Major Cardiovascular Events In Patients Research Articles

Walking Disability Raises Risk of CVD, Diabetes Problems

Walking Disability Raises Risk of CVD, Diabetes Problems

Impact of combined lipid lowering with blood pressure control on coronary plaque regression: rationale and design of MILLION study.

A line of epidemiological studies suggests that the accumulation of coronary risk factors promotes the progression of coronary atherosclerosis. Recent clinical studies showed that aggressive low-density lipoprotein (LDL) cholesterol-lowering therapy using statins could regress coronary atheroma and reduce major cardiovascular events. Additionally, therapy that controlled amlodipine-based blood pressure reduced major cardiovascular events in patients with hypertension compared with an atenolol-based regimen. An open-label randomized multicenter study is primarily planned to evaluate the changes in coronary atheroma volume using intravascular ultrasonography 18-24months after intensive lowering of LDL-cholesterol and blood pressure compared with a standard therapy indicated by current guidelines in Japanese patients with coronary artery disease (CAD). The secondary endpoints include changes in serum lipid levels, inflammatory markers, glucose markers and blood pressure. In total, 100 subjects with CAD who are undergoing percutaneous coronary intervention will be tested. The MILLION study will provide new evidence and therapeutic standards for the prevention of CAD in Japanese patients by controlling both LDL-C levels and blood pressure.

Glucagon-like peptide-1 receptor agonists for diabetes mellitus: a role in cardiovascular disease.

Diabetes mellitus, defined as a fasting plasma glucose of ≥126 mg/dL or a glycosylated hemoglobin A1c level (HbA1c) of ≥6.5%, afflicts ≈12.9% of adults in the United States and nearly 285 million adults worldwide.1,2 Diabetes mellitus is a major risk factor for the development of cardiovascular disease, independently conferring a 2-fold excess risk of coronary heart disease and stroke.3 Macrovascular events in diabetes mellitus remain the leading cause of mortality, and the burden of cardiovascular disease attributable to diabetes mellitus has increased over the past decade.4 An increase in the prevalence of obesity has contributed to the rise in diabetes mellitus. Additionally, obesity independently increases the risk of cardiovascular disease in patients with diabetes mellitus.5 Although strict glycemic control unequivocally reduces the microvascular complications of diabetes mellitus, the macrovascular benefits of intensive therapy have been difficult to establish, with conflicting results from large clinical trials.6–9 Multifactorial strategies are recommended to reduce cardiovascular risk in diabetes mellitus through enhanced glycemic control, blood pressure reduction, lipid management, weight loss, and physical activity.10 Unfortunately, despite aggressive interventions for hyperglycemia, <50% of patients achieve standard HbA1c targets with conventional therapy.11 Polypharmacy is required to achieve glycemic control in the majority of patients within 3 years of diagnosis.12 Although combinations of drug classes can synergistically target multiple pathophysiological defects, novel therapies are required to manage diabetes mellitus and mitigate cardiovascular risks. Dipeptidyl-peptidase IV (DPP-IV) inhibitor and glucagon-like peptide-1 (GLP-1) receptor agonist incretin therapies were developed to complement conventional treatment options for diabetes mellitus. Despite promising initial reports of cardioprotective effects, DPP-IV inhibitors have failed to demonstrate improved cardiovascular outcomes in large clinical trials.13–15 Randomized studies to evaluate cardiovascular outcomes associated with GLP-1 receptor agonists are currently underway. This review presents …

Influenza vaccination reduces hospitalization for acute coronary syndrome in elderly patients with chronic obstructive pulmonary disease: A population-based cohort study

BackgroundElderly patients with chronic obstructive pulmonary disease (COPD) are at a higher risk of hospitalization for cardiovascular complications, especially during respiratory infections. Previous studies showed that vaccination for influenza may reduce the risk of recurrent major cardiovascular events in patients with acute coronary syndrome (ACS). The purpose of this study was to evaluate the hypothesis that influenza vaccination could reduce hospitalizations for ACS in elderly patients with COPD. MethodUsing the Taiwan Longitudinal Health Insurance Database 1996–2008, this cohort study comprised elderly patients (≥55 years old) with a recorded diagnosis of COPD (n=7722) between January 1, 2000 and December 31, 2007. Each patient was followed until the end of 2007. A propensity score was derived by using a logistic regression model to reduce vaccine therapy selection bias. The hazard ratio (HR) and 95% confidence interval (CI) for the association between the influenza vaccination and the occurrence of first hospitalization for ACS in elderly COPD patients was examined by Cox proportional hazards regression analysis. In addition, we categorized the patients into four groups according to vaccination status (unvaccinated, total number of vaccinations: 1, 2−3, and ≥4). ResultsWe found that elderly patients with COPD receiving influenza vaccination had a lower risk of hospitalization for ACS (adjusted HR=0.46, 95% CI (0.39–0.55), p<0.001). We observed similar protective effects in both sexes and all age groups (55−64, 65−74, ≥75) regardless of influenza seasonality. When the patients were stratified according to the total number of vaccinations, the adjusted HRs for hospitalization because of ACS were 0.48 (0.38−0.62) and 0.20 (0.14−0.28) for patients who received 2−3 and ≥4 vaccinations during the follow-up period. ConclusionOur data showed that there was a lower risk of ACS hospitalization in elderly patients with COPD receiving annual influenza vaccination.

Effect of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on All-Cause Mortality, Cardiovascular Deaths, and Cardiovascular Events in Patients With Diabetes Mellitus

Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) may have different effects on cardiovascular (CV) events in patients with diabetes mellitus (DM). To conduct a meta-analysis to separately evaluate the effects of ACEIs and ARBs on all-cause mortality, CV deaths, and major CV events in patients with DM. DATA SOURCES Data sources included MEDLINE (1966-2012), EMBASE (1988-2012), the Cochrane Central Register of Controlled Trials, conference proceedings, and article reference lists. We included randomized clinical trials reporting the effects of ACEI and ARB regimens for DM on all-cause mortality, CV deaths, and major CV events with an observation period of at least 12 months. Studies were excluded if they were crossover trials. Dichotomous outcome data from individual trials were analyzed using the risk ratio (RR) measure and its 95% CI with random-effects models. We estimated the difference between the estimates of the subgroups according to tests for interaction. We performed meta-regression analyses to identify sources of heterogeneity. Primary end points were all-cause mortality and death from CV causes. Secondary end points were the effects of ACEIs and ARBs on major CV events. Twenty-three of 35 identified trials compared ACEIs with placebo or active drugs (32,827 patients) and 13 compared ARBs with no therapy (controls) (23,867 patients). When compared with controls (placebo/active treatment), ACEIs significantly reduced the risk of all-cause mortality by 13% (RR, 0.87; 95% CI, 0.78-0.98), CV deaths by 17% (0.83; 0.70-0.99), and major CV events by 14% (0.86; 0.77-0.95), including myocardial infarction by 21% (0.79; 0.65-0.95) and heart failure by 19% (0.81; 0.71-0.93). Treatment with ARBs did not significantly affect all-cause mortality (RR, 0.94; 95% CI, 0.82-1.08), CV death rate (1.21; 0.81-1.80), and major CV events (0.94; 0.85-1.01) with the exception of heart failure (0.70; 0.59-0.82). Both ACEIs and ARBs were not associated with a decrease in the risk for stroke in patients with DM. Meta-regression analysis showed that the ACEI treatment effect on all-cause mortality and CV death did not vary significantly with the starting baseline blood pressure and proteinuria of the trial participants and the type of ACEI and DM. Angiotensin-converting enzyme inhibitors reduced all-cause mortality, CV mortality, and major CV events in patients with DM, whereas ARBs had no benefits on these outcomes. Thus, ACEIs should be considered as first-line therapy to limit excess mortality and morbidity in this population.

Baseline Plasma Fatty Acids Profile and Incident Cardiovascular Events in the SU.FOL.OM3 Trial: The Evidence Revisited

ObjectiveWe aimed to investigate the association between baseline plasma fatty acids profile and the risk of future major cardiovascular events in patients with a history of ischaemic heart disease or ischemic stroke.MethodsBaseline plasma fatty acids as well as established cardiovascular risk factors were measured in 2,263 patients enrolled in the SUpplementation with FOLate, vitamins B-6 and B-12 and/or OMega-3 fatty acids randomized controlled trial. Incident major cardiovascular, cardiac and cerebrovascular events were ascertained during the 4.7 years of follow up. Hazard ratios were obtained from Cox proportional hazards models after adjustment for cardiovascular risk factors.ResultsDuring the follow-up, 154, 379 and 84 patients had major cardiovascular, cardiac and cerebrovascular events respectively. Upon adjustment for gender, initial event, baseline age and BMI, the risk of developing a major cardiovascular event decreased significantly in successive quartiles of arachidonic acid (Ptrend<0.002), total omega 3 polyunsaturated fatty acids (Ptrend<0.03), docosapentaenoic acid (Ptrend<0.019), docosahexaenoic acid (Ptrend<0.004), eicosapentaenoic acid + docosahexaenoic acid (Ptrend<0.03) and eicosapentaenoic acid + docosapentaenoic acid + docosahexaenoic acid (Ptrend<0.02). This inverse association was borderline significant with increased quartiles of stearidonic acid (Ptrend<0.06). In the full model, only stearidonic acid remained inversely associated with the risk of developing a major cardiovascular event (Ptrend<0.035), a cardiac event (Ptrend<0.016) or a cerebrovascular event (Ptrend<0.014), while arachidonic acid was inversely associated with the risk a cerebrovascular event (Ptrend<0.033).ConclusionThe inverse association of long chain omega 3 polyunsaturated fatty acids with recurrence of Cardiovascular diseases was mainly driven by well-known cardiovascular risk factors.Trial RegistrationControlled-Trials.com ISRCTN41926726

Factors Associated with Major Cardiovascular Events in Patients with Systemic Necrotizing Vasculitides: Results of a Longterm Followup Study

Systemic necrotizing vasculitides (SNV) are associated with more frequent subclinical atherosclerosis, suggesting that SNV might be associated with a higher risk of major cardiovascular events (MCVE). We aimed to identify factors predictive of MCVE in patients with SNV. Patients in remission from SNV were assessed for CV risk factors and subclinical atherosclerosis. MCVE was defined as myocardial infarction, stroke, arterial revascularization, hospitalization for unstable angina, and/or death from CV causes. MCVE-free survival curves were compared using the log-rank test. Forty-two patients were followed for 7.1±2.6 years. Eight patients (18.9%) had MCVE. The respective 5- and 10-year MCVE rates were 9.5% and 26.8%. National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III)-defined high-risk status [hazard ratio (HR) 5.02 (95% CI: 1.17-27.4), p=0.03], BMI>30 kg/m2 [HR 4.84 (95% CI: 1.46-116), p=0.02], and plaque detection in the abdominal aorta (p=0.01) were significantly associated with MCVE. SNV characteristics, corticosteroid maintenance therapy, and C-reactive protein>5 mg/l were not associated with MCVE. Plaque in the aorta was significantly associated with high-risk status (p<0.001), while BMI and high-risk status were independent variables. Thus, a BMI>30 kg/m2 and/or a high-risk status were strongly associated with MCVE (p=0.004). Carotid intima-media thickness (IMT) identified patients with early MCVE and was correlated with the time to MCVE (r2=0.68, p=0.01). These results suggest that factors associated with a higher MCVE risk in patients with SNV are NCEP/ATP III-defined high-risk status and BMI>30 kg/m2. Carotid IMT could help identify patients with SNV at risk of early MCVE.

Radial artery intima-media thickness predicts major cardiovascular events in patients with suspected coronary artery disease

In the present study, we investigated the prognostic value of radial artery intima-media thickness (rIMT) in patients with suspected coronary artery disease (CAD). Carotid artery intima-media thickness is a well-known surrogate marker of atherosclerosis. Recently, using very high-resolution ultrasound, we showed rIMT can be imaged with great precision and is related to various cardiovascular risk factors. We recruited a total of 416 patients (62 ± 9 years, 44% male) with suspected CAD, referred to myocardial perfusion scintigraphy (MPS). Among these patients, 133 underwent coronary angiography on clinical indication. Two-dimensional images of carotid and radial arteries were acquired bilaterally (using 8 and 55 MHz ultrasound, respectively). All patients were followed regarding major adverse cardiovascular events (MACE), including cardiovascular death, myocardial infarction, stroke, and coronary revascularization. A group of 20 healthy subjects (aged 61 ± 3, 50% male) were recruited for reference. During 3 years of follow-up, 77 MACE occurred. Patients with MACE exhibited significantly thicker rIMT vs. those without (0.35 ± 0.06 vs. 0.32 ± 0.07 mm, P < 0.001). Increased rIMT was associated with an increased occurrence of significant coronary artery narrowing, diagnosed by coronary angiography (P = 0.028). Patients with rIMT values above the median had a nearly three-fold increased risk for MACE (hazard ratio 2.8, 95% confidence interval 1.6-4.8). In multivariate analysis, rIMT (P = 0.011) remained a significant predictor of MACE, along with type II diabetes (P = 0.012), body mass index (P = 0.024), and MPS-verified ischaemia (P < 0.001). Radial artery IMT, assessed by very high-resolution ultrasound, confers prognostic information in patients with suspected CAD.

The association of visceral adiposity with cardiovascular events in patients with peripheral artery disease.

BackgroundPrevious studies have suggested that patients with peripheral artery disease (PAD) suffer from a high incidence of cardiovascular events (CVE). Visceral adiposity has been implicated in promoting CVEs. This study aimed to assess the association of relative visceral adipose volume with incident cardiovascular events in patients with peripheral artery disease.MethodsThis was a prospective cohort study including 260 patients with PAD who presented between 2003 and 2012. Cases were patients with diagnosed PAD including symptomatic lower limb athero-thrombosis and asymptomatic abdominal aortic aneurysm. All patients underwent computed tomography angiography (CTA). Abdominal visceral to total adipose volume ratio (relative visceral adipose volume) was estimated from CTAs using a previously validated workstation protocol. Cardiovascular risk factors were recorded at entry. The association of visceral adiposity with major CVEs (death, non-fatal myocardial infarction or stroke) was examined using Kaplan Meier and Cox proportional hazard analyses.ResultsA total of 92 major CVEs were recorded in 76 patients during a median follow-up of 2.8 (IQR 1.2 to 4.8) years, including myocardial infarction (n = 26), stroke (n = 10) and death (n = 56). At 3 years the incidence of major CVEs stratified by relative visceral adipose volume quartiles were 15% [Quartile (Q) 1], 17% (Q2), 11% (Q3) and 15% (Q4) (P = 0.517). Relative visceral adipose volume was not associated with major CVEs after adjustment for other risk factors.ConclusionThis study suggests that visceral adiposity does not play a central role in the predisposition for major CVEs in patients with PAD.

Antiagregación: resistencia a fármacos tradicionales y papel de los nuevos antiplaquetarios

Platelet aggregation plays a key role in the development of major cardiovascular events (MACE) related to atherothrombosis. Since the appearance of coronary stenting, the importance of measuring and modulating platelet activity has considerably increased in the scientific literature during the last decade. Double antiplatelet therapy with aspirin and clopidogrel administrated to stent carriers has widely demonstrated its efficacy in the prevention of MACE compared with aspirin alone. These benefits are also present when a conservatory approach is chosen for acute coronary syndrome management. However, there are an important number of patients who develop MACE despite optimal dual antiplatelet therapy, most likely related to an incomplete platelet activity inhibition. Many studies suggest an important inter-individual variability in the response to the drugs, maybe related, at least in part, to the use of different assessment techniques of platelet aggregation. Other authors suggest an incomplete platelet inhibition as a possible explanation for the presence of MACE in patients under optimal antiplatelet therapy. Resistance to usual drugs has become a clinically relevant issue that requires an individual approach where new antiplatelet agents, such as prasugrel or ticagrelor, could play an important role as stated in current consensus documents.

PCV98 - Statin Cost-Effectiveness in Patients with Previous Coronary Heart Disease: A Systematic Review of the Cost-Effectiveness Analysis Derived from Single Randomised Clinical Trials

Large randomized clinical trials (RCT) evidenced the benefits of statins in reducing major cardiovascular events in patients with established coronary heart disease (CHD). These multinational trials are likely to provide internally valid evidence. Cost-effectiveness analysis based on single trials costs and effects are common and represent the potential net benefit of an intervention in a well-controlled environment. The aim of this study is to systematically review the cost-effectiveness studies based on statins single trials in patients with previous CHD. We searched to identify all literature relating to the cost-effectiveness of statins in the secondary prevention in patients with established CHD. Only studies with the effectiveness data extracted from a single RCT and clinical outcomes such as quality assessment, mortality or cardiovascular events rate were included. The cost per QALY was classified according to the WHO, following three categories of cost-effectiveness, Highly cost-effective, Cost-effective and Not cost-effective, adjusted with GDP per capita based on purchasing power parity (constant 2005 international USD). Twenty-one studies were included in the final analysis, covering a period range from 1996 to 2009. 7 large RCTs represented the origin of efficacy data. Most of studies assumed a full compliance, the Markov models were used in 11 out 21 studies. Time horizon ranged from 5 years to time life, with 10 years being the predominant choice. 9 studies performed a cost-utility analysis and showed the average cost per QALY, 8 of them classified as highly cost-effective and 1 cost-effective. Cost per QALY was sensitive for drug price, time horizon and event rates, 6 of this models models worked with composite endpoints. Statins are highly cost-effective in patients with CHD when effect size came from single well designed RCTs. Models heterogeneity and composite endpoints can decrease the robustness of the results.

Growth differentiation factor 15 and cardiovascular events in patients with stable ischemic heart disease (The Heart and Soul Study)

Growth differentiation factor 15 (GDF-15) is a relatively new biomarker that predicts mortality in patients with chronic stable angina or acute coronary syndrome. However, the association of GDF-15 with cardiovascular (CV) events and the mechanisms of this association are not well understood. We measured plasma GDF-15 and cardiac disease severity in 984 patients with stable ischemic heart disease who were recruited for the Heart and Soul Study between September 2000 and December 2002. Subsequent CV events (myocardial infarction, stroke, and CV death), hospitalization for heart failure, and all-cause mortality were determined by chart review during an average of 8.9-year follow-up. Each doubling in GDF-15 was associated with a 2.5-fold increased rate of CV events (hazard ratio [HR] 2.53, 95% CI 2.13-3.01, P < .001). This association persisted after extensive adjustment for covariates including comorbid conditions, measures of cardiac disease severity, cardiac function, inflammatory markers, and adipokines (HR 1.44, 95% CI 1.11-1.87, P < .01). Participants who had GDF-15 levels in the highest tertile had higher mortality compared with those in the lowest tertile (HR 2.73, 95% CI 1.80-4.15, P ≤ .001 adjusted for all covariates). Addition of GDF-15 to existing risk factors resulted in a 50% change in net reclassification of patients' risk for mortality. Higher levels of GDF-15 are associated with major CV events in patients with stable ischemic heart disease. This suggests that GDF-15 is capturing an element of risk not explained by other known risk factors.

The Effects of the Proton Pump Inhibitor Usage on the Development of Major Cardiovascular Event in Patients with Acute Coronary Syndrome Receiving Dual Antiplatelet Therapy

The Effects of the Proton Pump Inhibitor Usage on the Development of Major Cardiovascular Event in Patients with Acute Coronary Syndrome Receiving Dual Antiplatelet Therapy

Circulation: Cardiovascular Interventions Editors’ Picks

<i>Circulation: Cardiovascular Interventions</i> Editors’ Picks

Inflammation, platelet activity, renal function and major cardiovascular events in patients with severe peripheral artery disease

Cardiologia CROATICA Objectives: Inflammatory markers and impaired renal function are the predictors of adverse outcome in patients with peripheral arterial disease (PAD). Despite interrelated pathophysiology between inflammation, platelets and renal function, these risk factors have not been examined together in the clinical setting. Therefore, the purpose of the study was to investigate their prognostic impact in PAD patients and to verify if they could add to the prognostic power of the ankle/brachial index (ABI). Patients and Methods: The occurrence of major adverse cardiovascular events (MACE, defined as composite endpoint of death, myocardial infarction, stroke, percutaneous coronary intervention and coronary bypass surgery) was prospectively assessed in 174 PAD patients, Fontaine stages IIb and III (66% males, mean age 69.7 years, mean ABI 0.59). C-reactive protein (CRP), leukocyte count (WBC), mean platelet volume (MPV, an indicator of platelet reactivity) and estimated glomerular filtration rate (eGFR, calculated by MDRD formula) were obtained at the time of admission. Multivariate Cox regression analysis (adjusted for age, gender, traditional, cardiovascular risk factors, ABI, body mass index, concomitant coronary and carotid disease and medications used: statins, antiplatelets, antihypertensives) was applied to assess the predictive values of biomarkers on patients` outcome. Optimal cut-off points of WBC (>7.3x10/L), MPV (>7.7 fL) and eGFR (<60 ml/min) to predict MACE were calculated with ROC analysis. Comparison between c-statistics was made to assess the better ability of biomarkers in combination with ABI vs. ABI alone to predict MACE in PAD patients. Results: During a median follow-up of 24 months, 36 patients (21%) had an event. Higher baseline levels of WBC, MPV and lower eGFR were significantly associated with future MACE by univariate analysis (p<0.05), while CRP did not differ between the groups (p=0.89). After multivariable analysis, WBC (HR 2.71, 95% CI 1.29-5.69), MPV (HR 2.89, 95% CI 1.35-6.18) and eGFR (HR 2.12, 95% CI 1.05-4.25) remained significant independent predictors of cardiovascular events. The model that incorporated WBC, MPV and eGFR to ABI improved the prediction of MACE; the area under ROC curve rose from 0.57 to 0.71 (p=0.02). Conclusion: Leukocyte count, mean platelet volume and impaired renal function are independently related to future cardiovascular events in severe PAD patients, and improved the prognostic value of the ankle/brachial index.

Derivation and validation of a risk chart for future ischaemic events and mortality following peripheral bypass surgery

Purpose: Major cardiovascular events occur frequently in patients with peripheral arterial disease (PAD). A prediction model to identify determinants and quantify the risk of future ischaemic events could provide a personal risk profile to offer individualised patient care. In the present study, we developed and validated a risk chart in patients that underwent infrainguinal bypass surgery. Methods: The risk chart was derived from and validated in a clinical trial cohort including 2650 patients with severe PAD treated with infrainguinal bypass surgery between 1995-1998. Long-term follow-up data on the composite primary outcome event of all-cause death, non-fatal myocardial infarction, or non-fatal ischaemic stroke were collected from 1995 until 2009 in a subset of 482 patients, the development cohort. Data were obtained from hospital records, general practitioners, direct contact with patients or family. Determinants and the long-term risk of the primary outcome event were identified with multivariate Cox regression analyses. Validation of the risk chart was performed in the remaining 2168 of patients of the complete clinical trial cohort, the validation cohort. The 10-year follow-up data of the validation cohort were completed by consulting the National Death Registry and the National Registry of Hospital Discharge Diagnoses. Results: The follow-up data of the development cohort were complete in 454 of the 482 patients (94%) and in 2083 of the 2168 patients in the validation cohort (96%). The primary outcome event occurred in 321 (66.6%) patients in the development cohort during a median follow-up of 6.6 years and in 1371 (65.8%) patients in the validation cohort during a median follow-up of 6.6 years. Determinants included in the risk chart were age, critical limb ischaemia, diabetes, and a prior vascular intervention. The overall performance of the risk chart was fair with a Brier score of 0.19. ROC analysis showed good discriminatory performance of the risk chart with an area under the curve of 73%. The Hosmer-Lemeshow statistic (chi-squared 13.56; p=0.851) in combination with the calibration curve showed a good calibration of the risk chart. Conclusions: Our risk chart proves to be a valid tool for the prediction of mortality and major cardiovascular events in patients after peripheral bypass surgery and may serve as a tool for individualised care of patients with severe PAD.

Risk stratification in patients with stable angina pectoris - adenosine perfusion cardiac magnetic resonance serves as an excellent tool concerning long-term prediction of severe clinical endpoints

Purpose: Objective was to assess the hypothesis that cardiac magnetic resonance (CMR) myocardial perfusion imaging is able to provide prognostic value regarding the prediction of major cardiovascular events in patients presenting with stable angina pectoris. Therefore, a large, consecutive and thereby unselected cohort of patients who underwent stress CMR has been followed up to clarify the incremental prognostic benefit over other conventional risk factors. Methods: From 2003 to 2007 consecutive patients with stable angina pectoris who were referred for adenosine perfusion CMR were enrolled unless they exhibited the predefined exclusion criteria. Myocardial perfusion imaging by adenosine-stress and late gadolinium enhancement were assessed in a 1.5 T whole-body CMR-scanner. Follow-up information concerning the combined endpoint cardiac death, non-fatal myocardial infarction and stroke was gotten from the patient, the general practitioner or the treating hospital, respectively. Results: 1,229 consecutive patients were enrolled in our study. During the mean follow-up period of 4.2±2.1 years, 88 primary endpoints could be observed. Patients with a reversible perfusion deficit held significantly more cardiac deaths (p<0.0001) and non-fatal myocardial infarction (p=0.001) than patients without. Performing univariate and multivariate testing, we were able to demonstrate that the presence of a reversible perfusion deficit has to be considered as the strongest independent predictor for an adverse event with a 3-fold increased risk (Hazard ratio 2.99). Moreover, the absence of a perfusion deficit has shown to exhibit a high negative predictive value. Conclusion: In patients with stable angina pectoris, the presence of a reversible perfusion deficit diagnosed by adenosine perfusion CMR goes along with a significant higher risk concerning the occurrence of major cardiovascular events. We could demonstrate that the presence of a reversible perfusion deficit is a strong and independent variable that provides incremental information over other conventional risk factors.

Cost-effectiveness of zofenopril in patients with left ventricular systolic dysfunction after acute myocardial infarction: a post hoc analysis of SMILE-4

BackgroundIn SMILE-4 (the Survival of Myocardial Infarction Long-term Evaluation 4 study), zofenopril + acetylsalicylic acid (ASA) was superior to ramipril + ASA in reducing the occurrence of major cardiovascular events in patients with left ventricular dysfunction following acute myocardial infarction. The present post hoc analysis was performed to compare the cost-effectiveness of zofenopril and ramipril.MethodsIn total, 771 patients with left ventricular dysfunction and acute myocardial infarction were randomized in a double-blind manner to receive zofenopril 60 mg/day (n = 389) or ramipril 10 mg/day (n = 382) + ASA 100 mg/day and were followed up for one year. The primary study endpoint was the one-year combined occurrence of death or hospitalization for cardiovascular causes. The economic analysis was based on evaluation of cost of medications and hospitalizations and was applied to the intention-to-treat population (n = 716). Cost data were drawn from the National Health Service databases of the European countries participating in the study. The incremental cost-effectiveness ratio was used to quantify the cost per event prevented with zofenopril versus ramipril.ResultsZofenopril significantly (P = 0.028) reduced the risk of the primary study endpoint by 30% as compared with ramipril (95% confidence interval, 4%–49%). The number needed to treat to prevent a major cardiovascular event with zofenopril was 13 less than with ramipril. The cost of drug therapies was higher with zofenopril (328.78 Euros per patient per year, n = 365) than with ramipril (165.12 Euros per patient per year, n = 351). The cost related to the occurrence of major cardiovascular events requiring hospitalization averaged 4983.64 Euros for zofenopril and 4850.01 Euros for ramipril. The incremental cost-effectiveness ratio for zofenopril versus ramipril was 2125.45 Euros per event prevented (worst and best case scenario in the sensitivity analysis was 3590.09 and 3243.96 Euros, respectively).ConclusionZofenopril is a viable and cost-effective treatment for managing patients with left ventricular dysfunction after acute myocardial infarction.

Logro de metas de prevención secundaria, prescripción farmacológica y eventos cardiovasculares mayores en pacientes con enfermedad coronaria

Implementation of health programs to reduce cardiovascular risk, are needed for secondary prevention of cardiovascular diseases. To evalúate achievements of secondary prevention goals, pharmacologic prescription and major cardiovascular events in patients with coronary artery disease. Patients who had a first event of acute coronary syndrome, angioplasty or revascularization surgery, between January 2008 and June 2010, were contacted for a clinical and laboratory evaluation between June and October 2011. Seven hundred and two medical records were reviewed and 245 eligible patients were identified. Of these, we assessed 202 patients aged 64 ± 10 years (70% males). Sixty seven percent had two or more cardiovascular risk factors. A goal of HDL cholesterol level over 40 mg/dL was achieved in 91 % of patients, smoking cessation in 84% and a total cholesterol < 200 mg/dL in 66%. A blood pressure below 130/85 mm Hg was achieved in 30% of patients, a normal BMI in 19% and LDL cholesterol levels below 70 mg/dL in 18%. At the moment of assessment, 87%> were using aspirin, 78%> statins, 74% angiotensin converting enzyme inhibitors or angiotensin II receptor antagonists and 66%o were using β--blockers. Twenty two percent of patients had a major cardiovascular event during the follow up, which lasted 28 ± 8 months. A low percentage of cardiovascular goals achievement was observed in this sample of patients, with a high prevalence of overweight and obesity. A high percentage quit smoking after their first cardiovascular event. Despite the high percentage of drug prescription, hypertension and dyslipidemia were not fully controlled.

Large Study Suggests That Death Comprises Higher Proportion of Major CV Events in Patients with Greater CV Risk

A review of 51 clinical trials of antihypertensive agents suggested a method of creating simple equations to determine a patient's risk of suffering death, major cardiovascular (CV) death, or other CV disease once the patient's risk of CV mortality is known. The technique incorporated the latest ESH-ESC Hypertension Guidelines [J Hypertens 2013].