Stroke is considered among the most common causes of mortality and disability, leading to dramatic socioeconomic consequences. From a pathophysiologic perspective, enhanced blood viscosity due to increased hematocrit might be associated with stroke through impaired cerebral blood perfusion. This association has remained rather neglected during previous decades, but newly emerged as an epicenter of scientific interest due to the unexpected elevation of stroke rates with sodium-glucose cotransporter-2 inhibitors, a new class of hypoglycemic drugs with otherwise dramatic cardiovascular benefits. The purpose of this article is to review available data on the relation between stroke and hematocrit values. Data from large observational studies point toward an increased risk for stroke in individuals with elevated hematocrit. Data also suggest that the coexistence of increased hematocrit values and hypertension significantly enhance the risk of cerebrovascular events compared with each condition alone. Additionally, high hematocrit values seem related to worse survival outcomes in post-stroke patients. Collectively, the association between hematocrit and stroke seems to be strong and independent in high hematocrit values (>0.50) in both previously healthy individuals and post-stroke patients, but remains less clarified in patients with normal hematocrit values.
Background: Mineralocorticoid receptor antagonists are a second-line class of antihypertensive drugs, which have been accounted for as the optimal add-on therapy in the triple algorithm for the management of resistant hypertension. Objectives: To assess the effects of mineralocorticoid receptor antagonists in the treatment of patients with essential hypertension and resistant hypertension. Method: We conducted a meticulous review of the literature and comprehensive identification of the clinical trials assessing the efficacy of mineralocorticoid receptor antagonists in individuals with primary and resistant hypertension. Results: MRAs have been thoroughly tested in several clinical studies in relevance to blood pressure lowering effects, over the last six decades. Accumulating data observed that MRAs resulted in a significant reduction in blood pressure level in patients with resistant hypertension. In addition, spironolactone was found to beneficially affect the management of resistant hypertension. Conclusion: Mineralocorticoid receptor antagonists exert a significant antihypertensive effect. Future welldesigned randomized controlled studies are greatly needed to address crucial clinical aspects in the field.
Background: Female sexual dysfunction (FSD) has mainly been underdiagnosed and undertreated due to the lack of concrete definitions, validated assessment methods, and efficient treatments. However, during the last few decades, there has been significant progress in the clinical management and research of FSD. Objective: The purpose of this review is to describe the pathophysiology of FSD, report the prevalence of the disease in the setting of cardiovascular (CV) risk factors and disease, and review current and under investigation treatment options. Methods: A comprehensive literature review was performed to identify studies examining the association of FSD with CV risk factors and/or disease and studies reporting appropriate management options. Results: The prevalence of FSD is increased in the general population (approximately 40%) and is significantly higher in patients with hypertension, diabetes mellitus, and dyslipidemia. In patients with overt CV disease, FSD is even more prevalent (up to 90%). The cause of FSD is multifactorial and includes various vascular, hormonal, interpersonal, and psychological factors, which are all intertwined. Several treatment options exist that are efficient in improving female sexual function, while a cluster of other alternatives has been shown to offer benefits. Conclusion: FSD is a significant public health problem with a great impact on the patients’ quality of life. In the setting of increased CV burden, FSD is even more prevalent. Increased awareness is needed for the physician to establish a trustful environment with the patient, discuss such issues, and offer suitable management options.
The initial data suggest clinically meaningful benefits of the SGLT-2 inhibitors in diabetic patients in relevance with chronic kidney disease. Future, well-designed randomised clinical trials need to be further investigated such as nephroprotective outcomes, that if confirmed, could lead to new perspectives in the management of diabetic nephropathy.
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