European Heart Journal — Cardiovascular Pharmacotherapy最新文献

{"title":"Cardiovascular risks associated with use of non-steroidal anti-inflammatory drugs in patients with non-obstructive coronary artery disease.","authors":"Natascha Gaster,&nbsp;Lars Pedersen,&nbsp;Vera Ehrenstein,&nbsp;Morten Böttcher,&nbsp;Hans Erik Bøtker,&nbsp;Henrik Toft Sørensen,&nbsp;Morten Schmidt","doi":"10.1093/ehjcvp/pvab082","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvab082","url":null,"abstract":"<p><strong>Aims: </strong>To examine whether non-aspirin non-steroidal anti-inflammatory drug (NSAID) use is associated with increased cardiovascular risks in patients with non-obstructive coronary artery disease (CAD).</p><p><strong>Methods and results: </strong>Using Danish medical registries, we conducted a population-based cohort study in Western Denmark during 2008-17. We identified all patients undergoing first-time coronary computed tomography angiography (CCTA) due to suspected CAD (n = 35 399), with results showing no (n = 28 581) or non-obstructive CAD (n = 6818). Multivariate Cox regression was used to compute hazard ratios of major adverse cardiac events (MACEs), including incident myocardial infarction, coronary intervention, and death. The rate of MACE increased by 33% for any NSAID use compared with non-use [hazard ratio 1.33, 95% confidence interval (CI) 1.06-1.68] in patients with no CAD and by 48% (1.48, 95% CI 1.06-2.07) in patients with non-obstructive CAD. Rate difference of MACE, per 100 person-years, was 0.38 (95% CI 0.08-0.67) in patients with no CAD (number needed to harm: 267) and 1.08 (95% CI 0.06-2.11) in patients with non-obstructive CAD (number needed to harm: 92). Current use of older cyclooxygenase-2 inhibitors was associated with the highest hazard ratio in patients with non-obstructive CAD, both when ascertained as pre-CCTA use (2.9-fold increase) and when ascertained from time-varying use (1.8-fold increase).</p><p><strong>Conclusion: </strong>NSAID use in patients with CCTA-confirmed no and non-obstructive CAD was associated with an increased cardiovascular risk compared with non-use. The absolute risk differences and numbers needed to harm were considered clinically relevant, particularly in patients with non-obstructive CAD.</p>","PeriodicalId":11995,"journal":{"name":"European Heart Journal — Cardiovascular Pharmacotherapy","volume":" ","pages":"282-290"},"PeriodicalIF":7.1,"publicationDate":"2022-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39960048","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":"Call for emergency action to limit global temperature increases, restore biodiversity, and protect health.","authors":"Laurie Laybourn-Langton,&nbsp;Richard Smith","doi":"10.1093/ehjcvp/pvab061","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvab061","url":null,"abstract":"","PeriodicalId":11995,"journal":{"name":"European Heart Journal — Cardiovascular Pharmacotherapy","volume":" ","pages":"e85-e87"},"PeriodicalIF":7.1,"publicationDate":"2021-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8453267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39388295","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":"Summary of new trials presented at the 2021 American College of Cardiology Scientific Sessions.","authors":"Husam M Salah,&nbsp;Muhammad Shahzeb Khan,&nbsp;Marat Fudim","doi":"10.1093/ehjcvp/pvab046","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvab046","url":null,"abstract":"Unlike the PARADIGM HF study, which showed that sacubitril/ valsartan is superior to enalapril in reducing mortality and hospitalization for heart failure (HF) in patients with left ventricular ejection fraction (LVEF) of <_40%; the PARADISE-MI trial, which investigated sacubitril/valsartan compared with ramipril in patients following acute myocardial infraction (AMI) and LVEF of <_40% (without prior HF) showed no difference in the primary endpoint of cardiovascular death, first HF-hospitalization, or outpatient HF between sacubitril/ valsartan and ramipril. However, trends towards benefit were seen in the sacubitril/valsartan group with numerically lower rate of events.","PeriodicalId":11995,"journal":{"name":"European Heart Journal — Cardiovascular Pharmacotherapy","volume":" ","pages":"e79-e80"},"PeriodicalIF":7.1,"publicationDate":"2021-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9034204/pdf/pvab046.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39094100","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":"Off-label underdosed apixaban use in Asian patients with non-valvular atrial fibrillation.","authors":"So-Ryoung Lee,&nbsp;Eue-Keun Choi,&nbsp;Sang-Hyun Park,&nbsp;Jin-Hyung Jung,&nbsp;Kyung-Do Han,&nbsp;Seil Oh,&nbsp;Gregory Y H Lip","doi":"10.1093/ehjcvp/pvab004","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvab004","url":null,"abstract":"<p><strong>Aims: </strong>To compare the effectiveness and safety of off-label underdosed apixaban with on-label standard dose apixaban in Asian patients with atrial fibrillation (AF).</p><p><strong>Methods and results: </strong>Using the Korean nationwide claims database, we identified patients who were prescribed apixaban and did not fulfil the dose reduction criteria for apixaban between January 2015 and December 2017. A multivariable Cox hazard regression model was performed, and hazard ratios (HRs) for ischaemic stroke, major bleeding (MB), all-cause death, and composite outcome were analysed. Compared to patients prescribed on-label standard dose apixaban (n = 4194), patients prescribed off-label underdosed apixaban (n = 2890) showed a higher risk of ischaemic stroke [adjusted HR (aHR) 1.38, 95% confidence interval (CI) 1.06-1.81], all-cause death (aHR 1.19, 95% CI 1.01-1.39), and the composite outcome (aHR 1.17, 95% CI 1.03-1.34), but with no significant differences in MB between the two groups. Among the patients who did not meet any dose reduction criteria, off-label underdosed apixaban use was associated with a significantly higher risk of ischaemic stroke than on-label standard dose apixaban use (aHR 1.85, 95% CI 1.25-2.73). Among the patients who met a single dose reduction criterion, off-label underdosed apixaban use was associated with a higher risk of all-cause death than on-label standard dose apixaban (aHR 1.32, 95% CI 1.07-1.64).</p><p><strong>Conclusion: </strong>The off-label underdosed apixaban group showed higher risks of ischaemic stroke, all-cause death, and composite clinical outcomes than the on-label standard dose apixaban group, but both showed comparable risks of MB. Label adherence to apixaban dosing should be emphasized to achieve the best clinical outcomes for Asian patients with AF.</p>","PeriodicalId":11995,"journal":{"name":"European Heart Journal — Cardiovascular Pharmacotherapy","volume":" ","pages":"415-423"},"PeriodicalIF":7.1,"publicationDate":"2021-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/ehjcvp/pvab004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38839672","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":"Wait a minute to prescribe off-label reduced dose of apixaban.","authors":"Ichitaro Abe,&nbsp;Naohiko Takahashi","doi":"10.1093/ehjcvp/pvab006","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvab006","url":null,"abstract":"","PeriodicalId":11995,"journal":{"name":"European Heart Journal — Cardiovascular Pharmacotherapy","volume":" ","pages":"424-425"},"PeriodicalIF":7.1,"publicationDate":"2021-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/ehjcvp/pvab006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25364054","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":"Effectiveness and safety of oral anticoagulants among non-valvular atrial fibrillation patients with polypharmacy.","authors":"Gregory Y H Lip,&nbsp;Allison Keshishian,&nbsp;Amiee Kang,&nbsp;Amol D Dhamane,&nbsp;Xuemei Luo,&nbsp;Christian Klem,&nbsp;Lisa Rosenblatt,&nbsp;Jack Mardekian,&nbsp;Jenny Jiang,&nbsp;Huseyin Yuce,&nbsp;Steven Deitelzweig","doi":"10.1093/ehjcvp/pvaa117","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvaa117","url":null,"abstract":"<p><strong>Aims: </strong>Polypharmacy is prevalent among non-valvular atrial fibrillation (NVAF) patients and presents a potential issue for the effective management of NVAF. This study compared the risk of stroke/systemic embolism (SE) and major bleeding (MB) among NVAF patients with polypharmacy newly prescribed oral anticoagulants (OACs).</p><p><strong>Methods and results: </strong>A retrospective study of NVAF patients with polypharmacy who initiated OACs from 01 January 2013 to 30 September 2015 was conducted using US CMS Medicare and four commercial databases. Polypharmacy was defined as ≥6 concomitant medications on the index date. Propensity score matching was conducted to compare non-vitamin K antagonists OACs (NOACs) to warfarin as well as between NOACs. Cox proportional hazard models were used to evaluate the risk of stroke/SE and MB. A total of 188 893 patients with polypharmacy were included, with an average of 8 concomitant medications (interquartile range 6-9). Compared to warfarin, apixaban [hazard ratio (HR): 0.59, 95% confidence interval (CI): 0.52-0.68], and rivaroxaban (HR: 0.75, 95% CI: 0.69-0.83) were associated with a lower risk of stroke/SE. Apixaban (HR: 0.57, 95% CI: 0.54-0.61) and dabigatran (HR: 0.76, 95% CI: 0.66-0.88) were associated with a decreased risk of MB compared with warfarin. Compared with dabigatran and rivaroxaban, apixaban was associated with a lower risk of stroke/SE and MB. Dabigatran was associated with lower risk of MB compared with rivaroxaban.</p><p><strong>Conclusions: </strong>In this observational study of anticoagulated NVAF patients with polypharmacy, effectiveness and safety profiles are more favourable for NOACs vs. warfarin. Our observations are hypothesis generating and may help inform future clinical trials regarding appropriate OAC treatment selection in polypharmacy patients.</p>","PeriodicalId":11995,"journal":{"name":"European Heart Journal — Cardiovascular Pharmacotherapy","volume":" ","pages":"405-414"},"PeriodicalIF":7.1,"publicationDate":"2021-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/ehjcvp/pvaa117","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38451537","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":"The age of randomized clinical trials: three important aspects of randomized clinical trials in cardiovascular pharmacotherapy with examples from lipid, diabetes, and antithrombotic trials.","authors":"Heinz Drexel,&nbsp;Basil S Lewis,&nbsp;Giuseppe M C Rosano,&nbsp;Christoph H Saely,&nbsp;Gerda Tautermann,&nbsp;Kurt Huber,&nbsp;Joern F Dopheide,&nbsp;Juan Carlos Kaski,&nbsp;Arthur Mader,&nbsp;Alexander Niessner,&nbsp;Gianluigi Savarese,&nbsp;Thomas A Schmidt,&nbsp;AnneGrete Semb,&nbsp;Juan Tamargo,&nbsp;Sven Wassmann,&nbsp;Keld Per Kjeldsen,&nbsp;Stefan Agewall,&nbsp;Stuart J Pocock","doi":"10.1093/ehjcvp/pvaa126","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvaa126","url":null,"abstract":"<p><p>This review article aims to explain the important issues that data safety monitoring boards (DSMB) face when considering early termination of a trial and is specifically addressed to the needs of clinical and research cardiologists. We give an insight into the overall background and then focus on the three principal reasons for stopping trials, i.e. efficacy, futility, and harm. The statistical essentials are also addressed to familiarize clinicians with the key principles. The topic is further highlighted by numerous examples from lipid trials and antithrombotic trials. This is followed by an overview of regulatory aspects, including an insight into industry-investigator interactions. To conclude, we summarize the key elements that are the basis for a decision to stop a randomized clinical trial (RCT).</p>","PeriodicalId":11995,"journal":{"name":"European Heart Journal — Cardiovascular Pharmacotherapy","volume":" ","pages":"453-459"},"PeriodicalIF":7.1,"publicationDate":"2021-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/ehjcvp/pvaa126","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38555121","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":"Renal protection in chronic heart failure: focus on sacubitril/valsartan.","authors":"Roberto Pontremoli,&nbsp;Claudio Borghi,&nbsp;Pasquale Perrone Filardi","doi":"10.1093/ehjcvp/pvab030","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvab030","url":null,"abstract":"<p><p>Chronic kidney disease (CKD) is highly prevalent in patients with chronic heart failure (CHF) and increases the risk of overall and cardiovascular (CV) mortality. Despite evidence supporting the effectiveness of angiotensin-converting enzyme inhibitors (ACE-Is), angiotensin receptor blockers, and mineralocorticoid receptor antagonists in decreasing mortality in patients with CHF, CKD hampers the optimization of standard pharmacologic therapy for heart failure. Therefore, other treatment options are needed to optimize treatment outcomes in CHF patients with CKD. The first-in-class angiotensin receptor-neprilysin inhibitor, sacubitril/valsartan, has a complementary activity that counteracts the potential unwanted long-term effects of over-activation of the renin-angiotensin-aldosterone system. Sacubitril/valsartan reduced the risk of CV mortality compared to standard therapy with an ACE-I in patients with heart failure with reduced ejection fraction (HFrEF) in the PARADIGM-HF trial and has been shown to be safe and effective in a broad range of HFrEF patients. However, data on the efficacy and tolerability of sacubitril/valsartan in patients with more advanced CKD are limited. This review discusses the evidence for the role of sacubitril/valsartan in providing additional renal benefit in patients with HFrEF. Data from clinical trials and real-world experience in patients with HFrEF and advanced CKD support the benefits of dual angiotensin/neprilysin inhibition across the breadth of kidney disease stages, including patients with significant renal impairment that was not reported in the pivotal PARADIGM-HF trial, and suggests a central role for the cardiac benefits of sacubitril/valsartan in nephroprotection.</p>","PeriodicalId":11995,"journal":{"name":"European Heart Journal — Cardiovascular Pharmacotherapy","volume":" ","pages":"445-452"},"PeriodicalIF":7.1,"publicationDate":"2021-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/ehjcvp/pvab030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25579564","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":"Dosage of direct oral anticoagulants during dual and triple antithrombotic therapy: a focus on the net clinical benefit.","authors":"Niema Kazem,&nbsp;Patrick Sulzgruber,&nbsp;Alexander Niessner","doi":"10.1093/ehjcvp/pvab058","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvab058","url":null,"abstract":"","PeriodicalId":11995,"journal":{"name":"European Heart Journal — Cardiovascular Pharmacotherapy","volume":" ","pages":"e83-e84"},"PeriodicalIF":7.1,"publicationDate":"2021-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39274269","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":"Haematuria and urinary tract cancers in patients with atrial fibrillation treated with oral anticoagulants.","authors":"Peter Vibe Rasmussen,&nbsp;Frederik Dalgaard,&nbsp;Gunnar Hilmar Gislason,&nbsp;Axel Brandes,&nbsp;Søren Paaske Johnsen,&nbsp;Erik Lerkevang Grove,&nbsp;Christian Torp-Pedersen,&nbsp;Anne-Marie Bloch Münster,&nbsp;Marie Schmidt Erikson,&nbsp;Jannik Langtved Pallisgaard,&nbsp;Paul Blanche,&nbsp;Morten Lock Hansen","doi":"10.1093/ehjcvp/pvaa045","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvaa045","url":null,"abstract":"<p><strong>Aims: </strong>Patients with atrial fibrillation (AF) treated with oral anticoagulants (OACs) have an increased risk of bleeding including haematuria. In the general population, gross haematuria is associated with urinary tract cancer. Consequently, we aimed to investigate the potential association between gross haematuria and urinary tract cancer in anticoagulated patients with AF.</p><p><strong>Methods and results: </strong>Using Danish nationwide registers, we included Danish AF patients treated with OACs between 2001 and 2015. Non-parametric estimation and semi-parametric absolute risk regression were used to estimate the absolute risk of urinary tract cancer in patients with and without gross haematuria. We included 125 063 AF patients with a median age of 74 years (interquartile range 65-80) and a majority of males (57%). The absolute risk of gross haematuria 12 months after treatment initiation increased with age ranging from 0.37% [95% confidence interval (CI) 0.31-0.42] to 0.85% (95% CI 0.75-0.96) in the youngest and oldest age groups of ≤70 and >80 years of age, respectively. The 1-year risk of urinary tract cancer after haematuria ranged from 4.2% (95% CI 2.6-6.6) to 6.5% (95% CI 4.6-9.0) for patients in age group >80 and 71-80 years, respectively. Gross haematuria conferred large risk ratios of urinary tract cancer when comparing patients with and without haematuria across all age groups.</p><p><strong>Conclusion: </strong>Gross haematuria was associated with clinically relevant risks of urinary tract cancer in anticoagulated patients with AF. These findings underline the importance of meticulously examining anticoagulated patients with haematuria.</p>","PeriodicalId":11995,"journal":{"name":"European Heart Journal — Cardiovascular Pharmacotherapy","volume":" ","pages":"373-379"},"PeriodicalIF":7.1,"publicationDate":"2021-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/ehjcvp/pvaa045","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37902104","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}