Cost-utility analysis of antihypertensive medications in Nigeria: a decision analysis
The objective of this study was to evaluate the cost-effectiveness of drugs from 4 classes of antihypertensive medications commonly used in Nigeria in management of hypertension where there is no compelling indication to use a particular antihypertensive drug. Methods: The study employed decision analytic modelling.  Interventions were obtained from a meta-analysis.  The Markov process model calculated clinical outcomes and costs during a life cycle of 30 years of 1000 hypertensive patients stratified by 3 cardiovascular risk groups, under the alternative intervention scenarios.  Quality adjusted...
Source: NeLM - Cardiovascular Medicine - January 24, 2013 Category: Cardiology Source Type: news

NICE issues final appraisal determination on apixaban for prevention of stroke and systemic embolism in non-valvular atrial fibrillation
Source: NICE Area: News In its final appraisal determination (FAD), NICE has supported 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 one or more risk factors (prior stroke or ischaemic attack, age 75 years or older, hypertension, diabetes mellitus or symptomatic heart failure).   The appeal period for this appraisal will close on 6 February 2013. (Source: NeLM - Cardiovascular Medicine)
Source: NeLM - Cardiovascular Medicine - January 23, 2013 Category: Cardiology Source Type: news

Diuretic use in black patients with uncontrolled hypertension
This study assessed diuretic prescribing patterns in a sample of black patients with uncontrolled hypertension who were identified from a population of home care recipients. Methods: The study was conducted in an urban home health organisation in New York, USA.  Participants were black, aged 21 to 80 years, and had a diagnosis of hypertension.  Participants with uncontrolled hypertension were identified, and in-home interviewers collected information on prescribed antihypertensive medications. Results: Of 658 participants, 5.5% were not prescribed any antihypertensives, and only 46% were prescribed a diuretic...
Source: NeLM - Cardiovascular Medicine - January 23, 2013 Category: Cardiology Source Type: news

Shared decision making sheets to facilitate conversations about treatment options
Source: Right Care Area: News The BMJ Group has developed a number of shared decision making sheets, designed to facilitate a conversation between patients and healthcare professionals about the reasons for choosing one treatment option over and above another treatment option. The information sheets are both prompts for use in consultations by health professionals with their patients, and aide-memoires for patients with instructions for accessing the corresponding web-based patient decision aid.    Shared decision making sheets on the following are currently available:   - AAA repair - ...
Source: NeLM - Cardiovascular Medicine - January 22, 2013 Category: Cardiology Source Type: news

Long-term aspirin use associated with age-related macular degeneration
Source: JAMA Internal Medicine Area: News JAMA Internal Medicine has featured a study evaluating whether regular aspirin use is associated with a higher risk for developing age-related macular degeneration (AMD).   Data from an Australian population-based cohort over a 15-year period (1992-1994 to 2007-2009) were analysed. Participants with at least 4 examinations over the 15 year period were included, and they completed a detailed questionnaire at baseline assessing aspirin use, cardiovascular disease status, and AMD risk factors. Age-related macular degeneration was graded side-by-side from retinal photographs ...
Source: NeLM - Cardiovascular Medicine - January 22, 2013 Category: Cardiology Source Type: news

Public-use blood pressure machines in pharmacies for identification of undetected hypertension in the community
Source: Journal of Clinical Hypertension Area: Evidence > Medicines Management > References PharmaSmart PS-2000 (PharmaSmart Canada Corporation, Vancouver, BC, Canada) BP kiosks are validated devices measuring seated BP at the brachial artery.  The kiosks also have Internet connectivity, allowing collection of anonymised results obtained.  The writers of this letter obtained data from PharmaSmart on readings obtained from 341 locations of a Canadian chain pharmacy between Jan 2010 and Nov 2011.  A total of 8,457,552 readings were taken in the observation period, with an average usage across all phar...
Source: NeLM - Cardiovascular Medicine - January 22, 2013 Category: Cardiology Source Type: news

Impact of pharmacy outreach services on blood pressure management in the elderly community of Hong Kong
Source: Geriatrics and Gerontology International Area: Evidence > Medicines Management > References Aim: To investigate the impact of the Pharmacy Outreach Service (POS) on blood pressure (BP) and disease knowledge among community-dwelling elderly patients with hypertension, and to evaluate the sustainability of such impact of POS. Methods: A prospective open-labeled study of elderly adults (aged 65 years or older) with hypertension (BP 140/90 mmHg or higher for non-diabetics and 130/80 mmHg or higher for diabetics) was carried out at seven elderly community centres from Jul 2008 to Mar 2010....
Source: NeLM - Cardiovascular Medicine - January 22, 2013 Category: Cardiology Source Type: news

Efficacy of vitamin and antioxidant supplements in prevention of cardiovascular disease: systematic review and meta-analysis
Source: BMJ Area: News According to the results of a systematic review and meta-analysis, there is no evidence to support the use of vitamin and antioxidant supplements for the primary or secondary prevention of cardiovascular diseases (CVD).   The authors note that although several previous meta-analyses have evaluated the effect of vitamins and antioxidant supplements on CVD, they all involved individual vitamins or antioxidants, and none performed subgroup analyses by factors such as methodological quality or funding source. They sought to address these limitations in the current study. They identified a total...
Source: NeLM - Cardiovascular Medicine - January 21, 2013 Category: Cardiology Source Type: news

CAS alert: Recall of Tredaptive® (nicotinic acid / laropiprant) modified-release tablets (Class 2 drug alert)
Source: CAS, MHRA Area: News The European Medicines Agency's Committee for Medicinal Products for Human Use (CHMP) confirmed on Friday 18th January 2013 that it is recommending the suspension of the marketing authorisations of Tredaptive® (nicotinic acid / laropiprant) used to treat adults with dyslipidaemia, as its benefits no longer outweigh its risks (see link below for previous NeLM report).   Following on from this, the MHRA has now issued a Class 2 drug alert recalling all unexpired stock of Tredaptive® modified-release tablets, which has been supplied both as originator and parallel-distributed product. ...
Source: NeLM - Cardiovascular Medicine - January 21, 2013 Category: Cardiology Source Type: news

CHMP recommends approval of generic telmisartan/hydrochlorothiazide medicines for essential hypertension
Source: European Medicines Agency Area: News The Committee for Medicinal Products for Human Use (CHMP) has recommending that the following two generic medicines be approved for the treatment of essential hypertension:   . Actelsar HCT (40mg/12.5 mg, 80mg/12.5 mg and 80mg/25 mg tablets) . Tolucombi (40mg/12.5 mg, 80mg/12.5 mg and 80mg/25 mg tablets)   The active substances of these medicines are telmisartan (angiotensin II receptor antagonist) and hydrochlorothiazide (thiazide diuretic).  Both are generics of MicardisPlus, which has been authorised in the EU since April 2002. Studies hav...
Source: NeLM - Cardiovascular Medicine - January 21, 2013 Category: Cardiology Source Type: news

Drug adherence behavior among hypertensive out-patients at a tertiary health institution in Manicaland province, Zimbabwe, 2011
This study investigated the level of drug adherence among hypertensive outpatients at a tertiary hospital in Zimbabwe.  Specific objectives included measurement of blood pressure (BP) control achievement, estimating prevalence of drug adherence behaviour, and establishing the association between drug adherence behaviour and achievement of BP control. Methods and Materials: An analytical, cross-sectional design was applied on a convenience sample of 102 participants using an interviewer-administered questionnaire.  Self-reported adherence was assessed using the Morisky Medication Adherence Scale. Findings: The...
Source: NeLM - Cardiovascular Medicine - January 21, 2013 Category: Cardiology Source Type: news

Factors associated with adherence to phosphodiesterase type 5 inhibitors for the treatment of pulmonary arterial hypertension
This study analysed pharmacy benefit claims of naive tadalafil (Adcirca) and sildenafil (Revatio) users between 1 Jan 2008 and 31 Dec 2010.  Patients were considered adherent if their proportion of days covered (PDC) was 80% or more over a 6-month period.  Logistic regressions were estimated to assess the factors associated with adherence.  Analyses were stratified by use of a specialty pharmacy or retail pharmacy.  A sensitivity analysis was performed by excluding individuals with 90-day supply. Results: Of the total of 2143 patients included, 46.8% were adherent.  Adherence was h...
Source: NeLM - Cardiovascular Medicine - January 18, 2013 Category: Cardiology Source Type: news

European Medicines Agency confirms recommendation to suspend Tredaptive (nicotinic acid/laropiprant)
Source: European Medicines Agency Area: News The European Medicines Agency's Committee for Medicinal Products for Human Use (CHMP) has confirmed the recommendation to suspend the marketing authorisations of Tredaptive (nicotinic acid / laropiprant) used to treat adults with dyslipidaemia, as its benefits no longer outweighed its risks. The results of the HPS2-THRIVE study, which are still preliminary, had indicated that taking Tredaptive together with a statin had no significant additional benefit in reducing the risk of major vascular events, compared with statin therapy alone; and it was also associated with a higher f...
Source: NeLM - Cardiovascular Medicine - January 18, 2013 Category: Cardiology Source Type: news

Differences and time trends in drug treatment of atrial fibrillation in men and women and doctors' adherence to warfarin therapy recommendations
Source: European Journal of Clinical Pharmacology Area: Evidence > Medicines Management > References Background: Little is known about prescription trends in atrial fibrillation (AF) in primary health care in Sweden. Objective: The aim was to study time trends in pharmacotherapy, in men and women with AF.  We also aimed at studying doctors' adherence to CHADS2 for prescribing warfarin.  CHADS2 assesses stroke risk by presence of known risk factors, i.e. congestive heart failure, hypertension, age over 75 years, diabetes, previous stroke and transient ischaemic attack. Methods: Data were obtained from...
Source: NeLM - Cardiovascular Medicine - January 18, 2013 Category: Cardiology Source Type: news

Decision on funding of dabigatran in Australia delayed
Source: National Prescribing Service (Australia) Area: News In Australia, the Pharmaceutical Benefits Advisory Committee (PBAC) recommended dabigatran for stroke prevention in atrial fibrillation (AF) for public funding in March 2011. Such a positive committee verdict usually ensures smooth passage into the national Pharmaceutical Benefits Scheme (PBS), but the Australian Minister for Health announced in December 2012 that the PBAC decision is being delayed. This follows the release of a report reviewing anticoagulation therapies in AF which identified uncertainties regarding the magnitude of any incremental clinical and ...
Source: NeLM - Cardiovascular Medicine - January 17, 2013 Category: Cardiology Source Type: news

Review: Drug-eluting coronary-artery stents
Source: New England Journal of Medicine (NEJM) Area: News This review on drug-eluting coronary-artery stents provides an overview of currently available devices, and covers the following topics:   . Platforms for drug-eluting stents . Vascular biology . Efficacy and safety . Indications for use . Antiplatelet therapy . Cost-effectiveness . Open issues and future directions (Source: NeLM - Cardiovascular Medicine)
Source: NeLM - Cardiovascular Medicine - January 17, 2013 Category: Cardiology Source Type: news

Phase III trial of darbepoetin alfa (Aranesp) in heart failure fails to meet primary efficacy endpoint
Source: PharmaLive Area: News Amgen has announced that its phase III Aranesp® (darbepoetin alfa) RED-HF® (Reduction of Events With Darbepoetin Alfa in Heart Failure) trial has failed to meet its primary efficacy endpoint.   The trial was initiated in 2006, and recruited 2278 patients with symptomatic systolic heart failure and anaemia (haemoglobin 9.0 to 12.0 g/dL) who were randomised to receive either treatment with darbepoetin to achieve a target haemoglobin of at least 13.0 g/dL (not to exceed 14.5 g/dL), or placebo. The study primary endpoint was a reduction in the composite endpoint of time to death from a...
Source: NeLM - Cardiovascular Medicine - January 17, 2013 Category: Cardiology Source Type: news

Benefits of beta blockers in patients with heart failure and reduced ejection fraction: network meta-analysis
Source: BMJ Area: News Beta blockers have been shown in randomised trials to prolong survival, prevent arrhythmia, improve symptoms of heart failure and left ventricular ejection fraction, and control ventricular rate, especially in patients with chronic heart failure. However, controversy exists as to the optimal selection of a particular agent for management of heart failure, as they differ in their selectivity for adrenergic receptors and their effects on the peripheral circulation.   This systematic review and network meta-analysis was conducted of efficacy of different beta- blockers in heart failure to clar...
Source: NeLM - Cardiovascular Medicine - January 17, 2013 Category: Cardiology Source Type: news

AWMSG issues Final Appraisal Recommendation on eplerenone (Inspra®) in patients with NYHA class II heart failure and left ventricular systolic dysfunction
Source: All Wales Medicines Strategy Group (AWMSG) Area: Evidence > Drug Specific Reviews In its Final Appraisal Recommendation, the All Wales Medicines Strategy Group (AWMSG) is of the opinion that eplerenone (Inspra®) tablets may be an appropriate treatment option within NHS Wales, in addition to standard optimal therapy, to reduce the risk of cardiovascular mortality and morbidity in adult patients with New York Heart Association (NYHA) class II (chronic) heart failure and left ventricular systolic dysfunction (LVEF ? 30%). (Source: NeLM - Cardiovascular Medicine)
Source: NeLM - Cardiovascular Medicine - January 17, 2013 Category: Cardiology Source Type: news

AWMSG issues Final Appraisal Recommendation on sildenafil (Revatio®) for treatment of pulmonary arterial hypertension in children
Source: All Wales Medicines Strategy Group (AWMSG) Area: Evidence > Drug Specific Reviews In its Final Appraisal Recommendation, the All Wales Medicines Strategy Group (AWMSG) is of the opinion that sildenafil (Revatio®) 10mg/ml powder for oral suspension is appropriate for specialist only prescribing within NHS Wales as an option for the treatment of paediatric patients aged 1 year to 17 years old with pulmonary arterial hypertension. Efficacy in terms of improvement of exercise capacity or pulmonary haemodynamics has been shown in primary pulmonary hypertension and pulmonary hypertension associated with congenital ...
Source: NeLM - Cardiovascular Medicine - January 17, 2013 Category: Cardiology Source Type: news

Hospital case volume and appropriate prescriptions at hospital discharge after acute myocardial infarction: a nationwide assessment
Source: Circulation: Cardiovascular Quality and Outcomes Area: Evidence > Medicines Management > References Background: In acute myocardial infarction, the relationship between volume and quality indicators (QIs) is poorly documented.  Through a nationwide assessment of QIs at discharge repeated for 3 years, we aimed to quantify the relationship between volume and QIs in survivors after acute myocardial infarction. Methods and Results: Almost all healthcare centres in France participated.  Medical records were randomly selected.  Data collection was performed by an independent group.  QIs fo...
Source: NeLM - Cardiovascular Medicine - January 17, 2013 Category: Cardiology Source Type: news

Temporal trends in medical therapies for ST- and non-ST elevation myocardial infarction: (from the Atherosclerosis Risk in Communities (ARIC) Surveillance Study)
Source: American Journal of Cardiology Area: Evidence > Medicines Management > References Reports from large studies using administrative data sets and event registries have characterised recent temporal trends and treatment patterns for acute myocardial infarction.  However, few were population-based, and fewer examined differences in patterns of treatment for patients presenting with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). The aim of this study was to examine 22-year trends in the use of 10 medical therapies and procedures by STEMI an...
Source: NeLM - Cardiovascular Medicine - January 17, 2013 Category: Cardiology Source Type: news

Review: Acute pneumonia and the cardiovascular system
Source: Lancet Area: News The Lancet has published a review on the burden of cardiac complications in adults with acute pneumonia, the cardiovascular response to this infection, the potential effects of commonly used cardiovascular and anti-infective drugs on these associations, and possible directions for future research.   Results of recent studies show that about a quarter of adults admitted to hospital with pneumonia develop a major acute cardiac complication during their hospital stay, which is associated with a 60% increase in short-term mortality. (Source: NeLM - Cardiovascular Medicine)
Source: NeLM - Cardiovascular Medicine - January 16, 2013 Category: Cardiology Source Type: news

Using a venous thromboembolism checklist significantly improves VTE prevention: a junior doctor led intervention
Conclusions: Most physicans are aware of the risk of VTE to inpatients, ... (Source: NeLM - Cardiovascular Medicine)
Source: NeLM - Cardiovascular Medicine - January 14, 2013 Category: Cardiology Source Type: news

Research suggests optimal duration of dual antiplatelet therapy may vary depending on stent type
Source: Eur Heart J Area: News According to research published early online in the European Heart Journal, the optimal duration of dual antiplatelet therapy (DAPT) may differ depending on the type of stent implanted.   The authors note that this currently remains a controversial issue due to the lack of prospective, randomised data.  They conducted a pre-specified analysis of the PRODIGY study to assess device-specific outcomes relative to different duration of DAPT after everolimus- (EES), paclitaxel (PES), zotarolimus- (ZES-S) eluting, or bare metal stent (BMS) insertion.   The open-label PRODIGY ...
Source: NeLM - Cardiovascular Medicine - January 14, 2013 Category: Cardiology Source Type: news

Analysis of recurrent events in patients receiving ticagrelor or clopidogrel for ACS in the PLATO study
Source: Circulation Area: News According to an analysis of recurrent events in the PLATO study, ticagrelor reduces both the first and recurrent cardiovascular events in patients with acute coronary syndrome (ACS) compared with clopidogrel. Although it is associated with a slightly increased risk of having a first non-CABG major bleed, the bleeding risk appears to be similar to clopidogrel thereafter.    The authors note that censoring patients after the first occurrence of any primary endpoint event in clinical trials limits the information available on the effect of therapy on subsequent events, and leaves ...
Source: NeLM - Cardiovascular Medicine - January 14, 2013 Category: Cardiology Source Type: news

PRAC recommends suspension of marketing authorisations of extended-release niacin/laropiprant (Tredaptive®) across the EU
Source: European Medicines Agency Area: News The European Medicines Agency (EMA)'s Pharmacovigilance Risk Assessment Committee (PRAC) has recommended that the marketing, supply and authorisations of extended-release niacin/laropiprant medicines (Tredaptive®) be suspended across the EU. This follows an assessment of the available data related to safety concerns, and the conclusion by the Committee that the risks are greater than the benefits in adults with dyslipidaemia. For further details, please see a related Q&A document at the link below.   The EMA recently advised that no new patients be started on tre...
Source: NeLM - Cardiovascular Medicine - January 14, 2013 Category: Cardiology Source Type: news

Relationship between urinary albumin excretion and blood pressure in the community pharmacy: the Palmera study
Source: American Journal of Hypertension Area: Evidence > Medicines Management > References Letter commenting on a paper by Andreadis et al. (Am J Hypertens Sep 2012;25(9):969-973) which showed that systolic and diastolic automated office blood pressure (BP) (AOBP) readings were independently associated with urine albumin and the presence of microalbuminuria.  As part of the Palmera study in Spain, the writers collected data on urinary albumin-to-creatinine ratio (ACR) from 70 treated hypertensive patients (average age: 61.8 +/- 12.4 years; women: 44.3%).  Blood pressure was measured by a physician ...
Source: NeLM - Cardiovascular Medicine - January 14, 2013 Category: Cardiology Source Type: news

RCT of oral treprostinil monotherapy for treatment of pulmonary arterial hypertension
Source: Circulation Area: News Parenteral and inhaled prostacyclin analogue therapies are effective for the treatment of pulmonary arterial hypertension (PAH), but complicated administration requirements can limit the use of these therapies in patients with less severe disease.   The Freedom-M trial study was designed to evaluate the safety and efficacy of the oral prostacyclin analogue, treprostinil diolamine, as initial treatment for de novo PAH. The study involved 349 patients (intent-to-treat population [ITT]) who were randomised to treprostinil, (n=233) or placebo (n=116). Study drug was administered every 1...
Source: NeLM - Cardiovascular Medicine - January 11, 2013 Category: Cardiology Source Type: news

European Medicines Agency update on combined contraceptives and risk of venous thromboembolism
Source: Eur Meds Agency Area: News The European Medicines Agency has issuing this update in response to growing media reports about combined contraceptives and venous thromboembolism (VTE). The Agency states it is well-established that these agents carry a very rare risk of VTW, and this risk differs between types of combined contraceptives. It stresses that these products are constantly and rigorously kept under close monitoring and there is currently no new evidence that would suggest any change to the known safety profile of any combined contraceptives marketed at present. Therefore, there is no reason for any woman to...
Source: NeLM - Cardiovascular Medicine - January 11, 2013 Category: Cardiology Source Type: news

MSD provides update on next steps for suspension of TredaptiveT (nicotinic acid/laropiprant)
Source: MSD Area: News MSD has announced that it is taking steps to suspend the availability of TredaptiveT (nicotinic acid/laropiprant, MSD) modified-release tablets worldwide. This action follows company the release of preliminary data from the HPS2-THRIVE (Heart Protection Study 2-Treatment of HDL to Reduce the Incidence of Vascular Events) study, and in consultation with regulatory authorities.   HPS2-THRIVE did not achieve its primary endpoint of reduction of major vascular events, and there was a statistically significant increase in the incidence of some types of non-fatal serious adverse events in the gro...
Source: NeLM - Cardiovascular Medicine - January 11, 2013 Category: Cardiology Source Type: news

Review: Cardioprotection- chances and challenges of its translation to the clinic
Source: Lancet Area: News Cardioprotection is a broad term that refers to all strategies aimed at the attenuation of injurious results of myocardial ischaemia and reperfusion. Such injury consists of arrhythmias, impairment of cardiac contractile function and coronary blood flow, and myocardial infarction. In this review, the author focuses on the reduction of myocardial infarct size, which is not only an unambiguous endpoint of studies into cardioprotection, but also a major determinant of prognosis. (Source: NeLM - Cardiovascular Medicine)
Source: NeLM - Cardiovascular Medicine - January 11, 2013 Category: Cardiology Source Type: news

NHS Evidence expert commentary: Benefits of drug therapy are unclear for mild hypertension
Source: NHS Evidence Area: News The January edition of 'Eyes on Evidence', the free monthly e-bulletin from NHS Evidence covering major new published evidence as it emerges with an explanation about what it means for current practice, includes an expert commentary on new data from a Cochrane review that aimed to quantify the effects of antihypertensive drug therapy versus no treatment on mortality and morbidity in adults with mild hypertension and no evidence of cardiovascular disease. It included four RCTs with 8912 participants. The review concluded that, compared with placebo, antihypertensive treatment does not reduce...
Source: NeLM - Cardiovascular Medicine - January 10, 2013 Category: Cardiology Source Type: news

Factors associated with non-adherence to three hypertension self-management behaviors: preliminary data for a new instrument
Source: Journal of General Internal Medicine Area: Evidence > Medicines Management > References Background: Clinicians have difficulty in identifying patients who are unlikely to adhere to hypertension self-management.  Identifying non-adherence is essential to addressing suboptimal blood pressure control and high costs. Objectives: 1) To identify risk factors associated with non-adherence to three key self-management behaviours in patients with hypertension: proper medication use, diet and exercise; 2) To evaluate the extent to which an instrument designed to identify the number of risk factors presen...
Source: NeLM - Cardiovascular Medicine - January 10, 2013 Category: Cardiology Source Type: news

RPS assessment of research into effects of lycopene on the risk of heart attack, stroke and cancer
Source: Royal Pharmaceutical Society Area: News The Royal Pharmaceutical Society has featured a report on a small study in which scientists claim a single pill which contains a chemical found in tomato skin (lycopene) could cut the risk of heart attacks, stroke and even slow down the development of cancer.   The two-month study looked at 36 patients with pre-existing heart disease, who were already taking cholesterol-lowering statin drugs, and 36 healthy volunteers. Tests showed that the natural remedy boosts the elasticity and efficiency of blood vessels; in turn this reduces the hardening of the arteries which ...
Source: NeLM - Cardiovascular Medicine - January 8, 2013 Category: Cardiology Source Type: news

Statins and the risk of interstitial lung disease: a cohort study
Source: Thorax Area: News A large cohort study Published early online in Thorax has concluded that there is no association between statin use and the incidence of interstitial lung disease (ILD).   Previously, case reports have suggested that the use of statins may be associated with an increase in the risk of ILD. Data from the Quebec health administrative databases during 1990-2005 was evaluated, and a nested case-control analysis of the relationship between statins and the risk of ILD as defined by specialist visits or hospitalisations were identified. The cohort included over 1.4 million patients, of which 66...
Source: NeLM - Cardiovascular Medicine - January 8, 2013 Category: Cardiology Source Type: news

The debate for generics: a view on statin therapy
Source: JAMA Internal Medicine Area: News Related to the results of a survey of US Physicians in which researchers sought to determine how frequently physicians comply with requests for brand-name drugs or the factors predicting this behaviour, JAMA Internal Medicine has featured a review of the case for generics when considering statin therapy.   The review considers the following: . Comparing statin efficacy . The choice of generic statins   The authors conclude that "lowering LDL-C level does not always reduce cardiovascular risk, although risk reduction is the appropriate goal of therap...
Source: NeLM - Cardiovascular Medicine - January 8, 2013 Category: Cardiology Source Type: news

RCT: Omega-3 fatty acids for prevention of recurrent symptomatic atrial fibrillation (FORWARD)
Source: J Am Coll Cardiol Area: News Polyunsaturated fatty acids (n-3 PUFA) have been reported to reduce ventricular arrhythmias and it has been speculated that some of these antiarrhythmic properties might also be translated to a decrease of atrial arrhythmias. However, results of RCTs have been conflicting.   The FORWARD (Randomized Trial to Assess Efficacy of PUFA for the Maintenance of Sinus Rhythm in Persistent Atrial Fibrillation) trial assessed the efficacy of n-3 PUFA for the prevention of recurrent atrial fibrillation (AF) in patients with normal sinus rhythm. The study was conducted at 42 Argentinean ce...
Source: NeLM - Cardiovascular Medicine - January 4, 2013 Category: Cardiology Source Type: news

Concomitant use of antiplatelet therapy with dabigatran or warfarin in the randomised evaluation of long-term anticoagulation therapy (RE-LY®) trial: subgroup analysis
Source: Circulation Area: News RE-LY showed that dabigatran etexilate 150 mg bid (DE150) was superior, and 110 mg bid (DE110) non-inferior to warfarin in preventing stroke and systemic embolism (SSE) in patients with atrial fibrillation (AF). A common clinical dilemma regarding treatment of patients with AF is the need to use concomitant antiplatelets for a variety of reasons. While the combination of OAC and antiplatelets carry the potential of additive benefits, they also carry the danger of increased risk of bleeding.   With the emergence of dabigatran, questions on its efficacy and safety in patients receivin...
Source: NeLM - Cardiovascular Medicine - January 4, 2013 Category: Cardiology Source Type: news

RCT: Omega-3 fatty acids for prevention of recurrent symptomatic atrial fibrillationFORWARD)
Source: J Am Coll Cardiol Area: News Polyunsaturated fatty acids (n-3 PUFA) have been reported to reduce ventricular arrhythmias and it has been speculated that some of these antiarrhythmic properties might also be translated to a decrease of atrial arrhythmias. However, results of RCTs have been conflicting.   The FORWARD (Randomized Trial to Assess Efficacy of PUFA for the Maintenance of Sinus Rhythm in Persistent Atrial Fibrillation) trial assessed the efficacy of n-3 PUFA for the prevention of recurrent atrial fibrillation (AF) in patients with normal sinus rhythm. The study was conducted at 42 Argentinean ce...
Source: NeLM - Cardiovascular Medicine - January 4, 2013 Category: Cardiology Source Type: news

Lipid lowering efficacy of atorvastatin
Source: Cochrane Area: Evidence > Drug Specific Reviews Background   Atorvastatin is one of the most widely prescribed drugs and the most widely prescribed statin in the world. It is therefore important to know the dose-related magnitude of effect of atorvastatin on blood lipids.       Objectives     To quantify the dose-related effects of atorvastatin on blood lipids and withdrawals due to adverse effects (WDAE). Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library Issue 4, 2011, MEDLINE (1966 to November ...
Source: NeLM - Cardiovascular Medicine - January 3, 2013 Category: Cardiology Source Type: news

Optimal loading dose of warfarin for the initiation of oral anticoagulation
Source: Cochrane Area: Evidence > Drug Specific Reviews Background   Warfarin is used as an oral anticoagulant. However, there is wide variation in patient response to warfarin dose. This variation, as well as the necessity of keeping within a narrow therapeutic range, means that selection of the correct warfarin dose at the outset of treatment is not straightforward.       Objectives     To assess the effectiveness of different initiation doses of warfarin in terms of time in-range, time to INR in-range and effect on serious adverse events.     ...
Source: NeLM - Cardiovascular Medicine - January 3, 2013 Category: Cardiology Source Type: news

Systematic review and meta-analysis assesses risk of venous thromboembolic events associated with VEGFR-TKIs
Source: Int J Cancer Area: News There have been concerns about the risk of venous thromboembolism with the use of vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitors (TKIs) but the risk has not been clearly defined. This meta-analysis aimed to determine the incidence and relative risk (RR) of venous thromboembolic events (VTEs) associated with these agents.   The review included phase II and III prospective trials evaluating pazopanib, sunitinib, sorafenib and vandetanib that included data on VTEs. Overall, 14 studies (n= 4430) were selected for the meta-analysis and the following findi...
Source: NeLM - Cardiovascular Medicine - January 3, 2013 Category: Cardiology Source Type: news

FDA approves lomitapide (Juxtapid) for treatment of homozygous familial hypercholesterolaemia
Source: BioSpace Area: News The FDA has approved lomitapide (Juxtapid) to reduce LDL cholesterol, total cholesterol, apolipoprotein B, and non-HDL cholesterol in patients with homozygous familial hypercholesterolemia (HoFH). Lomitapide is intended for use in combination with a low fat diet and other lipid-lowering treatments. It is taken as a capsule once a day, without food, and at least two hours after the evening meal. Patients should take supplements that contain fat-soluble vitamins and essential fatty acids daily while on this treatment.   The safety and effectiveness of lomitapide have been evaluated in a...
Source: NeLM - Cardiovascular Medicine - January 3, 2013 Category: Cardiology Source Type: news

In search of the right word: a statement of the HEART Group on scientific language
Source: European Heart Journal Area: Evidence > Medicines Management > References Editorial calling for the use of precise terminology when describing observational studies as opposed to randomised trials - see also editorial statement, Eur Heart J Jan 2013;34(1):20-21. (Source: NeLM - Cardiovascular Medicine)
Source: NeLM - Cardiovascular Medicine - January 2, 2013 Category: Cardiology Source Type: news

Statement on matching language to the type of evidence used in describing observational studies vs. randomized trials
Source: European Heart Journal Area: Evidence > Medicines Management > References Observational studies and randomised controlled trials (RCTs) provide different types of evidence for the evaluation of a therapeutic intervention.  Each has advantages and disadvantages.  As illustrated in a series of examples in a separate review, interpretation of observational studies, which are relatively descriptive, can be confounded and rendered ambiguous by the fact that many variables impacting outcomes can differ between studies.  See also a related editorial (Eur Heart J Jan 2013;34(1):7-9). (Source: NeLM ...
Source: NeLM - Cardiovascular Medicine - January 2, 2013 Category: Cardiology Source Type: news