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Lipid-lowering medication is effective in reducing the risk of cardiovascular disease in several clinical scenarios. However, the evidence in patients with familial hypercholesterolemia (FH) and severe primary hypercholesterolemia is less robust.The main objective of the present systematic review was to analyze the association between lipid-lowering medication and cardiovascular risk reduction in patients with FH or severe primary hypercholesterolemia.This systematic review was performed according to PRISMA guidelines. A literature search was performed to detect studies that evaluated the association between lipid-lowering medication and cardiovascular events in FH patients. The diagnosis of FH varied in the studies analyzed. Genetic and clinical criteria or a combination of both were used. Likewise, we considered patients with severe primary hypercholesterolemia.Fourteen studies including 21059 patients were considered eligible for this research. This systematic review showed that the vast majority of the studies with statins reported a significant cardiovascular risk reduction. Statin use was associated with a lower risk of major adverse cardiovascular events (3 studies), coronary heart disease (2 studies), cardiovascular death (4 studies), all-cause mortality (4 studies) and combined endpoint of coronary heart disease and mortality (1 study). When analyzing the association between non-statin lipid-lowering medications and the incidence of cardiovascular events, the results were conflicting.Despite the low level of evidence, this systematic review showed that statins reduce cardiovascular events in patients with HeFH. Evidence for other lipid-lowering drugs is not conclusive.

Sodium Glucose Co-transporter 2 inhibitors and glucagon-like peptide 1 receptor agonists (GLP-1RAs) were associated with a reduction in cardiovascular disease events in cardiovascular outcomes trials (CVOTs) in type 2 diabetes. Most of the patients included in these trials received metformin as background therapy. To evaluate the effect of glucagon-like peptide 1 receptor agonists on major cardiovascular events (MACE) and mortality in metformin-naive patients with type 2 diabetes. A systematic review and meta-analysis of randomized controlled clinical trials of GLP-1RAs on type 2 diabetes population was performed, after searching the PubMed/MEDLINE, Embase, Scielo, Google Scholar and Cochrane Controlled Trials databases. The primary endpoint was MACE. The secondary endpoints were cardiovascular death and all-cause mortality. A meta-analysis of time-to-event outcomes was performed. This meta-analysis was registered in PROSPERO (CRD42021260040) Seven trials, including 11510 patients, were identified and considered eligible for the analyses. GLP-1RAs were associated with a significant reduction in MACE incidence (HR: 0.86, 95% confidence interval: 0.79–0.94; I2: 0%). The secondary endpoints analysis showed a non-significant reduction in all-cause mortality (HR: 0.86, 95% confidence interval: 0.73–1.00 I2: 0%) and cardiovascular mortality (HR: 0.81, 95% confidence interval: 0.63–1.05; I2: 0%). In this meta-analysis, GLP-1RAs reduced the incidence of MACE in patients with type 2 diabetes without metformin at baseline, without significant reduction in all-cause mortality and cardiovascular mortality. These results support the fact that when a GLP-1RAs is administered, the benefit on cardiovascular outcomes is independent of the use of metformin.

Elevated lipoprotein(a) [Lp(a)] levels are independently associated with atherosclerotic cardiovascular disease, although this association is less explored in postmenopausal women. The main objective of this systematic review was to analyze the association between elevated Lp(a) levels and cardiovascular outcomes in posmenopausal women. Studies that evaluated this association were searched in the current literature. Ten studies including 157.690 women were considered eligible for this study. In total, 4 prospective cohorts, 3 cross-sectional studies, 2 nested case-control studies, and one post-hoc analysis from a randomized clinical trial were analyzed. The included studies showed different results regarding the association between Lp(a) levels and cardiovascular outcomes: a positive association (4 studies), no association (2 studies), or different results depending on the subgroups or outcomes evaluated (4 studies). The results were robust when evaluating coronary events. The reduction in coronary events attributed to a hormone replacement therapy-associated decrease in Lp(a) levels was controversial.

Background Given the complex aetiology and a limited amount of evidence, the medical treatment (including statin use) of myocardial infarction with non-obstructive coronary artery disease (MINOCA) remains uncertain. The objective of the present study was to evaluate the effect of statin therapy on major cardiovascular events (MACE) and mortality in MINOCA patients. Methods A systematic review and meta-analysis of time-to-event outcomes were performed of studies of statin therapy on MINOCA patients, reporting data from MACE or mortality, after searching the PubMed/MEDLINE, Embase, Science Direct, Scopus, Google Scholar, and Cochrane databases. A fixed-effects meta-analysis model was then applied. Results Six observational studies of statin therapy on MINOCA, involving a total of 11,171 patients, were identified and considered eligible for analysis (9129 subjects received statin therapy while 2042 patients were part of the respective control arms). Quantitative analysis (5 studies were included) showed that statin use was associated with lower mortality (HR: 0.65; 95% CI: 0.56-0.75, I2: 0%). Also, the meta-analysis showed that statin therapy was associated with a lower incidence of MACE (HR: 0.78; 95% CI: 0.69-0.88, I2:27%). Conclusion Our data suggest that in a population with MINOCA, the use of statin therapy results in significant reduction on MACE and mortality. These results must be confirmed in future clinical trials.

To evaluate the effect of very low levels of LDL-C (55 mg/dl) achieved with lipid-lowering therapy on hemorrhagic stroke incidence.We performed a meta-analysis including randomized trials that achieved LDL-C levels under 55 mg/dl in more intensive lipid-lowering arms, regardless of the lipid-lowering drug used. A fixed-effects model was used. This meta-analysis was performed according to PRISMA guidelines.Eight eligible trials including 122.802 patients, were identified and considered eligible for the analyses. A total of 62.526 subjects were allocated to receive more intensive lipid-lowering therapy while 60.276 subjects were allocated to the respective control arms. There were no differences in the incidence of hemorrhagic stroke between the group that received a more intensive lipid-lowering therapy (achieved LDL-C level55 mg/dl), and the group that received a less intense scheme (OR, 1.05; 95%CI, 0.85-1.31). The statistical heterogeneity was low (IThe use of more intensive lipid-lowering therapy that achieved an LDL-C level lower than 55 mg/dl in patients with high cardiovascular risk, is not associated with an increased risk of hemorrhagic stroke. Considering the cardiovascular benefit and safety observed with the achievement of very low LDL-C values, the challenging lipid goals recommended by the new guidelines seem consistent.

Objetivo: Evaluar el impacto del aislamiento social, preventivo y obligatorio sobre al aumento de peso, el nivel de actividad fisica, la adherencia al tratamiento y la inmunizacion antigripal y antineumococica en pacientes con diabetes tipo 2 (DM2). Metodo: Se realizo un seguimiento telefonico de pacientes con DM2 luego de al menos 100 dias de comienzo del aislamiento. Se compararon dos regiones agrupadas en relacion con el numero de casos: region 1, mas de 150 casos/100, 000 habitantes, y region 2, mas de 150 casos/100,000 habitantes. Resultados: Se contactaron 454 pacientes con DM2. El 42% reportaron incremento de peso y el 7% refirio haber aumentado mas de 5 kg. En relacion con la actividad fisica, se observo un promedio mas bajo en la region 1 (367.5 [0-5698] MET/sem) que en la region 2 (720 [0-7066] MET/sem) (p = 0.0009). La adherencia al tratamiento farmacologico disminuyo en forma global, pero aumento en las zonas de mayor circulacion viral. Por otra parte, hubo un incremento de vacunacion antigripal y antineumococica, alcanzando coberturas del 80% y el 70%, respectivamente. Conclusiones: En una poblacion de alto riesgo cardiovascular y con una prevalencia de sobrepeso/obesidad elevada, el aislamiento social, preventivo y obligatorio se asocio con ganancia de peso y menos actividad fisica, lo que podria resultar deletereo sobre la salud cardiovascular de los pacientes con DM2. Por otro lado, se observan algunos aspectos positivos, como el aumento de las inmunizaciones y el incremento de la adherencia en las zonas mas afectadas.

Background Bempedoic acid is a novel non-statin drug that was developed to treat hyperlipidemia in combination with other lipid-lowering drugs in those patients who need additional lipid lowering. Objectives (1) To investigate the lipid efficacy of bempedoic acid; (2) to analyze the anti-inflammatory effects of bempedoic acid estimated through high sensitivity C-reactive protein (hsCRP). Methods We performed a meta-analysis including randomized trials of bempedoic acid therapy, reporting low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), apolipoprotein B and hsCRP with a minimum of 4 weeks of follow-up. The primary endpoint was defined as the percentage change in lipids and hsCRP levels measured from baseline to follow-up, comparing groups of subjects on bempedoic acid versus placebo. Results Seven eligible trials of bempedoic acid (3892 patients) were included. The bempedoic acid therapy was associated with a significant reduction in LDL-C levels [−20.3% (CI 95% −23.5 to −17.1)]; I2 = 43%]. Similarly, a significant percentage reduction in the apolipoprotein B levels [−14.3% (CI 95% −16.4 to −12.1)]; p Conclusion Our data suggests that the use of bempedoic acid significantly reduces the levels of all atherogenic lipid markers, including LDL-C, non-HDL-C and apolipoprotein B. Furthermore, considering hsCRP levels, the drug produces an anti-inflammatory effect.

AimsTo evaluate the effect of sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1RAs) on major cardiovascular events (MACE) in metformin-naïve patients with type 2 diabetes (T2D).Methods and resultsA meta-analysis was performed of randomized controlled clinical trials of GLP-1RAs and SGLT-2 inhibitors on T2D populations, after searching the PubMed/MEDLINE, Embase, and Cochrane Controlled Trials databases. The primary endpoint was MACE. The secondary endpoint, explored in the subgroup of SGLT-2 inhibitors studies, was cardiovascular death or hospitalization for heart failure. A random-effects meta-analysis model was applied. Six eligible trials (three studies of SGLT-2 inhibitors and three trials of GLP-1RAs), including 13 049 patients, were identified and considered eligible for the analyses. The new antidiabetic drugs were associated with a significant reduction in MACE [odds ratio (OR): 0.80, 95% confidence interval: 0.70–0.93; I2: 53%]. The subgroup analysis showed the following findings: GLP-1RAs group, OR: 0.77 (95% confidence interval 0.67–0.88); SGLT-2 inhibitors, OR: 0.85 (95% confidence interval 0.63–1.15). SGLT-2 inhibitors were associated with a significant reduction in hospitalization for heart failure or cardiovascular mortality incidence (OR: 0.67, 95% confidence interval: 0.47–0.95; I2: 78%).ConclusionIn this meta-analysis, new antidiabetic drugs reduced the incidence of MACE in metformin-naïve T2D patients. The beneficial effect was especially observed in the GLP-1RAs subgroup. The use of SGLT-2 inhibitors was associated with a reduction in cardiovascular death or hospitalization for heart failure. These results support the fact that metformin would not be indispensable to obtain positive cardiovascular effects when new antidiabetic drugs are administered.

Background: Colchicine is a microtubule inhibitor with anti-inflammatory properties. As the body and quality of evidence regarding the efficacy of colchicine for cardiovascular prevention is controversial, the aims of this study was to evaluate the effect of colchicine therapy on vascular events. Methods: A meta-analysis was performed of randomized controlled clinical trials of colchicine on high cardiovascular risk populations, reporting data from stroke, myocardial infarction, cardiovascular mortality and all-cause mortality, after searching the PubMed/MEDLINE, Embase and Cochrane Controlled Trials databases. A random-effects meta-analysis model was then applied. Results: Nine eligible trials of colchicine therapy, involving a total of 6630 patients, were considered eligible for analysis (3359 subjects were allocated to receive colchicine while 3271 subjects were allocated to the respective control arms). The stroke incidence was lower in the colchicine group compared with placebo arm (OR, .33; 95%CI, .15-.70; 6 studies evaluated). We did not find a significant reduction in the incidence of myocardial infarction, cardiovascular mortality or all-cause mortality. Conclusions: Our data suggest that in a population with high cardiovascular risk, the use of colchicine results in significant reduction on stroke risk. Colchicine is an accessible drug that could be successfully utilized for the prevention of atherosclerotic cerebrovascular disease. The tolerability and benefits should be confirmed in ongoing clinical trials.

Introduction: Chest pain represents 5 to 10% of annual visits to emergency departments. Its diagnosis is sometimes difficult, with the added problem of inappropriate discharge of patients with acute coronary syndrome or unnecessary hospitalizations. This has led to the development of different algorithms for the evaluation of these patients. Objective: The aim of this study was to validate, in terms of safety and length of hospital stay, a novel algorithm incorporated in our center, which includes measurement of high-sensitivity troponin T in patients with suspected acute coronary syndrome. Methods: The study included 528 consecutive patients attending the emergency department with suspected acute coronary syndrome and evaluated according to the chest pain unit protocol. Clinical and laboratory variables and functional tests were analyzed. Follow-up at 30 days was performed in all the patients. Results: After observation, 90.7% of the patients were discharged and 1.25% presented a cardiovascular event during follow-up, represented by percutaneous coronary intervention and hospitalization due to acute coronary syndrome. The specificity of the global algorithm for the diagnosis of acute coronary syndrome was 97% with a negative predictive value of 99%. Emergency department length of stay was 4.5 ± 2.5 hours for all the patients. Conclusion: The novel algorithm incorporated in our center with measurement of high-sensitivity troponin T in patients with suspected acute coronary syndrome has proved to be safe, as it prevents the discharge of patients with acute coronary syndrome and at the same time reduces emergency department length of stay.

Background An oral single dose of flecainide is used worldwide for conversion of recent onset atrial fibrillation (AF) in hemodynamically stable patients without structural heart disease. Vernakalant is a novel, rapid drug, which is used intravenously, with proven effectiveness and safety compared to placebo and amiodarone in randomized clinical trials. The aim of our study was to compare the time taken for conversion of recent onset AF in patients treated with vernakalant or flecainide. Methods This is a sequential study in which 32 hemodynamically stable patients with recent onset AF without structural heart disease were prospectively and consecutively included in two periods, one for each drug. A single oral dose of flecainide 300mg was administered to 15 patients and 17 patients received intravenous vernakalant. Clinical and laboratory variables, conversion rate and time to conversion were recorded. Results Baseline characteristics were similar in both groups. Time to conversion to sinus rhythm was of 163min (120–300) in the flecainide group versus 10min (6–18) in the vernakalant group (p=0.0001). Conclusion Time to conversion of AF to sinus rhythm was significantly shorter in the vernakalant group compared with the flecainide group, and was associated with shorter hospital stay. This reduction in hospital stay length may produce benefits in patients' medical care, costs and welfare.