Problem considered Liver cirrhosis (LC) is linked to ischemic heart disease (IHD). This study investigates mortality trends due to concurrent LC and IHD using national-level data in the U.S. Methods This retrospective, population-based descriptive study utilized the CDC WONDER (Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research) database to retrieve mortality data among adults aged ≥25 years from 1999 to 2023. Crude rates (CRs), age-adjusted mortality rates (AAMRs) per 100,000 population, and annual percentage changes (APCs) with 95% confidence intervals (CIs) were calculated, and data were stratified by year, sex, race, urbanization, and state. Results Among 113,089 deaths, AAMRs decreased from 1999 to 2009 (APC: -1.16; 95% CI: -1.97 to -0.60), increased from 2009 to 2018 (APC: 2.71; 95% CI: 1.80 to 3.51), and rose sharply from 2018 to 2021 (APC: 9.72; 95% CI: 7.56 to 11.15). Rates between 2021 and 2023 were stable. (APC: 0.35; 95% CI: -1.95 to 2.93) Males had triple the AAMRs compared to females (3.08 vs 1.01). Non-Hispanic (NH) American Indian/Alaska Natives had the highest AAMRs (4.05), while NH Asian/Pacific Islanders (0.99) had the lowest. AAMRs in the West (2.14) were the highest, followed by the South (2.12), Midwest (1.77), and Northeast (1.66). Nonmetropolitan areas had higher AAMRs than metropolitan ones (1.96 vs 1.84). States in the top 90th percentile of crude mortality rates included West Virginia (CR: 3.89), Rhode Island (CR: 3.63), Oklahoma (CR: 3.29), Texas (CR: 3.01), and Vermont (CR: 3.01). Conclusion Mortality due to concurrent LC and IHD has risen in recent years, remaining higher in men, NH American Indian/Alaska Natives, nonmetropolitan areas, and the West, underscoring the need for strategic interventions to mitigate these disparities.

Background: Renin-angiotensin system (RAS) inhibitors, including ACE inhibitors, ARBs, and angiotensin receptor-neprilysin inhibitors (ARNIs), are essential in managing cardiovascular and renal diseases. Summary: The purpose of this narrative review was to comprehensively evaluate the cardiovascular outcomes associated with the use of RAS inhibitors in patients who have experienced acute kidney injury (AKI). The study highlighted cardiovascular complications of AKI, role of renin-angiotensin inhibitors for cardioprotection post-AKI, reviewed clinical considerations for RAS inhibitor use post-AKI to prevent cardiovascular complications, and discussed mechanistic basis of RAS inhibitors in post-AKI cardioprotection as well as cardiovascular safety concerns of RAS inhibitors post-AKI. Key Messages: By highlighting areas for future research, this review intended to stimulate further studies that will ultimately enhance patient care and outcomes.

BACKGROUND:Alzheimer's disease poses a significant health burden among older adults in the United States and is highly associated with metabolic syndrome. This study retrospectively analyzes trends and variations in Alzheimer's disease mortality among older adults with metabolic syndrome from 1999-2019 in the United States. METHOD:Our study utilized ICD-10 codes to analyze death certificate data between 1999 and 2019 from the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research database for patients aged ≥ 65 years. Age-adjusted mortality rates (AAMRs), per 100,000 people, and Annual Percentage Change (APCs) and their respective 95% Confidence Intervals (CI) were also calculated for data grouped according to year, gender, race and geography. RESULT:Alzheimer's disease in American adults aged ≥ 65 years with metabolic syndrome was responsible for 457,581 deaths. Overall the AAMR increased from 25.14 in 1999 to 39.55 in 2001 (APC: 25.8910*; 95%CI: 13.0083 to 42.849) to 57.3 in 2007 (APC: 5.7935*; 95%CI: 2.1975 to 8.046). A fall in rates to 42.4 by 2014 was observed (APC: -2.0112*; 95%CI: -7.3802 to -0.3521) after which rates continued to increase reaching 58.75 by 2020 (APC: 3.2339*; 95%CI: 0.4637 to 9.8161). Women had higher AAMRs than men (56.51 vs 44.27). The Non-Hispanic (NH) Black/African American (63) population had the highest AAMRs followed by NH White (52.02), Hispanic/Latino (50.4), NH American Indian/Alaska Native (42.33) and lastly NH Asian/Pacific Islander (34.3). AAMRs were highest in the West (62.33) followed by the South (55.29), Midwest (54.69) and Northeast (34.4). Furthermore, metropolitan areas revealed higher AAMRs (61.63) than nonmetropolitan ones (27.23). States in the top 90th percentile such as Oklahoma, Tennessee, Vermont, North Dakota and Mississippi had over triple the AAMRs when compared with states in the lower 10th percentile including New York, Florida, Nevada, Massachusetts and New Mexico. CONCLUSION:Mortality due to Alzheimer's disease in elderly patients with metabolic syndrome has shown a dramatic increase. The highest AAMRs were observed in women, NH Black/African Americans and residents of the West and metropolitan areas. An individualized approach to patient management is necessary moving forward to curb disease progression.

Elevated blood pressure poses a significant global health challenge, affecting over 1.28 billion adults worldwide, with a staggering 46% unaware of their condition. Despite its pervasive impact and association with cardiovascular disease, hypertension remains inadequately controlled, highlighting the urgent need for innovative treatment approaches. This review explores the potential of small interfering RNA (siRNA) therapeutics, focusing on zilebesiran, as a promising strategy for hypertension management. SiRNA therapy represents a groundbreaking approach to selectively modulate protein production, offering targeted intervention in the pathophysiological mechanisms underlying hypertension. Zilebesiran, a siRNA, targets hepatic angiotensinogen (AGT) synthesis through interaction with the asialoglycoprotein receptor, ultimately reducing angiotensin II levels and reducing blood pressure. Zilebesiran demonstrates remarkable pharmacokinetic properties, with sustained efficacy observed after single-dose administration. Clinical trials evaluating zilebesiran have shown significant reductions in blood pressure, with effects lasting up to 24 weeks post-administration. Moreover, combination therapy with angiotensin receptor blockers has demonstrated enhanced efficacy, highlighting the potential for synergistic effects in hypertension management. Importantly, zilebesiran exhibits a favorable safety profile, with manageable adverse events, primarily injection site reactions. Zilebesiran represents a transformative therapy in hypertension management, offering targeted and potent blood pressure reduction with favorable safety and dosing characteristics. Its emergence highlights the ongoing evolution of cardiovascular pharmacology and underscores the importance of innovative approaches to address the global burden of hypertension. Moving forward, concerted efforts in research and clinical practice are necessary to realize the benefits of zilebesiran into hypertension management protocols, ultimately advancing cardiovascular health worldwide.

Alzheimer's disease (AD), being a deteriorative and progressive neurocognitive condition, constitutes nearly 70% of all the cases related to dementia and has a prevalence of 50 million globally. This study aims to analyze the probiotic's effect on neurocognitive function and markers of inflammation and oxidative stress in AD patients. An exhaustive literature search was conducted across databases, including PubMed, Cochrane Central, and Google Scholar, for the relevant studies from inception to January 2025. Data from the included studies were extracted for relevant outcomes of interest. We used Review Manager version 5.4 to pool the mean differences (MD) and 95 % CIs for continuous outcomes. The random effects model was employed for statistical analysis, and the source of heterogeneity in the included studies was investigated through a sensitivity analysis. Five randomized clinical trials, including 219 AD individuals, were added to this quantitative analysis. The results depict that the Mini-Mental status examination score was significantly higher in the probiotics group (MD = 2.49, 95% CI: 0.44,4.53; p  =  0.02; I2 = 85%). Probiotics also resulted in a higher level of glutathione (MD = 17.78 µmol/L, 95% CI: [3.07 to 32.50]; p  = 0.02; I2=0%) and a lower malondialdehyde (MD = -1.54 µmol/L, 95% CI = -2.31 to -0.78; p  <0.0001; I2 = 95) compared to placebo. Other outcomes were comparable between the two groups. The results show that probiotics effectively improve neurocognitive function in AD patients. Probiotics also increase antioxidants like glutathione and decrease inflammatory markers like malondialdehyde, leading to favorable outcomes.

BACKGROUND:Kidney dysfunction and reduced filtration capacity due to chronic kidney disease (CKD) lead to a shift in the body's acid-base balance, ultimately causing metabolic acidosis (MA). Sodium bicarbonate has been used as a supplement to alleviate the symptoms and reverse the acidosis, and it may even slow the progression of CKD. However, its safety profile and overall effectiveness are uncertain. AIM:To conduct a systematic review and meta-analysis of clinical trials assessing sodium bicarbonate's safety and efficacy for treating CKD-induced MA. METHODS:Medline, Scopus, EMBASE, and Cochrane Central were systematically searched from inception until May 2024 to select all relevant randomized control trials (RCTs) and non-RCT (NRCTs) evaluating the effectiveness of sodium bicarbonate in correcting MA in end-stage renal disease patients. In addition, ClinicalTrials.gov, Medrxiv.org, and Google Scholar were searched for other literature. A random-effects meta-analysis was performed to derive mean differences (MD) and risk ratios (RR) with their 95%CI for continuous and dichotomous outcomes respectively. RESULTS:Following a systematic search of the databases, 20 RCTs and 2 and NRCTs comprising 2932 patients were included in our study. The results revealed that sodium bicarbonate significantly increased serum bicarbonate in CKD patients (MD: 2.59, 95%CI: 0.95-4.22; P = 0.02; I 2 = 95%). However, there was a non-significant increase in estimated glomerular filtration rate (eGFR) in patients on sodium bicarbonate therapy (MD: 0.93, 95%CI: -1.88-3.75; P = 0.52; I 2 = 93%). Upon assessment of the safety profile of sodium bicarbonate, no significant association was found in the outcomes of death/prolonged hospitalization (RR: 1.05, 95%CI: 0.84-1.32; P = 0.66; I 2 = 0%), or gastrointestinal disorders (RR: 1.64, 95%CI: 0.35-7.66; P = 0.53; I 2 = 76%), or worsening edema (RR: 1.26, 95%CI: 0.94-1.68; P = 0.12; I 2 = 37%) when compared to control. CONCLUSION:Sodium bicarbonate therapy may halt worsening kidney function by correcting serum bicarbonate levels and treating MA. Although sodium bicarbonate does not significantly improve the eGFR, it may potentially prevent CKD progression while maintaining an overall favorable safety profile.

Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) has emerged as a feasible alternative to reoperative surgery in patients with degenerated surgical bio-prosthesis. However, data regarding the choice of valve type in ViV-TAVI remain inconclusive. This meta-analysis compares the procedural and clinical outcomes of self-expanding (SE) vs. balloon-expandable (BE) valves in ViV-TAVI. MEDLINE and Scopus were queried to identify studies reporting outcomes of ViV-TAVI by SE/BE valve type or comparing outcomes between SE or BE valves for ViV-TAVI. The primary outcome was incidence of all-cause mortality at 30-days. Data were presented as incidence of outcomes, analyzed via random effects model using inverse variance method with 95 % confidence intervals. Further incidence rates of primary and secondary outcomes were presented as subgroups of BE and SE, with comparison in incidence rates between the subgroups made using p-interaction of proportions. 27 studies with 13,182 patients (SE: 7346; BE: 5836) were included. There were no significant differences between the BE vs. SE valves in 30-day mortality (BE 4 % vs. SE 3 %, p = 0.44), 1-year mortality (BE 12 % vs. SE 10 %, p = 0.60), and moderate-to-severe AR at 1-year (BE 1 % vs. SE 3 %, p = 0.36). However, patients with SE valves had higher rates of new permanent pacemaker insertion (BE 4 % vs. SE 9 %, p = 0.0019). There were no significant differences in the incidence of 30-day safety outcomes, including stroke, AKI, coronary obstruction, major bleeding, and major vascular complications. Both BE and SE valve types showed comparable mortality and safety outcomes in ViV-TAVI, except pacemaker insertion, which was higher in SE compared with BE valves.

To analyze mortality rates due to complications of cardiac and vascular prosthetic devices, implants, and grafts in the United States, International Classification of Diseases, Tenth Revision, codes were used on the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research (CDC WONDER) database to retrieve death certificate data between the years 1999 and 2020 for patients aged 55 and above. Age-adjusted mortality rates (AAMRs), per 100 000 people, and annual percentage change along with their respective 95% confidence intervals were also calculated. Complications of cardiac and vascular prosthetic devices, implants, and grafts were responsible for 91 539 deaths among adults aged 55 years and older. The overall AAMR decreased from 9.2 in 1999 to 3.4 in 2020. AAMRs for men were higher than for women (overall AAMR men: 7.5; women: 4.5). Stratifying patients according to race the order of AAMRs from highest to lowest was as follows: non-Hispanic Black or African American (6.8), NH White: (5.9), NH American Indian or Alaska Native (5.7), Hispanic or Latino (4.0) and lastly NH Asian or Pacific Islander (3.2). State wise the top 90th percentile states with regard to mortality included West Virginia, South Carolina, Mississippi, North Dakota, and Alabama. In census regions the South had the highest AAMR (6.2) followed by the Midwest (6.0), the Northeast (5.4), and the West (5.1) with nonmetropolitan areas having higher AAMRs (7.0) than metropolitan areas (5.4). Further research and a more individualized pattern of treatment of older patients are necessary moving forward.

BACKGROUND:Alzheimer's disease is one of the leading causes of death among the elderly in the United States with heart failure sharing similar risk factors. This study investigated trends and disparities in Alzheimer's disease mortality among older adults with heart failure from 1999-2020 in the United States. METHOD:Using ICD-10 codes death certificate data from the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research database was retrieved for patients aged ≥ 65 years between 1999-2020. Age-adjusted mortality rates (AAMRs), per 100,000 people, and Annual Percentage Change (APCs) with their respective 95% Confidence Intervals (CI) were also calculated. Data was stratified by year, gender, race and geographical distribution. RESULT:Alzheimer's disease with coexisting heart failure was responsible for 192,459 deaths between 1999-2020. Overall the AAMR increased from 21.32 in 1999 to 24.56 in 2005 (APC: 1.9760*; 95% CI: 0.6001 to 3.9507) after which a significant decrease to 16.52 by 2013 was observed (APC: -4.9301*; 95% CI: -6.5209 to -4.0119). AAMRs decreased from this point forward reaching 22.21 in 2020 (APC: 4.1573*; 95% CI: 3.0373 to 5.7232). Women had higher AAMRs than men (21.57 vs 18.41). Among racial groups, the Non-Hispanic (NH) White (21.62) population had the highest AAMRs followed by NH Black/African American (17.87), Hispanic/Latino (14.3) and NH Asian/Pacific Islander (8.96). Furthermore, AAMRs also varied by census region (West: 24.05; Midwest: 22.83; South: 21.1; Northeast: 13.38). Moreover, nonmetropolitan areas had higher AAMRs than metropolitan areas (27.23 vs 19.09). States in the top 90th percentile such as Kentucky, Oklahoma, Washington, North Dakota and Mississippi had AAMRs that were three times higher relative to states in the lower 10th percentile including Nevada, Florida, New York, District of Columbia and Hawaii. CONCLUSION:Alzheimer's disease mortality with associated heart failure has shown considerable variation in adults ≥ 65 years. AAMRs were highest in women, NH Whites, residents of the West and nonmetropolitan patient populations. Targeted interventions and a more holistic approach to patient management are essential in achieving favorable outcomes for vulnerable groups.

Background:Contrast-induced nephropathy (CIN), also called as contrast associated-acute kidney injury (CA-AKI) is a common complication following cardiac procedures. KDIGO guidelines define CIN as a ≥25% increase in serum creatinine or an absolute increase of at least 0.5 mg/dl 48-72 h post-contrast administration. The single most effective measure in preventing CIN is peri-procedural intravascular hydration typically from 12 h before to 24 h after contrast media exposure but has limitations. Recently, the RenalGuard (RG) system has emerged as a new tool, demonstrating safer and more efficient hydration and reducing the incidence of AKI caused by CIN. Aims:We conducted this meta-analysis on the effectiveness of the RG system in preventing CIN in patients undergoing cardiac interventions. Methods:A comprehensive literature search of PubMed (MEDLINE), Science Direct, and Embase was conducted from its inception until February 2024 for randomized controlled trials (RCTs) including patients aged >18 years undergoing cardiac procedures with underlying chronic kidney disease (CKD), estimated glomerular filtration rate (eGFR) 20-60 ml/min/1.73 m2 and left ventricular ejection fraction (LVEF) >50%. The outcomes of interest were risk of CIN, risk of renal replacement therapy (RRT), in-hospital mortality and 30-day mortality, major adverse cardiovascular events (MACE), changes in serum creatinine (sCr) levels, and incidence of pulmonary edema. A random-effects meta-analysis was performed using Review Manager (RevMan) [Computer Program] Version 5.4 Cochrane Collaboration. Results:A total of 9 RCTs including 3,215 patients with CKD undergoing cardiac procedures on volume expansion strategies were included with 1,802 patients on the RG system and 1,413 patients using alternate volume expansion techniques. Pooled analysis of 9 RCTs reported a significantly lower risk of CIN in patients using the RG system vs. control [OR 0.51 (0.35, 0.74), P = 0.0004; I2 = 55%]. There was no significant difference in the risks of RRT, in-hospital mortality, 30-day MACE, pulmonary edema, or change in sCr levels. Conclusion:This meta-analysis indicates the beneficial utilization of the RG system in populations with moderate-to-high risk and underlying CKD undergoing cardiac interventions in preventing CIN. However, it did not demonstrate a notable impact on mortality, RRT, MACE, pulmonary edema, and sCr levels when compared to the control group.

Background: Postpartum hypertensive disorders are a major cause of maternal mortality and hospital readmission. If untreated, elevated blood pressure can lead to complications such as eclampsia, stroke, and pulmonary edema. Labetalol, a combined α- and β-blocker, and nifedipine, a calcium channel blocker, are widely used oral agents for managing postpartum hypertension. Hypothesis: To compare the efficacy and safety of nifedipine versus labetalol in managing postpartum hypertension. Methods: A systematic review of PubMed, Google Scholar, and the Cochrane Library identified eight studies involving 31,436 patients (12,479 treated with nifedipine; 18,957 treated with labetalol). All randomized controlled trials and observational studies comparing nifedipine and labetalol in postpartum women were included. The primary outcome was hospital readmission. Secondary outcomes included time to blood pressure control, discharge on initial dose, and adverse effects, which included constipation, flushing, and headache. Dichotomous data were analyzed using risk ratios (RRs), and continuous data were assessed using mean differences (MDs) with their respective 95% confidence intervals (95% CIs). Statistical analysis was performed using Review Manager (RevMan) version 5.4.1. A p-value of less than 0.05 was considered statistically significant. Results: Nifedipine significantly reduced the risk of readmission compared to labetalol (RR = 0.40, 95% CI [0.31, 0.52]; P < 0.00001). No significant differences were found in time to blood pressure control (MD = –0.68, 95% CI [–2.20, 0.84]; P = 0.38), discharge on initial medication (RR = 0.78, 95% CI [0.45, 1.34]; P = 0.37), or incidence of adverse effects. Conclusion: Nifedipine was associated with lower readmission risk than labetalol, with comparable efficacy and safety in postpartum hypertension management. Keywords: Nifedipine, Labetalol, Postpartum hypertension, Oral antihypertensive

PURPOSE:To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the outcomes of bypass surgery with those of endovascular interventions for the treatment of peripheral artery disease. MATERIALS AND METHODS:PubMed, Google Scholar, Cochrane Library, and ClinicalTrials.gov were searched until July 2023 for RCTs comparing bypass surgery and endovascular interventions in patients with intermittent claudication or critical limb-threatening ischemia. Primary outcomes included technical success, 30-day morbidity and mortality, 1-year primary patency, and major amputation at 1 year. A random-effects model was employed for pooling odds ratios (ORs) with 95% confidence intervals (CIs). Subgroup and sensitivity analyses and meta-regression were used to explore heterogeneity. RESULTS:Fourteen RCTs involving 3,856 patients were included. Bypass surgery achieved significantly higher technical success (OR, 8.50; 95% CI, 5.46-13.25) and 1-year primary patency (OR, 1.43; 95% CI, 1.03-1.99), However, it was associated with increased 30-day morbidity (OR, 1.38; 95% CI, 1.03-1.86), 30-day mortality (OR, 1.87; 95% CI, 1.10-3.18), and 1-year major amputation rates (OR, 2.58; 95% CI, 1.13-5.88) compared with endovascular interventions. Differences in 1-year amputation-free survival, primary assisted and secondary patency at 1 year, reintervention rates within 1 year, 30-day major adverse cardiac events, postprocedural change in the ankle-brachial index, and changes in health-related quality of life at 1 year, 1-year clinical improvement, and 1-year all-cause mortality were statistically nonsignificant. CONCLUSIONS:Bypass surgery resulted in higher technical success and 1-year primary patency; however, endovascular interventions resulted in lower initial morbidity and mortality and major amputations.