The Cardiometabolic Center of the Metropolitan Hospital (and more broadly the Metropolitans of HHG) in collaboration with the First University Cardiology Clinic of the Athens Medical School and the Sorbonne University of France announce and organize a series of post-educational sessions and courses in the context of the implementation of the annual post-educational program of the Cardiometabolic School for the second consecutive year.
The Cardiometabolic School (KMS) is realized as a result of the necessity, concentration and specialization of knowledge in Cardiometabolic Medicine, the most prominent and modern field of medicine, which after 2019, especially in America, emerged and was shown significantly.
Cardiometabolic Medicine is the medicine of diagnosis, monitoring and treatment of cardiometabolic diseases: Obesity, metabolic syndrome, hypertension, dyslipidemic disorders, diabetes mellitus, conditions and diseases that have a particularly high prevalence and frequency in our country.
At the opening session of the Cardiometabolic School, which took place on October 26 in the auditorium of the Metropolitan Hospital, the new data in cardiometabolic diseases were presented. Thus, Mr. Andreas Melidonis, Pathologist – Diabetologist, presented the new developments in Diabetes Mellitus.
1. New epidemiological data confirm the characterization of diabetes as a modern metabolic pandemic. Thus, the EMENO study (of the Diabetes Association and the University) in 4,398 people across Greece showed a prevalence of DM of 12%. If it is taken into account that worldwide it is estimated that 30 – 40% of people with diabetes are unaware of their disease then the estimated prevalence of DM approaches 15% of the population. Compared to 3% of the frequency of DM in the 10 years of the 80s.
2. Weekly injections and SGLT-2 inhibitors in the treatment of T2DM and its complications.
Weekly GLP-1 agonists are new treatments with impressive anti-hyperglycemic activity and documented cardio-renal-protective effect. After the well-known dulaglutide, semaglutide was launched in 2022, which offers data of the highest antidiabetic treatment as it reduces glycosylated Hb by up to 1.8% and reduces body weight by 6.5 kg at a dosage of 1mg/week with 30 % of those assigned to lose at least 10% of their body weight.
Also, this treatment has a favorable cardiovascular effect, significantly reducing the risk of cardiovascular events by 26%. A similar cardio-renal-protective effect is offered by SGLT-2 inhibitors, which now appear to be the indicated treatment for any type of heart failure, as well as the first choice for chronic kidney disease.
3. GLP-1 and GIP receptor agonists (so-called dual agonists) are the exciting new injectable weekly treatment of the future in diabetes and obesity. The latest data show that tirzepatide (the dual agonist) at 40-week follow-up reduced glycated Hb by 2.46% and body weight by 11.4 kg in the obese DM patients treated.
4. Also impressive are the advances in the treatment of T1DM with new advanced continuous glucose monitoring devices (sensors) and new advanced insulin delivery pumps (780G) that can deliver insulin by receiving the signal from the sensors under 24-hour conditions.
Mrs. Genovefa Kolovou, Director of Preventive Cardiology, referred to the following:
Cardiometabolic diseases such as diabetes mellitus and dyslipidemias (hypercholesterolemia and/or hypertriglyceridemia), while often asymptomatic, their evolution is noisy and lead to acute myocardial infarction, strokes and early death.
For this reason, the annual Cardiometabolic School of the HHG Group continues for the third school year, with the aim of informing doctors of various specialties about diseases.
Regarding lipids, reference was made to their metabolism in primary and secondary dyslipidemias, to newer risk factors such as lipoprotein (a), to the pathophysiology of postprandial lipemia. Also, newer drugs such as bempedoic acid and interventions with monoclonal antibodies and complementary oligonucleotides were analyzed.
Mr. Stefanos Fousas, Cardiologist, presented the developments in cardiology, emphasizing that medicine is a rapidly evolving science and monitoring is done through medical journals and medical conferences.
Summary presentation of the latest data in Cardiology based on the American and European Congress of Cardiology 2022:
• Aspirin administration is not required for primary prevention.
• Cardiovascular risk is significantly reduced with the administration of flozins of the newer antidiabetic tablets.
• Patients with diabetes mellitus are classified into very high risk, high risk and moderate risk according to the presence of target organ damage.
• In stable coronary artery disease, administration of rivaroxaban and aspirin reduces overall mortality at 3 years.
• Significant reduction in HDL only slightly reduces cardiovascular risk.
• It is estimated that A-lipoprotein above 180mg/dl plays an important role.
• The indications for PCSK9 inhibitors concern patients who do not respond to statins and patients with congenital hypercholesterolemia.
• Significant reduction of LDL does not cause side effects.
• Blood pressure target is 130/80mmHg.
• CT angiography is gaining ground every day.
• Dual antiplatelet therapy is adjusted by thrombotic and bleeding risk with DAPT score or PRESTIGE DAPT score.
• Triple treatment in acute coronary syndromes with atrial fibrillation is limited to hospital coverage.
• Administration of LMWH only to high-risk patients who are to undergo surgery.
• Increased survival in heart failure with optimal drug therapy (Sacubitril – Valsartan) is achieved.
• Rapid administration (within 60 minutes) of diuretics is required in acute pulmonary edema to reduce in-hospital mortality.
• Ablation of atrial fibrillation in patients with heart failure reduces mortality.
• There are pacemakers without electrodes.
• Corridor access is now the first choice for coronary angiography and angioplasty.
• Angioplasty is gaining ground in the stem in a low SYNTAX score.
• Only 3rd generation coated STENTS are preferred.
• In pulmonary embolism the d dimer for patients over 50 years old is calculated from the formula 10 x age mg/L.
• NOACS are given in chronic coronary disease and atrial fibrillation (Pradaxa, Xarelto, Eliquis), while Sintrom remains in valvular diseases.
• TAVI is gaining ground in aortic stenosis and moderate-risk patients.
• For the closure of an open foramen ovale, the evidence is conflicting.
• About 5,000 people under the age of 75 need heart transplants.
• The future of Cardiology: Remote monitoring of heart patients online (telemedicine).
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