Introduction and objectives: Only about 1 out of every 3 patients with acute myocardial infarction (AMI) achieve low-density lipoprotein cholesterol (LDL-C) values < 55 mg/dL in the first year. The present study aims to evaluate the impact of early intensive therapy on lipid control after an AMI. Methods: An independent, prospective, pragmatic, controlled, randomized, open-label, evaluator- blinded clinical trial (PROBE design) will analyze the efficacy and safety of an oral lipid-lowering triple therapy: high-potency statin + bempedoic acid (BA) 180 mg + ezetimibe (EZ) 10 mg versus current European-based guidelines (high-potency statin f EZ 10 mg), in AMI patients. LDL-C will be determined within the first 48 hours. Patients with LDL-C > 115 mg/dL (without previous statin therapy), > 100 mg/dL (with previous low-potency or high-potency statin therapy at submaximal dose), or > 70 mg/dL (with previous high-potency statin therapy at high dose) will be randomly assigned 1:1 between 24 and 72 hours post-AMI to the BA/EZ combination or to statin f EZ, without BA. The primary endpoint is the proportion of patients reaching LDL-C < 55 mg/dL at 8 weeks after treatment. Results: The results of this study will provide novel information for post-AMI LDL-C control by evaluating the usefulness of an early intensive lipid-lowering strategy based on triple oral therapy. Conclusions: Early intensive lipid-lowering triple oral therapy vs the treatment recommended by current clinical practice guidelines could facilitate the achievement of optimal LDL-C levels in the first 2 months after AMI (a high-risk period). Identification number: EudraCT 2021-006550-31. C 2024 Sociedad Espanola de Cardiolog & imath;a. Published by Elsevier Espana, S.L.U. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Abstract Aims Frailty and dependence are frequent in patients admitted for acute heart failure (AHF), but their prognostic significance is unknown, especially in young adults. We aimed to study in adults admitted for AHF, regardless of age, the effect of frailty and dependence on the incidence of mortality and a combined event of mortality, readmissions for AHF, and visits to the emergency room (ER) for AHF at 1 and 6 months. Methods and results We designed a prospective cohort study by including all the patients with AHF admitted in our Cardiology Department from July 2020 through May 2021. A multidimensional geriatric assessment was performed during the admission. We clinically followed up the patients 6 months after discharge. We enrolled 202 patients. The mean age was 73 ± 12.32 years, and 100 (49.5%) of the patients were elderly (>75 years). Just 78 patients (38.6%) were women, and 100 (49.5%) had previous HF. Frailty (FRAIL ≥ 3) was observed in 68 (33.7%) patients (mean FRAIL score: 1.88 ± 1.48). Dependence (Barthel < 100) was observed in 65 (32.2%) patients (mean Barthel index: 94.38 ± 11.21). Frailty and dependence showed a significant association with both prognostic events at 1 and 6 months. In the multivariable analysis, frailty was associated with higher mortality at 1 month [hazard ratio (HR) 12.61, 95% confidence interval (CI) 1.57–101.47, P = 0.017] but not at 6 months (HR 2.25, 95% CI 0.61–8.26, P = 0.224) or with the combined endpoint at neither 1 month (HR 1.64, 95% CI 0.54–5.03, P = 0.384) nor 6 months (HR 1.35, 95% CI 0.75–2.46, P = 0.320). Dependence was related to higher mortality at 1 month (HR 13.04, 95% CI 1.62–104.75, P = 0.016) and 6 months (HR 7.18, 95% CI 1.99–25.86, P = 0.003) and to higher incidence of the combined event at 1 month (HR 5.93, 95% CI 1.63–21.50, P = 0.007) and 6 months (HR 2.62, 95% CI 1.49–4.61, P = 0.001). Conclusions In AHF patients, frailty and dependence implied a worse prognosis, rising mortality, readmissions, and ER visits for AHF.

Introducción y objetivos: En la práctica habitual, solamente 1 de cada 3 pacientes con infarto agudo de miocardio (IAM) alcanza cifras de colesterol unido a lipoproteínas de baja densidad (cLDL) < 55 mg/dl en el primer año. El presente estudio pretende evaluar el impacto de un tratamiento intensivo precoz para el control lipídico tras un IAM.Métodos: Ensayo clínico independiente, prospectivo, pragmático, controlado, aleatorizado, abierto, ciego para el evaluador (diseño PROBE), que analiza la eficacia y la seguridad de un tratamiento hipolipemiante oral triple: estatina de alta potencia + ácido bempedoico [AB] 180 mg + ezetimiba [EZ] 10 mg frente a la estrategia basada en las vigentes recomendaciones (estatina de alta potencia ± EZ 10 mg) en pacientes con IAM. Se determina el cLDL en las primeras 48 h tras el IAM. Se aleatoriza 1:1 a AB+EZ o estatina ± EZ sin AB a los pacientes con cifras, entre las 24 y las 72 h tras el IAM, de cLDL ≥ 115 mg/dl sin estatinas previas, ≥ 100 mg/dl tras estatina de baja potencia o alta potencia a dosis no máxima o ≥ 70 mg/dl tras estatina de alta potencia a dosis máxima. El objetivo primario es el porcentaje de pacientes con cLDL < 55 mg/dl tras 8 semanas del tratamiento.Resultados: estos resultados aportarán información novedosa para el control del cLDL tras el IAM evaluando la utilidad de una estrategia hipolipemiante oral intensiva y precoz.Conclusiones: El tratamiento hipolipemiante oral triple precoz frente al tratamiento recomendado por las guías de práctica clínica podría facilitar la optimización del cLDL en los primeros 2 meses tras el IAM (periodo de alto riesgo).

Transthyretin amyloid cardiomyopathy (ATTR-CM) is an increasingly diagnosed condition. Although wild-type transthyretin amyloidosis (ATTRwt) is the most common ATTR-CM, hereditary transthyretin amyloidosis (ATTRv) may also occur. Currently, genetic testing for transthyretin pathogenic variants is recommended for patients with a confirmed clinical diagnosis of ATTR-CM. In fact, confirmation of this autosomal dominant pathogenic variant prompts genetic counselling and allows early identification of affected relatives. Additionally, in the presence of an ATTR-CM-associated polyneuropathy, specific drugs targeting transthyretin can be used. In this paper, we review the utility of genetic testing for the detection of pathogenic variants among patients harboring ATTR-CM and its impact on the natural history of the disease.

BACKGROUND:Heart failure prevalence is increasing in elder adults. These patients usually present geriatric syndromes, especially frailty. The effect of frailty on heart failure is under discussion but there are few data about the clinical characterization of frail patients who are admitted for acute heart failure decompensation. OBJECTIVE:The purpose of this study was to study the differences in clinical baseline variables and geriatric scales between frail and non-frail patients admitted to the Cardiology unit via the Emergency Department for acute heart failure. METHODS:We enrolled all patients with acute heart failure who were admitted to the Cardiology unit from the Emergency Department of our hospital from July 2020 through May 2021. A multidimensional and comprehensive geriatric assessment was performed at the moment of admission. We studied differences in baseline variables and geriatric scales according to the frailty status determined by the FRAIL scale. RESULTS:A total of 202 patients were included. In the whole population, 68 (33.7%) patients presented frailty defined by a FRAIL score ≥ 3. The frail patients were older (80±9 vs. 69±12 years; p<0.001), and had a worse quality of life (58.31±12.18 vs.39.26±13.71 points; p<0.001) according to the Minnesota scale, presented high comorbidity (47 (69.1%) vs. 67 (50.4%) patients; p = 0.011) defined as ≥3 points according to the Charlson scale and were more dependent (40 (58.8%) vs. 25 (18.8%) patients; p<0.001) according to the Barthel scale. The frail patients presented higher MAGGIC risk scores (24.09±4.99 vs. 18.89±6.26; p<0.001). Despite this adverse profile, the treatments prescribed during the admission and at the hospital discharge were similar. CONCLUSIONS:The prevalence of geriatric syndromes, especially frailty, is very high in patients admitted for acute heart failure. Frail patients with acute heart failure had an adverse clinical profile with more prevalence of concomitant geriatric syndromes. Therefore, we consider that a geriatric assessment should be performed during the admission of acute heart failure patients to improve care and attention.

Frailty has traditionally been studied in the elderly population but scarcely in younger individuals. The objective of the present study is to analyze differences according to age in the diagnostic performance of cardiac biomarkers to predict frailty in patients admitted to the hospital for acute heart failure (AHF). A frailty assessment was performed with the SPPB and FRAIL scales (score > 3). We included 201 patients who were divided according to age: those older and younger than 75 years. In the younger group, no biomarker was related to the presence of frailty. This was mainly determined by age and comorbidities. In the elderly group, NT-proBNP was significantly related to the presence of frailty, but none of the baseline characteristics were. The best cut-off point in the elderly group for NT-proBNP was 4000 pg/mL. The area under the curve (AUC) for proBNP for frailty detection was 0.62 in the elderly. Another similar frailty scale, the SPPB, also showed a similar AUC in this group; however, adding the NT-proBNP (one point if NT-proBNP < 4000 pg/mL), it showed a slightly higher yield (AUC 0.65). The addition of biomarkers could improve frailty detection in members of the elderly population who are admitted to the hospital for AHF.