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Angina.com presents angina, angina pectoris and chest pain information and updates. Prominent heart disease research authors interviews are featured.

Angina.com presents angina, angina pectoris and chest pain information and updates. Prominent heart disease research authors interviews are featured.

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Angina com slideshare Presentation Transcript

  • 1. Angina.com A subsidiary of Eminent Domains Inc Contact information: Marie Benz [email_address] .com
  • 2.  
  • 3. FDA Drug Safety Communication: Multaq ( dronedarone ) and ncreased risk of death and serious cardiovascular adverse events
    • Safety Announcement
    • [07-21-2011] The U.S. Food and Drug Administration (FDA) is reviewing data from a clinical trial that was evaluating the effects of the antiarrhythmic drug Multaq (dronedarone) in patients with permanent atrial fibrillation. The study was stopped early after the data monitoring committee found a two-fold increase in death, as well as two-fold increases in stroke and hospitalization for heart failure in patients receiving Multaq compared to patients taking a placebo. Currently Multaq is approved for use in a different, but related patient population (see Facts about Multaq box). The approval of Multaq was based on another trial (ATHENA) in which use of Multaq was associated with a decreased number of deaths compared to placebo.1
    Read the rest of the interview on Angina.com
  • 4. FDA Drug Safety Communication: Multaq ( dronedarone ) and increased risk of death and serious cardiovascular adverse events
    • Safety Announcement
    • [07-21-2011] The U.S. Food and Drug Administration (FDA) is reviewing data from a clinical trial that was evaluating the effects of the antiarrhythmic drug Multaq (dronedarone) in patients with permanent atrial fibrillation. The study was stopped early after the data monitoring committee found a two-fold increase in death, as well as two-fold increases in stroke and hospitalization for heart failure in patients receiving Multaq compared to patients taking a placebo. Currently Multaq is approved for use in a different, but related patient population (see Facts about Multaq box). The approval of Multaq was based on another trial (ATHENA) in which use of Multaq was associated with a decreased number of deaths compared to placebo.1
    Read the rest of the interview on Angina.com
  • 5. Author Interview: Prateek K Gupta, MD Dept of SurgeryCreighton University Omaha, NE Development and Validation of a Risk Calculator for Prediction of Cardiac Risk After Surgery. Gupta PK, Gupta H, Sundaram A, Kaushik M, Fang X, Miller WJ, Esterbrooks DJ, Hunter CB, Pipinos II, Johanning JM, Lynch TG, Forse RA, Mohiuddin SM, Mooss AN.Department of Surgery. Circulation. 2011 Jul 5
    • What are the main findings of the study?
    • A) We found type of surgery, dependent functional status, abnormal creatinine, American Society of Anesthesiologists’ class, and age to be associated with perioperative myocardial infarction or cardiac arrest on multivariate analysis. The risk model was then used to develop an interactive risk calculator whose predictive performance surpasses that of the Revised Cardiac Risk Index.
    • Were any of the findings unexpected?
    • A) Surprisingly, a history of congestive heart failure was not significantly associated with postoperative myocardial infarction or cardiac arrest in the present study. It is likely that heart failure is not predictive of myocardial infarction or cardiac arrest independent of functional status or ASA class
    Read the rest of the interview on Angina.com
  • 6. Author Interview: Dr. AA Barvey Harmful Effects of NSAIDs among Patients with Hypertension and Coronary Artery Disease. Bavry AA, Khaliq A, Gong Y, Handberg EM, Cooper-Dehoff RM, Pepine CJ. Department of Medicine, College of Medicine, University of Florida, Gainesville. Am J Med. 2011 Jul;124(7):614-20.
    • What are the main findings of the study?
    • Among patients with hypertension and clinically stable coronary artery disease (mean age = 65 years), chronic self-reported use of NSAIDs over a mean follow-up of 2.7 years was harmful. This was due to an increase in cardiovascular mortality.
    • Were any of the findings unexpected?
    • Selective Cox-2 inhibitors have been firmly linked with harm and this study expand those findings to non-selective use of NSAIDs; however, the study did not have precise information on the type of NSAIDs that patients were taking.
    • What should clinicians and patients take away from this study?
    • Patients with hypertension and coronary artery disease who are regularly taking NSAIDs should talk to their doctor about the findings of this study. Some patients may need to consider alternative modes of pain relief.
    Read the rest of the interview on Angina.com
  • 7. Authors Interview: Drs. Blankstein & Nasir Predictors of Coronary Heart Disease Events Among Asymptomatic Persons With Low Low-Density Lipoprotein Cholesterol: MESA (Multi-Ethnic Study ofAtherosclerosis) Ron Blankstein, MD, Matthew J. Budoff, MD, Leslee J. Shaw, PhD, David C. Goff, Jr, MD, PhD, Joseph F. Polak, MD, MPH, Joao Lima, MD, Roger S. Blumenthal, MD and Khurram Nasir, MD, MPH J Am Coll Cardiol, 2011; 58:364-374, doi:10.1016/j.jacc.2011.01.055
    • What are the main findings of the study?
    • Reply: Although current treatment guidelines focus on lowering LDL cholesterol as the primary goal of therapy, it is known that even among individuals with low LDL cholesterol levels, some will still experience coronary heart disease events and may benefit from more aggressive pharmacologic and lifestyle therapies. Our study shows that among individuals with no known CAD and low LDL cholesterol, both traditional risk factors -- namely older age, male gender, hypertension, diabetes, and low HDL cholesterol -- and imaging biomarkers such coronary artery calcifications, and to a lesser extent carotid intima-media-thickness -- can be used to identify patients who have increased risk of future events.
    • An important finding in ours study is that even after accounting for all traditional clinical risk factors, the presence and severity of coronary artery calcifications (which is a direct marker of pre-clinical coronary atherosclerosis) can be used to substantially enhance risk assessment. For instance, even after accounting for clinical risk factors, the presence of even a mild amount of coronary artery calcifications imparted nearly a 3 fold increase in risk, a level of risk which was similar (or higher) to the risk associated with having any other clinical risk factor. Strikingly, in those individuals who had severe coronary artery calcifications (i.e. CAC score >400), the risk was increased approximately 9 folds. However, as importantly, the absence of CAC was associated with a very low event rate, even when multiple other risk factors were present.
    Read the rest of the interview on Angina.com
  • 8. Author Interview: Dr. David K. Murdock Comparison of Effectiveness and Safety of Ranolazine Versus Amiodarone for Preventing Atrial Fibrillation After Coronary Artery Bypass Grafting Ronald H. Miles, MD , Rod Passman, MD, MSCE, David K. Murdock, MD American Journal of Cardiology published online 04 July 2011.
    • What are the main findings of the study?
    • We found that the anti-anginal agent ranolazine was more effective than amiodarone in preventing atrial fibrillation after coronary artery bypass surgery
    • Were any of the findings unexpected?
    • We were hoping that ranolazine would be at least as effective as amiodarone at a much lower risk of adverse effects. We were pleasantly surprised it actually performed better than amiodarone in our hospital for the prevention of Post CABG atrial fibrillation
    Read the rest of the interview on Angina.com
  • 9. Author Interview: Rod Taylor, MSc, PhD Reduced dietary salt for the prevention of cardiovascular disease Taylor RS, Ashton KE, Moxham T, Hooper L, Ebrahim S. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD009217. DOI: 10.1002/14651858.CD009217
    • What are the implications of your results?
    • Our results do not mean that asking people to reduce their intake of salt is not a good thing – people should continue to strive to do this.
    • We believe our results suggest that individual-based (advice) strategies to reduce salt intake on their own are not as effective as we might hope and therefore we need to use population-based strategies such as the use of food labelling/traffic light systems on food packaging, continued policies of salt reduction in processed food, including bread, by industry, and reductions in salt in school, work canteens and restaurants.
    • Many of these population measures were advocated last year by NICE in its advice on prevention of cardiovascular disease. In parallel with implementing these multi-faceted measures, we also need more robust research to demonstrate that such measures are indeed effective in not only reducing salt, but that these changes are sustained and convert into improvements in long term health.
    • Our findings of a potential harmful effect of salt reduction in people in heart failure needs urgent follow up research in order to see if this finding is robust and whether current advice to reduce salt intake to these individuals should change.
    Read the rest of the interview on ANGINA.com
  • 10. Author Interview: Renato Delascio Lopes, MD, PhD, MHS Diagnosing Acute Myocardial Infarction in Patients With Left Bundle Branch Block. Lopes RD, Siha H, Fu Y, Mehta RH, Patel MR, Armstrong PW, Granger CB. Am J Cardiol. 2011 Jul 2. Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
    • What are the main findings of the study?
    • The main finding of our study was that a substantial proportion of patients with LBBB had acute MI with a culprit lesion and positive biomarkers.
    • Documented MI (elevated biomarkers) with an initially occluded infarct artery was more common in patients with LBBB with concordant ST-segment elevation (71.4%) than in patients without concordant ST-segment elevation (44.1%).
    • The use of ST-segment elevation concordance criteria in the presence of LBBB was more often associated with documented MI with an identifiable culprit vessel with an initially occluded infarct-related artery.
    • Importantly, these data support immediate catheterization with the intent for primary percutaneous coronary intervention for all patients presenting with suspected ST-segment elevation myocardial infarction, ischemic symptoms, and presumed new LBBB, particularly if concordant ST-segment elevation is present.
    Read the rest of the interview on ANGINA.com
  • 11. Author Interview: Jill Baumgartner Indoor Air Pollution and Blood Pressure in Adult Women Living in Rural China Jill Baumgartner, James J. Schauer, Majid Ezzati, Lin Lu, Chun Cheng, Jonathan A. Patz, Leonelo E. Bautista ENVIRONMENTAL HEALTH PERSPECTIVES http://dx.doi.org/10.1289/ehp.1003371
    • What are the main findings of the study?
    • Our study shows that personal exposure to indoor air pollution is linked to higher systolic and diastolic blood pressure in adult women, with the strongest effects in older women over 50 years old.
    • Were any of the findings unexpected?
    • There is growing evidence that outdoor air pollution increases cardiovascular risk.
    • However, we know very little about the cardiovascular effects of pollution exposure at the high levels experienced while cooking indoors with biomass.
    • Our study is the first to link personal exposure to indoor air pollution to increases inblood pressure.
    Read the rest of the interview on ANGINA.com
  • 12. Author Interview: Dr. Laura Hyttinen Effect of Cholesterol on Mortality and Quality of Life up to a 46-Year Follow-Up. Hyttinen L, Strandberg TE, Strandberg AY, Salomaa VV, Pitkälä KH, Tilvis RS, Miettinen TA. Department of Internal Medicine, North Karelia Central Hospital, Joensuu, Finland. Am J Cardiol. 2011 Jun 27
    • What are the main findings of the study?
    • Our main finding was that the total cholesterol value measured in midlife predicted survival after decades of life: survival was best with the lowest value (< 154 mg/dL) in midlife and there was a steady, graded relation between the total cholesterol value and mortality. The lowest value was also associated with the best result in old age in the physical functioning scale of RAND-36, which is a measure of the health-related quality of life (HRQoL).
    • Low cholesterol value in old age has been associated with higher mortality. However, cholesterol level is known to decrease in old age and low level is also associated with various chronic diseases and frailty; thus cholesterol level in old age does not necessarily represent lifetime exposure. Our results emphasizes that low level in midlife is associated with better and longer life in old age.
    • Cholesterol values in young age and midlife have remarkable effects on old age. In a lifetime perspective, a person can have an impact on future by means of lifestyle modification and if needed, with medication.
    • While taking care of middle-aged people cardiology health care providers should bear in mind the lifetime perspective and monitor and treat the cholesterol value accordingly.
    Read the rest of the interview on ANGINA.com
  • 13. Author Interview: Dr. John Nance Coronary Atherosclerosis in African American and White Patients with Acute Chest Pain: Characterization with Coronary CT Angiography. Nance JW Jr, Bamberg F, Schoepf UJ, Kang DK, Barraza JM Jr, Abro JA, Bastarrika G, Headden GF, Costello P, Thilo C. Radiology. 2011 Jun 28.
    • What are the main findings of the study?
    • We used coronary CT angiography to compare the extent and type of atherosclerotic plaque between African-American and white patients with acute chest pain.
    • We found that while the overall plaque burden between the patient groups was similar, there were significant differences in the relative types of plaque, with African-Americans displaying relatively more non-calcified plaque and whites displaying more calcified plaque.
    • Were any of the findings unexpected?
    • The relative amounts of mixed plaque were similar. While our day-to-day practice suggested that we would find more non-calcified plaque in African-Americans, we were surprised by the extent of the differences.
    Read the rest of the interview on ANGINA.com
  • 14. Author Interview: Dr. Peter Bogaty Routine Invasive Management After Fibrinolysis in Patients With ST-Elevation Myocardial Infarction: A Systematic Review of Randomized Clinical Trials. Bogaty P, Filion KB, Brophy JM. BMC Cardiovasc Disord. 2011 Jun 20;11(1):34
    • What are the main findings of the study?
    • The evidence in support of a systematic invasive approach following fibrinolytic therapy for patients with ST-elevation myocardial infarction (STEMI) is neither strong nor persuasive.
    • Were any of the findings unexpected?
    • Not to the authors who have long been skeptical of the prevailing mindset that believes that all patients should undergo invasive management following fibrinolysis for STEMI. The limitations and biases of randomized clinical trials purporting to examine this question are fairly evident although underappreciated
    Read the rest of the interview on ANGINA.com
  • 15. Authors' Interview: Drs. Cheol Whan Lee and Seung-Jung Park Comparison of Differential Expression of P2Y(12) Receptor in Culprit Coronary Plaques in Patients With Acute Myocardial Infarction Versus Stable Angina Pectoris. Lee CW, Hwang I, Park CS, Lee H, Park DW, Kang SJ, Lee SW, Kim YH, Park SW, Park SJ. Department of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea. Am J Cardiol. 2011 Jul 2.
    • What are the main findings of the study?
    • P2Y12 receptor is present in human coronary atherosclerotic plaques, and its level of expression is higher in plaques from patients with acute myocardial infarction than those with stable angina.
    • What should clinicians and patients take away from this study?
    • P2Y12 receptor may play a role in plaque destabilization.
    • What recommendations do you have for nephrology health care providers as a result of your study?
    • P2Y12 receptor inhibitors may have a dual anti-ischemic effect by inhibiting both platelet activation and plaque destabilization.
    Read the rest of the interview on ANGINA.com
  • 16. Author Interview : Dr. Igor Mrdovic Predicting 30-day major adverse cardiovascular events after primary percutaneous coronary intervention. The RISK-PCI score Mrdovic I, Savic L, Krljanac G, Asanin M, Perunicic J, Lasica R, Marinkovic J, Kocev N, Vasiljevic Z, Ostojic M; International Journal of Cardiology (Jun 2011)
    • What are the main findings of the study?
    • This report presents a novel risk score for the prediction of composite ischemic end point during a 30-day follow-up after pPCI. Our score comprises basal clinical, laboratory and angiographic predictors of 30-day major adverse cardiovascular events (MACE), with a graded 125-fold increase in the 30-day MACE with increasing risk score from ≤1 to ≥15. The model showed good discrimination and calibration for the prediction of 30-day MACE and 30-day death. Patients were classified into risk classes (low, intermediate, high and very high-risk). An 18-fold graded increase in the primary end point was observed between patients in a low risk class and those in a very high risk class.
    • Were any of the findings unexpected?
    • The model integrates some predictors of patients’ long-term outcome of documented prognostic importance: acute bundle branch block at presentation, post-procedural TIMI flow,, anterior infarction, renal dysfunction, and age. Our score also introduces some variables which were not used until now in pPCI risk scores: prior myocardial infarction, glucose intolerance, TIMI grade flow before mechanical reperfusion, atrioventricular block at presentation, leukocytosis on admission and small vessel size.
    • On the other hand, certain variables like heart failure at admission, diabetes, heart rate or systolic blood pressure, which appeared in previous scores, were not independently associated with 30-day composite end point in our trial.
    Read the rest of the interview on ANGINA.com
  • 17. Dr. Seamus Harrison Association of a sequence variant in DAB2IP with coronary heart disease Harrison SC, Cooper JA, Li K, Talmud PJ, Sofat R, Stephens JW, Hamsten A; on behalf of the HIFMECH Consortium, Sanders J, Montgomery H, Neil A; on behalf of the Simon Broome Research Consortium, Humphries SE. 11 Collaborators Eur Heart J. 2011 Mar 28.
    • What are the main findings of the study?
    • We provided robust replication of the association of a common sequence variant in a gene called DAB2IP with coronary heart disease, in both prospective and cross-sectional case-control studies. We also found that addition of a gene-score, including this variant and the previously well replicated 9p21 CHD locus, to the Framingham Risk Algorithm, improved prediction of CHD events in the prospective Northwick Park Heart Study II.
    • Were any of the findings unexpected?
    • The improvement in the c-statistic was modest (0.61 to 0.64, p=0.03). However, when we looked at the more clinically relevant net-reclassification index and considered current UK guidelines for preventative treatments, the number of men who went on to develop CHD and would have been eligible for treatment using the combination of gene score and classical risk factors increased considerably.
    Read the rest of the interview on ANGINA.com