Thiazolidinedione Drugs and Cardiovascular Risks. A Science Advisory From the American Heart Association and American College of Cardiology Foundation
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Translating Evidence Into Practice: A Decade of Efforts by
the American Heart Association/American Stroke
Association to Reduce Death and Disability Due to Stroke
A Presidential Advisory From the American Heart Association/American
Stroke Association
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Обнаружил новый источник свежих гайдов.
The Institute for Clinical Systems Integration (as it was originally called) was established in 1993 by HealthPartners, Mayo Clinic and Park Nicollet Health Services, and sponsored by HealthPartners.
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Сначала клопи, теперь аспирин
Patients with CAD treated with PPIs had a reduced response to
aspirin, as shown by increased residual platelet aggregation and
platelet activation, compared with patients with CAD not
taking PPIs. Concomitant use of aspirin and PPIs might leave
patients at an increased risk of thrombotic events. These
findings may affect the clinical practice of antithrombotic
treatment. In view of the widespread use of PPIs, a randomised
double-blind crossover study (PPI vs placebo + aspirin) is needed
to explore further the inhibitory effect of PPIs on aspirin.
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Digoxin is mainly given to an elderly and frailer subset of
patients with AF and is thus associated with an increased
mortality When these and other differences in patient characteristics
are accounted for, digoxin use appears to be neutral for
the long-term mortality and major cardiovascular events in
patients with AF.
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Calcium-channel blockers decrease clopidogrel-mediated platelet inhibition.
 

Heart. 2010 Feb;96(3):186-9. Epub 2009 Aug 16.

Calcium-channel blockers decrease clopidogrel-mediated platelet inhibition.

Gremmel T, Steiner S, Seidinger D, Koppensteiner R, Panzer S, Kopp CW.

Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. [Ссылки могут видеть только зарегистрированные пользователи. ]

Comment in:
Heart. 2010 Feb;96(3):179-80.


BACKGROUND: The extent of clopidogrel-mediated platelet inhibition varies considerably from one person to the next. Numerous studies have shown that low responders have significantly more adverse events after coronary stenting than patients who respond well to antithrombotic treatment with clopidogrel. Dihydropyridine calcium-channel blockers (CCBs) inhibit the cytochrome P450 3A4 enzyme, which metabolises clopidogrel to its active form. OBJECTIVE: To investigate the influence of CCBs on clopidogrel-mediated platelet inhibition. METHODS: Adenosine-5-diphosphate (ADP)-inducible platelet reactivity was assessed by light transmission aggregometry (LTA) and the VerifyNow P2Y12 assay in 162 patients after percutaneous intervention with stent implantation. Results in the fourth quartiles of both assays were considered as high on-treatment residual ADP-inducible platelet reactivity. RESULTS: Patients with concomitant CCB therapy showed a significantly higher on-treatment platelet reactivity than patients without CCB medication (p=0.001 for both assays). Further, high on-treatment residual ADP-inducible platelet reactivity was significantly more common among patients currently taking CCBs (p=0.001 for LTA and p=0.004 for the VerifyNow P2Y12 assay). A multivariate regression analysis confirmed CCB therapy as an independent predictor of reduced clopidogrel-mediated platelet inhibition (p=0.006 for LTA and p=0.004 for the VerifyNow P2Y12 assay). CONCLUSION: CCBs decrease clopidogrel-mediated platelet inhibition in patients undergoing angioplasty and stenting for cardiovascular disease.

Translating Evidence Into Practice: A Decade of Efforts by
the American Heart Association/American Stroke
Association to Reduce Death and Disability Due to Stroke
A Presidential Advisory From the American Heart Association/American Stroke Association
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При диабете ничего не помогает...
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Intensive BP treatment did not reduce the overall risk for CV events in patients with type 2 diabetes, elevated BP and high CV risk when compared with more conventional BP therapy, according to new data from the ACCORD Blood Pressure trial.
Targeting therapy to achieve a BP of <120 mm Hg had no significant effect on the combined rates of nonfatal myocardial infarction, nonfatal stroke or CV death compared with conventional BP control aimed at a systolic BP of <140 mm Hg, researchers said today at the American College of Cardiology 59th Annual Scientific Sessions.
Более того...
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Tight systolic BP control in high-risk patients with diabetes appears to be no more effective in avoiding myocardial infarction, stroke or death compared with standard BP treatment, and may be hazardous when BP is lowered below 110 mm Hg, according to new data from the INVEST trial.
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The addition of fenofibrate to simvastatin therapy failed to reduce the rate of fatal and nonfatal CV events in patients with diabetes, according to new results of the ACCORD Lipid Trial.
The trial investigated patients with well-controlled diabetes who were at high risk for CV disease. In this group, the combined risk for death, nonfatal MI or nonfatal stroke — the primary outcome — was similar whether patients were assigned to simvastatin plus fenofibrate or statin plus placebo.

Спасибо за новый источник? Теперь надо сравнить, может этот:
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DES-LATE: Clopidogrel after 1 year may not help.
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2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM
Guidelines for the Diagnosis and Management of Patients With
Thoracic Aortic Disease
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2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM
Guidelines for the Diagnosis and Management of Patients With
Thoracic Aortic Disease: Executive Summary
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Еще один кейс, показывающий, что сердечные проблемы, вызванные перегрузкой организма железом, потенциально обратимы при выведении железа из организма/его хелировании:

Haemophilia. 2010 Mar 4.

Remission of paroxysmal atrial fibrillation with iron reduction in haemophilia A.
Zacharski LR, McKernan L, Metzger ME, Malone MG, Samnotra V, Bhargava A, Steiner PR, Rauwerdink CA, Ornstein DL, Cornell CJ.

Section of Hematology/Oncology, Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.

Summary. Two male first cousins with mild haemophilia A had baseline factor VIII levels of 12-15% and experienced bleeding requiring coagulation factor infusion therapy with trauma and surgical procedures. Both the patients with haemophilia A also had electrocardiographically documented symptomatic paroxysmal atrial fibrillation (PAF) for several years that had become resistant to pharmacological suppression. Radiofrequency ablation was considered in both the cases but deferred considering refusal of consent by the patients to undergo the procedure. Remission of arrhythmias has been reported in patients with iron-overload syndromes. Body iron stores assessed by serum ferritin levels were elevated in both men but neither had the C282Y or H63D genes for haemochromatosis. Calibrated reduction of iron stores by serial phlebotomy, avoiding iron deficiency, was followed by remission of symptomatic PAF in both cases. Iron reduction may be an effective treatment for arrhythmias apart from the classic iron-overload syndromes and deserves further study particularly in patients with bleeding disorders who might be at risk for arrhythmias and other diseases of ageing.
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Более ранние публикации в полной версии:

Blood. 2007 Jan 1;109(1):362-4.
Reversal of cardiac complications by deferiprone and deferoxamine combination therapy in a patient affected by a severe type of juvenile hemochromatosis. [Ссылки могут видеть только зарегистрированные пользователи. ]

Br Heart J. 1995 Jan;73(1):73-5.
Haemochromatosis presenting as congestive cardiac failure. [Ссылки могут видеть только зарегистрированные пользователи. ]

Medication Errors in Acute Cardiovascular and Stroke Patients
A Scientific Statement From the American Heart Association
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ACCF/AHA 2010 Position Statement on Composite Measures for Healthcare
Performance Assessment
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