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

Circumscribing campo rupestre &#8211; megadiverse Brazilian rocky montane savanas

Currently campo rupestre (CR) is a name accepted and used internationally by botanists, zoologists, and other naturalists, usually applied to a very specific ecosystem, despite the lack of a consensual published circumscription. We present a tentative geographic circumscription of the term, combining data on climate, geology, geomorphology, soil, flora, fauna and vegetation. The circumscription of campo rupestre proposed herein is based on the following premises: (1) the classification of vegetation is not an exact science, and it is difficult to attain a high degree of consensus to the circumscription of vegetation names; (2) despite this, vegetation classification is useful for conservation and management. It is thus desirable to circumscribe vegetation types with the greatest attainable precision; (3) there is a need to preserve all montane and rocky vegetation types, regardless of classification, biome, etc; (4) the CRs are formed by a complex mosaic of vegetation types including rock-dwelling, psammophilous, aquatic, epiphytic, and penumbral plant communities. Campos rupestres stricto sensu are a Neotropical, azonal vegetation complex endemic to Brazil, forming a mosaic of rocky mountaintop &#8220;archipelagos&#8221; inserted within a matrix of zonal vegetation, mainly in the Cerrado and Caatinga provinces of the Brazilian Shield (southeastern, northeastern and central-western regions), occurring mainly above 900 m asl. up to altitudes exceeding 2000 m, having measured annual precipitation between 800 and 1500 mm, and an arid season of two to five months

Circumscribing campo rupestre – megadiverse Brazilian rocky montane savanas

Currently campo rupestre (CR) is a name accepted and used internationally by botanists, zoologists, and other naturalists, usually applied to a very specific ecosystem, despite the lack of a consensual published circumscription. We present a tentative geographic circumscription of the term, combining data on climate, geology, geomorphology, soil, flora, fauna and vegetation. The circumscription of campo rupestre proposed herein is based on the following premises: (1) the classification of vegetation is not an exact science, and it is difficult to attain a high degree of consensus to the circumscription of vegetation names; (2) despite this, vegetation classification is useful for conservation and management. It is thus desirable to circumscribe vegetation types with the greatest attainable precision; (3) there is a need to preserve all montane and rocky vegetation types, regardless of classification, biome, etc; (4) the CRs are formed by a complex mosaic of vegetation types including rock-dwelling, psammophilous, aquatic, epiphytic, and penumbral plant communities. Campos rupestres stricto sensu are a Neotropical, azonal vegetation complex endemic to Brazil, forming a mosaic of rocky mountaintop “archipelagos” inserted within a matrix of zonal vegetation, mainly in the Cerrado and Caatinga provinces of the Brazilian Shield (southeastern, northeastern and central-western regions), occurring mainly above 900 m asl. up to altitudes exceeding 2000 m, having measured annual precipitation between 800 and 1500 mm, and an arid season of two to five months