Deshpande, G.A.

Fukui, T.

Ohde, S.

Takahashi, O.

Elsevier - Publisher Connector 

PCV4 The Optimal Interval of Framingham Risk Score to Detect Cardiovasular Disease in Healthy Adults: A Large Cohort Study in Japan 

DISEASE-SPECIFIC STUDIES
CARDIOVASCULAR DISORDERS - Clinical Outcomes Studies
PCV1
ANGIOTENSIN RECEPTOR BLOCKERS AND THE RISK OF MYOCARDIAL
INFARCTION: NETWORK META-ANALYSIS AND PROBABILITY RANKING
Mazumder D, Arora A, Bhutani MK, Pathak P, Siddiqui MK
Heron Health Private Ltd., Chandigarh, India
OBJECTIVES: There is no head-to-head trial demonstrating the risk of myocardial
infarction (MI) across angiotensin receptor blockers (ARBs). This review assessed
the MI incidences associated with the use of ARBs through network meta-analyses
of randomised controlled trials (RCTs). METHODS: Embase® and MEDLINE® were
searched until June 2012 for RCTs assessing the safety of approved ARBs versus
active control/placebo. Studies were included based on a pre-specified protocol.
Data were extracted by two reviewers, with any discrepancy being reconciled by a
third, independent reviewer. A network meta-analysis was conducted and proba-
bility-based rank (P of being best) was generated using WinBUGS®. Subgroup anal-
yses by disease cohorts (hypertension, heart failure, and diabetes) were also
performed. RESULTS: Of the 3099 studies, 33 RCTs enrolling 143,205 patients were
included. Most studies reported data for up-titrated doses with continued back-
ground therapy. No significant differences were observed between ARBs and con-
trols in meta-analysis (relative risk [95% confidence interval]: 1.04 [0.99-1.10] vs.
active-control; 0.94 [0.83-1.07] vs. placebo). Network meta-analyses indicated no
significant difference among the ARBs. Subgroup analyses by disease cohorts
showed no significant difference between ARBs and active/placebo as well as
within ARBs. The probability of least MI incidence was highest with olmesartan 40
mg (P41%) followed by candesartan 16 mg (P19%), losartan 200 mg (P10%),
valsartan 80 mg (P9%), and candesartan 4 mg-8 mg (P4%-5%). Conversely, the
probability of least MI incidence was 1% with telmisartan 80 mg, irbesartan 300
mg, losartan 100 mg, valsartan 160 mg. A dose-risk assessment within ARBs re-
mained inconclusive due to limited data. CONCLUSIONS: ARBs did not differ sig-
nificantly from active control/placebo or from each other for the risk of MI. How-
ever, per probability-based ranking, olmesartan 40 mg may present the least risk of
MI. Limited data warranted careful interpretation of these results and further re-
search in this area using monotherapy data.
PCV2
COMPARATIVE EFFICACY AND SAFETY ANALYSIS OF ATRIAL FIBRILLAION
PATIENTS TREATED WITH DABIGATRAN IN RE-LY STUDY (CHADS 2 SCORE OF
3 OR GREATER ) VERSUS RIVAROXABAN IN ROCKET-AF
Rasty S1, Soliman W2, Taheri R3
1Roosevelt University, Buffalo Grove, IL, USA, 2Consultant, Fort lee, NJ, USA, 3West Coast
University, Los Angeles, CA, USA
OBJECTIVES: In this analysis we performed comparative efficacy and safety anal-
ysis of atrial fibrillation (AF) patients treated in RE-LY trial with ChadS2 score of 3 or
greater treated with Dabigatran (Dab) 150mg versus AF patients treated with Rivar-
oxaban (Riv) in ROCKET-AF study (Avg Chads2 score3.48). METHODS: Patient’s
baseline information and primary efficacy and safety outcomes data for both co-
horts were compared. WINPEPI (2011, version 11.15) epidemiological tool was used
to compare the event rates ( safety and efficacy) per 100 patient year (100PY).
RESULTS: Both groups were similar in age ( 73y), and consisted of roughly 40%
females. The average SBP and DBP were 130/80 vs 130.9 /76.3 mmHg in Riv vs Dab
patients. 82.5% of Riv compared to 69.8% of Dab had persistent AF. In Rocket –AF the
average Chads2 score was 3.38/ 0.94 with 87% of patients having score of 3.
Prior ASA intake was 36.3% in Riv vs 42.5% of Dab. 54.9% of Riv vs 55.2% of Dab had
previous Stroke/TIA/Systemic embolism. In Riv group 62.6%,92.3%, 40.4% and
16.6% had CHF, HTN, DM and MI compared to 48.3%, 91.5%,44.8% and 21.6% in the
Dab patients. For the primary end point of stroke or systemic embolism 1.7 events
in Riv vs 1.87 events in Dab occurred per 100PY (OR0.91; 95%CI0.62-1.32); for
safety end point of major bleed (any) 3.6 events in Riv vs 4.85 events in Dab occurred
per 100PY (OR0.73; 95%CI 0.57-0.93) and for Intracranial hemorrhage (ICH) 0.5
events in Riv vs 0.52 events in Dab occurred per 100 PY ( OR1; 95% CI 0.50-2.02).
CONCLUSIONS: This analysis of the published data suggests similar efficacy for
both agents when used in AF patients with higher risk for stroke (3), higher
major bleeding risks with Dab and similar rates for ICH with both agents.
PCV3
PREVALENCE, ASSOCIATED COMORBIDITIES AND TREATMENT PATTERNS
AMONG CHRONIC KIDNEY DISEASE PATIENTS: AN ANALYSIS USING UK GPRD
DATA
Jick S1, Hagberg KW1, O’Donoghue D2, Jameson K3, Ambegaonkar BM4
1Boston University School of Medicine, Lexington, MA, USA, 2Salford Royal NHS Foundation
Trust, Salford, UK, 3MSD Ltd., Hoddesdon, UK, 4Merck & Co. Inc., Whitehouse Station, NJ, USA
OBJECTIVES: To estimate the prevalence of stage 3-5 chronic kidney disease (CKD)
in 2010, evaluate the presence of comorbidities, and describe treatment among
CKD patients. METHODS: Data for patients with prevalent or incident CKD in 2010
(age  10 years at CKD diagnosis) were extracted from the UK General Practice
Research Database. Patients were identified using Read codes or eGFR values, and
those with cancer, hemolytic anemia, or sickle cell disease were excluded.
RESULTS: Among 3.16MM patients in GPRD, we identified 166,707 patients with
incident or prevalent stage 3-5 CKD in 2010 (5.3% of population). The majority of
patients were stage 3 (92.5%; stage 4  6.3%, stage 5  1.2%), female (62.1%) and,
92.6% were  60 years (92.6%; 99.9% were above 20 years). The most common
comorbidities were hypertension (64.7%), cardiovascular disease (37.1%), hyper-
cholesterolemia (25.2%), and diabetes (19.2%), each condition being significantly
more prevalent than in the general population (16.2%, 8.4%, 9%, and 5.5%, respec-
tively). With more advanced CKD, the presence of comorbidities increased: consid-
ering stage 3 to 5, the proportion of CKD patients with hypertension, CVD, hyper-
cholesterolaemia and diabetes increased from 63.7% to 80%, 36.2% to 43.5%, 25.1%
to 29.2%, and 18.4% to 33.1%, respectively. The proportion of CKD patients receiving
antihypertensive treatment or lipid-modifying therapy (LMT) also increased as
stage advanced: 76.5% in stage 3 to 79.8% in stage 5 were receiving antihypertensive
drugs, and 51.7% to 57.7% LMT. Statins were the most commonly used LMT agent (
89% for all these three stages). CONCLUSIONS: Stage 3 to 5 CKD affected 166,707
patients covered by GPRD in 2010 (prevalence rate  5.3%); most had stage 3 CKD
(92.5%). Diabetes, hypertension and cardiovascular disease became more common
with more advanced CKD. Antihypertensives and LMTs have been prescribed for a
little over 75% and 50% patients, respectively, regardless of their CKD stage.
PCV4
THE OPTIMAL INTERVAL OF FRAMINGHAM RISK SCORE TO DETECT
CARDIOVASULAR DISEASE IN HEALTHY ADULTS: A LARGE COHORT STUDY IN
JAPAN
Takahashi O1, Ohde S2, Deshpande GA2, Fukui T1
1St.Luke’s International Hospital, Tokyo, Japan, 2St.Luke’s Life Science Institute, Tokyo, Japan
OBJECTIVES: The Framingham risk score screening is an important tool to identify
adults’ 10-year risk of cardiovascular disease (CVD), but there are few studies re-
garding the appropriate monitoring interval for re-screening. We aimed to deter-
mine the optimal interval for rechecking the Framingham risk score for healthy
adults in Japan. METHODS: This was a population-based, retrospective cohort
study from 2005 to 2010 in Tokyo, Japan. In healthy adults with a Framingham risk
score of 20%, no prior CVD, and taking no hypertension or hyperlipidemia med-
ications at baseline, we calculated the Framingham risk score annually for 4 years.
We estimated the optimal interval of screening when the cumulative incidence of
CVD or 20% of Framingham risk scores surpassed 10%. RESULTS: At baseline,
13,758 individuals (53% female) with a mean age of 48 years old (SD: 10 years, range:
30 to 73), had a mean total cholesterol level of 204 mg/dl (SD: 33 mg/dl), and mean
systolic blood pressure of 116 mmHg (SD: 16 mmHg). The prevalence of diabetes
mellitus at baseline was 1.9%. The mean baseline Framingham risk score was 5.3%
(range: 0.3 – 19%). For those with baseline Framingham risk scores of  10 %, 10 –
15%, and  15%, cumulative incidences were 0.2%, 1.6%, and 16.8% at 1 year and
0.8%, 11.5%, and 43.6% at 3 years, respectively. CONCLUSIONS: In those with
Framingham risk scores 20% at baseline, the optimal interval for re-screening
should be more than 3 years for those with risk scores10%, 2 years for those with
risk scores of 10-15%, and yearly for those with baseline scores of 15 %.
PCV5
COMPARISON OF ATRIAL MEASUREMENTS AND ESTIMATIONS OF
TRANSMITRAL REGURGITATION USING THREE-DIMENSIONAL AND
CONVENTIONAL ECHOCARDIOGRAPHY IN DOGS
Poulsen Nautrup B1, Schultheiss S2, Poulsen Nautrup C2
1EAH Consulting, Juelich, Germany, 2Ludwig-Maximilians-University Munich, Munich, Germany
OBJECTIVES: Cardiac volume measurements using three-dimensional echocardi-
ography (3DE) have shown to deliver comparable results to magnetic resonance
imaging (MRI). In a previous investigation, volume measurements of the canine left
ventricle using 3DE was compared to conventional volume calculations by two-
dimensional echocardiography (2DE) and M-Mode, revealing increasingly deviat-
ing results with conventional methods in the mentioned sequence. The aim of this
study was to compare measurements of the left atrium and estimations of trans-
mitral regurgitation using 3DE and 2DE in unsedated dogs. METHODS: Measure-
ments of the left atrium were performed in 42 healthy dogs (beagles and dachs-
hunds), using conventional linear, planimetric and volume calculations with 2DE,
and volume measurements with 3DE. Agreement between methods was analyzed
using Spearman’s rank correlation, intraclass correlation coefficient, and Bland-
Altman plot. Additionally, 20 dogs suffering from mitral valve insufficiency (CHIEF
grades C2 and C3) were recruited for the estimation of transmitral regurgitation,
which was approximated from 2 or 3 planes using 2DE (conventional approach),
and from a live x-plane image using 3DE. RESULTS: Compared to 3DE semi-auto-
matic volume measurements of the left atrium, volume calculations performed
with 2DE (methods of discs, Simpson’s rule) underestimated volumes with devia-
tions being predictable for the respective dog sizes; whereas conventional linear
and planimetric measurements allowed the most rapid investigation, but results
deviated in some dogs unpredictably from those obtained with 3DE. Estimating the
transmitral regurgitation using conventional 2DE was time-consuming and re-
quired replacements of the dogs during investigation, lowering compliance in the
canine cardiac patients, whereas 3DE allowed accurate and more rapid evaluations
without the necessity of replacing the dogs. CONCLUSIONS: Volume measure-
ments of the left atrium are most accurate using 3DE. Additionally 3DE facilitates
the estimation of transmitral regurgitation in dogs, increasing compliance with the
investigation. However, further clinical and economic evaluations are needed in
veterinary cardiology.
PCV6
COMPARISON RIVAROXABAN WITH OTHER ANTITHROMBOTIC AGENTS:
EFFECTIVENESS AND SAFETY OF PROPHYLACTIC ANTITHROMBOTIC AGENTS
AFTER MAJOR ORTHOPEDIC SURGERIES IN TAIWAN
Chang WY1, Hsu HC2, Wu CH2, Chen PS2, Wu MT1
1Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, 2Taipei Medical University,
Taipei, Taiwan
OBJECTIVES: To evaluate the current utilization, effectiveness, and safety of anti-
thrombotics for preventing deep vein thrombosis (DVT) after major orthopedic
A362 V A L U E I N H E A L T H 1 5 ( 2 0 1 2 ) A 2 7 7 – A 5 7 5


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PCV4 The Optimal Interval of Framingham Risk Score to Detect Cardiovasular Disease in Healthy Adults: A Large Cohort Study in Japan

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