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Agarwal R, Pitt B, Rossing P, Anker SD, Filippatos G, Ruilope LM, Kovesdy CP, Tuttle K, Vaduganathan M, Wanner C, Bansilal S, Gebel M, Joseph A, Lawatscheck R, Bakris GL. Modifiability of Composite Cardiovascular Risk Associated With Chronic Kidney Disease in Type 2 Diabetes With Finerenone. JAMA Cardiol 2023; 8:732-741. [PMID: 37314801 PMCID: PMC10267848 DOI: 10.1001/jamacardio.2023.1505] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 09/23/2022] [Accepted: 04/23/2023] [Indexed: 06/15/2023]
Abstract
IMPORTANCE It is currently unclear whether chronic kidney disease (CKD)-associated cardiovascular risk in type 2 diabetes (T2D) is modifiable. OBJECTIVE To examine whether cardiovascular risk can be modified with finerenone in patients with T2D and CKD. DESIGN, SETTING, AND PARTICIPANTS Incidence rates from Finerenone in Chronic Kidney Disease and Type 2 Diabetes: Combined FIDELIO-DKD and FIGARO-DKD Trial Programme Analysis (FIDELITY), a pooled analysis of 2 phase 3 trials (including patients with CKD and T2D randomly assigned to receive finerenone or placebo) were combined with National Health and Nutrition Examination Survey data to simulate the number of composite cardiovascular events that may be prevented per year with finerenone at a population level. Data were analyzed over 4 years of consecutive National Health and Nutrition Examination Survey data cycles (2015-2016 and 2017-2018). MAIN OUTCOMES AND MEASURES Incidence rates of cardiovascular events (composite of cardiovascular death, nonfatal stroke, nonfatal myocardial infarction, or hospitalization for heart failure) were estimated over a median of 3.0 years by estimated glomerular filtration rate (eGFR) and albuminuria categories. The outcome was analyzed using Cox proportional hazards models stratified by study, region, eGFR and albuminuria categories at screening, and cardiovascular disease history. RESULTS This subanalysis included a total of 13 026 participants (mean [SD] age, 64.8 [9.5] years; 9088 male [69.8%]). Lower eGFR and higher albuminuria were associated with higher incidences of cardiovascular events. For recipients in the placebo group with an eGFR of 90 or greater, incidence rates per 100 patient-years were 2.38 (95% CI, 1.03-4.29) in those with a urine albumin to creatinine ratio (UACR) less than 300 mg/g and 3.78 (95% CI, 2.91-4.75) in those with UACR of 300 mg/g or greater. In those with eGFR less than 30, incidence rates increased to 6.54 (95% CI, 4.19-9.40) vs 8.74 (95% CI, 6.78-10.93), respectively. In both continuous and categorical models, finerenone was associated with a reduction in composite cardiovascular risk (hazard ratio, 0.86; 95% CI, 0.78-0.95; P = .002) irrespective of eGFR and UACR (P value for interaction = .66). In 6.4 million treatment-eligible individuals (95% CI, 5.4-7.4 million), 1 year of finerenone treatment was simulated to prevent 38 359 cardiovascular events (95% CI, 31 741-44 852), including approximately 14 000 hospitalizations for heart failure, with 66% (25 357 of 38 360) prevented in patients with eGFR of 60 or greater. CONCLUSIONS AND RELEVANCE Results of this subanalysis of the FIDELITY analysis suggest that CKD-associated composite cardiovascular risk may be modifiable with finerenone treatment in patients with T2D, those with eGFR of 25 or higher, and those with UACR of 30 mg/g or greater. UACR screening to identify patients with T2D and albuminuria with eGFR of 60 or greater may provide significant opportunities for population benefits.
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Affiliation(s)
- Rajiv Agarwal
- Richard L. Roudebush VA Medical Center and Indiana University, Indiana University School of Medicine, Indianapolis
| | - Bertram Pitt
- Department of Medicine, University of Michigan School of Medicine, Ann Arbor
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Stefan D. Anker
- Department of Cardiology (CVK) and Berlin Institute of Health Center for Regenerative Therapies, German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Gerasimos Filippatos
- Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Luis M. Ruilope
- Cardiorenal Translational Laboratory and Hypertension Unit, Institute of Research i+12, Madrid, Spain
- Centro de Investigación Biomédia en Red Enfermedades Cardiovasculares (CIBER-CV), Hospital Universitario 12 de Octubre, Madrid, Spain
- Faculty of Sport Sciences, European University of Madrid, Madrid, Spain
| | - Csaba P. Kovesdy
- Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis
| | - Katherine Tuttle
- Providence Medical Research Center, Providence Health Care, Spokane, Washington
- Division of Nephrology, University of Washington, Seattle
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christoph Wanner
- Division of Nephrology, University Hospital of Würzburg, Würzburg, Germany
| | | | - Martin Gebel
- Research and Development, Integrated Analysis Statistics, Bayer AG, Wuppertal, Germany
| | - Amer Joseph
- Cardiology and Nephrology Clinical Development, Bayer AG, Berlin, Germany
| | | | - George L. Bakris
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois
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Bonaca MP, Im K, Magnani G, Bansilal S, Dellborg M, Storey RF, Bhatt DL, Steg PG, Cohen M, Johanson P, Braunwald E, Sabatine MS. Patient selection for long-term secondary prevention with ticagrelor: insights from PEGASUS-TIMI 54. Eur Heart J 2022; 43:5037-5044. [PMID: 36367709 DOI: 10.1093/eurheartj/ehac402] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 09/21/2021] [Revised: 04/20/2022] [Accepted: 07/12/2022] [Indexed: 11/12/2022] Open
Abstract
AIM In patients with prior myocardial infarction (MI) on aspirin, the addition of ticagrelor reduces ischaemic risk but increases bleeding risk. The simultaneous assessment of baseline ischaemic and bleeding risk may assist clinicians in selecting patients who are most likely to have a favourable risk/benefit profile with long-term ticagrelor. METHODS AND RESULTS PEGASUS-TIMI 54 randomized 21 162 prior MI patients, 13 956 of which to the approved 60 mg dose or placebo and who had all necessary data. The primary efficacy endpoint was cardiovascular death, MI, or stroke, and the primary safety outcome was TIMI major bleeding; differences in Kaplan-Meier event rates at 3 years are presented. Post-hoc subgroups based on predictors of bleeding and ischaemic risk were merged into a selection algorithm. Patients were divided into four groups: those with a bleeding predictor (n = 2721, 19%) and then those without a bleeding predictor and either 0-1 ischaemic risk factor (IRF; n = 3004, 22%), 2 IRF (n = 4903, 35%), or ≥3 IRF (n = 3328, 24%). In patients at high bleeding risk, ticagrelor increased bleeding [absolute risk difference (ARD) +2.3%, 95% confidence interval (CI) 0.6, 3.9] and did not reduce the primary efficacy endpoint (ARD +0.08%, 95% CI -2.4 to 2.5). In patients at low bleeding risk, the ARDs in the primary efficacy endpoint with ticagrelor were -0.5% (-2.2, 1.3), -1.5% (-3.1, 0.02), and -2.6% (-5.0, -0.24, P = 0.03) in those with ≤1, 2, and 3 risk factors, respectively (P = 0.076 for trend across groups). There were significant trends for greater absolute risk reductions for cardiovascular death (P-trend 0.018), all-cause mortality (P-trend 0.027), and net outcomes (P-trend 0.037) with ticagrelor across these risk groups. CONCLUSION In a post-hoc exploratory analysis of patients with prior MI, long-term ticagrelor therapy appears to be best suited for those with prior MI with multiple IRFs at low bleeding risk. CLINICAL TRIAL REGISTRATION NCT01225562 ClinicalTrials.gov.
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Affiliation(s)
- Marc P Bonaca
- Department of Cardiology and Vascular Medicine, University of Colorado School of Medicine, 2115 N Scranton St Suite 2040, Aurora, CO 80045, USA
| | - KyungAh Im
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Mikael Dellborg
- Department of Medicine/Östra, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Robert F Storey
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Beech Hill Road, Sheffield S10 2RX, UK
| | - Deepak L Bhatt
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - P Gabriel Steg
- Université Paris-Cité, INSERM U-1148 and AP-HP, Hôpital Bichat, FACT (French Alliance for Cardiovascular Trials) Paris, France
| | - Marc Cohen
- Newark Beth Israel Medical Center, Rutgers Medical School, Newark, New Jersey, USA
| | | | - Eugene Braunwald
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marc S Sabatine
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Agarwal R, Pitt B, Rossing P, Anker SD, Filippatos G, Ruilope LM, Kovesdy CP, Tuttle K, Vaduganathan M, Wanner C, Bansilal S, Gebel M, Joseph A, Lawatscheck R, Bakris G. In patients with type 2 diabetes chronic kidney disease is a modifiable cardiovascular risk factor. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2420] [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: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Chronic kidney disease (CKD) in patients with type 2 diabetes (T2D) is associated with an increased risk of cardiovascular (CV) events. The modifiability of CKD-associated CV risk in patients with T2D across a spectrum of CKD stages remains unknown.
Purpose
To test whether CKD, as defined jointly by estimated glomerular filtration rate (eGFR) and albuminuria (urine albumin-to-creatinine ratio [UACR]), is a modifiable CV risk factor in patients with T2D. Furthermore, to estimate the population-wide reduction in first CV events in the US if all eligible patients were treated with finerenone.
Methods
We estimated the incidence rates of CV events (composite of CV death, non-fatal stroke, non-fatal myocardial infarction, or hospitalisation for heart failure) over a median follow-up of 3.0 years in 13,026 patients with CKD and T2D, treated with finerenone or placebo, in a joint analysis by eGFR and UACR categories. Patients were from FIDELITY, a prespecified pooled analysis of two phase III trials, and had an eGFR ≥25 ml/min/1.73 m2 and UACR 30–5000 mg/g at screening.The potential impact of finerenone treatment on the US population was evaluated by simulating the number of first CV events that could be prevented per year with finerenone, using incidence rates from FIDELITY and prevalence rates of CKD in patients with T2D from the National Health and Nutrition Examination Survey (NHANES).
Results
Lower eGFR and higher UACR categories were associated with higher incidences of CV events in finerenone and placebo recipients (Figure). Finerenone reduced CV risk versus placebo (hazard ratio 0.86; 95% CI 0.78–0.95; p=0.0018) without evidence of moderation of risk reduction by combined eGFR and UACR categories (p interaction = 0.66; Figure 1). Using NHANES, a total of 6.4 million treatment-eligible individuals with CKD and T2D were identified; 75% had CKD with an eGFR ≥60 ml/min/1.73 m2 and 25% had CKD with an eGFR <60 ml/min/1.73 m2. Simulations using this NHANES population projected that 1 year of finerenone treatment could prevent 38,359 CV events in US patients with CKD and T2D, with 66% of events prevented in patients with eGFR ≥60 ml/min/1.73 m2.
Conclusions
Higher albuminuria and lower eGFR are associated with increased CV risk in patients with T2D. Across a range of eGFR and albuminuria categories, CV risk is modifiable. Therefore, CKD is a modifiable CV risk factor in part mediated by mineralocorticoid receptor overactivation. UACR screening to identify patients with T2D and albuminuria with an eGFR ≥60 ml/min/1.73 m2 is likely to provide a significant opportunity for population benefits.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Bayer AG
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Affiliation(s)
- R Agarwal
- Richard L. Roudebush VA Medical Center and Indiana University , Indianapolis , United States of America
| | - B Pitt
- University of Michigan, Department of Medicine , Ann Arbor , United States of America
| | - P Rossing
- Steno Diabetes Center Copenhagen , Gentofte , Denmark
| | - S D Anker
- Berlin Institute of Health Center for Regenerative Therapies, Department of Cardiology (CVK) , Berlin , Germany
| | - G Filippatos
- National & Kapodistrian University of Athens, School of Medicine, Department of Cardiology, Attikon University Hospital , Athens , Greece
| | - L M Ruilope
- Institute of Research imas12, Cardiorenal Translational Laboratory and Hypertension Unit , Madrid , Spain
| | - C P Kovesdy
- University of Tennessee, Division of Nephrology, Department of Medicine , Memphis , United States of America
| | - K Tuttle
- Providence Medical Research Center, Providence Health Care , Seattle , United States of America
| | - M Vaduganathan
- Harvard Medical School, Cardiovascular Division, Brigham and Women's Hospital , Boston , United States of America
| | - C Wanner
- University Hospital of Wurzburg, Division of Nephrology , Wurzburg , Germany
| | - S Bansilal
- Bayer Corporation, US Medical Affairs , New Jersey , United States Minor Outlying Islands
| | - M Gebel
- Bayer AG, Research and Development, Integrated Analysis Statistics , Wuppertal , Germany
| | | | - R Lawatscheck
- Bayer AG, Medical Affairs & Pharmacovigilance, Pharmaceuticals , Berlin , Germany
| | - G Bakris
- University of Chicago Medicine, Department of Medicine , Chicago , United States of America
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Butler O, Ju S, Hoernig S, Vogtländer K, Bansilal S, Heresi GA. Assessment for residual disease after pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension. ERJ Open Res 2022; 8:00572-2021. [PMID: 35651369 PMCID: PMC9149390 DOI: 10.1183/23120541.00572-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/29/2022] [Indexed: 11/08/2022] Open
Abstract
Objectives Pulmonary endarterectomy (PEA) is recommended for eligible patients with chronic thromboembolic pulmonary hypertension (CTEPH) and is potentially curative. However, persistent/recurrent CTEPH post-PEA can occur. Here we describe symptom and diagnostic assessment rates for residual disease post-PEA and longitudinal diagnostic patterns before and after riociguat approval for persistent/recurrent CTEPH after PEA. Methods This US retrospective cohort study analysed MarketScan data (1 January 2002–30 September 2018) from patients who underwent PEA following a CTEPH/pulmonary hypertension (PH) claim with at least 730 days of continuous enrolment post-PEA. Data on pre-specified PH symptoms and the types and timings of diagnostic assessments were collected. Results Of 103 patients (pre-riociguat approval, n=55; post-riociguat approval, n=48), residual PH symptoms >3 months after PEA were reported in 89% of patients. Overall, 89% of patients underwent one or more diagnostic tests (mean 4.6 tests/patient), most commonly echocardiography (84%), with only 5% of patients undergoing right heart catheterisation (RHC). In the post- versus pre-riociguat approval subgroup, assessments were more specific for CTEPH with an approximately two-fold increase in 6-min walk distance and N-terminal prohormone of brain natriuretic protein measurements and ventilation/perfusion scans, and a four-fold increase in RHCs. Conclusions Low RHC rates suggest that many patients with PH symptoms post-PEA are not being referred for full diagnostic workup. Changes to longitudinal diagnostic patterns may indicate increased recognition of persistent/recurrent CTEPH post-PEA; however, there remains a need for greater awareness around the importance of continued follow-up for patients with residual PH symptoms post-PEA. Rates of residual PH symptoms are high after PEA but referral of patients with suspected persistent/recurrent CTEPH following PEA for CTEPH-specific diagnostic assessments is suboptimal, highlighting potential gaps in CTEPH patient care post-PEAhttps://bit.ly/3jfUZlO
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Benza RL, Boucly A, Farber HW, Frost AE, Ghofrani HA, Hoeper MM, Lambelet M, Rahner C, Bansilal S, Nikkho S, Meier C, Sitbon O. Change in REVEAL Lite 2 risk score predicts outcomes in patients with pulmonary arterial hypertension in the PATENT study. J Heart Lung Transplant 2021; 41:411-420. [PMID: 34848133 DOI: 10.1016/j.healun.2021.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 09/24/2021] [Accepted: 10/20/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Risk assessment is essential in pulmonary arterial hypertension (PAH) management. We investigated the effect of riociguat on REVEAL Lite 2 score, an abridged version of the REVEAL risk score, and its association with long-term outcomes in PATENT. METHODS PATENT-1 was a randomized, double-blind study of riociguat vs placebo in patients with PAH. In the PATENT-2 open-label extension, all patients received riociguat up to 2.5 mg three times daily (n = 396). REVEAL Lite 2 scores were calculated at baseline, PATENT-1 Week 12, and PATENT-2 Week 12, with patients stratified as low- (1-5), intermediate- (6-7), or high-risk (≥8). Kaplan-Meier and Cox proportional hazards analyses assessed association of riociguat with survival and clinical worsening-free survival (CWFS). RESULTS REVEAL Lite 2 score improved with riociguat 2.5 mg at PATENT-1 Week 12 (least-squares mean difference vs placebo: -0.8; p = 0.0004). More patients receiving riociguat 2.5 mg stabilized or improved risk stratum at PATENT-1 Week 12 vs placebo (p = 0.0005) and achieved low-risk status. REVEAL Lite 2 score at baseline and PATENT-1 Week 12 were associated with survival and CWFS (all p < 0.0001), as was change in score from baseline to Week 12 (p = 0.0002 and p < 0.0001, respectively). Survival and CWFS differed between risk strata at baseline (p < 0.0001) and PATENT-1 Week 12 (p < 0.0001). CONCLUSIONS This analysis confirms the risk-reduction benefits of riociguat in patients with PAH and further contributes to the validation of REVEAL Lite 2 in facilitating PAH risk assessment.
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Affiliation(s)
- Raymond L Benza
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Athénaïs Boucly
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France; AP-HP, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France; INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Harrison W Farber
- Pulmonary Hypertension Center, Boston University/Boston Medical Center, Boston, Massachusetts
| | - Adaani E Frost
- Houston Methodist Research Institute, Houston Methodist Hospital, Houston, Texas
| | - Hossein-Ardeschir Ghofrani
- Department of Medicine, University of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany; Imperial College London, London, UK; Department of Pneumology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Marius M Hoeper
- Department of Respiratory Medicine and the German Center for Lung Research, Hannover Medical School, Hannover, Germany
| | | | | | | | - Sylvia Nikkho
- Global Clinical Development, Bayer AG, Berlin, Germany
| | | | - Olivier Sitbon
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France; AP-HP, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France; INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
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Benza R, Boucly A, Farber H, Frost A, Bansilal S, Meier C, Rahner C, Hoeper M. COMPARISON OF RISK DISCRIMINATION BETWEEN REVEAL RISK SCORE CALCULATORS IN PATIENTS FROM THE PATENT STUDIES OF RIOCIGUAT IN PULMONARY ARTERIAL HYPERTENSION. Chest 2020. [DOI: 10.1016/j.chest.2020.08.1865] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Liao L, Lott J, Kong S, Fu C, Lin J, Bansilal S. COMPARISON OF HEALTHCARE COSTS OF PATIENTS WITH PULMONARY ARTERIAL HYPERTENSTION WITH PHOSPHODIESTERASE-5 INHIBITOR FAILURE WHO SWITCHED TO RIOCIGUAT VS THOSE WHO AUGMENTED THERAPY. Chest 2020. [DOI: 10.1016/j.chest.2020.08.1929] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Latina J, Fernandez-Jimenez R, Bansilal S, Sartori S, Vedanthan R, Lewis M, Kofler C, Hunn M, Martin F, Bagiella E, Farkouh M, Fuster V. Grenada Heart Project-Community Health ActioN to EncouraGe healthy BEhaviors (GHP-CHANGE): A randomized control peer group-based lifestyle intervention. Am Heart J 2020; 220:20-28. [PMID: 31765932 DOI: 10.1016/j.ahj.2019.08.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 08/28/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The incidence of cardiovascular (CV) risk factors is increasing globally, with a disproportionate burden in the low and low-middle income countries (L/LMICs). Peer support, as a low-cost lifestyle intervention, has succeeded in managing chronic illness. For global CV risk reduction, limited data exists in LMICs. AIM The GHP-CHANGE was designed as a community-based randomized trial to test the effectiveness of peer support strategy for CV risk reduction in the island of Grenada, a LMIC. METHODS We recruited 402 adults from the Grenada Heart Project (GHP) Cohort Study of 2827 subjects with at least two CV risk factors. Subjects were randomized in a 1:1 fashion to a peer-group based intervention group (n = 206) or a self-management control group (n = 196) for 12 months. The primary outcome was the change from baseline in a composite score related to Blood pressure, Exercise, Weight, Alimentation and Tobacco (FBS, Fuster-BEWAT Score), ranging from 0 to 15 (ideal health = 15). Linear mixed-effects models were used to test for intervention effects. RESULTS Participants mean age was 51.4 years (SD 14.5) years, two-thirds were female, and baseline mean FBS was 8.9 (SD 2.6) and 8.5 (SD 2.6) in the intervention and control group, respectively (P = .152). At post intervention, the mean FBS was higher in the intervention group compared to the control group [9.1 (SD 2.7) vs 8.5 (SD 2.6), P = .028]. When balancing baseline health profile, the between-group difference (intervention vs. control) in the change of FBS was 0.31 points (95% CI: -0.12 to 0.75; P = .154). CONCLUSIONS The GHP-CHANGE trial showed that a peer-support lifestyle intervention program was feasible; however, it did not demonstrate a significant improvement in the FBS as compared to the control group. Further studies should assess the effects of low-cost lifestyle interventions in LMICs.
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Marquis-Gravel G, Roe MT, Turakhia MP, Boden W, Temple R, Sharma A, Hirshberg B, Slater P, Craft N, Stockbridge N, McDowell B, Waldstreicher J, Bourla A, Bansilal S, Wong JL, Meunier C, Kassahun H, Coran P, Bataille L, Patrick-Lake B, Hirsch B, Reites J, Mehta R, Muse ED, Chandross KJ, Silverstein JC, Silcox C, Overhage JM, Califf RM, Peterson ED. Technology-Enabled Clinical Trials. Circulation 2019; 140:1426-1436. [DOI: 10.1161/circulationaha.119.040798] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [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: 12/17/2022]
Abstract
The complexity and costs associated with traditional randomized, controlled trials have increased exponentially over time, and now threaten to stifle the development of new drugs and devices. Nevertheless, the growing use of electronic health records, mobile applications, and wearable devices offers significant promise for transforming clinical trials, making them more pragmatic and efficient. However, many challenges must be overcome before these innovations can be implemented routinely in randomized, controlled trial operations. In October of 2018, a diverse stakeholder group convened in Washington, DC, to examine how electronic health record, mobile, and wearable technologies could be applied to clinical trials. The group specifically examined how these technologies might streamline the execution of clinical trial components, delineated innovative trial designs facilitated by technological developments, identified barriers to implementation, and determined the optimal frameworks needed for regulatory oversight. The group concluded that the application of novel technologies to clinical trials provided enormous potential, yet these changes needed to be iterative and facilitated by continuous learning and pilot studies.
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Affiliation(s)
| | - Matthew T. Roe
- Duke Clinical Research Institute, Durham, NC (G.M.-G., M.T.R., B.P.-L., E.D.P.)
| | - Mintu P. Turakhia
- Center for Digital Health (M.P.T.), Stanford University, CA
- VA Palo Alto Health Care System, CA (M.P.T.)
| | - William Boden
- Boston University and VA New England Health Care System, MA (W.B.)
| | - Robert Temple
- U.S. Food and Drug Administration, Silver Spring, MD (R.T., N.S.)
| | - Abhinav Sharma
- Division of Cardiology (A.S.), Stanford University, CA
- Division of Cardiology, McGill University Health Centre, Montreal, QC, Canada (A.S.)
| | | | - Paul Slater
- Life Sciences Innovation, Microsoft, Seattle, WA (P.S.)
| | | | | | | | | | | | | | | | | | | | | | - Lauren Bataille
- The Michael J. Fox Foundation for Parkinson’s Research, New York (L.B.)
| | - Bray Patrick-Lake
- Duke Clinical Research Institute, Durham, NC (G.M.-G., M.T.R., B.P.-L., E.D.P.)
| | | | | | | | - Evan D. Muse
- Scripps Research Translational Institute; Division of Cardiovascular Disease, Scripps Clinic, Scripps Health, La Jolla, CA (E.D.M.)
| | | | | | | | | | - Robert M. Califf
- Department of Medicine (R.M.C.), Stanford University, CA
- Duke Forge, Duke University School of Medicine, Durham, NC (R.M.C.)
- Verily Life Sciences (Alphabet), South San Francisco, CA (R.M.C.)
| | - Eric D. Peterson
- Duke Clinical Research Institute, Durham, NC (G.M.-G., M.T.R., B.P.-L., E.D.P.)
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Bansilal S, Bonaca MP, Cornel JH, Storey RF, Bhatt DL, Steg PG, Im K, Murphy SA, Angiolillo DJ, Kiss RG, Parkhomenko AN, Lopez-Sendon J, Isaza D, Goudev A, Kontny F, Held P, Jensen EC, Braunwald E, Sabatine MS, Oude Ophuis AJ. Ticagrelor for Secondary Prevention of Atherothrombotic Events in Patients With Multivessel Coronary Disease. J Am Coll Cardiol 2019; 71:489-496. [PMID: 29406853 DOI: 10.1016/j.jacc.2017.11.050] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [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: 07/06/2017] [Revised: 11/05/2017] [Accepted: 11/25/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Patients with prior myocardial infarction (MI) and multivessel coronary disease (MVD) are at high risk for recurrent coronary events. OBJECTIVES The authors investigated the efficacy and safety of ticagrelor versus placebo in patients with MVD in the PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis In Myocardial Infarction 54) trial. METHODS Patients with a history of MI 1 to 3 years before inclusion in the PEGASUS-TIMI 54 trial were stratified in a pre-specified analysis based on the presence of MVD. The effect of ticagrelor (60 mg and 90 mg) on the composite of cardiovascular death, MI, or stroke (major adverse cardiovascular events [MACE]), as well as the composite of coronary death, MI, or stent thrombosis (coronary events), and on TIMI major bleeding, intracranial hemorrhage (ICH), and fatal bleeding were evaluated over a median of 33 months. RESULTS A total of 12,558 patients (59.4%) had MVD. In the placebo arm, compared with patients without MVD, those with MVD were at higher risk for MACE (9.37% vs. 8.57%, adjusted hazard ratio [HRadj]: 1.24; p = 0.026) and for coronary events (7.67% vs. 5.34%, HRadj: 1.49; p = 0.0005). In patients with MVD, ticagrelor reduced the risk of MACE (7.94% vs. 9.37%, HR: 0.82; p = 0.004) and coronary events (6.02% vs. 7.67%, HR: 0.76; p < 0.0001), including a 36% reduction in coronary death (HR: 0.64; 95% confidence interval: 0.48 to 0.85; p = 0.002). In this subgroup, ticagrelor increased the risk of TIMI major bleeding (2.52% vs. 1.08%, HR: 2.67; p < 0.0001), but not ICH or fatal bleeds. CONCLUSIONS Patients with prior MI and MVD are at increased risk of MACE and coronary events, and experience substantial relative and absolute risk reductions in both outcomes with long-term ticagrelor treatment relative to those without MVD. Ticagrelor increases the risk of TIMI major bleeding, but not ICH or fatal bleeding. For patients with prior MI and MVD, ticagrelor is an effective option for long-term antiplatelet therapy. (Prevention of Cardiovascular Events [e.g., Death From Heart or Vascular Disease, Heart Attack, or Stroke] in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin [PEGASUS]; NCT01225562).
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Affiliation(s)
- Sameer Bansilal
- Zena and Michael Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marc P Bonaca
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jan H Cornel
- Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar and Dutch Network for Cardiovascular Research (WCN), the Netherlands
| | - Robert F Storey
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Deepak L Bhatt
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ph Gabriel Steg
- DHU (Département Hospitalo-Universitaire)-FIRE (Fibrosis, Inflammation, REmodelling), Hôpital Bichat, AP-HP (Assistance Publique-Hôpitaux de Paris), Université Paris-Diderot, Sorbonne-Paris Cité, and FACT (French Alliance for Cardiovascular clinical Trials), an F-CRIN network, INSERM U-1148, Paris, France; National Heart and Lung Institute, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, Imperial College, London, United Kingdom
| | - Kyungah Im
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sabina A Murphy
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida
| | - Robert G Kiss
- Department of Cardiology, Military Hospital, Budapest, Hungary
| | | | | | - Daniel Isaza
- Fundacion Cardioinfantil, Instituto de Cardiología, Bogotá, Cundinamarca, Colombia
| | - Assen Goudev
- Medical University Sofia, Queen Ioanna Hospital, Sofia, Bulgaria
| | - Frederic Kontny
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway; Drammen Heart Center, Drammen, Norway
| | - Peter Held
- AstraZeneca Research and Development, Mölndal, Sweden
| | - Eva C Jensen
- AstraZeneca Research and Development, Mölndal, Sweden
| | - Eugene Braunwald
- 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.
| | - A J Oude Ophuis
- Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar and Dutch Network for Cardiovascular Research (WCN), the Netherlands; Department of Cardiology, CWZ Hospital, Nijmegen, the Netherland
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11
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Faggioni M, Baber U, Chandrasekhar J, Sartori S, Weintraub W, Rao SV, Vogel B, Claessen B, Kini A, Effron M, Ge Z, Keller S, Strauss C, Snyder C, Toma C, Weiss S, Aquino M, Baker B, Defranco A, Bansilal S, Muhlestein B, Kapadia S, Pocock S, Poddar KL, Henry TD, Mehran R. Use of prasugrel and clinical outcomes in African-American patients treated with percutaneous coronary intervention for acute coronary syndromes. Catheter Cardiovasc Interv 2019; 94:53-60. [PMID: 30656812 DOI: 10.1002/ccd.28033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/07/2018] [Accepted: 12/02/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate the use of prasugrel after percutaneous coronary intervention (PCI) in African American (AA) patients presenting with acute coronary syndrome (ACS). BACKGROUND AA patients are at higher risk for adverse cardiovascular outcomes after PCI and may derive greater benefit from the use of potent antiplatelet therapy. METHODS Using the multicenter PROMETHEUS observational registry of ACS patients treated with PCI, we grouped patients by self-reported AA or other races. Clinical outcomes at 90-day and 1-year included non-fatal myocardial infarction (MI), major adverse cardiac events (composite of death, MI, stroke, or unplanned revascularization) and major bleeding. RESULTS The study population included 2,125 (11%) AA and 17,707 (89%) non-AA patients. AA patients were younger, more often female (46% vs. 30%) with a higher prevalence of diabetes mellitus, chronic kidney disease, and prior coronary intervention than non-AA patients. Although AA patients more often presented with troponin (+) ACS, prasugrel use was much less common in AA vs. non-AA (11.9% vs. 21.4%, respectively, P = 0.001). In addition, the use of prasugrel increased with the severity of presentation in non-AA but not in AA patients. Multivariable logistic regression showed AA race was an independent predictor of reduced use of prasugrel (0.42 [0.37-0.49], P < 0.0001). AA race was independently associated with a significantly higher risk of MI at 90-days and 1 year after PCI. CONCLUSIONS Despite higher risk clinical presentation and worse 1-year ischemic outcomes, AA race was an independent predictor of lower prasugrel prescription in a contemporary population of ACS patients undergoing PCI.
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Affiliation(s)
- Michela Faggioni
- Icahn School of Medicine at Mount Sinai, New York, New York.,James J Peters Veterans Affairs Medical Center, Bronx, New York
| | - Usman Baber
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | - Sunil V Rao
- The Duke Clinical Research Institute, Durham, North Carolina
| | - Birgit Vogel
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Mark Effron
- John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, Louisiana.,Eli Lilly and Company, Indianapolis, Indiana
| | - Zhen Ge
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Clayton Snyder
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Catalin Toma
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Melissa Aquino
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | | | | | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, New York
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12
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Fernandez-Jimenez R, Jaslow R, Bansilal S, Santana M, Diaz-Munoz R, Latina J, Soto AV, Vedanthan R, Al-Kazaz M, Giannarelli C, Kovacic JC, Bagiella E, Kasarskis A, Fayad ZA, Hajjar RJ, Fuster V. Child Health Promotion in Underserved Communities. J Am Coll Cardiol 2019; 73:2011-2021. [DOI: 10.1016/j.jacc.2019.01.057] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/24/2019] [Accepted: 01/28/2019] [Indexed: 01/30/2023]
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13
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Scirica BM, Bansilal S, Davoudi F, Armstrong PW, Clare RM, Schulte PJ, Pieper KS, Becker RC, James SK, Storey RF, Steg PG, Held C, Himmelmann A, Mahaffey KW, Wallentin L, Cannon CP. Safety of ticagrelor in patients with baseline conduction abnormalities: A PLATO (Study of Platelet Inhibition and Patient Outcomes) analysis. Am Heart J 2018; 202:54-60. [PMID: 29859968 DOI: 10.1016/j.ahj.2018.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/25/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although bradyarrhythmias have been observed with ticagrelor and its use with advanced atrioventricular block is not recommended, questions arise regarding its use in patients with mild conduction abnormalities. The objectives were to compare rates of clinically relevant arrhythmias in relation to any mild baseline conduction abnormality in patients with acute coronary syndrome randomized to ticagrelor versus clopidogrel. METHODS We included all subjects in the electrocardiographic (ECG) substudy of the Platelet Inhibition and Patient Outcomes trial, excluding those with missing baseline ECG or with a pacemaker at baseline (N = 15,460). Conduction abnormality was defined as sinus bradycardia, first-degree atrioventricular block, hemiblock, or bundle-branch block. The primary arrhythmic outcome was the composite of any symptomatic brady- or tachyarrhythmia, permanent pacemaker placement, or cardiac arrest through 12 months. RESULTS Patients with baseline conduction abnormalities (n = 4,256, 27.5%) were older and more likely to experience the primary arrhythmic outcome. There were no differences by ticagrelor versus clopidogrel in the composite arrhythmic end point in those with baseline conduction disease (1-year cumulative incidence rate: 17% for both study arms; hazard ratio: 0.99 [0.86-1.15]) or without baseline conduction disease (1-year cumulative incidence rate: clopidogrel 12.8% vs ticagrelor 12.4%; hazard ratio: 0.98 (0.88-1.09). There were also no statistically significant differences between ticagrelor and clopidogrel in the rates of bradycardic (or any individual arrhythmic) events in patients with baseline conduction abnormalities. CONCLUSIONS Ticagrelor compared to clopidogrel did not increase arrhythmic events even in subjects with acute coronary syndrome who present with mild conduction abnormalities on their baseline ECG.
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14
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Wiviott SD, Raz I, Bonaca MP, Mosenzon O, Kato ET, Cahn A, Silverman MG, Bansilal S, Bhatt DL, Leiter LA, McGuire DK, Wilding JP, Gause-Nilsson IA, Langkilde AM, Johansson PA, Sabatine MS. The design and rationale for the Dapagliflozin Effect on Cardiovascular Events (DECLARE)-TIMI 58 Trial. Am Heart J 2018; 200:83-89. [PMID: 29898853 DOI: 10.1016/j.ahj.2018.01.012] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [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: 08/04/2017] [Accepted: 01/28/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Dapagliflozin is a sodium-glucose co-transporter-2 (SGLT-2) inhibitor that reduces blood glucose in patients with type 2 diabetes mellitus (T2DM) by promoting glycosuria via inhibiting urinary glucose reabsorption. In addition to improving blood glucose control, treatment with dapagliflozin results in glucose-induced osmotic diuresis, weight loss, and blood pressure lowering. Previous trials of SGLT-2 inhibitors showed reductions in cardiovascular (CV) events, including CV death and hospitalization for heart failure, and ischemic events in patients with atherosclerotic cardiovascular disease (ASCVD). RESEARCH DESIGN AND METHODS DECLARE-TIMI 58 (NCT01730534) is a phase 3b randomized, double-blind, placebo-controlled trial designed to evaluate the CV safety and efficacy of dapagliflozin that has completed randomization of 17,160 patients with T2DM and a history of either established ASCVD (n=6,971) or multiple risk factors for ASCVD (n=10,189). Patients were randomized in a 1:1 fashion to dapagliflozin 10 mg or matching placebo. The primary safety outcome is the time to the first event of the composite of CV death, myocardial infarction, or ischemic stroke (major adverse cardiovascular events; MACEs). The co-primary efficacy outcomes are the composite of CV death, myocardial infarction, or ischemic stroke and the composite of CV death or hospitalization for heart failure. This event-driven trial will continue until at least 1,390 subjects have a MACE outcome, thereby providing >99% power to test for the primary outcome of safety of dapagliflozin measured by rejecting the hypothesis that the upper bound of the CI >1.3 for the primary outcome of MACE, as well as 85% power to detect a 15% relative risk reduction in MACE and an estimated 87% power to detect a 20% reduction in the composite of CV death or hospitalization for heart failure at a 1-sided α level of .0231. CONCLUSION The DECLARE-TIMI 58 trial is testing the hypotheses that dapagliflozin is safe (does not increase) and may reduce the occurrence of major CV events. DECLARE-TIMI 58 is the largest study to address this question with an SGLT-2 inhibitor in patients with T2DM and with established CV disease and without CV disease but with multiple risk factors.
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Affiliation(s)
- Stephen D Wiviott
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
| | - Itamar Raz
- The Diabetes Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Marc P Bonaca
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA
| | - Ofri Mosenzon
- The Diabetes Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | | | - Avivit Cahn
- The Diabetes Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | | | - Sameer Bansilal
- Zena and Michael A Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Deepak L Bhatt
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA
| | - Lawrence A Leiter
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Darren K McGuire
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - John Ph Wilding
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom
| | | | | | | | - Marc S Sabatine
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA
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15
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Baber U, Sartori S, Aquino M, Kini A, Kapadia S, Weiss S, Strauss C, Muhlestein JB, Toma C, Rao SV, DeFranco A, Poddar KL, Chandrasekhar J, Weintraub W, Henry TD, Bansilal S, Baker BA, Marrett E, Keller S, Effron M, Pocock S, Mehran R. Use of prasugrel vs clopidogrel and outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention in contemporary clinical practice: Results from the PROMETHEUS study. Am Heart J 2017; 188:73-81. [PMID: 28577683 DOI: 10.1016/j.ahj.2017.02.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 02/14/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVES We sought to determine the frequency of use and association between prasugrel and outcomes in acute coronary syndrome patients undergoing percutaneous coronary intervention (PCI) in clinical practice. METHODS PROMETHEUS was a multicenter observational registry of acute coronary syndrome patients undergoing PCI from 8 centers in the United States that maintained a prospective PCI registry for patient outcomes. The primary end points were major adverse cardiovascular events at 90days, a composite of all-cause death, nonfatal myocardial infarction, stroke, or unplanned revascularization. Major bleeding was defined as any bleeding requiring hospitalization or blood transfusion. Hazard ratios (HRs) were generated using multivariable Cox regression and stratified by the propensity to treat with prasugrel. RESULTS Of 19,914 patients (mean age 64.4years, 32% female), 4,058 received prasugrel (20%) and 15,856 received clopidogrel (80%). Prasugrel-treated patients were younger with fewer comorbid risk factors compared with their counterparts receiving clopidogrel. At 90days, there was a significant association between prasugrel use and lower major adverse cardiovascular event (5.7% vs 9.6%, HR 0.58, 95% CI 0.50-0.67, P<.0001) and bleeding (1.9% vs 2.9%, HR 0.65, 95% CI 0.51-0.83, P<.001). After propensity stratification, associations were attenuated and no longer significant for either outcome. Results remained consistent using different approaches to adjusting for potential confounders. CONCLUSIONS In contemporary clinical practice, patients receiving prasugrel tend to have a lower-risk profile compared with those receiving clopidogrel. The lower ischemic and bleeding events associated with prasugrel use were no longer evident after accounting for these baseline differences.
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16
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Gorga E, Regazzoni V, Bansilal S, Carubelli V, Trichaki E, Gavazzoni M, Lombardi C, Raddino R, Metra M. School and family-based interventions for promoting a healthy lifestyle among children and adolescents in Italy: a systematic review. J Cardiovasc Med (Hagerstown) 2017; 17:547-55. [PMID: 27168142 DOI: 10.2459/jcm.0000000000000404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIMS Cardiovascular diseases affect adult population but risk factors develop as a result of known or assumed behavior since childhood. In Italy, up to 22.2% of children are overweight, 10.6% are obese, and 2.5% have severe obesity. METHODS We performed a systematic review of the literature to identify studies and initiatives addressing health promotion among children in Italy. Given the high heterogeneity of interventions and outcomes assessed we opted to perform a qualitative synthesis of the results. We described also nonrandomized trial where the intervention of primary prevention was very innovative, explained in detail, and reached an improving outcome for participants. RESULTS We identified 11 projects since 1983, only five were randomized control trials. Three involved children and teachers of primary and secondary schools and were based on specific curricular lectures about health. One was based on a game developed for high schools with the purpose to promote healthy lifestyle and physical activity. The fifth project was based on an enhanced physical activity program. CONCLUSION Our results show that school and family should be considered as the privileged places for health promotion. In Italy, the development of scientific-validated lifestyle interventions for children is still an unmet need.
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Affiliation(s)
- Elio Gorga
- aCardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy bMount Sinai Cardiovascular Institute, New York, USA; Centro Nacional de Investigaciones Cardiovasculares (CNIC) Carlos III, Madrid, Spain
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17
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Plitt A, Bansilal S. The Nonvitamin K Antagonist Oral Anticoagulants and Atrial Fibrillation: Challenges and Considerations. J Atr Fibrillation 2017; 9:1547. [PMID: 29250278 PMCID: PMC5673394 DOI: 10.4022/jafib.1547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 01/20/2017] [Accepted: 01/23/2017] [Indexed: 01/18/2023]
Abstract
The nonvitamin K antagonist oral anticoagulants (NOACs) dabigatran, rivaroxaban, apixaban, and edoxaban are used for the reduction of the risk of stroke or systemic embolism (SEE) in patients with nonvalvular atrial fibrillation (NVAF). The purpose of this review is to highlight the safety and efficacy results of the pivotal NOAC clinical trials for use in NVAF, discuss some of the unique management challenges in the use of NOACs in special populations, summarize data on emerging and novel indications, and address potential future directions. METHODS A literature search was conducted and to identify relevant clinical trials and studies regarding the use of NOACs for the prevention of stroke or SEE in patients with atrial fibrillation. RESULTS Relative to warfarin, NOACs are as effective or superior in the prevention of stroke or SEE, and are associated with similar or lower rates of major bleeding and significantly decreased rates of intracranial bleeding, but may be associated with a slightly increased risk of gastrointestinal bleeding in patients with AF. The NOACs are not indicated for use and have not been widely tested in AF patients with other cardiovascular conditions. Additional ongoing and planned clinical trials will provide additional information regarding the use of NOACs in these patients. In situations requiring rapid reversal of anticoagulation, the availability of specific antidotes will improve safety and facilitate NOAC use. CONCLUSIONS Use of NOACs in clinical practice requires consideration of patient characteristics as well as potentially required procedures.
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Affiliation(s)
- Anna Plitt
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sameer Bansilal
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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18
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Bansilal S, Fuster V. Reply. J Am Coll Cardiol 2017; 69:599-600. [DOI: 10.1016/j.jacc.2016.10.074] [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] [Received: 10/11/2016] [Accepted: 10/13/2016] [Indexed: 11/16/2022]
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19
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Coffeng JK, van der Ploeg HP, Castellano JM, Fernández-Alvira JM, Ibáñez B, García-Lunar I, van der Beek AJ, Fernández-Ortiz A, Mocoroa A, García-Leal L, Cárdenas E, Rojas C, Martínez-Castro MI, Santiago-Sacristán S, Fernández-Gallardo M, Mendiguren JM, Bansilal S, van Mechelen W, Fuster V. A 30-month worksite-based lifestyle program to promote cardiovascular health in middle-aged bank employees: Design of the TANSNIP-PESA randomized controlled trial. Am Heart J 2017; 184:121-132. [PMID: 28224926 DOI: 10.1016/j.ahj.2016.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 11/08/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of death worldwide. With atherosclerosis as the underlying cause for many CVD events, prevention or reduction of subclinical atherosclerotic plaque burden (SAPB) through a healthier lifestyle may have substantial public health benefits. OBJECTIVE The objective was to describe the protocol of a randomized controlled trial investigating the effectiveness of a 30-month worksite-based lifestyle program aimed to promote cardiovascular health in participants having a high or a low degree of SAPB compared with standard care. METHODS We will conduct a randomized controlled trial including middle-aged bank employees from the Progression of Early Subclinical Atherosclerosis cohort, stratified by SAPB (high SAPB n=260, low SAPB n=590). Within each stratum, participants will be randomized 1:1 to receive a lifestyle program or standard care. The program consists of 3 elements: (a) 12 personalized lifestyle counseling sessions using Motivational Interviewing over a 30-month period, (b) a wrist-worn physical activity tracker, and (c) a sit-stand workstation. Primary outcome measure is a composite score of blood pressure, physical activity, sedentary time, body weight, diet, and smoking (ie, adapted Fuster-BEWAT score) measured at baseline and at 1-, 2-, and 3-year follow-up. CONCLUSIONS The study will provide insights into the effectiveness of a 30-month worksite-based lifestyle program to promote cardiovascular health compared with standard care in participants with a high or low degree of SAPB.
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Mandel-Portnoy YE, Loo GT, Gregoriou D, Bansilal S, Richardson LD. The role of reduced heart rate volatility in predicting disposition from the emergency department. Emerg Med J 2016; 34:289-293. [DOI: 10.1136/emermed-2016-206007] [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] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 11/14/2016] [Accepted: 12/08/2016] [Indexed: 11/03/2022]
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Chao J, Bansilal S. Polypill: Can its Potential Enhancement of Efficacy Trigger New Interest? Glob Heart 2016; 11:469-472. [PMID: 27938845 DOI: 10.1016/j.gheart.2016.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 10/19/2016] [Indexed: 12/21/2022] Open
Affiliation(s)
- Jennifer Chao
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Abstract
Despite encouraging advances in prevention and treatment of atherothrombosis, cardiovascular disease (CVD) remains a major cause of deaths and disability worldwide and will continue to grow mainly due to the increase in incidence in low and middle income countries (LMIC). In Europe and the United States of America (USA), coronary heart disease (CHD) mortality rates have decreased since the mid-1990s due to improvements in acute care, however the prevalence of CHD is increasing largely in part due to the overall aging of the population, increased prevalence of cardiovascular (CV) risk factors, and improved survival of patients after a CV event. Data from clinical trials has consistently proven the efficacy of pharmacologic interventions with aspirin, statins, and blood pressure (BP)-lowering agents in reducing the risk of CV events and total mortality in the ever growing pool of patients in secondary prevention. However, large gaps between indicated therapy and prescribed medication can be observed worldwide, with very low rates of use of effective therapies in LMIC countries. Adherence to medication is very poor in chronic patients, especially those treated with multiple pharmacologic agents, and has been directly correlated to a greater incidence of recurrent CV events and increase in direct and indirect healthcare costs. In this article, we review the global burden of CV disease, status of secondary prevention therapy and major barriers for treatment adherence.
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Affiliation(s)
- Sameer Bansilal
- Mount Sinai Cardiovascular Institute, New York, USA; Centro Nacional de Investigaciones Cardiovasculares (CNIC) Carlos III, Madrid, Spain
| | - José M Castellano
- Mount Sinai Cardiovascular Institute, New York, USA; Centro Nacional de Investigaciones Cardiovasculares (CNIC) Carlos III, Madrid, Spain; HM Hospitales, Hospital Universitario Montepríncipe, Madrid, Spain
| | - Valentín Fuster
- Mount Sinai Cardiovascular Institute, New York, USA; Centro Nacional de Investigaciones Cardiovasculares (CNIC) Carlos III, Madrid, Spain.
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Chandrasekhar J, Bansilal S, Baber U, Sartori S, Aquino M, Farhan S, Vogel B, Faggioni M, Giustino G, Ariti C, Colombo A, Chieffo A, Kini A, Saporito R, Michael Gibson C, Witzenbichler B, Cohen D, Moliterno D, Stuckey T, Henry T, Pocock S, Dangas G, Gabriel Steg P, Mehran R. Impact of proton pump inhibitors and dual antiplatelet therapy cessation on outcomes following percutaneous coronary intervention: Results From the PARIS Registry. Catheter Cardiovasc Interv 2016; 89:E217-E225. [DOI: 10.1002/ccd.26716] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 07/27/2016] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Usman Baber
- Icahn School of Medicine at Mount Sinai; New York New York
| | | | - Melissa Aquino
- Icahn School of Medicine at Mount Sinai; New York New York
| | - Serdar Farhan
- Icahn School of Medicine at Mount Sinai; New York New York
| | - Birgit Vogel
- Icahn School of Medicine at Mount Sinai; New York New York
| | | | | | - Cono Ariti
- London School of Hygiene and Tropical Medicine; London United Kingdom
| | | | | | | | | | | | | | - David Cohen
- St Luke's Mid America Heart Institute, University of Missouri-Kansas City; Kansas City Missouri
| | | | - Thomas Stuckey
- Moses Cone Heart and Vascular Center, LeBauer Cardiovascular Research Foundation; Greensboro North Carolina
| | | | - Stuart Pocock
- London School of Hygiene and Tropical Medicine; London United Kingdom
| | - George Dangas
- Icahn School of Medicine at Mount Sinai; New York New York
| | | | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai; New York New York
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Peñalvo JL, Fernández-Friera L, López-Melgar B, Uzhova I, Oliva B, Fernández-Alvira JM, Laclaustra M, Pocock S, Mocoroa A, Mendiguren JM, Sanz G, Guallar E, Bansilal S, Vedanthan R, Jiménez-Borreguero LJ, Ibañez B, Ordovás JM, Fernández-Ortiz A, Bueno H, Fuster V. Association Between a Social-Business Eating Pattern and Early Asymptomatic Atherosclerosis. J Am Coll Cardiol 2016; 68:805-14. [DOI: 10.1016/j.jacc.2016.05.080] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 05/21/2016] [Indexed: 11/25/2022]
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Shimada YJ, Bansilal S, Wiviott SD, Becker RC, Harrington RA, Himmelmann A, Neely B, Husted S, James SK, Katus HA, Lopes RD, Steg PG, Storey RF, Wallentin L, Cannon CP. Impact of glycoprotein IIb/IIIa inhibitors on the efficacy and safety of ticagrelor compared with clopidogrel in patients with acute coronary syndromes: Analysis from the Platelet Inhibition and Patient Outcomes (PLATO) Trial. Am Heart J 2016; 177:1-8. [PMID: 27297843 DOI: 10.1016/j.ahj.2016.03.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 03/31/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Ticagrelor reduced cardiovascular events compared with clopidogrel in PLATO without increasing overall major bleeding. We evaluated whether the use of glycoprotein IIb/IIIa inhibitor (GPI) impacts the relative efficacy and safety of ticagrelor compared with clopidogrel. METHODS PLATO randomized 18,624 subjects with acute coronary syndrome to ticagrelor versus clopidogrel. The primary efficacy end point was cardiovascular death/myocardial infarction/stroke, and the primary safety end point was major bleeding. The use of GPI was at the physician's discretion and open-label. We evaluated outcomes at 30 days stratified by GPI use in the subgroup of 9,983 patients who underwent percutaneous coronary intervention (PCI) within 72 hours. RESULTS A total of 4,020 (40%) received a GPI. Those receiving a GPI were more likely to be younger, be male, and undergo multivessel PCI. There was no interaction between treatment and GPI use for the primary efficacy and safety end points. Patients treated without GPI had a lower rate of definite stent thrombosis and higher rate of minor/major bleeding with ticagrelor compared with clopidogrel (P < .05), whereas there was no such difference with GPI (P interaction < .05). CONCLUSIONS In patients with acute coronary syndrome undergoing early PCI, the efficacy and safety of ticagrelor as compared with clopidogrel were not modified by GPI use according to the primary efficacy and safety end point of the trial, although there were indications of greater benefit on definite stent thrombosis and more major or minor bleeding with ticagrelor in patients without (vs with) GPI treatment.
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Affiliation(s)
- Pekka Puska
- Department of Health, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Sameer Bansilal
- Clinical Trials & Global Health Studies, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jagat Narula
- Department of Medicine, Mount Sinai Hospital, New York, NY, USA.
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Giacoppo D, Madhavan MV, Baber U, Warren J, Bansilal S, Witzenbichler B, Dangas GD, Kirtane AJ, Xu K, Kornowski R, Brener SJ, Généreux P, Stone GW, Mehran R. Impact of Contrast-Induced Acute Kidney Injury After Percutaneous Coronary Intervention on Short- and Long-Term Outcomes: Pooled Analysis From the HORIZONS-AMI and ACUITY Trials. Circ Cardiovasc Interv 2016. [PMID: 26198286 DOI: 10.1161/circinterventions.114.002475] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Contrast-induced acute kidney injury (CI-AKI), defined as a serum creatinine increase ≥0.5 mg/dL or ≥25% within 72 hours after contrast exposure, is a common complication of procedures requiring contrast media and is associated with increased short- and long-term morbidity and mortality. Few studies describe the effects of CI-AKI in a large-scale acute coronary syndrome population, and the relationship between CI-AKI and bleeding events has not been extensively explored. We sought to evaluate the impact of CI-AKI after percutaneous coronary intervention in patients presenting with acute coronary syndrome. METHODS AND RESULTS We pooled patient-level data for 9512 patients from the percutaneous coronary intervention cohorts of the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) and Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) multicenter randomized trials. Patients were classified according to CI-AKI development, and cardiovascular outcomes at 30 days and 1 year were compared between groups. A total of 1212 patients (12.7%) developed CI-AKI. Patients with CI-AKI were older, with a more extensive comorbidity profile than without CI-AKI. Multivariable analysis confirmed several previously identified predictors of CI-AKI, including diabetes mellitus, contrast volume, age, and baseline hemoglobin. Mortality rates were significantly higher in the CI-AKI group at 30 days (4.9% versus 0.7%; P<0.0001) and 1 year (9.8% versus 2.9%; P<0.0001), as were rates of 1-year myocardial infarction, definite/probable stent thrombosis, target lesion revascularization, and major adverse cardiac events. Major bleeding (13.8% versus 5.4%; hazard ratio, 2.64; 95% confidence interval, 2.21-3.15; P<0.0001) was also higher in patients with CI-AKI. After multivariable adjustment, results were unchanged. CONCLUSIONS CI-AKI after percutaneous coronary intervention in patients presenting with acute coronary syndrome is independently associated with increased risk of short- and long-term ischemic and hemorrhagic events. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00433966 (HORIZONS-AMI) and ACUITY (NCT00093158).
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Affiliation(s)
- Daniele Giacoppo
- From the Icahn School of Medicine at Mount Sinai, New York (D.G., U.B., J.W., S.B., G.D.D., R.M.); NewYork-Presbyterian Hospital and the Columbia University Medical Center (M.V.M., A.J.K., P.G., G.W.S.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cardiovascular Research Foundation, New York (G.D.D., A.J.K., K.X., S.J.B., P.G., G.W.S., R.M.); Rabin Medical Center, Petach Tikva, Israel (R.K.); New York Methodist Hospital, Brooklyn (S.J.B.); and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada (P.G.)
| | - Mahesh V Madhavan
- From the Icahn School of Medicine at Mount Sinai, New York (D.G., U.B., J.W., S.B., G.D.D., R.M.); NewYork-Presbyterian Hospital and the Columbia University Medical Center (M.V.M., A.J.K., P.G., G.W.S.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cardiovascular Research Foundation, New York (G.D.D., A.J.K., K.X., S.J.B., P.G., G.W.S., R.M.); Rabin Medical Center, Petach Tikva, Israel (R.K.); New York Methodist Hospital, Brooklyn (S.J.B.); and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada (P.G.)
| | - Usman Baber
- From the Icahn School of Medicine at Mount Sinai, New York (D.G., U.B., J.W., S.B., G.D.D., R.M.); NewYork-Presbyterian Hospital and the Columbia University Medical Center (M.V.M., A.J.K., P.G., G.W.S.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cardiovascular Research Foundation, New York (G.D.D., A.J.K., K.X., S.J.B., P.G., G.W.S., R.M.); Rabin Medical Center, Petach Tikva, Israel (R.K.); New York Methodist Hospital, Brooklyn (S.J.B.); and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada (P.G.)
| | - Josephine Warren
- From the Icahn School of Medicine at Mount Sinai, New York (D.G., U.B., J.W., S.B., G.D.D., R.M.); NewYork-Presbyterian Hospital and the Columbia University Medical Center (M.V.M., A.J.K., P.G., G.W.S.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cardiovascular Research Foundation, New York (G.D.D., A.J.K., K.X., S.J.B., P.G., G.W.S., R.M.); Rabin Medical Center, Petach Tikva, Israel (R.K.); New York Methodist Hospital, Brooklyn (S.J.B.); and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada (P.G.)
| | - Sameer Bansilal
- From the Icahn School of Medicine at Mount Sinai, New York (D.G., U.B., J.W., S.B., G.D.D., R.M.); NewYork-Presbyterian Hospital and the Columbia University Medical Center (M.V.M., A.J.K., P.G., G.W.S.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cardiovascular Research Foundation, New York (G.D.D., A.J.K., K.X., S.J.B., P.G., G.W.S., R.M.); Rabin Medical Center, Petach Tikva, Israel (R.K.); New York Methodist Hospital, Brooklyn (S.J.B.); and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada (P.G.)
| | - Bernhard Witzenbichler
- From the Icahn School of Medicine at Mount Sinai, New York (D.G., U.B., J.W., S.B., G.D.D., R.M.); NewYork-Presbyterian Hospital and the Columbia University Medical Center (M.V.M., A.J.K., P.G., G.W.S.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cardiovascular Research Foundation, New York (G.D.D., A.J.K., K.X., S.J.B., P.G., G.W.S., R.M.); Rabin Medical Center, Petach Tikva, Israel (R.K.); New York Methodist Hospital, Brooklyn (S.J.B.); and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada (P.G.)
| | - George D Dangas
- From the Icahn School of Medicine at Mount Sinai, New York (D.G., U.B., J.W., S.B., G.D.D., R.M.); NewYork-Presbyterian Hospital and the Columbia University Medical Center (M.V.M., A.J.K., P.G., G.W.S.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cardiovascular Research Foundation, New York (G.D.D., A.J.K., K.X., S.J.B., P.G., G.W.S., R.M.); Rabin Medical Center, Petach Tikva, Israel (R.K.); New York Methodist Hospital, Brooklyn (S.J.B.); and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada (P.G.)
| | - Ajay J Kirtane
- From the Icahn School of Medicine at Mount Sinai, New York (D.G., U.B., J.W., S.B., G.D.D., R.M.); NewYork-Presbyterian Hospital and the Columbia University Medical Center (M.V.M., A.J.K., P.G., G.W.S.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cardiovascular Research Foundation, New York (G.D.D., A.J.K., K.X., S.J.B., P.G., G.W.S., R.M.); Rabin Medical Center, Petach Tikva, Israel (R.K.); New York Methodist Hospital, Brooklyn (S.J.B.); and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada (P.G.)
| | - Ke Xu
- From the Icahn School of Medicine at Mount Sinai, New York (D.G., U.B., J.W., S.B., G.D.D., R.M.); NewYork-Presbyterian Hospital and the Columbia University Medical Center (M.V.M., A.J.K., P.G., G.W.S.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cardiovascular Research Foundation, New York (G.D.D., A.J.K., K.X., S.J.B., P.G., G.W.S., R.M.); Rabin Medical Center, Petach Tikva, Israel (R.K.); New York Methodist Hospital, Brooklyn (S.J.B.); and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada (P.G.)
| | - Ran Kornowski
- From the Icahn School of Medicine at Mount Sinai, New York (D.G., U.B., J.W., S.B., G.D.D., R.M.); NewYork-Presbyterian Hospital and the Columbia University Medical Center (M.V.M., A.J.K., P.G., G.W.S.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cardiovascular Research Foundation, New York (G.D.D., A.J.K., K.X., S.J.B., P.G., G.W.S., R.M.); Rabin Medical Center, Petach Tikva, Israel (R.K.); New York Methodist Hospital, Brooklyn (S.J.B.); and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada (P.G.)
| | - Sorin J Brener
- From the Icahn School of Medicine at Mount Sinai, New York (D.G., U.B., J.W., S.B., G.D.D., R.M.); NewYork-Presbyterian Hospital and the Columbia University Medical Center (M.V.M., A.J.K., P.G., G.W.S.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cardiovascular Research Foundation, New York (G.D.D., A.J.K., K.X., S.J.B., P.G., G.W.S., R.M.); Rabin Medical Center, Petach Tikva, Israel (R.K.); New York Methodist Hospital, Brooklyn (S.J.B.); and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada (P.G.)
| | - Philippe Généreux
- From the Icahn School of Medicine at Mount Sinai, New York (D.G., U.B., J.W., S.B., G.D.D., R.M.); NewYork-Presbyterian Hospital and the Columbia University Medical Center (M.V.M., A.J.K., P.G., G.W.S.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cardiovascular Research Foundation, New York (G.D.D., A.J.K., K.X., S.J.B., P.G., G.W.S., R.M.); Rabin Medical Center, Petach Tikva, Israel (R.K.); New York Methodist Hospital, Brooklyn (S.J.B.); and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada (P.G.)
| | - Gregg W Stone
- From the Icahn School of Medicine at Mount Sinai, New York (D.G., U.B., J.W., S.B., G.D.D., R.M.); NewYork-Presbyterian Hospital and the Columbia University Medical Center (M.V.M., A.J.K., P.G., G.W.S.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cardiovascular Research Foundation, New York (G.D.D., A.J.K., K.X., S.J.B., P.G., G.W.S., R.M.); Rabin Medical Center, Petach Tikva, Israel (R.K.); New York Methodist Hospital, Brooklyn (S.J.B.); and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada (P.G.)
| | - Roxana Mehran
- From the Icahn School of Medicine at Mount Sinai, New York (D.G., U.B., J.W., S.B., G.D.D., R.M.); NewYork-Presbyterian Hospital and the Columbia University Medical Center (M.V.M., A.J.K., P.G., G.W.S.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Cardiovascular Research Foundation, New York (G.D.D., A.J.K., K.X., S.J.B., P.G., G.W.S., R.M.); Rabin Medical Center, Petach Tikva, Israel (R.K.); New York Methodist Hospital, Brooklyn (S.J.B.); and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada (P.G.).
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Theodoropoulos K, Mennuni MG, Dangas GD, Meelu OA, Bansilal S, Baber U, Sartori S, Kovacic JC, Moreno PR, Sharma SK, Mehran R, Kini AS. Resistant in-stent restenosis in the drug eluting stent era. Catheter Cardiovasc Interv 2016; 88:777-785. [DOI: 10.1002/ccd.26559] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/01/2016] [Accepted: 03/21/2016] [Indexed: 01/09/2023]
Affiliation(s)
- Kleanthis Theodoropoulos
- Interventional Cardiovascular Research and Clinical Trials, The Icahn School of Medicine at Mount Sinai; New York New York
| | - Marco G. Mennuni
- Interventional Cardiovascular Research and Clinical Trials, The Icahn School of Medicine at Mount Sinai; New York New York
- Division of Clinical and Interventional Cardiology; Humanitas Research Hospital; Rozzano Milan Italy
| | - George D. Dangas
- Interventional Cardiovascular Research and Clinical Trials, The Icahn School of Medicine at Mount Sinai; New York New York
| | - Omar A. Meelu
- Interventional Cardiovascular Research and Clinical Trials, The Icahn School of Medicine at Mount Sinai; New York New York
| | - Sameer Bansilal
- Interventional Cardiovascular Research and Clinical Trials, The Icahn School of Medicine at Mount Sinai; New York New York
| | - Usman Baber
- Interventional Cardiovascular Research and Clinical Trials, The Icahn School of Medicine at Mount Sinai; New York New York
| | - Samantha Sartori
- Interventional Cardiovascular Research and Clinical Trials, The Icahn School of Medicine at Mount Sinai; New York New York
| | - Jason C. Kovacic
- Interventional Cardiovascular Research and Clinical Trials, The Icahn School of Medicine at Mount Sinai; New York New York
| | - Pedro R. Moreno
- Interventional Cardiovascular Research and Clinical Trials, The Icahn School of Medicine at Mount Sinai; New York New York
| | - Samin K. Sharma
- Interventional Cardiovascular Research and Clinical Trials, The Icahn School of Medicine at Mount Sinai; New York New York
| | - Roxana Mehran
- Interventional Cardiovascular Research and Clinical Trials, The Icahn School of Medicine at Mount Sinai; New York New York
| | - Annapoorna S. Kini
- Interventional Cardiovascular Research and Clinical Trials, The Icahn School of Medicine at Mount Sinai; New York New York
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Bansilal S, Bonaca M, Cornel J, Storey R, Bhatt D, Steg P, Im K, Held P, Jensen E, Braunwald E, Sabatine M, Ophuis TO. EFFICACY AND SAFETY OF TICAGRELOR FOR LONG-TERM SECONDARY PREVENTION OF ATHEROTHROMBOTIC EVENTS IN PATIENTS WITH PRIOR MI AND MULTIVESSEL CORONARY DISEASE: INSIGHTS FROM THE PEGASUS-TIMI 54 TRIAL. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)32147-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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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Bhatt DL, Bonaca MP, Bansilal S, Angiolillo DJ, Cohen M, Storey RF, Im K, Murphy SA, Held P, Braunwald E, Sabatine MS, Steg PG. Reduction in Ischemic Events With Ticagrelor in Diabetic Patients With Prior Myocardial Infarction in PEGASUS-TIMI 54. J Am Coll Cardiol 2016; 67:2732-2740. [PMID: 27046160 DOI: 10.1016/j.jacc.2016.03.529] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [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: 03/23/2016] [Accepted: 03/28/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Patients with diabetes appear to be at elevated risk of atherothrombotic events. OBJECTIVES The purpose of this study was to determine the effect of antiplatelet therapy with ticagrelor on recurrent ischemic events in patients with diabetes and prior myocardial infarction (MI). METHODS We examined the subgroups of patients with diabetes (n = 6,806) and without diabetes (n = 14,355) from PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis In Myocardial Infarction 54), in which 21,162 patients with a history of MI 1 to 3 years prior and with additional risk factors were randomized to ticagrelor (90 or 60 mg twice daily) or placebo. Patients were followed for a median of 33 months. The primary efficacy endpoint was major adverse cardiovascular events (MACE) (cardiovascular death, MI, stroke) and the primary safety endpoint was TIMI (Thrombolysis In Myocardial Infarction) major bleeding. RESULTS The relative risk reduction in MACE with ticagrelor was consistent for the pooled doses versus placebo in patients with diabetes (hazard ratio [HR]: 0.84; 95% confidence interval [CI]: 0.72 to 0.99; p = 0.035) and without diabetes (HR: 0.84; 95% CI: 0.74 to 0.96; p = 0.013; p interaction = 0.99). As patients with diabetes were at higher risk of MACE, the absolute risk reduction tended to be greater in patients with versus without diabetes (1.5% vs. 1.1%, with corresponding 3-year number needed to treat of 67 vs. 91). In patients with diabetes requiring pharmacological therapy (n = 5,960), the absolute risk reduction was 1.9% with a 3-year number needed to treat of 53. Additionally, in patients with diabetes, ticagrelor reduced cardiovascular death by 22% and coronary heart disease death by 34%. Similar to patients without diabetes, there was increased TIMI major bleeding in patients with diabetes (HR: 2.56; 95% CI: 1.52 to 4.33; p = 0.0004). CONCLUSIONS In patients with diabetes with prior MI, adding ticagrelor to aspirin significantly reduces the risk of recurrent ischemic events, including cardiovascular and coronary heart disease death. (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin [PEGASUS]; NCT01225562).
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Affiliation(s)
- Deepak L Bhatt
- TIMI Study Group, Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts.
| | - Marc P Bonaca
- TIMI Study Group, Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
| | | | | | - Marc Cohen
- Cardiovascular Division, Newark Beth Israel Medical Center, Rutgers-New Jersey Medical School, Newark, New Jersey
| | | | - Kyungah Im
- TIMI Study Group, Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Sabina A Murphy
- TIMI Study Group, Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
| | | | - Eugene Braunwald
- TIMI Study Group, Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Marc S Sabatine
- TIMI Study Group, Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Ph Gabriel Steg
- Département Hospitalo-Universitaire-Fibrosis, Inflammation, REmodelling, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Université Paris-Diderot, Sorbonne-Paris Cité, and the French Alliance for Cardiovascular Clinical Trials, an F-CRIN network, INSERM U-1148, Paris, France
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Vedanthan R, Bansilal S, Soto AV, Kovacic JC, Latina J, Jaslow R, Santana M, Gorga E, Kasarskis A, Hajjar R, Schadt EE, Björkegren JL, Fayad ZA, Fuster V. Family-Based Approaches to Cardiovascular Health Promotion. J Am Coll Cardiol 2016; 67:1725-37. [DOI: 10.1016/j.jacc.2016.01.036] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 12/22/2015] [Accepted: 01/03/2016] [Indexed: 02/04/2023]
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Soto A, Bansilal S, Fernández-Alvira JM, Martinez R, de Miguel M, Latina J, Vedanthan R, Gomez E, Fuster V. A PEER-GROUP-BASED INTERVENTION ON CARDIOVASCULAR RISK FACTORS AND THE IMPACT ON QUALITY OF LIFE: THE FIFTY-FIFTY TRIAL. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31956-8] [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: 11/29/2022]
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Chandrasekhar J, Mastoris I, Baber U, Sartori S, Schoos M, Bansilal S, Dangas G, Mehran R. Antithrombotic strategy variability in ATrial fibrillation and obstructive coronary disease revascularized with PCI-rationale and study design of the prospective observational multicenter AVIATOR 2 registry. Am Heart J 2015; 170:1234-42. [PMID: 26678646 DOI: 10.1016/j.ahj.2015.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 08/13/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND In the era of novel antithrombotic therapy, the optimal treatment for patients with nonvalvular atrial fibrillation (AF) or flutter undergoing percutaneous coronary intervention (PCI) is undetermined. STUDY DESIGN The AVIATOR 2 study is a multicenter prospective observational registry that will enroll approximately 2,500 patients with nonvalvular AF or flutter undergoing PCI starting March 2015 over an 18-month enrollment period. Antithrombotic therapy selection will be at the discretion of the treating physician. An integral feature of this study is the use of a smartphone-based survey to capture physician and patient perspectives regarding antithrombotic therapies after PCI. Survey-derived patient treatment concerns, perceived need, and affordability will be used to calculate the risk of non-adherence. Subjective risk for ischemic or bleeding events will be correlated with previously validated risk scores as well as observed event rates at 1, 6, or 12 months post-PCI. ENDPOINTS The primary efficacy end point will be major adverse cardiac and cerebrovascular events, a composite occurrence of death, nonfatal myocardial infarction, stroke, stent thrombosis, and clinically driven target lesion revascularization at 1 year. The primary safety end point will be major bleeding as per Bleeding Academic Research Consortium criteria types 2, 3, or 5. The secondary end points will include (i) net adverse clinical events, a composite occurrence of all major adverse cardiac and cerebrovascular events, and major bleeding at 1 year; (ii) correlation between estimated subjective and objective (CHADS2, CHA2DS2-VASc, stent thrombosis score, HAS-BLED, and ATRIA scores) ischemic and bleeding risks; (iii) modes of antithrombotic therapy cessation and their impact on outcomes; and (iv) correlation between observed and expected non-adherence to treatment. SUMMARY AVIATOR 2 is a real-world registry designed to evaluate ischemic and bleeding outcomes according to conventional and novel antithrombotic regimens in patients with nonvalvular AF or flutter undergoing PCI. The study will also provide insights in to physician- and patient-centered factors affecting treatment selection and adherence and their overall impact on clinical outcomes. The study is registered on clinicaltrials.gov NCT02362659.
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Gómez-Pardo E, Fernández-Alvira JM, Vilanova M, Haro D, Martínez R, Carvajal I, Carral V, Rodríguez C, de Miguel M, Bodega P, Santos-Beneit G, Peñalvo JL, Marina I, Pérez-Farinós N, Dal Re M, Villar C, Robledo T, Vedanthan R, Bansilal S, Fuster V. A Comprehensive Lifestyle Peer Group-Based Intervention on Cardiovascular Risk Factors: The Randomized Controlled Fifty-Fifty Program. J Am Coll Cardiol 2015; 67:476-85. [PMID: 26562047 DOI: 10.1016/j.jacc.2015.10.033] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [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: 09/26/2015] [Revised: 10/22/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cardiovascular diseases stem from modifiable risk factors. Peer support is a proven strategy for many chronic illnesses. Randomized trials assessing the efficacy of this strategy for global cardiovascular risk factor modification are lacking. OBJECTIVES This study assessed the hypothesis that a peer group strategy would help improve healthy behaviors in individuals with cardiovascular risk factors. METHODS A total of 543 adults 25 to 50 years of age with at least 1 risk factor were recruited; risk factors included hypertension (20%), overweight (82%), smoking (31%), and physical inactivity (81%). Subjects were randomized 1:1 to a peer group-based intervention group (IG) or a self-management control group (CG) for 12 months. Peer-elected leaders moderated monthly meetings involving role-play, brainstorming, and activities to address emotions, diet, and exercise. The primary outcome was mean change in a composite score related to blood pressure, exercise, weight, alimentation, and tobacco (Fuster-BEWAT score, 0 to 15). Multilevel models with municipality as a cluster variable were applied to assess differences between groups. RESULTS Participants' mean age was 42 ± 6 years, 71% were female, and they had a mean baseline Fuster-BEWAT score of 8.42 ± 2.35. After 1 year, the mean scores were significantly higher in the IG (n = 277) than in the CG (n = 266) (IG mean score: 8.84; 95% confidence interval (CI): 8.37 to 9.32; CG mean score: 8.17; 95% CI: 7.55 to 8.79; p = 0.02). The increase in the overall score was significantly larger in the IG compared with the CG (difference: 0.75; 95% CI: 0.32 to 1.18; p = 0.02). The mean improvement in the individual components was uniformly greater in the IG, with a significant difference for the tobacco component. CONCLUSIONS The peer group intervention had beneficial effects on cardiovascular risk factors, with significant improvements in the overall score and specifically on tobacco cessation. A follow-up assessment will be performed 1 year after the final assessment reported here to determine long-term sustainability of the improvements associated with peer group intervention. (Peer-Group-Based Intervention Program [Fifty-Fifty]; NCT02367963).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Jose Luis Peñalvo
- Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain; Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Iñaki Marina
- Internal Medicine Department, Catalan Health Institute, Viladecans, Spain
| | | | - Marian Dal Re
- Spanish Agency for Consumer Affairs, Food Safety and Nutrition
| | - Carmen Villar
- Spanish Agency for Consumer Affairs, Food Safety and Nutrition
| | - Teresa Robledo
- Spanish Agency for Consumer Affairs, Food Safety and Nutrition
| | | | | | - Valentin Fuster
- SHE Foundation, Barcelona, Spain; Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain; Icahn School of Medicine at Mount Sinai, New York, New York.
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Bansilal S, Bloomgarden Z, Halperin JL, Hellkamp AS, Lokhnygina Y, Patel MR, Becker RC, Breithardt G, Hacke W, Hankey GJ, Nessel CC, Singer DE, Berkowitz SD, Piccini JP, Mahaffey KW, Fox KAA. Efficacy and safety of rivaroxaban in patients with diabetes and nonvalvular atrial fibrillation: the Rivaroxaban Once-daily, Oral, Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF Trial). Am Heart J 2015; 170:675-682.e8. [PMID: 26386791 DOI: 10.1016/j.ahj.2015.07.006] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [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: 06/09/2015] [Accepted: 07/13/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND The prevalence of both atrial fibrillation (AF) and diabetes mellitus (DM) are rising, and these conditions often occur together. Also, DM is an independent risk factor for stroke in patients with AF. We aimed to examine the safety and efficacy of rivaroxaban vs warfarin in patients with nonvalvular AF and DM in a prespecified secondary analysis of the ROCKET AF trial. METHODS We stratified the ROCKET AF population by DM status, assessed associations with risk of outcomes by DM status and randomized treatment using Cox proportional hazards models, and tested for interactions between randomized treatments. For efficacy, primary outcomes were stroke (ischemic or hemorrhagic) or non-central nervous system embolism. For safety, the primary outcome was major or nonmajor clinically relevant bleeding. RESULTS The 5,695 patients with DM (40%) in ROCKET AF were younger, were more obese, and had more persistent AF, but fewer had previous stroke (the CHADS2 score includes DM and stroke). The relative efficacy of rivaroxaban and warfarin for prevention of stroke and systemic embolism was similar in patients with (1.74 vs 2.14/100 patient-years, hazard ratio [HR] 0.82) and without (2.12 vs 2.32/100 patient-years, HR 0.92) DM (interaction P = .53). The safety of rivaroxaban vs warfarin regarding major bleeding (HRs 1.00 and 1.12 for patients with and without DM, respectively; interaction P = .43), major or nonmajor clinically relevant bleeding (HRs 0.98 and 1.09; interaction P = .17), and intracerebral hemorrhage (HRs 0.62 and 0.72; interaction P = .67) was independent of DM status. Adjusted exploratory analyses suggested 1.3-, 1.5-, and 1.9-fold higher 2-year rates of stroke, vascular mortality, and myocardial infarction in DM patients. CONCLUSIONS AND RELEVANCE The relative efficacy and safety of rivaroxaban vs warfarin was similar in patients with and without DM, supporting use of rivaroxaban as an alternative to warfarin in diabetic patients with AF.
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Affiliation(s)
| | | | | | - Anne S Hellkamp
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Yuliya Lokhnygina
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Manesh R Patel
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | | | - Günter Breithardt
- Department of Cardiovascular Medicine, Division of Electrophysiology, University Hospital Münster, Münster, Germany
| | | | - Graeme J Hankey
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Australia
| | | | - Daniel E Singer
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | | | - Jonathan P Piccini
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | | | - Keith A A Fox
- University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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Peñalvo JL, Santos-Beneit G, Sotos-Prieto M, Bodega P, Oliva B, Orrit X, Rodríguez C, Fernández-Alvira JM, Redondo J, Vedanthan R, Bansilal S, Gómez E, Fuster V. The SI! Program for Cardiovascular Health Promotion in Early Childhood. J Am Coll Cardiol 2015; 66:1525-1534. [DOI: 10.1016/j.jacc.2015.08.014] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 08/10/2015] [Accepted: 08/10/2015] [Indexed: 11/16/2022]
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Bonaca MP, Bhatt DL, Cohen M, Steg PG, Storey RF, Jensen EC, Magnani G, Bansilal S, Fish MP, Im K, Bengtsson O, Oude Ophuis T, Budaj A, Theroux P, Ruda M, Hamm C, Goto S, Spinar J, Nicolau JC, Kiss RG, Murphy SA, Wiviott SD, Held P, Braunwald E, Sabatine MS. Long-term use of ticagrelor in patients with prior myocardial infarction. N Engl J Med 2015; 372:1791-800. [PMID: 25773268 DOI: 10.1056/nejmoa1500857] [Citation(s) in RCA: 1288] [Impact Index Per Article: 143.1] [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] [Indexed: 12/11/2022]
Abstract
BACKGROUND The potential benefit of dual antiplatelet therapy beyond 1 year after a myocardial infarction has not been established. We investigated the efficacy and safety of ticagrelor, a P2Y12 receptor antagonist with established efficacy after an acute coronary syndrome, in this context. METHODS We randomly assigned, in a double-blind 1:1:1 fashion, 21,162 patients who had had a myocardial infarction 1 to 3 years earlier to ticagrelor at a dose of 90 mg twice daily, ticagrelor at a dose of 60 mg twice daily, or placebo. All the patients were to receive low-dose aspirin and were followed for a median of 33 months. The primary efficacy end point was the composite of cardiovascular death, myocardial infarction, or stroke. The primary safety end point was Thrombolysis in Myocardial Infarction (TIMI) major bleeding. RESULTS The two ticagrelor doses each reduced, as compared with placebo, the rate of the primary efficacy end point, with Kaplan-Meier rates at 3 years of 7.85% in the group that received 90 mg of ticagrelor twice daily, 7.77% in the group that received 60 mg of ticagrelor twice daily, and 9.04% in the placebo group (hazard ratio for 90 mg of ticagrelor vs. placebo, 0.85; 95% confidence interval [CI], 0.75 to 0.96; P=0.008; hazard ratio for 60 mg of ticagrelor vs. placebo, 0.84; 95% CI, 0.74 to 0.95; P=0.004). Rates of TIMI major bleeding were higher with ticagrelor (2.60% with 90 mg and 2.30% with 60 mg) than with placebo (1.06%) (P<0.001 for each dose vs. placebo); the rates of intracranial hemorrhage or fatal bleeding in the three groups were 0.63%, 0.71%, and 0.60%, respectively. CONCLUSIONS In patients with a myocardial infarction more than 1 year previously, treatment with ticagrelor significantly reduced the risk of cardiovascular death, myocardial infarction, or stroke and increased the risk of major bleeding. (Funded by AstraZeneca; PEGASUS-TIMI 54 ClinicalTrials.gov number, NCT01225562.).
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Affiliation(s)
- Marc P Bonaca
- From the Thrombolysis in Myocardial Infarction (TIMI) Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (M.P.B., D.L.B., G.M., M.P.F., K.I., S.A.M., S.D.W., E.B., M.S.S.); the Cardiovascular Division, Department of Medicine, Newark Beth Israel Medical Center, Rutgers-New Jersey Medical School, Newark (M.C.); French Alliance for Cardiovascular Trials, Département Hospitalo-Universitaire Fibrosis, Inflammation, Remodeling, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, INSERM Unité 1148, and Université Paris-Diderot, Sorbonne Paris Cité - all in Paris (P.G.S.); National Heart and Lung Institute, Royal Brompton Hospital, Imperial College, London (P.G.S.), and Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom (R.F.S.); AstraZeneca, Mölndal, Sweden (E.C.J., O.B., P.H.); Icahn School of Medicine at Mount Sinai, New York (S.B.); Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands (T.O.O.); Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland (A.B.); Montreal Heart Institute, Université de Montréal, Montreal (P.T.); Cardiology Research Center, Moscow (M.R.); Kerckhoff Heart Center, Bad Nauheim, and University of Giessen, Giessen - both in Germany (C.H.); Department of Medicine (Cardiology), Tokai University School of Medicine, Isehara, Japan (S.G.); University Hospital, Jihlavska, Brno, Czech Republic (J.S.); Heart Institute (InCor)-University of São Paulo Medical School, São Paulo (J.C.N.); and the Department of Cardiology, Military Hospital, Budapest, Hungary (R.G.K.)
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Sardar P, Udell JA, Chatterjee S, Bansilal S, Mukherjee D, Farkouh ME. Effect of Intensive Versus Standard Blood Glucose Control in Patients With Type 2 Diabetes Mellitus in Different Regions of the World: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Am Heart Assoc 2015; 4:e001577. [PMID: 25944874 PMCID: PMC4599400 DOI: 10.1161/jaha.114.001577] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 04/01/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Regional variation in type 2 diabetes mellitus care may affect outcomes in patients treated with intensive versus standard blood glucose control. We sought to evaluate these differences between North America and the rest of the world. METHODS AND RESULTS Databases were searched from their inception through December 2013. Randomized controlled trials comparing the effects of intensive therapy with standard therapy for macro- and microvascular complications in adults with type 2 diabetes mellitus were selected. We calculated summary odds ratios (ORs) and 95% CIs with the random-effects model. The analysis included 34 967 patients from 17 randomized controlled trials (7 in North America and 10 in the rest of the world). There were no significant differences between intensive and standard therapy groups for all-cause mortality (OR 1.03, 95% CI 0.93 to 1.13) and cardiovascular mortality (OR 1.09, 95% CI 0.90 to 1.32). For trials conducted in North America, intensive therapy compared with standard glycemic control resulted in significantly higher all-cause mortality (OR 1.21, 95% CI 1.05 to 1.40) and cardiovascular mortality (OR 1.41, 95% CI 1.05 to 1.90) than trials conducted in the rest of the world (all-cause mortality OR 0.93, 95% CI 0.85 to 1.03; interaction P=0.006; cardiovascular mortality OR 0.89, 95% CI, 0.79 to 1.00; interaction P=0.007). Analysis of individual macro- and microvascular outcomes revealed no significant regional differences; however, the risk of severe hypoglycemia was significantly higher in trials of intensive therapy in North America (OR 3.52, 95% CI 3.07 to 4.03) compared with the rest of the world (OR 1.45, 95% CI 0.85 to 2.47; interaction P=0.001). CONCLUSION Randomization to intensive glycemic control in type 2 diabetes mellitus patients was associated with increases in all-cause mortality, cardiovascular mortality, and severe hypoglycemia in North America compared with the rest of the world. Further investigation into the pathobiology or patient variability underlying these findings is warranted.
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Affiliation(s)
- Partha Sardar
- Division of Cardiovascular Medicine, University of UtahSalt Lake City, UT (P.S.)
| | - Jacob A Udell
- Cardiovascular Division, Department of Medicine, Women's College Hospital, University of TorontoOntario, Canada (J.A.U.)
- Peter Munk Centre of Excellence in Multinational Clinical Trials, University Health Network, Heart & Stroke Richard Lewar Centre of Excellence, University of TorontoOntario, Canada (J.A.U., M.E.F.)
| | - Saurav Chatterjee
- Division of Cardiovascular Diseases, St. Luke's-Roosevelt Hospital Center of the Mount Sinai Health SystemNew York, NY (S.C.)
| | - Sameer Bansilal
- Cardiovascular Institute, The Mount Sinai Medical CenterNew York, NY (S.B.)
| | - Debabrata Mukherjee
- Division of Cardiovascular Diseases, Texas Tech University Health Sciences Center, Paul L. Foster School of MedicineEl Paso, TX (D.M.)
| | - Michael E Farkouh
- Peter Munk Centre of Excellence in Multinational Clinical Trials, University Health Network, Heart & Stroke Richard Lewar Centre of Excellence, University of TorontoOntario, Canada (J.A.U., M.E.F.)
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Bansilal S, Wei HG, Castellano J, Garrido E, Freeman AN, Sanz G, Garcia-Alonso F, Spettell CM, Steinberg G, Fuster V. ASSESSING THE IMPACT OF MEDICATION ADHERENCE ON LONG-TERM OUTCOMES IN PATIENTS WITH DIABETES. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61409-7] [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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Bansilal S, Vedanthan R, Woodward M, Iyengar R, Hunn M, Lewis M, Francis L, Charney A, Graves C, Farkouh ME, Fuster V. Cardiovascular risk surveillance to develop a nationwide health promotion strategy: the grenada heart project. Glob Heart 2015; 7:87-94. [PMID: 25691303 DOI: 10.1016/j.gheart.2012.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 06/07/2012] [Accepted: 06/08/2012] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The Grenada Heart Project aims to study the clinical, biological, and psychosocial determinants of the cardiovascular health in Grenada in order to develop and implement a nationwide cardiovascular health promotion program. METHODS We recruited 2,827 adults randomly selected from the national electronic voter list. The main outcome measures were self-reported cardiovascular disease and behavioral risk factors, anthropometric measures, blood pressure, point-of-care testing for glucose and lipids, and ankle-brachial index. Risk factors were also compared with the U.S. National Health and Nutritional Survey data. RESULTS Prevalence of cardiovascular disease risk factors were: overweight and obesity-57.7% of the population, physical inactivity-23.4%, diabetes-13.3%, hypertension-29.7%, hypercholesterolemia-8.6%, and smoking-7%. Subjects who were physically active had a significantly lower 10-year Framingham risk score (p<0.001). Compared with the U.S. National Health and Nutrition Survey data, Grenadian women had higher rates of adiposity, diabetes, hypertension, and elevated low-density lipoprotein cholesterol, whereas Grenadian men had a higher rate of diabetes, a similar rate of hypertension, and lower rates of the other risk factors. Prevalence of peripheral arterial disease was 7.6%; stroke and coronary heart disease were equally prevalent at ∼2%. CONCLUSIONS This randomly selected adult sample in Grenada reveals prevalence rates of obesity, hypertension, and diabetes significantly exceeding those seen in the United States. The contrasting, paradoxically low levels of prevalent cardiovascular disease support the concept that Grenada is experiencing an obesity-related "risk transition." These data form the basis for the implementation of a pilot intervention program based on the Institute of Medicine recommendations and may serve as a model for other low- and middle-income countries.
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Affiliation(s)
| | | | - Mark Woodward
- George Institute, University of Sydney, Sydney, Australia
| | - Rupa Iyengar
- Mount Sinai School of Medicine, New York, NY, USA
| | - Marilyn Hunn
- Mount Sinai School of Medicine, New York, NY, USA
| | | | | | | | | | - Michael E Farkouh
- Mount Sinai School of Medicine, New York, NY, USA; University of Toronto, Toronto, Canada
| | - Valentin Fuster
- Mount Sinai School of Medicine, New York, NY, USA; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
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Castellano JM, Sanz G, Peñalvo JL, Bansilal S, Fernández-Ortiz A, Alvarez L, Guzmán L, Linares JC, García F, D’Aniello F, Arnáiz JA, Varea S, Martínez F, Lorenzatti A, Imaz I, Sánchez-Gómez LM, Roncaglioni MC, Baviera M, Smith SC, Taubert K, Pocock S, Brotons C, Farkouh ME, Fuster V. A Polypill Strategy to Improve Adherence. J Am Coll Cardiol 2014; 64:2071-82. [DOI: 10.1016/j.jacc.2014.08.021] [Citation(s) in RCA: 220] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 08/22/2014] [Accepted: 08/22/2014] [Indexed: 11/30/2022]
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Castellano JM, Peñalvo JL, Bansilal S, Fuster V. Promoción de la salud cardiovascular en tres etapas de la vida: nunca es demasiado pronto, nunca demasiado tarde. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2014.03.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Giacoppo D, Mehran R, Bansilal S, Witzenbichler B, Dangas G, Kirtane A, Parise H, Kornowski R, Brener S, Genereux P, Stone G. IMPACT OF CONTRAST-INDUCED ACUTE KIDNEY INJURY AFTER CORONARY ANGIOGRAPHY OR PERCUTANEOUS CORONARY INTERVENTION ON LONG-TERM OUTCOMES: A POOLED ANALYSIS FROM THE HORIZONS-AMI AND ACUITY TRIALS. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61681-8] [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: 11/15/2022]
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Bansilal S, Mehran R. Polymer-free stents in diabetic patients-not so sweet after all! Catheter Cardiovasc Interv 2014; 83:425-6. [PMID: 24497456 DOI: 10.1002/ccd.25352] [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] [Received: 12/09/2013] [Accepted: 12/19/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Sameer Bansilal
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai
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Bansilal S, Fayad ZA. Coronary artery disease: appropriate testing for stable ischaemic heart disease. Nat Rev Cardiol 2014; 11:137-8. [PMID: 24492787 DOI: 10.1038/nrcardio.2014.5] [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: 11/09/2022]
Abstract
Currently, numerous tests are available for the assessment and triage of patients with stable ischaemic heart disease. National societies in the USA have collaborated to develop appropriate use criteria to give guidance to clinicians about the evidence-based use of these tests.
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Affiliation(s)
- Sameer Bansilal
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029-6574, USA
| | - Zahi A Fayad
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029-6574, USA
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Bansilal S, Wiviott S, Becker R, Harrington R, Himmelmann A, Neely B, Husted S, Storey R, Steg P, Katus H, James S, Wallentin L, Cannon C. THE EFFICACY AND SAFETY OF TICAGRELOR AS COMPARED TO CLOPIDOGREL, WITH AND WITHOUT A GLYCOPROTEIN IIB/IIIA INHIBITOR IN PATIENTS WITH ACUTE CORONARY SYNDROMES UNDERGOING PERCUTANEOUS INTERVENTION: A PLATO (STUDY OF PLATELET INHIBITION AND PATIENT OUTCOMES) ANALYSIS. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61858-6] [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: 10/27/2022]
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Farkouh ME, Domanski M, Sleeper LA, Siami FS, Dangas G, Mack M, Yang M, Cohen DJ, Rosenberg Y, Solomon SD, Desai AS, Gersh BJ, Magnuson EA, Lansky A, Boineau R, Weinberger J, Ramanathan K, Sousa JE, Rankin J, Bhargava B, Buse J, Hueb W, Smith CR, Muratov V, Bansilal S, King S, Bertrand M, Fuster V. Strategies for multivessel revascularization in patients with diabetes. N Engl J Med 2012; 367:2375-84. [PMID: 23121323 DOI: 10.1056/nejmoa1211585] [Citation(s) in RCA: 1256] [Impact Index Per Article: 104.7] [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: 12/28/2022]
Abstract
BACKGROUND In some randomized trials comparing revascularization strategies for patients with diabetes, coronary-artery bypass grafting (CABG) has had a better outcome than percutaneous coronary intervention (PCI). We sought to discover whether aggressive medical therapy and the use of drug-eluting stents could alter the revascularization approach for patients with diabetes and multivessel coronary artery disease. METHODS In this randomized trial, we assigned patients with diabetes and multivessel coronary artery disease to undergo either PCI with drug-eluting stents or CABG. The patients were followed for a minimum of 2 years (median among survivors, 3.8 years). All patients were prescribed currently recommended medical therapies for the control of low-density lipoprotein cholesterol, systolic blood pressure, and glycated hemoglobin. The primary outcome measure was a composite of death from any cause, nonfatal myocardial infarction, or nonfatal stroke. RESULTS From 2005 through 2010, we enrolled 1900 patients at 140 international centers. The patients' mean age was 63.1±9.1 years, 29% were women, and 83% had three-vessel disease. The primary outcome occurred more frequently in the PCI group (P=0.005), with 5-year rates of 26.6% in the PCI group and 18.7% in the CABG group. The benefit of CABG was driven by differences in rates of both myocardial infarction (P<0.001) and death from any cause (P=0.049). Stroke was more frequent in the CABG group, with 5-year rates of 2.4% in the PCI group and 5.2% in the CABG group (P=0.03). CONCLUSIONS For patients with diabetes and advanced coronary artery disease, CABG was superior to PCI in that it significantly reduced rates of death and myocardial infarction, with a higher rate of stroke. (Funded by the National Heart, Lung, and Blood Institute and others; FREEDOM ClinicalTrials.gov number, NCT00086450.).
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Bansilal S, Farkouh ME, Hueb W, Ogdie M, Dangas G, Lansky AJ, Cohen DJ, Magnuson EA, Ramanathan K, Tanguay JF, Muratov V, Sleeper LA, Domanski M, Bertrand ME, Fuster V. The Future REvascularization Evaluation in patients with Diabetes mellitus: optimal management of Multivessel disease (FREEDOM) trial: clinical and angiographic profile at study entry. Am Heart J 2012; 164:591-9. [PMID: 23067919 DOI: 10.1016/j.ahj.2012.06.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 06/22/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The optimal revascularization strategy for diabetic patients with multivessel coronary artery disease (MVD) remains uncertain for lack of an adequately powered, randomized trial. The FREEDOM trial was designed to compare contemporary coronary artery bypass grafting (CABG) to percutaneous coronary intervention (PCI) with drug-eluting stents in diabetic patients with MVD against a background of optimal medical therapy. METHODS A total of 1,900 diabetic participants with MVD were randomized to PCI or CABG worldwide from April 2005 to March 2010. FREEDOM is a superiority trial with a mean follow-up of 4.37 years (minimum 2 years) and 80% power to detect a 27.0% relative reduction. We present the baseline characteristics of patients screened and randomized, and provide a comparison with other MVD trials involving diabetic patients. RESULTS The randomized cohort was 63.1 ± 9.1 years old and 29% female, with a median diabetes duration of 10.2 ± 8.9 years. Most (83%) had 3-vessel disease and on average took 5.5 ± 1.7 vascular medications, with 32% on insulin therapy. Nearly all had hypertension and/or dyslipidemia, and 26% had a prior myocardial infarction. Mean hemoglobin A1c was 7.8 ± 1.7 mg/dL, 29% had low-density lipoprotein <70 mg/dL, and mean systolic blood pressure was 134 ± 20 mm Hg. The mean SYNTAX score was 26.2 with a symmetric distribution. FREEDOM trial participants have baseline characteristics similar to those of contemporary multivessel and diabetes trial cohorts. CONCLUSIONS The FREEDOM trial has successfully recruited a high-risk diabetic MVD cohort. Follow-up efforts include aggressive monitoring to optimize background risk factor control. FREEDOM will contribute significantly to the PCI versus CABG debate in diabetic patients with MVD.
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Bansilal S, Bhatt DL. Clopidogrel resistance - a clear problem with an unclear solution. Indian Heart J 2012; 64:353-5. [PMID: 22929816 DOI: 10.1016/j.ihj.2012.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 06/15/2012] [Indexed: 01/18/2023] Open
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