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Special Issue "Targeting Residual Cardiovascular Risk: The Long Road towards Precision Medicine"

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Vascular Medicine".

Deadline for manuscript submissions: 21 June 2023 | Viewed by 3543

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Special Issue Editor

Dr. Giulia Magnani

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Guest Editor

Department of Cardiology, Parma University Hospital, Parma, Italy
Interests: traditional and non-traditional cardiovascular risk factors; antithrombotic therapy; lipid lowering therapy; inflammation; diabetes; cardiovascular risk stratification; precision medicine

Special Issue Information

Dear Colleagues,

Coronary artery disease (CAD) remains one of the most common causes of mortality and morbidity worldwide, despite significant progresses in this field. Indeed, patients with established CAD are at high risk for recurrent major cardiovascular and cerebral events (MACCE), and even with evidence-based secondary preventive strategies, a consistent residual risk persists.

In recent years, new approaches targeting residual risk pathways have been developed, including nonstatin-lipid lowering therapy, antithrombotic drugs, anti-inflammatory therapies and drugs affecting the cardiometabolic pathway, such as sodium-glucose cotransporter-2 inhibitors. Furthermore, there is increasing evidence concerning the role of non-traditional cardiovascular risk factors, such as acute and chronic exposure to environmental stressors (e.g., air pollution), sleep deprivation, and psychosocial stress, in the modulation of pathways involved in residual CV risk.

Thus, now more than ever, there is a need for a personalized approach to target the right pathway or multiple pathways that may be differently involved from one patient to another, providing a tailored treatment, the cornerstone of precision medicine.

The goal of this Special Issue is therefore to update clinicians on the current strategies and most recent advances in risk stratification, diagnosis, and therapies in patients with established CAD.

Dr. Giulia Magnani
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Coronary artery disease
Residual cardiovascular risk
Traditional and non-traditional cardiovascular risk factors
Risk stratification
Lipid-lowering therapy
Antithrombotic therapy
Anti-inflammatory therapy
Cardiometabolic pathway
Sodium-glucose cotransporter-2 inhibitors

Published Papers (4 papers)

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Research

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Open AccessArticle

Lipoprotein (a), Inflammation, and Atherosclerosis

Stefania Angela Di Fusco

and

J. Clin. Med. 2023, 12(7), 2529; https://doi.org/10.3390/jcm12072529 (registering DOI) - 27 Mar 2023

Viewed by 119

Abstract

Growing evidence has shown that high levels of lipoprotein (a) (Lp(a)) and chronic inflammation may be responsible for the residual risk of cardiovascular events in patients managed with an optimal evidence-based approach. Clinical studies have demonstrated a correlation between higher Lp(a) levels and several atherosclerotic diseases including ischemic heart disease, stroke, and degenerative calcific aortic stenosis. The threshold value of Lp(a) serum concentrations associated with a significantly increased cardiovascular risk is >125 nmol/L (50 mg/dL). Current available lipid-lowering drugs have modest-to-no impact on Lp(a) levels. Chronic inflammation is a further condition potentially implicated in residual cardiovascular risk. Consistent evidence has shown an increased risk of cardiovascular events in patients with high sensitivity C reactive protein (>2 mg/dL), an inflammation biomarker. A number of anti-inflammatory drugs have been investigated in patients with or at risk of cardiovascular disease. Of these, canakinumab and colchicine have been found to be associated with cardiovascular risk reduction. Ongoing research aimed at improving risk stratification on the basis of Lp(a) and vessel inflammation assessment may help refine patient management. Furthermore, the identification of these conditions as cardiovascular risk factors has led to increased investigation into diagnostic and therapeutic strategies targeting them in order to reduce atherosclerotic cardiovascular disease burden. Full article

(This article belongs to the Special Issue Targeting Residual Cardiovascular Risk: The Long Road towards Precision Medicine)

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Open AccessArticle

The Oscillometric Pulse Wave Analysis Is Useful in Evaluating the Arterial Stiffness of Obese Children with Relevant Cardiometabolic Risks

Monica Simina Mihuta

Corina Paul

Andreea Borlea

Cristina Mihaela Cepeha

Iulian Puiu Velea

Ioana Mozos

and

Dana Stoian

J. Clin. Med. 2022, 11(17), 5078; https://doi.org/10.3390/jcm11175078 - 29 Aug 2022

Cited by 2 | Viewed by 931

Abstract

Early detection of all complications of childhood obesity is imperative in order to minimize effects. Obesity causes vascular disruptions, including early increased arterial stiffness and high blood pressure. This study’s aim is to assess the reliability of pulse wave analysis (PWA) in obese children and how additional risk factors influence the evaluated parameters. We analyzed 55 children aged 6–18 years old by measuring their pulse wave velocity (PWV), augmentation index (AIx), peripheral blood pressure (SBP, DBP), heart rate, central blood pressure (cSBP, cDBP) and central pulse pressure (cPP). We used the oscillometric IEM Mobil-O-Graph and performed a single-point brachial measurement. The subjects were divided into two groups: obese (n = 30) and normal-weight (n = 25) and were clinically and anamnestically assessed. BMI and waist circumference are significantly correlated to higher values for PWV, SBP, DBP, cSBP, and cDBP. Weight significantly predicts PWV, SBP, DBP and cPP. The risk factors that significantly influence the PWA and BP values are: a cardiometabolically risky pregnancy (higher PWV, AIx, SBP), active and passive smoking (higher PWV, SBP, cSBP, cDBP), sleep deprivation (higher PWV, SBP, cSBP) and sedentariness (higher PWV, AIx, peripheral and central BP). We conclude that obese children with specific additional cardiometabolic risk factors present increased arterial stiffness and higher blood pressure values. Full article

(This article belongs to the Special Issue Targeting Residual Cardiovascular Risk: The Long Road towards Precision Medicine)

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Open AccessArticle

Management of High-Risk Hypercholesterolemic Patients and PCSK9 Inhibitors Reimbursement Policies: Data from a Cohort of Italian Hypercholesterolemic Outpatients

Daniela Degli Esposti

Claudio Borghi

and

Arrigo F. G. Cicero

J. Clin. Med. 2022, 11(16), 4701; https://doi.org/10.3390/jcm11164701 - 11 Aug 2022

Cited by 2 | Viewed by 1145

Abstract

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are effective and safe lipid-lowering treatments (LLT). The primary endpoint of the study was to assess the prevalence of patients eligible for treatment with PCSK9 inhibitors in a real-life clinical setting in Italy before and after the recent enlargement of reimbursement criteria. For this study, we consecutively considered the clinical record forms of 6231 outpatients consecutively admitted at the Lipid Clinic of the University Hospital of Bologna (Italy). Patients were stratified according to whether they were allowed or not allowed to access to treatment with PCSK9 inhibitors based on national prescription criteria and reimbursement rules issued by the Italian Medicines Agency (AIFA). According to the indications of the European Medicines Agency (EMA), 986 patients were candidates to treatment with PCSK9 inhibitors. However, following the prescription criteria issued by AIFA, only 180 patients were allowed to access to PCSK9 inhibitors before reimbursement criteria enlargement while 322 (+14.4%) with the current ones. Based on our observations, low-cost tailored therapeutic interventions for individual patients can significantly reduce the number of patients potentially needing treatment with PCSK9 inhibitors among those who are not allowed to access to the treatment. The application of enlarged reimbursement criteria for PCSK9 inhibitors could mildly improve possibility to adequately manage high-risk hypercholesterolemic subjects in the setting of an outpatient lipid clinic. Full article

(This article belongs to the Special Issue Targeting Residual Cardiovascular Risk: The Long Road towards Precision Medicine)

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Review

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Open AccessReview

Endothelial Dysfunction and Arterial Stiffness in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

and

J. Clin. Med. 2022, 11(11), 3179; https://doi.org/10.3390/jcm11113179 - 02 Jun 2022

Cited by 3 | Viewed by 1066

Abstract

Population-based studies have suggested that patients with inflammatory bowel disease (IBD) might be at an increased risk for cardiovascular diseases. A meta-analysis was performed on clinical studies to evaluate endothelial function, arterial stiffness, and carotid intima-media thickness (cIMT) in patients with IBD, after searching PubMed, Embase, Cochrane library, and Web of Science databases. A random-effects model was used to allow for the pooling of studies and for determination of the overall effect. After exclusion, a total of 41 eligible studies with 2330 patients with IBD and 2032 matched controls were identified and included for the analysis. It was found that cIMT was significantly increased in patients with IBD as compared with that in matched controls (Cohen’s d: 0.63; 95% CI: 0.34, 0.93; I² = 91.84%). The carotid–femoral pulse wave velocity was significantly higher in patients with IBD compared to that in matched controls (Cohen’s d: 0.76; 95% CI: 0.54, 0.98; I² = 70.03%). The augmentation index was also significantly increased in patients with IBD compared to matched control subjects (Cohen’s d: 0.35; 95% CI: 0.08, 0.63; I² = 61.37%). Brachial artery flow-mediated dilatation was significantly decreased in patients with IBD than that in matched controls (Cohen’s d: −0.73; 95% CI: −1.10, −0.36; I² = 81.02%). Based on the meta-analysis, it was found that patients with IBD exhibit significant endothelial dysfunction, increased arterial stiffness, and cIMT. Thus, patients with IBD may benefit from aggressive risk stratification for cardiovascular diseases. Full article

(This article belongs to the Special Issue Targeting Residual Cardiovascular Risk: The Long Road towards Precision Medicine)

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