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Discussion In a recent survey among 2625 high risk patients on atorvastatin, 10.5% of patients achieved an LDL-target of <70 mg/dl, whereas more than 60% of patients were assessed by their physicians to have clinically met the target . Similarly, the data from DYSIS II showed that use of lipid lowering therapy was widespread and improved after hospitalization for an ACS. However, the intensity of such a therapy was only moderate in both the CHD and ACS cohorts with only 37% reaching the target value of <70 mg/dl LDL-C within 120 days since hospital discharge . Given the linear relationship between LDL and atherosclerosis progression with even further LDL-reduction below the target of 70mg/dl leading to reduction in cardiovascular outcomes [, , , , ], our data suggests that clinical practice keeps the majority of our patients at harm. Antibodies to the proprotein convertase subtilisin-kexin type 9 (PCSK9) have proven to reduce LDL-levels in addition to statin therapy by 50% and more, reducing both coronary plaque burden and cardiovascular event probability [23,28]. However, given the limited acceptance of more aggressive statins by patients and treating physicians as documented in our study, the willingness to follow more cost-intensive treatments regimens may be questioned. Multi-disciplinary approaches on patient and KN-93 hydrochloride level for improvement of acceptance and adherence to effective lipid lowering therapy are warranted to maximize the benefits of standard treatment options . Compared to ESC-guidelines, current American lipid-lowering guidelines suggest an earlier and more aggressive use of statins especially in primary prevention cohorts, leading towards recommendations for statin therapy in broader parts of the population [27,30,31]. Whether this approach leads to a sustained reduction of LDL-cholesterol levels in appropriate populations needs to be determined in future studies. While the reduction of LDL-targets by the ESC led to an initial reduction of LDL-levels in patients with manifest CAD in our study, potentially triggered by an increase in awareness regarding the medical need, this effect was diluted over time.
Conclusions The following is the supplementary data related to this article.
Introduction Cardiovascular diseases that damage the heart and lead to Heart Failure (HF), stimulate myocytes death and generation of fibrosis, as well as ventricular remodeling . Heart failure is considered, deadly, incapacitating and a heavy disorder worldwide. The occurrence of HF in developed countries has extended epidemic proportions increasingly. However, the estimate HF patients referred to the hospital remains low. In the United States, HF is reported to affect about 6 million individuals, with more than 300,000 deaths annually, which costs over 40 billion dollars in the health care service . Recent therapeutic approaches in HF patients increase the lifespan, but so far no document has been reported the essential efforts for the repair of cardiac tissue. Stem cells are cell types distinguished by their ability of self-renewal as well as their capacity to differentiate into developed progenitor cells that themselves could discriminate into specific matured cells types [3,4]. Throughout the past 15 years, various preclinical and clinical studies investigated the capability of numerous stem cells to progress cardiac function and weaken adversative Left Ventricular (LV) remodeling in heart diseases . In spite of this quick development, various essential questions arise which need to be determined, beside the fact that up to now no operative cell therapy in patients with cardiomyopathy has been reported. Afterward two decades of focused investigation and efforts of clinical trials, stem cell based therapies for cardiac diseases are not receiving nearer to clinical accomplishment . This review addresses the existing state of advancement of Stem Cell (SC) therapy in heart diseases. We summarize the impact of studies conducted regarding the use of Induced Pluripotent Stem Cells (iPSCs), Embryonic Stem Cells (ESC), Cardiac Stem Cells (CSC), and Skeletal Myoblasts (Fig.1), and argue current debates, unsolved problems, as well as the prospective instructions.