Prevention Of Recurrent Cardiovascular Events Research Articles

Proportion of patients with systemic inflammation and their characteristics for groups at high cardiovascular risk in phase 3 randomized placebo-controlled trials of semaglutide (SELECT, SOUL, FLOW)

Abstract Introduction Inflammation is a pathophysiological process associated with increased cardiovascular (CV) risk, with high-sensitivity C-reactive protein (hsCRP) used as a biomarker to predict CV risk. However, the prevalence of systemic inflammation (defined as hsCRP ≥ 2 mg/L) in contemporary cohorts with high CV risk, including CV disease (CVD), chronic kidney disease (CKD), obesity and/or type 2 diabetes (T2D), is not well characterized. Purpose To evaluate the proportion of individuals with systemic inflammation and the characteristics of individuals with and without systemic inflammation among groups at high risk of CV events, using baseline data from three ongoing randomized, placebo-controlled, phase 3 trials investigating the efficacy of semaglutide versus placebo in high CV risk populations (SELECT, SOUL and FLOW). Methods SELECT (NCT03574597) recruited adults ≥ 45 years old with a body mass index (BMI) ≥ 27 kg/m² and established CVD (previous myocardial infarction, ischaemic or haemorrhagic stroke, or symptomatic peripheral artery disease [PAD]), without diabetes. SOUL (NCT03914326) recruited adults ≥ 50 years old with T2D and at least one of coronary heart disease, cerebrovascular disease, symptomatic PAD or CKD (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m²). FLOW (NCT03819153) recruited adults ≥ 18 years old with T2D and CKD (eGFR ≥ 25–≤ 75 mL/min/1.73 m² and urinary albumin-to-creatinine ratio > 100–< 5000 mg/g) treated with renin-angiotensin-aldosterone system-blocking agents. Baseline hsCRP levels were measured in the three trials. Descriptive statistics were used to analyse the baseline characteristics of participants; p values were calculated with chi-squared tests using Yates’s correction for continuity. Results Baseline characteristics were available for 17 487 individuals from SELECT, 9577 from SOUL and 3519 from FLOW (Table), with systemic inflammation present in 47.2%, 49.5% and 56.8% of the trial populations, respectively. Across trials, PAD and heart failure were significantly more prevalent in individuals with hsCRP ≥ 2 mg/L than in those with hsCRP < 2 mg/L; in addition, CKD stage 3–5 and stroke were more prevalent in groups with hsCRP ≥ 2 mg/L in SELECT and SOUL. The following factors were characteristic of the groups with systemic inflammation in the three trials: female sex, younger age, higher BMI, lower levels of high-density lipoprotein cholesterol, and higher levels of glycated haemoglobin (HbA1c), total cholesterol, low-density lipoprotein cholesterol and triglycerides. Conclusion In these large phase 3 trials, systemic inflammation was present at baseline in approximately 50% of individuals and was associated with several CV and kidney risk characteristics. The large proportion of participants with systemic inflammation in the groups with high CV risk shown here supports systemic inflammation as a plausible therapeutic target for the prevention of recurrent CV events.

Coste-efectividad de la polipíldora CNIC frente a los monocomponentes separados en prevención secundaria cardiovascular en España

Introduction and objectivesDespite advances in treatment, cardiovascular disease is the second leading cause of death in Spain. The objective of this study was to determine the cost-effectiveness of the CNIC-Polypill strategy (acetylsalicylic acid 100mg, atorvastatin 20/40mg, ramipril 2.5/5/10mg) compared with the same separate monocomponents for the secondary prevention of recurrent cardiovascular events in adults in Spain. Materials and methodsA Markov cost-utility model was adapted considering four health states (stable, subsequent major adverse cardiovascular event, subsequent ischemic stroke and death) and the SMART risk equation over a lifetime horizon from the perspective of the Spanish National Healthcare System. The CNIC-Polypill strategy was compared with monocomponents in a hypothetical cohort of 1000 secondary prevention patients. Effectiveness, epidemiological, cost and utilities data were obtained from the NEPTUNO study, official databases and literature. Outcomes were costs (in 2021euros) per life-year (LY) and quality-adjusted LY (QALY) gained. A 3% discount rate was applied. Deterministic one-way and probabilistic sensitivity analyses evaluated the robustness of the model. ResultsThe CNIC-Polypill strategy in secondary prevention results in more LY (13.22) and QALY (11.64) gains at a lower cost than monocomponents. The CNIC-Polypill is dominant and saves €280.68 per patient compared with monocomponents. The probabilistic sensitivity analysis shows that 82.4% of the simulations are below the threshold of €25,000 per QALY gained. ConclusionsThe CNIC-Polypill strategy in secondary cardiovascular prevention is cost-effective compared with the same separate monocomponents, resulting in a cost-saving strategy to the Spanish National Healthcare System.

Cost-effectiveness of the CNIC-Polypill versus separate monocomponents in cardiovascular secondary prevention in Spain

Introduction and objectivesDespite advances in treatment, cardiovascular disease is the second leading cause of death in Spain. The objective of this study was to determine the cost-effectiveness of the CNIC-Polypill strategy (acetylsalicylic acid 100 mg, atorvastatin 20/40 mg, ramipril 2.5/5/10 mg) compared with the same separate monocomponents for the secondary prevention of recurrent cardiovascular events in adults in Spain. Materials and methodsA Markov cost-utility model was adapted considering 4 health states (stable, subsequent major adverse cardiovascular event, subsequent ischemic stroke and death) and the SMART risk equation over a lifetime horizon from the perspective of the Spanish National Healthcare System. The CNIC-Polypill strategy was compared with monocomponents in a hypothetical cohort of 1000 secondary prevention patients. Effectiveness, epidemiological, cost and utilities data were obtained from the NEPTUNO study, official databases and literature. Outcomes were costs (in 2021 euros) per life-year (LY) and quality-adjusted LY (QALY) gained. A 3% discount rate was applied. Deterministic one-way and probabilistic sensitivity analyses evaluated the robustness of the model. ResultsThe CNIC-Polypill strategy in secondary prevention results in more LY (13.22) and QALY (11.64) gains at a lower cost than monocomponents. The CNIC-Polypill is dominant and saves є280.68 per patient compared with monocomponents. The probabilistic sensitivity analysis shows that 82.4% of the simulations are below the threshold of є25,000 per QALY gained. ConclusionsThe CNIC-Polypill strategy in secondary cardiovascular prevention is cost-effective compared with the same separate monocomponents, resulting in a cost-saving strategy to the Spanish National Healthcare System.

Associations of Serum 25(OH)D With Risk of Recurrent Cardiovascular Events in Individuals With Coronary Heart Disease.

Few studies have examined the relationship between vitamin D and the risk of recurrent cardiovascular (CV) events in people with coronary heart disease (CHD). This study aimed to investigate the associations of serum 25-hydroxyvitamin D (25(OH)D) concentration and the vitamin D receptor (VDR) polymorphisms with the risk of recurrent CV events in individuals with established CHD. A total of 22 571 participants with CHD were included from the UK Biobank. Recurrent CV events, including myocardial infarction (MI), heart failure (HF), stroke, and CV disease mortality, were identified from electronic health records. Cox proportional-hazard models were used to calculate hazard ratios (HRs) and 95% CIs. The median (interquartile range) of serum 25(OH)D concentration was 44.8 nmol/L (range, 30.3-61.4 nmol/L), and 58.6% of participants had 25(OH)D below 50 nmol/L. During a median follow-up of 11.2 years, a total of 3998 recurrent CV events were documented. After multivariable adjustment, there was a nonlinear inverse relationship between serum 25(OH)D and recurrent CV events (P nonlinearity <.01), and the decreasing risk gradually leveled off at around 50 nmol/L. Compared with participants with serum 25(OH)D less than 25.0 nmol/L, the HRs (95% CIs) for participants with serum 25(OH)D of 50.0 to 74.9 nmol/L were 0.64 (0.58-0.71) for recurrent CV events, 0.78 (0.65-0.94) for MI, 0.66 (0.57-0.76) for HF, and 0.66 (0.52-0.84) for stroke. In addition, these associations were not modified by genetic variants in the VDR. In people with established CHD, higher serum 25(OH)D concentrations were nonlinearly associated with a lower risk of recurrent CV events, with a potential threshold around 50 nmol/L. These findings highlight the importance of maintaining adequate vitamin D status in the prevention of recurrent CV events among individuals with CHD.

Comparative effect of varenicline and nicotine patches on preventing repeat cardiovascular events

ObjectiveTo determine the comparative effectiveness of postdischarge use of varenicline versus prescription nicotine replacement therapy (NRT) patches for the prevention of recurrent cardiovascular events and mortality and whether this association...

Cost-Effectiveness of Colchicine for Recurrent Cardiovascular Events

BackgroundColchicine is an anti-inflammatory therapy with a low associated cost that has been shown in 2 large studies to reduce cardiovascular (CV) events, but its use is associated with side effects. The main objective for this analysis is to determine whether colchicine therapy is cost-effective for the prevention of recurrent CV events in patients who have suffered a myocardial infarction (MI). MethodsA decision model was developed to estimate the healthcare costs in Canadian dollars and the clinical outcomes among patients who have suffered an MI and are treated with colchicine. Probabilistic Markov modelling was used in combination with Monte Carlo simulation to derive expected lifetime costs and quality-adjusted life-years, which permitted the calculation of incremental cost-effectiveness ratios. Models were derived for both short-term (20 months) and long-term (lifelong) colchicine use in this population. ResultsLong-term colchicine use was dominant over standard of care, with lower average lifetime costs per patient (CAD$91,552.80 vs $97,085.84) and a higher average number of quality-adjusted life-years per patient (19.92 vs 19.80). Short-term colchicine use also dominated over standard of care. Results were consistent over a range of scenario analyses. ConclusionsBased on 2 large randomized controlled trials, treatment of patients post-MI with colchicine appears cost-effective, compared to the standard of care at the current price. Based on these studies and currently accepted willingness-to-pay thresholds in Canada, healthcare payers could consider funding long-term colchicine therapy for CV secondary prevention while we await results from ongoing trials.

Abnormal Glucose Tolerance in Prediabetes Patients with Acute Myocardial Infarction: Implications for Therapy

Newly discovered abnormal glucose tolerance is common in patients who present with acute myocardial infarction (MI). These individuals are at very high risk for recurrent major adverse cardiovascular events (MACE), cardiovascular (CV) mortality, and all-cause mortality compared to normal-glucose-tolerant individuals who present with acute MI. Early and aggressive intervention with lifestyle and pharmacologic treatment are essential for the prevention of prediabetes progression to diabetes and recurrent cardiovascular events in this high risk population. Management, both with regard to prevention of recurrent cardiovascular events and development of diabetes, has been poorly addressed in current cardiology and diabetes guidelines. In this article, we review current evidence regarding the use of glucagon-like peptide 1 receptor agonists (GLP-1 RAs), sodium glucose cotransporter 2 inhibitors (SGLT2i), and pioglitazone to prevent recurrent cardiovascular events and propose areas of research to be explored in the future.

Prediction of the Possibility of Hemorrhagic Syndrome during Combined Antiplatelet Therapy According to the Krasnodar Region Registry

Background. According to the literature data, acute coronary syndrome (ACS) in 2-20 % of cases is combined with atrial fibrillation (AF). According to the current guidelines of the European Society of Cardiology (ESC), patients with coexisting AF and ACS should receive dual antiplatelet therapy for the prevention of recurrent cardiovascular events and anticoagulant therapy for the prevention of thromboembolic complications. However, this combination is fraught with the development of hemorrhagic syndrome.Aim. To develop a model and software module for predicting possible bleeding in patients with ACS combined with AF taking three-component antithrombotic therapy.Materials and Methods. To build prognostic models for the development of hemorrhagic syndrome, a statistical method was used for classification trees and the neural network procedure implemented in the STATISTICA package. To build prognostic models, a sample was used consisting of 201 patients with a combination of ACS and AF with and without fatal outcome, the state of which was described by 42 quantitative and qualitative clinical indicators. The control group included 205 patients with ACS and intact sinus rhythm.Results. To identify predictors of predictive models of the possible development of hemorrhagic syndrome in patients with triple antithrombotic therapy, the Spearman correlation coefficient was used. The study of correlations allowed to reveal clinical indicators – predictors of prognostic models. After analyzing the predictive ability of the developed models, a software module was created in the Microsoft Visual C # 2015 programming environment that allows determining the possibility of hemorrhagic syndrome in patients with a combination of ACS and AF using classification trees and neural networks.Сonclusion. A classification model and a software module were developed to predict possible bleeding in patients taking three-component antithrombotic therapy. Models contain both quantitative and qualitative (categorical) clinical indicators. The current level of development of data analysis technologies opens up broad horizons for medicine in solving problems on real medical data, without translating them into scoring risk scales, including prediction of the diagnosis of the disease, stage of the disease, treatment outcome, possible complications, etc. High reliability of such systems can be provided by large volumes of medical data accumulated on servers.

Hybrid cardiac rehabilitation trial (HYCARET): protocol of a randomised, multicentre, non-inferiority trial in South America

IntroductionCardiac rehabilitation (CR) programmes are well established, and their effectiveness and cost-effectiveness are proven. In spite of this, CR remains underused, especially in lower-resource settings such as Latin America. There...

TIMI risk score for secondary prevention of recurrent cardiovascular events in a real-world cohort of post-non-ST-elevation myocardial infarction patients

BackgroundPatients who survive non-ST-elevation myocardial infarction (NSTEMI) are at heightened risk of recurrent cardiovascular events. Data on long-term secondary atherothrombotic risk stratification are limited.ObjectivesTo stratify post-NSTEMI patients for risk of...

Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention of Recurrent Cardiovascular Events in a Real-World Cohort of Post-Acute Myocardial Infarction Patients.

Patients who survive myocardial infarction (MI) are at risk of recurrent cardiovascular (CV) events. This study stratified post-MI patients for risk of recurrent CV events using the Thrombolysis in Myocardial Infarction (TIMI) Risk Score for Secondary Prevention (TRS 2°P). Methods and Results: This was an observational study that applied TRS 2°P to a consecutive cohort of post-MI patients. The primary outcome was a composite endpoint of CV death, non-fatal MI, and non-fatal ischemic stroke. A total of 1,688 post-MI patients (70.3±13.6 years; male, 63.1%) were enrolled. After a mean follow-up of 41.5±34.4 months, 405 patients (24.0%) had developed a primary outcome (9.3%/year) consisting of 278 CV deaths, 134 non-fatal MI, and 33 non-fatal strokes. TRS 2°P was strongly associated with the primary outcome. The annual incidence of primary composite endpoint for patients with TRS 2°P 0 was 1.0%, and increased progressively to 39.9% for those with TRS 2°P ≥6 (HR, 27.6; 95% CI: 9.87-77.39, P<0.001). The diagnostic sensitivity of TRS 2°P for the primary composite endpoint was 76.3% (95% CI: 72.1-80.5%). Similar associations were also observed between TRS 2°P and CV death and non-fatal MI, but not non-fatal ischemic stroke. TRS 2°P reliably stratified post-MI patients for risk of future CV events.

Cost-effectiveness of Canakinumab for Prevention of Recurrent Cardiovascular Events

In the Canakinumab Anti-inflammatory Thrombosis Outcome Study (CANTOS) trial, the anti-inflammatory monoclonal antibody canakinumab significantly reduced the risk of recurrent cardiovascular events in patients with previous myocardial infarction (MI) and high-sensitivity C-reactive protein (hs-CRP) levels of 2 mg/L or greater. To estimate the cost-effectiveness of adding canakinumab to standard of care for the secondary prevention of major cardiovascular events over a range of potential prices. A state-transition Markov model was constructed to estimate costs and outcomes over a lifetime horizon by projecting rates of recurrent MI, coronary revascularization, infection, and lung cancer with and without canakinumab treatment. We used a US health care sector perspective, and the base case used the current US market price of canakinumab of $73 000 per year. A hypothetical cohort of patients after MI aged 61 years with an hs-CRP level of 2 mg/L or greater was constructed. Canakinumab, 150 mg, administered every 3 months plus standard of care compared with standard of care alone. Lifetime costs and quality-adjusted life-years (QALYs), discounted at 3% annually. Adding canakinumab to standard of care increased life expectancy from 11.31 to 11.36 years, QALYs from 9.37 to 9.50, and costs from $242 000 to $1 074 000, yielding an incremental cost-effectiveness ratio of $6.4 million per QALY gained. The price would have to be reduced by more than 98% (to $1150 per year or less) to meet the $100 000 per QALY willingness-to-pay threshold. These results were generally robust across alternative assumptions, eg, substantially lower health-related quality of life after recurrent cardiovascular events, lower infection rates while receiving canakinumab, and reduced all-cause mortality while receiving canakinumab. Including a potential beneficial effect of canakinumab on lung cancer incidence improved the incremental cost-effectiveness ratio to $3.5 million per QALY gained. A strategy of continuing canakinumab selectively in patients with reduction in hs-CRP levels to less than 2 mg/L would have a cost-effectiveness ratio of $819 000 per QALY gained. Canakinumab is not cost-effective at current US prices for prevention of recurrent cardiovascular events in patients with a prior MI. Substantial price reductions would be needed for canakinumab to be considered cost-effective.

P5554TIMI risk score for secondary prevention of recurrent cardiovascular events in a real world cohort of post acute ST-elevation myocardial infarction patients

P5554TIMI risk score for secondary prevention of recurrent cardiovascular events in a real world cohort of post acute ST-elevation myocardial infarction patients

P1727TIMI risk score for secondary prevention of recurrent cardiovascular events in a real world cohort of post acute non-ST-elevation myocardial infarction patients

P1727TIMI risk score for secondary prevention of recurrent cardiovascular events in a real world cohort of post acute non-ST-elevation myocardial infarction patients

Combination Lipid-Lowering Therapies for the Prevention of Recurrent Cardiovascular Events.

There has been confusion following the 2013 American College of Cardiology/American Heart Association (ACC/AHA) Lipid guidelines on the role of non-statin medications for cardiovascular prevention. Several recent large trials have also now shown that lowering LDL with non-statins reduces cardiovascular events. In ASCVD patients on statins, adding ezetimibe or a PCSK9 inhibitor led to reductions in CV events in the IMPROVE IT, FOURIER, and most recently the ODYSSEY-OUTCOMES trials. Additional novel therapies reducing LDL and other atherogenic lipoproteins are in development during this exciting time in this field. With recent evidence, the 2017 ACC Expert Consensus Decision pathway calls for initial therapy with statins, monitoring LDL levels, and then adding ezetimibe and/or PCSK9 inhibitors to further lower LDL-C to targets based on the patient's risk.

Interventions for improving modifiable risk factor control in the secondary prevention of stroke.

People with stroke or transient ischaemic attack (TIA) are at increased risk of future stroke and other cardiovascular events. Stroke services need to be configured to maximise the adoption of evidence-based strategies for secondary stroke prevention. Smoking-related interventions were examined in a separate review so were not considered in this review. This is an update of our 2014 review. To assess the effects of stroke service interventions for implementing secondary stroke prevention strategies on modifiable risk factor control, including patient adherence to prescribed medications, and the occurrence of secondary cardiovascular events. We searched the Cochrane Stroke Group Trials Register (April 2017), the Cochrane Effective Practice and Organisation of Care Group Trials Register (April 2017), CENTRAL (the Cochrane Library 2017, issue 3), MEDLINE (1950 to April 2017), Embase (1981 to April 2017) and 10 additional databases including clinical trials registers. We located further studies by searching reference lists of articles and contacting authors of included studies. We included randomised controlled trials (RCTs) that evaluated the effects of organisational or educational and behavioural interventions (compared with usual care) on modifiable risk factor control for secondary stroke prevention. Four review authors selected studies for inclusion and independently extracted data. The quality of the evidence as 'high', 'moderate', 'low' or 'very low' according to the GRADE approach (GRADEpro GDT).Three review authors assessed the risk of bias for the included studies. We sought missing data from trialists.The results are presented in 'Summary of findings' tables. The updated review included 16 new studies involving 25,819 participants, resulting in a total of 42 studies including 33,840 participants. We used the Cochrane risk of bias tool and assessed three studies at high risk of bias; the remainder were considered to have a low risk of bias. We included 26 studies that predominantly evaluated organisational interventions and 16 that evaluated educational and behavioural interventions for participants. We pooled results where appropriate, although some clinical and methodological heterogeneity was present.Educational and behavioural interventions showed no clear differences on any of the review outcomes, which include mean systolic and diastolic blood pressure, mean body mass index, achievement of HbA1c target, lipid profile, mean HbA1c level, medication adherence, or recurrent cardiovascular events. There was moderate-quality evidence that organisational interventions resulted in improved blood pressure control, in particular an improvement in achieving target blood pressure (odds ratio (OR) 1.44, 95% confidence interval (CI) 1.09 to1.90; 13 studies; 23,631 participants). However, there were no significant changes in mean systolic blood pressure (mean difference (MD), -1.58 mmHg 95% CI -4.66 to 1.51; 16 studies; 17,490 participants) and mean diastolic blood pressure (MD -0.91 mmHg 95% CI -2.75 to 0.93; 14 studies; 17,178 participants). There were no significant changes in the remaining review outcomes. We found that organisational interventions may be associated with an improvement in achieving blood pressure target but we did not find any clear evidence that these interventions improve other modifiable risk factors (lipid profile, HbA1c, medication adherence) or reduce the incidence of recurrent cardiovascular events. Interventions, including patient education alone, did not lead to improvements in modifiable risk factor control or the prevention of recurrent cardiovascular events.

Contemporary Drug Treatment of Hypertension: Focus on Recent Guidelines.

The 2017 American College of Cardiology/American Heart Association hypertension guidelines diagnose hypertension if systolic blood pressure (SBP) is ≥ 130mmHg or diastolic blood pressure (DBP) is ≥ 80mmHg. Increased BP is SBP 120-129mmHg with DBP < 80mmHg. Lifestyle measures should be used to treat individuals with increased BP. Lifestyle measures plus BP-lowering drugs should be used for secondary prevention of recurrent cardiovascular events in individuals with clinical cardiovascular disease (coronary heart disease, congestive heart failure, or stroke) and an average SBP ≥ 130mmHg or an average DBP ≥ 80mmHg. Lifestyle measures plus BP-lowering drugs should be used for primary prevention of cardiovascular disease in individuals with an estimated 10-year risk of atherosclerotic cardiovascular disease (ASCVD) ≥ 10% and an average SBP ≥ 130mmHg or an average DBP ≥ 80mmHg. Lifestyle measures plus BP-lowering drugs should be used for primary prevention of cardiovascular disease in individuals with an estimated 10-year risk of ASCVD < 10% and an average SBP ≥ 140mmHg or an average DBP ≥ 90mmHg. White coat hypertension must be excluded before starting antihypertensive drug treatment in individuals with hypertension with a low risk for ASCVD. BP should be lowered to < 130/80mmHg in patients with coronary heart disease, heart failure, or chronic kidney disease; after renal transplantation; for secondary stroke prevention; in lacunar stroke, peripheral arterial disease, and diabetes mellitus; and in ambulatory community-dwelling adults aged > 65years. The selection of antihypertensive drug treatment is discussed.

Abstract TP390: Tetrad Therapy With Antiplatelets, Antihypertensives, High Intensity Statins and a PCSK9 Inhibitor Reduces Vascular Events in Patients With a History of Stroke

Background: The mainstay of medical secondary prevention of recurrent vascular events in patients with an index stroke of atherosclerotic origin has been the triad of 1) antiplatelet (AP), 2) antihypertensive (aHTN), and 3) high intensity statin agents. The PCSK9 inhibitors (-i) are a new class of cholesterol reducers. Recently, the FOURIER trial demonstrated that Evolocumab, a PCSK9-i, confers additional benefit in reducing recurrent vascular events. Indices of the degree of this additional benefit would be helpful to patients, physicians, and payers. Methods: Vascular event rates were extracted for patients with a history of stroke from the FOURIER database. We compared event rates versus those of established medical therapies. Results: Vascular events over 3 years in patients with an index stroke were reduced with a PCSK9-i (7.26%) versus control (8.87%) (RR 0.83,95% CI 0.69-1.0), resulting in a NNT of 62. Risk ratios were comparable to the established triad of medical therapies: antiplatelets (RR 0.83,CI 0.79-0.88), antihypertensives (RR 0.91,CI 0.87-0.96) and high intensity statins (RR 0.81,CI 0.71-0.92). Vascular event rates were lower with each sequential addition of medical intervention (AP 22.1%, AP+aHTN 17.1%, AP+aHTN+Statin 9.01%), down to 7.26% with tetrad therapy (triad therapy plus a PCSK9-i). Standard triad therapy results in a 66% reduction in vascular events while tetrad therapy results in a 73% reduction. Conclusions: In patients with an index stroke of atherosclerotic origin, tetrad therapy results in a 73% reduction of vascular events to a 3 year event rate of 7.26%. The magnitude of additional benefit with a PCSK9-i is comparable to established medical therapies and may be considered as part the medical armamentarium for the prevention of recurrent cardiovascular events in this high risk population.

Les anticoagulants oraux directs dans la maladie coronaire

Antiplatelet therapy is essential for the prevention of recurrent cardiovascular events in stable and unstable coronary artery disease. Oral anticoagulants have been rarely used for treatment of coronary artery disease. The new direct oral anticoagulants offer various molecules and dosages and may be used in coronary artery disease. Dedicated studies are currently being conducted to confirm the optimal doses and the ideal association of antithrombotic drugs in different settings of coronary artery disease.

Cost-effectiveness of a text message programme for the prevention of recurrent cardiovascular events

ObjectiveTo estimate the cost-effectiveness of Tobacco, Exercise and Diet Messages (TEXT ME), a text message-based intervention that provides advice, motivation, information and support to improve health-related behaviours.MethodsA lifetime Markov model...