Risk Of Events Research Articles

Effect of Sodium-Glucose Cotransporter Type 2 Inhibitors on The Development and Course of Atrial Fibrillation

Atrial fibrillation is one of the most common heart rhythm disorders associated with an increased risk of stroke, cardiovascular mortality and hospitalizations. The development of arrhythmias is influenced by a number of risk factors, including arterial hypertension, chronic heart failure, coronary heart disease and endocrine disorders. New guidelines from the European Society of Cardiology (2024) emphasize the importance of managing risk factors to improve treatment efficacy and prognosis in patients with atrial fibrillation. Sodium-glucose cotransporter type 2 inhibitors (gliflozins), originally used as hypoglycemic drugs, are now also widely used to reduce the risk of adverse cardiovascular events. However, the use of these drugs to reduce the risk of atrial fibrillation and improve the course of atrial fibrillation remains an open question. In order to find an answer to this question, a literature review was conducted, which showed that inhibitors of sodium-glucose cotransporter type 2 can theoretically have an antiarrhythmic effect realized through several mechanisms. Analysis of scientific data suggests that in most cases, the use of sodium-glucose cotransporter type 2 inhibitors reduces the risk of first-time atrial fibrillation, has a positive effect on the course of arrhythmia and reduces the risk of its recurrence after ablation. At the same time, it is not clear to the end whether the discussed issues are class-effect or the drugs belonging to the gliflozin group have different efficacy. The mentioned issues necessitate further prospective studies to confirm the antiarrhythmic effect in sodiumglucose cotransporter type 2 inhibitors.

Navigating the Double- Edged Sword of Diclofenac: Pain Relief and Associated Cardiovascular Safety

Diclofenac sodium (DFS) is a widely prescribed nonsteroidal anti-inflammatory drug (NSAID) effective in managing pain and inflammation in patients with arthritis and musculoskeletal conditions. While DFS is known for its rapid analgesic effects and broad therapeutic indications, it also poses significant cardiovascular (CV) safety concerns. Research highlights that prolonged or high-dose use of diclofenac increases the risk of myocardial infarction, stroke, and thrombotic events. Despite clinical guidelines discouraging its use in patients with heart conditions, a large percentage of individuals continue its use after hospital discharge. This review explores the dual nature of diclofenac’s benefits for pain relief and its associated cardiovascular risks, discussing pharmacokinetics, therapeutic indications, adverse effects, and regulatory recommendations. Key words: Diclofenac, Nonsteroidal Anti-inflammatory Drugs (NSAIDs), Cardiovascular Risk, Pain Relief, COX-1 and COX-2 Inhibition, Myocardial Infarction, Prostaglandins, Thrombosis, Atherosclerosis

New Onset Diabetes After Organ Transplantation: Risk Factors, Treatment, and Consequences

New onset diabetes mellitus after organ transplantation (NODAT) is a frequent and serious complication of solid organ transplantation. It significantly impacts graft function, patient survival, and quality of life. NODAT is diagnosed based on the criteria for type 2 diabetes, with the oral glucose tolerance test (OGTT) serving as the gold standard for diagnosis. The development of NODAT is influenced by a range of risk factors, which are classified into modifiable and non-modifiable categories. Post-transplant, regular glycemic monitoring at specific intervals is essential for timely diagnosis and initiation of therapy. Early intervention can help prevent or delay the onset of diabetes-related complications. The treatment strategy for NODAT involves lifestyle modifications and pharmacological interventions. These include medications such as metformin, sulfonylureas, glinides, thiazolidinediones, DPP-4 inhibitors, GLP-1 agonists, SGLT-2 inhibitors, and insulin. Adjusting immunosuppressive therapy—either by reducing dosages or substituting drugs with lower diabetogenic potential—is a common preventative and therapeutic measure. However, this must be performed cautiously to avoid acute graft rejection, which poses a greater risk to the patient compared to NODAT itself. In addition to managing diabetes, addressing comorbidities such as hypertension and dyslipidemia is crucial, as they elevate the risk of cardiovascular events and mortality. Patients with NODAT are also prone to developing common diabetes-related complications, including diabetic nephropathy, neuropathy, retinopathy, and peripheral vascular disease. Therefore, regular follow-ups and appropriate treatment are vital to maintaining quality of life and improving long-term outcomes.

Using monitoring and simulation to analyze the failure characteristics of multizone landslides controlled by faults: a case study

Slopes influenced by multiple faults are prone to large-scale landslides triggered by multi-regional failures. Understanding the failure process and sequence is essential for the sustainable development of mining operations. This paper presents a method combining InSAR monitoring and numerical simulation to analyze the failure processes of slopes affected by multiple faults. Using the 298–710 m bench in the central area of the eastern slope of the Nanfen open-pit mine as a case study, the multidimensional small baseline subset (MSBAS) technique of InSAR was employed to calculate the vertical and horizontal deformation time series in the study area, enabling an analysis of the deformation characteristics of multizone bedding sliding. Subsequently, a numerical simulation was performed to replicate the three-dimensional evolution of the multizone failure. The simulation results aligned well with field surveys and InSAR monitoring data. Furthermore, the failure sequence analysis identified critical trigger zones within the region. The findings demonstrate that the proposed method effectively identifies the critical areas and movement sequence of multi-regional failures. In this paper, the faults disrupted the connectivity between slopes, acting as the initial trigger for entire landslide. The first failure occurred in a critical area, creating space for further sliding in other regions and reducing lateral constraints in neighboring areas, eventually leading to significant deformations. Therefore, by using this method to identify potential critical areas before landslides occur, targeted mitigation measures can be implemented to reduce the risk of such events.

Impact of vitamin D supplementation on symptom severity and quality of life in patients with irritable bowel syndrome: A meta-analysis.

Vitamin D supplementation could offer irritable bowel syndrome (IBS) patients significant improvements in terms of symptom severity and overall quality of life (QoL). Yet, the potential benefits and risks associated with vitamin D supplementation still require additional investigation. We aimed to evaluate the impact of vitamin D supplementation on IBS using a systematic review and meta-analysis. A comprehensive search was carried out utilizing 4 electronic databases (PubMed, Embase, Scopus, and Cochrane Library) to identify articles published in English-language peer-reviewed journals. The odds ratios (ORs), risk ratios (RRs) and mean differences (MDs), along with their respective 95% confidence intervals (95% CIs), were computed. Heterogeneity was evaluated using the appropriate p-value and Cochrane Q and I2 statistics. For the analysis, RevMan 5.3 was utilized. Nine randomized controlled trials involving a total of 780 participants were included in this study. Vitamin D supplementation, in adolescents and young adults with IBS, improves the IBS symptoms severity score, QoL and serum 25(OH)D levels compared to controls. We obtained an OR of 2.34 (95% CI: 1.56-3.50) for change in the IBS severity scoring system (IBS-SSS), OR = 2.51 (95% CI: 1.71-3.70) for change in QoL, low risk of any adverse events (RR 0.49 (95% CI: 0.35-0.69)), and substantial changes in serum 25(OH)D level (MD = 11.29 (95% CI: 7.13-15.45)). Results were statistically significant (p < 0.05). Vitamin D supplementation could lead to better IBS management with a low risk of adverse events.

Cracking the Code of Calcification: How Presence and Burden among Intracranial Arteries Influence Stroke Incidence and Recurrence.

Intracranial atherosclerosis accounts for about 8% of all strokes in Western societies but the influence of arterial calcification on plaque instability is a topic on ongoing debate. Explore the association between the presence and burden of calcium in atherosclerotic plaques among intracranial arteries with the risk of clinical or silent stroke events through a systematic review and meta-analysis. Adhering to PRISMA guidelines, studies from PubMed and Embase were analyzed up to May 2024. Adult populations undergoing CT/CTA scans for symptomatic and asymptomatic atherosclerosis among intracranial vessels. Statistical analyses were performed to identify the impact of calcium presence and relative burden on stroke incidence or recurrence. Risk of bias was evaluated with QUADAS-2 criteria while GRADE system was used to assess quality of evidence. The study synthesized data from 8 longitudinal studies, creating two different models: Calcium presence (heterogeneity: Q 9.19; I2 42.61%) and calcium burden (heterogeneity: Q 6.01; I2 0.01%). As for calcium presence and stroke events, 6839 patients were considered, and two statistical models were made. Our analysis established a significant association between the presence of calcium and stroke events. [OR= 1.54, 95% CI 1.06, 2.24, p=0.001]. A subsequent effect size analysis showed a similar correlation's strength [OR = 1.56, 95% CI 1.11, 2.19, p = 0.001]. As for calcium burden and stroke events, 4885 patients were considered with effect size analysis establishing a positive correlation [OR = 1.31, 95% CI, 1.17, 1.46, p =< 0.001). A decrease in correlation strength was found between calcium presence [OR = 1.56] and burden [OR = 1.31] with stroke events. Despite strict exclusion criteria, heterogeneity across studies and between different statistical models of the present study persisted. Valuable data loss among excluded studies could have affected the findings of this meta-analysis. Unified calcium scoring pattern and individual arterial segment analysis was not widely adopted by included literature. Our meta-analysis showed a weak, yet present association between presence and burden of calcification among intracranial arterial vessels and clinical or silent stroke events. Considering the high prevalence of intracranial calcification in the general population, widespread intracranial calcium assessment for stroke prediction has currently poor evidence. Investigation on specific intracranial vessels or exploration of newer calcium patterns could be essential to enhance the predictive accuracy of calcification in stroke incidence or recurrence. IAC = Intracranial Arterial Calcification; HU = Hounsfield Unit; RE = Random Effect.

The Efficacy of Emerging Ultrasound Applications in Characterizing Vulnerable Carotid Plaques

The emergence and integration of nonconventional ultrasound applications into the vascular diagnostic armamentarium offers the opportunity for answering a long-standing question about the morphological makeup of focal carotid atherosclerotic lesions, that is, is this particular plaque vulnerable or not? Vulnerable lesions are those which, based on their histological and morphological features, predispose a patient to an increased risk of a cerebral ischemic event (CIE) secondary to plaque or thrombus embolization. The ability to reliably differentiate plaque types using readily available noninvasive imaging methods facilitates risk stratification in both symptomatic and asymptomatic patients. Improved identification of at-risk lesions makes more targeted patient management and/or interventional decisions possible. Three emerging ultrasound applications that have demonstrated efficacy in offering this enhanced diagnostic capability are point shear wave elastography (pSWE), contrast-enhanced ultrasound (CEUS), and microvascular ultrasound imaging (MUI).

Association between apolipoprotein E ε4 status and the risk of Alzheimer’s disease: a meta-analysis

BackgroundThe apolipoprotein E ε4 (APOE ε4) status has a controversial role in predicting Alzheimer’s disease (AD) factors. This meta-analysis assessed AD event risk in patients with APOE ε4 status.Materials and methodsThe relevant English-language articles were identified by searching the Cochrane Library, EMBASE, and PubMed databases. The prognostic significance of APOE ε4 status in AD patients was examined on the basis of pooled hazard ratios (HRs).ResultsA total of 22 studies published after 1987, including 571,800 patients, were included. Consequently, APOE ε4 status was a risk factor for disease-free survival (DFS, HR = 2.033; 95% confidence interval [CI] = 1.589–2.602; P = 0.000; I 2 = 93.1%) in patients with AD. Additionally, subgroup analysis suggested that the ROC curve was the main risk factor among patients with AD.ConclusionsAD patients with different events are managed via different methods; however, the present meta-analysis suggests an increased risk of AD events in patients with different APOE ε4 statuses.

Sex differences in intracranial plaque burden in patients with type 2 diabetes mellitus with acute ischemic cerebrovascular disease: a pilot study based on high-resolution MRI

BackgroundAtherosclerosis (AS) is the main cause of macrovascular disease. Previous studies have found sex differences in the prevalence of type 2 diabetes mellitus (T2DM) and its associated macrovascular disease outcomes. However, the relationship between sex differences, T2DM, and AS is not fully understood. This study attempts to explore possible associations between sex, treatment, and the burden of intracranial atherosclerosis (ICAS) in patients with T2DM who have experienced an acute ischemic cerebrovascular disease.MethodsWe focused on patients with T2DM with acute ischemic stroke or transient ischemic attack due to intracranial atherosclerotic stenosis. ICAS was assessed by 3T cardiovascular magnetic resonance vascular wall imaging. Plaque counts of the total, proximal, and distal intracranial arteries were used to assess plaque burden. Patients with a history of T2DM and currently taking hypoglycemic drugs were defined as being treated. Poisson regression models or negative binomial regression models were used to analyze the interaction between sex and treatment in relation to plaque burden.ResultsA total of 495 plaques were detected in 120 patients (75 male; mean age, 60.77 ± 11.01 years), including 311 proximal and 184 distal plaques. The intracranial culprit plaque was located proximal to the artery in both male (85.3%) and female (88.9%) patients. The adjusted total and proximal intracranial plaque burdens were 1.261 times (95% confidence interval [CI], 1.050–1.515, P=0.013) and 1.322 times (95%CI, 1.055–1.682, P=0.016) higher in male than in female patients. The risk ratio for proximal plaque burden in untreated male versus female patients was 0.966 (95%CI, 0.704–1.769). However, the proximal plaque risk ratio for treated male versus female patients was 1.530 (95%CI, 1.076–2.174). The interaction of sex and treatment significantly affected the proximal plaque burden.ConclusionMale patients with T2DM and acute cerebrovascular disease have a significantly higher adjusted risk of total and proximal intracranial plaque burden compared to female patients. Female patients undergoing antidiabetic treatment have a significantly reduced risk of proximal plaque to males. Considering that culprit plaques tend to accumulate in the proximal arteries, understanding how to reduce the burden of proximal plaques may help reduce the risk of adverse cerebrovascular events.

Correlation between atherogenic index of plasma and cardiovascular disease risk across Cardiovascular–kidney–metabolic syndrome stages 0–3: a nationwide prospective cohort study

BackgroundThe Cardiovascular–kidney–metabolic (CKM) syndrome, a concept recently proposed by the American Heart Association (AHA), highlights the intricate connection between metabolic, renal, and cardiovascular illnesses. Furthermore, the Atherogenic Index of Plasma (AIP), a useful biomarker for evaluating the risk of Cardiovascular Diseases (CVDs), has been associated with the risk of Adverse Cardiovascular Events (ACEs). Nonetheless, its precise function in populations in CKM syndrome Stages 0–3 remains unknown.MethodsThis prospective study analyzed the data of 7,708 eligible participants (aged ≥ 45 years) from the Chinese Longitudinal Research of Ageing (CHARLS), particularly the 2011–2012 baseline survey (Wave 1). The primary exposure variable was AIP—a natural logarithm of the ratio of Triglycerides (TGs) to High-Density Lipoprotein Cholesterol (HDL-C). On the other hand, the primary endpoint was CVD incidence, which was determined based on self-reported past diagnoses. The relationship between AIP and CVD risk in the population in CKM syndrome stages 0–3 was examined using a Cox proportional risk model. Subgroup and mediation analyses were performed to further elucidate the interactions among these factors.ResultsThis study involved 7,708 participants in the CKM syndrome stages 0–3 [Mean age = 58.00 years; Interquartile Range (IQR) = 52.00–65.00 years]. The risk of developing CVD increased significantly with higher AIP levels. Specifically, the risk ratio for each unit increase in AIP was 1.31 (95% CI 1.11–1.55), while the Hazard Ratio (HR) for the group with the highest AIP levels compared to the group with the lowest AIP levels was 1.22 (95% CI 1.08–1.39). Mediation analysis revealed that metabolic syndrome accounted for 12.3% of the association between AIP levels and CVD risk (p = 0.024), highlighting its significance in CVD risk assessment.ConclusionHerein, AIP levels correlated significantly positively with CVD risk in individuals in CKM stages 0–3, with metabolic syndrome as a key mediating factor. These findings suggest that AIP levels could be valuable not only for CVD risk assessment but also for clinical screening.

Risk of hospital inpatient opioid overdose (RHINOO): a review of factors impacting naloxone administration in patients receiving opioids.

Opioid medications remain a common treatment for acute pain in hospitalized patients. This study aims to identify factors contributing to opioid overdose in the inpatient population, addressing the gap in data on which patients are at higher risk for opioid-related adverse events in the hospital setting. A retrospective chart review of inpatients receiving at least one opioid medication was performed at a large academic medical center from January 1, 2022, through December 31, 2022. Patients who received naloxone were designated as the overdose group, while those who received opioids without naloxone served as the control group. Suspected risk factors were included in a multivariable direct logistic regression model to identify patients at higher risk for opioid-related adverse events. The review included 11,050 admitted patients who received an inpatient opioid, of whom 130 received naloxone. Analysis revealed that patients with creatinine clearance (CrCl) < 60 mL/min, co-administered benzodiazepine, body mass index (BMI) > 30 kg/m2, underlying pulmonary disease, obstructive sleep apnea, chronic opioid use, and/or substance use disorder were at higher risk for requiring naloxone. These factors significantly influenced the likelihood and magnitude of in-hospital opioid overdose. These validated risk factors should be considered when administering opioid analgesics in the inpatient setting. Consideration should be given to reducing the dose and/or frequency of opioids in addition to the use of alternative analgesic modalities for patients with these risk factors to mitigate the risk of opioid-related adverse events. Incorporating these considerations into clinical practice can enhance patient safety and outcomes.

The ability of end-tidal carbon dioxide value to predict the risk of major cardiovascular events in patients with acute coronary syndrome

ABSTRACT Objectives In this study, the capacity of End-tidal carbon dioxide (EtCO2) levels to predict the risk of major cardiovascular events (MACE) in patients diagnosed with acute coronary syndrome and the relationship between risk scoring systems (TIMI, GRACE, HEART) and EtCO2 values were examined. Methods EtCO2 values of the patients in the study were measured with a capnography device. Each patient’s MACE status was recorded. Results The results we found in our study are as follows: (i) EtCO2 values were significantly lower in the group with MACE (n = 45) than in the group without MACE (n = 288) (p < 0.05). (ii) According to ROC analysis, EtCO2 was effective in predicting one-month mortality (AUC = 0.81, p < 0.00). (iii) The optimal EtCO2 cut-off point was 30 mmHg. This threshold value provided both sensitivity and specificity for the risk of MACE. (IV) Significant associations were found between EtCO2 and GRACE, TIMI and HEART scoring systems. EtCO2 values were significantly higher in the low-risk groups. (V) EtCO2 was significantly different in all three risk scoring systems in the non-MACE group, but only with the GRACE score in the MACE group. Conclusion This study demonstrated that EtCO2 is a valuable indicator for predicting the risk of MACE in patients with ACS.

Protective association between dietary phytosterol intake and cardiovascular health: an analysis of the UK Biobank cohort.

Background: Cardiovascular diseases (CVDs) remain a leading cause of morbidity and mortality worldwide, with dietary interventions showing promise in reducing CVD risk factors. Phytosterols (PSs) in plant-based foods may reduce CVD risk by lowering low-density lipoprotein cholesterol. However, the relationship between dietary PS intake and CVD outcomes remains inconclusive. Methods: This study investigated the association between dietary PS intake and CVD outcomes, including coronary heart disease (CHD) and cardiovascular mortality, using a large cohort of 167 209 UK Biobank participants. PS intake was assessed through repeated 24 hour dietary recall data, with participants stratified into quintiles. The Cox proportional-hazards model was used to estimate hazard ratios (HRs) for CVD risk across quintiles of PS intake, adjusting for potential confounders. Restricted cubic splines were used to examine the nonlinear relationship between phytosterol intake and cardiovascular disease risk. Sensitivity and subgroup analyses explored interactions with demographic and lifestyle factors. Results: Higher dietary PS intake was significantly associated with a reduced risk of CVD events, including CHD and cardiovascular mortality. Each 100 mg increase in PS intake was linked to an 8% reduction in CVD risk (HR = 0.92, 95% CI: 0.87, 0.97). Multivariable-adjusted analyses revealed that participants in the highest quintile of PS intake had significantly lower CVD hazard ratios (HR = 0.81, 95% CI: 0.77, 0.84) compared to those in the lowest quintile. Significant inverse associations were also observed for cardiovascular mortality (HR: 0.86, 95% CI: 0.80, 0.94) and CHD (HR: 0.91, 95% CI: 0.84, 0.98). Subgroup analysis highlighted stronger inverse associations in current smokers, individuals with lower body mass index (BMI), and those with moderate to high physical activity levels, with variations observed based on dyslipidemia status. Sensitivity analyses, excluding early events and adjusting for energy intake, confirmed the robustness of the findings. Conclusions: This large cohort study provides evidence supporting the cardioprotective effects of dietary PS intake, particularly for CHD and cardiovascular mortality. Dietary PS may be considered an integral component of heart-healthy diets.

Impact of Acute Myocardial Injury on Short- and Long-Term Outcomes in Patients With Primary Intracerebral Hemorrhage.

Myocardial injury is common after brain injury; however, few studies have reported serial cardiac troponin (cTn) measurements to distinguish whether the myocardial injury is acute or chronic. The fourth Universal Definition of Myocardial Infarction introduced for the first time the criteria for acute myocardial injury (AMI). We aimed to investigate the prevalence and prognostic implications of AMI in primary intracerebral hemorrhage. We retrospectively analyzed patients with primary intracerebral hemorrhage within 48 hours after symptom onset. All patients included had at least 2 cTn measurements: 1 obtained at the time of emergency admission and at least 1 more within the first 2 days of hospitalization. AMI was defined as an elevated cTn above the upper-reference limit (14 ng/L) along with a rise/fall >20%. Patients were followed for up to 5 years. Outcomes included major adverse cardiac events (MACEs; a composite of vascular death, nonfatal coronary events, and nonfatal stroke) and 90-day unfavorable outcomes (modified Rankin scale score ≥4). Cox proportional hazards models, multivariable logistic regression models, and Kaplan-Meier analyses were used to evaluate the association between AMI and outcomes. Of 600 patients included, 115 had AMI (19.2%). AMI independently conferred an increased risk for major adverse cardiac events (adjusted hazard ratio, 1.69 [95% CI, 1.12-2.53]) and 90-day unfavorable outcomes (adjusted odds ratio, 2.15 [95% CI, 1.26-3.67]) compared with patients without AMI. AMI is relatively common in patients with intracerebral hemorrhage and is associated with both long-term major adverse cardiac events and 90-day unfavorable outcomes.

Differences in Postoperative Disposition by Kidney Disease Severity: A Population-Based Cohort Study.

People with advanced kidney disease undergo more non-cardiac operations compared to the general population, with a higher risk of perioperative cardiac events and death. However, little is known about the associations between severity of preoperative kidney dysfunction with postoperative length of hospitalization and discharge disposition; these were the focus of this study. Population-based retrospective cohort. Adults from Alberta, Canada undergoing inpatient major noncardiac surgery between April 2005 and February 2019. Categorical preoperative outpatient estimated glomerular filtration rate (eGFR) or kidney failure status. Length of stay (LOS), days alive at home after surgery within 30 and 90 days, and discharge disposition location. Associations were estimated with unadjusted and adjusted generalized estimating equation models. 927,560 inpatient surgeries in 666,770 people (55.9% female, median age 57.4 years) were identified. People receiving dialysis had the longest LOS (11 days [95% CI 6, 29), 2 times greater than that among people with normal kidney function (adjusted incidence rate ratio [IRR] 2.21 [95% CI 2.10, 2.32]). This group also had the fewest days alive at home within the first 30 days after surgery, with an IRR of 0.69 (95% CI 0.67, 0.70) compared to people with normal eGFR. The majority of people (82.8%) were discharged home without nursing support after surgery, though people receiving dialysis were discharged to a facility with 24-hour nursing care nearly 4 times more often. There were graded increases in risks of these outcomes with lower levels of kidney function. Many people did not have preoperative kidney function assessed, reflecting standard clinical practice in the general population. After major surgery, people with kidney disease spend more time recovering in hospital and have less independence from post-discharge nursing supports than otherwise similar patients who have normal or near normal kidney function. These differences were more pronounced for those with the most severe stages of kidney disease.

Optimization of treatment of endothelial dysfunction and arterial stiffness in patients with arterial hypertension and ischemic heart disease

The relevance of complex correction of endothelial dysfunction and arterial stiffness in patients with arterial hypertension and coronary heart disease is associated with their leading role in the development of cardiovascular diseases. Endothelial dysfunction, characterized by a deficiency of vasodilators, such as nitric oxide, and an increase in vasoconstrictor mediators, contributes to atherogenesis and thrombosis. At the same time, an increase in arterial stiffness leads to an increase in systolic pressure and impaired diastolic filling of the myocardium, which aggravates myocardial ischemia and contributes to the progression of heart failure. The introduction of an integrative approach to optimizing endothelial function and reducing arterial stiffness into clinical practice can significantly improve the prognosis and quality of life of patients, reducing the risk of serious cardiovascular events, including myocardial infarction and stroke. Results from randomized clinical trials support the efficacy of such a strategy, demonstrating that normalization of endothelial function and reduction in arterial stiffness are achievable with modern antihypertensive and lipidlowering drugs, including polypills. These drugs improve treatment adherence through simplified dosing regimens and provide effective management of multifactorial risks in patients. In addition, ongoing research and development of new therapeutics and treatments continue to highlight the need for early detection and targeted therapy in this patient population. Such strategies not only address the underlying pathophysiological changes but also aim to prevent long-term complications associated with these cardiovascular risk factors. By focusing on an individualized treatment protocol that includes both pharmacologic interventions and lifestyle changes, healthcare providers can offer a more dynamic and effective treatment plan that meets each patient’s individual needs, thereby optimizing therapeutic outcomes and improving patient compliance.Background. Cardiovascular diseases are the leading cause of death in Russia, with hypertension, coronary heart disease, and cerebrovascular disease predominating. The prevalence of hypertension is 53.9 %, but disease control remains poor, with less than 30 % of patients achieving target blood pressure levels. Therapy often includes combinations of medications, such as ACE inhibitors and angiotensin receptor blockers, which demonstrate advantages over monotherapy. Approximately 70.7 % of patients require combination therapy to effectively manage their condition.Objective. Comparison of the effects of fixed combinations of amlodipine, atorvastatin and perindopril (Lipertance® 10/20/10 mg) with a combination of amlodipine, lisinopril and rosuvastatin (Equamer® 5/10/20 mg) on the clinical progression of grade 2 and 3 arterial hypertension and functional class II and III coronary heart disease. Also study the effect on arterial stiffness, endothelial function, ankle-brachial index, vascular age.Materials and methods. The study included 65 patients with uncontrolled hypertension with systolic blood pressure (BP) ≥160 mmHg and/or diastolic BP ≥90 mmHg in combination with stable angina, taking two antihypertensive drugs at the beginning of the study. Depending on the therapy, the participants were divided into II groups: I – 30 people receiving a fixed combination of Lipertance; II group – 35 people taking a fixed combination of Equamer. All patients also received bisoprolol at a dosage of 5–10 mg and an antiplatelet agent at a dosage of 75–100 mg.Conclusions. Fixed combinations of Lipertance® and Equamer® drugs were highly effective in controlling blood pressure in patients with hypertension and coronary heart disease, achieving target systolic and diastolic levels in more than 85 % of patients. Both groups showed significant improvements in arterial stiffness and endothelial function, demonstrating their potential to reduce cardiovascular complications. Thus, these combinations can be recommended for routine use in clinical practice to improve prognosis and quality of life in patients.

Inflammation in atherosclerosis: a Big Idea that has underperformed so far.

For many years, inflammation has been a major concept in basic research on atherosclerosis and in the development of potential diagnostic tools and treatments. The purpose of this review is to assess the performance of this concept with an emphasis on recent clinical trials. In addition, contemporary literature may help identify new therapeutic targets, particularly in the context of the treatment of early, rather than end-stage, arterial disease. Newly reported clinical trials cast doubt on the efficacy of colchicine, the sole anti-inflammatory agent currently approved for use in patients with atherosclerotic cardiovascular disease (ASCVD). New analyses also challenge the hypothesis that residual ASCVD event risk after optimal management of lipids, blood pressure, and smoking arises primarily from residual inflammatory risk. Current clinical practice to initiate interventions so late in the course of atherosclerotic arterial disease may be a better explanation. Lipid-lowering therapy in early atherosclerosis, possibly combined with novel add-on agents to specifically accelerate resolution of maladaptive inflammation, may be more fruitful than the conventional approach of testing immunosuppressive strategies in end-stage arterial disease. Also discussed is the ongoing revolution in noninvasive technologies to image the arterial wall. These technologies are changing screening, diagnosis, and treatment of atherosclerosis, including early and possibly reversable disease. The burden of proof that the Big Idea of inflammation in atherosclerosis has clinical value remains the responsibility of its advocates. This responsibility requires convincing trial data but still seems largely unmet. Unfortunately, the focus on inflammation as the source of residual ASCVD event risk has distracted us from the need to screen and treat earlier.

The effect of waiting time on ovarian cancer survival in oncology centres, Addis Ababa, Ethiopia: a retrospective cohort study

BackgroundOvarian cancer is a leading cause of mortality worldwide. The third most prevalent gynecological cancer globally, following cervical and uterine cancer, and the third leading cause of cancer-related mortality among women in Sub-Saharan Africa, including Ethiopia. The time ovarian cancer patients have to wait between diagnosis and initiation of treatment are the indicators of quality in cancer care and influence patient outcomes. Despite extensive studies in the field, little is known about the strength of the association between ovarian cancer survival and waiting time. So, the main purpose of this study is to assess the effect of waiting time on ovarian cancer survival in oncology centers in Addis Ababa, Ethiopia.MethodsA facility-based retrospective cohort study was conducted with a total of 561 study participants included. The main outcome of interest for this study was death due to ovarian cancer. The authors compared the ovarian cancer patients with waiting times ≤ 10 weeks and waiting times > 10 weeks for overall survival rate using the log rank test. The incidence density rate of mortality was calculated for each group variable. The effect of waiting time on ovarian cancer mortality was estimated using the Cox proportional hazards model at the 5% level of significance.ResultsThe incidence density rate of mortality among ovarian cancer patients for waiting time ≤ 10 weeks was found to be 10.85 (95%CI, 9.10-12.98) per 1,000 person years observation, while for waiting time > 10 weeks the mortality rate was found to be 18.05 (95%CI, 15.33–21.23) per 1,000 person years observation. In the Cox regression analysis after full adjustments for confounder variables, the mortality event risk was 36% higher among waiting time > 10 weeks women (AHR = 1.36; 95%CI = 1.05–1.75) as compared to waiting time ≤ 10 weeks.ConclusionsWe have found that the incidence density rate of mortality among ovarian cancer patients was significantly higher in waiting time > 10 weeks groups. Therefore, future policy and clinician programmers should consider the impact of waiting time from diagnosis until to get the first treatment more carefully.

Comparison of 12- to 24-Hour Versus 72-Hour Intravenous Terlipressin in Patients With Acute Esophageal Variceal Bleeding: A Systematic Review and Meta-analysis.

Objective: To compare the efficacy and safety of 12-24 hours versus 72 hours of intravenous terlipressin therapy in patients with acute esophageal variceal bleeding (AVB). Data sources: A systematic search was conducted using PubMed, Scopus, Cochrane Library, Google Scholar, Web of Science, VHL, and ClinicalTrials.gov for studies published up to February 24, 2024. The search terms included "terlipressin," "variceal bleeding," "short-course," and "72-hour treatment." Study selection and data extraction: Randomized controlled trials (RCTs) comparing 12 to 24 hours with 72 hours of terlipressin therapy in patients with AVB were included. Studies not meeting these criteria or focusing on unrelated outcomes were excluded. Two authors conducted data extraction and bias assessment independently, with discrepancies resolved by a third reviewer. Baseline characteristics and outcomes (rebleeding and mortality within 5 days) were recorded. Results: Four RCTs with 469 patients were included in the analysis. There were no significant differences observed in 5-day rebleeding rates (OR = 0.943; 95% CI [0.384, 2.317]; P = 0.898) or mortality rates (OR = 0.386; 95% CI [0.066, 2.260]; P = 0.291) between terlipressin treatment durations of 12 to 24 hours and 72 hours within the first 5 days posttreatment. In addition, no heterogeneity was found in both variables (P > 0.1). Conclusion: This meta-analysis indicates that there is no significant difference in rebleeding rates or mortality between 12 to 24 hours and 72 hours of terlipressin therapy for AVB within 5 days posttreatment. Shorter treatment durations may offer advantages in terms of resource utilization and adverse event risk but require further validation through studies involving larger patient populations.

P0695 Quantifying the benefit-risk trade-offs adult patients and providers are willing to make when considering advanced therapies for moderate to severe Ulcerative Colitis: A discrete choice experiment

Abstract Background As advanced therapy options for ulcerative colitis (UC) increase, it is important to understand the benefit-risk trade-offs patients and providers are willing to make to better inform shared decision making. Methods We used a cross-sectional survey with a discrete choice experiment (DCE) design to quantify advanced UC therapy preferences in patients with moderate to severe UC and practicing providers from the US, UK, France, Germany, Italy and Spain. Respondents chose between hypothetical combinations of attributes that were informed by a targeted literature search and formative qualitative research with patients and clinicians. Attributes comprised of time until symptom improvement, probability of remission at one year, probability of corticosteroid (CS)-free remission at one year, annual risk of serious infection, five-year risk of cancer and annual risk of major adverse cardiovascular event (MACE). Relative importance (RI; scaled 0–100%) for each attribute was calculated as the difference in mean preference weights between the most and least preferred level divided by the sum of the differences; for RI, remission attributes were combined. The maximum-acceptable risk (MAR) for each risk attribute, and the simultaneous MAR thresholds (SMARTs) for all risk attributes considered jointly, in exchange for a 10-percentage point increase in probability of remission at one year were estimated. Results For treatment choices, combined remission and CS-free remission at one year was significantly prioritised by patients (N=557; RI 40.1%) and providers (N=500; RI 51.1%), followed by five-year risk of cancer (RI 31.7% and 25.7%, respectively) (Table). Time to symptom improvement was significantly preferred vs annual risk of MACE and serious infection for providers, but not patients (Table). For a 10-percentage point increase in probability of remission at one year, providers had a higher MAR for five-year risk of cancer vs patients (4.0% vs 2.5%); for the other two risk attributes, reported MARs were beyond the DCE-included limits (Figure). For a 10-percentage point increase in the probability of remission at one year when annual risk of serious infection was 1% or 3%, providers were willing to jointly accept higher annual risk of MACE and five-year risk of cancer vs patients (Figure). Conclusion Combined probability of remission and CS-free remission at one year had the strongest influence on treatment choice. Compared with patients, providers on average placed greater importance on benefits and had a higher tolerance of risks, particularly 5-year risk of cancer. These findings highlight the importance of shared clinical decision making. References Pfizer’s generative artificial intelligence tool MAIA was used to assist production of the abstract first draft. Authors reviewed/edited and take responsibility for the content.