Prevention Of Cardiovascular Events Research Articles

L'activité sportive pour réduire le risque cardiovasculaire – Pourquoi s'en priverait-on ?

Sports-related sudden death is an uncommon event, affecting mainly middle-aged men who practice leisure sports, and is related to unknown coronary artery disease. In athletes, cardiac causes are also predominant, with a greater proportion of structural and electrical heart disease. If first-aid resuscitation measures are initiated, survival easily exceeds 50%, and this is an excellent educational illustration of how to improve the prognosis of non-sport-related cardiac arrest. Prevention of a sport-related cardiovascular event remains difficult, and relies on clinical examination, questioning (including family history) and resting ECG in participants >35 years old. The non-contraindication visit is also an opportunity to pass on to the patient the rules of good sports "hygiene" and life-saving gestures in the event of sudden death during sport in one of the partners (and the importance of regularly educating oneself in life-saving gestures...).

Navigating patient reluctance to statin intolerance.

Statin therapy is a cornerstone in the management of dyslipidemia, both in primary and secondary prevention of cardiovascular events. Despite strong guidelines supporting statin use, concerns regarding side effects, particularly musculoskeletal symptoms, contribute to statin intolerance and patient reluctance. While statin intolerance is reported in 5% to 30% of patients, its true prevalence may be overestimated due to the influence of the nocebo effect. Factors associated with higher incidence of statin intolerance include older age, female gender, comorbidities such as diabetes and chronic kidney disease, and concurrent use of medications such as antiarrhythmic agents or calcium channel blockers. Clinical characterization of statin intolerance requires thorough evaluation and exclusion of alternative causes of musculoskeletal symptoms. Strategies to address statin intolerance include reassessing cardiovascular risk, engaging in shared decision-making, statin rechallenge after appropriate washout periods, dosage titration for tolerability, and consideration of alternative therapies when LDL goals cannot be achieved with statins. This review provides an overview of the spectrum of statin intolerance, its clinical assessment, and a systematic approach to caring for a patient with statin intolerance.

Repeatability of Platelet Aggregation Characteristics Using Impedance Aggregometry With and Without Aspirin Intervention

Nearly 40% of adults over 50-years-old regularly take aspirin for primary or secondary prevention of cardiovascular disease and/or adverse cardiovascular events. The effcacy of aspirin therapy is commonly assessed with light transmission aggregometry. However, this method requires removal of large platelets as well as the mechanical disturbance of platelets remaining to be tested in the sample. Impedance aggregometry presents a solution to this problem, but the repeatability of impedance aggregometry analysis remains to be tested. We hypothesized repeated impedance aggregometry analysis would show decreased platelet aggregation activity following aspirin intervention compared with control visits. Venous blood samples were obtained from ten participants on three occasions each, separated by at least two weeks. One sample followed seven days of aspirin intervention (81 mg once daily; ASA) and the other two with no intervention (control). Platelet aggregation was induced using 1 μg/ml collagen (Col1), 5 μg/ml collagen (Col5), and 0.5 mM arachidonic acid (AA) via impedance aggregometry to determine area under the aggregation curve (AUC, au), time to aggregation initiation following addition of reagent (Lag, s), the rate of aggregation (Slope), and the maximal aggregation (Amp, Ohms). These characteristics were statistically analyzed for an impact of aggregometer channel (intra-test repeatability), visit (inter-test repeatability), intervention (ASA or control), and incubation (samples were incubated with either saline or Terutroban solution to block thromboxane receptors). Results were analyzed by multiple paired t-tests and represented with lowest relevant p-value if insignificant or highest relevant p-value if significant. Impedance aggregometry revealed no difference in any aggregation characteristics (AUC, Lag, Slope, or Amp) for duplicate samples (all p ≥ 0.10) or visits (all p ≥ 0.06). ASA decreased AUC, Slope, and Amp while increasing or completely inhibiting Lag response to the addition of all reagents (all p ≤ 0.01). Terutroban incubation had no effect on aggregation characteristics following the ASA intervention (all p ≥ 0.09), but attenuated the AUC, Slope, and Amp (all p ≤ 0.01), and entirely prevented or substantially increased the Lag response to AA (p ≤ 0.01) without impacting the responses to Col1 or Col5 (all p ≥ 0.24). These findings suggest the impedance aggregometry approach is a repeatable method for platelet aggregometry analysis for the characteristics of AUC, Lag, Slope, and Amp. NIH R01 Grant 1R01AG067471-01 NIH F31 Grant 1F31HL170616-01. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Platelet, Antiplatelet Therapy and Metabolic Dysfunction-Associated Steatotic Liver Disease: A Narrative Review.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is not only related to traditional cardiovascular risk factors like type 2 diabetes mellitus and obesity, but it is also an independent risk factor for the development of cardiovascular disease. MASLD has been shown to be independently related to endothelial dysfunction and atherosclerosis. MASLD is characterized by a chronic proinflammatory response that, in turn, may induce a prothrombotic state. Several mechanisms such as endothelial and platelet dysfunction, changes in the coagulative factors, lower fibrinolytic activity can contribute to induce the prothrombotic state. Platelets are players and addresses of metabolic dysregulation; obesity and insulin resistance are related to platelet hyperactivation. Furthermore, platelets can exert a direct effect on liver cells, particularly through the release of mediators from granules. Growing data in literature support the use of antiplatelet agent as a treatment for MASLD. The use of antiplatelets drugs seems to exert beneficial effects on hepatocellular carcinoma prevention in patients with MASLD, since platelets contribute to fibrosis progression and cancer development. This review aims to summarize the main data on the role of platelets in the pathogenesis of MASLD and its main complications such as cardiovascular events and the development of liver fibrosis. Furthermore, we will examine the role of antiplatelet therapy not only in the prevention and treatment of cardiovascular events but also as a possible anti-fibrotic and anti-tumor agent.

Primary and secondary prevention of stroke and cardiovascular events using evolocumab and alirocumab: Meta-analysis of randomized controlled trials.

Although the clinical role of protein convertase subtilisin kexin type 9 (PCSK9) inhibitors for cholesterol management is increasing, the post-marketing period of use is short compared to other lipid-lowering drugs, so there is still insufficient evidence for their efficacy and safety. In this meta-analysis, we evaluated preventive effects of stroke and cardiovascular (CV) events using evolocumab and alirocumab. We assessed the relative risk of stroke and CV events after alirocumab or evolocumab treatment in individuals with or without clinical CV diseases compared with that in controls. In addition, we evaluated the relative risk of hemorrhagic stroke. A total of 25 articles were included (median of study duration = 52 weeks). The risk of stroke was significantly decreased after treatment with alirocumab or evolocumab (primary prevention in patients without CV diseases: RR = 0.733; 95% CI, 0.618-0.870; secondary prevention in patients with CV diseases: RR = 0.703; 95% CI, 0.562-0.880). The risk of CV events also significantly decreased in patients treated with alirocumab or evolocumab (primary prevention: RR = 0.818; 95% CI, 0.777-0.861; secondary prevention: RR = 0.725; 95% CI, 0.578-0.910). The relative risk of hemorrhagic stroke was not significantly different between PCSK9 inhibitor-treated patients and controls (RR=1.041; 95% CI, 0.690-1.573). Our findings indicate that evolocumab and alirocumab are significantly effective without increasing the risk of hemorrhagic stroke. Based on this, the PCSK9 inhibitors can be highly recommended for cholesterol management.

Colchicine's Role in Cardiovascular Disease Management.

Colchicine-an anti-inflammatory alkaloid-has assumed an important role in the management of cardiovascular inflammation ≈3500 years after its first medicinal use in ancient Egypt. Primarily used in high doses for the treatment of acute gout flares during the 20th century, research in the early 21st century demonstrated that low-dose colchicine effectively treats acute gout attacks, lowers the risk of recurrent pericarditis, and can add to secondary prevention of major adverse cardiovascular events. As the first Food and Drug Administration-approved targeted anti-inflammatory cardiovascular therapy, colchicine currently has a unique role in the management of atherosclerotic cardiovascular disease. The safe use of colchicine requires careful monitoring for drug-drug interactions, changes in kidney and liver function, and counseling regarding gastrointestinal upset. Future research should elucidate the mechanisms of anti-inflammatory effects of colchicine relevant to atherosclerosis, the potential role of colchicine in primary prevention, in other cardiometabolic conditions, colchicine's safety in cardiovascular patients, and opportunities for individualizing colchicine therapy using clinical and molecular diagnostics.

Abstract P305: Room for Improved Secondary Prevention of Major Cardiovascular Events Among the Population With New Onset Diabetes: A Longitudinal Latent Class Trajectory Analysis

Background: After a diagnosis of diabetes, specialist physicians may play a key role in the secondary prevention of major cardiovascular events (MACE). Yet, trajectories of visits to specialists are heterogenous and their efficacy in the prevention of MACE remains unexplored. Goal: To assess whether trajectories of visits to specialists are associated with MACE among new cases of diabetes. Methods: Using the Quebec Integrated Chronic Disease Surveillance System, we identified new cases of diabetes ≥20 years old during fiscal year 2013, who had no prior history of MACE (ischemic cardiopathy, stroke, myocardial infarction or cardiovascular death). Firstly, individual trajectories according to the presence/absence of ≥1 ambulatory visit to a specialist (cardiologist, internist, endocrinologist) were compiled over consecutive 3-month periods up to 2 years following diagnosis. Patients with no visit were compiled in a “primary care only” group, while others were classified in groups using latent class growth analysis. Patients who had a MACE during this period were excluded. Secondly, the risk of MACE occuring after the 2 years following diagnosis up to December 31 st 2019 was compared between groups using a marginal Cox proportional hazards regression model, adjusted with inverse probability weighting and providing adjusted hazard ratio (aHR) with 95% confidence intervals (CI). Results: Among the 24,782 patients included, 5 groups were identified ( Figure 1 ). A total of 2,837 MACE occurred. Compared with the “primary care only group”, those who consulted a specialist were at higher risk of MACE (Regular/frequent visits: aHR: 1.50 [95% CI: 1.26 to 1.66]; Late visits: aHR: 1.41 [1.13 to 1.73]; Regular/sparce visits: 1.38 [1.27 to 1.51]; Early visits: 1.36 [1.19 to 1.54]), while no difference was observed between these groups. Conclusions: Although confounding by indication cannot be totally ruled out, these results may suggest room for improvement in the secondary prevention of MACE after a diabetes diagnosis.

Comparison of Effectiveness of High Dose Statin Monotherapy With Combination of Statin and Ezetimibe to Prevent Cardiovascular Events in Patients With Acute Coronary Syndrome: A Systematic Review and Meta-Analysis.

This meta-analysis aimed to compare the effectiveness of high statin monotherapy and a combination of statin and ezetimibe to prevent cardiovascular outcomes in patients with acute coronary syndrome (ACS). The study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted comprehensive searches across online databases, including MEDLINE/ PubMed, EMBASE, and the Web of Science, to find the relevant articles from the databases' inception to 10 Feb 2024. Outcomes assessed in the meta-analysis included major cardiovascular events (MACE), all-cause mortality, stroke, myocardial infarction, and unplanned revascularization. Data analysis was conducted utilizing RevMan Version 5.3.1. The comparison of outcomes between the two groups involved the calculation of risk ratios (RR) accompanied by 95% confidence intervals (CI) using either a random or fixed-effect model. Five studies were included in this meta-analysis, encompassing 48,668 patients. The pooled analysis showed that the risk of all-cause mortality was higher in patients receiving high statin monotherapy. However, no significant differences in MACE, myocardial infarction, stroke, and revascularization were reported. While acknowledging the limitations, including the lack of randomized controlled trials and the dominance of one study in the analysis, these findings underscore the importance of further research to clarify the comparative effectiveness of these treatment modalities in preventing cardiovascular outcomes in ACS patients.

Metabolic syndrome and hyperuricemia: features of patient management (clinical case)

Metabolic syndrome (MS) is a group of interrelated metabolic disorders such as high blood pressure, central obesity, insulin resistance (IR), dyslipidemia. The main mechanisms that indicate a metabolic disorder and contribute to its development are IR and a large amount of circulating free fatty acids. In turn, tissue IR is often combined with other abnormalities including disorders of uric acid metabolism, changes in the hemostasis system, endothelial dysfunction, increased levels of C-reactive protein. At the same time, metabo­lic disorders are a risk factor for hyperuricemia. MS occurs in 25–60 to 90 % of all gout patients. About 50 % of patients with hyperuricemia have symptoms of MS. Hyperuricemia as a component of MS is a predictor of cardiovascular mortality, development of diabetes mellitus, hypertension and nephrolithiasis. Hyperuricemia is closely related to diabetes, obesity, coronary heart disease, hypertension. On the example of a clinical case, the main components of MS are considered, as well as the issue of the relationship between hyperuricemia, gout and the components of MS. The main idea behind the creation of the MS concept is to select a population of patients at a high cardiovascular risk in whom preventive measures such as lifestyle modification and the use of adequate drugs can significantly affect the main health indicators. The goal of managing patients with MS is to minimize cardiovascular risk and mortality as much as possible. Accordingly, the therapeutic strategy should include optimal ways to modify the lifestyle; lowering blood pressure to the target level and treating comorbid conditions; reducing low-density lipoprotein cholesterol according to the risk profile: > 50 %, and < 70 mg/dL (1.4 mmol/L) in patients at a very high cardiovascular risk; > 50 %, and < 100 mg/dL (1.8 mmol/l) in high-risk patients; reducing fasting serum glucose < 126 mg/dl (7 mmol/l) or glycated hemoglobin < 7 % (53 mmol/mol); maintaining uric acid level < 6.5 mg/dL (0.387 mmol/L), in patients with gout — below 6 mg/dL (0.357 mmol/L). Thus, according to the results of the research, a causal relationship was found between insulin resistance and serum uric acid levels in patients with metabolic syndrome. The strategy for managing patients with metabolic syndrome should include screening and correction of hypertension, carbohydrate purine metabolism, dyslipidemia, and prevention of cardiovascular events.

Vaccination in Prevention of Acute Cardiovascular Events in Adults

Epidemiological studies have shown that acute coronary events, heart failure, atrial fibrillation with fast ventricular rate and brain stroke events have increased prevalence in winter season. Infections have a pivotal role in triggering such events. Vaccination against influenza and pneumococcus has been documented to prevent such events in large epidemiological studies. Majority of the deaths during Corona virus-19 (COVID-19) pandemic were related to cardiovascular event apart from serious lung condition. Vaccination has been proven to reduce risk of recurrent hospitalizations and death especially in sick and frail patients with heart failure, chronic obstructive lung diseases, renal failure and acute coronary syndromes. It becomes more relevant in countries like India where patient has to pay huge amounts for hospitalization from the pocket. On the other hand, it reduces unnecessary strain on the healthcare manpower and resources. Practice of vaccination in addition to guidelines based pharmacological, device or surgical therapy, is to help both the patients and physicians.

Abstract 9: Efficacy of Colchicine for Prevention of Stroke and Major Adverse Cardiovascular Events in Patients With Coronary Artery Disease: A Meta-Analysis of 15 Randomized Controlled Trials

Background: Clinical evidence supports the role of Inflammation in atherosclerosis and associated complications. Colchicine as a potential anti-inflammatory treatment among such patients has attracted much attention in recent years. However, its efficacy on cerebrovascular and cardiovascular events is still controversial. Objective: We sought to evaluate the efficacy of Colchicine for coronary artery disease patients. Methods: We performed a systematic literature search on PubMed, EMBASE, and Clinicaltrial.gov for relevant randomized controlled trials (RCTs) from inception until August 30th, 2023. Odds ratios (OR) were pooled using a random-effect model, and a p-value of <0.05 was considered statistically significant. Results: A total of 15 randomized controlled trials were included (6863 in Colchicine and 6756 in the control group) in the analysis. Pooled analysis of primary and secondary endpoints showed that Colchicine significantly reduced the risk of incidence of stroke by 50% (OR, 0.50 (95%CI: 0.31-0.81), P>0.001), myocardial infarction by 40% (OR, 0.60 (95%CI: 0.44-0.84), P>0.001), new acute coronary syndrome by 53% (OR, 0.47(95%CI: 0.47-0.85), P>0.001), and major adverse cardiovascular events 45% (OR, 0.55(95%CI: 0.39-0.78), P>0.001) compared with control. However, the risk of all-cause mortality (OR, 1.06(95%CI: 0.83-1.35), P=0.55) was comparable between both groups of patients. Conclusion: Colchicine was associated with an overall reduction in the risk of incidence of stroke, MI, MACE, ACS in patients with coronary heart disease. However, no such effect was observed with mortality.

Abstract 135: Efficacy and Safety of PCSK9 Inhibitors for Stroke Prevention: Systematic Review and Meta-Analysis

Objective: Investigate the efficacy and safety of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) on stroke prevention. Background: PCSK9i reduce low-density lipoprotein cholesterol (LDL-Chol) and lipoprotein a (LpA) levels. Their efficacy in reducing the risk of major cardiovascular events has been shown in multiple randomized clinical trials (RCT). However, clinical equipoise remains on the magnitude and mechanisms by which PCSK9i decrease the risk of stroke. Methods: We performed a systematic search of biomedical databases from inception to July 15, 2023, to identify RCTs that investigated the efficacy of PCSK9i versus placebo for major cardiovascular event prevention. The primary outcome was total stroke. The safety outcome was the risk of adverse neurological events, as defined by each trial. Effect size was represented by risk ratio (RR), and analysis was done using random-effects meta-analysis. Heterogeneity was assessed by I 2 and Cochrane Q statistics. Meta-regression analyses were performed to assess the association between LDL-Chol and LpA reduction and stroke risk. Results: Overall, 19 studies with 92,786 patients were included. The quality of the evidence was moderate and heterogeneity for all comparisons was low ( I 2 <25%). The mean age was 60.1 years for the PCSK9i group and 59.6 years for the placebo group, with a mean follow-up time of 60.1 weeks. PCSK9i reduced the LDL-Chol levels by 11% and LpA levels by 8%. PCSK9i were associated with a significant reduction in stroke risk (RR 0.71, 95% CI 0.62-0.81, I 2 =0%), without an increase in mortality (RR 0.94, 95% CI 0.85-1.05, I 2 =0%). The risk of adverse neurological events was similar between groups (RR 1.02, 95% CI 0.88-1.18, I 2 =0%). In meta-regression analyses, the stroke risk was not associated with the magnitude of the effect of PCSK9i on LDL-Chol (LDL Chol β=-0.01, 95% CI=-0.03-0.01) and LpA (β=-0.01, 95% CI=-0.06-0.03) levels. Conclusions: PCSK9i significantly reduced the stroke risk, without increasing mortality or the risk of adverse neurological events. Our findings also suggest that the beneficial effect of PCSK9i on stroke risk is mediated by LDL-Chol- and LpA-independent mechanisms.

Retrospective review of recent ASA prescribing practices for primary prevention of major adverse cardiovascular events in the Canadian Fabry Disease Initiative cohort

Retrospective review of recent ASA prescribing practices for primary prevention of major adverse cardiovascular events in the Canadian Fabry Disease Initiative cohort

A randomized, placebo-controlled crossover trial to assess the influence of body weight on aspirin-triggered specialized pro-resolving mediators: Protocol for the DISCOVER Study.

Low-dose aspirin is ineffective for primary prevention of cardiovascular events in people with body weight greater than 70kg. While the prevalent explanation for this is reduced platelet cyclooxygenase-1 (COX-1) inhibition at higher body weights, supporting data are limited, thereby demanding further investigation of the reason(s) underlying this observation. We propose that aspirin-mediated cyclooxygenase-2 (COX-2) acetylation and the resulting synthesis of 15-epi-lipoxin A4, a specialized pro-resolving mediator, is suboptimal in higher weight individuals, which may contribute to the clinical trial findings. To test this hypothesis, we are conducting a double-blind, placebo-controlled, randomized, mechanistic crossover trial. Healthy men and women exhibiting a wide range of body weights take 81mg aspirin and 325mg aspirin for 3 weeks each, following 3-week placebo run-in and wash-out phases. Our target sample size is 90 subjects, with a minimum of 72 completing all visits estimated to be necessary to achieve power adequate to test our primary hypothesis. Our primary endpoint is the difference in change in plasma 15-epi-lipoxin A4 occurring with each dose of aspirin. Secondary endpoints include lipid mediator profiles, serum bioactive lipid profiles, and other endpoints involved in the resolution of vascular inflammation. Study enrollment began in November 2021 and is ongoing. The results of this study will improve our understanding of the mechanisms underlying aspirin's role(s) in the prevention of adverse cardiovascular outcomes. They may also lead to additional studies with the potential to inform dosing strategies for patients based on body weight.

Intermediate and long-term residual cardiovascular risk in patients with established cardiovascular disease treated with statins.

Statins remain the first-line treatment for secondary prevention of cardiovascular (CV) events, with lowering of low-density lipoprotein cholesterol (LDL-C) being their therapeutic target. Although LDL-C reduction significantly lowers CV risk, residual risk persists, even in patients with well-controlled LDL-C; thus, statin add-on agents that target pathways other than LDL-C, such as the omega-3 fatty acid eicosapentaenoic acid, may help to further reduce persistent CV risk in patients with established CV disease. This narrative review examines the contemporary literature assessing intermediate- and long-term event rates in patients with established CV disease treated with statins. CV event rates among patients treated with statins who have established CV disease, including coronary artery disease, cerebrovascular disease, or peripheral arterial disease, accumulate over time, with a cumulative incidence of CV events reaching up to approximately 40% over 10 years. Recurrent stroke occurs in up to 19% of patients seven years after a first cerebrovascular event. Repeat revascularization and CV-related death occurs in up to 38% and 33% of patients with peripheral artery disease after three years, respectively. Additional treatment strategies, such as eicosapentaenoic acid, are needed to reduce persistent CV risk in patients with established CV disease treated with statins.

Low-Dose Colchicine for the Prevention of Cardiovascular Events After Acute Coronary Syndrome.

Colchicine, an established anti-inflammatory drug, is examined for its potential in mitigating adverse cardiovascular events following acute coronary syndrome (ACS). ACS, primarily triggered by plaque rupture and subsequent thrombosis, is a critical cardiovascular condition. Colchicine's mechanism of action involves inhibiting microtubule activity, leading to immobilization of white blood cells and reducing inflammation. Clinical data from studies, including low-dose colchicine for secondary prevention of cardiovascular disease two and colchicine cardiovascular outcomes trial, support its efficacy in reducing major cardiovascular events post-ACS, though some studies report varying results. Colchicine can cause transient gastrointestinal side effects and is prescribed with caution in patients with certain medical conditions. The recent FDA approval of a low dose of colchicine reiterates its benefit in reducing cardiovascular risk. The cost-effectiveness of colchicine products (0.5 and 0.6 mg doses) are compared, suggesting the generic 0.6 mg dose of colchicine to be an alternative to branded forms of the drug.

Generalisability of trials on antithrombotic treatment intensification in patients with cardiovascular disease

ObjectiveAssessment of generalisability of guideline-informing trials on antithrombotic treatment intensification to real-world patients with cardiovascular disease (CVD).MethodsInclusion and exclusion criteria of the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS),...

Probucol will become a New Model for Treating Cerebral Infarction with a High Risk of Hemorrhage.

Antiplatelet, antihypertensive, and lipid-lowering agents are the three foundational agents for secondary prevention of ischemic stroke, among which lipid-lowering is one of the most important cornerstones. Probucol is a potent antioxidative lipid-lowering drug used to prevent and treat atherosclerotic cardiovascular diseases and xanthomas. However, it has faded from Western markets by lowering LDL-C and HDL-C levels. Probucol alleviates atherosclerosis improving high-density lipoprotein function, and does not increase the risk of cardiovascular events. Probucol-induced pharmacological changes in HDL-C may not be a reliable prognostic marker for cardiovascular risk. Q-T interval prolongation is a rare adverse reaction as described in the manufacturer's instructions, but prolonged Q-T interval may only be an intermediate pharmacological phenomenon of electrophysiological changes, and as a result, probucol has a strong benefit for secondary prevention of cardiovascular events and can reduce mortality without increasing the risk of cardiovascular and cerebrovascular adverse events. The new mechanism is that probucol penetrates the core of lowdensity lipoprotein particles, enhancing the activity of plasma cholesteryl ester transfer protein and liver scavenger receptor type I activity, thereby reducing LDH; at the same time, increasing the activity of paraoxonase 1, strengthened the antioxidant function of HDL, and reduced the serum HDL-C. If clinical or imaging findings suggest a high risk of recurrence of cerebral ischemia with a high risk of cerebral hemorrhage, probucol may be selected for prevention. This article focuses on basic research and clinical evidence and provides new insights into the low bioavailability.

A Care Coordination Model to Prevent Cardiovascular Events in Patients with Psoriatic Disease: A Multicenter Pilot Study

A Care Coordination Model to Prevent Cardiovascular Events in Patients with Psoriatic Disease: A Multicenter Pilot Study

The impact of aspirin use on outcomes in patients with inflammatory bowel disease: Insights from a national database

BackgroundInflammatory bowel disease (IBD) is an inflammatory disorder that can increase the risk of mortality. Aspirin is an anti-inflammatory drug used for primary prevention of cardiovascular events. A single center analysis previously reported that aspirin use did not impact major outcomes in IBD. In this study, we aim to assess the impact of aspirin use on mortality and other outcomes in patients with IBD using national data.MethodsNational inpatient sample (NIS) 2016–2020 was used to identify adult patients with IBD. Data were collected on patient demographics, hospital characteristics, and comorbidities. The outcomes studied were in-hospital mortality, sepsis, shock, Intensive Care Unit (ICU) admission, and need for surgery. Multivariate logistic regression analysis was performed.ResultsA total of 1,524,820 IBD hospitalizations were included. Of these, 137,430 (9%) were long-term aspirin users. The majority of the patients in the aspirin group were aged > 65 years (34.11%), female (56.37%), White (78.83%) and had Medicare insurance (36.77%). Aspirin users had a lower incidence of in-hospital mortality (1.6% vs 1.4%, P = 0.06), sepsis (2.5% vs 2.9%, P < 0.001), shock (2.9% vs 3.4%, P < 0.001), ICU admission (2.6% vs 2.9%, P < 0.001), need for surgery (2.1% vs 4.2%, P < 0.001). After adjusting for confounders, aspirin was associated with a reduction in mortality (adjusted odds ratio: 0.49, 95%CI 0.45–0.55, P < 0.001).ConclusionOur study reports that aspirin use among patients with IBD was associated with a lower risk of death, sepsis, and shock. Aspirin use may have a protective effect in patients with IBD. Further studies are needed to confirm these results.