Is prothrombotic effect linked to high lipoprotein(a) levels?
High levels of lipoprotein(a) have been identified as a cause of cardiovascular disease and aortic valve stenosis. Previously, it was thought that proatherogenic and prothrombotic effects of lipoprotein(a) were contributing mechanisms. However, a new study of over 440,000 adults found no clinically significant venous or arterial prothrombotic effect linked to high lipoprotein(a) levels.
Using Lipoprotein (A) Levels For CVD Prevention
Lipoprotein(a) levels of 120 nmol/L or greater are seen in more than 20% of the population. It is linked to a 37% increased risk of major coronary events. This risk of coronary events can be overcome by maintaining about 0.5 mmol/L lower LDL-C levels, from age 40 years. If LDL-C lowering begins later, at the age of 60, more intensive LDL-C lowering is required to cut risk.
Endothelial Function (EF) Parameters in Patients With CAD
A study investigated EF parameters in patients with CAD who are younger than 50 years old, have long-term arterial hypertension, or have never had hypertension. Endothelial function metrics were considerably different when comparing patients with coronary artery disease to healthy people. Pathological reactions of IR and FMD were recorded more often in patients.
Pulse wave velocity (PWV) Correlates in FH Patients
A study included 154 Familial Hypercholesterolemia (FH) patients with DLCN criteria. PWV was higher in patients with carotid plaques, arterial hypertension and CAD than in those without. PWV was found to have a significant positive relationship with BMI, triglyceride, and apo A1 serum concentrations. Significant associations between SBP/DBP and PWV were observed.
Atherothrombotic Risk In Patients Receiving Antiplatelet monotherapy
Despite being on guideline-recommended APMT, residual atherothrombotic risk remains substantial in a contemporary group with atherosclerotic cardiovascular disease. Recent evidence based interventions, such as novel medicines used in conjunction with antiplatelet therapy, have emerged that may reduce residual risk in these patients.
Impact of CYP2C19 genetic variants on Clopidogrel
A study included 110 CHD patients (aged 42-75 years) who had PCI followed by DES stenting. Clopidogrel was found to be effective in 84% of patients. Majority of the non-responders had the CYP2C19*2 and CYP2C19*3 genotypes. Platelet aggregation inhibition increased significantly in CYP2C19*17 subjects with 5 and 20 mmol/L ADP, and increased normally in CYP2C19*1 subjects after 12 hours.
Combination Therapies For Very High Risk CV Patients
In 2020, International Lipid Expert Panel introduced upfront combination therapy to prevent CVD events. It suggested use of combination therapy with statins along with PCSK9 inhibitor in hospitalized patients. EVACS study with Evolocumab clearly reveals to start early with PCSK9i as it reduced LDL-C levels. PCSK9i can significantly reduce present atheroma volume and the fibrous cap thickness.
vWF as a Risk Factor For Cardiovascular Events
A study determined the relationship between CVE recurrence and Von Willebrand factor (vWF) levels in patients with early coronary atherosclerosis. Out of 80 patients, 68 patients had increased vWF levels: 57.43±18.66 ng/ml. Patients with high vWF had 13 additional CVEs during follow-up. This revealed that the degree of vWF had greatest predictive value for the probability of recurrent CVE.
Imaging And Biomarkers to Detect Atherosclerosis
Atherosclerosis is a disease of the arterial vascular wall, and imaging allows a direct evaluation of the disease process. This may be relevant for early appropriate risk stratification. And biomarkers representing different pathways of the complex pathophysiology of atherosclerosis might help to further refine risk stratification and indeed identify the right patient for the right treatment.
Familial Chylomicronemia Syndrome Diagnosis
Familial Chylomicronemia Syndrome (FCS) is a lipid metabolic disorder characterised by severe hypertriglyceridemia and recurrent pancreatitis. Five individuals had their FCS diagnosis confirmed by molecular investigation of potential genes (4 for LPL mutations and 1 for GPIHBP1). In comparison to non-genetic hypertriglyceridemia, carriers of FCS causal mutations had greater TG and pancreatitis.
Omega-3 Fatty Acids For Cardiovascular Prevention
JELIS trial has revealed that eicosapentaenoic acid (EPA) is a promising treatment for prevention of major coronary events in hypercholesterolaemic patients. REDUCE-IT reported that among patients with elevated triglycerides (TG) despite the use of statins, the risk of ischemic events was significantly lower in those who received 2 gram of icosapent ethyl twice daily.
Reverse Residual Cholesterol Transport (RRT) Hypothesis
Low and extremely high HDL-cholesterol levels are linked to increased cardiovascular risk, forming a U-shaped connection with cardiovascular disease (CVD). The authors developed the reverse residual cholesterol transport (RRT) hypothesis to explain this association, which includes the transfer of free cholesterol from triglyceride-rich lipoproteins (TGRLs) to HDL as a first step after lipolysis.
Anti-atherosclerotic Potential of Incretin
GLP-1 reduces CV events and shows benefits in weight loss, better glycemic control, improvements in BP and lipids. The incretin therapy has shown reductions in TNF alpha, oxidative stress and collagen content suggesting that it improves plaque stability and progression in T2D patients. Animal studies showed that GLP-1 RA or DPP-4i exert an anti-atherosclerotic effect in hypercholestetolemic mice.
Prescribing Patterns of SGLT2 Inhibitors
Clinical trials have shown that adding SGLT2 inhibitors to patients with HF with reduced ejection fraction and HF with preserved ejection fraction, with/without type 2 diabetes, reduces cardiovascular death and HF-related hospitalizations (T2D). Despite guidelines, SGLT2i are underused in patients with HF, with or without T2D. Future research is needed to identify the challenges to adoption.
Stress Hyperglycemia: Independent Marker of Acute Illness
Stress hyperglycemia [inpatient hyperglycemia in patients without known diabetes] is associated with poor outcomes. Stress hyperglycemia is linked to increased prevalence of inpatient CVD, critical illness, organ damage (MI, kidney injury, respiratory failure), and incident DM after discharge. Furthermore, iRPG >140 mg/dl identifies high-risk diabetic patients who should be closely monitored.
Cardiovascular Effectiveness of SGLT2 Inhibitors
SGLT2i lowered the risk of CV events in people with T2D and CVD. Individual SGLT2i did not, however, demonstrate consistent CV improvements in all trials. Dapagliflozin and empagliflozin exhibited similar risks of MI/stroke as canagliflozin, however empagliflozin was linked with a lower risk of HHF. Individual SGLT2i were shown to have a chance of developing additional complications.
SGLT2 Inhibitors Reduce Cardiovascular and Renal Risks
A meta-analysis revealed that SGLT2 inhibitors significantly lowered risks of kidney-specific outcome, MACE and HHF compared to DPP4 inhibitors, and reduced risks of kidney-specific outcome and HHF compared to GLP-1 RAs. GLP-1 RAs also showed cardiovascular and renal outcome benefits compared to placebo. DPP4 inhibitors did not improve either CV or renal outcomes compared to placebo.
24-Hour Plasma FFAs in People with Obesity & Prediabetes
A study meaured plasma FFA concentrations over 24 hours in 20 people with obesity and normal fasting glucose and glucose tolerance (MHO) and 20 adults with prediabetes. It was found that prediabetes group had higher plasma FFA over 24 hours than the MHO group These findings back with the theory that higher 24-hour plasma free fatty acids contribute to obesity-related insulin resistance.
Prevalence of Newly Detected Diabetes
RSSDI data revealed that among people with diabetes, 68669 (87.3%) were on treatment for diabetes. 17646 of them presented in fasting state and 14834 (21.6%) of them had fasting sugar above 130 mg/dl. Out of 42308 diabetic subjects on treatment, 28335 (41.3%) had random blood sugar more than 180 mg/dl. 62.9% of diabetes patients on treatment had their sugar values beyond target range.
Once-Weekly Insulin Injection - The Future of Diabetes Treatment
A huge step forward in making Type 2 diabetes management easier is on the horizon: the promise of a once-weekly insulin injection. It helps improve adherence, convenience, improve clinical inertia with less missed injections & offer better glycaemic control. However, more data are required on glycaemic control, efficacy & safety, dosing algorithms, post-marketing studies.
