👤 Arowa Abdelgadir

Lipoprotein(a) (Lp(a)) is increasingly recognized as a significant contributor to the risk of atherosclerotic cardiovascular disease (ASCVD). We report the case of a 53-year-old woman who presented with chest pain and has notable family history of premature cardiovascular events. Investigation revealed a markedly elevated Lp(a) level of 492 nmol/L, alongside the presence of coronary artery disease necessitating stenting. Despite adherence to high-intensity statin therapy, her low-density lipoprotein (LDL) cholesterol levels remained suboptimal. Consequently, we initiated treatment with a PCSK9 inhibitor to achieve further reductions in LDL cholesterol. This case underscores the importance of routinely measuring Lp(a), as recommended by European guidelines, which advocate for its assessment at least once during adulthood for effective risk stratification. While lifestyle interventions play a critical role in cardiovascular health, targeted therapies such as PCSK9 inhibitors and emerging nucleic acid-based treatments, including Zerlasiran, offer promising options for significantly lowering Lp(a) levels. Recognizing and addressing elevated Lp(a) is vital for identifying patients at high cardiovascular risk and for informing tailored management strategies aimed at improving patient outcomes. Show less

This study aims to investigate the current evidence regarding long-term outcomes using laparoscopic peritoneal lavage (LPL) versus primary bowel resection (PR) in Hinchey III diverticulitis. A systematic review was undertaken based upon articles published between January 1, 2000, and March 1, 2024. Databases Pubmed, Scopus, and Embase were used employing the key search terms "Diverticulitis" and "Peritoneal Lavage." Articles were selected according to the PRISMA guidelines and statistical analysis was undertaken. Cumulative analysis of diverticulitis recurrence and secondary outcomes of disease-related mortality, serious adverse events, stoma incidence, reoperation, and readmission rates were performed. An initial search identified 506 articles for review. A total of 294 patients were included for final analysis from 3 prospective randomized controlled trials. There was no significant difference in disease-related mortality or serious adverse events between LPL and PR. There was significantly decreased likelihood of having a stoma in the LPL group; however, there was also a significantly increased likelihood of having recurrent diverticulitis. There was heterogenicity across all trials. There is a paucity of level 1 evidence available regarding the long-term outcomes of Hinchey III diverticulitis managed with LPL. At 3-year follow-up, there is a significantly decreased likelihood of having a stoma, tempered by the fact that there is a significantly increased likelihood of having recurrent diverticulitis. Further homogenous high-quality randomized studies are required to clarify whether LPL shows long-term benefit over PR. Show less