#angiotensin converting enzyme

[neil-perrys-suicidal-tendencies]

Guys

What have I created

[deinheilpraktiker]

Es wurde festgestellt, dass die ultralange komplementaritätsbestimmende Region H3 von Rindern mit Sarbecoviren kreuzreagiert

In einer kürzlich veröffentlichten Studie in der Zeitschrift für biologische ChemieForscher führten eine In-vitro-Analyse durch, um ultralange bovine schwere Ketten zu isolieren, die eine Bindung mit dem schweren akuten respiratorischen Syndrom-Coronavirus 2 (SARS-CoV-2) und verwandten Coronaviren (CoVs) zeigten. Studie: Ein boviner Antikörper, der über eine ultralange…

[covid-safer-hotties]

Patients With Long-COVID Show Abnormal Lung Perfusion Despite Normal CT Scans - Published Sept 12, 2024

VIENNA — Some patients who had mild COVID-19 infection during the first wave of the pandemic and continued to experience postinfection symptoms for at least 12 months after infection present abnormal perfusion despite showing normal CT scans. Researchers at the European Respiratory Society (ERS) 2024 International Congress called for more research to be done in this space to understand the underlying mechanism of the abnormalities observed and to find possible treatment options for this cohort of patients.

Laura Price, MD, PhD, a consultant respiratory physician at Royal Brompton Hospital and an honorary clinical senior lecturer at Imperial College London, London, told Medscape Medical News that this cohort of patients shows symptoms that seem to correlate with a pulmonary microangiopathy phenotype.

"Our clinics in the UK and around the world are full of people with long-COVID, persisting breathlessness, and fatigue. But it has been hard for people to put the finger on why patients experience these symptoms still," Timothy Hinks, associate professor and Wellcome Trust Career Development fellow at the Nuffield Department of Medicine, NIHR Oxford Biomedical Research Centre senior research fellow, and honorary consultant at Oxford Special Airway Service at Oxford University Hospitals, England, who was not involved in the study, told Medscape Medical News.

The Study Researchers at Imperial College London recruited 41 patients who experienced persistent post-COVID-19 infection symptoms, such as breathlessness and fatigue, but normal CT scans after a mild COVID-19 infection that did not require hospitalization. Those with pulmonary emboli or interstitial lung disease were excluded. The cohort was predominantly female (87.8%) and nonsmokers (85%), with a mean age of 44.7 years. They were assessed over 1 year after the initial infection.

Exercise intolerance was the predominant symptom, affecting 95.1% of the group. A significant proportion (46.3%) presented with myopericarditis, while a smaller subset (n = 5) exhibited dysautonomia. Echocardiography did not reveal pulmonary hypertension. Laboratory findings showed elevated angiotensin-converting enzyme and antiphospholipid antibodies. "These patients are young, female, nonsmokers, and previously healthy. This is not what you would expect to see," Price said. Baseline pulmonary function tests showed preserved spirometry with forced expiratory volume in 1 second and forced vital capacity above 100% predicted. However, diffusion capacity was impaired, with a mean diffusing capacity of the lungs for carbon monoxide (DLCO) of 74.7%. The carbon monoxide transfer coefficient (KCO) and alveolar volume were also mildly reduced. Oxygen saturation was within normal limits.

These abnormalities were through advanced imaging techniques like dual-energy CT scans and ventilation-perfusion scans. These tests revealed a non-segmental and "patchy" perfusion abnormality in the upper lungs, suggesting that the problem was vascular, Price explained.

Cardiopulmonary exercise testing revealed further abnormalities in 41% of patients. Peak oxygen uptake was slightly reduced, and a significant proportion of patients showed elevated alveolar-arterial gradient and dead space ventilation during peak exercise, suggesting a ventilation-perfusion mismatch.

Over time, there was a statistically significant improvement in DLCO, from 70.4% to 74.4%, suggesting some degree of recovery in lung function. However, DLCO values did not return to normal. The KCO also improved from 71.9% to 74.4%, though this change did not reach statistical significance. Most patients (n = 26) were treated with apixaban, potentially contributing to the observed improvement in gas transfer parameters, Price said.

The researchers identified a distinct phenotype of patients with persistent post-COVID-19 infection symptoms characterized by abnormal lung perfusion and reduced gas diffusion capacity, even when CT scans appear normal. Price explains that this pulmonary microangiopathy may explain the persistent symptoms. However, questions remain about the underlying mechanisms, potential treatments, and long-term outcomes for this patient population.

Causes and Treatments Remain a Mystery Previous studies have suggested that COVID-19 causes endothelial dysfunction, which could affect the small blood vessels in the lungs. Other viral infections, such as HIV, have also been shown to cause endothelial dysfunction. However, researchers don't fully understand how this process plays out in patients with COVID-19.

"It is possible these patients have had inflammation insults that have damaged the pulmonary vascular endothelium, which predisposes them to either clotting at a microscopic level or ongoing inflammation," said Hinks.

Some patients (10 out of 41) in the cohort studied by the Imperial College London's researchers presented with Raynaud syndrome, which might suggest a physiological link, Hinks explains. "Raynaud's is a condition of vascular control or dysregulation, and potentially, there could be a common factor contributing to both breathlessness and Raynaud's."

He said there is an encouraging signal that these patients improve over time, but their recovery might be more complex and lengthy than for other patients. "This cohort will gradually get better. But it raises questions and gives a point that there is a true physiological deficit in some people with long-COVID."

Price encouraged physicians to look beyond conventional diagnostic tools when visiting a patient whose CT scan looks normal yet experiences fatigue and breathlessness. Not knowing what causes the abnormalities observed in this group of patients makes treatment extremely challenging. "We need more research to understand the treatment implications and long-term impact of these pulmonary vascular abnormalities in patients with long-COVID," Price concluded.

[snarp]

Oops.

Relevant catechin here is epigallocatechin gallate aka EGCG. I'd noticed that the lisinopril didn't seem to be doing anything most days... This is just one 10-person study, but I might have just made it 11. Thanks, @ms-demeanor .

[coupleoffanfics]

Two Are Better Than One

CW: Mentions of suicidal ideation.

Part 1 | Part 2

Half of the day y/n was left alone. She was given a few books to read, but she didn't bother touching them. She would have thrown them at whoever came through the door. It didn't matter if it was Jeremiah or Ecco, just as long as it hurt. But that wouldn't be the best thing to do. You can catch more flies with honey as they say.

She believed that they could still talk this out. If they hear each other out then they could move on from this. They moved on from a lot of things and this could be one of them. She didn't care how delusional it sounded, she was always in it for the long hall when Jeremiah was involved.

Reverting to her old ways y/n slept her worries away. Whenever things become too much she always rolled into bed and slept. It wasn't easy to sleep this time with her one hand being cuffed but she managed somehow.

She would be woken up by Jeremiah. "It's time to take your medicine." She slightly grimaced when she opened her eyes but sat up and gave him a confused look. "Ecco took everything you needed from your apartment." He explained as he handed her the glass of water.

It would have been so easy for y/n to throw it at him or just smash it against his forehead until it broke. It would be easy, but it'd only get her into trouble.

"Open wide." y/n felt her face heat up hearing him say that. This felt a bit humiliating and he must have found it amusing by the grin on his face. Not wanting to be perceived as reluctant or defiant, she opened her mouth so that he put the pill in her mouth. After that, she closed her mouth and took a sip of the water.

She almost choked on the water when she made eye contact with him. His eyes were one of the many things she liked about him. A simple glance made her flustered, and when his eyes were on her it made her squirm. He still has the effect but it didn't make her squirm or giggle like it used to. It could be because of the context of this situation, but his now-green eyes always put her off.

She took her medication without too much trouble. She said a quiet thank you before holding the cup out to him trying to hand it back. "You have one more pill to take."

"Another one? I only take Zoloft."

"I know, darling, but you have to take this."

y/n was taken aback a bit by the pet name. She was always the one to call him a pet name. Sometimes just to embarrass him, but he'd always just call her by her name. She quickly shook that out of her head to ask, "What is it?"

"ACE."

Angiotensin-converting enzyme, y/n remembers her doctor recommending it. She denied it along with any other medication recommended for her heart failure because she wanted to die faster.

She didn't want to prolong the inevitable. She didn't want to feel hopeless and numb anymore. She didn't want to watch the only person in her life devolve into madness. She didn't want to wake up the next morning.

Jeremiah must have known exactly what y/n was thinking too. He gave her a hard look and he dropped his grin after telling her the name of it. He wonders what she'd say or do while he watches the flash of realization appear on her.

It was interesting because Jeremiah didn't know what route she'd take. This morning showed her defiance, but aggressiveness wasn't in her nature. He knew she wasn't the smartest person at times, yet she knew there wasn't a freedom of choice. How she reacts will determine how restricted things will be. Even then he can't always predict what she'll do regardless of their years of being together and how she'd tell him just about every little thing.

But he doubts that she'd openly tell him she wanted to kill herself faster. Of course, he knows her history of mental instability. He's watched her fall into those depressive lows multiple times. Suicide was a different story. Anything about suicide or even self-harm is off the table of discussion for y/n. It was least off the table when having casual conversations.

Suddenly y/n opened her mouth much to Jeremiah's delight. Silently complying. Once she had successfully taken the ACE, he lightly patted her cheek, "Good girl." He watched as her face contorted into embarrassment for a moment. He knew he had power over her, but he didn't know how much until now. It was like their roles had been reversed.

y/n slightly moved her head to the right as if that would stop him from touching her face. "Miah, honey," She started with an anxious smile, "Why do feel like you have to do this?" Right after the question came out of her mouth he raised an eyebrow and slightly squinted his eyes. She felt her mouth go dry as she was scrambling to explain, "I mean, I understand what you mean when you explained earlier. I think we could compromise."

Jeremiah slowly spoke while holding back a laugh, "Compromise? You want to compromise with me?" Her lips moved to the left and she slightly pounded. She was being serious. He bit down on his tongue so a laugh couldn't escape. Quickly inhaling and exhaling, he asked her to continue.

Still full of hope, or what could be called delusion, y/n spoke of different ideas. That's maybe he could still take that blood sample or not at all. She'll never doubt or bring up her past concern about his sanity. In each idea, she promised not to leave the bunker. Jeremiah would be lying if he said her ideas weren't tempting.

But not tempting enough. The whole time his amused smile did not filter once because he knew what his final verdict was.

"No." Her shoulders slumped and a defeated sigh came out. He needed her to know that there was no point in trying to fight. That she didn't have any control and that she'd be better off listening to him. There wasn't going to be anyone else that she'd want or need, but him.

"Someone's going to notice I'm gone. My therapist, my professors, and my family." He rolled his eyes at the last example. "I've already dropped your therapist for you through your email. College isn't a problem for you anymore. As for your family."

She didn't like how he dragged out 'your family' with such disdain. "Do you think they'll search for you? They'll send a few search teams and act sad, but they aren't going to look for you." She mentally scolded herself for being so quick to believe him. Even if it was just for a second. It was a second that she believed that they were anything, but moral people.

"You know that's a lie. When Jerome-"

Jeremiah's mood soured at the name. "Who wouldn't be worried? Jerome stands for nothing and will burn everything. When I–" He stopped to prevent himself from becoming so pressed, "Can't you see that they're just acting at this point? They wouldn't be pretending if didn't make them look heartless."

"Because they aren't heartless. You've never even met them, so I don't think it's even fair to judge them." Jeremiah couldn't understand why after all this time, she still defends them. The nights when poured out her feelings towards her family are still fresh in his mind. She'd get so emotional when talking about how alone she was and how she wished they could be a normal family.

"You're right, I never met them because they never showed up to anything. Not once have they shown up to any of your art galleries or even your graduation. I had to comfort you because they always upset you somehow. You've been fine without them for years, and you'll be fine without them now."

y/n let out a frustrated sigh. The Wayne family was complicated and held many secrets. Secrets that she couldn't talk about meaning he'd never have the full picture. They were good people deep down, she knows it. It wasn't fair for her to demand their attention after they came back from saving lives. Yet it reminded her that she wasn't worthy of their time or effort after she quit.

"They're good people, it's just that they're always so busy."

"Your father or brothers can't give you an hour of their time? Jesus Christ, y/n, I know you have attachment issues but come on." Her eyes widen in surprise.

"I don't have attachment issues," She balls her hands into fists, "I'm mentally sound and have normal, healthy relationships with others."  Her words made Jeremiah tisk, yet almost smile at the same time.

"You're accusing me of being mentally ill, but look at yourself. You had to go to therapy weekly, every few years you'll end up in the ER for suicidal ideation, and you rely on medication to make you feel normal. This morning you attacked Ecco when she did nothing wrong." The look of hurt painted y/n's face.

"Okay, but I wasn't-"

He faked a shocked expression like he was outraged by the few things she had said. "y/n, you don't have to yell at me. I know you're insecure about your mental health, but you have to accept that you are nothing without anyone." She tried to say something, but he spoke over her. "It's clear you aren't ready to talk about this by how emotional you are. I'll give you some time to calm down."

He got up and began making his way out of the room. As he was leaving and closed the door he could hear y/n begging him to come back. To not leave her alone. That she was sorry, in a perfect world he might have gone back to comfort the distraught girl, but there was too much work and so little time.

When passing by Ecco he said, "If she doesn't quite down give her midazolam."

Right after y/n was handed her diploma, she quickly walked off the stage with a clenched jaw and a big smile. Jeremiah sighed as he looked at the text he received not long after she fled. 'I'm ready to go. I'll be waiting in the car.' He glanced around the people seeing the families hugging and praising their loved ones. Yeah, he could understand and he didn't want to be there any longer himself.

Leaving the school he found y/n sitting in the passenger seat with the side of her head resting against the window. He couldn't tell because it was dark out, but he was sure her eyes were slightly reddened. While he got behind the steering wheel he asked, "Do you want to go back to my place?" She nodded her head.

y/n has been making it a habit of going to Jeremiah's place instead of home. He doesn't understand it personally, but he did understand the reasoning behind it to a certain extent. She told him of how lonely Wayne Manor was because everyone was doing their own thing. Saying that she didn't want to disturb their work which he found ironic because she'd always try to distract him when he was doing something. Still, his place was less lonely because he still lived with his Uncle.

During the ride back to his apartment the radio filled the silence. Every so often he'd glance at her to see that she was staring out the window. The look on her face didn't tell him that she was numbing herself by ignoring her feelings. Instead, her eyebrows were furrowed as hugged herself. He would have liked to know what she thinking, but he didn't want to push her to tell him.

When they made it in front of the mixed-use building they just sat there. The radio and the purring engine no longer provided a slight distraction. Jeremiah waited a moment for y/n to move. It took a little longer, but eventually, she pulled herself out of the car. Her movements held no energy in them and it made her seem like she had just got out of her nine-to-five.

She didn't grab his hand and intertwine their fingers just to feel close. She only walked beside him slightly slouching. He wanted to reach out for her hand, but there was this pit in his stomach that made him anxious. This mildly intense feeling made him worry about what he should do.

Comfort. He didn't know how to comfort her let alone anyone. Yes, there were moments when she'd open up about what was bothering her but all he did was be there. Listen to the [hair color] haired girl ramble more so towards herself than him. If she wanted to, which was often, she asked him for a hug or something that didn't require him to do much.

He could do that right now, right? A hug or a kiss on the cheek– no. It was too risky. This was uncharted territory for Jeremiah, to be the one to entail any physical affection. When y/n suddenly held his hand or pecked his cheek that'd fluster him a bit. Flustered doesn't describe what he feels when thinking of reaching out to her hand because his heart races and his hands start to feel shaky. Panicked might be the word.

Jeremiah's thoughts were suddenly cut off when they entered the apartment and were greeted by a sweet aroma. He was surprised his uncle didn't jump out to greet y/n into their home as if she doesn't sleep there four times a week. y/n didn't seem bothered and made a beeline toward Jeremiah's room. He could hear her flop onto the bed.

He wandered around the kitchen to find a note with a cake next to it.

'I might be still working by the time you get back. To congratulate her on graduation, I baked a cake for her. Tell her I said congratulations.'

Glancing, he slightly smiled at his uncle's gesture. Putting down the piece of paper he entered his room to find y/n had rolled herself up in his blankets. Hearing his footsteps she opened her eyes. "My uncle made you a cake and wanted to tell you congratulations."

y/n only lazily hummed a response but he could see her face soften. She watched Jeremiah from his bed as he pulled out the chair from his desk to sit on it. Then listened to him write and scribe on some paper while she stared at the ceiling thinking to herself.

It felt awkward. At least to him. Once again he didn't know what to do except wait. That in itself is fine and normal for them, but this time just felt different. Maybe it was because the problem was different. He didn't know except that he didn't want to wait for her. Wait for her to talk or cling to him for comfort. He wanted to do something. He had to do something.

"Do you want to talk about it?" His quiet, almost soft voice startled her. Looking at him, she slightly smiled, "Do you think I was stupid to get my hopes up?"

He struggled to think of a response. He wanted to say the right thing and think of a long response. Yet he only blurted out, "Of course not." Not getting a response immediately made him slightly panicked. Fearing that he had somehow worsened her mood with his words.

"Do you…" The question y/n was going to ask quickly died when she realized it would have been too specific to ask. So she quickly thought of a different way to ask her original question, "Do you think I'm worthless?" Her words hung in the air before she spoke up again. "Nevermind. Forget what I asked, it's stupid."

"y/n…"

She looked at his face. Those deep blue eyes look back at her with a mixture of emotions. The ones she could identify were pity or sadness. It made her shift her eyes away out of embarrassment. In an attempt to move away from her weird question, she asked him to please lie in bed with her.

Now they lay on their side holding each other. She had her ear resting against his chest while his chin sat atop her head. Being close to each other like this made it seem like tonight was just like any other night.

The steady thumping of his heart was putting her to rest until it started picking up the pace. He took a deep breath before quietly telling her, "I love you, y/n."

She broke out into a huge smile. It was the first time he ever said this. When she says it, she never expected a response back because of how flustered he'd looked after hearing it. Not wanting to show how much of a big deal it was to her, she earnestly responded.

"I love you too, Xander, and I won't ever stop."

Masterlist I might as well make this into a series, but I have no ideas for the next part. The heart failure plotline is inspired by an old Jeremiah x Reader story I read a while ago. I'll look for it later, but I remember liking the idea because I found it beautifully horrifying. If I do find the fanfic I'll link it here.

[willowreader]

Story out! An albumin fused ACE2 design that blocks all SARS-CoV-2 variants. The design has a long plasma half-life and can be delivered in a needle-free manner across mucosal surfaces.

This is fantastic news. A COVID blocker is exactly what we need.

[petfurri]

Captopril for Dogs: Benefits, Dosage, Side Effects, and More

Captopril for Dogs

Captopril is an angiotensin-converting enzyme (ACE) inhibitor commonly used in veterinary medicine to manage heart conditions in dogs, particularly congestive heart failure (CHF) and systemic hypertension (high blood pressure). Initially developed for human use, captopril has found its place in treating canine patients with cardiovascular issues, offering numerous benefits but also requiring careful administration and monitoring due to potential side effects.

Understanding Captopril and Its Mechanism of Action

Captopril works by inhibiting the angiotensin-converting enzyme, which is responsible for converting angiotensin I into angiotensin II, a potent vasoconstrictor. Angiotensin II causes blood vessels to narrow, leading to increased blood pressure and making the heart work harder. By blocking this conversion, captopril allows blood vessels to relax and widen, reducing the workload on the heart and lowering blood pressure. This action is particularly beneficial for dogs suffering from CHF, as it helps to improve blood flow and reduce fluid buildup in the lungs and other tissues.

Benefits of Captopril for Dogs

Managing Congestive Heart Failure (CHF): CHF is a common condition in dogs, especially in older or certain breeds like Cavalier King Charles Spaniels. Captopril helps manage CHF by reducing the resistance the heart faces when pumping blood, thus improving cardiac output and reducing symptoms like coughing, difficulty breathing, and lethargy.

Lowering Blood Pressure: For dogs diagnosed with systemic hypertension, captopril can effectively lower blood pressure, preventing damage to organs such as the kidneys, eyes, and brain, which can result from prolonged high blood pressure.

Improving Quality of Life: By easing the burden on the heart and lowering blood pressure, captopril can significantly improve a dog's overall quality of life. Dogs may exhibit increased energy levels, better appetite, and greater overall comfort as a result of treatment.

Potential Renal Protection: In some cases, captopril may offer renal protection by reducing the progression of kidney disease, particularly in dogs with proteinuria (protein in the urine), which is often associated with high blood pressure.

Dosage and Administration

The dosage of captopril for dogs must be carefully determined by a veterinarian, as it varies depending on the dog's weight, the severity of the condition being treated, and the presence of any other health issues. Captopril is usually administered orally, with or without food, typically two to three times a day.

Typical Dosage: The usual starting dose is around 0.5 to 2 mg per kg of body weight, given every 8 to 12 hours. The dosage may be adjusted based on the dog’s response to the medication and any side effects observed.

Monitoring: Regular monitoring is crucial when a dog is on captopril. Blood pressure, kidney function (via blood tests for creatinine and blood urea nitrogen levels), and electrolyte levels should be checked periodically to ensure the medication is working effectively without causing harm.

Potential Side Effects of Captopril

While captopril can be highly beneficial, it also carries the risk of side effects, particularly if not used correctly. Some of the potential side effects include:

Gastrointestinal Issues: Dogs may experience vomiting, diarrhea, or loss of appetite. These symptoms are usually mild but should be reported to the veterinarian if they persist.

Hypotension (Low Blood Pressure): As captopril lowers blood pressure, there is a risk that it may cause blood pressure to drop too low, leading to weakness, dizziness, or fainting. This is more likely to occur in dogs that are dehydrated or have other underlying health conditions.

Kidney Dysfunction: Captopril can affect kidney function, particularly in dogs with pre-existing kidney issues. It’s important to monitor kidney parameters closely during treatment to avoid exacerbating any renal problems.

Hyperkalemia (High Potassium Levels): Captopril can cause an increase in potassium levels, which can lead to dangerous heart rhythms if not managed properly. Regular blood tests are essential to monitor electrolyte levels.

Coughing: A persistent dry cough is a less common side effect but can occur due to the buildup of bradykinin, a substance that captopril can increase in the body.

Allergic Reactions: Though rare, some dogs may have an allergic reaction to captopril, manifesting as itching, rash, or swelling. Immediate veterinary attention is required in such cases.

Precautions and Considerations

Captopril should be used with caution in dogs with pre-existing kidney disease, dehydration, or electrolyte imbalances. It should not be used in dogs that are pregnant, as it can cause harm to the developing fetus. Additionally, it’s important to inform the veterinarian of any other medications the dog is taking, as captopril can interact with other drugs, including diuretics and nonsteroidal anti-inflammatory drugs (NSAIDs), potentially leading to adverse effects.

[dyingroses]

The different meanings I associate with the same initials:

HR

human resources

heart rate

RR

rest and recreation

respiratory rate

BO

body odor

behavioral observation

SO

significant other

superior officer

CO

commanding officer

cardiac output

ACE

angiotensin-converting enzyme

adverse childhood experience

academic center for excellence

BC

before the common-era/before christ

birth control

because

RN

right now

registered nurse

[lacepockets]

can i ask what meds your guineapig was put on and what they do? i recently found out my guneapig has an enlarged heart too & i hope i can help him

Oh no, I hope you can help your piggy! 😟 Dilated cardiomyopathy is a fairly common problem for them, and it's terrible. They're such wonderful little creatures, and so delicate, so it's really frightening when something is wrong with them. And cardiac problems in general are scary! I earnestly wish you and your piggy the absolute best!!!

Dolly is on a cocktail of three medicines:

Enalapril once per day. This is an ACE (angiotensin converting enzyme) inhibitor. That enzyme is responsible for narrowing blood vessels, so an inhibitor prevents that enzyme from working, so the blood vessels don't get narrowed and it's easier for blood to travel through them. This is a same medication given to humans with the same condition.

Pimobendan twice a day. This is an inodilator, which in simplest terms, lowers blood pressure. When blood pressure is high, it's easier for it to cause damage to vessels and the heart itself, which in DCM (dilated cardiomyopathy) already has a heard enough time pumping. I believe this is a veterinary-only medication, and it's typically given to dogs but works in other animals too.

Furosemide twice a day. This one is a diuretic, which helps clear fluid from places in the body where it shouldn't be, and expels said fluid in urine. When there's fluid around the heart, the heart can't expand and beat properly, so a diuretic helps with that. This is also given to humans.

[thenursingtime-blog]

Captopril Nursing Considerations & Management

Introduction Captopril is a cornerstone medication in the management of hypertension, heart failure, and other cardiovascular conditions. As the first angiotensin-converting enzyme (ACE) inhibitor, it has been widely used to reduce blood pressure, decrease cardiac workload, and improve survival in heart failure patients. Nurses play a critical role in administering captopril, monitoring its…

[covid-safer-hotties]

Reference preserved in our archive

A preprint from the latest vaccine study in the Prevent-19 trial. Novavax elicits broader, longer lasting, and sequentially increasing protection from past and present strains of covid than Pfizer and Moderna's mRNA vaccines. This is the fourth study in a row showing Novavax's increasing efficacy with additional boosters, something not seen with mRNA covid vaccines. If you can, you should try and get started on a Novavax series. The more doses you can get, the better lasting protection you'll have.

Abstract Background NVX-CoV2373, a recombinant SARS-CoV-2 spike (rS) protein vaccine with Matrix-M™ adjuvant, has been authorized for use in adults and adolescents. PREVENT-19 (NCT04611802/2019nCoV-301), a pivotal phase 3, randomized, placebo-controlled trial demonstrated robust efficacy of a primary, 2-dose series of NVX-CoV2373 against COVID-19. Methods Protocol expansions to PREVENT-19 included enrollment of adolescents (aged 12 to <18 years) and administration of 3rd and 4th doses of NVX-CoV2373 to adults and adolescents. Participants randomized 2:1 received NVX-CoV2373 or placebo 21 days apart; 3rd and 4th doses were administered ≥6 months after the preceding dose. Secondary and additional assessments included post-3rd- and 4th-dose immune responses (neutralizing antibody [nAb], anti-rS IgG, human angiotensin-converting enzyme-2-receptor binding inhibition [hACE2-RBI]) and response durability (post-3rd dose) to ancestral virus; cross-reactivity to Omicron subvariants; safety; and reactogenicity. Results Immune responses were observed against ancestral virus after two doses of NVX-CoV2373 but not after placebo. In both adults and adolescents, additional doses of NVX-CoV2373 increased nAb titers, anti-rS IgG levels, and hACE2-RBI; durable responses were recorded 8 months post 3rd dose. nAb responses post 3rd dose were noninferior to those post primary series. Cross-reactivity to BA.5 and BQ.1.1 variants was also observed, with anti-rS IgG levels post 3rd or 4th dose exceeding previously reported correlates of protection. Additional doses of NVX-CoV2373 were well tolerated, with no new safety signals. Conclusions NVX-CoV2373 elicited robust and durable humoral immune responses to ancestral SARS-CoV 2 as a 3rd and 4th dose after the primary series in adults and adolescents. Cross-reactivity to relevant variants provides insight into potential protection against antigenically related, but shifted, viral strains. Additional doses of NVX-CoV2373 were well tolerated with no new safety signals. These results support the utility of this vaccine platform and continued updates, based on currently circulating strains, to help effectively combat SARS-CoV-2 infection.

[literaturereviewhelp]

The spread of coronavirus disease that originated in Wuhan, China, led to a global pandemic affecting people in different ways. COVID-19 causes pulmonary problems and impacts other systems of the human body, including cardiovascular/circulatory, digestive, immune, and sensory nervous. Various forms of ophthalmic manifestations of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) occur as a result of the immune response to the virus and might be used for differential diagnosis. The following literature review will investigate the sources of evidence and discuss the prevalence and examples of eye-related COVID-19 symptoms, as well as the pathogenesis of the disease. The results of the five studies also create implications for research and clinical practice, which will be considered. Prevalence and Examples of Ocular Manifestations Specific data on the prevalence and distinct forms of ophthalmic symptoms is important because it might help healthcare workers ensure timely and accurate diagnosis of SARS-CoV-2. The systematic review by Nasiri et al. (2021) aimed to eliminate the gap in the understanding of the ocular symptoms of COVID-19. The researchers examined 895 articles available in several major databases (Pubmed, Embase, Web of Science, Scopus, and medRxiv) and discovered that the prevalence of ocular manifestations was 11.03%. Similarly, Wu et al. (2020) reported that 11 of 38 COVID-positive patients monitored during their research had ocular abnormalities, while 2 had positive results from conjunctival swabs. The estimated prevalence of viral nucleotides in conjunctival samples was relatively low (5.2%). In contrast to the findings discussed above, Lawrenson and Buckley (2020) maintain that viral conjunctivitis and other ophthalmic symptoms are rare complications of COVID-19 with an average prevalence of 4% or less. The experts state that the reports of positive SARS-CoV-2 patients reveal insufficient use of conjunctival swabs and doubt the existence of the causal relationship between COVID-19 and ocular symptoms. The researchers aimed to identify and describe distinct ophthalmic symptoms that might be used for diagnostic purposes. According to Nasiri et al. (2021), the most common symptoms are dry eye or foreign object sensation, redness, itching, tearing, and pain. Chen et al. (2020) conducted experimentation on animal models and concluded that eye infections, such as conjunctivitis, uveitis, retinitis, and optic neuritis, might be additional signs of coronavirus infection. Wu et al. (2020) also discovered that conjunctival hyperemia, epiphora, chemosis, and excessive eye discharge contribute to the list of ophthalmic manifestations. The researchers did not observe the instances of blurred vision in COVID-19 patients, while epiphora appeared to be the first symptom of the infection in one instance. Pathogenic Mechanisms The examination of pathogenesis in relation to ocular manifestations of COVID-19 might provide valuable insights into the problem of the infectious disease. Willcox et al. (2020) stated that several types of coronaviruses, including SARS-CoV-2, employ the spike protein to bind to host cell receptors and replicate. Chen et al. (2020) noticed that the angiotensin-converting enzyme 2 (ACE2) is a receptor associated with coronavirus infection that is present in the human conjunctiva, retina, cornea, and aqueous humor. Moreover, Lawrenson and Buckley (2020) discovered that the priming protease TMPRSS2 facilitates the binding of the virus to the ACE2 receptors. The authors proposed that SARS-CoV-2 targets the receptors located in different eye tissues, causing conjunctivitis, anterior uveitis, retinitis, and optic neuritis. ACE2 is also present in the kidneys, heart, and liver, which might explain the coincidence of severe ocular symptoms with organ damage. The researchers mentioned above agree that ACE2 is the main receptor involved in coronavirus pathogenesis. There are opposing views on the ophthalmic origin of COVID-19, as the studies of ocular manifestations demonstrated a low prevalence of SARS-CoV-2 fragments (nucleotides) in conjunctival specimens. Wu et al. (2020) reported only one patient whose primary symptom was conjunctivitis. Furthermore, the initial reports from Wuhan, China, 17 studies from Singapore, and 32 international cases did not list conjunctivitis or other ocular manifestations as COVID-19 symptoms (Willcox et al., 2020). Conjunctival inoculation is associated with mild cases of lung infection in comparison with trachea inoculation (Willcox et al., 2020). Therefore, conjunctival testing might be ineffective for confirming COVID-19, which makes nasopharyngeal swabs and blood samples the primary diagnostic methods. Implications for Research and Clinical Practice The research findings related to the ophthalmic manifestations of coronavirus disease may promote further research and support the development of effective prevention and treatment strategies. Thus, the experts addressed the problem of ocular symptoms to identify its potential for application in clinical practice. The ocular surface is a possible target for viral infections, which means that retinopathy in COVID-19 patients may correlate with the degree of microvascular lesions and predict damage in other organs (Chen et al., 2020). It should be noted that the fragments of the original SARS-CoV, which is 79.5% genetically consistent with the novel coronavirus, were detected in tears of individuals with the acute respiratory syndrome (Chen et al., 2020). Based on the univariate analysis of 38 COVID-positive patients, Wu et al. (2020) concluded that individuals with ocular symptoms experienced higher neutrophil and white blood cell counts than patients without ophthalmologic manifestations. The researchers also reported higher C-reactive protein, procalcitonin, and lactate hydrogenase in these patients. The findings suggest that ocular abnormalities may serve as early indicators of coronavirus disease, as they are consistent with severe systemic symptoms and blood test results. The articles also provide implications for ophthalmologic and epidemiologic practice and research. The eye is considered a possible site of coronavirus infection due to the risk of exposure to airborne droplets transmitted during person-to-person contact. Additionally, respiratory tract infection can facilitate the migration of the virus through the nasolacrimal duct to the ocular surface (Willcox et al., 2020). The article by Wu et al. (2020) confirms the idea and shows that unprotected eyes can increase the risk of viral transmission, which implies that COVID-19 might spread through the eye. Notably, animal studies identified SARS-CoV-2 RNA on the ocular surface of rhesus monkeys shortly after an infection, and the highest antibody levels were detected on day 14 (Willcox et al., 2020). Despite the possibility of ocular transmission, the literature review conducted by Willcox et al. (2020) indicates that contact lenses and other forms of vision correction are safe if proper hygiene is practiced. It can be concluded that coronavirus attaches to ocular surface cells, which explains its potential to cause conjunctivitis. Conclusion   The review of the articles contributed valuable information on the prevalence of ocular manifestations, examples, and pathogenic mechanisms of COVID-19. The authors reported different percentages of ophthalmic symptom prevalence, while the ACE2 receptor was assumed to play a significant role in the pathogenesis. According to some authors, the manifestations may be considered as indicators of organ damage, while others doubt the effectiveness of the conjunctival testing. The ocular surface was described as the target for the infection, which indicated the possibility of ocular transmission. Therefore, the research findings provided several implications for clinical practice and academic research, which might improve diagnostic procedures and treatment options. References Chen, J., Pan, S., Chen, G., & Sun, H. (2020). A review of COVID-19 related eye disease. Social Science Research Network. Web. Lawrenson, J. G., & Buckley, R. J. (2020). COVID‐19 and the eye. Ophthalmic and Physiological Optics. Web. Nasiri, N., Sharifi, H., Bazrafshan, A., Noori, A., Karamouizan, M., & Sharifi, A. (2021). Ocular manifestations of COVID-19: A systematic review and meta-analysis. Journal of Ophthalmic and Vision Research, 16(1), 103-112. Web. Willcox, M., Walsh, K., Nichols, J. J. Morgan, P. B., & Jones, L. W. (2020). The ocular surface, coronaviruses and COVID-19. Clinical and Experimental Optometry, 103(4), 418-424. Web. Read the full article

[rainyducktiger]

Cardiovascular Diseases Drug Market Supply Chain Challenges and Future Strategies to 2033

Introduction

Cardiovascular diseases (CVDs), encompassing conditions such as coronary artery disease, stroke, heart failure, and hypertension, remain the leading cause of mortality globally. With over 17.9 million deaths annually attributed to CVDs, according to the World Health Organization (WHO), the burden on global healthcare systems is profound. The increasing prevalence of lifestyle-related factors such as sedentary behavior, poor diet, smoking, and alcohol consumption have only intensified the need for effective pharmaceutical interventions. As a result, the cardiovascular diseases drug market is poised for significant growth through 2032, driven by continuous innovation, expanding patient populations, and evolving treatment strategies.

This article provides a comprehensive overview of the cardiovascular diseases drug market, highlighting current trends, key market segments, technological advancements, and future projections up to 2032.

Market Overview

The cardiovascular diseases drug market is a vast and complex segment of the global pharmaceutical industry. In 2024, the market size is estimated to be over USD 65 billion, and is expected to grow at a compound annual growth rate (CAGR) of 4.5%, reaching approximately USD 95 billion by 2032.

The market includes various drug classes such as antihypertensives, lipid-lowering agents (statins), antiplatelets, anticoagulants, beta-blockers, calcium channel blockers, and ACE inhibitors. These drugs are essential in managing chronic cardiovascular conditions, preventing recurrence, and improving overall patient survival rates.

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Market Drivers

Rising Global Prevalence of Cardiovascular Diseases

The number of individuals affected by CVDs is rising due to urbanization, an aging population, and increased exposure to risk factors. As of 2023, over 520 million people globally were living with CVDs. The growing prevalence of diabetes, obesity, and hypertension, especially in developing economies, has further accelerated demand for cardiovascular medications.

Aging Population

The global demographic shift toward an older population significantly contributes to the demand for cardiovascular drugs. Elderly individuals are more prone to cardiovascular complications due to physiological changes and comorbidities. By 2032, individuals aged 65 and older are projected to make up over 20% of the population in several major economies, including the U.S., Japan, and Germany.

Technological Advancements in Drug Development

Advancements in pharmaceutical technologies, such as targeted drug delivery, precision medicine, and RNA-based therapies, have led to the development of more effective and personalized treatments. This innovation is enhancing the efficacy and safety profile of cardiovascular drugs, thereby increasing patient adherence and outcomes.

Government Initiatives and Health Campaigns

Governments and health organizations around the world have launched various initiatives aimed at reducing the burden of CVDs. Public health campaigns promoting early detection and prevention, along with subsidies for cardiovascular medications in several countries, have supported market growth.

Key Drug Categories

Antihypertensive Drugs

Hypertension is a primary risk factor for multiple cardiovascular events. Antihypertensive drugs, including angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), diuretics, and beta-blockers, represent one of the largest segments of the cardiovascular drug market.

Lipid-Lowering Agents (Statins)

Statins are the most prescribed drugs for managing cholesterol levels and reducing the risk of heart attack and stroke. Drugs such as atorvastatin, rosuvastatin, and simvastatin dominate this category. Innovations such as PCSK9 inhibitors are also gaining popularity for patients who are statin-intolerant.

Anticoagulants and Antiplatelet Agents

These drugs prevent blood clot formation and are vital in managing conditions such as atrial fibrillation, deep vein thrombosis (DVT), and post-stroke treatment. Leading products include warfarin, rivaroxaban, apixaban, and clopidogrel.

Heart Failure Medications

Recent years have seen the development of novel heart failure therapies, such as sacubitril/valsartan (Entresto) and SGLT2 inhibitors (e.g., dapagliflozin), which are now proving effective in both diabetic and non-diabetic heart failure patients.

Regional Insights

North America

North America remains the largest market for cardiovascular drugs, accounting for over 35% of the global market share. The United States, in particular, benefits from high healthcare expenditure, strong reimbursement policies, and robust R&D activities.

Europe

Europe holds a significant share, driven by aging populations in countries like Germany, France, and the UK. The European Medicines Agency (EMA) supports innovation through fast-track approvals, further fueling market expansion.

Asia-Pacific

The Asia-Pacific region is expected to witness the fastest growth, with a projected CAGR exceeding 6% through 2032. Key factors include a rapidly aging population, rising healthcare awareness, and increasing incidences of lifestyle-related diseases in countries like China, India, and Japan.

Latin America and the Middle East & Africa

These regions are emerging markets with untapped potential. Government initiatives, improved healthcare infrastructure, and growing urbanization are expected to support market growth over the coming years.

Key Market Players

Several major pharmaceutical companies dominate the cardiovascular diseases drug market:

Pfizer Inc.

Bristol Myers Squibb

Novartis AG

Merck & Co., Inc.

Sanofi

AstraZeneca

Amgen Inc.

Johnson & Johnson

Daiichi Sankyo Co., Ltd.

These companies focus heavily on research and development, strategic partnerships, and mergers & acquisitions to expand their cardiovascular drug portfolios.

Challenges in the Market

Patent Expiry and Generic Competition

Many blockbuster cardiovascular drugs have faced or will soon face patent expirations, leading to the influx of generics and biosimilars. This has put downward pressure on pricing and affected revenues of branded products.

High Drug Costs

Although new drug therapies are more effective, they often come with high price tags. Access remains a challenge in low-income regions, limiting market penetration and creating disparities in treatment.

Regulatory Hurdles

Strict regulatory frameworks and long drug approval timelines can delay the launch of innovative products. Additionally, post-marketing surveillance is necessary to ensure safety, adding to the operational burden.

Emerging Trends

Shift Toward Combination Therapies

Combination drugs that address multiple risk factors in a single pill are gaining favor. These simplify treatment regimens and improve patient compliance.

Digital Health Integration

Wearable devices and mobile apps are being integrated with cardiovascular treatment protocols to track patient metrics such as blood pressure, heart rate, and medication adherence.

Personalized Medicine

With advances in genomics and biomarkers, personalized treatment approaches tailored to an individual’s genetic makeup are becoming more prevalent in cardiovascular therapy.

Focus on Preventive Therapies

Pharmaceutical companies are increasingly focusing on preventive strategies, developing drugs that delay the onset of cardiovascular complications in high-risk populations.

Future Outlook (2024–2032)

The cardiovascular diseases drug market is expected to experience steady and sustained growth, reaching USD 95 billion by 2032. Innovation will continue to play a pivotal role in shaping the industry landscape. As precision medicine, digital health tools, and AI-driven diagnostics become more embedded in clinical practice, treatment regimens will become more tailored and efficient.

Opportunities will also arise in emerging markets where healthcare access is improving rapidly. However, addressing affordability, regulatory alignment, and patient education will be key to fully unlocking growth in these regions.

Conclusion

The cardiovascular diseases drug market stands at a dynamic intersection of unmet medical needs, scientific advancement, and global health imperatives. While challenges such as cost barriers and regulatory complexities persist, the market's trajectory remains promising. With a robust pipeline, expanding patient base, and technological innovations on the horizon, the next decade is poised to bring transformative changes in the prevention and treatment of cardiovascular diseases.

As stakeholders across the healthcare ecosystem collaborate to tackle the world’s leading cause of death, the cardiovascular drug market will continue to be a focal point for investment, innovation, and impactful outcomes through 2032 and beyond.Read Full Report:-https://www.uniprismmarketresearch.com/verticals/healthcare/cardiovascular-diseases-drug

[nursingwriter]

ACE INHIBITORS vs. TIGHT GLYCEMIC CONTROL Diabetic Nephropathy Diabetic Nephropathy: ACE Inhibitors vs. Tight Glycemic Control Diabetic Nephropathy: ACE Inhibitors vs. Tight Glycemic Control Proteinuria is considered a risk factor for end-stage renal disease and coronary artery disease, secondary to diabetes (reviewed by Tan, Jaung, Gamble, & Cundy, 2014). The recommended treatment approach relies on angiotensin-converting-enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARB), with the goal of proteinuria remission and the control of hypertension. This strategy is effective for approximately 50% of type 2 diabetes patients suffering from microalbuminuria. The same treatment approach has been used for type 1 and type 2 diabetes patients suffering from macroalbuminuria and researchers have shown that remission is possible in a percentage of type 1 diabetes patients. Tight glycemic control vs. regular glycemic control were compared for efficacy in reducing the risk of cardiovascular adverse events and nephropathy in several recent large randomized-controlled trials and the results were encouraging, especially for newly diagnosed patients and long-term prognosis (reviewed by Tandon, Ali, & Narayan, 2012). These results suggest that tight glycemic control may be as effective as ACE inhibitors in achieving proteinuria remission. To better understand the relative effectiveness of the ACE inhibitors vs. tight glycemic control, a systematic review of the literature will be conducted. Medline, as accessed through the portal PubMed, and Google.com, will be the search engines used. The search strings will be "proteinuria AND tight glycemic" and "proteinuria AND ACE inhibitors." Integration and Synthesis of the Evidence Once considered a progressive and irreversible disease, diabetic nephropathy (DN) has since been shown to be amenable to aggressive treatment (reviewed by Tan, Jaung, Gamble, & Cundy, 2014). Tan and colleagues (2014) examined the effectiveness of ACE inhibitors or ARBs in achieving remission in New Zealand patients with type 2 diabetes and macroalbuminuria in a mixed-race cohort (N = 78) and discovered that remission was possible in only a third of the patients. Of the 28% who achieved remission, a relapse was observed in 27%, while another 15% experienced a gradual increase in ACR during the study period. In addition, it took an average of 30 months from peak ACR for remission to occur, with a range between 12 and 54 months. When remission did occur it lasted anywhere from 12 months to almost a decade. When macroalbuminuria was first diagnosed in this study sample, 32% of patients had no evidence of renal disease, 24% had mild to moderate nephropathy, and 44% had severe nephropathy. The generalizability of these findings is limited because of both the small sample size and how sick these patients were, but the results appear to be validated by the larger, better controlled studies discussed below. A large trial of cardiovascular patients (N = 10,251) with a mean glycated hemoglobin (HbA1c) of 8.1% were randomized to either intensive therapy to lower HbA1c below 6.0% or to standard therapy to lower HbA1c to between 7.0 and 7.9% (ACCORD Study Group, 2008). The study had to be stopped because all cause mortality for the intensive therapy group increased significantly above the standard therapy group, possibly due to an increased incidence of hypoglycemia; however, intensive group participants who survived enjoyed a reduction in cardiovascular risk several years later. In terms of DN, there was no difference between the intensive and standard therapy groups, except for a delay in onset of albuminuria and in the prevalence of macroalbuminuria (Ismail-Beigi et al., 2010). For the purposes of this review, this study is limited because it did not directly compare tight glycemic control with ACE inhibitors; however, it does reveal that tight glycemic control with a target HbA1c of 6.0% or less may be contraindicated in this patient population due to the risk of hypoglycemia. An international study investigating the relative efficacy of ACE inhibitor/diuretic with usual glucose control or intensive glucose control (HbA1c ? 6.5%) versus intensive or usual glucose control alone was conducted recently (Zoungas et al., 2009). The large cohort (N = 11,140) consisted of patients with type 2 diabetes, either with a history of major microvascular or macrovascular disease or at least one other risk factor for cardiovascular disease. The combination of ACE inhibitor and intensive glucose control reduced the prevalence of microvascular events by 19% (p = .02), when compared to intensive glucose control or ACE inhibitor alone. More specifically, all renal events declined by 28% (p < .0001), new or worsening nephropathy was reduced by 33% (p = .005), macroalbuminuria was reduced by 54% (p < 0.0001), and microalbuminuria declined by 25% (p < .001). By comparison, ACE inhibitor with usual glucose control or intensive glucose alone produced intermediate risk values between placebo and combination therapy. Based on the results of this study, tight glucose control and ACE inhibitors both provide protection against DN, but the magnitude of the effect is additive when both are combined. For the purposes of this review this is the most relevant study, but the findings would be generalizable only to patients that meet the inclusion criteria of type 2 diabetes together with major microvascular or macrovascular events. Based on the findings discussed above, both ACE inhibitors and intensive glucose control provide protection against onset or worsening of DN. The degree of success in providing reduced risk of DN or worsening DN in these studies depended on the severity of disease at the onset of the studies. In terms of safety, however, the ACCORD study revealed tight glucose control (HbA1c ? 6.0%) may not be worth the risk in patients with cardiovascular comorbidity (ACCORD Study Group, 2008). By comparison, tight glucose control (HbA1c ? 6.5%) in the ADVANCE study did not increase the risk of all cause mortality, and when combined with an ACE inhibitor/diuretic actually reduced mortality significantly (p = .04). The patient populations between the ACCORD and ADVANCE studies differed, because in the former they all had cardiovascular disease, whereas in the latter all had diabetes with or without cardiovascular disease. Based on this evidence alone, a combination of ACE inhibitors and tight glycemic control would be indicated for all diabetes patients at risk for developing microvascular events, including DN; however, tight glucose control with a target HbA1c level of 6.0% or less may be contraindicated for cardiovascular patients due to the increased risk of hypoglycemia and all cause mortality. Comparative Evaluation of the Evidence to Practice The use of both ACE inhibitors and tight glycemic control for preventing or controlling proteinuria associated with type 2 diabetes is essentially non-existent in my clinic; however, a diagnosis of type 2 diabetes triggers a test for albuminuria, which is repeated annually. Even if a diabetes patient with microalbuminuria is normotensive, they are given an ACE inhibitor or ARB to slow progression to macroalbuminuria. By comparison, tight control of hyperglycemia to an HbA1c level at or below 6.0% is simply not routine nor recommended for patients. In my clinic, we consider any HbA1c level below 9.0% better and below 8.0% best, depending on the disease severity and prognosis. There is thus a wide margin between what some research groups define as tight glucose control and what is considered tight glucose control in my clinic. If my clinic were to adopt tight glucose control as best practice, with a target HbA1c level somewhere between 6.5 and 7.0%, there would be significant barriers to change. From the perspective of patients, taking multiple drugs with a risk of side effects, including drug interactions, would tend to increase the risk of noncompliance. Based on my experience, patients also tend to lack sufficient diabetes knowledge to increase their treatment self-efficacy, including making the necessary lifestyle changes and complying with aggressive treatment recommendations. From the clinician perspective, there would be some resistant to the increased time burden required to fully evaluate and follow patients who are being treated using tight glycemic control, let alone deciphering the conflicting guidelines that have been published (reviewed by Bailey, 2013). Other clinician-associated barriers would include the lack of financial incentives, practice inertia, and resistance to prescribing multiple drugs for patients. Of all the barriers to implementing combination therapy with an HbA1c target below 7.0%, probably the most significant is a lack of consensus. Without agreement between the government and non-profit stakeholders the implementation of combination therapy based on tight glycemic control to prevent or control DN will not be feasible. Summary The evidence supporting the efficacy of tight glycemic control for controlling and preventing DN is growing with each passing year. The current state of research suggests that the primary benefit of tight glycemic control, with an HbA1c target below 7.0%, may not be realized until years later. While this finding is indeed promising, current best practice for treating DN is standard glycemic control in combination with ACE inhibitors or ARBs. The HbA1c target, however, is typically based on local guidelines and therefore remains controversial. Most patients would benefit from this conservative approach, so the main question raised by the research presented here is "how low should the HbA1c target be and for which patients?" References ACCORD (Action to Control Cardiovascular Risk in Diabetes) Study Group. (2008). Effects of intensive glucose lowering in type 2 diabetes. New England Journal of Medicine, 358(24), 2545-59.  https://www.paperdue.com/customer/paper/poorly-controlled-type-ii-diabetes-mellitus-183087#:~:text=Logout-,PoorlyControlledTypeIIDiabetesMellitus,-Length5pages Bailey, T. (2013). Options for combination therapy in type 2 diabetes: Comparison of the ADA/EASD Position Statement and AACE/ACE Algorithm. American Journal of Medicine, 126, S10-S20. Ismail-Beigi, F., Craven, T., Banerji, M.A., Basile, J., Calles, J., Cohen, R.M. et al. (2010). Effect of intensive treatment of hyperglycaemia on microvascular outcomes in type 2 diabetes: An analysis of the ACCORD randomized trial. Lancet, 376(9739), 419-30. Tan, J., Jaung, R., Gamble, G., & Cundy, T. (2014). Proteinuric renal disease in type 2 diabetes: Is remission of proteinuria associated with improved mortality and morbidity? Diabetes Research and Clinical Practice, 103, 63-70. Tandon, N., Ali, M.K., & Narayan, K.M. (2012). Pharmacologic prevention of microvascular and macrovascular complications in diabetes mellitus: Implications of the results of recent clinical trials in type 2 diabetes. American Journal of Cardiovascular Drugs, 12(1), 7-22. Whittemore, R., Melkus, G., Wagner, J., Northrup, V., Dziura, J., & Grey, M. (2009). Translating the Diabetes Prevention Program to primary care: A pilot study. Nursing Research, 58(1), 2-12. Zoungas, S., de Galan, B.E., Ninomiya, T., Grobbee, D., Hamet, P., Heller, S. et al. (2009). Combined effects of routine blood pressure lowering and intensive glucose control on macrovascular and microvascular outcomes in patients with type 2 diabetes: New results from the ADVANCE trial. Diabetes Care, 32(11), 2068-74. Read the full article

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Unlocking the Power of Calcium and Vitamin D: Your Guide to Optimal Health by Nik Shah

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Vitamins A, E, K: Essential Nutrients for Lifelong Wellness by Nik Shah

Vitamins A, E, and K are vital for maintaining good health throughout life. In this article, Nik Shah explains the critical roles these vitamins play in vision, immune function, skin health, and blood clotting. Shah provides a comprehensive guide on how to incorporate these vitamins into your daily diet through whole foods and supplements. With contributions from experts like Pory Yingyongsuk and Nattanai Yingyongsuk, Shah discusses the benefits of these vitamins and offers tips on how to maintain optimal levels for lifelong wellness.

Mastering ACE Inhibition: Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers by Nik Shah

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are crucial in managing blood pressure and preventing heart failure. Nik Shah’s article provides an in-depth look at how ACE inhibitors and ARBs work to regulate blood pressure and improve cardiovascular health. Shah, in collaboration with Darshan Shah, explains the mechanisms behind these medications and their therapeutic benefits for individuals with hypertension and heart disease. This guide offers valuable insights into how these treatments can enhance heart health and prevent complications from chronic cardiovascular conditions.

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Nik Shah’s Comprehensive Guide to Mastering Health, Wellness, and Performance Optimization

Nik Shah's groundbreaking work in the fields of health optimization, nutrition, and wellness has provided individuals with the tools to master their physical and mental well-being. His extensive research spans from the biological intricacies of endorphins to practical solutions for managing chronic health issues. Shah’s approach integrates cutting-edge science, personalized health strategies, and actionable insights to empower individuals to take charge of their health. This article explores his contributions to various areas of health, from hormone regulation and gut health to chronic conditions like diabetes and high cholesterol, while also delving into mental wellness.

Mastering Endorphin Antagonists: Their Role in Opioid and Alcohol Use Disorders by Rajeev Chabria https://nikhil.blog/2025/01/22/mastering-endorphin-antagonists-their-role-in-opioid-and-alcohol-use-disorders-by-rajeev-chabria/

Rajeev Chabria’s exploration of endorphin antagonists highlights their crucial role in treating opioid and alcohol use disorders. Endorphins are often referred to as "feel-good" hormones, but their dysregulation can contribute to addiction and substance abuse. Chabria discusses how endorphin antagonists can block the effects of these neurotransmitters, providing a therapeutic strategy for those struggling with addiction. This work ties into Nik Shah’s broader approach to optimizing brain chemistry and mental health, as Shah emphasizes the importance of neurochemical balance for overall wellness. By understanding the role of endorphins in addiction, Shah and Chabria offer valuable solutions for those seeking recovery and long-term mental clarity.

Mastering Endorphin Synthesis, Production, and Availability by Nik Shah https://nikhil.blog/2025/01/22/mastering-endorphin-synthesis-production-and-availability-by-nik-shah/

Nik Shah’s article on mastering endorphin synthesis and availability offers a comprehensive look at how endorphins influence mood, stress, and overall well-being. Shah explains how endorphins are produced and how their availability can be optimized through lifestyle interventions, exercise, and nutrition. By enhancing endorphin production, individuals can reduce stress, improve emotional regulation, and increase their ability to experience pleasure. Shah’s insights into the biochemical processes behind endorphin function help readers harness these powerful neurotransmitters to enhance both mental and physical health, leading to improved happiness, reduced anxiety, and greater resilience.

Mastering Fungal Parasites, Bacteria, Tapeworms, and Ringworms by Nik Shah https://nikhil.blog/2025/01/22/mastering-fungal-parasites-bacteria-tapeworms-ringworms-by-nik-shah/

Nik Shah’s exploration of fungal parasites, bacteria, and other pathogens provides essential knowledge on managing common health concerns like infections caused by tapeworms and ringworms. Shah explains how these pathogens affect the body and immune system, offering practical advice on prevention, treatment, and long-term health management. By understanding how to combat these infections effectively, individuals can optimize their immune response and maintain overall health. Shah’s focus on gut health and immunity aligns with his broader approach to mastering cellular health, ensuring that individuals can live free from the disruptions caused by parasitic and bacterial infections.

Mastering Processed Food Digestion, Gut Biome, and High Metabolism by Nik Shah https://nikhil.blog/2025/01/22/mastering-processed-food-digestion-gut-biome-high-metabolism-by-nik-shah/

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Mastering Slipped Discs and Hernias: Maintaining Perfect Spinal Erection by Nik Shah https://nikhil.blog/2025/01/22/mastering-slipped-discs-and-hernias-maintaining-perfect-spinal-erection-by-nik-shah/

Nik Shah provides a comprehensive guide on managing slipped discs and hernias, common conditions that affect the spine. These conditions can lead to chronic pain, mobility issues, and reduced quality of life. Shah offers strategies for preventing and managing these conditions, including posture correction, strengthening exercises, and lifestyle adjustments to support spinal health. By focusing on spinal alignment and strengthening the muscles that support the spine, individuals can avoid the debilitating effects of slipped discs and hernias while maintaining perfect spinal posture and mobility.

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