Infective endocarditis (IE) is a disease with serious, even fatal complications, often requiring long-term and expensive treatment. Therefore, prophylaxis has emerging importance. Previous guidelines suggested the use of prophylactic... more
Infective endocarditis (IE) is a disease with serious, even fatal complications, often requiring long-term and expensive treatment. Therefore, prophylaxis has emerging importance. Previous guidelines suggested the use of prophylactic treatment for a wide range of patients and procedures. The Working Group of the European Society of Cardiology accepted a new guideline on the prevention, diagnosis, and treatment of infective endocarditis in 2009. One of its major point is a radical decrease in the type of procedures requiring prophylaxis. These changes also affect dental and oral surgical procedures. It is important for dentists and oral surgeons to come to know the changes and to apply them in their everyday practice.
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Research Interests: Biology, Cardiovascular disease, Medicine, Gene expression, In Vitro, and 14 moreHumans, Endothelial Cells, Human Body, Vascular endothelium, Vascular, Doxorubicin, Endothelial cell, In vitro culture, Endothelin-1, Side Effect, Vascular Pharmacology, ENDOTHELIUM, Pharmacology and pharmaceutical sciences, and mRNA expression
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Research Interests: Clinical Trial, Medicine, Thrombin, Humans, Heparin, and 15 moreHungary, Pulmonary Embolism, Anticoagulants, Drug Costs, Pyridines, Intensive Care Medicine, Venous thromboembolism, Pyrazoles, Benzimidazoles, Thiazoles, Oligosaccharides, Clinical Trials as Topic, Vitamin K, Vitamin K Antagonist, and Medical and Health Sciences
The incidence of ventricular tachyarrhythmias in the early post-operative period following implantable cardioverter-defibrillator (ICD) implantation is relatively high compared with that in control periods. Since endothelin-1 (ET-1) has... more
The incidence of ventricular tachyarrhythmias in the early post-operative period following implantable cardioverter-defibrillator (ICD) implantation is relatively high compared with that in control periods. Since endothelin-1 (ET-1) has been proven to be an endogenous arrhythmogenic substance, we investigated the changes in serum ET-1 and big-ET levels in patients undergoing ICD implantation. Serum concentrations of ET-1 and big-ET were measured in 14 patients with various heart diseases before the operation, as well as 1 min and 1 h after the last shock therapy. Big-ET levels and the sum of ET-1 and big-ET levels were unchanged immediately after the operation, but had increased significantly by 1 h after implantation (before, 1.57+/-0.61 pmol/l; 1 min, 1.86+/-0.87 pmol/l; 1 h, 4.29+/-1.65 pmol/l for big-ET; before, 3.44+/-1.07 pmol/l; 1 min, 3.79+/-1.29 pmol/l; 1 h, 6.36+/-2.03 pmol/l for big-ET+ET-1). There was a significant correlation between left ventricular ejection fraction and big-ET level measured 1 h after the last shock delivery (r=-0.542, P<0.05). We conclude that the increased big-ET level observed 1 h after the last induction and shock therapy of ventricular fibrillation might have a pathophysiological role in the increased incidence of post-operative spontaneous ventricular arrhythmias.
Research Interests: Cardiology, Medicine, Humans, Internal Medicine, Female, and 15 moreMale, Aged, Middle Aged, Public health systems and services research, Time Factors, Endothelin-1, Implantable defibrillators-cardioverters, Ejection Fraction, Ventricular Fibrillation, Endothelin Receptor, Heart Diseases, Endothelins, Medical and Health Sciences, Cardiovascular medicine and haematology, and Implantable Cardioverter-Defibrillator
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Supplemental material 2 for Rationale, design, and baseline participant characteristics in the MRI and cognitive substudy of the cardiovascular outcomes for people using anticoagulation strategies trial by Mukul Sharma, Robert G Hart,... more
Supplemental material 2 for Rationale, design, and baseline participant characteristics in the MRI and cognitive substudy of the cardiovascular outcomes for people using anticoagulation strategies trial by Mukul Sharma, Robert G Hart, Eric E Smith, Jackie Bosch, Fei Yuan, Amparo Casanova, John W Eikelboom, Stuart J Connolly, Gloria Wong, Rafael Diaz, Patricio Lopez-Jaramillo, Georg Ertl, Stefan Störk, Gilles R Dagenais, Eva M Lonn, Lars Ryden, Andrew M Tonkin, John D Varigos, Deepak L Bhatt, Kelley RH Branch, Jeffrey L Probstfield, Jae-Hyung Kim, Jong-Won Ha, Martin O'Donnell, Dragos Vinereanu, Keith AA Fox, Yan Liang, Lisheng Liu, Jun Zhu, Nana Pogosova, Aldo P Maggioni, Alvaro Avezum, Leopoldo S Piegas, Katalin Keltai, Matyas Keltai, Nancy Cook Bruns, Scott Berkowitz and Salim Yusuf in International Journal of Stroke
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Supplemental material 1 for Rationale, design, and baseline participant characteristics in the MRI and cognitive substudy of the cardiovascular outcomes for people using anticoagulation strategies trial by Mukul Sharma, Robert G Hart,... more
Supplemental material 1 for Rationale, design, and baseline participant characteristics in the MRI and cognitive substudy of the cardiovascular outcomes for people using anticoagulation strategies trial by Mukul Sharma, Robert G Hart, Eric E Smith, Jackie Bosch, Fei Yuan, Amparo Casanova, John W Eikelboom, Stuart J Connolly, Gloria Wong, Rafael Diaz, Patricio Lopez-Jaramillo, Georg Ertl, Stefan Störk, Gilles R Dagenais, Eva M Lonn, Lars Ryden, Andrew M Tonkin, John D Varigos, Deepak L Bhatt, Kelley RH Branch, Jeffrey L Probstfield, Jae-Hyung Kim, Jong-Won Ha, Martin O'Donnell, Dragos Vinereanu, Keith AA Fox, Yan Liang, Lisheng Liu, Jun Zhu, Nana Pogosova, Aldo P Maggioni, Alvaro Avezum, Leopoldo S Piegas, Katalin Keltai, Matyas Keltai, Nancy Cook Bruns, Scott Berkowitz and Salim Yusuf in International Journal of Stroke
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Importance The relative safety and patency of skeletonized vs pedicled internal mammary artery grafts in patients undergoing coronary artery bypass graft (CABG) surgery are unknown. Objective To investigate the association of skeletonized... more
Importance The relative safety and patency of skeletonized vs pedicled internal mammary artery grafts in patients undergoing coronary artery bypass graft (CABG) surgery are unknown. Objective To investigate the association of skeletonized vs pedicled harvesting with internal mammary artery graft patency and clinical outcomes 1 year after CABG surgery. Design, Setting, and Participants This study was a post hoc analysis of the multicenter, randomized, double-blind, placebo-controlled Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) clinical trial, which enrolled 27 395 patients from 602 centers in 33 countries from March 2013 through May 2016. Eligibility criteria for the trial included CABG surgery for coronary artery disease with at least 2 grafts implanted and an estimated glomerular filtration rate of at least 30 mL/min. A total of 1002 of 1448 patients were randomized to the CABG arm of the COMPASS trial and underwent skeletonized (282 [28.1%]) or pedicled (720 [71.9%]) internal mammary artery harvesting. The patients had evaluable angiography results 1 year after surgery. Data were analyzed from October 11, 2019, to May 14, 2020. Interventions Patients underwent graft harvesting with either the pedicled technique or skeletonized technique. Main Outcomes and Measures The primary outcome was graft occlusion 1 year after CABG surgery, as assessed by computed tomography angiography. Results A total of 1002 patients underwent skeletonized (282 [28.1%]; mean [SD] age, 65.9 [8.1] years; 229 men [81.2%]; 194 White patients [68.8%]) or pedicled (720 [71.9%]; mean [SD] age, 64.8 [7.6] years; 603 men [83.8%]; 455 White patients [63.2%]) internal mammary artery harvesting. Rates of internal mammary artery graft occlusion 1 year after CABG surgery were higher in the skeletonized group than in the pedicled group (33 of 344 [9.6%] vs 30 of 764 [3.9%]; graft-level adjusted odds ratio, 2.41; 95% CI, 1.39-4.20; P = .002), including the left internal mammary artery to left anterior descending artery (21 of 289 [7.3%] vs 25 of 725 [3.4%]; graft-level adjusted odds ratio, 2.10; 95% CI, 1.14-3.88, P = .02). After a mean follow-up of 23 months, skeletonized graft harvesting was also associated with a higher rate of major adverse cardiovascular events (20 [7.1%] vs 15 [2.1%]; adjusted hazard ratio, 3.19; 95% CI, 1.53-6.67; P = .002) and repeated revascularization (14 [5.0%] vs 10 [1.4%]; adjusted hazard ratio, 2.75; 95% CI, 1.10-6.88; P = .03). Conclusions and Relevance This post hoc analysis of the COMPASS randomized clinical trial found that harvesting of the internal mammary artery during CABG surgery using a skeletonized technique was associated with a higher rate of graft occlusion and worse clinical outcomes than the traditional pedicled technique. Future randomized clinical trials are needed to establish the safety and patency of the skeletonized technique. Trial Registration ClinicalTrials.gov Identifier: NCT01776424.
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Background: Patients with established coronary artery disease or peripheral artery disease often have diabetes mellitus. These patients are at high risk of future vascular events. Methods: In a prespecified analysis of the COMPASS trial... more
Background: Patients with established coronary artery disease or peripheral artery disease often have diabetes mellitus. These patients are at high risk of future vascular events. Methods: In a prespecified analysis of the COMPASS trial (Cardiovascular Outcomes for People Using Anticoagulation Strategies), we compared the effects of rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg daily) versus placebo plus aspirin in patients with diabetes mellitus versus without diabetes mellitus in preventing major vascular events. The primary efficacy end point was the composite of cardiovascular death, myocardial infarction, or stroke. Secondary end points included all-cause mortality and all major vascular events (cardiovascular death, myocardial infarction, stroke, or major adverse limb events, including amputation). The primary safety end point was a modification of the International Society on Thrombosis and Haemostasis criteria for major bleeding. Results: There were 10 341 patients w...
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Research Interests:
Infective endocarditis (IE) is a disease with serious, even fatal complications, often requiring long-term and expensive treatment. Therefore, prophylaxis has emerging importance. Previous guidelines suggested the use of prophylactic... more
Infective endocarditis (IE) is a disease with serious, even fatal complications, often requiring long-term and expensive treatment. Therefore, prophylaxis has emerging importance. Previous guidelines suggested the use of prophylactic treatment for a wide range of patients and procedures. The Working Group of the European Society of Cardiology accepted a new guideline on the prevention, diagnosis, and treatment of infective endocarditis in 2009. One of its major point is a radical decrease in the type of procedures requiring prophylaxis. These changes also affect dental and oral surgical procedures. It is important for dentists and oral surgeons to come to know the changes and to apply them in their everyday practice.
Research Interests:
Research Interests: Biology, Cardiovascular disease, Medicine, Gene expression, In Vitro, and 14 moreHumans, Endothelial Cells, Human Body, Vascular endothelium, Vascular, Doxorubicin, Endothelial cell, In vitro culture, Endothelin-1, Side Effect, Vascular Pharmacology, ENDOTHELIUM, Pharmacology and pharmaceutical sciences, and mRNA expression
Research Interests: Cardiology, Medicine, Dogs, Internal Medicine, Ischemia, and 12 moreCardiovascular Pharmacology, Female, Animals, Male, Time Factors, Endothelin-1, Pericardium, Action Potentials, Ventricular Fibrillation, Myocardial Ischemia, Cardiovascular medicine and haematology, and Pharmacology and pharmaceutical sciences
Research Interests: Cardiology, Treatment Outcome, Medicine, Humans, Internal Medicine, and 15 moreCardiovascular Pharmacology, Female, Male, Recurrence, Aged, Middle Aged, Adult, Endothelin-1, Implantable defibrillators-cardioverters, Ejection Fraction, Ventricular Fibrillation, Endothelin Receptor, Severity of Illness Index, Cardiovascular medicine and haematology, and Pharmacology and pharmaceutical sciences
Endothelin-1 (ET-1) probably plays an important role in myocardial damage in acute ischemia. Coronary sinus ET-1 and its precursor big endothelin-1 (big ET-1) levels and also tissue levels of preproendothelin-1 mRNA (ET-1 mRNA) were... more
Endothelin-1 (ET-1) probably plays an important role in myocardial damage in acute ischemia. Coronary sinus ET-1 and its precursor big endothelin-1 (big ET-1) levels and also tissue levels of preproendothelin-1 mRNA (ET-1 mRNA) were investigated in an in vivo canine ischemia-reperfusion model in nine consecutive mongrel dogs, surviving 30-minute ligation of the left descending coronary artery followed by a 90-minute reperfusion period. Samples were collected before and at the end of ischemia and during reperfusion. ET-1 and big ET-1 were obtained by immunoprecipitation and detected by western blotting. The ET-1 mRNA level was assessed by reverse transcription-polymerase chain reaction. During ischemia the plasma ET-1 levels and big ET-1 levels did not change significantly, while the myocardial ET-1 mRNA level decreased to 57.8%. During reperfusion an increase of the coronary sinus ET-1 and big ET-1 levels was observed (control versus reperfusion, 90 minutes; ET-1, 15.2 +/- 4.18 fmol/mL versus 23.2 +/- 5.23 fmol/mL, P < 0.01; big ET-1, 14.7 +/- 5.9 fmol/mL versus 27.2 +/- 7.1 fmol/mL, P < 0.001). Simultaneously, the ET-1 mRNA level increased by 322% relative to the ischemic and by 214% relative to the baseline level. The decrease of ET-1 mRNA during ischemia may be due to degradation and decreased metabolism in the hypoxic cells locally. The elevation of the ET-1 mRNA level during reperfusion indicates rapid big ET-1 synthesis. This was confirmed by the increases in big ET-1 and ET-1 plasma levels. This latter can be associated with the generation of reperfusion arrhythmias or other complications of acute myocardial infarction.
Research Interests: Medicine, Western blotting, Dogs, Internal Medicine, Ischemia, and 14 moreCardiovascular Pharmacology, Female, Animals, Male, Immunoprecipitation, Myocardium, Time Factors, Endothelin-1, Gene Expression Regulation, Endothelin Receptor, Myocardial Ischemia, reverse transcriptase polymerase chain reaction, Cardiovascular medicine and haematology, and Pharmacology and pharmaceutical sciences
Clinical data on the risk factors, incidence, consequences and current treatment options of venous thromboembolism are reviewed. Current guidelines advise anticoagulant treatment for a few weeks or months in immobilized patients treated... more
Clinical data on the risk factors, incidence, consequences and current treatment options of venous thromboembolism are reviewed. Current guidelines advise anticoagulant treatment for a few weeks or months in immobilized patients treated in hospital, and after major surgery. The initial treatment is based on heparin, followed by vitamin K antagonist treatment. Recently a number of new, partially orally administered medications have undergone clinical investigations and based on the results three of them were also registered for the prevention and treatment of venous thromboembolism. Direct thrombin inhibitors, direct and indirect Factor Xa inhibitors exhibited proven non-inferiority or superiority compared with traditional treatment options. The superior efficacy or non-inferiority was not accompanied with an increase in the bleeding risk. Results of the most important clinical trials are reviewed. Based on these results, prevention and treatment of venous thromboembolism will change...
Research Interests: Clinical Trial, Incidence Geometry, Medicine, Thrombin, Humans, and 15 moreHeparin, Hungary, Pulmonary Embolism, Anticoagulants, Drug Costs, Pyridines, Intensive Care Medicine, Venous thromboembolism, Pyrazoles, Benzimidazoles, Thiazoles, Oligosaccharides, Clinical Trials as Topic, Vitamin K, and Medical and Health Sciences
Research Interests: Engineering, Chemistry, Analytical Chemistry, Electrochemistry, Scanning Electron Microscopy, and 14 moreMorphology, Conducting Polymers, Molecular Imprinting, Electrosynthesis, Ph, Physical sciences, Polypyrrole, Quartz crystal microbalance, CHEMICAL SCIENCES, Surface Structure, Enantioselective Synthesis, Amino Acid Profile, Amino Acid Sequence, and electrochemical quartz crystal microbalance sensor
Background— Atrial fibrillation (AF) is the most common sustained arrhythmia; however, little is known about patients in a primary care setting from high-, middle-, and low-income countries. Methods and Results— This prospective registry... more
Background— Atrial fibrillation (AF) is the most common sustained arrhythmia; however, little is known about patients in a primary care setting from high-, middle-, and low-income countries. Methods and Results— This prospective registry enrolled patients presenting to an emergency department with AF at 164 sites in 46 countries representing all inhabited continents. Patient characteristics were compared among 9 major geographic regions. Between September 2008 and April 2011, 15 400 patients were enrolled. The average age was 65.9, standard deviation 14.8 years, ranging from 57.2, standard deviation 18.8 years in Africa, to 70.1, standard deviation 13.4 years in North America, P <0.001. Hypertension was globally the most common risk factor for AF, ranging in prevalence from 41.6% in India to 80.7% in Eastern Europe, P <0.001. Rheumatic heart disease was present in only 2.2% of North American patients, in comparison with 21.5% in Africa and 31.5% in India, P <0.001. The use ...
Research Interests: Epidemiology, Global Health, Medicine, Humans, Hypertension, and 15 moreFemale, Anticoagulation, Asia, Male, Atrial Fibrillation, Anticoagulants, Guidelines, Clinical Sciences, Aged, Middle Aged, Internationality, Circulation, Emergency Department, Acute Disease, and Cardiovascular medicine and haematology
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Aims To describe outcomes of patients with chronic coronary artery disease (CAD) and/or peripheral artery disease (PAD) enrolled in the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) randomized trial who... more
Aims To describe outcomes of patients with chronic coronary artery disease (CAD) and/or peripheral artery disease (PAD) enrolled in the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) randomized trial who were treated with the combination of rivaroxaban 2.5 mg twice daily and aspirin 100 mg once daily during long-term open-label extension (LTOLE). Methods and results Of the 27 395 patients enrolled in COMPASS, 12 964 (mean age at baseline 67.2 years) from 455 sites in 32 countries were enrolled in LTOLE and treated with the combination of rivaroxaban and aspirin for a median of 374 additional days (range 1–1191 days). During LTOLE, the incident events per 100 patient years were as follows: for the primary outcome [cardiovascular death, stroke, or myocardial infarction (MI)] 2.35 [95% confidence interval (CI) 2.11–2.61], mortality 1.87 (1.65–2.10), stroke 0.62 (0.50–0.76), and MI 1.02 (0.86–1.19), with CIs that overlapped those seen during the randomized...
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Aims Rosuvastatin (10 mg per day) compared with placebo reduced major adverse cardiovascular (CV) events by 24% in 12 705 participants at intermediate CV risk after 5.6 years. There was no benefit of blood pressure (BP) lowering treatment... more
Aims Rosuvastatin (10 mg per day) compared with placebo reduced major adverse cardiovascular (CV) events by 24% in 12 705 participants at intermediate CV risk after 5.6 years. There was no benefit of blood pressure (BP) lowering treatment in the overall group, but a reduction in events in the third of participants with elevated systolic BP. After cessation of all the trial medications, we examined whether the benefits observed during the active treatment phase were sustained, enhanced, or attenuated. Methods and results After the randomized treatment period (5.6 years), participants were invited to participate in 3.1 further years of observation (total 8.7 years). The first co-primary outcome for the entire length of follow-up was the composite of myocardial infarction, stroke, or CV death [major adverse cardiovascular event (MACE)-1], and the second was MACE-1 plus resuscitated cardiac arrest, heart failure, or coronary revascularization (MACE-2). In total, 9326 (78%) of 11 994 sur...
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OBJECTIVE Finerenone significantly improved cardiorenal outcomes in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) in the Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease... more
OBJECTIVE Finerenone significantly improved cardiorenal outcomes in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) in the Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease trial. We explored whether baseline HbA1c level and insulin treatment influenced outcomes. RESEARCH DESIGN AND METHODS Patients with T2D, urine albumin-to-creatinine ratio (UACR) of 30–5,000 mg/g, estimated glomerular filtration rate (eGFR) of 25 to <75 mL/min/1.73 m2, and treated with optimized renin–angiotensin system blockade were randomly assigned to receive finerenone or placebo. Efficacy outcomes included kidney (kidney failure, sustained decrease ≥40% in eGFR from baseline, or renal death) and cardiovascular (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure) composite endpoints. Patients were analyzed by baseline insulin use and by baseline HbA1c <7.5% (58 mmol/mol) or ≥7.5%. RESULTS...
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Background and Purpose: Covert brain infarcts are associated with cognitive decline. It is not known whether therapies that prevent symptomatic stroke prevent covert infarcts. COMPASS compared rivaroxaban with and without aspirin with... more
Background and Purpose: Covert brain infarcts are associated with cognitive decline. It is not known whether therapies that prevent symptomatic stroke prevent covert infarcts. COMPASS compared rivaroxaban with and without aspirin with aspirin for the prevention of stroke, myocardial infarction, and vascular death in participants with stable vascular disease and was terminated early because of benefits of rivaroxaban 2.5 mg twice daily plus aspirin over aspirin. We obtained serial magnetic resonance imagings and cognitive tests in a consenting subgroup of COMPASS patients to examine treatment effects on infarcts, cerebral microbleeds, and white matter hyperintensities. Methods: Baseline and follow-up magnetic resonance imagings were completed in 1445 participants with a mean (SD) interval of 2.0 (0.7) years. Whole-brain T1, T2 fluid-attenuated inversion recovery, T2* sequences were centrally interpreted by blinded, trained readers. Participants had serial measurements of cognition an...
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Research Interests:
Background Covert vascular disease of the brain manifests as infarcts, white matter hyperintensities, and microbleeds on MRI. Their cumulative effect is often a decline in cognition, motor impairment, and psychiatric disorders. Preventive... more
Background Covert vascular disease of the brain manifests as infarcts, white matter hyperintensities, and microbleeds on MRI. Their cumulative effect is often a decline in cognition, motor impairment, and psychiatric disorders. Preventive therapies for covert brain ischemia have not been established but represent a huge unmet clinical need. Aims The MRI substudy examines the effects of the antithrombotic regimens in COMPASS on incident covert brain infarcts (the primary outcome), white matter hyperintensities, and cognitive and functional status in a sample of consenting COMPASS participants without contraindications to MRI. Methods COMPASS is a randomized superiority trial testing rivaroxaban 2.5 mg bid plus acetylsalicylic acid 100 mg and rivaroxaban 5 mg bid against acetylsalicylic acid 100 mg per day for the combined endpoint of MI, stroke, and cardiovascular death in individuals with stable coronary artery disease or peripheral artery disease. T1-weighted, T2-weighted, T2*-weig...
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Patients with lower extremity peripheral artery disease (PAD) are at increased risk of major adverse cardiovascular events (MACE) and major adverse limb events (MALE). There is limited information on the prognosis of patients who... more
Patients with lower extremity peripheral artery disease (PAD) are at increased risk of major adverse cardiovascular events (MACE) and major adverse limb events (MALE). There is limited information on the prognosis of patients who experience MALE. Among participants with lower extremity PAD, this study investigated: 1) if hospitalizations, MACE, amputations, and deaths are higher after the first episode of MALE compared with patients with PAD who do not experience MALE; and 2) the impact of treatment with low-dose rivaroxaban and aspirin compared with aspirin alone on the incidence of MALE, peripheral vascular interventions, and all peripheral vascular outcomes over a median follow-up of 21 months. We analyzed outcomes in 6,391 patients with lower extremity PAD who were enrolled in the COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) trial. COMPASS was a randomized, double-blind placebo-controlled study of low-dose rivaroxaban and aspirin combination or r...
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The aims of the present study were to describe the proportion of patients eligible for the COMPASS trial within the Reduction of Atherothrombosis for Continued Health (REACH) registry, the reasons for ineligibility, and to put in... more
The aims of the present study were to describe the proportion of patients eligible for the COMPASS trial within the Reduction of Atherothrombosis for Continued Health (REACH) registry, the reasons for ineligibility, and to put in perspective the characteristics and outcomes of trial-eligible patients from the REACH registry compared with those of patients enrolled in the reference aspirin arm of the COMPASS trial. The COMPASS selection and exclusion criteria were applied to REACH patients with either coronary artery disease (CAD) or peripheral artery disease (PAD). We used the COMPASS primary composite outcome of cardiovascular (CV) death, myocardial infarction (MI), or stroke. In REACH, 31 873 patients had CAD or PAD and detailed information allowing evaluation of eligibility. Among these, 9518 (29.9%) patients had exclusion criteria and an additional 5480 patients (17.2%) did not fulfil the inclusion criteria and thus were not eligible. The 'COMPASS-Eligible' population th...
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Patients with peripheral artery disease have an increased risk of cardiovascular morbidity and mortality. Antiplatelet agents are widely used to reduce these complications. This was a multicentre, double-blind, randomised... more
Patients with peripheral artery disease have an increased risk of cardiovascular morbidity and mortality. Antiplatelet agents are widely used to reduce these complications. This was a multicentre, double-blind, randomised placebo-controlled trial for which patients were recruited at 602 hospitals, clinics, or community practices from 33 countries across six continents. Eligible patients had a history of peripheral artery disease of the lower extremities (previous peripheral bypass surgery or angioplasty, limb or foot amputation, intermittent claudication with objective evidence of peripheral artery disease), of the carotid arteries (previous carotid artery revascularisation or asymptomatic carotid artery stenosis of at least 50%), or coronary artery disease with an ankle-brachial index of less than 0·90. After a 30-day run-in period, patients were randomly assigned (1:1:1) to receive oral rivaroxaban (2·5 mg twice a day) plus aspirin (100 mg once a day), rivaroxaban twice a day (5 m...
Research Interests: Medicine, Humans, Internal Medicine, Female, Male, and 15 moreAmputation, Incidence, Aspirin, Clinical Sciences, Aged, Middle Aged, Cardiovascular Diseases, Combination drug therapy, Hemorrhage, Lower Extremity, Carotid Artery Disease, Arterial disease, Medical and Health Sciences, Cardiovascular medicine and haematology, and Carotid artery diseases
We demonstrate the first application of a nuclease resistant aptamer, the so-called Spiegelmer, in a sandwich-type affinity assay by quantitative assessment of cardiac Troponin I (cTnI) in blood serum samples.
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Background Elevated blood pressure and elevated low-density lipoprotein (LDL) cholesterol increase the risk of cardiovascular disease. Lowering both should reduce the risk of cardiovascular events substantially. Methods In a trial with... more
Background Elevated blood pressure and elevated low-density lipoprotein (LDL) cholesterol increase the risk of cardiovascular disease. Lowering both should reduce the risk of cardiovascular events substantially. Methods In a trial with 2-by-2 factorial design, we randomly assigned 12,705 participants at intermediate risk who did not have cardiovascular disease to rosuvastatin (10 mg per day) or placebo and to candesartan (16 mg per day) plus hydrochlorothiazide (12.5 mg per day) or placebo. In the analyses reported here, we compared the 3180 participants assigned to combined therapy (with rosuvastatin and the two antihypertensive agents) with the 3168 participants assigned to dual placebo. The first coprimary outcome was the composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke, and the second coprimary outcome additionally included heart failure, cardiac arrest, or revascularization. The median follow-up was 5.6 years. Results The decreas...
Research Interests: Medication Adherence, Medicine, Humans, Internal Medicine, Hypertension, and 15 moreBlood Pressure, Cholesterol, Female, Disease, Male, Hydrochlorothiazide, Aged, Middle Aged, Myocardial Infarction, Cardiovascular Diseases, Combination drug therapy, Benzimidazoles, Antihypertensive agents, Medical and Health Sciences, and hazard ratio
Background Previous trials have shown that the use of statins to lower cholesterol reduces the risk of cardiovascular events among persons without cardiovascular disease. Those trials have involved persons with elevated lipid levels or... more
Background Previous trials have shown that the use of statins to lower cholesterol reduces the risk of cardiovascular events among persons without cardiovascular disease. Those trials have involved persons with elevated lipid levels or inflammatory markers and involved mainly white persons. It is unclear whether the benefits of statins can be extended to an intermediate-risk, ethnically diverse population without cardiovascular disease. Methods In one comparison from a 2-by-2 factorial trial, we randomly assigned 12,705 participants in 21 countries who did not have cardiovascular disease and were at intermediate risk to receive rosuvastatin at a dose of 10 mg per day or placebo. The first coprimary outcome was the composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke, and the second coprimary outcome additionally included revascularization, heart failure, and resuscitated cardiac arrest. The median follow-up was 5.6 years. Results The over...
Research Interests: Medication Adherence, Vascular Surgery, Medicine, Population, Humans, and 15 moreInternal Medicine, Cholesterol, Female, Disease, Male, Hypercholesterolemia, Risk factors, LDL-cholesterol, Aged, Middle Aged, Cardiovascular Diseases, Risk Factors, New England Journalof Medicine, Uncategorized, and Medical and Health Sciences
Background Antihypertensive therapy reduces the risk of cardiovascular events among high-risk persons and among those with a systolic blood pressure of 160 mm Hg or higher, but its role in persons at intermediate risk and with lower blood... more
Background Antihypertensive therapy reduces the risk of cardiovascular events among high-risk persons and among those with a systolic blood pressure of 160 mm Hg or higher, but its role in persons at intermediate risk and with lower blood pressure is unclear. Methods In one comparison from a 2-by-2 factorial trial, we randomly assigned 12,705 participants at intermediate risk who did not have cardiovascular disease to receive either candesartan at a dose of 16 mg per day plus hydrochlorothiazide at a dose of 12.5 mg per day or placebo. The first coprimary outcome was the composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke; the second coprimary outcome additionally included resuscitated cardiac arrest, heart failure, and revascularization. The median follow-up was 5.6 years. Results The mean blood pressure of the participants at baseline was 138.1/81.9 mm Hg; the decrease in blood pressure was 6.0/3.0 mm Hg greater in the active-treatment...
Research Interests: Medicine, Humans, Internal Medicine, Hypertension, Blood Pressure, and 15 moreFemale, Male, Incidence, Hydrochlorothiazide, Aged, Middle Aged, Myocardial Infarction, Cardiovascular Diseases, Combination drug therapy, Hypotension, Benzimidazoles, New England Journalof Medicine, Antihypertensive agents, Medical and Health Sciences, and hazard ratio
Endothelium responds to physical and chemical stimuli by synthesis and release of a variety of vasoactive and signal molecules. Cardiac performance is regulated by cardiac endothelial cells in a paracrin manner, analogous to vascular... more
Endothelium responds to physical and chemical stimuli by synthesis and release of a variety of vasoactive and signal molecules. Cardiac performance is regulated by cardiac endothelial cells in a paracrin manner, analogous to vascular endothelial control of vascular tone. Endothelin-1 (ET-1) one of the most potent vasoconstrictor peptides, which is synthetized and released by endothelial cells. The role of ET-1 in some special pathological state is still unclear. Authors have investigated the effect of anthracyclines (maximal dose: 450 mg/bodysurface m2) on left ventricular systolic and diastolic function and on the level of plasma ET-1, in 31 (13 male, aged 19-70 years, mean:38,9) patients suffered from Hodgkin (24) and Non-Hodgkin (7) lymphomas. They have also studied the association between plasma ET-1 concentration and echocardiographic parameters. Methods: Serum ET-1 was measured by ELISA method. Left ventricular function analysed by echocardiography: ejection fraction (EF), time velocity integral (VTI), E and A waves, E/A ratio, deceleration time (DT), Doppler index were assessed. Statistical analysis was made by the Wilcoxon rank test. Results: ET-1 plasma level decreased significantly after therapy (5,6± 3,5 vs. 3,1±0,9 pg/ml, p<0,0006). EF (56,4±5,0% vs. 48,7±5,1%, p<0,0001) decreased, and DT (168,1±36,8ms vs. 206,5±58,8ms p<0,0073) increased significantly after administration of anthracycline, showing that both systolic and diastolic left ventricular performance was deteriorated. There was no difference in other echocardiographic parameters before and after therapy. Conclusion: Decrease of serum ET-1 concentration might be a result of anthracyclin’s direct cytotoxic effect and the decreasing level of ET-1 can play a role in the reduction of the EF. More studies are needed to evaluate the presence and severity of endothelial damage and long term follow up may reveal the importance of low ET-1 level and may show the time needed for the restoration of the ET-1 concentration to the basic level after cessation of cytostatic therapy.
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Research Interests: Global Health, Medicine, Humans, Internal Medicine, Placebo, and 15 moreBlood Pressure, Diuretics, Female, Male, Incidence, Hydrochlorothiazide, Aged, Middle Aged, Myocardial Infarction, Cardiovascular Diseases, Combination drug therapy, Benzimidazoles, Primary Prevention, Cardiovascular medicine and haematology, and Population surveillance
Research Interests:
Research Interests:
The incidence of ventricular tachyarrhythmias in the early post-operative period following implantable cardioverter-defibrillator (ICD) implantation is relatively high compared with that in control periods. Since endothelin-1 (ET-1) has... more
The incidence of ventricular tachyarrhythmias in the early post-operative period following implantable cardioverter-defibrillator (ICD) implantation is relatively high compared with that in control periods. Since endothelin-1 (ET-1) has been proven to be an endogenous arrhythmogenic substance, we investigated the changes in serum ET-1 and big-ET levels in patients undergoing ICD implantation. Serum concentrations of ET-1 and big-ET were measured in 14 patients with various heart diseases before the operation, as well as 1 min and 1 h after the last shock therapy. Big-ET levels and the sum of ET-1 and big-ET levels were unchanged immediately after the operation, but had increased significantly by 1 h after implantation (before, 1.57+/-0.61 pmol/l; 1 min, 1.86+/-0.87 pmol/l; 1 h, 4.29+/-1.65 pmol/l for big-ET; before, 3.44+/-1.07 pmol/l; 1 min, 3.79+/-1.29 pmol/l; 1 h, 6.36+/-2.03 pmol/l for big-ET+ET-1). There was a significant correlation between left ventricular ejection fraction a...
Research Interests: Cardiology, Medicine, Humans, Internal Medicine, Female, and 15 moreMale, Aged, Middle Aged, Public health systems and services research, Time Factors, Endothelin-1, Implantable defibrillators-cardioverters, Ejection Fraction, Ventricular Fibrillation, Endothelin Receptor, Heart Diseases, Endothelins, Medical and Health Sciences, Cardiovascular medicine and haematology, and Implantable Cardioverter-Defibrillator
Research Interests:
Endothelium responds to physical and chemical stimuli by synthesis and release of a variety of vasoactive and signal molecules. Cardiac performance is regulated by cardiac endothelial cells in a paracrine manner, analogous to vascular... more
Endothelium responds to physical and chemical stimuli by synthesis and release of a variety of vasoactive and signal molecules. Cardiac performance is regulated by cardiac endothelial cells in a paracrine manner, analogous to vascular endothelial control of vascular tone. Endothelin-1 (ET-1), one of the most potent vasoconstrictor peptides, which is synthetized and released by endothelial cells. The role of ET-1 in some special pathological state is still unclear. Authors have investigated the effect of anthracyclines (maximal dose: 450 mg/bodysurface m2) on left ventricular systolic and diastolic function and on the level of plasma ET-1, in 31 (13 male, aged 19-70 years, mean: 38.9) patients suffered from Hodgkin (24) and Non-Hodgkin (7) lymphomas. They have also studied the association between plasma ET-1 concentration and echocardiographic parameters. Serum ET-1 was measured by ELISA method. Left ventricular function analyzed by echocardiography: ejection fraction (EF), time velocity integral (VTI), E and A waves, E/A ratio, deceleration time (DT), Doppler index were assessed. Statistical analysis was made by the Wilcoxon rank test. ET-1 plasma level decreased significantly after therapy (5.6 +/- 3.5 vs. 3.1 +/- 0.9 pg/ml, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0006). EF (56.4 +/- 5.0% vs. 48.7 +/- 5.1%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001) decreased, and DT (168.1 +/- 36.8 ms vs. 206.5 +/- 58.8 ms, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0073) increased significantly after administration of anthracycline, showing that both systolic and diastolic left ventricular performance was deteriorated. There was no difference in other echocardiographic parameters before and after therapy. In conclusion, decrease of serum ET-1 concentration might be a result of anthracyclin&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s direct cytotoxic effect and the decreasing level of ET-1 may play a role in the reduction of the EF. More studies are needed to evaluate the presence and severity of endothelial damage, and long-term follow-up may reveal the importance of low ET-1 level and may show the time is needed for the restoration of the ET-1 concentration to the basic level after cessation of cytostatic therapy.
Research Interests: Cardiology, Medicine, Echocardiography, Humans, Internal Medicine, and 15 moreFemale, Male, Clinical Sciences, Aged, Adult, Cardiomyopathy, Cardiomyopathies, ENDOTHELIUM, Ejection Fraction, Anthracyclines, Enzyme Linked Immunosorbent Assay, Hodgkin disease, Endothelin Receptor, Endothelins, and Diastole
Research Interests: Cardiology, Medicine, Humans, Internal Medicine, Cardiovascular Pharmacology, and 15 moreFemale, Male, Aged, Middle Aged, Doxorubicin, Adult, Cardiomyopathy, Bleomycin, Ejection Fraction, Cyclophosphamide, Hodgkin disease, Heart Diseases, Cardiac function, Diastole, and Cardiovascular medicine and haematology
Background: Strokes were significantly reduced by the combination of rivaroxaban plus aspirin in comparison with aspirin in the COMPASS trial (Cardiovascular Outcomes for People Using Anticoagulation Strategies). We present detailed... more
Background: Strokes were significantly reduced by the combination of rivaroxaban plus aspirin in comparison with aspirin in the COMPASS trial (Cardiovascular Outcomes for People Using Anticoagulation Strategies). We present detailed analyses of stroke by type, predictors, and antithrombotic effects in key subgroups. Methods: Participants had stable coronary artery or peripheral artery disease and were randomly assigned to receive aspirin 100 mg once daily (n=9126), rivaroxaban 5 mg twice daily (n=9117), or rivaroxaban 2.5 mg twice daily plus aspirin (n=9152). Patients who required anticoagulation or had a stroke within 1 month, previous lacunar stroke, or intracerebral hemorrhage were excluded. Results: During a mean follow-up of 23 months, fewer patients had strokes in the rivaroxaban plus aspirin group than in the aspirin group (83 [0.9% per year] versus 142 [1.6% per year]; hazard ratio [HR], 0.58; 95% CI, 0.44–0.76; P <0.0001). Ischemic/uncertain strokes were reduced by nearl...