Are ACE Inhibitors Still The Cornerstone of Cardiovascular Protection?
Perindopril improves life/death cycle of the endothelium preventing ACS. It works well when combined with either Ca2+ antagonists, diuretics and/or statins. Prescribing ARBs for hypertension deprives patients from the benefit of ACEi on the coronary artery. In RCTs, ACEi exert a better coronary artery protection than ARBs. In Post AMI patients, Perindopril decreases endothelial apoptosis.
Can We Individualize Treatment of Hypertensive Patients With Single-pill Combination Therapies?
Recent guidelines suggests to start with two drugs and ideally as a single pill combination. SPC is more effective and provides rapid BP control than monotherapy. Single pill combination also enhances adherence, improves CV protection and is more cost-effective. In PROGRESS trial, Perindopril or Indapamide showed 28% risk reduction of recurrent stroke.
How to Treat a Patient With Heart Failure and LVEF> 40%?
Heart failure with preserved ejection fraction is often under-diagnosed in clinical practice. Empagliflozin is the first drug to reduce CV death or first hospitalization for heart failure (HHF) in HFpEF patients. Effect of Empagliflozin is consistent across multiple patient subgroups with HFpEF. In HFpEF patients, Empagliflozin protects the kidney by slowing the decline of renal function.
Optimal Medical Treatment of Chronic Coronary Syndromes (CCS)
More tailored pharmacological treatment before considering percutaneous coronary intervention is required. The stepwise approach for CCS should be abandoned for a rationale combination of hemodynamic and metabolic agents along with reconsideration of preventive strategies. Trimetazidine can be used for symptom control in CCS as an early combination therapy with BB and CCB.
Great Debate: Hypertension During Exercise Should be Treated
Hypertension during exercise may contribute to the overall burden of pressure-related and residual CV risk. Exercise BP can't be used to diagnose HTN. It does not reflect vascular pathology or pre-hypertension. Is not associated with reduced exercise capacity. One should not be concerned about an increase in BP during exercise, rather BP should be under control before commencing the exercises.
2022 ESC Guidelines on Pulmonary Hypertension
Individuals with suspected pulmonary hypertension are suggested to get transthoracic echocardiography guidance for right heart imaging (TTE). Right heart catheterization is recommended to confirm the diagnosis. Initial combination treatment with PDE5i and an endothelin receptor antagonist is advised in individuals with IPAH/HPAH/DPAH who are at low or intermediate risk of mortality.
2022 ESC Guidelines on Cardio-oncology
Echocardiography is suggested as the first-line modality for assessing heart function in cancer patients, with cardiovascular magnetic resonance being evaluated when echocardiography is unavailable or undiagnostic. Cancer prognosis, cancer therapies and CV symptoms need alternative solutions, drug- drug interactions, and patient preferences should be considered when making treatment decisions.
Interventional Solutions For Heart Failure
The FDA has approved an innovative treatment for heart failure called Baroreceptor Stimulation, which relieves symptoms of HFrEF. Baroreflex Activation Therapy (BAT) reduces sympathetic activity while improving parasympathetic activity. In BEAT HF trial, the BAT improved the quality of life and NT-pro-BNP considerably.
LDL-C: New insights Into its Role as Casual Risk Factor and Target For Therapy
An annual dosage of siRNA vaccine presents a viable method for lowering LDL, reducing cardiovascular events, and decreasing the progression of atherosclerosis. Starting at age 55, twice-yearly siRNA treatment reduces LDL by 52%. Injectables ensures compliance.
Addressing The Unmet Needs in LDL-C Lowering - What Can We Expect?
According to evidence, the combination of ezetimibe, bempedoic acid, and inclisiran is more effective in reducing LDL-C levels. At their maximum dose, statins have several drawbacks. Novel agents, such as the CETP inhibitor Obicetrapib, as well as oral PCSK9 modulators, have showed encouraging outcomes.
The Beginning of The End For NOACs? The Extra Mile
NOACs are an effective therapy option for stroke in individuals with NVAF, diabetes, and compromised renal function. NOACs are recommended for the treatment of cancer associated thrombosis by clinical recommendations like as ISTH, ASCO, ESC, NCCN, and ITAC. When compared to LMWH, patients taking a NOAC have greater effectiveness and a comparable overall major bleeding risk.
CV Assessment and Management of Patients Undergoing Non-cardiac Surgery
Patients with CVD, CV risk factors (including age >65 years), or CVD symptoms should utilize hs-cTN or hs-CTN I before immediate or high risk NCS, as well as at 24 and 48 hours thereafter. They should have BNP or NT-proBNP measured before intermediate and high risk NCS. It is not advisable to start beta-blockers before non-cardiac surgery on a regular basis.
SECURE – Secondary Prevention of Cardiovascular Disease in Elderly
A polypill therapy comprising aspirin, atorvastatin, and ramipril resulted in fewer recurrent cardiovascular events after myocardial infarction, likely due to greater adherence. The polypill method is safe to use with no differences in adverse events between groups. Using a polypill as a substitution approach might be an important component of the global strategy to improve secondary prevention.
2022 ESC Guidelines on Ventricular Arrhythmias and Sudden Cardiac Death
Genetic testing and genetic should be undertaken in patients with clinical suspicion or clinical diagnosis of catecholaminergic polymorphic ventricular tachycardia. It is advised that public access defibrillation be made available in areas where cardiac arrest is more prone to occur. Promoting community training in basic life support is advised to boost bystander CPR and AED use.
Efficacy and Safety of Sacubitril And Valsartan on Cognitive Function
Sacubitril & valsartan did not affect cognitive function in a 3-year randomised trial. Beta-amyloid deposition in the brain was less in patients treated with Sacubitril/valsartan compared to valsartan. There was no evidence of an increased risk of cognitive impairment by neprilysin inhibition related to beta-amyloid accumulation in the brains of individuals with HFmrEF or HFpEF.
Targeting the PCSK9 pathway: Where do novel therapies fit in?
Inclisiran, the first-in-class siRNA, is approved by EU and FDA for LDL lowering in two doses per year. Gene editing therapy inhibits proprotein convertase subtilisin/kexin type 9 (PCSK9) synthesis by RNA interference. Blocking PCSK9 synthesis reduces LDL levels and is one of the most sought after novel approaches investigated by pharmaceutical firms.
Treatment in the morning versus evening (TIME) study
TIME study is pragmatic, decentralised, large study compared the effects of evening vs. morning dosage on CV outcomes. The study found that allocating antihypertensive medicine to the evening dose did not enhance the primary endpoint. Patients can be instructed to take their antihypertensive medicine in the morning or evening because the timing has no effect on cardiovascular outcomes.
