RESUMEN
Type 2 diabetes mellitus is a metabolic condition where vascular inflammation and oxidative stress contribute to disease progression and associated complications. Although statins are recommended for managing dyslipidemia in diabetes, additional therapies are often required to achieve target lipid levels. This meta-analysis aimed to evaluate the efficacy of rosuvastatin monotherapy versus combination therapy with ezetimibe in patients with type 2 diabetes. A systematic literature search was conducted across multiple databases until April 2024, identifying six randomized controlled trials meeting the inclusion criteria. The meta-analysis revealed that the rosuvastatin plus ezetimibe combination resulted in significantly greater reductions in total cholesterol (mean difference, or MD: 19.49; 95% CI: 13.99 to 24.99), triglycerides (MD: 13.44; 95% CI: 2.04 to 24.85), and low-density lipoprotein cholesterol (MD: -17.68; 95% CI: 12.85 to 22.51) compared to rosuvastatin monotherapy. Conversely, rosuvastatin monotherapy achieved a greater reduction in HbA1c levels (MD: -0.11; 95% CI: -0.17 to -0.04). Subgroup analysis demonstrated that using the same dose of rosuvastatin in both groups led to more significant improvements in lipid parameters with lower heterogeneity. The findings suggest that the rosuvastatin-ezetimibe combination may be a more effective lipid-lowering strategy for patients with type 2 diabetes, though larger studies are needed to assess long-term safety and optimal dosing. Additionally, while rosuvastatin monotherapy provided modest HbA1c reductions, the clinical relevance remains uncertain, and potential risks with high-dose statins should be considered.
RESUMEN
Myocardial infarction (MI), a leading cause of morbidity and mortality globally, is characterized by an underlying inflammatory process driven by atherosclerosis. The neutrophil-to-lymphocyte ratio (NLR), a readily available and cost-effective marker of systemic inflammation, has emerged as a potential predictor of adverse outcomes in patients with MI. This meta-analysis aimed to evaluate the association between elevated NLR and the risk of major adverse cardiovascular events (MACE) and all-cause mortality in patients with MI. A comprehensive literature search was conducted across multiple databases, including Embase, Web of Science, PubMed, and OVID Medicine, to identify relevant studies published from January 1, 2011, onward. Studies reporting the effect of NLR values on MACE and mortality in adult patients with MI, including both ST-elevation (STEMI) and non-ST-elevation (NSTEMI) subtypes, were included. Data extraction and quality assessment were performed independently by multiple authors. The meta-analysis included 37 studies, comprising a total of 18 studies evaluating the risk of MACE and 30 studies assessing all-cause mortality. The pooled analysis revealed a significantly increased risk of MACE (odds ratio [OR] 1.86, 95% confidence interval [CI] 1.53-2.28, P < 0.01) and all-cause mortality (OR 2.29, 95% CI 1.94-2.70, P < 0.01) in patients with elevated NLR compared to those without elevated NLR. Subgroup analyses stratified by follow-up duration and study design further supported the consistent association between elevated NLR and adverse outcomes. In conclusion, this meta-analysis demonstrates a significant association between elevated NLR and an increased risk of MACE and all-cause mortality in patients with MI. These findings highlight the potential clinical utility of NLR as a prognostic marker and underscore the importance of further research to validate its predictive value and establish optimal cutoff values for risk stratification in this patient population.
RESUMEN
Patients with atrial fibrillation and concurrent liver cirrhosis have been excluded from major clinical trials evaluating direct oral anticoagulants (DOACs) due to safety concerns. This has led to uncertainty regarding the optimal anticoagulant therapy in this population at high risk of thromboembolic events. We conducted a systematic review and meta-analysis to compare the effectiveness and safety of DOACs versus vitamin K antagonists (VKAs) in patients with atrial fibrillation and liver cirrhosis. Databases including Embase, MEDLINE/PubMed, and Web of Science were searched for relevant studies. The primary effectiveness outcome was stroke or systemic embolism, and the safety outcome was major bleeding events. A total of 10 studies were included in the meta-analysis. Compared to VKAs, the use of DOACs was associated with a significantly lower risk of stroke or systemic embolism (RR: 0.78, 95% CI: 0.65-0.92, p=0.005). The risk of all-cause mortality was comparable between the two groups (RR: 0.89, 95% CI: 0.74-1.07, p=0.23). Notably, DOACs demonstrated a significantly lower risk of major bleeding events (RR: 0.67, 95% CI: 0.61-0.73, p<0.01) compared to VKAs. This meta-analysis suggests that DOACs may be a favorable alternative to VKAs for the prevention of thromboembolic events in patients with atrial fibrillation and liver cirrhosis, with a lower risk of stroke or systemic embolism and major bleeding. However, further research is needed to establish optimal dosing strategies and assess the safety and efficacy of DOACs in patients with advanced liver disease.
RESUMEN
Atrial fibrillation (AF) is a cardiac condition characterized by an irregular heart rhythm, which is increasingly prevalent in the modern era. All international guidelines strongly advise the administration of anticoagulants to individuals with AF who are at high risk of stroke. These guidelines recommend the use of direct oral anticoagulants (DOACs) over warfarin because warfarin is significantly associated with increased rates of major bleeding, numerous interactions with food and drugs, and the necessity for frequent monitoring. The aim of this study is to compare the effectiveness and safety of direct oral anticoagulants (DOACs) in obese patients with atrial fibrillation. Two authors independently conducted a comprehensive literature search using electronic databases including PubMed, CINAHL, and EMBASE from inception to June 1, 2023. The efficacy outcome assessed in this meta-analysis included the composite of stroke and systemic embolism. For safety analysis, major bleeding events were compared among the study groups. Eleven studies fulfilled all the inclusion criteria and were included in the present meta-analysis enrolling 144,502 patients. In this study, DOACs demonstrate superior efficacy in preventing stroke/systemic embolism compared to warfarin. Among the DOACs, apixaban emerged as the most effective, followed by rivaroxaban, warfarin, and dabigatran. In terms of safety, apixaban was also found to be the most favorable treatment option, followed by rivaroxaban, dabigatran, and warfarin. In summary, our study concludes that apixaban exhibited greater effectiveness and safety when compared to other DOACs and warfarin in obese patients with AF.
RESUMEN
The aim of this study was to determine the effect of liraglutide on cardiac function in individuals with type 2 diabetes. The present meta-analysis aimed to identify studies testing liraglutide in individuals with type 2 diabetes. We included observational and randomized controlled trials comparing liraglutide with placebo or any other drug alone or in combination with other drugs. A comprehensive search was carried out using online databases including PubMed, Google Scholar, and Cochrane Library to find relevant studies from inception to June 30, 2023, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Key terms used to search for relevant studies included "liraglutide," "cardiac function," and "type 2 diabetes," along with their synonyms and Medical Subject Heading (MeSH) terms. The outcomes assessed in the present meta-analysis included diastolic cardiac function and systolic cardiac function. For diastolic cardiac function, we assessed the E to A (E/A) ratio and the E to Ea (E/Ea) ratio. To assess the impact of liraglutide on systolic function, we assessed stroke volume in mL, left ventricular ejection fraction (LVEF) in %, cardiac output in L/min, and cardiac index in L/min/m². A total of seven studies were included, with a pooled sample size of 307 individuals (160 in the liraglutide group and 147 in the control group). The results indicated that liraglutide significantly reduced the E/A ratio (mean difference [MD]: -0.22, 95% CI: -0.38 to -0.06, p-value: 0.008) and E/Ea ratio (MD: -0.76, 95% confidence interval (CI): -1.39 to -0.12, p-value: 0.02, suggesting a potential clinical benefit on ventricular diastolic function. However, there was no significant impact on LVEF (MD: 0.46, 95% CI: -3.13 to 4.05, p-value: 0.80), cardiac output (MD: 0.05, 95% CI: -0.39 to 0.49), cardiac index (MD: 0.07, 95% CI: -0.18 to 0.32), and stroke volume (MD: -5.34, 95% CI: -14.81 to 4.12), indicating that liraglutide did not improve systolic function.
RESUMEN
A 69-year-old woman was airlifted to the emergency department after awakening with angina, diaphoresis, and shortness of breath. She was found to have ST-elevation myocardial infarction with 100% occlusion of her left anterior descending artery, and aspiration thrombectomy was performed. Blood cultures confirmed Enterococcus faecalis bacteremia. Our team used a clinical tool to determine whether transesophageal echocardiography was warranted to investigate for infective endocarditis. The patient's transesophageal echocardiogram showed a large mobile vegetation on her mitral valve. Given the presence of infective endocarditis in the absence of known coronary artery disease, we determined that the patient had likely developed acute coronary syndrome from a septic embolus originating from her mitral valve vegetation. Further investigation for the source of the bacteremia revealed a perforation 20 cm from the anal verge at the rectosigmoid junction. After perforation repair, the patient became hypoxic and tachycardic with diffuse abdominal pain, guarding, rebound tenderness, and loss of pulse. Exploratory laparotomy revealed air in the mesentery consistent with extraperitoneal perforation of the rectum, and an end-colostomy was performed. Unfortunately, the patient subsequently died.
