Groundbreaking studies on the diagnosis, treatment, and prevention of stroke and heart disease were presented at the American Heart Association's scientific meeting in November.
The American Heart Association Scientific Sessions: Recap for Pharmacists
The American Heart Association Scientific Sessions 2010, held November 13 to 17, 2010, in Chicago, Illinois, featured a variety of exciting announcements from key studies focusing on the diagnosis, treatment, and prevention of cardiovascular disease and stroke. Here is a summary of the results from 10 studies of interest to pharmacists.
CETP-Inhibitor Dramatically Lowers Bad Cholesterol, Raises Good
In one of the most anticipated presentations of this year’s conference, researchers from the Determining the EFficacy and Tolerability of CETP INhibition with AnacEtrapib (DEFINE) trial reported that the experimental cholesterol drug anacetrapib reduced low-density lipoprotein (LDL) cholesterol by 40% and more than doubled high-density lipoprotein (HDL) cholesterol without raising blood pressure in patients who were already taking statins or other lipid-lowering agents. Christopher Cannon, MD, senior investigator of the TIMI Study Group in the cardiovascular division of Brigham and Women’s Hospital, said, “Anacetrapib has a knock-your-socks-off effect on HDL and a jaw-dropping effect on LDL.” Cannon also noted, “These changes are striking because virtually all the patients in the study were already taking cholesterol- lowering drugs and achieved previously unattainable levels of good and bad cholesterol….If the cardiovascular effects are borne out by future research, it would be a very promising approach to reducing cardiovascular events in patients with or prone to atherosclerosis.” Read more at http://hcp.lv/9Va0KH.
No Relationship Between Stroke Risk and Vitamin D Deficiency in African Americans
Analysis of data from the Third National Health and Nutrition Examination Survey (NHANES-III) of Americans revealed that although vitamin D deficiency nearly doubled the risk of fatal stroke among Caucasians, there was no corresponding relationship between fatal stroke and vitamin D deficiency among African Americans. Lead researcher Erin Michos, MD, MHS, assistant professor of medicine at Johns Hopkins University School of Medicine, said that the results were surprising because not only were African Americans in the study much more likely to be vitamin D deficient compared with their Caucasian counterparts (32% vs 7%), but African Americans in the study also had a 60% higher risk of dying from stroke compared with Caucasians. “We thought maybe the lower vitamin D levels might actually explain why blacks have higher risks for stroke.…But we did not find the same relationship between vitamin D and stroke in blacks,” he said. Read more at http://hcp.lv/9lqnDc.
How Can We Convince Patients to Take Their Meds?
Studies show that nearly 1 in 4 patients do not fill their initial prescription, and even if they do, adherence often decreases over time. Part of the problem is that nonadherence is underrecognized among providers and therefore undertreated. Effective interventions incorporate tailored instruction, frequent communication and counseling, and input from clinicians along the continuum of care, especially pharmacists. One particularly successful strategy is the ACE-ME model, which emphasizes the collaborative approach to adherence. Read more at http://hcp.lv/apbv71.
Just About Everyone Was Wrong About Nesiritide
Results from the ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure) trial revealed that although use of nesiritide in patients with decompensated heart failure did not increase the risk of death or renal failure, it was also not much better than placebo in improving breathing function. Robert M. Califf, MD, study chair and vice chancellor for clinical research at Duke University School of Medicine, said, “Now that we finally have a proper clinical trial, we know that both perceptions [about the risks and benefits of nesiritide] were incorrect; nesiritide is safe but has only a modest effect on dyspnea. This is a major signal that we must do a better job defining the biological effects of drugs early in development and conduct adequately powered outcomes trials much earlier to give doctors and patients the necessary information to enable appropriate use of the treatment in practice.” Read more at http:// hcp.lv/bXMoaQ.
New Anticlotting Drug Offers Alternative to Warfarin
Rivaroxaban is just as effective as warfarin in preventing stroke and embolism in patients with atrial fibrillation, without increasing their risk of bleeding. Robert M. Califf, MD, vice chancellor for clinical research at Duke University School of Medicine and coprincipal investigator of the Stroke Prevention Using the Oral Direct Factor Xa Inhibitor Rivaroxaban Compared With Warfarin in Patients with Nonvalvular Atrial Fibrillation (ROCKET-AF) trial, said that the availability of an alternative to warfarin that does not raise bleeding risk means that “we have a drug you can take once a day, without monitoring, which is at least as good as warfarin and causes no additional risk.” Read more at http://hcp. lv/fkYC8p.
Eplerenone Greatly Increases Survival in Patients With Systolic Heart Failure
Results from the Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure (EMPHASIS-HF) trial confirmed that patients with New York Heart Association class II heart failure and an ejection fraction of no more than 35% who received treatment with the aldosterone antagonist eplerenone had a 37% reduced combined risk of death and hospitalization compared with patients who received placebo. Lead author Faiez Zannad, MD, PhD, professor of therapeutics and director of the Clinical Investigation Center at the Nancy University Hospital Center in Nancy, France, said, “This treatment is certainly going to change the guidelines for mild heart failure. Now, patients with all kinds of severity of systolic heart failure, whether it is post-myocardial infarction, with mild or severe symptoms, are potentially eligible for some kind of aldosterone blockade, and certainly for eplerenone.” Read more at http://hcp.lv/dJ4j9t.
Prescription Omega-3 Is No Better Than Placebo for Atrial Fibrillation
Analysis of data from the Efficacy and Safety of Prescription Omega-3 Acid Ethyl Esters (P-OM3) for the Prevention of Recurrent Symptomatic Atrial Fibrillation trial found that patients with paroxysmal AF treated with prescription omega-3 experienced no significant reduction in time to first recurrence of symptoms compared with patients who received placebo. Researchers also reported no significant difference between treated persistent AF and the placebo group. Lead author Peter R. Kowey, MD, chief of cardiology at Main Line Health Hospital System in the Philadelphia area, said, “The trial’s major implication is that using prescription omega-3 in the vast majority of paroxysmal atrial fibrillation patients who do not have significant heart disease is fruitless.… In the absence of any data that it works, it is probably better not to take prescription omega-3.” However, Dr. Kowey and his fellow researchers were careful to point out that these findings should not be applied to omega-3 ingested from fish. “This was not a dietary study; this was a product manufactured from fish oil,” Dr. Kowey said. Read more at http://hcp.lv/ bFxQ20.
What Are the Best Options for Lowering Cholesterol in the Statin-Intolerant Patient?
Although determining whether a patient is truly statinintolerant can be difficult, clinicians who treat these patients do have several alternative medications from which to choose. However, researchers are divided on the merits of some of these options. Read more at http://hcp. lv/dd4G9L.
Seven Factors Linked to Better Cardiovascular Health
Results from the Multi-Ethnic Study of Atherosclerosis (MESA) show that adherence to the AHA’s “Life’s Simple 7” approaches to cardiovascular health, which include not smoking, keeping the body mass index below 25 kg/m2, keeping cholesterol below 200 mg/dL, and keeping blood pressure below 120/80 mm Hg, is associated with lower incidence of cardiovascular disease. Read more at http://hcp. lv/eKJkCv. High-Dose Clopidogrel No Better Than Standard Dose in Patients Implanted with Drug-Coated Stents Results from the Gauging Responsiveness With A VerifyNow Assay – Impact on Thrombosis and Safety (GRAVITAS) trial showed that giving patients with high residual platelet reactivity implanted with drug-coated stents (who face a higher risk of major poststent cardiovascular events) double the dose of the blood thinner clopidogrel does not reduce the incidence of death, heart attack, or blood clots. Lead investigator Matthew Price, MD, director of the Cardiac Catheterization Laboratory at the Scripps Clinic and assistant professor at the Scripps Translational Science Institute in La Jolla, California; said, “The high dose of clopidogrel doesn’t appear to improve outcomes, so alternative treatment strategies should be tested.” Read more at http://hcp.lv/blHwpq. PT
Todd Kunkler is editorial director of the MDNG family of publications, part of the HCPLive.com network for health care professionals.