9 research outputs found
Rivaroxaban with or without Aspirin in Stable Cardiovascular Disease
BACKGROUND
We evaluated whether rivaroxaban alone or in combination with aspirin would be more
effective than aspirin alone for secondary cardiovascular prevention.
METHODS
In this double-blind trial, we randomly assigned 27,395 participants with stable atherosclerotic vascular disease to receive rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg
once daily), rivaroxaban (5 mg twice daily), or aspirin (100 mg once daily). The primary outcome was a composite of cardiovascular death, stroke, or myocardial infarction. The study was stopped for superiority of the rivaroxaban-plus-aspirin group after
a mean follow-up of 23 months.
RESULTS
The primary outcome occurred in fewer patients in the rivaroxaban-plus-aspirin group
than in the aspirin-alone group (379 patients [4.1%] vs. 496 patients [5.4%]; hazard
ratio, 0.76; 95% confidence interval [CI], 0.66 to 0.86; P<0.001; z=−4.126), but major
bleeding events occurred in more patients in the rivaroxaban-plus-aspirin group (288
patients [3.1%] vs. 170 patients [1.9%]; hazard ratio, 1.70; 95% CI, 1.40 to 2.05;
P<0.001). There was no significant difference in intracranial or fatal bleeding between
these two groups. There were 313 deaths (3.4%) in the rivaroxaban-plus-aspirin group
as compared with 378 (4.1%) in the aspirin-alone group (hazard ratio, 0.82; 95% CI,
0.71 to 0.96; P=0.01; threshold P value for significance, 0.0025). The primary outcome
did not occur in significantly fewer patients in the rivaroxaban-alone group than in the
aspirin-alone group, but major bleeding events occurred in more patients in the rivaroxaban-alone group.
CONCLUSIONS
Among patients with stable atherosclerotic vascular disease, those assigned to rivaroxaban (2.5 mg twice daily) plus aspirin had better cardiovascular outcomes and more
major bleeding events than those assigned to aspirin alone. Rivaroxaban (5 mg twice
daily) alone did not result in better cardiovascular outcomes than aspirin alone and
resulted in more major bleeding events. (Funded by Bayer; COMPASS ClinicalTrials.gov
number, NCT01776424.
Are ACE inhibitors cardioprotective? ACE inhibitors prevent post-infarction arrhythmias and reinfarction.
ArticleThe original publication is available at http://www.samj.org.za[No abstract available]Publisher’s versio
Blood pressure variability and structural brain changes: a systematic review
Background: Blood pressure variability (BPV) has been linked with cognitive impairment and dementia. However, the pathophysiological mechanisms by which BPV affects cognition are unclear. This systematic review aims to assess the links between different BPV measures and white and grey matter structures. Methods and results: The following databases were searched from inception through to January 2021; EMBASE, MEDLINE, EMCARE and SCOPUS. Studies that reported on the relationship between within-individual BPV (short, medium or long-term variability) or a circadian blood pressure (BP) measurement and MRI assessed brain structures were included. Overall, 20 studies met the criteria and were included, of which 11 studies looked at short-term BPV, eight articles investigated visit-to-visit BPV and one study looked at a compositional BPV measurement. Due to heterogeneity in study samples, meta-analysis was not possible. Across the included studies, associations between MRI indices and BP dipping patterns were mixed; higher long-term BPV and higher sleep systolic BPV was found to be associated with lower whole brain volume and hippocampal volume. Conclusion: Increased BPV, in particular systolic long-term and systolic night-time BPV, appears to be associated with lower brain volume and hippocampal volume. This highlights the adverse effect that increased BPV has upon the brain, potentially contributing to cognitive decline, including dementia, in late-life.Gutteridge, Daria S., Tully, Phillip J., Ghezzi, Erica S., Jamadar, Sharna, Smith, Ashleigh E., Commerford, Toby, Keage, Hannah A.D