HMG-CoA reductase inhibitors or as they are commonly known as statins have been postulated to produce significant reductions in major vascular events irrespective of age, but their efficacy and benefit among patients older than 75 years have not been well documented. In a recent meta-analysis published in The Lancet, by The Cholesterol Treatment Trialists’ Collaboration (CTT collaboration), the influence of advancing age and statin therapy on major vascular episodes in 28 statin trials was analyzed. The collaboration found that statins do reduce the risk of vascular events in older people but have no effect, irrespective of age, on non-vascular mortality and cancer incidence. In the past, 14 meta-analyses have been done each with inconsistent evidence about the use of statins among older people (generally >65 years). This gap in evidence concerning the perception of risk-benefit for the use of statins as the primary prevention in people older than 75 years may be one of the reasons explaining why statin therapy is often discontinued in older patients. Unlike these studies, the present meta-analysis conducted by the CTT collaboration analyzed individual participant data from randomized controlled trials of 186, 854 participants who were older than 75 years with a median follow-up of 4·9 years. Continue reading →

So far, there has been no definitive treatment for dementia. There are medications that provide symptomatic relief but there has been an advance towards developing disease-modifying medications. Due to the long preclinical period of most neurodegenerative diseases, prevention as a mode of treatment seems to be an important area of exploration. The relation between high blood pressure and cognitive impairment is one important aspect. In a recent randomized controlled trial called Systolic Blood Pressure Intervention Trial (SPRINT) Memory and Cognition in Decreased Hypertension (MIND) study published in JAMA NETWORK, researchers from the SPRINT group embarked to ascertain if intensive blood pressure control could decrease the risk of Alzheimer disease and related dementias. This was the first trial ever to demonstrate an effectual strategy for preventing of age-related cognitive impairment as it compared the effectiveness of intensive blood pressure control (targeting a systolic blood pressure of less than 120 mm Hg) to standard blood pressure control (targeting a systolic blood pressure of less than 140 mm Hg) towards the prevention of probable dementia. Continue reading →

An original investigation by Zheng et al. published in JAMA showed that the use of aspirin in individuals without cardiovascular disease was associated with a lower risk of cardiovascular events and an increased risk of major bleeding.  This may assist in discussions with patients about aspirin for the primary prevention of cardiovascular events and bleeding.

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The FDA issued a Dear Doctor letter while investigating a potential safety signal with paclitaxel-coated balloons and stents used to treat peripheral artery disease. “This review will focus on the causes of death, the paclitaxel dose delivered, and patient characteristics that may impact clinical outcomes. Additional statistical analyses will be performed to clarify the presence and magnitude of any long-term risks,” the letter stated.  Continue reading →

A series of systematic reviews and meta-analyses have depicted how findings from prospective studies and clinical trials associated with relatively high intakes of dietary fiber and whole grains were complementary, and striking dose-response evidence indicated that the relationships to several non-communicable diseases could be causal. According to the publication in The Lancet, the implementation of recommendations to increase dietary fiber intake and to replace refined grains with whole grains is expected to benefit human health. Continue reading →

The results of a fascinating study conducted by Dr. Patricia Iozzo and her colleagues at the Institute of Clinical Physiology, in Pisa, Italy showed that neonatal changes in cardiac morphology were explained by late-trimester maternal body mass index; myocardial glucose overexposure seen in minipigs could justify early human findings. Moreover, long-term effects in minipigs consisted of myocardial insulin resistance, enzymatic alterations, and hyperdynamic systolic function, according to the publication in JACC: Cardiovascular Imaging. Continue reading →

Results from a study conducted by investigators at Stanford University School of Medicine did not support the Hispanic paradox in a highly educated Hispanic population. The study demonstrated that Hispanic and non-Hispanic white (NHW) men and women with high educational attainment had similar atherosclerotic cardiovascular disease risk, subclinical coronary atherosclerosis, and mortality during follow-up. The results were published online in the latest issue of JAMA Cardiology. Continue reading →

COAPT trial

This prospective, multicenter, open-label, randomized trial aimed to assess the use of transcatheter mitral valve repair in heart failure (HF) patients with mitral regurgitation due to left ventricular dysfunction. A total of 614 patients were randomized to either receiving guideline-directed medical therapy (GDMT) alone or GDMT in addition to transcatheter mitral-valve repair. The primary efficacy endpoint was all hospitalizations due to heart failure at 24 months of follow-up, while the primary safety endpoint was freedom from device-related complications at 12 months of follow-up. The study showed that the device group had a lower risk of hospitalization for HF (HR 0.53, 95% CI 0.4-0.7) and all-cause mortality (HR 0.62, 95% CI 0.46-0.82) at 24 months. Moreover, the rate of freedom from device complications at 12 months was 96.6% which exceeded the prespecified safety threshold. Continue reading →

A population-based cohort study has shown that patients with a higher serum cholesterol efflux capacity, the capacity of HDL particles to mediate cholesterol efflux from macrophages, have a marked decrease in all-cause mortality as compared to patients with a lower serum cholesterol efflux capacity. Continue reading →

A molecular analysis of bacterial contamination on stethoscopes in an intensive care unit conducted by Vincent R. Knecht and his colleagues at University of Pennsylvania Perelman School of Medicine, Philadelphia, has shown that stethoscopes used in an ICU carry bacterial DNA reflecting complex microbial communities that include nosocomially important taxa. Commonly used cleaning practices reduce contamination but are only partially successful at modifying or eliminating these communities. Continue reading →

A recent study published in the European Heart Journal showed that chronic red meat consumption is associated with increased serum and urine concentrations of trimethylamine N-oxide (TMAO), a metabolite associated with increased risk of atherosclerosis and cardiovascular disease (CVD), when compared to white meat and non-meat sources of protein. Continue reading →

A recent article published in Circulation by John Del Coso and his team demonstrated that the cardiac stress during a marathon is higher than the cardiac stress produced by competing in shorter-distance events, at least in athletes with lesser experience and lower training background. The manuscript provides evidence of the relatively-high cardiac stress of marathoners, following a competition.  Reasons for this high cardiac stress after the marathon arise from the combination of a long distance event and the lack of appropriate training in the study sample. Interestingly, athletes with lower running experience and training backgrounds presented much lower values of cardiac stress, as they decided to compete in shorter distances. Continue reading →

In a report in this issue of the JACC: Cardiovascular Interventions, Dr. John A Dodson and his colleagues from the New York University School of Medicine reported that frail patients had lower use of cardiac catheterization and higher risk of major bleeding (when catheterization was performed) as compared to non-frail patients, thereby drawing attention to clinical strategies to avoid bleeding imperative in this population. Continue reading →

A study published in JACC Cardiovascular Interventions has shown that among patients with chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI), there was no benefit of IV sodium bicarbonate over IV sodium chloride or of acetylcysteine over placebo for the prevention of contrast-associated acute kidney injury (CAAKI) or intermediate-term adverse outcomes. Continue reading →

A European study has revealed that bullying and violence are common at workplaces and those exposed to such stressors are at higher risk of cardiovascular disease (CVD). Psychosocial cardiovascular risk factors such as depression, subclinical depressive symptoms, vital exhaustion, anger, and personality traits such as hostility have been demonstrated as independent predictors of incident cardiovascular disease (CVD). Additionally, social factors associated with increased CVD risk include low socio-economic status, social isolation, low social support, and stress at work or in family life. Psychological and social factors are strongly inter-related and tend to cluster in certain individuals. In the recent most issue of the European Heart Journal, Xu et al. aimed to provide evidence for yet another psychosocial factor involved in CVD risk. Continue reading →

A randomized clinical trial that was conducted by Paul M Ridker et al. and published in NEJM showed that there was no meaningful association between low dose methotrexate (MTX) administration and a decrease in cardiovascular events. Additionally, MTX usage was associated with adverse effects. Continue reading →

A prospective cohort study that was conducted by Mohamed Farag et al. in European Heart Journal demonstrated that evaluating endogenous fibrinolysis in patients with acute coronary syndrome may help physicians identify high-risk patients developing recurrent cardiovascular events, especially among those treated with dual antiplatelet therapy (DAT) after primary percutaneous coronary intervention (PPCI). Continue reading →

A retrospective cohort study performed by David P. Fisher and his colleagues was published in JAMA, showing that bariatric surgery in obese patients with diabetes was associated with a lower incidence of macrovascular events. Continue reading →

A new meta-analysis published in the Journal of American College of Cardiology showed that sodium glucose co-transporter (SGLT)-2 inhibitors are more effective than glucagon-like peptide (GLP)-1 agonists and dipeptidyl peptidase (DPP)-4 inhibitors in reducing the risk of Heart Failure (HF) hospitalization in patients with type 2 diabetes mellitus. Continue reading →

A study by Mee Kyoung Kim and her colleagues published in Circulation has shown that there is a graded association between the number of high variability parameters like fasting blood glucose and total cholesterol levels, systolic blood pressure, and body mass index and cardiovascular outcomes. They showed that the mentioned variables may be considered as independent predictors of mortality and cardiovascular events. Continue reading →