This is a sub-study of the THEMIS presented during the ESC 2019 scientific sessions in Paris, and simultaneously published in Lancet. They were all diabetics with stable coronary artery disease, but in this sub-study patients also had prior PCI. It included over 11000 patients with prior PCI for whom the combination of ticagrelor and aspirin…
ESC 2019 | THEMIS: Ticagrelor in Diabetics with Stable Coronary Artery Disease
The use of ticagrelor in patients with stable coronary artery disease significantly reduces the rate of major cardiovascular events when compared against aspirin, according to this study presented on Sunday at ESC 2019 simultaneously published in NEJM, though the cost in terms of major bleeding seems unacceptable. Primary end point rate (composite of cardiovascular death,…
ESC 2019 | POPULAR AGE: Good Old Clopidogrel Still Valid
According to this study, presented during the ESC 2019 scientific sessions, non-ST acute coronary syndrome (NSTE-ACS) patients treated with ticagrelor presented a significantly higher risk of bleeding than patients treated with clopidogrel, with no counterbalance by higher benefit in thrombotic events. Researchers suggest clopidogrel might be the gold standard for this elderly NSTE-ACS population, though…
Though Systolic BP Seems More Important, Diastolic BP Should Not Be Disregarded
Systolic hypertension is more often associated to cardiovascular events. However, diastolic blood pressure should not be disregarded, since it can also predict even worse outcomes. Although systolic blood pressure is very frequently associated to adverse cardiovascular events, by no means should diastolic blood pressure be considered unimportant. Such is the message of this study recently…
Dietary Supplements and Diets Show No Impact on Cardiovascular Risk
Americans spend billions in dietary supplements every year but, in truth, this money is only wasted, according to evidence form a recent study published in Intern Med. Most of dietary interventions and nutritional supplements including multi-vitamins, selenium and antioxidants, do not reduce cardiovascular risk or mortality, according to this large analysis and systematic revision of…
Many Guidelines, Much Confusion. Blood Pressure Targets in the Elderly
Seeing as hypertension prevalence and incidence increases with age, treating elderly patients of paramount importance. The AHA/ACC guidelines have lowered cohort hypertension thresholds to >130/80 mmHg, whereas the European guidelines have kept the classic >140/90 mmHg, though recommending lower thresholds for most patients at the same time. Lower than 130/80 mmHg is recommended with the…
After Much Toing and Froing, Gastrointestinal Protection Is Back to the Forefront
Several clinical guidelines differ in their recommendation regarding the prescription of proton pump inhibitors to patients being treated with dual antiplatelet therapy after infarction. In 2015, the European Society of Cardiology (ESC) recommended their use in patients with high bleeding risk; however, in the 2017 update that recommendation became general after the assumption that, for…
Antithrombotic Strategies in Atrial Fibrillation and Angioplasty
What is the most appropriate antithrombotic strategy for a patient with atrial fibrillation and coronary artery disease, particularly when admitted with acute coronary syndrome or undergoing coronary angioplasty? This is a question whose answer is still in the works and that literature is addressing dynamically. Whatever we read yesterday may already be out of date…
Aspirin in Primary Prevention: Another “Trendy” Topic in Publications
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…