Minerva cardiology and angiology最新文献

Dyslipidemia remains a central modifiable risk factor for cardiovascular disease, necessitating comprehensive and evolving management strategies. This review provides an updated overview of currently approved and emerging lipid-lowering therapies, focusing on their mechanisms of action, efficacy, and safety profiles. Traditional agents such as statins and bile acid sequestrants continue to play foundational roles, while newer therapies - including PCSK9 inhibitors, bempedoic acid, and RNA-based treatments - have expanded therapeutic options, particularly for high-risk or statin-intolerant patients. Additionally, therapies targeting triglyceride reduction, such as fibrates and omega-3 fatty acids, have demonstrated potential benefits in specific subgroups. Novel strategies such as gene editing, oral PCSK9 inhibitors, HDL-targeted treatments, and gut microbiota modulation represent promising future directions. The review also explores the utility of non-pharmacologic approaches, including lipid apheresis and bariatric surgery, in selected cases. Together, these developments highlight the importance of tailored, multi-targeted approaches to lipid management in the prevention of cardiovascular events. Continued research is essential to refine therapeutic algorithms and optimize patient outcomes.

Coronary artery bypass grafting has evolved considerably since it was introduced approximately 50 years ago, with continuously improved patient outcomes as a result of this growth. The most up-to-date evidence on topics such as graft patency, grafting strategy, approaches to graft harvesting, minimally invasive coronary artery bypass grafting, and postoperative pharmacotherapy may lead to changes in current accepted practice. In addition, several unanswered questions in the field of coronary artery bypass grafting may benefit from further investigation and, if resolved, might advance the field and change practice. Current or upcoming clinical trials seek to answer these unanswered questions and may generate data that yields improved outcomes and quality of life for all patients after coronary artery bypass grafting. In addition, cutting edge clinical trials designed specifically for women and racial and ethnic minorities who have had poorer outcomes and have traditionally been underrepresented in cardiovascular surgery research, have recently been launched that may change the way that a large portion of the coronary artery bypass grafting population is treated in the future.

Background: In percutaneous coronary interventions (PCI), the ability to anticipate procedural challenges and a comprehensive knowledge of specialized equipment are paramount. Among these, the choice of guide catheters is crucial. A retrospective analysis was conducted on patients who underwent elective PCI procedures targeting type A and B1 circumflex artery lesions.

Methods: A total of 311 patients were categorized into two groups based on selection of guiding catheter: Group-1 used passive support catheters, whereas Group-2 employed standard Judkins catheters. We assessed the differences in procedural duration and characteristics, and contrast medium dosage between the two groups.

Results: In the Group-2, the utilization of extra support wire (7.8% vs. 17.3%, P=0.023), repeated predilatation (6.8% vs. 15.4%, P=0.031), and guide catheter exchange (2.9% vs. 9.1%, P=0.044) was more prevalent. Additionally, in the Group-2, the amount of contrast agent used was higher (146±43 vs. 110±37, P<0.001) and the procedure duration was longer (35±16 vs. 25±8, P<0.001).

Conclusions: In our study, when comparing the use of a Judkins catheter to a passive support catheter for type A/B1 circumflex artery lesions, the group utilizing the passive support catheter exhibited advantages in terms of procedure duration, usage of interventional materials, and contrast consumption. The choice of the guide catheter plays a pivotal role in performing PCI.

Introduction: The aim of this paper was to determine whether vitamin D supplementation reduces the incidence of postoperative atrial fibrillation (POAF) in patients undergoing coronary artery bypass grafting (CABG).

Evidence acquisition: PubMed and Cochrane Central Register of Controlled Trials were systematically searched from inception through May 2023 for randomized controlled trials (RCTs) assessing the effectiveness of Vitamin D in preventing atrial fibrillation among postoperative patients after CABG.

Evidence synthesis: The primary outcome extracted was the incidence of atrial fibrillation after Vitamin D in CABG patients. Secondary outcome included the length of hospital stay. Data were pooled using a random-effect model. A total of 4 RCTs, involving 694 patients, were included in the final analysis. The results showed that Vitamin D supplementation significantly reduced the incidence of POAF in CABG patients (RR: 0.55; 95% CI: 0.40 to 0.76; P=0.0003; I²=1%). However, administration of Vitamin D did not lead to significant reduction in the length of hospital stay (WMD: -0.14; 95% CI: -0.82 to 0.53; P=0.68; I²=34%).

Conclusions: Our updated pooled analysis concludes that vitamin D reduces the incidence of POAF in CABG patients. Future large-scale studies should focus on more diverse patient populations and explore a broader range of outcomes to better understand the full impact of Vitamin D supplementation in this context.

Background: The aging population in the USA has led to a concomitant rise in the prevalence of vascular dementia (VaD), yet there remains a paucity of investigation into mortality trends associated with VaD among adults.

Methods: This cross-sectional analysis utilized death certificate data from the Centers for Disease Control and Prevention's WONDER database. VaD-associated mortality was identified using the International Statistical Classification of Diseases and Related Health Problems-10th revision (ICD-10) code F01. Crude, and age-adjusted VaD-associated mortality rates per 100,000 and their corresponding 95% confidence intervals (CI) were computed. Age-adjusted mortality rates (AAMRs) were standardized to the 2000 US census population.

Results: From 2005 to 2020, there were 375,575 deaths attributed to VaD among older adults. We observed a gradual increase in AAMR (APC: 3.70, 95% CI [-4.14, 5.21]) from 2005 to 2015, succeeded by a pronounced escalation (APC: 9.07, 95% CI [6.09, 17.62]) until 2020. The highest AAMR was noted in the West (17.65, 95% CI [17.55, 17.76]), followed by the Midwest (AAMR: 12.66, 95% CI [12.58, 12.75]), the South (AAMR: 12.60, 95% CI [12.54, 12.67]), and the Northeast (AAMR: 8.60, 95% CI [8.53, 8.68]). Metropolitan areas exhibited higher AAMRs (10.9, 95% CI [10.8, 11.0]) compared to non-metropolitan areas (8.1, 95% CI [8.00, 8.3]). Among age groups, individuals aged 75-85 and older showed the highest overall AAMR (99.80, 95% CI [99.47, 100.14]). In addition, non-Hispanic Black or African-American subset of the population showed the highest overall AAMR (8.12, [95% CI: 8.03, 8.20]).

Conclusions: Our findings underscore the imperative for targeted public health interventions aimed at addressing regional disparities and age-specific vulnerabilities to mitigate the mounting burden of VaD-related mortality.