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.
Effect of SGLT2 inhibitors in People with Advanced CKD with T2D
In a study, initiation of SGLT2i decreased eGFR from 46.1±14.1 to 3.6±13.5 ml/min/1.73m in 1st month in patients with T2D and CKD. Individualized eGFR slopes were improved from -6.4±9.1 to -1.5±3.2ml/min/1.73m/year. Rate of responders: stage 3a (22/29), 3b (22/28), 4 (16/18). Responders were rapid eGFR decliners and had high macro-albuminuria (53% vs 33%)
SGLT2i and GLP-1 RA Use Among US Adults with T2D
How common SGLT2i and GLP1 RA use is among persons with T2D in the US? SGLT2i were used by 7.2% adults with CKD or CHF, and GLP1 RA were used by 3.5% adults with ASCVD. Age, colour & insurance had an impact on medicine use. SGLT2i and GLP1 RA were used less frequently than biguanides, sulfonylureas, DPP-4i, and insulin. From 2013-2014 to 2017-2020, the utilisation of SGLT2i grew dramatically.
ANGPTL3/8 Lowers Triglycerides and Cholesterol
In patients with mixed dyslipidaemia, single doses of LY3475766, a monoclonal antibody to the angiopoietin-like protein 3/8 (ANGPTL3/8) complex, significantly lowered plasma triglycerides and residual cholesterol levels. The ANGPTL3/8 complex is a promising target since it inhibits lipoprotein lipase, a major regulator of triglyceride metabolism, 100 times more effectively than ANGPTL3 alone.
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.
