1) The IMPROVE-IT trial investigated whether adding ezetimibe to simvastatin therapy provides additional cardiovascular benefit compared to simvastatin monotherapy in 18,144 high-risk patients who had an acute coronary syndrome.
2) At a median follow-up of 6 years, combination ezetimibe/simvastatin therapy resulted in a statistically significant 9% relative risk reduction in major cardiovascular events compared to simvastatin alone.
3) Combination therapy also significantly reduced the risk of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke by 10% compared to simvastatin monotherapy.
SGLT2 inhibitors in Heart failure: A prized addition to HF treatment optionsahvc0858
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Chan Wan Xian
Cardiologist, Echocardiologist
Heart Failure Intensivist
Asian Heart & Vascular Centre
www.ahvc.com.sg
Olmesartan medoxomil is an angiotensin II receptor antagonist which is used for the treatment of high blood pressure. An ester prodrug, it is completely and rapidly hydrolyzed to the active acid form. It is indicated for the treatment of hypertension. It may be used alone or in combination with other antihypertensive agents
SGLT2 inhibitors in Heart failure: A prized addition to HF treatment optionsahvc0858
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Chan Wan Xian
Cardiologist, Echocardiologist
Heart Failure Intensivist
Asian Heart & Vascular Centre
www.ahvc.com.sg
Olmesartan medoxomil is an angiotensin II receptor antagonist which is used for the treatment of high blood pressure. An ester prodrug, it is completely and rapidly hydrolyzed to the active acid form. It is indicated for the treatment of hypertension. It may be used alone or in combination with other antihypertensive agents
ARBs (Angiotensin receptor blockers) are the most widely used anti hypertensive throughout the world. A solid knowledge related to ARB will make our practice more patients friendly & benefit will be maximum.
SGLT2I The paradigm change in diabetes managementPraveen Nagula
Just like ARNI, SGLT2I have changed the face of diabetes management and they have a good profile in multimodality management because of pleiotropic effects
ARBs (Angiotensin receptor blockers) are the most widely used anti hypertensive throughout the world. A solid knowledge related to ARB will make our practice more patients friendly & benefit will be maximum.
SGLT2I The paradigm change in diabetes managementPraveen Nagula
Just like ARNI, SGLT2I have changed the face of diabetes management and they have a good profile in multimodality management because of pleiotropic effects
This case was presented during an Ambulatory Care rotation at 7th Avenue Clinic with Dr. Norwood in July 2011. I was assignment was to write a detailed SOAP Note regarding the case, summarizing pertinent problems and pharmacy-related recommendations
How to review a journal paper and prepare oral presentationSeppo Karrila
The slides are for an about 2-hour lecture to students who each have to review one scientific journal article.
There are guidelines on key content, as well as planning, preparing, and delivering an oral presentation.
This should be useful to any student preparing for an oral presentation with slides.
Eplerenone in Patients with Systolic Heart Failure and Mild Symptoms.
Presented at AHA by: Faiez Zannad, M.D., Ph.D., John J.V. McMurray, M.D., Henry Krum, M.B., PhD., Dirk J. van Veldhuisen, M.D.,Ph.D., Karl Swedberg, M.D., Ph.D, Harry Shi, M.S., John Vincent, M.B., PhD., Stuart J Pocock, Ph.D. and Bertram Pitt, M.D. for the EMPHASIS-HF Study Group * Eplerenone in Mild Patients Hospitalization And SurvIval Study in Heart Failure
Courtesy of http://www.cardiovascularbusiness.com
Talimogene laherparepvec (T-VEC, OncoVEX GM-CSF) phase 3 data in melanoma pre...Virotherapist
Phase 3 data from the OPTiM study in melanoma with talimogene laherparepvec presented as part of a talk on oncolytic immunotherapy at The Eighth International Conference on Oncolytic Virus Therapeutics, Oxford, UK,9-13 April 2014.
Novedades en Cardiopatía Isquémica en los principales congresos del año
24/11/15 18:00h - 20:00h Casa del Corazón, Madrid
Intervencionismo en Cardiopatía Isquémica
Dr. Iván Núñez Gil, Hospital Universitario Clínico San Carlos (Madrid)
Lo mejor del AHA14, Chicago
17, 18, 19 y 20 de Noviembre
http://directos.secardiologia.es/aha14.html
Sociedad Española de Cardiología
Lípidos
Dr. Fernando Civeira Murillo
Hospital Universitario Miguel Servet, Zaragoza
@FernandoCiveir1
Ponencia realizada el 23 de noviembre de 2022 en CardioTV titulado 'Nuevas fronteras en la reducción del riesgo CV residual. Integrando icosapento de etilo en la práctica clínica' por el Dr. Subodh Verma
Enquête: les nouvelles contraintes peuvent-elle pousser à un arrêt prématuré ...Medical Web Services
L’inflation des contraintes, des contrôles, des restrictions budgétaires et des tâches administratives imposées et non rémunérées ne risquent-ils pas de pousser certains médecins à un arrêt prématuré de la pratique médicale?
Faut-il abolir l’obligation des visites pendant la garde de nuit ?Medical Web Services
Enquête MediPlanet réalisée du 12 au 16 fév. 2016
De nombreuses voix s’élèvent dans les forums et demandent de supprimer l’obligation des visites pendant la garde de nuit. Qu’en pensent les médecins belges ?
Problèmes de peau: Les pathologies les plus rencontrées en médecine généraleMedical Web Services
Les problèmes de peau concerneraient, chez plus d'un généraliste sur deux, entre 10 et 20 % de sa patientèle. Mais quels sont les pathologies les plus rencontrées ? C'est ce que nous révèle une enquête de MediPlanet chez près de 300 généralistes.
Moet het aanmaken van een Gedeeld Farmaceutisch Dossier verplicht zijn in Bel...Medical Web Services
Moet het aanmaken van een Gedeeld Farmaceutisch Dossier verplicht zijn in België?
Een exclusieve peiling bij de Belgische apothekers.
Nationale resultaten – Enquête gehouden van 1 tot 7 december 2015.
Le DPP devrait-il être obligatoire en Belgique. Une enquête PharmaPlanet exclusive auprès des pharmaciens Belges. Résultats nationaux – Enquête réalisée du 1er au 7 décembre 2015
De enquête werd in juli 2015 bij 1.051 mannen en vrouwen van alle leeftijden afgenomen in de straten van 7 Belgische steden: Gent, Antwerpen, Leuven, Brussel, Namen, Luik en Louvain-la–Neuve.
--------
L’enquête a été réalisée en juillet 2015 auprès de 1051 hommes et femmes de tous âges dans les rues de sept villes belges: Gand, Anvers, Louvain, Bruxelles, Namur, Liège et Louvain-la-Neuve.
Doel van de barometer « Save Your Liver »
Belgische populatie ondervragen over 3 essentiële pijlers van Hepatitis C
- Overdracht
- Preventie
- Behandeling
Objectif du baromètre « Save Your Liver »
Sonder la population belge sur 3 piliers essentiels de l’hépatite C
- la transmission
- la prévention
- le traitement
Peiling: zetten de nieuwe restricties aan tot een voortijdige beëindiging van...Medical Web Services
Dreigt de explosieve toename van de beperkingen, controles, budgettaire restricties, opgelegde en niet-vergoede administratieve taken, om bepaalde artsen
voortijdig een duwtje te geven richting de stopzetting van hun medische praktijk?
Enquête: Les nouvelles contraintes peuvent-elle pousser à un arrêt prématuré ...Medical Web Services
L’inflation des contraintes, des contrôles, des restrictions
budgétaires et des tâches administratives imposées et non
rémunérées ne risquent-ils pas de pousser certains médecins à un arrêt prématuré de la pratique médicale?
Een gespecialiseerd ziekenhuis op meer dan 50 kilometer afstand? Preventieve tandzorg bij een tandartsassistent? Of een goedkoper geneesmiddel dan wat de dokter voorschreef? De meeste patiënten hebben er geen probleem mee. Uit de grootste CM-bevraging ooit blijkt dat de Belg meer dan ooit bereid is om zijn verantwoordelijkheid op te nemen.
Un hôpital spécialisé à plus de 50 kilomètres ? Des soins dentaires préventifs chez un hygiéniste dentaire ? Un médicament moins cher que celui prescrit par le médecin, délivré par le pharmacien ? La plupart des patients n’y voient là aucun inconvénient. La plus grande enquête jamais réalisée par la Mutualité chrétienne (MC) montre que les Belges sont, plus que jamais, prêts à assumer leurs responsabilités en matière de santé.
Verplichte Derde Betaler: de huisartsen laten hun stem horen (Peiling)Medical Web Services
Wat denkt u hierover?
Hoe wenst u te reagereren?
Een exclusieve peiling bij de Belgische huisartsen.
Nationale resultaten – Enquête gehouden van 9 tot 16 april 2015.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
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ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
1. IMProved Reduction of
Outcomes: Vytorin Efficacy
International Trial
A Multicenter, Double-Blind, Randomized Study to
Establish the Clinical Benefit and Safety of Vytorin
(Ezetimibe/Simvastatin Tablet) vs Simvastatin
Monotherapy in High-Risk Subjects Presenting
With Acute Coronary Syndrome
2. Trial Leadership
Study Chairmen: Eugene Braunwald and Robert Califf
TIMI Study Group: Christopher Cannon Robert Giugliano
Amy McCagg Christina Pelland
Sabina Murphy Erin Bohula May
DCRI: Michael Blazing Craig Reist
Jennifer White Yuliya Lokhnygina
Curtis Campbell Cathy Martz
Merck: Thomas Musliner Andrew Tershakovec
Ann Kilian Rona Harmelin-Kadouri
Paul DeLucca Steve Bird
DSMB Chair: Scott Grundy
CEC Chair: Stephen Wiviott
3. National Lead Investigators and Steering
Committee (1158 sites, 39 Countries)
Enrique Gurfinkel¹
Argentina (331)
Philip Aylward
Andrew Tonkin*
Australia (116)
Gerald Maurer
Austria (249)
Frans Van de Werf
Belgium (249)
Jose C. Nicolau
Brazil (423)
Pierre Theroux
Paul Armstrong*
Jacques Genest*
Canada (1106)
Ramon Cobalan
Chile (152)
Daniel Isaza
Colombia (568)
Jindrich Spinar
Czech Rep (371)
Peer Grande²
Denmark (576)
Juri Voitk
Estonia (10)
Antero Kesaniemi
Finland (341)
Jean-Pierre Bassand
Michel Farnier*
France (268)
Harald Darius
Germany (935)
Matayas Keltai
Hungary (116)
Atul Mathur
Sanjay Mittal
Krishna Reddy
India (259)
Basil Lewis
Israel (589)
Gaetano DeFerrari
Italy (593)
Ton Oude Ophuis
J. Wouter Jukema*
Netherlands (1191)
Harvey White
New Zealand (164)
Terje Pedersen
Norway (295)
Frank Britto
Peru (66)
Witold Ruzyllo
Poland (589)
Manuel Carrageta
Portugal (102)
Ki-Bae Seung
S. Korea (118)
Singapore (75), Malaysia (59), Hong Kong (58) Ecuador (45), Taiwan (46)
*Steering Comm Member, ¹ Deceased, ² 2005–2013
Tibor Duris
Slovakia (121)
Anthony Dalby
S. Africa (186)
Jose Lopez-Sendon
Spain (551)
Mikael Dellborg
Sweden (480)
Francois Mach
Switzerland (263)
Sema Guneri
Turkey (50)
Alexander Parkhomenko
Ukraine (159)
Adrian Brady
United Kingdom (318)
Michael Blazing
Christopher Cannon
Christie Ballantyne*
James de Lemos*
Neal Kleiman*
Darren McGuire*
United States (5869)
4. Background:
Cholesterol Lowering
➢ Lowering LDL cholesterol (LDL-C) has been a mainstay
of cardiovascular prevention
➢ Evidence mostly from statin trials which show reduction
in morbidity and mortality
– High-dose statins further reduce non-fatal CV events
➢ To date, no lipid-modifying therapy added to statins has
been demonstrated to provide a clinical benefit
– Fibrates, niacin, CETP inhibitors
➢ Recent ACC/AHA Guidelines have emphasized use of
statin therapy
➢ Despite current therapies, patients remain at high risk
5. Ezetimibe: Background
➢ Ezetimibe inhibits Niemann-Pick C1-like 1 (NPC1L1)
protein
– located primarily on the epithelial brush border of
the GI tract
– resulting in reduced cholesterol absorption
➢ When added to statin, produces ~20% further
reduction in LDL-C
➢ Two recent human genetic analyses have correlated
polymorphisms in NPC1L1 with lower levels of LDL-C
and lower risk of CV events*
*MI Genetics Consortium Investigators NEJM 2014; online Nov 12; Ference BA et al AHA 2014
6. Goals
IMPROVE-IT: First large trial evaluating clinical
efficacy of combination EZ/Simva vs. simvastatin
(i.e., the addition of ezetimibe to statin therapy):
➢ Does lowering LDL-C with the non-statin agent
ezetimibe reduce cardiac events?
➢ “Is (Even) Lower (Even) Better?”
(estimated mean LDL-C ~50 vs. 65mg/dL)
➢ Safety of ezetimibe
Cannon CP AHJ 2008;156:826-32; Califf RM NEJM 2009;361:712-7; Blazing MA AHJ 2014;168:205-12
7. Patient Population
Inclusion Criteria:
➢ Hospitalization for STEMI, NSTEMI/UA < 10 days
➢ Age ≥ 50 years, and ≥ 1 high-risk feature:
– New ST chg, + troponin, DM, prior MI, PAD, cerebrovasc,
prior CABG > 3 years, multivessel CAD
➢ LDL-C 50-125 mg/dL (50–100 mg/dL if prior lipid-lowering Rx)
Major Exclusion Criteria:
➢ CABG for treatment of qualifying ACS
➢ Current statin Rx more potent than simva 40mg
➢ Creat Cl < 30mL/min, active liver disease
8. Patients stabilized post ACS ≤ 10 days:
LDL-C 50–125*mg/dL (or 50–100**mg/dL if prior lipid-lowering Rx)
Standard Medical & Interventional Therapy
Ezetimibe / Simvastatin
10 / 40 mg
Simvastatin
40 mg
Follow-up Visit Day 30, every 4 months
Duration: Minimum 2 ½-year follow-up (at least 5250 events)
Primary Endpoint: CV death, MI, hospital admission for UA,
coronary revascularization (≥ 30 days after randomization), or stroke
N=18,144
Uptitrated to
Simva 80 mg
if LDL-C > 79
(adapted per
FDA label 2011)
Study Design
*3.2mM
**2.6mM
Cannon CP AHJ 2008;156:826-32; Califf RM NEJM 2009;361:712-7; Blazing MA AHJ 2014;168:205-12
90% power to detect
~9% difference
9. Study Metrics
Simva
(N=9077)
EZ/Simva
(N=9067)
Uptitration to Simva 80mg, % 27 6
Premature study drug D/C, % 42 42
Median follow-up, yrs 6.0 5.9
Withdraw consent w/o vital status, %/yr 0.6 0.6
Lost to follow-up, %/yr 0.10 0.09
Follow up for primary endpoint, % 91 91
Follow up for survival, % 97 97
Total primary endpoint events = 5314
Total patient-years clinical follow-up = 97,822
Total patient-years follow-up for survival = 104,135
10. Baseline Characteristics
Simvastatin
(N=9077)
%
EZ/Simva
(N=9067)
%
Age (years) 64 64
Female 24 25
Diabetes 27 27
MI prior to index ACS 21 21
STEMI / NSTEMI / UA 29 / 47 / 24 29 / 47 / 24
Days post ACS to rand (IQR) 5 (3, 8) 5 (3, 8)
Cath / PCI for ACS event 88 / 70 88 / 70
Prior lipid Rx 35 36
LDL-C at ACS event (mg/dL, IQR) 95 (79, 110) 95 (79,110)
11. LDL-C and Lipid Changes
1 Yr Mean LDL-C TC TG HDL hsCRP
Simva 69.9 145.1 137.1 48.1 3.8
EZ/Simva 53.2 125.8 120.4 48.7 3.3
Δ in mg/dL -16.7 -19.3 -16.7 +0.6 -0.5
Median Time avg
69.5 vs. 53.7 mg/dL
16. Simva† EZ/Simva†
Male 34.9 33.3
Female 34.0 31.0
Age < 65 years 30.8 29.9
Age ≥ 65 years 39.9 36.4
No diabetes 30.8 30.2
Diabetes 45.5 40.0
Prior LLT 43.4 40.7
No prior LLT 30.0 28.6
LDL-C > 95 mg/dl 31.2 29.6
LDL-C ≤ 95 mg/dl 38.4 36.0
Major Pre-specified
Subgroups
Ezetimibe/Simva
Better
Simva
Better
0.7 1.0 1.3
†7-year
event rates
*
*p-interaction = 0.023, otherwise > 0.05
17. IMPROVE-IT vs. CTT:
Ezetimibe vs. Statin Benefit
CTT Collaboration.
Lancet 2005; 366:1267-78;
Lancet 2010;376:1670-81.
IMPROVE-IT
18. Safety — ITT
No statistically significant differences in cancer or
muscle- or gallbladder-related events
Simva
n=9077
%
EZ/Simva
n=9067
% p
ALT and/or AST≥3x ULN 2.3 2.5 0.43
Cholecystectomy 1.5 1.5 0.96
Gallbladder-related AEs 3.5 3.1 0.10
Rhabdomyolysis* 0.2 0.1 0.37
Myopathy* 0.1 0.2 0.32
Rhabdo, myopathy, myalgia with CK elevation* 0.6 0.6 0.64
Cancer* (7-yr KM %) 10.2 10.2 0.57
* Adjudicated by Clinical Events Committee % = n/N for the trial duration
19. Conclusions
IMPROVE-IT: First trial demonstrating incremental
clinical benefit when adding a non-statin agent
(ezetimibe) to statin therapy:
YES: Non-statin lowering LDL-C with ezetimibe
reduces cardiovascular events
YES: Even Lower is Even Better
(achieved mean LDL-C 53 vs. 70 mg/dL at 1 year)
YES: Confirms ezetimibe safety profile
Reaffirms the LDL hypothesis, that reducing
LDL-C prevents cardiovascular events
Results could be considered for future guidelines