The ONTARGET trial compared the angiotensin receptor blocker (ARB) telmisartan to the angiotensin converting enzyme (ACE) inhibitor ramipril and their combination in 25,620 patients with cardiovascular disease or diabetes. The trial found that telmisartan was noninferior to ramipril for the primary outcome of cardiovascular death, heart attack, stroke or hospitalization for heart failure. The combination of telmisartan and ramipril showed no additional benefit compared to ramipril alone and was associated with more side effects such as renal impairment.
#flozins
🫀DAPA 🆚placebo in HFpEF
Now we have a positive trial!
⬇️18% in CV☠️ death or
worsening HF among LVEF>40%
⬇️ 21%heart failure
💥Results same for LVEF> 60% 🆚LVEF<60%
Association and prevalence of different comorbidities in hypertension and management with focus guidelines with benefits & choice of different antihypertensives in different comorbidities.
Beta Blockers in current cardiovascular practice Praveen Nagula
betablockers are the drug of choice for prevention of progression of heart failure with mortality benefit, after the evolution of neurohormonal regulation as pathogenesis of heart failure
Javed Butler, MD, MPH, MBA, discusses heart failure in this CME activity titled, "New Frontiers in Managing Heart Failure: Are SGLT2 Inhibitors the Next Leap Forward in Optimizing Patient Care?" For the full presentation, downloadable infographics, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2JG2v9l. CME credit will be available until May 29, 2020.
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
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)
#flozins
🫀DAPA 🆚placebo in HFpEF
Now we have a positive trial!
⬇️18% in CV☠️ death or
worsening HF among LVEF>40%
⬇️ 21%heart failure
💥Results same for LVEF> 60% 🆚LVEF<60%
Association and prevalence of different comorbidities in hypertension and management with focus guidelines with benefits & choice of different antihypertensives in different comorbidities.
Beta Blockers in current cardiovascular practice Praveen Nagula
betablockers are the drug of choice for prevention of progression of heart failure with mortality benefit, after the evolution of neurohormonal regulation as pathogenesis of heart failure
Javed Butler, MD, MPH, MBA, discusses heart failure in this CME activity titled, "New Frontiers in Managing Heart Failure: Are SGLT2 Inhibitors the Next Leap Forward in Optimizing Patient Care?" For the full presentation, downloadable infographics, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2JG2v9l. CME credit will be available until May 29, 2020.
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
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)
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)
http://www.theheart.org/web_slides/1144191.do
A randomized to prasugrel or clopidogrel study on TRITON-TIMI 38 with patients who have moderate- to high-risk ACS.
Primary Prevention of Cardiovascular Disease: The Role of Aspirin and StatinsCTSI at UCSF
Presented by Michael Pignone, MD, MPH, at UCSF's symposium "The Role of Risk Stratification and Biomarkers in Prevention of Cardiovascular Disease" in Jan 2012.
http://www.theheart.org/web_slides/1146285.do
A prospective randomized trial on Embolic Protection in Patients with Atrial Fibrillation (PROTECT-AF) comparing closure of the LAA* (with the Watchman occluder) with long-term warfarin therapy
http://www.theheart.org/web_slides/1303305.do
A randomized trial on Prolonging Dual Antiplatelet Treatment after Grading Stent-induced Intimal Hyperplasia (PRODIGY) to address the ongoing debate of the duration of dual antiplatelet therapy after drug-eluting-sent implantation
Powerpoint presentation of a talk I gave in World Congress of Nephrology 2009 in Milan about subdistribution hazard regression models as a method of analyzing ESRD clinical trials in the setting of informative censoring (due to transplantation or drop-out).
Important Trials of the Day & Basics of Biostatistics | IACTS SCORE 2020IACTSWeb
This presentation emphasizes on the importance of biostatistics in the interpretation, analysis and design of studies and trials in the daily life of an academic surgeon. It also sheds light on some important clinical trials of the present milieu that are playing a vital role in the course that cardiothoracic surgery is taking.
Courtesy of Dr. Prasanna Simha Mohan Rao, MS, MCh, DNB, PGDHHM. He presently serves as Professor and Unit Chief of Cardiothoracic and Vascular Surgery at Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru.
This presentation accompanies a video that is part of the lecture series of IACTS SCORE 2020 held at the SSSIHMS Whitefield, Bengaluru between 7th and 8th March, 2020.
Similar to ONTARGET trial - Summary & Results with Ramipril Global Endpoint (20)
TCT 2012 research highlights: A slideshow presentationtheheart.org
TCT 2012 took place in Miami, FL, on October 22-26. Key trials and presentations at the sessions included: PFO Closure, RESPECT, PC Trial, FAME II, ADVANCE, TAVR, TRILOGY-ACS, Live cases, DESSOLVE I and II, SES PARTNER B, MASTER, Career Achievement Award, ADAPT-DES, STEMI-RADIAL and POST
ESC 2012 research highlights: A slideshow presentationtheheart.org
The European Society of Cardiology (ESC) 2012 Congress took place in Munich, Germany from August 25 through August 29, 2012. Key trials presented at the sessions include: WOEST, ALTITUDE, FAME II, TRILOGY ACS, ACCESS EU,PURE, GARY. IABP SHOCK II, PARAMOUNT and DeFACTO
The American Heart Association (AHA) 2012 Scientific Sessions took place in Los Angeles, CA on November 3-7, 2012. Key trials presented at the sessions include: FREEDOM, TACT, UMPIRE, PHS II, OPERA and FORWARD, ASPIRE, TRILOGY ACS/ARCTIC, MADIT-RIT, RELAX-AHF, POSEIDON / SCIPIO, PCSK9 studies, PCSK9, dal-OUTCOMES andLoDoCo.
AHA 2010 research highlights: A slideshow presentation theheart.org
http://www.theheart.org/editorial-program/1156073.do
The American Heart Association (AHA) 2010 Scientific Sessions took place in Chicago. Key trials presented at the sessions include: ADVANCE,RAFT,QRS EMPHASIS-HF,ASCEND HF,ROCKET AF,CLOSURE I,GRAVITAS,P-OM3,BASKET-PROVE,DEFINE,SYMPLICITY HTN,ASCOT CRP and ACT.
TCT 2010 research highlights: A slideshow presentation theheart.org
http://www.theheart.org/editorial-program/1128553.do
The 22nd annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium took place in Washington. Key trials presented at the meeting include: PARTNER, ZILVER PTX, ISAR-TEST 4,SORT-OUT 4, COMPARE,SPIRIT IV, HORIZONS-AMI, BIOFREEDOM, PROTECT-AF, CAP and Robotically assisted PCI
OASIS-6 trial - Summary & Results at ACCtheheart.org
http://www.theheart.org/web_slides/1136801.do
A randomized, placebo study using patients with STEMI exposed to fondaparinux or to usual care-placebo. The Sixth Organization to Assess Strategies in Acute Ischemic Syndromes.
http://www.theheart.org/web_slides/1136565.do
A prospective,randomized, open-label, blinded-end-point evaluation trial on incremental decrease in endpoints through aggressive lipid lowering (IDEAL) using patients with a history of acute MI
http://www.theheart.org/web_slides/1283911.do
A survey of 153,996 adults on prospective urban rural epidemiology (PURE) to examine the relationship of societal influences on human lifestyle behaviors, CV risk factors, and incidence of chronic non communicable diseases
http://www.theheart.org/web_slides/1146197.do
A randomized study,on action to control cardiovascular risk in diabetes and blood-pressure-lowering arm (ACCORD BP) in a nonblinded fashion, to intensive BP-lowering
http://www.theheart.org/web_slides/1186083.do
A randomized study on Acetylcysteine for Contrast-Induced Nephropathy Trial (ACT) with patients undergoing an angiographic procedure.
http://www.theheart.org/web_slides/1425587.do
A randomized to placebo or ivabradine study on Systolic Heart Failure Treatment with the If Inhibitor Ivabradine (SHIFT) with patients on standard HF medications according to guidelines
http://www.theheart.org/web_slides/1242353.do
An analysis based on an Italian registry of 308 patients with Brugada syndrome who underwent programmed electrical stimulation (PES) studies according to one consistent protocol (unlike earlier multicenter studies that were based on varying PES protocols)
http://www.theheart.org/web_slides/1242347.do
A trial on ALTITUDE to evaluate mortality after device implantation or after shock therapy in large numbers of patients with implanted devices
http://www.theheart.org/web_slides/1225253.do
A PRECOMBAT trial Premier of randomized comparison of bypass surgery vs angioplasty using sirolimus-eluting stent in patients with left main coronary artery disease
http://www.theheart.org/web_slides/1225165.do
A randomized study on Olmesartan and Calcium Antagonists Randomized (OSCAR) using high-dose of olmesartan or standard dose calcium-channel blocker (CCB) (amlodipine or azelnidipine) with patients with uncontrolled 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
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
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
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.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
2. ONTARGET (Ongoing Telmisartan Alone and in
Combination with Ramipril Global Endpoint Trial)
S Yusuf (McMaster University, Hamilton, ON)
American College of Cardiology 2008 Scientific Sessions
• Goal:
To test whether an ARB (which blocks the effects of angiotensin II without
enhancing bradykinin) was similarly effective to an ACE inhibitor and
whether the combination of an ACE inhibitor and an ARB may be superior
• Population and treatment:
25 620 patients ≥ 55 years of age with CHD or diabetes plus additional risk
factors without evidence of HF
Randomized to ramipril 10 mg/day, telmisartan 80 mg/day, or combination
of the two for a mean duration of 55 months
• Primary outcome:
A composite of CV death, MI, stroke, or hospitalization for HF
ARB=angiotensin=receptor blocker
3. ONTARGET: Results
• Telmisartan was shown to be noninferior to ramipril
Key results
Outcome Ramipril Telmisartan Combination Risk ratio (95% CI)a Risk ratio (95% CI)b
(n=8576), % (n=8542), % (n=8502), %
Primary end point 16.5 16.7 16.3 1.01 (0.94–1.09) 0.99 (0.92–1.07)
CV death/MI/stroke 14.1 13.9 14.1 0.99 (0.91–1.07) 1.00 (0.93–1.09)
MI 4.8 5.2 5.2 1.07 (0.94–1.22) 1.08 (0.94–1.23)
Stroke 4.7 4.3 4.4 0.91 (0.79–1.05) 0.93 (0.81–1.07)
CHF hospitalization 4.1 4.6 3.9 1.12 (0.97-1.29) 0.95 (0.82– 1.10)
CV death 7.0 7.0 7.3 1.00 (0.89–1.12) 1.04 (0.93–1.17)
Any death 11.8 11.6 12.5 0.98 (0.90–1.07) 1.07 (0.98–1.16)
Renal impairment 10.2 10.6 13.5 1.04 (0.96–1.14) 1.33 (1.22–1.44)
a. Telmisartan vs ramipril
b. Combination therapy vs ramipril
4. ONTARGET: Commentary*
"This was a great trial. It was large, with a simple design and a rigorous
noninferiority margin, so we can definitely say that telmisartan is similarly as
effective as ramipril. It asked two specific questions and got two clear answers."
- Dr Sanjay Kaul
"It lays all the ghosts to rest about suggestions of increased risk of MI with ARBs—
this trial shows that was all nonsense."
- Dr Peter Sleight
*All comments from ONTARGET: Clear messages from well-conducted study
(http://www.theheart.org/article/853429.do)
5. Become a member of http://www.theheart.org
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