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Topic Review
Control of LDL Level with LDLR Pathway
Since the discovery of the LDL receptor in 1973 by Brown and Goldstein as a causative protein in hypercholesterolemia, tremendous amounts of effort have gone into finding ways to manage high LDL cholesterol in familial hypercholesterolemic (HoFH and HeFH) individuals with loss-of-function mutations in the LDL receptor (LDLR) gene. Statins proved to be the first blockbuster drug, helping both HoFH and HeFH individuals by inhibiting the cholesterol synthesis pathway rate-limiting enzyme HMG-CoA reductase and inducing the LDL receptor. However, statins could not achieve the therapeutic goal of LDL. Other therapies targeting LDLR include PCSK9, which lowers LDLR by promoting LDLR degradation. Inducible degrader of LDLR (IDOL) also controls the LDLR protein, but an IDOL-based therapy is yet to be developed. Among the LDLR-independent pathways, such as angiopoietin-like 3 (ANGPTL3), apolipoprotein (apo) B, apoC-III and CETP, only ANGPTL3 offers the advantage of treating both HoFH and HeFH patients and showing relatively better preclinical and clinical efficacy in animal models and hypercholesterolemic individuals, respectively.
  • 570
  • 03 Jul 2023
Topic Review
CT Application in Structural Heart Diseases
Computed tomography (CT) scanning has recently assumed a first-pillar role in the preoperative planning of patients undergoing transcatheter structural heart procedures (e.g., transcatheter aortic valve implantation, TAVI; MitraClip; Triclip; left atrial appendage occlusion, LAAO). A careful preprocedural assessment is crucial for achieving the best possible result, and, currently, CT represents the paramount technique to obtain morphological data on cardiac and vessel structures, thus allowing to choose the most appropriate vascular approach, the type and size of devices, and all the required steps to meet procedural expectations. The image reconstruction accuracy also provides information to predict potential complications such as misplacements and leakages. 
  • 568
  • 22 May 2023
Topic Review
Meta-Inflammation, Diabetes and Cardiovascular Disease
Type 2 diabetes mellitus (DM) represents, with its macro and microvascular complications, one of the most critical healthcare issues. The pathogenesis of DM shares with cardiovascular diseases (CAD) a complex landscape of risk factors, including genetic predisposition and various environmental factors like a high-fat diet, sedentary lifestyle, and chronic stress. In particular, CAD is the leading cause of morbidity and mortality in diabetic patients, determining a significant impact on life expectancy. Notably, DM is equivalent to established ischemic CAD risk, and patients with diabetes have a two- to four-fold greater risk of developing CAD than non-diabetic patients. Myocardial infarction, ischemic ictus, and peripheral arterial disease are the main expression of DM progression and, often, the first event in diabetic patients. CAD and DM strictly depend on various inflammatory pathways that are able to promote the onset and development of insulin resistance, atherosclerotic plaque, and heart failure (HF).
  • 568
  • 25 May 2023
Topic Review
C-Reactive Protein as Inflammatory Marker in Cardiovascular Disease
C-reactive protein (CRP) is an inflammatory molecule that has demonstrated value as a predictive marker for cardiovascular risk assessment, both independently and in conjunction with other parameters. It has been incorporated into risk assessment algorithms, enhancing risk prediction and guiding therapeutic decisions. Pharmacological interventions with anti-inflammatory properties, such as statins, glucagon-like peptide-1 agonists, and interleukin-1 inhibitors, have shown promising effects in reducing both cardiovascular risks and CRP levels.
  • 567
  • 05 Sep 2023
Topic Review
Measurement Tools in Peripheral Arterial Disease Patients
 Peripheral arterial disease (PAD) is the third leading cause of atherosclerotic cardiovascular morbidity worldwide, with high prevalence and associated complications, and is often overlooked and undertreated. Research has shown that there is a profound lack of PAD-related knowledge and awareness; additionally, information sources are not often reliable and accessible.
  • 566
  • 09 Jan 2024
Topic Review
Women with Ischemic Heart Disease
Cardiac diseases are the main cause of death for both sexes worldwide. Treatment varies widely according to the sex of a patient, as there are differences in physiopathology, epidemiology, clinical presentation and management.
  • 565
  • 29 Aug 2023
Topic Review
Mitral Annular Calcification and Its Management
The mitral valve annulus serves as a boundary between the left atrium (LA) and the left ventricular (LV). The mitral annulus has an anterior and posterior segment. The anterior segment connects the aortic root to the anterior leaflet of the mitral valve and thereby forms the aorto-mitral curtain. The anterior and posterior segments act as anchoring points for the respective mitral valve (MV) leaflets. Mitral valve annular calcification-related valvular disease is increasingly common due to the rising prevalence of age-related mitral annular calcifications. Mitral annular calcification alters the structure and function of the mitral valve annulus, which in turn causes mitral valve regurgitation, stenosis, or both. As it frequently coexists with comorbid conditions and overlapping symptoms, mitral annular calcification-related valvular disease poses significant diagnostic and therapeutic challenges.
  • 565
  • 08 Feb 2024
Topic Review
Relationship between Obesity and Cardiovascular Disease
Obesity is defined when the body mass index (BMI) exceeds a value of 30 kg/m2. It is implicated in slowing improved life expectancy and increasing cardiovascular (CV) risk.
  • 563
  • 11 Aug 2023
Topic Review
Cardiac Masses and Pseudomasses
A cardiac lesion detected at ultrasonography might turn out to be a normal structure, a benign tumor or rarely a malignancy, and lesion characterization is very important to appropriately manage the lesion itself. The exact relationship of the mass with coronary arteries and the knowledge of possible concomitant coronary artery disease are necessary preoperative information.
  • 563
  • 09 Jan 2024
Topic Review
Immune Senescence in Atherosclerosis
Atherosclerosis is one of the main underlying causes of cardiovascular diseases (CVD). It is associated with chronic inflammation and intimal thickening as well as the involvement of multiple cell types including immune cells. The engagement of innate or adaptive immune response has either athero-protective or atherogenic properties in exacerbating or alleviating atherosclerosis. In atherosclerosis, the mechanism of action of immune cells, particularly monocytes, macrophages, dendritic cells, and B- and T-lymphocytes have been discussed. Immuno-senescence is associated with aging, viral infections, genetic predispositions, and hyperlipidemia, which contribute to atherosclerosis. Immune senescent cells secrete SASP that delays or accelerates atherosclerosis plaque growth and associated pathologies such as aneurysms and coronary artery disease. Senescent cells undergo cell cycle arrest, morphological changes, and phenotypic changes in terms of their abundances and secretome profile including cytokines, chemokines, matrix metalloproteases (MMPs) and Toll-like receptors (TLRs) expressions.
  • 560
  • 11 Jan 2023
Topic Review
Iodixanol in CCTA and Cardiac Catheterization
Iodixanol is an iso-osmolar non-ionic dimeric hydrophilic contrast agent with a higher viscosity than the monomeric agents. It is the only Food and Drug Administration (FDA)-approved iso-osmolar agent in the United States, and it is the only contrast agent with an FDA-approved indication for use in cardiac computed tomographic angiography (CCTA), to assist in the diagnostic evaluation of patients with suspected coronary artery disease.
  • 558
  • 10 Nov 2023
Topic Review
Interleukin-1 Blockers in Recurrent Pericarditis
Diseases of the pericardium encompass a spectrum of conditions, including acute and recurrent pericarditis, where inflammation plays a pivotal role in the pathogenesis and clinical manifestations. Anti-inflammatory therapy indeed forms the cornerstone of treating these conditions: NSAIDs, colchicine, and corticosteroids (as a second-line treatment) are recommended by current guidelines. However, these medications come with several contraindications and are not devoid of adverse effects. There has been an increased focus on the role of the inflammasome and potential therapeutic targets. Recurrent pericarditis also shares numerous characteristics with other autoinflammatory diseases, in which interleukin-1 antagonists have already been employed with good efficacy and safety. 
  • 558
  • 11 Mar 2024
Topic Review
Intrastent Restenosis
Restenosis refers to the narrowing of a blood vessel’s diameter following an angioplasty procedure. Intrastent restenosis (ISR) is a challenging medical problem. A meta-analysis showed that percutaneous coronary intervention (PCI) for ISR is associated with a higher incidence of adverse cardiac events than PCI for de novo lesions. This happens especially because of a higher incidence of risk-adjusted major adverse cardiac events compared with PCI for de novo lesions at a median of ≈30 months.
  • 557
  • 16 Feb 2024
Topic Review
Long-Term Mechanical Circulatory Support Devices
Cardiovascular disease (CVD) includes a range of disorders that affect the myocardium and/or the vascular system. It stands as the number one cause of death worldwide, accounting for one-third of all deaths. The prevalence of CVD contributes to the rise in healthcare costs, which is attributed to increased rates of hospitalisation, primary care usage and prescription medication. Heart failure (HF) is a common clinical syndrome caused by functional and structural abnormalities of the heart, imposing a burden of disability, reduced quality of life and increased mortality rate. Durable mechanical circulatory support (MCS) devices have become progressively more common as a long-term therapeutic option. Many patients are initially deemed eligible for MCS device implantation as a bridge to transplant but face the harsh reality of limited organ availability. 
  • 557
  • 07 Mar 2024
Topic Review
Myostatin and the Heart
Myostatin (growth differentiation factor 8) is a member of the transforming growth factor-β superfamily. It is secreted mostly by skeletal muscles, although small amounts of myostatin are produced by the myocardium and the adipose tissue as well. Myostatin binds to activin IIB membrane receptors to activate the downstream intracellular canonical Smad2/Smad3 pathway, and additionally acts on non-Smad (non-canonical) pathways. Studies on transgenic animals have shown that overexpression of myostatin reduces the heart mass, whereas removal of myostatin has an opposite effect. 
  • 557
  • 20 Dec 2023
Topic Review
Potential Mechanisms of Sodium-Glucose Co-Transporter 2 Inhibitors
Sodium-glucose co-transporter 2 (SGLT2) inhibitors, originally used for diabetes mellitus, are gaining more popularity for other indications, owing to their positive cardiovascular and renal effects. SGLT2 inhibitors reduce heart failure (HF) hospitalization and improve cardiovascular outcomes in patients with type 2 diabetes. SGLT2 inhibitors exhibit pleotropic effects on the cardiovascular system. It is clear that these beneficial effects are not related to the anti-glycemic properties. Cardiovascular benefits of SGLT2 inhibitors are mediated by several pathways. Enhanced diuresis and vascular dilation result in afterload reduction and coronary blood flow augmentation. Ketogenesis mediated by adipose tissue and hepatocytes promote ketogenesis, which serves as an energy source for the failing heart. In addition, SGLT2 inhibitors contribute to decreasing inflammation and improving systolic and diastolic functions by reducing fibrosis and inhibiting remodeling pathways.
  • 556
  • 21 Aug 2023
Topic Review
Human Gut Microbiota in Heart Failure
There is a bidirectional relationship between the heart and the gut. The gut microbiota, the community of gut micro-organisms themselves, is an excellent gut-homeostasis keeper since it controls the growth of potentially harmful bacteria and protects the microbiota environment. There is evidence suggesting that a diet rich in fatty acids can be metabolized and converted by gut microbiota and hepatic enzymes to trimethyl-amine N-oxide (TMAO), a product that is associated with atherogenesis, platelet dysfunction, thrombotic events, coronary artery disease, stroke, heart failure (HF), and, ultimately, death. HF, by inducing gut ischemia, congestion, and, consequently, gut barrier dysfunction, promotes the intestinal leaking of micro-organisms and their products, facilitating their entrance into circulation and thus stimulating a low-grade inflammation associated with an immune response.
  • 555
  • 08 Oct 2023
Topic Review
Stem and Progenitor Cell for Ischemic Heart Disease
Despite improvements in contemporary medical and surgical therapies, cardiovascular disease (CVD) remains a significant cause of worldwide morbidity and mortality; more specifically, ischemic heart disease (IHD) may affect individuals as young as 20 years old. Typically managed with guideline-directed medical therapy, interventional or surgical methods, the incurred cardiomyocyte loss is not always completely reversible; however, recent research into various stem cell (SC) populations has highlighted their potential for the treatment and perhaps regeneration of injured cardiac tissue, either directly through cellular replacement or indirectly through local paracrine effects. Different stem cell (SC) types have been employed in studies of infarcted myocardium, both in animal models of myocardial infarction (MI) as well as in clinical studies of MI patients, including embryonic stem cells (ESCs) and induced pluripotent stem cells (iPSCs), Muse cells, multipotent stem cells such as bone marrow-derived cells, mesenchymal stem cells (MSCs) and cardiac stem and progenitor cells (CSC/CPCs). These have been delivered as is, in the form of cell therapies, or have been used to generate tissue-engineered (TE) constructs with variable results. 
  • 554
  • 27 Mar 2024
Topic Review
Direct Oral Anticoagulants in Special Populations
Direct oral anticoagulants (DOACs) are the first-line anticoagulant strategy in patients with non-valvular atrial fibrillation (NVAF). For special populations, such as elderly and frail patients, subjects with extreme body weight, cancer, and bioprosthetic heart valves (BHV), the indications and the choice of the optimal OAC therapy are a challenge because of the poor representation of these populations in major randomized clinical trials (RCTs).
  • 553
  • 17 Jan 2023
Topic Review
Microvascular Disease in Heart and Brain by MRI
Microvascular disease (small vessel disease), affecting the small arteries, arterioles, capillaries, and venules of the heart and brain, presents a significant burden on patients and healthcare systems with costs totalling billions each year. Heart failure with preserved ejection fraction (HFpEF) and cerebral small vessel disease (CSVD) are complex conditions that present significant ongoing challenges in both diagnosis and treatment. 
  • 553
  • 19 Sep 2023
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