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Prevalence of Peripheral Artery Disease by Abnormal Ankle-Brachial Index in Atrial Fibrillation: Implications for Risk and Therapy
Nonvalvular atrial fibrillation (NVAF) is the most common sustained arrhythmia encountered in clinical practice and is associated with a 5-fold increased risk for stroke . Moreover, patients with NVAF often suffer from atherosclerotic complications such as acute myocardial infarction (AMI) . Peripheral artery disease (PAD) is an established marker of systemic atherosclerosis but its prevalence in NVAF is still unclear. We reasoned that inclusion of ankle-brachial index (ABI), which is an established tool for diagnosis of PAD , in the CHA2DS2-VASc score would better define the prevalence of vascular disease.
Source: Journal of the American College of Cardiology - August 16, 2013 Category: Cardiology Authors: Francesco Violi, Giovanni Daví, William Hiatt, Gregory Y.H. Lip, Gino R. Corazza, Francesco Perticone, Marco Proietti, Pasquale Pignatelli, Anna R. Vestri, Stefania Basili, ARAPACIS Study Investigators Tags: Research Correspondence Source Type: research

Low High-Density Lipoprotein Cholesterol Is Not a Risk Factor for Recurrent Vascular Events in Patients With Vascular Disease on Intensive Lipid-Lowering Medication
Conclusions: In patients with clinically manifest vascular disease using no or usual dose lipid-lowering medication, low plasma HDL-C levels are related to increased vascular risk, whereas in patients using intensive lipid-lowering medication, HDL-C levels are not related to vascular risk.
Source: Journal of the American College of Cardiology - August 14, 2013 Category: Cardiology Authors: Anton P. van de Woestijne, Yolanda van der Graaf, An-Ho Liem, Maarten J.M. Cramer, Jan Westerink, Frank L.J. Visseren, SMART Study Group Tags: Cardiometabolic Risk Source Type: research

Carotid Revascularization Before Open Heart Surgery: The Data-Driven Treatment Strategy∗
Optimal management of high-grade obstructive carotid artery disease at the time of open heart surgery (OHS) has never been addressed in a randomized clinical trial. Data suggest that the combined approach of carotid endarterectomy (CEA) and OHS leads to a higher risk of procedural stroke , and, therefore, staged carotid revascularization by CEA or carotid artery stenting (CAS) is often performed before OHS. Does the staged approach lead to an overall reduction in the rate of major adverse cardiovascular events (MACE = death, myocardial infarction, and stroke) for patients with concomitant coronary and cerebrovascular di...
Source: Journal of the American College of Cardiology - August 2, 2013 Category: Cardiology Authors: Ehtisham Mahmud, Ryan Reeves Tags: Coronary Artery Disease: Editorial Comment Source Type: research

Relationship of Lipoproteins to Cardiovascular Events: The AIM-HIGH Trial (Atherothrombosis Intervention in Metabolic Syndrome With Low HDL/High Triglycerides and Impact on Global Health Outcomes)
This study sought to examine the relationship between niacin treatment, lipoproteins, and cardiovascular (CV) outcomes in this secondary analysis of the AIM-HIGH (Atherothrombosis Intervention in Metabolic Syndrome With Low HDL/High Triglycerides and Impact on Global Health Outcomes) trial.Background: During a 3-year follow-up in 3,414 patients with established CV disease and low high-density lipoprotein cholesterol (HDL-C) levels, combined niacin + low-density lipoprotein cholesterol (LDL-C)–lowering therapy did not reduce CV events compared with LDL-C–lowering therapy alone.Methods: Subjects taking simvastatin and/o...
Source: Journal of the American College of Cardiology - August 2, 2013 Category: Cardiology Authors: John R. Guyton, April E. Slee, Todd Anderson, Jerome L. Fleg, Ronald B. Goldberg, Moti L. Kashyap, Santica M. Marcovina, Stephen D. Nash, Kevin D. O'Brien, William S. Weintraub, Ping Xu, Xue-Qiao Zhao, William E. Boden Tags: Cardiometabolic Risk Source Type: research

A Direct Comparison of Early and Late Outcomes With Three Approaches to Carotid Revascularization and Open Heart Surgery
Conclusions: Staged CAS-OHS and combined CEA-OHS are associated with a similar risk of death, stroke, or MI in the short term, with both being better than staged CEA-OHS. However, the outcomes significantly favor staged CAS-OHS after the first year.
Source: Journal of the American College of Cardiology - July 22, 2013 Category: Cardiology Authors: Mehdi H. Shishehbor, Sridhar Venkatachalam, Zhiyuan Sun, Jeevanantham Rajeswaran, Samir R. Kapadia, Christopher Bajzer, Heather L. Gornik, Bruce H. Gray, John R. Bartholomew, Daniel G. Clair, Joseph F. Sabik, Eugene H. Blackstone Tags: Coronary Artery Disease Source Type: research

The ATLAS ACS 2–TIMI 51 Trial and the Burden of Missing Data: (Anti-Xa Therapy to Lower Cardiovascular Events in Addition to Standard Therapy in Subjects With Acute Coronary Syndrome ACS 2–Thrombolysis In Myocardial Infarction 51)
Rivaroxaban is a factor Xa inhibitor that was recently reviewed by the Food and Drug Administration as a potential therapy to reduce the risk of recurrent atherothrombotic events in patients with acute coronary syndromes. Approval of this drug would represent a paradigm shift away from dual antiplatelet therapy toward long-term triple antithrombotic therapy. However, to date, no other experimental anticoagulant agent has demonstrated a favorable risk-benefit profile in this population, in part because of the expected increased risk in major bleeding by combining aspirin, a P2Y12 receptor inhibitor, and an anticoagulant. Ap...
Source: Journal of the American College of Cardiology - June 10, 2013 Category: Cardiology Authors: Mori J. Krantz, Sanjay Kaul Tags: VIEWPOINT Source Type: research

Oral Anticoagulation and Antiplatelets in Atrial Fibrillation Patients After Myocardial Infarction and Coronary Intervention
Conclusions: In real-life AF patients with indication for multiple antithrombotic drugs after MI/PCI, OAC and clopidogrel was equal or better on both benefit and safety outcomes compared to triple therapy.
Source: Journal of the American College of Cardiology - June 10, 2013 Category: Cardiology Authors: Morten Lamberts, Gunnar H. Gislason, Jonas Bjerring Olesen, Søren Lund Kristensen, Anne-Marie Schjerning Olsen, Anders Mikkelsen, Christine Benn Christensen, Gregory Y.H. Lip, Lars Køber, Christian Torp-Pedersen, Morten Lock Hansen Tags: Coronary Artery Disease Source Type: research

Antithrombotic Regimens in Patients With Atrial Fibrillation and Coronary Disease: Optimizing Efficacy and Safety∗
Clear evidence supports the value of oral anticoagulation (OAC) with vitamin K antagonists in preventing stroke and thromboembolism in patients with atrial fibrillation (AF) who have well-established risk factors. For this indication, vitamin K antagonists have been shown to be superior to single or dual antiplatelet agents in reducing thromboembolic complications . Yet, up to 30% of patients with AF also have indications for antiplatelet therapy because of coronary artery disease . Dual antiplatelet therapy with aspirin and a P2Y12 receptor inhibitor (e.g., clopidogrel) is usually recommended after stent implantation or a...
Source: Journal of the American College of Cardiology - June 10, 2013 Category: Cardiology Authors: Steven M. Markowitz Tags: Coronary Artery Disease: Editorial Comment Source Type: research

Rivaroxaban in Patients Stabilized After a ST-Segment Elevation Myocardial Infarction: Results From the ATLAS ACS-2–TIMI-51 Trial (Anti-Xa Therapy to Lower Cardiovascular Events in Addition to Standard Therapy in Subjects with Acute Coronary Syndrome–Thrombolysis In Myocardial Infarction-51)
Objectives: The present analysis reports on the pre-specified subgroup of ST-elevation myocardial infarction (STEMI) patients, in whom anticoagulant therapy has been of particular interest. Background: In ATLAS ACS-2–TIMI-51 (Anti-Xa Therapy to Lower Cardiovascular Events in Addition to Standard Therapy in Subjects with Acute Coronary Syndrome–Thrombolysis In Myocardial Infarction-51), rivaroxaban reduced cardiovascular events across the spectrum of acute coronary syndrome (ACS). Methods: Seven thousand eight hundred seventeen patients in ATLAS ACS-2-TIMI 51 presented with a STEMI. After being stabilized (1 to 7 d...
Source: Journal of the American College of Cardiology - May 1, 2013 Category: Cardiology Authors: Jessica L. Mega, Eugene Braunwald, Sabina A. Murphy, Alexei N. Plotnikov, Paul Burton, Robert Gabor Kiss, Alexander Parkhomenko, Michal Tendera, Petr Widimsky, C. Michael Gibson Tags: Coronary Artery Disease Source Type: research

Primary Percutaneous Coronary Intervention: The Deception of Delay⁎
Primary percutaneous coronary intervention (PCI) has become the predominant reperfusion strategy for ST-segment elevation myocardial infarction (STEMI) throughout western healthcare systems. Recent estimates in the United States suggest that primary PCI is used in 85% of all STEMI cases that undergo reperfusion, with thrombolytic agents used in only 9% and the combination of thrombolytic agents with PCI in 6% (). This dramatic switch from thrombolytic therapy to primary PCI was the result of several studies conducted in the early 1990s that demonstrated the superiority of primary PCI at reducing stroke and reinfarction as ...
Source: Journal of the American College of Cardiology - April 17, 2013 Category: Cardiology Authors: Cindy L. Grines, Theodore Schreiber Tags: Acute Coronary Syndromes: Editorial Comment Source Type: research

The Transaortic Approach for Transcatheter Aortic Valve Replacement: Initial Clinical Experience in the United States
Conclusions: TAVR via the TAO approach is technically feasible, seems to be associated with favorable outcomes, and expands the current alternative options for access sites in patients with inoperable aortic stenosis who are ineligible for TF TAVR.
Source: Journal of the American College of Cardiology - April 12, 2013 Category: Cardiology Authors: Joel A. Lardizabal, Brian P. O'Neill, Harit V. Desai, Conrad J. Macon, Alexis P. Rodriguez, Claudia A. Martinez, Carlos E. Alfonso, Martin S. Bilsker, Roger G. Carillo, Mauricio G. Cohen, Alan W. Heldman, William W. O'Neill, Donald B. Williams Tags: Interventional Cardiology Source Type: research

Efficacy and Safety of Dabigatran Etexilate and Warfarin in “Real-World” Patients With Atrial Fibrillation: A Prospective Nationwide Cohort Study
Conclusions: In this “everyday clinical practice” post-approval nationwide clinical cohort, there were similar stroke/systemic embolism and major bleeding rates with dabigatran (both doses) compared with warfarin. Mortality, intracranial bleeding, pulmonary embolism, and MI were lower with dabigatran, compared with warfarin. We found no evidence of an excess of bleeding events or MI among dabigatran-treated patients in this propensity-matched comparison against warfarin, even in the subgroup with ≥1-year follow-up.
Source: Journal of the American College of Cardiology - April 4, 2013 Category: Cardiology Authors: Torben Bjerregaard Larsen, Lars Hvilsted Rasmussen, Flemming Skjøth, Karen Margrete Due, Torbjörn Callréus, Mary Rosenzweig, Gregory Y.H. Lip Tags: Atrial Fibrillation Source Type: research

Triple Therapy With Aspirin, Prasugrel, and Vitamin K Antagonists in Patients With Drug-Eluting Stent Implantation and an Indication for Oral Anticoagulation
This study sought to evaluate whether prasugrel may serve as an alternative to clopidogrel in patients with triple therapy. Background: Approximately 10% of patients who receive dual antiplatelet therapy after percutaneous coronary intervention have an indication for oral anticoagulation and are thus treated with triple therapy. The standard adenosine diphosphate receptor blocker in this setting is clopidogrel. Data regarding prasugrel as part of triple therapy are not available. Methods: We analyzed a consecutive series of 377 patients who underwent drug-eluting stent implantation and had an indication for oral antico...
Source: Journal of the American College of Cardiology - March 25, 2013 Category: Cardiology Authors: Nikolaus Sarafoff, Amadea Martischnig, Jill Wealer, Katharina Mayer, Julinda Mehilli, Dirk Sibbing, Adnan Kastrati Tags: Interventional Cardiology Source Type: research

Cost-Effectiveness of Statins for Primary Cardiovascular Prevention in Chronic Kidney Disease
Conclusions: Although statins reduce absolute CVD risk in patients with CKD, the increased risk of rhabdomyolysis, and competing risks associated with progressive CKD, partly offset these gains. Low-cost generic statins appear cost-effective for primary prevention of CVD in patients with mild-to-moderate CKD and hypertension.
Source: Journal of the American College of Cardiology - March 20, 2013 Category: Cardiology Authors: Kevin F. Erickson, Sohan Japa, Douglas K. Owens, Glenn M. Chertow, Alan M. Garber, Jeremy D. Goldhaber-Fiebert Tags: Cardiovascular Risk Source Type: research

Percutaneous Coronary Intervention Versus Coronary Bypass Surgery in United States Veterans With Diabetes
Conclusions: This study was severely underpowered for its primary endpoint, and therefore no firm conclusions about the comparative effectiveness of CABG and PCI are possible. There were interesting differences in the components of the primary endpoint. However, the confidence intervals are very large, and the findings must be viewed as hypothesis generating only. (Coronary Artery Revascularization in Diabetes; NCT00326196)
Source: Journal of the American College of Cardiology - February 20, 2013 Category: Cardiology Authors: Masoor Kamalesh, Thomas G. Sharp, X. Charlene Tang, Kendrick Shunk, Herbert B. Ward, James Walsh, Spencer King, Cindy Colling, Thomas Moritz, Kevin Stroupe, Domenic Reda, VA CARDS Investigators Tags: Interventional Cardiology Source Type: research

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