Secondary Prevention Of Cardiovascular Disease Research Articles

Prospects of using miRNA-378 as a biomarker for cardiovascular diseases: A literature review

Currently, there is an active search for new biomarkers and therapeutic targets to develop effective approaches to risk stratification and secondary prevention of cardiovascular diseases (CVD). Microribonucleic acids (miRNAs) are of particular interest to investigators. MiRNAs are endogenous small noncoding RNAs that regulate the transcription of factors that play a role in the proliferation, differentiation, cell growth, and tissue remodeling processes in CVD. MiRNA-378 is currently being analyzed as a biomarker for CVD. Thus, in this review, we aimed to describe the regulatory role of miRNA-378 and provide strong evidence for its feasibility as a biomarker. Further preclinical and clinical studies are required to identify the potential benefits of miRNA-378 as a biomarker in CVD.

Polypills in the Management of Cardiovascular Risk-A Perspective.

Cardiovascular disease and cardiovascular risk factors are global healthcare problems, given their high prevalence and the recognized low rates of adequate control despite the abundant body of evidence on different therapeutic options. The World Heart Federation has scrutinized the reasons for poor control of cardiovascular risk factors. Among these reasons, patients' poor adherence to treatment regimens as well as limited rates of evidence-based therapy prescription from healthcare providers play a substantial role in the challenge of cardiovascular risk management. Polypills are fixed-dose combinations including two or more active drugs, from different pharmacological classes, combined in a single dosage form. Polypills were designed to simplify the clinical management of pharmacotherapy and increase adherence to treatment. From this perspective, we discuss the current literature on the use of polypills in the primary and secondary prevention of cardiovascular disease as well as future challenges and the potentials of this treatment strategy.

Sex specific analysis of patients with and without reported statin intolerance referred to a specialized outpatient lipid clinic

BackgroundLowering LDL-cholesterol is a fundamental goal for both primary and secondary prevention of atherosclerotic cardiovascular diseases. Our study aims to analyse potential sex disparities regarding the tolerability and effectiveness of lipid-lowering therapy in patients with and without reported statin intolerance who are being treated at a lipid-outpatient clinic.MethodsFrom 2017 to 2022, n = 1062 patients (n = 612 men, n = 450 women) at high-risk were referred to our lipid-outpatient clinic because of difficulties in lipid control by primary healthcare providers. The main therapeutic objective was to optimize lipid-lowering therapy according to current treatment guidelines.ResultsPatients presented with high LDL-C baseline levels (4.97 ± 1.81 mmol/l (192 ± 70 mg/dL) in men and 5.46 ± 2.04 mmol/l (211 ± 79 mg/dL) in women). Intolerance towards statins was reported more frequently by women (48.2%) than by men (38.9%, p = 0.004). LDL-C continuously decreased with individual treatment adjustments across follow-up visits. In total, treatment goals (LDL < 1.4 mmol/l (< 55 mg/dl) or < 1.8 mmol/l (< 70 mg/dl)) were accomplished in 75.8% of men and 55.5% of women after the last follow-up visit (p < 0.0001). In men, these data are almost identical in subjects with statin intolerance. In contrast, treatment goals were reached less frequently in women with statin intolerance compared to women tolerant to statin therapy.ConclusionEven if treated in a specialized lipid clinic, women are less likely to reach their target LDL-C than men, particularly when statin intolerant. Nevertheless, many patients with statin intolerance can be successfully treated using oral combination and PCSK9 inhibitor therapy. However, ongoing follow-up care to monitor progress and to adjust treatment plans is necessary to reach this goal.

Statin-associated muscle symptoms: A comprehensive exploration of epidemiology, pathophysiology, diagnosis, and clinical management strategies.

Statins are the first line of treatment for both primary and secondary prevention of atherosclerotic cardiovascular disease. Despite the positive effects of statins on cardiovascular events, not all patients can use them at an optimized dose. The reason for this is the skeletal muscle side effects, termed statin-associated muscle symptoms (SAMS). Despite extensive research, the precise pathophysiology of SAMS remains unclear and multiple mechanisms may contribute to this phenomenon. Various therapeutic options are available for the management of SAMS, ranging from rechallenging with the same or a different statin to utilizing non-statin therapeutic alternatives in patients intolerant to statins. However, the lack of consensus on the definition of SAMS, the absence of a definitive diagnostic test, and lack of a universally accepted management algorithm pose a great challenge in dealing with this entity. This review aims to explore the various pathophysiological mechanisms involved in SAMS and understand the difference between self-limited toxic myopathy and immune-mediated myopathy requiring immunomodulatory therapy. The conundrum of statin withdrawal, tapering, and rechallenge in SAMS will also be explored in detail along with the newer non-statin therapies that are available.

Comparison of Various Low Density Lipoprotein Cholesterol Calculators: Is It Time for the Friedewald Equation to Go in India?

Low-density lipoprotein cholesterol (LDL-c) is the main target in the management of dyslipidemia in primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD). Our study aims to compare the conventional and most popular Friedewald equation, and the more recent Sampson equation (literally unknown in India but more accurate), to the directly estimated LDL-c by the homogenous method. No such comparative study has been done in India. A multicenter retrospective analysis of the lipid profiles of patients whose LDL-c was derived directly by the homogenous method was included. Indirect LDL-c was estimated using the Friedewald and Sampson equations. The accuracy, error, and level of correlation between direct LDL-c and the two equations were assessed for concordance and discordance based on LDL-c categories (≤50, 51-70, 71-100, 101-130, ≥131 mg/dL). Upward discordance is when the calculated LDL-c was at least one category higher and downward discordance is when the calculated LDL-c was at least one category lower than the corresponding direct LDL-c (DLDL-c). Subgroup analyses were also done for triglycerides (TGLs) <150, 151-199, ≥200 mg/dL. TGL >400 were assessed separately. A total of 30,810 samples from four centers were studied. The overall mean DLDL-c was 107.86 mg/dL. The mean estimated LDL-c by Friedewald's equation (FLDL-c) and Sampson's equation (SLDL-c) were 101.37 and 104.37 mg/dL, respectively. There was statistical significance (p-value < 0.0005) in the mean difference when DLDL-c was compared with combined SLDL-c and FLDL-c as per the Games-Howell multiple comparison study, in which the mean difference was greater with the Friedewald equation (6.495) than with the Sampson equation (3.491). The overall concordance between FLDL-c vs DLDL-c and SLDL-c vs DLDL-c was nearly similar (74 vs 77%, respectively). The overall discordance upward was 5% with FLDL-c and 7% with SLDL-c (p-value < 0.0005). The overall discordance downward for FLDL-c and SLDL-c was 22 and 15% (p-value < 0.0005). When subgroup analysis was done for LDL-c ≤ 70, the downward discordance was 41% (FLDL-c) and 32% (SLDL-c), giving a false sense of goal LDL-c being achieved more often with FLDL-c. For LDL-c > 70, the corresponding downward discordance was 16 and 11%, respectively. Starting from TGL ≥ 200 mg/dL, there was consistent underestimation of LDL-c by the Friedewald equation. When TGL was > 400, the mean DLDL-c was 109 mg/dL, while for FLDL-c, it was 82 mg/dL and for SLDL-c, it was 98 mg/dL. Sampson's equation improves the accuracy of the indirectly calculated LDL-c compared to Friedewald's equation. The FLDL-c is estimated falsely low at LDL-c ≤ 70 mg/dL, giving a lower sense of LDL-c goal being achieved, and these patients will be undertreated. By switching to Sampson's equation, 9% in the LDL-c ≤ 70 mg/dL and 5% in the LDL-c > 70 mg/dL can be correctly classified. The shift to Sampson's equation requires a simple formula change and can be easily embraced in India-a small change but in the right direction.

Obesity and cardiovascular disease: an ESC clinical consensus statement.

The global prevalence of obesity has more than doubled over the past four decades, currently affecting more than a billion individuals. Beyond its recognition as a high-risk condition that is causally linked to many chronic illnesses, obesity has been declared a disease per se that results in impaired quality of life and reduced life expectancy. Notably, two-thirds of obesity-related excess mortality is attributable to cardiovascular disease. Despite the increasingly appreciated link between obesity and a broad range of cardiovascular disease manifestations including atherosclerotic disease, heart failure, thromboembolic disease, arrhythmias, and sudden cardiac death, obesity has been underrecognized and sub-optimally addressed compared with other modifiable cardiovascular risk factors. In the view of major repercussions of the obesity epidemic on public health, attention has focused on population-based and personalized approaches to prevent excess weight gain and maintain a healthy body weight from early childhood and throughout adult life, as well as on comprehensive weight loss interventions for persons with established obesity. This clinical consensus statement by the European Society of Cardiology discusses current evidence on the epidemiology and aetiology of obesity; the interplay between obesity, cardiovascular risk factors and cardiac conditions; the clinical management of patients with cardiac disease and obesity; and weight loss strategies including lifestyle changes, interventional procedures, and anti-obesity medications with particular focus on their impact on cardiometabolic risk and cardiac outcomes. The document aims to raise awareness on obesity as a major risk factor and provide guidance for implementing evidence-based practices for its prevention and optimal management within the context of primary and secondary cardiovascular disease prevention.

Obesity and cardiovascular disease: an ESC clinical consensus statement.

The global prevalence of obesity has more than doubled over the past four decades, currently affecting more than a billion individuals. Beyond its recognition as a high-risk condition that is causally linked to many chronic illnesses, obesity has been declared a disease per se that results in impaired quality of life and reduced life expectancy. Notably, two-thirds of obesity-related excess mortality is attributable to cardiovascular disease. Despite the increasingly appreciated link between obesity and a broad range of cardiovascular disease manifestations including atherosclerotic disease, heart failure, thromboembolic disease, arrhythmias, and sudden cardiac death, obesity has been underrecognized and sub-optimally addressed compared with other modifiable cardiovascular risk factors. In the view of major repercussions of the obesity epidemic on public health, attention has focused on population-based and personalized approaches to prevent excess weight gain and maintain a healthy body weight from early childhood and throughout adult life, as well as on comprehensive weight loss interventions for persons with established obesity. This clinical consensus statement by the European Society of Cardiology discusses current evidence on the epidemiology and aetiology of obesity; the interplay between obesity, cardiovascular risk factors and cardiac conditions; the clinical management of patients with cardiac disease and obesity; and weight loss strategies including lifestyle changes, interventional procedures, and anti-obesity medications with particular focus on their impact on cardiometabolic risk and cardiac outcomes. The document aims to raise awareness on obesity as a major risk factor and provide guidance for implementing evidence-based practices for its prevention and optimal management within the context of primary and secondary cardiovascular disease prevention.

The Spectrum of Coronary Artery Disease in Elite Endurance Athletes-A Long-Standing Debate: State-of-the-Art Review.

Physical activity is recommended for the prevention of primary and secondary cardiovascular (CV) disease as it is linked to a number of health benefits, especially CV. However, recent research suggests that high-volume, long-term endurance exercise may hasten rather than slow the coronary atherosclerosis progression. This contentious theory has generated a great discussion and is still a major source of doubt when it comes to the clinical treatment of coronary artery disease (CAD) in athletes. CAD is the primary cause of sudden cardiac death in athletes over 35 years. Thus, recent studies evaluated the prevalence of CAD in athletes and its clinical and prognostic implications. Indeed, many studies have shown a relationship between endurance sports and higher volumes of coronary calcified plaque as determined by computed tomography. However, the precise pathogenetic substrate for the existence of an increased coronary calcification burden among endurance athletes remains unclear. Moreover, the idea that coronary plaques in elite athletes present a benign morphology has been cast into doubt by some recent studies showing potential association with adverse cardiovascular events. This review aims to analyze the association between physical activity and CAD, explaining possible underlying mechanisms of atherosclerotic progression and non-ischemic coronary lesions, focusing primarily on clinical and prognostic implications, multimodal evaluation, and management of CAD in endurance athletes.

Secondary Prevention Program through Hybrid Tele-Cardiac Rehabilitation using a Combination of Vigorous-intensity Interval Training and Low-Intensity Home-based Exercise in Patient with Refractory Angina Post-Percutaneous Coronary Intervention

Background: Refractory angina (RA) refers to symptoms lasting &gt;3 months due to reversible ischemia occurring with coronary artery disease, which cannot be controlled by increased medical therapy or revascularization including percutaneous coronary intervention (PCI). It may result in a significant impact on patient outcomes such as exercise limitation, biopsychosocial disorders, and decreased quality of life. Participation of patients with RA in cardiac rehabilitation (CR) reduces angina frequency and increases exercise capacity. Exercise-based CR also improves endothelial function, reduces oxidative stress and arterial stiffness, and improves myocardial perfusion. CR is also known as a secondary prevention program with the main goal to help patients return to their normal activities by increasing their functional capacity and preventing long-term complications. Case illustration: A 64-year-old male has undergone PCI and experienced RA. This patient was given a CR program to increase his functional capacity as a secondary prevention of cardiovascular disease through a center-based combined with a home-based CR program. Aerobic exercise given was hospital-based vigorous-intensity interval training and low-intensity home-based exercise. Problems found were refractory angina that often appeared during activity, and low cardiorespiratory endurance or muscular fitness. Angina symptoms and hand grip strength improved after 2 weeks, even though muscular fitness classification was still poor. During the program, he could achieve the exercise heart rate target without any symptoms. After 4 weeks, hand grip strength and physical activity were improved, and an exercise test revealed no symptoms during the test, appropriate hemodynamic response, and good fitness classification. However, there were still frequent VES with couplet episodes, so the patient was still classified as high-risk stratification. Although risk stratification was still high, the patient was allowed to enter phase III CR, with the prescription of moderate-intensity aerobic, low-intensity resistance, flexibility, and breathing exercises. These exercises were given based on recommendations for the average adult to maintain his level of physical activity and promote lifelong healthy behavior. Conclusion: Hybrid tele-cardiac rehabilitation through a combination of vigorous-intensity interval training and low-intensity home-based exercise in a patient with refractory angina post-PCI improved functional capacity as a key component for the prevention of long-term cardiac or non-cardiac complications.

Time-Use Sequences: A Mixed-Methods Study Exploring How, When, and Where Spatiotemporal Patterns of Everyday Routines Can Strengthen Public Health Interventions.

Behavior change interventions are critical for the secondary prevention of cardiovascular disease and for reducing the risk of a repeat event or mortality. However, the effectiveness of behavior change interventions is challenged by a lack of spatiotemporal contexts, limiting our understanding of factors that influence the timing and location in which day-to-day activities occur and the maintenance of behavior change. This study explored how behavior change interventions could incorporate spatiotemporal contexts of patient activities for modifying behaviors. A mixed-methods approach with adapted geo-ethnography techniques was used to solicit detailed descriptions of patients' day-to-day routines, including where, when, and how patients spend time. Data were gathered from patients in one cardiac intervention program in Nova Scotia, Canada, from June to September 2021. A total of 29 individuals (19 men and 10 women) between the ages of 45 and 81 and referred to the program after a cardiac event participated. The results show three key findings: (1) most patients exceeded the minimum guidelines of 30 min of daily physical activity but were sedentary for long periods of time, (2) patient time-use patterns are heterogenous and unique to contexts of individual space-time activity paths, and (3) time-use patterns reveal when, where, and how patients spend significant portions of time and opportunities for adapting patients' day-to-day health activities. This study demonstrates the potential for interventions to integrate tools for collecting and communicating spatial and temporal contexts of patient routines, such as the types of activities that characterize how patients spend significant portions of time and identification of when, where, and how to encourage health-promoting changes in routine activities. Time-use patterns provide insight for tailoring behavior change interventions so that clinic-based settings are generalizable to the contexts of where, when, and how patient routines could be adapted to mitigate cardiovascular risk factors.

Use of Cardiovascular Disease Secondary Prevention Medications in Four Middle East Countries in a Community Setting.

Evidence-based International clinical practice guidelines, universally recommend secondary prevention medications for those with previous cardiovascular disease (CVD). There is limited data on the community use of these medications in the Middle East (ME). This study assesses the use and predictors of evidence based secondary prevention medications in individuals with a history of CVD [coronary heart disease (CHD) or stroke]. Between 2005 and 2015, we enrolled 11,228 individuals aged between 35-70 years from 52 urban and 35 rural communities from four ME countries, United Arab Emirates (n = 1499), Kingdom of Saudi Arabia (n = 2046), Occupied Palestinian Territory (n = 1668) and Islamic Republic of Iran (n = 6013). With standardized questionnaires, we report estimates of medication use in those with CVD at national level and the independent predictors of their utilization through a multivariable analysis model. Results: Of the total ME cohort, 614 (5.5%) had CVD, of which 115 (1.0%) had stroke, 523 (4.7%) had CHD and 24 (0.2%) had both. The mean age of those with CVD was 56.6 ± 8.8 years and 269 (43.8%) were female. Overall, only 23.5% of those with CVD reported using three or more proven secondary prevention medications, and a substantial proportion (stroke 27.8%, CHD 25.8%) did not take any of these medications. In a fully adjusted analysis, increasing age, female gender, higher education, higher wealth in individual household, residence in a higher income country as well as being obese, hypertensive or diabetic were independent predictors of medication use. The use of secondary prevention medication is low in ME and has not reached the modest recommended WHO target of 50% use of 3 or more medications. Independent factors of higher use were, better socioeconomic status (household wealth, country wealth and education) and better contact and accessibility to health care (increasing age, female gender, obesity, diabetes and hypertension).

Strategies to Address Statin Medication Intolerance Among Patients at Risk of Cardiovascular Disease Identified Through Electronic Health Records: A Literature Review and Pooled Analysis.

Statins are a group of medications that lower lipid and are used for primary and secondary prevention of cardiovascular diseases (CVD). Patients can either be partially (15%) or completely (5%) intolerant to statins. Symptoms of statin intolerance can include muscle aches (myalgia), weakness, cramps, myopathy, diabetes mellitus, and elevated creatine kinase levels. Decreasing statin intolerance also improves statin adherence, which in turn results in lower number of CVD events among patients. Studies on statin intolerance is often embedded within studies of statin adherence. However, relevant data can be obtained from digital health systems. This preliminary literature review looks at studies from the past 10 years to identify and determine the effectiveness of strategies to address statin intolerance. The NLA definition for statin intolerance was used in this review. The initial search results on EMBASE, PubMed, SCOPUS, and CINAHL showed 91 articles and applying the inclusion and exclusion criteria, four articles were used in this review and pooled analysis. The study patients were identified through electronic health records. The pooled analysis was done using the Metafor package in R, applying a random-effect model to estimate pooled effect size. The findings suggest that using fixed dose combination therapy and switching from a lipophilic statin to a hydrophilic statin, while correcting metabolic abnormalities, or initiating evolocumab alongside statin can address statin intolerance. The overall relative risk (RR) was 0.40 (95% CI, 0.09 to 1.70) with I2 90%, and the overall odds ratio (OR) was 0.11 (95% CI, 0.01 to 1.59) with I2 94%, suggesting that the interventions work well in addressing statin intolerance. Since statin intolerance is has a vast range of effects, further research works may be done on exploring the possibility of using digital health systems to identify and provide targeted interventions to patients.

The effectiveness of the Mediterranean Diet for primary and secondary prevention of cardiovascular disease: An umbrella review.

This study aimed to review meta-analyses of randomised controlled trials that evaluated the effectiveness of the Mediterranean Diet for the primary and secondary prevention of cardiovascular disease. Five databases (Medline, Embase, Cochrane, CINAHL and ProQuest) were searched from inception to November 2022. Inclusion criteria were: (i) systematic review of randomised controlled studies with metanalysis; (ii) adults ≥18 years from the general population with (secondary prevention) and without (primary prevention) established cardiovascular disease; (iii) Mediterranean Diet compared with another dietary intervention or usual care. Review selection and quality assessment using AMSTAR-2 were completed in duplicate. GRADE was extracted from each review, and results were synthesised narratively. Eighteen meta-analyses of 238 randomised controlled trials were included, with an 8% overlap of primary studies. Compared to usual care, the Mediterranean Diet was associated with reduced cardiovascular disease mortality (n = 4 reviews, GRADE low certainty; risk ratio range: 0.35 [95% confidence interval: 0.15-0.82] to 0.90 [95% confidence interval: 0.72-1.11]). Non-fatal myocardial infarctions were reduced (n = 4 reviews, risk ratio range: 0.47 [95% confidence interval: 0.28-0.79] to 0.60 [95% confidence interval: 0.44-0.82]) when compared with another active intervention. The methodological quality of most reviews (n = 16/18; 84%) was low or critically low and strength of evidence was generally weak. This review showed that the Mediterranean Diet can reduce fatal cardiovascular disease outcome risk by 10%-67% and non-fatal cardiovascular disease outcome risk by 21%-70%. This preventive effect was more significant in studies that included populations with established cardiovascular disease. Better quality reviews are needed.

The concept of fixed-dose combination drugs in primary and secondary prevention of cardiovascular disease. Position paper of the Russian Society of Cardiology, the Russian Society for the Prevention of Noncommunicable Diseases, the Russian Scientific Medical Society of Internal Medicine, the Russian Association of Endocrinologists, the Association of Clinical Pharmacologists, the Eurasian Association of Internal Medicine, the Russian Association of Gerontologists

The paper describes the position of of the Russian Society of Cardiology, the Russian Society for the Prevention of Noncommunicable Diseases, the Russian Scientific Medical Society of Internal Medicine, the Russian Association of Endocrinologists, the Association of Clinical Pharmacologists, the Eurasian Association of Internal Medicine, the Russian Association of Gerontologists and Geriatricians on the most important and controversial issues of the use of fixed-dose combination drugs in the primary and secondary prevention of cardiovascular disease.

Impact of Antiplatelet Therapy on 5-Year Outcomes After Fractional Flow Reserve-Guided Deferral of Revascularization in Nonsignificant Obstructive Coronary Artery Disease.

Because the clinical benefit of antiplatelet therapy (APT) for patients with nonsignificant coronary artery disease (CAD) remains poorly understood, we evaluated it in patients after fractional flow reserve (FFR)-guided deferral of revascularization. From the J-CONFIRM (Long-Term Outcomes of Japanese Patients with Deferral of Coronary Intervention Based on Fractional Flow Reserve in Multicenter Registry), we investigated 265 patients with deferred lesions who did not require APT for secondary prevention of cardiovascular disease. A 2-year landmark analysis assessed the relationship between APT at 2 years and 5-year major cardiac adverse events (MACE: composite of all-cause death, target vessel-related myocardial infarction, clinically driven target vessel revascularization). Of the 265 patients, 163 (61.5%) received APT. The 5-year MACE did not significantly differ between the APT and non-APT groups after adjustment for baseline clinical characteristics (9.2% vs. 6.9%, inverse probability weighted hazard ratio, 1.40 [95% confidence interval, 0.53-3.69]; P=0.49). There was a marginal interaction between the effect of APT on MACE and FFR values (< or ≥0.84) (P for interaction=0.066). The 5-year outcomes after FFR-guided deferral of revascularization did not significantly differ between the APT and non-APT groups, suggesting that APT might not be a critical requirement for nonsignificant obstructive CAD patients not requiring APT for secondary prevention of cardiovascular disease.

Impact of aspirin dose according to race in secondary prevention of atherosclerotic cardiovascular disease: a secondary analysis of the ADAPTABLE randomised controlled trial

ObjectivesTo evaluate whether the effectiveness and safety of low (81 mg daily) versus high-dose (325 mg daily) aspirin is consistent across races among patients with established atherosclerotic cardiovascular disease (ASCVD).DesignA...

The effect of Ba Duan Jin exercise intervention on cardiovascular disease: a meta-analysis of randomized controlled trials.

There is a growing interest in the use of complementary therapies for the prevention of disease and the maintenance of health. Furthermore, complementary therapies that incorporate exercise are becoming increasingly prevalent among the older adult, and thus may represent a crucial strategy for the primary and secondary prevention of cardiovascular disease (CVD). Exercise therapy, as a means to prevent and treat cardiovascular diseases, has been gradually applied in clinical practice. It has the advantages of reducing mortality, improving clinical symptoms, restoring physical function and improving quality of life. In recent years, traditional Chinese sports such as Ba Duan Jin and Qigong have developed rapidly. Therefore, a comprehensive systematic review is required to examine interventions involving Ba Duan Jin exercise in healthy adults or those at increased risk of CVD in order to determine the effectiveness of Ba Duan Jin exercise for the primary prevention of CVD. To investigate the effect of Ba Duan Jin exercise intervention for the primary prevention of cardiovascular diseases. Eight databases were systematically searched from inception to July, 2024 for randomized controlled trials (RCTs) to evaluated the impact of Ba Duan Jin exercise intervention on cardiovascular diseases. The search terms were "Cardiovascular diseases" "Ba Duan Jin" and "Randomized controlled." The Cochrane risk assessment tool was used to evaluate the study quality, and the meta-analysis was performed using Rev. Man 5.4 software. Seventeen completed trials were conducted with 1,755 participants who were randomly assigned and met the inclusion criteria. All 17 studies were conducted in China. The meta-analysis indicates that Ba Duan Jin exercise therapy can provide long-term benefits (20-30 years) by reducing all-cause mortality (RR = 0.55, 95% CI: 0.44-0.68, p < 0.01) and stroke mortality (RR = 0.49, 95% CI: 0.36-0.66, p < 0.01) in hypertensive patients. Subgroup analyses reveal that Ba Duan Jin exercise therapy decreases SBP (MD = -4.05, 95% CI = -6.84 to -1.26, p < 0.01) and DBP (MD = -3.21, 95% CI = -5.22 to -1.20, p < 0.01) levels in patients with essential hypertension, significantly reduces serum TC (MD = -0.78, 95% CI = -1.06 to -0.50, p < 0.01), TG (MD = -0.78, 95% CI = -0.93 to -0.62, p < 0.01), and LDL-C (MD = -0.76, 95% CI = -0.92 to -0.60, p < 0.01) levels in patients with hyperlipidemia, increases HDL-C (MD = 0.32, 95% CI = 0.14-0.51, p < 0.01) levels, and produces beneficial effects on cardiovascular function. Additionally, it can alleviate anxiety (MD = -3.37, 95% CI = -3.84 to -2.89, p < 0.01) and improve sleep quality (MD = -2.68, 95% CI = -3.63to -1.73, p < 0.01). Ba Duan Jin exercise therapy can improve the physical and mental condition and quality of life of patients with cardiovascular diseases, and it is worthy of further promotion and application in clinical practice. PROSPERO, identifier: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024496934.

The cost-effectiveness of semaglutide in reducing cardiovascular risk among people with overweight and obesity and existing cardiovascular disease, but without diabetes.

The Semaglutide Effects on Cardiovascular Outcomes in People with Overweight or Obesity (SELECT) trial demonstrated significant reductions in cardiovascular outcomes in people with cardiovascular disease (CVD) and overweight or obesity (but without diabetes). However, the cost of the medication has raised concerns about its financial viability and accessibility within healthcare systems. This study explored whether use of semaglutide for the secondary prevention of CVD in overweight or obesity is cost-effective from the Australian healthcare perspective. A Markov model was developed based on the SELECT trial to model the clinical outcomes and costs of a hypothetical population treated with semaglutide versus placebo, in addition to standard care, and followed up over 20 years. With each annual cycle, subjects were at risk of having non-fatal CVD events or dying. Model inputs were derived from SELECT and published literature. Costs were obtained from Australian sources. All outcomes were discounted by 5% annually. The main outcome of interest was the incremental cost-effectiveness ratio (ICER) in terms of cost per year of life saved (YoLS) and cost per quality-adjusted life year (QALY) gained. With an annual estimated cost of semaglutide of A${\$}$4175, the model resulted in ICERs of A${\$}$99853 (US${\$}$143504; £40873) per YoLS and A${\$}$96055 (US${\$}$138046; £39318) per QALY gained. Assuming a willingness-to-pay threshold of A${\$}$50000, semaglutide is not considered cost-effective at the current price. A price of≤A${\$}$2000 per year or more targeted use in high-risk patients would be needed for it to be considered cost-effective in the Australian setting.

Estimated glomerular filtration rate slope and risk of primary and secondary major adverse cardiovascular events and heart failure hospitalization in people with type 2 diabetes: An analysis of the EXSCEL trial.

The decline in estimated glomerular filtration rate (eGFR), a significant predictor of cardiovascular disease (CVD), occurs heterogeneously in people with diabetes because of various risk factors. We investigated the role of eGFR decline in predicting CVD events in people with type 2 diabetes in both primary and secondary CVD prevention settings. Bayesian joint modelling of repeated measures of eGFR and time to CVD event was applied to the Exenatide Study of Cardiovascular Event Lowering (EXSCEL) trial to examine the association between the eGFR slope and the incidence of major adverse CV event/hospitalization for heart failure (MACE/hHF) (non-fatal myocardial infarction, non-fatal stroke, CV death, or hospitalization for heart failure). The analysis was adjusted for age, sex, smoking, systolic blood pressure, baseline eGFR, antihypertensive and lipid-lowering medication, diabetes duration, atrial fibrillation, high-density cholesterol, total cholesterol, HbA1c and treatment allocation (once-weekly exenatide or placebo). Data from 11 101 trial participants with (n = 7942) and without (n = 3159) previous history of CVD were analysed. The mean ± SD eGFR slope per year in participants without and with previous CVD was -0.68 ± 1.67 and -1.03 ± 2.13 mL/min/1.73 m2, respectively. The 5-year MACE/hHF incidences were 7.5% (95% CI 6.2, 8.8) and 20% (95% CI 19, 22), respectively. The 1-SD decrease in the eGFR slope was associated with increased MACE/hHF risks of 48% (HR 1.48, 95% CI 1.12, 1.98, p = 0.007) and 33% (HR 1.33, 95% CI 1.18,1.51, p < 0.001) in participants without and with previous CVD, respectively. eGFR trajectories over time significantly predict incident MACE/hHF events in people with type 2 diabetes with and without existing CVD, with a higher hazard ratio for MACE/hHF in the latter group.

Is Semaglutide Cost-Effective for the Secondary Prevention of Cardiovascular Disease in People with Overweight or Obesity in Australia?

Is Semaglutide Cost-Effective for the Secondary Prevention of Cardiovascular Disease in People with Overweight or Obesity in Australia?