Differences in clinical presentation and outcomes in pregnancy-associated Takotsubo Syndrome- A scoping review of the literature: Outcomes in pregnancy-associated Takotsubo

BACKGROUND: Takotsubo syndrome (TS) during pregnancy and postpartum is rare but may lead to significant maternal and fetal morbidity. We compared clinical characteristics and prognosis according to [a] timing of presentation (pregnancy vs post-partum) and [b] modes of delivery (cesarean section vs vaginal delivery). METHODS: Systematic review of articles published in PubMed, Scopus, Embase, and Medline databases from inception to July 30, 2023. Patient demographics, obstetric, electrocardiographic, laboratory, echocardiographic characteristics, and prognosis were summarized descriptively. RESULTS: An initial database search identified 2162 articles, of which 81 studies were included in this review. TS during pregnancy can have emotional, obstetric, and metabolic triggers and has a higher proportion of adverse fetal outcomes when compared with women who developed TS postpartum. Women with TS after cesarean section had an earlier onset and higher proportion of anesthesia use when compared with those who developed TS after vaginal delivery. There were no differences regarding the degree of systolic dysfunction or the need for advanced therapies, including ventilator support, intra-aortic balloon pump, and extracorporeal membrane oxygenation among groups. CONCLUSIONS: TS is associated with various triggers and adverse fetal outcomes when it develops during pregnancy than in the postpartum period. TS occurs more rapidly and with a more aggressive course after cesarean section than after vaginal delivery

Clinical efficacy and safety outcomes of bempedoic acid: An updated systematic review and meta-analysis after CLEAR Outcomes trial

Purpose: Statins are the cornerstone therapy for primary or secondary prevention of atherosclerotic cardiovascular disease (ASCVD). However, a significant portion of patients are intolerant to statin or show inadequate lipid-lowering. Bempedoic acid (BA) has been shown to decrease low-density lipoprotein cholesterol (LDL-C) in clinical trials. However, the evidence on the effect of BA on clinical cardiovascular outcomes was limited until the CLEAR Outcomes trial. Thus, to fully appraise the available data, we performed this meta-analysis. Methods: PubMed, Pubmed Central, Embase, and Scopus databases were searched for relevant articles published before May 1, 2023. Pertinent data from the included studies were extracted and analyzed using RevMan v5.4. Results: Out of 2209 studies evaluated, five randomized control trials with 17,384 patients with established ASCVD or at high risk of ASCVD were included for analysis. The BA therapy reduced major adverse cardiovascular events (OR 0.85, CI 0.77-0.93; <0.0001), non-fatal myocardial infarction (OR 0.75, 95 % CI 0.64-0.88; p <0.0001), hospitalization for unstable angina (OR 0.69, CI 0.53-0.89; p = 0.005) and coronary revascularization (OR 0.80, CI 0.61-0.91; <0.0001) significantly without decreasing the risk of all-cause death (OR 1.19, CI 0.73-1.94; p = 0.49), cardiovascular death (OR 1.04, CI 0.87-1.25; p = 0.68) and non-fatal stroke (OR 0.84, CI 0.66-1.06; p = 0.15). Conclusion: Based on our analysis the bempedoic acid addition to therapy reduced cardiovascular events in selective patients who are either intolerant to statins or do not achieve recommended LDL-C levels despite being on a maximum dose of statins and/or ezetimibe

Safety and efficacy of direct oral anticoagulants in comparison to warfarin in obese patients with atrial fibrillation: A systematic review and meta‐analysis

Abstract Background and Aim Obesity affects nearly 650 million adults worldwide, and the prevalence is steadily rising. This condition has significant adverse effects on cardiovascular health, increasing the risk of hypertension, coronary artery disease, heart failure, and atrial fibrillation (AF). While anticoagulation for obese patients with AF is a well‐established therapy for the prevention of thromboembolism, the safety and efficacy of different anticoagulants in this specific population are not well explored. This meta‐analysis aimed to compare direct oral anticoagulants (DOAC) to vitamin K antagonists in obese populations with AF. Methods The PRISMA guidelines were followed for this meta‐analysis, registered in PROSPERO (CRD42023392711). PubMed, PubMed Central, Embase, Cochrane Library, and Scopus databases were searched for relevant articles from inception through January 2023. Two independent authors screened titles and abstracts, followed by a full‐text review in Covidence. Data were extracted in Microsoft Excel and analyzed using RevMan v5.4 using odds ratio as an effect measure. Results Two thousand two hundred fifty‐nine studies were identified from the database search, and 18 were included in the analysis. There were statistically significant reductions in the odds of ischemic and hemorrhagic stroke in the DOAC group compared with the VKA group (OR 0.70, CI 0.66–0.75) and (OR 0.47, CI 0.35–0.62), respectively. In addition, the DOAC group exhibited lower odds of systemic embolism (OR 0.67, CI 0.54–0.83), major bleeding (OR 0.62, CI 0.54–0.72), and composite outcome (OR 0.72, CI 0.63–0.81). Conclusion Based on the findings from this meta‐analysis, DOACs demonstrate superior safety and efficacy in obese patients with AF compared with VKAs. These results may have significant implications for guiding anticoagulation strategies in this patient population

Determination of level of self‐reported adherence of antihypertensive drug(s) and its associated factors among patient with hypertension at a tertiary care center

Abstract The study aimed to determine the level of self‐reported adherence to antihypertensive drug(s) and its associated factors among patient with hypertension at a tertiary care center. The authors performed hospital based observational cross‐sectional study using semi‐structured questionnaires, WHO STEP tool and Hill and Bone high blood pressure compliance scale from December 1, 2021 to February 28, 2022. Descriptive statistics, Chi‐square/Fisher's exact test and non‐parametric tests were used for statistical analysis. Among 150 cases included in the study, majority (94, 62.67%) had good adherence based on Hill and Bone high blood pressure compliance scale with adherence level labelled as “good adherence” (score 3) and “not good adherence” (score < 3). The adherence to drug therapy was significantly better in females compared to males (50 [71.43%] vs. 44 [55.00%], p = .038). Among the factors related to hypertension and anti‐hypertensive therapy, people with higher body mass index (ρ = ‐.324, n = 56, p = .015) and taking three or more pills (6, 1.71%, p = .017) had lower adherence to therapy. Likewise, forgetfulness (30, 53.57%), ineffective counseling (7, 12.50%), and missed follow‐up (13, 23.21%) were the factors associated with lower adherence to anti‐hypertensive therapy. This study finds good adherence among the patients taking anti‐hypertensive medications. However, with the improved education, lesser number of pills and physical fitness help to adhere with the anti‐hypertensive therapy