Atherosclerosis is a chronic and progressive inflammatory process beginning early in life with late clinical manifestation. This slow pathological trend underlines the importance to early identify high-risk patients and to treat intensively risk factors to prevent the onset and/or the progression of atherosclerotic lesions. In addition to the common Cardiovascular (CV) risk factors, new markers able to increase the risk of CV disease have been identified. Among them, high levels of Lipoprotein(a)—Lp(a)—lead to very high risk of future CV diseases; this relationship has been well demonstrated in epidemiological, mendelian randomization and genome-wide association studies as well as in meta-analyses. Recently, new aspects have been identified, such as its association with aortic stenosis. Although till recent years it has been considered an unmodifiable risk factor, specific drugs have been developed with a strong efficacy in reducing the circulating levels of Lp(a) and their capacity to reduce subsequent CV events is under testing in ongoing trials. In this paper we will review all these aspects: from the synthesis, clearance and measurement of Lp(a), through the findings that examine its association with CV diseases and aortic stenosis to the new therapeutic options that will be available in the next years.

Introduction Central venous catheters (CVCs) are commonly used in clinical practice. Their use may be associated to complications like catheter-related thrombosis, that may not only result in vascular and catheter occlusion but also infection, pulmonary embolism, and formation of right heart thromboemboli. Patients who develop catheter-related thrombosis have an increased risk of mortality due to the potential risk of embolization to the pulmonary vasculature. Case presentation We describe the case of a 76-year-old man with multiple cardiovascular risk factors, admitted to the Nephrology Department for a suspected UTI. The patient develops a central venous catheter-related thrombosis on the CVC placed in the right jugular vein. The finding of the thrombus was accidental and happened during a transthoracic echocardiography performed to exclude endocarditis. The thrombus was successfully treated with LMWH infusion, preventing complications like pulmonary embolism. Conclusion Although generally considered safe, central venous catheters can be associated with complications such as catheter-related venous thrombosis. Intensivists who use these devices should be aware of this possible complication and may use strategies to prevent them in order to improve patient outcome. The present case highlights the importance of maintaining a high index of suspicion for thromboembolic complications in patients with CVCs.

Introduction polyvascular atherosclerotic involvement is one of the definitions of extreme CV risk. For this reason, the search for carotid or lower limb asyntomatic atherosclerotic pathology can be useful to guarantee more intensive treatments for these individuals, who have already had a heart attack. Purpose: the aim was to understand how much the polyvascular patients can improve in functional terms after Cardiological Rehabilitation, comparing them with monovasculars. Besides, the study purpose was to evaluate how many patients are reclassified with an active research of asyntomatic atherosclerotic pathology with carotid ultrasound and Ankle Brachial Index (ABI). Methods The study sample was composed by 87 patients who underwent a cardiological rehabilitation cycle at the Niguarda hospital in Milan from March 2021 to April 2022. Of these, personal, medical, clinical, laboratory and instrumental data were collected. Functional improvement was assested as the difference in meters walked on the 6–minutes walking test (6MWT) on the start day (6MWT–1) and on the end day of rehabilitation (6MWT–2). All patients performed an ABI (to evaluate asyntomatic PAD) and a carotid ultrasound (to evaluate asyntomatic cerebrovascular disease). Results pre–riclassification, polyvascolar patients (13) compared to monovascular (74), in addition to being on average older (70 years vs 59 years, p=0.01), males (100% vs 73%, p<0.001) and having had more previous recurrent myocardial infarctions (46% vs 8%, p=0.002), are less performing in terms of 6MWT–1 (428m vs 514m, p=0.002) and 6MWT–2 (517m vs 597m, p=0.008). About absolute functional improvement from the beginning to the end of rehabilitation, there are no statistically significant differences (81m vs 82m, p=0.919). Following reclassification, 7 patients switched from monovascular (67) to polyvascular (20). Conclusions our data showed that polyvascular patients can improve as much as monovasculars after Cardiological Rehabilitation. Furthermore, following ABI and carotid ultrasound, 8% of patients were reclassified. Polyvascular patients may receive more targeted and intensive therapies if properly diagnosed.

Objective: polyvascular atherosclerotic involvement is one of the definitions of extreme CV risk. For this reason, the search for carotid or lower limb asyntomatic atherosclerotic pathology can be useful to guarantee more intensive treatments for these individuals, who have already had a myocardial infarction. To understand how much the polyvascular patients can improve in functional terms after Cardiological Rehabilitation, comparing them with monovasculars. Furthermore, we want to evaluate how many patients are reclassified with an active research of asyntomatic atherosclerotic disease with carotid ultrasound and Ankle Brachial Index (ABI). Design and method: The study sample was composed by 87 patients who underwent a cardiological rehabilitation cycle at the Niguarda hospital in Milan from March 2021 to April 2022. Anamnestic, clinical, laboratory and instrumental data were collected. Functional improvement was assessed as the difference in meters walked on the 6-minutes walking test (6MWT) at the beginning (6MWT-1) and at the end of the rehabilitation (6MWT-2). All patients underwent ABI (to evaluate asyntomatic PAD) and carotid ultrasound (to evaluate asyntomatic cerebrovascular disease). Results: Pre-riclassification, polyvascolar patients (13) compared to monovascular (74) were older (70 years vs 59 years, p = 0.01), more frequenly males (100% vs 73%, p<0.001), had more previous recurrent myocardial infarctions (46% vs 8%, p = 0.002) and had a worse performance in terms of 6MWT-1 (428m vs 514m, p = 0.002) and 6MWT-2 (517m vs 597m, p = 0.008). However, absolute functional improvement durgin rehabilitation is imilar between the two group (81m vs 82m, p = 0.919). Following reclassification, 7 patients switched from monovascular (87) to polyvascular (20). Conclusions: Our data showed that polyvascular patients can improve as much as monovasculars after Cardiological Rehabilitation. Furthermore, following ABI and carotid ultrasound, 8% of patients were reclassified. Polyvascular patients may receive more targeted and intensive therapies if properly diagnosed.

Electronic cigarettes (e-cigarettes) are battery-powered devices containing a liquid based on propylene glycol or vegetable glycerin, compounds which, when vaporized, act as a vehicle for nicotine, flavours, and other chemical components. These devices have been marketed without clear evidence of risks, long-term safety, and efficacy as a means of traditional smoking cessation. Recent clinical studies have shown how the use of the e-cigarette, combined with adequate psychological support, can be effective in reducing traditional smoking but not nicotine addiction. However, meta-analyses of observational studies have not confirmed this efficacy. Several studies have also highlighted an increase in sympathetic tone, vascular stiffness, and endothelial dysfunction, all factors associated with an increased cardiovascular risk. Clinicians, therefore, should carefully monitor the possible risks to public health deriving from the use of e-cigarettes and should discourage non-smokers and adolescents from using such devices. Finally, particular attention should be paid to smokers so that the combined use of electronic and traditional cigarettes can be limited as much as possible.