Newsletters April 2010 - Jefferson Cardiology Happenings
What's in this Newsletter:
In an effort to keep our patients up to date with new advances in cardiac care, our newsletter devotes space each year to major studies presented at the Annual Scientific Sessions of the American College of Cardiology. This year’s meeting was held in March and about half the presentations were from international investigators. In this issue some of the studies relevant to our patients will be discussed.
Current guidelines state that patients should be maintained on dual antiplatelet therapy, most often aspirin plus Plavix, for one year after drug-eluting stent placement. This recom-mendation was questioned because of isolated reports of stents clotting off after Plavix was stopped more than one year after the stent was placed. Up to now, there was no study evaluating ef-fective duration of combined antiplatelet therapy.
At the recent meeting, a study from Korea was presented that was de-signed to answer this question. The study divided patients receiving drug eluting stents into two categories. Ini-tially all patients received both aspirin and Plavix for one year. After the first year one group received only aspirin and the other group received both aspirin and Plavix for two more years.
The investigators found no difference in clotting of stents in the two groups. There was a statistically nonsig-nificant trend toward an increase in death, heart attack or stroke in those tak-ing Plavix for an additional two years. More studies will be needed to verify these findings. On the basis of this study, it would appear that one year of combined aspirin and Plavix is sufficient. Questions can be raised about this study as there may be genetic differences in Plavix resistance and this study only included Asians. Also, there may still be reason to continue Plavix longer for high risk lesions.
How low should blood pressure be lowered in diabetics? Previously, studies suggested benefit in severely lowering blood pressure in diabetic pa-tients. In the recently presented ACCORD study this concept was chal-lenged. In this study of type 2 diabetic patients, 2300 patients were randomized to a treatment goal of systolic blood pressure under 140 mm mercury and 2300 patients were randomized to sys-tolic blood pressure under 120 mm mer-cury.
Results of the study showed no advantage for more intense blood pressure lowering. There were similar incidence of cardiovascular mortality, death and stroke over a mean follow-up of 4.7 years. This would suggest there is no need to lower type 2 diabetic’s blood pressure under 120 mm mercury.
The other half of the ACCORD study included the evaluation of lipid therapy in diabetics. The hypothesis tested was that adding fenofibrate, Tricor, to statin therapy in diabetics would prevent additional cardiovascular events. In this study all patients received statin therapy and only half received fenofibrate therapy.
The results revealed that adding fenofibrate to statin therapy did not significantly benefit cardiovascular outcomes. There was some triglyceride reduction but no significant benefit in HDL cholesterol elevation. Specifically adding fenofibrate did not reduce car-diovascular mortality, heart attacks, stroke, bypass surgery, angioplasty or hospitalization for heart failure. Questions remain whether fenofibrate may be of benefit in persons with very high triglycerides and low HDL cholesterol.
Other trials included the STICH trial that demonstrated that surgery de-signed to reduce heart size in congestive heart failure patients had no outcome benefit compared to bypass surgery alone.
Another showed that Tekturna had no additional benefit in treating heart failure in patients on conventional heart failure medications. A study involving in-travenous diuretic therapy for hospital-ized heart failure patients indicates better symptomatic relief with higher rather than standard dose diuretic. A number of other studies reported can be found at www.acc.org.
Please join us in wishing Valerie Rhall, ultrasound tech, and Kim Gray, recep-tionist, a very Happy Birthday. We hope you both have a very special birthday.
½ cup prepared mustard
1. Prepare grill
Nutritional info: Calories: 317; Fat 13g (sat 3.6, mono 4.9, poly 2.9); Iron 1.9mg; Cholest 112mg; Calcium 34mg; Carbs 18.3g; Sodium 471mg; Protein 30.5g; Fiber 0.3g
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