MD Conference Express AHA 2011 - (Page 4)

Dear Practitioners, We are pleased to share with you these official peer-reviewed highlights from the American Heart Association’s 2011 Scientific Sessions. The articles that were selected for this issue of MD Conference Express® were chosen from the hundreds of presentations at the conference and represent the most newsworthy topics of relevance to a broad range of practitioners. First-time clinical trial presentations include two studies of novel antithrombotics in patients with acute coronary syndromes (ACS). The ATLAS ACS 2-TIMI 51 trial showed that very-low-dose (2.5 mg) and low-dose (5 mg) rivaroxaban twice daily, in combination with standard antiplatelet therapies, significantly reduced cardiac events and mortality in patients after ACS compared with placebo. Bleeding was increased with rivaroxaban, although the balance of safety and efficacy was more favorable for the very low dose (2.5 mg). The TRA•CER study found that the novel antiplatelet vorapaxar (a PAR-1 antagonist) did not reduce mortality or serious cardiovascular (CV) events in patients with ACS, but it did significantly increase the risk of major bleeding, including intracranial hemorrhage. TRA•CER had been stopped in January 2011 after an interim safety analysis revealed an excess of intracranial hemorrhage in patients with a history of stroke who were treated with vorapaxar. Whether protease-activated receptor-1 (PAR-1) blockade improves outcomes with different medication strategies or in other patient populations merits further study. One such trial, TRA 2°P TIMI-50 [NCT00526474], is evaluating vorapaxar in patients with stable cardiac and vascular disease and is due to report in 2012. The AIM HIGH study was another landmark trial that was stopped early when niacin showed no signs of benefit (and an unexpected increase in ischemic stroke) in patients with dyslipidemia and a history of cardiovascular disease (CVD), casting doubt on the utility of niacin. The ongoing HPS2 THRIVE [NCT00461630] trial, which is designed to assess the effects of raising high-density lipoprotein (HDL) cholesterol with extended release niacin, in combination with an antiflushing agent (laropiprant), should provide more answers about the role for niacin. In addition to the highlights from other top late-breaking clinical trials, such as ELEVATE TIMI 56 (a comparison of higher versus lower maintenance doses of clopidogrel in carriers of a reduced-function CYP2C19 allele), MI-FREEE (assessment of the elimination of medication copayments on adherence), and PALLAS (the efficacy of dronedarone in patients with permanent atrial fibrillation), you will also find information on selected areas of cardiovascular medicine, including strategies for complex valvular disease, new transcatheter valve technologies and techniques, and how imaging can be best used to determine CV risk. In addition, we review several guideline updates, in particular for CVD prevention in women, peripheral arterial disease, and and percutaneous coronary intervention (PCI) in stable coronary artery disease (CAD). We hope that you find the articles and practical perspectives that are contained in the pages of this issue of MD Conference Express helpful in integrating this new information into your clinical practice. For more information on MD Conference Express, please visit www.mdconferencexpress.com. Robert P. Giugliano, MD, SM Associate Physician Cardiovascular Division Brigham & Women’s Hospital Associate Professor in Medicine Harvard Medical School Boston, MA Marc P. Bonaca, MD, MPH Associate Physician Cardiovascular Division Brigham & Women’s Hospital Boston, MA Jay Udell, MD, MPH Cardiovascular Fellow Cardiovascular Division Brigham & Women’s Hospital Boston, MA 4 January 2012 www.mdconferencexpress.com http://www.mdconferencexpress.com http://www.mdconferencexpress.com

Table of Contents for the Digital Edition of MD Conference Express AHA 2011

MD Conference Express AHA 2011

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