scholarly journals Current Evidence and Future Perspectives on Pharmacological Treatment of Calcific Aortic Valve Stenosis

2020 ◽  
Vol 21 (21) ◽  
pp. 8263 ◽  
Author(s):  
Maristella Donato ◽  
Nicola Ferri ◽  
Maria Giovanna Lupo ◽  
Elisabetta Faggin ◽  
Marcello Rattazzi
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Stenosis ◽  
Current Knowledge ◽  
Present Report ◽  
Lipid Lowering ◽  
Heart Valve Disease ◽  
Current Evidence ◽  
Medical Need ◽  
Health Care Burden ◽  
Lipid Lowering Agents

Calcific aortic valve stenosis (CAVS), the most common heart valve disease, is characterized by the slow progressive fibro-calcific remodeling of the valve leaflets, leading to progressive obstruction to the blood flow. CAVS is an increasing health care burden and the development of an effective medical treatment is a major medical need. To date, no effective pharmacological therapies have proven to halt or delay its progression to the severe symptomatic stage and aortic valve replacement represents the only available option to improve clinical outcomes and to increase survival. In the present report, the current knowledge and latest advances in the medical management of patients with CAVS are summarized, placing emphasis on lipid-lowering agents, vasoactive drugs, and anti-calcific treatments. In addition, novel potential therapeutic targets recently identified and currently under investigation are reported.

scholarly journals Aortic Valve Stenosis

2020 ◽  
Vol 40 (4) ◽  
pp. 885-900 ◽  
Author(s):  
Philip Roger Goody ◽  
Mohammed Rabiul Hosen ◽  
Dominik Christmann ◽  
Sven Thomas Niepmann ◽  
Andreas Zietzer ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Stenosis ◽  
Immune Cell ◽  
Current Knowledge ◽  
Osteoblastic Differentiation ◽  
Heart Valve Disease ◽  
Interventional Treatment ◽  
High Morbidity ◽  
Aortic Valve Calcification ◽  
Valve Calcification

Aortic valve stenosis is the most prevalent heart valve disease worldwide. Although interventional treatment options have rapidly improved in recent years, symptomatic aortic valve stenosis is still associated with high morbidity and mortality. Calcific aortic valve stenosis is characterized by a progressive fibro-calcific remodeling and thickening of the aortic valve cusps, which subsequently leads to valve obstruction. The underlying pathophysiology is complex and involves endothelial dysfunction, immune cell infiltration, myofibroblastic and osteoblastic differentiation, and, subsequently, calcification. To date, no pharmacotherapy has been established to prevent aortic valve calcification. However, novel promising therapeutic targets have been recently identified. This review summarizes the current knowledge of pathomechanisms involved in aortic valve calcification and points out novel treatment strategies.

scholarly journals Targeting Metabolic Dysfunction for the Treatment of Mood Disorders: Review of the Evidence

Life ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 819
Author(s):  
Brett D. M. Jones ◽  
Salman Farooqui ◽  
Stefan Kloiber ◽  
Muhammad Omair Husain ◽  
Benoit H. Mulsant ◽  
...  
Keyword(s):  
Mood Disorders ◽  
Structural Changes ◽  
Current Knowledge ◽  
Lipid Lowering ◽  
Current Evidence ◽  
Metabolic Dysfunction ◽  
Specific Symptom ◽  
Novel Treatments ◽  
Lipid Lowering Agents ◽  
The Impact

Major depressive disorder (MDD) and bipolar disorder (BD) are often chronic with many patients not responding to available treatments. As these mood disorders are frequently associated with metabolic dysfunction, there has been increased interest in novel treatments that would target metabolic pathways. The objectives of this scoping review were to synthesize evidence on the impact on mood symptoms of lipid lowering agents and anti-diabetics drugs, while also reviewing current knowledge on the association between mood disorders and dyslipidemia or hyperglycemia. We propose that metabolic dysfunction is prevalent in both MDD and BD and it may contribute to the development of these disorders through a variety of pathophysiological processes including inflammation, brain structural changes, hormonal alterations, neurotransmitter disruptions, alteration on brain cholesterol, central insulin resistance, and changes in gut microbiota. Current evidence is conflicting on the use of statins, polyunsaturated fatty acids, thiazolidinediones, glucagon-like peptide agonists, metformin, or insulin for the treatment of MDD and BD. Given the paucity of high-quality randomized controlled trials, additional studies are needed before any of these medications can be repurposed in routine clinical practice. Future trials need to enrich patient recruitment, include evaluations of mechanism of action, and explore differential effects on specific symptom domains such as anhedonia, suicidality, and cognition.

scholarly journals Management of patients with combined arterial hypertension and aortic valve stenosis: a consensus document from the Council on Hypertension and Council on Valvular Heart Disease of the European Society of Cardiology, the European Association of Cardiovascular Imaging (EACVI), and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

2020 ◽  
Author(s):  
Costantino Mancusi ◽  
Giovanni de Simone ◽  
Jana Brguljan Hitij ◽  
Isabella Sudano ◽  
Felix Mahfoud ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Arterial Hypertension ◽  
Aortic Valve Stenosis ◽  
European Association ◽  
Antihypertensive Drugs ◽  
Pressure Overload ◽  
Left Ventricular ◽  
Expert Advice ◽  
Current Evidence ◽  
Drug Induced

Abstract Aortic valve stenosis (AS) is the third most common cardiovascular disease. The prevalence of both AS and arterial hypertension increases with age, and the conditions therefore often co-exist. Co-existence of AS and arterial hypertension is associated with higher global left ventricular (LV) pressure overload, more abnormal LV geometry and function, and more adverse cardiovascular outcome. Arterial hypertension may also influence grading of AS, leading to underestimation of the true AS severity. Current guidelines suggest re-assessing patients once arterial hypertension is controlled. Management of arterial hypertension in AS has historically been associated with prudence and concerns, mainly related to potential adverse consequences of drug-induced peripheral vasodilatation combined with reduced stroke volume due to the fixed LV outflow obstruction. Current evidence suggests that patients should be treated with antihypertensive drugs blocking the renin–angiotensin–aldosterone system, adding further drug classes when required, to achieve similar target blood pressure (BP) values as in hypertensive patients without AS. The introduction of transcatheter aortic valve implantation has revolutionized the management of patients with AS, but requires proper BP management during and following valve replacement. The purpose of this document is to review the recent evidence and provide practical expert advice on management of hypertension in patients with AS.

Cholesterol Testing by General Practitioners in Grampian: Patterns and Outcomes

1996 ◽  
Vol 41 (3) ◽  
pp. 78-82 ◽  
Author(s):  
B.H. Smith ◽  
V. Vranjkovic ◽  
S.R. McEwan ◽  
L.D. Ritchie
Keyword(s):  
Current Knowledge ◽  
Clinical Chemistry ◽  
Chemistry Laboratory ◽  
Lipid Lowering ◽  
Biochemical Tests ◽  
Wide Range ◽  
Prescription Rates ◽  
Lipid Lowering Agents ◽  
Cholesterol Testing

Initiation, distribution, concomitants and follow-up of cholesterol testing were studied in Grampian. Data were examined for 4979 patients, representing all patients in one year from those general practices who made exclusive use of the clinical chemistry laboratory for cholesterol testing. A random sample of 215 patients was studied in further detail. Age and sex distribution, results of cholesterol tests and their follow-up, nature and results of associated biochemical tests, test initiation, testing rates by practice, and prescription rates of lipid lowering agents by practice were measured. Cholesterol testing was mostly in line with current knowledge of cardiovascular risk, and associated with further cardiovascular and biochemical assessment. There was a 90-fold range in practice cholesterol testing rates, and a similarly wide range in prescription rates of lipid lowering agents; there was a significant correlation between these. Rates and results of follow-up testing suggests a “rule of halves” for cholesterol testing.

scholarly journals High sensitivity C reactive protein as a prognostic marker in patients with mild to moderate aortic valve stenosis during lipid-lowering treatment: an SEAS substudy

Open Heart ◽  
2015 ◽  
Vol 2 (1) ◽  
pp. e000152 ◽  
Author(s):  
Adam Blyme ◽  
Camilla Asferg ◽  
Olav W Nielsen ◽  
Thomas Sehestedt ◽  
Y Antero Kesäniemi ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Prognostic Marker ◽  
Aortic Valve Stenosis ◽  
High Sensitivity ◽  
Lipid Lowering ◽  
C Reactive Protein ◽  
Reactive Protein

scholarly journals Genetic determinants of lipids and cardiovascular disease outcomes: a wide-angled Mendelian randomization investigation

2019 ◽  
Author(s):  
Elias Allara ◽  
Gabriele Morani ◽  
Paul Carter ◽  
Apostolos Gkatzionis ◽  
Verena Zuber ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Valve ◽  
Aortic Aneurysm ◽  
Aortic Stenosis ◽  
Aortic Valve Stenosis ◽  
Ldl Cholesterol ◽  
Mendelian Randomization ◽  
Cardiovascular Outcomes ◽  
Lipid Lowering ◽  
Abdominal Aortic

ABSTRACTAimsTo systematically investigate causal relationships between circulating lipids and cardiovascular outcomes, using a Mendelian randomization approach.Methods and ResultsIn the primary analysis, we performed two-sample multivariable Mendelian randomization using data from participants of European ancestry. We also conducted univariable analyses using inverse-variance weighted and robust methods, and gene-specific analyses using variants that can be considered as proxies for specific lipid-lowering medications. We obtained associations with lipid fractions from the Global Lipids Genetics Consortium, a meta-analysis of 188,577 participants, and genetic associations with cardiovascular outcomes from 367,703 participants in UK Biobank.For LDL-cholesterol, in addition to the expected positive associations with coronary artery disease (CAD) risk (odds ratio per 1 standard deviation increase [OR], 1.45; 95% confidence interval [95%CI] 1.35-1.57) and other atheromatous outcomes (ischemic cerebrovascular disease and peripheral vascular disease), we found independent associations of genetically-predicted LDL-cholesterol with abdominal aortic aneurysm (OR 1.75; 95%CI 1.40-2.17), and aortic valve stenosis (OR 1.46; 95%CI 1.25-1.70). Genetically-predicted triglyceride levels were positively associated with CAD (OR 1.25; 95%CI 1.12-1.40), aortic valve stenosis (OR 1.29; 95%CI 1.04-1.61), and hypertension (OR 1.17; 95%CI 1.07-1.27), but inversely associated with venous thromboembolism (OR 0.79; 95%CI 0.67-0.93). The positive associations of genetically-predicted LDL-cholesterol and triglycerides with heart failure and aortic stenosis appeared to be mediated by CAD.ConclusionLowering LDL-cholesterol is likely to prevent abdominal aortic aneurysm and aortic stenosis, in addition to CAD and other atheromatous cardiovascular outcomes. Lowering triglycerides is likely to prevent CAD and aortic valve stenosis, but may increase risk of thromboembolism.

scholarly journals Hypocholesterolemia and Statins in Multiple Myeloma

2021 ◽  
pp. 8-10
Author(s):  
Irfan Yavaşoğlu ◽  
Atakan Turgutkaya
Keyword(s):  
Multiple Myeloma ◽  
Current Knowledge ◽  
Lipid Lowering ◽  
Current Therapy ◽  
Beneficial Effects ◽  
Plasma Cell Disorder ◽  
Lipid Lowering Agents ◽  
Low Cholesterol ◽  
Beneficial Approach ◽  
Cell Disorder

Statins are lipid-lowering agents. They also have immunomodulatory, anti-inflammatory, anti-angiogenic, and anti-proliferative functions. In this context, they are demonstrated to have beneficial effects on mortality in several malignancies including esophageal, breast, lung, liver, pancreatic, endometrial, and colorectal cancers. Multiple myeloma is considered as an incurable plasma cell disorder with current therapy; however due to the current knowledge about the correlation between cholesterol-lowering agents and myeloma; it’s suggested to have lower mortality rates for patients using statins.  Patients with multiple myeloma usually have a low cholesterol level which is often underestimated by clinicians. Hereby we aimed to summarize the myeloma-hypocholesterolemia relationship and emphasize the importance of statins as an inexpensive and beneficial approach for these patients.

scholarly journals Genetic Determinants of Lipids and Cardiovascular Disease Outcomes

2019 ◽  
Vol 12 (12) ◽  
Author(s):  
Elias Allara ◽  
Gabriele Morani ◽  
Paul Carter ◽  
Apostolos Gkatzionis ◽  
Verena Zuber ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Valve ◽  
Aortic Aneurysm ◽  
Aortic Valve Stenosis ◽  
Ldl Cholesterol ◽  
Mendelian Randomization ◽  
Cardiovascular Outcomes ◽  
Lipid Lowering ◽  
Abdominal Aortic ◽  
Cad Risk

Background: Evidence from randomized trials has shown that therapies that lower LDL (low-density lipoprotein)-cholesterol and triglycerides reduce coronary artery disease (CAD) risk. However, there is still uncertainty about their effects on other cardiovascular outcomes. We therefore performed a systematic investigation of causal relationships between circulating lipids and cardiovascular outcomes using a Mendelian randomization approach. Methods: In the primary analysis, we performed 2-sample multivariable Mendelian randomization using data from participants of European ancestry. We also conducted univariable analyses using inverse-variance weighted and robust methods, and gene-specific analyses using variants that can be considered as proxies for specific lipid-lowering medications. We obtained associations with lipid fractions from the Global Lipids Genetics Consortium, a meta-analysis of 188 577 participants, and genetic associations with cardiovascular outcomes from 367 703 participants in UK Biobank. Results: For LDL-cholesterol, in addition to the expected positive associations with CAD risk (odds ratio [OR] per 1 SD increase, 1.45 [95% CI, 1.35–1.57]) and other atheromatous outcomes (ischemic cerebrovascular disease and peripheral vascular disease), we found independent associations of genetically predicted LDL-cholesterol with abdominal aortic aneurysm (OR, 1.75 [95% CI, 1.40–2.17]) and aortic valve stenosis (OR, 1.46 [95% CI, 1.25–1.70]). Genetically predicted triglyceride levels were positively associated with CAD (OR, 1.25 [95% CI, 1.12–1.40]), aortic valve stenosis (OR, 1.29 [95% CI, 1.04–1.61]), and hypertension (OR, 1.17 [95% CI, 1.07–1.27]), but inversely associated with venous thromboembolism (OR, 0.79 [95% CI, 0.67–0.93]) and hemorrhagic stroke (OR, 0.78 [95% CI, 0.62–0.98]). We also found positive associations of genetically predicted LDL-cholesterol and triglycerides with heart failure that appeared to be mediated by CAD. Conclusions: Lowering LDL-cholesterol is likely to prevent abdominal aortic aneurysm and aortic stenosis, in addition to CAD and other atheromatous cardiovascular outcomes. Lowering triglycerides is likely to prevent CAD and aortic valve stenosis but may increase thromboembolic risk.

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