57 results on '"Kober, Lars"'
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2. Aptamer Proteomics for Biomarker Discovery in Heart Failure With Reduced Ejection Fraction
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Zhang, Luqing, Cunningham, Jonathan W., Claggett, Brian L., Jacob, Jaison, Mendelson, Michael M., Serrano-Fernandez, Pablo, Kaiser, Sergio, Yates, Denise P., Healey, Margaret, Chen, Chien-Wei, Turner, Gordon M., Patel-Murray, Natasha L., Zhao, Faye, Beste, Michael T., Laramie, Jason M., Abraham, William T., Jhund, Pardeep S., Kober, Lars, Packer, Milton, Rouleau, Jean, Zile, Michael R., Prescott, Margaret F., Lefkowitz, Martin, McMurray, John J.V., Solomon, Scott D., and Chutkow, William
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- 2022
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3. Natriuretic peptide plasma concentrations and risk of cardiovascular versus non-cardiovascular events in heart failure with reduced ejection fraction: Insights from the PARADIGM-HF and ATMOSPHERE trials.
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Khan, Muhammad Shahzeb, Kristensen, Soren Lund, Vaduganathan, Muthiah, Kober, Lars, Abraham, William T, Desai, Akshay S, Solomon, Scott D, Swedberg, Karl, Dickstein, Kenneth, Zile, Michael R, Packer, Milton, McMurray, John JV., and Butler, Javed
- Abstract
Background: N-terminal pro-B-type natriuretic peptide (NT-proBNP) plasma concentrations are independent prognostic markers in patients with heart failure and reduced ejection fraction (HFrEF). Whether a differential risk association between NT-proBNP plasma concentrations and risk of cardiovascular (CV) vs non-CV adverse events exists is not well known.Objective: To assess if there is a differential proportional risk of CV vs non-CV adverse events by NT-proBNP plasma concentrations.Methods: In this post hoc combined analysis of PARADIGM-HF and ATMOSPHERE trials, proportion of CV vs non-CV mortality and hospitalizations were assessed by NT-proBNP levels (<400, 400-999, 1000-1999, 2000-2999, and >3000 pg/mL) at baseline using Cox regression adjusting for traditional risk factors.Results: A total of 14,737 patients with mean age of 62 ± 8 years (24% history of atrial fibrillation [AF]) were studied. For CV deaths, the event rates per 1000 patient-years steeply increased from 33.8 in the ≤400 pg/mL group to 142.3 in the ≥3000 pg/mL group, while the non-CV death event rates modestly increased from 9.0 to 22.7, respectively. Proportion of non-CV deaths decreased across the 5 NT-proBNP groups (21.1%, 18.4%, 17.9%, 17.4%, and 13.7% respectively). Similar trend was observed for non-CV hospitalizations (46.4%, 42.6%, 42.9%, 42.0%, and 36.9% respectively). These results remained similar when stratified according to the presence of AF at baseline and prior HF hospitalization within last 12 months.Conclusions: The absolute CV event rates per patient years of follow-up were greater and had higher stepwise increases than non-CV event rates across a broad range of NT-proBNP plasma concentrations indicating a differential risk of CV events at varying baseline NT-proBNP values. These results have implications for future design of clinical trials. [ABSTRACT FROM AUTHOR]- Published
- 2021
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4. Risk of atrial fibrillation after pacemaker implantation: A nationwide Danish registry-based follow-up study.
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Tayal, Bhupendar, Riahi, Sam, Sogaard, Peter, Nielsen, Gitte, Thøgersen, Anna Margrethe, Dutta, Abhishek, Gislason, Gunnar, Kober, Lars, Torp-Pedersen, Christian, and Kragholm, Kristian Hay
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Background: The overall risk of atrial fibrillation (AF) among patients with pacemaker (PM) in comparison to control cohort is unknown.Purpose: To investigate the risk of AF after implantation of a PM in an AF-naive population in comparison to an age- and sex-matched PM- and AF-free population cohort.Methods: All patients with a dual chamber PM (DDD) implanted between 2000 and 2014 without a known history of AF were included (n = 17,428). To compare, a general population cohort without pacemaker and a cohort with loop recorder was identified. Outcome was the cumulative incidence of AF within the first 2 years from 3-months after device implantation.Results: At the end of first 3-months after device implantation, 16,383 patients were free of AF and were included in the current study. In comparison to controls (n = 86,167), patients with PM had higher cumulative incidence of AF (5.2% vs 2.7%, P < 0.001)). Due to interaction with age, patients were divided into three age-groups) and the relative risk for the diagnosis of AF were: < 70 years (HR 4.46, 95% CI 3.65-5.44); 70-79 years (HR 2.60, 95% CI 2.27-2.98); and ≥ 80 years (HR 1.29, 95% CI 1.15-1.45). For comparison between PM and loop-recorder cohort (1:1 matching), 2202 patients were available in both groups. The incidence of AF within the first 2-years in the both groups was 7.9% vs. 8.4% (loop vs pacemaker).Conclusions: Patients with PM have an increased risk of being diagnosed with AF in comparison to general cohort likely due to continuous monitoring. [ABSTRACT FROM AUTHOR]- Published
- 2020
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5. Five-year risk of heart failure and death following myocardial infarction with cardiogenic shock: a nationwide cohort study
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Lauridsen, Marie Dam, Rorth, Rasmus, Butt, Jawad Haider, Kristensen, Soren Lund, Schmidt, Morten, Moller, Jacob Eifer, Hassager, Christian, Torp-Pedersen, Christian, Gislason, Gunnar, Kober, Lars, and Fosbol, Emil Loldrup
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- 2021
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6. Immediate vs Delayed Stenting in ST-Elevation Myocardial Infarction: Rationale and Design of the International PRIMACY Bayesian Randomized Controlled Trial
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Jolicoeur, E. Marc, Dendukuri, Nandini, Belisle, Patrick, Range, Grégoire, Souteyrand, Geraud, Bouisset, Frédéric, Zemour, Gilles, Delarche, Nicolas, Harbaoui, Brahim, Schampaert, Erick, Kouz, Simon, Cayla, Guillaume, Roubille, François, Boueri, Ziad, Mansour, Samer, Marcaggi, Xavier, Tardif, Jean-Claude, McGillion, Michael, Tanguay, Jean-François, Brophy, James, Yu, Cheol Woong, Berry, Colin, Carrick, David, Høfsten, Dan Eik, Engstrøm, Thomas, Kober, Lars, Kelbæk, Henning, and Belle, Loic
- Abstract
Primary percutaneous coronary intervention is used to restore blood flow in the infarct-related coronary artery, followed by immediate stenting to prevent reocclusion. Stents implanted in thrombus-laden arteries cause distal embolization, which paradoxically impairs myocardial reperfusion and ventricular function. Whether a strategy of delayed stenting improves outcomes in patients with acute ST-elevation myocardial infarction (STEMI) is uncertain.
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- 2020
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7. Myocardial Infarction in Heart Failure With Preserved Ejection Fraction
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Cunningham, Jonathan W., Vaduganathan, Muthiah, Claggett, Brian L., John, Jenine E., Desai, Akshay S., Lewis, Eldrin F., Zile, Michael R., Carson, Peter, Jhund, Pardeep S., Kober, Lars, Pitt, Bertram, Shah, Sanjiv J., Swedberg, Karl, Anand, Inder S., Yusuf, Salim, McMurray, John J.V., Pfeffer, Marc A., and Solomon, Scott D.
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The authors investigated the relationship between past or incident myocardial infarction (MI) and cardiovascular (CV) events in heart failure with preserved ejection fraction (HFpEF).
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- 2020
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8. Effects of Sacubitril/Valsartan on N-Terminal Pro-B-Type Natriuretic Peptide in Heart Failure With Preserved Ejection Fraction
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Cunningham, Jonathan W., Vaduganathan, Muthiah, Claggett, Brian L., Zile, Michael R., Anand, Inder S., Packer, Milton, Zannad, Faiez, Lam, Carolyn S.P., Janssens, Stefan, Jhund, Pardeep S., Kober, Lars, Rouleau, Jean, Shah, Sanjiv J., Chopra, Vijay K., Shi, Victor C., Lefkowitz, Martin P., Prescott, Margaret F., Pfeffer, Marc A., McMurray, John J.V., and Solomon, Scott D.
- Abstract
The authors sought to evaluate the prognostic significance of baseline N-terminal pro–B-type natriuretic peptide (NT-proBNP), whether NT-proBNP modified the treatment response to sacubitril/valsartan, and the treatment effect of sacubitril/valsartan on NT-proBNP overall and in key subgroups.
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- 2020
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9. Sacubitril/Valsartan Across the Spectrum of Ejection Fraction in Heart Failure
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Solomon, Scott D., Vaduganathan, Muthiah, L. Claggett, Brian, Packer, Milton, Zile, Michael, Swedberg, Karl, Rouleau, Jean, A. Pfeffer, Marc, Desai, Akshay, H. Lund, Lars, Kober, Lars, Anand, Inder, Sweitzer, Nancy, Linssen, Gerard, Merkely, Bela, Luis Arango, Juan, Vinereanu, Dragos, Chen, Chen-Huan, Senni, Michele, Sibulo, Antonio, Boytsov, Sergey, Shi, Victor, Rizkala, Adel, Lefkowitz, Martin, and McMurray, John J.V.
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Supplemental Digital Content is available in the text.
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- 2020
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10. Low-Dose Aspirin in Heart Failure Not Complicated by Atrial Fibrillation
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Madelaire, Christian, Gislason, Gunnar, Kristensen, Søren L., Fosbøl, Emil L., Bjerre, Jenny, D’Souza, Maria, Gustafsson, Finn, Kober, Lars, Torp-Pedersen, Christian, and Schou, Morten
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This study sought to assess safety and effectiveness of low-dose aspirin in heart failure (HF) not complicated by atrial fibrillation.
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- 2024
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11. Safety and Tolerability of the Chymase Inhibitor Fulacimstat in Patients With Left Ventricular Dysfunction After Myocardial Infarction—Results of the CHIARA MIA 1 Trial
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Düngen, Hans‐Dirk, Kober, Lars, Nodari, Savina, Schou, Morten, Otto, Christiane, Becka, Michael, Kanefendt, Friederike, Winkelmann, Bernhard R., Gislason, Gunnar, Richard, Frank, Nielsen, Olav Wendelboe, Gheorghiade, Mihai, and Senni, Michele
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The chymase inhibitor fulacimstat is developed as a first‐in‐class treatment option for the inhibition of adverse cardiac remodeling in patients with left ventricular dysfunction (LVD) after acute myocardial infarction (MI). The aim of the study was to examine the safety and tolerability of fulacimstat in patients with LVD after remote MI. A multicenter, multinational randomized, placebo‐controlled study was performed in clinically stable patients (40–79 years of age, left ventricular ejection fraction ≤ 45% because of MI in medical history) who were on stable evidence‐based standard‐of‐care therapies for LVD post‐MI including an angiotensin converting enzyme inhibitor or angiotensin receptor blocker at doses of at least half the recommended target dose. Patients were treated for 2 weeks with either placebo (n = 12) or 4 different doses of fulacimstat (5 mg twice daily, n = 9; 10 mg twice daily, n = 9; 25 mg twice daily, n = 10; 50 mg once daily, n = 9). Fulacimstat was safe and well tolerated at all examined doses. There were no clinically relevant effects on vital signs or potassium levels compared with placebo treatment. Mean plasma concentrations of fulacimstat increased with the administered dose and reached exposures predicted to be therapeutically active. The safety profile and the absence of effects on blood pressure or heart rate in a chronic patient population having similar comorbidities and receiving similar comedication as patients after acute MI support future clinical trials with fulacimstat in patients after acute MI.
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- 2019
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12. Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial
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Hernandez, Adrian F, Green, Jennifer B, Janmohamed, Salim, D'Agostino, Ralph B, Granger, Christopher B, Jones, Nigel P, Leiter, Lawrence A, Rosenberg, Anne E, Sigmon, Kristina N, Somerville, Matthew C, Thorpe, Karl M, McMurray, John J V, Del Prato, Stefano, Del Prato, Stefano, McMurray, John J.V., D'Agostino, Ralph B., Granger, Christopher B., Hernandez, Adrian F., Janmohamed, Salim, Leiter, Lawrence A., Califf, Robert M, Holman, Rury, DeMets, David, Riddle, Matthew, Goodman, Shaun, McGuire, Darren, Alexander, Karen, Devore, Adam, Melloni, Chiara, Patel, Chetan, Kong, David, Bloomfield, Gerald, Roe, Matthew, Tricoci, Pierluigi, Harrison, Rob, Lopes, Renato, Mathews, Robin, Mehta, Rajendra, Schuyler Jones, William, Vemulapalli, Sreekanth, Povsic, Thomas, Eapen, Zubin, Dombrowski, Keith, Kolls, Brad, Jordan, Dedrick, Ambrosy, Andrew, Greene, Stephen, Mandawat, Aditya, Shavadia, Jay, Cooper, Lauren, Sharma, Abhinav, Guimaraes, Patricia, Friedman, Daniel, Wilson, Matt, Endsley, Patricia, Gentry, Tracy, Collier, Jeannie, Perez, Kathleen, James, Kourtnei, Roush, Jennifer, Pope, Connie, Howell, Christina, Johnson, Megan, Bailey, Matt, Cole, Joanna, Akers, Teresa, Vandyne, Beth, Thomas, Betsy, Rich, Jenny, Bartone, Susan, Beaulieu, Gail, Brown, Kim, Chau, Tuan, Christian, Tamra, Coker, Rebecca, Greene, Deb, Haddock, Trevorlyn, Jenkins, Wendy, Haque, Ghazala, Marquess, Marsha, Pesarchick, Jean, Rethaford, Renee, Stone, Allegra, Al Kawas, Firas, Anderson, Michelle, Enns, Robert, Sinay, Isaac, Mathieu, Chantal, Yordanov, Victor, Hramiak, Irene, Haluzik, Martin, Galatius, Søren, Guerci, Bruno, Nauck, Michael, Migdalis, Ilias, Tan, Choon Beng Kathryn, Kocsis, Gyozo, Giaccari, Andrea, Lee, Moon Kyu, Muñoz, Ernesto German Cardona, Cornel, Jan, Birkeland, Kare, Pinto, Miguel, Tirador, Louie, Olesinska-Mader, Martyna, Shestakova, Marina, Distiller, Larry, Lopez-Sendon, Jose, Eliasson, Bjorn, Chiang, Chern-En, Srimahachota, Suphot, Mankovsky, Boris, Bethel, M Angelyn, Dungan, Kathleen, Kosiborod, Mikhail, Alvarisqueta, Andres, Baldovino, Jorge, Besada, Diego, Calella, Pedro, Cantero, Maria Cecilia, Castaño, Patricia, Chertkoff, Alejandro, Cuadrado, Jesus, De Loredo, Luis, Dominguez, Andrea, Español, Maria Vanesa, Finkelstein, Hernan, Frechtel, Gustavo, Fretes, Jose, Garrido Santos, Natalia, Gonzalez, Joaquin, Litvak, Marcos, Loureyro, Juan, Maffei, Laura, Maldonado, Natacha, Mohr Gasparini, Diego, Orio, Silvia, Perez Manghi, Federico, Rodriguez Papini, Nelson, Sala, Jorgelina, Schygiel, Pablo, Sposetti, Georgina, Ulla, Maria, Verra, Fernando, Zabalua, Silvina, Zaidman, Cesar, Crenier, Laurent, Debroye, Corinne, Duyck, Francis, Scheen, André, Van Gaal, Luc, Vercammen, Chris, Damyanova, Velichka, Dimitrov, Stefan, Kovacheva, Snezhina, Lozanov, Lachezar, Margaritov, Viktor, Mihaylova-Shumkova, Rositsa, Nikolaeva, Antoaneta, Stoyanova, Zhasmina, Akhras, Ronald, Beaudry, Yves, Bedard, Jacques, Berlingieri, Joseph, Chehayeb, Raja, Cheung, Stephen, Conway, James, Cusson, Jean, Della Siega, Anthony, Dumas, Richard, Dzongowski, Peter, Ferguson, Murdo, Gaudet, Daniel, Grondin, Francois, Gupta, Anil, Gupta, Milan, Halperin, Frank, Houle, Pierre-Alain, Jones, Michael, Kouz, Simon, Kovacs, Christopher, Landry, Daniel, Lonn, Eva, O'Mahony, William, Peterson, Sean, Reich, Dennis, Rosenbloom, Alan, St-Maurice, Francois, Tugwell, Barna, Vizel, Saul, Woo, Vincent, Brychta, Tomas, Cech, Vladimir, Dvorakova, Eva, Edelsberger, Tomas, Halciakova, Katarina, Krizova, Jarmila, Lastuvka, Jiri, Piperek, Martin, Prymkova, Vera, Raclavska, Lea, Silhova, Elena, Urbanek, Robin, Vrkoc, Jan, Andersen, Ulla, Brønnum-Schou, Jens, Hove, Jens, Jensen, Jan Skov, Kober, Lars, Kristiansen, Ole Peter, Lund, Per, Melchior, Thomas, Nyvad, Ole, Schou, Morten, Boye, Alain, Cadinot, Didier, Gouet, Didier, Henry, Patrick, Kessler, Laurence, Lalau, Jean-Daniel, Petit, Catherine, Thuan, Jean-Francois, Voinot, Christel, Vouillarmet, Julien, Axthelm, Christoph, Berger, Dirk, Bieler, Tasso, Birkenfeld, Andreas, Bott, Jochen, Busch, Klaus, Caca, Karel, Chevts, Julia, Donaubauer, Torsten, Erlinger, Rudolf, Funke, Klaus, Grosskopf, Josef, Hagenow, Andreas, Hamann, Monika, Hartard, Manfred, Heymer, Peter, Huppertz, Wolfgang, Illies, Gabriele, Jacob, Stephan, Jung, Thomas, Kahrmann, Gerd, Kast, Petra, Kellerer, Monika, Kempe, Hans-Peter, Khariouzov, Andrei, Klausmann, Gerhard, Klein, Christiane, Kleinecke-Pohl, Uwe, Kleinertz, Klaus, Koch, Thorsten, Kosch, Christine, Lorra, Babette, Luedemann, Joerg, Luttermann, Matthias, Maxeiner, Stephan, Milek, Karsten, Moelle, Andrea, Neumann, Gerhard, Nischik, Ruth, Oehrig-Pohl, Edith, Plassmann, Georg, Pohlmeier, Lars, Proepper, Felix, Regner, Stefan, Rieker, Werner, Rose, Ludger, Samer, Holger, Sauter, Joachim, Schaper, Frank, Schiffer, Clemens, Schmidt, Juergen, Scholz, Bernd-M., Schulze, Joerg, Segner, Alexander, Seufert, Jochen, Sigal, Helena, Steindorf, Joerg, Stockhausen, Juergen, Stuebler, Petra, Taeschner, Heidrun, Tews, Dietrich, Tschoepe, Diethelm, Wilhelm, Karl, Zeller-Stefan, Helga, Avramidis, Iakovos, Bousboulas, Stavros, Bristianou, Magdalini, Dimitriadis, Georgios, Elisaf, Moses, Kotsa, Kalliopi, Melidonis, Andreas, Mitrakou, Asimina, Pagkalos, Emmanouil, Papanas, Nikolaos, Pappas, Angelos, Sampanis, Christos, Tentolouris, Nikolaos, Tsapas, Apostolos, Tzatzagou, Glykeria, Ozaki, Risa, Hajdú, Csaba, Harcsa, Eleonóra, Konyves, Laszlo, Mucsi, János, Pauker, Zsolt, Petró, Gizella, Plés, Zsolt, Revesz, Katalin, Sándor, Vangel, Vass, Viktor, Avogaro, Angelo, Boemi, Massimo, Bonadonna, Riccardo, Consoli, Agostino, De Cosmo, Salvatore, Di Bartolo, Paolo, Dotta, Francesco, Frontoni, Simona, Galetta, Marianna, Gambineri, Alessandra, Gazzaruso, Carmine, Giorgino, Francesco, Lauro, Davide, Orsi, Emanuela, Paolisso, Giuseppe, Perriello, Gabriele, Piatti, Piermarco, Pontiroli, Antonio, Ponzani, Paola, Rivellese, Angela Albarosa, Sesti, Giorgio, Tonolo, Giancarlo, Trevisan, Roberto, Ahn, Chul Woo, Baik, Sei-Hyun, Cha, Bong-Soo, Chung, Choon-Hee, Jang, Hak Chul, Kim, Chong-Jin, Kim, Hye Soon, Kim, In Joo, Lee, Eun Young, Lee, Hyoung Woo, Lee, Kwan-Woo, Moon, Keon-Woong, Namgung, June, Park, Kyong Soo, Yoo, Soon Jib, Yu, Jaemyung, Llamas, Edmundo-Alfredo Bayram, Cervantes-Escárcega, Jose-Luis, Flota-Cervera, Luis Fernando, González-González, José Gerardo, Pascoe-Gonzalez, Sara, Pelayo-Orozco, Emilia Susana, Ramirez-Diaz, Santiago-Paulino, Saldana-Mendoza, Arturo, Jerjes-Díaz, Carlos Sánchez, Torres-Colores, Jose Juan, Vidrio-Velázquez, Maricela, Villagordoa-Mesa, Juan, Beijerbacht, Hugo Peter, Groutars, Reginald G.E.J., Hoek, Boudewijn A, Hoogslag, Pieter A.M., Kooy, Adriaan, Kragten, Johannes A., Lieverse, Aloysius G., Swart, Hendrik P., Viergever, Eric P., Ahlqvist, Jørn, Cooper, John, Gulseth, Hanne, Guttormsen, Gaute, Wium, Cecilie, Arbañil, Hugo, Calderon, Jorge, Camacho, Luis, Espinoza, Augusto Dextre, Garrido, Elizabeth, Luna, Alejandro, Manrique, Helard, Revoredo, Frederick Massucco, Gonzales, Rolando Vargas, Rincon, Luis Zapata, Zubiate, Carlos, Ebo, Geraldine, Morales-Palomares, Ellen, Arciszewska, Malgorzata, Banach, Marek, Bijata-Bronisz, Renata, Derezinski, Tadeusz, Gadzinski, Waldemar, Gajek, Jacek, Klodawska, Katarzyna, Krzyzagorska, Ewa, Madej, Andrzej, Miekus, Pawel, Opiela, Jaroslaw, Romanczuk, Piotr, Siegel, Anna, Skokowska, Ewa, Stankiewicz, Andrzej, Stasinska, Teresa, Trznadel-Morawska, Iwona, Witek, Robert, Aksentyev, Sergey, Bondar, Irina, Demidova, Irina, Dreval, Alexander, Ershova, Olga, Galstyan, Gagik, Garganeeva, Alla, Izmozherova, Nadezhda, Karetnikova, Victoria, Kharakhulakh, Marina, Khokhlov, Aleksandr, Kobalava, Zhanna, Koshelskaya, Olga, Kosmacheva, Elena, Kostin, Vladimir, Koziolova, Natalia, Kuzin, Anatoly, Lesnov, Victor, Lysenko, Tatyana, Markov, Valentin, Mayorov, Alexander, Moiseev, Sergey, Myasoedova, Svetlana, Petunina, Nina, Rebrov, Andrey, Ruyatkina, Ludmila, Samoylova, Julia, Sazonova, Olga, Shilkina, Natalia, Sokolova, Nadezhda, Vasilevskaya, Olga, Verbovaya, Nelli, Vishneva, Elena, Vorobyev, Sergey, Vorokhobina, Natalya, Zanozina, Olga, Zhdanova, Elena, Zykova, Tatyana, Burgess, Lesley, Coetzee, Kathleen, Dawood, Saleem, Lombard, Landman, Makotoko, Ellen, Moodley, Rajendran, Oosthuysen, Wessels, Sarvan, Mohamed, Calvo Gómez, Carlos, Cano Rodríguez, Isidoro, Castro Conde, Almudena, Cequier Fillat, Angel, Cuatrecasas Cambra, Guillem, de Álvaro Moreno, Fernando, De Teresa Parreño, Luis, Delgado Lista, Javier, Domínguez Escribano, José Ramón, Durán García, Santiago, Elvira González, Javier, Fernández Rodríguez, José María, Goday Arno, Alberto, Gomez Huelgas, Ricardo, González Juanatey, José Ramón, Hernandez Mijares, Antonio, Jiménez Díaz, Víctor Alfonso, Jodar Gimeno, Esteban, Lucas Morante, Tomás, Marazuela, Monica, Martell Claros, Nieves, Mauricio Puente, Didac, Mena Ribas, Elena, Merino Torres, Juan Francisco, Mezquita Raya, Pedro, Nubiola Calonge, Andreu, Ordoñez Sánchez, Xavier, Pascual Izuel, Jose Maria, Perea Castilla, Verónica, Pérez Pérez, Antonio, Perez Soto, Isabel, Quesada Charneco, Miguel, Quesada Simón, Angustias, Redón Mas, Josep, Rego Iraeta, Antonia, Rodriguez Alvarez, Maria, Rodríguez Rodríguez, Irene, Sabán Ruiz, José, Soto González, Alfonso, Tinahones Madueno, Francisco, Trescoli Serrano, Carlos, Ulied Armiñana, Angels, Bachus, Erasmus, Berndtsson Blom, Katarina, Eliasson, Ken, Koskinen, Pekka, Larnefeldt, Hans, Lif-Tiberg, Cornelia, Linderfalk, Carina, Lund, Gustav, Lundman, Pia, Moris, Linda, Olsson, Åke, Salmonsson, Staffan, Sanmartin Berglund, Johan, Sjöberg, Folke, Söderberg, Stefan, Torstensson, Ingemar, Chen, Jung-Fu, Tien, Kai Jen, Tseng, Shih-Ting, Tu, Shih-Te, Wang, Chih-Yuan, Wang, Ji-Hung, Phrommintikul, Arintaya, Yamwong, Sukit, Jintapakorn, Woravut, Hutayanon, Pisit, Sansanayudh, Nakarin, Bazhan, Larysa, Fushtey, Ivan, Grachova, Mariya, Katerenchuk, Vitaliy, Korpachev, Vadym, Kravchun, Nonna, Larin, Oleksandr, Mykhalchyshyn, Galyna, Myshanych, Halyna, Oleksyk, Olga, Orlenko, Valeriia, Pashkovska, Nataliia, Pertseva, Nataliia, Petrosyan, Olena, Smirnov, Ivan, Vlasenko, Maryna, Zlova, Tetiana, Aye, Myint, Baksi, Arun, Balasubramani, Mathangi, Beboso, Ronnie, Blagden, Mark, Bundy, Charles, Cookson, Tobias, Copland, Allan, Emslie-Smith, Alistair, Green, Fiona, Gunstone, Anthony, Issa, Basil, Jackson-Voyzey, Ewart, Johnson, Andrew, Maclean, Malcolm, McKnight, John, Muzulu, Solomon, O'Connell, Ian, Oyesile, Babatunde, Patterson, Catherine, Pearson, Ewan, Philip, Sam, Smith, Paul, Sukumaran, Usha, Abbas, Jalal, Aggarwala, Gaurav, Akhter, Faiq, Andersen, James, Anglade, Moise, Argoud, Georges, Ariani, Mehrdad, Ashdji, Reswan, Bakhtari, Ladan, Banerjee, Subhash, Bartlett, Andrew, Baum, Howard, Bays, Harold, Beasley, Richard, Belfort de Aguiar, Renata, Benjamin, Sabrina, Bhagwat, Ravi, Bhargava, Anuj, Bode, Bruce, Bratcher, Christina, Briskin, Toby, Brockmyre, Andrew, Broughton, Raymond, Brown, Judith, Budhraja, Madhusudan, Cannon, Kevin, Carr, Jewell, Cathcart, Harold, Cavale, Arvind, Chaykin, Louis, Cheung, Deanna, Childress, Richard, Cohen, Allan, Condit, Jonathan, Cooksey, Erin, Cornett, George Mitchell, Dauber, Ira, Davila, William, De Armas, Luis, Dean, Julius, Detweiler, Robert, Diaz, Ernesto, Di Giovanna, Michael, Dor, Isaac, Drummond, Waymon, Eagerton, Donald, Earl, John, Eaton, Charles, Ellison, Howard, Farris, Neil, Fiel, Thomas, Firek, Anthony, First, Brian, Forgosh, Les, French, William, Gandy, Winston, Garcia, Ronald, Gill, Santosh, Gordon, Murray, Guice, Michael, Gummadi, Siva, Hackenyos, Jonathan, Hairston, Kristen, Hanson, Lenita, Harrison, Lindsay, Hartman, Israel, Heitner, John, Hejeebu, Srini, Hermany, Paul, Hernandez-Cassis, Carlos, Hidalgo, Horacio, Higgins, Alexander, Ibrahim, Hassan, Jacobs, Shahram, Johnson, David, Joshi, Parag, Kaster, Steven, Kellum, Daniel, Kim, Christopher, Kim, Ellen, Kirby, William, Knouse, Albert, Kulback, Steven, Kumar, Mariananda, Kuruvanka, Tulsidas, Labroo, Ajay, Lasswell, William, Lentz, John, Lenzmeier, Thomas, Lewis, David, Li, Zhaoping, Lillestol, Michael, Little, Raymond, Lorraine, Richard, McKeown-Biagas, Cecilia, McNeill, Robert, Mehta, Anand, Miller, Alan, Moran, Joseph, Morawski, Emily, Nadar, Venkatesh, O'Connor, Thomas, Odio, Alberto, Parker, Reginald, Patel, Rajesh, Phillips, Lawrence, Raad, George, Rahman, Aref, Raikhel, Marina, Raisinghani, Ajit, Rajan, Raj, Rasouli, Neda, Rauzi, Frank, Rohr, Kathryn, Roseman, Hal, Rovner, Sergio, Saba, Fadi, Sachson, Richard, Schabauer, Alex, Schneider, Ricky, Schuchard, Timothy, Sensenbrenner, John, Shlesinger, Yshay, Singh, Narendra, Sivalingam, Kanagaratnam, Stonesifer, Larry, Storey, Daniel, Suh, David, Tahir, Mohammed, Tan, Anjanette, Tan, Marilyn, Taylon, Alain, Thakkar, Maitreya, Tripathy, Devjit, Uwaifo, Gabriel, Vedere, Amarnath, Venugopal, Chandra, Vo, Anthony, Welch, Michelle, Welker, James, White, Alexander, Willis, John, Wynne, Alan, Yazdani, Shahram, Green, Jennifer B, Rosenberg, Anne, Price, Lauren, Sigmon, Kristina, Lokhngina, Yuliya, Xing, Weibing, Overton, Robert, Stewart, Murray, Stead, Janet, Lindsay, Alistair, Patel, Vickas, Ross, Jorge, Soffer, Joseph, Daga, Shruti, Sowell, Margaret, Patel, Prashant, Garvey, Louisa, Ackert, Jessica, Abraham, Sybil, Sabol, Mary Beth, Altobelli, Desma, Ha, JuYoung, Kulkarni, Mangesh, Somerville, Matthew, Noronha, Drusilla, Casson, Ed, Zang, Eddie, Sandhu, Chamandeep, Kumar, Rakesh, Chen, David, Taft, Lin, Patel, Rajivkumar, Ye, June, Shannon, Jennifer, Wilson, Tim, Babi, Charleen, Miller, Diane, Jones, Nigel P, Thorpe, Karl, Russell, Rachael, Bull, Georgina, Hereghty, Belinda, Fernandez-Salazar, Eva, Longley, Troy, Donaldson, Jill, Jarosz, Marie, Murphy, Karen, Adams, Patricia, Smith, Peter, James, Rachel, Richards, Jackie, Sedani, Sangeeta, Althouse, Denise, Watson, David, Lorimer, Jamie, Lauder, Steven, Schultheis, Ron, Womer, Terese, Wraight, Ella, Li, Wenyan, Price-Olsen, Emma, Watson, Anthony, Kelly, Aoife, McLaughlin, Patricia, Fleming, John, Schubert, Jessica, Schleiden, Debra, Harris, Tara, Prakash, Rahul, Breneman, Jody, Deshpande, Sameer, Saswadkar, Aarti, Kumari, Aditi, Shitut, Aditi, Raorane, Amruta, Karmalkar, Anisha, Mhambrey, Ankita, Bhosale, Archana, Vaphare, Ashok, Patil, Ashwini P, Khandelwal, Chaitali, Shaik, Fayaz, Nadar, Madhumitha, Karka, Mounika, Kadgaonkar, Neha, Gupta, Nikita, Aher, Nutan, Potnis, Omkar, Naicker, Pallavi, Shinde, Rakesh, Sharma, Richa, Godse, Rupali, Solanki, Sheetal, Sahu, Shruti, Dumbre, Snehal, Kumar, Somesh, Patil, Suradnya, and Mandal, Trisha
- Abstract
Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke.
- Published
- 2018
- Full Text
- View/download PDF
13. Rivaroxaban with or without aspirin in patients with stable coronary artery disease: an international, randomised, double-blind, placebo-controlled trial
- Author
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Connolly, Stuart J, Eikelboom, John W, Bosch, Jackie, Dagenais, Gilles, Dyal, Leanne, Lanas, Fernando, Metsarinne, Kaj, O'Donnell, Martin, Dans, Anthony L, Ha, Jong-Won, Parkhomenko, Alexandr N, Avezum, Alvaro A, Lonn, Eva, Lisheng, Liu, Torp-Pedersen, Christian, Widimsky, Petr, Maggioni, Aldo P, Felix, Camilo, Keltai, Katalin, Hori, Masatsugu, Yusoff, Khalid, Guzik, Tomasz J, Bhatt, Deepak L, Branch, Kelley R H, Cook Bruns, Nancy, Berkowitz, Scott D, Anand, Sonia S, Varigos, John D, Fox, Keith A A, Yusuf, Salim, SALA, JORGELINA, CARTASEGNA, LUIS, VICO, MARISA, HOMINAL, MIGUEL ANGEL, HASBANI, EDUARDO, CACCAVO, ALBERTO, ZAIDMAN, CESAR, VOGEL, DANIEL, HRABAR, ADRIAN, SCHYGIEL, PABLO OMAR, CUNEO, CARLOS, LUQUEZ, HUGO, MACKINNON, IGNACIO J., AHUAD GUERRERO, RODOLFO ANDRES, COSTABEL, JUAN PABLO, BARTOLACCI, INES PALMIRA, MONTANA, OSCAR, BARBIERI, MARIA, GOMEZ VILAMAJO, OSCAR, GARCIA DURAN, RUBEN OMAR, SCHIAVI, LILIA BEATRIZ, GARRIDO, MARCELO, INGARAMO, ADRIAN, BORDONAVA, ANSELMO PAULINO, PELAGAGGE, MARIA JOSE, NOVARETTO, LEONARDO, ALBISU DI GENNERO, JUAN PABLO, IBANEZ SAGGIA, LUZ MARIA, ALVAREZ, MOIRA, VITA, NESTOR ALEJANDRO, MACIN, STELLA MARIS, DRAN, RICARDO DARIO, CARDONA, MARCELO, GUZMAN, LUIS, SARJANOVICH, RODOLFO JUAN, CUADRADO, JESUS, NANI, SEBASTIAN, LITVAK BRUNO, MARCOS RAUL, CHACON, CAROLINA, MAFFEI, LAURA ELENA, GRINFELD, DIEGO, VENSENTINI, NATALIA, MAJUL, CLAUDIO RODOLFO, LUCIARDI, HECTOR LUCAS, GONZALEZ COLASO, PATRICIA DEL CARMEN, FERRE PACORA, FREDY ANTONI, VAN DEN HEUVEL, PAUL, VERHAMME, PETER, ECTOR, BAVO, DEBONNAIRE, PHILIPPE, VAN DE BORNE, PHILIPPE, LEROY, JEAN, SCHROE, HERMAN, VRANCKX, PASCAL, ELEGEERT, IVAN, HOFFER, ETIENNE, DUJARDIN, KARL, INDIO DO BRASIL, CLARISSE, PRECOMA, DALTON, ABRANTES, JOSE ANTONIO, MANENTI, EULER, REIS, GILMAR, SARAIVA, JOSE, MAIA, LILIA, HERNANDES, MAURO, ROSSI, PAULO, ROSSI DOS SANTOS, FABIO, ZIMMERMANN, SERGIO LUIZ, RECH, RAFAEL, ABIB JR, EDUARDO, LEAES, PAULO, BOTELHO, ROBERTO, DUTRA, OSCAR, SOUZA, WEIMAR, BRAILE, MARIA, IZUKAWA, NILO, NICOLAU, JOSE CARLOS, TANAJURA, LUIZ FERNANDO, SERRANO JUNIOR, CARLOS VICENTE, MINELLI, CESAR, NASI, LUIZ ANTONIO, OLIVEIRA, LIVIA, DE CARVALHO CANTARELLI, MARCELO JOSE, TYTUS, RICHARD, PANDEY, SHEKHAR, LONN, EVA, CHA, JAMES, VIZEL, SAUL, BABAPULLE, MOHAN, LAMY, ANDRE, SAUNDERS, KEVIN, BERLINGIERI, JOSEPH, KIAII, BOB, BHARGAVA, RAKESH, MEHTA, PRAVINSAGAR, HILL, LAURIE, FELL, DAVID, LAM, ANDY, AL-QOOFI, FAISAL, BROWN, CRAIG, PETRELLA, ROBERT, RICCI, JOSEPH A, GLANZ, ANTHONY, NOISEUX, NICOLAS, BAINEY, KEVIN, MERALI, FATIMA, HEFFERNAN, MICHAEL, DELLA SIEGA, ANTHONY, DAGENAIS, GILLES R, DAGENAIS, FRANCOIS, BRULOTTE, STEEVE, NGUYEN, MICHEL, HARTLEIB, MICHAEL, GUZMAN, RANDOLPH, BOURGEOIS, RONALD, RUPKA, DENNIS, KHAYKIN, YAARIV, GOSSELIN, GILBERT, HUYNH, THAO, PILON, CLAUDE, CAMPEAU, JEAN, PICHETTE, FRANCIS, DIAZ, ARIEL, JOHNSTON, JAMES, SHUKLE, PRAVIN, HIRSCH, GREGORY, RHEAULT, PAUL, CZARNECKI, WLODZIMIERZ, ROY, ANNIE, NAWAZ, SHAH, FREMES, STEPHEN, SHUKLA, DINKAR, JANO, GABRIEL, COBOS, JORGE LEONARDO, CORBALAN, RAMON, MEDINA, MARCELO, NAHUELPAN, LEONARDO, RAFFO, CARLOS, PEREZ, LUIS, POTTHOFF, SERGIO, STOCKINS, BENJAMIN, SEPULVEDA, PABLO, PINCETTI, CHRISTIAN, VEJAR, MARGARITA, TIAN, HONGYAN, WU, XUESI, KE, YUANNAN, JIA, KAIYING, YIN, PENGFEI, WANG, ZHAOHUI, YU, LITIAN, WU, SHULIN, WU, ZONGQUI, LIU, SHAO WEN, BAI, XIAO JUAN, ZHENG, YANG, YANG, PING, YANG, YUN MEI, ZHANG, JIWEI, GE, JUNBO, CHEN, XIAO PING, LI, JUNXIA, HU, TAO HONG, ZHANG, RUIYAN, ZHENG, ZHE, CHEN, XIN, TAO, LIANG, LI, JIANPING, HUANG, WEIJIAN, FU, GUOSHENG, LI, CHUNJIAN, DONG, YUGANG, WANG, CHUNSHENG, ZHOU, XINMIN, KONG, YE, SOTOMAYOR, ARISTIDES, ACCINI MENDOZA, JOSE LUIS, CASTILLO, HENRY, URINA, MIGUEL, AROCA, GUSTAVO, PEREZ, MARITZA, MOLINA DE SALAZAR, DORA INES, SANCHEZ VALLEJO, GREGORIO, FERNANDO, MANZUR J, GARCIA, HENRY, GARCIA, LUIS HERNANDO, ARCOS, EDGAR, GOMEZ, JUAN, CUERVO MILLAN, FRANCISCO, TRUJILLO DADA, FREDY ALBERTO, VESGA, BORIS, MORENO SILGADO, GUSTAVO ADOLFO, ZIDKOVA, EVA, LUBANDA, JEAN-CLAUDE, KALETOVA, MARKETA, KRYZA, RADIM, MARCINEK, GABRIEL, RICHTER, MAREK, SPINAR, JINDRICH, MATUSKA, JIRI, TESAK, MARTIN, MOTOVSKA, ZUZANA, BRANNY, MARIAN, MALY, JIRI, MALY, MARTIN, WIENDL, MARTIN, FOLTYNOVA CAISOVA, LENKA, SLABY, JOSEF, VOJTISEK, PETR, PIRK, JAN, SPINAROVA, LENKA, BENESOVA, MIROSLAVA, CANADYOVA, JULIA, HOMZA, MIROSLAV, FLORIAN, JINDRICH, POLASEK, ROSTISLAV, COUFAL, ZDENEK, SKALNIKOVA, VLADIMIRA, BRAT, RADIM, BRTKO, MIROSLAV, JANSKY, PETR, LINDNER, JAROSLAV, MARCIAN, PAVEL, STRAKA, ZBYNEK, TRETINA, MARTIN, DUARTE, YAN CARLOS, POW CHON LONG, FREDDY, SANCHEZ, MAYRA, LOPEZ, JOSE, PERUGACHI, CARMITA, MARMOL, RICARDO, TRUJILLO, FREDDY, TERAN, PABLO, TUOMILEHTO, JAAKKO, TUOMILEHTO, HENRI, TUOMINEN, MARJA-LEENA, TUOMILEHTO, HENRI, KANTOLA, ILKKA, STEG, GABRIEL, ABOYANS, VICTOR, LECLERCQ, FLORENCE, FERRARI, EMILE, BOCCARA, FRANCK, MESSAS, EMMANUEL, MISMETTI, PATRICK, SEVESTRE, MARIE ANTOINETTE, CAYLA, GUILLAUME, MOTREFF, PASCAL, STOERK, STEFAN, DUENGEN, HANS-DIRK, STELLBRINK, CHRISTOPH, GUEROCAK, OSMAN, KADEL, CHRISTOPH, BRAUN-DULLAEUS, RUEDIGER, JESERICH, MICHAEL, OPITZ, CHRISTIAN, VOEHRINGER, HANS-FRIEDRICH, APPEL, KARL-FRIEDRICH, WINKELMANN, BERNHARD, DORSEL, THOMAS, NIKOL, SIGRID, DARIUS, HARALD, RANFT, JURGEN, SCHELLONG, SEBASTIAN, JUNGMAIR, WOLFGANG, DAVIERWALA, PIROZE, VORPAHL, MARC, BAJNOK, LASZLO, LASZLO, ZOLTAN, NOORI, EBRAHIM, VERESS, GABOR, VERTES, ANDRAS, ZSARY, ANDRAS, KIS, ERNO, KORANYI, LASZLO, BAKAI, JUDIT, BODA, ZOLTAN, POOR, FERENC, JARAI, ZOLTAN, KEMENY, VENDEL, BARTON, JOHN, MCADAM, BRENDAN, MURPHY, ANDREW, CREAN, PETER, MAHON, NIALL, CURTIN, RONAN, MACNEILL, BRIAIN, DINNEEN, SEAN, HALABI, MAJDI, ZIMLICHMAN, REUVEN, ZELTSER, DAVID, TURGEMAN, YOAV, KLAINMAN, ELIEZER, LEWIS, BASIL, KATZ, AMOS, ATAR, SHAUL, ZIMLICHMAN, REUVEN, NIKOLSKY, EUGENIA, BOSI, STEFANO, NALDI, MONICA, FAGGIANO, POMPILIO, ROBBA, DEBORA, MOS, LUCIO, SINAGRA, GIANFRANCO, COSMI, FRANCO, OLTRONA VISCONTI, LUIGI, CARMINE, DE MATTEIS, DI PASQUALE, GIUSEPPE, DI BIASE, MATTEO, MANDORLA, SARA, BERNARDINANGELI, MARINO, PICCINNI, GIOVANNI CARLO, GULIZIA, MICHELE MASSIMO, GALVANI, MARCELLO, VENTURI, FLAVIO, MOROCUTTI, GIORGIO, BALDIN, MARIA GRAZIA, OLIVIERI, CARLO, PERNA, GIAN PIERO, CIRRINCIONE, VINCENZO, KANNO, TAKAYASU, DAIDA, HIROYUKI, OZAKI, YUKIO, MIYAMOTO, NAOMASA, HIGASHIUE, SHINICHI, DOMAE, HIROSHI, HOSOKAWA, SHINOBU, KOBAYASHI, HIROO, KURAMOCHI, TAKEHIKO, FUJII, KENSHI, MIZUTOMI, KAZUAKI, SAKU, KEIJIRO, KIMURA, KAZUO, HIGUCHI, YOSHIHARU, ABE, MITSUNORI, OKUDA, HARUHITO, NODA, TOSHIYUKI, MITA, TERUAKI, HIRAYAMA, ATSUSHI, ONAKA, HARUHIKO, INOKO, MORIAKI, HIROKAMI, MITSUGU, OKUBO, MUNENORI, AKATSUKA, YUTAKA, IMAMAKI, MIZUHO, KAMIYA, HARUO, MANITA, MAMORU, HIMI, TOSHIHARU, UENO, HIDEKI, HISAMATSU, YUJI, AKO, JUNYA, NISHINO, YASUHIRO, KAWAKAMI, HIDEO, YAMADA, YUTAKA, KORETSUNE, YUKIHIRO, YAMADA, TAKAHISA, YOSHIDA, TETSURO, SHIMOMURA, HIDEKI, KINOSHITA, NORIYUKI, TAKAHASHI, AKIHIKO, YUSOFF, KHALID, WAN AHMAD, WAN AZMAN, ABU HASSAN, MUHAMMAD RADZI, KASIM, SAZZLI, ABDUL RAHIM, AIZAI AZAN, MOHD ZAMRIN, DIMON, MACHIDA, MASAHARU, HIGASHINO, YORIHIKO, UTSU, NORIAKI, NAKANO, AKIHIKO, NAKAMURA, SHIGERU, HASHIMOTO, TETSUO, ANDO, KENJI, SAKAMOTO, TOMOHIRO, PRINS, F.J., LOK, DIRK, MILHOUS, JOHANNES GERT-JAN, VIERGEVER, ERIC, WILLEMS, FRANK, SWART, HENK, ALINGS, MARCO, BREEDVELD, ROB, DE VRIES, KEES-JAN, VAN DER BORGH, ROGER, OEI, FANNY, ZOET-NUGTEREN, STIENEKE, KRAGTEN, HANS, HERRMAN, JEAN PAUL, VAN BERGEN, PAUL, GOSSELINK, MARCEL, HOEKSTRA, EDUARD, ZEGERS, ERWIN, RONNER, EELKO, DEN HARTOG, FRANK, BARTELS, GERARD, NIEROP, PETER, VAN DER ZWAAN, COEN, VAN ECK, JACOB, VAN GORSELEN, EDWIN, GROENEMEIJER, BJORN, HOOGSLAG, PIETER, DE GROOT, MARC ROBERT, LOYOLA, ALDRIN, SULIT, DENNIS JOSE, REY, NANNETTE, ABOLA, MARIA TERESA, MORALES, DANTE, PALOMARES, ELLEN, ABAT, MARC EVANS, ROGELIO, GREGORIO, CHUA, PHILIP, DEL PILAR, JOSE CARLO, ALCARAZ, JOHN DENNIS, EBO, GERALDINE, TIRADOR, LOUIE, CRUZ, JOSEFINA, ANONUEVO, JOHN, PITARGUE, ARTHUR, JANION, MARIANNA, GUZIK, TOMASZ, GAJOS, GRZEGORZ, ZABOWKA, MACIEJ, RYNKIEWICZ, ANDRZEJ, BRONCEL, MARLENA, SZUBA, ANDRZEJ, CZARNECKA, DANUTA, MAGA, PAWEL, STRAZHESKO, IRINA, VASYUK, YURY, SIZOVA, ZHANNA, POZDNYAKOV, YURY, BARBARASH, OLGA, VOEVODA, MIKHAIL, POPONINA, TATIANA, REPIN, ALEXEY, OSIPOVA, IRINA, EFREMUSHKINA, ANNA, NOVIKOVA, NINA, AVERKOV, OLEG, ZATEYSHCHIKOV, DMITRY, VERTKIN, ARKADIY, AUSHEVA, AZA, COMMERFORD, PATRICK, SEEDAT, SAADIYA, VAN ZYL, LOUIS, ENGELBRECHT, JAN, MAKOTOKO, ELLEN MAKONLI, PRETORIUS, CATHARINA ELIZABETH, MOHAMED, ZAID, HORAK, ADRIAN, MABIN, THOMAS, KLUG, ERIC, BAE, JANG-HO, KIM, CHEOLHO, KIM, CHONG-JIN, KIM, DONG-SOO, KIM, YONG JIN, JOO, SEUNGJAE, HA, JONG-WON, PARK, CHUL SOO, KIM, JANG YOUNG, KIM, YOUNG-KWON, JARNERT, CHRISTINA, MOOE, THOMAS, DELLBORG, MIKAEL, TORSTENSSON, INGEMAR, ALBERTSSON, PER, JOHANSSON, LARS, AL-KHALILI, FARIS, ALMROTH, HENRIK, ANDERSSON, TOMMY, PANTEV, EMIL, TENGMARK, BENGT-OLOV, LIU, BO, RASMANIS, GUNDARS, WAHLGREN, CARL-MAGNUS, MOCCETTI, TIZIANO, PARKHOMENKO, ALEXANDER, TSELUYKO, VIRA, VOLKOV, VOLODYMYR, KOVAL, OLENA, KONONENKO, LYUDMYLA, PROKHOROV, OLEKSANDR, VDOVYCHENKO, VALERIY, BAZYLEVYCH, ANDRIY, RUDENKO, LEONID, VIZIR, VADYM, KARPENKO, OLEKSANDR, MALYNOVSKY, YAROSLAV, KOVAL, VALENTYNA, STOROZHUK, BORYS, COTTON, JAMES, VENKATARAMAN, ASOK, MORIARTY, ANDREW, CONNOLLY, DEREK, DAVEY, PATRICK, SENIOR, ROXY, BIRDI, INDERPAUL, CALVERT, JOHN, DONNELLY, PATRICK, TREVELYAN, JASPER, CARTER, JUSTIN, PEACE, AARON, AUSTIN, DAVID, KUKREJA, NEVILLE, HILTON, THOMAS, SRIVASTAVA, SUNNY, WALSH, RONALD, FIELDS, RONALD, HAKAS, JOSEPH, PORTNAY, EDWARD, GOGIA, HARINDER, SALACATA, ABRAHAM, HUNTER, JOHN J., BACHARACH, J MICHAEL, SHAMMAS, NICOLAS, SURESH, DAMODHAR, SCHNEIDER, RICKY, GURBEL, PAUL, BANERJEE, SUBHASH, GRENA, PAUL, BEDWELL, NOEL, SLOAN, STEPHEN, LUPOVITCH, STEVEN, SONI, ANAND, GIBSON, KATHLEEN, SANGRIGOLI, RENEE, MEHTA, RAJENDRA, I-HSUAN TSAI, PETER, GILLESPIE, EVE, DEMPSEY, STEPHEN, HAMROFF, GLENN, BLACK, ROBERT, LADER, ELLIS, KOSTIS, JOHN B., BITTNER, VERA, MCGUINN, WILLIAM, BRANCH, KELLEY, MALHOTRA, VINAY, MICHAELSON, STEPHEN, VACANTE, MICHAEL, MCCORMICK, MATTHEW, ARIMIE, RALUCA, CAMP, ALAN, DAGHER, GEORGE, KOSHY, N. MATHEW, THEW, STEPHEN, COSTELLO, FREDERICK, HEIMAN, MARK, CHILTON, ROBERT, MORAN, MICHAEL, ADLER, FREDRIC, COMEROTA, ANTHONY, SEIWERT, ANDREW, FRENCH, WILLIAM, SEROTA, HARVEY, HARRISON, ROBERT, BAKAEEN, FAISAL, OMER, SHUAB, CHANDRA, LOKESH, WHELAN, ALAN, BOYLE, ANDREW, ROBERTS-THOMSON, PHILIP, ROGERS, JAMES, CARROLL, PATRICK, COLQUHOUN, DAVID, SHAW, JAMES, BLOMBERY, PETER, AMERENA, JOHN, HII, CHRIS, ROYSE, ALISTAIR, SINGH, BHUWAN, SELVANAYAGAM, JOSEPH, JANSEN, SHIRLEY, LO, WINGCHI, HAMMETT, CHRISTOPHER, POULTER, ROHAN, NARASIMHAN, SESHASAYEE, WIGGERS, HENRIK, NIELSEN, HENRIK, GISLASON, GUNNAR, KOBER, LARS, HOULIND, KIM, BOENELYKKE SOERENSEN, VIBEKE, DIXEN, ULRIK, REFSGAARD, JENS, ZEUTHEN, ELISABETH, SOEGAARD, PETER, HRANAI, MARIAN, GASPAR, LUDOVIT, PELLA, DANIEL, HATALOVA, KATARINA, DROZDAKOVA, ERIKA, COMAN, IOAN, DIMULESCU, DOINA, VINEREANU, DRAGOS, CINTEZA, MIRCEA, SINESCU, CRINA, ARSENESCU, CATALINA, BENEDEK, IMRE, BOBESCU, ELENA, DOBREANU, DAN, GAITA, DAN, IANCU, ADRIAN, ILIESIU, ADRIANA, LIGHEZAN, DANIEL, PETRESCU, LUCIAN, PIRVU, OCTAVIAN, TEODORESCU, IULIA, TESLOIANU, DAN, VINTILA, MARIUS MARCIAN, and CHIONCEL, OVIDIU
- Abstract
Coronary artery disease is a major cause of morbidity and mortality worldwide, and is a consequence of acute thrombotic events involving activation of platelets and coagulation proteins. Factor Xa inhibitors and aspirin each reduce thrombotic events but have not yet been tested in combination or against each other in patients with stable coronary artery disease.
- Published
- 2018
- Full Text
- View/download PDF
14. Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial
- Author
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Anand, Sonia S, Bosch, Jackie, Eikelboom, John W, Connolly, Stuart J, Diaz, Rafael, Widimsky, Peter, Aboyans, Victor, Alings, Marco, Kakkar, Ajay K, Keltai, Katalin, Maggioni, Aldo P, Lewis, Basil S, Störk, Stefan, Zhu, Jun, Lopez-Jaramillo, Patricio, O'Donnell, Martin, Commerford, Patrick J, Vinereanu, Dragos, Pogosova, Nana, Ryden, Lars, Fox, Keith A A, Bhatt, Deepak L, Misselwitz, Frank, Varigos, John D, Vanassche, Thomas, Avezum, Alvaro A, Chen, Edmond, Branch, Kelley, Leong, Darryl P, Bangdiwala, Shrikant I, Hart, Robert G, Yusuf, Salim, SALA, JORGELINA, CARTASEGNA, LUIS, VICO, MARISA, HOMINAL, MIGUEL ANGEL, HASBANI, EDUARDO, CACCAVO, ALBERTO, ZAIDMAN, CESAR, VOGEL, DANIEL, HRABAR, ADRIAN, SCHYGIEL, PABLO OMAR, CUNEO, CARLOS, LUQUEZ, HUGO, MACKINNON, IGNACIO J., AHUAD GUERRERO, RODOLFO ANDRES, COSTABEL, JUAN PABLO, BARTOLACCI, INES PALMIRA, MONTANA, OSCAR, BARBIERI, MARIA, GOMEZ VILAMAJO, OSCAR, GARCIA DURAN, RUBEN OMAR, SCHIAVI, LILIA BEATRIZ, GARRIDO, MARCELO, INGARAMO, ADRIAN, BORDONAVA, ANSELMO PAULINO, PELAGAGGE, MARIA JOSE, NOVARETTO, LEONARDO, ALBISU DI GENNERO, JUAN PABLO, IBANEZ SAGGIA, LUZ MARIA, ALVAREZ, MOIRA, VITA, NESTOR ALEJANDRO, MACIN, STELLA MARIS, DRAN, RICARDO DARIO, CARDONA, MARCELO, GUZMAN, LUIS, SARJANOVICH, RODOLFO JUAN, CUADRADO, JESUS, NANI, SEBASTIAN, LITVAK BRUNO, MARCOS RAUL, CHACON, CAROLINA, MAFFEI, LAURA ELENA, GRINFELD, DIEGO, VENSENTINI, NATALIA, MAJUL, CLAUDIO RODOLFO, LUCIARDI, HECTOR LUCAS, GONZALEZ COLASO, PATRICIA DEL CARMEN, FERRE PACORA, FREDY ANTONI, VAN DEN HEUVEL, PAUL, VERHAMME, PETER, ECTOR, BAVO, DEBONNAIRE, PHILIPPE, VAN DE BORNE, PHILIPPE, LEROY, JEAN, SCHROE, HERMAN, VRANCKX, PASCAL, ELEGEERT, IVAN, HOFFER, ETIENNE, DUJARDIN, KARL, INDIO DO BRASIL, CLARISSE, PRECOMA, DALTON, ABRANTES, JOSE ANTONIO, MANENTI, EULER, REIS, GILMAR, SARAIVA, JOSE, MAIA, LILIA, HERNANDES, MAURO, ROSSI, PAULO, ROSSI DOS SANTOS, FABIO, ZIMMERMANN, SERGIO LUIZ, RECH, RAFAEL, ABIB JR, EDUARDO, LEAES, PAULO, BOTELHO, ROBERTO, DUTRA, OSCAR, SOUZA, WEIMAR, BRAILE, MARIA, IZUKAWA, NILO, NICOLAU, JOSE CARLOS, TANAJURA, LUIZ FERNANDO, SERRANO JUNIOR, CARLOS VICENTE, MINELLI, CESAR, NASI, LUIZ ANTONIO, OLIVEIRA, LIVIA, DE CARVALHO CANTARELLI, MARCELO JOSE, TYTUS, RICHARD, PANDEY, SHEKHAR, LONN, EVA, CHA, JAMES, VIZEL, SAUL, BABAPULLE, MOHAN, LAMY, ANDRE, SAUNDERS, KEVIN, BERLINGIERI, JOSEPH, KIAII, BOB, BHARGAVA, RAKESH, MEHTA, PRAVINSAGAR, HILL, LAURIE, FELL, DAVID, LAM, ANDY, AL-QOOFI, FAISAL, BROWN, CRAIG, PETRELLA, ROBERT, RICCI, JOSEPH A, GLANZ, ANTHONY, NOISEUX, NICOLAS, BAINEY, KEVIN, MERALI, FATIMA, HEFFERNAN, MICHAEL, DELLA SIEGA, ANTHONY, DAGENAIS, GILLES R, DAGENAIS, FRANCOIS, BRULOTTE, STEEVE, NGUYEN, MICHEL, HARTLEIB, MICHAEL, GUZMAN, RANDOLPH, BOURGEOIS, RONALD, RUPKA, DENNIS, KHAYKIN, YAARIV, GOSSELIN, GILBERT, HUYNH, THAO, PILON, CLAUDE, CAMPEAU, JEAN, PICHETTE, FRANCIS, DIAZ, ARIEL, JOHNSTON, JAMES, SHUKLE, PRAVIN, HIRSCH, GREGORY, RHEAULT, PAUL, CZARNECKI, WLODZIMIERZ, ROY, ANNIE, NAWAZ, SHAH, FREMES, STEPHEN, SHUKLA, DINKAR, JANO, GABRIEL, COBOS, JORGE LEONARDO, CORBALAN, RAMON, MEDINA, MARCELO, NAHUELPAN, LEONARDO, RAFFO, CARLOS, PEREZ, LUIS, POTTHOFF, SERGIO, STOCKINS, BENJAMIN, SEPULVEDA, PABLO, PINCETTI, CHRISTIAN, VEJAR, MARGARITA, TIAN, HONGYAN, WU, XUESI, KE, YUANNAN, JIA, KAIYING, YIN, PENGFEI, WANG, ZHAOHUI, YU, LITIAN, WU, SHULIN, WU, ZONGQUI, LIU, SHAO WEN, BAI, XIAO JUAN, ZHENG, YANG, YANG, PING, YANG, YUN MEI, ZHANG, JIWEI, GE, JUNBO, CHEN, XIAO PING, LI, JUNXIA, HU, TAO HONG, ZHANG, RUIYAN, ZHENG, ZHE, CHEN, XIN, TAO, LIANG, LI, JIANPING, HUANG, WEIJIAN, FU, GUOSHENG, LI, CHUNJIAN, DONG, YUGANG, WANG, CHUNSHENG, ZHOU, XINMIN, KONG, YE, SOTOMAYOR, ARISTIDES, ACCINI MENDOZA, JOSE LUIS, CASTILLO, HENRY, URINA, MIGUEL, AROCA, GUSTAVO, PEREZ, MARITZA, MOLINA DE SALAZAR, DORA INES, SANCHEZ VALLEJO, GREGORIO, FERNANDO, MANZUR J, GARCIA, HENRY, GARCIA, LUIS HERNANDO, ARCOS, EDGAR, GOMEZ, JUAN, CUERVO MILLAN, FRANCISCO, TRUJILLO DADA, FREDY ALBERTO, VESGA, BORIS, MORENO SILGADO, GUSTAVO ADOLFO, ZIDKOVA, EVA, LUBANDA, JEAN-CLAUDE, KALETOVA, MARKETA, KRYZA, RADIM, MARCINEK, GABRIEL, RICHTER, MAREK, SPINAR, JINDRICH, MATUSKA, JIRI, TESAK, MARTIN, MOTOVSKA, ZUZANA, BRANNY, MARIAN, MALY, JIRI, MALY, MARTIN, WIENDL, MARTIN, FOLTYNOVA CAISOVA, LENKA, SLABY, JOSEF, VOJTISEK, PETR, PIRK, JAN, SPINAROVA, LENKA, BENESOVA, MIROSLAVA, CANADYOVA, JULIA, HOMZA, MIROSLAV, FLORIAN, JINDRICH, POLASEK, ROSTISLAV, COUFAL, ZDENEK, SKALNIKOVA, VLADIMIRA, BRAT, RADIM, BRTKO, MIROSLAV, JANSKY, PETR, LINDNER, JAROSLAV, MARCIAN, PAVEL, STRAKA, ZBYNEK, TRETINA, MARTIN, DUARTE, YAN CARLOS, POW CHON LONG, FREDDY, SANCHEZ, MAYRA, LOPEZ, JOSE, PERUGACHI, CARMITA, MARMOL, RICARDO, TRUJILLO, FREDDY, TERAN, PABLO, TUOMILEHTO, JAAKKO, TUOMILEHTO, HENRI, TUOMINEN, MARJA-LEENA, TUOMILEHTO, HENRI, KANTOLA, ILKKA, STEG, GABRIEL, ABOYANS, VICTOR, LECLERCQ, FLORENCE, FERRARI, EMILE, BOCCARA, FRANCK, MESSAS, EMMANUEL, MISMETTI, PATRICK, SEVESTRE, MARIE ANTOINETTE, CAYLA, GUILLAUME, MOTREFF, PASCAL, STOERK, STEFAN, DUENGEN, HANS-DIRK, STELLBRINK, CHRISTOPH, GUEROCAK, OSMAN, KADEL, CHRISTOPH, BRAUN-DULLAEUS, RUEDIGER, JESERICH, MICHAEL, OPITZ, CHRISTIAN, VOEHRINGER, HANS-FRIEDRICH, APPEL, KARL-FRIEDRICH, WINKELMANN, BERNHARD, DORSEL, THOMAS, NIKOL, SIGRID, DARIUS, HARALD, RANFT, JURGEN, SCHELLONG, SEBASTIAN, JUNGMAIR, WOLFGANG, DAVIERWALA, PIROZE, VORPAHL, MARC, BAJNOK, LASZLO, LASZLO, ZOLTAN, NOORI, EBRAHIM, VERESS, GABOR, VERTES, ANDRAS, ZSARY, ANDRAS, KIS, ERNO, KORANYI, LASZLO, BAKAI, JUDIT, BODA, ZOLTAN, POOR, FERENC, JARAI, ZOLTAN, KEMENY, VENDEL, BARTON, JOHN, MCADAM, BRENDAN, MURPHY, ANDREW, CREAN, PETER, MAHON, NIALL, CURTIN, RONAN, MACNEILL, BRIAIN, DINNEEN, SEAN, HALABI, MAJDI, ZIMLICHMAN, REUVEN, ZELTSER, DAVID, TURGEMAN, YOAV, KLAINMAN, ELIEZER, LEWIS, BASIL, KATZ, AMOS, ATAR, SHAUL, ZIMLICHMAN, REUVEN, NIKOLSKY, EUGENIA, BOSI, STEFANO, NALDI, MONICA, FAGGIANO, POMPILIO, ROBBA, DEBORA, MOS, LUCIO, SINAGRA, GIANFRANCO, COSMI, FRANCO, OLTRONA VISCONTI, LUIGI, CARMINE, DE MATTEIS, DI PASQUALE, GIUSEPPE, DI BIASE, MATTEO, MANDORLA, SARA, BERNARDINANGELI, MARINO, PICCINNI, GIOVANNI CARLO, GULIZIA, MICHELE MASSIMO, GALVANI, MARCELLO, VENTURI, FLAVIO, MOROCUTTI, GIORGIO, BALDIN, MARIA GRAZIA, OLIVIERI, CARLO, PERNA, GIAN PIERO, CIRRINCIONE, VINCENZO, KANNO, TAKAYASU, DAIDA, HIROYUKI, OZAKI, YUKIO, MIYAMOTO, NAOMASA, HIGASHIUE, SHINICHI, DOMAE, HIROSHI, HOSOKAWA, SHINOBU, KOBAYASHI, HIROO, KURAMOCHI, TAKEHIKO, FUJII, KENSHI, MIZUTOMI, KAZUAKI, SAKU, KEIJIRO, KIMURA, KAZUO, HIGUCHI, YOSHIHARU, ABE, MITSUNORI, OKUDA, HARUHITO, NODA, TOSHIYUKI, MITA, TERUAKI, HIRAYAMA, ATSUSHI, ONAKA, HARUHIKO, INOKO, MORIAKI, HIROKAMI, MITSUGU, OKUBO, MUNENORI, AKATSUKA, YUTAKA, IMAMAKI, MIZUHO, KAMIYA, HARUO, MANITA, MAMORU, HIMI, TOSHIHARU, UENO, HIDEKI, HISAMATSU, YUJI, AKO, JUNYA, NISHINO, YASUHIRO, KAWAKAMI, HIDEO, YAMADA, YUTAKA, KORETSUNE, YUKIHIRO, YAMADA, TAKAHISA, YOSHIDA, TETSURO, SHIMOMURA, HIDEKI, KINOSHITA, NORIYUKI, TAKAHASHI, AKIHIKO, YUSOFF, KHALID, WAN AHMAD, WAN AZMAN, ABU HASSAN, MUHAMMAD RADZI, KASIM, SAZZLI, ABDUL RAHIM, AIZAI AZAN, MOHD ZAMRIN, DIMON, MACHIDA, MASAHARU, HIGASHINO, YORIHIKO, UTSU, NORIAKI, NAKANO, AKIHIKO, NAKAMURA, SHIGERU, HASHIMOTO, TETSUO, ANDO, KENJI, SAKAMOTO, TOMOHIRO, PRINS, F.J., LOK, DIRK, MILHOUS, JOHANNES GERT-JAN, VIERGEVER, ERIC, WILLEMS, FRANK, SWART, HENK, ALINGS, MARCO, BREEDVELD, ROB, DE VRIES, KEES-JAN, VAN DER BORGH, ROGER, OEI, FANNY, ZOET-NUGTEREN, STIENEKE, KRAGTEN, HANS, HERRMAN, JEAN PAUL, VAN BERGEN, PAUL, GOSSELINK, MARCEL, HOEKSTRA, EDUARD, ZEGERS, ERWIN, RONNER, EELKO, DEN HARTOG, FRANK, BARTELS, GERARD, NIEROP, PETER, VAN DER ZWAAN, COEN, VAN ECK, JACOB, VAN GORSELEN, EDWIN, GROENEMEIJER, BJORN, HOOGSLAG, PIETER, DE GROOT, MARC ROBERT, LOYOLA, ALDRIN, SULIT, DENNIS JOSE, REY, NANNETTE, ABOLA, MARIA TERESA, MORALES, DANTE, PALOMARES, ELLEN, ABAT, MARC EVANS, ROGELIO, GREGORIO, CHUA, PHILIP, DEL PILAR, JOSE CARLO, ALCARAZ, JOHN DENNIS, EBO, GERALDINE, TIRADOR, LOUIE, CRUZ, JOSEFINA, ANONUEVO, JOHN, PITARGUE, ARTHUR, JANION, MARIANNA, GUZIK, TOMASZ, GAJOS, GRZEGORZ, ZABOWKA, MACIEJ, RYNKIEWICZ, ANDRZEJ, BRONCEL, MARLENA, SZUBA, ANDRZEJ, CZARNECKA, DANUTA, MAGA, PAWEL, STRAZHESKO, IRINA, VASYUK, YURY, SIZOVA, ZHANNA, POZDNYAKOV, YURY, BARBARASH, OLGA, VOEVODA, MIKHAIL, POPONINA, TATIANA, REPIN, ALEXEY, OSIPOVA, IRINA, EFREMUSHKINA, ANNA, NOVIKOVA, NINA, AVERKOV, OLEG, ZATEYSHCHIKOV, DMITRY, VERTKIN, ARKADIY, AUSHEVA, AZA, COMMERFORD, PATRICK, SEEDAT, SAADIYA, VAN ZYL, LOUIS, ENGELBRECHT, JAN, MAKOTOKO, ELLEN MAKONLI, PRETORIUS, CATHARINA ELIZABETH, MOHAMED, ZAID, HORAK, ADRIAN, MABIN, THOMAS, KLUG, ERIC, BAE, JANG-HO, KIM, CHEOLHO, KIM, CHONG-JIN, KIM, DONG-SOO, KIM, YONG JIN, JOO, SEUNGJAE, HA, JONG-WON, PARK, CHUL SOO, KIM, JANG YOUNG, KIM, YOUNG-KWON, JARNERT, CHRISTINA, MOOE, THOMAS, DELLBORG, MIKAEL, TORSTENSSON, INGEMAR, ALBERTSSON, PER, JOHANSSON, LARS, AL-KHALILI, FARIS, ALMROTH, HENRIK, ANDERSSON, TOMMY, PANTEV, EMIL, TENGMARK, BENGT-OLOV, LIU, BO, RASMANIS, GUNDARS, WAHLGREN, CARL-MAGNUS, MOCCETTI, TIZIANO, PARKHOMENKO, ALEXANDER, TSELUYKO, VIRA, VOLKOV, VOLODYMYR, KOVAL, OLENA, KONONENKO, LYUDMYLA, PROKHOROV, OLEKSANDR, VDOVYCHENKO, VALERIY, BAZYLEVYCH, ANDRIY, RUDENKO, LEONID, VIZIR, VADYM, KARPENKO, OLEKSANDR, MALYNOVSKY, YAROSLAV, KOVAL, VALENTYNA, STOROZHUK, BORYS, COTTON, JAMES, VENKATARAMAN, ASOK, MORIARTY, ANDREW, CONNOLLY, DEREK, DAVEY, PATRICK, SENIOR, ROXY, BIRDI, INDERPAUL, CALVERT, JOHN, DONNELLY, PATRICK, TREVELYAN, JASPER, CARTER, JUSTIN, PEACE, AARON, AUSTIN, DAVID, KUKREJA, NEVILLE, HILTON, THOMAS, SRIVASTAVA, SUNNY, WALSH, RONALD, FIELDS, RONALD, HAKAS, JOSEPH, PORTNAY, EDWARD, GOGIA, HARINDER, SALACATA, ABRAHAM, HUNTER, JOHN J., BACHARACH, J MICHAEL, SHAMMAS, NICOLAS, SURESH, DAMODHAR, SCHNEIDER, RICKY, GURBEL, PAUL, BANERJEE, SUBHASH, GRENA, PAUL, BEDWELL, NOEL, SLOAN, STEPHEN, LUPOVITCH, STEVEN, SONI, ANAND, GIBSON, KATHLEEN, SANGRIGOLI, RENEE, MEHTA, RAJENDRA, I-HSUAN TSAI, PETER, GILLESPIE, EVE, DEMPSEY, STEPHEN, HAMROFF, GLENN, BLACK, ROBERT, LADER, ELLIS, KOSTIS, JOHN B., BITTNER, VERA, MCGUINN, WILLIAM, BRANCH, KELLEY, MALHOTRA, VINAY, MICHAELSON, STEPHEN, VACANTE, MICHAEL, MCCORMICK, MATTHEW, ARIMIE, RALUCA, CAMP, ALAN, DAGHER, GEORGE, KOSHY, N. MATHEW, THEW, STEPHEN, COSTELLO, FREDERICK, HEIMAN, MARK, CHILTON, ROBERT, MORAN, MICHAEL, ADLER, FREDRIC, COMEROTA, ANTHONY, SEIWERT, ANDREW, FRENCH, WILLIAM, SEROTA, HARVEY, HARRISON, ROBERT, BAKAEEN, FAISAL, OMER, SHUAB, CHANDRA, LOKESH, WHELAN, ALAN, BOYLE, ANDREW, ROBERTS-THOMSON, PHILIP, ROGERS, JAMES, CARROLL, PATRICK, COLQUHOUN, DAVID, SHAW, JAMES, BLOMBERY, PETER, AMERENA, JOHN, HII, CHRIS, ROYSE, ALISTAIR, SINGH, BHUWAN, SELVANAYAGAM, JOSEPH, JANSEN, SHIRLEY, LO, WINGCHI, HAMMETT, CHRISTOPHER, POULTER, ROHAN, NARASIMHAN, SESHASAYEE, WIGGERS, HENRIK, NIELSEN, HENRIK, GISLASON, GUNNAR, KOBER, LARS, HOULIND, KIM, BOENELYKKE SOERENSEN, VIBEKE, DIXEN, ULRIK, REFSGAARD, JENS, ZEUTHEN, ELISABETH, SOEGAARD, PETER, HRANAI, MARIAN, GASPAR, LUDOVIT, PELLA, DANIEL, HATALOVA, KATARINA, DROZDAKOVA, ERIKA, COMAN, IOAN, DIMULESCU, DOINA, VINEREANU, DRAGOS, CINTEZA, MIRCEA, SINESCU, CRINA, ARSENESCU, CATALINA, BENEDEK, IMRE, BOBESCU, ELENA, DOBREANU, DAN, GAITA, DAN, IANCU, ADRIAN, ILIESIU, ADRIANA, LIGHEZAN, DANIEL, PETRESCU, LUCIAN, PIRVU, OCTAVIAN, TEODORESCU, IULIA, TESLOIANU, DAN, VINTILA, MARIUS MARCIAN, and CHIONCEL, OVIDIU
- Abstract
Patients with peripheral artery disease have an increased risk of cardiovascular morbidity and mortality. Antiplatelet agents are widely used to reduce these complications.
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- 2018
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15. Abstract 12779: Serial High-Sensitivity Troponin I and Long-Term Risk of Death in Subjects With Suspected Acute Coronary Syndrome
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Pareek, Manan, Kragholm, Kristian, Kristensen, Anna Meta, Biering-Srensen, Tor, Byrne, Christina, Fosbol, Emil L, Kober, Lars, Gislason, Gunnar, Olsen, Niels T, Bhatt, Deepak L, and Torp-Pedersen, Christian
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Introduction:Long-term prognostic implications of serial high-sensitivity troponin concentrations in subjects with suspected acute coronary syndrome (ACS) are unknown.Hypothesis:To determine mortality according to high-sensitivity troponin I (TnI) concentrations and their changes from baseline, in patients with suspected ACS.Methods:Using Danish registries, we identified individuals with a first diagnosis of myocardial infarction, unstable angina, observation for suspected myocardial infarction, or chest pain from 2012 through 2019 who underwent two high-sensitivity TnI (Siemens TnI Flex® Reagent, 99thpercentile 45 ng/l) measurements during the same hospitalization. Prognostic implications of serial sampling were examined stratifying subjects for normal and elevated concentrations, and for relative changes of 20% and 50%. Absolute and relative risks for death from any cause at days 0-30 and 31-365 were calculated through multivariable logistic regression with average treatment effect modeling.Results:Of the 20,609 individuals included, 2.3% had died at 30 days, while 4.7% of 30-day-survivors died between days 31-365. The standardized risk of death at both 0-30 and 31-365 days was highest among subjects with two elevated TnI concentrations (0-30 days: 8.0%, 31-365 days: 11.1%) and lowest among those with two normal TnI concentrations (0-30 days: 0.5%, 31-365 days: 2.6%). In neither case did relative changes between measurements clearly affect mortality. Nevertheless, among persons who went from a normal to an elevated TnI concentration, 30-day mortality was highest in those with a >50% rise versus subjects with a less pronounced rise (2.2% vs. <0.1%). The Figure shows the standardized absolute risk of death from any cause from days 31-365.Conclusions:Among individuals with suspected ACS, those with two elevated TnI concentrations consistently had the highest risk of death. Mortality was very low in subjects with two normal TnI values.
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- 2022
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16. Abstract 10311: Atrioventricular Junctional Ablation in Patients With Atrial Fibrillation With and Without Heart Failure: A Meta-Analysis
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Lewinter, Christian, Sögütlü, Eslem, Nielsen, Torsten Holm H, Cleland, John G, Kober, Lars, Lewinter, Martin M, Linde, cecilia M, and Braunschweig, Frieder
- Abstract
Introduction:Rapid atrial fibrillation (AF) leads to heart failure (HF), but can also result from cardiac remodelling during HF. Atrioventricular junctional ablation (AVJA) cures rapid AF at the cost of permanent pacemaker dependency. We compared mortality in AF patients treated with AVJA to pharmacological therapy.Methods:We performed data searches in the PubMed, Central, and Embase till Marts 31, 2022. Inclusion criteria were observational and randomised controlled trials evaluating mortality and left ventricular ejection fraction (LVEF) in patients with AF. An exclusion criterion was lack of a parallel study design.Our primary endpoint was all-cause mortality. A secondary endpoint was the mean difference (MD) in LVEF during the follow-up. Endpoints were assessed through meta-analyses computing hazard ratios (HRs) and MDs. Mantel-Haenszel and DerSimonian random effect models were applied, respectively. LVEF<41% was used as a surrogate for HF in a sensitivity analysis.Results:Overall,1738 studies were found from the data searches. Of these, 24 fulfilled the inclusion criteria (HF, N=15). The range of age was 60-75 years and 14 to 74% were women. The follow-up time varied between 3 to 96 months. AVJA as compared with pharmacological therapy reduced all-cause mortality by 27% in patients with AF (Fig. 1), whereas the LVEF MD between groups was not significantly different (Fig. 2). In HF patients, mortality was significantly favouring AVJA as compared with pharmacological therapy (HR, 0.68; 95% confidence interval [CI], 0.51 to 0.91; P=0.009) but not for the LVEF (MD, 1.12; 95% CI, -2.90 to 5.14; P=0.54). In patients without HF, neither mortality nor the LVEF MD were significantly different between AJVA and pharmacological therapy (results not reported).Conclusion:Mortality was significantly reduced in the AVJA group as compared with the pharmacological therapy group. This benefit was only persistent in HF patients in a sensitivity analysis.
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- 2022
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17. Abstract 13993: Sex Differences in Cardiac Structure and Function Following Acute Myocardial Infarction: Insights From the PARADISE-MI Echocardiographic Sub-Study
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Wang, Xiaowen, Cikes, Maja, Claggett, Brian, Jering, Karola, Mullens, Wilfried, Kober, Lars, Jhund, Pardeep S, Kovacs, Attila, Zhou, Yinong, Shah, Amil M, Pfeffer, Marc A, and Solomon, Scott
- Abstract
Introduction:Women have a higher incidence of heart failure (HF) hospitalizations than men following acute myocardial infarction (AMI). The extent to which differential cardiac remodeling between men and women might account for this higher risk in women is poorly understood.Hypothesis:Women and men have differences in cardiac remodeling after AMI that are predictive of clinical outcomes.Methods:The Prospective ARNI versus ACE inhibitor trial to Determine Superiority in reducing heart failure Events after Myocardial Infarction (PARADISE-MI) trial randomized patients within 0.5 to 7 days of AMI complicated by left ventricular (LV) dysfunction, pulmonary congestion, or both to sacubitril/valsartan or ramipril. In the pre-specified echocardiographic sub-study, 544 participants were enrolled to undergo protocol echocardiography at the time of randomization and after 8 months.Results:At baseline, women (n=142, 26%) were older, more likely to have a history of hypertension, and less likely to have a history of MI. Women had a higher LV ejection fraction (LVEF), lower LV end-diastolic index (LVEDVi) and end-systolic volume index (LVESVi), and LV mass index, but no difference in left atrium (LA) volume index compared with men (Table). Women had better diastolic function compared with men. The absolute and relative changes in these echocardiographic parameters from baseline to 8 months were not significantly different between women and men. In univariate analyses, baseline LVEF, LVEDVi, LVESVi, LA dimensions and diastolic measurements are associated with primary outcome (Table).Conclusion:In PARADISE-MI, women have higher LVEF and lower indexed LV and LA chamber sizes compared to men following high-risk MI. The changes between baseline and 8-month in LVEF, LV and LA dimensions did not differ significantly between men and women, suggesting that differential cardiac remodeling post-MI may not account for the increased HF risk in women compared with men.
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- 2022
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18. Abstract 9438: Serial Troponin T and Long-Term Risks of Myocardial Infarction and Revascularization in Patients With Suspected Acute Coronary Syndrome
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Pareek, Manan, Kragholm, Kristian, Kristensen, Anna Meta D, Biering-Srensen, Tor, Byrne, Christina, Fosbol, Emil L, Kober, Lars, Gislason, Gunnar, Olsen, Niels Thue, Bhatt, Deepak, and Torp-Pedersen, Christian
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Introduction:Long-term prognostic implications of serial high-sensitivity troponin concentrations in patients with suspected myocardial infarction (MI) are unknown.Hypothesis:To determine short- and long-term risks of MI and revascularization (PCI or CABG) according to high-sensitivity troponin T (hsTnT) concentrations and their changes from baseline, in patients with suspected acute coronary syndrome.Methods:Retrospective cohort study based on Danish national registries. We identified all patients discharged from the hospital with either MI, unstable angina, suspected MI, or chest pain from January 2012 through December 2019 and merged them with records of two serial hsTnT measurements obtained 1-7 hours apart. Absolute risks of MI and revascularization were calculated through multivariable logistic regression with average treatment effect modeling (G-formula), with patients stratified in groups according to normal and elevated concentrations and relative changes of 20% and 50% from baseline.Results:Complete data were available in 28,902 individuals (median age [25th-75thpercentile] 65.2 [53.4-75.4] years, 11,632 [40.2%] women). The standardized risk of MI was highest in individuals with two elevated hsTnT concentrations (0-30 days: 54.1%, 31-365 days: 9.7%) and lowest in those with two normal values (0-30 days: 2.5%, 31-365 days: 0.4%). In the latter group, the risk of MI did not appear to depend on the relative hsTnT change between samples while in persons with two elevated hsTnT concentrations, the risks at both 0-30 days and 31-365 days increased in a stepwise fashion with more pronounced hsTnT rises. Individuals with a >20% to 50% fall also had a higher risk of MI than those with a less pronounced change while results were not significant for those with a >50% fall. Finally, individuals who went from a normal to an elevated hsTnT level and had a concomitant >50% rise had a significantly higher risk of MI at days 0-30 than those with a less pronounced rise. The standardized likelihood of undergoing coronary revascularization according to serial hsTnT concentrations followed the same pattern.Conclusions:Serial hsTnT measurements identify patients at long-term risk for both MI and revascularization.
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- 2022
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19. Abstract 14610: Geographic Differences Among Patients With Acute Myocardial Infarction in the PARADISE-MI Trial
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Butt, Jawad H, Sim, David, Claggett, Brian, Jering, Karola, van der meer, peter, Kerkar, Prafulla, Nuez Llota, Julio E, Cadena, Alberto, Ntsekhe, Mpiko, Zhou, Yinong, Kober, Lars, McMurray, John J, and Pfeffer, Marc A
- Abstract
Introduction:The globalization of clinical trials has highlighted geographic differences in patient characteristics, treatments and outcomes, but there are few data on those with high-risk acute MI. We examined these differences in PARADISE-MI, the most globally representative trial in high-risk MI patients to dateMethods:PARADISE-MI enrolled 5661 patients with an acute MI complicated by left ventricular dysfunction and/or pulmonary congestion; 23.0% were randomized in Eastern Europe/Russia (EER), 17.5% Western Europe, 12.2% Southern Europe, 10.1% Northern Europe (NE), 12.0% Latin America (LA), 9.3% North America (NA), 10.0% East/South-East Asia, 5.8% South Asia (SA)Results:Those from Asia, particularly SA, were notably different from patients enrolled in the other regions - they were younger, thinner and had a different pattern of comorbidities (high prevalence of diabetes despite lower BMI, and very low prevalence of AF), type of MI (more often STEMI) and treatment (low rate of primary PCI). By contrast, the characteristics of patients from LA did not differ meaningfully from those in Europe or NA. Use of ACEi/ARB (34.8%) and beta-blockers (65.5%) was remarkably low in SA, whereas MRA use was lowest in NA (21.8%) compared with the highest rate (53.0%) in EER. Rates of the primary composite outcome of cardiovascular death or incident HF varied two-fold among regions with the lowest rate in SA (4.6 / 100 person-years [PY]) and the highest in LA (9.2 / 100 PY). Strikingly, rates of incident HF varied almost six-fold among regions with the lowest rate in SA (1.0 /100 PY) and the highest in NE (5.9 /100 PY). Conversely, the rate of death from any cause varied about two-fold among regions (Figure) with the lowest rate in NA (2.4 /100 PY) and the highest in LA (5.3 / 100 PY) although the rate in the other six regions differed little (range 3.9 to 4.7 / 100 PY)Conclusion:In PARADISE-MI, there were substantial regional differences in patient characteristics, treatments and outcomes
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- 2022
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20. Patterns Of Recurrent Heart Failure Hospitalizations In Relation To Cardiovascular Death In Heart Failure With Reduced Ejection Fraction.
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Adamson, Carly, Abraham, William, Desai, Akshay, Dickstein, Kenneth, Kober, Lars, McMurray, John J.V., Packer, Milton, Rouleau, Jean, Solomon, Scott, Zile, Michael, and Jhund, Pardeep S.
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The accepted understanding of the patient journey in heart failure (HF) is one of recurrent episodes of deterioration which accelerate in frequency as the patient approaches death. However, this may not be true when different modes of death are considered separately. We explored patterns of HF hospitalizations (HFH) in patients who died from either sudden death or death due to progressively worsening heart failure ("pump failure") in a contemporary cohort of patients with HFrEF. We examined timing of HF hospitalizations in the PARADIGM-HF and ATMOSPHERE trials. Inclusion and exclusion for these trials were similar; NYHA class II-IV, LVEF≤35% (PARADIGM-HF LVEF≤40% reduced to ≤35% by amendment) and elevated natriuretic peptide levels. In PARADIGM-HF, patients were randomized to sacubitril-valsartan or enalapril, in ATMOSPHERE treatments were enalapril, aliskiren or both. The number of hospitalizations per patient was calculated and cross tabulated with cause of CV death. Rates of total HFH were calculated according to different causes of CV death. HFH were visualized using recurrent event plots. Of the 15415 patients enrolled, 2518 had at least 1 hospitalization after randomization and between them these 2518 participants accrued a total of 4318 admissions. There were 2872 CV deaths which accounted for 83% of all deaths. Of the 2872 CV deaths 1332 (46%) occurred suddenly and 735 (26%) were due to worsening heart failure. Of patients experiencing sudden death, only 205 (15%) had a preceding hospitalization compared with 569 (77%) patients dying from pump failure. Rates of HFH per 100 patient years were 17 [95% CI 15-19] in patients with sudden death, 93 [95% CI 88-98]) in the pump failure death group and 7 [95% CI 6-7] in patients without CV death. Recurrent event plots show a greater density of HFH in patients with pump failure deaths as compared with other CV deaths. This analysis shows that the accepted patient trajectory in HFrEF is true for individuals who die from progressive worsening of heart failure but not for sudden death where only a minority of patients experience preceding HFH. [ABSTRACT FROM AUTHOR]
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- 2022
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21. Blood Pressure Drops During Hospitalization for Acute Heart Failure Treated With Serelaxin: A Patient-Level Analysis of 4 Randomized Controlled Trials.
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Grand, Johannes, Miger, Kristina, Sajadieh, Ahmad D, Kober, Lars D, Torp-Pedersen, Christian D, Ertl, Georg D, Lopez-Sendon, Jose, Pietro Maggioni, Aldo, Teerlink, John R., Sato, Naoki, Gimpelewicz, Claudio, Metra, Marco, Holbro, Thomas, and Nielsen, Olav W. D
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Background: Hypotensive events and drops in systolic blood pressure (SBP-drop) are frequent in patients hospitalized with acute heart failure. We investigated whether SBP-drops are associated with outcomes in patients treated with serelaxin. Methods: Patient-level retrospective analyses of 4 prospective trials investigating serelaxin in acute heart failure. Main inclusion criteria were SBP 125 to 180 mm Hg, pulmonary congestion, and elevated NT-proBNP (N-terminal pro-B-type natriuretic peptide). SBP-drops were prospectively defined as SBP<100 mm Hg, or, if SBP remained >100 mm Hg, a drop from baseline of 40 mm Hg from baseline. Outcomes were a short-term composite outcome (worsening heart failure, hospital readmission for heart failure or all-cause mortality through 14 days) and 180-day mortality. Results: Overall, 2559/11 226 (23%) patients had an SBP-drop. SBP-drop, versus no SBP-drop, was associated with a worse outcome: cumulative incidence of 180-day mortality (11% versus 9%, hazard ratio [HR]. 1.21 [95% CI, 1.05-1.39]; P =0.009) and the short-term outcome (11% versus 9%, HR, 1.29 [95% CI, 1.13-1.49]; P <0.001).> P =0.0005) and 1.22 (95% CI, 0.97-1.56; P =0.09), for each component respectively, with a P value for interaction of 0.05. SBP-drops were associated with a worse short-term outcome in the placebo group (HR, 1.46 [95% CI, 1.19-1.79]; P =0.0003), but not in the serelaxin-group (HR, 1.18 [95% CI, 0.97-1.42]; P =0.10); P interaction=0.003. Conclusions: SBP-drops in patients with acute heart failure and normal to high SBP at admission is associated with worse short- and long-term outcomes especially for SBP <100 mm Hg. However, in patients treated with the intravenous vasodilator serelaxin, SBP-drops seemed less harmful. Registration: URL: https://www.clinicaltrials.gov ; Unique identifiers: NCT02064868, NCT02007720, NCT01870778, NCT00520806. * This study finds an incidence of 23% of in-hospital hypotensive episodes in a clinical cohort of patients admitted with acute heart failure. These episodes are independently associated with adverse outcomes. However, in patients treated with the intravenous vasodilator serelaxin, systolic blood pressure drops seemed to be less harmful. * Hypotensive events in patients with acute heart failure and normal to high systolic blood pressure at admission is an independent risk factor for adverse short- and long-term outcomes. Its occurrence highlights the need for careful monitoring and urgent management. The observations from the reported analysis suggest that blood pressure lowering in patients hospitalized for acute heart failure with baseline systolic blood pressures between 125 and 180 mm Hg may need to be tempered, taking care to avoid lowering systolic blood pressure below 100 mm Hg, particularly in patients with baseline systolic blood pressure <=140 mm Hg. /div> [ABSTRACT FROM AUTHOR]
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- 2022
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22. Return to Work in Out-of-Hospital Cardiac Arrest Survivors
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Kragholm, Kristian, Wissenberg, Mads, Mortensen, Rikke Normark, Fonager, Kirsten, Jensen, Svend Eggert, Rajan, Shahzleen, Lippert, Freddy Knudsen, Christensen, Erika Frischknecht, Hansen, Poul Anders, Lang-Jensen, Torsten, Hendriksen, Ole Mazur, Kober, Lars, Gislason, Gunnar, Torp-Pedersen, Christian, and Rasmussen, Bodil Steen
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Data on long-term function of out-of-hospital cardiac arrest survivors are sparse. We examined return to work as a proxy of preserved function without major neurologic deficits in survivors.
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- 2015
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23. Peripheral artery disease is a coronary heart disease risk equivalent among both men and women: results from a nationwide study
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Subherwal, Sumeet, Patel, Manesh, Kober, Lars, Peterson, Eric, Bhatt, Deepak, Gislason, Gunnar, Olsen, Anne-Marie, Jones, William, Torp-Pedersen, Christian, and Fosbol, Emil
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AimsLower extremity peripheral artery disease (PAD) has been proposed as a ‘coronary heart disease (CHD) risk equivalent’. We aimed to examine whether PAD confers similar risk for mortality as incident myocardial infarction (MI) and whether risk differs by gender.MethodsUsing nationwide Danish administrative registries (2000–2008), we identified patients aged ≥40 years with incident PAD (PAD only, n = 35,628), incident PAD with a history of MI (PAD + MI, n = 7029), and incident MI alone (MI alone, n = 71,115).ResultsPatients with PAD only tended to be younger, female, and have less comorbidity than the other groups. During follow up (median 1051 d, IQR 384–1938), we found that MI-alone patients had greater risk of adverse outcomes in the acute setting (first 90 d); however, the PAD-only and PAD + MI groups had higher long-term mortality at 7 years than those with MI alone (47.8 and 60.4 vs. 36.4%, respectively; p < 0.0001). After adjustment, the PAD-only and PAD + MI groups had a higher long-term risk for mortality [hazard ratio (HR) 1.47, 95% confidence interval (CI) 1.44–1.51; and HR 1.65, 95% CI 1.58–1.72, respectively], cardiovascular mortality (HR 1.30, 95% CI 1.26–1.34; and HR 1.71, 95% CI 1.62–1.80, respectively), and composite of death, MI, and ischaemic stroke, 95% CI HR, 1.38, 95% CI 1.36–1.42; and HR 1.68, 95% CI 1.61–1.75, respectively). The greater long-term risks of PAD were seen for both women and men.ConclusionsBoth women and men with incident PAD have greater long-term risks of total and cardiovascular mortality vs. those with incident MI. PAD should be considered a CHD risk equivalent, warranting aggressive secondary prevention.
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- 2015
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24. Incidence and Predictors of End-Stage Renal Disease in Outpatients With Systolic Heart Failure.
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Bosselmann, Helle, Gislason, Gunnar, Gustafsson, Finn, Hildebrandt, Per R., Videbaek, Lars, Kober, Lars, Torp-Pedersen, Christian, Tonder, Niels, Rossing, Kasper, Christensen, Stefan, Kamper, Anne-Lise, Heaf, James, and Schou, Morten
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Renal dysfunction is an important prognostic factor in heart failure (HF), but whether this dysfunction progresses to end-stage renal disease (ESRD) is unknown. Therefore, we examined incidence and predictors of ESRD in outpatients with HF.Patients with systolic HF were identified in The Danish Heart Failure database and new-onset ESRD from the Danish Registry on Dialysis. Renal function was estimated by The Chronic Kidney Disease Epidemiology Collaboration equation and patients grouped by estimated glomerular filtration rate (eGFR)—group I: ≥60 mL/min per 1.73 m
2 , group II: 30 to 59 mL/min per 1.73 m2 , group III: 15 to 29 mL/min per 1.73 m2 , group IV: <15 mL/min per 1.73 m2 . Cox hazard models for time to ESRD, to death, and the composite end point of ESRD or death were constructed and predictors of ESRD identified. A total of 8204 patients were included in the analyses. Median age was 70 years (Q, 61-77), 28% were women, median left ventricular ejection fraction was 30% (Q, 24-40), and median eGFR was 68 (Q, 51-85) mL/min per 1.73 m2 . Forty-one patients developed ESRD (1.3/1000 patient-years). Baseline eGFR group II (P<0.001), eGFR group III (P<0.001), eGFR group IV (P<0.001), uncontrolled hypertension (P=0.049), need of diuretics, and age <60 years (P=0.016) were associated with time to ESRD.ESRD is rare in outpatients with systolic HF and is mainly observed in patients with an eGFR <30 mL/min per 1.73 m2 . A low eGFR, age <60 years, need of diuretics, and uncontrolled hypertension identify patients with an increased risk for ESRD. [ABSTRACT FROM AUTHOR]- Published
- 2013
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25. Efficacy and Safety of Angiotensin-Converting Enzyme Inhibitors in Patients With Left Ventricular Systolic Dysfunction and Hyponatremia.
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BALLING, LOUISE, KOBER, LARS, SCHOU, MORTEN, TORP-PEDERSEN, CHRISTIAN, and GUSTAFSSON, FINN
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Background: The presence of hyponatremia has been perceived to increase the risk of adverse events on initiation of treatment with angiotensin-converting enzyme inhibition in heart failure patients. The aim of this study was to investigate if baseline hyponatremia (plasma Na
+ < 135 retool/L) predicts development of hypotension and renal impairment in patients with myocardial infarction (MI) and left ventricular dysfunction (LVD) treated with angiotensin-converting enzyme inhibitors. Methods and Results: A retrospective analysis was performed with data from the Trandolapril Cardiac Evaluation (TRACE) a double-blind randomized study. Plasma sodium levels were available in 1,731 patients, who were considered as the study population. Patients 3-7 days after MI with left LVD (LVEF ≤0.35), were randomized to trandolapril 01 = 876) or placebo (n = 873). Baseline hyponatremia did not predict development of hypotension or worsening renal function after 1 month in patients treated with trandolapril compared with placebo (122 ± 29.1 mm Hg vs 123.2 ± 20.4 mm Hg [P = .84]; and creatinine clearance 57.4 ± 21.4 mL/min vs 55.2 ± 21.0 mL/min [P = .8]). There was no interaction between hyponatremia and the effect of trandolapril (P = .68). Conclusions: Mild hyponatremia was not a contraindication for the initiation of treatment with angiotensin-converting enzyme inhibitors in patients with post-MI heart failure. [ABSTRACT FROM AUTHOR]- Published
- 2013
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26. Fatal myocardial rupture after acute myocardial infarction complicated by heart failure, left ventricular dysfunction, or both: The VALsartan In Acute myocardial iNfarcTion Trial (VALIANT).
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Shamshad, Faisal, Kenchaiah, Satish, Finn, Peter V., Soler-Soler, Jordi, McMurray, John J.V., Velazquez, Eric J., Maggioni, Aldo P., Califf, Robert M., Swedberg, Karl, Kober, Lars, Belenkov, Yuri, Varshavsky, Sergei, Pfeffer, Marc A., and Solomon, Scott D.
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Background: Myocardial rupture is a relatively rare and usually fatal complication of myocardial infarction (MI). Early recognition of patients at greatest risk of myocardial rupture provides an opportunity for early intervention. Methods: VALIANT was a double-blind, randomized, controlled trial comparing valsartan, captopril, and their combination in high-risk patients post-MI. Myocardial rupture was identified by autopsy (available in 138/589 patients dying within 30 days of index MI), echocardiography, direct surgical visualization, or presence of hemopericardium. An independent clinical end points committee reviewed medical records for all deaths or suspected nonfatal cardiovascular events. Results: Rupture was identified in 45 (0.31%) patients enrolled in VALIANT, occurring 9.8 ± 6.0 days after the qualifying MI. Rupture accounted for 7.6% (45/589) of all deaths occurring in the first 30 days of follow-up and 24% (33/138) of deaths in which autopsies were obtained. Compared with survivors, rupture was associated with increased age, hypertension, increased Killip class, lower estimated glomerular filtration rate, and Q wave MI, and inversely related to β-blocker and diuretic use. Compared with patients who died of other causes within 30 days, patients with myocardial rupture were more likely to have had an inferior MI, Q wave MI, or hypertension; to have used oral anticoagulants; or to have received thrombolytic therapy. Conclusions: Although rare, myocardial rupture accounted for nearly one fourth of all deaths within the first 30 days after high-risk MI, suggesting an estimated incidence of approximately 1% within the first 30 days. A number of clinical characteristics may identify post-MI patients at higher risk of myocardial rupture. [Copyright &y& Elsevier]
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- 2010
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27. Effect of Empagliflozin on Blood Volume Redistribution in Patients With Chronic Heart Failure and Reduced Ejection Fraction: An Analysis From the Empire HF Randomized Clinical Trial.
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Omar, Massar, Jensen, Jesper, Burkhoff, Daniel, Frederiksen, Peter H., Kistorp, Caroline, Videbaek, Lars, Poulsen, Mikael Kjaer, Gustafsson, Finn Di, Kober, Lars Di, Borlaug, Barry A., Schou, Morten, and Moller, Jacob Eifer Di
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Background: Stressed blood volume (SBV) is a major determinant of systemic and pulmonary venous pressures which, in turn, determine left and right ventricular fillings and regulates cardiac output via the Frank-Starling mechanism. It is not known whether inhibition of the SGLT2 (sodium-glucose cotransporter-2) favorably affects SBV. We investigated the effect of empagliflozin on estimated SBV in patients with heart failure and reduced ejection fraction compared with placebo. Methods: This was a post hoc analysis of an investigator-initiated, double-blinded, placebo-controlled, randomized trial. Seventy patients were assigned to empagliflozin 10 mg or matching placebo once daily for 12 weeks. Patients underwent right heart catheterization at rest and during exercise at baseline and follow-up. The outcome was change in estimated SBV after 12 weeks of empagliflozin treatment over the full range of exercise, determined using a recently introduced analytical approach based on invasive hemodynamic assessment. Results: Patients with heart failure and reduced ejection fraction, mean age, 57 years and mean ejection fraction 27%, with 47 patients (71%) receiving diuretics were randomized. The effect of empagliflozin on estimated SBV over the full range of exercise loads showed a statistically significant reduction compared with placebo (-198.4 mL [95% CI, -317.4 to -79.3] P =0.001), a 9% decrease. The decrease in estimated SBV by empagliflozin was significantly correlated with the decrease in PCWP (R =-0.33, P <0.0001).> Conclusions: Empagliflozin treatment significantly reduced SBV compared with placebo after 12 weeks of treatment in patients with stable chronic heart failure and reduced ejection fraction during sub maximal exercise. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03198585. * Twelve weeks of treatment with empagliflozin added to contemporary guideline-directed heart failure therapy significantly reduced estimated stressed blood volume compared with placebo over the full range of exercise by 198.4 mL (9%), while reducing estimated total blood volume by only 65.4 mL (1%) from baseline to 12 weeks follow-up. The decrease in estimated stressed blood volume was correlated with decreases of pulmonary capillary wedge pressure but not with estimated total blood volume. The present data suggest that an effect on the distribution of blood volume may partially explain the salutary effects of empagliflozin on pulmonary capillary wedge pressure in heart failure and reduced ejection fraction. * The effect on the distribution of blood volume may partially explain the salutary effects of empagliflozin on pulmonary capillary wedge pressure in heart failure and reduced ejection fraction. * Modulation of sympathetic activity might be one of the mechanisms explaining the decreased estimated stressed blood volume by empagliflozin. * These data may provide new potential insights into the mechanisms by which empagliflozin improves clinical status in heart failure. [ABSTRACT FROM AUTHOR]
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- 2022
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28. Prognostic Implications of Left Ventricular Mass and Geometry Following Myocardial Infarction: The VALIANT (VALsartan In Acute myocardial iNfarcTion) Echocardiographic Study.
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Verma, Anil, Meris, Alessandra, Skali, Hicham, Ghali, Jalal K., Arnold, J. Malcolm O., Bourgoun, Mikhail, Velazquez, Eric J., McMurray, John J.V., Kober, Lars, Pfeffer, Marc A., Califf, Robert M., and Solomon, Scott D.
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MYOCARDIAL infarction ,ECHOCARDIOGRAPHY ,LEFT heart ventricle ,HYPERTROPHY - Abstract
Objectives: This study sought to understand prognostic implications of increased baseline left ventricular (LV) mass and geometric patterns in a high risk acute myocardial infarction. Background: The LV hypertrophy and alterations in LV geometry are associated with an increased risk of adverse cardiovascular events. Methods: Quantitative echocardiographic analyses were performed at baseline in 603 patients from the VALIANT (VALsartan In Acute myocardial iNfarcTion) echocardiographic study. The left ventricular mass index (LVMi) and relative wall thickness (RWT) were calculated. Patients were classified into 4 mutually exclusive groups based on RWT and LVMi as follows: normal geometry (normal LVMi and normal RWT), concentric remodeling (normal LVMi and increased RWT), eccentric hypertrophy (increased LVMi and normal RWT), and concentric hypertrophy (increased LVMi and increased RWT). Cox proportional hazards models were used to evaluate the relationships among LVMi, RWT, LV geometry, and clinical outcomes. Results: Mean LVMi and RWT were 98.8 ± 28.4 g/m
2 and 0.38 ± 0.08. The risk of death or the composite end point of death from cardiovascular causes, reinfarction, heart failure, stroke, or resuscitation after cardiac arrest was lowest for patients with normal geometry, and increased with concentric remodeling (hazard ratio [HR]: 3.0; 95% confidence interval [CI]: 1.9 to 4.9), eccentric hypertrophy (HR: 3.1; 95% CI: 1.9 to 4.8), and concentric hypertrophy (HR: 5.4; 95% CI: 3.4 to 8.5), after adjusting for baseline covariates. Also, baseline LVMi and RWT were associated with increased mortality and nonfatal cardiovascular outcomes (HR: 1.22 per 10 g/m2 increase in LVMi; 95% CI: 1.20 to 1.30; p < 0.001) (HR: 1.60 per 0.1-U increase in RWT; 95% CI: 1.30 to 1.90; p < 0.001). Increased risk associated with RWT was independent of LVMi. Conclusions: Increased baseline LV mass and abnormal LV geometry portend an increased risk for morbidity and mortality following high-risk myocardial infarction. Concentric LV hypertrophy carries the greatest risk of adverse cardiovascular events including death. Higher RWT was associated with an increased risk of cardiovascular complications after high-risk myocardial infarction. [Copyright &y& Elsevier]- Published
- 2008
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29. Effect of antecedent hypertension and follow-up blood pressure on outcomes after high-risk myocardial infarction.
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Thune, Jens J., Signorovitch, James, Kober, Lars, Velazquez, Eric J., McMurray, John J. V., Califf, Robert M., Maggioni, Aldo P., Rouleau, Jean L., Howlett, Jonathan, Zelenkofske, Steven, Pfeffer, Marc A., and Solomon, Scott D.
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The influence of blood pressure on outcomes after high-risk myocardial infarction is not well characterized. We studied the relationship between blood pressure and the risk of cardiovascular events in 14 703 patients with heart failure, left ventricular systolic dysfunction, or both after acute myocardial infarction in the Valsartan in Myocardial Infarction Trial. We assessed the relationship between antecedent hypertension and outcomes and the association between elevated (systolic: >140 mm Hg) or low blood pressure (systolic: <100 mm Hg) in 2 of 3 follow-up visits during the first 6 months and subsequent cardiovascular events over a median 24.7 months of follow-up. Antecedent hypertension independently increased the risk of heart failure (hazard ratio [HR]: 1.19; 95% CI: 1.08 to 1.32), stroke (HR: 1.27; 95% CI: 1.02 to 1.58), cardiovascular death (HR: 1.11; 95% CI: 1.01 to 1.22), and the composite of death, myocardial infarction, heart failure, stroke, or cardiac arrest (HR: 1.13; 95% CI: 1.06 to 1.21). While low blood pressure in the postmyocardial infarction period was associated with increased risk of adverse events, patients with elevated blood pressure (n=1226) were at significantly higher risk of stroke (adjusted HR: 1.64; 95% CI: 1.17 to 2.29) and combined cardiovascular events (adjusted HR: 1.14; 95% CI: 1.00 to 1.31). Six months after a high-risk myocardial infarction, elevated systolic blood pressure, a potentially modifiable risk factor, is associated with an increased risk of subsequent stroke and cardiovascular events. Whether aggressive antihypertensive treatment can reduce this risk remains unknown. [ABSTRACT FROM AUTHOR]
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- 2008
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30. Amiodarone use after acute myocardial infarction complicated by heart failure and/or left ventricular dysfunction may be associated with excess mortality.
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Thomas, Kevin L., Al-Khatib, Sana M., Lokhnygina, Yuliya, Solomon, Scott D., Kober, Lars, McMurray, John J.V., Califf, Robert M., and Velazquez, Eric J.
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MYOCARDIAL infarction ,CORONARY disease ,HEART failure ,CARBOHYDRATE intolerance - Abstract
Background: We sought to assess the association of amiodarone use with mortality during consecutive periods in patients with post–acute myocardial infarction with left ventricular systolic dysfunction and/or HF treated with a contemporary medical regimen. Methods: This study used data from VALIANT, a randomized comparison of valsartan, captopril, or both in patients with acute myocardial infarction with HF and/or left ventricular systolic dysfunction. We compared baseline characteristics of 825 patients treated with amiodarone at randomization with 13 875 patients not treated with amiodarone. Using Cox models, we examined the association of amiodarone use with subsequent mortality during consecutive periods after randomization (days 1-16, 17-45, 46-198, and 199-1096). Results: Patients treated with amiodarone were older, had higher Killip class, and were more likely to have a history of diabetes mellitus and hypertension. Adjusting for baseline predictors of mortality, we found that amiodarone use was associated with a significant increase in mortality during 3 of the 4 periods: hazard ratio 1.5, 95% CI (1.1-2.0), P = .02, for days 1 to 16; 2.1 (1.5-2.9), P < .001, for days 17 to 45; 1.1 (0.83-1.46), P = .51, for days 46 to 198; and 1.4 (1.2-1.6), P < .001, for days 199 to 1096. Conclusion: In this study, amiodarone use was associated with excess early and late all-cause and cardiovascular mortality. These observational findings are in contrast to earlier randomized trials of amiodarone and need to be validated prospectively. [Copyright &y& Elsevier]
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- 2008
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31. Long-term outcomes of left bundle branch block in high-risk survivors of acute myocardial infarction: the VALIANT experience.
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Stephenson, Kent, Skali, Hicham, McMurray, John J.V., Velazquez, Eric J., Aylward, Philip G., Kober, Lars, Van de Werf, Frans, White, Harvey D., Pieper, Karen S., Califf, Robert M., Solomon, Scott D., and Pfeffer, Marc A.
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MYOCARDIAL infarction ,HEART failure ,MORTALITY ,CARDIOLOGY ,ACE inhibitors ,CAPTOPRIL ,HETEROCYCLIC compounds ,ANGIOTENSIN receptors ,HEART ventricle diseases ,BUNDLE-branch block ,COMPARATIVE studies ,ELECTROCARDIOGRAPHY ,EXPERIMENTAL design ,LEFT heart ventricle ,LONGITUDINAL method ,RESEARCH methodology ,MEDICAL cooperation ,MULTIVARIATE analysis ,RESEARCH ,SURVIVAL analysis (Biometry) ,TIME ,EVALUATION research ,VALINE ,RANDOMIZED controlled trials ,TREATMENT effectiveness ,PREDICTIVE tests ,PROPORTIONAL hazards models ,STROKE volume (Cardiac output) ,PREVENTION ,THERAPEUTICS - Abstract
Background: In survivors of myocardial infarction (MI), new left bundle branch block (LBBB) is associated with adverse outcomes, but its impact is not well described in post-MI patients with left ventricular (LV) systolic dysfunction and/or heart failure (HF).Objectives: The aim of this study was to determine if new LBBB is an independent predictor of long-term fatal and nonfatal outcomes in high-risk survivors of MI by reviewing data from the VALsartan In Acute myocardial iNfarcTion (VALIANT) trial.Methods: In VALIANT, 14,703 patients with LV systolic dysfunction and/or HF were randomized to valsartan, captopril, or both a mean of 5 days after MI. Baseline ECG data were available from 14,259 patients. We assessed the predictive value of new LBBB for death and major cardiovascular outcomes after 3 years, adjusting for multiple baseline covariates including LV ejection fraction.Results: At follow-up, patients with new LBBB (608 [4.2%]) compared with patients without new LBBB had more comorbidities and increased adjusted risk of death (hazard ratio [HR] 1.3, 95% confidence interval [CI] 1.2-1.6), cardiovascular death (HR 1.4, 95% CI 1.2-1.7), HF (HR 1.3, 95% CI 1.1-1.6), MI (HR 1.5, 95% CI 1.2-1.9), and the composite of death, HF, or MI (HR 1.4, 95% CI 1.2-1.6).Conclusion: In post-MI survivors with LV systolic dysfunction and/or HF, new LBBB was an independent predictor of all major adverse cardiovascular outcomes during long-term follow-up. This readily available ECG marker should be considered a major risk factor for long-term cardiovascular complications in high-risk patients after MI. [ABSTRACT FROM AUTHOR]- Published
- 2007
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32. Geographic variation in the treatment of acute myocardial infarction in the VALsartan In Acute myocardial iNfarcTion (VALIANT) trial.
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Reed, Shelby D., McMurray, John J.V., Velazquez, Eric J., Schulman, Kevin A., Califf, Robert M., Kober, Lars, Maggioni, Aldo P., Van de Werf, Frans, White, Harvey D., Diaz, Rafael, Mareev, Viatcheslav, and Murin, Jan
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MYOCARDIAL infarction ,CORONARY disease ,NECROSIS ,THERAPEUTICS - Abstract
Background: The VALIANT trial compared the efficacy and safety of captopril, valsartan, and their combination in patients with left ventricular systolic dysfunction, heart failure, or both after acute myocardial infarction (MI). By examining this international trial population of high-risk patients, we sought to determine geographic variations in the use of 3 key treatments for MI. Methods: We analyzed data from 14512 high-risk patients with MI in the VALIANT trial from the 20 countries that had enrolled >100 patients. International variation in the proportion of patients receiving (1) reperfusion therapy (thrombolysis or primary percutaneous coronary intervention), (2) β-blockers, or (3) aspirin at the time of MI was measured by using adjusted W scores. These scores correspond to the number of additional or fewer patients who received each of the therapies compared with the number expected, as estimated from multivariable regression models that account for patients'' baseline characteristics. Results: There was marked variation between countries in the use of reperfusion therapy (equivalent to a difference of up to 36/100 potentially eligible patients) and β-blockers (41/100), whereas there was much less variation in the use of aspirin (13/100). Conclusions: Marked geographic variation persists in the use of standard evidence-based therapy advocated by international guidelines. Our findings have implications not only for care of patients but also for the conduct of international trials. [Copyright &y& Elsevier]
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- 2006
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33. Effects of long-term treatment with angiotensin-converting-enzyme inhibitors in the presence or absence of aspirin: a systematic review.
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Teo, Koon K, Yusuf, Salim, Pfeffer, Marc, Kober, Lars, Hall, Alistair, Pogue, Janice, Latini, Roberto, and Collins, Rory
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Background Results from a retrospective analysis of the Studies of Left Ventricular Dysfunction (SOLVD) study suggest that angiotensin-converting-enzyme (ACE) inhibitors may be less effective in patients receiving aspirin. We aimed to confirm or refute this theory.Methods We used the Peto-Yusuf method to undertake a systematic overview of data for 22 060 patients from six long-term randomised trials of ACE inhibitors to assess whether aspirin altered the effects of ACE inhibitor therapy on major clinical outcomes (composite of death, myocardial infarction, stroke, hospital admission for congestive heart failure, or revascularisation).Findings Baseline characteristics, and prognosis in patients allocated placebo, differed strikingly between those who were and were not taking aspirin at baseline. Results from analyses of all trials, except SOLVD, did not suggest any significant differences between the proportional reductions in risk with ACE inhibitor therapy in the presence or absence of aspirin for the major clinical outcomes (p=0·15), or in any of its individual components, except myocardial infarction (interaction p=0·01). Overall, ACE inhibitor therapy significantly reduced the risk of the major clinical outcomes by 22% (p<0·0001), with clear reductions in risk both among those receiving aspirin at baseline (odds ratio 0·80, [99% CI 0·73–0·88]) and those who were not (0·71 [99% CI 0·62–0·81], interaction p=0·07).Interpretation Considering the totality of evidence on all major vascular outcomes in these trials, there is only weak evidence of any reduction in the benefit of ACE-inhibitor therapy when added to aspirin. However, there is definite evidence of clinically important benefits with respect to these major clinical outcomes with ACE-inhibitor therapy, irrespective of whether concomitant aspirin is used. [Copyright &y& Elsevier]
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- 2002
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34. Impact of Cardiovascular Events on Change in Quality of Life and Utilities in Patients After Myocardial Infarction
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Lewis, Eldrin F., Li, Yanhong, Pfeffer, Marc A., Solomon, Scott D., Weinfurt, Kevin P., Velazquez, Eric J., Califf, Robert M., Rouleau, Jean-Lucien, Kober, Lars, White, Harvey D., Schulman, Kevin A., and Reed, Shelby D.
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The objective of this study was to determine the impact of nonfatal cardiovascular (CV) events on changes in health-related quality of life (HRQL).
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- 2014
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35. Incidence and Predictors of End-Stage Renal Disease in Outpatients With Systolic Heart Failure
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Bosselmann, Helle, Gislason, Gunnar, Gustafsson, Finn, Hildebrandt, Per R., Videbaek, Lars, Kober, Lars, Torp-Pedersen, Christian, Tonder, Niels, Rossing, Kasper, Christensen, Stefan, Kamper, Anne-Lise, Heaf, James, and Schou, Morten
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Renal dysfunction is an important prognostic factor in heart failure (HF), but whether this dysfunction progresses to end-stage renal disease (ESRD) is unknown. Therefore, we examined incidence and predictors of ESRD in outpatients with HF.
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- 2013
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36. Body mass index is closely correlated to incident diabetes in patients with heart failure or myocardial infarction
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Schmiegelow, Michelle, Andersson, Charlotte, Olesen, Jonas, Abildstrom, Steen, Kober, Lars, and Torp-Pedersen, Christian
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Background: Diabetes in patients with heart failure or myocardial infarction (MI) increases morbidity and mortality, but little is known about the impact of obesity on the risk of developing diabetes in these populations.Design: A cohort of patients consecutively hospitalized with heart failure (n = 3472) or MI (n = 5723) was followed in the period 1995–2006.Methods: Multivariable Cox proportional-hazard models were used to estimate the risk of developing diabetes according to the World Health Organization body mass index (BMI) classification. Normal weight patients (BMI 18.5–24.9 kg/m2) were used as the reference.Results: In both populations, more than half of the patients with a BMI above 34.9 kg/m2 developed diabetes. In heart failure patients, a BMI above 24.9 kg/m2 was associated with an increased risk of diabetes for the three BMI groups, i.e. 25.0–29.9 kg/m2, 30.9–34.9 kg/m2, and >34.9 kg/m2, with adjusted hazard ratios (HRs) of 2.16 (95% confidence interval 1.50–3.12), 3.89 (2.61–5.78), and 6.06 (3.79–9.69), respectively. In MI patients, the adjusted HRs in the three corresponding BMI groups were 1.84 (1.44–2.37), 4.31 (3.26–5.69), and 9.50 (6.70–13.46), respectively. Incident diabetes was associated with increased cardiovascular and all-cause mortality risks with adjusted HRs of greater magnitude than in prevalent diabetes.Conclusion: BMI was an independent predictor of incident diabetes in patients with either heart failure or MI. More than half of the patients with a BMI above 34.9 kg/m2 developed diabetes during follow-up. Incident diabetes carries an increased mortality risk.
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- 2011
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37. Cardiovascular Effects of Growth Hormone in Adult Hemodialysis Patients: Results from a Randomized Controlled Trial
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Kober, Lars, Rustom, Rana, Wiedmann, Jonas, Kappelgaard, Anne-Marie, El Nahas, Meguid, and Feldt-Rasmussen, Bo
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AbstractBackground/Aims:The high morbidity and mortality rates in hemodialysis (HD) patients are due, at least in part, to their increased risk for cardiovascular diseases (CVD). This prospective study evaluated the effect of growth hormone (GH) on a number of CVD risk markers in adult patients on HD. Methods:139 HD patients were randomized to one of three GH doses or to placebo. Change from baseline in lean body mass (LBM), CVD risk markers (e.g. lipid profile, plasma homocysteine, inflammatory markers, blood pressure, IGF-I, IGFBP-3 and echocardiography) and correlations with serum IGF-I levels and body mass index were evaluated. Results:LBM increased in GH-treated groups compared with placebo (p < 0.001 pooled GH groups vs. placebo). IGF-I (p = 0.0027) and serum high-density-lipoprotein cholesterol levels (p = 0.038) increased with GH treatment. Serum low-density-lipoprotein cholesterol showed a trend to reduction. IGF-I was negatively correlated with plasma homocysteine levels (p = 0.01) and systolic blood pressure (p < 0.0001). Logistic regression analysis showed that interleukin-6, ghrelin and hematocrit values were significant determinants of all-cause mortality. Left ventricular mass was unchanged from baseline in GH-treated groups. Conclusion:In adult HD patients, GH treatment had a predominantly beneficial effect on CVD risk markers.Copyright © 2010 S. Karger AG, Basel
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- 2010
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38. Abstract 10875: Long-Term Mortality Associated with Use of Carvedilol vs Metoprolol in Heart Failure Patients with and Without Type 2 Diabetes
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Schwartz, Brian, Pierce, Colin, Madelaire, Christian, Schou, Morten, Kristensen, Soren L, Gislason, Gunnar, Kober, Lars, Torp-Pedersen, Christian, and Andersson, Charlotte
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Background:Carvedilol may have favorable glycemic properties compared with metoprolol, but it is unknown if carvedilol has mortality benefit over metoprolol in patients with type 2 diabetes (T2DM) and heart failure with reduced ejection fraction (HFrEF).Methods and Results:Using Danish nationwide databases between 2010-2018, we followed patients with new-onset HFrEF treated with either carvedilol or metoprolol for all-cause mortality until the end of 2018. Follow-up started 120 days after initial HFrEF diagnosis to allow initiation of guideline-directed medical therapy. There were 39,260 patients on carvedilol or metoprolol at baseline (mean age 70.8 years, 35% women), of which 9,355 (24%) had T2DM. Carvedilol was used in 2,989 (32%) patients with TD2M and 10,411 (35%) of patients without T2DM. Users of carvedilol had a lower prevalence of atrial fibrillation (20% vs. 35%), but other characteristics appeared well-balanced between the groups. Totally 11,306 (29%) were deceased by the end of follow-up. We observed no mortality differences between carvedilol and metoprolol, multivariable-adjusted hazards ratio 0.97 (0.90-1.05) in patients with T2DM versus 1.00 (0.95-1.05) for those without T2DM, p for difference =0.99. Rates of new-onset T2DM were lower in users of carvedilol vs. metoprolol; age, sex, and calendar year adjusted hazards ratio 0.83 (0.75-0.91), p<0.0001.Conclusion:In a contemporary clinical cohort of HFrEF patients with and without T2DM, carvedilol was not superior to metoprolol for long-term mortality reduction. However, carvedilol was associated with lowered risk of new-onset T2DM supporting the assertion that carvedilol have a more favorable metabolic profile than metoprolol overall.
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- 2021
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39. Abstract 10903: Cardiovascular Morbidity Associated with Monoclonal Gammopathy of Undetermined Significance - A Danish Nationwide Study
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Schwartz, Brian, Schou, Morten, Ruberg, Frederick, Rucker, Dane, Choi, Jihoon, Siddiqi, Omar, Kober, Lars, Gislason, Gunnar, Torp-Pedersen, Christian, and Andersson, Charlotte
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Introduction:Case reports and smaller observational studies have suggested an association between monoclonal gammopathy of undetermined significance (MGUS) and various cardiovascular diseases. We aimed to explore the association of MGUS with a broad spectrum of incident cardiovascular disease further, using the Danish nationwide administrative databases.Methods:Between 1995-2018, all patients eighteen years and older with MGUS were matched (10:1) with controls from the general population based on age and sex. Patients with a diagnosis of multiple myeloma were excluded. Incident cardiovascular diseases were identified using ICD coding. Hazard ratios for cardiovascular outcomes were calculated using Cox proportional hazard regression.Results:Patients with MGUS (n= 8,445, mean age 69.9 years, 51.3% male) had a higher risk of developing most cardiovascular diseases after multivariable adjustment, including heart failure (HR 1.65, 95% CI 1.51-1.81), atrial fibrillation (HR 1.47, 95% CI 1.37-1.58), acute myocardial infarction (HR 1.24, 95% CI 1.08- 1.43), stroke (HR 1.25, 95% CI 1.12-1.40), aortic aneurysm (HR 1.49, 95% CI 1.23-1.80), aortic stenosis (HR 1.72, 95% CI 1.52-1.96), aortic regurgitation (HR 1.70, 95% CI 1.36-2.12), conduction disease (HR 1.52, 95% CI 1.25-1.82), pericarditis (HR 1.62, 95% CI 1.03-2.55), peripheral arterial disease (HR 1.86, 95% CI 1.61-2.14), cor pulmonale (HR 2.32, 95% CI 1.76-3.06), venous thromboembolism (HR 1.29, 95% CI 1.12-1.48), and implantation of a cardiac pacemaker or defibrillator (HR 1.34, 95% CI 1.14-1.59).Conclusions:MGUS is associated with a broad spectrum of cardiovascular diseases, with somewhat greater risk estimates observed for cardiovascular disorders that have previously been associated with infiltrative diseases (such as heart failure, pulmonary hypertension, aortic valvular disease, atrial fibrillation, and conduction abnormality) than for atherosclerotic and thrombotic disorders. Further studies are warranted to understand the underlying mechanisms.
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- 2021
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40. Abstract 12124: A Composite Score Summarizing Use and Dosing of Evidence-Based Medical Therapies in Heart Failure: A Nationwide Cohort Study
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Johansen, Niklas, Vaduganathan, Muthiah, Zahir, Deewa, Fiuzat, Mona, Defilippis, Ersilia M, Januzzi, James L, Butler, Javed, O'Connor, Christopher, Abraham, William T, Psotka, Mitchell, McMurray, John J, Jensen, Jens-Ulrik Staehr, Schou, Morten, Torp-Pedersen, Christian, Kober, Lars, Gislason, Gunnar H, and Biering-Sørensen, Tor
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Introduction:As heart failure (HF) therapeutic care becomes increasingly complex, determining optimal medical therapy (OMT) can be challenging. The HF Collaboratory consortium developed a scoring system to assist with standardization of comparing OMT within and across trials. We evaluated the score in the Danish HF population.Methods:In a retrospective nationwide cohort study, we identified all Danish HF patients alive on July 1, 2018. Patients were excluded if they were diagnosed after July 1, 2017 to allow a minimum of 365 days for up-titration of medical therapy. Treatment doses were estimated by analysis of consecutive claimed prescriptions. An integer-based composite medical therapy score (range 0-10) was designed to consider use and dosing of multiple therapies prescribed to each patient (Panel A). Risk-adjusted association was assessed between the composite score and subsequent death.Results:In total, 26,779 patients (median age 73y; 32% women) were identified. At baseline, ACEi/ARB was used in 77%, β-blocker in 81%, MRA in 30%, ARNi in 2%, SGLT2i in 2%, and ivabradine in 2%. The median composite medical therapy score was 4 (and was consistently 4 from January 2016-July 2018). During median follow-up of 1.5 years, 3,326 deaths occurred. After accounting for demographics, comorbidities, loop diuretic use, HF diagnosis setting, and time since HF diagnosis, higher composite scores were independently associated with lower mortality (≥median vs
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- 2021
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41. Abstract 12895: Superior Effectiveness and Safety of Ticagrelor in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: A Nationwide Registry-Based Study
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Godtfredsen, Sissel Johanne, Pareek, Manan, Leutscher, Peter, Hylgaard Jørgensen, Steen, Butt, Jawad, Gislason, Gunnar, Kober, Lars, Fosbøl, Emil, Bhatt, Deepak L, Torp-Pedersen, Christian, and Kragholm, Kristian
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Introduction:Dual antiplatelet therapy with aspirin and a P2Y12inhibitor is recommended following PCI for ACS. The optimal choice of P2Y12inhibitor remains debated. We compared effectiveness and safety of clopidogrel, ticagrelor, and prasugrel in a large, nationwide cohort of patients with ACS undergoing PCI.Methods:Registry-based study of first-time ACS patients who underwent PCI ≤7 days of admission and redeemed a prescription of a P2Y12inhibitor ≤30 days of the index event. The primary outcome was major adverse cardiovascular events (MACE): a composite of cardiovascular death, recurrent myocardial infarction, stroke, or repeat revascularization at 12 months. The safety outcome was bleeding requiring hospitalization at 12 months. Multivariable logistic regression with average treatment effect modeling was used to calculate standardized absolute and relative risks for outcomes across age, sex, comorbidity, bleeding, and concomitant anticoagulant therapy distributions.Results:We included 26,997 patients; 6,585 were discharged on clopidogrel, 18,425 on ticagrelor, and 1,987 on prasugrel. Corresponding median ages were 70, 64, and 59 years (p<0.001). Patients in the clopidogrel group were more likely to have had a prior bleeding episode (p<0.001). Adjusted relative risks of MACE were 0.80 for ticagrelor vs clopidogrel (p<0.001), 0.85 for prasugrel vs clopidogrel (p<0.001), and 1.05 for prasugrel vs ticagrelor (p=0.22). Adjusted relative risks of bleeding were 0.82 for ticagrelor vs clopidogrel (p=0.001), 1.07 for prasugrel vs clopidogrel (p=0.56), and 1.30 for prasugrel vs ticagrelor (p=0.03). While statistically significant, the absolute differences in risk of bleeding among groups were modest (Figure).Conclusion:Ticagrelor and prasugrel were associated with lower risk of MACE than clopidogrel but did not significantly differ from each other. Ticagrelor was associated with a lower risk of bleeding than both clopidogrel and prasugrel.
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- 2021
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42. Abstract 9221: Long-Term Risk of New-Onset Arrhythmia in Patients With ST-Segment Elevation Myocardial Infarction According to Revascularization Status
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Thomsen, Anna Foged, Jons, Christian, Jabbari, Reza, Ravn Jacobsen, Mia R, Stampe, Niels K, Butt, Jawad H, Olsen, Niels T, Kelbæk, Henning, Torp-Pedersen, Christian, Fosbol, Emil, Pedersen, Frants, Kober, Lars, Engstrom, Thomas, and Jacobsen, Peter Karl K
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Introduction:Emerging data show that complete revascularization reduces cardiovascular death and recurrent myocardial infarction in ST-segment elevation myocardial infarction (STEMI). The influence of revascularization status on development of arrhythmia in the chronic post-STEMI phase is poorly described.Hypothesis:We hypothesized that incomplete compared with complete revascularization in STEMI is associated with an increased long-term risk of new-onset arrhythmia.Methods:Using unique Danish registries, the risk of new-onset arrhythmia was assessed in STEMI with complete or incomplete revascularization after primary percutaneous coronary intervention (PPCI) at Rigshospitalet University Hospital, Denmark, from 2009-2016. The primary outcome was new-onset arrhythmia defined as a composite of atrial fibrillation/flutter, sinoatrial dysfunction, advanced 2nd- or 3rd-degree atrioventricular block, ventricular tachycardia/fibrillation, cardiac arrest, or pacemaker/ICD implantation, with presentation >7 days post-PPCI. Secondary outcome was all-cause mortality.Results:A total of 5,062 patients (median age: 62.0 years; 76% men) were included, of which 3,985 and 1,077 patients underwent complete and incomplete revascularization, respectively. During a median follow-up of 4.9 years, 580 (15%) patients in the complete and 217 (20%) patients in the incomplete revascularization group were diagnosed with new-onset arrhythmia (Figure 1). Compared with complete revascularization, incomplete revascularization was associated with a higher risk of new-onset arrhythmia (adjusted hazard ratio [HR] 1.3; 95% CI, 1.1-1.5; P=0.004) and higher all-cause mortality (adjusted HR 1.3; 95% CI, 1.0-1.5; P=0.02).Conclusions:Incomplete revascularization in STEMI was associated with an increased long-term risk of new-onset arrhythmia and all-cause mortality compared with complete revascularization.
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- 2021
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43. Abstract 13062: The Effect of Empagliflozin on Contractile Reserve in Heart Failure: Prespecified Sub-Study of a Randomized, Double-Blind, and Placebo-Controlled Trial
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Jensen, Jesper, Omar, Massar, Mulham, Ali, Frederiksen, Peter H, Kistorp, Caroline, Tuxen, Christian, Andersen, Camilla, Larsen, Julie H, Ersbøll, Mads K, Kober, Lars, Gustafsson, Finn, Forman, Julie L, Moller, Jacob E, and Schou, Morten
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Introduction:Sodium-glucose co-transporter-2 (SGLT2) inhibitors improve cardiac structure but most studies suggest no change in left ventricular (LV) systolic function at rest. Whether SGLT2 inhibitors improve LV contractile reserve is unknown. We investigated the effect of empagliflozin on LV contractile reserve in patients with heart failure (HF) and reduced ejection fraction (HFrEF).Methods:Prespecified sub-study of the Empire HF trial, a double-blind, placebo-controlled, and randomized trial. Patients with LV ejection fraction (LVEF) ≤40% on guideline-directed HF therapy were randomized (1:1) to empagliflozin 10 mg or placebo for 12 weeks. The treatment effect on contractile reserve was assessed by low dose dobutamine stress echocardiography.Results:In total, 120 patients were included. The mean age was 68 (SD 10) years, 83% were male, and the mean LVEF was 38 (SD 10) %. Respectively 60 (100%) and 59 (98%) patients in the empagliflozin and placebo groups completed stress echocardiography. No statistically significant effect of empagliflozin was observed for the contractile reserve assessed by LV-GLS [adjusted mean absolute change, empagliflozin versus placebo, 0.7% (95% CI -0.5 to 2.0, P=0.25)] or LVEF [adjusted mean absolute change, empagliflozin versus placebo, 2.2% (95% CI -1.4 to 5.8, P=0.22)] from baseline to 12 weeks. LV-GLS contractile reserve was associated with accelerometer-measured daily activity level [coefficient, -24 accelerometer counts (95% CI -46 to -1.8, P=0.03)] as opposed to LVEF contractile reserve [coefficient, -2.9 accelerometer counts (95% CI -10 to 4.5, P=0.43)].Conclusions:Empagliflozin for 12 weeks added to guideline-directed HF therapy did not improve LV contractile reserve in patients with HFrEF. Registration:NCT03198585. https://www.clinicaltrials.gov/ct2/show/NCT03198585?term=Empire+HF&draw=2&rank=1
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- 2021
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44. Abstract 10837: Prognostic Importance of Atrial Fibrillation in Heart Failure According to Time Elapsed Since Diagnosis
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Schwartz, Brian, Schou, Morten, Lara, Maria Irene Barillas, Monahan, Kevin M, Helm, Robert, Kober, Lars, Gislason, Gunnar, Ramachandran, Vasan S, Torp-Pedersen, Christian, and Andersson, Charlotte
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Introduction:Mortality rates in heart failure (HF) are greatest early after onset and decline rapidly with time (with the survival of the less sick patients). However, it is not known if the presence of atrial fibrillation (AF), a well-known risk factor for mortality in this population, alters such course.Methods:From the Danish nationwide administrative database, all first time HF patients were identified between 1998-2018 using ICD coding and followed for all cause mortality until the end of 2018. AF was categorized as occurring antecedent (before), concomitant (with), or after HF diagnosis. Time-dependent Poisson regression model was used to determine mortality rate ratios, using ‘no AF’ as referent, with multivariable adjustment.Results:A total of 252,988 HF patients (45% women, mean age 74 ±13 years) were included. Of these, 54,064 (21%) had AF before HF onset and 27,651 (11%) patients had AF diagnosed concomitantly with HF. During follow-up, 30,565 additional patients developed AF. The cumulative mortality and mortality rates were highest early after onset for all groups, but greater for those with AF versus without AF, regardless of the time of onset, Figure A and B. Of note, the rates declined substantially more and faster for patients without AF, rendering AF greater prognostic importance the longer out from initial diagnosis, p for interaction between AF groups and HF duration <0.0001, Figure C.Conclusion:While mortality declined in all patients with HF over time, patients with AF experienced substantially less decline in mortality than the no AF group, rendering AF of greater prognostic importance later in the clinical course of HF.
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- 2021
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45. Abstract 10575: The Effect of Empagliflozin on the Biomarker Growth Differentiation Factor 15 in Patients with Heart Failure and Reduced Ejection Fraction: A Post-Hoc Study of a Randomized, Double-Blind, and Placebo-Controlled Trial
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Omar, Massar, Jensen, Jesper, Kistorp, Caroline N, Højlund, Kurt, Larsen, Julie H, Andersen, Camilla Fuchs F, Videbaek, Lars, Tuxen, Christian D, Poulsen, Mikael Kjaer K, Gustafsson, Finn, Kober, Lars, Schou, Morten, and Moller, Jacob
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Introduction:Growth differentiation factor 15 (GDF-15) is considered as a biomarker of inflammatory and myocardial tissue injury. However, metformin increases plasma GDF-15, and may be responsible for the metabolic benefits (e.g. weight loss, decrease in Hemoglobin A1c and systolic blood pressure, and improvement in insulin resistance) effects in type 2 diabetes (T2D). Recently, sodium-glucose cotransporter-2 inhibitors (SGLT2i) demonstrated increment in GDF-15 in a proteomic analysis in T2D patients.Hypothesis:To examine SGLT2i’s effect on GDF-15 in HFrEF patients.Methods:This multicenter, randomized, double-blind, placebo-controlled exploratory sub-study enrolled 190 stable HFrEF patients with an ejection fraction of 40% or below. Patients were randomized (1:1) to empagliflozin 10 mg once daily or matching placebo for 12 weeks. Outcome measures were changes from baseline in GDF-15, high sensitive C-reactive protein (hsCRP), and high sensitive troponin T (hsTNT) adjusted for age, sex, BMI, T2D.Results:Mean age was 64 (SD, 11) years; 85% male, 13% with T2D, mean ejection fraction 29 (SD, 8)). Empagliflozin significantly increased GDF-15 compared to placebo [Empagliflozin: baseline, median (interquartile range (IQR)) 1177 (899-1720) pg/mL, follow-up, 1394 (970-1942) pg/mL: Placebo: baseline 1299 (915-1849) pg/mL, follow-up, 1276 (879-1924) pg/mL, adjusted ratio of change (1.10 [95% confidence interval (CI), 1.04-1.17]: p=0.002). There was no significant change in hsCRP (1.13 [95%CI, 0.89-1.43]: p=0.31), nor in hsTNT (1.09 [95%CI, 0.98-1.20]: p=0.12) (Figure 1).Conclusions:Empagliflozin significantly increased GDF-15 in predominantly non-diabetic HFrEF patients regardless of HF etiology, without a concomitant increase in hsCRP, or hsTNT compared to placebo. These results might explain the link between empagliflozin and the metabolic benefits seen in this population.
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- 2021
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46. Abstract 13569: A Composite Score Summarizing Use And Dosing Of Evidence-based Medical Therapies In Heart Failure: Application To The DAPA-HF Trial
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Dewan, Pooja, Bengtsson, Olof, Docherty, Kieran, Inzucchi, Silvio E, Jhund, Pardeep S, Kober, Lars, Kosiborod, Mikhail N, Langkilde, Anna Maria, Martinez, Felipe, Ponikowski, Piotr, Sabatine, Marc S, Sjostrand, Mikaela, Solomon, Scott, Biering-srensen, Tor, Vaduganathan, Muthiah, Defilippis, Ersilia M, Fiuzat, Mona, and McMurray, John J
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Introduction:The Heart Failure Collaboratory consortium (HFC) has developed a score to quantify background guideline-directed medical therapy (GDMT) in patients with heart failure and reduced ejection fraction (HFrEF). One potential use of this score is to test the incremental value of new therapies. We evaluated the effect of dapagliflozin according to a modified HFC score in the DAPA-HF trial.Methods:The key inclusion criteria in DAPA-HF were: 1) NYHA class II-IV, 2) LVEF ≤40%, and 3) elevated plasma NT-proBNP and 4) eGFR ≥30 ml/min/1.73m2. The primary outcome was a composite of a first episode of worsening HF (hospitalization for HF or an urgent HF visit requiring iv therapy) or cardiovascular death. The HFC score is calculated based on the use of GDMT and dose of GDMT. The modified HFC score used here also accounted for race (Black/non-Black) and ECG rhythm/rate with a maximum possible score of 100 (percent) for any patient (Panel A).Results:Among the 4744 patients (mean age 66 years; 23% women) randomized, an ACEi/ARB was used in 84%, beta-blocker 96%, MRA 71%, ARNI 11%, ivabradine 4.8%, and hydralazine 4.3%. During a median follow-up of 18.2 months, the primary outcome occurred in 386 of 2373 patients (16.3%) in the dapagliflozin group and 502 of 2371 patients (21.2%) in the placebo group (HR, 0.74; 95%CI 0.65 to 0.85; P<0.001). The benefit of dapagliflozin on the primary outcome was consistent across the range of baseline treatment score (Panel B). Examination of the effect of dapagliflozin on the primary outcome by score tertile (T1 ≤40, T2 41-60 and T3 >60) gave HRs for the effect of dapagliflozin, compared with placebo, of 0.75 (0.61-0.93), 0.77 (0.61-0.98), and 0.71 (0.55-0.90), respectively (P-interaction 0.87).Conclusions:A composite score for GDMT of the type developed by the HFC can be easily calculated in clinical trials and used to evaluate the incremental effect of new therapies.
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- 2021
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47. Abstract 11309: Significance of Blood Pressure Drops in Patients Hospitalized for Acute Heart Failure: A Patient-Level Analysis of 4 Randomized Placebo-Controlled Serelaxin Trials
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Grand, Johannes, Miger, Kristina, Sajadieh, Ahmad, Kober, Lars, Torp-Pedersen, Christian, Ertl, Georg, Lopez-sendon, Jose L, Maggioni, Aldo P, and Nielsen, Olav W
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Introduction:Hypotensive events and drops in systolic blood pressure (SBP-drop) are frequent in patients with acute heart failure (AHF). We investigated SBP-drop and associations with outcomes and whether treatment with the vasodilator serelaxin affected the association between SBP-drops and outcomes.Methods:Analyses of data from four randomized, controlled trials investigating serelaxin as an intervention in patients hospitalized with AHF. Main inclusion criteria were SBP 125-180 mmHg, pulmonary congestion, elevated NT-proBNP. SBP-drops (predefined as an SBP-value below 100 mmHg and/or a drop of 40 mmHg from baseline) were prospectively registered during the first 48 hours of hospitalization. Outcomes were a composite outcome (worsening heart failure, hospital readmission for heart failure or all-cause mortality through 14 days) and 180-day mortality.Results:Overall, 2558/11226 (23%) patients had an SBP-drop, with a median time from randomization to event of 15 (6-25) hours. In multivariable analyses, SBP-drop was associated with 180-day mortality (hazard ratio 1.21, 95% CI 1.05-1.39; p=0.009) and the composite outcome (1.29 (1.13-1.49); p<0.001). Treatment-allocation interacted significantly on the relationship between SBP-drops and outcomes (p-interaction=0.003 for composite outcome, p-interaction=0.11 for 180-day mortality). In patients treated with placebo (n=5141), there was a strong association between SBP-drops and the composite outcome (HR: 1.46, 95% CI 1.19-1.79), p=0.0003), but no significant association in patients treated with serelaxin (HR 1.18, 95% CI 0.97-1.42, p=0.10) (Figure).Conclusions:SBP-drops in hospitalized patients treated for AHF is an independent risk factor for adverse short- and long-term outcomes, and its occurrence highlights the need for careful monitoring and urgent treatment. However, in patients treated with serelaxin under careful observation, SBP-drops were not associated with worse outcome.
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- 2021
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48. Abstract 10629: Effect of Empagliflozin on Blood Volume Redistribution in Patients with Chronic Heart Failure and Reduced Ejection Fraction
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Omar, Massar, Jensen, Jesper, Burkhoff, Daniel, Frederiksen, Peter H, Kistorp, Caroline N, Videbaek, Lars, Poulsen, Mikael Kjaer, Gustafsson, Finn, Kober, Lars, Borlaug, Barry A, Schou, Morten, and Moller, Jacob
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Background:The relationship between blood volume and pressure in the vascular system can be described in terms of unstressed and stressed blood volume. Stressed blood volume determines venous pressure and provides preload back to the heart, which regulates the generation of cardiac output (CO) via the Frank-starling mechanism. Whether sodium-glucose cotransporter-2 (SGLT2i) favorably modifies stressed blood volume is not known.Hypothesis:To investigate the effect of SGLT2i (empagliflozin) on the hemodynamic estimated stressed blood volume (eSBV) in HFrEF patients compared to placebo.Methods:A post hoc analysis of investigator-initiated, double-blinded, placebo-controlled, randomized trial. Seventy patients were assigned to empagliflozin of 10 mg or matching placebo once daily for 12 weeks. Patients underwent right heart catheterization at rest and during exercise at baseline and follow-up. Outcome was change in eSBV after 12 weeks of empagliflozin treatment at each level of exercise. We conducted computer-modelling simulations based on invasive hemodynamic assessment to measure eSBV.Results:HFrEF patients with mean age was 57 years, mean ejection fraction 27%, 47 (71%) on diuretics were randomized. After 12 weeks treatment exercise eSBV was significantly reduced at 0 watt, 25 watt and 25 % of maximal exercise watt, compared to placebo [(0 watt; –258 mL, 95% CI –476 to –39, p=0.021); (25 watt; –301 mL, 95% CI –561 to –40, p=0.024); and (25% of peak exercise watt; –262 mL, 95% CI –490 to –34, p=0.024)]. There was no effect on rest, or at peak exercise eSBV [(Rest; –75 ml, 95% confidence interval [CI] –279 to 130; p=0.47); and (Peak; –96 mL, 95% CI –444 to 251, p=0.59)]. This was consistent among patients with and without type 2 diabetes, etiology of HFrEF, and diuretic usage (Figure 1).Conclusion:Empagliflozin may contribute to shift blood from the effective circulatory beds to the venous reservoir in reducing filling pressure and eSBV, but maintaining CO.
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- 2021
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49. Cardiac and Noncardiac Disease Burden and Treatment Effect of Sacubitril/Valsartan: Insights From a Combined PARAGON-HF and PARADIGM-HF Analysis.
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Rohde, Luis E., Claggett, Brian L., Wolsk, Emil, Packer, Milton, Zile, Michael, Swedberg, Karl, Rouleau, Jean, Pfeffer, Marc A., Desai, Akshay S., Lund, Lars H., Kober, Lars, Anand, Inder, Merkely, Bela, Senni, Michele, Shi, Victor, Rizkala, Adel, Lefkowitz, Martin, McMurray, John J.V., and Solomon, Scott D.
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Supplemental Digital Content is available in the text. Background: The net clinical benefit of cardiac disease-modifying drugs might be influenced by the interaction of different domains of disease burden. We assessed the relative contribution of cardiac, comorbid, and demographic factors in heart failure (HF) and how their interplay might influence HF prognosis and efficacy of sacubitril/valsartan across the spectrum of left ventricular ejection fraction. Methods: We combined data from 2 global trials that evaluated the efficacy of sacubitril/valsartan compared with a renin-angiotensin antagonist in symptomatic HF patients (PARADIGM-HF [Prospective Comparison of Angiotensin Receptor Neprilysin Inhibitor With an Angiotensin-Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure; n=8399] and PARAGON-HF [Prospective Comparison of Angiotensin-Converting Enzyme Inhibitor With Angiotensin Receptors Blockers Global Outcomes in Heart Failure With Preserved Ejection Fraction; n=4796]). We decomposed the previously validated Meta-Analysis Global Group in Chronic Heart Failure risk score into cardiac (left ventricular ejection fraction, New York Heart Association class, blood pressure, time since HF diagnosis, HF medications), noncardiac comorbid (body mass index, creatinine, diabetes, chronic obstructive pulmonary disease, smoking), and demographic (age, gender) categories. Based on these domains, an index representing the balance of cardiac to noncardiac comorbid burden was created (cardiac-comorbid index). Clinical outcomes were time to first HF hospitalization or cardiovascular deaths and all-cause mortality. Results: Higher scores of the cardiac domain were observed in PARADIGM-HF (10 [7–13] versus 5 [3–6], P <0.001) and higher scores of the demographic domain in PARAGON-HF (10 [8–13] versus 5 [2–9], P <0.001). In PARADIGM-HF, the contribution of the cardiac domain to clinical outcomes was greater than the noncardiac domain (P <0.001), while in PARAGON-HF the attributable risk of the comorbid and demographic categories predominated. Individual scores from each sub-domain were linearly associated with the risk of clinical outcomes (P <0.001). Beneficial effects of sacubitril/valsartan were observed in patients with preponderance of cardiac over noncardiac comorbid burden (cardiac-comorbid index >5 points), suggesting a significant treatment effect modification (interaction P <0.05 for both outcomes). Conclusions: Domains of disease burden are clinically relevant features that influence the prognosis and treatment of patients with HF. The therapeutic benefits of sacubitril/valsartan vary according to the balance of components of disease burden, across different ranges of left ventricular ejection fraction. [ABSTRACT FROM AUTHOR]
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- 2021
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50. Global systolic load, left ventricular hypertrophy, and atrial fibrillation.
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Bang, Casper N., Greve, Anders M., Wachtell, Kristian, and Kober, Lars
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- 2012
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