European Heart Journal - Cardiovascular Pharmacotherapy最新文献

{"title":"Aspirin in Patients with Glucose-6-Phosphate Dehydrogenase Deficiency: A True Clinical Issue?","authors":"Gianmarco Sarto, Emanuele Soraci, Sebastiano Sciarretta, Mattia Galli","doi":"10.1093/ehjcvp/pvae101","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvae101","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Untapped Potential of Guideline-Directed Heart Failure Pharmacotherapy: Consequences of Missed Opportunities.","authors":"Ester J Herrmann, Samuel Sossalla","doi":"10.1093/ehjcvp/pvae096","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvae096","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of bleeding with the concurrent use of amiodarone and DOACs: A systematic review and meta-analysis.","authors":"Faith Michael, Travis Quevilllon, Sabrina Maisonneuve, Cynthia A Jackevicius, Eugene Crystal, Ratika Parkash, Jason G Andrade, Jeff S Healey, Dennis T Ko, Mohammed Shurrab","doi":"10.1093/ehjcvp/pvae097","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvae097","url":null,"abstract":"<p><strong>Background and aims: </strong>Amiodarone is frequently prescribed alongside direct oral anticoagulants (DOACs) in atrial fibrillation (AF). There are concerns regarding drug-drug interactions (DDIs) between amiodarone and DOACs. The literature is conflicting on the clinical implications of this DDI, hence we conducted a meta-analysis to compare bleeding risk among patients receiving DOACs, with and without concurrent amiodarone.</p><p><strong>Methods: </strong>A systematic search was conducted for studies published between January 1, 2009 and June 26, 2024 in MEDLINE via PubMed, Embase and CENTRAL. Included studies compared major bleeding in patients on concurrent amiodarone and DOACs to those on DOACs without amiodarone. Event rates were used to calculate odds ratios (ORs), which were pooled with a random-effects model.</p><p><strong>Results: </strong>Nine studies were identified, which included 124 813 patients on amiodarone/DOACs, and 314 074 on DOACs. Average age was 77.2 years in the amiodarone/DOAC group, compared to 74.4 years in the DOAC group (p= 0.21). Among DOAC patients, there was a statistically significant increase in major bleeding with concurrent amiodarone (OR 1.22, 95% confidence interval (CI) 1.03-1.44, p=0.02, I2=88%). Intracranial bleeding rate was numerically higher in the amiodarone/DOAC group (1.0% vs. 0.4%), but the difference did not reach statistical significance (OR 2.20, 95% CI 0.53-9.06, p=0.27, I2=100%). There were no significant differences in gastrointestinal bleeding (OR 1.10, 95% CI 0.98-1.23, p=0.12, I2=62%) and all-cause mortality (OR 1.38, 95% CI 0.70-2.73, p=0.35, I2=99%).</p><p><strong>Conclusion: </strong>Concurrent use of amiodarone and DOACs was associated with an increase in major bleeding. This should be considered when co-prescribing these medications.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of dyslipidaemia in patients with comorbidities - facing the challenge Value and limitations of lipid lowering drugs in liver disease Effects/Interactions of lipid-lowering agents on/with the liver.","authors":"Lisa Frühwald, Peter Fasching, Dobromir Dobrev, Juan Carlos Kaski, Claudio Borghi, Sven Wassmann, Kurt Huber, Anne Grete Semb, Stefan Agewall, Heinz Drexel","doi":"10.1093/ehjcvp/pvae095","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvae095","url":null,"abstract":"<p><strong>Objectives: </strong>This review aims to examine the evidence on the benefits and risks of lipid lowering drugs in patients with liver disease. Elevated liver enzyme levels often lead to cautious discontinuation of these drugs, potentially withholding from patients their benefit in reducing cardiovascular disease morbidity and mortality.</p><p><strong>Methods and results: </strong>Using a literature search of PubMed, we examine the efficacy and safety profiles of various lipid lowering agents, including statins, ezetimibe, bempedoic acid, PCSK9 inhibitors, fibrates, and icosapent ethyl, focusing particularly on their potential side effects related to liver health. A major challenge in the assessment of drug-induced hepatotoxicity is the fact that it relies heavily on case reports rather than real world evidence. There is currently a lack of robust evidence on lipid-lowering therapy in people with pre-existing liver disease. Nevertheless, we have attempted to summarize the available data for all the drugs mentioned in order to provide guidance for the treatment of patients with liver dysfunction.</p><p><strong>Conclusion: </strong>This review highlights the need for further research to optimize treatment strategies for patients with coexisting liver and cardiovascular disease.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lipid lowering therapies for aortic stenosis: a drug-target Mendelian randomisation study.","authors":"Jonathan L Ciofani, Daniel Han, Karan Rao, Dipender Gill, Benjamin Woolf, Kazem Rahimi, Usaid K Allahwala, Ravinay Bhindi","doi":"10.1093/ehjcvp/pvae092","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvae092","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of Implementing a Genotype-Guided De-Escalation Strategy in Patients with Acute Coronary Syndrome.","authors":"W W A van den Broek, Jaouad Azzahhafi, Dean R P P Chan Pin Yin, Niels M R van der Sangen, Shabiga Sivanesan, Lea M Dijksman, Ronald J Walhout, Melvyn Tjon Joe Gin, Nicoline J Breet, Jorina Langerveld, Georgios J Vlachojannis, Rutger J van Bommel, Yolande Appelman, Ron H N van Schaik, José P S Henriques, Wouter J Kikkert, Jurriën M Ten Berg","doi":"10.1093/ehjcvp/pvae087","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvae087","url":null,"abstract":"<p><strong>Aims: </strong>A genotype-guided P2Y12-inhibitor de-escalation strategy, switching acute coronary syndrome (ACS) patients without a CYP2C19 loss-of-function allele from ticagrelor or prasugrel to clopidogrel, has shown to reduce bleeding risk without affecting effectivity of therapy by increasing ischemic risk. We estimated the cost-effectiveness of this personalized approach compared to standard dual antiplatelet therapy (DAPT; aspirin plus ticagrelor/prasugrel) in the Netherlands.</p><p><strong>Methods and results: </strong>We developed a one-year decision tree based on results of the FORCE-ACS registry, comparing a cohort of ACS patients who underwent genotyping with a cohort of ACS patients treated with standard DAPT. This was followed by a lifelong Markov model to compare lifetime costs, and quality-adjusted life years (QALYs) for a fictional cohort of 1000 patients. The cost-effectiveness analysis was performed from the perspective of the Dutch healthcare system. A genotype-guided de-escalation strategy led to anincrease of 55.30 QALYs and saved €698,286 compared to standard DAPT based on a lifetime horizon. Probabilistic sensitivity analysis showed that the genotype-guided strategy was cost-saving in 93% and increased QALYs in 86% of simulations. The intervention remained cost-effective in the scenario where prices for all P2Y12-inhibitors were equalized. The genotype-guided strategy remained dominant in various other scenario and sensitivity analyses.</p><p><strong>Conclusion: </strong>A genotype-guided de-escalation strategy in patients with ACS was both cost-saving and yielded higher QALYs compared to standard DAPT, highlighting its potential for implementation in clinical practice. Trial registration: ClinicalTrials.gov identifier: NCT03823547.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The ESC Working Group on cardiovascular pharmacotherapy: continuity through transformation.","authors":"Dobromir Dobrev, Bianca Rocca, Juan-Carlos Kaski","doi":"10.1093/ehjcvp/pvae070","DOIUrl":"10.1093/ehjcvp/pvae070","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"571"},"PeriodicalIF":5.3,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ticagrelor 60 vs. 90 mg in elderly ACS patients undergoing PCI: a randomized, crossover trial.","authors":"Raffaele Piccolo, Fiorenzo Simonetti, Marisa Avvedimento, Maria Cutillo, Mario Enrico Canonico, Valeria Conti, Giuseppe Gargiulo, Roberta Paolillo, Fabrizio Dal Piaz, Amelia Filippelli, Bruno Charlier, Alessandra Spinelli, Stefano Cristiano, Plinio Cirillo, Luigi Di Serafino, Anna Franzone, Giovanni Esposito","doi":"10.1093/ehjcvp/pvae054","DOIUrl":"10.1093/ehjcvp/pvae054","url":null,"abstract":"<p><strong>Aims: </strong>Although dual antiplatelet therapy with aspirin and a potent P2Y12 receptor inhibitor is currently recommended in patients with acute coronary syndrome (ACS), its use in elderly patients remains challenging. The aim of this trial is to evaluate the pharmacodynamic and pharmacokinetic profile of ticagrelor 60 vs. 90 mg twice daily among elderly patients (≥75 years) with ACS undergoing percutaneous coronary intervention (PCI).</p><p><strong>Methods and results: </strong>PLINY The ELDER (NCT04739384) was a randomized, crossover trial testing the non-inferiority of a lower vs. standard dose of ticagrelor with respect to the primary endpoint of P2Y12 inhibition as determined by pre-dose P2Y12 reaction units (PRU) using the VerifyNow-P2Y12 (Accumetrics, San Diego, CA, USA). Other pharmacodynamic tests included light transmittance aggregometry, multiple electrode aggregometry, and response to aspirin. Plasma levels of ticagrelor and its active metabolite AR-C124910XX were also evaluated. A total of 50 patients (mean age 79.6 ± 4.0 years, females 44%) were included in the trial. Ticagrelor 60 mg was non-inferior to ticagrelor 90 mg according to VerifyNow-P2Y12 results (PRU 26.4 ± 32.1 vs. 30.4 ± 39.0; least squares mean difference: -4; 95% confidence interval: -16.27 to 8.06; P for non-inferiority = 0.002). Other pharmacodynamic parameters were similar between the two ticagrelor doses and there were no differences in response to aspirin. Plasma levels of ticagrelor (398.29 ± 312.36 ng/mL vs. 579.57 ± 351.73 ng/mL, P = 0.006) and its active metabolite were significantly lower during treatment with ticagrelor 60 mg.</p><p><strong>Conclusion: </strong>Although plasma concentrations were lower, ticagrelor 60 mg twice daily provided a similar magnitude of platelet inhibition compared with ticagrelor 90 mg twice daily among elderly patients undergoing PCI.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"578-587"},"PeriodicalIF":5.3,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141723336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Update on antithrombotic therapy and body mass: a clinical consensus statement of the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy and the European Society of Cardiology Working Group on Thrombosis.","authors":"Bruna Gigante, Juan Tamargo, Stefan Agewall, Dan Atar, Jurrien Ten Berg, Gianluca Campo, Elisabetta Cerbai, Christina Christersson, Dobromir Dobrev, Péter Ferdinandy, Tobias Geisler, Diana A Gorog, Erik L Grove, Juan Carlos Kaski, Andrea Rubboli, Sven Wassmann, Håkan Wallen, Bianca Rocca","doi":"10.1093/ehjcvp/pvae064","DOIUrl":"10.1093/ehjcvp/pvae064","url":null,"abstract":"<p><p>Obesity and underweight are a growing health problem worldwide and a challenge for clinicians concerning antithrombotic therapy, due to the associated risks of thrombosis and/or bleeding. This clinical consensus statement updates a previous one published in 2018, by reviewing the most recent evidence on antithrombotic drugs based on body size categories according to the World Health Organization classification. The document focuses mostly on individuals at the extremes of body weight, i.e. underweight and moderate-to-morbid obesity, who require antithrombotic drugs, according to current guidelines, for the treatment or prevention of cardiovascular diseases or venous thromboembolism. Managing antithrombotic therapy or thromboprophylaxis in these individuals is challenging, due to profound changes in body composition, metabolism and organ function, and altered drug pharmacokinetics and pharmacodynamics, as well as weak or no evidence from clinical trials. The document also includes artificial intelligence simulations derived from in silico pharmacokinetic/pharmacodynamic models, which can mimic the pharmacokinetic changes and help identify optimal regimens of antithrombotic drugs for severely underweight or severely obese individuals. Further, bariatric surgery in morbidly obese subjects is frequently performed worldwide. Bariatric surgery causes specific and additional changes in metabolism and gastrointestinal anatomy, depending on the type of the procedure, which can also impact the pharmacokinetics of antithrombotic drugs and their management. Based on existing literature, the document provides consensus statements on optimizing antithrombotic drug management for underweight and all classes of obese patients, while highlighting the current gaps in knowledge in these complex clinical settings, which require personalized medicine and precision pharmacology.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"614-645"},"PeriodicalIF":5.3,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of dyslipidaemia in patients with comorbidities: facing the challenge.","authors":"Gert Mayer, Dobromir Dobrev, Juan Carlos Kaski, Anne Grete Semb, Kurt Huber, Andreas Zirlik, Stefan Agewall, Heinz Drexel","doi":"10.1093/ehjcvp/pvae058","DOIUrl":"10.1093/ehjcvp/pvae058","url":null,"abstract":"<p><p>Dyslipidaemia is a common chronic kidney disease (CKD) and contributes to excessively elevated cardiovascular mortality. The pathophysiology is complex and modified by comorbidities like the presence/absence of proteinuria, diabetes mellitus or drug treatment. This paper provides an overview of currently available treatment options. We focused on individuals with CKD and excluded those on renal replacement therapy (haemodialysis, peritoneal dialysis, or kidney transplantation). The use of statins is safe and recommended in most patients, but guidelines vary with respect to low-density lipoprotein (LDL) cholesterol goals. While no dedicated primary or secondary prevention studies are available for pro-protein convertase subtilisin/kexin type 9 inhibitors, secondary analyses of large outcome trials reveal no effect modification on endpoints by the presence of CKD. Similar data have been shown for bempedoic acid, but no definite conclusion can be drawn with respect to efficacy and safety. No outcome trials are available for inclisiran while the cholesterol lowering effects seem to be unaffected by CKD. Finally, the value of fibrates and icosapent ethyl in CKD is unclear. Lipid abnormalities contribute to the massive cardiovascular disease burden in CKD. Lowering of LDL cholesterol with statins (and most likely PCSK9 inhibitors) reduces the event rate and thus statin therapy should be initiated in almost all individuals. Other interventions (bempedoic acid, inclisiran, fibrates, or icosapent ethyl) currently need a case-by-case decision before prescription.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"608-613"},"PeriodicalIF":5.3,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}