Legumain in acute coronary syndromes: A substudy of the PLATO (Platelet Inhibition and Patient Outcomes) trial

Background The cysteine protease legumain is increased in patients with atherosclerosis, but its causal role in atherogenesis and cardiovascular disease is still unclear. The aim of the study was to investigate the association of legumain with clinical outcome in a large cohort of patients with acute coronary syndrome. Methods and Results Serum levels of legumain were analyzed in 4883 patients with acute coronary syndrome from a substudy of the PLATO (Platelet Inhibition and Patient Outcomes) trial. Levels were analyzed at admission and after 1 month follow‐up. Associations between legumain and a composite of cardiovascular death, spontaneous myocardial infarction or stroke, and its individual components were assessed by multivariable Cox regression analyses. At baseline, a 50% increase in legumain level was associated with a hazard ratio (HR) of 1.13 (95% CI, 1.04–1.21), P=0.0018, for the primary composite end point, adjusted for randomized treatment. The association remained significant after adjustment for important clinical and demographic variables (HR, 1.10; 95% CI, 1.02–1.19; P=0.013) but not in the fully adjusted model. Legumain levels at 1 month were not associated with the composite end point but were negatively associated with stroke (HR, 0.62; 95% CI, 0.44–0.88; P=0.0069), including in the fully adjusted model (HR, 0.57; 95% CI, 0.37–0.88; P=0.0114). Conclusions Baseline legumain was associated with the primary outcome in patients with acute coronary syndrome, but not in the fully adjusted model. The association between high levels of legumain at 1 month and decreased occurrence of stroke could be of interest from a mechanistic point of view, illustrating the potential dual role of legumain during atherogenesis and acute coronary syndrome. Registration URL: https://www.clini​caltr​ials.gov; Unique identifier: NCT00391872

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

Large-scale monitoring of waders on their boreal and arctic breeding grounds in northern Europe

Large-scale and population-wide monitoring of waders on their boreal and arctic breeding grounds has hitherto been lacking, mainly because logistics are truly challenging in regions with few ornithologists, vast areas and few roads. In Norway, Sweden and Finland (here 'Fennoscandia') there are now national monitoring schemes in place, aimed at tracking all bird species, which allows trends to be estimated for northern wader populations. We present joint Fennoscandian population trends for 24 wader species, covering the period 2002-2013 (in some cases somewhat shorter time periods). The data stem from 1263 routes in Norway, Finland, and the northern two thirds of Sweden, all situated north of 58 degrees N. This area of one million km(2) largely coincides with the boreal and arctic parts of Fennoscandia. The trends found are rather evenly distributed between strong increases and strong declines. Trends do not differ between short-and long-distance migrants, nor do they vary in relation to breeding latitude. Ringed Plover Charadrius hiaticula, Wood Sandpiper Tringa glareola, Green Sandpiper T. ochropus and Common Redshank T. totanus had significant positive trends, whereas Common Snipe Gallinago gallinago, Ruff Philomachus pugnax and Spotted Redshank Tringa erythropus were declining significantly in numbers. Trends could be calculated even for relatively uncommon breeding birds such as Temminck's Stint Calidris temminckii, Eurasian Dotterel Chara drius morinellus, Broad-billed Sandpiper Limicola falcinellus, Jack Snipe Lymno cryptes minimus and Red-necked Phalarope Phalaropus lobatus, although these trends build on few routes and individuals, and thus have low precision. The monitoring schemes in Norway and Finland are expected to increase in coverage in the coming years, with up to a total of 1555 northern routes being tracked when the schemes are fully developed. This should enable still more robust trend estimates for northern waders on their Fennoscandian breeding grounds to be calculated in the future