248 research outputs found

    Beneficial effects of simvastatin and pravastatin on cardiac allograft rejection and survival: Reply

    Get PDF

    Global consumption patterns of combination hypertension medication: an analysis of pharmaceutical sales data from 2010–2021

    Get PDF
    Hypertension is the most significant risk factor for cardiovascular disease and mortality worldwide, affecting 1.3 billion adults. Global disparities in hypertension control are widening with low- and middle-income countries (LMIC) having the fastest growing rates of hypertension and low rates of control. Treatment for hypertension can be challenging, with multiple drug classes and dosing schedules. Combination antihypertensives have been suggested as a solution for their efficacy and potential to improve adherence. Global consumption of combination and non-combination antihypertensives across 75 countries and 2 regions from 2010 to 2021 was estimated using the IQVIA MIDAS database on pharmaceutical sales. Consumption rates were standardized using Standard Units (SUs) and analysed by high-income (HIC), upper-middle income (UMIC), and LMIC income classification. Global median consumption rate of all antihypertensives per 1000 inhabitants per day increased from 184.78 SUs in 2010 to 325.6 SUs in 2021, with HICs consistently having the highest rates. Median consumption rates of combination and non-combination antihypertensives increased across all country income groups but combination drugs were consumed at a lower rate and proportion. LMICs consumed a higher percentage of combination antihypertensives relative to non-combination (45.5%) than UMICs (24.3%) and HICs (24.4%) in 2021. While combination antihypertensives may be preferred for their potential for increased adherence and effectiveness, their global uptake is inconsistent. HICs consume less combination medication relative to non-combination, despite higher overall consumption rates of antihypertensives. LMICs show increasing use of combination medications, indicating a shift towards their use

    A clinical and cost-effectiveness analysis of the HeartMate 3 left ventricular assist device for transplant-ineligible patients: a United Kingdom perspective

    Get PDF
    Background: The clinical and cost-effectiveness of left ventricular assist device (LVAD) therapy for patients with advanced heart failure (HF) who are ineligible for heart transplantation is debated in the UK. This study develops an indirect comparison between the fully magnetically levitated HeartMate 3 (HM 3) LVAD and medical therapy (MT) to evaluate expected clinical and cost-effectiveness in the UK National Health Service (NHS) context. Methods: We performed an economic analysis comparing the HM3 pump against the HeartMate II LVAD (MOMENTUM 3), and then another analysis comparing MT with the first- and second-generation HeartMate XVE pump LVAD and HeartMate II LVAD for the same patient population (REMATCH and ROADMAP, respectively). By bridging those 2 analyses, an indirect comparison between HM3 and MT in the form of a network meta-analysis was developed. A literature search was performed to select the most appropriate pair of studies for this purpose. Outcomes were adjusted to produce Kaplan-Meier curves for the cost-effectiveness evaluation by using a decision-analytic model. Data were extrapolated linearly over a 5-year time horizon. Uncertainty and additional scenarios were addressed by one-way and probabilistic sensitivity analysis. Local costs and health utility were used from England, thereby representing the UK context. Results: The incremental cost-effectiveness ratio (ICER) for LVAD vs MT in transplant ineligible patients with advanced HF was estimated to be £47,361 per quality-adjusted life year gained, with a 97.1% probability of being cost-effective at £50,000. In a subgroup of patients who are inotropic therapy dependent (INTERMACS 1-3 severity profile), the ICER was £45,616, while for a population with less-ill ambulatory HF (INTERMACS profile 4-7) the ICER changed to £64,051. Conclusions: This study provides evidence that HM3 LVAD therapy in advanced HF patients ineligible for heart transplantation may be cost-effective compared to MT in the NHS UK-England context. The ICER is lowest for patients dependent on inotropic support, but exceeds the willingness to pay threshold of £50,000 in ambulatory noninotropic therapy dependent advanced HF patients

    Advanced cancer is also a heart failure syndrome: a hypothesis

    Get PDF
    We present the hypothesis that advanced stage cancer is also a heart failure syndrome. It can develop independently of or in addition to cardiotoxic effects of anti-cancer therapies. This includes an increased risk of ventricular arrhythmias. We suggest the pathophysiologic link for these developments includes generalized muscle wasting (i.e. sarcopenia) due to tissue homeostasis changes leading to cardiac wasting associated cardiomyopathy. Cardiac wasting with thinning of the ventricular wall increases ventricular wall stress, even in the absence of ventricular dilatation. In addition, arrhythmias may be facilitated by cellular wasting processes affecting structure and function of electrical cells and conduction pathways. We submit that in some patients with advanced cancer (but not terminal cancer), heart failure therapy or defibrillators may be relevant treatment options. The key points in selecting patients for such therapies may be the predicted life expectancy, quality of life at intervention time, symptomatic burden, and consequences for further anti-cancer therapies. The cause of death in advanced cancer is difficult to ascertain and consensus on event definitions in cancer is not established yet. Clinical investigations on this are called for. Broader ethical considerations must be taken into account when aiming to target cardiovascular problems in cancer patients. We suggest that focused attention to evaluating cardiac wasting and arrhythmias in cancer will herald a further evolution in the rapidly expanding field of cardio-oncology

    901-25 The Paradox of Donor Stimulation of Endothelial-induced Smooth Muscle Growth

    Get PDF
    Cardiac allograft vasculopathy (CAV) is the major cause of long-term morbidity and mortality in cardiac transplant recipients. It appears to be related to immune damage to the coronary endothelial cells, resulting in intimal proliferation. In order to delineate the mechanisms by which CAY can occur, a co-culture model of human endothelial cells (EC) and smooth muscle cells (SMC) obtained from the donor at the time of organ procurement was utilized. These cells were separated by collagenase digestion, and cultured for four passages. EC and SMC were then grown to confluence in the separate chambers of a co-culture plate separated by a 0.45 micron Millipore filter. Preserved lymphocytes (LYMPH) obtained from the donor and pooled blood lymphocytes from the recipient 3-4 weeks following transplant were added to the EC well so as to cause an immunologic stimulation of the EC. None of the recipients were exposed to monoclonal or polyclonal antibodies to lymphocytes. All cultures and assays were done in triplicate. Results are as follows:Patient#% Increase in donor lymph H3thymidinep ValueDonor 1+510.04Donor 2+450.05Donor 3+1040.05Donor 4+250.01Donor 5-19NSThe donor EC/donor LYMPH co-culture stimulated SMC growth measured by H3thymidine incorporation in 4 of 5 patients. The donor EC/recipient LYMPH co-culture did not result in significant SMC H3thymidine incorporation.ConclusionThese paradoxical findings of a lack in significant SMC proliferation in the recipient stimulated donor cells continue to raise questions in relation to the effects of circulating lymphocytes on the development of cardiac allograft vasculopathy
    • …
    corecore