scholarly journals Features of Antithrombotic Therapy in Patients with Multifocal Arterial Disease

Kardiologiia ◽  
2021 ◽  
Vol 61 (3) ◽  
pp. 87-95
Author(s):  
V. G. Grachev ◽  
S. S. Vedenskaya ◽  
O. G. Smolenskaya
Keyword(s):  
Heart Disease ◽  
Cardiovascular Diseases ◽  
Antithrombotic Therapy ◽  
Arterial Disease ◽  
Arterial Injury ◽  
Cardiovascular Complications ◽  
Peripheral Artery ◽  
Increased Risk ◽  
Atherosclerotic Cardiovascular Diseases ◽  
Peripheral Artery Diseases

Multifocal arterial injury is common in patients with atherosclerotic cardiovascular diseases and is associated with increased risk of cardiovascular complications and death. Administration of more intensive antithrombotic therapy, particularly combinations of acetylsalicylic acid and a “vascular” dose of rivaroxaban, in patients with multifocal arterial injury is characterized by a beneficial ratio of efficiency and safety due to a pronounced decrease in the risk of cardiovascular complications. Detection of peripheral artery diseases in patients with ischemic heart disease and atherosclerotic cerebrovascular pathology makes it possible to improve the risk stratification, optimize the diagnostic tactics and clarify indications for more intensive antithrombotic therapy.

scholarly journals Combined Antithrombotic Therapy in Patients with a Stable Atherosclerotic Cardiovascular Diseases: What Direction did COMPASS Show?

Kardiologiia ◽  
2020 ◽  
Vol 60 (2) ◽  
pp. 131-141
Author(s):  
S. G. Kanorskii
Keyword(s):  
Secondary Prevention ◽  
Antithrombotic Therapy ◽  
Cardiovascular Complications ◽  
Practical Application ◽  
Peripheral Artery ◽  
Risk Of Death ◽  
Increased Risk ◽  
Artery Disease ◽  
Additional Influence ◽  
Atherosclerotic Cardiovascular Diseases

In patients with stable ischemic heart disease (IHD) and/or peripheral artery disease (PAD), current secondary prevention, including the antiplatelet monotherapy, is associated with a significant residual risk of recurrent cardiovascular complications (CVC). Practical application of results from many modern studies evaluating the effect of secondary prevention of atherothrombosis is complicated. An additional influence on coagulation may play a key role in prevention of atherothrombosis. In the COMPASS study, adding rivaroxaban 2.5 mg, b.i.d., to the acetylsalicylic acid (ASA) monotherapy significantly reduced the risk of death from cardiovascular complications, myocardial infarction or stroke, or all-cause death compared to the ASA monotherapy, in patients with IHD or PAD. The combination antithrombotic therapy was associated with an increased risk of major, but not fatal, or intracranial bleeding. In addition, PAD patients had a reduced risk of severe ischemic lower limb complications, including amputations. According to the subgroup analysis in the COMPASS study, supplementing ASA with rivaroxaban 2.5 mg, b.i.d., may appear most beneficial for patients with stable atherosclerotic disease and with a high risk of severe CVC without causing an increased risk of bleeding.

Cardiovascular complications of novel multiple myeloma treatments

ESC CardioMed ◽  
2018 ◽  
pp. 1176-1178
Author(s):  
Daniel J. Lenihan
Keyword(s):  
Heart Failure ◽  
Multiple Myeloma ◽  
Heart Disease ◽  
Early Detection ◽  
Antithrombotic Therapy ◽  
Cardiovascular Events ◽  
Cardiovascular Complications ◽  
Novel Therapies ◽  
Cardiac Events ◽  
Increased Risk

The treatment of multiple myeloma has dramatically changed in the last decade. Novel therapies have had an important impact on the overall outcome for patients but are associated with important cardiovascular events. There is certainly concern about the development of heart failure but also treatment-induced hypertension and a known increased risk of thrombotic events, including ischaemic heart disease. The management of these cardiac events includes prevention, early detection, and optimal treatment with antithrombotic therapy as well as medical therapy for heart failure.

scholarly journals Fibrinogen and Atherosclerotic Cardiovascular Diseases—Review of the Literature and Clinical Studies

2021 ◽  
Vol 23 (1) ◽  
pp. 193
Author(s):  
Stanisław Surma ◽  
Maciej Banach
Keyword(s):  
Cardiovascular Diseases ◽  
Premature Death ◽  
Arterial Disease ◽  
Current Data ◽  
Point Of View ◽  
Fibrinogen Concentration ◽  
Stage Of Development ◽  
Increased Risk ◽  
Peripheral Arterial ◽  
Atherosclerotic Cardiovascular Diseases

Atherosclerotic cardiovascular diseases (ASCVD), including coronary artery disease, cerebrovascular disease, and peripheral arterial disease, represent a significant cause of premature death worldwide. Biomarkers, the evaluation of which would allow the detection of ASCVD at the earliest stage of development, are intensively sought. Moreover, from a clinical point of view, a valuable biomarker should also enable the assessment of the patient’s prognosis. It has been known for many years that the concentration of fibrinogen in plasma increases, inter alia, in patients with ASCVD. On the one hand, an increased plasma fibrinogen concentration may be the cause of the development of atherosclerotic lesions (increased risk of atherothrombosis); on the other hand, it may be a biomarker of ASCVD, as it is an acute phase protein. In addition, a number of genetic polymorphisms and post-translational modifications of fibrinogen were demonstrated that may contribute to the risk of ASCVD. This review summarizes the current data on the importance of fibrinogen as a biomarker of ASCVD, and also presents the relationship between molecular modifications of this protein in the context of ASCVD.

scholarly journals Colchicine in patients with coronary heart disease: new possibilities in reduction of the residual inflammatory risk

2021 ◽  
Vol 6 ◽  
pp. 12-21
Author(s):  
E.S. Eniseeva ◽  
◽  
K.V. Protasov ◽  
Keyword(s):  
Coronary Heart Disease ◽  
Acute Coronary Syndrome ◽  
Heart Disease ◽  
Clinical Practice ◽  
Cardiovascular Diseases ◽  
Cardiovascular Complications ◽  
Coronary Syndrome ◽  
Anti Inflammatory ◽  
Atherosclerotic Cardiovascular Diseases ◽  
Colchicine Application

Inflammation plays an important role in atherosclerotic plaque destabilisation and the development of cardiovascular complications. Suppression of its activity in order to reduce residual inflammatory risk in atherosclerotic cardiovascular diseases remains an urgent and unresolved problem to the date. Over the recent years, evidence of the effectiveness of such an approach in secondary prevention of coronary heart disease has been obtained. The purpose of this review was to analyse modern literature on the effect of anti-inflammatory therapy with colchicine on the prognosis of patients with coronary heart disease. The review was carried out using the search for papers published in the PubMed and ClinicalTrials databases within the period from 2007 to 2021. The search was carried out using the keywords «colchicine», «inflammation», «atherosclerosis», «coronary heart disease» and «acute coronary syndrome». The anti-inflammatory and antiatherogenic effects of colchicine are discussed. The paper presents results of studies devoted to the use of colchicine in chronic and acute coronary syndrome, including the key ones LoDoCo2 (2020) and COLCOT (2019) which provided evidence of the effect of the drug on the disease outcome. The issues of safety and prospects of colchicine application in clinical practice for reduction of the residual inflammatory risk in patients with coronary heart disease are addressed.

Complex antithrombotic therapy and bleeding risk in patients with peripheral arterial disease

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Tseng ◽  
S Bhatt ◽  
M Girardo ◽  
D Liedl ◽  
P Wennberg ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Triple Therapy ◽  
Major Bleeding ◽  
Antithrombotic Therapy ◽  
Oral Anticoagulants ◽  
Bleeding Risk ◽  
Arterial Disease ◽  
Risk Of Bleeding ◽  
Increased Risk ◽  
Peripheral Arterial

Abstract Introduction Antiplatelet therapy is the cornerstone of treatment for many atherosclerotic vascular pathologies including peripheral arterial disease (PAD). Patients with PAD often have comorbid conditions that require complex antithrombotic therapy, i.e. combined antiplatelet and anticoagulation. Methods All adult patients undergoing ankle brachial index (ABI) measurements were included in the study. ABI values between 1.00 and 1.40 were considered normal, and values below 1.00 or above 1.40 were considered PAD. Demographic, comorbidity and outcome data were obtained using diagnostic codes from the electronic health record. Three medication classes were analyzed: aspirin, non-aspirin oral antiplatelets (e.g. P2Y12 inhibitors) and oral anticoagulants (warfarin and the direct oral anticoagulants). Medication use was determined for patients who had been on a medication for at least one year. Cox proportional hazard analysis for the time to first bleeding event was analyzed. Bleeding was defined as any bleeding requiring medical evaluation (including clinically-relevant non-major bleeding and major bleeding). Results In all, 40,144 patients were included in the analysis (mean age 66±15, 43% female). Patients with PAD were more likely to be on double therapy (one antiplatelet with anticoagulation) (28% vs 19%) and triple therapy (dual antiplatelet with anticoagulation) (10% vs 4%). Unadjusted hazard ratios for bleeding risk showed increased risk of bleeding for patients with PAD (1.18, 95% confidence interval [CI]: 1.08–1.29), though the association is no longer present after adjustment for antithrombotic therapy. Adjusting for age, sex and PAD class, compared to no antithrombotic therapy, there was increased risk of bleeding for monotherapy (1.91, 95% CI: 1.61–2.26), double therapy (3.40, 95% CI: 2.89–4.00) and triple therapy (5.00, 95% CI: 4.21–5.96). Among medications, aspirin and anticoagulant use was independently associated with the greatest increase in risk of bleeding. Conclusion Patients in PAD are at increased risk of bleeding secondary to antithrombotic therapy. Complex antithrombotic therapy with double or triple therapy confer additional bleeding risk, particularly regimens containing aspirin and oral anticoagulants. Funding Acknowledgement Type of funding source: None

scholarly journals Association between cholesterol efflux capacity and peripheral artery disease in coronary heart disease patients with and without type 2 diabetes: from the CORDIOPREV study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Elena M. Yubero-Serrano ◽  
Juan F. Alcalá-Diaz ◽  
Francisco M. Gutierrez-Mariscal ◽  
Antonio P. Arenas-de Larriva ◽  
Patricia J. Peña-Orihuela ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Secondary Prevention ◽  
Peripheral Artery Disease ◽  
Cholesterol Efflux ◽  
Newly Diagnosed ◽  
Peripheral Artery ◽  
Cholesterol Efflux Capacity ◽  
Increased Risk ◽  
Artery Disease

Abstract Background Peripheral artery disease (PAD) is recognized as a significant predictor of mortality and adverse cardiovascular outcomes in patients with coronary heart disease (CHD). In fact, coexisting PAD and CHD is strongly associated with a greater coronary event recurrence compared with either one of them alone. High-density lipoprotein (HDL)-mediated cholesterol efflux capacity (CEC) is found to be inversely associated with an increased risk of incident CHD. However, this association is not established in patients with PAD in the context of secondary prevention. In this sense, our main aim was to evaluate the association between CEC and PAD in patients with CHD and whether the concurrent presence of PAD and T2DM influences this association. Methods CHD patients (n = 1002) from the CORDIOPREV study were classified according to the presence or absence of PAD (ankle-brachial index, ABI ≤ 0.9 and ABI > 0.9 and < 1.4, respectively) and T2DM status. CEC was quantified by incubation of cholesterol-loaded THP-1 cells with the participants' apoB-depleted plasma was performed. Results The presence of PAD determined low CEC in non-T2DM and newly-diagnosed T2DM patients. Coexisting PAD and newly-diagnosed T2DM provided and additive effect providing an impaired CEC compared to non-T2DM patients with PAD. In established T2DM patients, the presence of PAD did not determine differences in CEC, compared to those without PAD, which may be restored by glucose-lowering treatment. Conclusions Our findings suggest an inverse relationship between CEC and PAD in CHD patients. These results support the importance of identifying underlying mechanisms of PAD, in the context of secondary prevention, that provide potential therapeutic targets, that is the case of CEC, and establishing strategies to prevent or reduce the high risk of cardiovascular events of these patients. Trial registrationhttps://clinicaltrials.gov/ct2/show/NCT00924937. Unique Identifier: NCT00924937

Antithrombotic Therapy in Patients Undergoing Transcatheter Interventions for Structural Heart Disease

Circulation ◽  
2021 ◽  
Vol 144 (16) ◽  
pp. 1323-1343
Author(s):  
Paolo Calabrò ◽  
Felice Gragnano ◽  
Giampaolo Niccoli ◽  
Rossella Marcucci ◽  
Marco Zimarino ◽  
...  
Keyword(s):  
Heart Disease ◽  
Antithrombotic Therapy ◽  
Structural Heart Disease ◽  
Current Evidence ◽  
Bleeding Complications ◽  
Tricuspid Valve Repair ◽  
Left Atrial Appendage Occlusion ◽  
Increased Risk ◽  
Valve Implantation ◽  
Transcatheter Interventions

Contemporary evidence supports device-based transcatheter interventions for the management of patients with structural heart disease. These procedures, which include aortic valve implantation, mitral or tricuspid valve repair/implantation, left atrial appendage occlusion, and patent foramen ovale closure, profoundly differ with respect to clinical indications and procedural aspects. Yet, patients undergoing transcatheter cardiac interventions require antithrombotic therapy before, during, or after the procedure to prevent thromboembolic events. However, these therapies are associated with an increased risk of bleeding complications. To date, challenges and controversies exist regarding balancing the risk of thrombotic and bleeding complications in these patients such that the optimal antithrombotic regimens to adopt in each specific procedure is still unclear. In this review, we summarize current evidence on antithrombotic therapies for device-based transcatheter interventions targeting structural heart disease and emphasize the importance of a tailored approach in these patients.

scholarly journals Cardiovascular Vulnerability to COVID-19 in Cancer Survivors

2020 ◽  
Author(s):  
Beshay Zordoky
Keyword(s):  
Cardiovascular Diseases ◽  
Cancer Survivors ◽  
Cancer Treatment ◽  
Myocardial Damage ◽  
Cardiovascular Complications ◽  
World Health ◽  
Global Pandemic ◽  
Increased Risk ◽  
Health Organization ◽  
Shared Risk

Coronavirus disease 2019 (COVID-19) has been declared a global pandemic by the World Health Organization on March 11, 2020. COVID-19 is caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-Cov-2). Although primarily a respiratory disease, cardiovascular complications of COVID-19 have been increasingly recognized. In addition, higher fatality has been reported in COVID-19 patients with underlying cardiovascular diseases. Cancer survivors have a considerably increased risk for premature cardiovascular diseases, mainly due to cardiotoxic cancer treatments. Therefore, it is foreseeable that cancer survivors will be more vulnerable to cardiovascular complications caused by COVID-19. In this review, three scenarios for increased cardiovascular complications of COVID-19 in cancer patients are proposed. In the first scenario, cardiotoxic cancer treatment and COVID-19 synergize to exacerbate direct myocardial damage. In the second scenario, cardiotoxic cancer treatment leads to a reduced cardiac reserve in cancer survivors, making them more vulnerable to COVID-19 in a “two-hit” model. The third scenario suggests that several shared risk factors may aggravate cardiovascular complications caused by both cancer treatment and COVID-19. Taken together, cancer survivors may be more vulnerable to cardiovascular complications when challenged by the COVID-19, and special cardiovascular care should be given to these patients.

Cardiovascular complications in end-stage renal disease patients

2015 ◽  
Author(s):  
Gerard M. London
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Sudden Death ◽  
End Stage Renal Disease ◽  
Ventricular Hypertrophy ◽  
Arterial Disease ◽  
Cardiovascular Complications ◽  
Left Ventricular ◽  
Stage Renal Disease ◽  
End Stage

Cardiovascular complications are the predominant cause of death in patients with end-stage renal disease (ESRD). The high incidence of cardiovascular complications results from pathology present before ESRD (generalized atherosclerosis, diabetes, hypertension) and an additive effect of multiple factors including haemodynamic overload and metabolic and endocrine abnormalities more or less specific to uraemia or its treatment modalities. These disorders are usually associated and can exacerbate each other. While ischaemic heart disease is a frequent cause of cardiac death, heart failure and sudden death are the most frequent causes of death in ESRD. Cardiomyopathy of overload with development of left ventricular hypertrophy and fibrosis are the most characteristic alterations and major determinants of prognosis. Left ventricular hypertrophy may result in systolic and/or diastolic dysfunction and is a risk factor for arrhythmias, sudden death, heart failure, and myocardial ischaemia. Arterial disease, whether due to atherosclerosis or arteriosclerosis (or both), represents a major contributory factor to the cardiovascular complications. Arterial disease may result in ischaemic complications (ischaemic heart disease, peripheral artery diseases) or arterial stiffening with direct consequences on left ventricular afterload, decreased coronary perfusion, and microvascular abnormalities (inward remodelling and microvessel rarefaction).

Valvular heart disease and calcification in CKD: more common than appreciated

2019 ◽  
Vol 35 (12) ◽  
pp. 2046-2053 ◽  
Author(s):  
Pablo Ureña-Torres ◽  
Luis D’Marco ◽  
Paolo Raggi ◽  
Xavier García–Moll ◽  
Vincent Brandenburg ◽  
...  
Keyword(s):  
Heart Disease ◽  
Vascular Calcification ◽  
Heart Valves ◽  
Current Knowledge ◽  
Arterial Disease ◽  
Therapeutic Implications ◽  
Risk Of Death ◽  
Age Related ◽  
Increased Risk ◽  
Clinical Consequences

Abstract Ischaemic heart disease, sudden cardiac death and arrhythmias, heart failure, stroke and peripheral arterial disease make up &gt;50% of the causes of death in advanced chronic kidney disease (CKD). Calcification of the vascular tree and heart valves is partially related to these complications and has received growing attention in the literature. However, the main focus of research has been on the pathophysiology and consequences of vascular calcification, with less attention being paid to valvular calcification (VC) and its impact on the survival of CKD patients. Although VC has long been seen as an age-related degenerative disorder with minimal functional impact, several studies proved that it carries an increased risk of death and clinical consequences different from those of vascular calcification. In dialysis patients, the annual incidence of aortic valve calcification is nearly 3.3% and the reported prevalence of aortic and mitral VC varies between 25% and 59%. Moreover, calcification of both valves occurs 10–20 years earlier in CKD patients compared with the general population. Therefore, the purpose of this review is to summarize the current knowledge on the pathophysiology and relevance of VC in CKD patients, and to highlight specific clinical consequences and potential therapeutic implications.

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