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The article focuses on the utilization of several biomarkers including C-reactive protein (CRP), cystatin C, and B-type natriuretic peptide (BNP) in identifying the cardiovascular risk factors. A study was conducted to test whether these biomarkers can be considered as risk elements for cardiovascular and coronary diseases. The result of the study shows that biomarkers can be less considered as the main risk factor for cardiovascular diseases although CRP and N-BNP can predict its occurrence.

The article presents information on the meta-analysis of Omega-3 that demonstrates the benefit of mortality in general cardiology. It states that omega-3 fatty acids might have the power to reduce death from cardiovascular cases. It mentions that previous systematic reviews of the therapy of fish oil have been undetermined and has not yet been concluded in recent data.

The article reports on the study about Simvastatin and Ezetimibe in Aortic Stenosis (SEAS). It is stated that calcific aortic stenosis shares the risk factors with coronary heart disease and predicts death and myocardial infarction even before large gradients appears. It shows an increase in cancer mortality risk in the combined ezetimibe groups. Whether the increased risk of cancer is solely due to chance remains uncertain, longer follow-up data are required to provide a definitive answer.

The article reports on the study about chronic obstructive pulmonary disease. It was conducted to 14,873 patients to determine the cardiovascular risks of inhaled anticholinergics. Result shows that most of the excess risk was found to come when anticholinergics were taken for at least 6 months. It is stated that any risk associated with their use may remain acceptable to some patients.

The article reports on the study about diabetic patients treated with drug-eluting coronary stents (DES) who received short-term, less than six months dual antiplatelet therapy. It is stated that longer antiplatelet therapy gives good DES outcomes in diabetes mellitus. According to the study authors, DES appear to be safe and effective compared with using bare metal stents (BMS), provided that patients receive an adequate duration of dual antiplatelet pharmacotherapy.

The article reports on the study conducted by the European Cooperative Acute Stroke about thromolysis in stroke. It is designed to test the hypothesis that alteplase administered in patients with acute ischaemic stroke. The study's limitations include the small numbers of diabetic patients enrolled and the exclusion of patients with severe stroke. It is not suggested that the ideal window for thrombolytic agent administration is after 4.5 hours from the moment the patient arrives the hospital.

The article discusses the spectrum of variants seen on electrocardiograms (ECGs) of young athletes. Such variants include repolarisation abnormalities and increased R- or S-wave voltage that suggest left ventricular hypertrophy. The article explains the procedures done which resulted to a useful insight of abnormal ECG in asymptomatic athletes and an illustration of relevant sequelae regardless of the existence of normal concomitant cardiac imaging and investigations.

The article discusses the study of thromboembolism in warfarin cessation. It is implied that patients are often asked to refrain from taking warfarin for a short duration while they undergo an elective procedure such as ophthalmic surgery and colonoscopy because of the risk of thromboembolism and bleeding. Results of the study show a low risk of thromboembolism from warfarin stoppage and a high risk of bleeding for patients taking parenteral heparin while undergoing an elective procedure.

The article discusses the study of real world primary percutaneous intervention (PPCI) strategy applied to ST-elevation myocardial infarction (STEMI) patients. It was initiated by the cardiologists in Ottawa, Canada who referred STEMI patients to PPCI center wherein they were evaluated by advanced care paramedics and hospitals in the city. Results suggest that real world primary PCI strategy may minimize the effect on time to reperfusion and door-to-balloon times.

The article discusses the delay in defibrillation after in-hospital cardiac arrest. The association between delayed defibrillation and survival to hospital discharge was evaluated and studied using 369 hospitals participating in the National Registry of Cardiopulmonary Resuscitation. The findings suggested that rapid defibrillation is connected with relevant survival gains and also identified the graded relationship between poor survival and prolonged time to defibrillation.

A list of articles related to cardiology that were published in several journals is presented including "N-acetylcysteine and Contrast-induced Nephropathy in Primary Angioplasty," by G. Marenzi, E. Assanelli, and I. Marana and "Association of Parental Heart Failure With Risk of Heart Failure in Offspring," by D.S. Lee, M.J. Penciana, and E.J. Benjamin.

The article presents several studies dealing with ischaemic heart disease in Great Britain. The Euro Heart survey was set out to investigate the prognosis associated with stable angina. Meta-analysis on the administration of aspirin in patient without cardiovascular disease is presented in this article. The amino acid L-arginine is a substrate for nitric oxide synthase has the potential to reduce vascular stiffness.

The article investigates the use of angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB) in treating renal disease. Conventional wisdom suggests a specific benefit for ACE inhibitors and ARB in patients with diabetes or renal disease who have hypertension. Comparisons of ACE inhibitors or ARB with other antihypertensive drugs yielded a relative risk for doubling of creatinine and a small benefit on end stage renal disease.

The article focuses on CHARM, a double blind, randomized, controlled clinical trial, comparing the effects of the angiotensin receptor blocker candesartan with placebo in patients with chronic heart failure. The findings suggests that adherence is a marker for adherence to effective treatments other than study medications, or to other adherence behaviors that affect the outcome.

This article focuses on a meta-analysis of exercise training in heart failure that saves lives. In health taking more exercise is associated with better prognosis, the same should hold true when you are not healthy. Single studies of exercise in heart failure have not been powered to show reduced mortality. Results imply a number needed to treat of 17 to prevent one death in two years.

This article reports on some developments in research related to ischaemic heart disease. In a meta-analysis of 12 trials, low molecular weight heparin was associated with a non-significant decrease in recurrent symptomatic venous thromboembolism at the end of treatment. Warfarin for six months removes atrial appendage thrombus in 25%. The emergency room of a large hospital sees a lot of chest pain patients. Sorting the wheat from the chaff is easier with troponin measurements, but is still a problem.

Daprodustat is a hypoxia‐inducible factor‐prolyl hydroxylase inhibitor in development for treatment of anemia of chronic kidney disease. We evaluated the role of hepatic impairment on daprodustat pharmacokinetics, pharmacodynamics, and tolerability. Participants with mild (Child‐Pugh Class A, score 5‒6) and moderate (Child‐Pugh Class B, score 7‒9) hepatic impairment and matched healthy controls were administered single 6‐mg doses of daprodustat. Exposure parameters were determined for daprodustat and its six metabolites. Comparisons resulted in 1.5‐ and 2.0‐fold higher daprodustat Cmax and area under the curve (AUC) exposures in participants with mild and moderate hepatic impairment, respectively, versus controls; Cmax in mild hepatic impairment was comparable to controls. Similarly, aligned with parent drug, unbound daprodustat Cmax and AUC exposures increased 1.6‐ to 2.3‐fold in hepatic‐impaired participants versus controls, and metabolite exposures were 1.2‐ to 2.0‐fold higher in participants with hepatic impairment. Erythropoeitin (EPO) baseline‐corrected AUC exposures were between 0.3‐fold lower and 2.2‐fold higher in matched controls versus hepatic‐impaired participants. No serious or study drug‐related adverse events were reported. Daprodustat exposure was increased in participants with moderate and mild hepatic impairment compared with matched controls; however, no meaningful differences in EPO were observed and no new safety concerns were identified (ClinicalTrials.gov: NCT03223337). [ABSTRACT FROM AUTHOR]

Abstract: Neurohumoral activation, in which enhanced activity of the autonomic nervous system (ANS) is a key component, plays a pivotal role in heart failure. The neurohumoral system affects several organs and currently our knowledge of the molecular and systemic pathways involved in the neurohumoral activation is incomplete. All the methods of assessing the degree of activation of the autonomic system have limitations and they are not interchangeable. The methods considered include noradrenaline spillover, microneurography, radiotracer imaging and analysis of heart rate and blood pressure (heart rate variability, baroreceptor sensitivity, heart rate turbulence). Despite the difficulties, medications that affect the ANS have been shown to improve mortality in heart failure and the mechanism is related to attenuation of the sympathetic nervous system (SNS) and stimulation of the parasympathetic nervous system. However, limitations of compliance with medication, side effects and inadequate SNS attenuation are issues of concern with the pharmacological approach. The newer device based therapies for sympathetic modulation are showing encouraging results. As they directly influence the autonomic nervous system, more mechanistic information can be gleaned if appropriate investigations are performed at the time of the outcome trials. However, clinicians should be reminded that the ANS is an evolutionary survival mechanism and therefore there is a need to proceed with caution when trying to completely attenuate its effects. So our enthusiasm for the application of these devices in heart failure should be controlled, especially as none of the devices have trial data powered to assess effects on mortality or cardiovascular events. [Copyright &y& Elsevier]

Daprodustat, an oral hypoxia‐inducible factor prolyl hydroxylase inhibitor, is being investigated for treatment of anemia in chronic kidney disease. This phase 1, nonrandomized, 2‐period, crossover study in 6 healthy men characterized the absorption, distribution, and excretion of daprodustat when administered as oral and intravenous (IV) doses of unlabeled and radiolabeled daprodustat ([14C]‐GSK1278863). Tolerability and pharmacokinetic properties of daprodustat, and its 6 metabolites in the systemic circulation, were also evaluated. The mean recovery of radiolabeled daprodustat was ≈95% by day 5, with the majority in feces and minor renal elimination, indicating that daprodustat and metabolites are primarily eliminated via hepatobiliary and fecal routes. Approximately 40% of total circulating radioactivity in plasma following both IV and oral administration was daprodustat; thus, 60% was attributed to metabolites. It was estimated that ≈80% of daprodustat was absorbed across the gastrointestinal tract, and ≈18% cleared by hepatic extraction. Pharmacokinetics were essentially dose proportional, with moderate (≈66%) oral tablet bioavailability. Following IV administration, daprodustat plasma clearance (19.3 L/h) and volume of distribution (14.6 L) were low, suggesting low tissue distribution outside systemic circulation with likely low penetration into tissues. Daprodustat was generally well tolerated, with no deaths or serious or significant adverse events reported. [ABSTRACT FROM AUTHOR]