tarun w. dasari, md,mph,facc assistant professor of ... · tarun w. dasari, md,mph,facc assistant...
TRANSCRIPT
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Updates in Cardiology-2015
Tarun W. Dasari, MD,MPH,FACC
Assistant Professor of Medicine,
Cardiovascular Section,
OUHSC
*no financial disclosures
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Topics
• Cholesterol management
• Heart failure treatment
• Atrial fibrillation
• Stress testing for CAD
• Recurrent pericarditis
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Cholesterol management
Non Hispanic whites
Non Hispanic blacks
ARIC
CARDIA
CHS
Framingham*
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PCSK9 inhibitors
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-2341 patients at high risk for cardiovascular events who had LDL >70
-receiving treatment with statins at the maximum tolerated dose
- alirocumab (150 mg) or placebo as a 1-ml subcutaneous injection every 2 weeks
for 78 weeks
-primary efficacy end point was the percentage change in calculated
LDL cholesterol level from baseline to week 24
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-enrolled 4465 patients
-randomly assigned in a 2:1 ratio to receive either evolocumab
(140 mg every 2 weeks or 420 mg monthly) plus standard therapy or standard therapy alone
-Patients were followed for a median of 11.1 months
-Data from the two trials were combined
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75 mg SC q2 weekly
Max dose 150 mg q2 weekly
140 mg SC every two weeks or
420 mg SC monthly
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Approved as an adjunct to
statins • Maximally tolerated statin therapy for treatment of adults
with heterozygous familial hypercholesterolemia (HeFH)
or clinical atherosclerotic cardiovascular disease (CVD),
who require additional lowering of LDL
• Other LDL-lowering therapies (e.g., statins, ezetimibe,
LDL apheresis) in patients with homozygous familial
hypercholesterolemia (HoFH) who require additional
lowering of LDL-C
• The effect on cardiovascular morbidity
and mortality has not been determined
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Heart Failure
• TOPCAT
• SHIFT trial
• PARADIGM HF trial
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• randomized, double-blind trial
• 3445 patients with symptomatic heart failure and EF>45%
• spironolactone (15 to 45 mg daily) or placebo
• primary outcome was a composite of CV death, aborted cardiac arrest,
or hospitalization for the management of heart failure
• mean follow-up of 3.3 years
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Death, HF hospitalization HF hospitalization
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• Double blind RCT
• 8442 patients with class II, III, or IV heart failure and an ejection fraction of <40%
• LCZ696 (at a dose of 200 mg twice daily) or enalapril (at a dose of 10 mg twice daily)
• primary outcome was a composite of death from CV causes or hospitalization for HF
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Atrial Fibrillation
• Post stroke monitoring
• Novel anticoagulant
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Warfarin
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Highlights
• A strategy of anatomical testing with the use of CTA, as
compared with use of functional testing, did not reduce
the incidence of events over a median follow-up of 25
months
• CTA was associated with fewer catheterizations showing
no obstructive CAD than was functional testing (3.4% vs.
4.3%)
• More patients in the CTA group underwent
catheterization within 90 days after randomization
(12.2% vs. 8.1%)
• overall exposure was higher in the CTA group (mean,
12.0 mSv vs. 10.1 mSv; P<0.001)
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• multicentre, double-blind trial at four general hospitals in northern Italy.
• 240 pts with recurrent pericarditis assigned to Colchine bid vs. placebo
• colchicine (0.5 mg bid x 6 months if >70 kg or 0.5 mg daily if < 70 kg
• primary outcome was recurrent pericarditis in the intention-to-treat
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Conclusions
• PCSK9 inhibitors aid in significant lowering of LDL cholesterol in
patients who respond poorly or are intolerant of statins
• Spironolactone failed to have a meaningful clinical impact on
patients with heart failure with preserved ejection fraction
• Ivabradine and Sacubitril offer new hope for patients suffering from
heart failure with reduced ejection fraction
• Long term monitoring may aid in detection of atrial fibrillation in
patients with cryptogenic stroke
• Novel oral anticoagulants offer wider options for prevention of
stroke/systemic thromboembolism in patients with non-valvular atrial
fibrillation
• Anatomical assessment of coronary artery disease is not superior to
functional assessment in patients with suspected coronary artery
disease
• Oral Colchicine is effective in reducing recurrences of pericarditis
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OSLER
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ODYSSEY
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ODYSSEY
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