FIGARO-DK- Finerenone Reduces Cardiovascular Mortality in Patients With T2D and CKD
FIGARO-DKD trial showed that finerenone has salutary effects on CV outcomes among patients with T2DM and CKD, who were on a background of maximal RAS blockade therapy, primarily due to a reduction in hospitalization for HF. There was also a reduction in ESKD. New-onset HF was reduced among patients without HF at baseline. There was a higher risk of hyperkalemia with finerenone.
REVIVED-BCIS2 Trial - Efficacy and Safety of Percutaneous Coronary Intervention to Improve Survival
Percutaneous coronary intervention does not improve event-free survival in patients with ischaemic left ventricular systolic dysfunction. 700 patients with LVEF ≤35% and coronary artery disease were randomly assigned to PCI plus optimal medical therapy or optimal medical therapy alone. PCI did not result in a lower incidence of death from any cause or hospitalisation for HF over 3.4 years.
ACT Inpatient Trial: Colchicine and Rivaroxaban Plus Aspirin in Patients Hospitalized With COVID-19
One out of every five patients in the ward with COVID-19 died in the ACT inpatient trial (high mortality rate). Colchicine did not give a mortality advantage in the ACT study, regardless of whether the patient is on MV or has previously been vaccinated, or if the patient has long or short duration of symptoms. A meta-analysis of anticoagulation in inpatients showed 40% decrease in VTE.
Implementing Best Practices Across The Spectrum of Heart Failure
To avoid morbidity, patients with HFpEF and HTN should be administered titrated drugs to achieve their BP targets. SGLT2i is an ideal cardio-renal-metabolic therapy for HF, as one pill/day improves survival, prevents hospitalization, and improves QoL and functional status. In a 55-year-old patient with HFrEF, comprehensive therapy (with ARNI+BB+MRA+SGLT2i) provided an overall 6.3 additional years.
SGLT2 Inhibitors in HFpEF - Light at The End of The Tunnel
SGLT2i was first intended to treat diabetes, but studies have shown that it is also useful in treatment of HF. In individuals with HFpEF or HFmrEF, dapagliflozin treatment decreases the risk of the primary composite outcome of CV death or worsening HF. EMPEROR-Preserved trial showed that empagliflozin improved HF outcomes in patients with symptomatic stable HFpEF on good baseline GDMT.
FOURIER-OLE Primary Results
Long-term use of Evolocumab with a median follow-up of more than 7 years appears to be safe and well-tolerated. Early initiation of Evolocumab is beneficial for CVD and CVD mortality over several years. FOURIER-OLE study results argue for early initiation of marked and sustained LDL-C reduction for maximum clinical effect.
FIDELITY: Causes of Mortality
Finerenone not only reduced the risk of all-cause and CV mortality but also reduced the risk of sudden cardiac death. The effect of Finerenone on mortality outcomes was more pronounced in patients with higher baseline eGFR. Finerenone improves prognosis even in well-managed patients.
15-month Results of The MASTER DAPT Trial
Antiplatelet therapy intensity (DAPT vs SAPT or SAPT vs no APT) was influenced by perceived ischemic risk or prior ischemic events, but not by bleeding risk or prior bleeding events. Adverse clinical events and MACCE remained similar, MCB was low at 15 months suggesting no ischemic or fatal events and at least persistent bleeding compared to standard treatment after Ultimaster stent implantation.
PARADISE-MI Trial - Win Ratio Analysis
PARADISE-MI trial showed that Sacubitril/Valsartan was superior than Ramipril in high-risk survivors of MI. Win ratio analysis can be a useful adjunct to the conventional time-to-first event analysis for trials with composite outcomes, where the ranking of the clinical importance of the different types of events is considered relevant. This analysis can inform the design of future CV trials.
PANTHER - P2Y12 Inhibitor VS Aspirin Monotherapy in Patients With Coronary Artery Disease
P2Y12 inhibitor monotherapy was associated with lower risks of CVD and MI. The incidence of major bleeding was similar, but gastrointestinal (GI) bleeding and haemorrhagic stroke were lower with P2Y12 inhibitor monotherapy. Long-term P2Y12 inhibitor monotherapy is better than long-term aspirin monotherapy for secondary prevention in patients with CAD.
What Do Real-World Analyses Tell Us About NOACs?
In a large, real-world FDA/MCS analysis, each NOAC was associated with reduced risk of thromboembolic stroke vs warfarin. As per GARFIELD-AF study, NOACs were associated with significantly lower rates of major bleeding and all-cause death vs VKA. As per GARFIELD-AF registry, dabigatran was the only NOAC with significant reduction in major bleeding and all-cause mortality vs VKA.
Implementing ESC 2021 Guideline-Recommended HF Care: Where Do We Stand Now
Initiate standard therapies as soon as possible and titrate every 2-4 weeks to target or maximally tolerated dose over 3-6 months. The ESC/HFA society recommends personlized approach for treatment of heart failure. Real-world data suggest better outcomes with simultaneous VS sequential prescription of Ivabradine and Sacubitril/Valsartan in patients with HFrEF.
GLORIA-AF: New Phase III Data From This Innovative Registry Program
Dabigatran showed significant relative risk reduction of major bleeding by 39% and all-cause death by 22% vs vitamin K antagonists (VKA). Dabigatran was associated with a 41% lower relative risk of major bleeding vs rivaroxaban. There were similar risks of clinical outcomes with dabigatran vs apixaban.
INVICTUS - Rivaroxaban Versus VKA For Rheumatic Atrial Fibrillation
Rheumatic heart disease affects over 40 million people worldwide and 20% of symptomatic RHD patients also suffer from AF. An anticoagulant that does not require monitoring would be of great benefit to RHD-AF patients. INVICTUS trial showed that in RHD-AF patients, vitamin K antagonist reduced ischemic stroke and mortality without increasing the risk of major bleeding compared with rivaroxaban.
The Evolution Of T2D And CV Guidelines
In patients with ASCVD, including stroke, GLP-1 RA should be added to metformin regardless of baseline HbA1c. Lifestyle modification, glucose targeting, BP control, dyslipidemia management, antiplatelet therapy, weight control, and anti-inflammatory therapy are considered for T2D management. Interventions for glucose management will reduce the risk of neurocognitive and discrete stroke events.
GLP-1 RA: More Than Just Glucose-Lowering Agents
10% of cardiologists, endocrinologists, or HCPs are using GLP-1 RA for the management of diabetes. GLP-1RAs target both fasting and postprandial glycemia, in general by increasing insulin and decreasing glucagon levels. In patients with T2D at high cardiovascular risk, studies have revealed that GLP-1 RA significantly reduces 3-P MACE (composite of CV death, nonfatal MI, or nonfatal stroke).
Individualized Approach in HF Management: What More Can We Do?
A personlized approach may allow to achieve a better and more comprehensive therapy for each individual patient. As per the 2021 ESC consensus on HF patient profiling for tailoring medical therapy, achieving better and more comprehensive therapy for each indivual patient is a must. Ivabradine can be added in patients who have low BP and elevated HR and are taking SGLT2i, MRA, diuretics, BB.
Efficacy & Safety of FXIa Inhibitor Asundexian on Top of Dual Antiplatelet Therapy After AMI
Patients with AF have an increased risk of stroke due to their tendency to develop atrial thrombi. After AMI, antiplatelet therapy with aspirin and a P2Y12i (DAPT) is considered the standard of care. Pacific-AMI study showed asundexion (an oral FXIa inhibitor) was well tolerated in the Phase 1 trial and its 50 mg daily dosage resulted in almost complete (>90%) suppression of FXIa activity.
Valve-in-valve TAVI For Bioprosthetic Valve Failure
As per 2020 ACC/AHA guidelines, SAVR is indicated for patients aged 80 years. For patients with longer life-expectancy, consider life-time management before first re-valving. Choose a bioprosthetic valve with good durability and possibility for safe valve-in-valve when it fails.
Which SPC For Patients With Diabetes And Chronic Kidney Disease?
Renin angiotensin blockers are more effective at reducing albuminuria than other antihypertensive agents. Renin angiotensin blockers are recommended as part of treatment strategy in HTN patients in the presence of microalbuminuria or proteinuria. Blood pressure target for CKD patients recommended by international guidelines is less than140/90 mmHg.
