Publications by authors named "Richard C Becker"
Bridging the gap: strategies for recognizing and managing post-COVID conditions.
Front Med (Lausanne)
November 2024
Article Synopsis
- Post-COVID conditions (PCC) affect 20-30% of adults recovering from COVID-19, leading to a variety of persistent symptoms that complicate diagnosis and management for healthcare providers and patients.
- There is an urgent need for increased awareness, understanding of long-term effects, and appropriate screening strategies, particularly for high-risk individuals to support early diagnosis and better quality of life.
- Effective management of PCC involves patient-centered approaches, standardized screening tools, and initiatives like RECOVER and N3C to improve treatment options and psychosocial health for those affected.
Article Synopsis
- The PATCH-1 study compared two types of 12-lead electrocardiograms (ECGs) – the standard S-ECG and a new patch ECG (P-ECG), to see which one performed better in patients with stable cardiovascular conditions.
- 200 participants were involved, and results showed that the P-ECG was faster to administer (about 1.4 minutes) and had fewer issues with artifacts affecting readings compared to the S-ECG (6.5% vs. 15%).
- Most participants either preferred the P-ECG (47%) or were indifferent (52%), and both types of ECGs provided similar findings regarding heart health metrics.
Reassessing the role of aspirin in patients with coronary artery disease.
Expert Opin Pharmacother
December 2024
Article Synopsis
- * Ongoing research is evaluating whether aspirin can be safely discontinued in favor of P2Y receptor inhibitor therapy, but there is still no consensus on the best timing for discontinuation.
- * New findings suggest that using P2Y inhibitors alone may pose a lower risk of bleeding, prompting a reevaluation of aspirin's role, while exploring innovative formulations and delivery methods like inhaled aspirin for improved patient care.
Article Synopsis
- The study investigated the link between elevated systolic blood pressure (SBP) and neurocognitive performance in adolescents, focusing on measures like auscultatory SBP and ambulatory SBP, along with cardiovascular health risk indicators.
- It involved 365 adolescents, averaging 15.5 years old, from various academic medical centers in the U.S., analyzing their cognitive abilities like nonverbal IQ and attention, considering factors like maternal education.
- Results showed that higher SBP corresponded to lower nonverbal IQ and verbal attention scores, indicating that even slight elevations in blood pressure can negatively affect adolescent cognitive functions, suggesting a need for further research on these implications for clinical care.
Article Synopsis
- COVID-19 significantly increases the risk of thrombosis, affecting both small (micro) and large (macro) blood vessels in patients, particularly during the acute phases of the illness.
- Thrombotic events are not only limited to severe cases; they can also occur in patients with mild-to-moderate symptoms during later recovery phases (up to 12 weeks post-infection).
- The review aims to detail the clinical signs, underlying causes, and mechanisms of thrombosis in COVID-19 to improve screening, prevention, and treatment for affected patients.
Article Synopsis
- Balancing the risk of thrombosis and bleeding when using antiplatelet and anticoagulant medications is challenging for clinicians, especially in patients with acute coronary syndrome (ACS).
- Research focuses on FXIa inhibitors, like milvexian, examining their effectiveness in preventing thrombotic events while minimizing bleeding risks.
- The LIBREXIA-ACS trial is a significant study that aims to demonstrate how milvexian can achieve optimal antithrombotic effects with less bleeding when added to potent P2Y receptor blockers in ACS patients.
Article Synopsis
- Primary hypertension in children can lead to increased cardiovascular risks as they grow into adults, making early studies crucial for understanding organ damage.
- A study involving 132 youths showed significant correlations between blood pressure levels, gene expression, and molecular profiles, highlighting distinct biological changes in those with high blood pressure.
- Findings suggest that mechanisms behind elevated blood pressure could involve issues with blood vessel growth and tissue breakdown, offering potential targets for intervention in preventing long-term cardiovascular damage.
Article Synopsis
- DAOH (Days Alive Out of Hospital) is a key end point for assessing patient outcomes in atrial fibrillation treatments, but its clinical utility has not been previously explored in trials.
- The ROCKET AF trial compared the effectiveness of rivaroxaban and warfarin in patients with atrial fibrillation, revealing similar DAOH outcomes for both treatments, indicating no significant benefit of one over the other.
- Overall, low event rates among participants led to a skewed distribution in DAOH measurements, which may explain the lack of treatment differences observed in the study.
The foundation for investigating factor XI as a target for inhibition in human cardiovascular disease.
J Thromb Thrombolysis
December 2024
Article Synopsis
- Anticoagulant therapy is crucial for treating cardiovascular conditions with a high risk of thrombosis, such as acute coronary syndrome, chronic coronary syndrome, ischemic stroke, and atrial fibrillation.
- * These conditions are linked by inflammation, endothelial dysfunction, oxidative stress, and immune dysregulation, challenging researchers to find effective treatment methods.
- * The review discusses factor XI in coagulation and its potential as a target for new drugs, aiming to improve patient care through better management of thrombosis and related complications.
Article Synopsis
- Arterial and venous thromboembolism is a serious health issue that requires anticoagulation therapy to prevent severe outcomes, but traditional treatments like heparin and VKAs can lead to bleeding risks.
- Direct oral anticoagulants (DOACs) are safer alternatives to VKAs but still carry some bleeding concerns, prompting research into new anticoagulants with better safety profiles.
- Factor XI (FXI) is being studied as a target for safer anticoagulants, with promising results in early trials, but further phase 3 studies are needed to validate their effectiveness and safety before they can be widely used in clinical practice.
Article Synopsis
- The study investigates how biomarker concentrations change during acute coronary syndrome (ACS) to provide insights into heart damage, stress, and inflammation.
- Researchers measured several biomarkers in nearly 17,000 ACS patients from the PLATO trial, finding that most biomarkers showed varying concentration patterns correlated with the time since symptoms began.
- Results indicated that biomarkers like hs-cTnT and hs-cTnI responded differently based on patients' sex, and emphasizes the importance of considering the time from symptom onset when analyzing these biomarker results in ACS.
Article Synopsis
- Vitamin K antagonists like warfarin are currently the approved oral anticoagulants for preventing complications in patients with mechanical heart valves, but the efficacy of apixaban in this context was unknown.
- In a trial comparing apixaban to warfarin for patients with On-X mechanical aortic valves, there were significantly more thromboembolic events in the apixaban group, leading to the study being halted after enrolling 863 participants.
- The results showed that apixaban was less effective than warfarin, failing to meet the criteria for noninferiority in preventing valve thrombosis, and had comparable but slightly lower major bleeding rates.
Article Synopsis
- - Lipoprotein(a) [Lp(a)] is linked to atherothrombosis through various mechanisms, yet high levels of Lp(a) haven’t been definitively connected to an increased risk of venous thromboembolism, and Lp(a) reduction doesn’t seem to change plasma clotting properties.
- - Elevated Lp(a) may enhance platelet activity and is associated with poorer long-term outcomes in patients undergoing procedures like revascularization, but those with high Lp(a) benefit more from extended dual antiplatelet treatment.
- - Research such as the ASPREE trial indicates that in healthy older adults, those with genetic variations leading to higher Lp(a) levels experience fewer ischemic events when treated
Article Synopsis
- Atrial fibrillation (AF) is a common heart rhythm disorder that increases stroke risk, and although anticoagulation therapy is effective, it is often underused among patients.
- A study was conducted to evaluate the impact of a Best Practice Advisory (BPA) integrated with an Atrial Fibrillation Decision Support Tool (AFDST) on improving anticoagulation therapy in primary care settings.
- Results showed that the BPA significantly increased the percentage of patients receiving appropriate anticoagulation therapy, with an improvement from 5% to 11% among those who received the intervention.
Evaluating chest pain in patients with post COVID conditions permission to think outside of the box.
J Thromb Thrombolysis
May 2023
Article Synopsis
- Chest pain is a frequent symptom of post-COVID-19 Conditions (PCC) that leads individuals to seek medical help.
- The SARS-CoV-2 virus can affect multiple organs in the chest, including the heart, lungs, vessels, and nerves.
- Healthcare providers should consider a wide range of possible causes for chest pain and adopt a thorough management strategy when assessing these patients.
Article Synopsis
- The immediate effects of SARS-CoV-2, which causes COVID-19, are widely recognized, but the long-term impact on heart and lung health remains unclear.
- Patients who survive severe cases may experience lengthy recovery times, while others with milder symptoms can also have ongoing issues.
- Together, these individuals form a group known as Post Acute Sequelae of SARS-CoV-2 infection (PASC), and understanding their conditions can be aided by looking at factors such as past heart problems, lung complications, and the treatments received during the initial illness.
Aims: The vascular endothelial growth factor (VEGF) family is involved in pathophysiological mechanisms underlying cardiovascular (CV) diseases. The aim of this study was to investigate the associations between circulating VEGF ligands and/or soluble receptors and CV outcome in patients with acute coronary syndrome (ACS) and chronic coronary syndrome (CCS).
Methods And Results: Levels of VEGF biomarkers, including bFGF, Flt-1, KDR (VEGFR2), PlGF, Tie-2, VEGF-A, VEGF-C, and VEGF-D, were measured in the PLATO ACS cohort (n = 2091, discovery cohort).
Multiple genome-wide association studies (GWAS) have identified specific genetic variants in the coiled-coil domain containing 92 () locus that is associated with obesity and type 2 diabetes in humans. However, the biological function of CCDC92 in obesity and insulin resistance remains to be explored. Utilizing wild-type (WT) and whole-body knockout (KO) mice, we found that KO reduced obesity and increased insulin sensitivity under high-fat diet (HFD) conditions.
View Article and Find Full Text PDFBackground The pathobiology of myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA) is often uncertain. Investigating biomarker concentrations and their changes may offer novel pathophysiological insights. Methods and Results In this post hoc study of the PLATO (Platelet Inhibition and Patient Outcomes) trial, concentrations of hs-cTnT (high-sensitivity cardiac troponin T), NT-proBNP (N-terminal pro-B-type natriuretic peptide), hs-CRP (high-sensitivity C-reactive protein), and GDF-15 (growth differentiation factor 15) were measured in patients with MINOCA at baseline (n=554) and at 1-month follow-up (n=107).
View Article and Find Full Text PDFArticle Synopsis
- A study was conducted to create biomarker-based models that predict the 1-year risk of cardiovascular death and myocardial infarction in patients with acute coronary syndrome undergoing treatment.
- Researchers analyzed data from over 10,000 patients and identified key predictors, including specific biomarkers and patient characteristics.
- The resulting prediction model, named ABC-ACS ischemia, demonstrated good accuracy, effectively distinguishing high-risk patients with C-indices of 0.71 for overall risk and 0.80 for cardiovascular death in the development cohort.
Background: Hypertension-related increased arterial stiffness predicts development of target organ damage (TOD) and cardiovascular disease. We hypothesized that blood pressure (BP)-related increased arterial stiffness is present in youth with elevated BP and is associated with TOD.
Methods: Participants were stratified by systolic BP into low- (systolic BP <75th percentile, n=155), mid- (systolic BP ≥80th and <90th percentile, n=88), and high-risk BP categories (≥90th percentile, n=139), based on age-, sex- and height-specific pediatric BP cut points.
Coronavirus disease 2019 (COVID-19) predisposes patients to thrombotic and thromboembolic events, owing to excessive inflammation, endothelial cell activation and injury, platelet activation and hypercoagulability. Patients with COVID-19 have a prothrombotic or thrombophilic state, with elevations in the levels of several biomarkers of thrombosis, which are associated with disease severity and prognosis. Although some biomarkers of COVID-19-associated coagulopathy, including high levels of fibrinogen and D-dimer, were recognized early during the pandemic, many new biomarkers of thrombotic risk in COVID-19 have emerged.
View Article and Find Full Text PDFA 25-base pair (25bp) intronic deletion in the gene enriched in South Asians (SAs) is a risk allele for late-onset left ventricular (LV) dysfunction, hypertrophy, and heart failure (HF) with several forms of cardiomyopathy. However, the effect of this variant on exercise parameters has not been evaluated. As a pilot study, 10 asymptomatic SA carriers of the variant (52.
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