Further analysis of the ACTIVE-W trial emphasises the importance of maintaining the INR in the therapeutic range in chronic atrial fibrillation.
The ACTIVE-A trial results indicate that Aspirin with Clopidogrel is better than Aspirin alone in patients with atrial fibrillation that can not or will not take Warfarin.
Report from the European Society of Cardiology Congress, 2008. The COURAGE Trial- quality of life gains do not make this a cost-effective treatment.
The COURAGE Trial- this prospective randomised examined the potential benefits from percutaneous intervention. The study found
no evidence for reduction in non-fatal myocardial infarction or death from routine PCI in those with stable coronary disease.
Coronary Calcium Scoring: The Dallas Heart Study. This study found that one in fifteen men aged between thirty and sixty-five years, assessed as being at "moderate risk" using the Framingham risk equation, were in fact at "high risk" on the basis of a calcium score greater than 400.
Stable Coronary Artery Disease: The COURAGE trial
confirms previous meta-analysis findings- percutaneous intervention with coronary artery stenting to stable lesions does not reduce the rates of myocardial infarction
or death. This trial will provide further support for continued medical therapy with intensive risk factor modification for patients whose anginal
symptoms can be easily controlled with medical therapy.
Atrial Fibrillation: Anticoagulant therapy was found to be superior to the combination of aspirin with clopidogrel in the ACTIVE-W trial. However,
the differences in primary event rates between the two groups was not as large as in older studies that compared
anticoagulation with aspirin.
The CHADS2 score is being promoted as a means to assess the risk of stroke in patients with atrial fibrillation.
Prospective data showing calcium screening helps improve prediction of future cardiovascular events. The St Francis Heart Study. Prominent Cardiologist in the USA reported to agree that the test has a role for risk stratification in intermediate risk patients.
Patent Foramen Ovale have been associated with cryptogenic stroke, decompression sickness, altitude sickness and also migrane headaches.
SAFE-T. A trial comparing amiodarone, sotalol and placebo to maintain sinus rhythm in patients in NYHA Class I or II.
The ASCOT trial was stopped early because of
lower mortality in hypertensives treated with amlodipine/peridopril than with atenolol/thiazide diuretic. What are the implications
for beta-blocker therapy in hypertension?
The TNT and PROVE-IT trials support even lower LDL cholesterol targets for secondary prevention
PROVE IT and CRP levels- CRP levels were lower in those treated with very high dose atorvastatin, further analysis suggests that lowering CRP levels provides additional benefit to lowering of LDL cholesterol levels.
The DEFINITE trial reveals lower than expected mortality in those with severe cardiomyopathy and this presumably reflects the benefits of use of beta-blockers and ace-inhibitors. The study also found a benefit from implantable defibrillators
Angiotensin blockers instead of or in addition to ace-inhibitor therapy for those with heart failure, particularly those with systolic dysfunction.
UPDATE. PEACE trial: this study suggests that, unlike the EUROPA and HOPE trials, ACE-inhibitors need not be prescribed to all patients with coronary artery disease.
UPDATE. NZ Guidelines- adjusting calculated risk. The NZ Guidelines seem to be relatively conservative.
Until the threshold for pharmacological therapy is reduced, we should try to identify those
at higher risk by measurement of emerging risk factors.