Switching from Plavix to Effient? Any need or data?

FROM CARDIOSOURCE: http://tinyurl.com/cy7wpaf

Journal Scan Summary

Title:	A Randomized Trial of Prasugrel Versus Clopidogrel
Date Posted:	April 18, 2012
Authors:	Trenk D, Stone G, Gawaz M, et al.
Citation:	J Am Coll Cardiol 2012;Apr 18:[Epub ahead of print].

Study Question:

What is the safety and efficacy of prasugrel as compared with clopidogrel in patients with high on-treatment platelet reactivity (HTPR) after elective percutaneous coronary intervention (PCI)?

Methods:

The authors enrolled patients who had HTPR on clopidogrel after undergoing PCI with drug-eluting stents for stable coronary artery disease. HTPR was defined as >208 P2Y₁₂ reaction units [PRU] by the VerifyNow test. A total of 423 patients were randomly assigned to either prasugrel 10 mg daily or clopidogrel 75 mg daily. Platelet reactivity of the patients on the study drug was reassessed at 3 and 6 months. The study was stopped prematurely for futility.

Results:

Among the 212 patients assigned to prasugrel, PRU decreased from a median of 245 to 80 at 3 months, whereas in 211 patients assigned to clopidogrel, PRU decreased from 249 to 241 (p < 0.001 vs. prasugrel). There was no difference in the primary efficacy endpoint of cardiac death or myocardial infarction at 6 months (none on prasugrel vs. one on clopidogrel). The primary safety endpoint of non–coronary artery bypass graft Thrombolysis in Myocardial Infarction major bleeding at 6 months occurred in three patients (1.4%) on prasugrel versus one (0.5%) on clopidogrel.

Conclusions:

The authors concluded that switching from clopidogrel to prasugrel in patients with HTPR was associated with effective platelet inhibition. Despite the enhanced platelet inhibition, there was no difference in ischemic events, which were low in both arms.

Perspective:

This study failed to demonstrate a clinical benefit of better platelet inhibition with prasugrel in patients with HTPR after elective PCI. Combined with the results of the GRAVITAS trial, these findings question the utility of using platelet function assays to guide antiplatelet therapy after elective PCI. Furthermore, the ischemic event rates in this population were very low in patients who were treated with clopidogrel, and it should remain the thienopyridine of choice in patients undergoing elective PCI.

Author(s):

Hitinder S. Gurm, M.B.B.S., F.A.C.C. (Disclosure)

Topic(s):

Interventional Cardiology, General Cardiolog

Only 3 Months of Aspirin and Plavix after a Drug Eluting Stent?

Nice article in Cardiology News: http://tinyurl.com/7xxmga3

Major Finding: Patients assigned to 3 months of dual antiplatelet therapy following implantation of a zotarolimus-eluting stent had a 1-year combined adverse event rate of 4.7%, identical to that in recipients of other drug-eluting stents plus the standard 12 months of dual antiplatelet therapy.

Data Source: An open-label, randomized trial including 2,117 patients who received a zotarolimus-eluting Endeavor stent and 3 months of dual antiplatelet therapy, or a different drug-eluting stent and the standard 12 months of dual antiplatelet therapy.

Disclosures: The study was sponsored by the South Korean Ministry of Health and Welfare, the Cardiovascular Research Center of Seoul, and Medtronic.

Weight Loss

Everyone has struggled with the question: What is the best way to lose weight? There is no magically diet or pills that can bring your weight down safely. The basics: It is all about calories: take how many calories you consume in a day minus the amount of calories you burn. If you burn more calories than you take in, you will lose weight.

A great article from LIVESTRONG.COM

http://www.livestrong.com/article/460819-recommended-caloric-intake-based-on-weight/

Maintaining your weight can be a challenge as you age. The simplest way to maintain a healthy weight is to know how many calories you need to eat, and then consume roughly that amount each day. If you need to lose or gain weight, you can modify this number to meet your needs.

Basics: Multiply your current weight by 13 to if you are male and 10 if you are female. This is the base number of calories you need to maintain your current weight.Lose Belly Fat Naturally 3 sneaky hormones that are making you fat & how to stop them now.

Activity Level: If you are active, you need more calories than if you are sedentary. If you perform cardiovascular exercise several times a week or have a physical job, add two to the number by which you multiply your weight. For example, if you are a man who works out several times a week, multiply your weight by 15. The resulting number is the amount of calories you should eat each day to maintain your weight.

Age: As you age, you will probably find that you need fewer calories. Make small adjustments in the amount you eat now and you can eliminate the unpleasant surprise of an extra 10 or more pounds next year. The easiest way to know if you need to adjust is to maintain a food diary and weigh yourself regularly. By doing this, you will catch weight gain early and know how many calories you consume, which allows you to cut back and lose the weight painlessly.

Weight Gain or Loss: Once you know how many calories you should consume each day, you can adjust the number to meet your goals. If you are happy with your weight, make this your target number. If you want to lose weight, lower the amount of calories you consume by 300 per day. In addition, add enough physical activity to burn another 300 calories each day. You can burn approximately 300 calories by walking briskly for an hour or jogging for 30 minutes. If you want to gain weight, increase the number of calories you eat by 500 or more daily and add strength training to your workout for healthy weight gain.

On a Statin -- get your HbA1C checked

The FDA has approved safety label changes for statins, which include eliminating the requirement for routine monitoring of liver enzymes from the drug labels and adding information about the potential for generally non-serious and reversible cognitive side effects and reports of increased blood sugar and HbA1c levels.

Fit and Fat?

Changes in Fitness and Fatness on the Development of Cardiovascular Disease Risk Factors

Hypertension, Metabolic Syndrome, and Hypercholesterolemia

Duck-chul Lee, PhD^_*,_*, Xuemei Sui, MD^_*,Timothy S. Church, MD, Carl J. Lavie, MD,Andrew S. Jackson, PED^|| and Steven N. Blair, PED^_*,

^_* Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
 Department of Preventive Medicine Research, Pennington Biomedical Research Center, Baton Rouge, Louisiana
 Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School–University of Queensland School of Medicine, New Orleans, Louisiana
^|| Department of Health and Human Performance, University of Houston, Houston, Texas

Manuscript received September 12, 2011; revised manuscript received November 7, 2011, accepted November 12, 2011.

^_* Reprint requests and correspondence: Dr. Duck-chul Lee, Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, South Carolina 29208 (Email: lee23@mailbox.sc.edu).

Objectives: This study sought examine the independent and combined associations of changes in fitness and fatness with the subsequent incidence of the cardiovascular disease (CVD) risk factors of hypertension, metabolic syndrome, and hypercholesterolemia.

Background: The relative and combined contributions of fitness and fatness to health are controversial, and few studies are available on the associations of changes in fitness and fatness with the development of CVD risk factors.

Methods: We followed up 3,148 healthy adults who received at least 3 medical examinations. Fitness was determined by using a maximal treadmill test. Fatness was expressed by percent body fat and body mass index. Changes in fitness and fatness between the first and second examinations were categorized into loss, stable, or gain groups.

Results: During the 6-year follow-up after the second examination, 752, 426, and 597 adults developed hypertension, metabolic syndrome, and hypercholesterolemia, respectively. Maintaining or improving fitness was associated with lower risk of developing each outcome, whereas increasing fatness was associated with higher risk of developing each outcome, after adjusting for possible confounders and fatness or fitness for each other (all p for trend <0.05). In the joint analyses, the increased risks associated with fat gain appeared to be attenuated, although not completely eliminated, when fitness was maintained or improved. In addition, the increased risks associated with fitness loss were also somewhat attenuated when fatness was reduced.

Conclusions: Both maintaining or improving fitness and preventing fat gain are important to reduce the risk of developing CVD risk factors in healthy adults.

Key Words: body fatness • cardiorespiratory fitness • hypercholesterolemia • hypertension • metabolic syndrome

J Am Coll Cardiol, 2012; 59:665-672, doi:10.1016/j.jacc.2011.11.013
© 2012 by the American College of Cardiology Foundation

Painless Heart Attacks in Women

Association of Age and Sex With Myocardial Infarction Symptom Presentation and In-Hospital Mortality

1. John G. Canto, MD, MSPH; 
2. William J. Rogers, MD; 
3. Robert J. Goldberg, PhD;
4. Eric D. Peterson, MD, MPH; 
5. Nanette K. Wenger, MD; 
6. Viola Vaccarino, MD, PhD; 
7. Catarina I. Kiefe, MD, PhD; 
8. Paul D. Frederick, MPH, MBA; 
9. George Sopko, MD, MPH; 
10. Zhi-Jie Zheng, MD, PhD 
11. for the NRMI Investigators

[+] Author Affiliations

1. Author Affiliations: Watson Clinic and Lakeland Regional Medical Center, Lakeland, Florida (Dr Canto); University of Alabama Medical Center, Birmingham (Dr Rogers); Department of Quantitative Health Sciences, University of Massachusetts Medical Center, Worcester (Drs Goldberg and Kiefe); Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina (Dr Peterson); Department of Medicine, Division of Cardiology, Emory School of Medicine (Drs Wenger and Vaccarino), and the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia (Dr Vaccarino); ICON Late Phase & Outcomes Research, San Francisco, California (Dr Frederick); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland (Dr Sopko); and the School of Public Health, Shanghai Jiao Tong University, Shanghai, China (Dr Zheng).

ABSTRACT

Context Women are generally older than men at hospitalization for myocardial infarction (MI) and also present less frequently with chest pain/discomfort. However, few studies have taken age into account when examining sex differences in clinical presentation and mortality.

Objective To examine the relationship between sex and symptom presentation and between sex, symptom presentation, and hospital mortality, before and after accounting for age in patients hospitalized with MI.

Design, Setting, and Patients Observational study from the National Registry of Myocardial Infarction, 1994-2006, of 1 143 513 registry patients (481 581 women and 661 932 men).

Main Outcome Measures We examined predictors of MI presentation without chest pain and the relationship between age, sex, and hospital mortality.

Results The proportion of MI patients who presented without chest pain was significantly higher for women than men (42.0% [95% CI, 41.8%-42.1%] vs 30.7% [95% CI, 30.6%-30.8%]; P < .001). There was a significant interaction between age and sex with chest pain at presentation, with a larger sex difference in younger than older patients, which became attenuated with advancing age. Multivariable adjusted age-specific odds ratios (ORs) for lack of chest pain for women (referent, men) were younger than 45 years, 1.30 (95% CI, 1.23-1.36); 45 to 54 years, 1.26 (95% CI, 1.22-1.30); 55 to 64 years, 1.24 (95% CI, 1.21-1.27); 65 to 74 years, 1.13 (95% CI, 1.11-1.15); and 75 years or older, 1.03 (95% CI, 1.02-1.04). Two-way interaction (sex and age) on MI presentation without chest pain was significant (P < .001). The in-hospital mortality rate was 14.6% for women and 10.3% for men. Younger women presenting without chest pain had greater hospital mortality than younger men without chest pain, and these sex differences decreased or even reversed with advancing age, with adjusted OR for age younger than 45 years, 1.18 (95% CI, 1.00-1.39); 45 to 54 years, 1.13 (95% CI, 1.02-1.26); 55 to 64 years, 1.02 (95% CI, 0.96-1.09); 65 to 74 years, 0.91 (95% CI, 0.88-0.95); and 75 years or older, 0.81 (95% CI, 0.79-0.83). The 3-way interaction (sex, age, and chest pain) on mortality was significant (P < .001).

Conclusion In this registry of patients hospitalized with MI, women were more likely than men to present without chest pain and had higher mortality than men within the same age group, but sex differences in clinical presentation without chest pain and in mortality were attenuated with increasing age.

High Blood Pressure, What is the Big Deal?

As your blood pressure goes up, the risk of stroke goes up. Even when the top number (systolic) number goes from 100 to 130. Also, even if your blood pressure is ok -- in the 130 to 150 range -- the risk of stroke goes up when you start to add other medical conditions, such as diabetes or smoking. The left of the graph is the risk of stroke over 10 years and the bottom is blood pressure and associated conditions. 

Next Generation Bioresorbable Stents

Have a look, very promising technology -- from http://www.art-stent.com/products.php

Nitro Under Tongue or Spray for Chest Pain?

Nitro works well for chest pain. For those that do not like the pill, try the spray under the tongue. No need for the tablet to dissolve, it gets right into your system. 

Need a new cardiologist in New Milford, CT?

Need a new cardiologist in New Milford, CT? Call me; Dr. Sumit Tickoo 203-739-7155