Proton pump inhibitors and gastroprotection in patients treated with antithrombotic drugs: A cardiologic point of view

Aspirin,other antiplatelet agents,and anticoagulant drugs are used across a wide spectrum of cardiovascular and cerebrovascular diseases.A concomitant proton pump inhibitor(PPI)treatment is often prescribed in these patients,as gastrointestinal complications are relatively frequent.On the other hand,a potential increased risk of cardiovascular events has been suggested in patients treated with PPIs;in particular,it has been discussed whether these drugs may reduce the cardiovascular protection of clopidogrel,due to pharmacodynamic and pharmacokinetic interactions through hepatic metabolism.Previously,the concomitant use of clopidogrel and omeprazole or esomeprazole has been discouraged.In contrast,it remains less known whether PPI use may affect the clinical efficacy of ticagrelor and prasugrel,new P2Y12 receptor antagonists.Current guidelines recommend PPI use in combination with antiplatelet treatment in patients with risk factors for gastrointestinal bleeding,including advanced age,concurrent use of anticoagulants,steroids,or non-steroidal anti-inflammatory drugs,and Helicobacter pylori(H.pylori)infection.In patients taking oral anticoagulant with risk factors for gastrointestinal bleeding,PPIs could be recommended,even if their usefulness deserves further data.H.pylori infection should always be investigated and treated in patients with a history of peptic ulcer disease(with or without complication)treated with antithrombotic drugs.The present review summarizes the current knowledge regarding the widespread combined use of platelet inhibitors,anticoagulants,and PPIs,discussing consequent clinical implications.

Experience of a Single Center in the Diagnosis and Classification of Cases of Left Ventricular Noncompaction

Objectives: To analyse the clinical profile of consecutive cases of Left Ventricular Non Compaction (LVNC) with particular interest in non-compacted segments valuation. Methods: There were 18,000 patients seen from 2007 to 2010, with a complete evaluation including family history and personal cardiac history, clinical examination and electrocardiography. Diagnosis was based on three published definitions. Results: The diagnosis of LVNC was placed in 1.4% of cases. Clinical and echo-cardiographic data for the 250 cases of LVNC are presented. Trabecular meshwork was observed predominantly at the apex (91.6%), in the lateral and inferior wall (40.4% and 38.0% respectively), and less frequently in the posterior and anterior wall (21.6% and 9.2% respectively). Conclusions: This study suggests that LVNC is a form of cardiomyopathy with higher prevalence and relatively better prognosis than previously reported.

Burden of Cardiometabolic Risk Factors on Cerebrovascular Events in a Southern Italian Population

Background: Stroke is the second leading cause of death in the world and the third due to disability. However, there are few data available that identify the risk factors associated with it and their weight in different populations (population risk). Aim: Contribute to the knowledge of burden risk factors in stroke in a large cohort of Southern Italy. Methods: The data refer to a randomized Campania cohort of 1200 subjects (35 - 74 years) enrolled in 2008-09. Ten years later (2018-19) they were re-evaluated. We analyzed data from 32 patients who reported a cerebrovascular event (stroke or TIA) with the event-free group of subjects (804 subjects: 378 men and 426 women). We evaluated: absolute risk, Odds Ratio (OR), Additional Risk (AR), Risk Attributable to the Population (PAR) and, finally, the Population Attributable risk Fraction (FAP). Results: In the comparison between the two groups (patients with events and patients without events) the risk factors with statistically significant differences were: age, Systolic Blood Pressure (SBP), BMI, cholesterol, triglycerides, glycemia and hyperinsulinemia. The ORs with the greatest impact were: blood glucose (5.1), BMI (3.3) and BPS (2.9). Linear regression analysis identified Glycemia and BMI as the only independent variables. The FAPs with the greatest impact were SBP (47.4%) and BMI (42.6%). Discussion and Conclusions: Our data confirm that the high incidence of stroke in Campania is particularly related to the high prevalence of obesity and hypertension. In the single patient, however, the risk factors with the greatest impact are: glycaemia BMI an SBP.

Climatic influences on cardiovascular diseases

Classical risk factors only partially account for variations in cardiovascular disease incidence;therefore,also other so far unknown features,among which meteorological factors,may influence heart diseases(mainly coronary heart diseases,but also heart failure,arrhythmias,aortic dissection and stroke)rates.The most studied phenomenon is ambient temperature.The relation between mortality,as well as cardiovascular diseases incidence,and temperature appears graphically as a"U"shape.Exposure to cold,heat and heat waves is associated with an increased risk of acute coronary syndromes.Other climatic variables,such as humidity,atmospheric pressure,sunlight hours,wind strength and direction and rain/snow precipitations have been hypothesized as related to fatal and nonfatal cardiovascular diseases incidence.Main limitation of these studies is the unavailability of data on individual exposure to weather parameters.Effects of weather may vary depending on other factors,such as population disease profile and age structure.Climatic stress may increase direct and indirect risks to human health via different,complex pathophysiological pathways and exogenous and endogenous mechanisms.These data have attracted growing interest because of the recent earth’s climate change,with consequent increasing ambient temperatures and climatic fluctuations.This review evaluates the evidence base for cardiac health consequences of climate conditions,and it also explores potential further implications.

Time trends in antithrombotic therapy prescription patterns: Realworld monocentric study in hospitalized patients with atrial fibrillation

BACKGROUND Since 2010,the European Society of Cardiology has extended prescription criteria for oral antithrombotic therapy(OAT)in atrial fibrillation(AF).Direct oral anticoagulants(DOACs)were upgraded from an IIAa recommendation in 2012 to an IA in 2016.In real-world scenarios,however,OAC prescription is still suboptimal,mainly for DOACs.AIM To evaluate OAT temporal prescription patterns in a cohort of patients hospitalized with AF in a Cardiology Department.METHODS A retrospective observational study was conducted on a cohort of hospitalized patients in a secondary setting(Trapani,Italy)from 2010 to 2021 with AF as the main or secondary diagnosis.For 4089 consecutive patients,the variables extracted from the Cardiology department database were:Sex,age,time of hospitalization,antithrombotic therapy(warfarin,acenocoumarol,apixaban,dabigatran,edoxaban,rivaroxaban,aspirin,clopidogrel,other antiplatelet agents,low molecular weight heparin,and fondaparinux),diagnosis at discharge and used resources.Basal features are presented as percentage values for categorized variables and as mean+/-SD for categorized once.RESULTS From January 1st,2010 to October 6th,2021,25132 patients were hospitalized in our department;4089(16.27%,mean age 75.59+/-10.82)were discharged with AF diagnosis;of them,2245 were males(54.81%,mean age 73.56+/-11.45)and 1851 females(45.19%,mean age 78.06+/-9.47).Average length of stay was 5.76+/-4.88 days;154 patients died and 88 were moved to other Departments/Structures.AF was the main diagnosis in 899 patients(21.94%).The most frequent main diagnosis in patients with AF was acute myocardial infarction(1973 discharges,48.19%).The most frequent secondary cardiac diagnosis was chronic coronary syndrome(1864 discharges,45.51%),and the most frequent secondary associated condition was arterial hypertension(1010 discharges,24.66%).For the analysis of antithrombotic treatments,the final sample included 3067 patients,after excluding in-hospital deaths,transferred out or self-discharged patients,as well as discharges lacking indications for prescribed treatments.OAC treatment increased significantly(35.63%in 2010-2012 vs 61.18%in 2019-2021,+25.55%,P<0.0001),in spite of any antiplatelet agent use.This rise was due to increasing use of DOACs,with or without antiplatelet agents,from 3.04%in 2013-2015 to 50.06%in 2019-2021(+47.02%,P<0.0001)and was greater for factor Xa inhibitors,especially apixaban.In addition,treatment with a vitamin K antagonist,in spite of any antiplatelet agent use,decreased from 35.63%in 2010-2012 to 11.12%in 2019-2021(-24.48%,P<0.0001),as well as any antiplatelet therapy,alone or in double combination,(49.18%in 2010-2012 vs 34.18%in 2019-2021,-15.00%,P<0.0001);and patients not receiving antithrombotic therapy declined with time(14.58%in 2010-2012 vs 1.97%in 2021,P<0.0001).CONCLUSION Real-world patients with AF are elderly and affected by cardiovascular and non-cardiovascular diseases.The percentage of patients on OAT and DOACs increased.These data suggest a slow,gradual guidelines implementation process.