Management Of Cardiovascular Disease Research Articles

Clinically approved representative small-molecule drugs for cardiopathy therapy.

The application of therapeutic agents for cardiopathy has brought about significant advancements in the treatment of cardiovascular diseases. The intervention of small-molecule drugs has led to substantial reductions in morbidity and mortality rates, along with decreased utilization of healthcare resources. However, current treatment modalities do not exhibit uniform efficacy across all patients, and the emergence of drug resistance poses a significant challenge to further therapeutic efforts. Additionally, chronic administration of these drugs can result in toxicities, adding complexity to long-term management. This review focuses on the application of clinically approved small-molecule drugs for the treatment of cardiopathy, covering major classes such as angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, β-blockers, and sodium-glucose co-transporter 2 inhibitors. The review provides an in-depth analysis of their synthetic routes, mechanisms of action, and roles in cardiopathy treatment. It also offers perspectives on future directions in the development of next-generation cardioprotective agents, aiming to optimize therapeutic strategies for cardiovascular disease management.

Analysis of the characteristics and illness comprehension bias among Chinese patients with psycho-cardiovascular disease: a multi-centre cross-sectional survey.

Psychological distress, such as depression and anxiety, impacts cardiovascular disease (CVD) prognosis and management. Illness comprehension is essential for effective treatment, but biases can lead to suboptimal outcomes. We explored psycho-cardiovascular disease (PCD) patient characteristics, with a specific focus on comprehension biases and treatment choices from patients' perspectives in China, to improve management strategies. We enrolled 864 PCD patients in Chinese hospitals across 11 provinces. Tools included the seven-item General Anxiety Disorder scale, the nine-item Patient Health Questionnaire, and a self-designed PCD illness comprehensibility survey. We used χ2 test, univariate, and multivariate logistic regression to examine patient characteristics. Of 834 enrolled PCD patients, over 90% experienced mild to moderate anxiety and depression, yet less than 10% received treatment. 52.90% of patients had high illness comprehension. Among the high comprehension group, there were fewer labourers (19.30% vs. 26.40%; P < 0.05), fewer older individuals (39.20% vs. 46.90%; P < 0.05), and those with lower household income (15.60% vs. 30.50%; P < 0.05). A greater proportion of those in the high comprehension group lacked insurance (17.50% vs. 10.00%; P < 0.05), and they were more highly educated (42.90% vs. 32.10% with a college education). Additionally, more patients in the high comprehension group frequently received psychological consultation (24.00% vs. 5.10%; P < 0.05) and therapy (7.70% vs. 2.30%; P < 0.05). These patient groups preferred tertiary hospitals (71.66% vs. 63.33%; P < 0.05) and psycho-cardiovascular clinics (40.14% vs. 25.90%; P < 0.05). In comparison, low comprehension patients prioritised cost (32.65% vs. 46.41%; P < 0.05) and favoured a transition to community hospitals (16.55% vs. 25.38%; P < 0.05). More than 90% of PCD patients in Chinese CVD departments experience mild to moderate anxiety and depression with low treatment rates. Different illness comprehension levels are associated with variations in treatment willingness, considerations, health care preferences, medication choices, and illness knowledge acquisition methods.

Countries with Fewer Procedures for Cardiovascular Disease Management Face Greater Premature Mortality from Noncommunicable Diseases

Abstract Background: The rate at which low- and middle-income countries (LMICs) are transitioning into high-burden states for noncommunicable diseases (NCDs) is currently posing a global health security threat. Not only cardiovascular disease (CVD) occurs earlier in these countries but also it is likely that individuals do not have access to adequate management procedures. The present study was undertaken to find the effect of availability of procedures for CVD management on premature mortality in NCDs and to juxtapose this with the prevalence of two main risk factors, hypertension and diabetes. Methods: The World Health Organization’s Global Health Observatory data were used, which include health-related data on its 194 member states. The correlation matrix was constructed for risk factors, income classification, availability of CVD management procedures, and premature NCD mortality. Multiple linear regression was done to find the association between availability of management procedures, income classification, and premature NCD mortality. Results: A negative correlation was observed between premature NCD mortality and income group and between premature NCD mortality and availability of CVD management procedures. Countries possessing fewer procedures for CVD management suffered a greater burden of premature NCD mortality, and this was in the form of a strong linear association. Income class and availability of CVD management procedures both independently affected premature NCD mortality. Each unit increase in income class and number of CVD management procedures reduced the premature NCD mortality by 7.9 and 2.8 units, respectively. The impact of both these factors on premature NCD mortality was statistically significant. Countries with higher prevalence of hypertension were seen to be possessing fewer CVD management procedures. Income groups also demonstrated disparities, with high-income countries bearing less burden of hypertension and having more ubiquitous CVD management resources. Conclusion: The present study found that availability of CVD management procedures, such as thrombolysis, coronary bypass/stenting, and acute stroke care and rehabilitation, significantly reduce premature NCD mortality across the world. Countries that face higher burden of premature NCD mortality are not only the ones that are least prepared to manage them but also the ones that bear the greatest prevalence of risk factors like hypertension and diabetes. Making procedures for NCD management available in LMICs must be put on high priority on the global health agenda.

A cross-sectional study on the assessment of adherence to cardiovascular medications in Sudan heart center.

Non-adherence to cardiovascular medications is a global problem with clinical, economic, and humanistic consequences. Investigation of this problem may open the road for proper management of cardiovascular diseases. Our objectives were to assess the level of adherence to, and to examine factors influencing adherence to, cardiovascular medications in subjects visiting a heart center in Sudan. We have conducted a cross-sectional study that assessed adherence to cardiovascular medications among subjects visiting outpatient cardiac clinics in a heart center-Khartoum State, Sudan. The validated Adherence to Refills and Medication Scale (ARMS) tool was used to assess the level of medication adherence. A score of >16 was used as a cut-off point to categorize surveyed patients into non-adherent (e.g., 17-48) and adherent (e.g., 12-16) in ARMS. Descriptive statistics (frequencies and percentages) and inferential tests such as One-Way ANOVA and Binary regression were used for data analysis. A total of 255 subjects were enrolled in this study. Slightly more than half the respondents were males (54.5%) and their ages ranged between (51-60 years), and have no insurance coverage (58%). Most of the subjects were married (60.4%), were from Khartoum-State (67.8%), and were unemployed (77.6%). About 39.6% had primary education while 34.5% had secondary (34.5%) education. Diabetes (56.1%) and hypertension (45.5%) were common among the study population. The results showed a high non-adherence prevalence rate (97.6%). The cited reasons for non-adherence include forgetfulness and the costs of refilling medications. Education and age were associated with the level of adherence. Those with high non-adherence behaviors were the more educated, younger and old patients, those not employed, and those having comorbid diseases. The results generally showed a high level of non-adherence to cardiovascular medications, necessitating interventions to support patients' adherence.

Optimal cut plane for the measurement of tricuspid annular plane systolic excursion: how should we measure TASPE?

Abstract Introduction Assessment of right ventricular systolic function plays an important role in management of cardiovascular disease. Tricuspid annular plane systolic excursion (TAPSE) is the most widely used quantitative parameter; however, there is a lack of evidence regarding the appropriate cut plane for its measurement. Purpose This study aimed to elucidate the optimal cut plane for TAPSE measurement, focusing on the incidence angle of the M-mode cursor and relationship to an angle-independent right ventricular systolic parameter. Methods This retrospective study included 113 adult patients referred for echocardiography for a variety of clinical indications. TAPSE was measured using the M-mode in the standard, focused, and modified apical four-chamber views (Figure 1). Incident angles between the M-mode cursor and the direction of the lateral tricuspid annulus movement were also measured. Right ventricular free wall longitudinal strain was measured as an angle-independent parameter. Results TAPSE measured from the modified apical four-chamber view was the largest among the three approaches (standard apical four-chamber view: 20.7 ± 5.2 mm; focused apical four-chamber view: 19.9 ± 4.7 mm; modified apical four-chamber view: 22.9 ± 5.5 mm; one-way repeated measures ANOVA P &amp;lt; 0.001) (Figure 2A). The incident angle was the smallest in the modified apical four-chamber view (standard apical four-chamber view: 24.1 ± 9.8 degrees; focused apical four-chamber view: 28.6 ± 11.0 degrees; modified apical four-chamber view: 14.7 ± 7.9 degrees; one-way repeated measures ANOVA P &amp;lt; 0.001) (Figure 2B). TAPSE from the modified apical four-chamber view showed a better correlation with right ventricular free wall longitudinal strain compared to other approaches (standard apical four-chamber view: r = 0.632 [95% confidence interval: 0.506 to 0.731], p &amp;lt; 0.001; focused apical four-chamber view: r = 0.626 [95% confidence interval: 0.499 to 0.727], p &amp;lt; 0.001; modified apical four-chamber view: r = 0.700 [95% CI: 0.592 confidence interval 0.783], p &amp;lt; 0.001, respectively). Conclusions The modified apical four-chamber view was the most optimal for TAPSE measurements owing to the largest value and the smallest incident angle. Standardization of measurements to the modified apical four-chamber view would provide accurate assessment of the right ventricular systolic function in daily practice. Figure 1 Figure 2

Advancing Cardiovascular Diagnostics: The Expanding Role of CMR in Heart Failure and Cardiomyopathies

Cardiovascular magnetic resonance (CMR) imaging has become a cornerstone in the diagnosis, risk stratification, and management of cardiovascular disease (CVD), particularly heart failure (HF) and cardiomyopathies. Renowned as the gold standard for non-invasive quantification of ventricular volumes and ejection fraction, CMR delivers superior spatial and temporal resolution with excellent tissue–blood contrast. Recent advancements, including T1, T2, and T2* mapping, extracellular volume quantification, and late gadolinium enhancement, enable precise tissue characterization, allowing early detection of myocardial changes such as fibrosis, edema, and infiltration. These features provide critical insights into the pathophysiological mechanisms underlying HF phenotypes and diverse cardiomyopathies, enhancing diagnostic accuracy and guiding therapeutic decisions. This review explores the expanding role of CMR in CV disease, highlighting its diagnostic value in HF and in several cardiomyopathies, as well as its contribution to improving patient outcomes through detailed tissue characterization and prognosis.

Application of artificial intelligence technologies in cardiovascular disease detection and management authors

Cardiovascular diseases (CVD) remain the leading cause of death worldwide, including in the Russian Federation. Early detection and continuous monitoring are crucial to reduce mortality and improve patient outcomes. This article examines the use of artificial intelligence technologies in the detection and treatment of cardiovascular diseases, emphasizing their potential for the development of the field of cardiology. A comprehensive literature search was conducted using, focusing on studies in which artificial intelligence was used to diagnose, treat, and monitor cardiovascular diseases. The review includes an analysis of various artificial intelligence methods, including machine learning and neural networks, and their effectiveness in detecting heart rhythm disorders using wireless sensors and wearable devices. The review highlights promising solutions using artificial intelligence developed both internationally and in the Russian Federation, and provides practical recommendations for their implementation. By addressing existing research gaps and offering directions for the future, the article aims to improve the understanding and application of artificial intelligence in cardiology, which ultimately contributes to improved patient care and treatment outcomes.

Pregnancy-Related Cardiovascular Diseases: A Radiological Overview

Pregnancy induces significant hemodynamic changes, and cardiovascular diseases (CVDs) are one of the leading causes of non-obstetric maternal morbidity and mortality during pregnancy or the postpartum period in developed countries. The effective diagnosis and management of CVDs in pregnant women require a thorough evaluation that considers the health of both the mother and the fetus. Imaging plays a pivotal role in this evaluation, offering essential insights into the most significant pregnancy-related CVDs. However, due to concerns about fetal exposure, the use of contrast agents and radiation exposure must be carefully managed. Following to the principle of “As Low As Reasonably Achievable” (ALARA), strategies to minimize these risks are crucial for ensuring patient safety while maintaining diagnostic accuracy. This review highlights the contribution of cardiovascular imaging techniques, particularly computed tomography (CT) and magnetic resonance imaging (MRI), in the assessment of common pregnancy-related CVDs, and outlines strategies to reduce radiation exposure and limit contrast agent use when feasible, aiming to increase radiologists’ awareness of this crucial topic.

Optimizing Cardiovascular Health: A Narrative Review of Lifestyle, Psychobehavioral, and Alternative Strategies for Management and Prevention

Abstract Nonpharmacological approaches are essential in the prevention and management of cardiovascular disease (CVD), providing significant benefits that complement pharmacological treatments. This review offers a comprehensive analysis of various lifestyle modifications, behavioral and psychosocial interventions, and alternative therapies in managing CVD. Key findings demonstrate the effectiveness of dietary changes, physical activity, weight management, smoking cessation, stress reduction, improved sleep quality, acupuncture, Yoga, Tai Chi, and herbal supplements in reducing cardiovascular risk factors and enhancing overall heart health. By incorporating these evidence-based interventions, healthcare providers can optimize cardiovascular health, improve patient outcomes, and significantly reduce the burden of CVD. This review highlights the importance of a holistic approach to CVD management.

P0389 Cardiovascular risk assessment and ultrasound-assisted reclassification in patients with Inflammatory Bowel Disease (IBD): a single-centre study

Abstract Background Patients with inflammatory bowel disease (IBD) have an increased cardiovascular risk (CVR) and cardiovascular disease (CVD) is the leading cause of mortality in IBD patients. A more in-depth screening of patients has become important with the EMA warning for JAK-inhibitors. The current CV risk stratification algorithms are based on traditional risk factors not considering subclinical atherosclerosis. This study aimed to stratify the CVR of IBD patients according to the European Society of Cardiology (ESC 2021/23) and European Society of Atherosclerosis (EAS), together with the evaluation of the presence of previously subclinical atherosclerosis by carotid ultrasound. Methods Demographic and disease-related data were collected from consecutive IBD patients aged over 40 years, including systolic blood pressure, body mass index (BMI), lipid panel, and cardiovascular comorbidities. Asymptomatic atherosclerotic disease was assessed by carotid ultrasound in order to measure the carotid intima-media thickness (cIMT) and to detect the presence of plaques. CVR was stratified based on the latest guidelines on dyslipidemias (EAS/ESC 2019), cardiovascular prevention (ESC 2021), and the management of cardiovascular disease in patients with diabetes (ESC 2023). Moreover, additional IBD-related parameters potentially associated with an increased CVR were investigated, such as disease activity, current therapies, duration of disease, and extraintestinal manifestations. Results A total of 120 IBD patients were included (UC: 67 patients, CD: 53 patients) Baseline characteristics are presented in Table 1. Patients with UC had significantly higher mean values of total cholesterol (C-TOT) and low-density lipoprotein cholesterol (C-LDL) (p&amp;lt;0.001 and p=0.001 respectively). At baseline, 48% of patients were classified as having intermediate CVR, 34% as high risk, and 18% as very high risk (Table 2). Following carotid ultrasonography, subclinical atherosclerosis was diagnosed in 48.3% of patients. Based on these findings, CVR re-stratification was performed in 21% of patients resulting in 71% of patients with high and very high risk, compared to 50% at baseline. Additional risk factors for an increased CVR identified by multivariate regression analysis were having active disease (p=0.047) and concomitant spondiloathropathies (p=0.03). Conclusion Our study demonstrates that carotid ultrasound contributed to re-classify the CVR in patients who were previously considered to be in lower risk categories confirming that the use of traditional risk scores underestimates CVR in IBD patients. Having active intestinal disease and concomitant spondiloarthritis increases further the CV risk.

IMPACTO DA INTELIGÊNCIA ARTIFICIAL NA DETECÇÃO PRECOCE DE DOENÇAS CARDIOVASCULARES: UM ESTUDO DE REVISÃO INTEGRATIVA

Introduction: Artificial intelligence (AI) has emerged as a transformative tool in medicine, with significant applications in the cardiovascular field, especially in the early detection of cardiovascular diseases (CVDs). Its ability to process large volumes of clinical data through technologies such as machine learning (ML) and deep neural networks (DL) has provided faster, more accurate, and personalized diagnoses. Objectives: To analyze how AI contributes to the early detection of CVDs and, as specific objectives, to identify the main algorithms used, describe the benefits for patients and health professionals, and discuss the ethical and technical challenges associated with their implementation. Justification: The research highlights the social importance of reducing mortality associated with CVDs, the academic relevance of consolidating knowledge about AI in cardiology, and the scientific impact of exploring new diagnostic approaches to improve health care. Methodology: An integrative literature review was carried out, covering articles published between 2018 and 2023, in databases such as PubMed, Scopus, and Embase. Inclusion criteria prioritized peer-reviewed studies that discussed the application of AI in the diagnosis and management of CVDs. Results and discussion: The results showed that AI improves diagnostic accuracy, reduces response time, and enables personalized prognoses. However, challenges such as data privacy, algorithmic bias, and acceptance by professionals were identified as barriers to its implementation. Conclusion: AI is a promising tool in cardiovascular clinical practice, but its consolidation depends on strategies that address ethical and technical limitations and promote adequate training of health professionals.

Therapeutic Potential of GLP-1 Receptor Agonists in Diabetes and Cardiovascular Disease: Mechanisms and Clinical Implications.

Glucagon-like peptide-1 (GLP-1) is a crucial incretin hormone secreted by intestinal endocrine L cells. Given its pivotal physiological role, researchers have developed GLP-1 receptor agonists (GLP-1 RAs) through structural modifications. These analogues display pharmacological effects similar to those of GLP-1 but with augmented stability and are regarded as an effective means of regulating blood glucose levels in clinical practice. This review aims to comprehensively summarize the role of GLP-1 RAs in the management of diabetes mellitus (DM) and cardiovascular disease (CVD), with a particular emphasis on the underlying signal transduction pathways and their therapeutic potential. A comprehensive review was carried out through literature research. In pancreatic β-cells, GLP-1 RAs regulate the secretion of insulin and glucagon in a glucosedependent manner by influencing signaling pathways such as cAMP, PI3K, and MAPK. They also contribute to the regulation of blood glucose levels by promoting the proliferation of β-cells and inhibiting apoptosis in these cells. Recent comprehensive studies have also demonstrated the favorable impact of GLP-1 RAs on cardiovascular wellbeing. In addition to the cardiovascular protection afforded by glucose metabolism regulation, a large body of evidence from animal and cellular studies has corroborated the beneficial effects of GLP-1 RAs on conditions such as heart failure (HF), hypertension, and ischemic cardiomyopathy. These benefits are mainly attributed to the alleviation of inflammatory responses, reduction of oxidative stress, and prevention of cell apoptosis. Clinical data shows that GLP-1 RAs can reduce the risk of major adverse cardiovascular events (MACE) in diabetic patients. GLP-1 RAs play an important role in the management of both diabetes and cardiovascular diseases. They show potential therapeutic value through the modulation of multiple signal transduction pathways. However, there may still be some issues in practical applications that require further research and resolution.

Rigour of Development of European Society of Cardiology, American College of Cardiology and American Heart Association guidelines over a 12-year period (2013-2024): a systematic review of guidelines.

The ESC and ACC/AHA regularly publish guidelines for the management of cardiovascular disease. By definition, a guideline should follow strict methodological criteria, and have a transparent, traceable and reproducible development process. We aimed to assess the overall strength of the recommendations and rigour of methodological development in ESC and ACC/AHA guidelines. A systematic review of the ESC and ACC/AHA guidelines published from 2013 to 2024 was conducted. Documents Class of Recommendation (COR) and Level of Evidence (LOE) of recommendations were included. For each document, data regarding citation count (ISI and Scholar), and COR and LOE of the recommendations were extracted. Guidelines were assessed for rigour of methodological development using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. Among the 76 included guidelines, the average citation-per-year was 344 (ISI) and 681 (Scholar). Forty-nine % of the recommendations were classified as COR I (strong recommendations), while 46% were based solely on expert opinion (LOE C). The overall AGREE II methodology domain score was 29±6 (range 7-56), with lowest performance for the domains of systematic search of evidence, use of predefined criteria for selecting the evidence and external review. Both the strength of the recommendations and rigour of development showed a stable trend over the past 12 years. The ACC/AHA guidelines followed more rigorous development methods compared to ESC (AGREE II 36±3vs. 24±3). Clinical guidelines from the main European and American cardiovascular societies are highly cited but show significant limitations in methodological rigour.

Mycoplasma pneumoniae drives macrophage lipid uptake via GlpD-mediated oxidation, facilitating foam cell formation.

Cardiovascular diseases, primarily caused by atherosclerosis, are a major public health concern worldwide. Atherosclerosis is characterized by chronic inflammation and lipid accumulation in the arterial wall, leading to plaque formation. In this process, macrophages play a crucial role by ingesting lipids and transforming into foam cells, which contribute to plaque instability and cardiovascular events. Recent studies have suggested that various pathogens are involved in the development of atherosclerosis, with Mycoplasma pneumoniae considered one of the potential candidates. Therefore, this study investigated whether this bacterium induces lipid accumulation in macrophages, which play a crucial role in the development of atherosclerosis, using the Raw264.7 model. Our findings revealed that M. pneumoniae infection promotes lipid droplet formation in macrophages. Glycerol 3-phosphate oxidase, GlpD, in the bacterium is involved in this process by producing reactive oxygen species, which in turn causes the oxidation of low-density lipoprotein. Furthermore, the significant increase in the expression of oxidized lipid receptors involved in the uptake of this oxidized lipid indicates that the bacteria promote lipid uptake in infected macrophages. These results suggest that M. pneumoniae has a direct pro-atherogenic effect, promoting the formation of atherosclerotic lesions through foam cell formation. Understanding the mechanisms by which M. pneumoniae influences atherosclerosis provides valuable insights for devising new therapeutic strategies for the prevention and management of cardiovascular diseases.

Factors influencing evidence-based cardiovascular disease prevention programming in rural African American communities: a community-engaged concept mapping study

BackgroundAfrican Americans experience cardiovascular disease (CVD) disparities, and the burden is greatest in the rural south. Although evidence-based CVD prevention and management programs have been tailored to this context, implementation has been limited and not sustained long-term. To understand how to implement and sustain evidence-based CVD programs at scale, we must explore the perspectives of organizations serving rural African American communities and situate findings within foundational Implementation Science frameworks.MethodsThis study used group concept mapping (GCM) to elicit and synthesize stakeholder perspectives into an action-focused conceptual model depicting factors influencing implementation of evidence-based CVD programs. Representatives of community-based, faith, and healthcare organizations serving African Americans in five rural North Carolina counties were recruited via purposive sampling techniques. Participants (total n = 31) completed three activities: 1) brainstorming in response to an open-ended prompt (n = 31); 2) sorting brainstorm data into wider concepts and rating each in terms of relative importance and feasibility (n = 26); and 3) collaborative interpretation and refinement of the concept map (n = 19). Multivariate statistical analysis was used to generate a concept map. Absolute pattern matches comparing ratings of the relative importance and feasibility of each factor were generated and depicted via ladder graphs.ResultsThe final concept map included five factors: Accessibility, Community and Social Factors, Education and Training, Financial/Resource Development, and Organization Capacity and Staffing. There was high agreement (r = .98) between ratings of importance and feasibility. Education and Training, both within organizations and the wider community, was rated as the most important and feasible factor and Financial/Resource Development was the least important and feasible.ConclusionsThe concept map emphasizes aspects of organizations (inner setting), their surrounding community (outer setting), and individual stakeholders (participants, implementers) as influencing implementation of evidence-based CVD prevention and management programs in rural African American communities. The nature of the intervention or implementation processes were de-emphasized. Organizations in rural African American communities may feel equipped to implement a range of evidence-based programs, provided strategies address the contextual and structural barriers that impede their success. Group concept mapping helped distill and prioritize initial leverage points for action in our project catchment area by facilitating a community-engaged process of data generation and interpretation.

Artificial Intelligence Techniques for Prognostic and Diagnostic Assessments in Peripheral Artery Disease: A Scoping Review.

Peripheral artery disease (PAD) is a major public health concern worldwide, associated with high risk of mortality and morbidity related to cardiovascular and adverse limb events. Despite significant advances in both medical and interventional therapies, PAD often remains under-diagnosed, and the prognosis of patients can be difficult to predict. Artificial intelligence (AI) has brought a wide range of opportunities to improve the management of cardiovascular diseases, from advanced imaging analysis to machine-learning (ML)-based predictive models, and medical data management using natural language processing (NLP). The aim of this review is to summarize and discuss current techniques based on AI that have been proposed for the diagnosis and the evaluation of the prognosis in patients with PAD. The review focused on clinical studies that proposed AI-methods for the detection and the classification of PAD as well as studies that used AI-models to predict outcomes of patients. Through evaluation of study design, we discuss model choices including variability in dataset inputs, model complexity, interpretability, and challenges linked to performance metrics used. In the light of the results, we discuss potential interest for clinical decision support and highlight future directions for research and clinical practice.

Trends in drug repurposing: Advancing cardiovascular disease management in geriatric populations.

Drug repurposing is a promising strategy for managing cardiovascular disease (CVD) in geriatric populations, offering efficient and cost-effective solutions. CVDs are prevalent across all age groups, with a significant increase in prevalence among geriatric populations. The middle-age period (40-65 years) is critical due to factors like obesity, sedentary lifestyle, and psychosocial stress. In individuals aged 65 and older, the incidence of CVDs is highest due to age-related physiological changes and prolonged exposure to risk factors. In this review we find that certain drugs, such as non-cardiovascular drugs like anakinra, probenecid, N-acetyl cysteine, quercetin, resveratrol, rapamycin, colchicine, bisphosphonates, hydroxychloroquine, SGLT-2i drugs, GLP-1Ras drugs and sildenafil are recommended for drug repurposing to achieve cardiovascular benefits in geriatric patients. However, agents such as canakinumab, methotrexate, ivermectin, erythromycin, capecitabine, carglumic acid, chloroquine, and furosemide are constrained in their therapeutic use and warrant meticulous consideration, rendering them less favorable for this specific application. This review emphasizes the importance of exploring alternative therapeutic strategies to improve outcomes in geriatric populations and suggests drug repurposing as a promising avenue to enhance treatment efficacy.

Cardiovascular diseases, prevention and management of complications in older adults and frail patients treated for elective or post-traumatic hip orthopaedic interventions.

Due to the aging population, focusing on healthy aging has become a global priority. Cardiovascular diseases (CVDs) and frailty, characterized by increased vulnerability to adverse stress and health events, interact synergistically in advanced age. In older adults, hip fractures are a frequent dramatic "life-transition" event. Conditions such as arrhythmias, orthostatic hypotension, heart failure, peripheral artery disease and adverse drug reactions may facilitate falls and thus bone fractures in older adults. Cardiovascular complications or the worsening of previous CVDs may increase the degree of frailty and disability following this surgery. The close relationship between older age, CVDs, frailty and orthopaedic surgery leads to the need to focus on the various phases of interventions in a multidisciplinary approach. This document aims to provide practical support to prevent cardiovascular complications in older and frail patients undergoing hip procedures by suggesting specific assessments and interventions. In particular, in pre-operative care the focus should be on the assessment and management of concomitant CVD and frailty, while immediate peri- and post-operative care should highlight specific concerns for anesthesia, prevention and management of thrombotic complications, specific nursing needs, including the prevention of infections and delirium, and the establishment of an integrated rehabilitation program focusing on CVDs and the risk of new falls, with a positive role for care-givers. Furthermore, by optimizing the "hip surgery pathway" the objective is to help avoid the deterioration of health and loss of independence that often result from this surgery through the correct management of cardiovascular patients in this peculiar context.

Role of Trained Immunity in Heath and Disease.

This review aims to explore the role of immune memory and trained immunity, focusing on how innate immune cells like monocytes, macrophages, and natural killer cells undergo long-term epigenetic and metabolic rewiring. Specifically, it examines the mechanisms by which trained immunity, often triggered by infection or vaccination, could impact cardiac processes and contribute to both protective and pathological responses within the cardiovascular system. Recent research demonstrates that vaccination and infection not only activate immune responses in circulating monocytes and tissue macrophages but also affect immune progenitor cells within the bone marrow environment, conferring lasting protection against heterologous infections. These protective effects are attributed to epigenetic and metabolic reprogramming, which enable a heightened immune response upon subsequent encounters with pathogens. However, while trained immunity is beneficial in combating infections, it has been linked to exacerbated inflammation, which may increase susceptibility to cardiovascular diseases, including atherosclerosis and heart failure. Our review highlights the dual nature of trained immunity: while it offers protective advantages against infections, it also poses potential risks for cardiovascular health by promoting chronic inflammation. Understanding the molecular mechanisms underlying immune memory's impact on cardiac processes could lead to new therapeutic strategies to mitigate cardiovascular diseases, such as atherosclerosis, heart failure, and diabetes. These insights build the grounds for future research to balance the benefits of trained immunity with its potential risks in cardiovascular disease management.

UNVEILING THE POTENTIAL OF SALIVARY EXOSOMAL BIOMARKERS IN CARDIOVASCULAR DISEASE:INSIGHTS AND FUTURE DIRECTIONS

Cardiovascular disease (CVD) is the primary cause of mortality world wide, necessitating innovative diagnostic approaches due to the limitations of current tools. The growing significance of salivary exosomes as biomarkers for CVD detection and treatment is explored in this narrative review. Salivary diagnostics offer a non-invasive alternative, with exosomes-small extracellular vesicles containing proteins, lipids, and nucleic acids—serving as potential indicators of cardiovascular health. The review highlights how salivary exosomes reflect the physiological states of their parent cells and can indicate systemic inflammation, oxidative stress, and endothelial dysfunction, all critical factors in CVD progression. Furthermore, it discusses specific exosomal biomarkers linked to different cardiovascular diseases such as valvular heart disease, coronary artery disease, cardiac fibrosis, arrhythmias, and heart failure. By integrating salivary exosome analysis into clinical practice, there is potential for enhanced early detection, risk stratification, and monitoring of cardiovascular diseases, ultimately paving the way for more personalized treatment strategies. This exploration underscores the transformative potential of salivary exosomes in improving cardiovascular disease management and patient outcomes.