Prevention Of Cardiovascular Complications Research Articles

PRIORITIES OF ANTI-HYPERGLYCAEMIC DRUG THERAPY IN PATIENTS WITH TYPE 2 DIABETES AND HEART FAILURE

The aim is to explore the possibilities of improving the effectiveness in preventing cardiovascular diseases and heart failure using sodium-glucose co-transporter 2 inhibitors. Materials and methods: The analysis of the existing clinical and experimental data on the effect of sodium-glucose co-transporter 2 (SGLT-2) inhibitors on the cardiovascular system, the condition of kidneys, cardiovascular risk factors. Review: SGLT-2 inhibitors are the first class of glucose-lowering agents in large-scale studies (EMPA-REG OUTCOME, CANVAS, CVD-REAL, CVD-REAL2) which have demonstrated the ability to improve cardiorenal outcomes and reduce the risk of hospitalization with heart failure in patients with diabetes. In addition to hypoglycaemic action, SGLT-2 inhibitors show a number of pleiotropic effects, which are potentially capable of reducing cardiovascular risk: diuretic effect, decrease in: blood pressure, arterial wall stiffness, waist and body weight, expression of albuminuria, etc. The use of drugs of this class opens great prospects not only in terms of glycaemic control, but also in the prevention of cardiovascular complications of diabetes. Conclusions: 1. When choosing glucose-lowering agents in patients with type 2 diabetes, it is necessary to take into account their impact on the risk of development and the course of heart failure. 2. SGLT-2 inhibitors ought to be considered as a preferred method of treatment for type 2 diabetes in patients with heart failure or with a risk of heart failure that meets the latest recommendations of the European and American Diabetes Association.

Antioxidant and Anti-inflammatory Protective Properties of Thai Shallot (Allium ascalonicum cv. Chiangmai) Juice on Human Vascular Endothelial Cell Lines (EA.hy926)

Oxidative stress and inflammation are 2 major contributors to numerous life-threatening disorders, including vascular pathologies. Shallots (Allium ascalonicum) are a type of red onion which grows in Southeast Asia. Bulbs of this plant are used both as a food ingredient and in traditional medicine. This study attempted to investigate the possible ways that juice extracted from Thai shallot (A.ascalonicum cv. Chiangmai) bulbs could be used in the prevention of cardiovascular complications. The antioxidative and anti-inflammatory effects of shallot juice extract (SHE) on human vascular endothelial cells (EA.hy926) were investigated. Cell viability was evaluated by MTT assay, membrane lipid peroxidation by thiobarbituric acid reactive substances assay, intracellular reactive oxygen species (ROS) production by the fluorescent probe 6-carboxy-2'-7'-dichlorofluoresceine, and interleukin-6 (IL-6) released by ELISA. The shallot juice showed extremely low cytotoxicity against EA.hy926 cells, with IC50 of 41.9 and 27.3 mg/ml for 24 h- and 48 h-incubation, respectively. SHE reduced the iron-induced malondialdehyde production in a dose-dependent manner. The extract also demonstrated antioxidant activity as shown by a significant reduction of H2O2-induced ROS production at a low concentration (< 200 mg/ml). Furthermore, SHE significantly attenuated the level of IL-6 released during lipopolysaccharide stimulation (p < 0.05). It is of interest that the juice extracted from Thai shallot bulbs demonstrated both cellular antioxidant and anti-inflammatory properties in endothelial cell models, combined with a reduction in toxicity. Shallot extract could be considered as a nutraceutical for the prevention or management of vascular diseases as it is related to oxidative stress and inflammation.

Development of cardio-oncology in Ukraine: rationale, organization and implementation in clinical practice

Cardio-oncology is a new discipline in the field of medicine, with the main goal of identification, treatment and prevention of cardiovascular complications before, during and after cancer therapy. In recent years, progress in cancer treatment and the use of novel technologies has contributed to the improvement of cancer patients’ survival. The development of cardiovascular complications during anticancer treatment negatively affects the quality of life and worsens prognosis in potentially cured patients, especially in those with previous cardiovascular disease. Cardio-oncologists work in partnership with oncologists, oncohematologists, oncological surgeons, chemotherapists, radiologists, and primary care physicians. Proposed multidisciplinary approach makes it possible to provide the optimal anticancer treatment thereby improving the survival of cancer patients. In SI National Scientific Center «M.D. Strazhesko Institute of Cardiology» of NAMS of Ukraine, a center of cardio-oncology was established, which provides highly specialized outpatient and inpatient cardiac care to cancer patients. The main tasks of the cardio-oncology center are as follows: cardiovascular risk stratification before complex anticancer treatment: by operative intervention, before the beginning of polychemotherapy and radiotherapy, during treatment – by correction of cardiotoxic complications and comorbidities, monitoring of cardiotoxicity, primarily in patients with a high risk of cardiovascular complications, during and after anticancer therapy. The cardio-oncology center provides educational work, research and coordination activities to introduce the new subspecialty in the clinical practice, and collaborates with non-governmental organizations. Ukrainian Association of Cardiology has created a cardio-oncology working group, issued the first guidance on the management of patients with cardiotoxicity.

Evidence, Guidelines and Treatment Algorithms for Patients with Arterial Hypertension and Dyslipidemia: the Need for Compromise and Optimization of Tactics in Practical Healthcare

The scientific basis of the selection algorithms for the management of patients with hypertension and hypercholesterolemia is presented in article. The advantages and limitations of current recommendations on the management of patients with hypercholesterolemia, which were presented by American and European experts, are discussed. Data on the narrow-mindedness of use of risk assessment scales for the development of cardiovascular complications for primary prevention in a wide population are presented. The question of the ratio of proven facts and expert opinions in clinical recommendations, as well as the validity of a flexible approach to the choice of tactics for a specific patient, considering the most acceptable approaches presented in different clinical recommendations, is being considered. The validity of recommendations for achieving lower concentrations of lowdensity lipoprotein cholesterol in patients with high and very high cardiovascular risk is discussed. The difficult problem of choosing target blood pressure levels in patients with hypertension and with some characteristics or concomitant diseases and/or risk factors is discussed. The evidence base of modern drugs for preventing the development of cardiovascular complications and/or treating patients with such complications is discussed, including new data on the benefits of longer treatment with atorvastatin for the primary prevention of cardiovascular complications in patients with hypertension are discussed. Data on the problems of the choice of drugs used for the primary or secondary prevention of cardiovascular complications in patients with hypertension and hypercholesterolemia are presented.

In vivo Effects of Black and Green Tea on Serum Lipid Profile and Cardiac Function in Hyperlipidemic Rats

Objective: The study was designed to investigate the in vivo effects of black and green tea consumption on serum lipid profile and cardiac function in hyperlipidemic rats. Methods: 24 male Wistar rats, average weight 125 g were sorted into four groups: A, B, C and D. Normal control group (A) were fed standard rat chow; the remaining three groups (B, C and D) received rat chow supplemented with 2% (w/w) cholesterol to induce hypercholesterolemia. Group C and D were administered 40 mg/ml of black and green tea respectively while group B (hyperlipidemic control) were not treated. The feeding and tea administration lasted 6 weeks. Results: Significant reduction in body weight and heart weight index was recorded in rats administered black and green tea compared with the untreated group. Black and green tea consumption also caused significant decrease in total cholesterol, LDL-cholesterol, triglycerides and coronary heart disease (CHD) risk ratio accompanied with elevated HDL-cholesterol compared to untreated group. Significant alterations in cardiac marker enzymes: creatine kinase (CK), gamma glutamyl transferase (GGT) and lactate dehydrogenase (LDH) were also observed in serum and heart homogenates of untreated hyperlipidemic rats which were normalized in rats administered the teas. These results are synonymous with decreased risk of atherosclerosis and protective potential on cardiac function by green and black tea. Conclusion: We conclude in this study that regular intake of black and green tea might be useful in treatment of obesity and prevention of cardiovascular complications arising from hyperlipidemia.

Biomarkers for Kawasaki Disease: Clinical Utility and the Challenges Ahead.

Kawasaki disease (KD) has replaced acute rheumatic fever as the most common cause of acquired heart disease in children in the developed world and is increasingly being recognized from several developing countries. It is a systemic vasculitis with a predilection for coronary arteries. The diagnosis is based on a constellation of clinical findings that appear in a temporal sequence. Quite understandably, this can become a problem in situations wherein the clinical features are not typical. In such situations, it can be very difficult, if not impossible, to arrive at a diagnosis. Several biomarkers have been recognized in children with acute KD but none of these has reasonably high sensitivity and specificity in predicting the course of the illness. A line up of inflammatory, proteomic, gene expression and micro-RNA based biomarkers has been studied in association with KD. The commonly used inflammatory markers e.g. erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and total leucocyte counts (TLC) lack specificity for KD. Proteomic studies are based on the identification of specific proteins in serum, plasma and urine by gel electrophoresis. A host of genetic studies have identified genes associated with KD and some of these genes can predict the course and coronary outcomes in the affected individuals. Most of these tests are in the early stages of their development and some of these can predict the course, propensity to develop coronary artery sequelae, intravenous immunoglobulin (IVIg) resistance and the severity of the illness in a patient. Development of clinical criteria based on these tests will improve our diagnostic acumen and aid in early identification and prevention of cardiovascular complications.

ARMYTHMIC ACTIVITY OF MYOCARDIUM AT DIFFERENT STAGES OF ANESTHESIA AND PERI-OPERATIVE PERIOD IN PATIENTS UNDERGOING CHOLECYSTECTOMY

Prevention of cardiovascular complications, which often result in fatal events in the peri-operative period, is one of the most crucial issues of modern anesthesiology.The objective: to investigate the changes in arrhythmic activity and conduction disorders during anesthesia and in the peri-operative period in the patients undergoing open cholecystectomy under general anesthesia.Subjects and methods. 57 patients of 60.1 ± 3.8 years old were enrolled in the study; they all underwent planned open cholecystectomy under combined anesthesia with tracheal intubation and artificial pulmonary ventilation. Group 1 consisted of 28 patients suffering from coronary heart disease (CHD) in the form of exertional angina of functional classes of I and II; and Group 2 included 29 patients without CHD. The frequency of episodes of group and polymorphic premature ventricular contractions, supraventricular tachycardia and atrioventricular block of degree II, was analyzed by daily Holter ECG monitoring for certain time periods during anesthesia and the peri-operative period. Stages of the study: I – on the eve of the surgery (18 h); II – within 6 hours before the surgery; III – immediate preparation and induction of anesthesia (62.0 ± 6.7 min); IV – maintenance of anesthesia (57 ± 14 min); V – recovery from anesthesia (48 ± 11 min); VI – the 2nd day after surgery (18 h).Results. A significant increase in the frequency of episodes of group and polymorphic premature ventricular contractions, supraventricular tachycardia and atrioventricular block of degree II, was found out at the stages of induction, maintenance and recovery from anesthesia in patients with CHD and in patients without concurrent cardiovascular disorders. Increased frequency of episodes of group and polymorphic premature ventricular contractions was observed in patients with CHD at the stages of induction and recovery from anesthesia (by 242 and 225%). The highest increase in the frequency of polymorphic premature ventricular contractions was observed in patients with CHD during recovery from anesthesia (by 284%) and in those without cardiovascular pathology at the induction stage (by 461%); the increase in episodes of supraventricular tachycardia was maximum at the induction stage in the patients without cardiovascular pathology (by 291%).Conclusion: Open cholecystectomy in general anesthesia is associated with increased arrhythmic activity and higher conduction disturbances incidence at all stages of anesthesia in patients with coronary heart disease and those without concurrent cardiovascular disorders.

Moxonidine in treatment of arterial hypertension in patients with metabolic syndrome

Purpose. To evaluate the efficacy of moxonidine, an imidazoline receptor agonist, in patients with arterial hypertension (AH) and metabolic syndrome compared to enalapril, an ACE inhibitor. Materials and methods. The complex study included 50 patients with AH and metabolic syndrome. Inclusion criteria were abdominal obesity (waist-to-hip ratio (WHR) exceeded 0.95 in men and exceeded 0.80 in women, with BMI ≥25 kg/m 2 , AH of 1st - 2-nd degrees, type 2 diabetes mellitus (DM) in the stage of compensation, dyslipidemia. The mean age of patients was 52 years, duration of AH is 11 years, duration of type 2 DM is 7 years. After examination under conditions of a pure background and obtaining of DM compensation, all patients with AH and metabolic syndrome were randomized into 2 groups. The first group of patients (25 people) received moxonidine, an imidazoline receptor agonist, in individually selected dose of 0.2-0.6 mg per day, an average daily dose of 0.4 mg in twice a day form. The second group (25 people) took enalapril, an ACE inhibitor, in a dose of 5-15 mg per day, an average dose of 10 mg, respectively. A control study was performed after 4 weeks. Results. In patients with AH and metabolic syndrome, the use of moxonidine and enalapril for the correction of blood pressure (BP) showed a comparable effect in changes of office BP, average 24-hour BP, average day-time and night-time BP with the same frequency of achieving target BP. However, only moxonidine showed additional positive effect on the increased BP variability, contributed to the normalization of 24-hour BP profile, reducing the morning rise in BP, reduced the frequency of heart rate and the value of the double product. Moreover, moxonidine had cerebroprotective effects, increasing the cerebrovascular reactivity index. Conclusion. In hypertensive patients with metabolic syndrome, moxonidine provides the best prevention of cardiovascular complications.

Cardiovascular Diseases and Drug Treatment in Patients with the History of Cerebral Stroke: Data of the Outpatient Registry REGION

Aim. To evaluate the structure of combined cardiovascular diseases, drug treatment and observation of patients with a history of stroke in the framework of prospective outpatient registries. Material and methods. The study was conducted based on 3 outpatient clinics of Ryazan city. Patients with a history of acute cerebrovascular accident (ACVA) of any remoteness (AR) were included into ACVA-AR outpatient registry (n=511). Patients who had visited the outpatient clinics for the first time (FT) after cerebral stroke (n=475) were included into the ACVA-FT outpatient registry. The structure of the cardiovascular diseases (CVD), compliance with the clinical recommendations of the prescribed and received drug therapy were evaluated. The proportion of patients with dispensary observation for CVD, using preferential drug provision was determined. Results. A combination of 2 or more CVDs was found in 84.4% and 82.5% of cases, and severe cardiovascular multimorbidity (3-4 CVDs) – in 69% and 64% of cases, respectively, in ACVA-AR and ACVA-FT registers. Compliance with the clinical guidelines prescribed and received drug therapy was insufficient at the outpatient stage. Necessary prescription of drugs with a proven beneficial effect on the prognosis were observed significantly more frequent in the ACVA-FT registry, compared to the ACVA-AR registry at the enrolling stage of the study (p<0.05): statins for stroke – 50.1% vs 25.2%; statins for coronary heart disease (CHD) – 47.2% vs 27.9%; antiplatelet agents for CHD without atrial fibrillation – 65.6% vs 54.3%; anticoagulants for atrial fibrillation – 17.7% vs 9.3%; beta-blockers for heart failure 43.5% vs 33.1%, respectively. After 2-3 years of the follow-up frequency of prognostically significant prescriptions in patients of the compared registries were not significantly different, except prescriptions for statin therapy (47.6% vs 21.3%, respectively). The prognostically significant prescriptions during the enrolling stage in ACVA-AR and ACVA-FT registries occurred in 44.4% and 54% of the total number of proper prescriptions, and in the long-term follow-up period – in 55% and 57%, respectively; and the dispensary observation coverage was only 35.0% and 31.8%, respectively. According to patient contact only 21-24% of patients used the system of preferential drug provision at the stage of inclusion into the registers, and after 2-3 years of follow-up – 1.5-2 times less (12-14%). Conclusion The results of the study REGION found the presence of cardiovascular multimorbidity in 83% of patients with a history of stroke, insufficient quality of prescribed drug therapy in the out-patient clinic, especially in the ACVA-AR registry. The quality of medical treatment of patients improved within 2-3-year follow-up after the reference visit to out-patient clinic, but not sufficiently. Increase in dispensary observation coverage and optimization of the system of preferential drug provision are also important reserves for improving the quality of treatment of patients with a history of stroke, as well as prevention of cardiovascular complications.

Correction of Hypercholesterolemia in Primary and Secondary Prevention of Cardiovascular Diseases: Features and Controversial Issues

The article discusses the current prevalence of hypercholesterolemia in everyday clinical practice in patients of different risk categories and approaches to its correction in the most frequently used clinical guidelines. High prevalence of hypercholesterolemia in practical health care with little change over time is shown. The existing problems of the practical implementation of the principles of a healthy lifestyle as the basis for reducing cardiovascular risk and possible solutions are described. Attention is focused on a low number of patients taking statins, and even less – reaching recommended target cholesterol levels. It is emphasized the validity of lower, compared to previous, target cholesterol levels in National recommendations on the correction of dyslipidemia in patients with proven atherosclerosis-related cardiovascular diseases as well as the feasibility in some cases of combined lipidlowering therapy (statins in combination with intestinal cholesterol absorption blockers, PCSK9 inhibitors, high doses of ethyl eicosopentaenoic acid). It is commented the need to prescribe statins in persons older than 75 years, but with a careful approach. Particular attention is paid to the use of statins in the primary prevention of cardiovascular complications. The validity of prescribing fixed moderate doses of statins for this purpose is discussed, which is both scientifically based and more realistic in practical terms.

Ацетилсалициловая кислота при вторичной профилактике сердечно-сосудистых осложнений

Ацетилсалициловая кислота при вторичной профилактике сердечно-сосудистых осложнений

What “new” factors should be considered when assessing cardiovascular risk?

One of the causes of high mortality from cardiovascular diseases is the lack of effective measures for the primary and secondary prevention of cardiovascular complications (CCO), due to the difficulty of timely identification risk factors (RF) and individuals with a high individual risk of CCO. This is especially true for patients from low/mean risk. This group is heterogeneous. Often, clinical manifestations of atherosclerosis occur for the first time without “classical” RF. Possible factors that increase the risk of developing cardiovascular diseases and CCO, are: heart rate, increased formation of advanced glycation endproducts, disorders of bone mineral metabolism, thyroid function, low adherence to therapy, psychosocial factors and climatic features. This review is devoted to the analysis of the evidence base of the influence of these “new” CCO RF and the individual patient prognosis.

Cardiovascular complications in patients with rheumatic diseases.

In the recent years, there are more and more reports stating an increased risk of atherosclerosis and cardiovascular complications in patients with rheumatic diseases. It should be noted that the development of atherosclerosis in this category of patients occurs much earlier than in the general population. Indeed, many rheumatic diseases are associated with an increased risk of developing of cardiovascular diseases and death from vascular accidents, including RA, systemic lupus erythematosus, ankylosing spondylitis, gout, psoriatic arthritis, vasculitis of the middle and large vessels. There are reports of an increased risk of cardiovascular disease in patients with systemic scleroderma. It is significant that rheumatic diseases and coronary heart disease combine common pathophysiological mechanisms - systemic and chronic inflammation. At the same time, traditional risk factors such as hypertension, old age, smoking, hypercholesterolemia, obesity and male sex can not fully explain the mechanism of accelerated development of atherosclerosis in patients with rheumatic diseases. The presence of specific risk factors, such as the duration of the course of treatment, glucocorticosteroids administration, the presence of an increased concentration of inflammatory mediators and autoimmune mechanisms create conditions for the acceleration of atherosclerosis in this group of patients. Coordination of efforts of rheumatologists and cardiologists in studying the mechanisms of accelerated development of atherosclerosis in patients with rheumatic diseases will allow to develop adequate methods for timely diagnosis and prevention of cardiovascular complications in patients with this widespread pathology.

Identification of the first Tangier disease patient in Lebanon carrying a new pathogenic variant in ABCA1

The Middle East region is characterized by low levels of high-density lipoprotein cholesterol (HDL-C). To date, no genetic study has investigated the cause of low HDL-C in the Lebanese population. Our objective was to study the genetic causes for hypoalphalipoproteinemia in a Lebanese family with extremely low HDL-C levels. We sequenced the ABCA1 gene and evaluated cholesterol efflux, inflammatory, and metabolic profiles in the proband and his family. We identified the first Lebanese pathogenic variant in ABCA1 gene causing Tangier disease in a consanguineous family. The proband carried a novel homozygous pathogenic variant p.Gly592Asp in exon 14 of ABCA1, which segregated with the disease in the family. Functional study of the p.Gly592Asp pathogenic variant revealed that lipid-free apolipoprotein A-I-dependent cholesterol efflux was completely abolished in cholesterol-loaded human monocytes-derived macrophages isolated from the proband when compared to controls. Systemic inflammatory and metabolic assessments showed that plasma cytokines (MCP-1, MIP-1α, IL-6, CRP, TNF-α), adhesion molecules (ICAM-1, VCAM-1, E-selectin), inflammatory soluble receptors (sIL-6r, sTNFRI, sTNFRII), and metabolic markers (Insulin, C-peptide) were elevated in the proband when compared to controls. Noninvasive cardiovascular investigation revealed the presence of premature artery lesions in the proband. It is the first case of Tangier disease reported in Lebanon harboring a novel pathogenic variant in ABCA1. Further genetic research is needed in the Middle East where the consanguinity rate is elevated, to understand the cause of the highly prevalent dyslipidemia. This will help guiding the early diagnosis, management, and prevention of cardiovascular complications.

Overview of aldosterone-related genetic syndromes and recent advances.

Primary aldosteronism is the most common form of secondary hypertension. Early diagnosis and treatment are key to cure of hypertension and prevention of cardiovascular complications. Recent genetic discoveries have improved our understanding on the pathophysiology of aldosterone production and triggered the development of new diagnostic procedures and targeted treatments for primary aldosteronism. Different inherited genetic abnormalities distinguish specific forms of familial hyperaldosteronism. Somatic mutations are found not only in aldosterone-producing adenoma (APA), leading to primary aldosteronism, but also in aldosterone producing cell clusters of normal and micronodules from image-negative adrenal glands. Genetic knowledge has allowed the discovery of surrogate biomarkers and specific pharmacological inhibitors. Ageing appears to be associated with dysregulated and relatively autonomous aldosterone production. New biochemical markers and pharmacological approaches may allow preoperative identification of somatic mutation carriers and use of targeted treatments.

GLP-1 Receptor Agonists and Cardiovascular Disease in Patients with Type 2 Diabetes.

Diabetes mellitus is a chronic disease prevalence of which is high and continually growing. Cardiovascular disease continues to be the leading cause of death in patients with T2DM. The prevention of cardiovascular complications and the cardiovascular safety of treatments should be a primary objective when selecting treatment. Among all the drugs available, the compounds known as glucagon-like peptide-1 receptor agonists (GLP-1 RAs) appear to be not just innocuous in terms of CVD but indeed to be beneficial. GLP-1 RA actions not only translate on an improvement of well-known cardiovascular risk factors such as glycaemic control, dyslipidaemia, weight, or arterial hypertension but also might show benefits on endothelial function, coronary ischaemia, and heart failure. On the other hand, recent clinical trials aimed at studying cardiovascular episodes have been conducted with GLP-1 RAs. Only liraglutide and semaglutide have shown superiority in cardiovascular benefit compared with placebo. Although many of the mechanisms by which liraglutide and semaglutide produce a cardiovascular benefit are still unknown it would be desirable for these benefits to be incorporated into the therapeutic algorithms routinely used in clinical practice. The purpose of this review is to explore GLP-1 RA actions not only in cardiovascular risk factors (glucose, weight, and hypertension) but also the possible effects on established cardiovascular disease.

Management of morning hypertension: a consensus statement of an Asian expert panel.

Morning blood pressure (BP) surge is an important aspect of hypertension research. Morning BP monitoring could be a clinically relevant concept in the therapeutic management of hypertension and in the prevention of cardiovascular complications by defining and treating morning hypertension. Because antihypertensive medication is often taken in the morning, uncontrolled morning BP during the trough effect hours could be a hallmark of inadequate choice of antihypertensive regimen, such as the use of short- or intermediate-acting drugs, underdosing of drugs, or no use or underuse of combination therapy. To improve the management of hypertension in general and morning hypertension in particular, long-acting antihypertensive drugs should be used in appropriate, often full dosages and in proper combinations. The clinical usefulness of antihypertensive drugs with specific mechanisms for morning BP or split or timed dosing of long-acting drugs in controlling morning BP remains under investigation.

RIVAROXABAN IN LONG-TERM PREVENTION OF CARDIOVASCULAR EVENTS IN PATIENTS WITH ACUTE CORONARY SYNDROME

In patients with acute coronary syndrome (ACS), the combination of dual antiplatelet therapy (DAT) and parenteral anticoagulants (unfractionated or low molecular weight heparin or fondaparinux) in the acute (inpatient) phase of the disease correlates with the most significant reduction in cardiovascular complications (CVC). Numerous attempts have been made to prolong the anticoagulant potential with enteral medications during long-term prevention of CVC in the outpatient setting in patients with recurrent ACS, both with vitamin K antagonists and new oral anticoagulants. J. Oldgren et al., based on the results of a metaanalysis of seven such studies, concluded that addition of an enteral anticoagulant “on top” of acetylsalicylic acid or DAT after an ACS episode is accompanied by a significant reduction in the risk of major CVC, while the hemorrhage frequency increases almost two-fold. [1]

Aspirin for Prevention of Preeclampsia.

Aspirin is currently the most widely prescribed treatment in the prevention of cardiovascular complications. The indications for the use of aspirin during pregnancy are, however, the subject of much controversy. Since the first evidence of the obstetric efficacy of aspirin in 1985, numerous studies have tried to determine the effect of low-dose aspirin on the incidence of preeclampsia, with very controversial results. Large meta-analyses including individual patient data have demonstrated that aspirin is effective in preventing preeclampsia in high-risk patients, mainly those with a history of preeclampsia. However, guidelines regarding the usage of aspirin to prevent preeclampsia differ considerably from one country to another. Screening modalities, target population, and aspirin dosage are still a matter of debate. In this review, we report the pharmacodynamics of aspirin, its main effects according to dosage and gestational age, and the evidence-based indications for primary and secondary prevention of preeclampsia.

Morning blood pressure monitoring in the management of hypertension.

: The aim of the current article is to review the current evidence on the role of morning blood pressure (BP) in the management of hypertension. Morning BP surge had been and will continue to be a hot topic of hypertension research. However, more evidence is needed to prove its clinical usefulness in the management of hypertension. Masked morning hypertension, as the other forms of masked hypertension, requires more research. The concept of morning BP monitoring could be clinically relevant in the therapeutic management of hypertension and in the prevention of cardiovascular complications by defining and treating morning hypertension. Antihypertensive medication is usually taken in the morning. The presence of uncontrolled morning BP during trough effect hours could be a hallmark of inadequate antihypertensive regimen, such as, for instance, the use of short-acting or intermediate-acting drugs, under dosing of drugs, or no or low use of combination therapy. To improve the management of hypertension in general and morning hypertension in particular, long-acting antihypertensive drugs should be used in appropriate often full dosages and in proper combinations. The clinical usefulness of antihypertensive drugs of specific mechanisms against morning BP or split or timed dosing of long-acting drugs in controlling morning BP remains under investigation. In conclusion, there is some evidence that morning BP is critical in the incidence of cardiovascular complications. However, proving its clinical usefulness in the management of hypertension requires further research.