Concomitant Cardiovascular Disease Research Articles

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<0.001. For people with cancer only, the risk of bleeding was 1.26 (95% CI 1.10-1.44), p<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<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<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<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 < 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 < 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<sup>th</sup> 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.

Prognostic value of humoral markers in patients with anthracycline-related cardiac dysfunction

Aim. To carry out a 12-month study on the prognostic role of humoral markers responsible for the main mechanisms of initiation of cardiotoxic myocardial damage (endothelin-1, soluble Fas-L, N-terminal pro-brain natriuretic peptide (NT-proBNP), tumor necrosis factor-α, interleukin (IL)-1β, matrix metalloproteinase (MMP)-2 and MMP9, soluble form of the ST2 protein (sST2), a tissue inhibitor of metalloproteinase-1, and tetranectin) in assessing the risk of progression of anthracycline-related left ventricular dysfunction.Materials and methods. The study included a total of 114 women aged 48.0 (46.0; 52.0) years without concomitant cardiovascular diseases and risk factors who received chemotherapy with anthracyclines in the past. The levels of serum biomarkers were determined using the enzyme immunoassay. Transthoracic echocardiography was performed at baseline and at 12 months of follow-up.Results. After 12 months of follow-up, all patients were retrospectively divided into 2 groups: group 1 (n = 54) included patients with an unfavorable course of anthracycline-related cardiac dysfunction (ARCD), group 2 (n = 60) encompassed patients with a favorable course of the disease. According to the ROC analysis, MMP-2 ≥ ≥ 338.8 pg / ml (sensitivity 57%, specificity 78%; AUC = 0.629; p = 0.025), MMP-9 ≥ 22.18 pg / ml (sensitivity 89%, specificity 87%; AUC = 0.886; p < 0.001), sST2 ≥ 32.4 ng / ml (sensitivity 64%, specificity 70.5%; AUC = 0.691; p = 0.002), and tetranectin ≤ 15.4 pg / ml (sensitivity 69%, specificity 72%; AUC = 0.764; p < 0.001) were identified as predictors of an adverse course of ARCD. When comparing ROC curves, it was found that the concentration of MMP-9 (p = 0.002) was the most significant predictor of the progression of ARCD.Conclusion. MMP-2 and -9, soluble ST2, and tetranectin can be considered as non-invasive markers for assessing the risk of ARCD progression. At the same time, an increased level of MMP-9 is the most significant predictor of ARCD progression.

Effectiveness and Safety of Fenofibrate in Routine Treatment of Patients with Hypertriglyceridemia and Metabolic Syndrome.

A non-interventional study was conducted among routine healthcare providers. Patients with TG levels of >2.3 mmol/L on stable statin therapy starting fenofibrate treatment were enrolled. Data on medical history, fenofibrate treatment, change in lipid levels, and C-reactive protein (CRP) were collected from medical records every 3 months for 6 to 7 months of observation. Overall, 988 patients receiving fenofibrate were enrolled (median age [95% CI] 60 [26.0-86.0] years), and 46.4% of the participants were females. Most patients had concomitant cardiovascular disease. A baseline TG level of 3.6 ± 1.5 mmol/L was reduced by 50.1% to 1.7 ± 0.58 mmol/L at 6 months of treatment (p < 0.001). Baseline non-high-density lipoprotein cholesterol (non-HDL-C) levels decreased by 33.7% at 6 months. Total cholesterol and low-density lipoprotein levels by the end of follow-up were reduced by 24.7 and 25.5% (p < 0.001 for both). C-reactive protein level decreased more than 39% from baseline. Fenofibrate in a real-world setting significantly reduced TG, LDL-C, and non-HDL-C levels. In addition, a C-reactive protein level reduction of 39% was achieved.

Survival of Patients with Acute Coronary Syndrome and Hematologic Malignancies-A Real-World Analysis.

The impact of the encounter between coronary heart disease (CHD) and cancer, and in particular hematologic malignancies (HM), remains poorly understood. The aim of this analysis was to clarify how HM affects the prognosis of acute coronary syndrome (ACS). We analyzed German health insurance data from 11 regional Ortskrankenkassen (AOK) of patients hospitalized for ACS between January 2010 and December 2018, matched by age, sex and all comorbidities for short- and long-term survival and major adverse cardiac events (MACE). Of 439,716 patients with ACS, 2104 (0.5%) also had an HM. Myelodysplastic/myeloproliferative disorders (27.7%), lymphocytic leukemias (24.8%), and multiple myeloma (22.4%) predominated. These patients were about 6 years older (78 vs. 72 years *). They had an ST-segment elevation myocardial infarction (STEMI, 18.2 vs. 34.9% *) less often and more often had a non-STEMI (NSTEMI, 81.8 vs. 65.1% *). With the exception of dyslipidemia, these patients had more concomitant and previous cardiovascular disease and a worse NYHA stage. They were less likely to undergo coronary angiography (65.3 vs. 71.6% *) and percutaneous coronary intervention (PCI, 44.3 vs. 52.0% *), although the number of bleeding events was not relevantly increased (p = 0.22). After adjustment for the patients' risk profile, the HM was associated with reduced long-term survival. However, this was not true for short-term survival. Here, there was no difference in the STEMI patients, * p < 0.001. Survival in ACS and HM is significantly lower, possibly due to the avoidance of PCI because of a perceived increased risk of bleeding.

Comparative Effectiveness of Aspirin Dosing in Cardiovascular Disease and Diabetes Mellitus: A Subgroup Analysis of the ADAPTABLE Trial.

Patients with diabetes mellitus (DM) and concomitant atherosclerotic cardiovascular disease (ASCVD) must be on the most effective dose of aspirin to mitigate risk of future adverse cardiovascular events. ADAPTABLE, an open-label, pragmatic study, randomized patients with stable, chronic ASCVD to 81 mg or 325 mg of daily aspirin. The effects of aspirin dosing was assessed on the primary effectiveness outcome, a composite of all-cause death, hospitalization for myocardial infarction, or hospitalization for stroke, and the primary safety outcome of hospitalization for major bleeding. In this prespecified analysis, we used Cox proportional hazards models to compare aspirin dosing in patients with and without DM for the primary effectiveness and safety outcome. Of 15,076 patients, 5,676 (39%) had DM of whom 2,820 (49.7%) were assigned to 81 mg aspirin and 2,856 (50.3%) to 325 mg aspirin. Patients with versus without DM had higher rates of the composite cardiovascular outcome (9.6% vs. 5.9%; P < 0.001) and bleeding events (0.78% vs. 0.50%; P < 0.001). When comparing 81 mg vs. 325 mg of aspirin, patients with DM had no difference in the primary effectiveness outcome (9.3% vs. 10.0%; hazard ratio [HR] 0.98 [95% CI 0.83-1.16]; P = 0.265) or safety outcome (0.87% vs. 0.69%; subdistribution HR 1.25 [95% CI 0.72-2.16]; P = 0.772). This study confirms the inherently higher risk of patients with DM irrespective of aspirin dosing. Our findings suggest that a higher dose of aspirin yields no added clinical benefit, even in a more vulnerable population.

PECULIARITIES OF THE COURSE OF CARDIOVASCULAR PATHOLOGY IN SUBCLINICAL HYPOTHYROIDISM

Primary hypothyroidism is one of the most common endocrine pathologies. Subclinical hypothyroidism (SH) is a common disorder diagnosed with elevated levels of thyroid-stimulating hormone (TSH) and normal serum free thyroxine (T4) levels. There are also the difficulties in diagnosing SH due to its low-symptomatic or asymptomatic course and numerous “masks”: cardiological, gastroenterological, rheumatological, hematological, psychiatric. A wide variety of causes also makes timely diagnosis difficult.There are many studies proving the effect of SH on the state of the cardiovascular system (CVS) and its association with a higher risk of cardiovascular events. Diastolic dysfunction and arterial hypertension (AH) are commonly observed. Of note, the issue of prescribing replacement therapy with Levothyroxine sodium is still controversial. It is necessary to conduct further research in order to develop unified algorithms for the treatment of patients with FH, including those with concomitant cardiovascular diseases (CVD).CVD is a frequent companion of hypothyroidism. The studies on FH replacement therapy are of low methodological quality and their conclusions on the outcomes of interest are not consistent. Thus, further studies with a large number of patients are required to identify the effect of FH on the state of the CVS.In this review, the authors summarize and present the available data on the incidence, pathogenetic mechanisms, cardiovascular pathology in HF, as well as its treatment.

Results of the DAPA-CKD trial and their impact on clinical practice

Chronic kidney disease (CKD) is a growing medical and social problem in the world. Data from population base stu­dies demonstrate an increase in the prevalence of CKD and mortality. One of the causes is an increase in the number of patients with diabetes. Another reason is the limited ability to prevent the progression of the loss of kidney function. The first studies with dapagliflozin, such as DECLARE-TIMI 58 in patients with type 2 diabetes, showed a slowing of the progression of CKD to end-stage renal disease. The DAPA-CKD trial included patients with both type 2 diabetes and those without diabetes with an estimated glomerular filtration rate of 25 to 75 ml/min/1.73 m2 and albuminuria. The DAPA-CKD trial was terminated prematurely by independent monitors because of dapagliflozin overwhelming placebo. The primary endpoint, which included a sustained decrease in estimated glomerular filtration rate ≥ 50 %, end-stage renal disease, or death from renal or cardiovascular causes, was 39 % lower in the dapagliflozin group than in the placebo group. The effect of dapagliflozin on the primary endpoint was also similar among patients with dia­betic nephropathy, glomerulonephritis, ischemic or hypertensive CKD, and CKD of other or unknown cause. Also, the effect of dapagliflozin was the same regardless of concomitant cardiovascular diseases or chronic heart failure. All-cause mortality was 31 % lower among patients who received dapagliflozin at a dose of 10 mg. Dapagliflozin also significantly reduced the frequency of sudden decline in kidney function in CKD patients by 32 %. According to the results of a post-hoc analysis of the DAPA-CKD trial, compared to placebo, dapagliflozin reduced the frequency of hospitalizations due to cardiac causes, kidney and urinary tract diseases, metabolic and nutritional disorders, and oncological problems. This effect of dapagliflozin was independent of baseline type 2 diabetes. Based on the DAPA-CKD trial, dapagliflozin was approved by the Food and Drug Administration for use in reducing the risk of worsening kidney function, kidney failure, cardiovascular death, and heart failure hospitalization in adults with CKD.

Impact of dapagliflozin on life expectancy in type 2 diabetes mellitus patients in routine practice

BACKGROUND: Value of diabetes mellitus as social and medical issue seems to be growing worldwide. High rates of concomitant cardiovascular disease represent significant problem for prognosis improvement in diabetes mellitus patients. During analysis of CARDIA-MOS study results overall mortality decrease of 38.6% was demonstrated for sodium-glucose cotransporter-2 dapagliflozin.AIM: To analyze the number of added life years in patients receiving dapagliflozin compared to patients who did not receive hypoglycemic treatment with cardioprotective effects.MATERIALS AND METHODS: To evaluate outcome rates in patients included in CARDIA-MOS register, two samples were formulated according to predetermined criteria: 1) patients who started dapagliflozin treatment in 2017 and received medication for 48 months; 2) control group of patients not receiving cardioprotective hypoglycemic treatment comparable to study group in key characteristics: age, duration of diabetes mellitus, presence of cardiovascular disease, use of insulin, glycated hemoglobin (HbA1c) levels.RESULTS: Dapagliflozin increased life expectancy. Earlier prescription of treatment was associated with larger difference compared to standard therapy. For patients aged 60 years old dapagliflozin added 3.7 years of life, while in patients aged 75 years — 1.4 years. Demonstrated trend was consistent in analysis using locally weighted scatterplot smoothing.CONCLUSION: Therefore, use of dapagliflozin in real clinical practice was associated with increase in life expectancy. Earlier start of treatment led to higher number of life years added.