The 2024 ESC Hypertension Guidelines introduce a more intensive systolic blood pressure (BP) target range of 120-129 mmHg for most patients, marking a significant shift from previous guidelines. A new "Elevated BP" category (120-139/70-89 mmHg) has been introduced to identify individuals at increased cardiovascular risk earlier, emphasizing the need for more aggressive treatment. The guidelines also include novel recommendations for renal denervation in resistant hypertension and provide updated lifestyle and dietary guidance. This approach aims to enhance BP management and reduce cardiovascular disease risks across a broader patient population.
The VERONICA-Nigeria trial found that a low-dose triple single-pill combination of blood pressure (BP)-lowering medications was more effective than standard care in controlling BP among Black African Nigerian adults with uncontrolled hypertension. The trial demonstrated significant improvements in both home and clinic BP control with good tolerability, highlighting the potential of this approach in overcoming barriers to effective hypertension management in this population. The study underscores the importance of tailored treatment strategies for different racial groups to achieve optimal outcomes.
The QUADRO trial demonstrated that a single tablet combining four blood pressure (BP)-lowering drugs, including bisoprolol, is more effective at reducing BP than a combination of three drugs taken separately in patients with resistant hypertension. This quadruple single-pill approach significantly improved BP control across multiple metrics, including office and ambulatory measurements, and could address issues of non-adherence commonly seen with multiple-pill regimens. No major differences in adverse events were observed between the two treatment methods.
Effectiveness of preoperative micronized purified flavonoid fraction treatment and sucralfate based rectal ointment on hemorrhoidal disease A case matched analysis
Springer Nature | Sep 17, 2024
Hemorrhoidal disease (HD) significantly impacts patients’ quality of life. This study aimed to evaluate the effectiveness of preoperative treatment with the micronized purified flavonoid fraction (MPFF) and a sucralfate-based rectal ointment in managing HD symptoms and reducing interventions.
Chronic venous insufficiency, cardiovascular disease, and mortality: a population study
European Heart Journal | October 21, 2021
Chronic venous insufficiency is highly prevalent in the population and is associated with the presence of cardiovascular risk factors and disease. Individuals with CVI experience an elevated risk of death, which is independent of age and sex, and present cardiovascular risk factors and comorbidities.
Chronic venous insufficiency is highly prevalent in the general population and associated with arterial cardiovascular disease and an increased risk of all-cause mortality.
Cardiovascular Insights for the Appropriate Management of Chronic Venous Disease: A Narrative Review of Implications for the Use of Venoactive Drugs
Springer Link | September 28, 2023
Evidence suggests that chronic venous disease (CVD) may be a cardiovascular disorder, as patients with CVD are prone to developing arterial (atherosclerosis) and venous (thromboembolism) diseases. This may be partly explained by shared risk factors. Thus, patients with CVD or cardiovascular disease require careful history-taking and physical assessment to identify coexisting pathologies and risk factors. This article summarises a symposium at the XIX World Congress of the International Union of Phlebology held in Istanbul, Turkey, in September 2022. Common pathophysiological features of CVD and cardiovascular disease are endothelial injury, hypercoagulability and systemic inflammation. In CVD, inflammation primarily affects the microcirculation, with changes in capillary permeability, vein wall and valve remodelling and increase in oxidative stress. Once patients develop symptoms/signs of CVD, they tend to reduce their physical activity, which may contribute to increased risk of cardiovascular disease. Data show that the presence of CVD is associated with an increased risk of cardiovascular disease, including peripheral arterial disease and heart failure (HF), and the risk of adverse cardiovascular events increases with CVD severity. In addition, patients with cardiovascular disease, particularly those with HF, are at increased risk of venous thromboembolism (VTE) and should be assessed for VTE risk if they are hospitalised with cardiovascular disease. Therefore, CVD management must include a multi-specialty approach to assess risk factors associated with both the venous and arterial systems. Ideally, treatment should focus on the resolution of endothelial inflammation to control both CVD and cardiovascular disease. International guidelines recommend various conservative treatments, including venoactive drugs (VADs), to improve the symptoms/signs of CVD. Micronized purified flavonoid fraction (MPFF) is a VAD, with high-quality evidence supporting its use in relieving symptoms/signs of CVD and improving quality of life. Moreover, in large-scale observational studies, MPFF has shown superior effectiveness in real-world populations compared with other VADs.
The article provides a comprehensive review of antiobesity medications (AOMs), which, when combined with lifestyle interventions, are effective in managing obesity—a condition affecting a significant portion of the global population. These medications work through various mechanisms, including altering digestive processes (e.g., orlistat), regulating appetite in the brain (e.g., phentermine-topiramate, naltrexone-bupropion), and mimicking enteropancreatic hormones (e.g., liraglutide, semaglutide, tirzepatide). Each medication has varying efficacy and side effects, with the most potent, tirzepatide, showing up to 12.4% greater weight loss compared to placebo. The review underscores the importance of AOMs as a valuable adjunct to lifestyle changes for improving obesity-related health outcomes.
The article reviews the advancements in understanding how reducing low-density lipoprotein cholesterol (LDL-C) impacts coronary plaque morphology and, consequently, cardiovascular outcomes. Since the advent of statins and subsequent trials, such as REVERSAL and ASTEROID, evidence has shown that LDL-C reduction is associated with modest decreases in plaque volume and significant clinical benefits. However, the mechanisms were not fully understood. The PACMAN-AMI trial, utilizing advanced imaging technologies like IVUS, OCT, and NIRS, provided more detailed insights, demonstrating that intensive LDL-C lowering leads to plaque volume reduction, fibrous cap thickening, and decreased lipid burden, especially in more severely diseased arteries. Although the study's findings are promising, they are limited by biases, small sample size, and the complexity of intracoronary imaging.
Dr. Jorge Plutzky, director of preventive cardiology at Brigham and Women's Hospital, engages in a discussion about effective communication regarding cholesterol management with his patient, Brian McMahon. McMahon recounts his experience with statin intolerance and subsequent concerns about lipid management. Plutzky emphasizes the importance of patient education and empowerment in navigating treatment options, particularly in cases of statin intolerance. He highlights the diverse alternatives available and the significance of achieving optimal LDL levels. Their conversation underscores the need for healthcare providers to effectively communicate risks and treatment strategies to empower patients in managing their cardiovascular health.
The TeleTAVI study, presented at ESC Congress 2024, demonstrated that an AI-based virtual voice assistant, named LOLA, effectively identified complications after transcatheter aortic valve implantation (TAVI) while achieving high patient satisfaction. The virtual assistant made over 1,000 follow-up calls to patients, facilitating early discharge and enabling close monitoring without significantly increasing healthcare resources. Among the 274 patients involved, 89% reported good or very good satisfaction with the service, and 86% would recommend its use. The study highlights the potential of telemedicine to enhance post-procedure care for heart patients.
American College of Cardiology | September 2, 2024
Two late-breaking studies presented at the ESC Congress 2024 explored the role of AI in enhancing clinical decision-making in the emergency department (ED). The PROTEUS trial from the UK found that AI-augmented decision-making improved accuracy among less-experienced clinicians in selecting patients for invasive coronary angiograms, though overall outcomes were similar to standard practices. The RAPIDxAI trial revealed that while AI did not improve cardiovascular outcomes in managing suspected myocardial infarction (MI) patients, it did promote evidence-based care practices. Both studies suggest AI's potential to standardize care and influence clinical decisions, especially among less experienced practitioners.
Cardiovascular diseases (CVDs) pose a severe threat in the WHO European Region, claiming 10,000 lives daily, with men at higher risk. A new WHO/Europe report emphasizes the alarming prevalence of high salt consumption and uncontrolled high blood pressure, major drivers of CVDs. Almost all countries exceed WHO-recommended salt intake levels, and hypertension affects over one-third of adults aged 30-79. The report advocates for integrated strategies to reduce salt intake, control hypertension, and save lives, stressing the need for policy interventions, industry cooperation, improved treatment protocols, patient education, and gender-responsive approaches.
India's rapid urbanization and economic growth have led to a significant increase in chronic diseases like type 2 diabetes, especially in rural areas undergoing socioeconomic changes. Contributing factors include increased disposable income, sedentary lifestyles, and unhealthy diets. Urbanization has also been linked to higher obesity rates, further elevating diabetes risk. Addressing these challenges requires a consistent approach, including early detection, balanced diets, and increased education on diabetes management. Emphasizing credible, science-based solutions and regular health screenings is essential for effective diabetes control in India.
Eating healthy while working in healthcare can be challenging, but it's possible with a few practical strategies. Many healthcare professionals struggle to maintain a nutritious diet due to the fast-paced nature of their jobs and the easy access to unhealthy foods. Experts suggest focusing on small, manageable steps like not skipping meals, prepping snacks, and finding healthier alternatives to junk food. Even small adjustments, such as bringing your own snacks or using meal delivery services, can make a big difference. Staying hydrated and advocating for better nutrition options in the workplace are also key to maintaining a healthy diet.
A large study published in The Lancet Diabetes & Endocrinology links regular consumption of red and processed meats with an increased risk of developing type 2 diabetes. Specifically, eating two slices of ham (50 grams of processed meat) daily can raise this risk by 15%. The study, which analyzed data from nearly 1.97 million people, also suggests that factors like saturated fat, preservatives, and cooking methods contribute to this increased risk. Experts recommend healthier alternatives, such as plant-based proteins and fish, to reduce the likelihood of developing type 2 diabetes.
Ivosidenib (IVO) has demonstrated efficacy as an oral inhibitor of the protein encoded by the mutant isocitrate dehydrogenase 1 (mIDH1) gene in patients (pts) with cholangiocarcinoma (CCA) in the phase 3 ClarIDHy study. To further consolidate safety and efficacy data of IVO in the real world, the ProvIDHe study was initiated. The study is in a setting similar to daily practice, enabling access to treatment with IVO for pts with CCA.
The fluorinated thymidine analog trifluridine (FTD) is a chemotherapeutic drug commonly used to treat cancer; however, the mechanism by which FTD induces cytotoxicity is not fully understood. In addition, the effect of gain-of-function (GOF) missense mutations of the TP53 gene (encoding p53), which promote cancer progression and chemotherapeutic drug resistance, on the chemotherapeutic efficacy of FTD is unclear. Here, we revealed the mechanisms by which FTD-induced aberrant mitosis and contributed to cytotoxicity in both p53-null and p53-GOF missense mutant cells. In p53-null mutant cells, FTD-induced DNA double-stranded breaks, single-stranded DNA accumulation, and the associated DNA damage responses during the G2 phase. Nevertheless, FTD-induced DNA damage and the related responses were not sufficient to trigger strict G2/M checkpoint arrest. Thus, these features were carried over into mitosis, resulting in chromosome breaks and bridges, and subsequent cytokinesis failure. Improper mitotic exit eventually led to cell apoptosis, caused by the accumulation of extensive DNA damage and the presence of micronuclei encapsulated in the disrupted nuclear envelope. Upon FTD treatment, the behavior of the p53-GOF-missense mutant, isogenic cell lines, generated by CRISPR/Cas9 genome editing, was similar to that of p53-null mutant cells. Thus, our data suggest that FTD treatment overrode the effect on gene expression induced by p53-GOF mutants and exerted its anti-tumor activity in a manner that was independent of the p53 function.
Despite decreased incidence rates in average-age onset patients in high-income economies, colorectal cancer is the third most diagnosed cancer in the world, with increasing rates in emerging economies. Furthermore, early onset colorectal cancer (age ≤50 years) is of increasing concern globally. Over the past decade, research advances have increased biological knowledge, treatment options, and overall survival rates. The increase in life expectancy is attributed to an increase in effective systemic therapy, improved treatment selection, and expanded locoregional surgical options. Ongoing developments are focused on the role of sphincter preservation, precision oncology for molecular alterations, use of circulating tumour DNA, analysis of the gut microbiome, as well as the role of locoregional strategies for colorectal cancer liver metastases. This overview is to provide a general multidisciplinary perspective of clinical advances in colorectal cancer.
