Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Data of 'In vitro effect of occlusal loading on cervical wall lesion development in a Class II composite restoration'

This dataset contains all data collected for the paper by Hollanders et al (Caries Res. 2022 doi: 10.1159/000522589). The paper describes an in vitro study investigating the effect of occlusal loading on secondary caries lesion development. 64 human molars received standardized (4.0x4.2x3.0 mm) box preparations. Composite restorations were made using two different restorative materials (Clearfil AP-X and Clearfil Majesty E-S flow) with different elastic moduli. A cervical gap (100 µm) was present in all samples. Samples were exposed to simulated caries lesion development in a lactic acid solution (pH 4.8) for 8 weeks. 4 samples were sliced and measured after 5 weeks to check lesion development. Half of the samples were subjected to 90N cyclic loading. Lesion depth was measured using microradiography. A full description of the study protocol can be found in the Methodology file. The Codebook describes the variables used in the analysis. The full dataset used for analysis is available in the file “2021_Hollanders_edited_complete dataset.csv”. The raw measured data which were used to compose the edited dataset can be found in three different files: “2021_Hollanders_raw_enamel thickness.csv” contains the values in µm measured in Adobe photoshop for each of the samples. “2021_Hollanders_raw_gap width.csv” contains the values in µm measured in Adobe Photoshop. There are three values for each sample. The average of these was used in the edited dataset. “2021_Hollanders_raw_lesion depth mineral loss.csv” contains the raw mesurements from the WIM program for measuring lesion depth and mineral loss. These measurements were arranged per sample to create the edited dataset. The syntax file (“2021_Hollanders_syntax.R”) can be run from top to bottom and will produce first descriptive data output and, subsequently, write the results of the regression analyses to different files. Data analysis was carried out in the R environment for statistical computing (R Core Team, 2013. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna, Austria. http://www.R-project.org/.) with the aid of packages “tidyverse”, “readxl”, “dplyr”, and “psych”

Recommandations pratiques pour le traitement d'arythmies aiguës: Rapport du Groupe Interdisciplinaire Belge de Cardiologie Aiguë

Les arythmies aiguës comprennent une variété large de troubles du rythme. Les auteurs proposent des recommandations pratiques pour l’approche et le traitement du patient souffrant d’une arythmie aiguë. Ainsi sont discutées les brady-cardies et les tachycardies. Les tachycardies sont divisées en tachycardies à complexes QRS fins et celles à complexes larges. Par ailleurs, une importante distinction concernant la stabilité hémodynamique du patient est faite ; celle-ci va entraîner des conséquences thérapeutiques immédiates. Des arbres décisionnels clairs avec schémas diagnostiques et thérapeutiques des différentes arythmies sont proposés, de même que les considérations pratiques concernant la cardioversion électrique

Data of 'In vitro effect of occlusal loading on cervical wall lesion development in a Class II composite restoration'

This dataset contains all data collected for the paper by Hollanders et al (Caries Res. 2022 doi: 10.1159/000522589). The paper describes an in vitro study investigating the effect of occlusal loading on secondary caries lesion development. 64 human molars received standardized (4.0x4.2x3.0 mm) box preparations. Composite restorations were made using two different restorative materials (Clearfil AP-X and Clearfil Majesty E-S flow) with different elastic moduli. A cervical gap (100 µm) was present in all samples. Samples were exposed to simulated caries lesion development in a lactic acid solution (pH 4.8) for 8 weeks. 4 samples were sliced and measured after 5 weeks to check lesion development. Half of the samples were subjected to 90N cyclic loading. Lesion depth was measured using microradiography. A full description of the study protocol can be found in the Methodology file. The Codebook describes the variables used in the analysis. The full dataset used for analysis is available in the file “2021_Hollanders_edited_complete dataset.csv”. The raw measured data which were used to compose the edited dataset can be found in three different files: “2021_Hollanders_raw_enamel thickness.csv” contains the values in µm measured in Adobe photoshop for each of the samples. “2021_Hollanders_raw_gap width.csv” contains the values in µm measured in Adobe Photoshop. There are three values for each sample. The average of these was used in the edited dataset. “2021_Hollanders_raw_lesion depth mineral loss.csv” contains the raw mesurements from the WIM program for measuring lesion depth and mineral loss. These measurements were arranged per sample to create the edited dataset. The syntax file (“2021_Hollanders_syntax.R”) can be run from top to bottom and will produce first descriptive data output and, subsequently, write the results of the regression analyses to different files. Data analysis was carried out in the R environment for statistical computing (R Core Team, 2013. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna, Austria. http://www.R-project.org/.) with the aid of packages “tidyverse”, “readxl”, “dplyr”, and “psych”

A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee

Many clinical trials have evaluated the benefit of long-term use of antiplatelet drugs in reducing the risk of clinical thrombotic events. Aspirin and ticlopidine have been shown to be effective, but both have potentially serious adverse effects. Clopidogrel, a new thienopyridine derivative similar to ticlopidine, is an inhibitor of platelet aggregation induced by adenosine diphosphate. METHODS: CAPRIE was a randomised, blinded, international trial designed to assess the relative efficacy of clopidogrel (75 mg once daily) and aspirin (325 mg once daily) in reducing the risk of a composite outcome cluster of ischaemic stroke, myocardial infarction, or vascular death; their relative safety was also assessed. The population studied comprised subgroups of patients with atherosclerotic vascular disease manifested as either recent ischaemic stroke, recent myocardial infarction, or symptomatic peripheral arterial disease. Patients were followed for 1 to 3 years. FINDINGS: 19,185 patients, with more than 6300 in each of the clinical subgroups, were recruited over 3 years, with a mean follow-up of 1.91 years. There were 1960 first events included in the outcome cluster on which an intention-to-treat analysis showed that patients treated with clopidogrel had an annual 5.32% risk of ischaemic stroke, myocardial infarction, or vascular death compared with 5.83% with aspirin. These rates reflect a statistically significant (p = 0.043) relative-risk reduction of 8.7% in favour of clopidogrel (95% Cl 0.3-16.5). Corresponding on-treatment analysis yielded a relative-risk reduction of 9.4%. There were no major differences in terms of safety. Reported adverse experiences in the clopidogrel and aspirin groups judged to be severe included rash (0.26% vs 0.10%), diarrhoea (0.23% vs 0.11%), upper gastrointestinal discomfort (0.97% vs 1.22%), intracranial haemorrhage (0.33% vs 0.47%), and gastrointestinal haemorrhage (0.52% vs 0.72%), respectively. There were ten (0.10%) patients in the clopidogrel group with significant reductions in neutrophils (< 1.2 x 10(9)/L) and 16 (0.17%) in the aspirin group. INTERPRETATION: Long-term administration of clopidogrel to patients with atherosclerotic vascular disease is more effective than aspirin in reducing the combined risk of ischaemic stroke, myocardial infarction, or vascular death. The overall safety profile of clopidogrel is at least as good as that of medium-dose aspirin

Antiinflammatory therapy with canakinumab for atherosclerotic disease

BACKGROUND: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. METHODS: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P=0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P=0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P=0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P=0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P=0.31). CONCLUSIONS: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. Copyright © 2017 Massachusetts Medical Society