Real Patients At The Heart Of Cardiology

Cardiology-300x200Fresh from the European Society of Cardiology meeting in Amsterdam, Dr Muiris Houston says while this year’s hot-line sessions were somewhat muted, one clinical trial had a ‘real patient’ feel about it, and shares the latest research on statins.
You can’t beat a good conference, especially one held during September, when we seem to be hardwired for enthusiasm and renewal as that well embedded back-to-school feeling kicks in.
So it was that I found myself at the biggest cardiology meeting of the year in Amsterdam; the annual European Society of Cardiology (ESC) meeting was absolutely massive, with more than 30,000 attendees this year. The RAI venue handled the numbers well, although for some of the most popular sessions you had to get there a good 10 minutes in advance of the starting time to get in.
Hot-line sessions
So what were the highlights of the 3.5-day event? Late-breaking trials presented at hot-line sessions throughout the conference by their very nature create excitement, although this year some of the trial results were muted.
Probably the one that stood out most was the Hokusai-VTE study of 8,292 patients with either acute symptomatic DVT, pulmonary embolism (PE), or both.
The study found the factor Xa inhibitor edoxoban was as effective as warfarin in the treatment and prevention of recurrent venous thromboembolism. The drug was also found to be better than warfarin when it came to the major safety concern of major bleeding (8.3% vs 10.5%).
The trial had a “real patient” feel about it which is important as there has been a feeling that clinical trials in general had become focused on the ideal patient rather than the warts and all variety we deal with in day-to-day practice. So the Hokusai-VTE study was designed to reflect clinical practice using flexible treatment duration of three to 12 months, including initial heparin treatment, in a broad spectrum of VTE patients.
The other nice touch was the decision of those behind the trial to encourage dose modification during the trial so that for example patients who developed a degree of renal failure had the once-a-day dose of edoxaban halved. Dosage reduction was also allowed for in participants with low body weight, and those taking drugs known to interact with the novel anticoagulant.
Overall, the study found that edoxaban use was associated with a lower incidence of VTE compared to warfarin (3.2% vs 3.5%).  Notably there was a sizable reduction in recurrent thromboembolic problems in patients who had survived severe pulmonary embolism.
guidelines-300x225New guidelines
The ESC itself released new guidelines on the treatment of hypertension and the management of chronic ischaemic heart disease. The latter helped with guidance on the question of when to perform repeat angiography in patients with long-standing coronary heart disease. In particular, we were told that deferring revascularisation in this group is not associated with worse outcomes. Similarly with stress ECG testing there is no need to repeat stress tests on a regular basis unless there has been a change in the clinical status of the patient.
When it comes to the use of statins, the guidance authors moved away from targeting specific LDL levels to encouraging doctors to prescribe either a moderate or high dose statin to all patients with chronic IHD. The thinking here is that statins have benefits even in patients with respectably low cholesterol levels.
Screen-Shot-2013-10-29-at-1.33.04-PM-300x237Statins also featured in research presented at the event suggesting they may help prevent dementia as well as reducing the risk of developing cataracts, new research suggests.
A study of almost 58,000 Taiwanese people aged 65 years and over who were followed up for 4.5 years found that those taking the highest dosage of statin drugs had a lower risk of developing symptoms of pre-senile and senile dementia. In comparison with a control group, the 5,500 participants who went on to develop dementia were less likely to have been prescribed a statin or had taken the drug in low dose.
This latest research contrasts with some recent reports of statin-associated cognitive impairment have led the US Food and Drug Administration (FDA) to list statin-induced cognitive changes as a potential side effect.
Lead investigator Dr Tin-Tse Lin of the National University Hospital in Taipei told the ESC “patients who received the highest total equivalent doses of statins had a three-fold decrease in the risk of developing dementia.”
He added: “It was the potency of the statins…which was a major determinant in reducing dementia. High potency statins such as atorvastatin and rosuvastatin showed a significant inverse association with developing dementia.”
Meanwhile, separate research from the US presented at the conference showed that the use of statins was associated with a 19% lower risk of developing cataracts compared with people who did not take the drug.
Source:; Dr. Muiris Houston; September 27, 2013.

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