Incidence of Stroke in Paroxysmal Versus Sustained Atrial Fibrillation in Patients Taking Oral Anticoagulation or Combined Antiplatelet Therapy: An ACTIVE W Substudy Stefan H. Hohnloser, Dimitri ...Pajitnev, Janice Pogue, Jeff S. Healey, Marc A. Pfeffer, Salim Yusuf, Stuart J. Connolly, for the ACTIVE W Investigators The risk of stroke and non-cerebral embolism and the efficacy of oral anticoagulation (OAC) in paroxysmal atrial fibrillation (AF) as compared with sustained AF are not precisely known. ACTIVE W (Atrial Fibrillation Clopidogrel Trial With Irbesartan For Prevention Off Vascular Events) was a trial in 6,706 AF patients comparing OAC to antiplatelet therapy with aspirin plus clopidogrel for prevention of vascular events. The annualized risk of stroke or non-cerebral embolism was 2.0 in paroxysmal AF (n = 1,202) compared with 2.2 in sustained AF (n = 5,495) (relative risk 0.87, 95% confidence interval 0.59 to 1.30, p = 0.496). The incidence of stroke and non-central nervous system embolism was lower for patients treated with OAC irrespective of type of AF.
Incidence and Predictors of Hyperkalemia in Patients With Heart Failure: An Analysis of the CHARM Program Akshay S. Desai, Karl Swedberg, John J. V. McMurray, Christopher B. Granger, Salim Yusuf, ...James B. Young, Mark E. Dunlap, Scott D. Solomon, James W. Hainer, Bertil Olofsson, Eric L. Michelson, Marc A. Pfeffer We examined the incidence and predictors of hyperkalemia in a broad population of patients with symptomatic heart failure enrolled in the CHARM (Candesartan in Heart Failure-Assessment of Reduction in Mortality and Morbidity) Program. Independent of assignment to candesartan or placebo, the risk of hyperkalemia increased with advanced age, male gender, baseline hyperkalemia, renal failure, diabetes, and background use of angiotensin-converting enzyme inhibitors or spironolactone. Candesartan increased the observed rate of hyperkalemia in these subgroups but was associated with a consistent reduction in the risk of cardiovascular death or heart failure hospitalization. Although renin-angiotensin-aldosterone antagonists improve clinical outcomes in heart failure patients, careful surveillance of serum potassium and creatinine is essential.
Racial Analysis of Patients With Myocardial Infarction Complicated by Heart Failure and/or Left Ventricular Dysfunction Treated With Valsartan, Captopril, or Both L. Michael Prisant, Kevin L. Thomas, ...Eldrin F. Lewis, Zhen Huang, Gary S. Francis, W. Douglas Weaver, Marc A. Pfeffer, John J. V. McMurray, Robert M. Califf, Eric J. Velazquez African Americans have a high incidence of heart failure (HF). Limited retrospective observational subgroup analyses of patients with left ventricular systolic dysfunction (LVSD) suggest marginal benefit of angiotensin-converting enzyme inhibitors in the prevention of HF hospitalizations or total mortality in African Americans. We found that African Americans sustaining an acute myocardial infarction with LVSD and/or HF had similar clinical outcomes compared with white Americans. Valsartan, captopril, or the combination had comparable effects on cardiovascular morbidity and mortality in African Americans and white Americans.
Red Cell Distribution Width as a Novel Prognostic Marker in Heart Failure: Data From the CHARM Program and the Duke Databank G. Michael Felker, Larry A. Allen, Stuart J. Pocock, Linda K. Shaw, John ...J. V. McMurray, Marc A. Pfeffer, Karl Swedberg, Duolao Wang, Salim Yusuf, Eric L. Michelson, Christopher B. Granger, for the CHARM Investigators Among 36 routine laboratory measures in the CHARM (Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity) program, higher red cell distribution width showed the greatest association with cardiovascular death and heart failure hospitalization (adjusted hazard ratio 1.17 per 1 SD increase, p < 0.001). Only age and cardiomegaly showed better independent association with outcome. This finding was replicated in the Duke Databank, in which red cell distribution width continued to be strongly associated with mortality (adjusted hazard ratio 1.29 per 1 SD, p < 0.001). Understanding how and why this marker is associated with outcome may provide novel insights into heart failure pathophysiology.
Prognostic Value of B-Type Natriuretic Peptides in Patients With Stable Coronary Artery Disease: The PEACE Trial Torbjørn Omland, Marc S. Sabatine, Kathleen A. Jablonski, Madeline Murguia Rice, ...Judith Hsia, Ragnhild Wergeland, Sverre Landaas, Jean L. Rouleau, Michael J. Domanski, Christian Hall, Marc A. Pfeffer, Eugene Braunwald, for the PEACE Investigators Baseline plasma B-type natriuretic peptide (BNP) and N-terminal (NT) pro-B-type natriuretic peptide (NT-proBNP) concentrations were measured in 3,761 patients with stable coronary artery disease and preserved left ventricular function participating in the PEACE (Prevention of Events With Angiotensin-Converting Enzyme Inhibition) study, a placebo-controlled trial of trandolapril. The BNP and NT-proBNP levels were strongly related to the incidence of cardiovascular mortality, heart failure, and stroke but not to myocardial infarction. Both BNP and NT-proBNP significantly improved the predictive accuracy of the best available model for incident heart failure, and NT-proBNP also improved the model for cardiovascular death. The magnitude of effect of angiotensin-converting enzyme inhibition on the likelihood of experiencing cardiovascular end points was similar regardless of either BNP or NT-proBNP baseline concentrations.
Association of the Trp719Arg Polymorphism in Kinesin-Like Protein 6 With Myocardial Infarction and Coronary Heart Disease in 2 Prospective Trials: The CARE and WOSCOPS Trials Olga A. Iakoubova, ...Carmen H. Tong, Charles M. Rowland, Todd G. Kirchgessner, Bradford A. Young, Andre R. Arellano, Dov Shiffman, Marc S. Sabatine, Hannia Campos, Christopher J. Packard, Marc A. Pfeffer, Thomas J. White, Eugene Braunwald, James Shepherd, James J. Devlin, Frank M. Sacks The Trp719Arg polymorphism in KIF6 was associated with recurrent myocardial infarction in the CARE (Cholesterol And Recurrent Events) trial and with primary CHD in the WOSCOPS (West of Scotland Coronary Prevention Study) trial. In placebo-treated patients, carriers of the KIF6 719Arg allele (59.4% of the CARE trial cohort) had an adjusted hazard ratio of 1.50 (95% confidence interval CI 1.05 to 2.15) in the CARE trial and an adjusted odds ratio of 1.55 (95% CI 1.14 to 2.09) in the WOSCOPS trial. Among carriers of the KIF6 719Arg risk allele, the absolute risk reduction by pravastatin was 4.89% (95% CI 1.81% to 7.97%) in the CARE trial and 5.49% (95% CI 3.52% to 7.46%) in the WOSCOPS trial
Reply Olsson, Lars, MB; Pfeffer, Marc A., MD, PhD, FACC; Swedberg, Karl, MD, FACC
Journal of the American College of Cardiology,
2007, Letnik:
49, Številka:
3
Journal Article
Blood Pressure in Heart Failure Pfeffer, Marc A., MD, PhD, FACC
Journal of the American College of Cardiology,
2007, 2007-01-00, Letnik:
49, Številka:
1
Journal Article
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