Concomitant Cardiovascular Disease Research Articles

A multidisciplinary, shared care clinic using personalized medicine and coordinated care in patients with concomitant type 2 diabetes and cardiovascular disease. Protocol and baseline characteristics

BackgroundConcomitant type 2 diabetes (T2DM) and cardiovascular disease (CVD) is frequent with a poor prognosis with high risk of comorbidities. Strict risk factor control reduces the risk for complications – yet many people do not achieve treatment targets. The complexity and fragmentation of the healthcare system may, together with the vulnerability of these patients, be a reason. ObjectiveThe purpose of this paper is to describe the protocol of a non-randomized interventional pilot study testing the feasibility and effect of a multidisciplinary, shared care clinic using personalized medicine and coordinated care in people living with concomitant T2D and CVD. MethodsParticipants were included from the Holbaek area in Denmark. People suffered from T2DM and CVD and were dysregulated regarding to HbA1c, cholesterol, micro/macroalbuminuaria or blood pressure. Participants went through a thorough evaluation to identify their needs and resources and received consultations every three months for one year. ResultsA total of 63 participants with T2DM and CVD were enrolled in the clinic. The participants had a mean age of 69 years and a BMI of 30.9 kg/m2. Almost 50 % had heart failure, 95 % dyslipidemia and 91 % hypertension. Around 54 % received GLP-1 agonists and 39 % received SGLT-2-inhibitors. PerspectivesTo our knowledge, a similar study with a multidisciplinary, shared care, outpatient clinic treating people living with concomitant T2DM and CVD, has not been performed previously. This study will provide information about the feasibility and efficacy of a multidisciplinary clinic based on changes in cardiovascular risk factors and medication.

Rhino-cerebral mucormycosis in patients with COVID-19: clinical cases and treatment in a regional hospital

Mucormycosis is a serious fungal infection, which increased significantly during the COVID-19 pandemic. We retrospectively analyzed 5 histopathologically confirmed cases of rhino-cerebral mucormycosis, which were diagnosed in patients admitted to Smolensk regional clinical hospital from November 2021 to January 2022. All patients were older than 60 years of age and had a recent history of laboratoryconfirmed severe COVID-19 and were treated in infection hospitals. All patients had decompensated type 2 diabetes mellitus; 80% of patients had concomitant cardiovascular diseases (coronary heart disease, arterial hypertension), 100% of patients received previous treatment with systemic corticosteroids for COVID-19 in hospitals. All patients underwent surgical treatment. Antifungal therapy (amphotericin B) was administered, and one patient received posaconazole due to a lack of efficacy of amphotericin B. The length of hospital stay ranged from 14 to 56 days. The overall 3-month survival rate of patients with rhinocerebral mucormycosis was 80%.

Rhino-cerebral mucormycosis in patients with COVID-19: clinical cases and treatment in a regional hospital

Mucormycosis is a serious fungal infection, which increased significantly during the COVID-19 pandemic. We retrospectively analyzed 5 histopathologically confirmed cases of rhino-cerebral mucormycosis, which were diagnosed in patients admitted to Smolensk regional clinical hospital from November 2021 to January 2022. All patients were older than 60 years of age and had a recent history of laboratoryconfirmed severe COVID-19 and were treated in infection hospitals. All patients had decompensated type 2 diabetes mellitus; 80% of patients had concomitant cardiovascular diseases (coronary heart disease, arterial hypertension), 100% of patients received previous treatment with systemic corticosteroids for COVID-19 in hospitals. All patients underwent surgical treatment. Antifungal therapy (amphotericin B) was administered, and one patient received posaconazole due to a lack of efficacy of amphotericin B. The length of hospital stay ranged from 14 to 56 days. The overall 3-month survival rate of patients with rhinocerebral mucormycosis was 80%.

Сложности и ограничения в медикаментозной терапии пациента с рецидивирующим нефролитиазом и сопутствующими хроническими заболеваниями сердечно-сосудистой системы

Nowadays, under conditions of an aging population, the comorbidity problem is of utmost importance in all branches of clinical medicine. The greatest difficulties are caused by the case when drug therapy of one nosology contradict with drugs prescribed for the treatment of another. In modern cardiology, extensive groups of diuretics and antihypertensives are widely used for therapy. At the same time, doctors do not always take into account the negative impact of cardiotropic therapy on the kidney stone disease process, as well as the general principles of metaphylaxis of nephrolithiasis on the cardiovascular system state. The paper presents data that allows to recommend the prescription of thiazides and combined antihypertensives, which have such in their composition, if the form of nephrolithiasis is idiopathic (stiff restriction). Besides, in conditions of urate nephrolithiasis, it is desirable to replace acetylsalicylic acid with clopidogrel, losartan with another sartan or an angiotensin-converting enzyme inhibitor. It is worth prescribing citrate mixtures with caution in metaphylaxis and nephrolithiasis litholysis, if there is no complete confidence in compensated cardiovascular diseases. KEYWORDS: recurrent nephrolithiasis, thiazides, potassium-sparing diuretics, gliflozines, losartan, acetylsalicylic acid, furosemide, acetazolamide, natural diuretics, urine pH. FOR CITATION: Yarovoy S.K., Royuk R.V. Difficulties and limitations in drug therapy of a patient with recurrent nephrolithiasis and concomitant chronic cardiovascular diseases. Russian Medical Inquiry. 2024;8(4):235–239 (in Russ.). DOI: 10.32364/2587-6821-2024-8-4-8.

Effectiveness of using a long-term individualized treatment regimen of tuberculosis with multiple drug resistance in elderly people with concomitant diseases

BACKGROUND. The actuality of the correct approach to the treatment of elderly patients with multidrug-resistance tuberculosis (MDR-TB) and concomitant diseases is unquestionable. We did not find in the available literature a study of the use of a completely oral long-term individualized treatment regimen (ITR) in this category of patients, which confirms the scientific novelty of the research.
 OBJECTIVE. To analyze the using of fully oral long-term ITR of MDR-TB in a 73-year-old patient with concomitant diseases on the example our own observation.
 MATERIALS AND METHODS. A clinical case of our own observation of a patient who was treated in the pulmonary TB department No. 2 of the Zaporizhzhia Regional Phthisiopulmonological Clinical Treatment and Diagnostic Center.
 RESULTS AND DISCUSSION. A 73-year-old man previously suffered from TB. He fell ill for the first time in 1987 and the first relapse of the specific process occurred in 2010. In both cases the patient received treatment of sensitive to antimycobacterial drugs TB, which ended with a positive outcome. During the relapse case described in the presented work, MDR-TB was diagnosed in the patient. Concomitant diseases of the cardiovascular system and the organ of vision were diagnosed in the patient. Before the ITR course completion the patient suffered a repeated myocardial infarction against the background of alcohol abuse. The patient received a completely oral long-term (18 month) course of MDR-TB ITR: 4 months of Lfx-Bdq-Cfz-Cs-Mpn-Amx/Clv, 2 months of Lfx-Bdq-Cfz-Cs, 12 months of Lfx-Cfz-Cs. Treatment was prescribed considering the data of the drug sensitivity test and the presence of contraindications to the appointment of Lzd. Complete cessation of bacterial excretion was registered after 4 months of antimycobacterial treatment. Tolerability of antimycobacterial therapy was satisfactory, adverse drugs’ reactions were not determined.
 CONCLUSIONS. The presented clinical case of our own observation demonstrates the high safety and effectiveness of a completely oral long-term (18 months) course of MDR-TB ITR in an elderly person with concomitant diseases, which is new data, since we did not find similar works in the available literature. The obtained data are an addition to the indications for use the all-oral long-term (18 months) course of ITR, including 4 months of Lfx-Bdq-Cfz-Cs-Mpn-Amx/Clv, 2 months of Lfx-Bdq-Cfz-Cs, 12 months of Lfx-Cfz-Cs in elderly patients with the simultaneous course of MDR-TB and concomitant cardiovascular and visual diseases.

Interplay Between TGF-β Signaling and MicroRNA in Diabetic Cardiomyopathy.

In diabetic patients, concomitant cardiovascular disease is the main factor contributing to their morbidity and mortality. Diabetic cardiomyopathy (DCM) is a form of cardiovascular disease associated with diabetes that can result in heart failure. Transforming growth factor-β (TGF-β) isoforms play a crucial role in heart remodeling and repair and are elevated and activated in myocardial disorders. Alterations in certain microRNAs (miRNA) are closely related to diabetic cardiomyopathy. One or more miRNA molecules target the majority of TGF-β pathway components, and TGF-β directly or via SMADs controls miRNA synthesis. Based on these interactions, this review discusses potential cross-talk between TGF-β signaling and miRNA in DCM in order to investigate the creation of potential therapeutic targets.

The use of calprotectin and other inflammatory parameters in the investigation of pseudoexfoliation syndrome concomitant glaucoma and systemic diseases.

The present study aimed to investigate the value of calprotectin and other inflammatory parameters in patients with glaucoma and systemic diseases accompanying pseudoexfoliation syndrome (PEX-S). This prospective study included 45 PEX-S patients and 45 non-PEX control patients. Patients were investigated for the presence of glaucoma, cardiovascular disease (CVD), ischemic brain disease (IBD), Alzheimer's disease, and neurosensory hearing loss (NSHL). After excluding diseases that may affect inflammatory parameters, a detailed biomicroscopic examination, and blood tests were performed for the patients. Glaucoma, CVD, NVK, Alzheimer's disease, and NSHL were high in the PEX-S group ( P = 0.01, P = 0.01, P = 0.04, P = 0.04, and P = 0.03, respectively). Calprotectin, ferritin, neutrophil-to-platelet ratio, and lymphocyte-to-platelet ratio were found to be high in the PEX-S group ( P < 0.01, P = 0.04, P < 0.01, and P < 0.01, respectively). On evaluating the relationship between PEX-S and glaucoma and systemic diseases, it was found that elevated calprotectin increased the risk of glaucoma by 4.36 times and elevated neutrophil-to-lymphocyte ratio (NLR) increased the risk of CVD by 3.23 times in PEX-S patients ( P = 0.02 and P = 0.03, respectively). This study demonstrated the value of calprotectin elevation in detecting concomitant glaucoma in PEX-S patients and, in addition, the value of NLR elevation in detecting concomitant CVD.

Simultaneous replacement of the aortic valve and hip joint in a patient with critical aortic stenosis and femoral neck fracture

Concomitant cardiovascular diseases in elderly patients with a hip fracture significantly increase the risk of developing postoperative complications. Developing the treatment algorithm for a combination of two or more diseases in this category of patients is the main task. The advantages of simultaneous surgery are one-stage repair of two or more surgical diseases, the implementation of one anesthetic procedure, the reduction in the total time of the patient’s stay in the hospital and the reduction in rehabilitation time. This paper presents the clinical observation of simultaneous surgical treatment of severe aortic stenosis and femoral neck fracture in an elderly patient.

Russian eligibility criteria prescribing menopausal hormonal hormones therapy for patients with cardiovascular and metabolic diseases. Consensus document of the Russian Cardiological Society, Russian Society of Obstetricians and Gynecologists, Russian Association of Endocrinologists, Eurasian Association of Therapists, Association of Phlebologists of Russia

Menopausal symptoms can disrupt the life course of women at the peak of their career and family life. Currently, the most effective treatment for these manifestations is menopausal hormone therapy (MHT). The presence of cardiovascular and metabolic diseases in itself does not exclude the possibility of prescribing MHT to relieve menopausal symptoms and improve quality of life. However, often an obstacle to the use of this type of hormonal therapy is the fear of doctors who are afraid of doing more harm to patients than good. Caution is especially important when it comes to women with underlying health conditions. Moreover, it should be recognized that there is a lack of high-quality research regarding the safety of MHT for major chronic non-infectious diseases and common comorbid conditions. The presented consensus document analyzed all currently available data obtained from clinical trials of various designs and created a set of criteria for the acceptability of prescribing MHT to women with concomitant cardiovascular and metabolic diseases. Based on the presented document, doctors of various specialties who advise women in menopause will receive an accessible algorithm that will allow them to avoid potentially dangerous situations and reasonably prescribe MHT in real practice.

COMPARATIVE ASSESSMENT OF THE RISKS OF FATAL AND NON-FATAL CARDIOVASCULAR EVENTS USING THE SCORE/SCORE-2 SCORE IN PATIENTS WITH CARDIOVACULAR PATHOLOGY

The main morbidity and mortality in the world is associated with pathologies of non-infectious origin, most of which are accounted for by diseases of the cardiovascular system. For the purpose of screening, a rating scale is currently used - SCORE. In 2021, the forecasting model was improved - the SCORE2 rating scale was released, which allows you to predict the risk of complications at an early stage using additional criteria. The purpose of the study: analysis of the risk assessment of cardiovascular events using the SCORE / SCORE - 2 scales. Materials and methods. A retrospective analysis of 140 patients' medical records was carried out. The inclusion criterion was the age of more than 40 years, the absence of concomitant cardiovascular diseases. Results. There were significant differences in Score (Men=9.5 points, Interwomen=3 points, p0.001) and SCORE2 (Men=22 points, Interwomen=18 points, p=0.049) between men and women aged 50 to 70 years old. When calculating, it turned out that most patients are at moderate risk of cardiovascular complications according to the SCORE scale, at very high risk according to the updated SCORE2 algorithm. Conclusion. In the course of comparing the 10-year risk of cardiovascular events calculated using the new SCORE2 algorithm, significant differences with the SCORE scale in digital values were revealed. All smokers, regardless of age and gender, were at very high risk, which absolutely increases the risk of complications.

Acute and long-term outcomes of acute coronary syndrome in patients with hematological malignancies

Abstract Background Coronary heart disease (CHD) and cancer are the leading causes of death. Treatment outcomes have improved significantly for both disease groups. In particular, patients with hematologic malignancies (HM) have an improved prognosis. However, knowledge of the interaction between acute coronary syndrome (ACS) and HM remains poor. Objective This analysis aimed to clarify how acute coronary syndrome affects the prognosis of HM patients. Results Between January 1, 2010, and December 31, 2018, 439,716 patients with ACS insured by AOK Germany were identified, of whom 2,104 (0.5%) also had HM. Myelodysplastic/myeloproliferative disorders, lymphocytic leukemias, and plasmacytomas predominated. These patients were approximately 6 years older and more likely to have had a myocardial infarction without ST-segment elevation. These patients had more concomitant cardiovascular disease and worse NYHA stage. They were less likely to receive coronary angiography and percutaneous coronary intervention (PCI), although the number of bleeding events was not significantly increased. Hospital stay was longer. All-cause mortality was increased regardless of age. After adjustment for patient risk profile, HM was associated with worse outcomes for all endpoints studied. Conclusion Survival is lower in ACS with HM, possibly due to the fact that these patients are less likely to undergo invasive diagnostics.Mortality, MACE and re-infarctionSurvival after STEMI and NSTEMI

Risks and benefits of antiplatelet therapy in patients with abdominal aortic aneurysm without symptomatic atherosclerotic disease: a nationwide cohort study

Abstract Background Patients with abdominal aortic aneurysm (AAA) suffer a high risk of ischemic events associated with concomitant atherosclerotic cardiovascular disease, and current clinical practice guidelines recommend antiplatelet therapies to mitigate this risk. However, in patients with AAA and no symptomatic atherosclerosis, the benefit of antiplatelet is sparsely investigated. Purpose To assess the effectiveness of antiplatelets vs no antiplatelets on the risk of ischemic events (composite of myocardial infarction and ischemic stroke) and bleeding in individuals with AAA who had no concomitant atherosclerotic vascular disease. Methods We designed a target trial to compare outcomes among treatment initiators and non-initiators and emulated the trial contingent on patient eligibility at time of inclusion, utilizing Danish nationwide observational data from January 2010 through August 2021. Confounding was handled by means of inverse probability treatment weighting based on the propensity score. The emulated sequential trial results for all possible trial months were pooled by means of pooled logistic regression models to estimate the intention-to-treat average treatment effects, and the 5-year associated treatment differences were expressed as hazard ratio (HR) with 95% confidence intervals (CI) and estimated event-free survival. Results A total of 6,344 patients provided 131,047 trial participants: 3,363 of these were new initiators of antiplatelet therapy, while 127,684 were non-initiators. During a median follow-up of 24 months, 173 and 369 ischemic events occurred among initiators and non-initiators, respectively. The corresponding HR of 0.91 (CI 95% 0.73 to 1.17) and an estimated absolute event-free survival difference of -0.6% (Figure 1). For bleeding, the HR was 1.26 (CI 0.97 to 1.58) and the event-free survival difference was 1.0%. Conclusion This target trial emulation, using nationwide observational data on all patients with AAA and no record of symptomatic atherosclerotic disease, did not find evidence of antiplatelets to lower the risk of ischemic events, but also no evidence of substantial higher bleeding risk. The observed differences between the treatment groups were minimal, suggesting limited clinically relevance of this treatment.ischemia- and bleeding free survival

Risk of bleeding in patients with and without cancer on antiplatelet therapy following myocardial infarction: a study in primary care

Abstract Background Antithrombotic medication and antiplatelet therapy (ATPL) are used in the treatment and prevention of thrombotic disorders, especially in patients following a myocardial infarction (MI). However, the risk reduction of future ischaemic events must be balanced against the potential bleeding risk. Co-morbidities may predispose individuals to bleeding events. Cancer influences risk of bleeding either directly through bleeding of fragile cancer-associated blood vessels or by indirectly increasing the risk of bleeding remote from the cancer site. In patients with cancer, bleeding risk may be increased due to ATPL given for concomitant cardiovascular disease. Purpose To investigate the association between pre-existing cancer and risk of bleeding in patients on ATPL after myocardial infarction in a primary care population. Methods We performed a matched cohort analysis using data from the Clinical Practice Research Datalink (CPRD) and linked Hospital Episodes Statistics (HES) in England. People with an MI between 2006–2017 were matched to patients without an MI at a 1:5 ratio. Four groups: patients with both MI and cancer (breast, digestive tract, lung, prostate at baseline [within 1-year prior to MI]), patients with only cancer or MI; and patients without either condition. Using flexible parametric methods, hazard ratios were calculated to determine the association between patient group and risk of bleeding, as well as between APTL-regimen after MI and bleeding risk during 1-year of follow-up after MI. All data were processed using STATA/SE16, using a significance level of ≤0.05. Results We included 58,951 patients with an average (mean) age of 74±10 years (66% male). Of all patients, 12,526 (21%) patients had cancer, and 9,942 (17%) had an MI; numbers per subgroup are presented in Figure 1. A bleeding event was observed in 1,193 (2%) patients. The vast majority (N=56,148 [95%]) of patients did not take ATPL. Of those who did receive ATPL, aspirin was the most common (N=2,359 [4%]). In a multivariable model (adjusted for age, gender, ethnicity, prior bleeding, diabetes, renal disease, smoking status, drug, hypertension, hypercholesteraemia and cancer), people with MI had a risk (hazard) of bleeding of 2.52 (95% CI 2.23-2.86), p&amp;lt;0.001. For people with cancer only, the risk of bleeding was 1.26 (95% CI 1.10-1.44), p&amp;lt;0.001. Conclusion(s) Bleeding risks are higher in people with cancer after an MI than those with MI or cancer alone. More research is needed on individual anti-platelet therapies for people with cancer who have a MI to minimize the risk of bleeding and future cardiovascular events.Figure 1

Russian Eligibility Criteria for Prescribing Menopausal Hormone Therapy to Patients With Cardiovascular and Metabolic Diseases. Consensus Document of RSC, RSOG, RAE, EUAT, RAP

Menopausal symptoms can impair the life of women at the peak of their career and family life. At the present time, the most effective treatment for these manifestations is menopausal hormone therapy (MHT). The presence of cardiovascular and metabolic diseases in itself does not exclude the possibility of prescribing MHT to relieve menopausal symptoms and improve quality of life. However, often an obstacle to the use of this type of hormone therapy is the fear of physicians to do more harm to patients than good. Caution is especially important when it comes to women with concurrent diseases. Moreover, it should be recognized that there is a shortage of high-quality research on the safety of MHT for underlying chronic non-infectious diseases and common comorbidities. The presented consensus analyzed all currently available data from clinical trials of various designs and created a set of criteria for the appropriateness of prescribing MHT to women with concomitant cardiovascular and metabolic diseases. Based on the presented document, physicians of various specialties who advise menopausal women will receive an accessible algorithm that will allow them to avoid potentially dangerous situations and reasonably prescribe MHT in real-life practice.

Patients with atrial fibrillation in outpatient practice: clinical characteristics and outcomes over a 10-year observation period (data from the REQUAZA AF registrу — Yaroslavl)

Aim. To present clinical characteristics and assess serious adverse outcomes (death, acute cardiovascular events) in outpatients with atrial fibrillation (AF) in one of the Yaroslavl clinics for 10 years.Material and methods. A total of 212 patients with AF aged from 23 to 94 years were included in the REQUAZA AF registrу — Yaroslavl at the first visit to the clinic in 2013. Their health status was monitored over 10,5 years through in-person visits, phone contacts with patients, their relatives, and treating physicians. Recorded data included the AF type, comorbid conditions, extent and quality of examinations and treatments, development of serious adverse events, and mortality. Statistical processing was carried out using the Microsoft Office 365 application software package.Results. Most patients (66,5%) were diagnosed with persistent AF. Paroxysmal, persistent, and newly detected forms were observed in 26,4%, 3,8%, and 3,3% of patients, respectively. Most AF patients had concomitant cardiovascular diseases, most frequently hypertension (96,7%), heart failure (91,6%), and coronary artery disease (91,2%). A total of 54 patients (25,5%) had prior stroke or transient ischemic attack. Complete information was obtained for 203 patients (95,8%), of which 164 (78,5%) passed away during the follow-up period. The leading death cause was cardiovascular disease, particularly cerebrovascular events (n=111; 67,7%). The highest mortality was recorded within the first two years of follow-up, during which more than a quarter (25,1%) of the registered patients had died. The COVID-19 pandemic did not significantly affect the mortality rates. The most common AF complications were stroke and transient ischemic attack, with a total of 74 episodes in the history and follow-up period, including 7 recurrences.Conclusion. Ambulatory AF patients represent a group with a high frequency of cardiovascular events and fatal outcomes. In the observed group of ambulatory AF patients, annual mortality exceeded 10%, and over 3/4 of patients died within 10 years. The leading death cause was cardiovascular disease, primarily cerebrovascular events.

Abstract 19029: Cardio-Oncology Incidence, Cardiac Arrest, and Mortality for Adolescent versus Pediatric Patients: Machine Learning Propensity Score National Analysis

Introduction: The incidence of cardio-oncology disease, arrest, and inpatient mortality among adolescent and pediatric versus adult patients is largely unknown, which undermines optimal care of these high-risk patients. Methods: BAyesian Machine learning-augmented Propensity Score (BAM-PS) translational statistics with multivariable regression was performed on the National Inpatient Sample. Results: Of the 142,651,868 hospitalizations from 2017-2020, 13.69% were pediatric (0-13 years old), 1.13% were adolescent (14-17 years old), and 85.18% were adult patients (over 17 years old). Adults were significantly more likely than adolescent and pediatric patients to have cancer and cardiac disease (99.37% versus 0.15% versus 0.47%, p&lt;0.001). The most common primary malignancies among adolescent or pediatric patients with cardio-oncology disease were leukemia (39.66% versus 52.60%), bone/connective (27.00% versus 12.43%), brain/nervous (8.02% versus 13.80%), Hodgkin lymphoma (7.17% versus 1.09%), and renal (6.01% versus 1.27%). In active cardio-oncology disease by BAM-PS multivariable regression controlling for clinical confounders and severity, adolescent and pediatric patients had comparable mortality odds to adults. Outside of active cardio-oncology disease, pediatric patients (OR 4.95, 95%CI 4.70-5.20, p&lt;0.001) had significantly greater mortality odds than adults, as did adolescent patients but with less magnitude of increased odds (OR 2.03, 95%CI 1.78-2.31, p&lt;0.001). In active cardio-oncology disease, pediatric patients (OR 0.17, 95%CI 0.04-0.68, p=0.013) had significantly lower odds of arrest compared to adults, with adolescents having comparable arrest odds versus adults. Among adolescent and pediatric patients with active cardio-oncology disease, African American versus Caucasians (OR 4.67, 95%CI 1.18-18.42, p=0.028) had significantly greater mortality odds. Conclusions: This machine learning multi-year national study suggests the existence of increased mortality in African American adolescent and pediatric patients with concomitant cancer and cardiovascular disease. Overall, adolescent and pediatric patients with cardio-oncology have better outcomes with more effective long-term management.

DIAGNOSIS AND TREATMENT OF PERIPHERAL ARTERIAL DISEASE IN PATIENTS WITH DIABETES MELLITUS

Patients with endocrine disorders often present with concomitant cardiovascular diseases. Peripheral arterial disease (PAD) in individuals with type 2 diabetes exhibits various clinical characteristics and diverse consequences. One of its primary manifestations is macrovascular complications. Although atherosclerosis is the primary cause, other contributory factors come into play. Notably, individuals with diabetes experience a more severe clinical course, marked by higher amputation rates and significant differences in mortality. The ankle-brachial index (ABI) is the standard diagnostic tool for identifying arterial diseases, while angiography is considered the gold standard for assessing anatomical aspects. Effective management of comorbidities including type 2 diabetes, hypertension, and dyslipidemia, has a substantial impact on clinical progression. Atherosclerotic disease manifests through the narrowing of affected vessels, resulting in reduced blood flow. The diagnosis of PAD requires the management of risk factors, medication-based therapies, and interventions for lower extremity issues. Physical exercise is also a valuable approach for alleviating PAD symptoms and extending pain-free walking distances. For patients with refractory conditions, surgical interventions are recommended. In cases where atherosclerotic arterial lesions are minor, pose minimal surgical risk, and have a high likelihood of successful intervention, percutaneous transluminal angioplasty should be considered. Early intervention is recommended in the presence of rest pain, ischemic ulcers, or necrosis. Balloon angioplasty and stent placement have shown efficacy in symptom relief for many PAD patients. Recent technological advancements have expanded the use of endovascular procedures, even before considering traditional "open" methods. Lesion location and length are essential factors for the long-term success of percutaneous vascular interventions.

Antiplatelet Therapy in Patients With Abdominal Aortic Aneurysm Without Symptomatic Atherosclerotic Disease

Patients with abdominal aortic aneurysm have a high risk of ischemic events associated with concomitant atherosclerotic cardiovascular disease, and current clinical practice guidelines recommend antiplatelet therapy to mitigate this risk. However, in patients with aneurysms without symptomatic atherosclerosis, the benefit of antiplatelet therapy has been sparsely investigated. To estimate the effect of antiplatelets on the risk of ischemic events and bleeding in individuals with abdominal aneurysms with no symptomatic atherosclerotic vascular disease. A comparative effectiveness research study using a target trial emulation framework was performed. Population-based, cross-linked observational data from Danish national health registries containing comprehensive, individual-level information on all Danish citizens were used to evaluate patients who were antiplatelet-naive and diagnosed with abdominal aortic aneurysms, with no record of symptomatic atherosclerotic vascular disease, from January 1, 2010, through August 21, 2021. Prescription filled for aspirin or clopidogrel. Risk of ischemic events (myocardial infarction and/or ischemic stroke) and risk of major bleeding. For target trial emulation, trials were emulated as sequential, contingent on patient eligibility at the time of inclusion, and were evaluated by means of pooled logistic regression models to estimate the intention-to-treat and as-treated effects, expressed as hazard ratio (HR) and event-free survival. A total of 6344 patients (65.2% men; age, 72 [IQR, 64-78] years) provided 131 047 trial cases; 3363 of these cases involved initiation of antiplatelet therapy and 127 684 did not. A total of 182 ischemic events occurred among initiators and 5602 ischemic events occurred among noninitiators, corresponding to an intention-to-treat HR of 0.91 (95% CI, 0.73-1.17) and an estimated absolute event-free survival difference of -0.6% (95% CI, -1.7% to 0.5%). After censoring nonadherent person-time, the treatment HR was 0.90 (95% CI, 0.68-1.20), with similar risk difference. For bleeding, the intention-to-treat HR was 1.26 (95% CI, 0.97-1.58) and the event-free survival difference was 1.0%. The treatment HR was 1.21 (95% CI, 0.82-1.72); the risk difference was similar. In this study, no evidence of effectiveness of antiplatelet therapy to lower the risk of ischemic events and a trend toward higher bleeding risk was noted. The observed differences between the treatment groups were minimal, suggesting limited clinical relevance of antiplatelet treatment.

Use of speckle tracking echocardiography in evaluating cardiac dysfunction in patients with acromegaly: an update.

In recent years, cardiovascular disease has garnered increasing attention as the second leading cause of death in individuals with acromegaly, following malignancy. Identifying cardiac dysfunction early in acromegaly patients for timely intervention has become a focal point of clinical research. Speckle tracking echocardiography, a well-established ultrasound technique, surpasses conventional Doppler ultrasound in its sensitivity to assess both local and global cardiac mechanics. It can accurately detect subclinical and clinical myocardial dysfunction, including myocardial ischemia, ventricular hypertrophy, and valvular changes. Over the past five years, the use of speckle tracking echocardiography in acromegaly patients has emerged as a novel approach. Throughout the cardiac cycle, speckle tracking echocardiography offers a sensitive evaluation of the global and regional myocardial condition by quantifying the motion of myocardial fibres in distinct segments. It achieves this independently of variations in ultrasound angle and distance, effectively simulating the deformation of individual ventricles across different spatial planes. This approach provides a more accurate description of changes in cardiac strain parameters. Importantly, even in the subclinical stage when ejection fraction remains normal, the strain parameters assessed by speckle tracking echocardiography hold a good predictive value for the risk of cardiovascular death and hospitalization in acromegaly patients with concomitant cardiovascular disease. This information aids in determining the optimal timing for interventional therapy, offering important insights for cardiac risk stratification and prognosis. In the present study, we comprehensively reviewed the research progress of speckle tracking echocardiography in evaluating of cardiac dysfunction in acromegaly patients, to pave the way for early diagnosis of acromegaly cardiomyopathy.

Results of a clinical study of Traumeel® S and Zeel® T in patients with knee osteoarthritis and concomitant cardiovascular disease

Objective: to evaluate the efficacy and safety of simultaneous intramuscular administration of Traumeel® S and Zeel® T followed by therapy with the tablet medication Zeel® T in patients with knee osteoarthritis (OA) and concomitant cardiovascular diseases. Material and methods. The analysis included 119 patients aged 45–79 years (78.2 % women and 21.8 % men) with confirmed diagnosis of knee OA according to Altman criteria, stage II–III according to Kellgren–Lawrence and confirmed cardiovascular disease. The main indicator of efficacy was the change in pain intensity in the target knee joint according to the “Pain” subscale of the WOMAC questionnaire (A) at the final examination compared to the baseline. Other criteria were the dynamics of each symptom of knee OA according to the WOMAC questionnaire (pain, stiffness, and functional impairment, total score) on each visit, pain intensity in the target joint on a visual analogue scale (VAS), time it takes to travel 15 m, and the patient's overall disease assessment on the VAS. In addition, duration of use and dose of paracetamol (if used) were assessed, as well as quality of life by EuroQol and adverse events (AEs). Treatment safety was also analyzed in patients who had received at least one dose of the study drug. Results and discussion. WOMAC pain intensity decreased by on average of 3.8 points: from 7.6 to 3.8 points (95 % confidence interval, CI from -4.3 to -3.3). Data on changes in knee OA symptoms (pain, stiffness, and functional impairment) for each WOMAC subscale and the total score showed significant improvement at each follow-up visit (p &lt; 0.0001). The VAS pain level decreased by 52%. An improvement in joint function was noted: the time it takes to travel 15 m fell from 19.5 to 16.4 s (p &lt; 0.0001). The EuroQol quality of life score also improved from 57.1 ± 16.2 points at baseline to 71.1 ± 14.8 points on the 84&lt;sup&gt;th&lt;/sup&gt; day of therapy. Thirty (25.2 %) patients had AEs, mainly neurological: headache (7.6 %) and hypoesthesia (1.7 %). No serious AEs were recorded. An association between AEs and study drug use was noted in 4 patients (headache, hypoesthesia, muscle cramps, and injection site pain). Conclusion. The results of the study confirm the efficacy and safety of the use of Traumeel® S and Zeel® T in patients with knee OA who have concomitant cardiovascular disease. During therapy, a significant decrease in pain and other clinical signs of OA (stiffness, limitation of physical activity) was observed, which allows us to recommend this treatment regimen for patients with comorbid pathology, as well as with the risk of developing of AEs during non-steroidal anti-inflammatory drugs therapy.