European Journal of Cardiovascular Medicine

Background: The cardiovasculardisease (CVD) continuum comprises the evolution from CV risk factors through atherosclerosis, hypertension, and then the target organ damage (heart, brain, kidneys), and finally, heart failure (HF).Beta-blockers differ in pharmacological properties. Nebivolol is a third-generation β-adrenergic receptor antagonist and also has a vasodilating effect mediated by the endothelial L-arginine/nitric oxide (NO) pathway. Objectives:To evaluate the role of nebivolol across the CV continuum To corroborate the reported benefits with the experience of Indian expert physicians and cardiologists treating CV diseases.Methodology:A literature searches of electronic databases such as PubMed and Google Scholar was conducted. The key search words were CV continuum, hypertension, ischemic heart disease (IHD), myocardial infarction (MI), HF, beta blockers, and nebivolol. Nebivolol reduced blood pressure (BP) and heart rate (HR) in hypertensive patients with coronary artery disease (CAD). Nebivolol is useful in improving angina, exercise capacity, and left ventricular (LV) function in patients with coronary slow flow (CSF).Results:The European Society of Hypertension (ESH) upgraded β-blockers to drugs of first choice inhypertensionmanagement. Nebivolol therapy lowers systolic and diastolic BP more than other β-blockers. Nebivolol therapy significantly lowers the risk of all-cause mortality and results in a lower risk of composite CV events versus both carvedilol and other beta-blockers. 95% of Indian experts have opined that nebivolol is the preferred beta-blocker in hypertensive patients with type 2 diabetes mellitus (T2DM).Nebivolol is also effective in heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF).Conclusion:β-blockers continue to serve as cornerstone agents across the CV continuum. Nebivolol is a third-generation beta blocker with unique vasodilating effects owing to its NO-releasing activity. National expert surveys and consensus statements endorse the role of nebivolol in patients withhypertensionand HFpEF. Multicentric clinical trials to endorse the benefits of nebivolol in patients with HFpEF are warranted.

Background: Monoleaflet tilting-disc mechanical valves were widely used before the contemporary bileaflet era. Their structural durability is well established, but contemporary cohorts documenting prostheses remaining in situ for four decades are uncommon. Objective: To describe the long-term observed longevity of monoleaflet mechanical prostheses in the mitral and aortic positions, with particular emphasis on patients reaching at least 40 years after implantation. Methods: We retrospectively reviewed 673 patient records. Operative descriptions were used to identify valve position and prosthesis type. Follow-up was recalculated from the recorded operation date to the last recorded follow-up. Entries with non-calendar operation fields, impossible chronology or invalid date-derived intervals were excluded from date-based analyses. Continuous follow-up was summarized using mean, median, interquartile range (IQR) and maximum duration. Formal Kaplan-Meier survival was prespecified but deferred because the database contains 'Yes', 'No' and 'NA' vital-status entries without consistently documented death dates or an adjudicated censoring definition. Results: Valid date-derived follow-up was available for 468 mitral and 315 aortic valve-position observations. Mean follow-up was 13.75 years for mitral and 13.60 years for aortic prostheses; median follow-up was 12.86 and 12.79 years, respectively. Maximum verified follow-up was 43.45 years in both positions. Five patients had verified follow-up of at least 40 years, all recorded alive at the latest follow-up. The longest observation was 43.45 years in a patient with a Björk-Shiley mitral and Lillehei-Kaster aortic prosthesis. Conclusion: This cohort documents exceptional observed longevity of historical monoleaflet mechanical valves, with multiple patients followed beyond 40 years. Definitive actuarial survival estimates require adjudication of death dates and censoring status