Rosuvastatin versus atorvastatin

treatment in LODESTAR trial

 Background:
• Statins in coronary artery disease
• » Intensive lowering of low-density lipoprotein (LDL) cholesterol levels is recommended in patients with coronary artery
disease (CAD).

• » Among the various lipid-lowering drugs, statins are the cornerstone of therapy and high-intensity statins are generally used as
the first-line therapy in patients with CAD.

• » Physicians make decisions for not only statin intensity but also statin type.
• » However, few RCTs have directly compared the long-term clinical outcomes of the two most potent
• statins (rosuvastatin versus atorvastatin) in patients with CAD

• Aim:
• » To compare the long-term effects and safety between rosuvastatin and atorvastatin
 Study type:

• » A randomised open label, multicentric trial

 Results:
» In the primary outcome there was statistical significance between the 2 groups
No statistical significance in the primary outcome parameters were seen
 Conclusion:
» To our knowledge, this study is the first randomised trial comparing 3-year: clinical outcomes of rosuvastatin treatment versus atorvastatin treatment patients with CAD.
» The 3-year composite of all-cause death, MI, stroke, or any coronary revascularization did not differ between the rosuvastatin and atorvastatin treatment.
» Rosuvastatin treatment was associated with lower LDL cholesterol levels but it also carried a higher risk of new-onset diabetes mellitus requiring a diabetic medication and cataract
operation, compared with atorvastatin treatment.
SHARE trial: P2Y12 Inhibitor Monotherapy vs DAPT After PCI
 Objective:
» To compare the efficacy & safety of P2Y12 inhibitor monotherapy after 3-month DAPT vs. 12-
month DAPT in patients who underwent successful PCI with the latest DES
 Results:
» In the baseline characteristics: 37% of the patients were on Ticagrelol and 50% were on clopidogrel
» In the primary outcome NACE (ITT) showed P2Y12 monotherapy was not inferior to DAPT.
» In the subgroup analysis of the primary outcomes showed the effect of monotherapy was consistency
 Conclusions
» In CAD patients undergoing PCI with the latest generation DES, P2Y12 inhibitor monotherapy after 3-month DAPT was not inferior to
12-month DAPT in terms of NACE
» Considering the study population and lower-than-expected event rates, further research is required in other populatio
3. Effects of Dapagliflozin in Patients with Heart Failure
and Deterioration of Kidney Function Below eGFR 25ml/
min/1.73m^2
 Background
» SGLT2 inhibitors are foundational in the management of patients with HF irrespective of LVEF
» HF and CKD frequently co-exist Such patients face higher risks of clinical events and progressive
deterioration in kidney function.
» Declines in kidney function are often associated with suboptimal HF medical therapy
» Number of pivotal trials have demonstrated consistent efficacy and safety of dapagliflozin over wide range of spectrum of kidney function with eGFR as low as 30 in DAPA-HF trial and 25 in DELIVER trial
» The USFDA does not recommend the use of dapagliflozin with eGFR less than 25.
 Results:
» The primary composite outcome nearly doubled in patients experiencing deterioration to eGFR below 25.
» The incidence of primary composite outcome was lower with patients treated with dapagliflozin regardless whether the patients experience or did not experience eGFR less than 25.
» The rates of adverse events of interest was higher in patients who experienced deterioration of eGFR less than 25.
 Conclusions
» Patients with HF experiencing deterioration in eGFR<25ml/min/1.73m2 were at heightened risk for the development of subsequent CV outcomes.
» Treatment with dapagliflozin was associated with lower rates of the CV death or worsening HF regardless of deterioration of eGFR to <25ml/min/1.73m2
» Safety of dapagliflozin appeared consistent, including among those remained on study drug after eGFR fell to <25ml/min/1.73m2
» The benefit-to-risk ratio may favour continued treatment with dapagliflozin in patients with HF and deterioration in kidney function below eGFR 25ml/min/1.73m2.
4. Dapagliflozin effect on functional mitral regurgitation and myocardial
remodeling (DEFORM trial)
 Background:
» Functional mitral regurgitation (FMR) has proven to cause negative results.
» Yet, the effectiveness of current guideline-directed medical therapy (GDMT) for FMR is still
constrained.
» This research aimed to evaluate how the sodium-glucose cotransporter 2 inhibitor dapagliflozin (SCLE21) could lessen mitral regurgitation and myocardial remodeling in FMR patient
 Results:
» Dapagliflozin showed a significant reduction in effective regurgitant orifice area (ERO) of FMR: (-0.074 + 0.099 vs -0.030 + 0.058 cm2 for dapagliflozin vs. control, P=0.008).
» Dapagliflozin led to a notable decrease in regurgitant volume (RV): (-9.08 + 15.27 vs. -2.98 + 9.28 ml for dapagliflozin vs. control, P=0.017).
» It also resulted in a significant reduction in left atrial dimension (LAD): (-2.45 + 4.44 vs. -0.36 + 3.08 mm for dapagliflozin vs. control, P=0.007).
» Dapagliflozin contributed to a decrease in the E/e’ ratio: (-5.88 + 7.41 vs -1.98 + 7.63 for dapagliflozin vs. control, P=0.011).
 Conclusion:
Based on the existing GDMT, dapagliflozin has the potential to further decrease the degree of mitral regurgitation and enhance
myocardial remodelling in patients with FMR. These results indicate that SGLT-2 inhibitors could be a viable consideration for the
GDMT of individuals experiencing moderate or severe FMR.
5. 2023 ESC Guidelines for the Management of Endocarditi
Education of high-risk patients to prevent infective endocarditis
Maintain good dental hygiene
Use dental floss daily, Brush teeth morning and evening, See your dentist for regular check-ups, Maintain good skin hygiene
Minimize good skin hygiene
Minimizine risk of skin lessions, In case of lessions, observe for signs of infection (redness, swelling, tenderness, puss), Avoid tattoos and piercings
6. 2023 ESC Guidelines for the Management of Cardiovascular Disease
in Patients with Diabetes
Management of cardiovascular disease in patients with type 2 diabetes:
clinical approach and key recommendations
Cardiovascular risk assessment in diabetes
» Novel concept: For patients with T2DM without ASCVD or severe target-organ damage, a novel T2DM-specific risk score is introduced: SCORE2-Diabetes
SCORE2-Diabetes: a new risk prediction tool
Key features
» Estimates 10-year risk of CD events in individuals with type-2 diabetes
» Discriminates risk in individuals with type-2 diabetes using conventional CVD risk factors and those
specifically related to diabetes
7. 2023 ESC Guidelines for the Management of Acute Coronary
Syndromes
NSTE-ACS pathway: Timing of angio based on risk
» GRACE score include CK-MB and conventional T (NOT hs-Tn)
» Most trials did not use hs-Tn
» Heterogeneity in different studies (“late” in some trials is earlier than “early” in others)
» No robust evidence of mortality benefit in meta-analyses (the largest in 2022)
» No prospective dedicated trial testing clinical benefit in GRACE>14