scholarly journals The Role of Haptoglobin Polymorphism in Cardiovascular Disease in the Setting of Diabetes

2020 ◽  
Vol 22 (1) ◽  
pp. 287
Author(s):  
Shmuel Somer ◽  
Andrew P. Levy
Keyword(s):  
Cardiovascular Disease ◽  
Glycemic Control ◽  
Diabetes Complications ◽  
Antioxidant Vitamin ◽  
Atherosclerotic Cardiovascular Disease ◽  
Proper Patient Selection ◽  
Strict Glycemic Control ◽  
High Doses ◽  
Haptoglobin Polymorphism

Atherosclerotic cardiovascular disease (CVD) is the major cause of morbidity and mortality in individuals with diabetes mellitus (DM). Preclinical models have suggested that excessive oxidative stress and hyperglycemia are directly responsible for this pathological association. However, numerous clinical trials involving the administration of high doses of the antioxidant vitamin E or attempts at strict glycemic control have failed to show a significant reduction of CVD in DM patients. We describe here a possible explanation for the failure of these trials, that being their lack of proper patient selection. The haptoglobin (Hp) genotype is a major determinant of the risk of CVD in the setting of DM. Treatment of individuals with the high-risk Hp genotype with antioxidants or aggressive glycemic control has shown benefit in several small studies. These studies suggest a precision medicine-based approach to preventing diabetes complications. This approach would have a profound effect on the costs of diabetes care and could dramatically reduce morbidity from diabetes.

Role of coronary artery calcium score in the primary prevention of cardiovascular disease

BMJ ◽  
2021 ◽  
pp. n776
Author(s):  
Khurram Nasir ◽  
Miguel Cainzos-Achirica
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Artery ◽  
Primary Prevention ◽  
Coronary Artery Calcium ◽  
Calcium Score ◽  
Coronary Plaque ◽  
Preventive Therapy ◽  
Atherosclerotic Cardiovascular Disease ◽  
International Studies

Abstract First developed in 1990, the Agatston coronary artery calcium (CAC) score is an international guideline-endorsed decision aid for further risk assessment and personalized management in the primary prevention of atherosclerotic cardiovascular disease. This review discusses key international studies that have informed this 30 year journey, from an initial coronary plaque screening paradigm to its current role informing personalized shared decision making. Special attention is paid to the prognostic value of a CAC score of zero (the so called “power of zero”), which, in a context of low estimated risk thresholds for the consideration of preventive therapy with statins in current guidelines, may be used to de-risk individuals and thereby inform the safe delay or avoidance of certain preventive therapies. We also evaluate current recommendations for CAC scoring in clinical practice guidelines around the world, and past and prevailing barriers for its use in routine patient care. Finally, we discuss emerging approaches in this field, with a focus on the potential role of CAC informing not only the personalized allocation of statins and aspirin in the general population, but also of other risk-reduction therapies in special populations, such as individuals with diabetes and people with severe hypercholesterolemia.

scholarly journals Comparative efficacy between atorvastatin and rosuvastatin in the prevention of cardiovascular disease recurrence

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Sofía Perez-Calahorra ◽  
Martin Laclaustra ◽  
Victoria Marco-Benedi ◽  
Xavier Pinto ◽  
Rosa M. Sanchez-Hernandez ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Randomized Clinical Trials ◽  
Disease Recurrence ◽  
National Study ◽  
Atherosclerotic Cardiovascular Disease ◽  
Start Time ◽  
Treatment Groups ◽  
High Doses ◽  
Event Rates

Abstract Background There is no randomized clinical trials with recurrence of atherosclerotic cardiovascular disease (ASCVD) as a major outcome with rosuvastatin. In order to analyze potential differences in the clinical response to atorvastatin and rosuvastatin in secondary ASCVD prevention, we have analyzed the clinical evolution of those subjects of the Dyslipemia Registry of the Spanish Society of Arteriosclerosis (SEA) who at the time of inclusion in the Registry had already suffered an ASCVD. Methods This observational, retrospective, multicenter, national study was designed to determine potential differences between the use of atorvastatin and rosuvastatin in the ASCVD recurrence. Three different follow-up start-times were performed: time of inclusion in the registry; time of first event if this occurred after 2005, and time of first event without date restriction. Results Baseline characteristics were similar between treatment groups. Among atorvastatin or rosuvastatin users, 89 recurrences of ASCVD were recorded (21.9%), of which 85.4% were coronary. At the inclusion of the subject in the registry, 345 participants had not suffered a recurrence yet. These 345 subjects accumulated 1050 person-years in a mean follow-up of 3 years. Event rates were 2.73 (95% CI: 1.63, 4.25) cases/100 person-years and 2.34 (95% CI: 1.17, 4.10) cases/100 person-years in the atorvastatin and rosuvastatin groups, respectively. There were no statistically significant differences between the two groups independently of the follow-up start-time. Conclusions This study does not find differences between high doses of rosuvastatin and atorvastatin in the recurrence of ASCVD, and supports their use as clinically equivalent in secondary prevention of ASCVD.

Diabetes and cardiovascular disease: The role of glycemic control

2009 ◽  
Vol 9 (1) ◽  
pp. 65-72 ◽  
Author(s):  
Alice Y. Y. Cheng ◽  
Lawrence A. Leiter
Keyword(s):  
Cardiovascular Disease ◽  
Glycemic Control

scholarly journals Lipoprotein(a): An update on its role in human health and disease

2021 ◽  
Vol 12 (3) ◽  
pp. 92-102
Author(s):  
Amalia-Despoina Koutsogianni ◽  
Evangelos Liberopoulos ◽  
Alexandros D. Tselepis
Keyword(s):  
Cardiovascular Disease ◽  
Atherosclerotic Cardiovascular Disease ◽  
Main Question ◽  
Lipoprotein A ◽  
The Past ◽  
Causal Risk Factor ◽  
Potential Clinical Benefit ◽  
Pathophysiological Role ◽  
Health And Disease

Over the past few years, there has been an undiminished interest on lipoprotein(a) [Lp(a)]. High Lp(a) levels have been proposed as an independent causal risk factor for atherosclerotic cardiovascular disease (CVD). The main question that remains to be answered, however, is the potential clinical benefit of Lp(a) reduction. This will contribute to the enrichment of our knowledge on the exact pathophysiological role of this lipoprotein. This narrative review aims to summarize currently available data on the structure, metabolism, and pathogenicity of Lp(a).

Chronic Inflammatory Diseases and Atherosclerotic Cardiovascular Disease: Innocent Bystanders or Partners in Crime?

2018 ◽  
Vol 24 (3) ◽  
pp. 281-290 ◽  
Author(s):  
Peter Riis Hansen
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Inflammatory Diseases ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Chronic Inflammatory Diseases ◽  
Increased Risk ◽  
Shared Risk

Inflammation plays a significant role in atherosclerosis and cardiovascular disease (CVD). Patients with chronic inflammatory diseases are at increased risk of CVD, but it is debated whether this association is causal or dependent on shared risk factors, other exposures, genes, and/or inflammatory pathways. The current review summarizes epidemiological, clinical, and experimental data supporting the role of shared inflammatory mechanisms between atherosclerotic CVD and rheumatoid arthritis, psoriasis, inflammatory bowel disease, and periodontitis, respectively, and provides insights to future prospects in this area of research. Awareness of the role of inflammation in CVD in patients with chronic inflammatory diseases and the potential for anti-inflammatory therapy, e.g., with tumor necrosis factor-α inhibitors, to also reduce atherosclerotic CVD has evolved into guideline- based recommendations. These include regular CVD risk assessment, aggressive treatment of traditional CVD risk factors, and recognition of reduced CVD as an added benefit of strict inflammatory disease control. At present, chronic inflammatory diseases would appear to qualify as partners in crime and not merely innocent bystanders to CVD. However, definite incremental contributions of inflammation versus effects of the complex interplay with other CVD risk factors may never be fully elucidated and for the foreseeable future, inflammation is posed to maintain its current position as both a marker and a maker of CVD, with clinical utility both for identification of patient at risk of CVD and as target for therapy to reduce CVD.

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