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Fulltext Statins in heart failure: do we need another trial?

Bonsu KO, Kadirvelu A, Reidpath DD

Vasc Health Risk Manag, 2013;9:303-19.
PMID: 23807852 DOI: 10.2147/VHRM.S44499

Statins lower serum cholesterol and are employed for primary and secondary prevention of cardiovascular events. Clinical evidence from observational studies, retrospective data, and post hoc analyses of data from large statin trials in various cardiovascular conditions, as well as small scale randomized trials, suggest survival and other outcome benefits for heart failure. Two recent large randomized controlled trials, however, appear to suggest statins do not have beneficial effects in heart failure. In addition to lowering cholesterol, statins are believed to have many pleotropic effects which could possibly influence the pathophysiology of heart failure. Following the two large trials, evidence from recent studies appears to support the use of statins in heart failure. This review discusses the role of statins in the pathophysiology of heart failure, current evidence for statin use in heart failure, and suggests directions for future research.
Fulltext Nonadherence to statins: individualized intervention strategies outside the pill box

Lansberg P, Lee A, Lee ZV, Subramaniam K, Setia S

Vasc Health Risk Manag, 2018;14:91-102.
PMID: 29872306 DOI: 10.2147/VHRM.S158641

Poor adherence to statin therapy is linked to significantly increased risk of cardiovascular events and death. Unfortunately, adherence to statins is far from optimal. This is an alarming concern for patients prescribed potentially life-saving cholesterol-lowering medication, especially for those at high risk of cardiovascular events. Research on statin adherence has only recently garnered broader attention; hence, major reasons unique to adherence to statin therapy need to be identified as well as suggestions for countermeasures. An integrated approach to minimizing barriers and enhancing facilitation at the levels of the patient, provider, and health system can help address adherence issues. Health care professionals including physicians, pharmacists, and nurses have an obligation to improve patient adherence, as routine care. In order to achieve sustained results, a multifaceted approach is indispensable.
Fulltext Promising Nutritional Fruits Against Cardiovascular Diseases: An Overview of Experimental Evidence and Understanding Their Mechanisms of Action

Zuraini NZA, Sekar M, Wu YS, Gan SH, Bonam SR, Mat Rani NNI, et al.

Vasc Health Risk Manag, 2021;17:739-769.
PMID: 34858028 DOI: 10.2147/VHRM.S328096

Cardiovascular diseases (CVDs) are one of the leading causes of morbidity and mortality in both developed and developing countries, affecting millions of individuals each year. Despite the fact that successful therapeutic drugs for the management and treatment of CVDs are available on the market, nutritional fruits appear to offer the greatest benefits to the heart and have been proved to alleviate CVDs. Experimental studies have also demonstrated that nutritional fruits have potential protective effects against CVDs. The aim of the review was to provide a comprehensive summary of scientific evidence on the effect of 10 of the most commonly available nutritional fruits reported against CVDs and describe the associated mechanisms of action. Relevant literatures were searched and collected from several scientific databases including PubMed, ScienceDirect, Google Scholar and Scopus. In the context of CVDs, 10 commonly consumed nutritious fruits including apple, avocado, grapes, mango, orange, kiwi, pomegranate, papaya, pineapple, and watermelon were analysed and addressed. The cardioprotective mechanisms of the 10 nutritional fruits were also compiled and highlighted. Overall, the present review found that the nutritious fruits and their constituents have significant benefits for the management and treatment of CVDs such as myocardial infarction, hypertension, peripheral artery disease, coronary artery disease, cardiomyopathies, dyslipidemias, ischemic stroke, aortic aneurysm, atherosclerosis, cardiac hypertrophy and heart failure, diabetic cardiovascular complications, drug-induced cardiotoxicity and cardiomyopathy. Among the 10 nutritional fruits, pomegranate and grapes have been well explored, and the mechanisms of action are well documented against CVDs. All of the nutritional fruits mentioned are edible and readily accessible on the market. Consuming these fruits, which may contain varying amounts of active constituents depending on the food source and season, the development of nutritious fruits-based health supplements would be more realistic for consistent CVD protection.
Fulltext Early Detection of Undiagnosed Abdominal Aortic Aneurysm and Sub-Aneurysmal Aortic Dilatations in Patients with High-Risk Coronary Artery Disease: The Value of Targetted Screening Programme

Saw ST, Leong BDK, Abdul Aziz DA

Vasc Health Risk Manag, 2020;16:215-229.
PMID: 32606718 DOI: 10.2147/VHRM.S250735

INTRODUCTION: Abdominal aortic aneurysm (AAA) and coronary artery disease (CAD) share common risk factors. The objective of this study was to determine the prevalence of undiagnosed AAA in patients with angiographically diagnosed significant CAD.
PATIENTS AND METHODS: Male patients aged 50 years and above (including indigenous people) with angiographically diagnosed significant CAD in the recent one year were screened for AAA. Standard definition of abdominal aortic aneurysm and CAD was used. All new patients were followed up for six months for AAA events (ruptured AAA and AAA-related mortality).
RESULTS: A total of 277 male patients were recruited into this study. The total prevalence of undiagnosed AAA in this study population was 1.1% (95% CI 0.2-3.1). In patients with high-risk CAD, the prevalence of undiagnosed AAA was 1.7% (95% CI 0.3-4.8). The detected aneurysms ranged in size from 35.0mm to 63.8mm. Obesity was a common factor in these patients. There were no AAA-related mortality or morbidity during the follow-up. Although the total prevalence of undiagnosed AAA is low in the studied population, the prevalence of sub-aneurysmal aortic dilatation in patients with significant CAD was high at 6.6% (95% CI 3.9-10.2), in which majority were within the younger age group than 65 years old.
CONCLUSION: This was the first study on the prevalence of undiagnosed AAA in a significant CAD population involving indigenous people in the island of Borneo. Targeted screening of patients with high-risk CAD even though they are younger than 65 years old effectively discover potentially harmful asymptomatic AAA and sub-aneurysmal aortic dilatations.
Fulltext Non-Contrast MRI Sequences for Ischemic Stroke: A Concise Overview for Clinical Radiologists

Bachtiar NA, Murtala B, Muis M, Ilyas MI, Abdul Hamid HB, As'ad S, et al.

Vasc Health Risk Manag, 2024;20:521-531.
PMID: 39618686 DOI: 10.2147/VHRM.S474143

Ischemic stroke is the second leading cause of mortality and morbidity worldwide. Due to the urgency of implementing immediate therapy, acute stroke necessitates prompt diagnosis. The current gold standards for vascular imaging in stroke include computed tomography angiography (CTA), digital subtraction angiography (DSA) and magnetic resonance angiography (MRA). However, the contrast agents used in these methods can be costly and pose risks for patients with renal impairment or allergies. The aim of this paper is to provide a comprehensive overview of current MRI techniques and sequences for evaluating ischemic stroke, emphasizing the importance of non-contrast options and their clinical implications for radiologists in the diagnosis and management of ischemic stroke. Standard MRI sequences-such as T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), fluid-attenuated inversion recovery (FLAIR), diffusion-weighted imaging (DWI), DWI-FLAIR mismatch, and apparent diffusion coefficient (ADC)-are essential for determining infarct location, volume, and age. Additionally, incorporating susceptibility-weighted imaging (SWI) sequence aids in identifying signs of hemorrhagic transformation within the infarcted region. Advanced techniques like arterial spin labeling (ASL) can serve as a non-contrast alternative for mapping cerebral blood flow (CBF) and allowing for comparison between infarcted and healthy brain areas. Adding ASL to the routine sequence allows ASL-DWI mismatch analysis that is useful for quantifying salvageable tissue volume and facilitate timely recanalization, while time-of-flight (TOF) MRA and magnetic resonance venography (MRV) help assess venous thrombosis, stenosis, or arterial occlusions. Finally, MR spectroscopy can provide insights into critical brain metabolites, including N-acetylaspartate (NAA), and lactate (Lac) to determine patient prognosis. Current MRI technology provides a myriad of sequence options for the comprehensive evaluation of ischemic stroke without the need for contrast material. A thorough understanding of the advantages and limitations of each sequence is crucial for its optimal implementation in diagnosis and treatment.