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Mhaimeed O, Burney ZA, Schott SL, Kohli P, Marvel FA, Martin SS. The importance of LDL-C lowering in atherosclerotic cardiovascular disease prevention: Lower for longer is better. Am J Prev Cardiol 2024; 18:100649. [PMID: 38576462 PMCID: PMC10992711 DOI: 10.1016/j.ajpc.2024.100649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/25/2024] [Accepted: 03/09/2024] [Indexed: 04/06/2024] Open
Abstract
Cumulative exposure to low-density lipoprotein cholesterol (LDL-C) is a key driver of atherosclerotic cardiovascular disease (ASCVD) risk. An armamentarium of therapies to achieve robust and sustained reduction in LDL-C can reduce ASCVD risk. The gold standard for LDL-C assessment is ultracentrifugation but in routine clinical practice LDL-C is usually calculated and the most accurate calculation is the Martin/Hopkins equation. For primary prevention, consideration of estimated ASCVD risk frames decision making regarding use of statins and other therapies, and tools such as risk enhancing factors and coronary artery calcium enable tailoring of risk assessment and decision making. In patients with diabetes, lipid lowering therapy is recommended in most patients to reduce ASCVD risk with an opportunity to tailor therapy based on other risk factors. Patients with primary hypercholesterolemia and familial hypercholesterolemia (FH) with baseline LDL-C greater than or equal to 190 mg/dL are at elevated risk, and LDL-C lowering with high-intensity statin therapy is often combined with non-statin therapies to prevent ASCVD. Secondary prevention of ASCVD, including in patients with prior myocardial infarction or stroke, requires intensive lipid lowering therapy and lifestyle modification approaches. There is no established LDL-C level below which benefit ceases or safety concerns arise. When further LDL-C lowering is required beyond lifestyle modifications and statin therapy, additional medications include oral ezetimibe and bempedoic acid, or injectables such as PCSK9 monoclonal antibodies or siRNA therapy. A novel agent that acts independently of hepatic LDL receptors is evinacumab, which is approved for patients with homozygous FH. Other emerging agents are targeted at Lp(a) and CETP. In light of the expanding lipid treatment landscape, this manuscript reviews the importance of early, intensive, and sustained LDL-C-lowering for primary and secondary prevention of ASCVD.
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Affiliation(s)
- Omar Mhaimeed
- Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Zain A Burney
- Department of Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Stacey L Schott
- Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, United States
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Payal Kohli
- Department of Cardiology, University of Colorado Anschutz, Aurora, CO, United States
- Department of Cardiology, Veterans Affairs Hospital, Aurora, CO, United States
- Cherry Creek Heart, Aurora, CO, United States
- Tegna Broadcasting, MD, United States
| | - Francoise A Marvel
- Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, United States
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Seth S Martin
- Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, United States
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Razavi AC, Kohli P, McGuire DK, Martin SS, Polonsky TS, McEvoy JW, Whelton SP, Blumenthal RS. PREVENT Equations: A New Era in Cardiovascular Disease Risk Assessment. Circ Cardiovasc Qual Outcomes 2024; 17:e010763. [PMID: 38506044 DOI: 10.1161/circoutcomes.123.010763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Affiliation(s)
- Alexander C Razavi
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA (A.C.R.)
| | - Payal Kohli
- Department of Cardiology, University of Colorado Anschutz, Aurora (P.K.)
- Division of Cardiology, Department of Medicine, Duke University, Durham, NC (P.K.)
| | - Darren K McGuire
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.)
| | - Seth S Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.S.M., J.W.M., S.P.W., R.S.B.)
| | - Tamar S Polonsky
- Section of Cardiology, Division of Medicine, University of Chicago Pritzker School of Medicine, IL (T.S.P.)
| | - John W McEvoy
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.S.M., J.W.M., S.P.W., R.S.B.)
| | - Seamus P Whelton
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.S.M., J.W.M., S.P.W., R.S.B.)
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.S.M., J.W.M., S.P.W., R.S.B.)
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Gami A, Everitt I, Blumenthal RS, Newby LK, Virani SS, Kohli P. Applying the ABCs of Cardiovascular Disease Prevention to the 2023 AHA/ACC Multisociety Chronic Coronary Disease Guidelines. Am J Med 2024; 137:85-91. [PMID: 37871731 DOI: 10.1016/j.amjmed.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/01/2023] [Accepted: 10/03/2023] [Indexed: 10/25/2023]
Abstract
The 2023 American Heart Association/American College of Cardiology Multisociety Guideline for the Management of Patients with Chronic Coronary Disease provides updated recommendations for the management of chronic coronary disease. The term "chronic coronary disease" reflects the lifelong nature of the disease and diverse disease etiologies that come under the chronic coronary disease umbrella, beyond the presence of epicardial coronary stenosis, which require targeted lifestyle recommendations, serial optimization of medications, and involvement of multiple care team members. In this review, we highlight several areas where a collaborative approach between cardiologists, primary care clinicians, and internists is essential to optimize the care of patients with chronic coronary disease.
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Affiliation(s)
- Abhishek Gami
- Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ian Everitt
- Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Roger S Blumenthal
- Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - L Kristin Newby
- Division of Cardiology and Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Salim S Virani
- Aga Khan University, Karachi, Pakistan; Texas Heart Institute and Baylor College of Medicine, Houston, TX
| | - Payal Kohli
- Department of Cardiology, University of Colorado Anschutz, Aurora, CO; Department of Cardiology, Veterans Affairs Hospital, Aurora, CO; Cherry Creek Heart, Aurora, CO; Associate Adjunct Professor in the Cardiology Division, Department of Medicine, Duke University, Durham, NC.
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Kodate N, Kohli P, McGinn C, Scott R, Ross E, Treusch P, Maeda Y, Donnelly S, Leonard C, Cogan L, Mannan H, O’Shea D, Obayashi K, Masuyama S. 43 EXPLORING STAFF PERCEPTIONS AND ATTITUDES TO CARE AND CAREBOTS: THE CASE OF AN ORIGINAL AIR-DISINFECTION ROBOT IN IRELAND. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The pandemic heightened the sense of security and safety in care settings, with cleanliness and infection control becoming an even more important aspect of care delivery. Although the impact of new welfare technology on health and social care has been discussed in recent years, few studies have reported the implementation processes or human-robot interactions in care facilities in different cultural settings. The aims of this interdisciplinary research therefore were to understand needs and aspects that have to be considered for implementing an assistive robot, and to explore user perceptions, and the process by which the robots are adopted in Ireland and Japan.
Methods
An original air-disinfection robot (V-Air) was developed by Akara Robotics, as part of research project “Harmonisation towards the establishment of Person-centred, Robotics-aided Care System” (Toyota Foundation, D18-ST-0005). Prior to its instalment in a rehabilitation centre in Dublin, semi-structured interviews were conducted, and observations carried out with seven care professionals, as they interacted with V-Air. The robot was then trialled for eight weeks (March-May 2022) in selected areas of the facility. After four weeks, the users filled out the System Usability Score and were asked questions at the end of the trial. Their scores and answers to the questions revealed staff perceptions and attitudes to care robots.
Results
Overall, the users had positive perceptions of V-Air and its usability. Initial differences existed in staff’s confidence levels, depending on prior experiences with technologies. Collective sensemaking was observed, particularly, around care delivery processes and robot functionalities. The adoption process was facilitated by several factors such as the timing of introduction, user-centred design, concept of care and organisational support.
Conclusion
The findings suggest that the introduction of care robots in care settings can offer an additional layer of organisational safety, while highlighting the significance of the iterative process in adopting assistive technologies.
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Affiliation(s)
- N Kodate
- University College Dublin School of Social Policy, Social Work and Social Justice, , Dublin, Ireland
- Universal Accessibility & Ageing Research Centre , Nishitokyo, Japan
- Hokkaido University Public Policy Research Center, , Sapporo, Japan
- L’École des Hautes Etudes En Sciences Sociales, Fondation France Japon , Paris, France
- University of Tokyo Institute for Future Initiatives, , Tokyo, Japan
| | - P Kohli
- Maynooth University Department of Sociology, , Maynooth, Ireland
| | - C McGinn
- Trinity College Dublin Department of Mechanical, Manufacturing & Biomedical Engineering, , Dublin, Ireland
- Akara Robotics , Dublin, Ireland
| | - R Scott
- Akara Robotics , Dublin, Ireland
| | - E Ross
- Royal Hospital Donnybrook , Dublin, Ireland
| | - P Treusch
- Trinity College Dublin Trinity Long Room Hub, , Dublin, Ireland
| | - Y Maeda
- Technological University Dublin , Dublin, Ireland
| | - S Donnelly
- University College Dublin School of Social Policy, Social Work and Social Justice, , Dublin, Ireland
| | - C Leonard
- Royal Hospital Donnybrook , Dublin, Ireland
| | - L Cogan
- Royal Hospital Donnybrook , Dublin, Ireland
| | - H Mannan
- University College Dublin School of Nursing, Midwifery and Health System, , Dublin, Ireland
| | - D O’Shea
- St. Vincent’s University Hospital , Dublin, Ireland
| | - K Obayashi
- Nihon Fukushi University Faculty of Healthcare Management, , Mihama, Japan
- Social Welfare Corporation Tokyo Seishin-kai , Nishitokyo, Japan
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Abstract
Purpose of
Review In this review, we outline the impacts of the COVID-19 pandemic on non-communicable diseases around the world. Recent Findings The mechanisms of COVID-19’s impact on non-communicable diseases are both direct and indirect. The direct mechanisms include direct vascular and myocardial injury as well as pancreatic injury increasing incidence of new-onset diabetes. Indirect effects of the pandemic on non-communicable disease include delayed presentation for acute illness including STEMI and the impact of social distancing and quarantine policies on socialization, mental health, physical activity, and the downstream health impacts of inactivity and deconditioning. Summary International focus has been on disease variants, infection control and management, healthcare system, and resource utilization and infection incidence. However, the impact of this pandemic on non-communicable diseases has been largely overlooked but will manifest itself in the coming years to decades.
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Affiliation(s)
- Karl Gordon Patti
- Department of Medicine, Division of Cardiology, Cardiac and Vascular Center, University of Colorado Anschutz, 12605 E 16th Ave, Aurora, CO, 80045, USA
| | - Payal Kohli
- Department of Medicine, Division of Cardiology, Cardiac and Vascular Center, University of Colorado Anschutz, 12605 E 16th Ave, Aurora, CO, 80045, USA. .,Cardiology Division, Rocky Mountain Regional VA Medical Center, Aurora, USA. .,Cherry Creek Heart, 4105 E. Florida Ave, Suite 200, Denver, CO, 80222, USA.
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Honigberg M, Lahm T, Wood M, Ho J, Kohli P, Natarajan P. Association of premature menopause with incident pulmonary hypertension. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Several forms of pulmonary hypertension (PH) disproportionately affect women. Prior animal and human studies suggest that oestradiol exerts mixed effects on the pulmonary vasculature. Whether premature menopause represents a risk factor for PH is currently unknown.
Purpose
To test the independent association of premature menopause with incident PH.
Methods
We included women in the UK Biobank who were 40–69 years old and postmenopausal at enrolment and underwent pulmonary function testing at the baseline study visit. Women with missing menopause data, prevalent PH, extreme pulmonary function test outliers (Z>5 or Z<−5), and those with congenital heart disease were excluded. Premature menopause was defined as occurring before age 40 years. Reproductive history, including age at menopause and use of menopausal hormone therapy (MHT), was ascertained by participant self-report at enrolment. PH risk factors and relevant co-morbidities were captured by participant self-report and by ICD code. Incident PH was ascertained by the appearance of a qualifying ICD code (ICD-9 4160; ICD-10 I27.0, I27.2). Follow-up began at study enrolment, with time to censoring determined by date of PH diagnosis or last encounter in the medical record. Multivariable Cox proportional hazard models tested the association between premature menopause and incident PH, with adjustment for age, race, ever-smoking, body-mass index, systolic blood pressure, antihypertensive medication use, non-high-density lipoprotein cholesterol, cholesterol-lowering medication use, C-reactive protein, prevalent type 2 diabetes, obstructive sleep apnoea, heart failure, venous thromboembolism, mitral regurgitation, aortic stenosis, forced vital capacity (FVC), the forced expiratory volume in 1 second (FEV1)/FVC ratio, and ever-use of MHT.
Results
Among 138,518 postmenopausal women (mean [SD] age at enrolment 60.0 [5.4] years), 5,440 women (3.9%) had a history of premature menopause. Incident PH was diagnosed in 253 women over a median 8.1 (interquartile range 7.4–8.8) years of follow-up. Mean age at menopause was 48.3 (6.4) years among women with incident PH vs. 49.7 (5.1) years among those without PH (P<0.001). Crude cumulative incidence of PH was 0.40% among women premature menopause vs. 0.17% among those without (Figure 1). After multivariable adjustment, premature menopause remained independently associated with PH (hazard ratio [HR] 1.91, 95% CI 1.15–3.16, P=0.01). Ever-use of MHT was not significantly associated with incident PH (HR 0.93, 95% CI 0.68–1.26, P=0.62). In sensitivity analysis excluding 4,461 women with prevalent heart failure, venous thromboembolism, mitral regurgitation, or aortic stenosis, the HR for PH associated with premature menopause was 2.19 (95% CI 1.28–3.74, P=0.004).
Conclusions
Premature menopause is an independent risk factor for PH in women.
Figure 1
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): U.S. National Heart, Lung, and Blood Institute
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Affiliation(s)
- M Honigberg
- Massachusetts General Hospital, Boston, United States of America
| | - T Lahm
- Indiana University School of Medicine, Indianapolis, United States of America
| | - M Wood
- Massachusetts General Hospital, Boston, United States of America
| | - J Ho
- Massachusetts General Hospital, Boston, United States of America
| | - P Kohli
- Massachusetts General Hospital, Boston, United States of America
| | - P Natarajan
- Massachusetts General Hospital, Boston, United States of America
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7
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Affiliation(s)
- Payal Kohli
- Cherry Creek Heart, NBC/9News Medical Expert, Denver, CO (P.K.).,Presbyterian St. Luke's Medical Center, Denver, CO (P.K.)
| | - Salim S Virani
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX (S.S.V.).,Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX (S.S.V.)
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8
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Kohli P, Wang P, Wang A, Liu L, Weinstein A, Curtis JP, Spertus JA, Piccini JP, Makary M, Gluckman T. PREDICTORS OF FFR UNDERUTILIZATION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30733-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
PURPOSE OF REVIEW Media sources, such as the Internet, television, and social media, have become powerful communication tools that have transformed the way medical information is acquired across the world. RECENT FINDINGS Over 40% of today's patients report that social media affects their healthcare decisions, and approximately 65% of healthcare professionals report using social media for professional activities. These enhanced communication tools have made a substantial impact on the widespread dissemination of medical information. However, as a consequence, popular media platforms have also become purveyors of medical misinformation. In this review, we propose a framework for clinicians on how to effectively and appropriately integrate medical information available via online resources including social media platforms into modern healthcare practices.
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Affiliation(s)
- Anandita Agarwala
- Division of Cardiology, School of Medicine, Washington University, 660 S. Euclid, Campus Box 8086, St. Louis, MO, USA
| | - Payal Kohli
- Heart and Vascular Institute of Colorado, Denver, CO, USA
| | - Salim S Virani
- Sections of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA. .,Section of Cardiology, Health Services Research and Development, Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX, 77030, USA.
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Abstract
PURPOSE OF REVIEW Omega-3 fatty acids (ω-3 FA) are among the most well-recognized health supplements but their cardiovascular benefits have long been controversial owing to inconsistent results from previous cardiovascular outcomes trials (CVOT). In this article, we provide a short review of existing literature followed by recent randomized clinical trial data, with a discussion of the potential clinical implications of these new findings. RECENT FINDINGS Data from the randomized, controlled trial REDUCE-IT, when viewed within the context of other recently published trials ASCEND and VITAL, add to a growing body of evidence on the use of ω-3 FA therapies in the treatment of atherosclerotic cardiovascular disease (ASCVD). Given the different formulations, dosages, and patient populations studied, CVOTs of ω-3 FA have provided valuable insight into the use of these agents in cardioprotection. Current data suggest that higher dosages of pure eicosapentaenoic acid ω-3 FA formulations provide additional benefit in reduction of ASCVD events.
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Affiliation(s)
- Xiaoming Jia
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Payal Kohli
- Heart and Vascular Institute of Colorado, SCL Health, Denver, CO, USA
| | - Salim S Virani
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA. .,Health Policy, Quality and Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations, Houston, TX, USA. .,Health Services Research and Development, Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX, 77030, USA.
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11
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Kohli P, Soler ZM, Storck KA, Shahangian A, Banglawala SM, Schlosser RJ. Responsiveness and reliability of the Sinus Control Test in chronic rhinosinusitis. Rhinology 2017; 55:39-44. [PMID: 28025986 DOI: 10.4193/rhin16.208] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The Sinus Control Test (SCT) is a patient-reported questionnaire designed to help physicians identify sub-optimally controlled chronic rhinosinusitis (CRS). This study measures responsiveness to surgery and reliability of the SCT. METHODOLOGY Adults meeting diagnostic criteria for CRS were recruited from rhinology clinics at a tertiary academic institution. To measure responsiveness, the SCT was administered at baseline and at least 3 months after surgery to 62 CRS patients. To measure reliability, the SCT was administered at two clinical encounters a maximum of 14 days apart to 22 CRS patients. RESULTS Total SCT scores significantly improved from baseline to post-operative follow-up, and the distribution of patients with total SCT scores falling into the uncontrolled, partially controlled, and controlled categories before and after surgery were significantly different in the direction of improvement. The SCT met minimum standards for reliability and internal consistency as measured by: test-retest reliability coefficient, intra-class correlation coefficients, and item-total correlations. Cronbach alpha; values with each item deleted were lower than the overall Cronbach alpha. The SCT captures the full range of disease control as measured by floor and ceiling effects. CONCLUSION The SCT is responsive to surgical intervention and a reliable tool to monitor changes in CRS control levels.
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Affiliation(s)
- P Kohli
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Z M Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - K A Storck
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - A Shahangian
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - S M Banglawala
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - R J Schlosser
- Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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Abbasi F, Kohli P, Reaven GM, Knowles JW. Hypertriglyceridemia: A simple approach to identify insulin resistance and enhanced cardio-metabolic risk in patients with prediabetes. Diabetes Res Clin Pract 2016; 120:156-61. [PMID: 27565692 DOI: 10.1016/j.diabres.2016.07.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 05/03/2016] [Accepted: 07/30/2016] [Indexed: 10/21/2022]
Abstract
AIMS Prediabetes (PreDM) is a metabolically heterogeneous condition, differing in degree of insulin resistance and risk of type 2 diabetes mellitus and coronary heart disease (CHD). This study was initiated to evaluate the hypothesis that a fasting plasma triglyceride (TG) concentration ⩾1.7mmol/L can aid in identifying the subset of individuals with PreDM who are most insulin resistant and at greatest risk to develop CHD as well as type 2 diabetes mellitus. METHODS In this cross-sectional study, measurements were made of: (1) steady-state plasma glucose (SSPG) concentration during the insulin suppression test to ascertain degree of insulin resistance and (2) conventional CHD risk factors in 587 apparently healthy individuals with normal fasting plasma glucose (NFG, n=370) or PreDM (n=217). RESULTS Subjects with PreDM were significantly (P<0.001) more insulin resistant (higher SSPG concentrations) and had a more adverse CHD risk profile than those with NFG. A TG concentration ⩾1.7mmol/L identified a subset of individuals with PreDM (38%) who had a higher mean SSPG concentration (11.3±3.5mmol/L vs. 9.3±3.9mmol/L, P<0.001), were more likely to be insulin resistant (66% vs. 39%, P<0.001), and had a more adverse CHD risk factor profile. CONCLUSIONS Measurement of fasting TG concentration in individuals with PreDM may provide a simple clinical approach to identify those who are insulin resistant, at enhanced risk of CHD, and more likely to develop type 2 diabetes mellitus.
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Affiliation(s)
- Fahim Abbasi
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University School of Medicine, Falk CVRC, 300 Pasteur Drive, Stanford, CA 94305-5406, USA.
| | - Payal Kohli
- Kaiser Permanente, 2045 Franklin Street, Denver, CO 80205, USA.
| | - Gerald M Reaven
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University School of Medicine, Falk CVRC, 300 Pasteur Drive, Stanford, CA 94305-5406, USA.
| | - Joshua W Knowles
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University School of Medicine, Falk CVRC, 300 Pasteur Drive, Stanford, CA 94305-5406, USA.
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Kohli P, Ganz P, Ma Y, Scherzer R, Hur S, Weigel B, Grunfeld C, Deeks S, Wasserman S, Scott R, Hsue PY. HIV and Hepatitis C-Coinfected Patients Have Lower Low-Density Lipoprotein Cholesterol Despite Higher Proprotein Convertase Subtilisin Kexin 9 (PCSK9): An Apparent "PCSK9-Lipid Paradox". J Am Heart Assoc 2016; 5:JAHA.115.002683. [PMID: 27130349 PMCID: PMC4889164 DOI: 10.1161/jaha.115.002683] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Proprotein convertase subtilisin kexin 9 (PCSK9) inhibitors reduce low‐density lipoprotein cholesterol (LDL‐C) and improve outcomes in the general population. HIV‐infected individuals are at increased risk for cardiovascular events and have high rates of dyslipidemia and hepatitis C virus (HCV) coinfection, making PCSK9 inhibition a potentially attractive therapy. Methods and Results We studied 567 participants from a clinic‐based cohort to compare PCSK9 levels in patients with HIV/HCV coinfection (n=110) with those with HIV infection alone (n=385) and with uninfected controls (n=72). The mean age was 49 years, and the median LDL‐C level was 100 mg/dL (IQR 77–124 mg/dL); 21% were taking statins. The 3 groups had similar rates of traditional risk factors. Total cholesterol, LDL‐C, and high‐density lipoprotein cholesterol levels were lower in coinfected patients compared with controls (P<0.001). PCSK9 was 21% higher in HIV/HCV‐coinfected patients versus controls (95% CI 9–34%, P<0.001) and 11% higher in coinfected individuals versus those with HIV infection alone (95% CI 3–20%, P=0.008). After adjustment for cardiovascular risk factors, HIV/HCV coinfection remained significantly associated with 20% higher PCSK9 levels versus controls (95% CI 8–33%, P=0.001). Interleukin‐6 levels increased in a stepwise fashion from controls (lowest) to HIV‐infected to HIV/HCV‐coinfected individuals (highest) and correlated with PCSK9 (r=0.11, P=0.018). Conclusions Despite having lower LDL‐C, circulating PCSK9 levels were increased in patients coinfected with HIV and HCV in parallel with elevations in the inflammatory, proatherogenic cytokine interleukin‐6. Clinical trials should be conducted to determine the efficacy of targeted PCSK9 inhibition in the setting of HIV/HCV coinfection.
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Affiliation(s)
- Payal Kohli
- Division of Cardiology, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA
| | - Peter Ganz
- Division of Cardiology, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA
| | - Yifei Ma
- Department of Medicine UCSF, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA
| | - Rebecca Scherzer
- Department of Medicine UCSF, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA
| | - Sophia Hur
- Division of Cardiology, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA
| | - Bernard Weigel
- Division of Cardiology, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA
| | - Carl Grunfeld
- Department of Medicine UCSF, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA
| | - Steven Deeks
- The Positive Health Program, San Francisco General Hospital, San Francisco, CA
| | | | | | - Priscilla Y Hsue
- Division of Cardiology, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA
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Shaw LJ, Kohli P, Chandrashekhar Y, Narula J. Cardiovascular Imaging of Women: We Have Come a Long Way But Still Have a Ways to Go. JACC Cardiovasc Imaging 2016; 9:502-3. [PMID: 27056169 DOI: 10.1016/j.jcmg.2016.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Leslee J Shaw
- Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | | | - Y Chandrashekhar
- University of Minnesota & VA Medical Center, Minneapolis, Minnesota
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, New York.
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Pinto DS, Kohli P, Fan W, Kirtane AJ, Kociol RD, Meduri C, Deliargyris EN, Prats J, Reynolds MR, Stone GW, Michael Gibson C. Bivalirudin is associated with improved clinical and economic outcomes in heart failure patients undergoing percutaneous coronary intervention: Results from an observational database. Catheter Cardiovasc Interv 2015; 87:363-73. [PMID: 26011467 DOI: 10.1002/ccd.26023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 04/18/2015] [Indexed: 11/05/2022]
Abstract
BACKGROUND Outcomes with bivalirudin compare favorably with heparin ± GPIIb/IIIa receptor inhibition (heparin ± GPI) during percutaneous coronary intervention (PCI). Patients with congestive heart failure (CHF) have increased risk for complications. The objective was to investigate clinical and economic outcomes for bivalirudin ± GPI vs. heparin ± GPI among PCI patients with CHF. METHODS Using the Premier Hospital Database, PCI patients with CHF were stratified by anticoagulant: bivalirudin, bivalirudin ± GPI, heparin and heparin ± GPI. The probability of receiving bivalirudin ± GPI was estimated using individual and hospital variables. Using propensity scores, each bivalirudin ± GPI patient was matched to a heparin ± GPI patient. The primary outcome was in-hospital death. Bleeding rates, transfusion, length of stay and in-hospital cost were ascertained. RESULTS Overall, 116,313 patients at 315 hospitals received bivalirudin (n = 45,559) bivalirudin + GPI (n = 8,115), heparin (n = 27,972) or heparin + GPI (n = 34,667). Patients had STEMI (21.2%), NSTEMI (29.1%), unstable angina (16.6%), stable angina (5.7%) or other ischemic heart disease (24.2%). Of these, 79.1% of bivalirudin patients matched, resulting in 84,948 analyzed patients. Compared with heparin ± GPI patients, bivalirudin ± GPI patients had fewer deaths (3.3% vs. 3.9%; p < 0.0001), less clinically apparent bleeding (10.2% vs. 11.4%; p < 0.0001), clinically apparent bleeding with transfusion (2.7% vs. 3.2%, p <0.0001), and transfusion (8.5% vs. 9.8%, p < 0.0001). Patients receiving bivalirudin had shorter length of stay (6.3 vs. 6.8 days; p < 0.0001) and lower in-hospital cost (mean $26,706 vs. $27,166 [median $19,414 vs. $19,798]; p < 0.0001). In conclusion, this is the largest retrospective analysis of PCI patients with CHF and demonstrates bivalirudin ± GPI compared with heparin ± GPI is associated with lower inpatient rates of death, bleeding, and cost.
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Affiliation(s)
- Duane S Pinto
- Cardiology Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Payal Kohli
- Cardiology Division, University of California, San Francisco
| | - Weihong Fan
- The Medicines Company, Parsippany, New Jersey
| | - Ajay J Kirtane
- Columbia University Medical Center/New York Presbyterian Hospital and Cardiovascular Research Foundation, New York, New York
| | - Robert D Kociol
- Cardiology Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Christopher Meduri
- Cardiology Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | | | - Jayne Prats
- The Medicines Company, Parsippany, New Jersey
| | - Matthew R Reynolds
- Lahey Clinic, Burlington, MA and Harvard Clinical Research Institute, Boston, Massachusetts
| | - Gregg W Stone
- Columbia University Medical Center/New York Presbyterian Hospital and Cardiovascular Research Foundation, New York, New York
| | - C Michael Gibson
- Cardiology Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
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Kohli P, Waters DD, Nemr R, Arsenault BJ, Messig M, DeMicco DA, Laskey R, Kastelein JJP. Risk of new-onset diabetes and cardiovascular risk reduction from high-dose statin therapy in pre-diabetics and non-pre-diabetics: an analysis from TNT and IDEAL. J Am Coll Cardiol 2015; 65:402-404. [PMID: 25634843 DOI: 10.1016/j.jacc.2014.10.053] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 09/27/2014] [Accepted: 10/07/2014] [Indexed: 11/27/2022]
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Kohli P, Waters D, Fayyad R, Laskey R, DeMicco D, Knowles J, Reaven G. RISK OF NEW-ONSET DIABETES FROM STATIN THERAPY INCREASES WITH INCREASING BASELINE TRIGLYCERIDES: DATA FROM TNT. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61441-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Kohli P, Ganz P, Ma Y, Scherzer R, Maka K, Deeks S, Grunfeld C, Wasserman S, Scott R, Hsue P. PCSK9 IS ELEVATED IN PATIENTS WITH HIV AND HEPATITIS C. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)62156-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kohli P, Whelton SP, Hsu S, Yancy CW, Stone NJ, Chrispin J, Gilotra NA, Houston B, Ashen MD, Martin SS, Joshi PH, McEvoy JW, Gluckman TJ, Michos ED, Blaha MJ, Blumenthal RS. Clinician's guide to the updated ABCs of cardiovascular disease prevention. J Am Heart Assoc 2014; 3:e001098. [PMID: 25246448 PMCID: PMC4323829 DOI: 10.1161/jaha.114.001098] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Payal Kohli
- Division of Cardiology, University of California San Francisco (UCSF), San Francisco, CA (P.K.)
| | - Seamus P. Whelton
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - Steven Hsu
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - Clyde W. Yancy
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (C.W.Y., N.J.S.)
| | - Neil J. Stone
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (C.W.Y., N.J.S.)
| | - Jonathan Chrispin
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - Nisha A. Gilotra
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - Brian Houston
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - M. Dominique Ashen
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - Seth S. Martin
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - Parag H. Joshi
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - John W. McEvoy
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - Ty J. Gluckman
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - Erin D. Michos
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - Michael J. Blaha
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - Roger S. Blumenthal
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
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Affiliation(s)
- Jacob A Udell
- Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Tracy Y Wang
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Shuang Li
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Payal Kohli
- Division of Cardiology, University of California, San Francisco
| | - Matthew T Roe
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - James A de Lemos
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Stephen D Wiviott
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
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Czarny MJ, Martin SS, Kohli P, Metkus T, Blumenthal RS. Nonfatal Outcomes in the Primary Prevention of Atherosclerotic Cardiovascular Disease. Circ Cardiovasc Qual Outcomes 2014; 7:481-5. [DOI: 10.1161/circoutcomes.114.000871] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Matthew J. Czarny
- From the Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD (M.J.C., S.S.M., T.M., R.S.B.); and Division of Cardiology, University of California San Francisco (P.K.)
| | - Seth S. Martin
- From the Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD (M.J.C., S.S.M., T.M., R.S.B.); and Division of Cardiology, University of California San Francisco (P.K.)
| | - Payal Kohli
- From the Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD (M.J.C., S.S.M., T.M., R.S.B.); and Division of Cardiology, University of California San Francisco (P.K.)
| | - Thomas Metkus
- From the Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD (M.J.C., S.S.M., T.M., R.S.B.); and Division of Cardiology, University of California San Francisco (P.K.)
| | - Roger S. Blumenthal
- From the Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD (M.J.C., S.S.M., T.M., R.S.B.); and Division of Cardiology, University of California San Francisco (P.K.)
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Kohli P, Waters D, Arsenault B, Messig M, Laskey R, Kastelein J. RISK OF NEW-ONSET DIABETES AND CARDIOVASCULAR RISK REDUCTION FROM STATIN THERAPY DIFFERS IN PRE-DIABETICS AND NON PRE-DIABETICS: A TNT AND IDEAL SUBSTUDY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61284-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Kohli P, Cohen B, Mishra R, Regan M, Schiller N. ILLICIT DRUG USE AND DIASTOLIC FUNCTION: DATA FROM THE MIND YOUR HEART STUDY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61081-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Makadia SS, Blaha M, Keenan T, Ndumele C, Jones S, DeFilippis A, Martin S, Kohli P, Conceicao R, Carvalho J, Nasir K, Blumenthal R, Santos RD. Relation of hepatic steatosis to atherogenic dyslipidemia. Am J Cardiol 2013; 112:1599-604. [PMID: 24012029 DOI: 10.1016/j.amjcard.2013.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 08/01/2013] [Accepted: 08/01/2013] [Indexed: 12/31/2022]
Abstract
Hepatic steatosis is closely associated with the metabolic syndrome. We assessed for an independent association between hepatic steatosis and atherogenic dyslipidemia after adjustment for obesity, physical activity, hyperglycemia, and systemic inflammation. We studied 6,333 asymptomatic subjects without clinical cardiovascular disease undergoing a health screen in Brazil from November 2008 to July 2010. Hepatic steatosis was diagnosed by ultrasound. Atherogenic dyslipidemia was defined using 2 definitions: criteria for (1) metabolic syndrome or (2) insulin resistance (triglyceride/high-density-lipoprotein cholesterol ratio of ≥2.5 in women and ≥3.5 in men). In hierarchical multivariate regression models, we evaluated for an independent association of hepatic steatosis with atherogenic dyslipidemia. Hepatic steatosis was detected in 36% of participants (average age 43.5 years, 79% men, average body mass index 26.3 kg/m(2)). Subjects with hepatic steatosis had similar levels of low-density-lipoprotein cholesterol, with significantly lower level of high-density-lipoprotein cholesterol and higher level of triglyceride compared with those without steatosis. Hepatic steatosis remained significantly independently associated with atherogenic dyslipidemia of both definitions (metabolic syndrome [odds ratio 2.47, 95% confidence interval 2.03 to 3.02] and insulin resistance [odds ratio 2.50, 95% confidence interval 2.13 to 2.91]) after multivariate adjustment. Stratified analyses showed a persistent independent association in nonobese subjects, those without metabolic syndrome, those with normal high-sensitivity C-reactive protein, nonalcohol abusers, and those with normal liver enzymes. Hepatic steatosis was significantly associated with atherogenic dyslipidemia independent of obesity, physical activity, hyperglycemia, and systemic inflammation after multivariate adjustment. In conclusion, this adds to the growing body of evidence that hepatic steatosis may play a direct metabolic role in conferring increased cardiovascular risk.
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Kohli P, Chandrashekhar Y, Narula J. Vini, Vidi, Vici… Restructured Format for Condensed Abstracts. JACC Cardiovasc Imaging 2013; 6:1220-1. [DOI: 10.1016/j.jcmg.2013.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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26
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Kohli P, Giugliano RP. Low-density lipoprotein lowering in 2013 by nonstatin agents: the discovery and development of promising novel targeted therapies. J Cardiovasc Pharmacol Ther 2013; 18:199-210. [PMID: 23580658 DOI: 10.1177/1074248413480270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Dyslipidemia is a major risk factor for the development of coronary artery disease, a leading cause of morbidity and mortality worldwide. Lowering low-density lipoprotein (LDL) has significantly reduced the risk of death and other major cardiovascular events, and statins remain the therapy of choice. However, as some patients are limited by the side effects of statins, cannot achieve their target LDL on statin therapy, or have other abnormalities in their lipid profile, alternative agents are being developed. In this review, we highlight the major classes of novel nonstatin LDL-lowering agents that are currently in various stages of development. Although many hold great promise, the results of large Phase III trials will be needed to definitely establish the efficacy, safety, and clinical utility of these agents in the general population.
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Affiliation(s)
- Payal Kohli
- TIMI Study Group/Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Desai NR, Giugliano RP, Zhou J, Kohli P, Somaratne R, Hoffman E, Liu T, Scott R, Wasserman SM, Sabatine MS. AMG 145, a monoclonal antibody against PCSK9, facilitates achievement of national cholesterol education program-adult treatment panel III low-density lipoprotein cholesterol goals among high-risk patients: an analysis from the LAPLACE-TIMI 57 trial (LDL-C assessment with PCSK9 monoclonal antibody inhibition combined with statin thErapy-thrombolysis in myocardial infarction 57). J Am Coll Cardiol 2013; 63:430-3. [PMID: 24161333 DOI: 10.1016/j.jacc.2013.09.048] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 08/27/2013] [Accepted: 09/19/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study sought to define the ability of AMG 145, a monoclonal antibody directed against proprotein convertase subtilisin kexin type 9 (PCSK9), to enable subjects at high risk for major adverse cardiovascular events to achieve National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) parameters for low-density lipoprotein cholesterol (LDL-C) and other lipid goals. BACKGROUND Many patients at high risk for adverse cardiovascular events are unable to achieve the NCEP-ATP III LDL-C goal of <70 mg/dl, even with high-potency statin therapy. METHODS In 282 subjects from the LAPLACE-TIMI 57 (LDL-C Assessment with PCSK9 monoclonaL Antibody Inhibition Combined With Statin thErapy-Thrombolysis In Myocardial Infarction 57) trial at high risk according to NCEP-ATP III criteria, we compared the proportion of subjects achieving the NCEP-ATP III recommended LDL-C goal of <70 mg/dl across treatment arms. Other outcomes included the triple goals of LDL-C <70 mg/dl, non-high-density lipoprotein cholesterol (HDL-C) <100 mg/dl, and apolipoprotein B (ApoB) <80 mg/dl. RESULTS During the dosing interval, more than 90% of subjects in both of the top dose groups every 2 weeks and every 4 weeks attained this lipid target over the dosing interval, with similar success rates for the triple lipid goal. CONCLUSIONS PCSK9 inhibition with AMG 145 enables high-risk patients to achieve established lipid goals. If this therapy demonstrates efficacy for reducing cardiovascular events with a favorable safety profile in ongoing phase 3 trials, we believe it will have major public health implications.
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Affiliation(s)
- Nihar R Desai
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert P Giugliano
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jing Zhou
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Payal Kohli
- Division of Cardiovascular Medicine, University of California at San Francisco, San Francisco, California
| | | | - Elaine Hoffman
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Marc S Sabatine
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Kohli P, Udell JA, Murphy SA, Cannon CP, Antman EM, Braunwald E, Wiviott SD. Discharge aspirin dose and clinical outcomes in patients with acute coronary syndromes treated with prasugrel versus clopidogrel: an analysis from the TRITON-TIMI 38 study (trial to assess improvement in therapeutic outcomes by optimizing platelet inhibition with prasugrel-thrombolysis in myocardial infarction 38). J Am Coll Cardiol 2013; 63:225-32. [PMID: 24140678 DOI: 10.1016/j.jacc.2013.09.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 09/08/2013] [Accepted: 09/16/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The goal of this study was to determine whether there is a relationship between aspirin dose and the potent antiplatelet agent prasugrel in the TRITON-TIMI 38 (Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel-Thrombolysis In Myocardial Infarction 38) study. BACKGROUND Optimal aspirin dosing after acute coronary syndromes remains uncertain. Previous studies have raised questions regarding an interaction between high-dose aspirin and the potent antiplatelet agent ticagrelor. METHODS In TRITON-TIMI 38, we classified 12,674 patients into low-dose (<150 mg) or high-dose (≥150 mg) aspirin groups based on discharge dose. We identified independent correlates of dose selection and studied the impact of aspirin dose on the clinical effects of prasugrel. RESULTS There was significant geographical variation in aspirin dosing, with North American patients receiving high-dose aspirin more frequently than other countries (66% vs. 28%; p < 0.001). Clinical factors correlating with high-dose aspirin included previous percutaneous coronary intervention and use of aspirin before randomization. Characteristics associated with the use of low-dose aspirin included age ≥75 years, white race, and use of bivalirudin or a glycoprotein IIb/IIIa inhibitor during coronary intervention. Regardless of low- or high-dose aspirin use, prasugrel had lower rates of the primary efficacy endpoint (cardiovascular death, myocardial infarction, or stroke [CVD/MI/stroke]) (hazard ratio [HR]CVD/MI/stroke = 0.78 [95% confidence interval (CI) 0.64 to 0.95] and HRCVD/MI/stroke = 0.87 [95% CI 0.69 to 1.10], respectively; p value for interaction = 0.48) and higher rates of the primary safety endpoint (HR TIMI major bleeding = 1.40 [95% CI 0.81 to 2.42] and TIMImajor bleeding = 1.30 [95% CI 0.63 to 2.68], respectively; p value for interaction = 0.84) compared with clopidogrel. CONCLUSIONS In TRITON-TIMI 38, the safety and efficacy outcomes of prasugrel compared with those of clopidogrel were directionally consistent regardless of aspirin dose, although only the primary efficacy endpoint achieved statistical significance. There was no clinically meaningful interaction of aspirin with prasugrel, suggesting that previous observations with potent antiplatelet agents indicating differential results are not universal. (A Comparison of Prasugrel [CS-747] and Clopidogrel in Acute Coronary Syndrome Subjects Who Are to Undergo Percutaneous Coronary Intervention; NCT00097591).
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Affiliation(s)
- Payal Kohli
- University of California San Francisco, Division of Cardiology, San Francisco, California; TIMI Study Group Division of Cardiology, Department of Medicine and Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jacob A Udell
- TIMI Study Group Division of Cardiology, Department of Medicine and Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sabina A Murphy
- TIMI Study Group Division of Cardiology, Department of Medicine and Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Christopher P Cannon
- TIMI Study Group Division of Cardiology, Department of Medicine and Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Elliott M Antman
- TIMI Study Group Division of Cardiology, Department of Medicine and Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Eugene Braunwald
- TIMI Study Group Division of Cardiology, Department of Medicine and Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Stephen D Wiviott
- TIMI Study Group Division of Cardiology, Department of Medicine and Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
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Kohli P, Srivastava SD, Srivastava SK. Synthesis and Biological Activity of Mercaptobenzoxazole Based Thiazolidinones and Their Arylidenes. J CHIN CHEM SOC-TAIP 2013. [DOI: 10.1002/jccs.200700144] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Chrispin J, Martin SS, Hasan RK, Joshi PH, Minder CM, McEvoy JW, Kohli P, Johnson AE, Wang L, Blaha MJ, Blumenthal RS. Landmark lipid-lowering trials in the primary prevention of cardiovascular disease. Clin Cardiol 2013; 36:516-23. [PMID: 23722477 PMCID: PMC6649586 DOI: 10.1002/clc.22147] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 04/25/2013] [Indexed: 01/20/2023] Open
Abstract
Although atherosclerotic cardiovascular disease (CVD) is the most common cause of morbidity and mortality in the world, the long disease latency affords ample opportunity for preventive care. Indeed, lifelong exposure to atherogenic apoliprotein B-containing lipoproteins has consistently been shown to increase the cumulative risk of suffering a CVD event, including myocardial infarction, stroke, and symptomatic peripheral arterial disease. Over the past 25 years, lipid-lowering therapies have been developed that are proven to not only lower cholesterol, but also to decrease adverse CVD events and CVD mortality. This review will highlight several key clinical trials encompassing several classes of lipid-lowering medications that have provided clinicians with an evidence-based framework for managing their patients' cardiovascular risk.
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Affiliation(s)
- Jonathan Chrispin
- The Johns Hopkins Ciccarone Center for the Prevention of Heart DiseaseJohns Hopkins School of MedicineBaltimoreMaryland
| | - Seth S. Martin
- The Johns Hopkins Ciccarone Center for the Prevention of Heart DiseaseJohns Hopkins School of MedicineBaltimoreMaryland
| | - Rani K. Hasan
- The Johns Hopkins Ciccarone Center for the Prevention of Heart DiseaseJohns Hopkins School of MedicineBaltimoreMaryland
| | - Parag H. Joshi
- The Johns Hopkins Ciccarone Center for the Prevention of Heart DiseaseJohns Hopkins School of MedicineBaltimoreMaryland
| | - C. Michael Minder
- The Johns Hopkins Ciccarone Center for the Prevention of Heart DiseaseJohns Hopkins School of MedicineBaltimoreMaryland
| | - John W. McEvoy
- The Johns Hopkins Ciccarone Center for the Prevention of Heart DiseaseJohns Hopkins School of MedicineBaltimoreMaryland
| | - Payal Kohli
- Cardiology DivisionUniversity of California San FranciscoSan FranciscoCalifornia.
| | - Amber E. Johnson
- The Johns Hopkins Ciccarone Center for the Prevention of Heart DiseaseJohns Hopkins School of MedicineBaltimoreMaryland
| | - Libin Wang
- The Johns Hopkins Ciccarone Center for the Prevention of Heart DiseaseJohns Hopkins School of MedicineBaltimoreMaryland
| | - Michael J. Blaha
- The Johns Hopkins Ciccarone Center for the Prevention of Heart DiseaseJohns Hopkins School of MedicineBaltimoreMaryland
| | - Roger S. Blumenthal
- The Johns Hopkins Ciccarone Center for the Prevention of Heart DiseaseJohns Hopkins School of MedicineBaltimoreMaryland
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Desai NR, Kohli P, Giugliano RP, O’Donoghue ML, Somaratne R, Zhou J, Hoffman EB, Huang F, Rogers WJ, Wasserman SM, Scott R, Sabatine MS. AMG145, a Monoclonal Antibody Against Proprotein Convertase Subtilisin Kexin Type 9, Significantly Reduces Lipoprotein(a) in Hypercholesterolemic Patients Receiving Statin Therapy. Circulation 2013; 128:962-9. [DOI: 10.1161/circulationaha.113.001969] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Lipoprotein(a) [Lp(a)] is an emerging risk factor for cardiovascular disease. Currently, there are few available therapies to lower Lp(a). We sought to evaluate the impact of AMG145, a monoclonal antibody against proprotein convertase subtilisin kexin type 9 (PCSK9), on Lp(a).
Methods and Results—
As part of the LDL-C Assessment With PCSK9 Monoclonal Antibody Inhibition Combined With Statin Therapy (LAPLACE)–Thrombolysis in Myocardial Infarction (TIMI) 57 trial, 631 patients with hypercholesterolemia receiving statin therapy were randomized to receive AMG145 at 1 of 3 different doses every 2 weeks or 1 of 3 different doses every 4 weeks versus placebo. Lp(a) and other lipid parameters were measured at baseline and at week 12. Compared with placebo, AMG145 70 mg, 105 mg, and 140 mg every 2 weeks reduced Lp(a) at 12 weeks by 18%, 32%, and 32%, respectively (
P
<0.001 for each dose versus placebo). Likewise, AMG145 280 mg, 350 mg, and 420 mg every 4 weeks reduced Lp(a) by 18%, 23%, and 23%, respectively (
P
<0.001 for each dose versus placebo). The reduction in Lp(a) correlated with the reduction in low-density lipoprotein cholesterol (ρ=0.33,
P
<0.001). The effect of AMG145 on Lp(a) was consistent regardless of age, sex, race, history of diabetes mellitus, and background statin regimen. Patients with higher levels of Lp(a) at baseline had larger absolute reductions but comparatively smaller percent reductions in Lp(a) with AMG145 compared with those with lower baseline Lp(a) values.
Conclusions—
AMG145 significantly reduces Lp(a), by up to 32%, among subjects with hypercholesterolemia receiving statin therapy, offering an additional, complementary benefit beyond robust low-density lipoprotein cholesterol reduction with regard to a patient’s atherogenic lipid profile.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01380730.
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Affiliation(s)
- Nihar R. Desai
- From the TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (N.R.D., P.K., R.P.G., M.L.O’D., J.Z., E.B.H., M.S.S.); Amgen, Inc, Thousand Oaks, CA (R. Somaratne, F.H., S.M.W., R. Scott); and University of Alabama at Birmingham (W.J.R.)
| | - Payal Kohli
- From the TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (N.R.D., P.K., R.P.G., M.L.O’D., J.Z., E.B.H., M.S.S.); Amgen, Inc, Thousand Oaks, CA (R. Somaratne, F.H., S.M.W., R. Scott); and University of Alabama at Birmingham (W.J.R.)
| | - Robert P. Giugliano
- From the TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (N.R.D., P.K., R.P.G., M.L.O’D., J.Z., E.B.H., M.S.S.); Amgen, Inc, Thousand Oaks, CA (R. Somaratne, F.H., S.M.W., R. Scott); and University of Alabama at Birmingham (W.J.R.)
| | - Michelle L. O’Donoghue
- From the TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (N.R.D., P.K., R.P.G., M.L.O’D., J.Z., E.B.H., M.S.S.); Amgen, Inc, Thousand Oaks, CA (R. Somaratne, F.H., S.M.W., R. Scott); and University of Alabama at Birmingham (W.J.R.)
| | - Ransi Somaratne
- From the TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (N.R.D., P.K., R.P.G., M.L.O’D., J.Z., E.B.H., M.S.S.); Amgen, Inc, Thousand Oaks, CA (R. Somaratne, F.H., S.M.W., R. Scott); and University of Alabama at Birmingham (W.J.R.)
| | - Jing Zhou
- From the TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (N.R.D., P.K., R.P.G., M.L.O’D., J.Z., E.B.H., M.S.S.); Amgen, Inc, Thousand Oaks, CA (R. Somaratne, F.H., S.M.W., R. Scott); and University of Alabama at Birmingham (W.J.R.)
| | - Elaine B. Hoffman
- From the TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (N.R.D., P.K., R.P.G., M.L.O’D., J.Z., E.B.H., M.S.S.); Amgen, Inc, Thousand Oaks, CA (R. Somaratne, F.H., S.M.W., R. Scott); and University of Alabama at Birmingham (W.J.R.)
| | - Fannie Huang
- From the TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (N.R.D., P.K., R.P.G., M.L.O’D., J.Z., E.B.H., M.S.S.); Amgen, Inc, Thousand Oaks, CA (R. Somaratne, F.H., S.M.W., R. Scott); and University of Alabama at Birmingham (W.J.R.)
| | - William J. Rogers
- From the TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (N.R.D., P.K., R.P.G., M.L.O’D., J.Z., E.B.H., M.S.S.); Amgen, Inc, Thousand Oaks, CA (R. Somaratne, F.H., S.M.W., R. Scott); and University of Alabama at Birmingham (W.J.R.)
| | - Scott M. Wasserman
- From the TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (N.R.D., P.K., R.P.G., M.L.O’D., J.Z., E.B.H., M.S.S.); Amgen, Inc, Thousand Oaks, CA (R. Somaratne, F.H., S.M.W., R. Scott); and University of Alabama at Birmingham (W.J.R.)
| | - Robert Scott
- From the TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (N.R.D., P.K., R.P.G., M.L.O’D., J.Z., E.B.H., M.S.S.); Amgen, Inc, Thousand Oaks, CA (R. Somaratne, F.H., S.M.W., R. Scott); and University of Alabama at Birmingham (W.J.R.)
| | - Marc S. Sabatine
- From the TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (N.R.D., P.K., R.P.G., M.L.O’D., J.Z., E.B.H., M.S.S.); Amgen, Inc, Thousand Oaks, CA (R. Somaratne, F.H., S.M.W., R. Scott); and University of Alabama at Birmingham (W.J.R.)
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Hsu S, Ton VK, Dominique Ashen M, Martin SS, Gluckman TJ, Kohli P, Sisson SD, Blumenthal RS, Blaha MJ. A clinician's guide to the ABCs of cardiovascular disease prevention: the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease and American College of Cardiology Cardiosource Approach to the Million Hearts Initiative. Clin Cardiol 2013; 36:383-93. [PMID: 23670948 PMCID: PMC6649529 DOI: 10.1002/clc.22137] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 04/10/2013] [Indexed: 02/06/2023] Open
Abstract
Atherosclerotic cardiovascular disease (CVD) is the leading cause of death in the United States and worldwide. Fortunately, it is often preventable with early adoption of lifestyle modification, prevention of risk factor onset, and aggressive treatment of existing risk factors. The Million Hearts Initiative is an effort by the Centers for Disease Control that aims to prevent 1 million myocardial infarctions and strokes over the next 5 years. As part of this initiative, we present a simply organized "ABCDE" approach for guiding a consistent comprehensive approach to managing cardiovascular risk in daily clinical practice. ABCDE stands for assessment of risk, antiplatelet therapy, blood pressure management, cholesterol management, cigarette/tobacco cessation, diet and weight management, diabetes prevention and treatment, and exercise, interventions regularly used to reduce cardiovascular (CV) risk. Throughout this article we summarize recommendations related to each topic and reference landmark trials and data that support our approach. We believe that the ABCDE approach will be the core framework for addressing CV risk in our effort to prevent CVD.
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Affiliation(s)
- Steven Hsu
- Ciccarone Center for the Prevention of Heart Disease, The Johns Hopkins School of Medicine, Baltimore, MD 21287, USA.
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Makadia S, Blaha M, Keenan T, Ndumele C, Jones S, DeFilippis A, Martin S, Kohli P, Nasir K, Blumenthal R, Filho RS. HEPATIC STEATOSIS IS ASSOCIATED WITH ATHEROGENIC DYSLIPIDEMIA INDEPENDENT OF OBESITY, COMPONENTS OF THE METABOLIC SYNDROME, MEDICATION USE, AND SYSTEMIC INFLAMMATION. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61430-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kohli P, Cannon CP. Dabigatran associated with increased risk of acute coronary events. Evid Based Med 2013; 18:e9. [PMID: 22740361 DOI: 10.1136/eb-2012-100733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Payal Kohli
- Division of Cardiology, University of California San Francisco, San Francisco, California, USA
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35
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Kohli P, Wallentin L, Reyes E, Horrow J, Husted S, Angiolillo DJ, Ardissino D, Maurer G, Morais J, Nicolau JC, Oto A, Storey RF, James SK, Cannon CP. Reduction in first and recurrent cardiovascular events with ticagrelor compared with clopidogrel in the PLATO Study. Circulation 2012; 127:673-80. [PMID: 23277305 DOI: 10.1161/circulationaha.112.124248] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We sought to evaluate the effect of potent platelet inhibition after acute coronary syndrome on total (ie, first and recurrent) occurrences of any of the primary outcome events (e.g., cardiovascular death, myocardial infarction, and stroke) as well as on other ischemic events, such as urgent revascularization, (severe) recurrent ischemia, transient ischemic attacks, and arterial thrombotic events. METHODS AND RESULTS In the PLATelet inhibition and patient Outcomes (PLATO) study, 18 624 patients presenting with acute coronary syndromes randomly received ticagrelor (n=9333) or clopidogrel (n=9291). Cox proportional hazard models were used to calculate time to first event and hazard ratios. Total events were compared using a Poisson regression model, and time to second event or death was calculated with the Wei Lin Weissfeld method. Patients randomized to ticagrelor had 1057 total primary end point events versus 1225 for patients on clopidogrel (rate ratio, 0.86; 95% confidence interval, 0.79-0.93; P=0.003). The number of additional events was numerically lower for ticagrelor (189 versus 205; P=0.40), resulting in a hazard for time to second event/death of 0.80 (95% confidence interval, 0.70-0.90; P<0.001) and a number needed to treat of 54. For cardiovascular death/myocardial infarction/stroke/(severe) recurrent ischemia/transient ischemic attack/arterial thrombotic events, total events were fewer with ticagrelor (2030 versus 2290; rate ratio, 0.88; 95% confidence interval, 0.82-0.95; P<0.001), with fewer recurrent events with ticagrelor (740 versus 834; P=0.01) and a highly significant concurrent reduction in hazard for time to second event or death of 0.83 (95% confidence interval, 0.75-0.91; P<0.001). Recurrent PLATO major or Thrombolysis in Myocardial Infarction (TIMI) major non-coronary artery bypass graft bleeding events were infrequent and not different between the two therapies (P=0.96 and 0.38, respectively). CONCLUSIONS In PLATO, treatment with ticagrelor compared with clopidogrel resulted in a reduction in total events, including first and subsequent recurrent cardiovascular events, when compared with clopidogrel. These types of analyses demonstrate an even greater absolute benefit of ticagrelor over clopidogrel than previously reported. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov/. Unique identifier: NCT00391872.
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Affiliation(s)
- Payal Kohli
- TIMI Study Group/Cardiovascular Division, Brigham and Women's Hospital, 350 Longwood Avenue, 1 floor office, Boston, MA 02115, USA
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36
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Giugliano RP, Desai NR, Kohli P, Rogers WJ, Somaratne R, Huang F, Liu T, Mohanavelu S, Hoffman EB, McDonald ST, Abrahamsen TE, Wasserman SM, Scott R, Sabatine MS. Efficacy, safety, and tolerability of a monoclonal antibody to proprotein convertase subtilisin/kexin type 9 in combination with a statin in patients with hypercholesterolaemia (LAPLACE-TIMI 57): a randomised, placebo-controlled, dose-ranging, phase 2 study. Lancet 2012; 380:2007-17. [PMID: 23141813 PMCID: PMC4347805 DOI: 10.1016/s0140-6736(12)61770-x] [Citation(s) in RCA: 326] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND LDL cholesterol (LDL-C) is a well established risk factor for cardiovascular disease. Proprotein convertase subtilisin/kexin type 9 (PCSK9) binds LDL receptors, targeting them for degradation. We therefore assessed the efficacy, safety, and tolerability of AMG 145, a human monoclonal IgG2 antibody against PCSK9, in stable patients with hypercholesterolemia on a statin. METHODS In a phase 2, dose-ranging study done in 78 centres in the USA, Canada, Denmark, Hungary, and Czech Republic, patients (aged 18-80 years) with LDL-C greater than 2·2 mmol/L on a stable dose of statin (with or without ezetimibe), were randomly assigned equally, through an interactive voice response system, to subcutaneous injections of AMG 145 70 mg, 105 mg, or 140 mg, or matching placebo every 2 weeks; or subcutaneous injections of AMG 145 280 mg, 350 mg, or 420 mg, or matching placebo every 4 weeks. Everyone was masked to treatment assignment within the every 2 weeks and every 4 weeks schedules. The primary endpoint was the percentage change in LDL-C concentration from baseline after 12 weeks. Analysis was by modified intention to treat. This study is registered with ClinicalTrials.gov, number NCT01380730. FINDINGS 631 patients with hypercholesterolaemia were randomly assigned to AMG 145 70 mg (n=79), 105 mg (n=79), or 140 mg (n=78), or matching placebo (n=78) every 2 weeks; or AMG 145 280 mg (n=79), 350 mg (n=79), and 420 mg (n=80), and matching placebo (n=79) every 4 weeks. At the end of the dosing interval at week 12, the mean LDL-C concentrations were reduced generally dose dependently by AMG 145 every 2 weeks (ranging from 41·8% to 66·1%; p<0·0001 for each dose vs placebo) and AMG 145 every 4 weeks (ranging from 41·8% to 50·3%; p<0·0001). No treatment-related serious adverse events occurred. The frequencies of treatment-related adverse events were similar in the AMG 145 and placebo groups (39 [8%] of 474 vs 11 [7%] of 155); none of these events were severe or life-threatening. INTERPRETATION The results suggest that PCSK9 inhibition could be a new model in lipid management. Inhibition of PCSK9 warrants assessment in phase 3 clinical trials. FUNDING Amgen.
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Abstract
Results from different types of clinical research studies provide different types of evidence for evaluating the effects of a new drug or intervention. For this reason, it is important to recognize this phenomenon during reporting and to choose appropriate language to match the type of study that was done, because this can become critical to the interpretation and application of the results in clinical practice. In this article, we aim to highlight this issue through a series of examples and provide some guidance on what the appropriate language for different types of studies should be.
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Kohli P, Desai NR, Giugliano RP, Kim JB, Somaratne R, Huang F, Knusel B, McDonald S, Abrahamsen T, Wasserman SM, Scott R, Sabatine MS. Design and rationale of the LAPLACE-TIMI 57 trial: a phase II, double-blind, placebo-controlled study of the efficacy and tolerability of a monoclonal antibody inhibitor of PCSK9 in subjects with hypercholesterolemia on background statin therapy. Clin Cardiol 2012; 35:385-91. [PMID: 22714699 PMCID: PMC4347804 DOI: 10.1002/clc.22014] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 04/27/2012] [Indexed: 12/19/2022] Open
Abstract
Lowering low-density lipoprotein cholesterol (LDL-C) is a cornerstone for the prevention of atherosclerotic heart disease, improving clinical outcomes and reducing vascular mortality in patients with hypercholesterolemia. The clinical benefits of LDL-C reduction appear to extend even to patients starting with LDL-C as low as 60-80 mg/dL prior to initiating therapy. Statins are the first-line agents for treating hypercholesterolemia and are effective in reducing LDL-C, but many patients are unable to achieve their optimal lipid targets despite intensive statin therapy. Therefore, there has been a strong impetus for the development of novel pharmacologic agents designed to lower LDL-C further in patients already on statin therapy. Genetic mutations resulting in altered cholesterol homeostasis provide valuable information regarding novel approaches for treating hypercholesterolemia. To that end, mutations in proprotein convertase subtilisin/kexin type 9 (PCSK9) were linked to altered levels of LDL-C, illustrating this protein's role in lipid metabolism. PCSK9 promotes degradation of the LDL receptor, preventing its transport back to the cell surface and thereby increasing circulating LDL-C. Conversely, inhibition of PCSK9 can profoundly decrease circulating LDL-C, and thus is an attractive new target for LDL-C-lowering therapy. AMG 145 is a fully human monoclonal immunoglobulin G2 antibody that binds specifically to human PCSK9 and inhibits its interaction with the low-density lipoprotein receptor. In this manuscript, we describe the rationale and design of LDL-C Assessment with PCSK9 Monoclonal Antibody Inhibition Combined With Statin Therapy-Thrombolysis In Myocardial Infarction 57 (LAPLACE-TIMI 57; NCT01380730), a 12-week, randomized, double-blind, dose-ranging, placebo-controlled study designed to assess the safety and efficacy of AMG 145 when added to statin therapy in patients with hypercholesterolemia.
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Affiliation(s)
- Payal Kohli
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Nihar R. Desai
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Robert P. Giugliano
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | | | | | | | | | - Shannon McDonald
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Timothy Abrahamsen
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | | | | | - Marc S. Sabatine
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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Chakrabarti AK, Patel SJ, Kohli P, Udell JA, Singh P, Gopalakrishnan L, Kumar V, Gibson CM. Cost-Effective Medicines for Stroke Prophylaxis in Patients with Atrial Fibrillation. J Atr Fibrillation 2012; 5:470. [PMID: 28496748 PMCID: PMC5153083 DOI: 10.4022/jafib.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2011] [Revised: 01/29/2012] [Accepted: 04/09/2012] [Indexed: 06/07/2023]
Abstract
Non-valvular atrial fibrillation is the most common arrhythmia encountered in clinical practice and is associated with substantial healthcare costs. The risk of thromboembolic stroke is 3-5 times higher in patients with atrial fibrillation compared with the general population. Until the recent emergence of direct thrombin (factor IIa) and factor Xa inhibitors, antithrombotic therapy for atrial fibrillation was achieved with antiplatelet agents or vitamin K antagonists, which are considered cost-effective strategies when compared to no treatment. Now newer agents, such as the direct thrombin inhibitor dabigatran, can lower thromboembolic events and reduce the risk of fatal and intracerebral hemorrhage compared with warfarin, in addition to eliminating the need for costly therapeutic monitoring. Multiple analyses have shown that dabigatran, when compared with warfarin therapy that achieves a time in therapeutic range (TTR) consistent with previous large-scale trials, is a cost-effective approach to antithrombotic therapy in atrial fibrillation, ranging from $16,385 to $86,000 per quality-adjust life-year (QALY) gained. It has been shown to be especially cost-effective (QALY < $50,000) for high stroke-risk patients, those with a CHADS2 score of > 3 (barring excellent INR control) and for lower-risk patients with a CHADS2 of 2 but concomitant high risk of hemorrhage. In addition, factor Xa inhibitors, such as rivaroxaban (recently approved by the Federal Drug Administration [FDA]) and apixaban, may exhibit the same cost savings as dabigatran in terms of reduction of bleeding and elimination of therapeutic level monitoring costs. Going forward, the use of these agents and their role in thromboembolic stroke prophylaxis will need to be evaluated on a patient-by-patient basis, balancing consideration of the patient?s stroke and bleeding risks, as well as quality of life post-therapy.
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Affiliation(s)
- Anjan K Chakrabarti
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center (AKC, SJP, LG, VK, CMG), Harvard Medical School, Boston, MA; TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women?s Hospital (PK, JAU), Harvard Medical School, Boston, MA; and the PERFUSE Angiographic Core Laboratories and Data Coordinating Center, Beth Israel Deaconess Medical Center (PS) in Boston, MA
| | - Shalin J Patel
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center (AKC, SJP, LG, VK, CMG), Harvard Medical School, Boston, MA; TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women?s Hospital (PK, JAU), Harvard Medical School, Boston, MA; and the PERFUSE Angiographic Core Laboratories and Data Coordinating Center, Beth Israel Deaconess Medical Center (PS) in Boston, MA
| | - Payal Kohli
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center (AKC, SJP, LG, VK, CMG), Harvard Medical School, Boston, MA; TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women?s Hospital (PK, JAU), Harvard Medical School, Boston, MA; and the PERFUSE Angiographic Core Laboratories and Data Coordinating Center, Beth Israel Deaconess Medical Center (PS) in Boston, MA
| | - Jacob A Udell
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center (AKC, SJP, LG, VK, CMG), Harvard Medical School, Boston, MA; TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women?s Hospital (PK, JAU), Harvard Medical School, Boston, MA; and the PERFUSE Angiographic Core Laboratories and Data Coordinating Center, Beth Israel Deaconess Medical Center (PS) in Boston, MA
| | - Priyamvada Singh
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center (AKC, SJP, LG, VK, CMG), Harvard Medical School, Boston, MA; TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women?s Hospital (PK, JAU), Harvard Medical School, Boston, MA; and the PERFUSE Angiographic Core Laboratories and Data Coordinating Center, Beth Israel Deaconess Medical Center (PS) in Boston, MA
| | - Lakshmi Gopalakrishnan
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center (AKC, SJP, LG, VK, CMG), Harvard Medical School, Boston, MA; TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women?s Hospital (PK, JAU), Harvard Medical School, Boston, MA; and the PERFUSE Angiographic Core Laboratories and Data Coordinating Center, Beth Israel Deaconess Medical Center (PS) in Boston, MA
| | - Varun Kumar
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center (AKC, SJP, LG, VK, CMG), Harvard Medical School, Boston, MA; TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women?s Hospital (PK, JAU), Harvard Medical School, Boston, MA; and the PERFUSE Angiographic Core Laboratories and Data Coordinating Center, Beth Israel Deaconess Medical Center (PS) in Boston, MA
| | - C Michael Gibson
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center (AKC, SJP, LG, VK, CMG), Harvard Medical School, Boston, MA; TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women?s Hospital (PK, JAU), Harvard Medical School, Boston, MA; and the PERFUSE Angiographic Core Laboratories and Data Coordinating Center, Beth Israel Deaconess Medical Center (PS) in Boston, MA
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Gopalakrishnan L, Kumar V, Kohli P, Singh P, Rastogi U, Gibson CM. Pharmacokinetic evaluation of rivaroxaban for the treatment of acute coronary syndromes. Expert Opin Drug Metab Toxicol 2012; 8:889-900. [PMID: 22577900 DOI: 10.1517/17425255.2012.688026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Arterial and venous thrombotic states, including myocardial infarction (MI), stroke and deep vein thrombosis with subsequent pulmonary embolism, are a significant cause of cardiovascular mortality and morbidity. Factor Xa (FXa) plays a pivotal role in thrombus formation. Its inhibition following acute coronary syndromes (ACS) blocks amplification of thrombin generation and subsequent clot formation, resulting in a risk reduction in recurrent MI, stroke and death. For this reason, a predictable form of oral anticoagulation continues to be an ongoing need. Rivaroxaban , the first oral FXa inhibitor, acts by direct inhibition of FXa and does not require an antithrombin cofactor for its activity. AREAS COVERED This paper describes the pharmacokinetics (PK) of low-dose rivaroxaban tested in patients with ACS. Age, gender, renal function and body weight have no clinically significant effects on the PK of the drug in treatment of ACS. Caution should be maintained during co-administration of strong CYP3A4 inducers and inhibitors. Among patients with moderate and severe hepatic impairment and in those with associated coagulopathies, rivaroxaban however is contraindicated. EXPERT OPINION The mortality benefit with low-dose rivaroxaban in ACS patients was first demonstrated in ATLAS ACS2 TIMI-51 trial. With its rapid oral bioavailability, predictable PK, low drug-drug interaction and no need for monitoring, the use of low-dose rivaroxaban in addition to dual antiplatelet therapy offers an appealing new option in improving outcomes following ACS in the modern era of novel oral FXa inhibitors.
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Affiliation(s)
- Lakshmi Gopalakrishnan
- Harvard Medical School, Beth Israel Deaconess Medical Center, Cardiovascular Division, Department of Medicine, Boston, MA 02115, USA
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Kohli P, Murphy SA, Cannon CP. Abstract 204: Who Funds “Evidence-Based Medicine” in our Guidelines: Government or Industry? Analysis of the AHA/ACC Class I Secondary Prevention Guidelines in 2011 vs. 2001. Circ Cardiovasc Qual Outcomes 2012. [DOI: 10.1161/circoutcomes.5.suppl_1.a204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Heated debate on the “influence” of the pharmaceutical industry has led some to question whether trials sponsored by industry provide strong evidence for clinical practice. We sought to analyze this issue by looking at what the independent ACC/AHA Guideline committee cited as the evidence base for Class I (strongest) recommendations, and evaluated the funding source, as well as changes over time.
Methods:
After importing all citations from the AHA/ACC Secondary Prevention 2011 Update into EndNote citation manager, we excluded those that were not primary publications (e.g. consensus statements or summary guidelines). Funding source was determined from the PubMed database (or if not specified, the primary publication itself). Research support was divided by PubMed categories: U.S. governmental (gov’t), non-U.S. gov’t (typically industry), or mixed. (Note that further division of funding source into any (U.S and foreign) governmental source vs. exclusively industry, is ongoing.) All Class I recommendations were reviewed to determine what percentage of the supporting evidence was funded by U.S. gov’t vs. non-U.S. gov’t, weighting those in the mixed category equally between the other two categories. Chi-square tests were used to statistically compare these percentages.
Results:
Overall, 62% of studies cited to support Class I recommendations in 2011 were sponsored by non-US gov’t (e.g. industry) sources. Nine of 12 categories of Class I recommendations had the majority of the studies supported by non-gov’t/industry rather than from US gov’t funding (Table 1). This was true both for lifestyle interventions and pharmacological therapies, although the percentage of industry-funded trials for pharmacological therapies was significantly higher as compared to studies for lifestyle interventions (83% vs. 46%, p<0.001). Looking at trends over time, in the 2001 guideline, 51% of studies supporting Class I recommendations were funded by the US gov’t, while of the newer additions since 2001, 78% have been funded by non-gov’t/industry sources (p=0.005). Thus, the time trend for the overall % of recommendations that were sponsored by non-US gov’t/industry has risen from 49% in 2001 to 62% in the 2011 guidelines.
Conclusion:
Based on this initial categorization from PubMed, it appears that the majority of trials providing the evidence for the ACC/AHA Secondary Prevention guideline comes from non-government/industry-sponsored trials, and this percentage has increased over time. This finding suggests that industry-sponsored trials do provide a positive impact on clinical guidelines.
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Kohli P, Wallentin L, Reyes E, Horrow J, Husted S, Storey R, James S, Cannon C. REDUCTION IN FIRST AND RECURRENT CARDIOVASCULAR AND ISCHEMIC EVENTS WITH TICAGRELOR COMPARED WITH CLOPIDOGREL IN THE PLATO STUDY. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)60505-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Udell JA, Kohli P, Li S, Wang T, Antman E, Wiviott S. CLINICAL TRIAL PARTICIPATION AFTER ACUTE CORONARY SYNDROME AND ASSOCIATED OUTCOMES: INSIGHT FROM THE ACTION REGISTRY-GWTG. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61807-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
In the modern era of statin therapy, major advances have been made in treating coronary heart disease. However, despite intensive treatment with statin therapy, residual cardiovascular risk persists and has been attributed to the persistence of atherogenic dyslipidemia and, in part, elevated triglycerides (TGs). In this review, the authors focus on the mechanism of elevated TGs and provide a discussion of the challenges of measuring TGs as a biomarker, its role in the pathogenesis of atherosclerotic heart disease, and results of several recent studies that have elucidated the relationship between TGs and cardiovascular morbidity and mortality.
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Affiliation(s)
- Payal Kohli
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital, Boston, MA 02115, USA.
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Affiliation(s)
- Payal Kohli
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Christopher P Cannon
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Kohli P, Bonaca MP, Kakkar R, Kudinova AY, Scirica BM, Sabatine MS, Murphy SA, Braunwald E, Lee RT, Morrow DA. Role of ST2 in non-ST-elevation acute coronary syndrome in the MERLIN-TIMI 36 trial. Clin Chem 2011; 58:257-66. [PMID: 22096031 DOI: 10.1373/clinchem.2011.173369] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE We investigated the prognostic performance of ST2 with respect to cardiovascular death (CVD) and heart failure (HF) in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) in a large multinational trial. BACKGROUND Myocytes that are subjected to mechanical stress secrete ST2, a soluble interleukin-1 receptor family member that is associated with HF after STE-ACS. METHODS We measured ST2 with a high-sensitivity assay in all available baseline samples (N=4426) in patients enrolled in the Metabolic Efficiency With Ranolazine for Less Ischemia in the Non-ST-Elevation Acute Coronary Syndrome Thrombolysis in Myocardial Infarction 36 (MERLIN-TIMI 36), a placebo-controlled trial of ranolazine in NSTE-ACS. All events, including cardiovascular death and new or worsening HF, were adjudicated by an independent events committee. RESULTS Patients with ST2 concentrations in the top quartile (>35 μg/L) were more likely to be older and male and have diabetes and renal dysfunction. ST2 was only weakly correlated with troponin and B-type natriuretic peptide. High ST2 was associated with increased risk for CVD/HF at 30 days (6.6% vs 1.6%, P<0.0001) and 1 year (12.2% vs 5.2%, P<0.0001). The risk associated with ST2 was significant after adjustment for clinical covariates and biomarkers (adjusted hazard ratio CVD/HF 1.90, 95% CI 1.15-3.13 at 30 days, P=0.012; 1.51, 95% CI 1.15-1.98 at 1 year, P=0.003), with a significant integrated discrimination improvement (P<0.0001). No significant interaction was found between ST2 and ranolazine (Pinteraction=0.15). CONCLUSIONS ST2 correlates weakly with biomarkers of acute injury and hemodynamic stress but is strongly associated with the risk of HF after NSTE-ACS. This biomarker and related pathway merit further investigation as potential therapeutic targets for patients with ACS at risk for cardiac remodeling.
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Affiliation(s)
- Payal Kohli
- TIMI Study Group, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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Abstract
Resolution of inflammation has historically been viewed as a passive process, occurring as a result of the withdrawal of pro-inflammatory signals, including lipid mediators such as leukotrienes and prostaglandins. Thus, most anti-inflammatory drugs have traditionally targeted primarily mediator pathways that are engaged at the onset of inflammation. Only recently has it been established that inflammation resolution is an active process with a distinct set of chemical mediators. Several clinical and epidemiological studies have identified beneficial effects of polyunsaturated fatty acids (PUFAs) for a variety of inflammatory diseases, yet without mechanistic explanations for these beneficial effects. Resolvins and protectins are recently identified molecules that are generated from omega-3 PUFA precursors and can orchestrate the timely resolution of inflammation in model systems. Dysregulation of pro-resolving mediators is associated with diseases of prolonged inflammation, so designing pharmacological mimetics of naturally occurring pro-resolving mediators offers exciting new targets for drug design. This review describes the discovery and synthesis of these novel lipid mediators, their receptors and mechanisms of action, and summarizes the studies to date that have uncovered roles for resolvins and protectins in disease states.
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Affiliation(s)
- Payal Kohli
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
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Kertzman Z, Marchal J, Suarez M, Staia MH, Filip P, Kohli P, Aouadi SM. Mechanical, tribological, and biocompatibility properties of ZrN-Ag nanocomposite films. J Biomed Mater Res A 2008; 84:1061-7. [PMID: 17685406 DOI: 10.1002/jbm.a.31533] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Nanocomposite films of ZrN-Ag were produced by reactive unbalanced magnetron sputtering, and their structural, chemical, mechanical, tribological, haemocompatibility, and antibacterial properties were studied as a function of film composition. The films formed a dense and homogeneous microstructure whereby nanocrystals of Ag are distributed evenly throughout the ZrN matrix. For small additions of silver, the hardness was found to increase, whereas the elastic modulus was found to decrease drastically. In the process of optimizing the deposition conditions, three kinds of coatings were prepared on 316 L surgical steel and tested by accelerated electrochemical polarization tests in order to detect the influence of Ag and the value of the bias potential on the corrosion performance of the system. Films produced under the optimum deposition conditions were, subsequently, deposited on medical grade Ti-Al-V and worn against ball-bearing steel using a ball-on-disk tribotester in bovine serum and were found to have superior tribological properties compared with single-phase ZrN coatings. The haemocompatibility of the films was assessed by investigating the adsorption of human serum albumin and fibrinogen on samples with different phase compositions. Quantification of the protein adsorption was carried out using spectroscopic ellipsometry, which confirmed the haemocompatibility of the films. Antibiotic activity of the films was quantified by incubating the films in bacterial cultures, namely, Staphylococcus epidermis, Staphylococcus aureus, and Escherichia coli. Films with a silver content > 10% exhibited superior antibacterial activity compared with the uncoated samples.
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Affiliation(s)
- Z Kertzman
- Department of Physics, Southern Illinois University, Carbondale, Illinois 62901, USA
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Levy BD, Kohli P, Gotlinger K, Haworth O, Hong S, Kazani S, Israel E, Haley KJ, Serhan CN. Protectin D1 is generated in asthma and dampens airway inflammation and hyperresponsiveness. J Immunol 2007; 178:496-502. [PMID: 17182589 PMCID: PMC3005704 DOI: 10.4049/jimmunol.178.1.496] [Citation(s) in RCA: 257] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Protectins are newly identified natural chemical mediators that counter leukocyte activation to promote resolution of inflammation. In this study, we provide the first evidence for protectin D1 (PD1, 10R,17S-dihydroxy-docosa-4Z,7Z,11E,13E,15Z,19Z-hexaenoic acid) formation from docosahexaenoic acid in human asthma in vivo and PD1 counterregulatory actions in allergic airway inflammation. PD1 and 17S-hydroxy-docosahexaenoic acid were present in exhaled breath condensates from healthy subjects. Of interest, levels of PD1 were significantly lower in exhaled breath condensates from subjects with asthma exacerbations. PD1 was also present in extracts of murine lungs from both control animals and those sensitized and aerosol challenged with allergen. When PD1 was administered before aeroallergen challenge, airway eosinophil and T lymphocyte recruitment were decreased, as were airway mucus, levels of specific proinflammatory mediators, including IL-13, cysteinyl leukotrienes, and PGD(2), and airway hyperresponsiveness to inhaled methacholine. Of interest, PD1 treatment after aeroallergen challenge markedly accelerated the resolution of airway inflammation. Together, these findings provide evidence for endogenous PD1 as a pivotal counterregulatory signal in allergic airway inflammation and point to new therapeutic strategies for modulating inflammation in asthmatic lung.
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Affiliation(s)
- Bruce D Levy
- Pulmonary and Critical Care Medicine, Department of Internal Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
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