Racial disparities in Coronavirus Disease 2019 (COVID-19) outcomes
Purpose of review
The Coronavirus Disease 2019 (COVID-19) pandemic has exposed preexisting racial disparities in the healthcare system. This review discusses racial-ethnic differences in COVID-19 related outcomes with an emphasis on the social determinants of health that are responsible for these disparities.
Recent findings
Higher hospitalizations and deaths have been reported amongst minority individuals after a COVID-19 infection. Cardiovascular disease and its risk factors are also more common in minority populations and negatively impact clinical outcomes after a COVID-19 illness. The racial disparities see...
Source: Current Opinion in Cardiology - April 16, 2021 Category: Cardiology Tags: CARDIAC FAILURE: Edited by Rebecca Cogswell and Gene Kim Source Type: research
Racial differences in outcomes after receiving advanced heart failure therapies
Purpose of review
Despite advances in medical and device-based therapies for advanced heart failure as well as public policy, disparities by race/ethnicity persist in heart failure clinical outcomes. The purpose of this review is to describe disparities in outcomes by race--ethnicity in patients after receipt of heart transplantation and left ventricular assist device (LVAD), and the current understanding of factors contributing to these disparities.
Recent findings
The proportion of black and Latinx patients receiving advanced heart failure therapies continues to rise, and they have worse hemodynamic profiles a...
Source: Current Opinion in Cardiology - April 16, 2021 Category: Cardiology Tags: CARDIAC FAILURE: Edited by Rebecca Cogswell and Gene Kim Source Type: research
Are the current evaluation tools for advanced therapies biased?
Purpose of review
Despite attention to racial disparities in outcomes for heart failure (HF) and other chronic diseases, progress against these inequities has been gradual at best. The disparities of COVID-19 and police brutality have highlighted the pervasiveness of systemic racism in health outcomes. Whether racial bias impacts patient access to advanced HF therapies is unclear.
Recent findings
As documented in other settings, racial bias appears to operate in HF providers’ consideration of patients for advanced therapy. Multiple medical and psychosocial elements of the evaluation process are particularly vu...
Source: Current Opinion in Cardiology - April 16, 2021 Category: Cardiology Tags: CARDIAC FAILURE: Edited by Rebecca Cogswell and Gene Kim Source Type: research
Disparities in acute decompensated heart failure
Purpose of review
The aim of this review is to discuss racial and sex disparities in the management and outcomes of patients with acute decompensated heart failure (ADHF).
Recent findings
Race and sex have a significant impact on in-hospital admissions and overall outcomes in patients with decompensated heart failure and cardiogenic shock. Black patients not only have a higher incidence of heart failure than other racial groups, but also higher admissions for ADHF and worse overall survival, while women receive less interventions for cardiogenic shock complicating acute myocardial infarction. Moreover, White pat...
Source: Current Opinion in Cardiology - April 16, 2021 Category: Cardiology Tags: CARDIAC FAILURE: Edited by Rebecca Cogswell and Gene Kim Source Type: research
Representation of Black patients in heart failure clinical trials
Purpose of review
Black patients with heart failure in the United States are underrepresented in clinical trials relative to their overrepresentation in the heart failure population and in adverse heart failure outcomes. We aim to evaluate historical trends in this space and highlight recent developments.
Recent findings
Multiple landmark heart failure trials published since 2019 have underrepresented Black patients, though several discussed this lack of representation as limitations. A review of large heart failure clinical trials from 2001 to 2016 found persistent underrepresentation of Black patients without ...
Source: Current Opinion in Cardiology - April 16, 2021 Category: Cardiology Tags: CARDIAC FAILURE: Edited by Rebecca Cogswell and Gene Kim Source Type: research
Racial and ethnic disparities in heart failure: current state and future directions
Purpose of review
This review discusses the current state of racial and ethnic inequities in heart failure burden, outcomes, and management. This review also frames considerations for bridging disparities to optimize quality heart failure care across diverse communities.
Recent findings
Treatment options for heart failure have diversified and overall heart failure survival has improved with the advent of effective pharmacologic and nonpharmacologic therapies. With increased recognition, some racial/ethnic disparity gaps have narrowed whereas others in heart failure outcomes, utilization of therapies, and advance...
Source: Current Opinion in Cardiology - April 16, 2021 Category: Cardiology Tags: CARDIAC FAILURE: Edited by Rebecca Cogswell and Gene Kim Source Type: research
Editorial: A call to action: let's work together to end racial disparities in heart failure
No abstract available (Source: Current Opinion in Cardiology)
Source: Current Opinion in Cardiology - April 16, 2021 Category: Cardiology Tags: CARDIAC FAILURE: Edited by Rebecca Cogswell and Gene Kim Source Type: research
Clinical approach to genetic testing in amyloid cardiomyopathy: from mechanism to effective therapies
Purpose of review
To highlight the evolving understanding of genetic variants, utility of genetic testing, and the selection of novel therapies for cardiac amyloidosis.
Recent findings
The last decade has seen considerable progress in cardiac amyloidosis recognition given the advancement in cardiac imaging techniques and widespread availability of genetic testing. A significant shift in the understanding of a genetic basis for amyloidosis has led to the development of disease-modifying therapeutic strategies that improve survival.
Summary
The systemic amyloidoses are disorders caused by extracellular depo...
Source: Current Opinion in Cardiology - April 16, 2021 Category: Cardiology Tags: MOLECULAR GENETICS: Edited by Ali J. Marian Source Type: research
The genetics of left ventricular noncompaction
This article summarises current understanding of the genetic architecture underpinning left ventricular noncompaction (LVNC) and highlights the difficulty in differentiating LVNC from hypertrabeculation seen in normal, healthy individuals, that caused by physiological adaptation or that seen in association with cardiomyopathy phenotypes.
Recent findings
Progress has been made in better defining the LVNC phenotype and those patients who may benefit from genetic testing. Yield of diagnostic genetic testing may be low in the absence of syndromic features, systolic dysfunction and a family history of cardiomyopathy. Sar...
Source: Current Opinion in Cardiology - April 16, 2021 Category: Cardiology Tags: MOLECULAR GENETICS: Edited by Ali J. Marian Source Type: research
Emergent expansion of clinical epigenetics in patients with cardiovascular diseases
Purpose of review
Cardiovascular diseases (CVDs) are typically caused by multifactorial events including mutations in a large number of genes. Epigenetic-derived modifications in the cells are normal but can be amended by aging, lifestyle, and exposure to toxic substances. Major epigenetic modifications are DNA methylation, histone modification, chromatin remodeling as well as the noncoding RNAs. These pivotal players are involved in the epigenetic-induced modifications observed during CVDs. Nevertheless, despite impressive efforts capitalized in epigenetic research in the last 50 years, clinical applications are still...
Source: Current Opinion in Cardiology - April 16, 2021 Category: Cardiology Tags: MOLECULAR GENETICS: Edited by Ali J. Marian Source Type: research
Genetics of dilated cardiomyopathy
Purpose of review
Dilated cardiomyopathy (DCM), which include genetic and nongenetic forms, is the most common form of cardiomyopathy. DCM is characterized by left ventricular or biventricular dilation with impaired contraction. In the United States, DCM is a burden to healthcare that accounts for approximately 10,000 deaths and 46,000 hospitalizations annually. In this review, we will focus on the genetic forms of DCM and on recent advances in the understanding of cytoskeletal, sarcomeric, desmosomal, nuclear membrane, and RNA binding genes that contribute to the complexity and genetic heterogeneity of DCM.
Recent ...
Source: Current Opinion in Cardiology - April 16, 2021 Category: Cardiology Tags: MOLECULAR GENETICS: Edited by Ali J. Marian Source Type: research
Genetics of atrial fibrillation
Purpose of review
Atrial fibrillation is the most common sustained cardiac arrhythmia. In addition to traditional risk factors, it is increasingly recognized that a genetic component underlies atrial fibrillation development. This review aims to provide an overview of the genetic cause of atrial fibrillation and clinical applications, with a focus on recent developments.
Recent findings
Genome-wide association studies have now identified around 140 genetic loci associated with atrial fibrillation. Studies into the effects of several loci and their tentative gene targets have identified novel pathways associated ...
Source: Current Opinion in Cardiology - April 16, 2021 Category: Cardiology Tags: MOLECULAR GENETICS: Edited by Ali J. Marian Source Type: research
Contemporary perspectives on the genetics and clinical use of lipoprotein(a) in preventive cardiology
Purpose of review
The pathogenicity of lipoprotein(a) [Lp(a)] as a risk factor for atherosclerotic cardiovascular disease (ASCVD) is well evidenced and recognized by international consensus-based guidelines. However, the measurement of Lp(a) is not routine clinical practice. Therapeutic agents targeting Lp(a) are now progressing through randomised clinical trials, and it is timely for clinicians to familiarize themselves with this complex and enigmatic lipoprotein particle.
Recent findings
Recent developments in the understanding of genetic influences on the structure, plasma concentration and atherogenicity of ...
Source: Current Opinion in Cardiology - April 16, 2021 Category: Cardiology Tags: MOLECULAR GENETICS: Edited by Ali J. Marian Source Type: research
Genetics of hypertriglyceridemia and atherosclerosis
Purpose of review
The relationship between elevated triglyceride levels (i.e. hypertriglyceridemia) and risk of atherosclerotic cardiovascular disease (ASCVD) has been investigated for decades. Recent genetic studies have sought to resolve the decades-old question of a causal relationship.
Recent findings
Genetic studies seem to demonstrate associations between elevated triglyceride levels and ASCVD risk. Mendelian randomization studies suggest this association may be causal. However, simultaneous pleiotropic effects of metabolically linked lipid variables – such as non-HDL cholesterol, apolipoprotein B and HD...
Source: Current Opinion in Cardiology - April 16, 2021 Category: Cardiology Tags: MOLECULAR GENETICS: Edited by Ali J. Marian Source Type: research
RNA therapeutics for cardiovascular disease
Purpose of review
The development of mRNA vaccines against coronavirus disease 2019 has brought worldwide attention to the transformative potential of RNA-based therapeutics. The latter is essentially biological software that can be rapidly designed and generated, with an extensive catalog of applications. This review aims to highlight the mechanisms of action by which RNA-based drugs can affect specific gene targets and how RNA drugs can be employed to treat cardiovascular disease, with the focus on the therapeutics being evaluated in clinical trials. The recent advances in nanotechnology aiding the translation of suc...
Source: Current Opinion in Cardiology - April 16, 2021 Category: Cardiology Tags: MOLECULAR GENETICS: Edited by Ali J. Marian Source Type: research
