Background: By lowering LDL cholesterol levels, the risk of coronary heart disease (CHD) and other serious vascular events can be significantly reduced. In order to prevent cardiovascular illnesses (CVD), mainly coronary heart disease, LDL-cholesterol (LDL-C) levels must be tightly controlled on both a primary and secondary level (CHD). Despite the fact that patients in primary prevention experience a higher absolute number of atherosclerotic cardiovascular (CV) events than those in secondary prevention of CVD, subjects in primary prevention frequently receive little attention when it comes to the clinical management of LDL-C levels. Aim: To summarise the research supporting LDL cholesterol reduction treatments for elderly people. Method: For this meta-analysis, we searched PubMed, GOOGLE SCHOLAR, SCI.HUB, MEDLINE, and Embase for publications released between January 1, 2017, and December 28, 2021. As recommended by the 2018 American Academy of Cardiology and American Heart Association guidelines, randomised controlled trials evaluating cardiovascular outcomes of an LDL cholesterol-lowering medicine with a median follow-up of at least 2 years and data on older patients (aged 75 years).The search for literature source was limited to randomized controlled trials (human being). This meta-analysis, comprised of 24 trials from the Cholesterol Therapy Trialists' Collaboration meta-analysis plus five other trials, used data from six journals. 21492 (8%) of the 244090 participants in 29 studies, were over the age of 75. Among them, 11750 (54%) came from statin trials, 6209 (28%) from ezetimibe trials, and 3533 (16%) from PCSK9 inhibitor trials. We conducted network meta-analyses for the statins and non statin treatments. Results: Of the 244090 participants in 29 studies, 21492(8%) were over 75. These included 3533 (16%) from PCSK9 inhibitor studies, 11750 (54%) from statin trials, and 6209 (28%) from ezetimibe trials. A median follow-up period of 2 to 6 years was used. Without statistically differentiating from the risk reduction in patients under the age of 75 (085 [078-092]; pinteraction=037), LDL cholesterol lowering significantly reduced the risk of major vascular events (n=3519) by 26% for 1 mmol/L reduction in LDL cholesterol (RR 074 [95% CI 061-089]; p=00019).In older patients, there was no statistically significant difference in the RRs for statin (0.82 [0.73-0.91] and non-statin (0.67 [0.47-0.95]; pinteraction=0.64) treatment. Reduced LDL cholesterol in older persons was shown to benefit all components of the composite, including coronary revascularization (080 [066-096], stroke (073 [061-087], and myocardial infarction (080 [071-090]. Practical implication: This meta analysis can be used to improve the treatment of people withlowering LDL cholesterol. Conclusion: The viability and security of diminishing LDL cholesterol in more seasoned adults are now supported by further research provided by this meta-analysis. By non-statin and statin LDL cholesterol-bringing down medication, we identified a risk reduction for major vascular events that were at least as effective as that observed in younger patients Keywords: LDL, Meta-analysis, Cardiovascular, Cholesterol,Atherosclerosis, Primary and secondary prevention.
Highlights. The main approaches to the aortic root valve-sparing surgery of are reimplantation and remodeling;The literature review demonstrates either the relative identity of the reimplantation and remodeling clinical outcomes, or the advantage of reimplantation in relation to long-term results.Abstract. In recent decades, valve-sparring methods of aortic root replacement, including reimplantation and remodeling, as well as their modifications, have been developed and put into widespread practice. The effectiveness and durability of these two approaches is the subject of discussions in the modern cardiac surgery community. The global experience in performing remodeling and reimplantation procedures allows for a comprehensive literature review to compare the results of these approaches. The presented review is devoted to the comparison of surgical aspects and clinical outcomes of reimplantation and remodeling techniques, the analysis of the feasibility of restoring the physiological architectonics of the aortic root in valve-sparring operations using Valsalva grafts, as well as the assessment of risk factors for residual aortic insufficiency after such interventions. The search strategy included the analysis of international (PubMed, Scopus, Embase) databases for the following keywords: “reimplantation versus remodeling for aortic root valve-sparring procedures”, “David procedure versus Yacoub procedure”, “Valsalva graft for aortic root valve-sparring procedures”, “Valve-sparing aortic root repair with an anatomically shaped sinus prosthesis”. Literature analysis demonstrates either the relative identity of early and long-term results of reimplantation and remodeling procedures, or the advantage of reimplantation in terms of freedom from late mortality and residual aortic insufficiency. Preservation of the physiology of the aortic root by implantation of Valsalva grafts or remodeling provides better hemodynamics and reduces stress on the leaflets, however, these postulates run counter to the data of clinical studies analyzing postoperative outcomes and demonstrating the lack of advantages of Valsalva grafts over linear prostheses in terms of freedom from aortic valve surgery. Residual postoperative regurgitation of a mild degree, a decrease in the effective height below 9 mm and additional interventions on the leaflets are reliable factors of significant aortic insufficiency in the long-term period after valve-sparring operations on the aortic root.
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