The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

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General Description: Figure of a women in a black dress, and black shoes with a birds head in front of an orange structure; purple backgroun

Efecto de la Edad de Corte en la Capacidad Fermentativa In Vitro y la Dinámica de Degradación Ruminal In Situ de Tithonia diversifolia

An experiment was conducted with Tithonia diversifolia , at different harvesting ages to determine the effect of age on the in vitro fermentation capacity and on the in situ dry matter dynamic of ruminal degradation. For the in vitro study there were utilized incubation times of 0, 3, 6, 12, 24, 48, 72 and 96 h of fermentation, meanwhile for the in situ study, samplings were taken at 6, 12, 36, 48, and 72 h. Fermentation data were adjusted to the exponential model. In vitro kinetics performance showed an increment in the gas production as samples were exposed to attack of the microorganisms with values of 36.03, 32.12, 34.12, 37.11 and 34.7 at 98h for 30, 50, 70, 90, and 110 d of growing respectively, with higher values of gas production at 90 h. Dynamics of in situ dry matter ruminal degradation showed an asymptotic type of progressive increment, meanwhile data for dry matter effective degradability for different constants of ruminal turnover rate (k=0.03, 0.044, and 0.05 %/h) had a similar performance in all nutrients, varying between 46.39-60.46, 42.40-56.23, 41.75-53.86, and 41.18-53.31 for 30, 50, 70, and 90d of growing, respectively. Results obtained suggested, according to the in vitro and in situ studies, that ages between 70 and 90d allow a great use of the nutrients by the animal. It is necessary to perform in vivo studies to confirm this hypothesis, considering inclusion of different levels of the plant in the diet of ruminants.Se desarrolló un experimento con Tithonia diversifolia , con diferentes edades de corte, para determinar el efecto de la edad en la capacidad fermentativa in vitro y en la dinámica de degradación ruminal in situ de su materia seca. Para el estudio in vitro se utilizaron tiempos de 0, 3, 6, 12, 24, 48, 72 y 96 h de fermentación, mientras que para la prueba in situ se realizaron muestreos a las 6, 12, 36, 48 y 72 h. Los resultados de la fermentación se ajustaron al modelo exponencial. El comportamiento cinético in vitro se caracterizó por un incremento de la producción de gases con el tiempo de exposición de las muestras al ataque de microorganismos, con valores de 36,03 32,12 34,12 37,11 y 34,7 a las 96 h para 30, 50, 70, 90 y 110 d de rebrote, respectivamente, con mayores valores en producción de gases a 90 h. La evolución en la dinámica de degradación ruminal in situ de la MS mostró un aumento progresivo de tipo asintótico, mientras que los valores de degradabilidad efectiva de MS para diferentes constantes de velocidad de recambio ruminal (k=0,03 0,044 y 0,05 %/h) tuvieron un comportamiento similar en todos los nutrientes y oscilaron entre 46,39-60,46; 42,40-56,23; 41,75-53,86 y 41,18-53,31 para 30, 50, 70 y 90 d de rebrote, respectivamente. Los resultados obtenidos permiten sugerir, por los estudios in vitro e in situ, que edades entre 70 y 90 d son las que permiten un mayor aprovechamiento de los nutrientes por el animal. Estudios in vivo se hacen necesarios para avalar esta hipótesis, considerando diferentes niveles de inclusión de este arbusto en las dietas de los rumiantes

Purakau Myths & Legends Mitos y Leyendas | Waikato Museum

All cultures have myths and legends woven into the fabric of their traditions. Eleven artists and fourteen writers from Aotearoa, Cuba, Mexico and Spain respond to the idea of myths and legends, creating twelve posters that tell of legends and contemporary political myths, challenging our complacency with war, the planet, colonisation and life. Over nine months, we will reveal to you four posters at a time... allowing each to tell their tale in Maaori, Spanish and English. We encourage you to read these walls

Pūrākau / Myths and legends / Mitos y leyendas

Trilingual Publication (English, Spanish and Te Reo Maori) Posters from Aotearoa, Cuba & Mexico Pūrākau = a Maori term referring to myths, legends and "lessons for life" Poster = a print-based medium that uses visual devices to form opinion, persuade, provoke, unite and divide us. In 2009 Xavier Meade (NZ) and Flor de Lis López Hernández (Cuba) invited twelve artists from Aotearoa, Cuba and Mexico to produce posters in response to the theme of ‘Pūrākau’. The artists activated a diverse range of indigenous myths and legends: “The Tangler”, “the Disappearance of Matias Perez”, “Origin of the Poisonous Guao Plant” among others. The stories are deeply embedded in their cultures or origin, but the underlying themes resonate across cultures. The craftsmanship of the posters is exquisite. The Cuban contributors come from a long-standing tradition of handcrafted screen-printing which has been maintained since the Cuban Revolution. All posters are made in their country of origin, through screen-print and lithographic processes. Pūrākau follows in the footsteps of Xavier Meade’s highly successful “Aotearoa Liberators” project, a collaborative exhibition of posters that found an audience in New Zealand, Mexico and Cuba. http://ramp.mediarts.net.nz/aotearoaliberators/ ---------- Pūrākau / Myths and Legends / Mitos y Leyendas is a publication accompanying the international poster project Pūrākau. Curated by expatriate Mexican artist Xavier Meade together with Cuban curator Flor de Lis López Hernández, the project exchanges the shape of poet-colonial resistance in the form of indigenous myths and legends. Taking its cue from Cuban revolutionary design, the collected posters use bold graphic imagery to convey pūrākau, or ‘lessons for life’. This touring exhibition brought together twelve leading artists from Cuba, Mexico and Aotearoa New Zealand to exchange indigenous myths and legends through poster design: Denis O'Connor, Natalie Robertson, Michael Reed, Claudio Sotolongo Menéndez, Giselle Monzón Calero, Michele Miyares Hollands, Eric Silva, Mario & Yesca, Arturo Meade and Carlos Pez. The publication is presented in three languages – English, Māori and Spanish – and features writing by Jon Bywater, Danny Butt, Yani Monzón Calero, Ernesto Pérez Castillo, Claudio Sotolongo, Carlos Meade, Luis Delaç, Los Appo Stoles Irreverentes, the curators and many of the artists

Aotearoa Liberators & Púrákau (Myths and Legends - Mitos y leyendas)

Two series of limited edition Posters with contributions from Mexican, Cuban and New Zealand asrists, designers and writers

Correction to: Comparative effectiveness and safety of non-vitamin K antagonists for atrial fibrillation in clinical practice: GLORIA-AF Registry

International audienceIn this article, the name of the GLORIA-AF investigator Anastasios Kollias was given incorrectly as Athanasios Kollias in the Acknowledgements. The original article has been corrected

Patterns of oral anticoagulant use and outcomes in Asian patients with atrial fibrillation: a post-hoc analysis from the GLORIA-AF Registry

Background: Previous studies suggested potential ethnic differences in the management and outcomes of atrial fibrillation (AF). We aim to analyse oral anticoagulant (OAC) prescription, discontinuation, and risk of adverse outcomes in Asian patients with AF, using data from a global prospective cohort study. Methods: From the GLORIA-AF Registry Phase II-III (November 2011-December 2014 for Phase II, and January 2014-December 2016 for Phase III), we analysed patients according to their self-reported ethnicity (Asian vs. non-Asian), as well as according to Asian subgroups (Chinese, Japanese, Korean and other Asian). Logistic regression was used to analyse OAC prescription, while the risk of OAC discontinuation and adverse outcomes were analysed through Cox-regression model. Our primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACE). The original studies were registered with ClinicalTrials.gov, NCT01468701, NCT01671007, and NCT01937377. Findings: 34,421 patients were included (70.0 ± 10.5 years, 45.1% females, 6900 (20.0%) Asian: 3829 (55.5%) Chinese, 814 (11.8%) Japanese, 1964 (28.5%) Korean and 293 (4.2%) other Asian). Most of the Asian patients were recruited in Asia (n = 6701, 97.1%), while non-Asian patients were mainly recruited in Europe (n = 15,449, 56.1%) and North America (n = 8378, 30.4%). Compared to non-Asian individuals, prescription of OAC and non-vitamin K antagonist oral anticoagulant (NOAC) was lower in Asian patients (Odds Ratio [OR] and 95% Confidence Intervals (CI): 0.23 [0.22-0.25] and 0.66 [0.61-0.71], respectively), but higher in the Japanese subgroup. Asian ethnicity was also associated with higher risk of OAC discontinuation (Hazard Ratio [HR] and [95% CI]: 1.79 [1.67-1.92]), and lower risk of the primary composite outcome (HR [95% CI]: 0.86 [0.76-0.96]). Among the exploratory secondary outcomes, Asian ethnicity was associated with higher risks of thromboembolism and intracranial haemorrhage, and lower risk of major bleeding. Interpretation: Our results showed that Asian patients with AF showed suboptimal thromboembolic risk management and a specific risk profile of adverse outcomes; these differences may also reflect differences in country-specific factors. Ensuring integrated and appropriate treatment of these patients is crucial to improve their prognosis. Funding: The GLORIA-AF Registry was funded by Boehringer Ingelheim GmbH

Cardiovascular Efficacy and Safety of Bococizumab in High-Risk Patients

Bococizumab is a humanized monoclonal antibody that inhibits proprotein convertase subtilisin- kexin type 9 (PCSK9) and reduces levels of low-density lipoprotein (LDL) cholesterol. We sought to evaluate the efficacy of bococizumab in patients at high cardiovascular risk. METHODS In two parallel, multinational trials with different entry criteria for LDL cholesterol levels, we randomly assigned the 27,438 patients in the combined trials to receive bococizumab (at a dose of 150 mg) subcutaneously every 2 weeks or placebo. The primary end point was nonfatal myocardial infarction, nonfatal stroke, hospitalization for unstable angina requiring urgent revascularization, or cardiovascular death; 93% of the patients were receiving statin therapy at baseline. The trials were stopped early after the sponsor elected to discontinue the development of bococizumab owing in part to the development of high rates of antidrug antibodies, as seen in data from other studies in the program. The median follow-up was 10 months. RESULTS At 14 weeks, patients in the combined trials had a mean change from baseline in LDL cholesterol levels of -56.0% in the bococizumab group and +2.9% in the placebo group, for a between-group difference of -59.0 percentage points (P<0.001) and a median reduction from baseline of 64.2% (P<0.001). In the lower-risk, shorter-duration trial (in which the patients had a baseline LDL cholesterol level of ≥70 mg per deciliter [1.8 mmol per liter] and the median follow-up was 7 months), major cardiovascular events occurred in 173 patients each in the bococizumab group and the placebo group (hazard ratio, 0.99; 95% confidence interval [CI], 0.80 to 1.22; P = 0.94). In the higher-risk, longer-duration trial (in which the patients had a baseline LDL cholesterol level of ≥100 mg per deciliter [2.6 mmol per liter] and the median follow-up was 12 months), major cardiovascular events occurred in 179 and 224 patients, respectively (hazard ratio, 0.79; 95% CI, 0.65 to 0.97; P = 0.02). The hazard ratio for the primary end point in the combined trials was 0.88 (95% CI, 0.76 to 1.02; P = 0.08). Injection-site reactions were more common in the bococizumab group than in the placebo group (10.4% vs. 1.3%, P<0.001). CONCLUSIONS In two randomized trials comparing the PCSK9 inhibitor bococizumab with placebo, bococizumab had no benefit with respect to major adverse cardiovascular events in the trial involving lower-risk patients but did have a significant benefit in the trial involving higher-risk patients