Atherosclerosis refers to a unique form of chronic inflammatory anomaly of the vasculature, presented as rupture-prone or occlusive lesions in arteries. In advanced stages, atherosclerosis leads to the onset and development of multiple cardiovascular diseases with lethal consequences. Inflammatory cytokines in atherosclerotic lesions contribute to the exacerbation of atherosclerosis. Pharmacotherapies targeting dyslipidemia, hypercholesterolemia and neutralizing inflammatory cytokines (TNF-α, IL-1β, IL-6, IL-17, and IL-12/23) have displayed some promising although contradictory results. Moreover, adjuvants such as melatonin, a pluripotent agent with proven anti-inflammatory, anti-oxidative and neuroprotective properties, also display promises in alleviating cytokine secretion in macrophages through mitophagy activation. Here, we share our perspectives on this concept and present melatonin-based therapeutics as a means to modulate mitophagy in macrophages and, thereby, ameliorate atherosclerosis.

Aims: The aim of the present meta-analysis was to evaluate the effectiveness and safety of non–vitamin K antagonist oral anticoagulants (NOACs) vs. vitamin K antagonists (VKAs) in atrial fibrillation (AF) patients with polypharmacy. Methods and results: Randomized controlled trials or observational studies reporting the data about the NOACs and VKAs therapy among AF patients with polypharmacy were included. The search was performed in the PubMed and Embase databases up to November 2022. There were no differences in the rates of SSE but increased risk of all-cause death and major bleeding between moderate polypharmacy and severe polypharmacy versus no-polypharmacy patients. The use of NOACs compared with VKAs was significantly associated with reduced risks of stroke or systemic embolism (SSE) in AF patients with moderate polypharmacy (hazard ratios [HRs], 0.77 [95% confidence intervals [CIs], 0.69–0.86]) and severe polypharmacy (HR, 0.76 [95% CI, 0.69–0.82]) and there was no significant difference in major bleeding (moderate polypharmacy: HR, 0.87 [95% CI, 0.74–1.01]; severe polypharmacy: HR, 0.91 [95% CI, 0.79–1.06]) between the two groups. There were no differences in the rates of ischemic stroke, all-cause death, and gastrointestinal bleeding but reduced risk of any bleeding between the NOACs and VKAs users. Compared with VKAs, the risk of intracranial hemorrhage was reduced in patients with moderate polypharmacy but not in patients with severe polypharmacy in NOACs users. Conclusion: In patients with AF and polypharmacy, NOACs showed advantages over VKAs in SSE and bleeding, and non-inferiority in major bleeding, ischemic stroke, all-cause death, intracranial hemorrhage, and gastrointestinal bleeding.

Background: Atrial fibrillation (AF) and venous thromboembolism (VTE) share several risk factors related to arterial thromboembolism. No study has reported the differential contribution to arterial thromboembolic events and mortality between these two conditions in the same population. Methods: We included AF and VTE national cohorts derived from Taiwan National Health Insurance Research Database between 2001 and 2013. The eligible population was 314,861 patients in the AF cohort and 41,102 patients in the VTE cohort. The primary outcome was arterial thromboembolic events, including ischemic stroke, extracranial arterial thromboembolism (ECATE) and myocardial infarction (MI). Secondary outcomes were all-cause mortality and cardiovascular death. Results: After a 1:1 propensity matching, 32,688 patients in either group were analyzed. The risk of arterial thromboembolic events was lower in the VTE cohort than that in the AF cohort (subdistribution hazard ratio [SHR], 0.60; 95% confidence interval [CI], 0.57–0.62)). The risk of ischemic stroke (SHR, 0.44; 95% CI, 0.42–0.46) and MI (SHR, 0.80; 95% CI, 0.72–0.89) were lower in the VTE cohort, while the risk of ECATE (SHR, 1.23; 95% CI, 1.14–1.33; particularly lower extremities) was higher in the VTE cohort. All-cause mortality rate was higher in the VTE cohort (HR, 1.18; 95% CI, 1.15–1.21) while the risk of cardiovascular death was lower in the VTE cohort (HR, 0.96; 95% CI, 0.93–0.995). Conclusions: Patients with AF had higher risks of arterial thromboembolic events compared to patients with VTE, despite having risk factors in common. The VTE cohort had higher risks of all-cause mortality and ECATE, particularly lower extremity events, compared to AF patients. These differential manifestations of thromboembolism sequelae in AF and VTE merit further investigation.

Background Symptom-focused management is one of the cornerstones of optimal atrial fibrillation (AF) therapy. Objectives To evaluate the use of rhythm control and rate control strategy. Second, to identify predictors of the use of amiodarone in patients with rhythm control and of the use of rhythm control strategy in patients with paroxysmal AF in the Balkans. Methods Prospective enrolment of consecutive patients from 7 Balkan countries to the BALKAN-AF survey was performed. Results Of 2,712 enrolled patients, 2,522 (93.0%) with complete data were included: 1,622 (64.3%) patients were assigned to rate control strategy and 900 (35.7%) to rhythm control. Patients with rhythm control were younger, more often hospitalized for AF and with less comorbidities (all p <0.05) than those with rate control. Symptom score [European Heart Rhythm Association (EHRA)] was not an independent predictor of a rhythm control strategy [odds ratio (OR) 0.99, 95% confidence interval (CI) 0.90-1.10, p = 0.945]. The most commonly chosen antiarrhythmic agents were amiodarone (49.7%), followed by propafenone (24.3%). Conclusion More than one third of patients in BALKAN-AF survey received a rhythm control strategy, and these patients tended to be younger with less comorbidities than those managed with rate control. EHRA symptom score is not significantly associated with rhythm control strategy. The most commonly used antiarrhythmic agents were amiodarone, followed by propafenone.

Background Identification of published data on prevalent/incidence of atrial fibrillation/flutter (AF) often relies on inpatient/outpatient claims, without consideration to other types of healthcare services and pharmacy claims. Purpose To examine AF prevalence/incidence and associated individual comorbidity and multi-morbidity profiles for a large US adult cohort spanning across a wide age range for both males/females based on both medical/pharmacy claims. Methods We studied a population of 8,343,992 persons across many geographical areas in the U.S. continent from 1 January /2016 to 31 October 2019. The prevalence and incidence of AF were comparatively analyzed for different healthcare parameters. Results Based on integrated medical and pharmacy claims, AF prevalence was 12.7% in the elderly population (> 65 years) and 0.9% in the younger population (< 65 years). These prevalence rates are different from estimates provided by the US CDC for those aged > 65 years (9%) and age < 65 years (2%); thus, the prevalence is under-estimated in the elderly population and over-estimated in the younger population. The incidence ratios for elderly females relative to younger females was 15.07 (95%CI 14.47-15.70), a value that is about 50% higher than for elderly males (10.57 (95%CI 10.24-10.92)). Comorbidity risk profile for AF identified on the basis of medical and pharmacy criteria varied by age and sex. The proportion with multimorbidity (defined as ≥2 long term comorbidities) was 10-12%. Conclusion Continued reliance only on outpatient and inpatient claims greatly underestimates AF prevalence and incidence in the general population by over 100%. Multimorbidity is common amongst AF patients, affecting approximately 1 in 10 patients. AF patients with 4 or more co-morbidities captured 20 to 40% of the AF cohorts depending on age groups and prevalent or incident cases. Our proposed methodology can guide future analysis of quality/cost of care for progressive medical conditions at the population level.

Objectives: In this paper we outline how inflammation related to oral disease such as periodontitis, bacteraemia and pulpal lesions have been linked to cardiovascular disease and undertake a systematic review of the literature focused on acute dental infection and cardiac arrhythmia. We also describe an illustrative case where an acute oral infection was associated with occurrence of new onset atrial fibrillation (AF). Methods: An electronic search was undertaken using MEDLINE and SCOPUS from 01 Jan 1970 until 30 June 2020. We also undertook manual searches using forward and backward citation chasing. Inclusion criteria were any primary research studies investigating symptomatic apical infections or dental abscess with outcomes of arrythmia. Results Over the last fifty years, only two low quality studies have been investigated this area. Our illustrative case involved a 58-year-old who was diagnosed with an acute dental infection from an upper canine tooth. The patient later developed tachycardia and new-onset AF. Conclusions: Based on the biological plausibility of a link between acute dental infection and arrythmia, together with the case report presented, it is evident that further study in this area is needed. If there are possible cardiovascular consequences for patients suffering acute dental infections, this has future implications for healthcare staff as they can integrate professional advice related to oral health and cardiovascular disease. Screening programmes situated in dental settings can also facilitate early intervention and prevention producing benefits not just for patients, but in savings to the health system.