Background: Bempedoic acid ( BA ) is a novel lipid‐lowering drug. We performed a systematic review and meta‐analysis on efficacy and safety of BA compared with standard treatment in patients with hypercholesterolemia. Methods and Results: Studies were systematically searched in the PubMed, Web of Science, Scopus, and EMBASE databases. Efficacy outcome was represented by percentage changes (mean difference [ MD ] with pertinent 95% CIs ) in total cholesterol, low‐density lipoprotein cholesterol, triglycerides, high‐density lipoprotein cholesterol, apolipoprotein B, non– high‐density lipoprotein cholesterol , and hs‐CRP (high‐sensitivity C‐reactive protein) in BA patients and controls. Seven studies were included (2767 BA ‐treated patients and 1469 controls), showing a more significant reduction in low‐density lipoprotein cholesterol ( MD , −17.5%; 95% CI , −22.9% to −12.0%), total cholesterol ( MD , −10.9%; 95% CI , −13.3% to −8.5%), non– high‐density lipoprotein cholesterol ( MD, −12.3%; 95% CI , −15.3% to −9.20%), apolipoprotein B ( MD , −10.6%; 95% CI , −13.2% to −8.02%), and hs‐CRP ( MD , −13.2%; 95% CI , −16.7% to −9.79%) in BA ‐treated patients compared with controls. Results were confirmed when separately analyzing studies on patients with high cardiovascular risk, studies on statin‐intolerant patients, and studies on patients with hypercholesterolemia on maximally tolerated lipid‐lowering therapy. BA ‐treated subjects reported a higher rate of treatment discontinuation caused by adverse effects, of gout flare, and of increase in uric acid compared with controls. On the other hand, BA ‐treated patients showed a lower incidence of new‐onset diabetes mellitus than controls. Conclusions: BA is associated with a significant reduction in low‐density lipoprotein cholesterol , total cholesterol , non– high‐density lipoprotein cholesterol , apolipoprotein B, and hs‐CRP compared with standard treatment. Documented efficacy is accompanied by an acceptable safety profile.

Worldwide population ageing is partly due to advanced standard of care, leading to increased incidence and prevalence of geriatric syndromes such as frailty and disability. Hence, the age at the onset of acute coronary syndromes (ACS) keeps growing as well. Moreover, ageing is a risk factor for both frailty and cardiovascular disease (CVD). Frailty and CVD in the elderly share pathophysiological mechanisms and associated conditions, such as malnutrition, sarcopenia, anemia, polypharmacy and both increased bleeding/thrombotic risk, leading to a negative impact on outcomes. In geriatric populations ACS is associated with an increased frailty degree that has a negative effect on re-hospitalization and mortality outcomes. Frail elderly patients are increasingly referred to cardiac rehabilitation (CR) programs after ACS; however, plans of care must be tailored on individual’s clinical complexity in terms of functional capacity, nutritional status and comorbidities, cognitive status, socio-economic support. Completing rehabilitative intervention with a reduced frailty degree, disability prevention, improvement in functional state and quality of life and reduction of re-hospitalization are the goals of CR program. Tools for detecting frailty and guidelines for management of frail elderly patients post-ACS are still debated. This review focused on the need of an early identification of frail patients in elderly with ACS and at elaborating personalized plans of care and secondary prevention in CR setting.

Oxidative stress and mitochondrial dysfunction are hallmarks of heart failure (HF). Coenzyme Q10 (CoQ10) is a vitamin-like organic compound widely expressed in humans as ubiquinol (reduced form) and ubiquinone (oxidized form). CoQ10 plays a key role in electron transport in oxidative phosphorylation of mitochondria. CoQ10 acts as a potent antioxidant, membrane stabilizer and cofactor in the production of adenosine triphosphate by oxidative phosphorylation, inhibiting the oxidation of proteins and DNA. Patients with HF showed CoQ10 deficiency; therefore, a number of clinical trials investigating the effects of CoQ10 supplementation in HF have been conducted. CoQ10 supplementation may confer potential prognostic advantages in HF patients with no adverse hemodynamic profile or safety issues. The latest evidence on the clinical effects of CoQ10 supplementation in HF was reviewed.