Cardiology News
Calcium supplements may raise risk of heart attack
Calcium supplements, which many people consume hoping to ward off osteoporosis, may increase the risk of heart attack by as much as 30 percent, researchers reported Friday. These tiny tablets which carry concentrated doses of calcium were also associated with higher incidences of stroke and death, but they were not statistically significant.
Predictive Value of Plasma Fibrinogen Levels in Patients Admitted for Acute Coronary Syndrome
In recent years, researchers have investigated the relationship between biological markers of inflammation and prognosis in patients who experience acute coronary syndromes; however, the association between plasma fibrinogen and coronary heart disease is still not clear. This article studied the prognostic value of fibrinogen, an acute-phase protein that is directly involved in thrombotic processes, by measuring plasma fibrinogen levels serially in 136 patients who had acute coronary syndromes, 142 patients who had stable coronary heart disease, and 82 healthy control participants. Plasma fibrinogen levels were significantly higher in the patients with acute coronary syndromes than in the patients with stable coronary heart disease and the control group. It was also found that significantly higher plasma fibrinogen levels in patients who developed clinical events than in those who did not, at 30 days and 2 years.
Early Outcomes of Radial Artery Use in All-Arterial Grafting of the Coronary Arteries in Patients 65 Years and Older
retrospectively evaluated early clinical results of coronary revascularization using none but arterial grafts in patients aged 65 years and older. The cases of 449 consecutive patients who had undergone isolated myocardial revascularization were divided into 2 groups: the arterial conduit group (n=107) received a left internal mammary artery (LIMA) graft and 1 or both radial arteries (RAs), while the mixed-conduit group (n=342) received a LIMA graft and 1 or more saphenous vein grafts (SVGs), with or without an RA. Overall myocardial revascularization using all arterial grafts (at least 50% RAs) in patients aged 65 years and older is safe and reliable, produces short-term results equal to those of saphenous vein grafting, and can reduce graft-harvest-site infections.
Advisory panel votes to recommend FDA approval of ticagrelor
The FDA Cardiovascular and Renal Drugs Advisory Committee voted to recommend approval of antiplatelet drug ticagrelor (Brilinta, AstraZeneca) for preventing thrombotic events in patients with acute coronary syndrome. The panel voted seven to one in favor of approving the drug for patients with either ST-elevation-MI or unstable angina/non-ST-elevation MI who will be treated with PCI and then voted seven to one again in favor of STEMI/NSTEMI patients who will be treated with medical management.
Overtime work increases the incident of coronary heart disease
This article examined the association between overtime work and incident coronary heart disease (CHD) among middle-aged employees. It followed Six thousand and fourteen British civil servants (4262 men and 1752 women), aged 39–61 years who were free from CHD and worked full time at baseline (1991–1994), were followed until 2002–2004, an average of 11 years. The outcome measure was incident fatal CHD, clinically verified incident non-fatal myocardial infarction (MI), or definite angina (a total of 369 events). It found that overtime work is related to increased risk of incident CHD independently of conventional risk factors, suggesting that overtime work adversely affects coronary health.
Dronedarone in patients with congestive heart failure
Dronedarone is a new multichannel blocking antiarrhythmic drug for treatment of atrial fibrillation (AF). In patients with recently decompensated congestive heart failure (CHF) and depressed LV function, the drug was associated with excess mortality compared with a placebo group. The present study aimed to analyse in detail the effects of dronedarone on mortality and morbidity in AF patients CHF. It showed that patients with AF and stable CHF, dronedarone did not increase mortality and showed a reduction of CV hospitalization or death similar to the overall population. However, in the light of the ANtiarrhythmic trial with DROnedarone in Moderate to severe CHF Evaluating morbidity DecreAse study, dronedarone should be contraindicated in patients with NYHA class IV or unstable NYHA classes II and III CHF.
Non-culprit coronary artery percutaneous coronary intervention during acute ST-segment elevation myocardial infarction
This article examined the incidence of and propensity for non-culprit interventions performed at the time of the primary percutaneous coronary intervention (PCI) and its association with 90-day outcomes. Overall it found that non-culprit coronary interventions were performed at the time of primary PCI in 10% of MVD patients and were significantly associated with increased mortality. This data supports current guideline recommendations discouraging the performance of such procedures in stable primary PCI patients. Prospective randomized study of this issue may be warranted.
Detection of Aortic Regurgitation with 64-slice Multidetector Computed Tomography (MDCT)
An article in this months Academic Radiology sought to determine the diagnostic accuracy of 64-row multidetector cardiac computed tomography (MDCT) in detecting aortic regurgitation (AR) on prospectively acquired images with trans-thoracic echocardiography (TTE) as a reference standard. The sensitivity, specificity, positive predictive value, and negative predictive value of MDCT were 100%, 85.7%, 93.5%, and 100%, respectively, showing that MDCT data acquired for the coronary artery evaluation can be used for the detection of aortic regurgitation with high diagnostic accuracy without additional scanning or radiation and can support appropriate referral for TTE.
Routine Fractional Flow Reserve Measuremnet During Angiography for Guiding Percutaneous Coronary Intervention Shows Benefit at 2 Years
In patients with multivessel CAD undergoing PCI, coronary angiography is the standard method for guiding stent placement. The FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) study showed that routine FFR in addition to angiography improves outcomes of PCI at 1 year. It is unknown if these favorable results are maintained at 2 years of follow-up. The purpose of this study was to investigate the 2-year outcome of percutaneous coronary intervention (PCI) guided by fractional flow reserve (FFR) in patients with multivessel coronary artery disease (CAD).The results showed that routine measurement of FFR in patients with multivessel CAD undergoing PCI with drug-eluting stents significantly reduces mortality and myocardial infarction at 2 years when compared with standard angiography-guided PCI.
Cardiovascular Risk in Clopidogrel-Treated Patients According to Cytochrome P450 2C19*2 Loss-of-Function Allele or Proton Pump Inhibitor Coadministration
The aim of this study was to assess the association between the loss-of-function cytochrome P450 2C19 (CYP2C19)*2 variant (10 studies, 11,959 patients) or the use of proton pump inhibitors (PPIs) (13 studies, 48,674 patients) and ischemic outcomes (major adverse cardiovascular events [MACE]) in patients treated with clopidogrel. Of the 11,959 patients, carriers of the loss-of-function CYP2C19*2 allele (28% [n = 3,418]) displayed a 30% increase in the risk for MACE compared with noncarriers, this single gene variant was also associated with an excess of mortality and of stent thrombosis. This increased risk was apparent in both heterozygotes and homozygotes and was independent of the baseline cardiovascular risk. PPI users displayed increased risk for MACE and mortality compared with nonusers. The impact of PPI use was, however, significantly influenced by baseline cardiovascular risk, being significant only in high-risk patients.
QT Prolongation Is an Independent Predictor of Mortality in End-Stage Renal Disease
Coronary artery disease (CAD) is the predominant cause of sudden cardiac death in the general population, and sudden cardiac death is the leading cause of mortality in end-stage renal disease (ESRD) and evaluated whether or not QT-interval prolongation is an independent prognosticator in ESRD.
This study found that during 40 ± 28 months of follow-up, 132 of the 280 (47%) patients died prior to renal transplantation. Patients with a prolonged QTc (39%) had 1-, 3-, and 5-year death-rates of 12%, 36%, and 47%, respectively, vs 8%, 24%, and 36% for those with normal QTc showing
that QTc prolongation is an independent predictor of mortality in ESRD patients being evaluated for renal transplantation. The prognostic information gained from the QTc is additive to that provided by the LVEF and the severity of CAD.
The Prognostic Importance of Isolated P-Wave Abnormalities
While certain P-Wave morphologies have been associated with abnormal atrial size and either pulmonary or cardiovascular (CV) disease, their relationship to mortality and specific cause of death has not been reported. This study found that P-wave amplitude in the inferior leads is the strongest independent predictor of pulmonary death while P-wave duration and the depth of P-wave inversion in leads V1 or V2 significantly predict CV death. These measurements can be obtained easily and should be considered as part of clinical risk stratification.
Left Main Disease Treated With Either Percutaneous Coronary Intervention Using Paclitaxel-Eluting Stents or Coronary Artery Bypass Graft Treatment
Contemporary consensus treatment guidelines continue to recommend coronary artery bypass grafting (CABG) as the "gold standard" for revascularization of unprotected left main (LM) stenosis but note that percutaneous coronary intervention (PCI) is feasible; for example, the American College of Cardiology/American Heart Association PCI guidelines recently upgraded LM PCI from a class III to class IIb (level B) recommendation. In the absence of a large randomized controlled trial, interventional cardiologists have had difficulty developing objective evidence-based criteria for determining the optimal revascularization strategy for a given patient. The Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) trial is the first large trial to randomize patients suitable for revascularization by either CABG or PCI using drug-eluting stents for the treatment of LM and/or 3-vessel disease. This article presents outcomes in the prespecified subgroup of patients (N=705) with LM disease. Patients with LM disease had comparable overall 12-month major adverse cardiovascular and cerebrovascular events in both the PCI and the CABG group (14% CABG versus 16% PCI). When patients were scored for anatomic complexity, those with higher baseline SYNTAX scores had significantly worse outcomes with PCI than those with low or intermediate SYNTAX scores; outcomes for patients with CABG did not correlate with baseline SYNTAX score. Thus, this short-term (1-year) analysis suggests that patients with LM disease who have low or intermediate SYNTAX scores may be safely treated with either PCI or CABG, but longer follow-up is needed.
Cardiac Origins of the Postural Orthostatic Tachycardia Syndrome
The purpose of this study was to test the hypothesis that a small heart coupled with reduced blood volume contributes to the postural orthostatic tachycardia syndrome (POTS) and that exercise training improves this syndrome. It is known that patients with POTS have marked increases in heart rate during orthostasis. However, the underlying mechanisms are unknown and the effective therapy is uncertain. This study found that autonomic function was intact in POTS patients. The marked tachycardia during orthostasis was attributable to a small heart coupled with reduced blood volume. Exercise training improved or even cured this syndrome in most patients. It seems reasonable to offer POTS a new name based on its underlying pathophysiology, the "Grinch syndrome," because in this famous children's book by Dr. Seuss, the main character had a heart that was "two sizes too small."
Moderate Alcohol Drinkers After Acute Myocardial Infarction Proves Beneficial
Light-to-moderate alcohol consumption has been previously associated with a lower risk of acute myocardial infarction (AMI) and mortality. The association of changes in drinking behavior after an AMI with health status and long-term outcomes is unknown. Using a prospective cohort of patients with AMI evaluated with the World Health Organization's Alcohol Use Disorders Identification Test, they investigated changes in drinking patterns in 325 patients who reported moderate drinking at the time of their AMI. The data suggested that there are no adverse effects for moderate drinkers to continue consuming alcohol and that they may have better physical functioning compared to those who quit drinking after an AMI.
Testosterone administration improves myocardial ischemia, lipid metabolism and insulin resistance in elderly male diabetic patients with coronary artery disease
The evidence of antiatherogenic and vasodilatatory effects of testosterone (T) suggest a possible role of the lack of this hormone in the development and pathophysiology of coronary artery disease (CAD). The aim of the present study was to evaluate the effects of oral administration of testosterone undecanoate during a period of three months on serum lipid levels and on the occurrence of anginal attacks and daily ischemic episodes in patients with CAD. Overall it found that three months administration of T has beneficial effect on serum cholesterol and triglyceride levels in patients with CAD and reduces the number of anginal attacks, and ischemic episodes. These effect may be related to the metabolic and vasoactive properties of the hormone.
Diclofenac: Similar CV risk to rofecoxib in healthy people
The first study to examine the cardiovascular risk associated with nonsteroidal anti-inflammatory drugs (NSAIDs) in healthy individuals has found increased morbidity and mortality with diclofenac, rofecoxib (Vioxx, Merck), and high doses of ibuprofen [1]. Naproxen, in contrast, has a safer cardiovascular risk profile, say Dr Emil Loldrup Fosbøl and colleagues in their paper published online June 8, 2010 in Circulation: Cardiovascular Quality and Outcomes. The increased cardiovascular morbidity and mortality seen with diclofenac, which is similar to that observed with rofecoxib—a drug that was withdrawn from the market in 2004 because of poor cardiovascular safety—is particularly concerning, Fosbøl told heartwire.
Allopurinol proves useful for angina
Researchers from the University of Dundee said that studies on allopurinol, a generic gout drug, showed it helped people suffering from angina to exercise more and delayed the time until their chest pain started. Allan Struthers of the University of Dundee and a team of fellow scientists asked 65 patients with chronic angina to exercise on a treadmill after treating some of them with allopurinol and others with a dummy pill, or placebo.The results of the study were published in The Lancet medical journal on Tuesday.Those who had the real drug were able to walk for 25 percent longer than those on placebo before they complained of chest pain. And electrical recordings of the patients' hearts showed that allopurinol enabled the heart to work for longer before showing signs of oxygen deprivation.
Pulmonary Monitor a Winner by All Measures
Among heart failure patients with moderate to severe disease, six months of monitoring with an investigational implantable sensor that measures pulmonary artery pressure was associated with a 30% relative risk reduction in hospitalizations for heart failure, researchers here reported. After six months there were 83 hospitalizations for heart failure among the 270 patients randomized to treatment guided by hemodynamic measurements from the CardioMems Heart Sensor, compared with 120 heart failure hospitalizations in the 280-patient control arm (P<0.001), said William T. Abraham, MD, of Ohio State University.
β-Blockers for Chest Pain Associated With Recent Cocaine Use
Although β-blockers prevent adverse events after myocardial infarction, they are contraindicated when chest pain is associated with recent cocaine use. Recommendations against this use of β-blockers are based on animal studies, small human experiments, and anecdote. This article in the Archives of Internal Medicine tested the hypothesis that β-blockers are safe in this setting and found of 331 patients with chest pain in the setting of recent cocaine use, 151 (46%) received a β-blocker in the emergency department. There were no meaningful differences in electrocardiographic changes, troponin levels, length of stay, use of vasopressor agents, intubation, ventricular tachycardia or ventricular fibrillation, or death between those who did and did not receive a β-blocker. It also found that over a median follow-up of 972 days , after adjusting for potential confounders, patients discharged on a β-blocker regimen exhibited a significant reduction in cardiovascular death.
Home-Measured Blood Pressure Is a Stronger Predictor of Cardiovascular Risk Than Office Blood Pressure
Previous studies with some limitations have provided equivocal results for the prognostic significance of home-measured blood pressure (BP). An article in the Journal Hypertension investigated whether home-measured BP is more strongly associated with cardiovascular events and total mortality than is office BP. The findings suggest that home-measured BP is prognostically superior to office BP. On the basis of the results of this and previous studies, it can be concluded that home BP measurement offers specific advantages more than conventional office measurement.
Tachycardia predicts CV events in VALUE
Baseline and in-trial tachycardia are strong, independent predictors of cardiovascular events in patients with high-risk hypertension, a new analysis of the Valsartan Antihypertensive Long-Term Use Evaluation (VALUE) trial has shown [1]. Risk seems to be particularly increased in those with a heart rate (HR) of >80 beats per minute (bpm), Dr Stevo Julius (University of Michigan Cardiovascular Center, Ann Arbor), told a late-breaking clinical-trials session at the American Society of Hypertension (ASH) 2010 Scientific Meeting last week.
P-Wave Duration Predicts Myocardial Ischemia During Exercise Testing
It is well recognized that ST-segment depression is due to subendocardial ischemia secondary to an increase in left ventricular end-diastolic pressure. The increase in left ventricular end-diastolic pressure is associated with increased left atrial pressure, resulting in left atrial wall distension that contributes to increasing P-wave duration (PWD). The objective of this study was to determine if PWD measured in leads II and V5 during maximum exercise stress testing could be a reliable predictor of myocardial ischemia. ΔPWD had sensitivity of 72%, specificity of 82%, negative predictive power (NPP) of 90%, and positive predictive power of 57% while ST-segment change had sensitivity of 34%, specificity of 87%, NPP of 80%, and positive predictive power of 47%. When ΔPWD and ST changes were combined, sensitivity increased to 79% and NPP increased to 91%.
Plasma homocysteine and cardiovascular risk in heart failure with and without cardiorenal syndrome
Plasma homocysteine (Hcy) has been associated with an increased cardiovascular (CV) risk in patients with chronic heart failure (CHF). An article in the International Journal of Cardiology investigated whether Hcy has a prognostic impact on CV events in CHF-patients with and without cardiorenal syndrome (CRS). 161 patients with CHF were included in the present analysis. 94 patients had systolic (SD) (EF <
40%) and 67 diastolic (DD) dysfunction (EF≥40%). Homocysteine is significantly increased in patients with CHF (20±7 µmol/l). The increase correlates not only with the severity of the disease (NYHA, EF, VO2max), but also with various metabolic (BNP, uric acid) and nephrologic parameters (creatinine, creatinine clearance). During follow-up (23±37 months), patients with the highest homocysteine (≥20 µmol/l) passed away more often (p<0.035) or decompensated more frequently (p<0.004) than those with a low Hcy. In patients with CRS the rate of decompensation was significantly higher than in those without CRS (p<0.0007).
Subgroup analysis from ACCORD BP prompts more debate on hypertension targets
Delving deeper into the findings of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) BP study reveals that certain subgroups may benefit more from intensive BP lowering because they are at higher absolute risk of stroke. Among these are the elderly, African Americans, and those with prior cardiovascular disease, said Dr William C Cushman (Veterans Affairs Medical Center, Memphis, TN), who presented the new data at a late-breaking clinical-trials session at the American Society of Hypertension (ASH) 2010 Scientific Meeting.
Risk Factors for Venous Thromboembolism
Studies have suggested a link between risk factors for atherosclerotic disease and venous thromboembolism (VTE), but results are heterogeneous. An article in Circulation sought to identify risk factors for VTE with a focus on risk factors for atherosclerotic disease. Data were taken from the Copenhagen City Heart Study, a prospective cohort study of a random, age-stratified sample of people living in a defined area in Copenhagen, Denmark, started in 1976 with follow-up until 2007. Out of all the different variables such as diabetes, gender, ect, it was shown that obesity and smoking were both found to be important risk factors for VTE whereas total/high-density lipoprotein/low-density lipoprotein cholesterol levels, triglyceride levels, and diabetes mellitus were not.
Anabolic steroid users may face heart trouble
While it's nothing new that steroids have bad health effects, the new findings show they may be more harmful than previously thought. In heart failure, a weakened heart can't pump enough blood around the body.The researchers measured the recruits' heart function using ultrasound. Among the 12 steroid users, 10 turned out to have hearts that pumped less blood into the body than they should. In contrast, only one of the seven non-users had this problem. "That is a stunning statistical difference, far greater that could possibly be explained by chance," Pope told Reuters Health. "The heart becomes more flappy and cannot contract with the same force as it usually does, and it also becomes less flexible."
Ace Inhibitors Help in Amiodarone Induced Toxicity
Amiodarone (AMD) is a strong antiarrhythmic drug but has severe side effects such as pulmonary toxicity. There are no indicators or drugs that can prevent the development of amiodarone-induced pulmonary toxicity (AIPT). An article out of the International Journal of Cardiology investigated this and the results indicate that Ang II induced by CHF increases the risk of AMD-induced pulmonary toxicity. An angiotensin-converting enzyme inhibitor or ARB should be given at a sufficient dose during AMD treatment.
BNP Improves with Excercising
BNP and the N-terminal portion (NT-pro-BNP) have emerged as powerful tools in the diagnosis and prognosis of heart failure on acute presentation. An article out of the International Journal of Cardiology systematically reviewed the effect of exercise training on BNP and NT-pro-BNP levels in patients with left ventricular dysfunction. Nine randomized controlled studies measuring BNP or NT-pro-BNP met our eligibility criteria. Exercise training had a favourable effect on BNP (mean difference −79 pg/ml 95% C.I. −141 to − 17 pg/ml, P=0.01) and NT-pro-BNP (mean difference −621 pg/ml, 95% C.I. −844 to −398 pg/ml, P=<0.00001). Moreover the trials that showed a significant change in NT-pro-BNP all had a weekly exercise energy expenditure of more than 400 Kcal.
Angiotensin-Converting Enzyme Inhibition Decreases One-Year Mortality and Frequency of Repeat Acute Myocardial Infarction in Patients With Acute Myocardial Infarction
Controversy exists regarding whether all patients with acute myocardial infarction (AMI) benefit from angiotensin-converting enzyme inhibitors (ACEIs). A Journal in the American Journal of Cardiology examined the association between ACEI treatment and mortality in a large, unselected population of patients with AMI. The present study included 105,224 patients with AMI who were not treated with ACEIs on admission. ACEI treatment was associated with a 24% reduction in mortality (relative risk 0.76, 95% confidence interval 0.73 to 0.80). The benefit was largest in patients with a history or present signs of heart failure. In patients without heart failure, a significant benefit of ACEI treatment was seen only in patients with renal dysfunction (relative risk 0.69, 95% confidence interval 0.54 to 0.88). In the whole group, the risk of AMI decreased by 7% (relative risk 0.93, 95% confidence interval 0.90 to 0.96), with a larger effect seen in patients with ST-segment elevation AMI or systolic left ventricular dysfunction.
Valsartan decreases the Incidence of Diabetes but not Cardiovascular Events
It is not known whether drugs that block the renin–angiotensin system reduce the risk of diabetes and cardiovascular events in patients with impaired glucose tolerance. An article in this months New England Journal of Medicine published an article which conducted a double-blind, randomized clinical trial with a 2-by-2 factorial design, we assigned 9306 patients with impaired glucose tolerance and established cardiovascular disease or cardiovascular risk factors to receive valsartan (up to 160 mg daily) or placebo (and nateglinide or placebo) in addition to lifestyle modification. The cumulative incidence of diabetes was 33.1% in the valsartan group, as compared with 36.8% in the placebo group and did not significantly reduce the incidence of either the extended cardiovascular outcome or the core cardiovascular outcome.
Significance of a prominent Q wave in lead negative aVR (−aVR) in acute anterior myocardial infarction
The aim of this study was to clarify the significance of a Q wave in lead negative aVR (−aVR) in anterior wall acute myocardial infarction (AMI). Eighty-seven patients with a first anterior wall AMI were classified into 2 groups according to the presence (n = 17, group A) or absence (n = 70, group B) of a prominent Q wave (duration ≥20 milliseconds) in lead −aVR at predischarge. Group A had a higher prevalence of a long left anterior descending coronary artery (LAD), a lower left ventricular ejection fraction, and more reduced regional wall motion in the apical and inferior regions than group B concluding that a prominent Q wave in lead −aVR in anterior wall AMI is related to severe regional wall motion abnormality in the apical and inferior regions, with an LAD wrapping around the apex.
Stroke in paroxysmal atrial fibrillation similar to that in permanent atrial fibrillation
Knowledge about stroke risk in paroxysmal atrial fibrillation (PxAF) is limited. Although current guideline recommendations advocate the same treatment as in permanent atrial fibrillation (PermAF), most patients with PxAF do not receive prophylactic anticoagulation. An article in this weeks European Heart Journal investigated whether there are differences in stroke risk between PxAF and PermAF. It was found that Ischaemic stroke is about as common in PxAF as in PermAF, and about twice as common as in the general population. Yet, PxAF patients do not receive protective anticoagulant treatment as often as patients with PermAF do. It is therefore important to increase the use of anticoagulants among PxAF patients in accordance with current guideline recommendations.
Comparison by Meta-Analysis of Drug-Eluting Stents and Bare Metal Stents for Saphenous Vein Graft Intervention
This meta-analysis was undertaken to assess the efficacy and safety of drug-eluting stents (DESs) compared to bare metal stents (BMSs) in saphenous vein graft (SVG) interventions. DESs decrease the risk of target vessel revascularization in native coronary arteries compared to BMSs. The ideal treatment strategy in patients with SVG disease is unknown. The ideal treatment strategy in patients with SVG disease is unknown. A search of the published reports was conducted to identify studies that compared DESs and BMSs in SVG intervention with a minimum follow-up of 6 months. Overall the results showed that Using the fixed effect model, target vessel revascularization was less frequently performed in patients who had undergone SVG intervention with a DES than with a BMS, the incidence of myocardial infarction was lower in patients with a DES than in those with a BMS, there was no differences were found in the risk of death or stent thrombosis between the 2 groups concluding the use of Drug Eluting Stents in SVG lesions.
Polyunsaturated Omega-3 Fatty Acids Increase Responsiveness to Dual Antiplatelet Therapy in Patients Undergoing Percutaneous Coronary Intervention
A study out of this weeks Journal of American College of Cardiology investigated whether omega-3 polyunsaturated fatty acids (PUFAs) are able to modify platelet responsiveness to dual antiplatelet therapy in stable coronary artery disease patients undergoing percutaneous coronary intervention (PCI). Patients receiving standard dual antiplatelet therapy (aspirin 75 mg/day and clopidogrel 600 mg loading dose followed by 75 mg/day) were randomly assigned to receive the addition of 1 g of omega-3 ethyl esters (n = 33) or placebo (n = 30) for 1 month. The P2Y12 reactivity index was significantly lower, by 22.2%, after 1 month of treatment with omega-3 polyunsaturated fatty acids compared with placebo when used in addition to dual antiplatelet therapy (p = 0.020). Maximal platelet aggregation induced by 5 and 20 µmol/l adenosine diphosphate was lower by 13.3% (p = 0.026) and 9.8% (p = 0.029), respectively, after 1 month of treatment with omega-3 polyunsaturated fatty acids compared with placebo.
Early Surgery Versus Conventional Treatment in Asymptomatic Very Severe Aortic Stenosis
The optimal timing of surgical intervention remains controversial in asymptomatic patients with very severe aortic stenosis. An article in this months Circulation Journal therefore compared the long-term results of early surgery and a conventional treatment strategy. Compared with the conventional treatment strategy, early surgery in patients with very severe aortic stenosis is associated with an improved long-term survival by decreasing cardiac mortality. Early surgery is therefore a therapeutic option to further improve clinical outcomes in asymptomatic patients with very severe aortic stenosis and low operative risk.
Bromocriptine in the Treatment of Acute Severe Peripartum Cardiomyopathy
Peripartum cardiomyopathy (PPCM) is a potentially life-threatening heart disease that occurs in previously healthy women. We identified prolactin, mainly its 16-kDa angiostatic and proapoptotic form, as a key factor in PPCM pathophysiology. Previous reports suggest that bromocriptine may have beneficial effects in women with acute onset of PPCM. A prospective, single-center, randomized, open-label, proof-of-concept pilot study of women with newly diagnosed PPCM receiving standard care (PPCM-Std; n=10) versus standard care plus bromocriptine for 8 weeks (PPCM-Br, n=10) was conducted. In this trial, the addition of bromocriptine to standard heart failure therapy appeared to improve left ventricular ejection fraction and a composite clinical outcome in women with acute severe PPCM, although the number of patients studied was small and the results cannot be considered definitive. Larger-scale multicenter and blinded studies are in progress to test this strategy more robustly.
QRS prolongation in patients with acute coronary syndromes
QRS prolongation with or without bundle branch block (BBB) has been associated with adverse outcome in myocardial infarction;An article in this months American Heart Journal examined the relationship between QRS duration and outcome in a broad spectrum of patients with acute coronary syndrome (ACS). Compared to patients with QRS <120 milliseconds, patients with QRS ≥120 milliseconds without BBB had higher in-hospital (3.5% vs 1.9%, odds ratio [OR] 1.87, 95% CI 0.85-4.09, P = .12) and 1-year mortality (14.9% vs 7.7%, OR 2.10, 95% CI 1.38-3.18, P = .001). In-hospital and 1-year mortality was significantly higher in patients with BBB . In patients presenting with a broad spectrum of suspected ACS, QRS prolongation—particularly in the setting of LBBB—is an independent predictor of in-hospital and 1-year mortality.
Elevated resting heart rate is an independent risk factor for cardiovascular disease in healthy men and women
Elevated resting heart rate (RHR) is known to be associated with reduced survival but inconsistencies remain, including lack of significance in most studies of healthy women, lack of independence from systolic blood pressure (SBP) in some, and the suggestion that RHR is merely functioning as a marker of physical inactivity or other comorbidities. A study out of the American Heart Journal aimed to clarify these inconsistencies. Overall a strong, graded, independent relationship between RHR and incident CVD was demonstrated. This was consistent in healthy men and women. We have clarified that the relationship is independent of SBP and that the temporal sequence would be compatible with a causal relationship. New findings include independence from both a validated measure of physical activity and comorbidities and the demonstration of a stronger effect for fatal than nonfatal events, supporting increased arrhythmogenicity of one of the mechanisms.
More heat for aspirin in new primary-prevention meta-analysis: "Creativity" needed to determine who will benefit
Two new analyses presented at the American College of Cardiology 2010 Scientific Sessions last week, aimed at updating the groundbreaking Aspirin Treatment Trialists' Collaboration (ATTC) meta-analysis of May 2009, has found that even with the addition of three new trials to the mix, the benefits of aspirin for primary prevention do not appear to "substantially outweigh" the risks. Moreover, in a subgroup analysis looking just at diabetic subjects, investigators found no relationship between aspirin use and 10-year risk of cardiovascular events.
Effectiveness of cardiac resynchronization therapy in mild congestive heart failure: systematic review and meta-analysis of randomized trials
Cardiac resynchronization therapy (CRT) improves echocardiographic parameters, symptoms, hospitalizations, and mortality in patients with New York Heart Association (NYHA) Class III or IV symptoms with left ventricular systolic dysfunction, sinus rhythm, and a prolonged QRS duration. The effectiveness of CRT in patients with mild heart failure symptoms has not been systematically reviewed. An article in this month's European Journal Heart Failure evaluated this and found CRT reduces heart failure events in patients with mild heart failure symptoms, left ventricular dysfunction, sinus rhythm, and prolonged QRS duration.
How to diurese in acute HF: Dosing strategies get an evidence base
Whether loop diuretics are given in a continuous infusion or intermittently or at conventional or high doses appears to make little difference in their effectiveness at relieving symptoms in patients hospitalized with acute heart failure, according to a study that, its investigators say, also suggests high-dose diuretics in that setting are safe. The trial was billed as the first randomized, controlled exploration of a management strategy that's been a mainstay for decades without much of a supporting evidence base to guide how it's performed.
Comparable patency achieved with radial artery and saphenous vein grafts
Study findings indicate that radial artery vein grafts provide comparable patency to saphenous vein grafts at 1 year after coronary artery bypass (CABG) graft surgery. The study was conducted at 11 centers between 2003 and 2008 and included a total of 733 patients undergoing elective CABG, of whom 366 were randomly assigned to receive radial artery grafts and 367 to undergo saphenous vein grafts. Angiography findings showed that graft patency at 1 week was 99% in patients who received radial artery grafts and 97% in those who had saphenous vein grafts. At 1 year, the patency rate was 89% in both groups.
Extended use of dual antiplatet therapy after stent implantation questioned
Extending the duration of dual antiplatelet therapy for more than 12 months after receipt of drug-eluting stents in patients with no prior bleeding does not appear to be more effective than aspirin monotherapy for reducing the rate of myocardial infarction (MI) or cardiovascular death, researchers report. Presenting the findings at the 59th Annual Scientific Session of the American College of Cardiology in Atlanta, Georgia, USA, Seung-Jung Park also reported the “unexpected finding” of a nonsignificant increase in the secondary composite endpoints of MI, stroke, or death from any cause and MI, stroke, or death from cardiac causes in patients taking dual antiplatelet therapy for more than 12 months.
Newer Blood Thinner Beats Plavix for Bypass Patients
In a trial comparing two anti-clotting drugs, patients given Brilinta before cardiac bypass surgery were less likely to die than those given Plavix, researchers found. "We did see about a 50 percent reduction in mortality in these patients [who took Brilinta], but without any increase in bleeding complications," Dr. Claes Held, an associate professor of cardiology at the Uppsala Clinical Research Center at Uppsala University in Sweden and the study's lead researcher, said during an afternoon press conference Tuesday.
Effect of Cyclosporine on Left Ventricular Remodeling After Reperfused Myocardial Infarction
A study from the Journal of the American College of Cardiology examined the effect of a single dose of cyclosporine administered at the time of reperfusion on left ventricular (LV) remodeling and function by cardiac magnetic resonance 5 days and 6 months after myocardial infarction. Twenty-eight patients of the original cyclosporine study had an acute (at 5 days) and a follow-up (at 6 months) cardiac magnetic resonance study to determine LV volumes, mass, ejection fraction, myocardial wall thickness in infarcted and remote noninfarcted myocardium, and infarct size. The results showed that Cyclosporine used at the moment of acute myocardial infarction reperfusion persistently reduces infarct size and does not have a detrimental effect on LV remodeling.
Gender Differences in the Treatment of Non-ST-Segment Elevation Myocardial Infarction
Women are at greater risk for worse outcomes associated with acute coronary syndrome (ACS) than are men. One explanation may be that they tend to be treated less aggressively than men even when more aggressive treatment is warranted. An article out of the Journal of Clinical Cardiology analysed this issue and found men demonstrated significantly higher rates (P < 0.05) of coronary intervention in 7 of the 16 cells and 9 of the 20 medical treatment cells suggesting that men are more likely than women to receive coronary intervention and to be medically treated when presenting with evidence of non-ST-segment myocardial infarction, controlled for age, cardiac catheterization findings, and biochemical evidence of myocardial infarction.
Current Status of Dual Renin Angiotensin Aldosterone System Blockade for the Treatment of Cardiovascular Diseases
Clinical and experimental studies have shown that the initial suppression of angiotensin II after the administration of angiotensin-converting enzyme (ACE) inhibitors is later reversed and returns almost to pretreatment levels. This raised the hypothesis of the “escape phenomenon,” which was strengthened by the discovery that angiotensin II can also be generated through non-ACEs. In conclusion, on the basis of the results of this analysis, dual blockade of the renin-angiotensin-aldosterone system should not be used for the treatment of hypertension, heart failure, and renal disease, with perhaps the exception of diabetic nephropathy with albuminuria, until additional information is provided from ongoing studies.
Fixed-dose enoxaparin thromboprophylaxis feasible for morbidly obese
Current practice guidelines recommend utilizing weight-based dosing of LMWH in obese patients, but do not provide specific dosing guidance and US researchers say that enoxaparin administered at a 0.5-mg/kg dose may be effective at preventing thrombosis in morbidly obese patients without increasing the risk for bleeding.
Comparison of Outcomes With Cardiac Surgery and Paclitaxel-Eluting Stents in Diabetic and Non Diabetic Patients
A study out of the Journal of the American College of Cardiology compared contemporary surgical revascularization (coronary artery bypass graft surgery [CABG]) versus TAXUS Express (Boston Scientific, Natick, Massachusetts) paclitaxel-eluting stents (PES) in diabetic and nondiabetic patients with left main and/or 3-vessel disease. The overall 1-year major adverse cardiac and cerebrovascular event rate was higher among diabetic patients treated with PES compared with CABG, but the revascularization method did not impact the death/stroke/myocardial infarction rate for nondiabetic patients (6.8% CABG vs. 6.8% PES, p = 0.97) or for diabetic patients (10.3% CABG vs. 10.1% PES, p = 0.96). These exploratory results may extend the evidence for PES use in selected patients with less complex left main and/or 3-vessel lesions.
Detection of elevated right atrial pressure using a simple bedside ultrasound measure
Accurate assessment of right atrial pressure (RAP) often requires invasive measurement. With normal RAP, Valsalva increases right internal jugular vein (RIJV) cross sectional area (CSA) 20% to 30%. With high RAP, when venous compliance is low, an article this months American Heart Journal hypothesized that the increase in CSA would be blunted and could be detected non-invasively with bedside ultrasound. Overal it showed that an increase in RIJV CSA >17% during Valsalva effectively rules out elevated RAP. This simple bedside technique may be useful to assess central venous pressure and reduce the need for invasive pressure measurement.
Resolution of ST-segment depression: a new prognostic marker in ST-segment elevation myocardial infarction
An article out of the European Heart Journal evaluatee the prognostic impact of ST depression resolution among patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI in the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) trial. When compared with patients with both STE-R and STD-R≥50%, patients with both STE-R and STD-R<50% had the worst outcomes [hazard ratios (HR) 90 day death: 2.54; 95% confidence intervals (CI): 1.71–3.77; HR 90 day composite: 2.18; 95% CI: 1.63–2.91]. Overall when ST depression is present in STEMI patients undergoing primary PCI, ST Depression-Resolution <50% provides independent prognostic value that is incremental to ST elevation-Resolution.
No Benefit Seen with Early Invasive Versus Selective Invasive Management in Patients With Non–ST-Segment Elevation Acute Coronary Syndrome
A study out of the Journal of the American College of Cardiology present the 5-year clinical outcomes according to treatment strategy with additional risk stratification of the ICTUS (Invasive versus Conservative Treatment in Unstable coronary Syndromes) trial. 1,200 patients were randomly assigned to an early invasive or selective invasive strategy. The outcomes were the composite of death or myocardial infarction (MI) and its individual components. Risk stratification was performed with the FRISC (Fast Revascularization in InStability in Coronary artery disease) risk score. At 5-year follow-up, revascularization rates were 81% in the early invasive and 60% in the selective invasive group. Cumulative death or MI rates were 22.3% and 18.1%, respectively. In patients presenting with NSTE-ACS and elevated troponin T, we could not demonstrate a long-term benefit of an early invasive strategy in reducing death or MI. (Invasive versus Conservative Treatment in Unstable coronary Syndromes [ICTUS].
Sympathetic Nonadrenergic Transmission Contributes to Autonomic Dysreflexia in Spinal Cord–Injured Individuals
Autonomic dysreflexia is a hypertensive episode in spinal cord–injured individuals induced by exaggerated sympathetic activity and thought to be -adrenergic mediated. -Adrenoceptor antagonists have been a rational first choice; nevertheless, calcium channel blockers are primarily used in autonomic dysreflexia management. However, -adrenoceptor blockade may leave a residual vasoconstrictor response to sympathetic nonadrenergic transmission unaffected. The aim was to assess the -adrenergic contribution and, in addition, the role of supraspinal control to leg vasoconstriction during exaggerated sympathetic activity provoked by autonomic dysreflexia in spinal cord–injured individuals and by a cold pressure test in control individuals. These results indicate that the leg vascular resistance increase during autonomic dysreflexia in spinal cord–injured individuals is not entirely -adrenergic mediated and is partly explained by nonadrenergic transmission, which may, in healthy subjects, be suppressed by supraspinal control.
Routine testing in patients with asymptomatic elevated blood pressure in the ED
There are no clear recommendations for the diagnostic evaluation of patients who present to the emergency department (ED) with asymptomatic elevated blood pressure. In patients presenting with asymptomatic elevated blood pressure in the ED, we measured the prevalence of abnormalities on a basic metabolic profile (BMP) that led to hospital admission as well as the prevalence of diminished renal function. One hundred sixty-seven patients with asymptomatic elevated BP were studied and Twelve patients were admitted due to abnormal results on the BMP. Twenty-seven patients met the secondary outcome measure of diminished renal function. In a homogenous African American population presenting to the ED with asymptomatic elevated BP, there is a relatively high prevalence of abnormalities on the BMP that led to hospital admission. We suggest routine testing of a serum creatinine should be strongly considered in a largely African American patient population with asymptomatic elevated BP in the ED.
Optimization of initial energy for cardioversion of atrial tachyarrhythmias with biphasic shocks
Optimization of initial energy for cardioversion of atrial tachyarrhythmias with biphasic shocks. Recommendations for optimal first-shock energies with biphasic waveforms are conflicting. We evaluated prospectively the relation between type and duration of atrial tachyarrhythmias and the probability of successful cardioversion with a specific biphasic shock waveform to develop recommendations for the initial energy setting aiming at the lowest total cumulative energy with 2 or less consecutive shocks.
Cardioversion was successful in 448 patients (cumulative efficacy, 99 %). In patients with AFL/AT, the lowest total cumulative energy was attained with an initial energy setting of 50 J. In patients with AF, lowest values were achieved with an initial energy of 100 J for arrhythmia durations of 2 days or less and an initial energy of 150 J for arrhythmia durations of more than 2 days.
We recommend an initial energy setting of 50 J in patients with AFL/AT, of 100 J in patients with AF 2 days or less, and of 150 J with AF more than 2 days.
ST-segment depression in aVR as a predictor of culprit artery and infarct size in acute inferior wall ST-segment elevation myocardial infarction
ST-segment depression in lead aVR in acute inferior wall ST-segment elevation myocardial infarction (STEMI) has recently been suggested as a predictor of left circumflex (LCx) artery involvement. The purpose of this study is to evaluate the clinical significance of aVR depression during inferior wall STEMI. The sensitivity and specificity of aVR depression as a predictor of LCx infarction were 53% and 86%, respectively. In patients with right coronary artery infarction, aVR depression was associated with increased cardiac enzymes and the involvement of a large posterolateral branch, which may explain the larger infarction. ST-segment depression in lead aVR in inferior wall STEMI predicts LCx infarction or larger RCA infarction involving a large posterolateral branch.
Plasma B-type natriuretic peptide reduction predicts long-term response to levosimendan therapy in acutely decompensated chronic heart failure
A study in the International Journal of Cardiology sought to identify predictors of long-term response to levosimendan therapy among patients' baseline features and treatment-induced changes in acutely decompensated chronic heart failure (ADHF Compared to standard therapy, levosimendan induced a significant improvement in NYHA class (F=37.529, p<0.001), B-type natriuretic peptide (BNP, F=22.917, p<0.001), left ventricular ejection fraction (F=23.561, p<0.001), transmitral E deceleration time. In the levosimendan group, treatment-induced percent BNP change was the best predictor of events (OR=0.970, 95% CI=0.954–0.986, p<0.001). A cut-off for BNP change of 58% predicted events with 87% sensitivity and 83% specificity. Event-free survival was longer in patients with a BNP reduction ≥58% (median, 135 versus 43 days, p=0.0001). JAMA: Levosimendan vs Dobutamine for Patients With Acute Decompensated Heart Failure
Omeprazole and clopidogrel: Should clinicians be worried?
The US Food and Drug Administration has issued a warning that omeprazole (Prilosec) reduces the antiplatelet activity of clopidogrel (Plavix) by about 50%. However, the warning is based largely on ex vivo data. Preliminary results from a randomized clinical trial revealed no effect on cardiovascular outcomes when omeprazole was given with clopidogrel. We recommend that physicians continue to prescribe a proton pump inhibitor for patients receiving dual antiplatelet therapy who are at risk of gastrointestinal bleeding or have an indication for use of a proton pump inhibitor.
Long-Term Prognosis of Patients Diagnosed With Brugada Syndrome
Brugada syndrome is characterized by ST-segment elevation in the right precordial leads and an increased risk of sudden cardiac death (SCD). Fundamental questions remain on the best strategy for assessing the real disease-associated arrhythmic risk, especially in asymptomatic patients. In the largest series of Brugada syndrome patients thus far
1029 patients were recruited in 11 tertiary centers in 4 European countries. The cardiac event rate per year was 7.7% in patients with aborted SCD, 1.9% in patients with syncope, and 0.5% in asymptomatic patients showing event rates in asymptomatic patients were low. Inducibility of ventricular tachyarrhythmia and family history of SCD were not predictors of cardiac events.
Enoxaparin Anticoagulation Monitoring in the Catheterization Laboratory Using a New Bedside Test
A study out of the Journal of the American College of Cardiology evaluated the ability of the bedside test Hemochron Jr. Hemonox (International Technidyne Corporation, Edison, New Jersey) to identify patients with insufficient anti-Xa activity level in the catheterization laboratory in 296 unselected patients undergoing catheterization and/or PC. When using Hemonox CT to discriminate patients with anti-Xa level <0.5 IU/ml a 94.9% sensitivity and a 73.3% specificity to detect patients with inadequate anti-Xa level. Hemonox CT appears to be a fast and reliable bedside test for detecting patients insufficiently anticoagulated and needing adjustment of anticoagulation therapy with enoxaparin before PCI.
African-American Women Have a Higher Risk for Developing Peripartum Cardiomyopathy
A study out of the Journal of the American College of Cardiology assessed whether African-American women are at increased risk of having peripartum cardiomyopathy. Peripartum cardiomyopathy is a heart disease of unknown cause that affects young women, often with devastating consequences. The frequency of peripartum cardiomyopathy varies markedly between African and non-African regions. A case-control study was performed and showed African-American women had a 15.7-fold higher relative risk of peripartum cardiomyopathy than non–African Americans. Other significant univariate risk factors were hypertension and having had >2 previous pregnancies. African-American ethnicity remained a significant risk factor for peripartum cardiomyopathy when other risk factors were considered in multivariable and stratified analyses. Although the frequency of peripartum cardiomyopathy (185 of 100,000 deliveries) at this center was higher than in previous U.S. reports, it was comparable to the frequency in countries with more women of African descent (100 to 980 of 100,000). Analysis of other U.S. studies confirmed that the frequency of peripartum cardiomyopathy was significantly higher among African-American women.
Study fails to link saturated fat, heart disease
The saturated fat found mainly in meat and dairy products has a bad reputation, but a new analysis of published studies finds no clear link between people's intake of saturated fat and their risk of developing heart disease.
Déjà vu? Experts debate new data on diuretic/CCB combo and MI risk
Low-risk hypertensive patients taking a combination of diuretics and calcium-channel blockers (CCBs) had a higher risk of MI than users of other common two-drug BP-lowering regimens in a new case-control study published online January 25, 2010 in BMJ. Lead author Dr Inbal Boger-Megiddo (University of Washington, Seattle) told heartwire she cannot determine "whether the findings indicate a positive effect of one group of drugs or a negative effect of another." But the new study "raises a good clinical question that we should address in further trials," she says. "We should definitely look into secondary hypertension and the fact that all drug groups, while being comparable in terms of their BP-lowering effects, are not necessarily comparable in terms of cardiovascular outcomes."
Red Yeast Rice Comparable to Pravastatin for Statin-intolerant Patients
Red-yeast-rice extract is as well tolerated as pravastatin in patients who previously developed a statin-associated myalgia and withdrew from therapy, research shows [1]. Withdrawals from the red-yeast-rice and pravastatin treatment arms were low; and both groups achieved comparable reductions in LDL-cholesterol levels, report researchers.
Red blood cell distribution width and 1-year mortality in acute heart failure
Red blood cell distribution width (RDW) predicts mortality in chronic heart failure (HF) and stable coronary artery disease. The prognostic value of RDW in more acute settings such as acute HF, and its relative prognostic value compared with more established measures such as N-terminal pro-brain natriuretic peptide (NT-proBNP), remains unknown. In a cohort of 205 patients with acute HF, independent predictors of RDW were identified using linear regression analysis and showed red blood cell distribution width is frequently elevated among patients with acute HF and does not appear to be associated with nutritional status, transfusion history, or inflammation. Red blood cell distribution width independently predicts 1-year mortality in acute HF. The value of RDW appears additive to other established prognostic variables such as NT-proBNP.
Restenosis Halved by Drug Eluting Stents in Diabetic Patients
Patients with diabetes mellitus have more extensive coronary artery disease, more disease progression, and restenosis. The use of drug-eluting stents (DES) in these patients is widespread, despite uncertain long-term safety and efficacy. All consecutive patients with diabetes mellitus in Sweden who underwent percutaneous coronary intervention were entered into the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) during 2003–06 with complete follow-up for 1–4 years and the results showed that myocardial infarction was significantly less common with DES in patients who received only one stent with a restenosis rate was 50% lower in DES-treated patients. DES was associated with reduced restenosis rates in all subgroups of diabetic patients with the greatest benefit in stent diameters <3 mm or stent length >20 mm. The number of lesions treated with DES to prevent one restenosis ranged from 11 to 47 in various subgroups.
FDA Reviewers Oppose CHF Indication for Beta-Blocker
In a harshly-worded document prepared for a meeting of FDA advisers, reviewers said there was no convincing evidence to support the use of the beta-blocker nebivolol (Bystolic) for treatment of heart failure in patients ages 70 and older.
Treatment of Aspirin-Resistant Patients With Omega-3 Fatty Acids Versus Aspirin Dose Escalation
Omega-3 fatty acids decrease the availability of platelet arachidonic acid (AA) and indirectly thromboxane A2 formation. A study out of the Journal of the American College of Cardiology was conducted to evaluate whether addition of omega-3 fatty acids or increase in aspirin dose improves response to low-dose aspirin among patients who are aspirin resistant. It was shown that plasma levels of thromboxane B2 were also reduced in both groups (56.8% reduction in the omega-3 fatty acids group, and 39.6% decrease in the aspirin group). Twelve patients (80%) who received omega-3 fatty acids and 11 patients (73%) who received aspirin 325 mg were no longer aspirin resistant after treatment.
Rosuvastatin in the Prevention of Stroke Among Men and Women With Elevated Levels of C-Reactive Protein
Prior primary prevention trials of statin therapy that used cholesterol criteria for enrollment have not reported significant decreases in stroke risk. We evaluated whether statin therapy might reduce stroke rates among individuals with low levels of cholesterol but elevated levels of high-sensitivity C-reactive protein.In Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER), 17 802 apparently healthy men and women with low-density lipoprotein cholesterol levels <130 mg/dL and high-sensitivity C-reactive protein levels 2.0 mg/L were randomly allocated to rosuvastatin 20 mg daily or placebo and then followed up for the occurrence of a first stroke. After a median follow-up of 1.9 years (maximum, 5.0 years), rosuvastatin resulted in a 48% reduction in the hazard of fatal and nonfatal stroke as compared with placebo.
