Therapy for Renal Artery Stenosis: A Call for Change.

CLINICAL IMPACT: We present a brief case description of a patient who benefitted from stenting in ARAS and provide a comprehensive review of ARAS; its prevalence, pathophysiology, clinical manifestations, diagnosis and treatment. We review the evidence for and against stenting in ARAS as well as consensus guidelines for stenting. Our review is valuable as we argue that stenting in ARAS is underutilized and the randomized control data for stenting in those patients who may benefit most is lacking. Our review will provide an important perspective for clinicians faced with decisions of how to treat ARAS.

Investigating Lipid-Modulating Agents for Prevention or Treatment of COVID-19: JACC State-of-the-Art Review.

Coronavirus disease-2019 (COVID-19) is associated with systemic inflammation, endothelial activation, and multiorgan manifestations. Lipid-modulating agents may be useful in treating patients with COVID-19. These agents may inhibit viral entry by lipid raft disruption or ameliorate the inflammatory response and endothelial activation. In addition, dyslipidemia with lower high-density lipoprotein cholesterol and higher triglyceride levels portend worse outcomes in patients with COVID-19. Upon a systematic search, 40 randomized controlled trials (RCTs) with lipid-modulating agents were identified, including 17 statin trials, 14 omega-3 fatty acids RCTs, 3 fibrate RCTs, 5 niacin RCTs, and 1 dalcetrapib RCT for the management or prevention of COVID-19. From these 40 RCTs, only 2 have reported preliminary results, and most others are ongoing. This paper summarizes the ongoing or completed RCTs of lipid-modulating agents in COVID-19 and the implications of these trials for patient management.

Lipid-Modulating Agents for Prevention or Treatment of COVID-19 in Randomized Trials.

Coronavirus disease 2019 (COVID-19) is associated with systemic inflammation, endothelial activation, and multi-organ manifestations. Lipid modulating agents may be useful in treating patients with COVID-19. They may inhibit viral entry by lipid raft disruption or ameliorate the inflammatory response and endothelial activation. In addition, dyslipidemia with lower high-density lipoprotein cholesterol and higher triglycerides portends worse outcome in patients with COVID-19. Upon a systematic search, 40 RCTs with lipid modulating agents were identified, including 17 statin trials, 14 omega-3 fatty acids RCTs, 3 fibrates RCTs, 5 niacin RCTs, and 1 dalcetrapib RCT for management or prevention of COVID-19. This manuscript summarizes the ongoing or completed randomized controlled trials (RCTs) of lipid modulating agents in COVID-19 and the implications of these trials for patient management.

Pharmacological Agents Targeting Thromboinflammation in COVID-19: Review and Implications for Future Research.

Coronavirus disease 2019 (COVID-19), currently a worldwide pandemic, is a viral illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The suspected contribution of thrombotic events to morbidity and mortality in COVID-19 patients has prompted a search for novel potential options for preventing COVID-19-associated thrombotic disease. In this article by the Global COVID-19 Thrombosis Collaborative Group, we describe novel dosing approaches for commonly used antithrombotic agents (especially heparin-based regimens) and the potential use of less widely used antithrombotic drugs in the absence of confirmed thrombosis. Although these therapies may have direct antithrombotic effects, other mechanisms of action, including anti-inflammatory or antiviral effects, have been postulated. Based on survey results from this group of authors, we suggest research priorities for specific agents and subgroups of patients with COVID-19. Further, we review other agents, including immunomodulators, that may have antithrombotic properties. It is our hope that the present document will encourage and stimulate future prospective studies and randomized trials to study the safety, efficacy, and optimal use of these agents for prevention or management of thrombosis in COVID-19.

COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-Up: JACC State-of-the-Art Review.

Coronavirus disease-2019 (COVID-19), a viral respiratory illness caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), may predispose patients to thrombotic disease, both in the venous and arterial circulations, because of excessive inflammation, platelet activation, endothelial dysfunction, and stasis. In addition, many patients receiving antithrombotic therapy for thrombotic disease may develop COVID-19, which can have implications for choice, dosing, and laboratory monitoring of antithrombotic therapy. Moreover, during a time with much focus on COVID-19, it is critical to consider how to optimize the available technology to care for patients without COVID-19 who have thrombotic disease. Herein, the authors review the current understanding of the pathogenesis, epidemiology, management, and outcomes of patients with COVID-19 who develop venous or arterial thrombosis, of those with pre-existing thrombotic disease who develop COVID-19, or those who need prevention or care for their thrombotic disease during the COVID-19 pandemic.

Changes in atrial fibrillation admissions following daylight saving time transitions.

BACKGROUND: Daylight saving time (DST) imposes a twice-yearly hour shift. The transitions to and from DST are associated with decreases in sleep quality and environmental hazards. Detrimental health effects include increased incidence of acute myocardial infarction (MI) following the springtime transition and increased ischemic stroke following both DST transitions. Conditions effecting sleep are known to provoke atrial fibrillation (AF), however the effect of DST transitions on AF are unknown. METHODS: Admitted patients aged 18-100 with primary ICD9 code of AF between 2009 and 2016 were included. The number of admissions was compiled and means were compared for the Monday to Thursday period and the entire seven day interval following each DST transition and the entire year for the entire cohort and separated by gender. Significance was determined with Wilcoxon nonparametric tests. RESULTS: Admission data for 6089 patients were included, with mean age of 68 years and 53% female. A significant increase was found in mean AF admissions over the Monday to Thursday period (3.09 vs 2.47 admissions/day [adm/d], P = 0.017) and entire week (2.48 vs 2.09 adm/d, P = 0.025) following the DST spring transition compared to the yearly mean. When separated by gender, women exhibited an increase in AF admissions following the DST spring transition (1.78 vs 1.28 adm/d for Monday to Thursday period, P = 0.036 and 1.38 vs 1.11 adm/d for entire week, P = 0.050) while a non-significant increase was seen in men. No significant differences were found following the autumn transition for the entire cohort or when separated by gender. CONCLUSION: An increase in AF hospital admissions was found following the DST springtime transition. When separated by gender, this finding persisted only among women. This finding adds to evidence of negative health effects associated with DST transitions and factors that contribute to AF episodes.