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Treatment of Diabetes in Patients with Heart Failure
AbstractPurpose of ReviewThis review aims to summarize and discuss heart failure outcomes for current glucose-lowering agents in patients with type 2 diabetes mellitus.Recent FindingsCurrent regulations require cardiovascular outcomes trials for new glucose-lowering therapies to establish that there is no unacceptable increase in cardiovascular risk prior to approval. These cardiovascular outcomes trials include glucagon-like peptide 1 receptor agonists, dipeptidyl peptidase-4 inhibitors, and sodium-glucose cotransporter-2 inhibitors. Overall, 87,162 patients have been studied in 10 published cardiovascular outcomes trials...
Source: Current Cardiology Reports - August 27, 2018 Category: Cardiology Source Type: research

The Impact of Diet and Lifestyle on Atrial Fibrillation
AbstractPurpose of ReviewAtrial fibrillation (AF) is the most common sustained cardiac arrhythmia in humans, affecting more than 33 million people globally. Its association with complex, resource intensive medical conditions such as stroke, heart failure and dementia have had profound impacts across existing health care structures. The global prevalence of AF has enjoyed significant growth despite significant improvement in our armamentarium for arrhythmia treatment.Recent FindingsEfforts aimed at curtailing the incidence, prevalence, or progression of AF have prompted re-evaluation of traditional frameworks for understand...
Source: Current Cardiology Reports - October 12, 2018 Category: Cardiology Source Type: research

Advances in Antiplatelet and Anticoagulant Therapies for NSTE-ACS
AbstractThe treatment of patients requiring anticoagulation who develop acute coronary syndrome (ACS) and/or require percutaneous coronary intervention (PCI) must balance the reduction in major adverse cardiovascular events, stroke, and major bleeding. The development of direct oral anticoagulants (DOACs) for the treatment of atrial fibrillation has ushered in an era of potential treatment options for these complex patients.Purpose of ReviewTo review the clinical evidence underlying the use of DOACs for the treatment of patients with atrial fibrillation and ACS or PCI.Recent FindingsThree trials studied this particular pat...
Source: Current Cardiology Reports - January 12, 2019 Category: Cardiology Source Type: research

Direct Oral Anticoagulants in Addition to Antiplatelet Therapy for Secondary Prevention after Acute Coronary Syndromes: a Review
AbstractPurpose of ReviewAs the management of acute coronary syndrome (ACS) continues to evolve, many old practices proved to be of a little benefit and other approaches established the new pillars of modern medicine. Treating ACS patients with dual antiplatelet therapy (DAPT) for a year by combining aspirin and a P2Y12 inhibitor (clopidogrel, ticagrelor, or prasugrel) has resulted in better outcomes and is currently the standard of therapy. However, owing to the persistent activation of the coagulation cascade, patients may continue to experience recurrent ischemia and high mortality rates despite compliance with the dual...
Source: Current Cardiology Reports - January 28, 2019 Category: Cardiology Source Type: research

Secondary Prevention with Antithrombotic Therapies in Stable Ischemic Heart Disease Patients: a Review
In conclusion, the evidence thus far has not been significant enough for the American College of Cardiology to recommend the incorporation of oral anticoagulants in the management of stable ischemic heart disease patients, in contrast to aspirin and clopidogrel. As the antithrombotic and antiischemic properties of these newer agents seem evident, so does their potential for increase in risk of bleeding events. Doctors have to individually tailor antithrombotic medication decisions based on the patient ’s risk-benefit profile.
Source: Current Cardiology Reports - May 17, 2019 Category: Cardiology Source Type: research

Can Direct Oral Anticoagulants Be Used for Stroke Prevention Among Patients with Valvular Atrial Fibrillation?
AbstractPurpose of ReviewTo review the clinical evidence underlying the efficacy and safety of the use of direct oral anticoagulants (DOACs) for the treatment of patients with valvular atrial fibrillation (AF).Recent FindingsThe recent focused update to the 2014 AHA/ACC/HRS Atrial Fibrillation Guidelines defines valvular AF as AF in the setting of moderate-to-severe mitral stenosis (MS) and/or in the presence of a mechanical heart valve. Landmark clinical trials of DOACs in patients with AF systematically excluded these patient populations. However, there are trial data in both animals and humans regarding the use of DOACs...
Source: Current Cardiology Reports - August 30, 2019 Category: Cardiology Source Type: research

Current Role of the Total Artificial Heart in the Management of Advanced Heart Failure
AbstractThe total artificial heart (TAH) is a form of mechanical circulatory support that involves resection of the native ventricles followed by placement of a device that can restore total pulmonary and systemic flow. Given the increasing burden of congestive heart failure and cardiovascular disease, the number of people in need of cardiac replacement therapy will continue to grow. Despite aggressive efforts to expand the donor pool, the number of heart transplants in the United States (US) has plateaued at less than 3000 per year. In addition, there is increasing recognition of the long-term complications of current gen...
Source: Current Cardiology Reports - November 21, 2019 Category: Cardiology Source Type: research

The Lotus Valve System: an In-depth Review of the Technology
AbstractPurpose of ReviewInnovation for transcatheter aortic valve replacement (TAVR) has transformed a medically complex treatment into a standardized procedure. While Edwards SAPIEN and Medtronic CoreValve occupy the market for TAVR in the United States (US), additional valve systems are being developed. The Boston Scientific Lotus Valve system was recently FDA-approved and will represent the third valve in the US market. This evidence-based review will summarize advantages, disadvantages, and projected impact of this new TAVR system.Recent FindingsThe Lotus Valve system demonstrates superiority in terms of rates of para...
Source: Current Cardiology Reports - November 24, 2019 Category: Cardiology Source Type: research

Transcarotid Artery Revascularization Results in Low Rates of Periprocedural Neurologic Events, Myocardial Infarction, and Death
AbstractPurpose of ReviewTranscarotid artery revascularization (TCAR) is a novel hybrid procedure that reverses carotid flow and places a stent using surgical access of the carotid artery in the neck under local anesthesia. We discuss the indications for carotid revascularization, the clinical rationale for TCAR, and evidence for its potential role in the management of carotid stenosis.Recent FindingsResults from pre-clinical studies, prospective single-arm studies, and comparative analyses of registry data indicate that TCAR results in low amounts of periprocedural microembolization, cerebral lesions detectable on magneti...
Source: Current Cardiology Reports - January 14, 2020 Category: Cardiology Source Type: research

Diversity of Organism-Wide and Organ-Specific Endothelial Cells
AbstractPurpose of ReviewEndothelial cells are of great importance in many types of diseases including the coronary artery diseases in heart and stroke in brain. In this review, we explore the heterogeneity among endothelial cells from an organism-wide, organ-specific, and healthy versus disease perspective.Recent FindingsRecent studies addressing the cellular heterogeneity between arterial versus venous endothelial cells (ECs) have revealed that arterial ECs have tighter junctions, a decreased immune response, anticoagulant properties while veins have both anticoagulant and procoagulant properties. Blood and lymphatic ECs...
Source: Current Cardiology Reports - February 7, 2020 Category: Cardiology Source Type: research

Can Anticoagulation Be Stopped After Ablation of Atrial Fibrillation?
AbstractyPurpose of ReviewThis review discusses the pros and cons of discontinuing oral anticoagulation therapy (OAT) after catheter ablation of atrial fibrillation (AF), and data from relevant studies, and summarizes the most recent Expert Consensus recommendations on the topic.Recent FindingsPatients with AF are at risk of cerebrovascular embolic events (CVEs) including stroke and transient ischemic attacks. OAT can be effective in preventing CVEs, while catheter ablation is an effective treatment to eliminate AF. Whether OAT can be safely discontinued after successful AF ablation remains a controversial topic. Retrospec...
Source: Current Cardiology Reports - June 18, 2020 Category: Cardiology Source Type: research

What Is New in Low Gradient Aortic Stenosis: Surgery, TAVR, or Medical Therapy?
AbstractBackgroundA significant proportion of patients with aortic stenosis (AS) have discordance in severity by mean gradient/peak velocity and aortic valve area. Low gradient aortic stenosis (LG-AS) is defined when the aortic valve area is<  1 cm2 consistent with severe AS and mean aortic gradient is<  40 mmHg consistent with non-severe AS. LG-AS represents a diagnostic and therapeutic challenge.Purpose of ReviewTo summarize the different categories, diagnosis, management, and prognosis of LG-AS. LG-AS is classified as classical (ejection fraction (EF)<  50%, indexed stroke volume (SVi) <  35 ml/...
Source: Current Cardiology Reports - July 8, 2020 Category: Cardiology Source Type: research

Cardiovascular Effects of Dipeptidyl Peptidase-4 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists: a Review for the General Cardiologist
AbstractPurpose of ReviewResults from cardiovascular (CV) outcome trials have revealed important insights into the CV safety and efficacy of glucose-lowering agents, including dipeptidyl peptidase-4 inhibitors (DPP-4i) and glucagon-like peptide-1 receptor agonists (GLP-1RA).Recent FindingsAmong patients with T2DM, DPP-4i have no significant effect on risk of major adverse CV events (MACE: CV death, myocardial infarction, or stroke) with mixed results regarding risk for heart failure (HF). While sitagliptin and linagliptin have neutral effects on HF risk, saxagliptin significantly increases the risk of HF. The CV safety of ...
Source: Current Cardiology Reports - August 7, 2020 Category: Cardiology Source Type: research

Risks and Benefits of Removal of the Left Atrial Appendage
AbstractPurpose of ReviewIn patients with atrial fibrillation who are unable to take novel oral anticoagulants for stroke prophylaxis due to bleeding risk or other contraindications, left atrial appendage (LAA) occlusion and exclusion devices have shown benefit. In this review, we highlight the risks and benefits associated with LAA removal.Recent FindingsLAA, once considered a vestigial organ, has been shown to have physiological, anatomical, and arrhythmogenic properties. Device-related complications such as pericardial effusion, device embolization, device-related thrombus, while uncommon, are still present. With increa...
Source: Current Cardiology Reports - September 9, 2020 Category: Cardiology Source Type: research

Intensive Care Unit Management of the Adult with Congenital Heart Disease
AbstractPurposeAdults with congenital heart disease (ACHD) are a rapidly growing population with ever-increasing complexity, and intensive care unit (ICU) management is often necessary. This review summarizes common cardiovascular and non-cardiovascular complications in ACHD and provides a framework for ICU care.Recent FindingsHeart failure is the leading cause of hospitalization and mortality in ACHD. Varied anatomy and repairs, as well as differing physiological complications, limit generalized application of management algorithms. Recent studies suggest that earlier mechanical support in advanced cases is feasible and p...
Source: Current Cardiology Reports - September 9, 2020 Category: Cardiology Source Type: research

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