Empagliflozin (Jardiance®) is an insulin independent antihyperglycemic agent used in treatment of T2D.The drug is a sodium glucose cotransporter-2 (SGLT2) inhibitor approved in USA and Europe and other countries of the world. As empagliflozin demonstrates cardioprotective and Reno protective properties its prime target are patients having CVD and CKD complicated by T2D.

Background: Surgical aortic valve replacement (SAVR) is the commonly used approach for aortic valve replacement (AVR) in patients with aortic stenosis at low or intermediate surgical risk. However, transcatheter aortic valve replacement (TAVR) has emerged as an alternative to SAVR for AVR. This meta-analysis aims to assess the comparative efficacy and safety of TAVR versus SAVR in low-to-intermediate surgical risk patients by analyzing temporal trends in the outcomes of TAVR and SAVR at various follow-up intervals, providing a more detailed understanding. Methods: A thorough literature search was performed across PubMed/MEDLINE, Embase, and the Cochrane Library from their inception up to May 2024 to identify eligible randomized controlled trials (RCTs). Clinical outcomes were evaluated using a random-effects model to pool risk ratios (RRs) with 95% CIs. Results: A total of 17 studies reporting data at different follow-ups for nine trials were included (n=9092). No statistically significant difference was observed between TAVR and SAVR for reducing all-cause death at 30 days, 1 year, and 2 years but significantly increased risk with TAVR at 5 years or longer follow-up (RR=1.13, 95% CI: 1.03–1.23). However, TAVR was associated with a significantly decreased risk for cardiac death at 1-year follow-up (RR=0.79, 95% CI: 0.64–0.96) and comparable risk for cardiac death at 30 days, 2 years, and 5 years or longer follow-up when compared with SAVR. No statistically significant difference was observed between TAVR and SAVR for reducing the risk of myocardial infarction (MI) at 30 days, 1 year, 2 years, and 5 years or longer follow-up. TAVR was associated with a significantly lower risk of major bleeding events at 30 days (RR=0.38, 95% CI: 0.21–0.67); lower risk of acute kidney injury (AKI) at 30 days (RR=0.38, 95% CI: 0.26–0.54) and 1 year (RR=0.58, 95% CI: 0.41–0.82) and lower risk of new onset or worsening atrial fibrillation (AF) at 30 days (RR=0.25, 95% CI: 0.18–0.34), 1 year (RR=0.26, 95% CI: 0.16–0.41) and 2 years (RR=0.32, 95% CI: 0.20–0.49) when compared with SAVR. However, TAVR was associated with a significantly increased risk of permanent pacemaker implantation (PPI) at 30 days (RR: 2.62, 95% CI: 1.40–4.91), at 1 year (RR: 2.19, 95% CI: 1.24–3.87), at 2 years (RR: 2.74, 95% CI: 1.31–5.71), and beyond 5 years (RR: 1.95, 95% CI: 1.20–3.15). TAVR was also associated with a significantly increased risk of prosthetic valve thrombosis at 2 years (RR=2.70, 95% CI: 1.08–6.71), though no significant association was observed at 30 days, 1 year, or 5 years. Similarly, no significant differences were observed in aortic-valve reintervention rates at 30 days, 2 years, or 5 years, but TAVR showed a significantly increased risk at 1 year (RR=1.98, 95% CI: 1.21–3.24). TAVR was associated with a significantly increased risk of major vascular complications at 30 days (RR=2.37, 95% CI: 1.38–4.04) and a significantly increased risk of TIA at 2 years (RR: 1.43, 95% CI: 1.02–2.00, I ²=0%). The risk of hospitalizations was comparable between the groups. Conclusion: TAVR and SAVR demonstrated comparable rates of all-cause death up to 2 years of follow-up. However, at 5 years or longer follow-up, TAVR was associated with a higher risk of all-cause death. While TAVR showed certain procedural advantages, such as a lower risk of major bleeding, AKI, and new-onset or worsening AF, the choice between TAVR and SAVR in patients with low or intermediate surgical risk should consider long-term outcomes, with SAVR potentially being more favorable due to better survival observed on longer follow-up durations.

Sepsis and cardiovascular disease (CVD) are common conditions, and both contribute to mortality. The objective of our study is to explore the contemporary mortality trends associated with CVD and sepsis among patients ≥25 years in the United States (US). We conducted an analysis of death data using CDC WONDER, extracting age-adjusted mortality rates (AAMR) per 100,000 for mortality with an underlying or contributing diagnosis of both CVD and sepsis. Trends by age, gender, ethnicity and race, census region, and metropolitan status were analyzed. Joinpoint regression calculated the annual percent change (APC) for AAMR with 95 % CI. From 1999 to 2019, there were a total of 1,601,794 deaths related to CVD and sepsis. The AAMR related to both CVD and sepsis showed an overall decrease from 1999 to 2019 (1999: 37.9; 95 % CI: 37.6 to 38.1 vs. 2019: 35.4; 95 % CI: 35.2 to 35.7). Men had consistently higher AAMRs compared to women (Men: 41.5; 95 % CI: 41.4 to 41.6 vs. Women: 31.3; 95 % CI: 31.2 to 31.4). Non-Hispanic Black or African American individuals and adults aged ≥65 had the highest CVD and sepsis-related AAMRs. Similarly, the AAMRs were highest in the Northeastern region and among residents of metropolitan areas. Though there has been a reduction in CVD and sepsis-related deaths among patients, significant disparities remain across various demographic groups, underscoring the need for continued research.

T cell lymphoma, a type of non-Hodgkin lymphomas is a rare form of malignancy with poor outcomes.

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly nonalcoholic fatty liver disease, is the most prevalent chronic liver disease worldwide, affecting more than 30% of adults and up to 70–90% of individuals with obesity or type 2 diabetes mellitus. Cardiovascular disease (CVD) represents the leading cause of mortality in this population. MASLD is increasingly recognized as an independent cardiovascular risk factor beyond traditional metabolic comorbidities. This narrative review summarizes epidemiologic, mechanistic, and clinical evidence linking MASLD with cardiovascular disease, with a focus on population-based cohort studies, imaging-based assessments of subclinical cardiovascular disease, and fibrosis-based risk stratification. Population-based cohorts, including the Framingham Heart Study and the Multi-Ethnic Study of Atherosclerosis, demonstrate that hepatic steatosis is associated with a 1.5–2.0-fold increased risk of incident cardiovascular events after adjustment for age, sex, body mass index, diabetes, and lipid levels. MASLD is characterized by insulin resistance, increased visceral adiposity, atherogenic dyslipidemia with elevated triglycerides, small dense low-density lipoprotein particles, and reduced high-density lipoprotein cholesterol. Patients exhibit systemic low-grade inflammation with elevated tumor necrosis factor-α, interleukin-6, and high-sensitivity C-reactive protein, alongside altered adipokine and hepatokine signaling, including reduced adiponectin and increased leptin, resistin, fetuin-A, and fibroblast growth factor 21. Imaging studies identify higher carotid intima–media thickness, increased coronary artery calcium scores, and early left ventricular diastolic dysfunction in patients with MASLD compared with controls. Fibrosis stage has emerged as the strongest hepatic predictor of cardiovascular outcomes. Individuals with advanced fibrosis have significantly higher rates of cardiovascular events and mortality compared with those without fibrosis, independent of traditional risk factors. Emerging data also implicate gut–liver axis dysfunction and increased intestinal permeability in amplifying systemic inflammation and vascular injury. MASLD is closely linked to cardiovascular disease through shared metabolic, inflammatory, and fibrotic pathways. Cardiovascular risk in MASLD is driven primarily by fibrosis severity rather than steatosis burden. Incorporation of liver disease assessment, particularly fibrosis evaluation, into cardiovascular risk stratification may improve identification of high-risk individuals and support integrated cardiometabolic care.

Asymptomatic severe aortic stenosis (AS) has traditionally been managed with watchful waiting because of low annual sudden death rates (<1%) and concerns regarding procedural risk. Emerging randomized data indicate that irreversible myocardial injury may occur before symptom onset and that early aortic valve replacement (AVR) may improve outcomes. This review summarizes evidence from contemporary randomized controlled trials evaluating early surgical AVR (SAVR) or transcatheter AVR (TAVR) vs conservative management or surveillance in asymptomatic patients with severe AS and preserved left ventricular ejection fraction (LVEF). The RECOVERY trial randomized 145 asymptomatic patients with very severe AS (mean age 64 years) to early SAVR or conservative care. Over a median follow-up of 6.2 years, all-cause mortality occurred in 1% of the early surgery group vs 15% with conservative management (hazard ratio [HR] 0.09; 95% CI 0.01-0.67; p=0.003). The AVATAR trial included 157 asymptomatic patients with severe AS, preserved LVEF, and negative exercise testing (mean age approximately 67 years). Over a median follow-up of 32 months, the composite endpoint of all-cause death, myocardial infarction, stroke, or heart failure hospitalization occurred in 16.6% of patients assigned to early surgery compared with 32.9% in the conservative group (HR 0.46; 95% CI 0.23-0.90; p=0.02). The EARLY TAVR trial randomized 901 asymptomatic patients with severe AS and preserved LVEF to TAVR or clinical surveillance (mean age 75.8 years). After a median follow-up of 3.8 years, the primary composite outcome of death, stroke, or unplanned cardiovascular hospitalization occurred in 26.8% of the TAVR group versus 45.3% of the surveillance group (HR 0.50; 95% CI 0.40-0.63; p<0.001). Cardiovascular hospitalizations occurred in 20.9% vs 41.7%, all-cause mortality in 8.4% vs 9.2%, and stroke in 4.2% vs 6.7%, with no excess procedural complications in the early TAVR group. Randomized evidence demonstrates that early AVR, including both SAVR and TAVR, reduces mortality and major cardiovascular events in carefully selected asymptomatic patients with severe AS. The integration of clinical features with risk stratification tools, such as global longitudinal strain, cardiac magnetic resonance imaging, natriuretic peptides, and computed tomography-based valve calcification, supports timely intervention before irreversible myocardial damage occurs.