This document reports on Dr. Montalescot's research grants and consulting/lecture fees from various pharmaceutical companies. It discloses potential conflicts of interest from his relationships with ADIR, Amgen, AstraZeneca, Bayer, Berlin Chimie AG, Boehringer Ingelheim, Bristol-Myers Squibb, and several other companies.
Strategy to Go for Goal in Dyslipidemia with Acute Coronary Syndrome PatientsPERKI Pekanbaru
Dr. A. Fauzi Yahya, SpJP (K), FIHA, FAsCC. 3rd Pekanbaru Cardiology Update, August 24th 2013. Pangeran Hotel Pekanbaru. Learn more at PerkiPekanbaru.com
Management strategy in HF with ARNI - Recent updates Praveen Nagula
- The document discusses management strategies for heart failure with reduced ejection fraction (HFrEF), including recent updates.
- It summarizes key differences between Indian and Western HF patients, noting that Indians develop HF at a younger age and with lower ejection fractions. Prognosis is also worse for Indian patients compared to those in the West.
- Core therapies for HFrEF are discussed, including a paradigm shift with the approval of sacubitril-valsartan which has been shown to reduce cardiovascular death compared to ACE inhibitors or ARBs alone in clinical trials.
Coversyl Plus and Coversyl Plus HD is Potent ACE Inhibitor of class drugs with Cardiovascular and stroke Protection with significant Mortality & Morbidity reduction in wide class of Patients with Newly Diagnosed Hypertension Patients,CAD Patients,Patients with H/O stroke/TIA ,hypertensive Diabetic Patients and CKD Patients
The document summarizes several landmark clinical trials from 2015 related to cardiovascular diseases. It discusses the SPRINT trial which compared intensive vs standard blood pressure control and found lower rates of cardiovascular events with intensive control below 120 mm Hg. It also summarizes the IMPROVE-IT trial which found adding ezetimibe to statin therapy after acute coronary syndrome further lowered cardiovascular risks. The MATRIX program evaluated bivalirudin vs heparin in PCI and found no significant difference in outcomes. The AMBITION trial found initial combination therapy with ambrisentan and tadalafil lowered risks compared to monotherapy in pulmonary arterial hypertension.
http://www.theheart.org/web_slides/1225049.do
A randomized double-blind, double-dummy trial on MAGELLAN (VTE Prophylaxis in Medically Ill Patients) to show noninferiority of rivaroxaban to enoxaparin at 10 days and superiority at 35 days
Interventional and Surgical Treatment of Valve Disease in Heart Failure PatientsDuke Heart
1) Transcatheter edge-to-edge repair (MitraClip) is recommended for treating severe secondary mitral regurgitation in heart failure patients with an ejection fraction of 20-50% and LVESD ≤70 mm who show reduced MR after the procedure.
2) TAVR improves left ventricular function and symptoms in patients with low-flow severe aortic stenosis but is still associated with high 1-year mortality of 20%.
3) The effect of isolated tricuspid valve intervention on outcomes in heart failure patients with reduced ejection fraction is currently undefined.
This document reports on Dr. Montalescot's research grants and consulting/lecture fees from various pharmaceutical companies. It discloses potential conflicts of interest from his relationships with ADIR, Amgen, AstraZeneca, Bayer, Berlin Chimie AG, Boehringer Ingelheim, Bristol-Myers Squibb, and several other companies.
Strategy to Go for Goal in Dyslipidemia with Acute Coronary Syndrome PatientsPERKI Pekanbaru
Dr. A. Fauzi Yahya, SpJP (K), FIHA, FAsCC. 3rd Pekanbaru Cardiology Update, August 24th 2013. Pangeran Hotel Pekanbaru. Learn more at PerkiPekanbaru.com
Management strategy in HF with ARNI - Recent updates Praveen Nagula
- The document discusses management strategies for heart failure with reduced ejection fraction (HFrEF), including recent updates.
- It summarizes key differences between Indian and Western HF patients, noting that Indians develop HF at a younger age and with lower ejection fractions. Prognosis is also worse for Indian patients compared to those in the West.
- Core therapies for HFrEF are discussed, including a paradigm shift with the approval of sacubitril-valsartan which has been shown to reduce cardiovascular death compared to ACE inhibitors or ARBs alone in clinical trials.
Coversyl Plus and Coversyl Plus HD is Potent ACE Inhibitor of class drugs with Cardiovascular and stroke Protection with significant Mortality & Morbidity reduction in wide class of Patients with Newly Diagnosed Hypertension Patients,CAD Patients,Patients with H/O stroke/TIA ,hypertensive Diabetic Patients and CKD Patients
The document summarizes several landmark clinical trials from 2015 related to cardiovascular diseases. It discusses the SPRINT trial which compared intensive vs standard blood pressure control and found lower rates of cardiovascular events with intensive control below 120 mm Hg. It also summarizes the IMPROVE-IT trial which found adding ezetimibe to statin therapy after acute coronary syndrome further lowered cardiovascular risks. The MATRIX program evaluated bivalirudin vs heparin in PCI and found no significant difference in outcomes. The AMBITION trial found initial combination therapy with ambrisentan and tadalafil lowered risks compared to monotherapy in pulmonary arterial hypertension.
http://www.theheart.org/web_slides/1225049.do
A randomized double-blind, double-dummy trial on MAGELLAN (VTE Prophylaxis in Medically Ill Patients) to show noninferiority of rivaroxaban to enoxaparin at 10 days and superiority at 35 days
Interventional and Surgical Treatment of Valve Disease in Heart Failure PatientsDuke Heart
1) Transcatheter edge-to-edge repair (MitraClip) is recommended for treating severe secondary mitral regurgitation in heart failure patients with an ejection fraction of 20-50% and LVESD ≤70 mm who show reduced MR after the procedure.
2) TAVR improves left ventricular function and symptoms in patients with low-flow severe aortic stenosis but is still associated with high 1-year mortality of 20%.
3) The effect of isolated tricuspid valve intervention on outcomes in heart failure patients with reduced ejection fraction is currently undefined.
The document summarizes the results of a clinical trial studying the effects of blood pressure lowering treatment on secondary stroke prevention. The trial involved over 6,000 patients with a history of cerebrovascular disease across 10 countries. It found that treatment with perindopril (an ACE inhibitor) plus indapamide lowered blood pressure more than single drug therapy or placebo and reduced the risk of fatal or non-fatal stroke by 28%. Combination therapy also reduced major vascular events by 26% and was well-tolerated with few side effects. The results indicate that blood pressure lowering provides significant benefits for secondary stroke prevention, regardless of baseline blood pressure or medical history.
The JUPITER trial was a randomized, double-blind, placebo-controlled trial that investigated whether rosuvastatin 20 mg could decrease major cardiovascular events in apparently healthy people with elevated levels of C-reactive protein (hsCRP > 2 mg/L) but normal cholesterol levels (LDL < 130 mg/dL). The trial enrolled 17,802 participants across 26 countries who were randomized to rosuvastatin 20 mg or placebo. Rosuvastatin significantly reduced the primary endpoint of myocardial infarction, stroke, hospitalization for unstable angina, arterial revascularization procedures, or cardiovascular death by 44% compared to placebo. Rosuvastatin also significantly lowered levels of LDL cholesterol, hsCRP, and triglycerides
This document discusses and compares the properties, clinical trials, and safety profiles of the direct oral anticoagulants dabigatran, rivaroxaban, and apixaban. It summarizes the results of major clinical trials demonstrating the non-inferiority of these drugs compared to warfarin for treating and preventing venous thromboembolism. It also notes that monitoring of renal function is important when using these drugs due to renal clearance and dose adjustments.
Newer Approach in management of Angina & CHF: Heart rate modulation and beyond..Arindam Pande
1) A study evaluated the addition of ivabradine to metoprolol in patients with stable angina pectoris and found that it significantly reduced mean resting heart rate, weekly angina attacks, and use of short-acting nitrates over 4 months compared to baseline.
2) The mean heart rate fell by 19.7 bpm, weekly angina attacks decreased 8-fold, and quality of life scores increased with the combination therapy.
3) Heart rate reductions and clinical benefits were greater in patients who had higher baseline heart rates of 70 bpm or more.
Rivaroxaban has shown benefits beyond antiplatelet therapy alone in reducing cardiovascular events. The COMPASS trial found that in patients with chronic coronary artery disease or peripheral artery disease, rivaroxaban plus aspirin reduced the composite of cardiovascular death, stroke, and myocardial infarction by 24% compared to aspirin alone. It also reduced mortality by 18% and ischemic stroke by 42%. Patients with multiple risk factors such as diabetes, chronic kidney disease, or heart failure derived the greatest benefits. However, use of anticoagulants remains lower than guidelines recommend due to overestimation of bleeding risks and underestimation of thrombotic risk.
Antiplatelet agents in acute coronary syndromesalahabusin
This document summarizes antiplatelet agents used in acute coronary syndrome. It discusses 3 oral P2Y12 inhibitors approved by the FDA - Clopidogrel, Prasugrel, and Ticagrelor. Clopidogrel was shown to reduce cardiovascular events in CURE trial but has slow onset and offset. Prasugrel provided greater platelet inhibition than Clopidogrel in TRITON trial but increased bleeding. Ticagrelor had faster, greater platelet inhibition than Clopidogrel and reduced mortality compared to Clopidogrel in PLATO trial. The document also discusses the IV P2Y12 inhibitor Cangrelor, which has very rapid onset and offset, and was shown to reduce periproced
This document discusses hypoperfusion in acute heart failure. It begins with case examples from Duke Hospital and considerations for diagnosis. It then covers inotropic options and mechanical support devices. Various studies on inotropes, percutaneous support devices, and extracorporeal membrane oxygenation are summarized. The conclusion is that hypoperfusion in acute heart failure presents major challenges for diagnosis and treatment.
Ticagrelor is a reversible P2Y12 inhibitor that was developed to overcome limitations of clopidogrel such as variable metabolism and slow onset of action. The PLATO trial found ticagrelor to be superior to clopidogrel in reducing cardiovascular events in ACS patients with no increase in major bleeding. The PEGASUS trial found ticagrelor reduced cardiovascular events in stable patients with prior MI compared to placebo on aspirin. However, the EUCLID trial found ticagrelor was no better than clopidogrel in reducing events in PAD patients and increased dyspnea. The TREAT trial is investigating ticagrelor vs clopidogrel after fibrinolytic therapy in STE
- Early initiation of high-intensity statin therapy in acute coronary syndrome patients significantly reduces mortality and morbidity rates compared to later initiation or lower-intensity statins. Clinical trials found a 16-36% reduction in major coronary events with early high-dose statin use.
- Guidelines recommend high-intensity statins like atorvastatin 80mg or simvastatin 80mg for acute coronary syndrome patients, though risks like side effects must be considered. Long-term statin therapy is also generally advised after acute coronary syndrome.
This document discusses several clinical studies that compare the effects of different statin drugs on cardiovascular outcomes and the progression of atherosclerosis. The STELLAR study showed that rosuvastatin more effectively lowered LDL-C and raised HDL-C than other statins. Two real-world studies found that rosuvastatin use was associated with a 28-40% lower risk of cardiovascular events compared to other statins. The METEOR study found that rosuvastatin slowed the progression of atherosclerosis whereas the ENHANCE study found that ezetimibe added to simvastatin provided no benefit.
LCZ696 was more effective than enalapril in reducing the risks of CV death and HF hospitalization, CV death, HF hospitalization, and all-cause mortality in patients with heart failure with reduced ejection fraction. LCZ696 also provided incremental improvements in symptoms and physical limitations. LCZ696 was better tolerated than enalapril with lower rates of symptomatic hypotension, hyperkalemia, renal impairment, and cough.
The PARADIGM-HF trial compared the angiotensin receptor-neprilysin inhibitor sacubitril/valsartan to the ACE inhibitor enalapril in patients with heart failure with reduced ejection fraction. It found that sacubitril/valsartan reduced cardiovascular mortality and heart failure hospitalizations compared to enalapril, as well as reducing overall mortality. The trial established sacubitril/valsartan as a new standard of care for treating HFrEF.
http://www.theheart.org/web_slides/1135309.do
A study on Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients (ADVANCE)
4 dan atar - anticoagulation af pci - what do trials saywebevo5
Professor Dan Atar presented on anticoagulation for atrial fibrillation and percutaneous coronary intervention based on recent trial results. The WOEST trial found that dual therapy with a vitamin K antagonist (VKA) and clopidogrel reduced bleeding compared to triple therapy with a VKA, aspirin, and clopidogrel, with a potential mortality benefit. The PIONEER AF-PCI trials found that rivaroxaban dual or triple therapy was associated with significantly less bleeding than VKA triple therapy, with comparable efficacy. The RE-LY-DUAL PCI study found dabigatran dual therapy significantly reduced bleeding compared to warfarin triple therapy. Guidelines recommend balancing the risks of bleeding from
Choosing antiplatelet therapy before during and after hosp for acscardiositeindia
- The document discusses guidelines for antiplatelet therapy before, during, and after hospitalization for acute coronary syndrome (ACS).
- It recommends aspirin for all patients without contraindications, and ticagrelor over clopidogrel or prasugrel due to its greater effectiveness in reducing ischemic events, stent thrombosis, and death for up to one year.
- For patients undergoing percutaneous coronary intervention (PCI), pretreatment with a P2Y12 inhibitor such as clopidogrel is recommended to reduce complications, with higher loading doses for those who have not received previous treatment.
The SPARCL trial investigated whether high-dose atorvastatin (80 mg daily) could reduce the risk of fatal or non-fatal stroke in patients who had a stroke or transient ischemic attack 1-6 months prior and no history of coronary heart disease. The double-blind randomized controlled trial assigned 4731 eligible patients to atorvastatin or placebo groups. After a median follow-up of 4.9 years, treatment with atorvastatin reduced the risk of fatal or non-fatal stroke by 2% compared to placebo, with a number needed to treat of 53. Atorvastatin also reduced the risk of major cardiovascular events by 18% compared to placebo.
This document discusses pharmacological management options for heart failure with reduced ejection fraction (HFrEF). The goals of treatment are to reduce symptoms, prolong survival, improve quality of life, and prevent disease progression. Key drug therapies recommended for prognosis include ACE inhibitors, ARBs, beta blockers, and mineralocorticoid receptor antagonists. Diuretics and digoxin are recommended to treat symptoms. Ivabradine may also be used for symptom control. Clinical trials have demonstrated the benefits of these drug classes in reducing mortality and hospitalizations.
The past, present and future of lipid managementGreg Searles
This document summarizes a presentation on lipid management given by Dr. Greg Searles. The presentation covered current lipid guidelines, LDL and other lipid profiles, dietary and pharmacological lipid-lowering therapies including statins, cholesterol absorption inhibitors, and PCSK9 inhibitors. It discussed landmark statin trials that demonstrated reductions in cardiovascular outcomes and the additional benefit seen when adding ezetimibe to statin therapy as shown in the IMPROVE-IT trial. The presentation aimed to provide an overview of the past, present, and future of lipid management.
past presnt and futer of dyslidema ttt.pdfAdelSALLAM4
Dr. Greg Searles presented on the past, present, and future of lipid management. He discussed current lipid management guidelines, which recommend statin treatment and LDL-C targets based on risk level. For high-risk patients, the guidelines recommend an LDL-C target of <2.0 mmol/L or >50% reduction from baseline. Dr. Searles reviewed evidence from landmark statin trials demonstrating their efficacy in reducing cardiovascular events. He also discussed current combination therapy options for further LDL-C lowering when targets are not met with statins alone, focusing on the modest additional benefit shown for ezetimibe in the IMPROVE-IT trial.
The document summarizes the results of a clinical trial studying the effects of blood pressure lowering treatment on secondary stroke prevention. The trial involved over 6,000 patients with a history of cerebrovascular disease across 10 countries. It found that treatment with perindopril (an ACE inhibitor) plus indapamide lowered blood pressure more than single drug therapy or placebo and reduced the risk of fatal or non-fatal stroke by 28%. Combination therapy also reduced major vascular events by 26% and was well-tolerated with few side effects. The results indicate that blood pressure lowering provides significant benefits for secondary stroke prevention, regardless of baseline blood pressure or medical history.
The JUPITER trial was a randomized, double-blind, placebo-controlled trial that investigated whether rosuvastatin 20 mg could decrease major cardiovascular events in apparently healthy people with elevated levels of C-reactive protein (hsCRP > 2 mg/L) but normal cholesterol levels (LDL < 130 mg/dL). The trial enrolled 17,802 participants across 26 countries who were randomized to rosuvastatin 20 mg or placebo. Rosuvastatin significantly reduced the primary endpoint of myocardial infarction, stroke, hospitalization for unstable angina, arterial revascularization procedures, or cardiovascular death by 44% compared to placebo. Rosuvastatin also significantly lowered levels of LDL cholesterol, hsCRP, and triglycerides
This document discusses and compares the properties, clinical trials, and safety profiles of the direct oral anticoagulants dabigatran, rivaroxaban, and apixaban. It summarizes the results of major clinical trials demonstrating the non-inferiority of these drugs compared to warfarin for treating and preventing venous thromboembolism. It also notes that monitoring of renal function is important when using these drugs due to renal clearance and dose adjustments.
Newer Approach in management of Angina & CHF: Heart rate modulation and beyond..Arindam Pande
1) A study evaluated the addition of ivabradine to metoprolol in patients with stable angina pectoris and found that it significantly reduced mean resting heart rate, weekly angina attacks, and use of short-acting nitrates over 4 months compared to baseline.
2) The mean heart rate fell by 19.7 bpm, weekly angina attacks decreased 8-fold, and quality of life scores increased with the combination therapy.
3) Heart rate reductions and clinical benefits were greater in patients who had higher baseline heart rates of 70 bpm or more.
Rivaroxaban has shown benefits beyond antiplatelet therapy alone in reducing cardiovascular events. The COMPASS trial found that in patients with chronic coronary artery disease or peripheral artery disease, rivaroxaban plus aspirin reduced the composite of cardiovascular death, stroke, and myocardial infarction by 24% compared to aspirin alone. It also reduced mortality by 18% and ischemic stroke by 42%. Patients with multiple risk factors such as diabetes, chronic kidney disease, or heart failure derived the greatest benefits. However, use of anticoagulants remains lower than guidelines recommend due to overestimation of bleeding risks and underestimation of thrombotic risk.
Antiplatelet agents in acute coronary syndromesalahabusin
This document summarizes antiplatelet agents used in acute coronary syndrome. It discusses 3 oral P2Y12 inhibitors approved by the FDA - Clopidogrel, Prasugrel, and Ticagrelor. Clopidogrel was shown to reduce cardiovascular events in CURE trial but has slow onset and offset. Prasugrel provided greater platelet inhibition than Clopidogrel in TRITON trial but increased bleeding. Ticagrelor had faster, greater platelet inhibition than Clopidogrel and reduced mortality compared to Clopidogrel in PLATO trial. The document also discusses the IV P2Y12 inhibitor Cangrelor, which has very rapid onset and offset, and was shown to reduce periproced
This document discusses hypoperfusion in acute heart failure. It begins with case examples from Duke Hospital and considerations for diagnosis. It then covers inotropic options and mechanical support devices. Various studies on inotropes, percutaneous support devices, and extracorporeal membrane oxygenation are summarized. The conclusion is that hypoperfusion in acute heart failure presents major challenges for diagnosis and treatment.
Ticagrelor is a reversible P2Y12 inhibitor that was developed to overcome limitations of clopidogrel such as variable metabolism and slow onset of action. The PLATO trial found ticagrelor to be superior to clopidogrel in reducing cardiovascular events in ACS patients with no increase in major bleeding. The PEGASUS trial found ticagrelor reduced cardiovascular events in stable patients with prior MI compared to placebo on aspirin. However, the EUCLID trial found ticagrelor was no better than clopidogrel in reducing events in PAD patients and increased dyspnea. The TREAT trial is investigating ticagrelor vs clopidogrel after fibrinolytic therapy in STE
- Early initiation of high-intensity statin therapy in acute coronary syndrome patients significantly reduces mortality and morbidity rates compared to later initiation or lower-intensity statins. Clinical trials found a 16-36% reduction in major coronary events with early high-dose statin use.
- Guidelines recommend high-intensity statins like atorvastatin 80mg or simvastatin 80mg for acute coronary syndrome patients, though risks like side effects must be considered. Long-term statin therapy is also generally advised after acute coronary syndrome.
This document discusses several clinical studies that compare the effects of different statin drugs on cardiovascular outcomes and the progression of atherosclerosis. The STELLAR study showed that rosuvastatin more effectively lowered LDL-C and raised HDL-C than other statins. Two real-world studies found that rosuvastatin use was associated with a 28-40% lower risk of cardiovascular events compared to other statins. The METEOR study found that rosuvastatin slowed the progression of atherosclerosis whereas the ENHANCE study found that ezetimibe added to simvastatin provided no benefit.
LCZ696 was more effective than enalapril in reducing the risks of CV death and HF hospitalization, CV death, HF hospitalization, and all-cause mortality in patients with heart failure with reduced ejection fraction. LCZ696 also provided incremental improvements in symptoms and physical limitations. LCZ696 was better tolerated than enalapril with lower rates of symptomatic hypotension, hyperkalemia, renal impairment, and cough.
The PARADIGM-HF trial compared the angiotensin receptor-neprilysin inhibitor sacubitril/valsartan to the ACE inhibitor enalapril in patients with heart failure with reduced ejection fraction. It found that sacubitril/valsartan reduced cardiovascular mortality and heart failure hospitalizations compared to enalapril, as well as reducing overall mortality. The trial established sacubitril/valsartan as a new standard of care for treating HFrEF.
http://www.theheart.org/web_slides/1135309.do
A study on Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients (ADVANCE)
4 dan atar - anticoagulation af pci - what do trials saywebevo5
Professor Dan Atar presented on anticoagulation for atrial fibrillation and percutaneous coronary intervention based on recent trial results. The WOEST trial found that dual therapy with a vitamin K antagonist (VKA) and clopidogrel reduced bleeding compared to triple therapy with a VKA, aspirin, and clopidogrel, with a potential mortality benefit. The PIONEER AF-PCI trials found that rivaroxaban dual or triple therapy was associated with significantly less bleeding than VKA triple therapy, with comparable efficacy. The RE-LY-DUAL PCI study found dabigatran dual therapy significantly reduced bleeding compared to warfarin triple therapy. Guidelines recommend balancing the risks of bleeding from
Choosing antiplatelet therapy before during and after hosp for acscardiositeindia
- The document discusses guidelines for antiplatelet therapy before, during, and after hospitalization for acute coronary syndrome (ACS).
- It recommends aspirin for all patients without contraindications, and ticagrelor over clopidogrel or prasugrel due to its greater effectiveness in reducing ischemic events, stent thrombosis, and death for up to one year.
- For patients undergoing percutaneous coronary intervention (PCI), pretreatment with a P2Y12 inhibitor such as clopidogrel is recommended to reduce complications, with higher loading doses for those who have not received previous treatment.
The SPARCL trial investigated whether high-dose atorvastatin (80 mg daily) could reduce the risk of fatal or non-fatal stroke in patients who had a stroke or transient ischemic attack 1-6 months prior and no history of coronary heart disease. The double-blind randomized controlled trial assigned 4731 eligible patients to atorvastatin or placebo groups. After a median follow-up of 4.9 years, treatment with atorvastatin reduced the risk of fatal or non-fatal stroke by 2% compared to placebo, with a number needed to treat of 53. Atorvastatin also reduced the risk of major cardiovascular events by 18% compared to placebo.
This document discusses pharmacological management options for heart failure with reduced ejection fraction (HFrEF). The goals of treatment are to reduce symptoms, prolong survival, improve quality of life, and prevent disease progression. Key drug therapies recommended for prognosis include ACE inhibitors, ARBs, beta blockers, and mineralocorticoid receptor antagonists. Diuretics and digoxin are recommended to treat symptoms. Ivabradine may also be used for symptom control. Clinical trials have demonstrated the benefits of these drug classes in reducing mortality and hospitalizations.
The past, present and future of lipid managementGreg Searles
This document summarizes a presentation on lipid management given by Dr. Greg Searles. The presentation covered current lipid guidelines, LDL and other lipid profiles, dietary and pharmacological lipid-lowering therapies including statins, cholesterol absorption inhibitors, and PCSK9 inhibitors. It discussed landmark statin trials that demonstrated reductions in cardiovascular outcomes and the additional benefit seen when adding ezetimibe to statin therapy as shown in the IMPROVE-IT trial. The presentation aimed to provide an overview of the past, present, and future of lipid management.
past presnt and futer of dyslidema ttt.pdfAdelSALLAM4
Dr. Greg Searles presented on the past, present, and future of lipid management. He discussed current lipid management guidelines, which recommend statin treatment and LDL-C targets based on risk level. For high-risk patients, the guidelines recommend an LDL-C target of <2.0 mmol/L or >50% reduction from baseline. Dr. Searles reviewed evidence from landmark statin trials demonstrating their efficacy in reducing cardiovascular events. He also discussed current combination therapy options for further LDL-C lowering when targets are not met with statins alone, focusing on the modest additional benefit shown for ezetimibe in the IMPROVE-IT trial.
This document provides biographical information about Dr. Wei-Chun Huang, including his academic and professional qualifications. It lists his positions, including serving as the director of the Department of Critical Care Medicine at Kaohsiung Veterans General Hospital, as well as his affiliations with professional organizations in Taiwan and internationally. The document also thanks the ICU departments from 14 hospitals across Taiwan for their participation in a conference.
Angina crónica estable: La punta del iceberg de la cardiopatía isquémica crónica
Congreso de las enfermedades cardiovasculares
Barcelona 22/10/2009
Sociedad Española de Cardiología
Novedades en el manejo del paciente con FA: actualización tras AHA 2016
22/11/2016 19:30h Casa del Corazón, Madrid
http://manejofa.secardiologia.es
#manejoFA
Pacientes con FA que sufren un SCA y son sometidos a intervención coronaria percutánea. Guías y preguntas abiertas
Dr. Antonio Fernández Ortiz, Hospital Universitario Clínico San Carlos (Madrid)
Achieving Blood Pressure Goal: From Clinical Trial into Real-World DataSuharti Wairagya
Hypertension remains a major global health issue, with over 7 million deaths annually associated with it. Less than 50% of hypertensive patients receive therapy, and approximately 70% of treated patients do not reach blood pressure goals. Most guidelines recommend initiating treatment with two drugs when blood pressure is more than 20/10 mmHg above goal or for those at high cardiovascular risk. Clinical trials have shown that the amlodipine/valsartan combination effectively lowers blood pressure and helps more patients achieve goals compared to monotherapy. Real-world Indonesian studies found that amlodipine/valsartan combination therapy was effective at controlling blood pressure in the majority of uncontrolled hypertensive patients switched from monotherapy.
Newer Oral Anticoagulants In Atrial Fibrillation - Dr Vivek BaligaDr Vivek Baliga
In this presentation, Dr Vivek Baliga, Baliga Diagnostics Bangalore, discusses the role of new oral anticoagulants in the management of non-valvular atrial fibrillation.
Dyslipidemia management an evidence based approachDr Vivek Baliga
In this presentation by Dr Vivek Baliga, he discusses the different available statins and how you can choose the right one in different clinical situations. See articles from Dr Baliga on http://drvivekbaliga.net
This document summarizes the key points from a lipidology conference presentation. It discusses recent guidelines and studies on cholesterol treatment, including more aggressive LDL lowering to under 70mg/dl for patients with cardiovascular disease. New tools for general cardiovascular risk prediction were presented. Treatment with high-dose statins was found to significantly reduce stroke recurrence and other outcomes for patients who had a stroke or TIA within the past 1-6 months. Immediate withdrawal of statins after acute stroke was associated with increased risks.
Ponencia presentada por la Dra. Lina Badimon Maestro en el directo online ‘Estudio ODYSSEY OUTCOMES: los expertos opinan’, realizado el 20 de noviembre de 2018 en la Casa del Corazón
Prevention of recurrent stroke in atrial fibrillation Jacek StaszewskiJacek Staszewski
Prevention of recurrent stroke in atrial fibrillation. Comaprison of NOAC vs VKA. Riks of hemorrhagic stroke. When anticoagulation should be initiated following acute stroke.
1) Risk scores help identify patients with NSTE-ACS who are at higher risk of death and recurrent cardiac events in both the short and long term.
2) Studies have found reductions in mortality rates for NSTE-ACS patients in recent years, which is due in part to improvements in pharmacological and invasive coronary strategies.
3) The GRACE risk score is the most widely used and has been shown to accurately predict mortality in NSTE-ACS patients at both 30 days and 1 year. It helps guide clinical decision making regarding treatment strategies.
Is early use of combination therapy the solution 35 minute slide setSoM
1) Combination antihypertensive therapy is more effective at controlling blood pressure and reducing cardiovascular events than monotherapy. Studies show combination therapy lowers blood pressure more than doubling the dose of a single drug.
2) The use of single pill combinations can improve medication adherence compared to free drug combinations. This is due to reducing pill burden and side effects. Improved adherence is associated with better blood pressure control and reduced cardiovascular outcomes.
3) Guidelines now recommend initiating treatment of hypertension with two drugs from different classes in a single pill combination, especially for patients with higher risk or uncontrolled blood pressure on monotherapy. Starting with low doses of multiple agents can provide rapid and effective blood pressure reduction.
This document summarizes the risk factors, pathophysiology, treatment, and role of new oral anticoagulants in preventing strokes related to atrial fibrillation. It describes how conditions like hypertension, heart failure, and diabetes increase stroke risk in atrial fibrillation patients. The pathophysiology leads to irregular heart rhythms that increase clotting. Treatment involves rate/rhythm control and anticoagulation using warfarin or new oral anticoagulants. Clinical trials found the new anticoagulants reduce stroke and intracranial bleeds compared to warfarin, with similar or lower risks of major bleeding. Patient characteristics and renal function help determine which new anticoagulant
Hypertension: New Concepts, Guidelines, and Clinical Management Hypertensio...MedicineAndFamily
This document summarizes guidelines for diagnosing and treating hypertension. It discusses the prevalence of hypertension and cardiovascular disease in the US population. It reviews risk factors for hypertension and cardiovascular events. It also summarizes findings from clinical trials demonstrating the benefits of treating hypertension, including reduced risks of stroke, heart failure, and myocardial infarction. Thiazide diuretics are recommended as first-line treatment based on their effectiveness and lower costs.
1) Hypertension is a significant risk factor for cardiovascular and renal diseases. It affects over 26% of the US adult population and control rates remain suboptimal.
2) Recent guidelines classify blood pressure into normal, prehypertensive, and hypertensive stages based on systolic and diastolic levels with goals of treating to lower risk levels.
3) Clinical trials demonstrate that treating hypertension reduces risks of stroke, heart attack, heart failure, and kidney disease and can prevent over a third of cardiovascular events.
1) Statins are highly effective in reducing LDL-C and cardiovascular risk, playing a cornerstone role in lipid management. They work by inhibiting HMG-CoA reductase.
2) Atorvastatin has been extensively studied in large trials and shown to significantly reduce major cardiovascular events when doses are increased from 10 mg to 80 mg.
3) Studies in India found that high dose atorvastatin (80 mg) was well tolerated and more effective at reducing LDL-C and hs-CRP than lower doses in ACS patients. However, many ACS patients in India were not receiving statins as recommended.
Recent Developments in the Treatment of Hypertension Recent Developments in...MedicineAndFamily
This document summarizes recent evidence from clinical trials on the treatment of hypertension, with a focus on patients with type 2 diabetes. It discusses trials comparing different classes of antihypertensive drugs and levels of blood pressure control. The evidence suggests that ACE inhibitors may provide greater benefits for diabetic patients compared to other drugs, reducing cardiovascular events and slowing kidney and eye disease progression. Intensive blood pressure control is also supported, though some calcium channel blockers may increase cardiovascular risk in diabetes. Ongoing long-term safety documentation is still needed for many antihypertensive agents.
Similar to Dual Therapy with Aspirin and Rivaroxaban -Dr. Verhamme (20)
La Sociedad Española de Cardiología (SEC) es una organización científica sin ánimo de lucro con la misión de reducir el impacto adverso de las enfermedades cardiovasculares y promover una mejor salud cardiovascular en la ciudadanía.
Ponencia presentada por la Dra. Marisol Bravo Amaro en el CardioTV Live ‘Debatiendo estrategias actuales para la reducción de eventos CV tras síndrome coronario agudo reciente’, realizado el 21 de mayo de 2024 en la Casa del Corazón
Ponencia presentada por el Dr. Armando Oterino Manzanas en el CardioTV Live ‘Debatiendo estrategias actuales para la reducción de eventos CV tras síndrome coronario agudo reciente’, realizado el 21 de mayo de 2024 en la Casa del Corazón
Ponencia presentada por la Dra. Miriam Martín Toro en el CardioTV Live ‘Debatiendo estrategias actuales para la reducción de eventos CV tras síndrome coronario agudo reciente’, realizado el 21 de mayo de 2024 en la Casa del Corazón
Ponencia presentada por los Dres. M.ª Dolores Mesa Rubio, Javier Mora Robles, Margarita Reina Sánchez, M.ª José Castillo Moraga y José Luis Bianchi Llave en el CardioTV Focus, publicado el 25 de abril de 2024 en la Casa del Corazón (Madrid).
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
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Dual Therapy with Aspirin and Rivaroxaban -Dr. Verhamme
1. Dual Therapy with
Aspirin and Rivaroxaban
Peter Verhamme
Dept. Cardiovascular Sciences
KU Leuven – Belgium
2. Disclosures Peter Verhamme
COMPASS Steering Committee
Honoraria for lectures from
Bayer, Boehringer, BMS, Pfizer, Daiichi Sankyo, Portola
3. 1. Combining Oral Anticoagulation and Antiplatelet therapy?
2. COMPASS trial
3. Identifying the high-risk patient
4. Combining Oral Anticoagulation and Antiplatelet therapy?
• Warfarin is more effective than aspirin / when added to aspirin in
post-MI patients
• Rivaroxaban is effective when added to DAPT in post-ACS
patients (ATLAS ACS 2 – TIMI 51)
Mega J, et al. N Engl J Med 2012; 366: 9-19. ATLAS ACS 2 – TIMI 51
Andreotti F, et al. Eur Heart J 2006; 27: 519-26. Anand S, et al. J Am Coll Cardiol 2003; 41: 62S-69S.
5. COMPASS trial
R
Rivaroxaban 2.5 mg bid
+ Aspirin 100 mg od
Aspirin 100 mg od
Rivaroxaban 5 mg bid
Expected mean follow up: 3-4 years
27,395 patients with Stable CAD or PAD
2,200 participants with a primary outcome event
Bosch JJ, et al. Can J Cardiol 2017; 33: 1027-1035.
6. COMPASS trial in patients with CAD or PAD:
Primary outcome
Eikelboom JW, et al. N Engl J Med 2017; 377: 1319-30.
7. COMPASS trial in patients with CAD or PAD:
Primary outcome
Eikelboom JW, et al. N Engl J Med 2017; 377: 1319-30.
8. COMPASS trial in patients with CAD or PAD:
Primary outcome
Eikelboom JW, et al. N Engl J Med 2017; 377: 1319-30.
9. Components of primary outcome
0
1
2
3
4
5
6
Overall CV Death Stroke MI
%Events
Riva + Aspirin
Aspirin
HR 0.78
95% CI, 0.64-0.96
HR 0.58
95% CI, 0.44-0.76
HR 0.86
95% CI, 0.70-1.05
HR 0.76
95% CI, 0.66-0.86
Eikelboom JW, et al. N Engl J Med 2017; 377: 1319-30.
15. Sites of major bleeding
Outcome
Riva + aspirin
N=9,152
Aspirin
N=9,126
Rivaroxaban +
aspirin vs. aspirin
N % N % HR 95% CI P
Intracranial 28 0.3 24 0.3 1.16 0.67-2.00 0.60
Gastrointestinal 140 1.5 65 0.7 2.15 1.60-2.89 <0.0001
Urinary 13 0.1 21 0.2 0.61 0.31-1.23 0.16
Eye 22 0.2 13 0.1 1.68 0.85-3.34 0.13
Skin/injection site 28 0.3 12 0.1 2.31 1.18-4.54 0.01
16. www.phri.ca
Association between gastrointestinal bleeding and
gastrointestinal cancer
Population
Total
N
New GI cancers
(n=212) HR
(95% CI)
P value
N %
GI bleeding
After bleeding 905* 67 7.4 20.6
(15.2-27.8)
<0.0001
No prior bleeding 27,395 145 0.5
*Excludes patients with bleeding who were diagnosed with cancer before the bleeding event
Eikelboom JW, et al. Circulation 2019;140:1451-1459.
17. www.phri.ca
1. Combining Oral Anticoagulation and Antiplatelet therapy?
2. COMPASS trial
3. Identifying the high-risk patient
18. Cardiovascular disease: who derives the greatest
benefit from the COMPASS regimen?
• Polyvascular disease
• Mild or moderate heart failure
• Chronic kidney disease
• Diabetes
• Multiple risk factors
Anand S, et al. J Am Coll Cardiol 2019;73:3271-3280.
Vanassche T, et al. Eur J Prevent Cardiol 2019
19. Regression tree analysis to identify high risk groups
Anand S, et al. J Am Coll Cardiol 2019;73:3271-3280.