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Hypertension and stroke: an appraisal of the evidence and implications for clinical management.
Authors: Lackland DT, Voeks JH, Boan AD Abstract While elevated blood pressure has long been associated with cardiovascular and renal outcomes, the association of hypertension and increased stroke risks is perhaps the strongest and best recognized. Furthermore, the reduction of blood pressure with antihypertensive agents has been well documented with lower stroke risks. The specific recommendations for high blood pressure management for stroke prevention have been somewhat unclear due to the study design and the quality of the evidence based on clinical study results. Further complicating the assessment process is ...
Source: Expert Review of Cardiovascular Therapy - February 17, 2016 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

A focus on inflammation as a major risk factor for atherosclerotic cardiovascular diseases.
Authors: Gregersen I, Holm S, Dahl TB, Halvorsen B, Aukrust P Abstract Atherosclerosis is a dynamic, pathogenic process in the artery wall, with potential adverse outcome for the host. Acute events such as myocardial infarction and ischemic stroke often result from rupture of unstable atherosclerotic lesions. Understanding the underlying pathology of such lesions and why and when they rupture, is therefore of great interest for the development of new diagnostics and treatment. Inflammation is one of the key drivers of atherosclerotic plaque development and the interplay between inflammation and lipids constitutes t...
Source: Expert Review of Cardiovascular Therapy - February 17, 2016 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Antithrombotic therapy following transcatheter aortic valve implantation: what challenge do we face?
Authors: Barbanti M, Gulino S, Tamburino C, Capodanno D Abstract The issue of stroke and bleeding events following transcatheter aortic valve implantation (TAVI) and its relation with antithrombotic regimens before, during and after the procedure is increasingly recognized as an important issue. While dedicated trials are ongoing, there is no clear evidence at present on the best antithrombotic regimen in the context of TAVI. In this article, we will go through the mechanisms involved in embolic and bleeding complications of TAVI, and we will discuss the key aspects of antithrombotic treatment in patients undergoin...
Source: Expert Review of Cardiovascular Therapy - February 17, 2016 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Vorapaxar in the secondary prevention of atherothrombosis.
Authors: Tantry US, Liu F, Chen G, Gurbel PA Abstract Dual antiplatelet therapy with aspirin, a platelet cyclooxygenase-1 inhibitor and P2Y12 receptor blockers, remains the major drug strategy to prevent ischemic event occurrence in patients with acute coronary syndromes and in patients undergoing coronary stenting, but there some limitations that can be overcome by targeting novel targets. Unlike direct thrombin inhibitors that bind directly to thrombin, targeting the platelet thrombin receptor, protease activated receptor (PAR)-1, may offer a better choice for the attenuation of atherosclerosis progression, throm...
Source: Expert Review of Cardiovascular Therapy - February 17, 2016 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Reducing periprocedural complications in transcatheter aortic valve replacement: review of paravalvular leaks, stroke and vascular complications.
Authors: Paradis JM, Altisent OA, RodÉs-Cabau J Abstract Transcatheter aortic valve replacement has been established as the standard of care for inoperable patients and a valid alternative for high-risk individuals with severe symptomatic native aortic stenosis. Over the last decade, substantial improvement has been made in the transcatheter technology. Nevertheless, this less-invasive procedure is still associated with complications like paravalvular leaks, strokes and vascular complications. This review article discusses these worrisome complications associated with transcatheter aortic valve replacement and pro...
Source: Expert Review of Cardiovascular Therapy - February 17, 2016 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Developments in the management of Chagas cardiomyopathy.
Authors: Tanowitz HB, Machado FS, Spray DC, Friedman JM, Weiss OS, Lora JN, Nagajyothi J, Moraes DN, Garg NJ, Nunes MC, Ribeiro AL Abstract Over 100 years have elapsed since the discovery of Chagas disease and there is still much to learn regarding pathogenesis and treatment. Although there are antiparasitic drugs available, such as benznidazole and nifurtimox, they are not totally reliable and often toxic. A recently released negative clinical trial with benznidazole in patients with chronic Chagas cardiomyopathy further reinforces the concerns regarding its effectiveness. New drugs and new delivery systems, incl...
Source: Expert Review of Cardiovascular Therapy - February 17, 2016 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

The potential role of the left atrial septal pouch in cryptogenic stroke.
Authors: Wong JM, Fisher M Abstract The left atrial septal pouch (LASP) is an anatomic variant of the atrial septum that forms a blind-ending pouch, communicating exclusively with the left atrium (LA). Case reports have demonstrated thrombus within LASP and in the setting of cryptogenic stroke. Initial epidemiologic results are mixed, one study showing and others not showing an association between LASP and cryptogenic stroke. Additional investigation should take place to determine the clinical significance of LASP and what interventions are required to prevent ischemic stroke in at-risk individuals. PMID: 2648...
Source: Expert Review of Cardiovascular Therapy - February 17, 2016 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Evaluating coagulation tests in patients with atrial fibrillation using direct oral anticoagulants.
Authors: Chan NC, Bhagirath V, Dale BJ, Eikelboom JW Abstract Four direct oral anticoagulants (dabigatran, rivaroxaban, apixaban, edoxaban) have been shown to be at least as effective and safe as warfarin for the prevention of stroke in atrial fibrillation and the prevention and treatment of venous thromboembolism. Although they are administered in fixed doses without routine coagulation monitoring, measurement of anticoagulant effect or drug levels may be useful to determine if: anticoagulant effect is present in patients who are bleeding or require an urgent procedure or thrombolysis; levels are within usual on-t...
Source: Expert Review of Cardiovascular Therapy - February 17, 2016 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Composite end point analyses of non-vitamin K antagonist oral anticoagulants compared with warfarin in patients with atrial fibrillation.
CONCLUSION: Generally, NOACs were associated with a more favorable efficacy and safety profile compared with warfarin with regard to composite end points. PMID: 26401923 [PubMed - in process]
Source: Expert Review of Cardiovascular Therapy - February 17, 2016 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Time is brain: an update.
Authors: Naylor AR Abstract The '6-month' threshold for treating symptomatic patients is obsolete. There is compelling evidence that the highest-risk period for stroke (after suffering a transient ischemic attack) is the first 2 weeks, especially the first few days, and that carotid endarterectomy (CEA) confers maximal benefit when performed early. Despite well-documented anxieties, there is increasing evidence that CEA can be performed safely within the first 7 days after onset of symptoms, although risks may be higher when performed within 48 h. The role for carotid artery stenting in the hyperacute period remain...
Source: Expert Review of Cardiovascular Therapy - February 17, 2016 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Imaging of prehospital stroke therapeutics.
Authors: Lin MP, Sanossian N, Liebeskind DS Abstract Despite significant quality improvement efforts to streamline in-hospital acute stroke care in the conventional model, there remain inherent layers of treatment delays, which could be eliminated with prehospital diagnostics and therapeutics administered in a mobile stroke unit. Early diagnosis using telestroke and neuroimaging while in the ambulance may enable targeted routing to hospitals with specialized care, which will likely improve patient outcomes. Key clinical trials in telestroke, mobile stroke units with prehospital neuroimaging capability, prehospital ...
Source: Expert Review of Cardiovascular Therapy - February 17, 2016 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Imaging of prehospital stroke therapeutics
Expert Review of Cardiovascular Therapy, Ahead of Print.
Source: Expert Review of Cardiovascular Therapy - August 6, 2015 Category: Cardiology Tags: article Source Type: research

Left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation
Expert Review of Cardiovascular Therapy, Ahead of Print.
Source: Expert Review of Cardiovascular Therapy - June 14, 2015 Category: Cardiology Tags: article Source Type: research

Prevention and management of stroke in women
Expert Review of Cardiovascular Therapy, Ahead of Print.
Source: Expert Review of Cardiovascular Therapy - March 8, 2015 Category: Cardiology Tags: article Source Type: research

Population-based approaches for reducing stroke risk
Expert Review of Cardiovascular Therapy, Ahead of Print.
Source: Expert Review of Cardiovascular Therapy - November 29, 2014 Category: Cardiology Tags: article Source Type: research

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