Khyber Medical College

Autoimmune cardiovascular disease (CVD) includes myocarditis, coronary microvascular dysfunction (CMD), and heart failure with preserved ejection fraction (HFpEF). Traditional risk scores often overlook these conditions despite their links to high morbidity. Recent research highlights the significance of immunophenotyping, such as clonal hematopoiesis of indeterminate potential (CHIP), type I interferon activity, Th17/Treg imbalance, and cardiac autoantibodies, to improve risk assessment and guide treatment. This review combines mechanistic and clinical data connecting these immune signatures to endothelial dysfunction, arrhythmias, and fibrotic remodeling. It underscores the atherogenic role of CHIP and its influence on HFpEF prognosis, the vasculopathy driven by type I interferon signaling in CMD, and autoimmunity in myocarditis mediated by Th17 dominance. Cardiac-specific autoantibodies, like anti-heart and v1-adrenergic receptor antibodies, serve as early prognostic markers. Moreover, integrating immune biomarkers with advanced imaging techniques, such as cardiac magnetic resonance and positron emission tomography, could enhance risk stratification and therapy monitoring. Current immunomodulating treatments, including TNF and IL-6 inhibitors, provide cardiovascular benefits, while glucocorticoids and JAK inhibitors carry dose-related risks. In the future, personalized algorithms that incorporate CHIP genotyping, interferon scoring, and continuous biomarker and imaging assessments may transform autoimmune CVD management. This review highlights these translational insights and research priorities to bridge the gap between immune dysregulation and cardiovascular outcomes.

Abstract Background An elevated calcium-phosphate product (CPP), defined as a product of serum calcium and serum phosphate, is a hallmark of CKD-mineral and bone disorder and has been implicated in accelerated coronary artery calcification, arterial stiffness, and left ventricular hypertrophy. These pathological changes contribute to adverse cardiovascular outcomes. While prior studies have shown worse percutaneous coronary outcomes (PCI) outcomes in CKD patients overall, the prognostic impact of CPP levels remains underexplored. The objective is to evaluate post-PCI outcomes in CKD patients with and without hypercalcemia and hyperphosphatemia. Methods A retrospective cohort analysis was conducted using the TriNetX U.S. Collaborative Network, focusing on adult patients with CKD undergoing PCI. Patients were grouped based on serum calcium and phosphorus levels, with those having hypercalcemia and hyperphosphatemia compared to those without. Diagnoses and procedures were identified using ICD-10 and CPT codes. Propensity score matching was applied to account for differences between groups. Post PCI outcomes were analyzed. Primary outcome was all-cause mortality. Secondary outcomes encompass coronary artery bypass grafting (CABG), myocardial infarction (MI), in-stent re-stenosis [redo PCI] and target vessel revascularization, heart failure (HF) exacerbations, and peri-/ post-procedural complications were assessed within a 5-year follow-up period. Kaplan-Meier analysis with log-rank was used for statistical comparisons, with significance set at p<0.05. Results The elevated CPP group was significantly associated with increased post-PCI all-cause mortality [hazard ratio (HR) 1.428], in-stent restenosis [HR 1.589], heart failure exacerbations [HR 1.492], and recurrent angina or MI [HR 1.396]. No significant differences were found in rates of post PCI CABG, periprocedural complications (postprocedural cardiac insufficiency, postprocedural cardiac arrest, postprocedural heart failure, intraoperative cerebrovascular infarction, postprocedural cerebrovascular infarction, and intraoperative cardiac arrest), or redo PCI. Conclusion In this propensity score-matched analysis, elevated CPP in CKD patients undergoing PCI was independently associated with worse outcomes, including higher mortality and cardiovascular event rates. These findings highlight the prognostic value of CPP and the need for closer metabolic monitoring and individualized risk stratification. Abstract Figure

Older adults with acute coronary syndrome (ACS) face high risks of recurrent ischemia, mortality, and bleeding complications from antiplatelet therapy. The safety and efficacy of ticagrelor versus clopidogrel in this vulnerable population remain uncertain due to their underrepresentation in clinical trials. We conducted a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, and the Cochrane Library were searched from inception to October 2025 for randomized controlled trials and cohort studies comparing ticagrelor versus clopidogrel in ACS patients aged ≥70 years. Outcomes included myocardial infarction (MI), stroke, major bleeding, all-cause death, cardiovascular (CV) death, and the composite of CV death/MI/stroke. Hazard ratios (HRs) or risk ratios with 95% confidence intervals (CIs) were pooled using random-effects models. Heterogeneity was assessed via I2 statistics. Five studies (2 randomized controlled trials and 3 cohort studies) with 22,806 participants were included. Ticagrelor significantly reduced the risk of MI (HR 0.84, 95% CI 0.75-0.95, P = 0.004) and the composite endpoint of CV death, MI, or stroke (HR 0.85, 95% CI 0.74-0.98, P < 0.05). No significant differences were found between ticagrelor and clopidogrel in stroke incidence, major bleeding, or all-cause mortality. Heterogeneity was substantial for certain outcomes, particularly bleeding and mortality. In patients aged ≥70 years with ACS, ticagrelor was associated with reduced MI and composite ischemic events compared with clopidogrel, while no statistically significant differences in bleeding events or mortality were observed. However, substantial heterogeneity and reliance on observational data for some outcomes warrant cautious clinical interpretation.

This commentary explores the pervasive challenge of malnutrition and diarrhea, particularly among vulnerable populations such as children and cancer patients, and highlights the limitations of conventional treatments such as standard oral rehydration solutions (ORSs). Drawing on recent evidence, it examines the emerging role of amino acid-based nutritional formulations, with a focus on branched-chain amino acids (BCAAs), VS001, and VS002A, in addressing both nutrient deficiencies and gut dysfunction. The commentary reviews mechanistic and clinical data demonstrating that BCAAs and specialized amino acid-enriched ORSs can promote mucosal healing, improve nutrient absorption, and reduce gastrointestinal symptoms, including those related to chemotherapy. Clinical studies show promising results for VS001 and VS002A in reducing the severity of diarrhea, enhancing hydration, and supporting recovery in both pediatric and oncology settings. While these interventions show considerable potential for transforming supportive care for malnutrition-related diarrhea, further large-scale randomized trials are needed to establish their efficacy across diverse patient populations.