Rikshospitalet, University of Oslo

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Rikshospitalet, University of Oslo"

Transcription

1 Rikshospitalet, University of Oslo Preventing heart failure by preventing coronary artery disease progression European Society of Cardiology Dyslipidemia

2 Objectives The trends in cardiovascular diseases Effect of statins in preventing heart failure Dose dependency Effect of statins in established chronic heart failure Risk factors and cause of end points in chronic heart failure

3 Temporal trends in mortality rate and the development of heart failure after a first MI J.A. Ezekowitz et al. J Am Coll Cardiol 2009;53:13-20

4 Effect of statin therapy on coronary artery stenoses (quantitative coronary angiography) C.M.Ballantyne et al. Circulation 2008;117:00-00

5 Risk factors in cardiovascular disease Dyslipidemia Hypertension Diabetes Smoking Inactivity STATINS Atherosclerosis Sudden death Cardiac rupture Cardiogenic shock Myocardial infarction Non-fatal MI Non-fatal heart failure

6 ApoB/apoA-1 and glucose are associated with late development of heart failure in healthy individuals Follow up 11.8 years Holme I, Eur J Heart Fail 2009;11:1036

7 Objectives The trends in cardiovascular diseases Effect of statins in preventing heart failure Dose dependency Effect of statins in established heart failure Risk factors and cause of end points in chronic heart failure

8

9 Proportion without Heart Failure Prevention of Heart Failure by Simvastatin 4S 1.00 post hoc analysis Mo significant: -21%, p< Mo diverge Simvastatin 0.92 Placebo Months Since Randomization Kjekshus et al., J Cardiac Failure 1997;3:249-54

10 Effect of statin treatment on new onset heart failure in patients with CHD RCT post hoc Hazard ratio and 95% CI 4S PROSPER CARE MIRACLE LIPID ALLHAT ASCOT S40: 184/2221(8.3%) 288/2223(10.3%) P:112/2891(3.9%) 122/2913 (4.2%) P:146/2081(7.0%) 160/2078 (7.7%) A:40/1538 (2.6%) 43/1548 (2.8%) P:36/4512 (0.8%) 46/4502 (1.02%) P:243/5170 (4.7%) 248/5185(4.8%) A: 41/5168 (0.8%) 36/5137(0.7%) ALL 508/14975 (3.4%) 371/15015 (2.5%) p< Favours statin Favours placebo

11 Objectives Trend changes in targets for cardiovascular treatment Effect of statins in preventing heart failure Dose dependency Effect of statins in established heart failure Risk factors and cause of end points in chronic heart failure

12 Benefit of agressive and moderate statin doses on HF hospitalisation Acute coronary syndrome PROVE-IT Atorvastatin 80mg vs pravastatin 40 mg Stable coronary disease TNT Atorvastatin 80 mg vs atorvastatin 10 mg Scirica BM J Am Coll Cardiol 2006;47: Kush KK Circulation 2007;115:

13 Benefit of intensive vs moderate statin therapy on HF hospitalisation in patients with CHD RCT Hazard ratio and 95% CI IDEAL TNT PROVE-IT A-Z ALLIANCE A80: 99/24439 (2.2%) S40: 123/4449 (2.8%) A 80: 122/4995(2.4%) A10 :164/5006(3.3%) A 80: 36 /2099(1.6%) P40: 67/2063 (3.1%) S80: 72/2265 (3.7%) S20: 98/2232 (5.0%) A80: 42/1217 (3.5%) MOD: 56/1225 (4.5%) ALL 943/23586 (4.0%) 802/23581 (3.5%) p< Favours intensive statin Favours moderate statin

14 Benefit of atorvastatin 80 vs 10 mg on hospitalization for heart failure - with and without prior heart failure (classii-iiia) Kush KK Circulation 2007;115:

15 Objectives Trend changes in targets for cardiovascular treatment Effect of statins in preventing heart failure Dose dependency Effect of statins in chronic heart failure Risk factors and cause of end points in chronic heart failure

16 Effect of Rosuvastatin on left ventricular ejection fraction in patients with heart failure of ischemic and non-ischemic etiology Change in Left Ventricular EF (%) Ischemic and nonischemic CM LVEF <40% Randomised to rosuvastatin 20-40mg or placebo Follow up 6 months H.Krum et al. J Card Fail 2007;13:1-7

17 GISSI-HF investigators. Lancet, 2008 Kjekshus J, N Engl J Med 2007;357 Effects of rosuvastatin in patients with chronic heart All cause death failure GISSI-HF CORONA All cause death Primary outcome Cardiovascular events Death from any cause

18 Statins and mortality among patients with heart failure A meta analysis of observational and RCT studies GISSI Observational RCT K.Ramasubbu et al. JACC 2008;51:415-26

19 Total Number of Hospitalizations Placebo Rosuvastatin All cause p=0.007 CV cause p<0.001 Heart failure p=0.01 Unstable angina p=0.30 Non-CV cause Kjekshus J et al, N Engl J Med 2007;357

20 Risk factors in cardiovascular disease Non-fatal heart failure Dyslipidemia Hypertension LV dilatation Diabetes Asynchrony Smoking Hypertrophy Inactivity Inflammation Endothelial dysfunction Iron deficiency Ischemia Renal dysfunction Atherosclerosis Myocardial Progressive infarction heart failure Sudden death Cardiac rupture Non-fatal MI Cardiogenic shock Non-fatal heart Fatal heart failure failure Sudden arrhythmic death Stroke

21 Effects of Simvastatin on vascular events in participants subdivided by baseline N-BNP level Heart Protection Study Collaborative Group. JACC 2007;49:311-19

22 Primary Endpoint by NT-proBNP Tertile 1 (n= 1221) Tertile 2 (n= 1222) Tertile 3 (n= 1221) Hazard ratio= % CI Hazard ratio= % CI Interaction by treatment p= Hazard ratio= % CI Adjusted for baseline risk factors 2 With NT-proBNP as continous variable Cleland J et al. on behalf of CORONA Study Group

23 Primary Endpoint hs-crp <2.0 mg/l hs-crp 2.0 mg/l Per cent Placebo Rosuvastatin Per cent Placebo Rosuvastatin Hazard ratio % CI Hazard ratio % CI Months of follow-up No. at risk Placebo Rosu Interaction by treatment p= Months of follow-up

24 Coenzyme Q 10 and outcome in heart failure Effect of rosuvastatin A prespecified substudy of CORONA Coenzyme Q 10 μg/ml Tertile1 Tertile 2 Tertile 3 Placebo Rosuvastatin Placebo Rosuvastatin Placebo Rosuvastatin Baseline 6months Median change (%) P< P< P< probnppmol/l All cause mortality + hosp. for worsening HF HR(CI) 1.16( ) 0.82 ( ) Interaction by treatment p= ( ) McMurray JJV JACC 2010, in press

25 Conclusion Onset of heart failure increase mortality fourfold Statins preven de novo heart failure in a dose dependent manner The effect of statin declines with onset of heart failure with a cut point at NT-proBNP 100pmol/L (845pg/ml) Moderate and severe HF are determined by arrhythmic sudden death and progressive myocardial dysfunction, probably not driven by coronary atherosclerosis We need more accurate understanding of the causal pathway of cardiovascular death in mild, moderate and severe heart failure The importance of modulation of inflammatory actvity, coenzyme Q 10, irondeficiency, endothelial dysfunction and renal impairment need to be defined

26

JUPITER NEJM Poll. Panel Discussion: Literature that Should Have an Impact on our Practice: The JUPITER Study

JUPITER NEJM Poll. Panel Discussion: Literature that Should Have an Impact on our Practice: The JUPITER Study Panel Discussion: Literature that Should Have an Impact on our Practice: The Study Kaiser COAST 11 th Annual Conference Maui, August 2009 Robert Blumberg, MD, FACC Ralph Brindis, MD, MPH, FACC Primary

More information

The JUPITER trial: What does it tell us? Alice Y.Y. Cheng, MD, FRCPC January 24, 2009

The JUPITER trial: What does it tell us? Alice Y.Y. Cheng, MD, FRCPC January 24, 2009 The JUPITER trial: What does it tell us? Alice Y.Y. Cheng, MD, FRCPC January 24, 2009 Learning Objectives 1. Understand the role of statin therapy in the primary and secondary prevention of stroke 2. Explain

More information

Calculating RR, ARR, NNT

Calculating RR, ARR, NNT Calculating RR, ARR, NNT In a trial RR = Event rate (eg # of people with one stroke/ total people) in treatment group/event rate in the control group. ARR = Event rate in control group minus the event

More information

In-Ho Chae. Seoul National University College of Medicine

In-Ho Chae. Seoul National University College of Medicine The Earlier, The Better: Quantum Progress in ACS In-Ho Chae Seoul National University College of Medicine Quantum Leap in Statin Landmark Trials in ACS patients Randomized Controlled Studies of Lipid-Lowering

More information

Severe Left Ventricular Dysfunction: Evolving Revascularization Strategies

Severe Left Ventricular Dysfunction: Evolving Revascularization Strategies Severe Left Ventricular Dysfunction: Evolving Revascularization Strategies Robert O. Bonow, MD, MS, MACC Northwestern University Feinberg School of Medicine Bluhm Cardiovascular Institute Northwestern

More information

Landmark Clinical Trials.

Landmark Clinical Trials. Landmark Clinical Trials 1 Learning Objectives Discuss clinical trials and their role in lipid and lipoprotein treatment in cardiovascular prevention. Review the clinical trials of lipid-altering drug

More information

Diagnosis is it really Heart Failure?

Diagnosis is it really Heart Failure? ESC Congress Munich - 25-29 August 2012 Heart Failure with Preserved Ejection Fraction From Bench to Bedside Diagnosis is it really Heart Failure? Prof. Burkert Pieske Department of Cardiology Med.University

More information

Is Lower Better for LDL or is there a Sweet Spot

Is Lower Better for LDL or is there a Sweet Spot Is Lower Better for LDL or is there a Sweet Spot ALAN S BROWN MD, FACC FNLA FAHA FASPC DIRECTOR, DIVISION OF CARDIOLOGY ADVOCATE LUTHERAN GENERAL HOSPITAL, PARK RIDGE, ILLINOIS DIRECTOR OF CARDIOLOGY,

More information

HYPERLIPIDEMIA IN THE OLDER POPULATION NICOLE SLATER, PHARMD, BCACP AUBURN UNIVERSITY, HARRISON SCHOOL OF PHARMACY JULY 16, 2016

HYPERLIPIDEMIA IN THE OLDER POPULATION NICOLE SLATER, PHARMD, BCACP AUBURN UNIVERSITY, HARRISON SCHOOL OF PHARMACY JULY 16, 2016 HYPERLIPIDEMIA IN THE OLDER POPULATION NICOLE SLATER, PHARMD, BCACP AUBURN UNIVERSITY, HARRISON SCHOOL OF PHARMACY JULY 16, 2016 NOTHING TO DISCLOSE I, Nicole Slater, have no actual or potential conflict

More information

Relationship of CRP Reduction to Cardiovascular Event Reduction Following Treatment with Canakinumab

Relationship of CRP Reduction to Cardiovascular Event Reduction Following Treatment with Canakinumab AHA 2017 Residual Inflammatory Risk and Residual Cholesterol Risk: Critical Analysis from CANTOS Relationship of CRP Reduction to Cardiovascular Event Reduction Following Treatment with Paul M Ridker MD,

More information

Cholesterol Management Roy Gandolfi, MD

Cholesterol Management Roy Gandolfi, MD Cholesterol Management 2017 Roy Gandolfi, MD Goals Interpreting cholesterol guidelines Cholesterol treatment in diabetics Statin use and side effects therapy Reporting- Comparison data among physicians

More information

LDL cholesterol and cardiovascular outcomes?

LDL cholesterol and cardiovascular outcomes? LDL cholesterol and cardiovascular outcomes? Prof Kausik Ray, BSc (hons), MBChB, FRCP, MD, MPhil (Cantab), FACC, FESC Professor of Cardiovascular Disease Prevention St Georges University of London Honorary

More information

STATINS FOR PAD Long - term prognosis

STATINS FOR PAD Long - term prognosis STATINS FOR PAD Long - term prognosis Prof. Pavel Poredos, MD, PhD Department of Vascular Disease University Medical Centre Ljubljana Slovenia DECLARATION OF CONFLICT OF INTEREST No conflict of interest

More information

What have We Learned in Dyslipidemia Management Since the Publication of the 2013 ACC/AHA Guideline?

What have We Learned in Dyslipidemia Management Since the Publication of the 2013 ACC/AHA Guideline? What have We Learned in Dyslipidemia Management Since the Publication of the 2013 ACC/AHA Guideline? Salim S. Virani, MD, PhD, FACC, FAHA Associate Professor, Section of Cardiovascular Research Baylor

More information

Dyslipidemia in women: Who should be treated and how?

Dyslipidemia in women: Who should be treated and how? Dyslipidemia in women: Who should be treated and how? Lale Tokgozoglu, MD, FACC, FESC Professor of Cardiology Hacettepe University Faculty of Medicine Ankara, Turkey. Cause of Death in Women: European

More information

Effective Treatment Options With Add-on or Combination Therapy. Christie Ballantyne (USA)

Effective Treatment Options With Add-on or Combination Therapy. Christie Ballantyne (USA) Effective Treatment Options With Add-on or Combination Therapy Christie Ballantyne (USA) Effective treatment options with add-on or combination therapy Christie M. Ballantyne, MD Center for Cardiovascular

More information

Heart Failure. Guillaume Jondeau Hôpital Bichat, Paris, France

Heart Failure. Guillaume Jondeau Hôpital Bichat, Paris, France Heart Failure Guillaume Jondeau Hôpital Bichat, Paris, France Epidemiology Importance of PEF Europe I-PREFER study. Abstract: 2835 Prevalence of HF Preserved LV systolic Function older (65 vs 62 y, p

More information

HFpEF, Mito or Realidad?

HFpEF, Mito or Realidad? HFpEF, Mito or Realidad? Ileana L. Piña, MD, MPH Professor of Medicine and Epidemiology/Population Health Associate Chief for Academic Affairs -- Cardiology Montefiore-Einstein Medical Center Bronx, NY

More information

Dyslipedemia New Guidelines

Dyslipedemia New Guidelines Dyslipedemia New Guidelines New ACC/AHA Prevention Guidelines on Blood Cholesterol November 12, 2013 Mohammed M Abd El Ghany Professor of Cardiology Cairo Universlty 1 1 0 Cholesterol Management Pharmacotherapy

More information

Does High-Intensity Pitavastatin Therapy Further Improve Clinical Outcomes?

Does High-Intensity Pitavastatin Therapy Further Improve Clinical Outcomes? Late Breaking Clinical Trial Session at AHA 2017 Does High-Intensity Pitavastatin Therapy Further Improve Clinical Outcomes? The REAL-CAD Study in 13,054 Patients With Stable Coronary Artery Disease Takeshi

More information

2013 Cholesterol Guidelines. Anna Broz MSN, RN, CNP, AACC Adult Certified Nurse Practitioner North Ohio Heart, Inc.

2013 Cholesterol Guidelines. Anna Broz MSN, RN, CNP, AACC Adult Certified Nurse Practitioner North Ohio Heart, Inc. 2013 Cholesterol Guidelines Anna Broz MSN, RN, CNP, AACC Adult Certified Nurse Practitioner North Ohio Heart, Inc. Disclosures Speaker Gilead Sciences NHLBI Charge to the Expert Panel Evaluate higher quality

More information

Ischemic Heart and Cerebrovascular Disease. Harold E. Lebovitz, MD, FACE Kathmandu November 2010

Ischemic Heart and Cerebrovascular Disease. Harold E. Lebovitz, MD, FACE Kathmandu November 2010 Ischemic Heart and Cerebrovascular Disease Harold E. Lebovitz, MD, FACE Kathmandu November 2010 Relationships Between Diabetes and Ischemic Heart Disease Risk of Cardiovascular Disease in Different Categories

More information

LDL and the Benefits of Statin Therapy

LDL and the Benefits of Statin Therapy LDL and the Benefits of Statin Therapy Allan Sniderman McGill University ACC/AHA did not recommend a target-based approach. Right? P 2899 The Expert Panel was unable to find any RCTs that evaluated titration

More information

Lifetime clinical and economic benefits of statin-based LDL lowering in the 20-year Followup of the West of Scotland Coronary Prevention Study

Lifetime clinical and economic benefits of statin-based LDL lowering in the 20-year Followup of the West of Scotland Coronary Prevention Study Lifetime clinical and economic benefits of statin-based LDL lowering in the 20-year Followup of the West of Scotland Coronary Prevention Study Harvey White Green Lane Cardiovascular Service and Cardiovascular

More information

1. Which one of the following patients does not need to be screened for hyperlipidemia:

1. Which one of the following patients does not need to be screened for hyperlipidemia: Questions: 1. Which one of the following patients does not need to be screened for hyperlipidemia: a) Diabetes mellitus b) Hypertension c) Family history of premature coronary disease (first degree relatives:

More information

Cosa c è di nuovo nelle LLGG e nella gestione del paziente con scompenso cardiaco. Maurizio Volterrani IRCCS San Raffaele Rome Capri, 24 April 2015

Cosa c è di nuovo nelle LLGG e nella gestione del paziente con scompenso cardiaco. Maurizio Volterrani IRCCS San Raffaele Rome Capri, 24 April 2015 Cosa c è di nuovo nelle LLGG e nella gestione del paziente con scompenso cardiaco Maurizio Volterrani IRCCS San Raffaele Rome Capri, 24 April 2015 Treatment options for patients with chronic symptomatic

More information

ESC Guidelines for the Diagnosis and Treatment of Chronic Heart Failure

ESC Guidelines for the Diagnosis and Treatment of Chronic Heart Failure ESC Guidelines for the Diagnosis and Treatment of Chronic Heart Failure - 2005 Karl Swedberg Professor of Medicine Department of Medicine Sahlgrenska University Hospital/Östra Göteborg University Göteborg

More information

Placebo-Controlled Statin Trials EXPLAINING THE DECREASE IN DEATHS FROM CHD! PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN EXPLAINING THE DECREASE IN

Placebo-Controlled Statin Trials EXPLAINING THE DECREASE IN DEATHS FROM CHD! PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN EXPLAINING THE DECREASE IN PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest EXPLAINING THE DECREASE

More information

Traitements associés chez l hypertendu: Statines, Aspirine

Traitements associés chez l hypertendu: Statines, Aspirine Traitements associés chez l hypertendu: Statines, Aspirine Pr Jean-Jacques Mourad CHU Avicenne, Université Paris 13, Bobigny DU HTA, Mars 2012 jean-jacques.mourad@avc.aphp.fr Global Mortality 2000: Impact

More information

RAS Blockade Across the CV Continuum

RAS Blockade Across the CV Continuum A Summary of Recent International Meetings RAS Blockade Across the CV Continuum Copyright New Evidence Presented at the 2009 Congress of the European Society of Cardiology (August 29-September 2, Barcelona)

More information

Reassessing the Benefits of Statins in the Prevention of Cardiovascular Disease in Diabetic Patients A Systematic Review and Meta-Analysis

Reassessing the Benefits of Statins in the Prevention of Cardiovascular Disease in Diabetic Patients A Systematic Review and Meta-Analysis Reprint from The Review of DIABETIC STUDIES Vol 10 No 2-3 2013 Special Issue CVD, Lipoproteins, and Diabetes The Review of DIABETIC STUDIES REVIEW Reassessing the Benefits of Statins in the Prevention

More information

CVD Risk Assessment. Lipid Management in Women: Lessons Learned. Conflict of Interest Disclosure

CVD Risk Assessment. Lipid Management in Women: Lessons Learned. Conflict of Interest Disclosure Lipid Management in Women: Lessons Learned Conflict of Interest Disclosure Emma A. Meagher, MD has no conflicts to disclose Emma A. Meagher, MD Associate Professor, Medicine and Pharmacology University

More information

Cindy L. Grines MD FACC FSCAI

Cindy L. Grines MD FACC FSCAI Cindy L. Grines MD FACC FSCAI Hofstra Northwell School of Medicine Chair, Cardiology Academic Chief of Cardiology, Northwell Health North Shore University Hospital, Manhasset NY Multivessel Disease in

More information

Disclosures. Choosing a Statin/New Therapies. Case. How else would you do to treat him? LDL-C Reduction with Different Statin Strategies

Disclosures. Choosing a Statin/New Therapies. Case. How else would you do to treat him? LDL-C Reduction with Different Statin Strategies Disclosures I have no disclosures relevant to this talk Choosing a Statin/New Therapies Aryan Aiyer, MD Assistant Professor of Medicine University of Pittsburgh School of Medicine UPMC Heart and Vascular

More information

Coronary interventions

Coronary interventions Controversial issues in the management of ischemic heart failure Coronary interventions Maciej Lesiak Department of Cardiology, University Hospital in Poznan none DECLARATION OF CONFLICT OF INTEREST CHF

More information

How to Handle Statin Intolerance in the High Risk Patient

How to Handle Statin Intolerance in the High Risk Patient How to Handle Statin Intolerance in the High Risk Patient Thomas D. Conley, MD FACC FSCAI Disclosures: None 1 Definition of High Risk Primary Prevention ASCVD Risk Calculator Adults >21 yrs, LDL 190 mg/dl

More information

Supplementary appendix

Supplementary appendix Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Cholesterol Treatment Trialists (CTT) Collaborators.

More information

Nicole Ciffone, MS, ANP-C, AACC Clinical Lipid Specialist

Nicole Ciffone, MS, ANP-C, AACC Clinical Lipid Specialist 1 Nicole Ciffone, MS, ANP-C, AACC Clinical Lipid Specialist New Cardiovascular Horizons Multidisciplinary Strategies for Optimal Cardiovascular Care February 7, 2015 2 Objectives After participating in

More information

Heart Failure with preserved ejection fraction (HFpEF)

Heart Failure with preserved ejection fraction (HFpEF) Heart Failure with preserved ejection fraction (HFpEF) Dr. Pierpaolo Pellicori Hull York Medical School Kingston-upon-Hull United Kingdom Conflict of interest: none Heart failure is a contemporary problem

More information

How to Reduce Residual Risk in Primary Prevention

How to Reduce Residual Risk in Primary Prevention How to Reduce Residual Risk in Primary Prevention Helene Glassberg, MD Assistant Professor of Medicine Section of Cardiology Hospital of the University of Pennsylvania Philadelphia, PA USA Patients with

More information

VALUE OF ACEI IN THE MANAGEMENT OF HYPERTENSION

VALUE OF ACEI IN THE MANAGEMENT OF HYPERTENSION VALUE OF ACEI IN THE MANAGEMENT OF HYPERTENSION Dr Catherine BESEME Paris 6 th December 2005 6 th International Congress of Bangladesh Society of Medicine Hypertension is a risk factor at the source, with

More information

All in the Past? Win K. Shen, MD Mayo Clinic Arizona Controversies and Advances in CV Diseases Cedars-Sinai Heart Institute, MFMER

All in the Past? Win K. Shen, MD Mayo Clinic Arizona Controversies and Advances in CV Diseases Cedars-Sinai Heart Institute, MFMER ICD for NICM All in the Past? Win K. Shen, MD Mayo Clinic Arizona Controversies and Advances in CV Diseases Cedars-Sinai Heart Institute, 2017 2017 MFMER 3686275-1 DISCLOSURE Relevant Financial Relationship(s)

More information

Andrew Cohen, MD and Neil S. Skolnik, MD INTRODUCTION

Andrew Cohen, MD and Neil S. Skolnik, MD INTRODUCTION 2 Hyperlipidemia Andrew Cohen, MD and Neil S. Skolnik, MD CONTENTS INTRODUCTION RISK CATEGORIES AND TARGET LDL-CHOLESTEROL TREATMENT OF LDL-CHOLESTEROL SPECIAL CONSIDERATIONS OLDER AND YOUNGER ADULTS ADDITIONAL

More information

Management of ST-elevation myocardial infarction Update 2009 Late comers: which options?

Management of ST-elevation myocardial infarction Update 2009 Late comers: which options? European Society of Cardiology Annual Session 2009 Management of ST-elevation myocardial infarction Update 2009 Late comers: which options? Antonio Abbate, MD Assistant Professor of Medicine Virginia Commonwealth

More information

Reducing Inflammation to Reduce Cardiovascular Risk: The Canakinumab Anti-inflammatory Thrombosis Outcomes Study (CANTOS)

Reducing Inflammation to Reduce Cardiovascular Risk: The Canakinumab Anti-inflammatory Thrombosis Outcomes Study (CANTOS) New York City Cardiovascular Symposium December 10, 2017 Reducing Inflammation to Reduce Cardiovascular Risk: The Canakinumab Anti-inflammatory Thrombosis Outcomes Study (CANTOS) Paul M Ridker, MD, MPH

More information

The Role of ICD Therapy in Cardiac Resynchronization

The Role of ICD Therapy in Cardiac Resynchronization The Role of ICD Therapy in Cardiac Resynchronization The Korean Society of Circulation 15 April 2005 Angel R. León, MD Carlyle Fraser Heart Center Division of Cardiology Emory University School of Medicine

More information

Clinical Review Criteria Galectin-3 Blood Assay Test

Clinical Review Criteria Galectin-3 Blood Assay Test Clinical Review Criteria Galectin-3 Blood Assay Test Kaiser Foundation Health Plan of Washington NOTICE: Kaiser Foundation Health Plan of Washington and Kaiser Foundation Health Plan of Washington Options,

More information

Efficacy of beta-blockers in heart failure patients with atrial fibrillation: An individual patient data meta-analysis

Efficacy of beta-blockers in heart failure patients with atrial fibrillation: An individual patient data meta-analysis Efficacy of beta-blockers in heart failure patients with atrial fibrillation: An individual patient data meta-analysis Dipak Kotecha, MD PhD on behalf of the Selection of slides presented at the European

More information

Dialysis-Dependent Cardiomyopathy Patients Demonstrate Poor Survival Despite Reverse Remodeling With Cardiac Resynchronization Therapy

Dialysis-Dependent Cardiomyopathy Patients Demonstrate Poor Survival Despite Reverse Remodeling With Cardiac Resynchronization Therapy Dialysis-Dependent Cardiomyopathy Patients Demonstrate Poor Survival Despite Reverse Remodeling With Cardiac Resynchronization Therapy Evan Adelstein, MD, FHRS John Gorcsan III, MD Samir Saba, MD, FHRS

More information

Heart Failure with Preserved EF (HFPEF) Epidemiology and management

Heart Failure with Preserved EF (HFPEF) Epidemiology and management Heart Failure with Preserved EF (HFPEF) Epidemiology and management Karl Swedberg Senior Professor of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg, Sweden e-mail: karl.swedberg@gu.se

More information

Estrogens vs Testosterone for cardiovascular health and longevity

Estrogens vs Testosterone for cardiovascular health and longevity Estrogens vs Testosterone for cardiovascular health and longevity Panagiota Pietri, MD, PhD, FESC Director of Hypertension Unit Athens Medical Center Athens, Greece Women vs Men Is there a difference in

More information

Statins in lung disease

Statins in lung disease Statins in lung disease Associate Professor Robert Young BMedSc, MBChB, DPhil (Oxon), FRACP, FRCP University of Auckland, New Zealand Smoking and its complications Respiratory COPD Cardiovascular CAD Smoking

More information

Saudi Arabia February Pr Michel KOMAJDA. Université Pierre et Marie Curie Hospital Pitié Salpétrière

Saudi Arabia February Pr Michel KOMAJDA. Université Pierre et Marie Curie Hospital Pitié Salpétrière Prevention of Cardiovascular events with Ivabradine: The SHIFT Study Saudi Arabia February 2011 Pr Michel KOMAJDA Université Pierre et Marie Curie Hospital Pitié Salpétrière Paris FRANCE Declaration Of

More information

Left Ventricular Ejection Fraction >35%

Left Ventricular Ejection Fraction >35% Controversies in Cardiac Resynchronisation Therapy Left Ventricular Ejection Fraction >35% Professor John GF Cleland University of Hull Kingston-upon-Hull United Kingdom Conflict of Interest: I have received

More information

Learning Objectives. Predicting and Preventing Cardiovascular Disease. ACC/AHA Cholesterol Guidelines Key differences vs ATP III

Learning Objectives. Predicting and Preventing Cardiovascular Disease. ACC/AHA Cholesterol Guidelines Key differences vs ATP III Presenter Disclosure Information 10:30 11:15am Predicting and Preventing Cardiovascular Disease: Can we put the Cardiologist out of business? The following relationships exist related to this presentation:

More information

rosuvastatin, 5mg, 10mg, 20mg, film-coated tablets (Crestor ) SMC No. (725/11) AstraZeneca UK Ltd.

rosuvastatin, 5mg, 10mg, 20mg, film-coated tablets (Crestor ) SMC No. (725/11) AstraZeneca UK Ltd. rosuvastatin, 5mg, 10mg, 20mg, film-coated tablets (Crestor ) SMC No. (725/11) AstraZeneca UK Ltd. 09 September 2011 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product

More information

Acute Coronary Syndrome. Sonny Achtchi, DO

Acute Coronary Syndrome. Sonny Achtchi, DO Acute Coronary Syndrome Sonny Achtchi, DO Objectives Understand evidence based and practice based treatments for stabilization and initial management of ACS Become familiar with ACS risk stratification

More information

Is it an era for statin for life?

Is it an era for statin for life? Is it an era for statin for life? Mohamed Abdel Ghany Professor of Cardiology Cairo University Cardiovascular Disease (CVD) is the leading global cause of death 1 Dyslipidemia as a main Risk Factor for

More information

Metoprolol Succinate SelokenZOC

Metoprolol Succinate SelokenZOC Metoprolol Succinate SelokenZOC Blood Pressure Control and Far Beyond Mohamed Abdel Ghany World Health Organization - Noncommunicable Diseases (NCD) Country Profiles, 2014. 1 Death Rates From Ischemic

More information

12 th Annual Biomarkers in Heart Failure and Acute Coronary Syndromes: Diagnosis, Treatment and Devices. Heart Rate as a Cardiovascular Biomarker

12 th Annual Biomarkers in Heart Failure and Acute Coronary Syndromes: Diagnosis, Treatment and Devices. Heart Rate as a Cardiovascular Biomarker 12 th Annual Biomarkers in Heart Failure and Acute Coronary Syndromes: Diagnosis, Treatment and Devices Heart Rate as a Cardiovascular Biomarker Inder Anand, MD, FRCP, D Phil (Oxon.) Professor of Medicine,

More information

HF-PEF: Symptoms, quality of life and mortality/morbidity

HF-PEF: Symptoms, quality of life and mortality/morbidity HF-PEF: Symptoms, quality of life and mortality/morbidity May 21, 2011 John McMurray, MD Eugene Braunwald Scholar in Cardiovascular Diseases, Brigham & Women s Hospital Boston; Visiting Professor of Medicine,

More information

Qué factores de riesgo lipídicos debemos controlar? En qué medida?

Qué factores de riesgo lipídicos debemos controlar? En qué medida? Qué factores de riesgo lipídicos debemos controlar? En qué medida? Risk category High risk: CHD or CHD risk equivalents (10- year risk >20%) Moderately high risk: two or more risk factors (10-year risk

More information

Diabetes and Cardiovascular Risk Management Denise M. Kolanczyk, PharmD, BCPS-AQ Cardiology

Diabetes and Cardiovascular Risk Management Denise M. Kolanczyk, PharmD, BCPS-AQ Cardiology Diabetes and Cardiovascular Risk Management Denise M. Kolanczyk, PharmD, BCPS-AQ Cardiology Disclosures In compliance with the accrediting board policies, the American Diabetes Association requires the

More information

Revascularization for Patients with HFrEF: CABG and PCI and the Concept of Myocardial Viability

Revascularization for Patients with HFrEF: CABG and PCI and the Concept of Myocardial Viability Revascularization for Patients with HFrEF: CABG and PCI and the Concept of Myocardial Viability 22nd Annual Heart Failure 2018: an Update on Therapy April 2018 Eric J. Velazquez, MD, FACP, FACC, FASE,

More information

Highlight Session Heart failure and cardiomyopathies Michel KOMAJDA Paris France

Highlight Session Heart failure and cardiomyopathies Michel KOMAJDA Paris France Highlight Session 2014 Heart failure and cardiomyopathies Michel KOMAJDA Paris France # esccongress www.escardio.org/esc2014 HEART FAILURE AND CARDIOMYOPATHIES TOPIC 1 Drug Therapy TOPIC 2 Device Therapy

More information

A Phase 2 Study of Intravenous Omecamtiv Mecarbil, A Novel Cardiac Myosin Activator, In Patients With Acute Heart Failure

A Phase 2 Study of Intravenous Omecamtiv Mecarbil, A Novel Cardiac Myosin Activator, In Patients With Acute Heart Failure A Phase 2 Study of Intravenous Omecamtiv Mecarbil, A Novel Cardiac Myosin Activator, In Patients With Acute Heart Failure John R. Teerlink, G. Michael Felker, John J. V. McMurray, Piotr Ponikowski, Marco

More information

The Atherogenic Dyslipidemia of Diabetes Mellitus- Not just a question of LDL-C

The Atherogenic Dyslipidemia of Diabetes Mellitus- Not just a question of LDL-C The Atherogenic Dyslipidemia of Diabetes Mellitus- Not just a question of LDL-C Eun-Jung Rhee Department of Endocrinology and Metabolism Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine

More information

Drugs acting on the reninangiotensin-aldosterone

Drugs acting on the reninangiotensin-aldosterone Drugs acting on the reninangiotensin-aldosterone system John McMurray Eugene Braunwald Scholar in Cardiovascular Diseases, Brigham and Women s Hospital, Boston & Visiting Professor, Harvard Medical School

More information

Dobutamine-induced increase in heart rate is blunted by ivabradine treatment in patients with acutely decompensated heart failure

Dobutamine-induced increase in heart rate is blunted by ivabradine treatment in patients with acutely decompensated heart failure Dobutamine-induced increase in heart rate is blunted by ivabradine treatment in patients with acutely decompensated heart failure Yuksel Cavusoglu, KU Mert, A Nadir, F Mutlu, E Gencer, T Ulus, A Birdane

More information

Cost effectiveness of statin therapy for the primary prevention of coronary heart disease in Ireland Nash A, Barry M, Walshe V

Cost effectiveness of statin therapy for the primary prevention of coronary heart disease in Ireland Nash A, Barry M, Walshe V Cost effectiveness of statin therapy for the primary prevention of coronary heart disease in Ireland Nash A, Barry M, Walshe V Record Status This is a critical abstract of an economic evaluation that meets

More information

Periprocedural Myocardial Infarction and Clinical Outcome In Bifurcation Lesion

Periprocedural Myocardial Infarction and Clinical Outcome In Bifurcation Lesion Periprocedural Myocardial Infarction and Clinical Outcome In Bifurcation Lesion Hyeon-Cheol Gwon Cardiac and Vascular Center Samsung Medical Center Sungkyunkwan University School of Medicine Dr. Hyeon-Cheol

More information

LXIV: DRUGS: 4. RAS BLOCKADE

LXIV: DRUGS: 4. RAS BLOCKADE LXIV: DRUGS: 4. RAS BLOCKADE ACE Inhibitors Components of RAS Actions of Angiotensin i II Indications for ACEIs Contraindications RAS blockade in hypertension RAS blockade in CAD RAS blockade in HF Limitations

More information

CT for Myocardial Characterization of Cardiomyopathy. Byoung Wook Choi, Yonsei University Severance Hospital, Seoul, Korea

CT for Myocardial Characterization of Cardiomyopathy. Byoung Wook Choi, Yonsei University Severance Hospital, Seoul, Korea CT for Myocardial Characterization of Cardiomyopathy Byoung Wook Choi, Yonsei University Severance Hospital, Seoul, Korea Cardiomyopathy Elliott P et al. Eur Heart J 2008;29:270-276 The European Society

More information

Gerasimos Filippatos MD, FESC, FCCP, FACC

Gerasimos Filippatos MD, FESC, FCCP, FACC Gerasimos Filippatos MD, FESC, FCCP, FACC Head of HF Unit at Athens University Hospital, Greece President (2014-2016) of the HF Association of the European Society of Cardiology (ESC) Served as Chair of

More information

Intravenous Inotropic Support an Overview

Intravenous Inotropic Support an Overview Intravenous Inotropic Support an Overview Shaul Atar, MD Western Galilee Medical Center, Nahariya Affiliated with the Faculty of Medicine of the Galilee, Safed, Israel INOTROPES in Acute HF (not vasopressors)

More information

Are statins useful in aortic stenosis? Rome Cardiology Forum 2010

Are statins useful in aortic stenosis? Rome Cardiology Forum 2010 Are statins useful in aortic stenosis? Rome Cardiology Forum 2010 Terje R. Pedersen Oslo, Norway Aortic valve stenosis Virginia Commonwealth University, Department of Pathology *)Helsinki Ageing study,

More information

Does quality of life predict morbidity or mortality in patients with atrial fibrillation (AF)?

Does quality of life predict morbidity or mortality in patients with atrial fibrillation (AF)? Does quality of life predict morbidity or mortality in patients with atrial fibrillation (AF)? Erika Friedmann a, Eleanor Schron, b Sue A. Thomas a a University of Maryland School of Nursing; b NEI, National

More information

Role of Clopidogrel in Acute Coronary Syndromes. Hossam Kandil,, MD. Professor of Cardiology Cairo University

Role of Clopidogrel in Acute Coronary Syndromes. Hossam Kandil,, MD. Professor of Cardiology Cairo University Role of Clopidogrel in Acute Coronary Syndromes Hossam Kandil,, MD Professor of Cardiology Cairo University ACS Treatment Strategies Reperfusion/Revascularization Therapy Thrombolysis PCI (with/ without

More information

FFR in Multivessel Disease

FFR in Multivessel Disease FFR in Multivessel Disease April, 26 2013 Coronary Physiology in the Catheterization Laboratory Location: European Heart House, Nice, France Pim A.L. Tonino, MD, PhD Hartcentrum, Eindhoven, the Netherlands

More information

Coenzyme Q 10, Rosuvastatin, and Clinical Outcomes in Heart Failure

Coenzyme Q 10, Rosuvastatin, and Clinical Outcomes in Heart Failure Journal of the American College of Cardiology Vol. 56, No. 15, 2010 2010 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2010.02.075

More information

Journal of the American College of Cardiology Vol. 54, No. 25, by the American College of Cardiology Foundation ISSN /09/$36.

Journal of the American College of Cardiology Vol. 54, No. 25, by the American College of Cardiology Foundation ISSN /09/$36. Journal of the American College of Cardiology Vol. 54, No. 25, 2009 2009 by the American College of Cardiology Foundation ISSN 0735-1097/09/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2009.10.005

More information

Choosing Study Outcomes that Reflect Cardiovascular Disease: From Biomarkers to Burden of Disease. Greg Wellenius Joel Kaufman

Choosing Study Outcomes that Reflect Cardiovascular Disease: From Biomarkers to Burden of Disease. Greg Wellenius Joel Kaufman Choosing Study Outcomes that Reflect Cardiovascular Disease: From Biomarkers to Burden of Disease Greg Wellenius Joel Kaufman Framework for Choosing Subclinical Outcomes To Study What clinical outcomes

More information

Statins and Cognition A Focus on Mechanisms

Statins and Cognition A Focus on Mechanisms Statins and Cognition A Focus on Mechanisms Note: Deleted copyrighted graphs/tables are described In red text and source references are provided Disclosures: SPARCL Steering Committee and past consultant

More information

9/29/2015. Primary Prevention of Heart Disease: Objectives. Objectives. What works? What doesn t?

9/29/2015. Primary Prevention of Heart Disease: Objectives. Objectives. What works? What doesn t? Primary Prevention of Heart Disease: What works? What doesn t? Samia Mora, MD, MHS Associate Professor, Harvard Medical School Associate Physician, Brigham and Women s Hospital October 2, 2015 Financial

More information

The statin studies: from targeting hypercholesterolaemia to targeting the high-risk patient

The statin studies: from targeting hypercholesterolaemia to targeting the high-risk patient Q J Med 2005; 98:599 614 Advance Access publication 8 July 2005 doi:10.1093/qjmed/hci093 Commentary The statin studies: from targeting hypercholesterolaemia to targeting the high-risk patient H.T. ONG

More information

03/30/2016 DISCLOSURES TO OPERATE OR NOT THAT IS THE QUESTION CAROTID INTERVENTION IS INDICATED FOR ASYMPTOMATIC CAROTID OCCLUSIVE DISEASE

03/30/2016 DISCLOSURES TO OPERATE OR NOT THAT IS THE QUESTION CAROTID INTERVENTION IS INDICATED FOR ASYMPTOMATIC CAROTID OCCLUSIVE DISEASE CAROTID INTERVENTION IS INDICATED FOR ASYMPTOMATIC CAROTID OCCLUSIVE DISEASE Elizabeth L. Detschelt, M.D. Allegheny Health Network Vascular and Endovascular Symposium April 2, 2016 DISCLOSURES I have no

More information

Current Advances and Best Practices in Acute STEMI Management A pharmacoinvasive approach

Current Advances and Best Practices in Acute STEMI Management A pharmacoinvasive approach Current Advances and Best Practices in Acute STEMI Management A pharmacoinvasive approach Frans Van de Werf, MD, PhD University Hospitals, Leuven, Belgium Frans Van de Werf: Disclosures Research grants

More information

Management of chronic heart failure: update J. Parissis Attikon University Hospital

Management of chronic heart failure: update J. Parissis Attikon University Hospital Management of chronic heart failure: update 2015 J. Parissis Attikon University Hospital Disclosures: received honoraria for lectures from Servier, Pfizer, Novartis Discharges in Thousands Heart Failure

More information

Cholesterol Treatment Update

Cholesterol Treatment Update Cholesterol Treatment Update Patrick E. McBride, M.D., M.P.H. Professor of Medicine, Cardiovascular Medicine Associate Director, Preventive Cardiology Program UW School of Medicine and Public Health Disclosure:

More information

1. How does the response to therapy compare in elderly versus middle age adults with diabetes in a randomized trial?

1. How does the response to therapy compare in elderly versus middle age adults with diabetes in a randomized trial? Jeff D. Williamson, MD, MHS Chief, Geriatric Medicine Sticht Center on Aging 1. How does the response to therapy compare in elderly versus middle age adults with diabetes in a randomized trial? 2. Are

More information

Trial to Reduce. Aranesp* Therapy. Cardiovascular Events with

Trial to Reduce. Aranesp* Therapy. Cardiovascular Events with Trial to Reduce Cardiovascular Events with Aranesp* Therapy John J.V. McMurray, Hajime Uno, Petr Jarolim, Akshay S. Desai, Dick de Zeeuw, Kai-Uwe Eckardt, Peter Ivanovich, Andrew S. Levey, Eldrin F. Lewis,

More information

2013 Cholesterol Guidelines. Anna Broz MSN, RN, CNP, AACC Cer=fied Adult Nurse Prac==oner North Ohio Heart, Inc.

2013 Cholesterol Guidelines. Anna Broz MSN, RN, CNP, AACC Cer=fied Adult Nurse Prac==oner North Ohio Heart, Inc. 2013 Cholesterol Guidelines Anna Broz MSN, RN, CNP, AACC Cer=fied Adult Nurse Prac==oner North Ohio Heart, Inc. Disclosures Speaker Gilead Sciences NHLBI Charge to the Expert Panel Evaluate higher quality

More information

ST2 in Heart Failure. ST2 as a Cardiovascular Biomarker. Competitive Model of ST2/IL-33 Signaling. ST2 and IL-33: Cardioprotective

ST2 in Heart Failure. ST2 as a Cardiovascular Biomarker. Competitive Model of ST2/IL-33 Signaling. ST2 and IL-33: Cardioprotective ST2 as a Cardiovascular Biomarker Lori B. Daniels, MD, MAS, FACC Professor of Medicine Director, Coronary Care Unit University of California, San Diego ST2 and IL-33: Cardioprotective ST2: member of the

More information

Iron Deficiency: New Therapeutic Target in Heart Failure. Stefan D. Anker, MD PhD

Iron Deficiency: New Therapeutic Target in Heart Failure. Stefan D. Anker, MD PhD Iron Deficiency: New Therapeutic Target in Heart Failure Stefan D. Anker, MD PhD Department of Cardiology, Applied Cachexia Research, Charité Campus Virchow-Klinikum, Universitätsmedizin Berlin, Germany.

More information

La prevenzione secondaria dopo sindrome coronarica acuta. Aldo Pietro Maggioni Centro Studi ANMCO Firenze

La prevenzione secondaria dopo sindrome coronarica acuta. Aldo Pietro Maggioni Centro Studi ANMCO Firenze La prevenzione secondaria dopo sindrome coronarica acuta Aldo Pietro Maggioni Centro Studi ANMCO Firenze Trial and community-based assessments of in-hospital (A) and 30-day (B) mortality relative to age

More information

This clinical study synopsis is provided in line with Boehringer Ingelheim s Policy on Transparency and Publication of Clinical Study Data.

This clinical study synopsis is provided in line with Boehringer Ingelheim s Policy on Transparency and Publication of Clinical Study Data. abcd Clinical Study Synopsis for Public Disclosure This clinical study synopsis is provided in line with s Policy on Transparency and Publication of Clinical Study Data. The synopsis which is part of the

More information

Digoxin And Mortality in Patients With Atrial Fibrillation With and Without Heart Failure: Does Serum Digoxin Concentration Matter?

Digoxin And Mortality in Patients With Atrial Fibrillation With and Without Heart Failure: Does Serum Digoxin Concentration Matter? Digoxin And Mortality in Patients With Atrial Fibrillation With and Without Heart Failure: Does Serum Digoxin Concentration Matter? Renato D. Lopes, MD, PhD, FACC on behalf of the ARISTOTLE Investigators

More information

Statin Use and Cardiovascular Disease in HIV

Statin Use and Cardiovascular Disease in HIV Statin Use and Cardiovascular Disease in HIV Steven K. Grinspoon, MD Professor of Medicine Harvard Medical School Boston, Massachusetts FLOWED: 04/18/16 Los Angeles, California: April 25, 2016 Statin Use

More information