Purpose of Review
Low-density lipoprotein cholesterol (LDL-C) is the most important causal risk factor for atherosclerotic cardiovascular disease (ASCVD). This article reviews why LDL-C remains ...overlooked and underestimated despite numerous studies that have proved its role.
Recent Findings
Recently published EAS/ESC Guidelines for dyslipidemia and EAS Guidelines for prevention set new targets for LDL-C levels in primary and secondary prevention of ASCVD. These guidelines are based on data from large studies and meta-analyzes that have shown that lower LDL-C also means lower cardiovascular event rates. Real-life experience published in registries worldwide has shown us that the guidelines have not been translated to everyday clinical practice, meaning that a significant number of patients are undertreated and have LDL-C levels well above target. Potential reasons for the abovementioned are poor adherence and education of the patient and physician and health care system related factors.
Summary
Implementation of the latest version of guidelines will require continuous patient and physicians education, as well as a shared decision-making process between physician and patient.
Glucagon like peptide-1 (GLP-1) receptor agonists are well established drugs for the treatment of type 2 diabetes (T2D). In addition to glycemic control, GLP-1 receptor agonists have beneficial other ...effects. They act by binding to GLP-1 receptors, which are widely distributed in the body, including cardiomyocytes and blood vessels. The aim of this article is to provide a comprehensive review of GLP-1 receptor agonists impact on cardiovascular outcomes and risk reduction. In the last decade, several cardiovascular outcomes trials (CVOT) have been conducted in order to explore cardiovascular benefit of GLP-1 receptor agonists. CVOTs primarily proved cardiovascular safety and tolerability of different GLP-1 receptor agonists, but also showed cardiovascular benefit of specific drugs. CVOTs have shown that GLP-1 receptor agonists reduce MACE in patients with T2D compared to placebo. In addition, they have positive impact on several cardiovascular risk factors such as obesity by promoting weight loss, blood pressure and blood lipid levels. Also, they stimulate the endothelium to produce nitric oxide, reduce oxidative stress, and have antiatherogenic and antiinflammatory effects. Studies have shown their positive impact on kidney outcomes in patients with T2D compared to placebo. The results of previous trials are encouraging in terms of multiple positive effects of GLP-1 receptor agonists. However, further research is needed to understand their full potential and all details of their mechanism of action, which will enable to expand the therapeutic indications and to determine their optimal use in clinical practice.
Aim
To examine safety and efficiency of electrocardioversion (EC) in elective treatment of atrial fibrillation and atrial flutter in
the setting of Day Hospital by determining success rate, frequency ...of adverse events and possible cost benefit compared to admitting a patient into hospital.
Methods
This prospective observational cohort study was performed in Day Hospital and in Intensive Care Department of Internal
Medicine Clinic, University Clinical Centre Tuzla from January 2019 to December 2022 and included 98 patients with a persistent form of atrial fibrillation (AF) or atrial flutter. The patients who were divided in two groups, 56 hospitalized and 42 patients accessed in Day Hospital. In all patients, medical history, physical examination, electrocardiogram (ECG) and transthoracic echocardiogram (TTE) evaluation was performed in addition to laboratory findings. Electrocardioversion was performed with a monophasic General Electric defibrillator in anterolateral electrode position with up to three repetitive shocks.
Results
In hospital setting group overall succes rate of electrocardioversion was 85%, with average 2.1 EC attemps, there was with one fatal outcome due to stroke, one case of ventricular fibrillation (VF) due to human error, and 6 minor adverse events; with average cost of was 1408.70 KM (720.23 €) per patient. In Day Hospital setting succes rate was 88%, with average 2 EC attempts, no major adverse events, 8 minor adverse events; and average cost was of 127.23 KM (65.05 €) per patient.
Conclusion
Performing elective electrocardioversion in Day Hospital setting is as safe as admitting patients into hospital but substantially more cost effective.
The following parameters were observed in the research: age, gender and vitamin D values, data on the body temperature of the patients and the duration of the disease, as well as the obtained results ...of the inflammatory parameters (Leukocytes and C- reactive protein CRP). There is a tendency towards a negative correlation between the concentration of vitamin D and the duration of the disease in the group of patients COVID-19, as like as the concentration of vitamin D and body temperature. In the context of SARS-C0V-2 infections, there have been few observational studies investigating the role of vitamin D. A large cross-sectional study examining the geographic distribution of COVID-rq in the USA examined the relationship between sunlight exposure and disease outcomes such as disease severity and death from COVID-rq. r Similarly, a correlational analysis of data from 88 countries found that countries above the equator had fewer deaths from COVID-rq compared to distally distributed countries, suggesting a potential link between vitamin D (by latitude and sunlight exposure) and mortality from COVID-rq. According to an insight into the available modern literature, we expected that the concentration of Vitamin D is lower in patients with the infection of COVID-rq, and therefore that its value has a significant impact on the clinical presentation of patients and the outcome of the disease, as well as the length and severity of the duration of the disease, with the fact that all this needs to be further shed light on. The following parameters were observed in the research: age, gender and vitamin D values, data on the body temperature of the patients and the duration of the disease, as well as the obtained results of the inflammatory parameters (Leukocytes and C- reactive protein - CRP).
Methods: In this analysis the data was obtained from the hospital information system (BIS), involving patients who were hospitalized for treatment of moderate to severe COVID-19 infection at the ...Infectious Diseases Clinic of the Tuzla University Clinical Center (UCC) between January 1 and April 8, 2021. SUBJECTS AND METHODS Subjects A retrospective observational study was conducted that included data from BIS from 400 subjects who were hospitalized for treatment of moderate to severe COVID-19 at the Infectious Diseases Clinic of the UCC Tuzla in the period between January 1 and April 8, 2021. The study was approved by the Ethics Committee of UCC Tuzla before data collection. Methods The following data analyzed for all 400 subjects: age, sex, symptoms (fever, cough, headache, sore throat, dyspnea, weakness, loss of appetite, loss of sense of smell and taste, vomiting, diarrhea, dizziness), presence of comorbidities during hospitalization (cardiovascular, gastrointestinal, nephrological, endocrinological, hematological, pulmonary, neurological, surgical, orthopedic, urological, psychiatric, ophthalmological, otorhinolaryngological).
We aimed to evaluate levels of amino-terminal pro-brain natriuretic peptid (NT-proBNP) in prediction of left ventricular ejection fraction (LVEF) in heart failure patients. Prospective study on 60 ...consecutive patients with symptoms and signs of heart failure was performed. Blood samples for NT-proBNP analysis was taken from all test subjects and echocardiography was also done in all of them. According to LVEF value, patients were divided into four groups; those with <or=30%, 31 to 39%, 40 to 49% and >or=50%. NT-proBNP values correlated with LVEF value. Regression analysis was used to evaluate how well NT-proBNP values predict LVEF. We used Receiver Operating Characteristic Curve calculation to evaluate diagnostic performance of NT-proBNP in estimation of LVEF. Average value of NT-proBNP in test group was 3191.69+/-642.89 pg/ml (p<0.001). Average value of NT-proBNP decreased with higher LVEF categories with significant (p<0.001) and high negative correlation (r= -0,75). Stepwise multivariate linear regression analysis showed that logarithmic value of NT-proBNP was excellent predictor of LVEF value (p<0.05). Model equation based on regression analysis was LVEF=88.645-15.311 x log (NT-proBNP). Predictive model for LVEF yielded from regression analysis had sensitivities of 98% and 81%, specificities of 20% and 90%, positive predictive values of 86% and 78% and negative predictive values of 67% and 92% for predicting patients with LVEF<50% and LVEF<40%, respectively. There was negative linear correlation between NT-proBNP and LVEF. NT-proBNP was excellent predictor of LVEF value (p<0.05).
...of the analysis, the most significant predictors of AF are: LVDD and LAVI. In recent studies, increased LAVI >26 ml/m2 has also been recognized as a relative independent marker of left ventricular ...filling pressure and LVDD in patients with suspected heart failure with preserved left ventricular ejection fraction (LVEF) (Lim et al., 2006). ...LAVI has been proposed as a biomarker for both diastolic left ventricular dysfunction and cardiovascular risk (Douglas et al. 2003, Alsaileek et al. 2006). LAVI > 34ml/m2 is an independent predictor of death, heart failure, atrial fibrillation and ischemic stroke (Abhayaratna et al., 2006). ...the aim of this study is to evaluate the effect of LAVI on the occurrence of atrial fibrillation after surgical myocardial revascularization. According to the degree of diastolic dysfunction, preoperatively the most prevalent diastolic dysfunction was first degree 72/116 (Table 3).
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