Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial

Aims  The third Universal Definition of Myocardial Infarction (MI) Task Force classified MIs into five types: Type 1, spontaneous; Type 2, related to oxygen supply/demand imbalance; Type 3, fatal without ascertainment of cardiac biomarkers; Type 4, related to percutaneous coronary intervention; and Type 5, related to coronary artery bypass surgery. Low-density lipoprotein cholesterol (LDL-C) reduction with statins and proprotein convertase subtilisin–kexin Type 9 (PCSK9) inhibitors reduces risk of MI, but less is known about effects on types of MI. ODYSSEY OUTCOMES compared the PCSK9 inhibitor alirocumab with placebo in 18 924 patients with recent acute coronary syndrome (ACS) and elevated LDL-C (≥1.8 mmol/L) despite intensive statin therapy. In a pre-specified analysis, we assessed the effects of alirocumab on types of MI. Methods and results  Median follow-up was 2.8 years. Myocardial infarction types were prospectively adjudicated and classified. Of 1860 total MIs, 1223 (65.8%) were adjudicated as Type 1, 386 (20.8%) as Type 2, and 244 (13.1%) as Type 4. Few events were Type 3 (n = 2) or Type 5 (n = 5). Alirocumab reduced first MIs [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.77–0.95; P = 0.003], with reductions in both Type 1 (HR 0.87, 95% CI 0.77–0.99; P = 0.032) and Type 2 (0.77, 0.61–0.97; P = 0.025), but not Type 4 MI. Conclusion  After ACS, alirocumab added to intensive statin therapy favourably impacted on Type 1 and 2 MIs. The data indicate for the first time that a lipid-lowering therapy can attenuate the risk of Type 2 MI. Low-density lipoprotein cholesterol reduction below levels achievable with statins is an effective preventive strategy for both MI types.For complete list of authors see http://dx.doi.org/10.1093/eurheartj/ehz299</p

Avaliação da eficiência da mistura pronta de glyphosate + 2,4-D no controle da Commelina virginica L. em citros Efficacy evaluation of ready mixture of glyphosate + 2,4-D in Commelina virginica L. control in citrus

Um dos herbicidas mais utilizados para o controle de plantas daninhas em pós-emergência nos pomares cítricos paulistas é o glyphosate. No entanto, este herbicida aplicado isoladamente e nas doses recomendadas, tem proporcionado seleção da planta daninha trapoeraba (Commelina virginica L.), devido à grande tolerância da mesma, somada à eficiente eliminação das demais espécies da comunidade infestante. Em vista disso, e pela falta de opções , faz-se necessária a pesquisa de outros herbicidas ou misturas de herbicidas que sejam eficientes no controle da trapoeraba, de baixa toxicidade para os aplicadores, sistêmicos, e que sejam seletivos às plantas cítricas. O presente trabalho foi desenvolvido com o objetivo de estudar a eficiência da mistura pronta dos herbicidas glyphosate + 2,4-D amina no controle da trapoeraba em citros [Citrus sinensis (L.) Osbeck], em comparação com estes mesmos herbicidas aplicados isoladamente, bem como os possíveis efeitos fitotóxicos da mesma à cultura. O experimento foi instalado na região de Catanduva-SP, em um pomar de laranja Pera clone Rio, enxertada sobre limão Cravo, com dez anos de idade, plantado em um espaçamento de 8,0 x 6,5 m. A aplicação dos herbicidas foi realizada em 20 de fevereiro de 1991, de forma dirigida, em pós-emergência tardia da trapoeraba, quando a mesma já florescia e tinha altura variável entre 15 e 60 cm. A análise e interpretação dos resultados obtidos mostraram que a mistura pronta de glyphosate + 2,4-D apresenta um controle superior da trapoeraba em relação aos produtos aplicados isoladamente, não havendo diferenças significativas no controle para doses superiores a 0,60 + 0,80 kg i.a./ha. Os dados obtidos reforçam a teoria de sinergismo entre os dois produtos. Em nenhum dos tratamentos foi verificado sintomas visuais de intoxicação nas laranjeiras.<br>In citrus orchard of São Paulo state, Brazil, one of the most employed post-emergency herbicide for weed control is glyphosate. However, when this herbicide is applied alone and at the recommended rates, it has been observed a selection of the weed Commelina virginica L. due to its great tolerance and the elimination of other weeds. Because of that, other chemicals must be studied to solve the problem. In this particular case, the herbicide should be sistemic and have a low toxicity to the operator and to the citrus trees. This work was conducted to study the efficacy of a ready mixture of glyphosate + 2,4-D compared to the products sprayed alone in orange orchards [Citrus sinensis (L.) Osbeck]. The phytotoxicity effects were studied too. The experiment was carried out in Catanduva, São Paulo, Brazil, in a ten years old orange orchard, with 8,0 x 6,0m spacing. On february, 20 th, 1991, the herbicides were sprayed directly on 15-60cm height Commelina during its flowering. The results showed that the ready mixture was better in Commelina control than other treatments. No significant differences were observed for the rates greater than 0,60 + 0,80 kg a.i./ha. The results reinforced the sinergism theory within both products. None of the treatments caused visual phytotoxicity to orange trees