Аспирин 100 через день для первичной профилактики ССЗ у женщих старше 45

[Habarov]

Сообщение от Korzun

Ваш Путин

слышь красавец а ты сам то давно в германии осел?
кстати не понял ты 82 или 72 года рождения? и где кандидатскую защищал

День рождения:
03-09-1992
Пол:
Мужской
Место жительства:
Германия
Специальность:
Кардиология, Аритмология
Ученая степень:
Кандидат медицинских наук
Интересы:
Аритмии сердца

[Dr.Vad]

Уважаемый коллега Виталий!

Давайте все же будем вежливее по отношению к коллегам и пациентам на форуме. Александр Иванович преподавал в ВМА СПб пропедевтику и, вероятно, из-за расхождения во взглядах с теперешним политруководством России перебрался в Берлин в прошлом году.

[Dr.Vad]

Уважаемые коллеги!

В продолжение кардионовостей некоторые тезисы из Орландо (АСС 2005):

Минимальная доза аспирина в сутки - наиболее безопасная (30-80 мг)

During the closing hours of the American College of Cardiology (ACC) 2005 Annual Scientific Sessions, there was one more caution about antiplatelet therapy for cardiovascular event prevention: when prescribing daily aspirin, lower dose is safer.

That was the conclusion from a meta-analysis of data from 31 randomized, placebo-controlled trials that enrolled a total of 192,036 patients. Victor L. Serebrauny, MD, PhD, a medical researcher at HeartDrug Research in Towson, Maryland, said, "It's not rocket science — lower is safer."

While his study did not address efficacy, Dr. Serebrauny told Medscape, "There is no evidence that higher-dose aspirin is more effective. Until those studies are done, I think it is safe to assume that lower dose, less than 100 mg, is an effective dose for primary and secondary prevention."

Dr. Serebrauny explained that he decided to investigate the relationship between aspirin dose and bleeding risk after being urged to do so by Eric Topol, MD, chairman of the department of cardiovascular medicine at the Cleveland Clinic Foundation in Ohio. According to Dr. Serebrauny, Dr. Topol was concerned about the wide variation in aspirin doses recommended by cardiologists. "Interventional cardiologists all like aspirin, but they disagree about how much aspirin should be used," said Dr. Serebrauny. Dr. Topol is a coauthor of the study.

The 31 randomized, placebo-controlled studies included in the analysis all had at least one month of follow-up and all included clear descriptions of hemorrhagic events. The data were reviewed independently by three statisticians from Duke University School of Medicine in Durham, North Carolina, and from Johns Hopkins University School of Medicine in Baltimore, Maryland. In nine studies, patients received less than 100 mg daily (range, 30-81 mg), eight trials investigated a moderate aspirin dose of 100 to 200 mg per day, and 19 studies investigated daily aspirin doses of more than 200 mg (range, 283-1,300 mg).

The major bleeding rate for patients in studies using the lowest aspirin dose was less than 1.5%; this increased to 1.56% among patients taking moderate-dose aspirin and increased to more than 5.0% among those taking the highest doses, Dr. Serebrauny explained at an ACC press conference.

Risk for all bleeding categories appeared to increase in a linear fashion as aspirin dose increased, Dr. Serebrauny said. But an interesting finding was that the risk of hemorrhagic stroke was highest for patients taking the moderate dose — almost 0.5% vs 0.2% in the high-dose group. Asked to explain this difference, Dr. Serebrauny speculated that it was an artifact of the trial design in the moderate-dose studies, which he said had "better reporting mechanisms."

[Dr.Vad]

Early IV Beta Blockade May Be Harmful in Acute MI

The Clopidogrel and Metoprolol Infarction Trial Second Chinese Cardiac Study (COMMIT/CCS-2) found that beta blockade with intravenous (IV) metoprolol followed by oral metoprolol is not the "sure winner" that many expected, and may in fact be risky in a significant number of patients, according to results reported here at the American College of Cardiology (ACC) 2005 Annual Scientific Session.

Rory Collins, MD, codirector of the clinical trials unit at Oxford University in the U.K., said that while IV beta blockade followed by oral metoprolol does reduce the risk of early reinfarction, it also increases the risk of cardiogenic shock, "which wipes out any benefit." Dr. Collins presented the COMMIT/CCS-2 findings at a late-breaking clinical trials session and discussed them during an ACC press conference.

In the study, metoprolol reduced the absolute risk of in-hospital reinfarction by five cases per 1,000 treated (P = .001) and ventricular fibrillation was reduced by six cases per 1,000 treated (P < .001). "But it increased the risk of cardiogenic shock by 11 cases per 1,000 (P < .00001)," Dr. Collins said.

Higher-risk patients, typically those with heart failure or hypotension, were most at risk for cardiogenic shock, while low-risk patients who had undergone thrombolytic therapy benefited from the treatment. "Therefore, the treatment should be targeted to those patients presenting with a lower-risk profile," Dr. Collins said.

The use of beta blockade during acute MI has been hotly debated for several years, but there have been few data to sustain the argument, Dr. Collins told Medscape. By contrast, COMMIT randomized 22,927 patients to metoprolol and 22, 922 to placebo. "With numbers this large, we now have very clear evidence about the effects," he said.

Christopher Cannon, MD, an associate professor at Harvard Medical School in Boston, Massachusetts, noted that the COMMIT/CCS-2 findings make a "significant contribution to the management of acute myocardial infarction."

But Dr. Cannon added that in terms of metoprolol, "I think we've learned the appropriate use of this previously 'ought-to-be-established' class, and I think the new data will help avoid any excess risk in these patients and allow appropriate benefit in patients who can derive it." He cochaired the late-breaking clinical trials session at which Dr. Collins presented the COMMIT/CCS results, and he served as discussant for the paper.

Dr. Cannon, however, characterized the results as unexpected, noting that earlier studies suggested an advantage for the IV beta blockade regimen

[Dr.Vad]

Calcium channel blockers and angiotensin-converting enzyme (ACE) inhibitors are a more effective combination for treating hypertension than beta-blockers and diuretics, according to results of the Anglo-Scandinavian Cardiac Outcomes in the Blood Pressure Lowering Arm (ASCOT-BPLA) trial.

Patients randomized to amlodipine/perindopril had significantly lower cardiovascular mortality, fewer strokes, and less new-onset diabetes than patients randomized to atenolol/bendroflumethiazide. Peter S. Sever, PhD, FRCC, professor of clinical pharmacology at Imperial College in London, U.K., said, "We were looking to see which treatment strategy worked best in high-risk hypertensive patients, rather than how well individual classes of drugs worked."

The patients were treated to a blood pressure goal of 140/90 mm Hg or less. The ASCOT-BPLA results were presented during a late-breaking clinical trials session here at the American College of Cardiology (ACC) 2005 Annual Scientific Session.

The trial is the latest hypertension study in which the findings raise questions about the recommendations of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure VII (JNC-VII) that “thiazide-like diuretics should be used as initial treatment for most patients with hypertension.”

The trial enrolled 19,257 hypertensive patients, aged 40 to 79 years, who had no previous myocardial infarction (MI) or clinical coronary heart disease (CHD). It was stopped early — November 2004 — when the trial's data monitoring and safety board determined that more end point events were occurring in the atenolol/bendroflumethiazide group than in the amlodipine/perindopril group. The early halt of the trial prevented the ASCOT results from reaching statistical significance for the primary end points of nonfatal MI and fatal CHD, Dr. Sever said. The study was powered to reach significance after 1,150 such events, but the trial was stopped after 5.4 years and 869 events. At the time the trial was halted, there was a 14% reduction in relative risk of all-cause mortality favoring the amlodipine/perindopril group (P < .001) There was also a 10% difference in the primary end point of nonfatal MI or fatal CHD — again favoring amlodipine/perindopril — but this did not reach significance.

ASCOT BPLA was designed as a step-therapy trial with patients initially randomized to either the calcium channel blocker or the beta-blocker with an ACE inhibitor added to the calcium channel blocker group and a diuretic to the beta-blocker group as needed, but only 14.3% of patients in the calcium channel blocker group and 8.6% in the beta-blocker group remained on monotherapy, said ASCOT copresenter Björn Dahlöf, MD, associate professor of medicine at Sahlgrenska University Hospital/Ostra in Goteborg, Sweden.

A number of prespecified secondary end points did, however, reach significance:

New-onset diabetes mellitus was decreased by 32% (P < .001).
Stroke was decreased by 23% (P < .001)
Cardiovascular death was decreased by 24% (P < .001).
Cardiovascular events and procedures were decreased by 16% (P < .001)
Total coronary events were reduced by 14% (P = .05).
Richard Devereux, MD, professor of medicine at Weill Medical College of Cornell University in New York, who served as discussant for the paper, said, “It is pretty clear that drugs which inhibit the renin system — such as perindopril — add much more of a benefit to the treatment regimen than does a beta-blocker and diuretic.”

Moreover, Dr. Devereux noted that patients in the calcium channel blocker group not only had about one third less diabetes, they also had better high-density lipoprotein cholesterol and triglyceride levels, which he said again favors the “newer” calcium channel blocker–ACE inhibitor combination over the older combination of beta blocker and diuretic.

Several attendees speculated that the ASCOT-BPLA results will increase pressure on the JNC to back away from the thiazide-first recommendations in JNC-VII.

At the ACC press conferences, Dr. Sever noted that the U.K. guidelines recommend beta-blockers as first-line treatment, but he and his colleagues expect the U.K. guideline committee to “reevaluate beta-blockers as first-line treatment” in light of the ASCOT BPLA results. Dr. Sever said the ASCOT data raise “serious questions about the future of beta-blockers in the management of hypertension.”

What Were the Reasons for These Results?

There was better blood pressure lowering with amlodipine/perindopril, but this is not the whole story, according to Prof. Sever. The investigators offered several possible explanations for the results:

Better blood pressure lowering with amlodipine/perindopril;
An adverse interaction between atenolol/thiazide and the statin;
A beneficial interaction between atenolol/thiazide and the statin;
Extra blood pressure-lowering benefits of amlodipine/perindopril;
Non-blood pressure-lowering disadvantages for atenolol/thiazide.

As a result, the ASCOT investigators believe that the choice of antihypertensive drug combinations in patients with and without statins requires further analysis and reevaluation.

[alex_md]

Сообщение от Dr. Vad

В продолжение кардионовостей некоторые тезисы из Орландо (АСС 2005):

Погоды в Орландо стояли теплые . Пора переезжать во Флориду.

[Dr.Vad]

Всем, кто старше 50, надо ежедневно принимать аспирин

Селия Холл, Daily Telegraph

Все, кому за 50, должны принимать мини-дозы аспирина ежедневно, чтобы снизить риск сердечно-сосудистых заболеваний и инсультов, сообщил сегодня ведущий ученый.
Небольшие дозы аспирина могут понизить риск сердечного приступа и инсульта примерно на треть, кроме того, они помогают предотвратить болезнь Альцгеймера и рак, заявил он на конференции.

Профессор Питер Элвуд из Медицинского института Университета в Кардиффе, пионер в исследованиях влияния аспирина на сердечно-сосудистые заболевания, начавший работу в этом направлении 30 лет назад, сказал: "Мы полагаем, что пришло время для обсуждения этой темы".

"Люди должны получить сведения о преимуществах и риске, чтобы они могли лично принять решение о том, чего они хотят".

Доктор Энтони Байер, директор группы исследования проблем памяти и исследователь из центра гериартрической медицины в Кардиффе, сказал, что 80% специалистов из Северной Америки думают, что пациентам, страдающим от слабоумия и подверженным факторам риска для сердечно-сосудистой системы, следует давать аспирин.

"Другие данные подтверждают эффективность аспирина для профилактики болезни Альцгеймера", – говорит он.

Профессор Элвуд, выступая на конференции, организованной в Лондоне фондом исследований аспирина, говорит, что, по их данным, только 53% пациентов, у которых был инсульт или инфаркт и которым было рекомендовано принимать аспирин, чтобы предотвратить новые приступы, выполняли эти предписания.

Однако эта тема противоречива, так как аспирин также повышает риск кровотечения. Желудочное кровотечение может быть серьезной проблемой, требующей переливания крови, и может само по себе привести к летальному исходу.

Многочисленные исследования показывают, что аспирин в малых дозах – обычно около 75 мг в день – снижает риск инфаркта почти на 30%. Такие же результаты получены в отношении инсульта, а данные, связанные с раком, в настоящий момент изучаются.

Согласно одному из исследований, для женщин, ежедневно принимающих аспирин в качестве болеутоляющего, риск рака груди снижается на 28%.

[Dr.Vad]

Abuissa H, O'Keefe J, Bell DSH, Jones P, Marso S. ACE inhibitors or angiotensin receptor blockers for prevention of type 2 diabetes. J Am Coll Cardiol. 2005;45:10A. Abstract 1058-117.

Of the 13 studies that met criteria for entering the meta-analysis, 6 used ACE inhibitors and 7 used ARBs. These trials involved 125,356 patients, of whom 90,474 did not have diabetes at baseline.

ACE inhibitors and ARBs were compared with placebo, diuretics, beta-blockers, or calcium channel antagonists in these various studies. New-onset diabetes was generally defined using the American Diabetes Association criteria of fasting plasma glucose >/= 126 mg/dL at 2 different visits (without a history of diabetes at the time of enrollment in the study).

The reduction in risk of new-onset diabetes was 24% for ACE inhibitors, 23% for ARBs, and 23% for the pooled analysis which included all of the studies (ARBs and ACE inhibitors). Confidence in the relative risk for the pooled analysis was 0.77, with confidence intervals of .71 to .83.

[Dr.Vad]

A British study finds that heart disease patients who take a combination of three drugs are more likely to survive than those taking a single drug.

The report in the British Medical Journal is the first survey to examine survival rates for coronary disease patients taking different drug combinations.

Researchers from the University of Nottingham tracked 13,000 patients diagnosed with ischaemic heart disease between 1996 and 2003.

The study found an 83 percent reduction in deaths among patients who took a combination of statins (cholesterol lowering drugs), aspirin and beta-blockers (a type of blood pressure lowering drug). Adding an angiotensin converting enzyme inhibitor, another blood-pressure-reduction drug, provided no additional benefit.

Taking beta-blockers alone reduced deaths by 19 percent, and angiotensin converting enzyme inhibitors alone by 20 percent.


Effect of combinations of drugs on all cause mortality in patients with ischaemic heart disease: nested case-control analysis
Julia Hippisley-Cox and Carol Coupland
BMJ 2005 330: 1059-1063.

Drug combinations associated with the greatest reduction in all cause mortality were statins, aspirin, and blockers (83% reduction, 95% confidence interval 77% to 88%); statins, aspirin, blockers, and angiotensin converting enzyme inhibitors (75% reduction, 65% to 82%); and statins, aspirin, and angiotensin converting enzyme inhibitors (71% reduction, 59% to 79%). Treatments associated with the smallest reduction in all cause mortality were blockers alone (19% reduction, 37% reduction to 4% increase), angiotensin converting enzyme inhibitors alone (20% reduction, 1% to 35%), and combined statins and angiotensin converting enzyme inhibitors (31% reduction, 57% reduction to 12% increase).

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Am J Cardiol. 2005 May 15;95(10):1218-22.
Analysis of risk of bleeding complications after different doses of aspirin in 192,036 patients enrolled in 31 randomized controlled trials.
Serebruany VL, Steinhubl SR, Berger PB, Malinin AI, Baggish JS, Bhatt DL, Topol EJ.
HeartDrug Research Laboratories, Towson, Maryland.

We compared the risk of hemorrhage due to the low (<100 mg), moderate (100 to 200 mg), and high (>200 mg) doses of aspirin (acetylsalicylic acid [ASA]) in 192,036 patients enrolled in 31 clinical trials. Despite substantial differences in the reporting patterns of bleeding complications, low-dose ASA was associated with the lowest risk, and moderate doses caused a relatively high hemorrhagic event rate, especially with regard to minor, gastrointestinal, and total bleeding, and stroke.