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- Erhardt, Leif RW
(författare)
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Managing cardiovascular risk: reality vs. perception
- 2005
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Ingår i: European Heart Journal Supplements. - : Oxford University Press (OUP). - 1520-765X .- 1554-2815 .- 1520-1554. ; 7:Suppl L, s. 11-15
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Tidskriftsartikel (refereegranskat)abstract
- Clinical practice guidelines attempt to bridge the gap between the generation of scientific evidence and its application. For cardiovascular risk reduction, the implementation of knowledge into practice, both with respect to lifestyle change and pharmacological treatment, has been shown to be poor. There are several reasons for this 'guidelines gap', with physician factors including insufficient time and underestimation of a patient's cardiovascular risk and patient factors including tack of adherence to lifestyle modification and lack of awareness about cardiovascular risk. Survey data indicate that physicians believe that they are implementing guidelines, but the majority of patients remains undertreated. There is a need for better physician and patient education and also for simplified guidelines to encourage their use by physicians. Cardiologists should work with primary care physicians to adapt national guidelines to ensure local acceptance.
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- Sutton, R, et al.
(författare)
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History of electrical therapy for the heart
- 2007
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Ingår i: EUROPEAN HEART JOURNAL SUPPLEMENTS. - : Oxford University Press (OUP). - 1520-765X .- 1554-2815 .- 1520-1554. ; 9:I, s. I3-I10
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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- Wallentin, Lars
(författare)
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Dual antiplatelet therapy in the drug-eluting stent era
- 2008
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Ingår i: European Heart Journal, Supplement. - : Oxford University Press (OUP). - 1520-765X .- 1554-2815 .- 1520-1554. ; 10:D, s. D38-D44
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Tidskriftsartikel (refereegranskat)abstract
- Data continue to accumulate showing that implantation of coronary stents, particularly drug-eluting stents (DES), is associated with persistent, long-term risk of thrombotic events. Dual antiplatelet therapy with aspirin and clopidogrel has reduced the risk of early and late thrombosis. However, early risk persists due to implantation, stent-related factors, and suboptimal response to clopidogrel, whereas late risk persists due not only to these factors, but to the limited duration of dual antiplatelet therapy as well. Third-generation oral P2Y(12) antagonists that exhibit faster onset of action and greater and more consistent inhibition of platelet aggregation than clopidogrel include the new thienopyridine prasugrel and the reversible P2Y(12) inhibitor AZD6140. Prospective, randomized, Long-term trials are warranted to investigate the benefits and risks of more effective P2Y(12) antagonists as part of dual antiplatelet therapy after both bare-metal stent and DES implantation.
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- Willenheimer, Ronnie
(författare)
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How to begin treatment in chronic heart failure? Results of CIBISIII
- 2006
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Ingår i: European Heart Journal Supplements. - : Oxford University Press (OUP). - 1520-765X .- 1554-2815 .- 1520-1554. ; 8:C, s. 43-50
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Tidskriftsartikel (refereegranskat)abstract
- Aims To compare the effect of initial monotherapy with either bisoprolot or enalapril, followed by their combination, on mortality and hospitalization in patients with mild-to-moderate CHF. Methods and results One thousand and ten patients with mild-to-moderate CHF and left ventricular ejection fraction <= 35%, without ACE-inhibitor, beta-blocker, or angiotensin-receptor-blocker therapy were randomized to open-label monotherapy with either bisoprolot (target dose 10 mg od, n = 505) or enalapril (target dose 10 mg bid, n = 505) for 6 months, followed by their combination for 6-24 months. The combined primary endpoint was all-cause mortality or hospitalization; bisoprolol-first was considered non-inferior to enalapril-first if the upper limit of the 95% Cl for the absolute between-group difference was below +5%, corresponding to HR 1.17. In the intention-to-treat population, the primary endpoint occurred in 178 patients allocated bisoprotol-first vs. 186 allocated enalapril-first: absolute difference, -1.6%; 95% Cl, -7.6 to +4.4%; HR, 0.94; 95% Cl, 0.77-1.16. Thus, non-inferiority was demonstrated in the intention-to-treat population. In the per-protocol population, the primary endpoint occurred in 163 patients in the bisoprolol-first group vs. 165 in the enalapril-first group: absolute difference, -0.7%; 95% Cl, -6.6 to +5.1%; HR, 0.97; 95% Cl, 0.78-1.21. With bisoprolol-first, 65 patients died vs. 73 with enalapril-first (HR, 0.88; 95% Cl, 0.63-1.22; between-group difference P = 0.44), and 151 vs. 157 patients were hospitalized (HR, 0.95; 95% Cl, 0.76-1.19; between-group difference P = 0.66). Post hoc analysis of data from the first year indicated that a bisoprolol-first strategy reduced mortality by 31%, compared with an enalapril-first strategy (HR, 0.69; 95% CI, 0.46-1.02; between-group difference P = 0.065). Conclusion Initiating treatment with bisoprolot is as effective and well-tolerated as initiating treatment with enalapril. Post hoc analysis suggests that starting treatment with enalapril may reduce the risk of death, especially in the first year of treatment.
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