Coagulation Disorders and Thrombotic Complications in Heart Failure With Preserved Ejection Fraction

Heart failure with preserved ejection fraction (HFpEF) is associated with multiple cardiovascular and noncardiovascular comorbidities and risk factors which increase the risk of thrombotic complications, such as atrial fibrillation, chronic kidney disease, arterial hypertension and type 2 diabetes mellitus. Subsequently, thromboembolic risk stratification in this population poses a great challenge. Since date from the large randomized clinical trials mostly include both patients with truly preserved EF, and those with heart failure with mildly reduced ejection fraction, there is an unmet need to characterize the patients with truly preserved EF. Considering the significant evidence gap in this area, we sought to describe the coagulation disorders and thrombotic complications in patients with HFpEF and discuss the specific thromboembolic risk factors in patients with HFpEF, with the goal to tailor risk stratification to an individual patient.

SGLT2 Inhibitors vs. GLP-1 Agonists to Treat the Heart, the Kidneys and the Brain

Sodium glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like-peptide-1 receptor (GLP-1-R) agonists are novel therapeutic agents used for the management of type 2 diabetes mellitus (T2DM). Recently, large-scale randomized clinical trials have been conducted to assess the cardiovascular safety of these medications. The findings of these trials have revealed that both SGLT2 inhibitors and GLP-1-R agonists exhibit favorable cardioprotective effects, including reduction in cardiovascular and all-cause mortality, a decreased risk of chronic kidney disease progression, a decrease in hospitalization for heart failure (HF), an effect shown by SGLT2 inhibitors, and stroke prevention, an effect shown by GLP-1-R agonists. Based on the results from above studies, the European and American Diabetes Associations have issued new recommendations strongly endorsing the use of SGLT2 inhibitors and GLP-1-R agonists in combination with metformin for patients with T2DM who have additional cardiovascular (CV) comorbidities or risk factors. The primary aim of this combined therapy is to prevent CV events. Although both medication groups offer beneficial effects, they demonstrate slightly different profiles. SGLT2 inhibitors have exhibited better effects regarding a reduced incidence of HF, whereas GLP-1-R agonists have shown a reduced risk of CV events, particularly stroke. Moreover, recent European Society of Cardiology as well as American College of Cardiology and American Heart Association guidelines of HF treatment stressed the importance of SGLT2 inhibitor administration in patients with HF regardless of T2DM. In this context, we present and discuss the outcomes of the most recent trials investigating the impact of SGLT2 inhibitors and GLP-1-R agonists on renal and cardiovascular outcomes in patients, both with and without T2DM. Additionally, we explore the synergistic effects of combining SGLT2 inhibitors and GLP-1-R agonists in patients with cardiovascular disease.

Bite me: Blue tails as a ‘risky-decoy’ defense tactic for lizards

Many lizard species use caudal autotomy to escape entrapment. Conspicuous coloration may increase the likelihood of being attacked, but if that attack can be directed towards the autotomous tail this may ultimately increase the chances of the lizard surviving a predatory attack. We tested the hypothesis that brightly-colored tails function to divert predatory attention away from the head and body using pairs of blue-tailed and all-brown clay model lizards. Predatory bird attacks on the 24 blue-tailed models occurred sooner (P = 0.001) than attacks on the 24 all-brown models, and over 7 days blue-tailed models were attacked more often than all-brown models (P = 0.007). Blue-tailed models were, however, more frequently attacked on the tail than other parts of the body (P < 0.001), while all-brown models were more frequently attacked on the head and body (P = 0.019) which would be more likely to be fatal for a real lizard. Our results suggest that models with a blue tail were more conspicuous than all-brown models, attracting attacks sooner and more often, but that the attacks were predominantly directed at the tail. It is better for individuals to be attacked unsuccessfully many times, than successfully just once. Having a brightly-colored tail may, therefore, act as a ‘risky decoy’. Despite increased conspicuousness, a blue tail increases the likelihood that the lizard would be able to effect escape through caudal autotomy rather than being grabbed by the head or body.