European Heart Journal — Cardiovascular Pharmacotherapy最新文献

{"title":"To treat or not to treat.","authors":"S Agewall","doi":"10.1093/ehjcvp/pvac062","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvac062","url":null,"abstract":"","PeriodicalId":11995,"journal":{"name":"European Heart Journal — Cardiovascular Pharmacotherapy","volume":" ","pages":"754-755"},"PeriodicalIF":7.1,"publicationDate":"2022-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40569988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ticagrelor monotherapy after PCI in patients with concomitant diabetes mellitus and chronic kidney disease: TWILIGHT DM-CKD.","authors":"Payam Dehghani,&nbsp;Davide Cao,&nbsp;Usman Baber,&nbsp;Johny Nicolas,&nbsp;Samantha Sartori,&nbsp;Carlo A Pivato,&nbsp;Zhongjie Zhang,&nbsp;George Dangas,&nbsp;Dominick J Angiolillo,&nbsp;Carlo Briguori,&nbsp;David J Cohen,&nbsp;Timothy Collier,&nbsp;Dariusz Dudek,&nbsp;Michael Gibson,&nbsp;Robert Gil,&nbsp;Kurt Huber,&nbsp;Upendra Kaul,&nbsp;Ran Kornowski,&nbsp;Mitchell W Krucoff,&nbsp;Vijay Kunadian,&nbsp;Shamir Mehta,&nbsp;David J Moliterno,&nbsp;E Magnus Ohman,&nbsp;Javier Escaned,&nbsp;Gennaro Sardella,&nbsp;Samin K Sharma,&nbsp;Richard Shlofmitz,&nbsp;Giora Weisz,&nbsp;Bernhard Witzenbichler,&nbsp;Stuart Pocock,&nbsp;Roxana Mehran","doi":"10.1093/ehjcvp/pvac016","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvac016","url":null,"abstract":"<p><strong>Aims: </strong>We aimed to evaluate the treatment effects of ticagrelor monotherapy in the very high risk cohort of patients with concomitant diabetes mellitus (DM) and chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI).</p><p><strong>Methods and results: </strong>In the TWILIGHT (Ticagrelor with Aspirin or Alone in High-Risk Patients after Coronary Intervention) trial, after 3-month dual antiplatelet therapy with ticagrelor and aspirin post-PCI, event-free patients were randomized to either aspirin or placebo in addition to ticagrelor for 12 months. Those with available information on DM and CKD status were included in this subanalysis and were stratified by the presence or absence of either condition: 3391 (54.1%) had neither DM nor CKD (DM-/CKD-), 1822 (29.0%) had DM only (DM+/CKD-), 561 (8.9%) had CKD only (DM-/CKD+), and 8.0% had both DM and CKD (DM+/CKD+). The incidence of the primary endpoint of Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding did not differ according to DM/CKD status (P-trend = 0.13), but there was a significant increase in BARC 3 or 5 bleeding (P-trend &lt; 0.001) as well as the key secondary endpoint of death, myocardial infarction, or stroke (P-trend &lt; 0.001). Ticagrelor plus placebo reduced bleeding events compared with ticagrelor plus aspirin across all four groups, including DM+/CKD+ patients with respect to BARC 2-5 [4.5% vs. 8.7%; hazard ratio (HR) 0.49, 95% confidence interval (CI) 0.24-1.01] as well as BARC 3-5 (0.8% vs. 5.3%; HR 0.15, 95% CI 0.03-0.53) bleeding, with no evidence of heterogeneity. The risk of death, myocardial infarction, or stroke was similar between treatment arms across all groups.</p><p><strong>Conclusion: </strong>Irrespective of the presence of DM, CKD, and their combination, ticagrelor monotherapy reduced the risk of bleeding without a significant increase in ischaemic events compared with ticagrelor plus aspirin.</p>","PeriodicalId":11995,"journal":{"name":"European Heart Journal — Cardiovascular Pharmacotherapy","volume":" ","pages":"707-716"},"PeriodicalIF":7.1,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40320562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial and ethnic differences in pharmacotherapy to prevent coronary artery disease and thrombotic events.","authors":"Juan Tamargo,&nbsp;Juan Carlos Kaski,&nbsp;Takeshi Kimura,&nbsp;Jack Charles Barton,&nbsp;Ko Yamamoto,&nbsp;Maki Komiyama,&nbsp;Heinz Drexel,&nbsp;Basil S Lewis,&nbsp;Stefan Agewall,&nbsp;Koji Hasegawa","doi":"10.1093/ehjcvp/pvac040","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvac040","url":null,"abstract":"<p><p>Awareness of racial/ethnic disparities represents a key challenge for healthcare systems that attempt to provide effective healthcare and to reduce existing inequalities in the use of and adherence to guideline-recommended cardiovascular drugs to improve clinical outcomes for cardiovascular disease (CVD). In this review, we describe important racial/ethnic differences between and within ethnic groups in the prevalence, risk factors, haemostatic factors, anti-inflammatory and endothelial markers, recurrence, and outcomes of CVD. We discuss important differences in the selection, doses, and response [efficacy and adverse drug reactions (ADRs)] in ethnically diverse patients treated with antithrombotics or lipid-lowering drugs. Differences in drug response are mainly related to racial/ethnic differences in the frequency of polymorphisms in genes encoding drug-metabolizing enzymes (DMEs) and drug transporters. These polymorphisms markedly influence the pharmacokinetics, dose requirements, and safety of warfarin, clopidogrel, and statins. This review aims to support a better understanding of the genetic differences between and among populations to identify patients who may experience an ADR or a lack of drug response, thus optimizing therapy and improving outcomes. The greater the understanding of the differences in the genetic variants of DMEs and transporters that determine the differences in the exposure, efficacy, and safety of cardiovascular drugs between races/ethnicities, the greater the probability that personalized medicine will become a reality.</p>","PeriodicalId":11995,"journal":{"name":"European Heart Journal — Cardiovascular Pharmacotherapy","volume":" ","pages":"738-751"},"PeriodicalIF":7.1,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/83/12/pvac040.PMC9520447.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40515900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treating patients with anticoagulants and antiplatelet drugs is always a balance between risk for thrombosis vs. risk for bleeding.","authors":"Stefan Agewall","doi":"10.1093/ehjcvp/pvac048","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvac048","url":null,"abstract":"","PeriodicalId":11995,"journal":{"name":"European Heart Journal — Cardiovascular Pharmacotherapy","volume":" ","pages":"645-647"},"PeriodicalIF":7.1,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40381911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevention is still the key to success.","authors":"Stefan Agewall","doi":"10.1093/ehjcvp/pvac046","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvac046","url":null,"abstract":"","PeriodicalId":11995,"journal":{"name":"European Heart Journal — Cardiovascular Pharmacotherapy","volume":" ","pages":"537-538"},"PeriodicalIF":7.1,"publicationDate":"2022-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40346566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Focus on optimizing treatment of coronary heart disease.","authors":"Stefan Agewall","doi":"10.1093/ehjcvp/pvac039","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvac039","url":null,"abstract":"","PeriodicalId":11995,"journal":{"name":"European Heart Journal — Cardiovascular Pharmacotherapy","volume":" ","pages":"431-433"},"PeriodicalIF":7.1,"publicationDate":"2022-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40538029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes after delayed primary percutaneous coronary intervention vs. pharmaco-invasive strategy in ST-segment elevation myocardial infarction in Norway.","authors":"Jarle Jortveit,&nbsp;Are Hugo Pripp,&nbsp;Sigrun Halvorsen","doi":"10.1093/ehjcvp/pvab041","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvab041","url":null,"abstract":"<p><strong>Aims: </strong>Primary percutaneous coronary intervention (pPCI) is the preferred reperfusion strategy in patients with ST-segment elevation myocardial infarction (STEMI) provided it can be performed within 120 min from diagnosis. However, it is unclear whether pPCI or a pharmaco-invasive (P-I) strategy is the best choice in patients who cannot receive timely pPCI. The aim of the present study was to compare outcomes after delayed and late pPCI vs. a P-I strategy in STEMI patients who did not receive timely pPCI.</p><p><strong>Methods and results: </strong>All patients with STEMI registered in the Norwegian Myocardial Infarction Registry (NORMI) between 2013 and 2019, with ≤12 h from symptom onset to first medical contact and available timelines were included in the study. The primary outcome was all-cause mortality, and follow-up was through 2019. A total of 21 121 (27% of 78 368) STEMI patients were registered in the NORMI. Among patients who met the inclusion criteria, 7238 (54%) patients underwent timely pPCI, 1537 (11%) delayed pPCI (121-180 min), 1012 (7%) late pPCI (>180 min), and 2338 (17%) patients were treated with a P-I strategy. After a median follow-up time of 2.5 years, mortality was higher in the delayed pPCI [adjusted hazard ratio (HR) 1.3, 95% confidence interval (CI) 1.0-1.5] and in the late pPCI group (adjusted HR 1.4, 95% CI 1.1-1.7) compared to the P-I strategy group, but bleeding complications were more frequent after P-I strategy.</p><p><strong>Conclusions: </strong>In STEMI patients who did not receive timely percutaneous coronary intervention, a P-I strategy seemed to be associated with better long-term survival compared to delayed/late pPCI.</p>","PeriodicalId":11995,"journal":{"name":"European Heart Journal — Cardiovascular Pharmacotherapy","volume":" ","pages":"442-451"},"PeriodicalIF":7.1,"publicationDate":"2022-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c2/b0/pvab041.PMC9366642.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39019423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concerns about the use of digoxin in acute coronary syndromes.","authors":"Raffaele Bugiardini,&nbsp;Edina Cenko,&nbsp;Jinsung Yoon,&nbsp;Mihaela van der Schaar,&nbsp;Sasko Kedev,&nbsp;Chris P Gale,&nbsp;Zorana Vasiljevic,&nbsp;Maria Bergami,&nbsp;Davor Miličić,&nbsp;Marija Zdravkovic,&nbsp;Gordana Krljanac,&nbsp;Lina Badimon,&nbsp;Olivia Manfrini","doi":"10.1093/ehjcvp/pvab055","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvab055","url":null,"abstract":"<p><strong>Aims: </strong>The use of digitalis has been plagued by controversy since its initial use. We aimed to determine the relationship between digoxin use and outcomes in hospitalized patients with acute coronary syndromes (ACSs) complicated by heart failure (HF) accounting for sex difference and prior heart diseases.</p><p><strong>Methods and results: </strong>Of the 25 187 patients presenting with acute HF (Killip class ≥2) in the International Survey of Acute Coronary Syndromes Archives (NCT04008173) registry, 4722 (18.7%) received digoxin on hospital admission. The main outcome measure was all-cause 30-day mortality. Estimates were evaluated by inverse probability of treatment weighting models. Women who received digoxin had a higher rate of death than women who did not receive it [33.8% vs. 29.2%; relative risk (RR) ratio: 1.24; 95% confidence interval (CI): 1.12-1.37]. Similar odds for mortality with digoxin were observed in men (28.5% vs. 24.9%; RR ratio: 1.20; 95% CI: 1.10-1.32). Comparable results were obtained in patients with no prior coronary heart disease (RR ratio: 1.26; 95% CI: 1.10-1.45 in women and RR ratio: 1.21; 95% CI: 1.06-1.39 in men) and those in sinus rhythm at admission (RR ratio: 1.34; 95% CI: 1.15-1.54 in women and RR ratio: 1.26; 95% CI: 1.10-1.45 in men).</p><p><strong>Conclusion: </strong>Digoxin therapy is associated with an increased risk of early death among women and men with ACS complicated by HF. This finding highlights the need for re-examination of digoxin use in the clinical setting of ACS.</p>","PeriodicalId":11995,"journal":{"name":"European Heart Journal — Cardiovascular Pharmacotherapy","volume":" ","pages":"474-482"},"PeriodicalIF":7.1,"publicationDate":"2022-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39176155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of chronic kidney disease on the pharmacodynamic and pharmacokinetic effects of ticagrelor in patients with diabetes mellitus and coronary artery disease.","authors":"Francesco Franchi,&nbsp;Fabiana Rollini,&nbsp;Latonya Been,&nbsp;Naji Maaliki,&nbsp;Patrick Abou Jaoude,&nbsp;Andrea Rivas,&nbsp;Xuan Zhou,&nbsp;Sida Jia,&nbsp;Maryuri Briceno,&nbsp;Chang Hoon Lee,&nbsp;Andres M Pineda,&nbsp;Siva Suryadevara,&nbsp;Daniel Soffer,&nbsp;Martin M Zenni,&nbsp;Theodore A Bass,&nbsp;Dominick J Angiolillo","doi":"10.1093/ehjcvp/pvab042","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvab042","url":null,"abstract":"<p><strong>Aims: </strong>Patients with diabetes mellitus (DM) and chronic kidney disease (CKD) are at increased risk of atherothrombotic events. Ticagrelor reduces ischaemic events compared to clopidogrel, with the greatest risk reduction in patients with both DM and CKD. How CKD status affects the pharmacodynamic (PD) and pharmacokinetic (PK) profiles of different ticagrelor maintenance dose regimens in patients with DM is unknown.</p><p><strong>Methods and results: </strong>In this randomized, crossover study, patients with DM on treatment with dual antiplatelet therapy (aspirin and clopidogrel) were stratified according to CKD status and randomized to ticagrelor 90 or 60 mg bid. PK/PD assessments were performed at baseline, after 7-10 days of ticagrelor (peak and trough), and after 7-10 days of alternative ticagrelor regimen (peak and trough). PK assessments included plasma concentrations of ticagrelor and its major metabolite. PD assessments included vasodilator-stimulated phosphoprotein (VASP)-platelet reactivity index (PRI), VerifyNow P2Y12, and light transmittance aggregometry (LTA). A total of 92 patients with DM (CKD, n = 44; non-CKD, n = 48) were randomized. Levels of platelet reactivity were lower with the 90 mg compared with the 60 mg ticagrelor dose, which was statistically significant in non-CKD but not in CKD patients for most PD measures. There were no significant differences in the primary endpoint (trough levels of VASP-PRI following ticagrelor 90 mg dosing) between cohorts (31 ± 20 vs. 25 ± 14; P = 0.105). VerifyNow and LTA provided similar findings. PK assessments tracked PD profiles showing increased plasma concentrations of ticagrelor and its major metabolite in CKD compared to non-CKD patients.</p><p><strong>Conclusion: </strong>In patients with DM, although ticagrelor maintenance dose regimens (60 and 90 mg) yield potent P2Y12 inhibition, levels of platelet reactivity tended to be higher and subject to broader variability in non-CKD compared with CKD patients.</p><p><strong>Clinical trial registration: </strong>http://www.clinicaltrials.gov Unique Identifier: NCT02539160.</p>","PeriodicalId":11995,"journal":{"name":"European Heart Journal — Cardiovascular Pharmacotherapy","volume":" ","pages":"452-461"},"PeriodicalIF":7.1,"publicationDate":"2022-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39015551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-dose rivaroxaban plus aspirin in patients with polypharmacy and multimorbidity: an analysis from the COMPASS trial.","authors":"Thomas Vanassche,&nbsp;Peter Verhamme,&nbsp;Sonia S Anand,&nbsp;Olga Shestakovska,&nbsp;Darryl P Leong,&nbsp;Keith A A Fox,&nbsp;Deepak L Bhatt,&nbsp;Alvaro Avezum,&nbsp;Marco Alings,&nbsp;Victor Aboyans,&nbsp;Aldo P Maggioni,&nbsp;Petr Widimsky,&nbsp;Eva Muehlhofer,&nbsp;Scott D Berkowitz,&nbsp;Salim Yusuf,&nbsp;Stuart J Connolly,&nbsp;John W Eikelboom,&nbsp;Jackie Bosch","doi":"10.1093/ehjcvp/pvab050","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvab050","url":null,"abstract":"<p><strong>Aims: </strong>To analyse whether the benefits and risks of rivaroxaban plus aspirin vary in patients with comorbidities and receiving multiple drugs. In patients with coronary or peripheral artery disease, adding low-dose rivaroxaban to aspirin reduces cardiovascular events and mortality. Polypharmacy and multimorbidity are frequent in such patients.</p><p><strong>Methods and results: </strong>We describe ischaemic events (cardiovascular death, stroke, or myocardial infarction) and major bleeding in participants from the randomized, double-blind COMPASS study by number of cardiovascular medications and concomitant medical conditions. We compared event rates and hazard ratios (HRs) for rivaroxaban plus aspirin vs. aspirin alone by the number of medications and concomitant conditions, and tested for interaction between polypharmacy or multimorbidity and the antithrombotic regimen. The risk of ischaemic events was higher in patients with more concomitant drugs (HR 1.7, 95% confidence interval 1.5-2.1 for >4 vs. 0-2) and with more comorbidities (HR 2.3, 1.8-2.1 for >3 vs. 0-1). Multimorbidity, but not polypharmacy, was associated with a higher risk of major bleeding. The relative efficacy, safety, and net clinical benefit of rivaroxaban were not affected by the number of drugs or comorbidities. Patients taking more concomitant medications derived the largest absolute reduction in the net clinical outcome with added rivaroxaban (1.1% vs. 0.4% reduction with >4 vs. 0-2 cardiovascular drugs, number needed to treat 91 vs. 250).</p><p><strong>Conclusion: </strong>Adding low-dose rivaroxaban to aspirin resulted in benefits irrespective of the number of concomitant drugs or comorbidities. Multiple comorbidities and/or polypharmacy should not dissuade the addition of rivaroxaban to aspirin in otherwise eligible patients.</p>","PeriodicalId":11995,"journal":{"name":"European Heart Journal — Cardiovascular Pharmacotherapy","volume":" ","pages":"462-473"},"PeriodicalIF":7.1,"publicationDate":"2022-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39055189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}