Annals of medicine
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Multicenter Study Observational Study
Prognostic value of myocardial injury-related findings onresting electrocardiography for cardiovascular risk in the asymptomatic general population: The 12-year follow-up report from the Ansan-Ansung cohort.
Background: We investigated the predictive values of myocardial injury-related findings (MIFs) including ST-T wave abnormalities (STA) and pathologic Q waves (PQ) in electrocardiography for long-term cardiovascular outcomes in an asymptomatic general population. Methods: We observed 8444 subjects without cardiovascular diseases and related symptoms biennially over a 12-year period. Major cardiovascular adverse events (MACEs) were defined as a composite of cardiovascular death, myocardial infarction, coronary artery disease and stroke. ⋯ However, the addition of MIFs to the conventional risk estimators was of limited value in the prediction of MACEs. Key MessagesMyocardial injury-related findings including ST-T wave abnormalities and anterior pathologic Q waves in resting electrocardiography predict long-term cardiovascular outcomes in an asymptomatic low-risk population. However, ST-T wave abnormalities and anterior pathologic Q waves add only limited value to conventional cardiovascular risk estimators in the prediction of cardiovascular outcomes.
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Review
Lipoprotein(a) in atherosclerosis: from pathophysiology to clinical relevance and treatment options.
Lipoprotein(a) (Lp(a)) was discovered more than 50 years ago, and a decade later, it was recognized as a risk factor for coronary artery disease. However, it has gained importance only in the past 10 years, with emergence of drugs that can effectively decrease its levels. Lp(a) is a low-density lipoprotein (LDL) with an added apolipoprotein(a) attached to the apolipoprotein B component via a disulphide bond. ⋯ KEY MESSAGESLipoprotein(a) is an important risk factor in patients with cardiovascular diseases. Lipoprotein(a) has many functions, which include proatherosclerotic, prothrombotic and pro-inflammatory roles. Treatment options to lower lipoprotein(a) levels are currently scarce, but new drugs are on the horizon.
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Heart failure (HF) is a major cause of morbidity and mortality worldwide, and the burden of HF continues to rise. There has been an interest in sodium-glucose co-transporter-2 (SGLT2) inhibitors for their role in reducing HF hospitalizations in pivotal trials. Since these agents were approved by the Food and Drug Administration for the management of diabetes mellitus, multiple small trials and analyses have tried to explain the underlying beneficial mechanisms in HF. ⋯ KEY MESSAGESSGLT2 inhibitors are associated with a reduction in HF hospitalizations in both diabetics and non-diabetics. The beneficial role of SGLT2 inhibitors in reducing HF hospitalization is observed among participants with established cardiovascular disease/HF and at-risk population. SGLT2 inhibitors pose an important role in renal protection, another mechanism by which these medications can be helpful in HF patients.
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Coronavirus disease 2019 (COVID-19), caused by novel enveloped single stranded RNA coronavirus (SARS-CoV-2), is responsible for an ongoing global pandemic. While other countries deployed widespread testing as an early mitigation strategy, the U. S. experienced delays in development and deployment of organism identification assays. ⋯ Key messagesDelayed testing deployment has led to uncertainty surrounding overall disease burden and community spread, severely hampering public health containment and healthcare system preparation efforts. A multi-tiered testing strategy incorporating rapid, host immune point-of-care tests can be used now and for future pandemic planning by effectively identifying patients at risk of disease thereby facilitating quarantine earlier in the progression of the outbreak during the weeks and months it can take for pathogen specific confirmatory tests to be developed, validated and manufactured in sufficient quantities. The ability to triage patients at the point of care and support the guidance of medical and therapeutic decisions, for viral isolation or confirmatory testing or for appropriate treatment of COVID-19 and/or bacterial infections, is a critical component to our national pandemic response and there is an urgent need to implement the proposed strategy to combat the current outbreak.
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In recent years a revival of interest has emerged in the health benefits of intermittent fasting and long-term fasting, as well as of other related nutritional strategies. In addition to meal size and composition a new focus on time and frequency of meals has gained attention. The present review will investigate the effects of the main forms of fasting, activating the metabolic switch from glucose to fat and ketones (G-to-K), starting 12-16 h after cessation or strong reduction of food intake. ⋯ Application of fasting patterns increases healthy life span and defences against oxidative and metabolic stresses. Today's strategies for the use of therapeutic fasting are based on different protocols, generally relying on intermittent fasting, of different duration and calorie intake. Long-term fasting, with durations between 5 and 21 days can be successfully repeated in the course of a year.