146 results on '"Waters, David D."'
Search Results
2. Inflammation in Cardiovascular Disease: From Basic Concepts to Clinical Application
- Author
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Waters, David D, Waters, David D, Waters, David D, and Waters, David D
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- 2020
3. Notes From the Cardiology Clinic: Facing Down the Dragons of Health Anxiety.
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Waters, David D, Waters, David D, Waters, David D, and Waters, David D
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- 2020
4. Notes From Cardiology Clinic: The Patients We Dislike.
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Waters, David D, Waters, David D, Waters, David D, and Waters, David D
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- 2020
5. Notes From Cardiology Clinic: The Patients We Dislike.
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Waters, David D, Waters, David D, Waters, David D, and Waters, David D
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- 2020
6. Notes From Cardiology Clinic: The Patients We Dislike.
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Waters, David D, Waters, David D, Waters, David D, and Waters, David D
- Published
- 2020
7. Notes From Cardiology Clinic: The Patients We Dislike.
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Waters, David D, Waters, David D, Waters, David D, and Waters, David D
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- 2020
8. Notes From Cardiology Clinic: Brittle Bones and Blue Sclerae.
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Waters, David D, Waters, David D, Waters, David D, and Waters, David D
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- 2020
9. Notes From the Cardiology Clinic: Facing Down the Dragons of Health Anxiety.
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Waters, David D, Waters, David D, Waters, David D, and Waters, David D
- Published
- 2020
10. Inflammation in Cardiovascular Disease: From Basic Concepts to Clinical Application
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Waters, David D, Waters, David D, Waters, David D, and Waters, David D
- Published
- 2020
11. Pharmacogenetics-guided dalcetrapib therapy after an acute coronary syndrome: the dal-GenE trial.
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Tardif, Jean Claude, Tardif, Jean Claude, Pfeffer, Marc A, Kouz, Simon, Koenig, Wolfgang, Maggioni, Aldo P, McMurray, John JV, Mooser, Vincent, Waters, David D, Grégoire, Jean C, L'Allier, Philippe L, Wouter Jukema, J, White, Harvey D, Heinonen, Therese, Black, Donald M, Laghrissi-Thode, Fouzia, Levesque, Sylvie, Guertin, Marie Claude, Dubé, Marie Pierre, dal-GenE Investigators, Tardif, Jean Claude, Tardif, Jean Claude, Pfeffer, Marc A, Kouz, Simon, Koenig, Wolfgang, Maggioni, Aldo P, McMurray, John JV, Mooser, Vincent, Waters, David D, Grégoire, Jean C, L'Allier, Philippe L, Wouter Jukema, J, White, Harvey D, Heinonen, Therese, Black, Donald M, Laghrissi-Thode, Fouzia, Levesque, Sylvie, Guertin, Marie Claude, Dubé, Marie Pierre, and dal-GenE Investigators
- Abstract
AimsIn a retrospective analysis of dal-Outcomes, the effect of dalcetrapib on cardiovascular events was influenced by an adenylate cyclase type 9 (ADCY9) gene polymorphism. The dal-GenE study was conducted to test this pharmacogenetic hypothesis.Methods and resultsdal-GenE was a double-blind trial in patients with an acute coronary syndrome within 1-3 months and the AA genotype at variant rs1967309 in the ADCY9 gene. A total of 6147 patients were randomly assigned to receive dalcetrapib 600 mg or placebo daily. The primary endpoint was the time from randomization to first occurrence of cardiovascular death, resuscitated cardiac arrest, non-fatal myocardial infarction, or non-fatal stroke. After a median follow-up of 39.9 months, the primary endpoint occurred in 292 (9.5%) of 3071 patients in the dalcetrapib group and 327 (10.6%) of 3076 patients in the placebo group [hazard ratio 0.88; 95% confidence interval (CI) 0.75-1.03; P = 0.12]. The hazard ratios for the components of the primary endpoint were 0.79 (95% CI 0.65-0.96) for myocardial infarction, 0.92 (95% CI 0.64-1.33) for stroke, 1.21 (95% CI 0.91-1.60) for death from cardiovascular causes, and 2.33 (95% CI 0.60-9.02) for resuscitated cardiac arrest. In a pre-specified on-treatment sensitivity analysis, the primary endpoint event rate was 7.8% (236/3015) in the dalcetrapib group and 9.3% (282/3031) in the placebo group (hazard ratio 0.83; 95% CI 0.70-0.98).ConclusionDalcetrapib did not significantly reduce the risk of occurrence of the primary endpoint of ischaemic cardiovascular events at end of study. A new trial would be needed to test the pharmacogenetic hypothesis that dalcetrapib improves the prognosis of patients with the AA genotype.Clinical trial registrationTrial registration dal-GenE ClinicalTrials.gov Identifier: NCT02525939.
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- 2022
12. Cholesterol Lowering Guidelines: From Whence We Came and Where We Are Now.
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Waters, David D, Waters, David D, Waters, David D, and Waters, David D
- Abstract
Treatment guidelines have proliferated in cardiology, although most guideline recommendations are not supported by clinical trial evidence. What is considered to be a normal cholesterol level has progressively declined over the past 50 years, with the increasing realization that "normal" is far from optimal and that lower is better. The first important United States and Canadian cholesterol guidelines were published in 1988, and recommended diet for 6 months to be followed by consideration of bile acid sequestrants or nicotinic acid. Over the ensuing 25 years guidelines have changed rapidly and dramatically in response to a large number of definitive clinical trials, usually with statins. Low-density lipoprotein cholesterol targets have moved progressively lower, and in some guidelines, have been abandoned entirely. The concept of selecting patients for treatment according to the absolute risk reduction expected from treatment on the basis of clinical trial data seems to be a rational approach. For secondary prevention, some patients are still untreated or undertreated, presenting an opportunity for improving outcomes.
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- 2019
13. Introduction to Cardiovascular Issues in HIV.
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Waters, David D, Waters, David D, Hsue, Priscilla Y, Waters, David D, Waters, David D, and Hsue, Priscilla Y
- Published
- 2019
14. Notes From Cardiology Clinic: Woman, Lost During Follow-up.
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Waters, David D, Waters, David D, Waters, David D, and Waters, David D
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- 2019
15. Notes From Cardiology Clinic: When Our Responsibilities Extend Beyond the Patient.
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Waters, David D, Waters, David D, Waters, David D, and Waters, David D
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- 2019
16. Lipid Abnormalities in Persons Living With HIV Infection.
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Waters, David D, Waters, David D, Hsue, Priscilla Y, Waters, David D, Waters, David D, and Hsue, Priscilla Y
- Abstract
Lipid abnormalities are prevalent among persons living with HIV infection and contribute to increasing the risk of cardiovascular events. Antiretroviral therapy (ART) is associated with lipid abnormalities, most commonly hypertriglyceridemia, but also increases in low-density lipoprotein cholesterol and total cholesterol. Different classes of ART, and different drugs within classes, have differing effects on lipid levels, but in general newer drugs have more favourable effects compared with older ones. Low-level inflammation and chronic immune activation act on lipids through a variety of mechanisms to make them more atherogenic. As a consequence, risk is higher than would be expected for any given cholesterol level. Clinical outcome trials of cholesterol-lowering therapies have not yet been completed in people living with HIV, so that treatment decisions depend on extrapolation from studies in uninfected populations. Traditional risk assessment tools underestimate cardiovascular risk in individuals with HIV. Statins are the mainstay of lipid-lowering drug treatment; however, drug-drug interactions with ART must be considered. Simvastatin and lovastatin are contraindicated in patients taking protease inhibitors, and the dose of atorvastatin and rosuvastatin should be limited to 40 mg and 10 mg/d with some ART combinations. Switching from older forms of ART to lipid-friendly newer ones is a useful strategy as long as virologic suppression is maintained, but adding a statin lowers low-density lipoprotein cholesterol more effectively. Studies indicate that lipid abnormalities are not treated as aggressively in individuals living with HIV as they are in uninfected people, making this an opportunity to improve care.
- Published
- 2019
17. Notes From Cardiology Clinic: Woman, Lost During Follow-up.
- Author
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Waters, David D, Waters, David D, Waters, David D, and Waters, David D
- Published
- 2019
18. Cholesterol Lowering Guidelines: From Whence We Came and Where We Are Now.
- Author
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Waters, David D, Waters, David D, Waters, David D, and Waters, David D
- Abstract
Treatment guidelines have proliferated in cardiology, although most guideline recommendations are not supported by clinical trial evidence. What is considered to be a normal cholesterol level has progressively declined over the past 50 years, with the increasing realization that "normal" is far from optimal and that lower is better. The first important United States and Canadian cholesterol guidelines were published in 1988, and recommended diet for 6 months to be followed by consideration of bile acid sequestrants or nicotinic acid. Over the ensuing 25 years guidelines have changed rapidly and dramatically in response to a large number of definitive clinical trials, usually with statins. Low-density lipoprotein cholesterol targets have moved progressively lower, and in some guidelines, have been abandoned entirely. The concept of selecting patients for treatment according to the absolute risk reduction expected from treatment on the basis of clinical trial data seems to be a rational approach. For secondary prevention, some patients are still untreated or undertreated, presenting an opportunity for improving outcomes.
- Published
- 2019
19. Lipid Abnormalities in Persons Living With HIV Infection.
- Author
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Waters, David D, Waters, David D, Hsue, Priscilla Y, Waters, David D, Waters, David D, and Hsue, Priscilla Y
- Abstract
Lipid abnormalities are prevalent among persons living with HIV infection and contribute to increasing the risk of cardiovascular events. Antiretroviral therapy (ART) is associated with lipid abnormalities, most commonly hypertriglyceridemia, but also increases in low-density lipoprotein cholesterol and total cholesterol. Different classes of ART, and different drugs within classes, have differing effects on lipid levels, but in general newer drugs have more favourable effects compared with older ones. Low-level inflammation and chronic immune activation act on lipids through a variety of mechanisms to make them more atherogenic. As a consequence, risk is higher than would be expected for any given cholesterol level. Clinical outcome trials of cholesterol-lowering therapies have not yet been completed in people living with HIV, so that treatment decisions depend on extrapolation from studies in uninfected populations. Traditional risk assessment tools underestimate cardiovascular risk in individuals with HIV. Statins are the mainstay of lipid-lowering drug treatment; however, drug-drug interactions with ART must be considered. Simvastatin and lovastatin are contraindicated in patients taking protease inhibitors, and the dose of atorvastatin and rosuvastatin should be limited to 40 mg and 10 mg/d with some ART combinations. Switching from older forms of ART to lipid-friendly newer ones is a useful strategy as long as virologic suppression is maintained, but adding a statin lowers low-density lipoprotein cholesterol more effectively. Studies indicate that lipid abnormalities are not treated as aggressively in individuals living with HIV as they are in uninfected people, making this an opportunity to improve care.
- Published
- 2019
20. Introduction to Cardiovascular Issues in HIV.
- Author
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Waters, David D, Waters, David D, Hsue, Priscilla Y, Waters, David D, Waters, David D, and Hsue, Priscilla Y
- Published
- 2019
21. Notes From Cardiology Clinic: When Our Responsibilities Extend Beyond the Patient.
- Author
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Waters, David D, Waters, David D, Waters, David D, and Waters, David D
- Published
- 2019
22. Notes From Cardiology Clinic: Woman, Lost During Follow-up.
- Author
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Waters, David D, Waters, David D, Waters, David D, and Waters, David D
- Published
- 2019
23. Pharmacogenomics of the Efficacy and Safety of Colchicine in COLCOT.
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Dubé, Marie-Pierre, Dubé, Marie-Pierre, Legault, Marc-André, Lemaçon, Audrey, Lemieux Perreault, Louis-Philippe, Fouodjio, René, Waters, David D, Kouz, Simon, Pinto, Fausto J, Maggioni, Aldo P, Diaz, Rafael, Berry, Colin, Koenig, Wolfgang, Lopez-Sendon, Jose, Gamra, Habib, Kiwan, Ghassan S, Asselin, Géraldine, Provost, Sylvie, Barhdadi, Amina, Sun, Maxine, Cossette, Mariève, Blondeau, Lucie, Mongrain, Ian, Dubois, Anick, Rhainds, David, Bouabdallaoui, Nadia, Samuel, Michelle, de Denus, Simon, L'Allier, Philippe L, Guertin, Marie-Claude, Roubille, François, Tardif, Jean-Claude, Dubé, Marie-Pierre, Dubé, Marie-Pierre, Legault, Marc-André, Lemaçon, Audrey, Lemieux Perreault, Louis-Philippe, Fouodjio, René, Waters, David D, Kouz, Simon, Pinto, Fausto J, Maggioni, Aldo P, Diaz, Rafael, Berry, Colin, Koenig, Wolfgang, Lopez-Sendon, Jose, Gamra, Habib, Kiwan, Ghassan S, Asselin, Géraldine, Provost, Sylvie, Barhdadi, Amina, Sun, Maxine, Cossette, Mariève, Blondeau, Lucie, Mongrain, Ian, Dubois, Anick, Rhainds, David, Bouabdallaoui, Nadia, Samuel, Michelle, de Denus, Simon, L'Allier, Philippe L, Guertin, Marie-Claude, Roubille, François, and Tardif, Jean-Claude
- Abstract
BackgroundThe randomized, placebo-controlled COLCOT (Colchicine Cardiovascular Outcomes Trial) has shown the benefits of colchicine 0.5 mg daily to lower the rate of ischemic cardiovascular events in patients with a recent myocardial infarction. Here, we conducted a post hoc pharmacogenomic study of COLCOT with the aim to identify genetic predictors of the efficacy and safety of treatment with colchicine.MethodsThere were 1522 participants of European ancestry from the COLCOT trial available for the pharmacogenomic study of COLCOT trial. The pharmacogenomic study's primary cardiovascular end point was defined as for the main trial, as time to first occurrence of cardiovascular death, resuscitated cardiac arrest, myocardial infarction, stroke, or urgent hospitalization for angina requiring coronary revascularization. The safety end point was time to the first report of gastrointestinal events. Patients' DNA was genotyped using the Illumina Global Screening array followed by imputation. We performed a genome-wide association study in colchicine-treated patients.ResultsNone of the genetic variants passed the genome-wide association study significance threshold for the primary cardiovascular end point conducted in 702 patients in the colchicine arm who were compliant to medication. The genome-wide association study for gastrointestinal events was conducted in all 767 patients in the colchicine arm and found 2 significant association signals, one with lead variant rs6916345 (hazard ratio, 1.89 [95% CI, 1.52-2.35], P=7.41×10-9) in a locus which colocalizes with Crohn disease, and one with lead variant rs74795203 (hazard ratio, 2.51 [95% CI, 1.82-3.47]; P=2.70×10-8), an intronic variant in gene SEPHS1. The interaction terms between the genetic variants and treatment with colchicine versus placebo were significant.ConclusionsWe found 2 genomic regions associated with gastrointestinal events in patients treated with colchicine. Those findings will benefit from replication to
- Published
- 2021
24. Pharmacogenomics of the Efficacy and Safety of Colchicine in COLCOT.
- Author
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Dubé, Marie-Pierre, Dubé, Marie-Pierre, Legault, Marc-André, Lemaçon, Audrey, Lemieux Perreault, Louis-Philippe, Fouodjio, René, Waters, David D, Kouz, Simon, Pinto, Fausto J, Maggioni, Aldo P, Diaz, Rafael, Berry, Colin, Koenig, Wolfgang, Lopez-Sendon, Jose, Gamra, Habib, Kiwan, Ghassan S, Asselin, Géraldine, Provost, Sylvie, Barhdadi, Amina, Sun, Maxine, Cossette, Mariève, Blondeau, Lucie, Mongrain, Ian, Dubois, Anick, Rhainds, David, Bouabdallaoui, Nadia, Samuel, Michelle, de Denus, Simon, L'Allier, Philippe L, Guertin, Marie-Claude, Roubille, François, Tardif, Jean-Claude, Dubé, Marie-Pierre, Dubé, Marie-Pierre, Legault, Marc-André, Lemaçon, Audrey, Lemieux Perreault, Louis-Philippe, Fouodjio, René, Waters, David D, Kouz, Simon, Pinto, Fausto J, Maggioni, Aldo P, Diaz, Rafael, Berry, Colin, Koenig, Wolfgang, Lopez-Sendon, Jose, Gamra, Habib, Kiwan, Ghassan S, Asselin, Géraldine, Provost, Sylvie, Barhdadi, Amina, Sun, Maxine, Cossette, Mariève, Blondeau, Lucie, Mongrain, Ian, Dubois, Anick, Rhainds, David, Bouabdallaoui, Nadia, Samuel, Michelle, de Denus, Simon, L'Allier, Philippe L, Guertin, Marie-Claude, Roubille, François, and Tardif, Jean-Claude
- Abstract
BackgroundThe randomized, placebo-controlled COLCOT (Colchicine Cardiovascular Outcomes Trial) has shown the benefits of colchicine 0.5 mg daily to lower the rate of ischemic cardiovascular events in patients with a recent myocardial infarction. Here, we conducted a post hoc pharmacogenomic study of COLCOT with the aim to identify genetic predictors of the efficacy and safety of treatment with colchicine.MethodsThere were 1522 participants of European ancestry from the COLCOT trial available for the pharmacogenomic study of COLCOT trial. The pharmacogenomic study's primary cardiovascular end point was defined as for the main trial, as time to first occurrence of cardiovascular death, resuscitated cardiac arrest, myocardial infarction, stroke, or urgent hospitalization for angina requiring coronary revascularization. The safety end point was time to the first report of gastrointestinal events. Patients' DNA was genotyped using the Illumina Global Screening array followed by imputation. We performed a genome-wide association study in colchicine-treated patients.ResultsNone of the genetic variants passed the genome-wide association study significance threshold for the primary cardiovascular end point conducted in 702 patients in the colchicine arm who were compliant to medication. The genome-wide association study for gastrointestinal events was conducted in all 767 patients in the colchicine arm and found 2 significant association signals, one with lead variant rs6916345 (hazard ratio, 1.89 [95% CI, 1.52-2.35], P=7.41×10-9) in a locus which colocalizes with Crohn disease, and one with lead variant rs74795203 (hazard ratio, 2.51 [95% CI, 1.82-3.47]; P=2.70×10-8), an intronic variant in gene SEPHS1. The interaction terms between the genetic variants and treatment with colchicine versus placebo were significant.ConclusionsWe found 2 genomic regions associated with gastrointestinal events in patients treated with colchicine. Those findings will benefit from replication to
- Published
- 2021
25. Myocardial Infarction in the ISCHEMIA Trial: Impact of Different Definitions on Incidence, Prognosis, and Treatment Comparisons.
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Chaitman, Bernard R, Chaitman, Bernard R, Alexander, Karen P, Cyr, Derek D, Berger, Jeffrey S, Reynolds, Harmony R, Bangalore, Sripal, Boden, William E, Lopes, Renato D, Demkow, Marcin, Piero Perna, Gian, Riezebos, Robert K, McFalls, Edward O, Banerjee, Subhash, Bagai, Akshay, Gosselin, Gilbert, O'Brien, Sean M, Rockhold, Frank W, Waters, David D, Thygesen, Kristian A, Stone, Gregg W, White, Harvey D, Maron, David J, Hochman, Judith S, ISCHEMIA Research Group, Chaitman, Bernard R, Chaitman, Bernard R, Alexander, Karen P, Cyr, Derek D, Berger, Jeffrey S, Reynolds, Harmony R, Bangalore, Sripal, Boden, William E, Lopes, Renato D, Demkow, Marcin, Piero Perna, Gian, Riezebos, Robert K, McFalls, Edward O, Banerjee, Subhash, Bagai, Akshay, Gosselin, Gilbert, O'Brien, Sean M, Rockhold, Frank W, Waters, David D, Thygesen, Kristian A, Stone, Gregg W, White, Harvey D, Maron, David J, Hochman, Judith S, and ISCHEMIA Research Group
- Abstract
BackgroundIn the ISCHEMIA trial (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches), an initial invasive strategy did not significantly reduce rates of cardiovascular events or all-cause mortality in comparison with a conservative strategy in patients with stable ischemic heart disease and moderate/severe myocardial ischemia. The most frequent component of composite cardiovascular end points was myocardial infarction (MI).MethodsISCHEMIA prespecified that the primary and major secondary composite end points of the trial be analyzed using 2 MI definitions. For procedural MI, the primary MI definition used creatine kinase-MB as the preferred biomarker, whereas the secondary definition used cardiac troponin. Procedural thresholds were >5 times the upper reference level for percutaneous coronary intervention and >10 times for coronary artery bypass grafting. Procedural MI definitions included (1) a category of elevated biomarker only events with much higher biomarker thresholds, (2) new ST-segment depression of ≥1 mm for the primary and ≥0.5 mm for the secondary definition, and (3) new coronary dissections >National Heart, Lung, and Blood Institute grade 3. We compared MI type, frequency, and prognosis by treatment assignment using both MI definitions.ResultsProcedural MIs accounted for 20.1% of all MI events with the primary definition and 40.6% of all MI events with the secondary definition. Four-year MI rates in patients undergoing revascularization were more frequent with the invasive versus conservative strategy using the primary (2.7% versus 1.1%; adjusted hazard ratio [HR], 2.98 [95% CI, 1.87-4.73]) and secondary (8.2% versus 2.0%; adjusted HR, 5.04 [95% CI, 3.64-6.97]) MI definitions. Type 1 MIs were less frequent with the invasive versus conservative strategy using the primary (3.40% versus 6.89%; adjusted HR, 0.53 [95% CI, 0.41-0.69]; P<0.0001) and secondary (3.48% versus 6.89%; adjusted HR, 0.53 [95% CI
- Published
- 2021
26. Role of Adenylate Cyclase 9 in the Pharmacogenomic Response to Dalcetrapib: Clinical Paradigm and Molecular Mechanisms in Precision Cardiovascular Medicine.
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Rhainds, David, Rhainds, David, Packard, Chris J, Brodeur, Mathieu R, Niesor, Eric J, Sacks, Frank M, Jukema, J Wouter, Wright, R Scott, Waters, David D, Heinonen, Therese, Black, Donald M, Laghrissi-Thode, Fouzia, Dubé, Marie-Pierre, Pfeffer, Marc A, Tardif, Jean-Claude, Rhainds, David, Rhainds, David, Packard, Chris J, Brodeur, Mathieu R, Niesor, Eric J, Sacks, Frank M, Jukema, J Wouter, Wright, R Scott, Waters, David D, Heinonen, Therese, Black, Donald M, Laghrissi-Thode, Fouzia, Dubé, Marie-Pierre, Pfeffer, Marc A, and Tardif, Jean-Claude
- Abstract
Following the neutral results of the dal-OUTCOMES trial, a genome-wide study identified the rs1967309 variant in the adenylate cyclase type 9 (ADCY9) gene on chromosome 16 as being associated with the risk of future cardiovascular events only in subjects taking dalcetrapib, a CETP (cholesterol ester transfer protein) modulator. Homozygotes for the minor A allele (AA) were protected from recurrent cardiovascular events when treated with dalcetrapib, while homozygotes for the major G allele (GG) had increased risk. Here, we present the current state of knowledge regarding the impact of rs1967309 in ADCY9 on clinical observations and biomarkers in dalcetrapib trials and the effects of mouse ADCY9 gene inactivation on cardiovascular physiology. Finally, we present our current model of the interaction between dalcetrapib and ADCY9 gene variants in the arterial wall macrophage, based on the intracellular role of CETP in the transfer of complex lipids from endoplasmic reticulum membranes to lipid droplets. Briefly, the concept is that dalcetrapib would inhibit CETP-mediated transfer of cholesteryl esters, resulting in a progressive inhibition of cholesteryl ester synthesis and free cholesterol accumulation in the endoplasmic reticulum. Reduced ADCY9 activity, by paradoxically leading to higher cyclic AMP levels and in turn increased cellular cholesterol efflux, could impart cardiovascular protection in rs1967309 AA patients. The ongoing dal-GenE trial recruited 6145 patients with the protective AA genotype and will provide a definitive answer to whether dalcetrapib will be protective in this population.
- Published
- 2021
27. Visit-to-visit variability of lipid measurements as predictors of cardiovascular events.
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Waters, David D, Waters, David D, Bangalore, Sripal, Fayyad, Rana, DeMicco, David A, Laskey, Rachel, Melamed, Shari, Barter, Philip J, Waters, David D, Waters, David D, Bangalore, Sripal, Fayyad, Rana, DeMicco, David A, Laskey, Rachel, Melamed, Shari, and Barter, Philip J
- Abstract
BACKGROUND:Higher visit-to-visit variability in risk factors such as blood pressure and low-density lipoprotein (LDL)-cholesterol are associated with an increase in cardiovascular (CV) events. OBJECTIVE:The purpose of this study was to determine whether variability in high-density lipoprotein cholesterol (HDL-C) and triglyceride levels predicted coronary and CV events in a clinical trial population with known coronary disease. METHODS:We assessed intraindividual variability in fasting high-density lipoprotein (HDL)-cholesterol, triglyceride, and LDL-cholesterol measurements among 9572 patients in the Treating to New Targets trial and correlated the results with coronary events over a median follow-up of 4.9 years. RESULTS:In the fully adjusted Cox model, 1 standard deviation of average successive variability, defined as the average absolute difference between successive values, was associated with an increased risk of a coronary event for HDL-cholesterol (hazard ratio [HR] 1.16, 95% confidence interval [CI] 1.11-1.21, P < .0001), for triglycerides (HR 1.09, 95% CI 1.04-1.15, P = .0005), and for LDL-cholesterol (HR 1.14, 95% CI 1.09-1.19, P < .0001). Similar results were found for the 3 other measures of variability, standard deviation, coefficient of variability, and variability independent of the mean. Similar results were seen for CV events, stroke, and nonfatal myocardial infarction. Higher variability in triglyceride and LDL-cholesterol, but not HDL-cholesterol, was predictive of incident diabetes. The correlation among the variability of the 3 lipid measurements was weak. CONCLUSION:Visit-to-visit variability in fasting measurements of HDL-cholesterol, triglycerides, and LDL-cholesterol are predictive of coronary events, CV events, and for triglyceride and low-density lipoprotein cholesterol variability, incident diabetes. The mechanisms accounting for these associations remain to be determined.
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- 2018
28. Visit-to-visit variability of lipid measurements as predictors of cardiovascular events.
- Author
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Waters, David D, Waters, David D, Bangalore, Sripal, Fayyad, Rana, DeMicco, David A, Laskey, Rachel, Melamed, Shari, Barter, Philip J, Waters, David D, Waters, David D, Bangalore, Sripal, Fayyad, Rana, DeMicco, David A, Laskey, Rachel, Melamed, Shari, and Barter, Philip J
- Abstract
BACKGROUND:Higher visit-to-visit variability in risk factors such as blood pressure and low-density lipoprotein (LDL)-cholesterol are associated with an increase in cardiovascular (CV) events. OBJECTIVE:The purpose of this study was to determine whether variability in high-density lipoprotein cholesterol (HDL-C) and triglyceride levels predicted coronary and CV events in a clinical trial population with known coronary disease. METHODS:We assessed intraindividual variability in fasting high-density lipoprotein (HDL)-cholesterol, triglyceride, and LDL-cholesterol measurements among 9572 patients in the Treating to New Targets trial and correlated the results with coronary events over a median follow-up of 4.9 years. RESULTS:In the fully adjusted Cox model, 1 standard deviation of average successive variability, defined as the average absolute difference between successive values, was associated with an increased risk of a coronary event for HDL-cholesterol (hazard ratio [HR] 1.16, 95% confidence interval [CI] 1.11-1.21, P < .0001), for triglycerides (HR 1.09, 95% CI 1.04-1.15, P = .0005), and for LDL-cholesterol (HR 1.14, 95% CI 1.09-1.19, P < .0001). Similar results were found for the 3 other measures of variability, standard deviation, coefficient of variability, and variability independent of the mean. Similar results were seen for CV events, stroke, and nonfatal myocardial infarction. Higher variability in triglyceride and LDL-cholesterol, but not HDL-cholesterol, was predictive of incident diabetes. The correlation among the variability of the 3 lipid measurements was weak. CONCLUSION:Visit-to-visit variability in fasting measurements of HDL-cholesterol, triglycerides, and LDL-cholesterol are predictive of coronary events, CV events, and for triglyceride and low-density lipoprotein cholesterol variability, incident diabetes. The mechanisms accounting for these associations remain to be determined.
- Published
- 2018
29. When Diastole Lets You Down: Clinical Relevance of a Widened Pulse Pressure.
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Tannenbaum, Jordan, Tannenbaum, Jordan, Bittner, Vera, Waters, David D, Tannenbaum, Jordan, Tannenbaum, Jordan, Bittner, Vera, and Waters, David D
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- 2020
30. Study design of Dal-GenE, a pharmacogenetic trial targeting reduction of cardiovascular events with dalcetrapib.
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Tardif, Jean-Claude, Tardif, Jean-Claude, Dubé, Marie-Pierre, Pfeffer, Marc A, Waters, David D, Koenig, Wolfgang, Maggioni, Aldo P, McMurray, John JV, Mooser, Vincent, White, Harvey D, Heinonen, Therese, Black, Donald M, Guertin, Marie-Claude, dal-GenE Investigators, Tardif, Jean-Claude, Tardif, Jean-Claude, Dubé, Marie-Pierre, Pfeffer, Marc A, Waters, David D, Koenig, Wolfgang, Maggioni, Aldo P, McMurray, John JV, Mooser, Vincent, White, Harvey D, Heinonen, Therese, Black, Donald M, Guertin, Marie-Claude, and dal-GenE Investigators
- Abstract
The objectives of precision medicine are to better match patient characteristics with the therapeutic intervention to optimize the chances of beneficial actions while reducing the exposure to unneeded adverse drug experiences. In a retrospective genome-wide association study of the overall neutral placebo-controlled dal-Outcomes trial, the effect of the cholesteryl ester transfer protein (CETP) modulator dalcetrapib on the composite of cardiovascular death, myocardial infarction or stroke was found to be influenced by a polymorphism in the adenylate cyclase type 9 (ADCY9) gene. Whereas patients with the AA genotype at position rs1967309 experienced fewer cardiovascular events with dalcetrapib, those with the GG genotype had an increased rate and the heterozygous AG genotype exhibited no difference from placebo. Measurements of cholesterol efflux and C-reactive protein (CRP) offered directionally supportive genotype-specific findings. In a separate, smaller, placebo-controlled trial, regression of ultrasonography-determined carotid intimal-medial thickness was only observed in dalcetrapib-treated patients with the AA genotype. Collectively, these observations led to the hypothesis that the cardiovascular effects of dalcetrapib may be pharmacogenetically determined, with a favorable benefit-risk ratio only for patients with this specific genotype. We describe below the design of dal-GenE, a precision medicine, placebo-controlled clinical outcome trial of dalcetrapib in patients with a recent acute myocardial infarction with the unique feature of selecting only those with the AA genotype at rs1967309 in the ADCY9 gene.
- Published
- 2020
31. Will Colchicine Soon Be Part of Primary and Secondary Cardiovascular Prevention?
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Samuel, Michelle, Samuel, Michelle, Waters, David D, Samuel, Michelle, Samuel, Michelle, and Waters, David D
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- 2020
32. Time-to-treatment initiation of colchicine and cardiovascular outcomes after myocardial infarction in the Colchicine Cardiovascular Outcomes Trial (COLCOT).
- Author
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Bouabdallaoui, Nadia, Bouabdallaoui, Nadia, Tardif, Jean-Claude, Waters, David D, Pinto, Fausto J, Maggioni, Aldo P, Diaz, Rafael, Berry, Colin, Koenig, Wolfgang, Lopez-Sendon, Jose, Gamra, Habib, Kiwan, Ghassan S, Blondeau, Lucie, Orfanos, Andreas, Ibrahim, Reda, Grégoire, Jean C, Dubé, Marie-Pierre, Samuel, Michelle, Morel, Olivier, Lim, Pascal, Bertrand, Olivier F, Kouz, Simon, Guertin, Marie-Claude, L'Allier, Philippe L, Roubille, Francois, Bouabdallaoui, Nadia, Bouabdallaoui, Nadia, Tardif, Jean-Claude, Waters, David D, Pinto, Fausto J, Maggioni, Aldo P, Diaz, Rafael, Berry, Colin, Koenig, Wolfgang, Lopez-Sendon, Jose, Gamra, Habib, Kiwan, Ghassan S, Blondeau, Lucie, Orfanos, Andreas, Ibrahim, Reda, Grégoire, Jean C, Dubé, Marie-Pierre, Samuel, Michelle, Morel, Olivier, Lim, Pascal, Bertrand, Olivier F, Kouz, Simon, Guertin, Marie-Claude, L'Allier, Philippe L, and Roubille, Francois
- Abstract
AimsThe COLchicine Cardiovascular Outcomes Trial (COLCOT) demonstrated the benefits of targeting inflammation after myocardial infarction (MI). We aimed to determine whether time-to-treatment initiation (TTI) influences the beneficial impact of colchicine.Methods and resultsIn COLCOT, patients were randomly assigned to receive colchicine or placebo within 30 days post-MI. Time-to-treatment initiation was defined as the length of time between the index MI and the initiation of study medication. The primary efficacy endpoint was a composite of cardiovascular death, resuscitated cardiac arrest, MI, stroke, or urgent hospitalization for angina requiring coronary revascularization. The relationship between endpoints and various TTI (<3, 4-7 and >8 days) was examined using multivariable Cox regression models. Amongst the 4661 patients included in this analysis, there were 1193, 720, and 2748 patients, respectively, in the three TTI strata. After a median follow-up of 22.7 months, there was a significant reduction in the incidence of the primary endpoint for patients in whom colchicine was initiated < Day 3 compared with placebo [hazard ratios (HR) = 0.52, 95% confidence intervals (CI) 0.32-0.84], in contrast to patients in whom colchicine was initiated between Days 4 and 7 (HR = 0.96, 95% CI 0.53-1.75) or > Day 8 (HR = 0.82, 95% CI 0.61-1.11). The beneficial effects of early initiation of colchicine were also demonstrated for urgent hospitalization for angina requiring revascularization (HR = 0.35), all coronary revascularization (HR = 0.63), and the composite of cardiovascular death, resuscitated cardiac arrest, MI, or stroke (HR = 0.55, all P < 0.05).ConclusionPatients benefit from early, in-hospital initiation of colchicine after MI.Trial registrationCOLCOT ClinicalTrials.gov number, NCT02551094.
- Published
- 2020
33. When Diastole Lets You Down: Clinical Relevance of a Widened Pulse Pressure.
- Author
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Tannenbaum, Jordan, Tannenbaum, Jordan, Bittner, Vera, Waters, David D, Tannenbaum, Jordan, Tannenbaum, Jordan, Bittner, Vera, and Waters, David D
- Published
- 2020
34. Study design of Dal-GenE, a pharmacogenetic trial targeting reduction of cardiovascular events with dalcetrapib.
- Author
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Tardif, Jean-Claude, Tardif, Jean-Claude, Dubé, Marie-Pierre, Pfeffer, Marc A, Waters, David D, Koenig, Wolfgang, Maggioni, Aldo P, McMurray, John JV, Mooser, Vincent, White, Harvey D, Heinonen, Therese, Black, Donald M, Guertin, Marie-Claude, dal-GenE Investigators, Tardif, Jean-Claude, Tardif, Jean-Claude, Dubé, Marie-Pierre, Pfeffer, Marc A, Waters, David D, Koenig, Wolfgang, Maggioni, Aldo P, McMurray, John JV, Mooser, Vincent, White, Harvey D, Heinonen, Therese, Black, Donald M, Guertin, Marie-Claude, and dal-GenE Investigators
- Abstract
The objectives of precision medicine are to better match patient characteristics with the therapeutic intervention to optimize the chances of beneficial actions while reducing the exposure to unneeded adverse drug experiences. In a retrospective genome-wide association study of the overall neutral placebo-controlled dal-Outcomes trial, the effect of the cholesteryl ester transfer protein (CETP) modulator dalcetrapib on the composite of cardiovascular death, myocardial infarction or stroke was found to be influenced by a polymorphism in the adenylate cyclase type 9 (ADCY9) gene. Whereas patients with the AA genotype at position rs1967309 experienced fewer cardiovascular events with dalcetrapib, those with the GG genotype had an increased rate and the heterozygous AG genotype exhibited no difference from placebo. Measurements of cholesterol efflux and C-reactive protein (CRP) offered directionally supportive genotype-specific findings. In a separate, smaller, placebo-controlled trial, regression of ultrasonography-determined carotid intimal-medial thickness was only observed in dalcetrapib-treated patients with the AA genotype. Collectively, these observations led to the hypothesis that the cardiovascular effects of dalcetrapib may be pharmacogenetically determined, with a favorable benefit-risk ratio only for patients with this specific genotype. We describe below the design of dal-GenE, a precision medicine, placebo-controlled clinical outcome trial of dalcetrapib in patients with a recent acute myocardial infarction with the unique feature of selecting only those with the AA genotype at rs1967309 in the ADCY9 gene.
- Published
- 2020
35. Will Colchicine Soon Be Part of Primary and Secondary Cardiovascular Prevention?
- Author
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Samuel, Michelle, Samuel, Michelle, Waters, David D, Samuel, Michelle, Samuel, Michelle, and Waters, David D
- Published
- 2020
36. Time-to-treatment initiation of colchicine and cardiovascular outcomes after myocardial infarction in the Colchicine Cardiovascular Outcomes Trial (COLCOT).
- Author
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Bouabdallaoui, Nadia, Bouabdallaoui, Nadia, Tardif, Jean-Claude, Waters, David D, Pinto, Fausto J, Maggioni, Aldo P, Diaz, Rafael, Berry, Colin, Koenig, Wolfgang, Lopez-Sendon, Jose, Gamra, Habib, Kiwan, Ghassan S, Blondeau, Lucie, Orfanos, Andreas, Ibrahim, Reda, Grégoire, Jean C, Dubé, Marie-Pierre, Samuel, Michelle, Morel, Olivier, Lim, Pascal, Bertrand, Olivier F, Kouz, Simon, Guertin, Marie-Claude, L'Allier, Philippe L, Roubille, Francois, Bouabdallaoui, Nadia, Bouabdallaoui, Nadia, Tardif, Jean-Claude, Waters, David D, Pinto, Fausto J, Maggioni, Aldo P, Diaz, Rafael, Berry, Colin, Koenig, Wolfgang, Lopez-Sendon, Jose, Gamra, Habib, Kiwan, Ghassan S, Blondeau, Lucie, Orfanos, Andreas, Ibrahim, Reda, Grégoire, Jean C, Dubé, Marie-Pierre, Samuel, Michelle, Morel, Olivier, Lim, Pascal, Bertrand, Olivier F, Kouz, Simon, Guertin, Marie-Claude, L'Allier, Philippe L, and Roubille, Francois
- Abstract
AimsThe COLchicine Cardiovascular Outcomes Trial (COLCOT) demonstrated the benefits of targeting inflammation after myocardial infarction (MI). We aimed to determine whether time-to-treatment initiation (TTI) influences the beneficial impact of colchicine.Methods and resultsIn COLCOT, patients were randomly assigned to receive colchicine or placebo within 30 days post-MI. Time-to-treatment initiation was defined as the length of time between the index MI and the initiation of study medication. The primary efficacy endpoint was a composite of cardiovascular death, resuscitated cardiac arrest, MI, stroke, or urgent hospitalization for angina requiring coronary revascularization. The relationship between endpoints and various TTI (<3, 4-7 and >8 days) was examined using multivariable Cox regression models. Amongst the 4661 patients included in this analysis, there were 1193, 720, and 2748 patients, respectively, in the three TTI strata. After a median follow-up of 22.7 months, there was a significant reduction in the incidence of the primary endpoint for patients in whom colchicine was initiated < Day 3 compared with placebo [hazard ratios (HR) = 0.52, 95% confidence intervals (CI) 0.32-0.84], in contrast to patients in whom colchicine was initiated between Days 4 and 7 (HR = 0.96, 95% CI 0.53-1.75) or > Day 8 (HR = 0.82, 95% CI 0.61-1.11). The beneficial effects of early initiation of colchicine were also demonstrated for urgent hospitalization for angina requiring revascularization (HR = 0.35), all coronary revascularization (HR = 0.63), and the composite of cardiovascular death, resuscitated cardiac arrest, MI, or stroke (HR = 0.55, all P < 0.05).ConclusionPatients benefit from early, in-hospital initiation of colchicine after MI.Trial registrationCOLCOT ClinicalTrials.gov number, NCT02551094.
- Published
- 2020
37. PCSK9 Inhibition to Reduce Cardiovascular Risk: Tempering Expectations.
- Author
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Waters, David D, Waters, David D, Hsue, Priscilla Y, Waters, David D, Waters, David D, and Hsue, Priscilla Y
- Published
- 2017
38. Are Cholesterol Treatment Targets a Deterrent to Optimal Lipid-Lowering Therapy?
- Author
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Waters, David D, Waters, David D, Waters, David D, and Waters, David D
- Published
- 2017
39. The Rise and Fall of Tuberculosis and Atherosclerosis: First There Is a Mountain….
- Author
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Waters, David D, Waters, David D, Waters, David D, and Waters, David D
- Published
- 2017
40. The Evolution of Myocardial Infarction: When the Truths We Hold To Be Self-Evident No Longer Have Evidence.
- Author
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Waters, David D, Waters, David D, Bangalore, Sripal, Waters, David D, Waters, David D, and Bangalore, Sripal
- Published
- 2017
41. An Evidence-Based Guide to Cholesterol-Lowering Guidelines.
- Author
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Waters, David D, Waters, David D, Boekholdt, S Matthijs, Waters, David D, Waters, David D, and Boekholdt, S Matthijs
- Abstract
Since 2014, guidelines for the management of lipid disorders to reduce cardiovascular (CV) events have been updated in the United States, the United Kingdom, Europe, and Canada. Some of these guidelines are almost entirely evidence-based whereas others are a mix of evidence and expert opinion. Guidelines differ on such simple questions as to whether blood samples should be fasting or nonfasting, and whether low-density lipoprotein cholesterol (LDL-C) or another lipid parameter should be the primary focus of treatment. Different risk assessment tools are recommended by different guidelines. Lifetime risk is highlighted in some guidelines, with the suggestion that earlier treatment will reduce lifetime risk in younger people even when short-term risk is low. Some guidelines have numerical treatment targets that differ according to level of risk, while others eschew targets but recommend statins at high or moderate intensity to reduce LDL-C by ≥ 50% or 30%-50%, respectively. Statins are the backbone of therapy in all guidelines. Ezetimibe produced a 6.4% relative risk reduction in the only large clinical outcomes trial in which it was tested, and is recommended for high-risk patients with an inadequate response to statins, despite the high number needed to treat to prevent 1 CV event. Proprotein convertase subtilisin/kexin 9 inhibitors lack outcome data to support their use, but are approved for patients with familial hypercholesterolemia or clinical atherosclerotic CV disease who require additional LDL-C lowering beyond statins. All these new guidelines are aimed at improving the problem of undertreatment of high-risk groups, leading to better outcomes for these patients.
- Published
- 2017
42. An Evidence-Based Guide to Cholesterol-Lowering Guidelines.
- Author
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Waters, David D, Waters, David D, Boekholdt, S Matthijs, Waters, David D, Waters, David D, and Boekholdt, S Matthijs
- Abstract
Since 2014, guidelines for the management of lipid disorders to reduce cardiovascular (CV) events have been updated in the United States, the United Kingdom, Europe, and Canada. Some of these guidelines are almost entirely evidence-based whereas others are a mix of evidence and expert opinion. Guidelines differ on such simple questions as to whether blood samples should be fasting or nonfasting, and whether low-density lipoprotein cholesterol (LDL-C) or another lipid parameter should be the primary focus of treatment. Different risk assessment tools are recommended by different guidelines. Lifetime risk is highlighted in some guidelines, with the suggestion that earlier treatment will reduce lifetime risk in younger people even when short-term risk is low. Some guidelines have numerical treatment targets that differ according to level of risk, while others eschew targets but recommend statins at high or moderate intensity to reduce LDL-C by ≥ 50% or 30%-50%, respectively. Statins are the backbone of therapy in all guidelines. Ezetimibe produced a 6.4% relative risk reduction in the only large clinical outcomes trial in which it was tested, and is recommended for high-risk patients with an inadequate response to statins, despite the high number needed to treat to prevent 1 CV event. Proprotein convertase subtilisin/kexin 9 inhibitors lack outcome data to support their use, but are approved for patients with familial hypercholesterolemia or clinical atherosclerotic CV disease who require additional LDL-C lowering beyond statins. All these new guidelines are aimed at improving the problem of undertreatment of high-risk groups, leading to better outcomes for these patients.
- Published
- 2017
43. The Rise and Fall of Tuberculosis and Atherosclerosis: First There Is a Mountain….
- Author
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Waters, David D, Waters, David D, Waters, David D, and Waters, David D
- Published
- 2017
44. The Evolution of Myocardial Infarction: When the Truths We Hold To Be Self-Evident No Longer Have Evidence.
- Author
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Waters, David D, Waters, David D, Bangalore, Sripal, Waters, David D, Waters, David D, and Bangalore, Sripal
- Published
- 2017
45. Are Cholesterol Treatment Targets a Deterrent to Optimal Lipid-Lowering Therapy?
- Author
-
Waters, David D, Waters, David D, Waters, David D, and Waters, David D
- Published
- 2017
46. PCSK9 Inhibition to Reduce Cardiovascular Risk: Tempering Expectations.
- Author
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Waters, David D, Waters, David D, Hsue, Priscilla Y, Waters, David D, Waters, David D, and Hsue, Priscilla Y
- Published
- 2017
47. HIV infection and coronary heart disease: mechanisms and management.
- Author
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Hsue, Priscilla Y, Hsue, Priscilla Y, Waters, David D, Hsue, Priscilla Y, Hsue, Priscilla Y, and Waters, David D
- Abstract
Antiretroviral therapy has largely transformed HIV infection into a chronic disease condition. As such, physicians and other providers caring for individuals living with HIV infection need to be aware of the potential cardiovascular complications of HIV infection and the nuances of how HIV infection increases the risk of cardiovascular diseases, including acute myocardial infarction, stroke, peripheral artery disease, heart failure and sudden cardiac death, as well as how to select available therapies to reduce this risk. In this Review, we discuss the epidemiology and clinical features of cardiovascular disease, with a focus on coronary heart disease, in the setting of HIV infection, which includes a substantially increased risk of myocardial infarction even when the HIV infection is well controlled. We also discuss the mechanisms underlying HIV-associated atherosclerotic cardiovascular disease, such as the high rates of traditional cardiovascular risk factors in patients with HIV infection and HIV-related factors, including the use of antiretroviral therapy and chronic inflammation in the setting of effectively treated HIV infection. Finally, we highlight available therapeutic strategies, as well as approaches under investigation, to reduce the risk of cardiovascular disease and lower inflammation in patients with HIV infection.
- Published
- 2019
48. High plasma FGF21 levels predicts major cardiovascular events in patients treated with atorvastatin (from the Treating to New Targets [TNT] Study).
- Author
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Ong, Kwok Leung, Ong, Kwok Leung, Hui, Nicholas, Januszewski, Andrzej S, Kaakoush, Nadeem O, Xu, Aimin, Fayyad, Rana, DeMicco, David A, Jenkins, Alicia J, Keech, Anthony C, Waters, David D, Barter, Philip J, Rye, Kerry-Anne, Ong, Kwok Leung, Ong, Kwok Leung, Hui, Nicholas, Januszewski, Andrzej S, Kaakoush, Nadeem O, Xu, Aimin, Fayyad, Rana, DeMicco, David A, Jenkins, Alicia J, Keech, Anthony C, Waters, David D, Barter, Philip J, and Rye, Kerry-Anne
- Abstract
BackgroundHigher plasma fibroblast growth factor 21 (FGF21) levels predict incident cardiovascular events in type 2 diabetes patients. However, whether FGF21 levels predict cardiovascular events in statin-treated patients in the general population is unknown. We investigated whether FGF21 levels predict major cardiovascular event (MCVE) in the Treating to New Targets (TNT) trial participants.MethodsAfter 8-week run-in on atorvastatin 10 mg/day, 10,001 patients with stable coronary disease in the TNT trial were randomized to 10 mg or 80 mg/day of atorvastatin for a median of 4.9 years. We analyzed data from 1996 patients with plasma FGF21 levels measured at randomization. Among them, 1835 patients had FGF21 measured one-year post-randomization.ResultsHigher ln-transformed FGF21 levels at randomization were associated with higher risk of incident MCVE (adjusted hazards ratio per SD increase = 1.18, P = 0.019). At 1-year post-randomization, FGF21 levels were lower in patients randomized to receive 80 mg versus 10 mg atorvastatin (186.9 versus 207.5 pg/mL respectively, P = 0.006). Higher ln-transformed FGF21 levels at 1-year post-randomization were also associated with higher subsequent risk of MCVEs (adjusted hazards ratio per SD increase = 1.24, P = 0.009). However, changes in FGF21 levels over 1-year were not related to subsequent MCVE risk. FGF21 levels had significant incremental value in net reclassification improvement in MCVE risk prediction.ConclusionsHigher plasma FGF21 levels are associated with higher CVD risk in statin-treated high-risk patients. Higher dose atorvastatin is associated with a reduction in FGF21 levels. FGF21 provides incremental value in CVD risk prediction in statin-treated patients.
- Published
- 2019
49. Improving Statin Noncompliance: If You Build It, Will They Come?
- Author
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Sparrow, Robert T, Sparrow, Robert T, Ferreira-Legere, Laura, Udell, Jacob A, Waters, David D, Sparrow, Robert T, Sparrow, Robert T, Ferreira-Legere, Laura, Udell, Jacob A, and Waters, David D
- Published
- 2019
50. Efficacy and Safety of Low-Dose Colchicine after Myocardial Infarction.
- Author
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Tardif, Jean-Claude, Tardif, Jean-Claude, Kouz, Simon, Waters, David D, Bertrand, Olivier F, Diaz, Rafael, Maggioni, Aldo P, Pinto, Fausto J, Ibrahim, Reda, Gamra, Habib, Kiwan, Ghassan S, Berry, Colin, López-Sendón, José, Ostadal, Petr, Koenig, Wolfgang, Angoulvant, Denis, Grégoire, Jean C, Lavoie, Marc-André, Dubé, Marie-Pierre, Rhainds, David, Provencher, Mylène, Blondeau, Lucie, Orfanos, Andreas, L'Allier, Philippe L, Guertin, Marie-Claude, Roubille, François, Tardif, Jean-Claude, Tardif, Jean-Claude, Kouz, Simon, Waters, David D, Bertrand, Olivier F, Diaz, Rafael, Maggioni, Aldo P, Pinto, Fausto J, Ibrahim, Reda, Gamra, Habib, Kiwan, Ghassan S, Berry, Colin, López-Sendón, José, Ostadal, Petr, Koenig, Wolfgang, Angoulvant, Denis, Grégoire, Jean C, Lavoie, Marc-André, Dubé, Marie-Pierre, Rhainds, David, Provencher, Mylène, Blondeau, Lucie, Orfanos, Andreas, L'Allier, Philippe L, Guertin, Marie-Claude, and Roubille, François
- Abstract
BackgroundExperimental and clinical evidence supports the role of inflammation in atherosclerosis and its complications. Colchicine is an orally administered, potent antiinflammatory medication that is indicated for the treatment of gout and pericarditis.MethodsWe performed a randomized, double-blind trial involving patients recruited within 30 days after a myocardial infarction. The patients were randomly assigned to receive either low-dose colchicine (0.5 mg once daily) or placebo. The primary efficacy end point was a composite of death from cardiovascular causes, resuscitated cardiac arrest, myocardial infarction, stroke, or urgent hospitalization for angina leading to coronary revascularization. The components of the primary end point and safety were also assessed.ResultsA total of 4745 patients were enrolled; 2366 patients were assigned to the colchicine group, and 2379 to the placebo group. Patients were followed for a median of 22.6 months. The primary end point occurred in 5.5% of the patients in the colchicine group, as compared with 7.1% of those in the placebo group (hazard ratio, 0.77; 95% confidence interval [CI], 0.61 to 0.96; P = 0.02). The hazard ratios were 0.84 (95% CI, 0.46 to 1.52) for death from cardiovascular causes, 0.83 (95% CI, 0.25 to 2.73) for resuscitated cardiac arrest, 0.91 (95% CI, 0.68 to 1.21) for myocardial infarction, 0.26 (95% CI, 0.10 to 0.70) for stroke, and 0.50 (95% CI, 0.31 to 0.81) for urgent hospitalization for angina leading to coronary revascularization. Diarrhea was reported in 9.7% of the patients in the colchicine group and in 8.9% of those in the placebo group (P = 0.35). Pneumonia was reported as a serious adverse event in 0.9% of the patients in the colchicine group and in 0.4% of those in the placebo group (P = 0.03).ConclusionsAmong patients with a recent myocardial infarction, colchicine at a dose of 0.5 mg daily led to a significantly lower risk of ischemic cardiovascular events than placebo. (Funded by the Gove
- Published
- 2019
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