Introduction: Atherosclerotic cardiovascular disease (ASCVD) is the main cause of morbidity and mortality worldwide. Dyslipidemia, in particular elevation of LDL-cholesterol levels (LDL-C), is one of the major cardiovascular risk factors and is characterized by high prevalence and independent unfavorable impact on cardiovascular prognosis; however, because of its asymptomatic course, it often remains undiagnosed. Strategies aimed at early identification of subjects with elevated LDL-C levels may allow early intervention, preventing ASCVD development.
Areas covered: The purpose of this review is to summarize the recommendations of current guidelines by leading scientific authorities on the pros and cons of lipid profile screening programs.
Expert opinion: Systematic assessment of LDL-C levels as part of global cardiovascular risk assessment in all adults is a cornerstone of ASCVD risk prevention. In young adults, adolescents, and children, selective lipid profile screening may be useful to reduce the impact of high cholesterol levels on ASCVD risk in the presence of specific conditions including either family history of early ASCVD or multiple concomitant cardiovascular risk factors. Cascade screening for family members of individuals diagnosed with familial hypercholesterolemia (FH) may be also of great clinical impact. Further evidence is needed to evaluate the cost/benefit ratio of systematic assessment of lipid profile in children, adolescents, and young adults.
{"title":"Lipid profile screening and ASCVD prevention.","authors":"Filippo Figorilli, Massimo Raffaele Mannarino, Amirhossein Sahebkar, Matteo Pirro","doi":"10.1080/14779072.2023.2218087","DOIUrl":"https://doi.org/10.1080/14779072.2023.2218087","url":null,"abstract":"<p><strong>Introduction: </strong>Atherosclerotic cardiovascular disease (ASCVD) is the main cause of morbidity and mortality worldwide. Dyslipidemia, in particular elevation of LDL-cholesterol levels (LDL-C), is one of the major cardiovascular risk factors and is characterized by high prevalence and independent unfavorable impact on cardiovascular prognosis; however, because of its asymptomatic course, it often remains undiagnosed. Strategies aimed at early identification of subjects with elevated LDL-C levels may allow early intervention, preventing ASCVD development.</p><p><strong>Areas covered: </strong>The purpose of this review is to summarize the recommendations of current guidelines by leading scientific authorities on the pros and cons of lipid profile screening programs.</p><p><strong>Expert opinion: </strong>Systematic assessment of LDL-C levels as part of global cardiovascular risk assessment in all adults is a cornerstone of ASCVD risk prevention. In young adults, adolescents, and children, selective lipid profile screening may be useful to reduce the impact of high cholesterol levels on ASCVD risk in the presence of specific conditions including either family history of early ASCVD or multiple concomitant cardiovascular risk factors. Cascade screening for family members of individuals diagnosed with familial hypercholesterolemia (FH) may be also of great clinical impact. Further evidence is needed to evaluate the cost/benefit ratio of systematic assessment of lipid profile in children, adolescents, and young adults.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9701129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.1080/14779072.2023.2221852
Majd B Protty, Tharindra Dissanayake, Daniel Jeffery, Ahmed Hailan, Anirban Choudhury
Introduction: Despite advances in stent technology for percutaneous coronary intervention (PCI) in the treatment of coronary disease, these procedures can be complicated by stent failure manifested as intracoronary stent restenosis (ISR). Even with advances in stent technology and medical therapy, this complication is reported to affect around 10% of all percutaneous coronary intervention (PCI) procedures. Depending on stent type (drug-eluting versus bare metal), ISR has subtle differences in mechanism and timing and offers different challenges in diagnosing etiology and subsequent treatment options.
Areas covered: This review will be visiting the definition, pathophysiology, and risk factors of ISR.
Expert opinion: The evidence behind management options has been illustrated with the aid of real life clinical cases and summarized in a proposed management algorithm.
{"title":"Stent failure: the diagnosis and management of intracoronary stent restenosis.","authors":"Majd B Protty, Tharindra Dissanayake, Daniel Jeffery, Ahmed Hailan, Anirban Choudhury","doi":"10.1080/14779072.2023.2221852","DOIUrl":"https://doi.org/10.1080/14779072.2023.2221852","url":null,"abstract":"<p><strong>Introduction: </strong>Despite advances in stent technology for percutaneous coronary intervention (PCI) in the treatment of coronary disease, these procedures can be complicated by stent failure manifested as intracoronary stent restenosis (ISR). Even with advances in stent technology and medical therapy, this complication is reported to affect around 10% of all percutaneous coronary intervention (PCI) procedures. Depending on stent type (drug-eluting versus bare metal), ISR has subtle differences in mechanism and timing and offers different challenges in diagnosing etiology and subsequent treatment options.</p><p><strong>Areas covered: </strong>This review will be visiting the definition, pathophysiology, and risk factors of ISR.</p><p><strong>Expert opinion: </strong>The evidence behind management options has been illustrated with the aid of real life clinical cases and summarized in a proposed management algorithm.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9695836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01Epub Date: 2023-12-13DOI: 10.1080/14779072.2023.2271388
Noel Chan, Jack Hirsh
Introduction: Currently approved direct oral anticoagulants (DOACs) target thrombin or coagulation factor Xa. Administered in fixed doses without routine laboratory monitoring, DOACs have simplified the approach to oral anticoagulation, when previously the choice was limited to vitamin K antagonists (VKAs).
Area covered: We discuss a) unresolved issues related to optimal use of DOACs and b) new developments including the potential for FXIa inhibitors to be effective and safer anticoagulants.
Expert opinion: By simplifying oral anticoagulation, DOACs have facilitated the uptake of anticoagulation. The DOACs are approved for stroke prevention in atrial fibrillation and for the prevention and treatment of venous thromboembolism, and their indications are expanding to include the prevention of atherothrombosis. DOACs have now replaced vitamin K antagonists (VKAs) for most indications, but not all. DOACs are inferior to VKAs for patients with mechanical heart valves, left ventricular assist device, rheumatic atrial fibrillation, and those with antiphospholipid syndrome, and their safety and efficacy are uncertain in some populations (e.g. advanced renal and liver disease). Impediments to use include concerns for bleeding and cost. The newly developed FXIa and FXIIa inhibitors have the potential to be safer than current anticoagulants, but phase 3 trials are needed to confirm their clinical efficacy and safety.
{"title":"Unresolved issues in the use of direct acting oral anticoagulants.","authors":"Noel Chan, Jack Hirsh","doi":"10.1080/14779072.2023.2271388","DOIUrl":"10.1080/14779072.2023.2271388","url":null,"abstract":"<p><strong>Introduction: </strong>Currently approved direct oral anticoagulants (DOACs) target thrombin or coagulation factor Xa. Administered in fixed doses without routine laboratory monitoring, DOACs have simplified the approach to oral anticoagulation, when previously the choice was limited to vitamin K antagonists (VKAs).</p><p><strong>Area covered: </strong>We discuss a) unresolved issues related to optimal use of DOACs and b) new developments including the potential for FXIa inhibitors to be effective and safer anticoagulants.</p><p><strong>Expert opinion: </strong>By simplifying oral anticoagulation, DOACs have facilitated the uptake of anticoagulation. The DOACs are approved for stroke prevention in atrial fibrillation and for the prevention and treatment of venous thromboembolism, and their indications are expanding to include the prevention of atherothrombosis. DOACs have now replaced vitamin K antagonists (VKAs) for most indications, but not all. DOACs are inferior to VKAs for patients with mechanical heart valves, left ventricular assist device, rheumatic atrial fibrillation, and those with antiphospholipid syndrome, and their safety and efficacy are uncertain in some populations (e.g. advanced renal and liver disease). Impediments to use include concerns for bleeding and cost. The newly developed FXIa and FXIIa inhibitors have the potential to be safer than current anticoagulants, but phase 3 trials are needed to confirm their clinical efficacy and safety.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41195887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01Epub Date: 2023-12-10DOI: 10.1080/14779072.2023.2276366
Richard J Jabbour, Nick Curzen
{"title":"How long will my TAVI valve last, doctor?","authors":"Richard J Jabbour, Nick Curzen","doi":"10.1080/14779072.2023.2276366","DOIUrl":"10.1080/14779072.2023.2276366","url":null,"abstract":"","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50161235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01Epub Date: 2023-12-13DOI: 10.1080/14779072.2023.2275662
Eva Soler-Espejo, María Asunción Esteve-Pastor, José Miguel Rivera-Caravaca, Vanessa Roldan, Francisco Marín
Introduction: Oral anticoagulation (OAC) significantly mitigates thromboembolism risks in atrial fibrillation (AF) and venous thromboembolism (VTE) patients yet concern about major bleeding events persist. In fact, clinically relevant hemorrhages can be life-threatening. Bleeding risk is dynamic and influenced by factors such as age, new comorbidities, and drug therapies, and should not be assessed solely based on static baseline factors.
Areas covered: We comprehensively review the bleeding risk associated with OAC therapy. Emphasizing the importance of assessing both thromboembolic and bleeding risks, we present clinical tools for estimating stroke and systemic embolism (SSE) and bleeding risk in AF and VTE patients. We also address overlapping risk factors and the dynamic nature of bleeding risk.
Expert opinion: The OAC management is undergoing constant transformation, motivated by the primary objective of mitigating thromboembolism and bleeding hazards, thereby amplifying patient safety throughout the course of treatment. The future of OAC embraces personalized approaches and innovative therapies, driven by advanced pathophysiological insights and technological progress. This holds promise for improving patient outcomes and revolutionizing anticoagulation practices.
{"title":"Reducing bleeding risk in patients on oral anticoagulation therapy.","authors":"Eva Soler-Espejo, María Asunción Esteve-Pastor, José Miguel Rivera-Caravaca, Vanessa Roldan, Francisco Marín","doi":"10.1080/14779072.2023.2275662","DOIUrl":"10.1080/14779072.2023.2275662","url":null,"abstract":"<p><strong>Introduction: </strong>Oral anticoagulation (OAC) significantly mitigates thromboembolism risks in atrial fibrillation (AF) and venous thromboembolism (VTE) patients yet concern about major bleeding events persist. In fact, clinically relevant hemorrhages can be life-threatening. Bleeding risk is dynamic and influenced by factors such as age, new comorbidities, and drug therapies, and should not be assessed solely based on static baseline factors.</p><p><strong>Areas covered: </strong>We comprehensively review the bleeding risk associated with OAC therapy. Emphasizing the importance of assessing both thromboembolic and bleeding risks, we present clinical tools for estimating stroke and systemic embolism (SSE) and bleeding risk in AF and VTE patients. We also address overlapping risk factors and the dynamic nature of bleeding risk.</p><p><strong>Expert opinion: </strong>The OAC management is undergoing constant transformation, motivated by the primary objective of mitigating thromboembolism and bleeding hazards, thereby amplifying patient safety throughout the course of treatment. The future of OAC embraces personalized approaches and innovative therapies, driven by advanced pathophysiological insights and technological progress. This holds promise for improving patient outcomes and revolutionizing anticoagulation practices.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71411247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.1080/14779072.2023.2215985
Juan Luis Bonilla Palomas, José Ignacio Morgado García de Polavieja, Miriam Padilla Pérez, Diego Rangel-Sousa, Antonio Castro Fernández, José López Aguilera, Carolina Ortiz Cortés, Francisco Torres Calvo
Introduction: Worsening heart failure (HF) is associated with a high risk of death and rehospitalization. Despite that, real world evidence about the impact of worsening HF on clinical practice is scarce.
Areas covered: A narrative review about registries addressing recent worsening HF events in Spain, with special emphasis on patients recently hospitalized for HF was performed.
Expert opinion: Worsening HF can be defined as situations where the patient's HF deteriorates to the extent that it necessitates initiation or intensification of diuretic treatment (mainly intravenous). The events can occur at the outpatient level, generally in the day hospital, in the emergency department or even hospitalization. Early identification of worsening HF events is essential to establish appropriate treatment as soon as possible. In this context, robust clinical benefits have been reported for renin-angiotensin system inhibitors, sacubitril-valsartan, beta-blockers, mineralocorticoid receptor antagonists, SGLT2 inhibitors, and vericiguat. In Spain, several registries of patients with HF have been developed, some of them including patients recently hospitalized for HF, but not with recent worsening HF events. Therefore, registries addressing recent worsening events would be desirable. Using a practical approach, this review analyzes the importance of worsening HF events, with special emphasis on Spanish data.
{"title":"What do Spanish registries report about worsening events in chronic heart failure? Needs and challenges.","authors":"Juan Luis Bonilla Palomas, José Ignacio Morgado García de Polavieja, Miriam Padilla Pérez, Diego Rangel-Sousa, Antonio Castro Fernández, José López Aguilera, Carolina Ortiz Cortés, Francisco Torres Calvo","doi":"10.1080/14779072.2023.2215985","DOIUrl":"https://doi.org/10.1080/14779072.2023.2215985","url":null,"abstract":"<p><strong>Introduction: </strong>Worsening heart failure (HF) is associated with a high risk of death and rehospitalization. Despite that, real world evidence about the impact of worsening HF on clinical practice is scarce.</p><p><strong>Areas covered: </strong>A narrative review about registries addressing recent worsening HF events in Spain, with special emphasis on patients recently hospitalized for HF was performed.</p><p><strong>Expert opinion: </strong>Worsening HF can be defined as situations where the patient's HF deteriorates to the extent that it necessitates initiation or intensification of diuretic treatment (mainly intravenous). The events can occur at the outpatient level, generally in the day hospital, in the emergency department or even hospitalization. Early identification of worsening HF events is essential to establish appropriate treatment as soon as possible. In this context, robust clinical benefits have been reported for renin-angiotensin system inhibitors, sacubitril-valsartan, beta-blockers, mineralocorticoid receptor antagonists, SGLT2 inhibitors, and vericiguat. In Spain, several registries of patients with HF have been developed, some of them including patients recently hospitalized for HF, but not with recent worsening HF events. Therefore, registries addressing recent worsening events would be desirable. Using a practical approach, this review analyzes the importance of worsening HF events, with special emphasis on Spanish data.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10054471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01Epub Date: 2023-08-28DOI: 10.1080/14779072.2023.2250627
Andrew Flett
{"title":"An interview with Andrew Flett: consultant cardiologist and coauthor of the CardioMEMS COAST study.","authors":"Andrew Flett","doi":"10.1080/14779072.2023.2250627","DOIUrl":"10.1080/14779072.2023.2250627","url":null,"abstract":"","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10220215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The role of oral anticoagulation during the COVID-19 pandemic has been debated widely. We studied the clinical outcomes of COVID-19 hospitalizations in patients who were on long-term anticoagulation.
Research design and methods: The Nationwide Inpatient Sample (NIS) database from 2020 was queried to identify COVID-19 patients with and without long-term anticoagulation. Multivariate regression analysis was used to calculate the adjusted odds ratio (aOR) of in-hospital outcomes.
Results: Of 1,060,925 primary COVID-19 hospitalizations, 102,560 (9.6%) were on long-term anticoagulation. On adjusted analysis, COVID-19 patients on anticoagulation had significantly lower odds of in-hospital mortality (aOR 0.61, 95% CI 0.58-0.64, P < 0.001), acute myocardial infarction (aOR 0.72, 95% CI 0.63-0.83, P < 0.001), stroke (aOR 0.79, 95% CI 0.66-0.95, P < 0.013), ICU admissions, (aOR 0.53, 95% CI 0.49-0.57, P < 0.001) and higher odds of acute pulmonary embolism (aOR 1.47, 95% CI 1.34-1.61, P < 0.001), acute deep vein thrombosis (aOR 1.17, 95% CI 1.05-1.31, P = 0.005) compared to COVID-19 patients who were not on anticoagulation.
Conclusions: Compared to COVID-19 patients not on long-term anticoagulation, we observed lower in-hospital mortality, stroke and acute myocardial infarction in COVID-19 patients on long-term anticoagulation. Prospective studies are needed for optimal anticoagulation strategies in hospitalized patients.
背景:口服抗凝在新冠肺炎大流行期间的作用一直备受争议。我们研究了长期接受抗凝治疗的新冠肺炎患者住院的临床结果。研究设计和方法:查询2020年全国住院患者样本(NIS)数据库,以确定新冠肺炎长期抗凝和非抗凝患者。多变量回归分析用于计算住院结果的调整比值比(aOR)。结果:在1060925例原发性新冠肺炎住院患者中,102560例(9.6%)接受了长期抗凝治疗。经调整的分析显示,接受抗凝治疗的新冠肺炎患者住院死亡率的几率显著降低(aOR 0.61,95%CI 0.58-0.64,P P P P P P = 0.005)与未接受抗凝治疗的新冠肺炎患者相比。结论:与未长期抗凝的新冠肺炎患者相比,长期抗凝的新冠肺炎患者住院死亡率、卒中和急性心肌梗死较低。需要对住院患者的最佳抗凝策略进行前瞻性研究。
{"title":"Contemporary outcomes of long-term anticoagulation in COVID-19 patients: a regression matched sensitivity analysis of the national inpatient sample.","authors":"Amro Taha, Irisha Badu, Harigopal Sandhyavenu, Varun Victor, Sanchit Duhan, Lalitsiri Atti, Hasham Masood Qureshi, Thatiana Schulze Goni, Bijeta Keisham, Vasantha Sandhya Venu, Harshith Thyagaturu, Karthik Gonuguntla, Waqas Ullah, Himanshu Deshwal, Sudarshan Balla","doi":"10.1080/14779072.2023.2234282","DOIUrl":"10.1080/14779072.2023.2234282","url":null,"abstract":"<p><strong>Background: </strong>The role of oral anticoagulation during the COVID-19 pandemic has been debated widely. We studied the clinical outcomes of COVID-19 hospitalizations in patients who were on long-term anticoagulation.</p><p><strong>Research design and methods: </strong>The Nationwide Inpatient Sample (NIS) database from 2020 was queried to identify COVID-19 patients with and without long-term anticoagulation. Multivariate regression analysis was used to calculate the adjusted odds ratio (aOR) of in-hospital outcomes.</p><p><strong>Results: </strong>Of 1,060,925 primary COVID-19 hospitalizations, 102,560 (9.6%) were on long-term anticoagulation. On adjusted analysis, COVID-19 patients on anticoagulation had significantly lower odds of in-hospital mortality (aOR 0.61, 95% CI 0.58-0.64, <i>P</i> < 0.001), acute myocardial infarction (aOR 0.72, 95% CI 0.63-0.83, <i>P</i> < 0.001), stroke (aOR 0.79, 95% CI 0.66-0.95, <i>P</i> < 0.013), ICU admissions, (aOR 0.53, 95% CI 0.49-0.57, <i>P</i> < 0.001) and higher odds of acute pulmonary embolism (aOR 1.47, 95% CI 1.34-1.61, <i>P</i> < 0.001), acute deep vein thrombosis (aOR 1.17, 95% CI 1.05-1.31, <i>P</i> = 0.005) compared to COVID-19 patients who were not on anticoagulation.</p><p><strong>Conclusions: </strong>Compared to COVID-19 patients not on long-term anticoagulation, we observed lower in-hospital mortality, stroke and acute myocardial infarction in COVID-19 patients on long-term anticoagulation. Prospective studies are needed for optimal anticoagulation strategies in hospitalized patients.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9922322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01Epub Date: 2023-12-13DOI: 10.1080/14779072.2023.2270906
Fang Qin Goh, Ching-Hui Sia, Mark Y Chan, Leonard Ll Yeo, Benjamin Yq Tan
Introduction: Left ventricular thrombus (LVT) occurs in acute myocardial infarction and in ischemic and non-ischemic cardiomyopathies. LVT may result in embolic stroke. Currently, the duration of anticoagulation for LVT is unclear. This is an important clinical question as prolonged anticoagulation is associated with increased bleeding risks, while premature discontinuation may result in embolic complications.
Areas covered: There are no randomized trial data regarding anticoagulation duration for LVT. Guidelines and expert consensus recommend anticoagulation for 3-6 months with cessation of anticoagulation if interval imaging demonstrates thrombus resolution. Cardiac magnetic resonance imaging (CMR) is more sensitive and specific compared to echocardiography for LVT detection, and may be appropriate for high-risk patients. Prolonged anticoagulation may be considered in unresolved protuberant or mobile LVT, and in patients with resolved LVT but persistent depressed left ventricular ejection fraction and/or myocardial akinesia or dyskinesia.
Expert opinion: CMR will likely be increasingly used for LVT surveillance to guide anticoagulation duration. Further research is needed to determine which patients with persistent LVT on CMR benefit from prolonged anticoagulation.
{"title":"What's the optimal duration of anticoagulation in patients with left ventricular thrombus?","authors":"Fang Qin Goh, Ching-Hui Sia, Mark Y Chan, Leonard Ll Yeo, Benjamin Yq Tan","doi":"10.1080/14779072.2023.2270906","DOIUrl":"10.1080/14779072.2023.2270906","url":null,"abstract":"<p><strong>Introduction: </strong>Left ventricular thrombus (LVT) occurs in acute myocardial infarction and in ischemic and non-ischemic cardiomyopathies. LVT may result in embolic stroke. Currently, the duration of anticoagulation for LVT is unclear. This is an important clinical question as prolonged anticoagulation is associated with increased bleeding risks, while premature discontinuation may result in embolic complications.</p><p><strong>Areas covered: </strong>There are no randomized trial data regarding anticoagulation duration for LVT. Guidelines and expert consensus recommend anticoagulation for 3-6 months with cessation of anticoagulation if interval imaging demonstrates thrombus resolution. Cardiac magnetic resonance imaging (CMR) is more sensitive and specific compared to echocardiography for LVT detection, and may be appropriate for high-risk patients. Prolonged anticoagulation may be considered in unresolved protuberant or mobile LVT, and in patients with resolved LVT but persistent depressed left ventricular ejection fraction and/or myocardial akinesia or dyskinesia.</p><p><strong>Expert opinion: </strong>CMR will likely be increasingly used for LVT surveillance to guide anticoagulation duration. Further research is needed to determine which patients with persistent LVT on CMR benefit from prolonged anticoagulation.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41195888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01Epub Date: 2023-12-10DOI: 10.1080/14779072.2023.2274502
Rita Louro, Ryan Gouveia E Melo, Jorge Ruivo, Ana G Almeida, Fausto J Pinto, Daniel Caldeira
Introduction: Statins are highly used in cardiovascular prevention. Statin intolerance is the most significant cause of decreased adherence, translating into a higher cardiovascular risk. This systematic review aims to estimate the incidence of muscle adverse events in patients with a history of statin intolerance receiving placebo.
Methods: Database search was performed in CENTRAL, MEDLINE, and EMBASE until March 2023. This systematic review included blinded randomized control trials enrolling patients with a history of statin intolerance who received a placebo. A random-effects meta-analysis was performed. Results were presented in percentages, with 95% confidence intervals (95% CI).
Results: Overall, eight studies with 8095 patients with a history of statin intolerance receiving placebo were included. The muscle adverse events incidence rate was 21.34% (95% CI 13.26-30.63%, 8 studies), and discontinuation due to adverse muscle events was 6.12% (95% CI 1.22-13.70%, 3 studies). The incidence was higher in subcutaneous placebo/sham (41.67%, 1 study) compared to oral placebo studies (22.95%, 6 studies).
Conclusion: In patients previously labeled as statin-intolerant, about a fifth of the patients exhibited muscle symptoms when receiving a placebo. This highlights the importance of ruling out non-statin-related symptoms to further optimize statin therapy for cardiovascular risk improvement.
{"title":"Incidence of muscle symptoms in placebo arm among statin-intolerant patients: a systematic review with meta-analysis.","authors":"Rita Louro, Ryan Gouveia E Melo, Jorge Ruivo, Ana G Almeida, Fausto J Pinto, Daniel Caldeira","doi":"10.1080/14779072.2023.2274502","DOIUrl":"10.1080/14779072.2023.2274502","url":null,"abstract":"<p><strong>Introduction: </strong>Statins are highly used in cardiovascular prevention. Statin intolerance is the most significant cause of decreased adherence, translating into a higher cardiovascular risk. This systematic review aims to estimate the incidence of muscle adverse events in patients with a history of statin intolerance receiving placebo.</p><p><strong>Methods: </strong>Database search was performed in CENTRAL, MEDLINE, and EMBASE until March 2023. This systematic review included blinded randomized control trials enrolling patients with a history of statin intolerance who received a placebo. A random-effects meta-analysis was performed. Results were presented in percentages, with 95% confidence intervals (95% CI).</p><p><strong>Results: </strong>Overall, eight studies with 8095 patients with a history of statin intolerance receiving placebo were included. The muscle adverse events incidence rate was 21.34% (95% CI 13.26-30.63%, 8 studies), and discontinuation due to adverse muscle events was 6.12% (95% CI 1.22-13.70%, 3 studies). The incidence was higher in subcutaneous placebo/sham (41.67%, 1 study) compared to oral placebo studies (22.95%, 6 studies).</p><p><strong>Conclusion: </strong>In patients previously labeled as statin-intolerant, about a fifth of the patients exhibited muscle symptoms when receiving a placebo. This highlights the importance of ruling out non-statin-related symptoms to further optimize statin therapy for cardiovascular risk improvement.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71422003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}