Coronary artery disease (CAD) is a pathological process characterized by atherosclerotic plaque accumulation in the epicardial arteries, whether obstructive or non-obstructive. This process can be modified by lifestyle adjustments, pharmacological therapies, and invasive interventions designed to achieve disease stabilization or regression. The disease can have long, stable periods but can also become unstable at any time, typically due to an acute atherothrombotic event caused by plaque rupture or erosion. However, the disease is chronic, most often progressive, and hence serious, even in clinically apparently silent periods. The dynamic nature of the CAD process results in various clinical presentations, which can be conveniently categorized as either acute coronary syndromes (ACS) or chronic coronary syndromes (CCS). The Guidelines presented here refer to the management of patients with CCS. The natural history of CCS is illustrated in Figure 1.

/pdf/2019-esc-guidelines-for-the-diagnosis-and-management-of-5b7mv2v506.pdf

2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes.

A correction has been published: European Heart Journal, ehaa895, https://doi.org/10.1093/eurheartj/ehaa895

2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

Document reviewers: Hind Beheiry (Sudan), Irina Chazova (Russia), Albertino Damasceno (Mozambique), Anna Dominiczak (UK), Anastase Dzudie (Cameroon), Stephen Harrap (Australia), Hiroshi Itoh (Japan), Tazeen Jafar (Singapore), Marc Jaffe (USA), Patricio Jaramillo-Lopez (Colombia), Kazuomi Kario (Japan), Giuseppe Mancia (Italy), Ana Mocumbi (Mozambique), Sanjeevi N.Narasingan (India), Elijah Ogola (Kenya), Srinath Reddy (India), Ernesto Schiffrin (Canada), Ann Soenarta (Indonesia), Rhian Touyz (UK), Yudah Turana (Indonesia), Michael Weber (USA), Paul Whelton (USA), Xin Hua Zhang, (Australia), Yuqing Zhang (China).

https://repository.nwu.ac.za/bitstream/10394/34842/1/2020%20International%20Society%20of%20Hypertension.pdf

2020 International Society of Hypertension global hypertension practice guidelines

/pdf/2021-esc-guidelines-on-cardiovascular-disease-prevention-in-14ygu7kat1.pdf

2021 ESC Guidelines on cardiovascular disease prevention in clinical practice

The current manuscript is the second update of the original Practical Guide, published in 2013 [Heidbuchel et al. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace 2013;15:625-651; Heidbuchel et al. Updated European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation. Europace 2015;17:1467-1507]. Non-vitamin K antagonist oral anticoagulants (NOACs) are an alternative for vitamin K antagonists (VKAs) to prevent stroke in patients with atrial fibrillation (AF) and have emerged as the preferred choice, particularly in patients newly started on anticoagulation. Both physicians and patients are becoming more accustomed to the use of these drugs in clinical practice. However, many unresolved questions on how to optimally use these agents in specific clinical situations remain. The European Heart Rhythm Association (EHRA) set out to coordinate a unified way of informing physicians on the use of the different NOACs. A writing group identified 20 topics of concrete clinical scenarios for which practical answers were formulated, based on available evidence. The 20 topics are as follows i.e., (1) Eligibility for NOACs; (2) Practical start-up and follow-up scheme for patients on NOACs; (3) Ensuring adherence to prescribed oral anticoagulant intake; (4) Switching between anticoagulant regimens; (5) Pharmacokinetics and drug-drug interactions of NOACs; (6) NOACs in patients with chronic kidney or advanced liver disease; (7) How to measure the anticoagulant effect of NOACs; (8) NOAC plasma level measurement: rare indications, precautions, and potential pitfalls; (9) How to deal with dosing errors; (10) What to do if there is a (suspected) overdose without bleeding, or a clotting test is indicating a potential risk of bleeding; (11) Management of bleeding under NOAC therapy; (12) Patients undergoing a planned invasive procedure, surgery or ablation; (13) Patients requiring an urgent surgical intervention; (14) Patients with AF and coronary artery disease; (15) Avoiding confusion with NOAC dosing across indications; (16) Cardioversion in a NOAC-treated patient; (17) AF patients presenting with acute stroke while on NOACs; (18) NOACs in special situations; (19) Anticoagulation in AF patients with a malignancy; and (20) Optimizing dose adjustments of VKA. Additional information and downloads of the text and anticoagulation cards in different languages can be found on an EHRA website (www.NOACforAF.eu).

/pdf/the-2018-european-heart-rhythm-association-practical-guide-4iood3iocz.pdf

The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation.

Relation of the Leu40Arg variant of glycoprotein IIIA to personal and family history of myocardial infarction GPIIb/IIIa fibrinogen receptor is a key element of the thrombotic pathway. In this study, we investigated the possible relation of PlA1/A2 polymorphism (1565T>C; Leu33Pro) and a rare 1586T>G (Leu40Arg) variation of GPIIIa gene to personal and family history of myocardial infarction (MI) among 601 patients with angiographically confirmed coronary heart disease. Four hundred and fifteen patients had MI and 94 of individuals reported family history of premature MI. The Arg40 (1586G) variant (n = 4) was present exclusively in MI-patients and significantly correlated with a family history of premature MI (P = 0.013), whereas the Pro33 (1565C; PlA2) allele (n = 204) was similarly prevalent among different groups of patients. These data indicate the importance of the Arg40 variant but do not support a significant role of Pro33 allele in susceptibility to MI. Glikoproteīna iiia leu40arg varianta saistība ar miokarda infarkta personīgo un gimenes vēsturi GPIIb/IIIa fibrinogēna receptors ir centrāls trombogenēzes elements. Balstoties uz 601 pacientu ar angiogrāfiski apstiprinātu koronāro sirds slimību, pētījumā analizēta GPIIIa gēna PlA1/A2 polimorfisma (1565T>C; Leu33Pro) un retas 1586T>G (Leu40Arg) variācijas asociācija ar miokarda infarktu (MI) un priekšlaicīga MI gimenes anamnēzi. 415 no pacientiem bija raksturīgs miokarda infarkts un 94 — MI gimenes vēsture. Arg40 (1586G) variants (n = 4) tika konstatēts vienīgi MI pacientos un būtiski korelēja ar pāragra MI gimenes anamnēzi (P = 0.013). Pro33 (1565C) alēle (n = 204), savukārt, dažādās pacientu grupās bija izplatīta līdzīgi. Šie rezultāti liecina par Arg40 varianta nozīmi, bet neapstiprina Pro33 alēles lomu MI predispozīcijā.

/pdf/relation-of-the-leu40arg-variant-of-glycoprotein-iiia-to-2abcrz2cj2.pdf

Relation of the Leu40Arg variant of glycoprotein IIIA to personal and family history of myocardial infarction

The use of international nonproprietary names (INNs) has been mandatory for prescriptions of state-reimbursed drugs in Latvia since 1 April 2020. In a retrospective analysis, we aimed to examine the impact of the new regulation on changes in the prescribing and dispensing practice of antihypertensive agents with an example of bisoprolol or/and perindopril and their combinations. All state-reimbursed bisoprolol and/or perindopril prescriptions for arterial hypertension were evaluated in two time periods: 1 April 2018 to 31 March 2019 and 1 April 2020 to 31 March 2021. The proportion of INN prescriptions increased from 2.1% to 92.3% (p < 0.001, φ = 0.903). The rate of fixed-dose combinations (FDCs) increased from 60.8% to 66.5% (p < 0.001, φ = 0.059). The rate of medication errors was 0.6%. The most common (80.6%) error was that the dispensed medicine dose was larger or smaller than indicated on the prescription. In addition, prescribing an FDC medicine increased the chance of making an error by 2.5 times on average. Regulatory changes dramatically affected the medicine-prescribing habits of INNs. The increase in FDC prescription rates may align with the recommendations of the 2018 ESC/ESH guidelines. The proportion of total errors is estimated as low, but control mechanisms are needed to prevent them.

/pdf/the-impact-of-international-nonproprietary-names-integration-2q6l0y1q.pdf

The Impact of International Nonproprietary Names Integration on Prescribing Reimbursement Medicines for Arterial Hypertension and Analysis of Medication Errors in Latvia

Number of lipid-lowering medications and attainment of lipid goals in familial hypercholesterolemia patients: Data from the Latvian registry

http://www.jvascsurg.org/article/S0741521422019425/pdf

Reply.

The aim of the REALITY Latvia survey was to accumulate information about treated stable angina outpatients regarding their characteristics, heart rate (HR), treatment, and quality of life. Thirty cardiologists were involved with 1-15 patients each. In total, data about 300 patients were obtained. Patients were examined and questioned during one visit. A high HR was defined above 70 beats per minute (bpm), in accordance to recent evidence. Mean HR was 70.3 ± 11.3 bpm and 45% of patients had HR above 70 bpm. The opinion of practitioners regarding HR differed. For example, a HR level within the range 70-80 bpm was perceived by cardiologists as "normal", "borderline high" and "high". The mean target HR that physicians wanted to achieve was 60.1 ± 4.7 bpm. Beta blockers were used in 91% of cases. The more widely used beta blockers were metoprolol (47%) and bisoprolol (35%) in mean daily doses 69.7 ± 30.1 mg and 5.3 ± 2.0 mg, respectively. REALITY Latvia data suggest that, despite wide use of beta blockers, HR control in stable angina patients is insufficient. This is caused by insufficient understanding of HR as a treatment target by physicians and use of beta blockers in suboptimal dosages.

Current state of angina treatment in the outpatient population and heart rate monitoring survey in Latvia (RELITY LATVIA) Section B Natural, exact, and applied sciences =

Gustavs Latkovskis

Papers

Relation of the Leu40Arg variant of glycoprotein IIIA to personal and family history of myocardial infarction

The Impact of International Nonproprietary Names Integration on Prescribing Reimbursement Medicines for Arterial Hypertension and Analysis of Medication Errors in Latvia

Number of lipid-lowering medications and attainment of lipid goals in familial hypercholesterolemia patients: Data from the Latvian registry

Reply.

Current state of angina treatment in the outpatient population and heart rate monitoring survey in Latvia (RELITY LATVIA) Section B Natural, exact, and applied sciences =