Chapter 1 Flashcards
Atrial fibrillation can often be abolished permanently early in the course by electrically disconnecting the source of arrhythmia triggers by _______.
pulmonary vein isolation sometimes using cryoballoon ablation
CHIP
clonal hematopoiesis of independent potential
-Exome sequencing of DNA obtained from leukocytes in the peripheral blood that acquires a progressive increase in mutations, especially in the elderly.
The most commonly mutated CHIP- driver genes frequently occur in patients with_______.
Aortic stenosis
classic risk factors for ASCVD
elevated LDL- C
hypertension
T2DM
Smoking
Addition:
inflammation
CHIP
inhibits expression of LPL, thereby increasing circulating TGs
synthesized by hepatocytes
Angiopoietin- like 3 (ANGPTL3)
Three approaches to reducing ANGPTL3 (Angiopoietin- like 3):
(1) a hepatocyte- directed antisense oligonucleotide (vupanorsen) that reduces TG as well as apolipoproteins B and CIII104
(2) evinacumab, a
monoclonal antibody against ANGPTL3 that reduces TG and has been approved to reduce LDL- C in patients with homozygous familial and other forms of hypercholesterolemia; and
(3) very preliminary studies on editing the gene encoding ANGPTL3
Elevations of circulating Lp(a) are associated with four interrelated phenotypic changes, each of which increases cardiovascular risk: (4)
(1) accelerated atherogenesis; (2) intensification of vascular inflammation; (3) worsening of calcific AS; and (4) enhancement of a prothrombotic state
SGLT2i that showed to be effective in nondiabetic patients with HFrEF (3)
dapagliflozin
empagliflozin
sotagliflozin
magnetically levitated centrifugal flow pump, which was even smaller, and in a trial led by Mandeep Mehra, a Boston cardiologist, it was shown to be safer as well, with the elimination of pump thrombosis and lower stroke rate
Heart Mate 3
Profiles of the small fraction of patients on chronic LVAD support who exhibited recovery of sufficient cardiac function to allow explantation of the device (3)
- younger than the patients usually receiving an LVAD,
- have a shorter duration of HF, and are more likely to have a
- dilated rather than ischemic cardiomyopathy.
A humanized monoclonal antibody that blocks the interleukin (IL)- 1β innate immunity pathway.
CANTOS validated the inflammatory hypothesis by demonstrating a statistically significant, albeit modest, reduction in lipid-independent cardiovascular events
Canakinumab
a well-known anti-inflammatory agent that appears to inhibit tubulin polymerization and reduce activation of IL- 1β.
Colchicine-
effective in halting acute gouty arthritis, familial Mediterranean fever, and acute pericarditis
shortens the half-life of intracellular LDL- C receptors, thus reducing their recycling to the cell surface, raising circulating LDL- C and the incidence of ASCVD
PCSK9
Name the trials for the following:
- colchicine reduced major cardiovascular adverse events in post-MI patients
- similar benefit in patients with chronic CAD
- COLCOT trial
- LODOCO- 2 trial
Inflammasome stimulates the formation of IL- 1β and IL18, two highly inflammatory cytokines. Which in turn activates IL-6, which enhances the production of CRP by the liver.
NLRP3
“risk factors” for CAD
male sex, hypertension, elevated serum cholesterol, diabetes, and electrocardiographic left ventricular hypertrophy
two gain-of-function mutations in a gene that encodes proprotein convertase subtilisin/kexin type 9 (PCSK9)
autosomal dominant hypercholesterolemia
The trial that showed monoclonal PCSK9 antibody evolocumab was shown to be moderately effective in reducing elevated Lp(a).
FOURIER- TIMI 59 trial
