Betablockers and clinical outcome after surgical aortic valve replacement: a report from the SWEDEHEART registry.

OBJECTIVES: Previous reports suggest that betablockers appear non-beneficial after surgical aortic valve replacement (SAVR). This study aims to clarify the associations between betablockers and long-term outcome after SAVR. METHODS: All patients with isolated SAVR due to aortic stenosis in Sweden between 2006 and 2020, alive at 6 months after surgery, were included. Patients were identified in the SWEDEHEART registry, and records were merged with data from 3 other mandatory national registries. Association between dispensed betablockers and major adverse cardiovascular events (MACE) (all-cause mortality, myocardial infarction and stroke) was analyzed using Cox proportional hazards models, with time-updated data on medication and adjusted for age, sex and comorbidities at baseline. RESULTS: In total, 11 849 patients were included [median follow-up 5.4 years (range 0-13.5)]. Betablockers were prescribed to 79.7% of patients at baseline, decreasing to 62.2% after 5 years. Continuing treatment was associated with higher risk of MACE [adjusted hazard ratio 1.14 (95% confidence interval, CI 1.05-1.23)]. The association was consistent over subgroups based on age, sex and comorbidities except atrial fibrillation [hazard ratio (HR) 1.05 (95% CI 0.93-1.19)]. A sensitivity analysis including time-updated data on comorbidites attenuated the difference between the groups [HR 1.04 (95% CI 0.95-1.14, P = 0.33)]. CONCLUSIONS: Treatment with betablockers did not appear to be associated with inferior long-term outcome after SAVR, when adjusting for new concomitant diseases. Thus, it is likely that it is the underlying cardiac diseases that are associated with MACE rather than betablocker treatment.

Evaluation of the Nutritional Knowledge in Relation to Secondary Prevention Among Doctors and Nurses in the Northern of Morocco: A Cross-Sectional Study.

BACKGROUND:  Morocco is a country that has been experiencing an epidemiological and health transition characterized by a change in lifestyle and an increase in mortality for non-communicable diseases (NCDs). The objective of this study is to evaluate the nutritional knowledge in relation to secondary prevention of doctors and nurses working in the hospital and primary healthcare centers in Morocco. Specific knowledge about nutrition for diabetes, for high blood pressure and high cholesterol, for functional colopathy, for iron deficiency anemia, for vitamin B12 deficiency, for overweight and for hyperuricemia or gout attack were evaluated. MATERIALS AND METHODS:  Cross-sectional exploratory study carried out between June and December 2022, using a self-administered questionnaire developed on the basis of similar studies and the several standardized nutrition guides. A random cluster survey included 238 nurses and 131 doctors working in health centers and 234 nurses and 54 doctors working in hospitals. Statistical analyses were carried out using SPSS version 21.0 software, the Kolmogorov-Smirnov test, the Mann Whitney test, and Spearmen's correlation. Multiple linear regression analysis was used to explore the most significant sociodemographic variables. RESULTS:  Among the seven nutritional content areas assessed in this study, we found that among doctors, the nutrition axis for high blood pressure and high cholesterol had the median correct response score of (0.57 interquartile range (IQR) (0.28, 0.71)). The same for nurse, but with the lower scores ((0.28 IQR (0, 0.43)) , (0.28 IQR (0.07, 0.42)) respectively). Our results do not reveal any statistically significant association of the median of total score of answers of both health professionals (nurses or of doctors) with their gender (p=0.383). However, they were significantly associated with basic training (p<0.001), continuous training (p=0.002), receiving information on nutrition (p=0.018), and their age (p=0.016). CONCLUSIONS AND IMPLICATIONS: In conclusion, this study highlighted the major gaps in the nutritional knowledge of doctors and nurses regarding secondary prevention of NCDs. However, they should undergo continuing nutrition education programs to ensure safe and sound nutritional advice not only to patients but also to the public. Furthermore, policymakers should devote systematic efforts to nutrition education during basic training in medical and nursing schools, which will provide doctors and nurses with adequate training.

Prevention of rheumatoid arthritis using a familial predictive medicine approach.

Most of the chronic-degenerative diseases deserve a very early recognition of symptoms and signs for the earliest secondary prevention, which could be also very useful in many cases for the most precocious clinical approach. The periodic monitoring of a subject at risk of a specific disease, because of genomic predisposition by predictive medicine approach, may help to earlier detection of onset and/or the progression of the pathology itself, through intra-individual monitoring. This is particularly the case of rheumatoid arthritis (RA) for which an early diagnosis is undoubtedly the first step to ensure the most proper therapy for the patient. Thus, the earlier identification of individuals at high risk of RA could lead to ultra-preventive strategies to start for the best lifestyle performances and/or for any other effective therapeutic interventions to contrast the onset, and/or the evolution of the putative RA. This will also optimize both costs and medical resources, according to the health care policies of many countries.

Lipoprotein Apheresis: Utility, Outcomes, and Implementation in Clinical Practice: A Scientific Statement From the American Heart Association.

Despite the availability of multiple classes of lipoprotein-lowering medications, some high-risk patients have persistent hypercholesterolemia and may require nonpharmacologic therapy. Lipoprotein apheresis (LA) is a valuable but underused adjunctive therapeutic option for low-density lipoprotein cholesterol and lipoprotein(a) lowering, particularly in children and adults with familial hypercholesterolemia. In addition to lipid lowering, LA reduces serum levels of proinflammatory and prothrombotic factors, reduces blood viscosity, increases microvascular myocardial perfusion, and may provide beneficial effects on endothelial function. Multiple observational studies demonstrate strong evidence for improved cardiovascular outcomes with LA; however, use in the United States is limited to a fraction of its Food and Drug Administration-approved indications. In addition, there are limited data regarding LA benefit for refractory focal segmental glomerulosclerosis. In this scientific statement, we review the history of LA, mechanisms of action, cardiovascular and renal outcomes data, indications, and options for treatment.

Barriers and facilitators for adherence to follow-up by HR-HPV-positive women with premalignant cervical lesions: a mixed-design study in Mexico.

BACKGROUND: Mexico reports low follow-up completion rates among women with abnormal cervical cancer screenings. This study aimed to identify barriers and facilitators to follow-up adherence among women with human papillomavirus (HPV) infection and premalignant cervical lesions in Mexico. METHODS: A mixed-methods study was conducted from February to April 2019. Participants included women undergoing follow-up care for high-risk human papillomavirus (HR-HPV) and premalignant lesions, along with health personnel from the Women's Healthcare Center (CAPASAM) in Mexico. Quantitative data were obtained from the Women's Cancer Information System and through a questionnaire about factors affecting follow-up adherence. Additionally, the health personnel involved completed a compliance checklist regarding care regulations. Descriptive statistics were used for analysis. Qualitative data were collected via semi-structured interviews with both groups, followed by a content analysis based on identified categories. The Hazard Analysis and Critical Control Point System confirmed care process risks. Proposals to enhance the Early Detection Program for Prevention and Control of Cervical Cancer were collected from a CAPASAM health personnel nominal group. RESULTS: Identified barriers to follow-up included low income among CAPASAM users, family provider roles limiting time for appointments, long waits for testing and results delivery, distant facilities, insufficient service hour communication, inadequate health personnel training, and a lack of systematic counseling. Hesitation toward follow-up was also linked to shame, apprehension, uncertainty, test aversion, fear of positive results, and limited cervical cancer and screening knowledge. Patriarchal attitudes of partners and limited access to the now-discontinued PROSPERA government program further discouraged follow-up. Facilitators comprised respectful treatment by CAPASAM staff, no-cost services, health campaigns, and positive user attitudes. CONCLUSIONS: The study found more barriers than facilitators to follow-up adherence, highlighting the need for strategies to bolster the Early Detection Program. Future strategies must address the comprehensive array of factors and incorporate stakeholder perspectives.

PCSK9 Inhibitors: Is the Time Ripe for the "Fast Track" Use Independently on the LDL-C Baseline Values in Acute Coronary Syndrome?

The low-density lipoprotein cholesterol (LDL-C) lowering decreases the risk to develop major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS). Therefore, the "fast track" use of PCSK9 inhibitors (PCSK9i) has been introduced in ACS patients not achieving LDL-C target (70 mg/dl) despite an ongoing lipid lowering therapy with statin at maximum tolerated dosage plus ezetimibe or stain-naïve (LDL-C > 130 mg/dl). PCSK9i "fast track" use has shown to achieve the regression of "non-culprit" atherosclerotic plaques leading to a further MACE decrease. Interestingly, it has been also hypothesized a role of PCSK9i beyond the LDL-C lowering in ACS. PCSK9i have been demonstrated to decrease the inflammation of atherosclerotic plaques and myocardium, inhibit platelet aggregation, and improve the cardiomyocyte survival against the reperfusion injury. All these findings may positively impact on the prognosis and suggest the PCSK9i use in the acute phase of ACS independently on the baseline LDL-C values.

Eligibility for marine omega-3 fatty acid supplementation after acute coronary syndromes.

Background and aims: The 2019 European Society of Cardiology guidelines for the management of dyslipidemia consider the use of high-dose marine omega-3 fatty acid (FA) eicosapentaenoic acid (EPA) supplementation (icosapent ethyl 2 × 2g/day) to lower residual cardiovascular risk in high-risk patients with hypertriglyceridemia. This study aimed to assess the eligibility for omega-3 FA-EPA supplementation in patients with acute coronary syndromes (ACS). Methods: In a prospective Swiss cohort of patients hospitalized for ACS, eligibility for marine omega-3 FA-EPA, defined as plasma triglyceride levels ranging from 1.5 to 5.6 mmol/l, was assessed at baseline and one-year follow-up and compared across subgroups. Lipid-lowering therapy intensification with statin and ezetimibe was modelled to simulate a hypothetical systematic treatment and its effect on omega-3 FA-EPA supplementation eligibility. Results: Of 2643 patients, 98 % were prescribed statin therapy at discharge, including 62 % at a high-intensity regimen; 93 % maintained it after one year, including 53 % at a high-intensity regimen. The use of ezetimibe was 3 % at discharge and 7 % at one year. Eligibility was observed in 32 % (32 % men, 29 % women) one year post-ACS. After modelling systematic treatment with statins, ezetimibe, and both, eligibility decreased to 31 %, 25 % and 24 %, respectively. Eligibility was higher in individuals aged <70 (34 vs 25 %), smokers (38 vs 28 %), diabetics (46 vs 29 %), hypertensive (35 vs 29 %), and obese patients (46 vs 22 % for normal weight), all with p-values <0.001. Conclusion: In a contemporary Swiss cohort of patients with ACS, up to 32 % would be eligible for omega-3 FA-EPA supplementation one year after ACS, highlighting an opportunity to mitigate residual cardiovascular risk in patients with ACS and hypertriglyceridemia.

Factors influencing implementation of digital cardiac rehabilitation: A qualitative analysis of health workers perspectives.

Background: Despite growing evidence for the effectiveness of digital cardiac rehabilitation (CR) uptake of this technology remains low. Understanding the factors that influence implementation of digital CR in clinical practice is a growing area of research. The aim of this nested qualitative study was to explore health worker perspectives on factors influencing implementation of a digital CR programme. Methods: Using convenience sampling, semi-structured interviews were conducted with health workers, including health care professionals (nurses, dietitians, physiotherapists) and those in administrative and managerial roles who were involved in delivering and referring patients to Croí MySláinte, a 12-week digital CR intervention delivered during the Coronavirus 2019 pandemic. The updated Consolidated Framework for Implementation Research (CFIR) guided data collection and framework analysis. Results: Interviews were conducted with 14 health workers. Factors influencing implementation of Croí MySláinte were multiple, with some operating independently and others in combination. They related to: (i) characteristics of individuals (e.g., senior leadership support, commitment and motivation of Health workers to meet patient needs, technical capability, workload and perceived fit with role); (ii) features of the programme (e.g., accessibility and convenience for patients, the digital platform, patient self- monitoring tools, the multidisciplinary team and core components); (iii) the external environment (e.g., partnership and connections between organisations, broadband and COVID-19); (iv) the internal environment (e.g., organisational culture, teamwork, resources including funding, digital infrastructure and staffing); and (v) the implementation process (e.g., engaging patients through provision of technical support). Conclusion: The study findings suggest that factors influencing implementation of digital CR operate at multiple levels. Therefore, multi-level implementation strategies are required if the true potential of digital health in improving equitable cardiac rehabilitation access, participation and patient outcomes is to be realised.

Feasibility of a blood pressure telemedicine program in the virtual age.

BACKGROUND: Despite strong evidence for maintaining blood pressure (BP) < 130/80 for secondary stroke prevention, there have been many barriers toward achieving this goal. The purpose of this pilot study was to assess the feasibility of a new physician-led BP telemedicine program on the improvement of BP and medication compliance in stroke survivors. METHODS: We prospectively enrolled patients with a history of stroke and hypertension into this BP telemedicine program where participants were paired with a physician for one-on-one counseling. Participants submitted daily recordings of their BP as well as completed surveys assessing the usability of the program (Marshfield Usability Survey) and medication compliance (Morisky Medication Adherence Scale). A repeated measures ANOVA was utilized to examine differences in BP recordings at enrollment, 3 months, and 6 months. RESULTS: Due to an interruption of external funding only 27 patients were ultimately enrolled (4/25/22-10/15/23). There were significant differences over time for both systolic (p = 0.022) and diastolic (p = 0.007) BP, however these differences were seen only between the enrollment and 6-month timepoint in follow-up testing. Participants rated the program highly favorably across multiple categories, commenting on the ease of using the program and feeling confident in the system. There was also an observed reduction in reported barriers to taking medications. CONCLUSION: This pilot program demonstrated the feasibility of managing BP using a telemedicine approach. A minimum of 6 months was required to see significant differences in BP as well as trends toward improvements in medication compliance. These results have an impact in how similar remote programs should be designed for future evaluations of this patient population.

Health knowledge after stroke in Switzerland: a survey among health professionals on current practice and suggestions for the implementation of a technology-based educational program for stroke survivors.

BACKGROUND: It is estimated that 1 in 4 stroke survivors will experience a second stroke. Educating patients about risk factors for stroke and a generally healthier lifestyle may help prevent recurrent strokes, which are a burden on society and the healthcare system. The goals of this paper were to investigate the estimated level of knowledge of stroke patients regarding their disease, the methods of information commonly used in clinical practice, the topics that should be included in an educational program aimed at improving health knowledge among stroke survivors, and how such a program could be delivered with the help of technology-based education (i.e., information delivered by digital platforms such as smartphones or rehabilitation technologies). METHODS: We performed a survey among health professionals working with stroke patients in Switzerland. RESULTS: 161 health professionals of different backgrounds took part in the survey, and 94 completed it. According to the results, only 33% of healthcare professionals thought that patients were well informed about stroke one month after stroke onset. These findings suggest that there is room for improvement in how stroke patients are educated about stroke, risk factors, and prevention. Additionally, it was highlighted that technology is not commonly used in clinical practice to support patients' education, although this is an acceptable method for healthcare professionals. The results also helped to identify key topics to be included in an educational program and recommendations for implementing such a program in rehabilitation technologies. CONCLUSIONS: This work allowed gaining more insight into healthcare professionals' opinions on the potential of technology-based education and key aspects to consider when implementing it to support health and prevention knowledge after stroke.

Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitor Eligibility and Prescription Rates in Patients Presenting With Recurrent Acute Coronary Syndromes.

BACKGROUND: Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are novel medications for reducing low-density lipoprotein cholesterol (LDL-C) levels. In 2020, the Australian Pharmaceutical Benefits Scheme (PBS) began subsidising PCSK9 inhibitors for secondary prevention of cardiovascular disease in patients with LDL-C >2.6 mmol/L despite statin and ezetimibe therapy. This criterion was expanded to LDL-C >1.8 mmol/L in 2022. METHOD: A retrospective analysis was conducted on patients admitted to a quaternary hospital with acute coronary syndrome (ACS) between 2020-2022. PCSK9 inhibitor eligibility and prescribing patterns were compared between recurrent ACS patients (≥2 events within 5 years) and first-presentation ACS patients. Australian PBS 2020 and 2022 criteria were applied to assess eligibility. RESULTS: Of 817 ACS patients with LDL-C >1.8 mmol/L, 118 (14.4%) were categorised as recurrent ACS (33.9% female, mean age 67 years, LDL-C 2.9 mmol/L). When compared with first-presentation ACS patients (n=699), recurrent ACS patients had significantly higher proportions already on statin therapy (49.2% vs 6.0%, p<0.001) and ezetimibe (20.3% vs 2.4%, p<0.001). Recurrent ACS patients had significantly higher proportions of 2020 PBS-eligible patients (11.0% vs 1.3%, p<0.001) and 2022 PBS-eligible patients (20.3% vs 2.2%, p<0.001). There were no significant differences in PCSK9 inhibitor prescription rates among eligible patients (four of 13, 30.8% vs four of nine, 44.4%, p=0.51). Univariate binary logistic regression demonstrated that statin intolerance was significantly associated with PCSK9 inhibitor prescription (odds ratio 10; 95% confidence interval 1.3-79.3; p=0.029). CONCLUSIONS: Despite significantly higher eligibility rates, PCSK9 inhibitor uptake remains low in recurrent ACS patients, demonstrating the need to raise further awareness about eligibility criteria and encourage proactive prescription to prevent recurrent cardiovascular events.

How social class shapes breast cancer risk perspectives and prevention practices of Australian midlife women: a qualitative study using the concept of 'breast cancer candidacy'.

BACKGROUND: The increasing incidence of breast cancer and disease burden is a significant public health concern. While 30% of breast cancers could be prevented through addressing modifiable risk factors, misconceptions among women about breast cancer risks hamper primary prevention. In the absence of primary prevention, secondary prevention such as mammography increases the early detection of breast cancer and improves health outcomes. However, current population-level screening rates indicate secondary prevention is suboptimal. More effective public health efforts to improve breast cancer prevention are required. Given breast cancer is socially patterned, this work explores how social class impacts women's breast cancer prevention practices. This study uses the concepts of lay epidemiology and candidacy as a mechanism to understand women's breast cancer risk perspectives. It engages Bourdieu's relational social class theory to unpack how women's social, cultural, and structured life contexts shape these perspectives and their considerations regarding primary and secondary prevention. METHODS: In this qualitative study 43 Australian midlife women (aged 45-64 years), were interviewed to explore their understandings of breast cancer risks, how they perceived their own risk, and how this shaped their prevention behaviours. A theory-informed thematic analysis applying Bourdieu's concepts of habitus, capital, and fields to understand how women's social class positions shapes risk perspectives and prevention practices was conducted. RESULTS: This social class analysis showed differences in how women engage in breast cancer discourse, consider risks, and participate in breast cancer prevention. Middle-class women prioritise health promoting practices and were more likely than working-class and affluent women to attend mammography screening. Working-class women experience structural factors, like low income, stress and difficult life circumstances, which hamper primary prevention practices and for some screening is not considered or prioritised, and their decisions not to screen are less active. Affluent women often do not consider themselves at-risk due to their healthier 'lifestyles. 'They suggest that this, and their knowledge of screening benefits and harms allows them to make informed decisions not to screen. CONCLUSIONS: Women interpret and understand breast cancer risks differently and enact prevention practices within the parameters afforded by their social class positions. These findings are useful to inform improved public health approaches regarding both modifiable breast cancer risks and increasing mammography screening. To improve equity in breast cancer prevention efforts, such approaches must respond to limitations based on social class and address structural factors that impact prevention practices.

Early adoption of innovation in HPV prevention strategies: closing the gap in cervical cancer.

Cervical cancer (CC) is one of the highest prevailing causes of female cancer-related mortality globally. A significant discrepancy in incidence has been noted between high and low-middle-income countries. The origins of CC have been accredited to the human papillomavirus (HPV) with serotypes 16 and 18 being the most prevalent. HPV vaccines, with 90%-97% efficacy, have proven safe and currently function as the primary prevention method. In addition, secondary prevention by timely screening can potentially increase the 5-year survival rate by >90%. High-precision HPV DNA testing has proven to be both highly sensitive and specific for early detection and is advocated by the WHO. Lack of public awareness, poor screening infrastructure and access to vaccines, socio-cultural concerns, along with economic, workforce-associated barriers and the presence of marginalised communities unable to access services have contributed to a continued high incidence. This article comprehensively analyses the efficacy, coverage, benefits and cost-effectiveness of CC vaccines and screening strategies including the transition from cytological screening to HPV self-sampling, while simultaneously exploring the real-world disparities in their feasibility. Furthermore, it calls for the implementation of population-based approaches that address the obstacles faced in approaching the WHO 2030 targets for CC elimination.

Adapting a Telehealth Physical Activity and Diet Intervention to a Co-Designed Website for Self-Management After Stroke: Tutorial.

People who experience a stroke are at a higher risk of recurrent stroke when compared with people who have not had a stroke. Addressing modifiable risk factors like physical inactivity and poor diet has been shown to improve blood pressure, a leading contributor to stroke. However, survivors of stroke often experience challenges with accessing risk reduction services including long wait lists, difficulty with transportation, fatigue, impaired function, and diminished exercise capacity. Providing health interventions via a website can extend the reach when compared with programs that are only offered face to face or via real-time telehealth. Given global challenges of accessing secondary prevention programs, it is important to consider alternative ways that this information can be made available to survivors of stroke worldwide. Using the "design thinking" framework and drawing on principles of the integrated knowledge translation approach, we adapted 2 co-designed telehealth programs called i-REBOUND - Let's get moving (physical activity intervention) and i-REBOUND - Eat for health (diet Intervention) to create the i-REBOUND after stroke website. The aim of this paper is to describe the systematic process undertaken to adapt resources from the telehealth delivered i-REBOUND - Let's get moving and i-REBOUND - Eat for health programs to a website prototype with a focus on navigation requirements and accessibility for survivors of stroke. We engaged a variety of key stakeholders with diverse skills and expertise in areas of stroke recovery, research, and digital health. We established a governance structure, formed a consumer advisory group, appointed a diverse project team, and agreed on scope of the project. Our process of adaptation had the following 3 phases: (1) understand, (2) explore, (3) materialize. Our approach considered the survivor of stroke at the center of all decisions, which helped establish guiding principles related to our prototype design. Careful and iterative engagement with survivors of stroke together with the application of design thinking principles allowed us to establish the functional requirements for our website prototype. Through user testing, we were able to confirm the technical requirements needed to build an accessible and easy-to-navigate website catering to the unique needs of survivors of stroke. We describe the process of adapting existing content and co-creating new digital content in partnership with, and featuring, people who have lived experience of stroke. In this paper, we provide a road map for the steps taken to adapt resources from 2 telehealth-delivered programs to a website format that meets specific navigation and accessibility needs of survivors of stroke.

Development of a Digital Health Intervention for the Secondary Prevention of Cardiovascular Disease (INTERCEPT): Co-Design and Usability Testing Study.

BACKGROUND: Secondary prevention is an important strategy to reduce the burden of cardiovascular disease (CVD), a leading cause of death worldwide. Despite the growing evidence for the effectiveness of digital health interventions (DHIs) for the secondary prevention of CVD, the majority are designed with minimal input from target end users, resulting in poor uptake and usage. OBJECTIVE: This study aimed to optimize the acceptance and effectiveness of a DHI for the secondary prevention of CVD through co-design, integrating end users' perspectives throughout. METHODS: A theory-driven, person-based approach using co-design was adopted for the development of the DHI, known as INTERCEPT. This involved a 4-phase iterative process using online workshops. In phase 1, a stakeholder team of health care professionals, software developers, and public and patient involvement members was established. Phase 2 involved identification of the guiding principles, content, and design features of the DHI. In phase 3, DHI prototypes were reviewed for clarity of language, ease of navigation, and functionality. To anticipate and interpret DHI usage, phase 4 involved usability testing with participants who had a recent cardiac event (<2 years). To assess the potential impact of usability testing, the System Usability Scale was administered before and after testing. The GUIDED (Guidance for Reporting Intervention Development Studies in Health Research) checklist was used to report the development process. RESULTS: Five key design principles were identified: simplicity and ease of use, behavioral change through goal setting and self-monitoring, personalization, system credibility, and social support. Usability testing resulted in 64 recommendations for the app, of which 51 were implemented. Improvements in System Usability Scale scores were observed when comparing the results before and after implementing the recommendations (61 vs 83; P=.02). CONCLUSIONS: Combining behavior change theory with a person-based, co-design approach facilitated the development of a DHI for the secondary prevention of CVD that optimized responsiveness to end users' needs and preferences, thereby potentially improving future engagement.

Teverelix is a potential treatment option for the prevention of acute urinary retention recurrence in men suffering from benign prostatic hyperplasia.

PURPOSE: To evaluate the efficacy and safety of teverelix in treatment naïve patients aged over 50 years with symptomatic benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS), and to explore teverelix' potential in preventing AUR secondary to BPH with the aim to inform a planned Phase 2 trial. METHODS: This Phase 2, multicenter, randomized, double-blind, placebo-controlled study involved BPH patients with an International Prostate Symptom Score (IPSS) ≥ 13 and uroflow < 13 mL/sec. After a 4-week single-blind placebo run-in, patients were randomized to receive teverelix 60 mg (n = 41) or placebo (n = 40) subcutaneously on day 1 and day 3. The primary endpoint was IPSS reduction at end of treatment period (Week 16); secondary endpoints included uroflow, prostate volume (PV), pharmacokinetics, pharmacodynamics, quality of life (QoL), and safety. Data were analyzed using analysis of covariance with α set at 0.05. RESULTS: At Week 16, teverelix significantly reduced IPSS by a mean of 6.3 (SD: ± 3.9) versus 1.1 (SD: ± 2.9) for placebo. By Week 2, teverelix showed a mean IPSS reduction of 13.0% compared to 3.8% for placebo, reaching 34.5% by Week 16 versus 5.2% for placebo. Clinically relevant IPSS reductions were observed in 44% of teverelix patients by Week 2, increasing to 83% by Week 12. Teverelix also achieved a significant 11% reduction in PV within 4 weeks, improved maximum urinary flow rate, and enhanced QoL scores. CONCLUSION: Teverelix shows potential as an effective, well-tolerated treatment for LUTS secondary to BPH, with rapid and sustained benefits. The significant prostate volume reduction suggests that teverelix may help prevent recurrent AUR, warranting further dedicated studies.

Novel Targets and Strategies Addressing Residual Cardiovascular Risk in Post-acute Coronary Syndromes Patients.

Despite the advancement in secondary cardiovascular prevention strategies for post-acute coronary syndrome (ACS) patients, the development of new drugs addressing dyslipidemia and the personalization of dual antiplatelet therapies (DAPT), these patients continue to suffer a significant incidence of recurrent ischemic events. Therefore, novel targets that can be tackled to reduce cardiovascular risk are needed to improve the outcome of this very high-risk population. The role of chronic inflammation and inflammasome in the development and progression of atherosclerosis has been broadly investigated in patients with established coronary artery disease (CAD) and recent randomized trials have highlighted the possibility to manage these targets with specific drugs such as colchicine and monocolonal antibodies with a significant improvement of cardiovascular outcomes in post-ACS patients. Lipoprotein(a) [Lp(a)] is the most promising non-traditional risk factor and has shown to predict worse outcome in post-ACS patients. Lowering Lp(a) through PCSK9 inhibitors and specific targeted therapies has shown positive results in reducing adverse cardiovascular events in patients with established CAD. The effect of microbiome and its alteration in gut dysbiosis seems to actively participate in residual cardiovascular risk of CAD patients; however, the risk-modifying effect of targeted-microbiome therapies hasn't been yet investigated in large population-based studies. Long-term outcome of post-ACS patients is a complex puzzle of multiple factors. In this minireview, we summarize the emerging risk factors that may interplay in the residual risk of post-ACS patients and their possible prognostic and therapeutic implications.

Incidence and Predictors of Appropriate Implantable Cardioverter Defibrillator Therapy in Japanese Ischemic Heart Disease Patients.

BACKGROUND: Although the efficacy of an implantable cardioverter defibrillator (ICD) in preventing sudden cardiac death is well established, the incidence and predictors of appropriate ICD therapy in Japanese ischemic heart disease (IHD) patients remain unclear. METHODS AND RESULTS: We retrospectively studied Japanese 141 IHD patients undergoing transvenous ICD or cardiac resynchronization therapy with a defibrillator (CRT-D) implantation for primary or secondary prevention at Hirosaki University Hospital. Over a mean (±SD) follow-up period of 5.5±2.8 years, the incidence of appropriate ICD therapy was similar in the primary and secondary prevention groups, although it was relatively more frequent in the first 2 years in the secondary prevention group. Four patients died due to sustained ventricular tachycardia (VT) or ventricular fibrillation (VF), mainly due to post-shock pulseless electrical activity. Once patients had received their first appropriate ICD therapy, 49.2% received second appropriate ICD therapy within 6 months. Cox proportional hazard analysis revealed that sustained VT as an index life-threatening ventricular tachyarrhythmia before ICD/CRT-D implantation was an independent predictor of appropriate ICD therapy, but VF was not. CONCLUSIONS: The incidence of appropriate ICD therapy was comparable in primary and secondary prevention among Japanese IHD patients. We need to recognize the high-risk period for second appropriate ICD therapy after the first therapy and sustained VT as index life-threatening ventricular tachyarrhythmia as a risk factor for appropriate ICD therapy.

The effect of clinical pharmacist-led pharmaceutical care services on medication adherence, clinical outcomes and quality of life in patients with stroke: a randomised controlled trial.

BACKGROUND: Stroke is a major cause of morbidity and mortality worldwide. Pharmaceutical care services play a significant role in managing the risk factors associated with stroke. AIM: This study aimed to examine the effects of a one-year pharmaceutical care programme on medication adherence, quality of life and clinical outcomes of patients with stroke. METHOD: This study was conducted as a randomised controlled trial at the neurology clinic of a university hospital in Türkiye. Patients were randomly assigned to either an intervention group or usual care group (IG vs UCG). A simple randomization method using computer-based random numbers was used to assign participants in a 1:1 ratio. The IG received pharmaceutical care including medication reconciliation, medication review and patient education in addition to routine health services. The medication adherence, quality of life and clinical parameters of the patients were evaluated at the beginning and the end of the 12th month. RESULTS: This study included 193 patients (89 and 104 patients in the IG and the UCG, respectively; mean age: 60.1 years), of whom 67.4% were male. At the one-year follow-up evaluation, the percentage of adherent patients (86.5% vs 47.1%, p < 0.001) and the total Stroke-Specific Quality of Life score (184.9 vs 166.0, p < 0.001) were higher in the IG than in the UCG. The stroke recurrence rate at the one-year follow-up (2.2% vs 10.6%, p = 0.044) was lower in the IG than in the UCG. CONCLUSION: Pharmaceutical care services improved the medication adherence, quality of life and clinical outcomes of patients with stroke. THE CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06129318; Study Registration Date: 13 November 2023.