Cardiology in Review最新文献

With the increasing prevalence of obesity and the advent of new and highly effective antiobesity medications, there is renewed interest in novel antiobesity pharmacotherapy. Currently, the most effective medications for obesity are injectable medicines. There is a need to develop equally efficacious oral drugs to increase availability to patients. Oral semaglutide was approved by the Food and Drug Administration for type 2 diabetes in 2019. Herein, we review the current literature regarding the use of oral GLP-1 receptor agonists specifically for obesity including semaglutide, danuglipron, and orforglipron, with a focus on oral semaglutide as it is Food and Drug Administration-approved, although not for obesity alone. We also examine the future directions and impacts it will have on patients with obesity and overweight related to weight loss and cardiovascular disease.

Acute isolated right ventricular (RV) myocardial infarctions are relatively uncommon in clinical practice; more frequently, RV infarctions occur in association with inferior ST-segment elevation myocardial infarctions. Recent advances in diagnostic tools and methods have significantly improved our ability to detect RV infarctions in both scenarios. For this reason, it is critical for physicians to understand the pathophysiology, clinical presentation, and diagnostic criteria for RV infarctions to initiate treatment and optimize the outcomes of patients. About half of all patients with an inferior ST-segment elevation myocardial infarction develop RV infarction. In the acute setting, RV infarctions can lead to hemodynamic instability and frank shock, which are responsible for the high morbidity and mortality associated with these episodes. However, when treated properly, the prognosis of RV myocardial infarctions is quite excellent if the patient survives the acute hemodynamic compromise. In addition, RV infarctions are likely a misnomer since these events tend to represent ischemia and stunning of the RV myocardium that results in its short-term dysfunction, but the myocardium remains viable and recovers over time with no signs of an infarct if the patient survives the episode. In fact, patient outcomes in RV ischemia are dependent more on the involvement of the left ventricle than RV involvement, especially since a left ventricular infarct and dysfunction can be difficult to overcome in the long term. It is imperative to understand the various treatments available to target the hemodynamic changes and shock often seen in patients with acute RV ischemia and to implement these treatments accordingly to improve patient survival and prognosis.

Salt-sensitive blood pressure is a clinical phenotype defined as exaggerated blood pressure responses to salt loading and salt depletion. This characteristic occurs in 25% of the general population and 50% of patients with hypertension and contributes to the pathogenesis of hypertension in some patients. Hypertension is associated with chronic inflammatory responses and has immune cell accumulation in several hypertensive target organs, including the brain, kidneys, heart, blood vessels, and the perivascular adipose tissue, and these cellular responses likely exacerbate hypertension. The different factors implicated in the pathogenesis of salt-sensitive hypertension include renin-angiotensin-aldosterone system dysfunction, aldosterone-dependent and aldosterone-independent mineralocorticoid receptor signaling, and the sympathetic nervous system dysfunction. Experimental studies have shown an important role of both innate and adaptive immune cells, especially lymphocytes, in angiotensin II-induced hypertension. The epithelial sodium channel (ENaC) allows entry of sodium into dendritic cells, and this leads to a sequence of events, including the production of reactive oxygen species, which activates the NLRP3 inflammasome and contributes to salt-sensitive hypertension through the amiloride-sensitive ENaC and isolevuglandin-adduct formation. This review summarizes the general aspects of salt sensitivity, focuses on the immunological/inflammatory factors involved in its development, considers general changes in microvasculature, and discusses management.

This review examines the cardiovascular effects of the mainstay drugs used to treat Alzheimer's disease (AD), namely cholinesterase inhibitors (ChEIs) and memantine. ChEIs represent the current first-line treatment for AD. Memantine is typically reserved for moderate to severe AD. Conventionally, ChEIs are thought to increase vagal tone, resulting in an increased risk of cardiac side effects such as bradycardia. However, emerging evidence suggests that ChEIs may offer a protective role on overall cardiovascular mortality in patients with dementia. Similarly, memantine, which is an N-methyl-D-aspartate receptor antagonist, has demonstrated cardioprotective properties in animal studies, raising the question of its clinical applications. Recently, aducanumab and lecanemab, antiamyloid-β monoclonal antibodies that aim to slow the progression of disease, have been Food and Drug Administration-approved for the treatment of AD. This review explores the current evidence regarding potential cardiovascular risks and protective effects of ChEIs and memantine in the treatment of AD, as well as the cardiovascular effects of aducanumab and lecanemab.

This study is to assess the efficacy and safety of endovascular treatment for acute ischemic stroke resulting from intracranial atherosclerosis-large vessel occlusion (ICAS-LVO) in comparison to embolic-large vessel occlusion (embolic-LVO). We undertook an extensive search of databases including PubMed, Embase, The Cochrane Library, Wanfang Data, and China National Knowledge Internet using a combination of free-text terms and mesh terms as part of our search strategy. Literature screening and data retrieval were conducted following predefined inclusion/exclusion criteria. The search timeframe was limited to studies published until August 2021. All statistical evaluations were carried out by Review Manager 5.3. This meta-analysis comprised a total of 2748 patients across 14 studies. Our results demonstrate a significantly lower rate of systematic intracranial hemorrhage in ICAS-LVO compared with embolic-LVO following endovascular therapy. Moreover, the rates of rescue therapy and stent implantation were significantly lower in ICAS-LVO versus embolic-LVO. However, the 2 groups had a similar recanalization rate, favorable outcome, and mortality rates at 90 days post endovascular treatment. Patients with ICAS-LVO exhibit a lower incidence of systematic intracranial hemorrhage after treatment compared with those with embolic-LVO. Furthermore, ICAS-LVO patients did not demonstrate a unique risk profile regarding recanalization, favorable outcomes (at 90 days), and mortality (at 90 days), resulting in comparable outcomes to embolic-LVO. However, a higher proportion of stent implantation and rescue therapy was observed in ICAS-LVO patients, highlighting the need for further investigation into the standardization of endovascular management for ICAS-LVO.

Metformin, a biguanide derived from Galega officinalis, was first synthesized by Werner and Bell in 1922. Metformin was approved for the treatment of diabetes by the US Food and Drug Administration in 1994. It has since become the most widely used oral antidiabetic agent. The exact mechanisms by which metformin exerts its clinical effects remain the subject of ongoing research. Metformin interacts with multiple molecular pathways, and the downstream effects of which affect weight, cardiovascular health, and longevity. Metformin reduces hunger by mitigating insulin resistance in the hypothalamic pro-opiomelanocortin neurons. It enhances satiety by stimulating the enteral release of glucagon-like peptide 1. It also induces favorable changes to enteric microbiota, enhancing metabolism. These effects cumulatively contribute to metformin-induced weight loss. Metformin use has shown associations with improved cardiovascular outcomes including reduced all-cause mortality, lower rates of myocardial infarctions, and improved heart failure outcomes. Many of these actions are mediated through the direct activation of adenosine monophosphate-activated kinase (AMPK), which, in turn, enhances cellular energy production and endothelial nitric oxide synthase-mediated vascular relaxation. It antagonizes proinflammatory cytokines, reducing cardiac fibrosis and remodeling. The metformin-AMPK pathway may also explain the potential utility of metformin in mitigating aging. Acting through AMPK, it inhibits the mammalian target of rapamycin, leading to increased autophagy and cell growth. The metformin-AMPK-sirtuin pathway may also contribute to longevity. In this review, we will discuss the use of metformin in weight loss, cardiovascular health, and longevity, highlighting the historic background, molecular mechanisms, and current evidence.

Transcatheter aortic valve replacement has emerged as an effective alternative to surgery in selected patients with aortic stenosis. It needs to be made clear which type of valve has better results in patients with small aortic annulus. We searched PubMed, Scopus, Embase, Cochrane Library, and Web of Science, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. A total of 27 articles were included, including 10,378 patients [5989 in balloon-expanding valve (BEV) and 4389 in the self-expanding valve (SEV) groups] with small aortic annulus. Our meta-analysis demonstrated no significant difference between SEVs and BEVs for 1-year all-cause mortality. There was a statistically significant increased risk of permanent pacemaker implantation (PPI) within 30 days and ischemic stroke at 1 year with SEVs [risk ratio (RR) = 1.69, 95% confidence interval (CI) = 1.18-2.42, P < 0.01, and RR = 1.83, 95% CI = 1.03-3.26, P = 0.04, respectively]. Our meta-analysis showed that SEVs are favored over BEVs in terms of 1-year change from baseline in effective orifice area (mean difference = 0.45, 95% CI = 0.19-0.71, P < 0.01). Moreover, after 1-year follow-up, severe patient-prosthesis mismatch was significantly lower in the SEV group (RR = 0.24, 95% CI = 0.11-0.53, P < 0.01). In conclusion, SEVs were associated with better echocardiographic outcomes from baseline. Patients with SEVs were more likely to develop stroke and require PPI but were less likely to have patient-prosthesis mismatch. The benefit of a larger effective aortic valve area with SEVs has to be balanced against higher PPI and stroke rates.

Chronic kidney disease (CKD) presents a significant burden on global health, with cardiovascular disease (CVD) being a leading cause of mortality in this population. Despite advancements in pharmacotherapies, preventing CVD in CKD patients remains challenging due to the intricate interplay of traditional risk factors and novel pathophysiological processes. This review aims to elucidate the current understanding of CVD prevention in CKD, encompassing epidemiology, risk factors, diagnostic considerations, and pharmacological therapeutic strategies. CKD patients exhibit a unique cardiovascular risk profile characterized by traditional risk factors such as hypertension and dyslipidemia, as well as CKD-specific factors including albuminuria, vascular calcification, and valvulopathies. The utility of coronary artery calcium scoring in risk stratification and the efficacy of aspirin, lipid-lowering agents, glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter 2 inhibitors, and nonsteroidal mineralocorticoid receptor antagonists in CVD prevention are discussed. Despite promising findings, challenges such as lack of specific guidelines and data gaps persist, highlighting the need for multidisciplinary efforts to address the CVD burden in the CKD population effectively. Further research is warranted to optimize preventative strategies and improve outcomes in this high-risk population.

Melatonin has become a popular choice for managing insomnia and sleep-related issues due to its effectiveness in promoting sleep and its minimal risk of side effects. This has led many individuals to opt for over-the-counter melatonin as an alternative to traditional sleep medications. Recent research indicates that melatonin not only aids in addressing sleep problems but also enhances muscle recovery and performance, thereby improving daytime functioning, particularly among athletes. In the United States, the prevalence of melatonin supplement usage has risen significantly from 0.08% in 2005-2006 to 0.28% in 2017-2018. Individuals with conditions such as heart failure, hypertension, coronary heart disease, and cardiovascular risk factors like diabetes and obesity typically exhibit lower levels of melatonin in their blood at night. This deficiency increases the likelihood of experiencing adverse cardiac events. Studies have highlighted melatonin's role not only in regulating sleep but also in safeguarding against cardiovascular diseases by influencing various cardiovascular functions. In summary, the increasing utilization of melatonin underscores its recognized efficacy in mitigating sleep disturbances, with emerging evidence suggesting potential benefits for cardiovascular health. As ongoing research explores additional therapeutic avenues, the multifaceted impact of melatonin emphasizes its significance in promoting overall well-being.