICITY HTN-3, showed no addi...
Source: Current Atherosclerosis Reports - August 19, 2015 Category: Cardiology Source Type: research

A Review on Carotid Ultrasound Atherosclerotic Tissue Characterization and Stroke Risk Stratification in Machine Learning Framework
Abstract Cardiovascular diseases (including stroke and heart attack) are identified as the leading cause of death in today’s world. However, very little is understood about the arterial mechanics of plaque buildup, arterial fibrous cap rupture, and the role of abnormalities of the vasa vasorum. Recently, ultrasonic echogenicity characteristics and morphological characterization of carotid plaque types have been shown to have clinical utility in classification of stroke risks. Furthermore, this characterization supports aggressive and intensive medical therapy as well as procedures, including endarterectomy ...
Source: Current Atherosclerosis Reports - August 2, 2015 Category: Cardiology Source Type: research

How Durable Are the Effects After Metabolic Surgery?
Abstract Bariatric surgery was initially developed as a tool for weight reduction only, but it is gaining popularity because of its remarkable effect on glucose metabolism in morbidly obese and less obese patients. Recent publications have shown the superiority of metabolic surgery over medical treatment for diabetes, creating a new field of clinical research that is currently overflowing in the medical community with outstanding high-quality data. Metabolic surgery is effective in treating diabetes, even in non-morbidly obese patients. (Source: Current Atherosclerosis Reports)
Source: Current Atherosclerosis Reports - August 2, 2015 Category: Cardiology Source Type: research

Bariatric and Metabolic Surgery in Adolescents: a Path to Decrease Adult Cardiovascular Mortality
Abstract Obesity is a major health problem across all age groups and has escalated to pandemic proportions. The proportion of children with overweight or obesity has risen rapidly over recent decades, and it is recognized that most obese children become obese adults. Furthermore, BMI is the strongest CV risk factor to track from childhood into adulthood. As well as BMI, multiple CV risk factors begin in childhood and strong associations between these factors and BMI are evident. Clear evidence exists for the CV benefits of reversing obesity in adults, much of which examines the effects of bariatric surgery. The c...
Source: Current Atherosclerosis Reports - July 25, 2015 Category: Cardiology Source Type: research

Role of Fractional-Flow Reserve in Guiding Percutaneous Revascularization in Stable Coronary Artery Disease
Abstract Optimal medical therapy unarguably forms the cornerstone of management for patients with stable coronary artery disease. There is, however, a significant body of evidence suggesting that reduction of ischemia can be achieved more effectively with revascularization than medical therapy and can confer significant symptomatic and prognostic advantages. Nonetheless, owing to limitations of coronary angiography and conventional non-invasive functional testing for myocardial ischemia, targeting of hemodynamically significant coronary stenoses for revascularization is often difficult. We discuss the role of inv...
Source: Current Atherosclerosis Reports - July 23, 2015 Category: Cardiology Source Type: research

Use of Heparin in Acute Ischemic Stroke: Is There Still a Role?
Abstract Heparin has long been a contested therapy in acute ischemic stroke (AIS). In current practice, heparin is considered on a case-by-case basis, but there is no consensus as to the appropriate timing of anticoagulation or for which ischemic stroke subtypes heparin may be beneficial. To provide better clarity on this issue, we review current research focusing on the use of heparin in AIS in each stroke subtype and subsequently make recommendations to provide readers with a systematic approach to managing complex stroke patients for which acute anticoagulation may be valuable. We conclude that there are certa...
Source: Current Atherosclerosis Reports - July 20, 2015 Category: Cardiology Source Type: research

Imaging Acute Ischemic Stroke: Mapping Present and Future Clinical Practice
Abstract Imaging is an increasingly key component of advances in stroke care. Its role in the success of multiple recently reported trials that have now driven new standards of practice highlights its expanding importance in acute stroke management. With significant gains already realized, routine practice only stands to benefit further from additional advances in imaging in the future. The degree to which imaging will impact stroke care, however, is uncertain and complex: multiple aspects of stroke research and its translation into updated practice contribute to it. In this article, a few of these critical issue...
Source: Current Atherosclerosis Reports - July 16, 2015 Category: Cardiology Source Type: research

Sex-Specific Disparities in Risk Factors for Coronary Heart Disease
Abstract In the past two decades, focused research on women at risk for cardiovascular disease (CVD) has helped to clarify our understanding of some of the sex-specific factors that are important in the prevention and early detection of coronary atherosclerosis with a resultant 30 % decrease in the number of women dying from CVD. In spite of these advances, CVD, specifically, ischemic heart disease due to coronary atherosclerosis is the leading cause of cardiovascular death of women in the USA. The 2010 landmark Institute of Medicine (IOM) report, “Women’s Health Research—Progress, Pitfalls...
Source: Current Atherosclerosis Reports - June 26, 2015 Category: Cardiology Source Type: research

Stenting in Intracranial Stenosis: Current Controversies and Future Directions
Abstract Angioplasty and stenting for intracranial atherosclerotic stenosis (ICAS) are a last resort for patients with high-grade intracranial stenosis with multiple ischemic events unresponsive to medical therapy. Medical management, consisting of aggressive risk factor control and dual antiplatelet therapy, is superior to angioplasty and stenting for the prevention of future stroke. Future studies of angioplasty and stenting in this population are important, as the stroke risk on medical therapy is 12 % at 1 year and post-procedure stroke rates are similar to rates with medical treatment. There are ma...
Source: Current Atherosclerosis Reports - June 25, 2015 Category: Cardiology Source Type: research

Anticoagulation for Atrial Fibrillation in Patients with Cerebral Microbleeds
Abstract Intracranial haemorrhage (ICH) is the most feared and devastating complication of oral anticoagulation, with high mortality and disability in survivors. Oral anticoagulant-related ICH is increasing in incidence, most likely in part due to the increased use of anticoagulation for atrial fibrillation in the elderly populations with a high prevalence of bleeding-prone cerebral small vessel diseases. Risk scores have been developed to predict bleeding, including ICH, as well as the risk of ischaemic stroke. Recently, attention has turned to brain imaging, in particular, MRI detection of potential prognostic ...
Source: Current Atherosclerosis Reports - June 21, 2015 Category: Cardiology Source Type: research