Cerebrovascular Disease
TIPS-3 Trial: The Combination of Polypill and Aspirin Administered to Patients at Intermediate Risk Led to a Lower Incidence of Cardiovascular Events Compared With Double Placebo
A recent trial by Dr. Salim Yusuf, published in The New England Journal of Medicine, indicated that combination therapy with aspirin plus a polypill (consisting of a statin plus three blood-pressure-lowering drugs) can reduce the incidence of cardiovascular events compared with placebo among participants without established cardiovascular disease, but at moderate cardiovascular risk.
ADRIFT Study: Reduced Rivaroxaban Doses Are Associated With Lower Thrombin Generation Following Percutaneous Left Atrial Appendage Closure Compared to Dual Antiplatelet Therapy
A recent study by Dr. Duthoit, MD, published in Circulation: Cardiovascular Interventions, showed that compared to dual antiplatelet therapy, nonvitamin k antagonist monotherapy using a reduced dose of rivaroxaban (10 and 15 mg) in patients undergone left atrial appendage closure was associated with lower thrombin generation. This data supported that reduced rivaroxaban doses could be a substitute for the antithrombotic medications currently used after this procedure. Continue reading
DAPA-HF Trial: Compared to Placebo, Dapagliflozin Was Beneficial in Patients with Heart Failure and Reduced Ejection Fraction Regardless of Background Diuretic Therapy
A recent study by Dr. Alice M. Jackson M.D., published in Circulation journal, showed that the use of dapagliflozin, a sodium-glucose cotransporter 2 inhibitor, in patients with reduced ejection fraction heart failure (HF) is associated with reduced risk of cardiovascular (CV) death or a worsening HF event, and all-cause death. These effects remained consistent among different subgroups of diuretic therapy.
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100,000 Patient Meta-Analysis Shows Carotid Intima-Media Thickness Progression Can Be Used as a Surrogate Marker for Cardiovascular Risk
A recent meta-analysis of clinical trials with more than 100,000 patients has shown that the carotid intima-media thickness (cIMT) progression can be used as a surrogate marker for cardiovascular risk in the clinical trials. The results of this study published in Circulation. According to Dr. Willeit, the assessment of cIMT progression can provide a link for the development and license of new therapies for cardiovascular disease. Continue reading
A Population-Based Study Showed No Association Between COVID-19-Induced In-Hospital Death and Angiotensin-Converting–Enzyme Inhibitors and Angiotensin-Receptor Blockers Use
A recent study by Dr. Mehra, published in the New England Journal of Medicine, disapproved of the previously concerning idea regarding the potential harmful effect of angiotensin-converting–enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) in the clinical context of Coronavirus disease 2019 (Covid-19). This study also demonstrated that Covid-19 may disproportionately affect individuals with cardiovascular disorders.
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Study Shows High-Intensity Statin Associated With Low Risk of Death, Stroke, ACS or Bleeding As Compared to Low to Moderate Intensity Statins or No Statins
Statins, especially high-intensity statins, could reduce the risk of a composite of death, stroke, acute coronary syndrome, or major bleeding as compared to a placebo in patients with acute ischemic stroke and atrial fibrillation. The observational study that was published in the Journal of the American Heart Association highlights the need for a further randomized control trial to further explore this observation.
GALILEO: Rivaroxaban Based Anti-thrombotic Strategy Associated with Increased Risk of Death or Thromboembolic Events and Bleeding Compared to Antiplatelet Based Strategy in Patients with TAVR
The results of the GALILEO trial were presented by Dr. George Dangas at the American Heart Association 2019 meeting. The trial, which was stopped early, showed that in patients with a successful transcatheter aortic valve replacement (TAVR), a rivaroxaban-based strategy was associated with excessive ischemic and bleeding events.
New-Onset AF After TAVR linked To Worse Long-Term Outcomes Compared With Patients With Pre-Existing AF and No AF New-onset AF associated with a higher rate of death, stroke, bleeding and heart failure hospitalizations after TAVR
A registry-based cohort study including 72,660 Medicare patients with and without atrial fibrillation (AF) who underwent non-apical transcatheter aortic valve replacement (TAVR) from 2014 to 2016, has shown that, TAVR patients with new-onset AF have the highest rate of all-cause mortality (32%) compared to patients with pre-existing or no AF (23.3% and 12.8%, respectively). New-onset AF was also associated with an increased risk of bleeding, stroke and heart failure (HF) hospitalizations.
HOPE 4: A Comprehensive Community-based Program Surpassing the Barriers in Improving BP Control and Associated Cardiovascular Disease Risk in 2 Middle Income Countries A successful 12-months follow-up open-labeled, cluster-randomized controlled trial
Significant improvement in blood pressure control and related cardiovascular disease (CVD) risk is seen as a result of a potentially effective and pragmatic comprehensive model of care conducted as HOPE 4 trial (Heart Outcomes and Prevention Evaluation-4) presented by Dr. JD Schwalm at the European Society of Cardiology (ESC) Congress 2019 and simultaneously published in The LANCET.
No significant association between myocardial viability & long-term survival benefit of CABG in patients with ischemic cardiomyopathy Results of a 10-year follow-up STICH trial & subsequent myocardial viability sub-study
According to a new study published in The New England Journal of Medicine (NEJM) based on a 10-year follow-up STICH trial, no association was found between myocardial viability as a long-term survival benefit of CABG in patients with ischemic cardiomyopathy.
SYNTAXES Study: No Significant Difference In All-Cause Death At 10 Years Between PCI and CABG Results of a 10-year Follow-up Study presented at the European Society of Cardiology (ESC) Congress 2019
A follow-up of a multicenter, randomized controlled trial, the results of which were debuted at the European Society of Cardiology (ESC) Congress 2019, has shown that at 10 years, no statistically significant difference existed in all-cause mortality between percutaneous coronary intevention (PCI) using first-generation paclitaxel-eluting stents and coronary artery bypass grafting (CABG). However, CABG was shown to provide significant survival benefit in patients with three-vessel disease, but not in patients with left main coronary artery disease.
Vascular Risk Factors Tied to Unhealthy Brains, Study from UK Biobank Suggests
Vascular risk factors such as smoking, hypertension, and diabetes were associated with poor brain health. The study by Cox et al., recently published in the European Heart Journal, revealed.
New 15,000 Patient Study In Young Adult Demonstrates Increased Mortality For Up To 15 Years After Stroke
A study led by Dr. Merel Sanne Ekker demonstrated that when compared to the general population, patients between the age of 18 and 49 who had a stroke and survived the first 30 days were at a higher risk of mortality up to 15 years in the future.
New Study Finds Higher Rates of All-Cause, Cardiovascular and Neurodegenerative Mortality in NFL Players when Compared to MLB Players
A study led by Vy Nguyen published in JAMA Network Open showed that when compared to Major League Baseball (MLB) players, US National Football League (NFL) players had higher all-cause, cardiovascular, and neurodegenerative mortality rates.
Genetic Epidemiological Study Provides Conflicting Evidence Regarding Protective Effect of Moderate Alcohol Consumption
An article published in the Lancet by Dr. Millwood provided conflicting evidence regarding the apparently protective effect of moderate alcohol consumption and cardiovascular risk. Many conventional epidemiological studies have associated moderate alcohol intake with a reduced risk of stroke and coronary artery disease. To assess whether alcohol truly has a protective effect, the authors conducted both a traditional and genetic epidemiological study in an east Asian population.
U.S. Food and Drug Administration (FDA) Continues To Investigate Recall of Contaminated Blood Pressure Medication Potentially carcinogenic nitrosamine impurities found in angiotensin receptor blockers (ARBs)
The US food and drug Administration (FDA) has recently been conducting an investigation on voluntary recalls of multiple generic angiotensin II receptor blocker (ARB) drug products used to treat high blood pressure and heart failure. The recalls initiated in July 2018 and continue to date due to the presence of Nitrosamine impurities, including N-Nitrosodimethylamine (NDMA) and N-Nitrosodiethylamine (NDEA), which are potential human carcinogens in different ARB products. Last week, AurobindoPharma USA notified that it is expanding its recall to include 38 more lots of valsartan and amlodipine/valsartan tablets due to objectionable levels of N-Nitrosodiethylamine (NDEA). This was later followed by an expanded voluntary recall of losartan potassium produced by Hetero Labs (India) when they were found to be contaminated by N-Nitroso-N-methyl-4-aminobutyric acid (NMBA). Camber Pharmaceuticals called back 87 lots of losartan potassium tablets (25 mg, 50 mg and 100 mg), 114 lots of losartan potassium or losartan potassium/hydrochlorothiazide tablets, and one lot of losartan potassium/hydrochlorothiazide tablets. Continue reading
Statin vs Healthy Adherer Effect On Mortality in ASCVD Association of Statin Adherence With Mortality in Patients With Atherosclerotic Cardiovascular Disease
In a vigorous retrospective cohort study published in JAMA, Fatima Rodriguez et al. found an inverse graded association between long-term statin adherence and all-cause mortality using a nationwide sample of the Veterans Affairs Health System, in patients with atherosclerotic cardiovascular disease(ASCVD). The study proposed that there was room for improvement in statin adherence and also stressed on its importance as a measure of secondary prevention of ASCVD. Continue reading
Does Aggressive Control of Blood Pressure Decrease the Risk of Cognitive Impairment? Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia- A Randomized Clinical Trial
So far, there has been no definitive treatment for dementia. There are medications that provide symptomatic relief but there has been an advance towards developing disease-modifying medications. Due to the long preclinical period of most neurodegenerative diseases, prevention as a mode of treatment seems to be an important area of exploration. The relation between high blood pressure and cognitive impairment is one important aspect. In a recent randomized controlled trial called Systolic Blood Pressure Intervention Trial (SPRINT) Memory and Cognition in Decreased Hypertension (MIND) study published in JAMA NETWORK, researchers from the SPRINT group embarked to ascertain if intensive blood pressure control could decrease the risk of Alzheimer disease and related dementias. This was the first trial ever to demonstrate an effectual strategy for preventing of age-related cognitive impairment as it compared the effectiveness of intensive blood pressure control (targeting a systolic blood pressure of less than 120 mm Hg) to standard blood pressure control (targeting a systolic blood pressure of less than 140 mm Hg) towards the prevention of probable dementia. Continue reading
Prior Cerebrovascular Disease: A Key Factor In The Assessment for Optimal Left Main Coronary Artery Revascularization Strategy Results From the EXCEL Trial
A study conducted by Dr. Gregg W.Stone and his colleagues from Columbia University Medical Center demonstrated that patients with left main coronary artery disease (LMCAD) and prior cerebrovascular disease (CEVD) compared with those without CEVD have higher rates of stroke and reduced event-free survival after revascularization. In their publication in JACC: Cardiovascular Interventions, they stated that PCI need not be a priori preferred over CABG for LMCAD in patients with known CEVD. Patients with CEVD should undergo evaluation for both PCI and CABG, with careful consideration of comorbidities, the likelihood of safely achieving complete revascularization, and patient preferences in order to determine the optimal coronary revascularization strategy. Continue reading
Coronary Artery Calcium Scoring: A Screening Tool For Statin Prescription In the Primary Prevention of Cardiovascular Disease? Impact of Statins on Cardiovascular Outcomes Following Coronary Artery Calcium Scoring
According to a new study published in the Journal of American College of Cardiology, patients with higher coronary artery calcium (CAC) scores were more likely to achieve benefit from statins in the primary prevention of cardiovascular disease. Continue reading
