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Reply Recent Diabetes and Atrial Fibrillation Report Diverges From Pre-Existing Evidence
We are delighted to recognize the thoughtful work by Overvad et al. (1) and Saliba et al. (2). The association of diabetes and ischemic stroke risk in patients with atrial fibrillation (AF) was first observed more than 20 years ago (3). Yet, there is scant published data analyzing this association by the core epidemiological components of diabetes duration and glycemic control.
Source: Journal of the American College of Cardiology - May 10, 2016 Category: Cardiology Source Type: research

Left Atrial Appendage Closure in Patients With Contraindications to Oral Anticoagulation
The PROTECT AF (Watchman Left Atrial Appendage Closure Technology for Embolic Protection in Patients With Atrial Fibrillation) and PREVAIL (Prospective Randomized Evaluation of the Watchman LAA Closure Device In Patients With Atrial Fibrillation Versus Long-Term Warfarin Therapy) trials revealed that in atrial fibrillation (AF) patients suitable for oral anticoagulation (OAC), mechanical left atrial appendage closure (LAAC) with a catheter-delivered heart implant device (Watchman; Boston Scientific, Marlborough, Massachusetts) is effective for stroke prevention (1,2). Importantly, these patients received at least 6 weeks ...
Source: Journal of the American College of Cardiology - May 3, 2016 Category: Cardiology Source Type: research

Adherence to Medical Therapy and the Global Burden of Cardiovascular Disease ∗
Ischemic heart disease and cerebrovascular disease account for>20% of worldwide mortality and are the 2 leading causes of death on a global basis (1). Although mortality from ischemic heart disease is greater than that from stroke worldwide, the mortality from stroke is actually higher than from ischemic heart disease in 39% of countries. For example, mortality from stroke is generally higher than that for ischemic heart disease in China, Africa, and South America. In addition, stroke disability–adjusted life-year loss rates exceed ischemic heart disease-related disability in 32% of countries (2). Because of this, strate...
Source: Journal of the American College of Cardiology - March 29, 2016 Category: Cardiology Source Type: research

Device Closure of Patent Foramen Ovale After Stroke Pooled Analysis of Completed Randomized Trials
ConclusionsAmong patients with PFO and cryptogenic stroke, closure reduced recurrent stroke and had a statistically significant effect on the composite of stroke, transient ischemic attack, and death in adjusted but not unadjusted analyses.
Source: Journal of the American College of Cardiology - February 23, 2016 Category: Cardiology Source Type: research

Impact of CYP2C19 Metabolizer Status on Patients With ACS Treated With Prasugrel Versus Clopidogrel
ConclusionsCYP2C19 metabolizer status is not associated with the composite outcome of cardiovascular death, MI, or stroke in medically managed ACS patients treated with clopidogrel or prasugrel. Our findings do not support routine CYP2C19 genetic testing in this population. (A Comparison of Prasugrel and Clopidogrel in Acute Coronary Syndrome Subjects [TRILOGY ACS]; NCT00699998)
Source: Journal of the American College of Cardiology - February 23, 2016 Category: Cardiology Source Type: research

Effect of Diabetes and Glycemic Control on Ischemic Stroke Risk in AF Patients ATRIA Study
BackgroundDiagnosed diabetes mellitus (DM) is a consistently documented risk factor for ischemic stroke in patients with atrial fibrillation (AF).ObjectivesThe purpose of this study was to assess the association between duration of diabetes and elevated hemoglobin A1c (HbA1c) with risk of stroke among diabetic patients with AF.MethodsWe assessed this association in the ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) California community-based cohort of AF patients (study years 1996 to 2003) where all events were clinician adjudicated. We used Cox proportional hazards regression to estimate the rate of isc...
Source: Journal of the American College of Cardiology - January 19, 2016 Category: Cardiology Source Type: research

Mechanical Thrombectomy for Acute Ischemic Stroke A Meta-Analysis of Randomized Trials
This study systematically determined if mechanical thrombectomy after usual care would be associated with better outcomes in patients with acute ischemic stroke caused by large artery occlusion.MethodsThe authors included randomized trials that compared mechanical thrombectomy after usual care versus usual care alone for acute ischemic stroke. Random effects summary risk ratios (RR) were constructed using a DerSimonian and Laird model.ResultsNine trials with 2,410 patients were available for analysis. Compared with usual care alone, mechanical thrombectomy was associated with a higher incidence of achieving good functional...
Source: Journal of the American College of Cardiology - November 30, 2015 Category: Cardiology Source Type: research

Treatment of Dyslipidemia in Elderly Patients With Coronary Heart Disease There Are Miles to Go Before We Sleep ∗
The treatment of dyslipidemia with statin therapy is a cornerstone in the management of patients in both the primary and secondary prevention settings. Dyslipidemia is widely prevalent in its various forms (1). The lowering of low-density lipoprotein cholesterol (LDL-C) with a statin in patients with established coronary heart disease (CHD) has shown unequivocal capacity to safely reduce risk for clinical sequelae such as nonfatal myocardial infarction, ischemic stroke, cardiovascular and all-cause mortality, as well as the need for revascularization (2,3). The American College of Cardiology/American Heart Association Guid...
Source: Journal of the American College of Cardiology - October 19, 2015 Category: Cardiology Source Type: research

Comparative Performance of ATRIA, CHADS 2 , and CHA 2 DS 2 -VASc Risk Scores Predicting Stroke in Patients With Atrial Fibrillation Results From a National Primary Care Database
ConclusionsThe ATRIA score performed better in the U.K. Clinical Practice Research Datalink AF cohort. It more accurately identified low-risk patients than the CHA2DS2-VASc score, which assigned these patients to higher-risk categories. Such reclassification of stroke risk could prevent overuse of anticoagulants in very low stroke risk patients with AF.
Source: Journal of the American College of Cardiology - October 19, 2015 Category: Cardiology Source Type: research

Age, Ethnicity, and Stroke Risk in Patients With Atrial Fibrillation Another Stitch in the Patchwork ∗
The frequency with which clinicians encounter patients with nonvalvular atrial fibrillation (AF) and its association with ischemic stroke make estimation of the risk borne by individuals a daily issue in contemporary cardiology practice across the globe. In the balance lies the decision to employ long-term anticoagulation therapy with its attendant risk of severe bleeding. A variety of clinical risk scores are available to guide this decision, most prominently the CHA2DS2-VASc score, which cumulates the widely accepted, if unequally validated, clinical risk factors: heart failure (or impaired left ventricular function), hy...
Source: Journal of the American College of Cardiology - September 14, 2015 Category: Cardiology Source Type: research

Age Threshold for Increased Stroke Risk Among Patients With Atrial Fibrillation A Nationwide Cohort Study From Taiwan
This study hypothesized that the age threshold (65 years) used in the CHA2DS2-VASc system for initiating oral anticoagulants (OACs) might be lower in Taiwanese AF patients than in non-Asians.MethodsWe used the National Health Insurance Research Database in Taiwan to study 186,570 nonanticoagulated AF patients. There were 9,416 males with a CHA2DS2-VASc score of 0 and 6,390 females with a CHA2DS2-VASc score of 1. Their risk of ischemic stroke was analyzed with stratification on the basis of age.ResultsThe annual risks of ischemic stroke for males (score 0) and females (score 1) were 1.15% and 1.12%, respectively, and contin...
Source: Journal of the American College of Cardiology - September 14, 2015 Category: Cardiology Source Type: research

Duration of Triple Therapy in Patients Requiring Oral Anticoagulation After Drug-Eluting Stent Implantation
We read with much interest the paper and editorial by Fiedler et al. (1) and Bhatt et al. (2) regarding the optimal duration of dual antiplatelet therapy (DAPT) in patients on systemic anticoagulation in a recent issue of the Journal. In this randomized, open-label trial, 614 patients underwent drug-eluting stent (DES) implantation and were randomized to either 6 weeks or 6 months of clopidogrel therapy. They found no difference in the primary endpoint (composite of death, myocardial infarction, definite stent thrombosis, stroke, or TIMI [Thrombolysis In Myocardial Infarction] major bleeding) between the 2 groups (9.8...
Source: Journal of the American College of Cardiology - August 24, 2015 Category: Cardiology Source Type: research

Measuring Blood microRNAs to Provide Personalized Advice to Sleep Apnea Patients With Resistant Hypertension Dreaming the Future ∗
Obstructive sleep apnea (OSA; defined as>15 episodes of obstructive apnea and hypopnea per hour of sleep) was recently estimated to affect 13% of men and 6% of women (1), the prevalence having increased substantially over the last 2 decades in parallel with rising rates of obesity. OSA is associated with a 2- to 3-fold increase in the risk of stroke, ischemic heart disease, heart failure, and sudden death (2). One of the main putative mechanisms for increased OSA-related cardiovascular risk is systemic hypertension. Epidemiological studies have shown an independent association between OSA and prevalent and incident hyper...
Source: Journal of the American College of Cardiology - August 24, 2015 Category: Cardiology Source Type: research

The Challenge of Getting it Just Right Optimizing Long-Term Antithrombotic Therapy After Acute Coronary Syndrome ∗
Acute coronary syndrome (ACS) is associated with substantial morbidity and mortality (1,2). Initial treatment in the hospital consists of intensive antithrombotic therapy combining parenteral anticoagulation with antiplatelet therapy, whereas secondary prevention relies primarily on dual antiplatelet therapy (DAPT), most commonly aspirin and clopidogrel. However, patients with ACS remain at significant risk of recurrent adverse cardiovascular events (3). Mitigation of this risk requires a delicate balance between escalation of antithrombotic therapy to reduce ischemic events, while hoping the increase in bleeding is tolera...
Source: Journal of the American College of Cardiology - August 10, 2015 Category: Cardiology Source Type: research

Apixaban Plus Mono Versus Dual Antiplatelet Therapy in Acute Coronary Syndromes Insights From the APPRAISE-2 Trial
ConclusionsPost-ACS treatment with apixaban versus placebo showed no efficacy, but it increased bleeding regardless of concomitant therapy with aspirin alone or aspirin plus clopidogrel. (Apixaban for Prevention of Acute Ischemic Events 2 [APPRAISE-2]; NCT00831441)
Source: Journal of the American College of Cardiology - August 10, 2015 Category: Cardiology Source Type: research

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