Aspirin is the standard treatment when it comes to optimal medical treatment in the context of secondary prevention of coronary artery disease, in patients with diagnosed, established atherosclerosis. Even though bleeding risk is rather small in the short period an acute event takes place, it increases substantially over time. However, the evidence clearly supports the…
Cardiovascular Risk, Dual Antiplatelet Therapy, and Age. What Should We Know?
Non-adherence to dual antiplatelet therapy varies with age and patients older than 75 years old are those who discontinue treatment most frequently. However, this characteristic in elderly patients was not associated with more cardiovascular events. Treatment compliance protected patients younger than 75 years old from events, while there was increased cardiovascular risk among this population…
EuroPCR 2019 | Global Leaders: Ticagrelor Monotherapy at Long Term Could Have a Role in Complex PCI
This post hoc analysis of what had been a trial with negative outcomes should be considered only as a hypothesis generator. Patients receiving complex PCI treated with ticagrelor monotherapy after one-month dual antiaggregation therapy (DAPT) showed better results at 2 years when compared against patients receiving a conventional DAPT scheme. In the global analysis, this…
Bariatric Surgery Associated with a Lower Rate of Mortality Due to Infarction and Stroke
Prior bariatric surgery in a patient with morbid obesity is associated with a significant effect on survival after infarction or stroke. While these are observational data, the significant metabolic improvement experienced after the surgery can explain perfectly such findings. This large nationwide registry of bariatric surgery found a 40% decrease in the risk of death,…
The First Antidote Against Ticagrelor Is a Rapid-Acting, Extended Effect Agent in Preliminary Results
This study attempts to test drug PB2452 for use in cases of catastrophic bleeding and, then, its potential use in other scenarios involving patients receiving ticagrelor. This specific ticagrelor reversal agent stops immediately and substantially the effect of the aforementioned P2Y12 receptor antagonist according to several test measurements conducted during this phase 1 trial in…
Is Alcohol Good, Bad, or Neutral for Cardiovascular Health?
In the 2018 Guidelines on Hypertension, commandment no. 6 states that we should make lifestyle interventions such as sodium restriction, healthy eating, regular exercise, weight control, and smoking cessation, and also alcohol moderation. It is clear that heavy alcohol consumption induces hypertension and may probably be one of the main causes of secondary hypertension, but…
E-Cigarettes vs. Nicotine Therapy to Stop Smoking
E-cigarettes were more effective for smoking cessation than nicotine-replacement therapy according to this randomized study recently published in the New England Journal of Medicine (NEJM). Both must be accompanied by medical and psychological support for optimal results. While e-cigarettes are commonly used as a smoking cessation strategy, evidence is limited regarding their effectiveness as compared…
ACC 2019 | STOPDAPT-2: P2Y12 Monotherapy After Short-Term Dual Antiplatelet Therapy After Angioplasty
Aspirin is against the ropes: first, it was primary prevention; now, its use is being reconsidered even in relation to angioplasty. There might be paradigm changes as regards antiplatelet therapy after angioplasty. These two studies presented at the American College of Cardiology (ACC) 2019 Scientific Session can really change what we have been doing unquestioningly…
ACC 2019 | AUGUSTUS: Apixaban Plus P2Y12 Inhibitor Is the Best Combination in Atrial Fibrillation and Angioplasty
Aspirin increases bleeding with no ischemic benefit, but a trend toward more stent thrombosis with placebo warrants further studies. Patients with atrial fibrillation who receive an anticoagulant agent and coronary angioplasty with a stent, and then continue with aspirin, experience an increased risk of bleeding without any ischemic benefit whatsoever. The use of a…
ACC 2019 | The New ACC/AHA Guidelines on Primary Prevention Focus on Life Style, Diet and Socioeconomic Factors.
These guidelines basically remind us that we should focus on life style changes to best prevent heart disease, heart failure and atrial fibrillation. These changes, of course, should be permanent. It is estimated that life style changes translate into 80% risk reduction of heart disease. These recommendations are based on 9 topics: risk estimation,…
The Most Relevant Articles of 2018 in Pharmacology and Clinical Cardiology – Part 2
1- What Antiplatelet Therapy Should We Use in Patients with Stroke/TIA? Interesting Results for the POINT Trial The New England Journal of Medicine (NEJM) recently published an article about the POINT trial (simultaneously presented at the European Stroke Organisation Conference), a long-awaited randomized clinical trial to assess the efficacy and safety of dual antiplatelet therapy…