European Heart Journal - Cardiovascular Pharmacotherapy最新文献

Cardiovascular disease (CVD) remains the leading global cause of morbidity and mortality. In addition to traditional risk factors, inflammation is established as a key mechanism in the initiation, progression, and complications of CVD. Elevated inflammatory biomarkers correlate with disease severity and adverse outcomes, prompting the evaluation of anti-inflammatory therapies in several cardiovascular settings. Colchicine has demonstrated potential in reducing cardiovascular events, though recent trial data have raised concerns regarding its overall benefit and optimal application after myocardial infarction. Alternative agents targeting inflammatory pathways-such as monoclonal antibodies against interleukins (e.g. canakinumab, tocilizumab, ziltivekimab)-have shown biological efficacy but are not yet approved for routine clinical use in CVD. Emerging strategies, including immune-modulatory therapies and RNA-based interventions, seek to achieve selective anti-inflammatory effects with reduced immunosuppressive risk. Future approaches will likely adopt personalized, multi-targeted regimens that integrate inflammation control with lipid-lowering and antithrombotic therapies. As evidence accumulates, inflammation may transition from an adjunctive target to a central focus in CVD management.

Aims: Ranolazine (Ran) is an anti-anginal drug inhibiting late sodium current, an action possibly hindering arrhythmias onset. Indeed, some evidence supports the anti-arrhythmic effects of Ran. The aim of this study, which evaluated Italian patients with chronic coronary syndrome (CCS), was to investigate whether Ran, as an add-on therapy, was associated with a lower incidence of atrial fibrillation (AF) compared with no-Ran prescription (No-Ran).

Methods and results: The original population (N = 6.1 million) derived from the databases of the Italian National Health System; information concerned hospitalizations with the related diagnoses, drug therapy, follow-up clinical events and visits. Patients hospitalized between 2011 and 2020 for any cause and discharged with an ICD-9-CM CCS code were studied if AF had not been diagnosed before. The follow-up duration was 4.4 and 5.0 years for the Ran and the No-Ran cohorts, respectively. Study subjects were 171 015 (mean age: 72 years; men: 66%; Ran: N = 22 207; No-Ran: N = 148 808). After propensity score matching, Ran (N = 6384) and No-Ran (N = 25 536) cohorts were similar for age, sex, comorbidities and drug therapy. AF incidence during follow-up was 5.3% and 9.6% in the Ran and in the No-Ran cohorts, respectively, with a 41% drug-related lower risk of arrhythmia development in the Cox model (HR = 0.59, 95% CI: 0.53-0.67, P < 0.001). Also, Ran correlated with reduced incidence of brady-arrhythmias (P = 0.001) and ventricular tachy-arrhythmias (P = 0.049), and with lower mortality (P < 0.001).

Conclusion: Our study, performed in a subset of the Italian CCS population, showed that Ran therapy was safe and associated with a long-term reduced AF incidence.

Type 2 diabetes mellitus typically has the lipid features of elevated trigycerides, reduced HDL-cholesterol (both parts of the metabolic syndrome) and average or slightly elevated LDL-cholesterol. In consequence of hypertriglyceridemia, LDL particles are small and dense and therefore highly atherogenic. Outcome studies reveal that LDL-C lowering drugs have an above-average efficacy in type 2 diabetes as compared with non-diabetic patients. A minor increase of glycaemia in statin trials does not impair the beneficial cardiovascular results. Non-statin lipid lowering drugs do not impair glycaemia. Type 2 diabetes mellitus is now considered a major indication for lipid lowering drugs, thus there is a high value of and no major limitation for those compounds.