Expert Review of Cardiovascular Therapy最新文献

Introduction: Stress-Induced Hyperglycemia (SIH) represents a transient increase in blood glucose levels triggered by acute physiological stress, frequently observed in patients with Acute Coronary Syndrome (ACS). It is linked to adverse outcomes, including higher mortality and an increased risk of Major Adverse Cardiac and Cerebrovascular Events (MACCE). Despite this, SIH remains inadequately defined and underappreciated in clinical risk assessment and patient management.

Areas covered: This narrative review delves into the mechanistic underpinnings of SIH in ACS (neuroendocrine, metabolic and inflammatory pathways). Evidence on current SIH markers [including the Stress-Hyperglycemia Ratio (SHR), Admission Blood Glucose, Glycemic Gap, and Glycemic Variability] was identified through searches of PubMed/MEDLINE for English-language human studies published between January 2017 and May 2025 (certain seminal earlier studies were also retained), with a focus on key subpopulations (diabetes, non-diabetes, and MINOCA). Particular emphasis is placed on SHR as a ratio of acute to chronic hyperglycemia with expanding prognostic applications.

Expert opinion: SIH is a multifaceted phenomenon, superiorly reflected by dynamic indices like SHR rather than traditional measures. Further research into the mechanisms linking SIH with adverse outcomes could lay the groundwork for interventional trials, ultimately reshaping ACS patient risk-stratification and management.

Introduction: High-density lipoprotein cholesterol (HDL-C) has long been regarded as 'good cholesterol,' but clinical trials and epidemiological studies have demonstrated that simply raising HDL-C levels does not reduce cardiovascular events. Attention has therefore shifted from HDL-C quantity to HDL functionality.

Areas covered: This review summarizes evidence from PubMed and Web of Science (2011-2024) on cholesterol efflux capacity (CEC), the most widely studied HDL functionality. CEC reflects the ability of HDL to remove cholesterol from macrophages, representing the first step of reverse cholesterol transport. Cohort and case-control studies consistently indicate that CEC provides incremental predictive value for atherosclerotic cardiovascular disease (ASCVD) beyond traditional lipid parameters. However, results vary across familial hypercholesterolemia cohorts, highlighting the influence of assay methods, treatment exposure, and HDL remodeling. The review also addresses lifestyle and genetic factors (e.g. alcohol consumption, ALDH2 polymorphisms), oxidative stress, and methodological challenges that complicate CEC measurement and standardization.

Expert opinion: While CEC is a promising surrogate marker, it remains a phenomenon rather than a therapeutic target, and there is no conclusive evidence that increasing CEC reduces ASCVD events. Future research should focus on disease-specific molecules, such as FABP5 and ORM1, that impair HDL function. Identifying these pathways may yield novel biomarkers and therapeutic targets, offering a more precise approach to residual cardiovascular risk beyond HDL-C levels.

Introduction: Obstructive sleep apnea (OSA) - characterized by recurrent upper airway obstruction during sleep - remains underdiagnosed and undertreated. Affecting nearly one billion adults globally, OSA is especially prevalent among patients with cardiovascular comorbidities. Diagnosis may be delayed due to atypical symptoms, particularly in women, and healthcare barriers including fragmented care, limited provider training, and restricted access to specialized diagnostics. Untreated OSA contributes to an increased prevalence of resistant hypertension, recurrent arrhythmias (atrial fibrillation), stroke, and heart failure.

Areas covered: This review focuses on the intricate relationship between OSA and cardiovascular health, highlighting key pathophysiological mechanisms such as intermittent hypoxia, autonomic dysregulation, and systemic inflammation that drive structural and functional cardiac impairments. Further, the review highlights the importance of improved screening tools for early detection. The special report is based on systemic search of PubMed.

Expert opinion: Early screening and detection are crucial, given the strong association between untreated OSA and adverse health outcomes. Expert consensus recommends routine OSA screening in high-risk cardiovascular populations and emphasizes comprehensive early interventions; CPAP, lifestyle modification, and metabolic risk management. Integrating OSA assessment into cardiology practice and expanding advanced diagnostic tools may improve detection, reduce morbidity and mortality, and lessen the economic burden on healthcare systems.

Introduction: Life expectancy is rising globally, leading to an expected increase in age-related cardiovascular diseases. Managing cardiovascular disease in older adults is particularly challenging, as these patients often face multimorbidity, polypharmacy, and increased frailty, factors independently associated with poor prognosis and a higher risk of iatrogenic complications.

Areas covered: Atrial fibrillation (AF) is the most common tachyarrhythmia worldwide, with its prevalence projected to reach 15.9 million in the U.S. by 2050 and 17.9 million in Europe by 2060, driven by the progressive aging of the population. AF patients are at high risk of thromboembolism, and oral anticoagulant (OAC) therapy remains the cornerstone of stroke prevention. However, older AF patients often have multiple comorbidities that elevate bleeding risk, making the net clinical benefit of OAC therapy uncertain.

Expert opinion: This review aims to outline strategies for balancing ischemic and hemorrhagic risks in this vulnerable population, following the integrated and holistic management pathway, an evidence-based approach proven to improve outcomes in complex and frail AF patients.

Background: Heart transplant (HTx) in dystrophy patients has been shown to have a similar survival to cardiomyopathy from other causes, but postoperative rehabilitation remains an issue. This study aimed to review and analyze the reports in the literature to determine whether pre- and post-transplant functional status along with wheelchair dependence in dystrophy patients can influence post-HTx outcomes.

Research design and methods: Relevant databases were queried for all case reports and case series regarding HTx in patients with dystrophy-associated cardiomyopathy published in the literature. Clinical data were extracted and tabulated. Patient survival was stratified according to preoperative and postoperative functional status, and Kaplan-Meier survival analysis was performed.

Results: We identified 22 studies yielding 36 patients with muscular dystrophy who underwent HTx. At baseline, there were three patients who were wheelchair dependent, and 22 patients had a diminished functional status preoperatively. Overall survival did not differ significantly between patients with normal baseline functional status and those with diminished functional status, either before or after transplantation.

Conclusions: Although no significant survival difference was found, diminished functional status, both pre- and post-transplant, appear to be associated with worse survival, highlighting its importance in transplant decision-making.