8 research outputs found
Effect of the Implantable Atrial Defibrillator on the Natural History of Atrial Fibrillation
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75480/1/j.1540-8167.1999.tb00296.x.pd
Miocardiopatía puerperal: causa de insuficiencia cardíaca en mujeres jóvenes. A propósito de un caso
Guía Europea de Prevención Cardiovascular en la Práctica Clínica: adaptación Española del CEIPC 2008
Presentamos la adaptación española realizada por el
CEIPC de la Guía Europea de Prevención de las Enfermedades
Cardiovasculares (ECV) 2008. Esta guía recomienda el
modelo SCORE de bajo riesgo para la valoración del riesgo
cardiovascular. El objetivo es prevenir la mortalidad y morbilidad
debidas a las ECV mediante el manejo de sus factores
de riesgo en la práctica clínica. La guía hace énfasis en
la prevención primaria y en el papel del médico y la enfermería
de atención primaria en la promoción de un estilo de
vida cardiosaludable, basado el incremento de los niveles de
actividad física, la adopción de una alimentación saludable
y, en los fumadores, el abandono del tabaco. La meta terapéutica
para la presión arterial es en general <140/90
mmHg; pero en pacientes con diabetes, enfermedad renal
crónica o ECV el objetivo es 130/80 mmHg. El colesterol
debe mantenerse por debajo de 200 mg/dl (cLDL < 130
mg/dl); en los pacientes con ECV o diabetes el objetivo es
cLDL < 100 mg/dl (80 mg/dl si factible en sujetos de muy
alto riesgo). En diabetes tipo 2 y en pacientes con síndrome
metabólico se debe reducir el peso y aumentar la actividad
física y en su caso utilizar los fármacos indicados, para
alcanzar los objetivos de IMC y de perímetro de cintura. El
objetivo en diabéticos tipo 2 debe ser alcanzar una HbA1C
< 7%. La amplia difusión de las guías y el desarrollo de los
programas destinados a favorecer su implantación, identificando
barreras y buscando soluciones, son objetivos prioritarios
del CEIPC, como uno de los medios fundamentales
para trasladar las recomendaciones establecidas a la práctica
clínica diaria
PERTINENT - PERindopril-Thrombosis, InflammatioN, endothelial dysfunction and neurohormonal activation trial: A sub-study of the EUROPA study
BACKGROUND: Markers of thrombosis, inflammation, endothelial dysfunction and neurohumoral activation such as fibrinogen, D-dimer, C-reactive protein, von Willebrand factor, tumour necrosis factor-alpha and chromogranin-A are reported to be linked to the increase of cardiovascular risk for atherosclerosis progression and events in patients with cardiovascular diseases. METHODS: EUROPA is a double blind, placebo-controlled trial on 12,231 patients that evaluates the effect of an angiotensin converting enzyme inhibitor--perindopril--on prevention of cardiovascular events in patients with coronary artery disease. PERTINENT is a sub-study of EUROPA that evaluates (a) in Part A (300 patients): the influence of perindopril vs. placebo on fibrinogen, D-dimer, C-reactive protein, von Willebrand factor, tumour necrosis factor-alpha and chromogranin-A. In addition, NOS expression and induction of apoptosis on human umbilical vein endothelial cells and angiotensin converting enzyme levels are also studied; (b) in Part B (about 1200 patients): the predictive role of plasma levels of C-reactive protein and von Willebrand factor on the occurrence of cardiovascular events. To this end, matched case-control analyses are planned (patients with vs. patients without events). STATUS OF PERTINENT: Blood analyses are in progress in four specialised laboratories: (a) Gaubius Laboratory, Leiden, TNO-PG, The Netherlands; (b) University Department of Medicine, Birmingham, UK; (c) University of Pavia, Italy; (d) Fondazione Salvatore Maugeri, Cardiovascular Research Centre, Gussago, Italy. CONCLUSIONS: The PERTINENT sub-study might help elucidating the phenomena contributing to the pathophysiology of cardiovascular events in patients with coronary artery disease and the role of perindopril in such context
the European trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease Investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA trial).
Background Treatment with angiotensin-converting-enzyme
(ACE) inhibitors reduces the rate of cardiovascular events
among patients with left-ventricular dysfunction and those at
high risk of such events. We assessed whether the ACE
inhibitor perindopril reduced cardiovascular risk in a low-risk
population with stable coronary heart disease and no apparent
heart failure.
Methods We recruited patients from October, 1997, to June,
2000. 13 655 patients were registered with previous
myocardial infarction (64%), angiographic evidence of coronary
artery disease (61%), coronary revascularisation (55%), or a
positive stress test only (5%). After a run-in period of 4 weeks,
in which all patients received perindopril, 12 218 patients
were randomly assigned perindopril 8 mg once daily (n=6110),
or matching placebo (n=6108). The mean follow-up was
4·2 years, and the primary endpoint was cardiovascular death,
myocardial infarction, or cardiac arrest. Analysis was by
intention to treat.
Findings Mean age of patients was 60 years (SD 9), 85% were
male, 92% were taking platelet inhibitors, 62% blockers, and
58% lipid-lowering therapy. 603 (10%) placebo and 488 (8%)
perindopril patients experienced the primary endpoint, which
yields a 20% relative risk reduction (95% CI 9–29, p=0·0003)
with perindopril. These benefits were consistent in all
predefined subgroups and secondary endpoints. Perindopril
was well tolerated.
Interpretation Among patients with stable coronary heart
disease without apparent heart failure, perindopril can
significantly improve outcome. About 50 patients need to be
treated for a period of 4 years to prevent one major
cardiovascular event. Treatment with perindopril, on top of
other preventive medications, should be considered in all
patients with coronary heart disease
Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study)
BACKGROUND: Treatment with angiotensin-converting-enzyme (ACE) inhibitors reduces the rate of cardiovascular events among patients with left-ventricular dysfunction and those at high risk of such events. We assessed whether the ACE inhibitor perindopril reduced cardiovascular risk in a low-risk population with stable coronary heart disease and no apparent heart failure. METHODS: We recruited patients from October, 1997, to June, 2000. 13655 patients were registered with previous myocardial infarction (64%), angiographic evidence of coronary artery disease (61%), coronary revascularisation (55%), or a positive stress test only (5%). After a run-in period of 4 weeks, in which all patients received perindopril, 12218 patients were randomly assigned perindopril 8 mg once daily (n=6110), or matching placebo (n=6108). The mean follow-up was 4.2 years, and the primary endpoint was cardiovascular death, myocardial infarction, or cardiac arrest. Analysis was by intention to treat. FINDINGS: Mean age of patients was 60 years (SD 9), 85% were male, 92% were taking platelet inhibitors, 62% beta blockers, and 58% lipid-lowering therapy. 603 (10%) placebo and 488 (8%) perindopril patients experienced the primary endpoint, which yields a 20% relative risk reduction (95% CI 9-29, p=0.0003) with perindopril. These benefits were consistent in all predefined subgroups and secondary endpoints. Perindopril was well tolerated. INTERPRETATION: Among patients with stable coronary heart disease without apparent heart failure, perindopril can significantly improve outcome. About 50 patients need to be treated for a period of 4 years to prevent one major cardiovascular event. Treatment with perindopril, on top of other preventive medications, should be considered in all patients with coronary heart disease
Vorapaxar in the secondary prevention of atherothrombotic events
Item does not contain fulltextBACKGROUND: Thrombin potently activates platelets through the protease-activated receptor PAR-1. Vorapaxar is a novel antiplatelet agent that selectively inhibits the cellular actions of thrombin through antagonism of PAR-1. METHODS: We randomly assigned 26,449 patients who had a history of myocardial infarction, ischemic stroke, or peripheral arterial disease to receive vorapaxar (2.5 mg daily) or matching placebo and followed them for a median of 30 months. The primary efficacy end point was the composite of death from cardiovascular causes, myocardial infarction, or stroke. After 2 years, the data and safety monitoring board recommended discontinuation of the study treatment in patients with a history of stroke owing to the risk of intracranial hemorrhage. RESULTS: At 3 years, the primary end point had occurred in 1028 patients (9.3%) in the vorapaxar group and in 1176 patients (10.5%) in the placebo group (hazard ratio for the vorapaxar group, 0.87; 95% confidence interval [CI], 0.80 to 0.94; P<0.001). Cardiovascular death, myocardial infarction, stroke, or recurrent ischemia leading to revascularization occurred in 1259 patients (11.2%) in the vorapaxar group and 1417 patients (12.4%) in the placebo group (hazard ratio, 0.88; 95% CI, 0.82 to 0.95; P=0.001). Moderate or severe bleeding occurred in 4.2% of patients who received vorapaxar and 2.5% of those who received placebo (hazard ratio, 1.66; 95% CI, 1.43 to 1.93; P<0.001). There was an increase in the rate of intracranial hemorrhage in the vorapaxar group (1.0%, vs. 0.5% in the placebo group; P<0.001). CONCLUSIONS: Inhibition of PAR-1 with vorapaxar reduced the risk of cardiovascular death or ischemic events in patients with stable atherosclerosis who were receiving standard therapy. However, it increased the risk of moderate or severe bleeding, including intracranial hemorrhage. (Funded by Merck; TRA 2P-TIMI 50 ClinicalTrials.gov number, NCT00526474.)
The European Trial On Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease
Background
Treatment with angiotensin-converting-enzyme (ACE) inhibitors reduces the rate of cardiovascular events among patients with left-ventricular dysfunction and those at high risk of such events. We assessed whether the ACE inhibitor perindopril reduced cardiovascular risk in a low-risk population with stable coronary heart disease and no apparent heart failure.
Methods
We recruited patients from October, 1997, to June, 2000. 13 655 patients were registered with previous myocardial infarction (64%), angiographic evidence of coronary artery disease (61%), coronary revascularisation (55%), or a positive stress test only (5%). After a run-in period of 4 weeks, in which all patients received perindopril, 12 218 patients were randomly assigned perindopril 8 mg once daily (n=6110), or matching placebo (n=6108). The mean follow-up was 4·2 years, and the primary endpoint was cardiovascular death, myocardial infarction, or cardiac arrest. Analysis was by intention to treat.
Findings
Mean age of patients was 60 years (SD 9), 85% were male, 92% were taking platelet inhibitors, 62% β blockers, and 58% lipid-lowering therapy. 603 (10%) placebo and 488 (8%) perindopril patients experienced the primary endpoint, which yields a 20% relative risk reduction (95% Cl 9–29, p=0·0003) with perindopril. These benefits were consistent in all predefined subgroups and secondary endpoints. Perindopril was well tolerated.
Interpretation
Among patients with stable coronary heart disease without apparent heart failure, perindopril can significantly improve outcome. About 50 patients need to be treated for a period of 4 years to prevent one major cardiovascular event. Treatment with perindopril, on top of other preventive medications, should be considered in all patients with coronary heart disease