Established Diseases Research Articles

Molecular Thumbprints: Biological Signatures That Measure Loss of Identity.

Each life is challenged to adapt to an ever-changing environment with integrity-simply put, to maintain identity. We hypothesize that this mission statement of adaptive homeostasis is particularly poignant in an adaptive response, like inflammation. A maladaptive response of unresolved inflammation can seed chronic disease over a lifetime. We propose the concept of a molecular thumbprint: a biological signature of loss of identity as a measure of incomplete return to homeostasis after an inflammatory response. Over time, personal molecular thumbprints can measure dynamic and precise trajectories to chronic inflammatory diseases and further loss of self to cancer. Why is this important? Because the phenotypes and molecular signatures of established complex inflammatory diseases are a far cry from the root of the complex problem, let alone the initial seed. Understanding the science behind key germinating seeds of disease helps to identify molecular factors of susceptibility, resilience, and early dietary or drug intervention. We pilot this hypothesis in a rat colitis model that is well-established for understanding molecular mechanisms of colonic health, disease, and transition of colitis to cancer.

A Study of Psychological Features in Patients With Type 2 Diabetes Mellitus.

There is a lack of multidisciplinary studies examining the link between psychological factors and glycemic control in individuals with chronic illnesses. The aim of this study is to investigate the relationship between psychological factors such as resilience, perceived stress, emotional regulation, aggressiveness, and glycated hemoglobin (HbA1c) levels in patients with type 2 diabetes. Additionally, the study seeks to determine the predictive value of perceived stress and resilience on HbA1c levels and to explore the role of anger expression and emotion regulation strategies in glycemic control, comparing diabetic patients to healthy controls. The study was conducted between November 2021 and November 2023 at the Clinic of Endocrinology and Metabolic Diseases at the St. George University Hospital, Bulgaria, and the Department of Science and Research at the Medical University of Plovdiv, Bulgaria. Of these 84 individuals were diagnosed with type 2 diabetes, divided into two groups of 42 individuals each, who had poor and fair glycated hemoglobin. The third group was a healthy control consisting of 42 individuals in the same age group who had no established chronic diseases. When comparing the study groups on HbA1c and individual psychological characteristics, there were statistically significant differences in resilience, perceived stress, emotion regulation suppression, and anger expression. When comparing the mean values of mental resilience with glycated hemoglobin levels, we find that there are statistically significantly higher mean values between the poor HbA1c control and the healthy group. From the regression analysis, we conclude that the psychological characteristics positively associated with perceived stress (β=0.502; p<0.001) and inversely associated with mental resilience (β=-0.359; p<0.001) are the most predictive. Less influential was the straight correlation with emotion regulation-expressive inhibition (β=0.226; p<0.05), the positive correlation with anger (β=0.170; p<0.001), and general aggressiveness (β=0.151; p<0.05). From the present study, we note that glycated hemoglobin level is strongly influenced by two psychological predictors, namely subjective perception of stressful situations and resilience level.

Marital Quality-A Neglected Player in the Prevention of Cardiovascular Diseases: A Systematic Review of Longitudinal Studies.

Marital quality (MQ) is a psychosocial factor that has been neglected in cardiovascular prevention guidelines, although its association with cardiovascular diseases has been identified in several studies. Therefore, we aim to investigate how MQ either in positive or negative dimensions affect different cardiovascular risk factors and diseases. We systematically searched different databases in September 2023 for longitudinal studies conducted to assess the contribution of MQ to well-established cardiovascular risk factors and diseases. Two independent researchers screened studies and carried out data extraction and quality assessment of included ones. From 12,175 potential studies screened, 40 were included. The presence of significant heterogeneity in methodology, follow-up, and subsequent effect estimates made it unfeasible to do a meta-analysis. Despite the variation, most studies found a significant association of negative MQ measures with physical inactivity (2/2), high levels of smoking (4/5) and alcohol (3/3) use, increased metabolic syndrome risk (3/3), elevated type 2 diabetes mellitus (T2DM) risk and poor T2DM management (3/6), elevated cardiovascular disease risk and progression (9/11), increased body weight and obesity risk (2/3), elevated blood pressure and hypertension risk (7/8). Positive MQ measures were mainly associated with improvement in blood pressure control (2/2), reduced T2DM risk and its good management (1/1), reduced body weight and obesity risk (2/2), and increased survival in cardiovascular diseases (4/4). Based on current evidence, MQ seems to play a crucial role in developing established cardiovascular risk factors and diseases and is worth considering in preventive strategies.

Forecasting the Burden of Cardiovascular Disease and Stroke in the United States Through 2050-Prevalence of Risk Factors and Disease: A Presidential Advisory From the American Heart Association.

Cardiovascular disease and stroke are common and costly, and their prevalence is rising. Forecasts on the prevalence of risk factors and clinical events are crucial. Using the 2015 to March 2020 National Health and Nutrition Examination Survey and 2015 to 2019 Medical Expenditure Panel Survey, we estimated trends in prevalence for cardiovascular risk factors based on adverse levels of Life's Essential 8 and clinical cardiovascular disease and stroke. We projected through 2050, overall and by age and race and ethnicity, accounting for changes in disease prevalence and demographics. We estimate that among adults, prevalence of hypertension will increase from 51.2% in 2020 to 61.0% in 2050. Diabetes (16.3% to 26.8%) and obesity (43.1% to 60.6%) will increase, whereas hypercholesterolemia will decline (45.8% to 24.0%). The prevalences of poor diet, inadequate physical activity, and smoking are estimated to improve over time, whereas inadequate sleep will worsen. Prevalences of coronary disease (7.8% to 9.2%), heart failure (2.7% to 3.8%), stroke (3.9% to 6.4%), atrial fibrillation (1.7% to 2.4%), and total cardiovascular disease (11.3% to 15.0%) will rise. Clinical CVD will affect 45 million adults, and CVD including hypertension will affect more than 184 million adults by 2050 (>61%). Similar trends are projected in children. Most adverse trends are projected to be worse among people identifying as American Indian/Alaska Native or multiracial, Black, or Hispanic. The prevalence of many cardiovascular risk factors and most established diseases will increase over the next 30 years. Clinical and public health interventions are needed to effectively manage, stem, and even reverse these adverse trends.

Distribution of cardiovascular risk severity among Egyptian patients with established cardiovascular diseases

Distribution of cardiovascular risk severity among Egyptian patients with established cardiovascular diseases

Salt and Cardiovascular Disease

Heart disease is a leading cause of mortality and morbidity globally. Sedentary lifestyle, bad eating habits, and little to no exercise have led to an alarming rise of lifestyle-mediated diseases in recent times. Table salt is one of the staples of all our kitchens and dining tables. Salt contains almost 98% sodium chloride. The unregulated amount of salt in our diet has led to adverse cardiovascular consequences. Fast foods such as salted French fries and Chinese cuisine may contain as much as 7,000 mg of sodium in a single meal! The American Heart Association (AHA) recommends a daily intake of not more than 2.3 g of salt per day (roughly one teaspoon). For patients with hypertension, heart failure, or kidney disease, a lower daily cut-off of 1.5 g of salt has been proposed but is still under debate. There is conflicting evidence of going too low with salt restriction as recent studies have shown increased adverse events when salt was restricted to beyond the recommended per-day threshold. The DASH (dietary approaches to stop hypertension) diet is a novel dietary pattern that is recommended for patients with hypertension. The DASH diet is not a restrictive or short-term diet but rather a sustainable and balanced approach to eating. It promotes a wide variety of foods, focusing on whole, unprocessed options, and encourages portion control. Adhering to a DASH eating pattern by itself can lower the systolic blood pressure by 6–11 mm Hg. Reducing salt intake can be challenging, as salt is present in many processed and packaged foods, restaurant meals, and fast food. More than 70% of the salt we eat, according to the AHA, comes from processed, prepackaged, and restaurant foods. “Salt Lite” is often marketed as a healthier alternative for individuals looking to lower their sodium intake. It typically contains a blend of potassium chloride with sodium chloride and is hence not totally “sodium free.” Individuals considering the use of “Salt Lite” should be aware of its higher potassium content and should not use it if they have a kidney disease or are on drugs that can cause hyperkalemia. There is a common misconception that pink Himalayan salt is lower in sodium than regular table salt. However, both types consist of approximately 98% sodium chloride. Research has not shown that Himalayan salt has any unique health benefits compared to other dietary salts. It is hence imperative for all individuals to restrict dietary salt intake to the recommended levels—as a measure toward a healthy lifestyle as well as a therapeutic modality for those with established cardiovascular diseases.

A-72 | Readmission after Weight Loss Surgery among Patients with Established Ischemic Heart Diseases: To Avoid the Procedure or to Better Risk Stratify?

A-72 | Readmission after Weight Loss Surgery among Patients with Established Ischemic Heart Diseases: To Avoid the Procedure or to Better Risk Stratify?

Comparative study of bone mineral density, phenotypes of emphysema in patients with or without established diagnosis of chronic airway disease

Background: Bone thinning and emphysema are established diseases caused by tobacco-related products proven beyond doubt. A paucity of literature available to establish the association between them. Objectives: To explore the association between the different emphysema subtypes and the presence of low bone mineral density among a population of active or former smokers with and without an established diagnosis of chronic obstructive pulmonary disease (COPD). Methods: 100 active and former smokers with chronic airway disease attending the Pulmonology Outpatient Department were identified, and they were administered clinical questionnaires, pulmonary function tests, chest computed tomography, and DEXA scans. Appropriate statistical tests were performed to analyze the association between the different emphysema subtypes, low bone mineral density, and smoking in the study participants. Results: Out of 100 samples, 80 % of the patients had low BMD (25 had osteoporosis, and 55 had osteopenia). Emphysema was more frequent and severe in patients with osteoporosis (63.2 vs. 36.8%, p=&amp;lt;0.01). For analyzing significant co-factors, a multivariable analysis was done, which yielded Body Mass Index (Odds ratio of 0.89 with a 95% Confidence Interval of 0.67–1.23) and the presence of centrilobular emphysema as most commonly associated with osteoporosis. (Odds ratio of 35.25, with a 95% confidence interval of 3.23 to 401.63). Conclusion: Patients having increased Body Mass Index (BMI) and the presence of centrilobular emphysema are having osteoporosis irrespective of their smoking status, which implicates BMI, and centrilobular emphysema has to be considered while evaluating COPD patients.

The impact of sodium-glucose co-transporter-2 inhibitors on dementia and cardiovascular events in diabetic patients with atrial fibrillation.

The effectiveness of sodium-glucose co-transporter-2 inhibitors (SGLT2i) on incident dementia in patients with diabetes and atrial fibrillation (AF) remains unknown. This study aimed to investigate the association between SGLT2i and the risk of incident dementia in diabetic patients with AF, and to explore the interactions with oral anticoagulants or dipeptidyl peptidase-4 inhibitors (DPP4i). We conducted a cohort study using Taiwan's National Health Insurance Research Database. Patients with diabetes and AFwithout a prior history of established cardiovascular diseases, were identified. Using propensity score matching, 810 patients receiving SGLT2i were matched with 1620 patients not receiving SGLT2i. The primary outcome was incident dementia, and secondary outcomes included composite cardiovascular events and mortality. After up to 5years of follow-up, SGLT2i use was associated with a significantly lower risk of incident dementia (hazard: 0.71, 95% confidence interval: 0.51-0.98), particularly vascular dementia (HR: 0.44, 95% CI: 0.24-0.82). SGLT2i was related to reduced risks of AF-related hospitalisation (HR: 0.72, 95% CI: 0.56-0.93), stroke (HR: 0.75, 95% CI: 0.60-0.94), and all-cause death (HR: 0.33, 95% CI: 0.24-0.44). The protective effects were consistent irrespective of the concurrent use of non-vitamin K antagonist oral anticoagulants (NOACs) or DPP4i. In diabetic patients with AF, SGLT2i was associated with reduced risks of incident dementia, AF-related hospitalisation, stroke, and all-cause death. The protective effects were independent of either concurrent use of NOACs or DPP4i.

Prevalence of anterior atlantoaxial subluxation and association with established rheumatoid arthritis.

Spinal involvement in rheumatoid arthritis (RA) is limited to the upper cervical spine, leading to cervical spine instability. This study aimed to evaluate the prevalence of anterior atlantoaxial subluxation (aAAS) and its associated risk factors in patients with RA. This single-centre cross-sectional study 240 patients consecutively were recruited. Radiographs of the cervical spine were obtained in the flexion and neutral neck positions and read by two blinded observers. The diagnosis of aAAS was based on the distance between the anterior aspect of the dens and the posterior aspect of the anterior arch of the atlas, which was >3mm during flexion. Statistical analysis was performed to determine the predictive factors of aAAS. Two hundred and forty patients with a mean±SD age of 56.4±11.4years were recruited, and 191 (78%) were female. The mean±SD duration of the disease was 10.2±8.5years. Of all 25 cases (10.4%) diagnosed with aAAS, the mean anterior atlantodental interval in patients with AAS was 4.19±1.20mm. One in three patients with aAAS had no neck pain. Patients with aAAS had longer disease duration, lower age at diagnosis, lower body mass index, higher anti-cyclic citrullinated peptide autoantibodies (anti-CCP), more frequent erosion, joint restriction, and joint prostheses. In the multivariate regression model, joint limitation, history of joint prostheses, low BMI, and higher anti-CCP levels were independent predictors of the aAAS. Thirty-three percent of patients with cervical involvement do not experience neck pain. Cervical involvement should be considered even without neck pain, particularly in established diseases.

The Role of Early Treatment in the Management of Axial Spondyloarthritis: Challenges and Opportunities.

Axial spondyloarthritis (axSpA) is a chronic, inflammatory rheumatic disease that primarily affects the axial skeleton, often inflicting severe pain, diminished mobility, and a compromised quality of life. The advent of Assessment of SpondyloArthritis international Society (ASAS) classification criteria for spondyloarthritis (SpA) have enabled the classification of patients with axSpA in the non-radiographic stage but poorly perform if mistakenly used for diagnostic purposes. Despite notable progress in early diagnosis facilitated by referral strategies and extensive magnetic resonance imaging (MRI) utilization, diagnostic delays persist as a concerning issue. This underscores the urgency to narrow the diagnostic gap and highlights the critical role of early diagnosis in mitigating the long-term structural damage associated with this condition. Research into the impact of non-steroidal anti-inflammatory drugs (NSAIDs) and biologic disease-modifying antirheumatic drugs (bDMARDs) on inflammatory symptoms and radiographic progression has been extensive. A compelling body of evidence suggests that early intervention leads to superior disease outcomes. However, most of these studies have centered on patients with established diseases rather than those in the early stages. Consequently, findings from studies on early pharmacological intervention remain inconclusive, and the potential for modifying the disease trajectory is still debatable. Without precise data from clinical trials, insights from basic science regarding the pathogenic mechanisms might point toward potential targets that warrant early intervention in the disease process. This review underscores the urgency of early diagnosis and intervention in axSpA, highlighting ongoing research gaps and the need for further exploration to improve patient outcomes.

Omega-3-acid ethyl ester medicines: risk of AF in patients with established CV diseases or CV risk factors

Omega-3-acid ethyl ester medicines: risk of AF in patients with established CV diseases or CV risk factors

The Burden of Treatment Among Delhi’s Homeless: An Analysis of Street Medicine Consultations

Background: The health challenges faced by the homeless are widely unaccounted for in the global south. In India, the lack of a primary healthcare sector in urban areas has led informal healthcare providers, such as Street Medicine, to step in. Methods: By compiling data collected by the Centre for Equity Studies’ Street Medicine teams from June 2016 to October 2018 (n =16,635), this study provides the first empirical assessment of the homeless disease burden in a global south country, while limited to only the people experiencing homelessness that the teams treat, hence being a burden of treatment. Our analysis quantifies this burden among those who seek care from Street Medicine teams and identifies variations in this burden’s distribution across demography and time. Results: The majority (n = 13,557; 81.5%) of Street Medicine cases can be attributed to 19 diagnoses or symptoms, which are mostly therapeutically-simple conditions. The distribution of disease seems to be affected by different configurations of three characteristics: demographics (age and sex), urban geography (where homeless reside), and season. Conclusion: The Street Medicine teams must reflect on the balance they wish to achieve by addressing the relatively common and mild conditions documented in the dataset, and more severe and established diseases within homeless communities. Rapid diagnostic tests for resource-constrained settings could be integrated into Street Medicine practice in order to strengthen the data on which resource allocation decisions are made and improve assessments of homeless disease burden.

Left ventricular speckle-tracking-derived mechanical dispersion in patients with transthyretin amyloidosis and their first-degree relatives

Abstract Background Mechanical dispersion has shown to predict ventricular (LV) arrhythmias and sudden cardiac death in populations with established cardiac diseases, such as cardiomyopathies and heart failure. Transthyretin amyloid (ATTR) cardiomyopathy arises from deposition of misfolded, insoluble transthyretin (TTR) in extracellular matrix. The disease impacts profoundly cardiac tissue architecture and its mechanical properties. Purpose The aim of this prospective study was assessment of LV speckle-tracking-derived mechanical dispersion in patients with ATTR cardiomyopathy and their first-degree relatives. Methods We present data based on evaluation of 85 patients, including 34 (group 1) index patients with ATTR and 51 (group 2) first-degree relatives who were studied between June 2020 and January 2023. Study protocol included clinical data, free light chain blood immunoglobulins and urine immunofixation, transthoracic echocardiography (TTE) with global longitudinal strain (GLS) analysis, hybrid technique single-photon emission computed tomography and computed tomography (SPECT/CT) with [99mTc] Tc 3,3-disphono-1,2-propanodicarboxylic acid (DPD), genetic testing by an amplicon-based next-generation TTR sequencing approach, and in selected cases cardiac or soft tissue biopsy. Mechanical dispersion was calculated manually from GLS measurements and defined as the standard deviation (SD) of contraction duration from R on the electrocardiogram (ECG) to peak negative longitudinal strain of all LV segments. Results In group 1 patients were older (66.6±11 vs. 50.7±14) and presented with higher New York Heart Association (NYHA) class (2.4± 1 vs. 1.1± 0.6) (p&amp;lt;0.05). Overall, there were detected following types of TTR variants - Phe53Leu, Ala101Val, Glu112Lys, Glu109Lys, Glu122Lys, Glu82Lys. Compared to group 2, group 1 presented with higher N-terminal (NT)-pro hormone BNP (NT-proBNP) value (5859±7320 vs. 281±990 pg/ml), greater intraventricular septum thickness (19±4 vs. 12±3 mm) and LV mass index values (199±69 vs.111±42 g/m2), impaired LV ejection fraction (44±13 vs. 59±10 %) and GLS (-12.7±6 vs. -18.7±4 %) (p&amp;lt;0.05). Moreover, patients with ATTR cardiomyopathy had significantly higher value of LV speckle-tracking-derived mechanical dispersion compared to their first-degree relatives (96.2±22.3 vs. 77.9±23.3 ms, p=0.0007). Conclusions Patients with ATTR cardiomyopathy present with significantly higher LV mass index value, impaired GLS and higher value of LV speckle-tracking-derived mechanical dispersion compared to their first-degree relatives (p&amp;lt;0.05). Assessment of LV speckle-tracking-derived mechanical dispersion may in future translate into further enhancement of disease evaluation and improving prognosis in the group of patients.

Predictors of Cardiovascular Morbidities in Adults With 21-Hydroxylase Deficiency Congenital Adrenal Hyperplasia.

The prevalence of cardiovascular and metabolic complications among adults with 21-hydroxylase deficiency (21OHD) is unknown. We sought to determine the prevalence of cardiovascular and metabolic morbidities among adults with 21OHD and to identify clinical factors and biomarkers associated with cardiovascular outcomes. A 10-year retrospective cross-sectional analysis was conducted on adult patients with confirmed 21OHD, aged 18 to 70 years, who had at least one clinical visit for assessment at the University of Michigan. The presence of cardiovascular diseases (CVDs) and other metabolic comorbidities was extracted from medical records based on International Classification of Diseases (ICD) codes. Medical treatments, glucocorticoid (GC) and mineralocorticoid doses, as well as specific biomarkers of disease control since age 18, were collected for analysis. A total of 254 patients with 21OHD, median age of 35 years (interquartile range, 28.25-46 y), were included in the analysis. The prevalence of CVDs in the entire cohort was 7.5%. An increase in prevalence was seen from early adulthood, reaching 25% in patients older than 60 years. Increasing age (adjusted odds ratio [OR], 1.05; 95% CI, 1.01-1.09), hypertension (OR, 4.27; 95% CI, 1.41-12.92), and higher GC doses (OR, 1.51; 95% CI, 1.11-2.06) were significantly associated with prevalent CVDs. Higher plasma renin activity was significantly associated with CVDs (OR, 1.07; 95% CI, 1.01-1.15) but not other biochemical markers of disease. Cardiometabolic morbidities are prevalent among adults with 21OHD. Hypertension, age, and GC exposure are the main predictive factors of established CVDs in our cohort.

Symptom-limited exercise capacity is associated with long-term survival.

The prognostic value of exercise capacity has been demonstrated in subjects with established cardiovascular diseases. We aim to evaluate the independence of exercise capacity measured by treadmill exercise test (TET) in predicting long-term outcomes among various comorbidities. This study was conducted from January 2003 to December 2012 in a tertiary medical center in Taiwan. Subjects referred for symptom-limited TET were recruited. Peak achieved metabolic equivalents (METs) were determined by treadmill grade and speed at peak exercise. The main outcomes were cardiovascular and all-cause mortality by linking to the National Death Registry. A total of 18,954 participants (57.8 ± 12.8 years, 62% men) achieved a mean peak METs of 9.2. Subjects in the lowest tertile of peak METs were older, had poorer renal function, lower hemoglobin, and more comorbidities. During a median follow-up of 4.3 years, there were 642 mortalities and 132 cardiovascular deaths. Peak METs significantly predicted cardiovascular death and all-cause mortality in the multivariable Cox regression models [hazard ratio (95% confidence intervals): 0.788 (0.660-0.940) and 0.835 (0.772-0.903), respectively]. The prognostic influence of peak METs consistently appeared in the subgroups, regardless of age, gender, body weight, comorbidities, use of beta-blockers, or the presence of exercise-induced ischemia. The fitness was more predictive of long-term outcomes in young or those with ischemic changes during TET (P for interaction: 0.035 and 0.018, respectively). The benefit of fitness was nonlinearly associated with long-term survival. The prognostic impacts of exercise capacity were universally observed in subjects with or without various comorbidities.

Perspective of primary care physicians on the management of dyslipidaemia in patients without atherosclerotic cardiovascular disease: a cross-sectional study

Evidence suggests many dyslipidemic patients do not reach target low-density lipoprotein and cholesterol (LDL-C) levels in primary health care. We aimed to describe the pharmacologic therapeutic management of dyslipidemia in patients without established atherosclerotic cardiovascular diseases (ASCVD) from the primary care physician's perspective in Spain. We conducted a cross-sectional study through an online survey directed to primary care physicians to explore their therapeutic management of dyslipidemia in patients without ASCVD, focusing on their knowledge and adherence to the 2019 European Society of Cardiology/ European Atherosclerosis Society (ESC/EAS) guidelines and their perspective concerning the barriers to achieving LDL-C therapeutic targets. In total, 279 primary care physicians completed the survey. Most interviewees (80.65%) stated they had already adopted the 2019 ESC/EAS guidelines in their clinical practice. Nevertheless, around 30% adhered to therapeutic targets by previous ESC/EAS guidelines (2016), and most treated their patients mainly with statins in monotherapy, prescribing doses below the maximum tolerated. Additionally, 50.18% were classified as low adherence to the 2019 ESC/EAS guidelines, especially to the treatment algorithm. According to the physicians, the underestimation of patients' cardiovascular risk and the reluctance to increase doses or use combined therapy were the most critical barriers to achieving LDL-C targets. Although primary care physicians in our survey reported adherence to the 2019 ESC/EAS guidelines recommendations, our observations indicate they need to integrate them better into their clinical practice.

Dual Antiplatelet Therapy: A Concise Review for Clinicians.

Dual antiplatelet therapy (DAPT) combines two antiplatelet agents to decrease the risk of thrombotic complications associated with atherosclerotic cardiovascular diseases. Emerging data about the duration of DAPT is being published continuously. New approaches are trying to balance the time, benefits, and risks for patients taking DAPT for established cardiovascular diseases. Short-term dual DAPT of 3-6 months, or even 1 month in high-bleeding risk patients, is equivalent in terms of efficacy and effectiveness compared to long-term DAPT for patients who experienced percutaneous coronary intervention in an acute coronary syndrome setting. Prolonged DAPT beyond 12 months reduces stent thrombosis, major adverse cardiovascular events, and myocardial infarction rates but increases bleeding risk. Extended DAPT does not significantly benefit stable coronary artery disease patients in reducing stroke, myocardial infarction, or cardiovascular death. Ticagrelor and aspirin reduce cardiovascular events in stable coronary artery disease with diabetes but carry a higher bleeding risk. Antiplatelet therapy duration in atrial fibrillation patients after percutaneous coronary intervention depends on individual characteristics and bleeding risk. Antiplatelet therapy is crucial for post-coronary artery bypass graft and transcatheter aortic valve implantation; Aspirin (ASA) monotherapy is preferred. Antiplatelet therapy duration in peripheral artery disease depends on the scenario. Adding vorapaxar and cilostazol may benefit secondary prevention and claudication, respectively. Carotid artery disease patients with transient ischemic attack or stroke benefit from antiplatelet therapy and combining ASA and clopidogrel is more effective than ASA alone. The optimal duration of DAPT after carotid artery stenting is uncertain. Resistance to ASA and clopidogrel poses an incremental risk of deleterious cardiovascular events and stroke. The selection and duration of antiplatelet therapy in patients with cardiovascular disease requires careful consideration of both efficacy and safety outcomes. The use of combination therapies may provide added benefits but should be weighed against the risk of bleeding. Further research and clinical trials are needed to optimize antiplatelet treatment in different patient populations and clinical scenarios.

Subclinical atherosclerosis of the carotid arteries in patients with rheumatoid arthritis with low cardiovascular risk

To evaluate the detection rate of subclinical carotid atherosclerosis in rheumatoid arthritis (RA) patients with low cardiovascular risk (CVR). The study included 182 RA patients with low CVR (mSCORE<1%) and no established cardiovascular diseases and a control group comprising 100 people. Atherosclerotic lesion of the carotid arteries was assessed using Doppler ultrasound of the carotid arteries and was determined by the detection of atherosclerotic plaque (ASP) - the local increase in the thickness of the intima-media complex (IMT) >1.5 mm. Carotid ASP were observed more frequently in RA patients with low CVR than in the control group (17% versus 8%; p=0.02). The frequency of ASP in RA patients with low CVR did not depend on the disease's stage or activity and ongoing therapy. In RA, the detection of subclinical atherosclerosis was associated with traditional risk factors: carotid ASP were detected 4 times more often in men than in women (48% versus 12%, p<0.01); carotid IMT correlated with age (R=0.46), body mass index (R=0.17), LDL-C level (R=0.20), systolic blood pressure (R=0.17); p<0.05 in all cases. According to a multivariate model, in RA, the risk of developing ASP increased in the presence of dyslipidemia (odds ratio - OR 2.97; 95% confidence interval - CI 1.36-6.49; p=0.006) and arterial hypertension (OR 2.16; 95% CI 1.03-4.54; p=0.04). In RA patients with carotid ASP, sCD40L level was associated with carotid IMT (R=0.32; p=0.04) and cholesterol concentration (R=0.39; p=0.01). Subclinical atherosclerotic lesions of the carotid arteries were observed in 24% of RA patients with low cardiovascular risk and were detected almost 2 times more often than in the control group. In RA patients with low CVR, the risk of developing carotid ASP increased by 2-3 times with concomitant hypertension and dyslipidemia. The carotid IMT was associated with traditional risk factors - age, gender, lipid levels and blood pressure indicators, in cases of detection of ASP - with an immunoinflammatory marker - sCD40L.

Clinical activities that contributed to the effectiveness of a cardiologist-pharmacist collaborative care model in managing diabetes.

The primary objectives of this study were to evaluate the change in glycated haemoglobin (HbA1c) and its association to clinical activities. The secondary objective was to elucidate moderators of the relationship between pharmacist-involved collaborative care (PCC) and change in HbA1c. This study was a retrospective cohort study conducted in a tertiary hospital over 12 months. Individuals with Type 2 diabetes, aged ≥21 years with established cardiovascular diseases were included while individuals with incomplete care documentation or missing data related to cardiovascular diseases were excluded. Individuals under the care of PCC were matched 1:1 based on baseline HbA1c with an eligible person who received care from the cardiologists (CC). Changes in mean HbA1c were analysed using linear mixed model. Linear regression was used to determine clinical activities that associated with improvement in HbA1c. Moderation analyses were conducted using the MacArthur framework. A total of 420 participants (PCC:210, CC:210) were analysed. The mean age of the participants was 65.6 ± 11.1 years, with the majority being male and Chinese. The mean HbA1c among participants in the PCC group decreased significantly after 6 months (PCC: -0.4% versus CC: -0.1%, P = 0.016), with maintenance of improvement at 12 months (PCC: -0.4% versus CC: -0.2%, P < 0.001). Frequencies of lifestyle counselling, reinforcement of visits to healthcare providers, health education, resolution of drug-related problems, emphasis on medication adherence, dose adjustments and advice on self-care techniques were significantly higher in the intervention group (P < 0.001). Improvements in HbA1c were associated with the provision of health education and medication adjustments.