Kidney transplantation (KT) is the treatment of choice for suitable candidates with advanced kidney disease, offering improved survival compared with chronic dialysis. However, KT recipients remain at high risk for cardi...Kidney transplantation (KT) is the treatment of choice for suitable candidates with advanced kidney disease, offering improved survival compared with chronic dialysis. However, KT recipients remain at high risk for cardiovascular mortality and complications. Cardiovascular-kidney-metabolic syndrome is commonly present, with high rates of obesity, diabetes, and dyslipidemia posttransplant. These risk factors are exacerbated by the metabolic effects of immunosuppression. Management includes utilizing standard pharmacologic therapy such as statins and antihypertensives, and newer agents such as glucagon-like peptide 1 receptor agonists and sodium-glucose co-transporter 2 inhibitors. Modification of the immunosuppressive regimen to reduce cardiometabolic effects should be weighed against other risks such as allograft rejection.
Atherosclerotic cardiovascular disease (CVD) remains an important cause of morbidity and mortality globally. The novel American Heart Association cardiovascular kidney metabolic health framework highlights a graded accum...Atherosclerotic cardiovascular disease (CVD) remains an important cause of morbidity and mortality globally. The novel American Heart Association cardiovascular kidney metabolic health framework highlights a graded accumulation of these risk enhancers that culminates in myocardial infarction, stroke, and peripheral arterial disease. The framework is supplemented by risk prediction models that allow earlier detection in order to implement risk reduction measures. The current therapeutic landscape includes agents that are targeted to the kidney and metabolic enhancers with specific benefits of reduced cardiovascular events including atherosclerotic CVD.
Use of glucagon-like peptide-1 (GLP-1) and dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonists, initially developed as glucose-lowering therapies for the management of type 2 diabetes, continu...Use of glucagon-like peptide-1 (GLP-1) and dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonists, initially developed as glucose-lowering therapies for the management of type 2 diabetes, continues to expand in parallel with our understanding of their beneficial effects on cardiovascular-kidney-metabolic conditions. Large clinical outcome trials have established GLP-1 receptor agonists as guideline-directed therapies to improve glycemia, achieve, and maintain weight management goals, and mitigate cardiovascular and kidney risk, with early evidence suggesting similar benefits with the dual GIP/GLP-1 receptor agonist tirzepatide.
The burden of metabolic diseases including diabetes and obesity is rising. Excess and dysfunctional adipose tissue can lead to inflammation and contribute to insulin resistance. Eventually, downstream effects include bot...The burden of metabolic diseases including diabetes and obesity is rising. Excess and dysfunctional adipose tissue can lead to inflammation and contribute to insulin resistance. Eventually, downstream effects include both cardiac and kidney disease across a spectrum of related risk factors and processes collectively known as the cardiovascular kidney metabolic (CKM) syndrome. Sodium glucose cotransporter 2 inhibitors (SGLT2i) by virtue of their action and robust clinical data play a central role in patients across the spectrum of CKM. The article summarizes the mechanisms and clinical evidence behind the benefits of SGLT2i across the spectrum of patients with CKM syndrome.
The global prevalence of obesity has tripled since 1990, adversely affecting the cardiovascular, kidney, and metabolic health of individuals worldwide. Studies show that obesity varies across ethnic groups, with Black an...The global prevalence of obesity has tripled since 1990, adversely affecting the cardiovascular, kidney, and metabolic health of individuals worldwide. Studies show that obesity varies across ethnic groups, with Black and Hispanic adults having higher rates than White adults, parallelly reflecting the epidemiologic distribution of cardiovascular, kidney, and metabolic diseases. Social determinants of health, genetic polymorphisms, and chronic inflammation play critical roles in the observed ethnicity and racial disparities. Tailored public health strategies and inclusive genetic research are needed to improve health outcomes in diverse populations and reduce the global burden of these intertwined epidemics.
Cardiol Clin
· 2025 Aug · PMID 40582731
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Cardiovascular disease (CVD) is the leading cause of death in patients with chronic kidney disease (CKD). We summarize the current knowledge of sex differences and associated vascular dysfunction in patients with CKD. We...Cardiovascular disease (CVD) is the leading cause of death in patients with chronic kidney disease (CKD). We summarize the current knowledge of sex differences and associated vascular dysfunction in patients with CKD. We discuss mechanisms that may partially explain the sex differences in cardiovascular risk in CKD, which include sex differences in CKD progression that may uniquely impact the hypothalamic-pituitary-gonadal axis and gonadal hormone production. We also highlight the gaps and challenges in research on sex differences in CVD risk and women's vascular health in CKD, as well as specific future approaches to further research on this topic.
Cardiol Clin
· 2025 Aug · PMID 40582730
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Nonatherosclerotic cardiovascular disease (CVD) in chronic kidney disease (CKD) is highly prevalent and involves distinct pathophysiological mechanisms. Arteriosclerosis, characterized by medial arterial layer thickening...Nonatherosclerotic cardiovascular disease (CVD) in chronic kidney disease (CKD) is highly prevalent and involves distinct pathophysiological mechanisms. Arteriosclerosis, characterized by medial arterial layer thickening and fibrosis, leads to increased arterial stiffness and vascular calcification, driven by disordered bone mineral metabolism. Clinical manifestations of nonatherosclerotic CVD include left ventricular hypertrophy, which occurs in up to 70% to 80% of patients with advanced CKD, heart failure (often with preserved ejection fraction), valvular heart disease, and both fatal and nonfatal arrhythmias. These conditions are exacerbated by CKD-specific factors such as volume overload, anemia, and sympathetic overactivity, contributing to high cardiovascular morbidity and mortality.
Cardiol Clin
· 2025 Aug · PMID 40582729
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Research has revealed that hypertension, chronic kidney disease, and type 2 diabetes mellitus have a common underlying pathophysiology of excess/or dysfunctional adiposity and share similar treatment plans. As a result,...Research has revealed that hypertension, chronic kidney disease, and type 2 diabetes mellitus have a common underlying pathophysiology of excess/or dysfunctional adiposity and share similar treatment plans. As a result, the American Heart Association issued a Presidential Advisory on Cardiovascular-Kidney-Metabolic (CKM) Health. The advisory outlines the definition and stages in the progression of CKM syndrome, with cardiovascular disease as the final outcome. It also emphasizes the importance of evaluating metabolic and social risk factors and considering various therapeutic approaches, including the involvement of a multidisciplinary team.
Acute type A dissection remains a challenging disease to manage, which is associated with high morbidity and mortality both at presentation and in the chronic setting. This article reviews contemporary debates in operati...Acute type A dissection remains a challenging disease to manage, which is associated with high morbidity and mortality both at presentation and in the chronic setting. This article reviews contemporary debates in operative management, summarizes the currently accepted standard of care, and explores the optimal extent of aortic repair given the high rate of long term aortic degeneration.
Acute aortic dissection is a life-threatening event that requires immediate medical attention and surgical intervention. Aortic dissections affect 4 to 5 per 10,000 individuals in the USA. These emergency events can have...Acute aortic dissection is a life-threatening event that requires immediate medical attention and surgical intervention. Aortic dissections affect 4 to 5 per 10,000 individuals in the USA. These emergency events can have as high as a 50% mortality risk. Twenty percent of patients who develop a thoracic aortic dissection have an underlying genetic cause for their increased risk for aortic aneurysm and dissection, which can be identified using genetic testing. Genes associated with abdominal aortic aneurysm and dissection have been identified but have not been reported for clinical use or management at this time.
Postoperative care following aortic dissection is a multidisciplinary effort, which is enhanced by the presence of an experienced team. Overall outcomes, including survival, are correlated with the early postoperative co...Postoperative care following aortic dissection is a multidisciplinary effort, which is enhanced by the presence of an experienced team. Overall outcomes, including survival, are correlated with the early postoperative course and presence of complications such as malperfusion. Despite improvements, in-hospital mortality remains high. Patients who do survive to hospital discharge have a positive prognosis; however, additional interventions for progression of aortic disease may be required. Discharge recommendations for patient care are largely institution and provider dependent due to limited data driven guidelines. Further study is warranted into these areas as well as health related quality of life following aortic dissection.
Patients with the highest risk of neurologic injury after cardiac surgery are those undergoing repair of type A aortic dissections. Since the 1950s, extensive research has been conducted to improve the safety and neurolo...Patients with the highest risk of neurologic injury after cardiac surgery are those undergoing repair of type A aortic dissections. Since the 1950s, extensive research has been conducted to improve the safety and neurologic outcomes of these patients. Surgeons now routinely use hypothermia with circulatory arrest, and adjunctive cerebral perfusion methods. This article highlights the historic development of modern cerebral perfusion and protection, and discusses technical details and clinical outcomes of cannulation strategies, temperature management, and antegrade cerebral perfusion and retrograde cerebral perfusion.
Aortic dissections are classified based on the location of the entry tear. A major concern in chronic aortic dissections is aneurysmal degeneration. Aneurysmal degeneration can lead to aortic expansion and potentially de...Aortic dissections are classified based on the location of the entry tear. A major concern in chronic aortic dissections is aneurysmal degeneration. Aneurysmal degeneration can lead to aortic expansion and potentially death. False lumen patency is a predictor of outcomes in type B aortic dissections. Thoracic endovascular aortic repair (TEVAR) can be used to treat chronic aortic dissections. TEVAR aims to occlude the false lumen to promote thrombosis and favorable aortic remodeling. However, its benefit may be limited in chronic dissection. Several techniques have been developed to treat chronic dissections with TEVAR.
Treatment of patients with Type B aortic dissections (TBADs) remains challenging due to both anatomic and medical complexities. This article outlines the current management considerations for patients with TBAD.Treatment of patients with Type B aortic dissections (TBADs) remains challenging due to both anatomic and medical complexities. This article outlines the current management considerations for patients with TBAD.
This article reviews the management of acute type A aortic dissection (ATAAD), from initial temporizing medical therapy to the technical aspects of urgent surgical repair, which is the definitive treatment for ATAAD. Sur...This article reviews the management of acute type A aortic dissection (ATAAD), from initial temporizing medical therapy to the technical aspects of urgent surgical repair, which is the definitive treatment for ATAAD. Surgical repair and the extent of aortic resection and replacement are dictated by the location and extent of intimal tears, as well as aneurysmal dilation of the aorta. Cardiopulmonary bypass, hypothermic circulatory arrest, and cerebral perfusion are major considerations in management of this acute process. Several techniques pertinent to each portion of the involved aorta and relevant intraoperative management points are also discussed.
This article reviews the use of point-of-care ultrasound (POCUS) for evaluating the aorta from anatomy and image acquisition to the diagnosis of aortic pathology, including aneurysms and dissection. Ruptured aortic aneur...This article reviews the use of point-of-care ultrasound (POCUS) for evaluating the aorta from anatomy and image acquisition to the diagnosis of aortic pathology, including aneurysms and dissection. Ruptured aortic aneurysm and aortic dissection are associated with high mortality and often experience a delay in time to diagnosis. Traditionally diagnosis was made through computed tomography which takes time and removes the patient from the emergency department. Incorporating POCUS into the evaluation of patients with suspected aortic pathology allows for rapid, accurate diagnosis and earlier definitive treatment.
Aortic pathologic conditions represent diverse disorders, including aortic aneurysm, acute aortic syndrome, traumatic aortic injury, and atherosclerosis. Given the nonspecific clinical features, noninvasive imaging is cr...Aortic pathologic conditions represent diverse disorders, including aortic aneurysm, acute aortic syndrome, traumatic aortic injury, and atherosclerosis. Given the nonspecific clinical features, noninvasive imaging is critical in screening, diagnosis, management, and posttherapeutic surveillance. Of the commonly used imaging modalities, including ultrasound, computed tomography, and MR imaging, the final choice often depends on a combination of factors: acuity of clinical presentation, suspected underlying diagnosis, and institutional practice. Further research is needed to identify the potential clinical role and define appropriate use criteria for advanced MR applications such as four-dimenional flow to manage patients with aortic pathologic conditions.
Imaging for aortic dissections and other acute aortic syndromes relies heavily on computed tomography (CT) scans. There is an ongoing need to educate providers and imaging specialists regarding the different protocols fo...Imaging for aortic dissections and other acute aortic syndromes relies heavily on computed tomography (CT) scans. There is an ongoing need to educate providers and imaging specialists regarding the different protocols for CT scans and the heightened value of aortic protocol scans for acute aortic syndromes. Current dissection guidelines recommend the treatment for patients with acute aortic syndromes be performed at a high-volume center by a multidisciplinary team that includes an imaging specialist. MRI and echocardiography can provide additional information and possibly at lower radiation exposure compared to CT scans. All imaging modalities are evolving with new and future uses and capabilities.
A timely diagnosis of aortic dissection can be lifesaving given its deadly nature. A high index of suspicion should be maintained because patient presentation can mimic other common emergency room complaints. The gold st...A timely diagnosis of aortic dissection can be lifesaving given its deadly nature. A high index of suspicion should be maintained because patient presentation can mimic other common emergency room complaints. The gold standard diagnostic test is a computed tomography angiogram from the thoracic inlet to the femoral arteries which identifies aortic dissection with excellent accuracy. Echocardiography should be used to assess aortic valve function and to evaluate for pericardial effusion. A finding of aortic dissection should prompt a thorough investigation for its sequelae including malperfusion and/or rupture which should guide further workup with appropriate laboratory and imaging studies.