Coronary Artery Disease in Patients Older than 35 and Eligible for Cardiovascular Secondary Prevention: An Italian Retrospective Observational Analysis of Healthcare Administrative Databases

Background: This study describes patients with coronary artery disease (CAD) who are eligible for secondary prevention and assesses their healthcare consumption and costs from the perspective of the Italian National Health Service (INHS). Methods: From the Fondazione Ricerca e Salute’s database, which collects Italian healthcare administrative data, all patients aged ≥ 35, with ≥1 primary in-hospital CAD diagnosis and/or procedure on the coronary arteries, or with the specific disease exemption code, and who are suitable for long-term secondary prevention treatments, were identified in 2018 and analyzed. Demographics, comorbidities, one-year supplied drugs, hospitalizations, and costs were analyzed. Results: From >3 million inhabitants aged ≥ 35, 46,063 (1.3%) were identified (72.1% males, mean age 70 ± 12; approximately 50% with ≥3 comorbidities). During a one-year follow-up, 96.4% were treated with ≥1 drug for secondary prevention (mainly antiplatelets and lipid lowering agents), 69.4% with ≥1 concomitant cardiovascular drug, and 95.8% with ≥1 concomitant non-cardiovascular therapy. Within one year, 30.6% of patients were hospitalized at least once, mostly due to non-cardiovascular events. Calculated by mean, the INHS paid EUR 6078 per patient. Conclusions: This analysis confirms the relevant burden of CAD for patients with many comorbidities and who are frequently hospitalized, and the burden on the INHS. A multidisciplinary healthcare approach is encouraged to improve patients’ outcomes and reduce costs for the INHS.

Challenges in Cardiovascular Pharmacogenomics Implementation: A viewpoint from the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy

Pharmacogenomics promises to advance cardiovascular therapy, but there remain pragmatic barriers to implementation. These are particularly important to explore within Europe, as there are differences in the populations, availability of resources and expertise, as well as in ethico-legal frameworks. Differences in healthcare delivery across Europe present a challenge, but also opportunities to collaborate on PGx implementation. Clinical work force upskilling is already in progress but will require substantial input. Digital infrastructure and clinical support tools are likely to prove crucial. It is important that widespread implementation serves to narrow rather than widen any existing gaps in health equality between populations. This viewpoint supplements the working group position paper on cardiovascular pharmacogenomics to address these important themes.

A Review on Novel Ligand Targeted Delivery for Cardiovascular Disorder

: Cardiovascular disease covers the various disorders like ischemic heart disease, hyperlipidemia, atherosclerosis, myocardial infarction, and hypertension etc. There are many synthetic drugs are available for the treatment of cardiovascular therapy, but they have several drawbacks like high dosing, toxicity, elevated blood potassium levels, low blood pressure, and gastrointestinal issues etc. To overcome these side effects of synthetic drugs by targeting the drug to the specific cardiac tissue is the best novel method in the cardiovascular therapy. The highest targeting efficacy of Ligand-based therapy with proper mechanisms and improved expandability provides a novel therapeutic strategy in the cardiovascular disease. Ligand therapy is cost-effective compared to cell-based therapy. The surface area of protein has much larger than the orally bioavailable drug. So, the targeting of various less active drug molecules to the particular ligand can be possible. The efficacy of ligands to induce cardiomyocytes proliferation has been ratified and point out the fact that ligand-based approaches are effective for cardiac transformation. Ligands interact with proteins in target cells, which are influenced through the chemical signals. These various receptors possess selective binding of biased ligands and also energizing the intracellular signaling pathway. The ligands can directly stabilize the active receptor conformations by a non-standard connective site. The key function of ligands is functional selectivity, which enhances the therapeutic efficacy and minimizes the side effects of drugs through the interpretation of signal transduction pathways. This review covers the role and effectiveness of novel ligands in the cardiovascular disorders.

The Use of Bioactive Polymers for Intervention and Tissue Engineering: The New Frontier for Cardiovascular Therapy

Coronary heart disease remains one of the leading causes of death in most countries. Healthcare improvements have seen a shift in the presentation of disease with a reducing number of ST-segment elevation myocardial infarctions (STEMIs), largely due to earlier reperfusion strategies such as percutaneous coronary intervention (PCI). Stents have revolutionized the care of these patients, but the long-term effects of these devices have been brought to the fore. The conceptual and technologic evolution of these devices from bare-metal stents led to the creation and wide application of drug-eluting stents; further research introduced the idea of polymer-based resorbable stents. We look at the evolution of stents and the multiple advantages and disadvantages offered by each of the different polymers used to make stents in order to identify what the stent of the future may consist of whilst highlighting properties that are beneficial to the patient alongside the role of the surgeon, the cardiologist, engineers, chemists, and biophysicists in creating the ideal stent.

Consensus statement of the Russian association of gerontologists and geriatricians «Novel coronavirus SARS-COV-2 infection in older adults: specific issues of prevention, diagnostics and management» (key points)

Novel coronavirus SARS-CoV-2 infection (COVID-19) is a dangerous disease for older adults. Preventive measures in this population should involve three groups of measures: 1) prevention of infection; 2) prevention of functional decline and geriatric syndromes, including social support; 3) control of chronic comorbidity. Older adults are common to present with atypical COVID-19 symptoms, and mildness of symptoms (no fever, cough, shortness of breath) does not correspond to the severity of the prognosis. Delirium may be the first manifestation of COVID-19, that is why it is screening should be widely implied. Risk of malnutrition resulting in sarcopenia increases during the hospitalization, especially if mechanical ventilation required, and promotes frailty progression and decreases quality of life after the discharge from the hospital. Geriatric assessment is an important component of the decision making process in the management of older adults. Full version was published as Tkacheva O.N., Kotovskaya Yu.V., Aleksanyan L.A., Milto A.S., Naumov A.V., Strazhesko I.D., Vorobyeva N.M., Dudinskaya E.N., Malaya I.P., Krylov K.Yu., Tyukhmenev E.A., Rozanov A.V., Ostapenko V.S., Manevich T.M., Shchedrina A.Yu., Semenov F.A., Mkhitaryan E.A., Khovasova N.O., Yeruslanova E.A., Kotovskaya N.V., Sharashkina N.V. Novel coronavirus infection SARS-CoV-2 in elderly and senile patients: prevention, diagnosis and treatment. Expert Position Paper of the Russian Association of Gerontology and Geriatrics. Cardiovascular Therapy and Prevention. 2020; 19(3): 2601. DOI: 10.15829/1728-8800-2020-2601

Studi Penggunaan Obat Golongan Beta-Blocker Pada Pasien Rawat Inap Rumah Sakit Ansari Saleh Banjarmasin

Beta-blockers have a role in cardiovascular and non-cardiovascular therapy. Many beta-blockers are now available and in general they are all equally effective. There are, however, differences between them, which may affect choice in treating particular diseases or individual patients. Research related to the profile of beta-blocker drug use in cardiovascular and non-cardiovascular therapy is still limited. This study aims to describe the use of beta-blockers in inpatients at Ansari Saleh Hospital, Banjarmasin. This retrospective descriptive study was conducted from April to May 2019 at the Anshari Saleh Hospital, Banjarmasin. The beta-blocker drugs used were bisoprolol and propranolol which were administered in cardiovascular medications such as angina (3.7%); arrhythmia (3%); Congestive Heart Failure (20%); hypertension (3%); myocardial infarction (54.8%); non hemorrhagic stroke (9.6%); and non-cardiovascular including hepatic cirrhosis (1.5%); hyperthyroidism (4.4%). The bisoprolol dosage used by inpatients at Ansari Saleh Hospital starts from 1.25 to 5 mg per day. Myocardial infarction and non-hemorrhagic stroke patients received bisoprolol dose uptitration. The propranolol dosage is 20-30 mg per day. In cardiovascular patients, bisoprolol is a drug that is often given to patients with comorbids than propranolol. Keywords: Beta-blockers, cardiovascular, non-cardiovascular, therapy

Investigating the Cardiac Effects of Sildenafil loaded Nanoparticles on Heart Failure using the Zebrafish Embryo Model

Background: Cardiovascular diseases (CVDs) are the first cause of death worldwide. Vasolidator agents are used to relax cardiac muscle, but their extremely short half-lifes limit their effectiveness. Sildenafil is such an agent used to relax the blood vessels muscles and increase the blood flow. The conventional drug can lead to serious problems in patients duo to the systematic drug delivery. Use of Nanomedicine potentially can enhance delivery of this agent while reducing the systematic effect of the drug. Aim: The purpose of the research is to examine the effectiveness sildenafil loaded nanoparticles in rescuing heart failure using zebrafish embryo model. Methods: There will be five experimental groups. The zebrafish will be treated with Aristolochic Acid (AA) at 24 hour per fertilization (hpf) to create the heart injury group. The treatment groups will be heart injury followed by a dose of either Sildenafil or Sildenafil loaded nanoparticles at 36 hpf. Two control groups will be the negative control (exposed to egg water) and vehicle control (exposed to the Dimethylsulfoxide (DMSO)).To evaluate the drug effects on embryo, toxicity assessment (Survival rate, tail flicking and hatching rate), cardiotoxicity assessment and gene expression of heart injury marker via RT-PCR will be conducted. Results: Preliminary findings demonstrate, loading Sildenafil to nanoparticles enhances its effectiveness dramatically. The experiments are ongoing to confirm the results. Conclusion: Nanomedicine is a powerful approach to enhance cardiovascular therapy. Vasodilator drugs in particular will benefit from this improvement as demonstrated with our findings