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Authors of the study say their study does not rule out a role for ankle/brachial index screening in the clinic or for other CVD drugs to reduce risk in asymptomatic subjects. But for aspirin and for populationwide screening, the study raises some questions.
Edinburgh, UK - Results of the Aspirin for Asymptomatic Atherosclerosis (AAA) trial,showing no reduction in vascular events in asymptomatic subjects with a low ankle/brachial index (ABI) randomized to daily aspirin, have now been published in the March 3, 2010 issue of the Journal of the American Medical Association [1]. First presented at the ESC 2009 meeting and reported there by heartwire, the trial adds to mounting evidence that the risks of aspirin may outweigh its benefits in people without established cardiovascular disease.
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Inside: Acute Coronary Syndromes
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supported by industry, developed by theheart.org
CHAMPION, PLATO, and OPTIMUS were among the trials featured at AHA. Read Dr. Prasad's review and watch presentations by Drs. Angiolillo, Gurbel, Harrington, and Storey.
Drs Toth and McPherson discuss the importance of collaboration between PCPs and cardiologists in managing patients with ACS to decrease adverse outcomes and mortality. They review the ACC/AHA guidelines for appropriate length of therapy, risk factor reduction, and medication use before and after interventions.
Dr. Gabriel Steg introduces a discussion between Drs. Anthony Gershlick and Martial Hamon on achieving a balance between favorable outcomes and reducing bleeding in STEMI patients.
Our international panel of experts, Drs. Hamm, Verheugt, Dauerman, and Rao, give their insights into which antiplatelet and antithrombotic agents they prefer to use and when.
Join Drs. Alexander, Becker, and Weitz for a discussion on the coagulation cascade, its link to platelet function, and the risk/benefit and clinical utility of agents that target the coagulation cascade and platelet receptors.
Recently reported and new trials of antiplatelet therapy continue to redefine optimal management strategies for patients with atherothrombotic disease and patients with atrial fibrillation. Drs. Harrington, Angiolillo, Bhatt, Connolly, Mehta, and Simon discuss guidelines? recommendations for the use of antiplatelet therapies and the potential impact of emerging data regarding currently used and novel antiplatelet agents.
In the US, each year over 1.4 million people will be hospitalized for unstable angina (UA) and non-ST-segment-elevation myocardial infarction (NSTEMI). Multiple antiplatelet agents have been developed to interfere with or inhibit the specific pathways of platelet activation and aggregation that lead to the development of UA and NSTEMI. Join Drs Newby, Popma, and Wiviot as they discuss.
What Happened at ESC 2009? The Perspective From DUKE Heart Center and DUKE Clinical Research Institute Drs. Rao, Alexander, Newby, and O?Connor discuss RE-LY, PLATO, and MADIT-CRT.
Cardiologists here at the ACC meeting were confused by a new analysis of PLATO, this time in ACS patients who subsequently underwent CABG surgery. Those in the ticagrelor group were 50% less likely to die, despite the fact that there was no difference in bleeding or MIs between these patients and those who got clopidogrel. The investigator admitted he didn't have the answers, and further analyses "are ongoing."
Adding cilostazol to clopidogrel and aspirin did not significantly reduce event rates, but it did improve posttreatment platelet reactivity in the CILON-T trial, and the study was underpowered for hard clinical events.
A host of new analyses published in the Lancet journals, some of which were also reported at the ACC meeting, suggest that variability in blood pressure is a much stronger determinant of both stroke and coronary disease outcome than average blood pressure. And calcium-channel blockers have the strongest effect of all antihypertensives on reducing BP variability, say the researchers.
Several experts have questioned why the FDA has issued a warning about poor metabolizers of clopidogrel when there are no firm data about what to do for these patients.
UPDATED // Cardiologists of every stripe are eager for any new information on just how long their patients should be taking dual antiplatelet therapy after receiving a drug-eluting stent. But the REAL-LATE/ZEST-LATE analysis seems to provide more questions than answers. The question everyone now seems to be asking now is, so what?
UPDATED // The standard heart-rate target of <80 bpm doesn't lead to better clinical outcomes and is harder to achieve than a target of <110 bpm, a prospective randomized trial found.
A more aggressive routine invasive strategy is clearly better than a conservative selective invasive strategy for all patients with non-ST-elevation acute coronary syndromes, a new meta-analysis shows. And the highest-risk patients had the most to gain, indicating that risk stratification is crucial, says the lead researcher.
The ACCORD BP study shows that there is no benefit to be gained from intensively lowering systolic blood pressure to less than 120 mm Hg in type 2 diabetics; for now, a goal of <140 mm Hg seems reasonable in this population, say the authors.
Despite looking fit and healthy, a third of firefighters examined in a new study were at high risk of a thrombotic event, and improving their fitness is more likely to reduce this risk than tackling excess body weight, say the researchers.
The warning will inform clinicians that tests are available to predict whether a patient will convert the drug to its active form based on the genetic profile of a key liver enzyme.
Either a sirolimus-eluting stent or a paclitaxel-eluting stent are suitable choices for treating in-stent restenosis of a sirolimus-eluting stent. Whether plain old or drug-eluting-balloon angioplasty might also work remains an open question.
The Heart of a Woman
Primary and Secondary Prevention of CVD and Stroke in Women
The role of lipids in women for primary prevention of cardiovascular disease is a challenging issue for all providers. Join Drs. Foody, Mora, and Welty as they discuss limitations to current risk stratification models, recent clinical trial data, and the changing paradigm in the management of lipids in women.
Primary and Secondary Prevention of CVD and Stroke in Women
We know there are sex and biological differences in the manifestation of CVD. How do these pathophysiological differences affect the diagnosis and treatment of our female patients? Drs. Hayes, Johnson, Manson, and Piña provide their insight.
Do gender perceptions affect the way female physicians are treated in cardiology? Drs Melissa Walton-Shirley, Judith Hochman, Suzanne Oparil, and Lynne Warner Stevenson tackle this important question.
Studies suggest public smoking bans reduce the incidence of acute MI. So why is America not smoke-free? Dr Melissa Walton-Shirley discusses this important issue with the AHA's Nancy Brown and Dr Clyde Yancy.