The role of magnesium in heart failure: a systematic review

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Purpose: The detection of the association of serum magnesium on mortality and morbidity in Heart Failure patients.

Methods: The selection of the studies was based on searching in the databases, Pubmed and Scopus. The assessment of the quality of the selected studies was accomplished according to validated quality criteria in prognostic studies (QUIPS tool).

Results: Eight studies were considered appropriate for participating in the systematic review, which include 8651 Heart Failure patients with low LVEF (left ventricular ejection fraction). In half of studies, hypomagnesemia is considered to be independent prognostic factor for cardiovascular mortality, including sudden death. Only in one study did magnesium levels >2.4 mg/dl constitute independent prognostic factor for all-cause mortality, whilst there was no statistical association between serum magnesium and morbidity outcomes in Heart Failure patients.

Conclusion: Heart failure patients who develop hypomagnesemia at heightened risk of increased cardiovascular mortality, including sudden death.

Keywords:

 Heart failure, Magnesium, Mortality, Morbidity

Celiac disease and cardiovascular disease

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Celiac disease is a chronic inflammatory enteropathy, caused by the consumption of foodstuffs containing gluten. The aim of this review is to explore the data concerning the association between celiac disease, atherosclerosis and cardiovascular diseases, and the role of inflammation as a causative factor.

Keywords

celiac disease, atherosclerosis, cardiovascular disease

The role of PCSK9 in atherosclerosis: a new age in dyslipidemia management

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PCSK9 is a protein with proven deleterious effects on lipid metabolism. PCSK9 facilitates the degradation of the LDL receptors on the surface of hepatocytes. As a result, LDL concentrations in the serum increase. Statin therapy stimulates a positive feedback circle which causes PCSK9 levels to increase, attenuating statin’s efficiency. PCSK9 inhibitors have proven themselves in several clinical trials as safe drugs that cause significant improvements in lipid profiles. The purpose of this review is to fully delineate the link between PCSK9 and atherosclerosis, as well as the future of PCSK9 inhibition.

Spontaneous coronary artery dissection (SCAD) and acute coronary syndrome. A review of nine cases.

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Spontaneous coronary artery dissection (SCAD) is considered a non-traumatic, non-iatrogenic rupture of the coronary artery wall with a consequential formation of a false lumen and an intramural hematoma (IMH), capable under certain circumstances of compressing the true lumen causing acute coronary syndrome. We report our recent experience in the field, by presenting 9 different cases of SCAD, first admitted with an initial diagnosis of non-ST segment elevation myocardial infarction (NSTEMI). We additionally provide a brief review of the literature.

Erectile dysfunction: a review focused on its relationship with atherosclerosis

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Erectile dysfunction (ED) is a highly prevalent disease that affects the quality of life of mainly older men. Among the complex etiology of ED, atherosclerosis is the predominant of the arteriogenic causes. It has been reported that ED and cardiovascular disease share common risk factors and common pathophysiological mechanisms (endothelial dysfunction, inflammation, and low testosterone levels). Moreover, increasing evidence suggests that clinical manifestations of ED precede cardiovascular events by about three years and thus, its diagnosis offers a window for early cardiologic assessment and intervention. In patients with suspected arteriogenic ED, data ha sshown that percutaneous revascularization of penile arteries may be considered an effective treatmentstrategy in patients with macroangiopathic disease who have not responded to oral conservative therapy. All in all, a complex and yet-to-be understood interplay between ED and cardiovascular disease has been revealed in recent years.

Keywords: erectile dysfunction, penis pumps,sildenafil

The prognostic value of aortic sclerosis on cardiovascular disease in Type 2 Diabetes Mellitus and the promising role of sodium-glucose co-transporter-2 (SGLT-2)

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Type 2 diabetes mellitus (T2DM) is a growing pandemic, constituting the 7th cause of death worldwide. Morbidity and mortality rates among patients with T2DM are increasing, while the incidence of cardiovascular disease in this population is estimated to be 14%greater compared to the general population. Aortic stiffness represents now a valuable biomarker of cardiovascular disease and a promising treatment target in various populations, including patients with T2DM; however, most of available studies are crosssectional, and thus, causality cannot be proven. Non-invasive measurement, easy learning and low cost constitute evaluation of aortic stiffness a routine diagnostic test with significant prognostic value. Recently, a new class of antidiabetics, namely sodium-glucose co-transporter-2 (SGLT-2) inhibitors have attracted scientific interest, due to their beneficial cardiovascular effects. There is limited relevant literature concerning the impact of the SGLT-2 inhibitors on the aortic stiffness, while the results are rather considered as ambiguous. The aim of the present review article is to present past and contemporary knowledge regarding the diagnostic and prognostic value of aortic stiffness in the field of T2DM and related cardiovascular disease, and to discuss the promising role of SGLT-2 inhibitors in aortic stiffness reduction.

Keywords: Aortic stiffness, type 2 diabetes mellitus, cardiovascular disease, SGLT-2 inhibitors.

Treating patients with resistant hypertension

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Resistant hypertension represents a significant problem in everyday clinical practice with substantial cardiovascular consequences. The recent European guidelines incorporated some important changes in the definition of resistant hypertension, which are expected to affect significantly the prevalence and the management of this clinical entity. The aim of this paper is to present the latest data about the definition, the prevalence, and the prognosis of resistant hypertension, but most importantly to propose a simplified strategy of approaching patients with resistant hypertension, which can be easily implemented in real life practice.

Keywords: resistant hypertension, hypertension therapy, aldosterone inhibitors

Diabetic Cardiomyopathy: What’s new and novel therapies

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Diabetic cardiomyopathy is a cardiac dysfunction with a prevalence of 12% in diabetic patients. The precise pathophysiological mechanism leading to the development of thisspecific type of cardiomyopathy is complex and not completely yet known. Since 1972, when the definition of diabetic cardiomyopathy wasintroduced, until today significant progress has been made in its diagnosis and treatment. The earlier the diagnosis is made by using mainly echocardiography, the higher the chances of reversing the progression of the disease to overt failure. Thisreview aimsto summarize the various diagnostic methods, current prevention approaches, and innovative treatment strategies.

Keywords: Cardiac dysfunction, diabetes mellitus, diabetic cardiomyopathy

Severe bioprosthetic aortic valve dysfunction in a patient with high Euroscore. Percutaneous Valve in Valve Management

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We present an interesting case of a patient with high Euroscore and early severe bioprosthetic aortic valve dysfunction due to rupture of a posterior aortic fold. Valve in valve transcatheter aortic valve implantation was decided by the heart team due to a very high surgical risk. Unfortunately severe hemorrhagic stroke followed the successful implantation of the valve.

Keywords: prosthetic aortic valve, TAVI, Valve in Valve,stroke

Arterial Hypertension and Diabetes Mellitus – Pathophysiologic mechanisms and treatment

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Hypertension and Diabetes mellitus are interrrelated diseases. Both strongly predispose to atherosclerotic cardiovascular disease. They are the leading cause of cardiovascular morbidity and mortality. Adequate treatment reduces the cardiovascular risk of patients who suffer from hypertension and diabetes with profound benefits. Guidelines related medication must be applied for each patient separately.

Keywords: diabetes mellitus, arterial hypertension

Sex and the heart

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Sex is called the sexual act between humans or other species of the animal kingdom. Sex is necessary for perpetuating the species, but also a human need, a source of pleasure. Sexual ability and coronary heart disease have common risk factors and erectile dysfunction in men, without previous symptoms from cardiovascular disease, may indicate incipient coronary artery disease. It is a common belief that people with coronary artery disease or stroke, are at risk of having a heart attack during sex. Sex is considered a great means of exercising and isrecommended in the context of rehabilitation of the myocardial infarction.