RCT: Extended use of dabigatran, warfarin, or placebo in venous thromboembolism (RE-MEDY and RE-SONATE trial)
Source: N Engl J Med
Area: News
Patients with provoked venous thromboembolism caused by transient risk factors can usually stop anticoagulation after 3 months of treatment. For patients with unprovoked venous thromboembolism (VTE), for which the risk of recurrence is as high as 40% at 5 years, a longer course of therapy may be considered. However, there are difficulties in balancing the risks and benefits of extended anticoagulation. Warfarin has greater than 90% efficacy in preventing recurrences but is associated with a risk of major bleeding of 1 to 2% per year.
Two studies in the New England Journal of Med...
Source: NeLM - Cardiovascular Medicine - February 21, 2013 Category: Cardiology Source Type: news
SIGN: Updated guideline on acute coronary syndromes
Source: SIGN
Area: Evidence > Guidelines
The Scottish Intercollegiate Guidelines Network (SIGN) has updated its 2007 clinical guideline on the in-hospital management of patients with an acute coronary syndrome (Guideline no:93).
The updated guideline contains a revised recommendation around optimal timing for delivery of primary percutaneous coronary intervention, in line with new European consensus guidelines, and incorporates two new good practice points.
See link below for further details. (Source: NeLM - Cardiovascular Medicine)
Source: NeLM - Cardiovascular Medicine - February 20, 2013 Category: Cardiology Source Type: news
Implementation of a web-based tool for patient medication self-management: the Medication Self-titration Evaluation Programme (Med-STEP) for blood pressure control
Source: Informatics in Primary Care
Area: Evidence > Medicines Management > References
Background: Informatics tools may help support hypertension management.
Objective: To design, implement and evaluate a web-based system for patient antihypertensive medication self-titration.
Methods: Study stages included: six focus groups (50 patients) to identify barriers/facilitators to patient medication self-titration, software design informed by qualitative analysis of focus group responses and a 6-month single-arm pilot study (20 patients) to assess implementation feasibility.
Results: Focus groups emphasised patie...
Source: NeLM - Cardiovascular Medicine - February 19, 2013 Category: Cardiology Source Type: news
Pharmacotherapy for hyperuricemia in hypertensive patients
Source: Cochrane
Area: Evidence > Disease Focused Reviews
Background
High blood pressure represents a major public health problem. Worldwide, approximately one fourth of the adult population has hypertension. Epidemiological and experimental studies suggest a linkage between hyperuricemia and hypertension. Hyperuricemia affects 25-40 % of patients with untreated hypertension. A much lower prevalence has been reported in normotensives or in the general population. However, whether lowering serum uric acid (SUA) might lower blood pressure (BP) is an unanswered question.
Objectives
To determine wheth...
Source: NeLM - Cardiovascular Medicine - February 18, 2013 Category: Cardiology Source Type: news
CADTH review of the clinical effectiveness of thrombolytic drugs for cardiac arrest
Source: Canadian Agency for Drugs and Technologies in Health (CADTH)
Area: News
This Canadian review looks at the clinical effectiveness of thrombolytic drugs in people experiencing cardiac arrest.
A limited literature search of the literature identified three publications suitable for inclusion - one systematic review and two observational studies. The authors summarise the findings of each of the included publications and discusses the limitations of the currently available evidence in this area.
Based on the evidence included in the review, the authors conclude that while thrombolytics may incre...
Source: NeLM - Cardiovascular Medicine - February 18, 2013 Category: Cardiology Source Type: news
Pharmacotherapy for hyperuricemia in hypertensive patients
Source: Cochrane
Area: Evidence > Disease Focused Reviews
Background
High blood pressure represents a major public health problem. Worldwide, approximately one fourth of the adult population has hypertension. Epidemiological and experimental studies suggest a linkage between hyperuricemia and hypertension. Hyperuricemia affects 25-40 % of patients with untreated hypertension. A much lower prevalence has been reported in normotensives or in the general population. However, whether lowering serum uric acid (SUA) might lower blood pressure (BP) is an unanswered question.
Objectives
To determine wheth...
Source: NeLM - Cardiovascular Medicine - February 18, 2013 Category: Cardiology Source Type: news
NSAIDs and cardiovascular risk: An examination of sales and Essential Medicines Lists in low-, middle-, and high-income countries
Source: PLoS Medicine
Area: News
It is known that certain non-steroidal anti-inflammatory drugs (NSAIDs) increase the risk of myocardial infarction and stroke and should be avoided in patients at high risk of cardiovascular events. A study, published in PLoS medicine, investigated the extent to which evidence on cardiovascular risk with NSAIDs has translated into guidance and sales in 15 countries.
The authors identified that three drugs (rofecoxib, diclofenac, and etoricoxib) ranked consistently highest in terms of cardiovascular risk compared with nonuse and naproxen was associated with a low risk. Diclofenac...
Source: NeLM - Cardiovascular Medicine - February 15, 2013 Category: Cardiology Source Type: news
Review: Diagnosis and treatment of familial hypercholesterolaemia
Source: European Heart Journal
Area: News
A review of the diagnosis and treatment of familial hypercholesterolaemia has been published early online in the European Heart Journal.
Familial hypercholesterolaemia (FH) is an autosomal dominant genetic disorder, associated with elevated levels of low-density lipoprotein-cholesterol (LDL-C), which can lead to premature cardiovascular disease. Early diagnosis of FH is important to prevent morbidity and mortality.
Current guidelines highlight the importance of reducing LDL-C levels in patients with FH. Statins are the current standard treatment for the maj...
Source: NeLM - Cardiovascular Medicine - February 15, 2013 Category: Cardiology Source Type: news
Revisiting the medication possession ratio threshold for adherence in lipid management
Source: Current Medical Research and Opinion
Area: Evidence > Medicines Management > References
Objective: We sought to evaluate the relationship between different levels of medication possession ratio (MPR) attained and achievement of clinically meaningful reductions in lipid levels.
Methods: This was a retrospective cohort study of 4691 new statin users from the US Dept of Veteran Affairs (VA). Subjects were required to be eligible for VA medical and pharmacy services throughout the 1-year study period from index date and to have complete data for exposure, outcome and adjustment variables....
Source: NeLM - Cardiovascular Medicine - February 15, 2013 Category: Cardiology Source Type: news
Selenium supplementation for the primary prevention of cardiovascular disease
Source: Cochrane
Area: Evidence > Complementary Medicine
Background
Selenium is a key component of a number of selenoproteins which protect against oxidative stress and have the potential to prevent chronic diseases including cardiovascular disease (CVD). However, observational studies have shown inconsistent associations between selenium intake and CVD risk; in addition, there is concern around a possible increased risk of type 2 diabetes with high selenium exposure.
Objectives
To determine the effectiveness of selenium only supplementation for the primary prevention of CVD and exam...
Source: NeLM - Cardiovascular Medicine - February 14, 2013 Category: Cardiology Source Type: news
Patient adherence to evidence-based pharmacotherapy in systolic heart failure and the transition of follow-up from specialized heart failure outpatient clinics to primary care
The objective of this study was to examine long-term adherence to and dosages of evidence-based pharmacotherapy during and after participation in specialised HFCs.
Methods and Results: Initiation, dosages and adherence were studied in patients with systolic HF attending HFCs in Denmark from 2002 to 2009. Information was obtained from an electronic patient file and research database used in the HFCs combined with prescription data from the Danish Registry of Medicinal Product Statistics. A total of 8792 patients were included in the study. The mean age was 68 years; with a mean LVEF of 30%, and 72% were ...
Source: NeLM - Cardiovascular Medicine - February 14, 2013 Category: Cardiology Source Type: news
Uptake of the NHS Health Check programme in an urban setting
Source: Family Practice
Area: Evidence > Medicines Management > References
Background: The NHS Health Check programme aims to improve prevention, early diagnosis and management of cardiovascular disease (CVD) in England. High and equitable uptake is essential for the programme to effectively reduce the CVD burden.
Objectives: Assessing the impact of a local financial incentive scheme on uptake and statin prescribing in the first 2 years of the programme.
Methods: Cross-sectional study using data from electronic medical records of general practices in Hammersmith and Fulham, London on all patients aged 40...
Source: NeLM - Cardiovascular Medicine - February 14, 2013 Category: Cardiology Source Type: news
RCT: Imatinib mesylate as add-on therapy for pulmonary arterial hypertension: (IMPRES)
Source: Circulation
Area: News
A recent phase II study has reported that imatinib could improve pulmonary haemodynamics, especially in those with greater haemodynamic impairment. The aim of the present international RCT (IMPRES) was to evaluate the safety, tolerability and efficacy of imatinib in patients with advanced pulmonary arterial hypertension (PAH).
Patients with pulmonary vascular resistance (PVR) ?800 dynes/sec/cm5 who were symptomatic on more than 2 PAH therapies (41% patients received 3 PAH therapies with the remainder on 2 therapies) were randomised to imatinib (n=103; starting dose of 200mg) or pl...
Source: NeLM - Cardiovascular Medicine - February 13, 2013 Category: Cardiology Source Type: news
Horizon scanning: Riociguat filed in the EU and US for pulmonary arterial hypertension
Source: PharmaTimes
Area: News
Bayer has submitted riociguat for filing in the US and EU as an oral treatment for patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH), a related condition.
The application is based on PAH data from the PATENT-I trial (see NELM abstract below) and data from the CHEST-1 study in CTEPH patients which reported similar improvements (no absolute data available for CHEST-1). (Source: NeLM - Cardiovascular Medicine)
Source: NeLM - Cardiovascular Medicine - February 13, 2013 Category: Cardiology Source Type: news
European Medicines Agency starts safety review of Diane 35 (cyproterone acetate and ethinylestradiol) and its generics
Source: European Medicines Agency (EMA)
Area: News
The European Medicines Agency (EMA)'s Pharmacovigilance Risk Assessment Committee (PRAC) has formally started a safety review of Diane 35 (cyproterone acetate 2mg, ethinylestradiol 35mcg) and its generics.
As reported previously on NeLM, this review has been initiated at the request of the French medicines regulatory agency (ANSM), following the announcement of its plan to suspend the marketing authorisations for Diane 35 and its generics for acne treatment in France over the next three months (see link below). These medicines are widely used across Europe; ho...
Source: NeLM - Cardiovascular Medicine - February 11, 2013 Category: Cardiology Source Type: news
