AIMS:Long-standing type 2 diabetes mellitus (DM) increases the risk of chronic coronary syndrome (CCS). We estimated the prevalence of undiagnosed CCS during routine outpatient care and described diagnostic testing strategies. METHODS:This multicenter observational study was conducted in eight diabetes and cardiology outpatient clinics in Greece. Adults with DM ≥10 years and suspected ischemia [angina equivalents and/or ischemic electrocardiographic (ECG) abnormalities] without known CCS underwent joint diabetologist-cardiologist evaluation and appropriate non-invasive and/or invasive testing at physician discretion. RESULTS:Overall, 110 people with type 2 DM (mean age 65.4 years; 47.3% women; mean DM duration 21.3 years) were evaluated. CCS was diagnosed in 15 individuals (13.6%). No patient with CCS reported typical or atypical angina; presentations were mainly angina equivalents, most commonly fatigue (66.7%) and dyspnea (58.3%). Ischemic ECG abnormalities were present in 6/15 (40.0%), including repolarization or conduction changes. Initial tests varied: exercise ECG (33.6%), SPECT/PET (32.7%), and stress echocardiography (28.2%). CONCLUSIONS:This study highlights the diagnostic complexity of detecting CCS in individuals with type 2 DM, particularly due to the prevalence of non-classical symptoms. The findings underscore the importance of a personalized diagnostic approach and multidisciplinary collaboration between diabetologists and cardiologists, to improve cardiovascular risk stratification.

Assess endothelial dysfunction in normal weight women with polycystic ovary syndrome (PCOS) after exercise. To compare brachial artery Flow Mediated Dilatation (FMD) between normal-weight with PCOS and normal-weight control women. The secondary endpoint is to explore if FMD shows correlation with blood pressure, heart rate, maximal oxygen consumption (VO2 max), and VO2 75

Arterial hypertension (AH) and familial hypercholesterolemia (FH) are major risk factors for atherosclerotic cardiovascular disease (ASCVD). The extent to which the coexistence of AH and FH amplifies the ASCVD risk is not well known. We aimed to explore the effect of AH on the prevalence of ASCVD in patients with FH. This was a cross-sectional analysis from the HELLAS-FH registry. A total of 2367 adults with heterozygous FH were studied. Out of these, 602 (25.4

Background and aims: Familial dyslipidemias are associated with increased cardiovascular risk. Increased lipoprotein(a) [Lp(a)] is considered as the most prevalent monogenic lipid disorder. The objective of the study was to identify the cardiovascular prognosis of patients with familial dyslipidemias (heterozygous familial hypercholesterolemia (FH) or familial combined hyperlipidemia (FCH)), without cardiovascular disease at baseline, investigating in parallel the effect of Lp(a). Methods and results: 909 patients with FH (n = 433, mean age 44.2 +/- 12.8 years) or FCH (n = 476, mean age 49.0 +/- 11.1 years) were evaluated during a mean period of 10 years. The main endpoint was the composite of major cardiovascular events. The incidence of major cardiovascular events in the total population was 6.6 %, while greater in patients with FH compared to patients with FCH (8.1 % vs 5.5 %, p = 0.03). Multiple Cox regression analysis revealed that FH patients had greater cardiovascular risk compared to FCH patients (HR 2.17, 95 % CI 1.10-4.26, p = 0.02). In FH patients, increased baseline Lp(a) (>= 30 mg/dl) was an independent predictor of adverse cardiovascular events (HR 2.37 95 % CI 1.41-4.90, p = 0.02), whereas in FCH patients was not. In FCH patients the presence of diabetes at baseline was a strong independent prognosticator of adverse cardiovascular events (HR 3.56 95 % CI 1.19-11.33, p = 0.03), after adjustment for confounders. Conclusions: FH patients demonstrate double cardiovascular risk compared to FCH patients. In FH patients increased Lp(a) doubles the cardiovascular risk, beyond low density lipoprotein cholesterol. In FCH patients the presence of diabetes triples the cardiovascular risk, beyond Lp(a) which does not seem to convey an independent prognostic value.

BACKGROUND: High triglyceride (TG) levels are associated with increased atherosclerotic cardiovascular disease (ASCVD) risk in the general population. Yet, the role of TG in familial hypercholesterolemia (FH) remains understudied. This research aims to evaluate the link between TG levels and ASCVD prevalence in adult patients with FH. METHODS: This cross-sectional analysis, derived from the Hellenic Familial Hypercholesterolemia Registry (HELLAS-FH), involves categorizing patients into tertiles based on their TG concentrations. RESULTS: In our study of 1772 adults with heterozygous FH (HeFH), aged 51 +/- 15 years at registration and diagnosed at 44 +/- 16 years, TG concentrations in the first (80 mg/dL), second (124 mg/dL), and third (200 mg/dL) tertiles revealed varying ASCVD prevalence (18.0%, 28.5%, and 28.5%, respectively). Adjusted for ASCVD risk factors, TGs >= 116 mg/dL were linked to higher ASCVD risk than levels < 116 mg/dL (odds ratio: 1.37, 95% CI 1.05-1.80, P = .02). CONCLUSION: A notable association with ASCVD is evident in FH patients, even at relatively low TG levels, starting from 116 mg/dL (1.31 mmol/L). (c) 2024 National Lipid Association. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Low high-density lipoprotein cholesterol (HDL-C) levels have been associated with increased risk of coronary artery disease (CAD) in the general population. We examined the association between HDL-C levels and CAD prevalence in adult patients with heterozygous familial hypercholesterolemia (HeFH) in the HELLAS-FH registry. Adult patients with HeFH were categorized into quartiles based on baseline (i.e., before any treatment) HDL-C levels. Patient demographics, lipid profile, CAD risk factors and CAD prevalence were analyzed. Patients (n = 1867; 960 males; mean age 51 ± 14 years) were divided into quartiles based on baseline HDL-C levels: Q1 (35 ± 5 mg/dL), Q2 (45 ± 2 mg/dL), Q3 (54 ± 3 mg/dL) and Q4 (70 ± 10 mg/dL). Lower HDL-C quartiles were associated with increased prevalence of CAD risk factors i.e. hypertension, type 2 diabetes (T2D), smoking and body mass index ≥ 25 kg/m2 compared with higher ones. The lowest HDL-C quartile was associated with the highest prevalence of established total (47.6

Background/Objectives: The quantitative flow ratio (QFR)-based functional Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score (FSSQFR) combines coronary arteries’ anatomy and physiology. Methods: We performed an offline FSSQFR calculation in all-comers undergoing coronary angiography in a single center. Based on the tertiles of SYNTAX Score (SS), patients were divided into low-, intermediate-, and high-risk groups with the following cut-offs: SS/FSSQFR < 13, SS/FSSQFR: 13–21, and SS/FSSQFR: >21. The primary endpoint was the predictive value of the FSSQFR of the composite endpoint of all-cause death, myocardial infarction, ischemia-driven revascularization, hospitalization for heart failure, and life-threatening arrhythmias after the follow-up period. Results: This study included 410 patients. SS and FSSQFR were measured for all patients. After calculating FSSQFR, the risk stratification changed in 11% of the study population; more specifically, 26.8, 32.7, and 40.5% of patients were classified as high-, intermediate-, and low-risk, respectively. After a median 30.2 (25.7–33.7) months follow-up period, we recorded 85 events of the primary outcome. The high-risk FSSQFR group compared to the low-risk group had a significantly higher rate of the primary composite outcome (HR: 1.95, 95% CI 1.33–3.34, p = 0.016). Conclusions: In our study, patients classified as the high-risk FSSQFR group had a significantly higher rate of cardiovascular adverse events.

Background & aims The effect of lipid-lowering treatment (LLT) on metabolic dysfunction associated steatotic liver disease (MASLD) is unclear. This is relevant for patients with familial hypercholesterolemia (FH) who are on lifelong LLT. We aimed to evaluate the effect of LLT on MASLD indices in this population. Methods Patients with at least possible diagnosis of FH were included into the Hellenic FH Registry (HELLAS-FH) registry. We analyzed the effect of statin monotherapy, statin/ezetimibe and statin/ezetimibe/proprotein convertase subtilisin/kexin 9 inhibitors (PCSK9i) on MASLD indices, i.e., original triglyceride-glucose index (TyGO) and triglyceride-glucose index (TyG). We compared changes of TyG and TyGO before any treatment and after at least one year of stable LLT. Results We included 1289 patients: n = 569 in the statin monotherapy group (mean age = 51 ± 15 years, 52.7 % males), n = 629 in the statin/ezetimibe group (52 ± 14 years, 51.8 %), and n = 91 in the statin/ezetimibe/PCSK9i group (54 ± 13 years, 58.2 %). Compared with baseline, TyGO and TyG decreased significantly following statin monotherapy (8.61 vs 8.49 and 4.65 vs 4.59, respectively, both p < 0.01), statin/ezetimibe (8.59 vs 8.41 and 4.64 vs 4.55, respectively, both p < 0.01) and statin/ezetimibe/PCSK9i (8.79 vs 8.55 and 4.74 vs 4.62, respectively, both p < 0.01). There was no difference regarding the change of TyGO and TyG between groups after adjusting for baseline levels. A greater percentage of patients in the statin/ezetimibe and statin/ezetimibe/PCSK9i groups exhibited TyGO-defined MASLD resolution compared with statin monotherapy (p < 0.05). After adjustment for possible confounders, LLT was significantly associated with MASLD resolution. Conclusions MASLD indices were significantly improved in all LLT groups in FH patients. Statin/ezetimibe and statin/ezetimibe/PCSK9i were associated with greater TyGO-defined MASLD resolution compared with statin monotherapy.

Hypertensive disorders of pregnancy affect approximately 5% to 10% of pregnant women. Eclampsia is a serious hypertensive disorder that is primarily characterized by the onset of grand mal seizure activity in the absence of other causative conditions. While eclampsia is diagnosed clinically, laboratory tests are recommended to assess for complications. Treatment strategies for eclampsia focus on controlling seizures and managing hypertension. Acute care during a seizure is critical because of the need for immediate medical interventions, including the management of the airway, breathing, and circulation, as well as ensuring the safety of the patient during convulsions. Magnesium sulfate is the preferred anticonvulsant drug. Care must be taken during administration to prevent magnesium toxicity. Antihypertensive drugs used in eclampsia include labetalol, hydralazine and nifedipine. The definitive treatment of eclampsia is delivery. Close monitoring of both mother and fetus is important to identify any indications for delivery. The timing and mode of delivery depend on obstetric indications, the severity of eclampsia, the gestational age of the fetus, and the overall clinical status of the patient. Neuraxial anesthesia is the anesthesia of choice for conscious, seizure-free, and with stable vital signs women undergoing cesarean section.

Background:Despite recent guidelines appropriate lipid-lowering treatment (LLT) remains suboptimal in everyday clinical practice. Aims:We aimed to describe clinical practice of use of LLT for at least high CV risk populations in a Hellenic real-world setting and assess how this relates to the European Society of Cardiology treatment guidelines. Methods:We analyzed data from a retrospective cohort study of the National Registry of patients with dyslipidemia between 1/7/2017 and 30/6/2019 who were at least of high CV risk and filled a dual or triple lipid-lowering treatment (dLLT, tLLT) prescription. The primary outcomes of interest of this analysis were to report on the patterns of LLT use in at least high CV risk patients. Results:A total of 994,255 (45.4% of Greeks on LLT) were of at least high CV risk and 120,490 (5.5%) were on dLLT or tLLT. The percentage of patients with reported statin intolerance ranged from 2 to 10%. While persistence was reported to be satisfactory (>85% for both dLLT or tLLT), adherence was low (ranging between 14 and 34% for dLLT). In 6-month intervals, the percentage of patients achieving a low-density lipoprotein cholesterol (LDL-C) target below 100 md/dL ranged from 20% to 23% for dLLT and 34%-37% for tLLT. Conclusions:The prevalence of at least high CV risk patients among patients receiving LLT in Greece is substantial. Despite the high persistence and probably due to the low adherence to treatment, LDL-C remains above targets in more than two thirds of patients.

The post-percutaneous coronary intervention (post-PCI) fractional flow reserve (FFR) can detect suboptimal PCI or residual ischemia and potentially lead to fewer adverse clinical outcomes. We sought to investigate the predictive value of the angiography-derived FFR for adverse cardiovascular events in patients after PCI. We conducted a comprehensive search of electronic databases, MEDLINE, EMBASE, and the Cochrane Library, for studies published until March 2023 that investigated the prognostic role of angiography-derived fractional flow reserve values after PCI. We investigated the best predictive ability of the post-PCI angiography-derived FFR and relative risk (RR) estimates with 95% confidence intervals (CIs) between post-PCI angiography-derived FFR values and adverse events. Thirteen cohort studies involving 6961 patients (9719 vascular lesions; mean follow-up: 2.2 years) were included in this meta-analysis. The pooled HR of the studies using specific cut-off points for post-PCI angiography-derived FFR was 4.13 (95% CI, 2.92–5.82) for total cardiovascular events, while the pooled HRs for target vessel revascularization, cardiac death, target vessel myocardial infarction, and target lesion revascularization were 6.87 (95% CI, 4.93–9.56), 6.17 (95% CI, 3.52–10.80), 3.98 (95% CI, 2.37–6.66) and 6.27 (95% CI, 3.08–12.79), respectively. In a sensitivity analysis of three studies with 1789 patients assessing the predictive role of the post-PCI angiography-derived FFR as a continuous variable, we found a 58% risk reduction for future adverse events per 0.1 increase in the post-PCI angiography-derived FFR value. In conclusion, post-PCI angiography-derived FFR is an effective tool for predicting adverse cardiovascular events and could be potentially used in decision making, both during PCI and in the long-term follow-up.