Updates in Cardiology-2015

Tarun W. Dasari, MD,MPH,FACC

Assistant Professor of Medicine,

Cardiovascular Section,

OUHSC

*no financial disclosures

Topics

• Cholesterol management

• Heart failure treatment

• Atrial fibrillation

• Stress testing for CAD

• Recurrent pericarditis

Cholesterol management

Non Hispanic whites

Non Hispanic blacks

ARIC

CARDIA

CHS

Framingham*

PCSK9 inhibitors

-2341 patients at high risk for cardiovascular events who had LDL >70

-receiving treatment with statins at the maximum tolerated dose

- alirocumab (150 mg) or placebo as a 1-ml subcutaneous injection every 2 weeks

for 78 weeks

-primary efficacy end point was the percentage change in calculated

LDL cholesterol level from baseline to week 24

-enrolled 4465 patients

-randomly assigned in a 2:1 ratio to receive either evolocumab

(140 mg every 2 weeks or 420 mg monthly) plus standard therapy or standard therapy alone

-Patients were followed for a median of 11.1 months

-Data from the two trials were combined

75 mg SC q2 weekly

Max dose 150 mg q2 weekly

140 mg SC every two weeks or

420 mg SC monthly

Approved as an adjunct to

statins • Maximally tolerated statin therapy for treatment of adults

with heterozygous familial hypercholesterolemia (HeFH)

or clinical atherosclerotic cardiovascular disease (CVD),

who require additional lowering of LDL

• Other LDL-lowering therapies (e.g., statins, ezetimibe,

LDL apheresis) in patients with homozygous familial

hypercholesterolemia (HoFH) who require additional

lowering of LDL-C

• The effect on cardiovascular morbidity

and mortality has not been determined

Heart Failure

• TOPCAT

• SHIFT trial

• PARADIGM HF trial

• randomized, double-blind trial

• 3445 patients with symptomatic heart failure and EF>45%

• spironolactone (15 to 45 mg daily) or placebo

• primary outcome was a composite of CV death, aborted cardiac arrest,

or hospitalization for the management of heart failure

• mean follow-up of 3.3 years

Death, HF hospitalization HF hospitalization

• Double blind RCT

• 8442 patients with class II, III, or IV heart failure and an ejection fraction of <40%

• LCZ696 (at a dose of 200 mg twice daily) or enalapril (at a dose of 10 mg twice daily)

• primary outcome was a composite of death from CV causes or hospitalization for HF

Atrial Fibrillation

• Post stroke monitoring

• Novel anticoagulant

Warfarin

Highlights

• A strategy of anatomical testing with the use of CTA, as

compared with use of functional testing, did not reduce

the incidence of events over a median follow-up of 25

months

• CTA was associated with fewer catheterizations showing

no obstructive CAD than was functional testing (3.4% vs.

4.3%)

• More patients in the CTA group underwent

catheterization within 90 days after randomization

(12.2% vs. 8.1%)

• overall exposure was higher in the CTA group (mean,

12.0 mSv vs. 10.1 mSv; P<0.001)

• multicentre, double-blind trial at four general hospitals in northern Italy.

• 240 pts with recurrent pericarditis assigned to Colchine bid vs. placebo

• colchicine (0.5 mg bid x 6 months if >70 kg or 0.5 mg daily if < 70 kg

• primary outcome was recurrent pericarditis in the intention-to-treat

Conclusions

• PCSK9 inhibitors aid in significant lowering of LDL cholesterol in

patients who respond poorly or are intolerant of statins

• Spironolactone failed to have a meaningful clinical impact on

patients with heart failure with preserved ejection fraction

• Ivabradine and Sacubitril offer new hope for patients suffering from

heart failure with reduced ejection fraction

• Long term monitoring may aid in detection of atrial fibrillation in

patients with cryptogenic stroke

• Novel oral anticoagulants offer wider options for prevention of

stroke/systemic thromboembolism in patients with non-valvular atrial

fibrillation

• Anatomical assessment of coronary artery disease is not superior to

functional assessment in patients with suspected coronary artery

disease

• Oral Colchicine is effective in reducing recurrences of pericarditis

OSLER

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