CADTH review: Antithrombotic therapy for patients with atrial fibrillation
Source: Canadian Agency for Drugs and Technologies in Health (CADTH) Area: News The Canadian Agency for Drugs and Technologies in Health (CADTH) has published a review addressing the use of novel oral anticoagulants (NOAC) and antiplatelet agents for the management of patients with atrial fibrillation (AF). Evidence-informed recommendations were developed to address the following policy questions:   . In AF patients with a lower risk of stroke (CHADS2 score < 2), which antithrombotic therapy is optimal? . In AF patients with a higher risk of stroke (CHADS2 score ? 2) who are unable to achieve ade...
Source: NeLM - Cardiovascular Medicine - March 26, 2013 Category: Cardiology Source Type: news

FDA rejects oral treprostinil diolamine for pulmonary arterial hypertension
Source: Reuters Health News Area: News Reuters Health News has reported that the US Food and Drug Administration (FDA) has denied approval of oral treprostinil diolamine for the treatment of pulmonary arterial hypertension. The drug was first rejected by the FDA in October 2012 after it had failed to show statistically significant results in patients taking the six-minute walk test during clinical studies.   The report does not provide information on the reasons for the rejection.   [Editor's note: Treprostinil is not licensed in the UK.] (Source: NeLM - Cardiovascular Medicine)
Source: NeLM - Cardiovascular Medicine - March 26, 2013 Category: Cardiology Source Type: news

A pharmacist-led, American Heart Association Heart360 web-enabled home blood pressure monitoring program
Source: Circulation: Cardiovascular Quality and Outcomes Area: Evidence > Medicines Management > References Background: To determine whether a pharmacist-led, Heart360-enabled, home blood pressure monitoring (HBPM) intervention improves blood pressure (BP) control compared with usual care (UC). Methods: This randomised, controlled trial was conducted by clinical pharmacy specialists at 10 Kaiser Permanente Colorado clinics.  Patients assigned to the HBPM intervention group were provided a properly fitted home BP cuff (Omron HEM-790IT) and were trained on how to use it.  Patients were as...
Source: NeLM - Cardiovascular Medicine - March 26, 2013 Category: Cardiology Source Type: news

The UK National Health Service: delivering equitable treatment across the spectrum of coronary disease
Source: Circulation: Cardiovascular Quality and Outcomes Area: Evidence > Medicines Management > References Background: Social gradients in cardiovascular mortality across the United Kingdom may reflect differences in incidence, disease severity or treatment.  It is unknown whether a universal healthcare system delivers equitable lifesaving medical therapy for coronary heart disease.  We therefore examined secular trends in the use of key medical therapies stratified by socioeconomic circumstances across a broad spectrum of coronary disease presentations, including acute coronary syndromes, secondary pr...
Source: NeLM - Cardiovascular Medicine - March 26, 2013 Category: Cardiology Source Type: news

Adherence to clinical guidelines in management of diabetes and prevention of cardiovascular disease in Qatar
Source: International Journal of Clinical Pharmacy Area: Evidence > Medicines Management > References Introduction: The prevalence of diabetes mellitus (DM) in the UK increased in 2009 to 4%, of which type-2 diabetes accounts for 85-95% of all cases.  In Qatar the prevalence of DM among the adult Qatari population in 2008 was 16.7%; around four times higher than the prevalence in the UK.  The aim of the study was to design and to apply a medication assessment tool (MAT) to determine the level of adherence to internationally recognised guideline recommendations in type-2 diabetes management and in primary...
Source: NeLM - Cardiovascular Medicine - March 26, 2013 Category: Cardiology Source Type: news

CHMP confirms refusal of marketing authorisation for mipomersen (Kynamro®) for familial hypercholesterolaemia
Source: European Medicines Agency Area: News Following a re-examination, the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) has recommended the refusal of the marketing authorisation for mipomersen (Kynamro®), intended for the treatment of patients with certain forms of familial hypercholesterolaemia.   At the request of the applicant, the CHMP re-examined its initial negative opinion, and has confirmed the refusal of the marketing authorisation. Please see the link below for details. (Source: NeLM - Cardiovascular Medicine)
Source: NeLM - Cardiovascular Medicine - March 25, 2013 Category: Cardiology Source Type: news

CHMP recommends approval of rituximab (MabThera®) for granulomatosis with polyangiitis (Wegener's) and microscopic polyangiitis
Source: European Medicines Agency Area: News The Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) has recommended the approval of a new indication for rituximab (MabThera®) - for use in combination with glucocorticoids, for the induction of remission in adult patients with severe, active Granulomatosis with polyangiitis (Wegener's) (GPA) and Microscopic polyangiitis (MPA).   Detailed recommendations for the use of this product will be described in the updated summary of product characteristics (SmPC), which will be published in the revised European public assessment r...
Source: NeLM - Cardiovascular Medicine - March 25, 2013 Category: Cardiology Source Type: news

CHMP adopts new indication for new strength of rivaroxaban (Xarelto®)
Source: European Medicines Agency Area: News The Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) has recommended a variation to the terms of the marketing authorisation for rivaroxaban (Xarelto®).    The CHMP has adopted a new indication for a new strength 2.5mg as follows: "Xarelto, co-administered with acetylsalicylic acid (ASA) alone or with ASA plus clopidogrel or ticlopidine, is indicated for the prevention of atherothrombotic events in adult patients after an acute coronary syndrome (ACS) with elevated cardiac biomarkers."   Detailed conditions fo...
Source: NeLM - Cardiovascular Medicine - March 25, 2013 Category: Cardiology Source Type: news

Systematic review and meta-analysis looks at risk factors for stroke in patients taking warfarin for AF
Source: Stroke Area: News The results of a systematic review and meta-analysis seeking to identify the risk factors that contribute to stroke risk in patients with atrial fibrillation (AF) who are taking an oral anticoagulant (OAC) have been published early online in the journal 'Stroke'.   The authors note that although OACs reduce the risks of stroke and mortality in patients with AF, some patients taking them will still sustain stroke.  They performed a systematic review to identify contemporary randomised clinical trials investigating OACs in patients with AF, and then performed a meta-analysis of recent...
Source: NeLM - Cardiovascular Medicine - March 25, 2013 Category: Cardiology Source Type: news

Cardiovascular events after clarithromycin use in lower respiratory tract infections: analysis of two prospective cohort studies
Source: BMJ Area: News There have been concerns about the possibility of harmful effects of widespread macrolide use on cardiovascular morbidity and mortality. Whilst clarithromycin is the macrolide that is used most often in the UK, the authors report that no studies have investigated the long term effect of clarithromycin on cardiovascular events and mortality in patients after acute exacerbations of chronic obstructive pulmonary disease (COPD) or community acquired pneumonia (CAP).  They conducted a secondary analysis of two large prospective cohort studies to investigate the association in these patient groups. T...
Source: NeLM - Cardiovascular Medicine - March 22, 2013 Category: Cardiology Source Type: news

European Medicines Agency recommends restricting use of cilostazol-containing medicines
Source: EMA Area: News Following a review of the current evidence, the European Medicines Agency's (EMA) Committee on Medicinal Products for Human Use (CHMP) has recommended that the use of cilostazol in the treatment of intermittent claudication should be restricted with a range of new measures aimed at targeting a patient population in which there are clinical benefits, and at the same time minimising important risks.   The Spanish Agency for Medicines and Health Products (AEMPS) asked the CHMP to carry out a review of cilostazol following a number of reports of serious suspected adverse effects, in particular ...
Source: NeLM - Cardiovascular Medicine - March 22, 2013 Category: Cardiology Source Type: news

Meta-analysis of effects of calcium channel blockers in prevention of stroke in adults with hypertension
Source: PLoS One Area: News The specific effects of calcium channel blockers (CCBs) against stroke in patients with hypertension as compared to no treatment and other antihypertensive drug classes are not known.   A systematic review and meta-analysis of data from 273,543 participants in 31 RCTs was conducted to evaluate the efficacy of CCBs on stroke in patients with hypertension in studies of CCBs versus placebo, ACE inhibitors (ACEIs), ?-adrenergic blockers, and diuretics.   A literature search to July 31, 2012 identified 31 RCTs with 273,543 participants (including 130,466 experimental subjects and 1...
Source: NeLM - Cardiovascular Medicine - March 21, 2013 Category: Cardiology Source Type: news

Review: Carotid atherosclerosis
Source: British Medical Journal (BMJ) Area: News This review discusses the risk factors, clinical presentation, investigations, and the medical and surgical treatment options for symptomatic and asymptomatic carotid atherosclerosis (defined as a pathological thickening of the common or internal carotid intima, typically into focal areas known as plaques). (Source: NeLM - Cardiovascular Medicine)
Source: NeLM - Cardiovascular Medicine - March 20, 2013 Category: Cardiology Source Type: news

NICE issues hypertension quality standard
Source: NICE Area: News This quality standard from NICE covering the diagnosis and treatment of primary hypertension in adults, defines clinical best practice and provides specific, concise quality statements, measures and audience descriptors to provide the public, health and social care professionals, commissioners and service providers with definitions of high-quality care. (Source: NeLM - Cardiovascular Medicine)
Source: NeLM - Cardiovascular Medicine - March 20, 2013 Category: Cardiology Source Type: news

The impact of pharmacist-initiated interventions in improving acute coronary syndrome secondary prevention pharmacotherapy prescribing upon discharge
Source: Journal of Clinical Pharmacy and Therapeutics Area: Evidence > Medicines Management > References Objectives: Pharmacists have the knowledge regarding optimal use of medications and the ability to influence physician prescribing.  Successful interventions by a pharmacist to implement cardioprotective medications to a coronary artery disease patient's regimen would not only improve the patient's quality of care but may also increase the likelihood of his or her survival.  Therefore, the aim of this study in Malaysia was (i) to evaluate the effectiveness of pharmacist-initiated interventio...
Source: NeLM - Cardiovascular Medicine - March 20, 2013 Category: Cardiology Source Type: news

Cohort study: Chlorthalidone vs. hydrochlorothiazide for the treatment of hypertension
Source: Ann Intern Med Area: News The Annals of Internal Medicine has featured a study comparing the effectiveness and safety of chlorthalidone and hydrochlorothiazide for the treatment of hypertension in older adults.   The Canadian propensity score-matched observational cohort study with up to 5 years of follow-up, incorporated data from 29,873 identified individuals aged 66 years or older who were newly treated with chlorthalidone or hydrochlorothiazide and who were not hospitalised for heart failure, stroke, or myocardial infarction in the prior year. Each chlorthalidone recipient was matched to up to 2 hydro...
Source: NeLM - Cardiovascular Medicine - March 19, 2013 Category: Cardiology Source Type: news

Review: New therapeutic principles in dyslipidaemia
Source: Eur Heart J Area: News This review article on new therapeutic approaches to the treatment of dyslipidaemia focuses on low-density-lipoprotein (LDL) cholesterol-lowering drugs and also those that could potentially modulate other lipoprotein classes linked to LDL, such as lipoprotein a. (Source: NeLM - Cardiovascular Medicine)
Source: NeLM - Cardiovascular Medicine - March 18, 2013 Category: Cardiology Source Type: news

Review: The long QT syndrome
Source: Eur Heart J Area: News This review focuses on the diagnosis and treatment of the long QT syndrome, including beta-adrenergic blockade, left cardiac sympathetic denervation, implantable cardioverter defibrillators, and gene-specific therapy and management. (Source: NeLM - Cardiovascular Medicine)
Source: NeLM - Cardiovascular Medicine - March 18, 2013 Category: Cardiology Source Type: news

Vorapaxar in patients with peripheral artery disease: subgroup analysis of the TRA 2P-TIMI 50 study
Source: Circulation Area: News According to research reported early online in Circulation, the addition of vorapaxar to standard therapy for peripheral arterial disease (PAD) was not associated with a statistically significant reduction on the risk of cardiovascular death, MI or stroke. Although it reduced the incidence of acute limb ischaemia and peripheral revascularisation, it was associated with an increased risk of bleeding.   The authors note that patients with PAD are at an increased risk of acute thromboembolic events. Those without clinically manifest coronary or cerebrovascular disease will often have s...
Source: NeLM - Cardiovascular Medicine - March 18, 2013 Category: Cardiology Source Type: news

Review: Iron deficiency and heart failure: diagnostic dilemmas and therapeutic perspectives
Source: European Heart Journal Area: News A review published in the European Heart Journal discusses the use and evidence of intravenous iron therapy on the functional status, quality of life, and exercise capacity  in patients with heart failure. (Source: NeLM - Cardiovascular Medicine)
Source: NeLM - Cardiovascular Medicine - March 15, 2013 Category: Cardiology Source Type: news

Strategy to reduce salt intake 'could lead to 20,000 fewer deaths each year from cardiovascular disease'
Source: NICE Area: News NICE has reported that a new government strategy to reduce salt intake could lead to 20,000 fewer deaths each year from cardiovascular disease (CVD). In order to limit the harm caused to health by excess of salt, the government has launched a new strategy that aims to help reduce the daily intake of salt from an average of 8.1g a day to 6g a day. The policy follows the NICE pathway on diet, based on guidance originally published in 2010, which recommends aiming for a maximum salt intake of 6g per day per adult by 2015, and 3g by 2025.   NICE says that a 3g reduction of daily salt intake by...
Source: NeLM - Cardiovascular Medicine - March 15, 2013 Category: Cardiology Source Type: news

Cohort study: Smoking, surgery, and venous thromboembolism risk in women
Source: Circulation Area: News Evidence about the effect of smoking on venous thromboembolism risk, generally and in the post-operative period, is limited and inconsistent. A large prospective study of UK women sought to examine the incidence of venous thromboembolism in relation to smoking habits, both in the absence of surgery and in the first 12 post-operative weeks.   The authors followed-up 1,162,718 women, mean age 56 years, for 6 years and reported the following results:   . 4630 women were admitted to hospital for, or died from, venous thromboembolism. . In the absence of surgery, cur...
Source: NeLM - Cardiovascular Medicine - March 15, 2013 Category: Cardiology Source Type: news

European Heart Rhythm Association launches a practical guide on new oral anticoagulants in atrial fibrillation
Source: Eur Heart J Area: News The European Heart Rhythm Association of the European Society of Cardiology has developed a practical guide on how to use the new oral anticoagulants for stroke prevention in atrial fibrillation. The guide has 15 chapters on clinical situations, including start up and follow-up for patients on newer oral anticoagulant drugs.   See the link below for more details (Source: NeLM - Cardiovascular Medicine)
Source: NeLM - Cardiovascular Medicine - March 15, 2013 Category: Cardiology Source Type: news

RCT: Digoxin reduces 30-day All cause hospital admission in older patients with chronic systolic heart failure
Source: Am J Med Area: News Heart failure is a leading cause of hospital admission and readmission in older adults. The authors of this RCT investigated the effect of digoxin on 30 day all cause hospital admission in older patients with heart failure and reduced ejection fraction. Ambulatory patients with chronic heart failure (ejection fraction ?45%) (n=6,800) were randomly assigned to digoxin or placebo. Of these, 3405 were aged ?65 years (mean age, 72 years and 25% were women). The main outcome in the current analysis was 30-day all-cause hospital admission.   The authors reported the following results: ...
Source: NeLM - Cardiovascular Medicine - March 15, 2013 Category: Cardiology Source Type: news

Editorial: Trastuzumab induced cardiomyopathy-wider implications for cardio-oncology
Source: Heart Area: News This editorial in 'Heart' notes the twofold rise in incidence of breast cancer over the past 20 years and that treatments have become significantly more effective and mortality has fallen by 50% over the last 30 years, though this has required more aggressive treatment regimens. The authors discuss anthracyclines, HER-2, anthracyclines plus trastuzumab and recent clinical studies, and note a number of unresolved issues:   (1) How big a problem is chemotherapy cardiomyopathy in routine clinical practice (2) Do we have effective means of early diagnosis? (3) Are there effective pharmace...
Source: NeLM - Cardiovascular Medicine - March 14, 2013 Category: Cardiology Source Type: news

BMJ Analysis: Is an EMA review on hormonal contraception and thrombosis needed?
Source: BMJ Area: News In February 2013, the European Medicines Agency (EMA) announced a review of the safety of combined oral contraceptives, particularly third and fourth generation drugs, including Diane-35(cyproterone acetate 2mg, ethinylestradiol 35mcg) and its generics. The authors of this BMJ Analysis note that third and fourth generation oral contraceptives are overprescribed and that the safest oral contraceptive is one that contains the lowest tolerable dose of ethinylestradiol (lowest dose that prevents breakthrough bleeding; 30mcg) together with the second generation progestogen, levonorgestrel, which is also ...
Source: NeLM - Cardiovascular Medicine - March 14, 2013 Category: Cardiology Source Type: news

Horizon scanning: Phase II study of betrixaban vs. warfarin in patients with atrial fibrillation (Explore-Xa)
Source: Eur Heart J Area: News Betrixaban is an investigational once daily oral factor Xa inhibitor mostly excreted unchanged in the bile and with low (17%) renal excretion. The phase II study assessed its safety and tolerability at three different doses compared with warfarin in 508 patients with AF and more than one risk factor for stroke.   The patients had mean CHADS2 score of 2.2 and 87% had previously received vitamin K antagonist therapy. They were randomised to betrixaban 40, 60, or 80 mg once daily (n= 127 each dose) or unblinded warfarin, adjusted to an INR of 2.0-3.0 (n= 127). The primary outcome was m...
Source: NeLM - Cardiovascular Medicine - March 14, 2013 Category: Cardiology Source Type: news

RCT: Ranolazine shows benefit for persistent angina in patients with type 2 diabetes
Source: Journal of the American College of Cardiology Area: News According to data presented at the American Society of Cardiology annual meeting, and published early online in the Journal of the American College of Cardiology, ranolazine reduced episodes of chest pain in patients with diabetes.   Researchers examined the efficacy of ranolazine versus placebo on weekly angina frequency in patients with type 2 diabetes, coronary artery disease (CAD), and chronic stable angina who remain symptomatic despite treatment with up to 2 anti-anginal agents.   The trial, Type 2 Diabetes Evaluation of Ranolazine in...
Source: NeLM - Cardiovascular Medicine - March 12, 2013 Category: Cardiology Source Type: news

Conference report: Niacin/laropripant combination (Tredaptive) associated with increased risk of bleeding and infections
Source: Reuters Health News Area: News Reuters Health News has reported that according to data presented at the annual American College of Cardiology scientific meeting, niacin in combination with laropripant (Tredaptive) was associated with statistically significantly higher rates of bleeding (2.5% vs 1.9%), and infections (8.0% vs 6.6%) compared to patients taking simvastatin or simvastatin/ezetimibe. They called the differences unexpected.   Additionally, patients taking Tredaptive also experienced higher rates of serious health problems that researchers said are known side effects of niacin, which included ne...
Source: NeLM - Cardiovascular Medicine - March 12, 2013 Category: Cardiology Source Type: news

RCT: Effect of phosphodiesterase-5 inhibition on exercise capacity and clinical status in heart failure - results from the RELAX trial
Source: JAMA Area: News According to research presented at the American College of Cardiology's Annual Scientific Session and published early online in the Journal of the American Medical Association, among patients with heart failure with preserved ejection fraction (HFPEF), phosphodiesterase-5 inhibition with administration of sildenafil for 24 weeks, did not result in significant improvement in exercise capacity or clinical status.   Studies in experimental and human heart failure suggest that phosphodiesterase-5 inhibitors may enhance cardiovascular function and thus exercise capacity in HFPEF. Researchers th...
Source: NeLM - Cardiovascular Medicine - March 12, 2013 Category: Cardiology Source Type: news

RCT: Effect of aliskiren on postdischarge mortality and heart failure readmissions - results from the ASTRONAUT study
Source: JAMA Area: News The Journal of the American Medical Association has featured a study evaluating the addition of aliskiren (a direct renin inhibitor) to standard therapy in the management of patients with heart failure and its effects on the rate of cardiovascular death or rehospitalisation due to heart failure (HF).   The double-blind, placebo-controlled study involved patients with haemodynamically stable HF after a median of 5 days after admission into hospital. Eligible patients were 18 years or older with left ventricular ejection fraction (LVEF) 40% or less, elevated natriuretic peptides (brain natri...
Source: NeLM - Cardiovascular Medicine - March 12, 2013 Category: Cardiology Source Type: news

SMC accepts rivaroxaban (Xarelto®) for treatment of PE and prevention of recurrent DVT or PE
Source: Scottish Medicines Consortium (SMC) Area: Evidence > Drug Specific Reviews The Scottish Medicines Consortium has accepted rivaroxaban (Xarelto®) for the treatment of pulmonary embolism (PE), and prevention of recurrent deep vein thrombosis (DVT) and PE in adults in NHS Scotland.   According to the SMC advice, rivaroxaban was non-inferior to a regimen including a low molecular weight heparin and a vitamin K antagonist for the treatment of PE and the prevention of recurrence of DVT or PE.  The duration of treatment was 3, 6 or 12 months at the discretion of the treating physician. Experience with ...
Source: NeLM - Cardiovascular Medicine - March 12, 2013 Category: Cardiology Source Type: news

Variations in the organization and delivery of the 'NHS health check' in primary care
Source: Journal of Public Health Area: Evidence > Medicines Management > References Background: To evaluate the organisation of the new cardiovascular risk assessment programme, NHS Health Checks, in general practices. Methods: All 99 general practices in two inner London boroughs were invited to participate in a cross-sectional survey by completing an online questionnaire. Results: Data were analysed for 66/99 (67%) eligible practices.  Training attended for delivering the Health Check included measurement methods (43%), delivering risk information (65%) and advising on lifestyle change (62%).  The ...
Source: NeLM - Cardiovascular Medicine - March 12, 2013 Category: Cardiology Source Type: news

EMA starts risk-benefit review of nicotinic acid and related substances
Source: European Medicines Agency Area: News The European Medicines Agency (EMA) has started a review of nicotinic acid and its related substances acipimox and xantinol nicotinate used to treat lipid disorders.   The review follows new data from a study which found the combination of nicotinic acid and laropiprant did not reduce the risk of major vascular events, and was in fact associated with a higher frequency of non-fatal but serious side effects. As a result, the EMA recommended the suspension of medicines containing the combination of nicotinic acid and laropiprant across the EU.   As data from th...
Source: NeLM - Cardiovascular Medicine - March 11, 2013 Category: Cardiology Source Type: news

Treatment of anaemia with darbepoetin alfa in systolic heart failure
Source: New England Journal of Medicine Area: News The findings of a study evaluating whether darbepoetin alfa improves clinical outcomes in patients with chronic systolic heart failure and non-iron-deficiency anaemia have been presented at the meeting of the American College of Cardiology and published early online in the New England Journal of Medicine.   The authors note that there is evidence to suggest that increasing haemoglobin (Hb) level with the use of erythropoiesis-stimulating agents (ESAs) may improve outcomes in patients with heart failure and anaemia, but it is not robust. Their study (Reduction of ...
Source: NeLM - Cardiovascular Medicine - March 11, 2013 Category: Cardiology Source Type: news

Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction
Source: New England Journal of Medicine Area: News The findings of a study comparing primary percutaneous coronary intervention (PCI) with an early fibrinolytic strategy in patients presenting with acute ST-segment elevation myocardial infarction (STEMI) have been presented at the meeting of the American College of Cardiology and published early online in the New England Journal of Medicine.   The authors note that primary PCI is recommended as the preferred reperfusion strategy in patients with acute STEMI; however this is contingent upon its performance in a timely fashion, and most patients presenting to non-P...
Source: NeLM - Cardiovascular Medicine - March 11, 2013 Category: Cardiology Source Type: news

Effect of platelet inhibition with cangrelor during PCI on ischaemic events
Source: New England Journal of Medicine Area: News The findings of a study evaluating whether cangrelor reduces ischaemic complications of percutaneous coronary intervention (PCI) have been presented at the meeting of the American College of Cardiology and published early online in the New England Journal of Medicine.   The authors note that thrombotic complications during PCI remain a major concern, despite advances in adjunctive pharmacotherapy. Although platelet adenosine diphosphate (ADP) P2Y12 inhibitors reduce the risk of ischaemic events, particularly stent thrombosis, only oral agents are currently availa...
Source: NeLM - Cardiovascular Medicine - March 11, 2013 Category: Cardiology Source Type: news

Are low molecular weight heparins preferred to unfractionated heparin in people with renal impairment for treatment indications?
Source: South West Medicines Information and Training Area: Evidence > Medicines Q & A . The American College of Chest Physicians (ACCP), National Institute for Health and Clinical Excellence (NICE) and British Society of Haematology (BSH) suggest the use of unfractionated heparin (UFH) may be preferred over low molecular weight heparins (LMWHs) for treatment indications in patients with severe renal impairment (RI) i.e. a CrCl of <30ml/min. . Important advantages of UFH compared to LMWHs are that its renal excretion is minimal, it has a relatively short half-life and its effects can be easily monitore...
Source: NeLM - Cardiovascular Medicine - March 11, 2013 Category: Cardiology Source Type: news

Conference report: Eplerenone in patients with acute STEMI without heart failure
Source: PharmaLive Area: News PharmaLive has reported on results from the REMINDER trial, which evaluated eplerenone in the early treatment of acute ST-segment elevation myocardial infarction (STEMI). These results were presented at the 62nd Annual Scientific Session of the American College of Cardiology.   The REMINDER study included 1,012 patients with acute STEMI without a history of heart failure (HF) or an ejection fraction of <40% and without signs of HF.  They were randomised to treatment (preferably before myocardial reperfusion) with eplerenone (25-50 mg OD) or placebo in addition to standard th...
Source: NeLM - Cardiovascular Medicine - March 11, 2013 Category: Cardiology Source Type: news

Horizon Scanning: Pitavastatin versus pravastatin for LDL cholesterol reduction in HIV infected adults with dyslipidaemia
Source: BioSpace Area: News According to a report in BioSpace, results of a comparative superiority study investigating pitavastatin 4mg versus pravastatin 40mg in adult HIV infected patients with dyslipidaemia met its primary endpoint, percent reduction in LDL cholesterol, and reported that, after 12 weeks of therapy, pitavastatin had a significantly greater decrease in LDL cholesterol compared with pravastatin (pitavastatin 31% vs. pravastatin 21% reduction, p<0.001).   The overall incidence of treatment emergent adverse events was 61.1% for pitavastatin and 62.7% for pravastatin.   Pravastatin is...
Source: NeLM - Cardiovascular Medicine - March 8, 2013 Category: Cardiology Source Type: news

RCT: High-dose allopurinol reduces left ventricular mass in patients with ischaemic heart disease
Source: J Am Coll Cardiol Area: News Left ventricular hypertrophy (LVH) is common in patients with IHD including normotensive patients. Allopurinol, a xanthine oxidase inhibitor, has been shown to reduce LV afterload in IHD and may therefore also regress LVH. This randomised placebo-controlled study sought to ascertain if high-dose allopurinol regresses left ventricular mass (LVM) in patients with ischemic heart disease (IHD). Sixty six patients with IHD and LVH were randomised to either 600mg allopurinol daily or placebo for 9 months. The primary outcome measure was change in LVM, assessed by cardiac magnetic resonance i...
Source: NeLM - Cardiovascular Medicine - March 8, 2013 Category: Cardiology Source Type: news

Systematic review and meta-analysis of new oral anticoagulants in addition to single or dual antiplatelet therapy after an acute coronary syndrome
Source: European Heart Journal Area: News Oral vitamin K antagonists have been shown to prevent recurrent ischaemic events after acute coronary syndrome (ACS), both as mono-therapy and in combination with aspirin, but substantially increase bleeding. The potential of new oral anticoagulants as antithrombotic therapy after ACSs has been investigated over the past few years and consistent increases in bleeding and the less consistent reduction in ischaemic events have been reported. The overall benefit-risk profile of adding new oral anticoagulants to antiplatelet treatment after an ACS is unknown.   This meta-anal...
Source: NeLM - Cardiovascular Medicine - March 7, 2013 Category: Cardiology Source Type: news

American Society of Clinical Oncology Clinical Practice Guideline on central venous catheter care for the patient with cancer
Source: JCO Area: News This evidence-based guideline addresses catheter type, insertion site, and placement as well as effective prophylaxis and management of catheter related infections, prophylaxis of catheter related thrombosis and treatment of catheter related occlusions. (Source: NeLM - Cardiovascular Medicine)
Source: NeLM - Cardiovascular Medicine - March 7, 2013 Category: Cardiology Source Type: news

Systematic review and meta-analysis of effect of statins on cardiovascular and renal outcomes in patients with chronic kidney disease
Source: European Heart Journal Area: News This systematic review and meta-analysis investigated the balance of risks and benefits of statin therapy in patients with chronic kidney disease (CKD) and the effect of kidney function on statin use.   A literature search was conducted for prospective RCTs assessing the effects of statins on cardiovascular outcomes in people with CKD published between 1970 and November 2011. Thirty-one trials that include at least one event were identified, providing data for 48,429 patients with CKD, including 6690 major cardiovascular events and 6653 deaths.   The following fi...
Source: NeLM - Cardiovascular Medicine - March 7, 2013 Category: Cardiology Source Type: news

Systematic review and meta-analysis of new oral anticoagulants in addition to single or dual antiplatelet therapy after an acute coronary syndrome
Source: European Heart Journal Area: News Oral vitamin K antagonists have been shown to prevent recurrent ischaemic events after acute coronary syndrome (ACS), both as mono-therapy and in combination with aspirin, but substantially increase bleeding. The potential of new oral anticoagulants as antithrombotic therapy after ACSs has been investigated over the past few years and consistent increases in bleeding and the less consistent reduction in ischaemic events have been reported. The overall benefit-risk profile of adding new oral anticoagulants to antiplatelet treatment after an ACS is unknown.   This meta-anal...
Source: NeLM - Cardiovascular Medicine - March 7, 2013 Category: Cardiology Source Type: news

PSNC: Shortage of isosorbide mononitrate tablets 10mg, 20mg and 40mg
Source: PSNC Area: News The Pharmaceutical Services Negotiating Committee (PSNC) has re-iterated advice from the Chief Pharmaceutical Officer on the shortage of isosorbide mononitrate tablets (10mg, 20mg and 40mg).   The PSNC has confirmed the following with the Department of Health: "Contractors will be reimbursed for dispensing an unlicensed medicine against prescriptions for all strengths of isosorbide mononitrate (10mg, 20mg and 40mg) tablets.  However, contractors will need to ensure that these prescriptions have been clearly prescribed as "unlicensed" and then endorsed with the actual price paid minus ...
Source: NeLM - Cardiovascular Medicine - March 1, 2013 Category: Cardiology Source Type: news

VTE risk assessment data collection: October to December 2012
Source: Department of Health (DH) Area: News The tenth set of quarterly statistics on Venous Thromboembolism (VTE) Risk Assessment in England, produced by the Department of Health have been published according to the arrangements approved by the UK Statistics Authority. The main points highlighted for this latest release are:   The key results for data collected on the number and proportion of VTE Risk Assessments carried out on adult admissions to NHS funded acute care are as follows:   . Of the 3.4m adult patients admitted to NHS funded acute care between October and December 2012, 94.2% of these ...
Source: NeLM - Cardiovascular Medicine - March 1, 2013 Category: Cardiology Source Type: news

Effect of antioxidant vitamin supplementation on cardiovascular outcomes: A meta-analysis of randomised controlled trials
Source: PLoS One Area: News According to the findings of this systematic review and meta-analysis of pooled data from randomised controlled trials (RCTs), antioxidant vitamin supplementation has no effect on the incidence of major cardiovascular events, myocardial infarction, stroke, total death, and cardiac death.   Data (published and unpublished) for the analysis were sourced through a search of databases such as PubMed, EmBase the Cochrane Central Register of Controlled Trials and conference reports. Studies were included if they were RCTs that reported on the effects of antioxidant vitamins on cardiovascular...
Source: NeLM - Cardiovascular Medicine - February 28, 2013 Category: Cardiology Source Type: news

Viagra (sildenafil) 25mg, 50mg and 100mg tablets - Pfizer Limited - Revised SPC
Source: eMC (electronic Medicines Compendium) Area: Other Library Updates > SPC Changes Section 4.8 Undesirable effects has been updated to include the ADRs haematuria, haematospermia and penile haemorrhage.   Please see link to the SPC for full prescribing information (Source: NeLM - Cardiovascular Medicine)
Source: NeLM - Cardiovascular Medicine - February 28, 2013 Category: Cardiology Source Type: news

NICE issues final guidance supporting the use of apixaban for prevention of stroke and systemic embolism in non-valvular atrial fibrillation (TA 275)
Source: NICE Area: Evidence > Guidelines NICE has issued final guidance (TA 275) supporting the use of apixaban as an option for preventing stroke and systemic embolism within its marketing authorisation, that is, in people with nonvalvular atrial fibrillation with 1 or more risk factors such as:   . prior stroke or transient ischaemic attack . age 75 years or older . hypertension . diabetes mellitus . symptomatic heart failure.   NICE notes that the decision about whether to start treatment with apixaban should be made after an informed discussion between the clinici...
Source: NeLM - Cardiovascular Medicine - February 27, 2013 Category: Cardiology Source Type: news