Venous access closure: From A to Z.

Points to increasing need for achieving safe and secure closure of femoral venous access site after large caliber venous sheath for after structural interventions. Emphasizes the role of a simple, easy to learn "Z-stitch" for achieving femoral vein hemostasis leading to early ambulation. Cautions and advocates the use of multiple complimentary techniques for venous access closure after extreme large bore devices.

APO B/APO AI Ratio with Coronary Artery Disease with Normal Lipid Profile in the Indian Population.

BACKGROUND: Abnormal lipids are an important risk factor for development of Coronary Artery Disease, significant patients have normal lipid profile and yet develop CAD. Apolipoproteins B, Apolipoproteins A and their ratio have been shown to be better predictor of risk of developing Coronary artery disease. OBJECTIVE: Assess the Apo B / Apo A ratio with coronary artery disease in patients with normal lipid profile. METHODS AND RESULTS: In 4232 patients with history of CAD 3724(88 %) had abnormal apo b / apo a ratio. Of 2920 patients with normal LDL levels (<100 mg), 2454 patients had abnormal apob/apoa ratio of which 2200 (91%) had CAD. In 1946 patients on lipid lowering agents 1819 had abnormal apo b/ apo a ratio and all had CAD. CONCLUSION: This study ascertains the importance Apo B, Apo A ratio over conventional lipid profile values for predicting CAD and its severity. Apo B/ Apo A ratio and CAD was found to be significant in patients with normal LDL, even in patients with history of dyslipidemia on statins this ratio was significant. Statins have been effective in lowering LDL, but have not shown changes in Apo B levels. Apo B and Apo A should be used to assess the atherogenic potential of lipid disorders.

The contemporary role of sodium-glucose co-transporter 2 inhibitor (SGLT2i) and angiotensin receptor-neprilysin inhibitor (ARNI) in the management of heart failure: State-of-the-art review.

Novel therapies for heart failure with reduced ejection fraction (HFrEF) are angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose co-transporter 2 inhibitor (SGLT2i), etc. The purpose of this review is to determine the effects of ARNI and SGLT2i in heart failure (HF), compare the impact of SGLT2i with ARNI, and finally evaluate the current data regarding the combination of these two drugs in HF. Various trials on the respective medications have shown some significant reduction in all-cause mortality and cardiovascular (CV) death. The combination of these drugs has shown more CV benefits than monotherapy. There is emerging data about these two drugs in patients with heart failure with preserved ejection fraction (HFpEF). At present, there are less head-to-head comparison trials of these two drugs. This review provides insights on the current evidence, comparative efficacy, and combination therapy of ARNI and SGLT2i in managing HF, focussing on HFrEF and HFpEF.

Evidence for intensive LDL-C lowering for acute coronary syndrome: Recommendations from the Lipid Association of India.

Patients with acute coronary syndrome (ACS) have a high risk of subsequent adverse cardiovascular outcomes, particularly within the first 30 days. Although it is well documented that initiation of statin therapy in the setting of ACS improves short- and long-term cardiovascular outcomes, and achievement of lower levels of low density lipoprotein cholesterol (LDL-C) incrementally improves outcomes, many patients with ACS have persistent hypercholesterolemia after discharge from the hospital. This is a missed opportunity that prompted the Lipid Association of India to develop recommendations for earlier initiation of more aggressive LDL-C lowering treatment, particularly for patients of South Asian descent who are well-documented to have earlier onset of more aggressive atherosclerotic cardiovascular disease. The Lipid Association of India recommends individualized aggressive LDL-C goals after ACS, which can be rapidly achieved with high intensity statin therapy and subsequent goal-directed adjunctive treatment with ezetimibe and PCSK9 inhibitors. Improved treatment of hypercholesterolemia achieved within weeks after ACS has the potential to reduce the high rate of morbidity and mortality in these high risk patients.

CHA2DS2-VASc-HSF score - New predictor of severity of coronary artery disease in 2976 patients.

BACKGROUND: CHADS2 and CHA2DS2-VASc scores have been used for assessing prognostic risk of thromboembolism in non valvular atrial fibrillation patients. They include similar risk factors for the development of CAD To increase the likelihood of determining CAD severity, the CHA2DS2-VASc-HS and CHA2DS2-VASc-HSF score comprising of hyperlipidemia, smoking and family history respectively in addition to the components of the CHA2DS2-VASc score and male instead of female gender. The aim was to investigate whether these risk scores can be used to predict CAD severity. METHODS AND RESULTS: A total of 2976 consecutive patients who underwent coronary angiography were enrolled in the study. Presence of >50% stenosis in a coronary artery was assessed as significant CAD. Of the patients,804 had normal coronary angiograms and served as group 1. The remaining 2172 patients with coronary stenosis were further classified into 2 groups according to CAD with stenosis of <50% or >50%: 834 patients with mild CAD as group 2 and 1338 patients with severe CAD as group 3. The scores were significantly different among the 3 groups. All the four scores correlated significantly with the number of diseased and the Gensini score. CONCLUSION: CHADS2, CHA2DS2-VASc, and especially CHA2DS2-VASc-HS and CHA2DS2-VASc-HSF scores could be considered predictive of the risk of severe CAD with CHA2DS2-VASc-HSF the best scoring scheme to predict CAD severity. The risk scoring systems may play an important role as predictive models because they are simple and can be easily applied by physicians without any additional costs in routine practice.