Changing paradigms in LDL-C reduction

• Combination treatments should be prioritized over monotherapy.
• There is a need to enhance the number of accessible LDL receptors.
• Bemepodoic acid is beneficial at lowering LDL-C levels.

LDL-C: New insights into its role as casual risk factor and target for therapy

• An annual dosage of siRNA vaccine presents a viable method for lowering LDL, reducing cardiovascular events, and decreasing the progression of atherosclerosis.
• Starting at age 55, twice-yearly siRNA treatment reduces LDL by 52%.
• Injectables ensures compliance.

Targeting the PCSK9 pathway: Where do novel therapies fit in?

• Inclisiran-the first-in-class siRNA is EU and FDA approved for LDL lowering in two doses per year.
• Gene editing therapy inhibits proprotein convertase subtilisin/kexin type 9 (PCSK9) synthesis by RNA interference.
• Blocking PCSK9 synthesis reduces LDL levels and is one of the most sought after novel approaches investigated by pharmaceutical firms.

Addressing the unmet needs in LDL-C lowering- What can we expect?

• According to evidence, the combination of ezetimibe, bempedoic acid, and inclisiran is more effective in reducing LDL-C levels.
• At their maximum dose, statins have several drawbacks.
• Novel agents, such as the CETP inhibitor Obicetrapib, as well as oral PCSK9 modulators, have showed encouraging outcomes

2022 ESC Guidelines on ventricular arrhythmias and sudden cardiac death

• Genetic testing and genetic should be undertaken in patients with clinical suspicion or clinical diagnosis of catecholaminergic polymorphic ventricular tachycardia.
• It is advised that public access defibrillation be made available in areas where cardiac arrest is more prone to occur.
• Promoting community training in basic life support is advised to boost bystander CPR and AED use.

2022 ESC Guidelines on cardio-oncology

• Features 272 new guidelines for the definition, diagnosis, treatment, and prevention of cancer therapy-related CV toxicities, as well as the management of CV induced directly or indirectly by cancer.
• Echocardiography is suggested as the first-line modality for assessing heart function in cancer patients, with csrdiovascular magnetic resonance being evaluated when echocardiography is unavailable or undiagnostic.
• Cancer and CV symptom burden, cancer prognosis, cancer therapies needing alternative solutions, drug-drug interactions, and patient preferences should all be considered when making treatment decisions.

2022 ESC Guidelines on pulmonary hypertension

• It is suggested for all individuals with suspected pulmonary hypertension to get transthoracic echocardiography guidance for right heart imaging (TTE).
• Right heart catheterization is recommended to confirm the diagnosis of pulmonary hypertension (particularly PAH or CTEPH) and to support treatment options.
• Initial combination treatment with PDE5i and an endothelin receptor antagonist is advised in individuals with IPAH/HPAH/DPAH who are at low or intermediate risk of mortality.

2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery

• Patients with CVD, CV risk factors (including age >65 years), or symptoms indicative of CVD should utilize hs-cTN or hs-CTN I before immediate or high risk NCS, as well as at 24 and 48 hours thereafter.
• Individuals with CVD, CV risk factors (including age >65 years), or symptoms indicative of CVD should have BNP or NT-proBNP measured before intermediate and high risk NCS.
• It is not advisable to start beta-blockers before non-cardiac surgery on a regular basis.

Results of the treatment in the morning versus evening (TIME) study

• TIME study is pragmatic, decentralised, large study comparing the effects of evening vs. morning dosage on CV outcomes.
• Allocating antihypertensive medicine to the evening dose did not enhance the primary endpoint.
• Patients can be instructed that they can take their antihypertensive medicine in the morning or evening because the timing has no effect on cardiovascular outcomes.

SECURE – Secondary prevention of cardiovascular disease in elderly

• A polypill therapy regimen comprising aspirin, atorvastatin, and ramipril resulted in fewer recurrent cardiovascular events after myocardial infarction, likely due to greater adherence.
• The polypill method is safe to use, with no differences in adverse events between groups.
• Using a cardiovascular polypill as a substitution approach might be an important component of the global strategy to improve secondary prevention.

PERSPECTIVE –Efficacy and safety of sacubitril/valsartan compared to valsartan on cognitive function in patients with CHF and HFpEF trial

• Sacubitril/valsartan did not affect cognitive function assessed during a comprehensive battery of tests in an adequately powered, blinded, 3-year randomised trial
• Beta-amyloid deposition in the brain was less in patients treated with Sacubitril/valsartan compared to valsartan.
• There was no evidence of an increased risk of cognitive impairment by neprilysin inhibition related to beta-amyloid accumulation in the brains of individuals with HFmrEF/HFpEF.

Interventional solutions for heart failure

• The FDA has approved an innovative treatment for heart failure called Baroreceptor Stimulation, which relieves symptoms of HFrEF.
• Baroflex Activation Therapy (BAT) reduces sympathetic activity while improving parasympathetic activity.
• In BEAT HF trial, the BAT improved the quality of life and NT-pro-BNP considerably.

Myosin inhibitors in hypertrophic obstructive cardiomyopathy

• Mavacamten is the first in class for inhibiting cardiac myosin and lowering profibrotic gene expression.
• Mavacamten is authorized by the FDA in the United States under the REMS program; nevertheless, medication interactions must be avoided.
• The REDHOOD study revealed that Aficatem is a next-generation agent that reduces hypercontractility

The beginning of the end for NOACs? The extra mile

• NOACs are an effective therapy option for stroke in individuals with NVAF, diabetes, and compromised renal function.
• NOACs are recommended for the treatment of cancer associated thrombosis by clinical recommendations like as ISTH, ASCO, ESC, NCCN, and ITAC.
• When compared to LMWH, patients taking a NOAC have greater effectiveness and a comparable overall major bleeding risk.