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Current Atherosclerosis Reports

Michael B Boffa
PURPOSE OF REVIEW: Elevated plasma concentrations of lipoprotein(a) (Lp(a)) are an independent and causal risk factor for cardiovascular diseases including coronary artery disease, ischemic stroke, and calcific aortic valve stenosis. This review summarizes the rationale for Lp(a) lowering and surveys relevant clinical trial data using a variety of agents capable of lowering Lp(a). RECENT FINDINGS: Contemporary guidelines and recommendations outline populations of patients who should be screened for elevated Lp(a) and who might benefit from Lp(a) lowering...
December 2016: Current Atherosclerosis Reports
Scott M Grundy
An ongoing dispute in the nutrition field is whether dietary cholesterol contributes significantly to elevated serum cholesterol and to atherosclerotic disease. Carefully controlled metabolic studies have shown that high-cholesterol intakes cause moderate increases in serum cholesterol levels. It is been difficult to verify this in population studies because of confounding factors. Nonetheless, meta-analysis of controlled studies documents a cholesterol-raising action of dietary cholesterol. Most of this effect occurs in low-density lipoproteins (LDLs), but the cholesterol content of other lipoproteins can be increased as well...
November 2016: Current Atherosclerosis Reports
Maryam Kavousi, Lawrence F Bielak, Patricia A Peyser
PURPOSE OF REVIEW: This review provides a brief synopsis of sexual dimorphism in atherosclerosis with an emphasis on genetic studies aimed to better understand the atherosclerotic process and clinical outcomes in women. Such studies are warranted because development of atherosclerosis, impact of several traditional risk factors, and burden of coronary heart disease (CHD) differ between women and men. RECENT FINDINGS: While most candidate gene studies pool women and men and adjust for sex, some sex-specific studies provide evidence of association between candidate genes and prevalent and incident CHD in women...
November 2016: Current Atherosclerosis Reports
Ana Lucrecia Marcano, José Luis Ferreiro
Dual therapy with a P2Y12 receptor antagonist in addition to aspirin is the antiplatelet treatment of choice in patients with acute coronary syndromes or undergoing percutaneous coronary intervention (PCI). However, available oral P2Y12 antagonists have several limitations, mostly due to their pharmacological profile, which can affect outcomes in certain clinical settings. Cangrelor is an intravenous, direct-acting, potent P2Y12 inhibitor with rapid onset and offset of action, which has been recently approved for clinical use in patients undergoing PCI...
November 2016: Current Atherosclerosis Reports
Joseph Brent Muhlestein, Fidela Ll Moreno
PURPOSE OF REVIEW: It is well known that there is a very high risk of cardiovascular complications among diabetic patients. In spite of all efforts at aggressive control of diabetes and its complications, the incidence of cardiovascular morbidity and mortality remains high, including in patients with no prior symptoms, underscoring a possible advantage for appropriate screening of asymptomatic patients for the presence of obstructive coronary artery disease (CAD). In this article, we sought primarily to review the results of studies designed to evaluate a possible role of coronary computed tomography angiography (CCTA) in the screening of asymptomatic diabetic patients for possible obstructive CAD...
November 2016: Current Atherosclerosis Reports
Karen M Goldstein, Leah L Zullig, Lori A Bastian, Hayden B Bosworth
PURPOSE OF REVIEW: Cardiovascular disease (CVD) continues to be the leading cause of death for men and women in the USA. Statins have contributed significantly to noted declines in cardiovascular-related mortality in the last decade; however, the benefit of statins is inequitable across genders. Women continue to be less likely to take statins and to meet target LDL goals than men. As a possible contributing factor to this disparity, we explore the evidence for gender-based differences in provision of, and adherence to statins...
November 2016: Current Atherosclerosis Reports
Erin A Fender, Jawad G Kiani, David R Holmes
PURPOSE OF REVIEW: Anticoagulant therapy effectively reduces the incidence of stroke in patients with atrial fibrillation (AF) but is underutilized and frequently contraindicated. The left atrial appendage (LAA) is the primary site of thrombus formation in AF patients. Surgical and percutaneous appendage closure has been evaluated as a site-specific therapy to reduce systemic thromboembolism. RECENT FINDINGS: We will review LAA closure techniques, examine recent outcome data, and discuss the indications for, and potential complications of, each approach...
November 2016: Current Atherosclerosis Reports
Ali E Denktas, David Paniagua, Hani Jneid
Coronary artery disease is the most prevalent cardiovascular disease in the USA. In the majority of settings, percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD) reduces angina and improves quality of life; however, it does not improve survival and is associated with infrequent but serious complications. Selection of appropriate patients and coronary lesions for revascularization with PCI is crucial to maximize the benefit-to-risk ratio. The assessment of the hemodynamic significance of intermediate coronary lesions has been shown to improve outcomes and reduce healthcare costs...
October 2016: Current Atherosclerosis Reports
Ozlem Bilen, Christie M Ballantyne
Bempedoic acid (ETC-1002), a novel therapeutic approach for low-density lipoprotein cholesterol (LDL-C) lowering, inhibits ATP citrate lyase (ACL), an enzyme involved in fatty acid and cholesterol synthesis. Although rodent studies suggested potential effects of ACL inhibition on both fatty acid and cholesterol synthesis, studies in humans show an effect only on cholesterol synthesis. In phase 2 studies, ETC-1002 reduced LDL-C as monotherapy, combined with ezetimibe, and added to statin therapy, with LDL-C lowering most pronounced when ETC-1002 was combined with ezetimibe in patients who cannot tolerate statins...
October 2016: Current Atherosclerosis Reports
Ryan Clare, Julianne Jorgensen, Somjot S Brar
Thoracic aortic aneurysms are associated with significant morbidity and mortality. There are multiple underlying etiologies, including genetic abnormalities, that have important implications in their natural history. The variable histologic, anatomic, and clinical presentations necessitate careful consideration of available treatment options. Surgical repair of these aneurysms has been the mainstay of treatment; however, these approaches can carry a relatively high risk of morbidity and mortality. Endovascular approaches have now become first-line therapy for descending thoracic aneurysms, and with advancements in graft technology, endovascular approaches are being increasingly employed for hybrid repairs of the aortic arch and even the ascending aorta...
October 2016: Current Atherosclerosis Reports
Marja-Riitta Taskinen, Jan Borén
ApoC-III was discovered almost 50 years ago, but for many years, it did not attract much attention. However, as epidemiological and Mendelian randomization studies have associated apoC-III with low levels of triglycerides and decreased incidence of cardiovascular disease (CVD), it has emerged as a novel and potentially powerful therapeutic approach to managing dyslipidemia and CVD risk. The atherogenicity of apoC-III has been attributed to both direct lipoprotein lipase-mediated mechanisms and indirect mechanisms, such as promoting secretion of triglyceride-rich lipoproteins (TRLs), provoking proinflammatory responses in vascular cells and impairing LPL-independent hepatic clearance of TRL remnants...
October 2016: Current Atherosclerosis Reports
Udhay Krishnan, Evelyn M Horn
In recent years, there have been major changes in the landscape of pulmonary arterial hypertension therapy with the introduction of novel agents and innovative treatment strategies for this progressive disease. The aim of this review is to discuss the evolution in trial design in this field and highlight the salient features of recently published studies. We also summarize our approach to therapy selection in this chronic disease and identify areas for future exploration. The therapeutic armamentarium now includes 13 approved therapies...
September 2016: Current Atherosclerosis Reports
Vu Hoang, Jill Grounds, Don Pham, Salim Virani, Ihab Hamzeh, Athar Mahmood Qureshi, Nasser Lakkis, Mahboob Alam
The development of multiple diagnostic intracoronary imaging modalities has increased our understanding of coronary atherosclerotic disease. These imaging modalities, intravascular ultrasound (IVUS), optical coherence tomography (OCT), and near-infrared spectroscopy (NIRS), have provided a method to study plaques and introduced the concept of plaque vulnerability. They are being increasingly used for percutaneous coronary intervention (PCI) optimization and are invaluable tools in research studying the pathophysiology of acute coronary syndrome (ACS), in-stent thrombosis and in-stent restenosis...
September 2016: Current Atherosclerosis Reports
Ramana Appireddy, Charlotte Zerna, Bijoy K Menon, Mayank Goyal
No abstract text is available yet for this article.
September 2016: Current Atherosclerosis Reports
Carlos E Pompilio, Paolo Pelosi, Melina G Castro
The increasing number of bariatric/metabolic operations as important alternatives for the treatment of obesity and type 2 diabetes brought several concerns about the intensive care of patients undergoing those procedures. Intensive Care Unit admission criteria are needed in order to better allocate resources and avoid unnecessary interventions. Furthermore, well-established protocols, helpful in many clinical situations, are not directly applicable to obese patients. Indeed, difficult airway management, mechanical ventilation, fluid therapy protocols, prophylaxis, and treatment of venous thromboembolic events have unique aspects that should be taken into consideration...
September 2016: Current Atherosclerosis Reports
Sumeet A Khetarpal, Arman Qamar, John S Millar, Daniel J Rader
Triglyceride-rich lipoproteins (TRLs) are causal contributors to the risk of developing coronary artery disease (CAD). Apolipoprotein C-III (apoC-III) is a component of TRLs that elevates plasma triglycerides (TGs) through delaying the lipolysis of TGs and the catabolism of TRL remnants. Recent human genetics approaches have shown that heterozygous loss-of-function mutations in APOC3, the gene encoding apoC-III, lower plasma TGs and protect from CAD. This observation has spawned new interest in therapeutic efforts to target apoC-III...
September 2016: Current Atherosclerosis Reports
Bart M Demaerschalk
Despite strong evidence that intravenous tissue plasminogen activator (tPA) improves outcomes in acute ischemic stroke patients, its use in clinical practice remains modest. Complex eligibility criteria have been postulated as barriers to greater utilization. Further complicating this has been multiple guidelines and prescribing labels that have been published since first being approved for use in 1996. In this review, several warning and exclusion criteria for tPA in acute ischemic stroke are reviewed with the goal of providing readers a nuanced understanding of historical context and available evidence to make informed decision...
August 2016: Current Atherosclerosis Reports
Oliver G Abela, Chowdhury H Ahsan, Fadi Alreefi, Negar Salehi, Imran Baig, Abed Janoudi, George S Abela
No abstract text is available yet for this article.
August 2016: Current Atherosclerosis Reports
Grant Bailey, Judith Meadows, Alan R Morrison
Calcification of atherosclerotic lesions was long thought to be an age - related, passive process, but increasingly data has revealed that atherosclerotic calcification is a more active process, involving complex signaling pathways and bone-like genetic programs. Initially, imaging of atherosclerotic calcification was limited to gross assessment of calcium burden, which is associated with total atherosclerotic burden and risk of cardiovascular mortality and of all cause mortality. More recently, sophisticated molecular imaging studies of the various processes involved in calcification have begun to elucidate information about plaque calcium composition and consequent vulnerability to rupture, leading to hard cardiovascular events like myocardial infarction...
August 2016: Current Atherosclerosis Reports
Carlos Aurelio Schiavon, Luciano F Drager, Luiz A Bortolotto, Celso Amodeo, Dimas Ikeoka, Otávio Berwanger, Ricardo Vitor Cohen
Obesity and hypertension are growing epidemics in the modern world. Lifestyle changes and medical treatment for obesity have disappointing long-term results and albeit drugs for hypertension are usually very effective, the necessity of multiple pills and frequent side effects make the adherence to treatment a huge challenge for healthcare systems. Bariatric/metabolic surgery is a very effective treatment and an exponential number of studies have been showing its positive impact beyond weight loss, mainly on type 2 diabetes...
August 2016: Current Atherosclerosis Reports
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