243 results on '"Pais, Prem"'
Search Results
2. General versus central adiposity as risk factors for cardiovascular-related outcomes in a high-risk population with type 2 diabetes: a post hoc analysis of the REWIND trial
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Franek, Edward, Pais, Prem, Basile, Jan, Nicolay, Claudia, Raha, Sohini, Hickey, Ana, Ahmad, Nadia N., Konig, Manige, Kan, Hong, and Gerstein, Hertzel C.
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- 2023
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3. Tobacco use and risk of acute stroke in 32 countries in the INTERSTROKE study: a case–control study
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Wang, Xingyu, Liu, Xin, O’Donnell, Martin J., McQueen, Matthew, Sniderman, Allan, Pare, Guillaume, Hankey, Graeme J., Rangarajan, Sumathy, Chin, Siu Lim, Rao-Melacini, Purnima, Ferguson, John, Xavier, Denis, Zhang, Hongye, Lisheng, Liu, Pais, Prem, Lopez-Jaramillo, Patricio, Damasceno, Albertino, Langhorne, Peter, Rosengren, Annika, Dans, Antonio L., Elsayed, Ahmed, Avezum, Alvaro, Mondo, Charles, Judge, Conor, Diener, Hans-Christoph, Ryglewicz, Danuta, Czlonkowska, Anna, Pogosova, Nana, Weimar, Christian, Iqbal, Romana, Diaz, Rafael, Yusoff, Khalid, Yusufali, Afzalhussein, Oguz, Aytekin, Penaherrera, Ernesto, Lanas, Fernando, Ogah, Okechukwu S., Ogunniyi, A., Iversen, Helle K., Malaga, German, Rumboldt, Zvonko, Oveisgharan, Shahram, Al Hussain, Fawaz, Nilanont, Yongchai, and Yusuf, Salim
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- 2024
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4. Fixed-Dose Combination Therapy for the Prevention of Cardiovascular Diseases in CKD: An Individual Participant Data Meta-Analysis
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Sepanlou, Sadaf G., Mann, Johannes F.E., Joseph, Philip, Pais, Prem, Gao, Peggy, Sharafkhah, Maryam, Roshandel, Gholamreza, Yusuf, Salim, and Malekzadeh, Reza
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- 2023
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5. Secondary prevention with a structured semi-interactive stroke prevention package in INDIA (SPRINT INDIA): a multicentre, randomised controlled trial
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Pandian, Jeyaraj Durai, Kate, Mahesh Pundlik, Sylaja, Padmavathyamma Narayanapillai, Khurana, Dheeraj, Pamidimukkala, Vijaya, Ray, Biman Kanti, Nambiar, Vivek Keshavan, Aaron, Sanjith, Mittal, Gaurav Kumar, Nagarjunakonda, Sundarachary, Pai, Aparna Ramakrishna, Gorthi, Sankar Prasad, Kumaravelu, Somasundaram, Reddy, Yerasu Muralidhar, Narayan, Sunil, Borah, Nomal Chandra, Das, Rupjyoti, Kulkarni, Girish Baburao, Huded, Vikram, Mathew, Thomas, Srivastava, M Vasantha Padma, Bhatia, Rohit, Ojha, Pawan Tarkeshwarnath, Roy, Jayanta, Abraham, Sherly Mary, Vaishnav, Anand Girish, Sharma, Arvind, Jabeen, Shaikh Afshan, Pathak, Abhishek, Bhoi, Sanjeev Kumar, Sharma, Sudhir, Sulena, Sulena, Saroja, Aralikatte Onkarappa, Ramrakhiani, Neetu, Kempegowda, Madhusudhan Byadarahalli, Sreedharan, Sapna Erat, Das, Gautam, George, Tina, Sebastian, Ivy, Sahonta, Rajeshwar, Jaiswal, Shyam Krishnakumar, Pidaparthi, Lalitha, Aghoram, Rajeshwari, Webster, Jemin Jeyachandra, Shah, Rakesh Hasmukhlal, Jha, Menka, Niak, Karkal Ravishankar, Arora, Deepti, Verma, Shweta Jain, Huilgol, Rahul, Dhasan, Aneesh, Renjith, Vishnu, Khatter, Himani, Sarma, Prabhakaran, Visakh, Sadasivan Laila, Kaur, Sukhmandeep, Rao, Tagallamudi Nagamalleswara, Dumpala, Venkatesh, Podder, Gargi, Biswas, Arindam, Rani, Karthika, Dhamodharan, Nishanthini, Sekhar, Shilpa, Chinka, Satish Kumar, Prabhu, Varsha Aroor, Zaha, Farhaz, Ramanathan, Sarvotham, Pabbu, Deepika, Choudhury, Nupur, Ramanathan, Ramya, James, Saji K, Kuthalia, Neha, Sharma, Sakshi, Gaikwad, Mayuri Ramchandra, Sen, Purbita, Basumatary, Sumita, Bhatt, Rachana Dhruvesh, Patel, Dipal, Cyriac, Mareena, Swain, Sasmita, Kumar, Narinder, Kurubara, Amaresh, Sharma, Devang, Sharma, Meenakshi, Dhaliwal, Rupinder, Murthy, Jagarlapudi Murali Krishna, Pais, Prem, Xavier, Denis, Satishchandra, Parthasarathy, Kaul, Subash, Sreenivas, Vishnubhatla, Chandran, Suresh, Calton, Rajneesh Kumar, and George, Jacob
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- 2023
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6. Fixed-Dose Combination Therapy for Prevention of Cardiovascular Diseases in CKD: An Individual Participant Data Meta-analysis
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Sepanlou, Sadaf G., primary, Mann, Johannes F.E., additional, Joseph, Philip, additional, Pais, Prem, additional, Gao, Peggy, additional, Sharafkhah, Maryam, additional, Roshandel, Gholamreza, additional, Yusuf, Salim, additional, and Malekzadeh, Reza, additional
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- 2023
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7. Anti-Inflammatory Therapy With Canakinumab for the Prevention and Management of Diabetes
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Everett, Brendan M., Donath, Marc Y., Pradhan, Aruna D., Thuren, Tom, Pais, Prem, Nicolau, Jose C., Glynn, Robert J., Libby, Peter, and Ridker, Paul M
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- 2018
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8. Total cardiovascular or fatal events in people with type 2 diabetes and cardiovascular risk factors treated with dulaglutide in the REWIND trail: a post hoc analysis
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Dagenais, Gilles R., Rydén, Lars, Leiter, Lawrence A., Lakshmanan, Mark, Dyal, Leanne, Probstfield, Jeffrey L., Atisso, Charles Messan, Shaw, Jonathan E., Conget, Ignacio, Cushman, William C., Lopez-Jaramillo, Patricio, Lanas, Fernando, Munoz, Ernesto German Cordona, Pirags, Valdis, Pogosova, Nana, Basile, Jan, Sheu, Wayne H. H., Temelkova-Kurktschiev, Theodora, Raubenheimer, Peter J., Keltai, Matyas, Hall, Stephanie, Pais, Prem, Colhoun, Helen M., Riddle, Matthew C., and Gerstein, Hertzel C.
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- 2020
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9. Resource and Infrastructure-Appropriate Management of ST-Segment Elevation Myocardial Infarction in Low- and Middle-Income Countries
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Chandrashekhar, Y., Alexander, Thomas, Mullasari, Ajit, Kumbhani, Dharam J., Alam, Samir, Alexanderson, Erick, Bachani, Damodar, Wilhelmus Badenhorst, Jacobus Cornelius, Baliga, Ragavendra, Bax, Jeroen J., Bhatt, Deepak L., Bossone, Eduardo, Botelho, Roberto, Chakraborthy, Rabindra Nath, Chazal, Richard A., Dhaliwal, Rupinder Singh, Gamra, Habib, Harikrishnan, Sivadasan Pillai, Jeilan, Mohamed, Kettles, David Ian, Mehta, Sameer, Mohanan, Padhinhare P., Kurt Naber, Christoph, Naik, Nitish, Ntsekhe, Mpiko, Otieno, Harun Argwings, Pais, Prem, Piñeiro, Daniel José, Prabhakaran, Dorairaj, Reddy, K. Srinath, Redha, Mustafa, Roy, Ambuj, Sharma, Meenakshi, Shor, Robert, Adriaan Snyders, Frederik, Weii Chieh Tan, Jack, Valentine, C. Michael, Wilson, B. Hadley, Yusuf, Salim, and Narula, Jagat
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- 2020
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10. Prevalence, treatments and outcomes of coronary artery disease in Indians: A systematic review
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Rao, Mangala, Xavier, Denis, Devi, Padmini, Sigamani, Alben, Faruqui, Atiya, Gupta, Rajeev, Kerkar, Prafulla, Jain, Rajendra Kumar, Joshi, Rajnish, Chidambaram, N., Rao, Daya Sagar, Thanikachalam, S., Iyengar, S.S., Verghese, Kiron, Mohan, V., and Pais, Prem
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- 2015
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11. Dulaglutide and cardiovascular and heart failure outcomes in patients with and without heart failure: a post‐hoc analysis from the REWIND randomized trial
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Branch, Kelley R.H., primary, Dagenais, Gilles R., additional, Avezum, Alvaro, additional, Basile, Jan, additional, Conget, Ignacio, additional, Cushman, William C., additional, Jansky, Petr, additional, Lakshmanan, Mark, additional, Lanas, Fernando, additional, Leiter, Lawrence A., additional, Pais, Prem, additional, Pogosova, Nana, additional, Raubenheimer, Peter J., additional, Ryden, Lars, additional, Shaw, Jonathan E., additional, Sheu, Wayne H.H., additional, Temelkova‐Kurktschiev, Theodora, additional, Bethel, M. Angelyn, additional, Gerstein, Hertzel C., additional, Chinthanie, Ramasundarahettige, additional, and Probstfield, Jeffrey L., additional
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- 2022
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12. The Anti-Coronavirus Therapies (ACT) Trials: Design, Baseline Characteristics, and Challenges
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Eikelboom, John, primary, Rangarajan, Sumathy, additional, Jolly, Sanjit S., additional, Belley-Cote, Emilie P., additional, Whitlock, Richard, additional, Beresh, Heather, additional, Lewis, Gayle, additional, Xu, Lizhen, additional, Chan, Noel, additional, Bangdiwala, Shrikant, additional, Diaz, Rafael, additional, Orlandini, Andres, additional, Hassany, Mohamed, additional, Tarhuni, Wadea M., additional, Yusufali, A.M., additional, Sharma, Sanjib Kumar, additional, Kontsevaya, Anna, additional, Lopez-Jaramillo, Patricio, additional, Avezum, Alvaro, additional, Dans, Antonio L., additional, Wasserman, Sean, additional, Felix, Camilo, additional, Kazmi, Khawar, additional, Pais, Prem, additional, Xavier, Denis, additional, Lopes, Renato D., additional, Berwanger, Otavio, additional, Nkeshimana, Menelas, additional, Harper, William, additional, Loeb, Mark, additional, Choudhri, Shurjeel, additional, Farkouh, Michael E., additional, Bosch, Jackie, additional, Anand, Sonia S., additional, and Yusuf, Salim, additional
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- 2022
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13. MO201: Effects of Aspirin in Primary Prevention of Cardiovascular (CV) Disease in People with Chronic Kidney Disease (CKD): Results of the TIPS3 Trial
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Mann, Johannes F E, primary, Joseph, Philip, additional, Gao, Peggy, additional, Pais, Prem, additional, Xavier, Denis, additional, Dans, Tony, additional, Lopez Jaramillo, Patricio, additional, Gamra, Habib, additional, Tyrwhitt, Jessica, additional, and Yusuf, Salim, additional
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- 2022
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14. Association of Lipids, Lipoproteins, and Apolipoproteins with Stroke Subtypes in an International Case Control Study (INTERSTROKE)
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O’Donnell, Martin J, McQueen, Matthew, Sniderman, Allan, Pare, Guillaume, Wang, Xingyu, Hankey, Graeme J, Rangarajan, Sumathy, Chin, Siu Lim, Rao-Melacini, Purnima, Ferguson, John, Xavier, Denis, Lisheng, Liu, Zhang, Hongye, Pais, Prem, Lopez-Jaramillo, Patricio, Damasceno, Albertino, Langhorne, Peter, Rosengren, Annika, Dans, Antonio L, Elsayed, Ahmed, Avezum, Alvaro, Mondo, Charles, Judge, Conor, Diener, Hans-Christoph, Ryglewicz, Danuta, Czlonkowska, Anna, Pogosova, Nana, Weimar, Christian, Iqbal, Romana, Diaz, Rafael, Yusoff, Khalid, Yusufali, Afzalhussein, Oguz, Aytekin, Penaherrera, Ernesto, Lanas, Fernando, Ogah, Okechukwu S, Ogunniyi, Adesola, Iversen, Helle K., Malaga, German, Rumboldt, Zvonko, Oveisgharan, Shahram, Hussain, Fawaz Al, Nilanont, Yongchai, Yusuf, Salim, O’Donnell, Martin J, McQueen, Matthew, Sniderman, Allan, Pare, Guillaume, Wang, Xingyu, Hankey, Graeme J, Rangarajan, Sumathy, Chin, Siu Lim, Rao-Melacini, Purnima, Ferguson, John, Xavier, Denis, Lisheng, Liu, Zhang, Hongye, Pais, Prem, Lopez-Jaramillo, Patricio, Damasceno, Albertino, Langhorne, Peter, Rosengren, Annika, Dans, Antonio L, Elsayed, Ahmed, Avezum, Alvaro, Mondo, Charles, Judge, Conor, Diener, Hans-Christoph, Ryglewicz, Danuta, Czlonkowska, Anna, Pogosova, Nana, Weimar, Christian, Iqbal, Romana, Diaz, Rafael, Yusoff, Khalid, Yusufali, Afzalhussein, Oguz, Aytekin, Penaherrera, Ernesto, Lanas, Fernando, Ogah, Okechukwu S, Ogunniyi, Adesola, Iversen, Helle K., Malaga, German, Rumboldt, Zvonko, Oveisgharan, Shahram, Hussain, Fawaz Al, Nilanont, Yongchai, and Yusuf, Salim
- Abstract
Background and Purpose The association of dyslipidemia with stroke has been inconsistent, which may be due to differing associations within etiological stroke subtypes. We sought to determine the association of lipoproteins and apolipoproteins within stroke subtypes. Methods Standardized incident case-control STROKE study in 32 countries. Cases were patients with acute hospitalized first stroke, and matched by age, sex and site to controls. Concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (apoA1), and apoB were measured. Non-HDL-C was calculated. We estimated multivariable odds ratio (OR) and population attributable risk percentage (PAR%). Outcome measures were all stroke, ischemic stroke (and subtypes), and intracerebral hemorrhage (ICH). Results Our analysis included 11,898 matched case-control pairs; 77.3% with ischemic stroke and 22.7% with ICH. Increasing apoB (OR, 1.10; 95% confidence interval [CI], 1.06 to 1.14 per standard deviation [SD]) and LDL-C (OR, 1.06; 95% CI, 1.02 to 1.10 per SD) were associated with an increase in risk of ischemic stroke, but a reduced risk of ICH. Increased apoB was significantly associated with large vessel stroke (PAR 13.4%; 95% CI, 5.6 to 28.4) and stroke of undetermined cause. Higher HDL-C (OR, 0.75; 95% CI, 0.72 to 0.78 per SD) and apoA1 (OR, 0.63; 95% CI, 0.61 to 0.66 per SD) were associated with ischemic stroke (and subtypes). While increasing HDL-C was associated with an increased risk of ICH (OR, 1.20; 95% CI, 1.14 to 1.27 per SD), apoA1 was associated with a reduced risk (OR, 0.80; 95% CI, 0.75 to 0.85 per SD). ApoB/A1 (OR, 1.38; 95% CI, 1.32 to 1.44 per SD) had a stronger magnitude of association than the ratio of LDL-C/HDL-C (OR, 1.26; 95% CI, 1.21 to 1.31 per SD) with ischemic stroke (P<0.0001). Conclusions The pattern and magnitude of association of lipoproteins and apolipoproteins with stroke varies by etiological s
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- 2022
15. Association of Lipids, Lipoproteins, and Apolipoproteins with Stroke Subtypes in an International Case Control Study (INTERSTROKE)
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O'Donnell, Martin J., McQueen, Matthew, Sniderman, Allan, Pare, Guillaume, Wang, Xingyu, Hankey, Graeme J., Rangarajan, Sumathy, Chin, Siu Lim, Rao-Melacini, Purnima, Ferguson, John, Xavier, Denis, Lisheng, Liu, Zhang, Hongye, Pais, Prem, Lopez-Jaramillo, Patricio, Damasceno, Albertino, Langhorne, Peter, Rosengren, Annika, Dans, Antonio L., Elsayed, Ahmed, Avezum, Alvaro, Mondo, Charles, Judge, Conor, Diener, Hans-Christoph, Ryglewicz, Danuta, Czlonkowska, Anna, Pogosova, Nana, Weimar, Christian, Iqbal, Romana, Diaz, Rafael, Yusoff, Khalid, Yusufali, Afzalhussein, Oguz, Aytekin, Penaherrera, Ernesto, Lanas, Fernando, Ogah, Okechukwu S., Ogunniyi, Adesola, Iversen, Helle K., Malaga, German, Rumboldt, Zvonko, Oveisgharan, Shahram, Al Hussain, Fawaz, Nilanont, Yongchai, Yusuf, Salim, and on Behalf of the INTERSTROKE Investigators
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Stroke ,Apolipoproteins ,Dyslipidemia ,Lipoproteins ,Medizin ,lipids (amino acids, peptides, and proteins) ,cardiovascular diseases ,Neurology (clinical) ,Risk factor ,Case-control ,Cardiology and Cardiovascular Medicine - Abstract
Background and Purpose:\ud The association of dyslipidemia with stroke has been inconsistent, which may be due to differing associations within etiological stroke subtypes. We sought to determine the association of lipoproteins and apolipoproteins within stroke subtypes.\ud Methods:\ud Standardized incident case-control STROKE study in 32 countries. Cases were patients with acute hospitalized first stroke, and matched by age, sex and site to controls. Concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (apoA1), and apoB were measured. Non-HDL-C was calculated. We estimated multivariable odds ratio (OR) and population attributable risk percentage (PAR%). Outcome measures were all stroke, ischemic stroke (and subtypes), and intracerebral hemorrhage (ICH).\ud Results:\ud Our analysis included 11,898 matched case-control pairs; 77.3% with ischemic stroke and 22.7% with ICH. Increasing apoB (OR, 1.10; 95% confidence interval [CI], 1.06 to 1.14 per standard deviation [SD]) and LDL-C (OR, 1.06; 95% CI, 1.02 to 1.10 per SD) were associated with an increase in risk of ischemic stroke, but a reduced risk of ICH. Increased apoB was significantly associated with large vessel stroke (PAR 13.4%; 95% CI, 5.6 to 28.4) and stroke of undetermined cause. Higher HDL-C (OR, 0.75; 95% CI, 0.72 to 0.78 per SD) and apoA1 (OR, 0.63; 95% CI, 0.61 to 0.66 per SD) were associated with ischemic stroke (and subtypes). While increasing HDL-C was associated with an increased risk of ICH (OR, 1.20; 95% CI, 1.14 to 1.27 per SD), apoA1 was associated with a reduced risk (OR, 0.80; 95% CI, 0.75 to 0.85 per SD). ApoB/A1 (OR, 1.38; 95% CI, 1.32 to 1.44 per SD) had a stronger magnitude of association than the ratio of LDL-C/HDL-C (OR, 1.26; 95% CI, 1.21 to 1.31 per SD) with ischemic stroke (P
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- 2022
16. The Incidence of Bradyarrhythmias and Clinical Bradyarrhythmic Events in Patients With Acute Coronary Syndromes Treated With Ticagrelor or Clopidogrel in the PLATO (Platelet Inhibition and Patient Outcomes) Trial: Results of the Continuous Electrocardiographic Assessment Substudy
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Scirica, Benjamin M., Cannon, Christopher P., Emanuelsson, Håkan, Michelson, Eric L., Harrington, Robert A., Husted, Steen, James, Stefan, Katus, Hugo, Pais, Prem, Raev, Dimitar, Spinar, Jindrich, Steg, Ph. Gabriel, Storey, Robert F., and Wallentin, Lars
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- 2011
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17. Lipid Profile, Plasma Apolipoproteins, and Risk of a First Myocardial Infarction Among Asians: An Analysis From the INTERHEART Study
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Karthikeyan, Ganesan, Teo, Koon K., Islam, Shofiqul, McQueen, Mathew J., Pais, Prem, Wang, Xingyu, Sato, Hiroshi, Lang, Chim Choy, Sitthi-Amorn, Chitr, Pandey, M.R., Kazmi, Khawar, Sanderson, John E., and Yusuf, Salim
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- 2009
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18. 376-P: REWIND Data on Obesity and Cardiovascular (CV) Health: Waist-to-Hip Ratio (WHR) Independently Predicted CV Outcomes
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FRANEK, EDWARD, primary, PAIS, PREM, additional, BASILE, JAN N., additional, RAHA, SOHINI, additional, AHMAD, NADIA, additional, KAN, HONG, additional, and KONIG, MANIGE, additional
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- 2021
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19. Lowering cholesterol, blood pressure, or both to prevent cardiovascular events: results of 8.7 years of follow-up of Heart Outcomes Evaluation Prevention (HOPE)-3 study participants
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Bosch, Jackie, primary, Lonn, Eva M, additional, Jung, Hyejung, additional, Zhu, Jun, additional, Liu, Lisheng, additional, Lopez-Jaramillo, Patricio, additional, Pais, Prem, additional, Xavier, Denis, additional, Diaz, Rafael, additional, Dagenais, Gilles, additional, Dans, Antonio, additional, Avezum, Alvaro, additional, Piegas, Leopoldo S, additional, Parkhomenko, Alexander, additional, Keltai, Kati, additional, Keltai, Matyas, additional, Sliwa, Karen, additional, Held, Claus, additional, Peters, Ronald J G, additional, Lewis, Basil S, additional, Jansky, Petr, additional, Yusoff, Khalid, additional, Khunti, Kamlesh, additional, Toff, William D, additional, Reid, Christopher M, additional, Varigos, John, additional, Joseph, Philip, additional, Leiter, Lawrence A, additional, and Yusuf, Salim, additional
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- 2021
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20. Lowering cholesterol, blood pressure, or both to prevent cardiovascular events : results of 8.7 years of follow-up of Heart Outcomes Evaluation Prevention (HOPE)-3 study participants
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Bosch, Jackie, Lonn, Eva M., Jung, Hyejung, Zhu, Jun, Liu, Lisheng, Lopez-Jaramillo, Patricio, Pais, Prem, Xavier, Denis, Diaz, Rafael, Dagenais, Gilles, Dans, Antonio, Avezum, Alvaro, Piegas, Leopoldo S., Parkhomenko, Alexander, Keltai, Kati, Keltai, Matyas, Sliwa, Karen, Held, Claes, Peters, Ronald J. G., Lewis, Basil S., Jansky, Petr, Yusoff, Khalid, Khunti, Kamlesh, Toff, William D., Reid, Christopher M., Varigos, John, Joseph, Philip, Leiter, Lawrence A., Yusuf, Salim, Bosch, Jackie, Lonn, Eva M., Jung, Hyejung, Zhu, Jun, Liu, Lisheng, Lopez-Jaramillo, Patricio, Pais, Prem, Xavier, Denis, Diaz, Rafael, Dagenais, Gilles, Dans, Antonio, Avezum, Alvaro, Piegas, Leopoldo S., Parkhomenko, Alexander, Keltai, Kati, Keltai, Matyas, Sliwa, Karen, Held, Claes, Peters, Ronald J. G., Lewis, Basil S., Jansky, Petr, Yusoff, Khalid, Khunti, Kamlesh, Toff, William D., Reid, Christopher M., Varigos, John, Joseph, Philip, Leiter, Lawrence A., and Yusuf, Salim
- Abstract
Aims: Rosuvastatin (10 mg per day) compared with placebo reduced major adverse cardiovascular (CV) events by 24% in 12 705 participants at intermediate CV risk after 5.6 years. There was no benefit of blood pressure (BP) lowering treatment in the overall group, but a reduction in events in the third of participants with elevated systolic BP. After cessation of all the trial medications, we examined whether the benefits observed during the active treatment phase were sustained, enhanced, or attenuated. Methods and results: After the randomized treatment period (5.6 years), participants were invited to participate in 3.1 further years of observation (total 8.7 years). The first co-primary outcome for the entire length of follow-up was the composite of myocardial infarction, stroke, or CV death [major adverse cardiovascular event (MACE)-1], and the second was MACE-1 plus resuscitated cardiac arrest, heart failure, or coronary revascularization (MACE-2). In total, 9326 (78%) of 11 994 surviving Heart Outcomes Prevention Evaluation (HOPE)-3 subjects consented to participate in extended follow-up. During 3.1 years of post-trial observation (total follow-up of 8.7 years), participants originally randomized to rosuvastatin compared with placebo had a 20% additional reduction in MACE-1 [95% confidence interval (CI), 0.64-0.99] and a 17% additional reduction in MACE-2 (95% CI 0.68-1.01). Therefore, over the 8.7 years of follow-up, there was a 21% reduction in MACE-1 (95% CI 0.69-0.90, P = 0.005) and 21% reduction in MACE-2 (95% CI 0.69-0.89, P = 0.002). There was no benefit of BP lowering in the overall study either during the active or post-trial observation period, however, a 24% reduction in MACE-1 was observed over 8. Conclusion: The CV benefits of rosuvastatin, and BP lowering in those with elevated systolic BP, compared with placebo continue to accrue for at least 3 years after cessation of randomized treatment in individuals without cardiovascular disease indicating a
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- 2021
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21. Antihypertensives and Statin Therapy for Primary Stroke Prevention : A Secondary Analysis of the HOPE-3 Trial
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Bosch, Jackie, Lonn, Eva M., Dagenais, Gilles R., Gao, Peggy, Lopez-Jaramillo, Patricio, Zhu, Jun, Pais, Prem, Avezum, Alvaro, Sliwa, Karen, Chazova, Irina E., Peters, Ron J. G., Held, Claes, Yusoff, Khalid, Lewis, Basil S., Toff, William D., Khunti, Kamlesh, Reid, Christopher M., Leiter, Lawrence A., Yusuf, Salim, Hart, Robert G., Bosch, Jackie, Lonn, Eva M., Dagenais, Gilles R., Gao, Peggy, Lopez-Jaramillo, Patricio, Zhu, Jun, Pais, Prem, Avezum, Alvaro, Sliwa, Karen, Chazova, Irina E., Peters, Ron J. G., Held, Claes, Yusoff, Khalid, Lewis, Basil S., Toff, William D., Khunti, Kamlesh, Reid, Christopher M., Leiter, Lawrence A., Yusuf, Salim, and Hart, Robert G.
- Abstract
BACKGROUND AND PURPOSE: The HOPE-3 trial (Heart Outcomes Prevention Evaluation-3) found that antihypertensive therapy combined with a statin reduced first stroke among people at intermediate cardiovascular risk. We report secondary analyses of stroke outcomes by stroke subtype, predictors, treatment effects in key subgroups. METHODS: Using a 2-by-2 factorial design, 12705 participants from 21 countries with vascular risk factors but without overt cardiovascular disease were randomized to candesartan 16 mg plus hydrochlorothiazide 12.5 mg daily or placebo and to rosuvastatin 10 mg daily or placebo. The effect of the interventions on stroke subtypes was assessed. RESULTS: Participants were 66 years old and 46% were women. Baseline blood pressure (138/82 mm Hg) was reduced by 6.0/3.0 mm Hg and LDL-C (low-density lipoprotein cholesterol; 3.3 mmol/L) was reduced by 0.90 mmol/L on active treatment. During 5.6 years of follow-up, 169 strokes occurred (117 ischemic, 29 hemorrhagic, 23 undetermined). Blood pressure lowering did not significantly reduce stroke (hazard ratio [H R], 0.80 [95% CI, 0.59-1.08]), ischemic stroke (H R, 0.80 [95% CI, 0.55-1.15]), hemorrhagic stroke (HR, 0.71 [95% CI, 0.34-1.48]), or strokes of undetermined origin (HR, 0.92 [95% CI, 0.41-2.08]). Rosuvastatin significantly reduced strokes (H R, 0.70 [95% CI, 0.52-0.95]), with reductions mainly in ischemic stroke (H R, 0.53 [95% CI, 0.37-0.78]) but did not significantly affect hemorrhagic (H R, 1.22 [95% CI, 0.59-2.54]) or strokes of undetermined origin (H R, 1.29 [95% CI, 0.57-2.95]). The combination of both interventions compared with double placebo substantially and significantly reduced strokes (HR, 0.56 [95% CI, 0.36-0.87]) and ischemic strokes (HR, 0.41 [95% CI, 0.23-0.72]). CONCLUSIONS: Among people at intermediate cardiovascular risk but without overt cardiovascular disease, rosuvastatin 10 mg daily significantly reduced first stroke. Blood pressure lowering combined with rosuvastatin reduced is
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- 2021
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22. Variations in knowledge, awareness and treatment of hypertension and stroke risk by country income level
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O'Donnell, Martin, Hankey, Graeme J., Rangarajan, Sumathy, Chin, Siu Lim, Rao-Melacini, Purnima, Ferguson, John, Xavier, Denis, Lisheng, Liu, Zhang, Hongye, Pais, Prem, Lopez-Jaramillo, Patricio, Damasceno, Albertino, Langhorne, Peter, Rosengren, Annika, Dans, Antonio L., Elsayed, Ahmed, Avezum, Alvaro, Mondo, Charles, Smyth, Andrew, Judge, Conor, Diener, Hans Christoph, Ryglewicz, Danuta, Czlonkowska, Anna, Pogosova, Nana, Weimar, Christian, Iqbal, Romana, Diaz, Rafael, Yusoff, Khalid, Yusufali, Afzalhussein, Oguz, Aytekin, Wang, Xingyu, Penaherrera, Ernesto, Lanas, Fernando, Ogah, Okechukwu Samuel, Ogunniyi, Adensola, Iversen, Helle K., Malaga, German, Rumboldt, Zvonko, Oveisgharan, Shahram, Alhussain, Fawaz, Daliwonga, Magazi, Nilanont, Yongchai, Yusuf, Salim, O'Donnell, Martin, Hankey, Graeme J., Rangarajan, Sumathy, Chin, Siu Lim, Rao-Melacini, Purnima, Ferguson, John, Xavier, Denis, Lisheng, Liu, Zhang, Hongye, Pais, Prem, Lopez-Jaramillo, Patricio, Damasceno, Albertino, Langhorne, Peter, Rosengren, Annika, Dans, Antonio L., Elsayed, Ahmed, Avezum, Alvaro, Mondo, Charles, Smyth, Andrew, Judge, Conor, Diener, Hans Christoph, Ryglewicz, Danuta, Czlonkowska, Anna, Pogosova, Nana, Weimar, Christian, Iqbal, Romana, Diaz, Rafael, Yusoff, Khalid, Yusufali, Afzalhussein, Oguz, Aytekin, Wang, Xingyu, Penaherrera, Ernesto, Lanas, Fernando, Ogah, Okechukwu Samuel, Ogunniyi, Adensola, Iversen, Helle K., Malaga, German, Rumboldt, Zvonko, Oveisgharan, Shahram, Alhussain, Fawaz, Daliwonga, Magazi, Nilanont, Yongchai, and Yusuf, Salim
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Objective Hypertension is the most important modifiable risk factor for stroke globally. We hypothesised that country-income level variations in knowledge, detection and treatment of hypertension may contribute to variations in the association of blood pressure with stroke. Methods We undertook a standardised case-control study in 32 countries (INTERSTROKE). Cases were patients with acute first stroke (n=13 462) who were matched by age, sex and site to controls (n=13 483). We evaluated the associations of knowledge, awareness and treatment of hypertension with risk of stroke and its subtypes and whether this varied by gross national income (GNI) of country. We estimated OR and population attributable risk (PAR) associated with treated and untreated hypertension. Results Hypertension was associated with a graded increase in OR by reducing GNI, ranging from OR 1.92 (99% CI 1.48 to 2.49) to OR 3.27 (2.72 to 3.93) for highest to lowest country-level GNI (p-heterogeneity<0.0001). Untreated hypertension was associated with a higher OR for stroke (OR 5.25; 4.53 to 6.10) than treated hypertension (OR 2.60; 2.32 to 2.91) and younger age of first stroke (61.4 vs 65.4 years; p<0.01). Untreated hypertension was associated with a greater risk of intracerebral haemorrhage (OR 6.95; 5.61 to 8.60) than ischaemic stroke (OR 4.76; 3.99 to 5.68). The PAR associated with untreated hypertension was higher in lower-income regions, PAR 36.3%, 26.3%, 19.8% to 10.4% by increasing GNI of countries. Lifetime non-measurement of blood pressure was associated with stroke (OR 1.80; 1.32 to 2.46). Conclusions Deficits in knowledge, detection and treatment of hypertension contribute to higher risk of stroke, younger age of onset and larger proportion of intracerebral haemorrhage in lower-income countries.
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- 2021
23. Polypill with or without Aspirin in Persons without Cardiovascular Disease
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Yusuf, Salim, Joseph, Philip, Dans, Antonio, Gao, Peggy, Teo, Koon, Xavier, Denis, Lopez-Jaramillo, Patricio, Yusoff, Khalid, Santoso, Anwar, Gamra, Habib, Talukder, Shamim, Christou, Courtney, Girish, Preeti, Yeates, Karen, Xavier, Freeda, Dagenais, Gilles, Rocha, Catalina, McCready, Tara, Tyrwhitt, Jessica, Bosch, Jackie, Pais, Prem, The International Polycap Study 3 Investigators, and Masira
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medicine.medical_specialty ,Aspirin ,business.industry ,Cholesterol ,Incidence (epidemiology) ,MEDLINE ,General Medicine ,Disease ,030204 cardiovascular system & hematology ,Article ,3. Good health ,law.invention ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Pharmacotherapy ,Randomized controlled trial ,chemistry ,law ,Internal medicine ,medicine ,030212 general & internal medicine ,Polypill ,business ,medicine.drug - Abstract
Digital, BACKGROUND A polypill comprising statins, multiple blood-pressure–lowering drugs, and aspirin has been proposed to reduce the risk of cardiovascular disease. METHODS Using a 2-by-2-by-2 factorial design, we randomly assigned participants without cardiovascular disease who had an elevated INTERHEART Risk Score to receive a polypill (containing 40 mg of simvastatin, 100 mg of atenolol, 25 mg of hydrochlorothiazide, and 10 mg of ramipril) or placebo daily, aspirin (75 mg) or placebo daily, and vitamin D or placebo monthly. We report here the outcomes for the polypill alone as compared with matching placebo, for aspirin alone as compared with matching placebo, and for the polypill plus aspirin as compared with double placebo. For the polypill-alone and polypill-plus-aspirin comparisons, the primary outcome was death from cardiovascular causes, myocardial infarction, stroke, resuscitated cardiac arrest, heart failure, or revascularization. For the aspirin comparison, the primary outcome was death from cardiovascular causes, myocardial infarction, or stroke. Safety was also assessed. RESULTS A total of 5713 participants underwent randomization, and the mean follow-up was 4.6 years. The low-density lipoprotein cholesterol level was lower by approximately 19 mg per deciliter and systolic blood pressure was lower by approximately 5.8 mm Hg with the polypill and with combination therapy than with placebo. The primary outcome for the polypill comparison occurred in 126 participants (4.4%) in the polypill group and in 157 (5.5%) in the placebo group (hazard ratio, 0.79; 95% confidence interval [CI], 0.63 to 1.00). The primary outcome for the aspirin comparison occurred in 116 participants (4.1%) in the aspirin group and in 134 (4.7%) in the placebo group (hazard ratio, 0.86; 95% CI, 0.67 to 1.10). The primary outcome for the polypill-plus-aspirin comparison occurred in 59 participants (4.1%) in the combined-treatment group and in 83 (5.8%) in the double-placebo group (hazard ratio, 0.69; 95% CI, 0.50 to 0.97). The incidence of hypotension or dizziness was higher in groups that received the polypill than in their respective placebo groups. CONCLUSIONS Combined treatment with a polypill plus aspirin led to a lower incidence of cardiovascular events than did placebo among participants without cardiovascular disease who were at intermediate cardiovascular risk. (Funded by the Wellcome Trust and others; TIPS-3 ClinicalTrials.gov number, NCT01646437. opens in new tab.), Ciencias Médicas y de la Salud
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- 2020
24. A post hoc analysis
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Dagenais, Gilles R., Rydén, Lars, Leiter, Lawrence A., Lakshmanan, Mark, Dyal, Leanne, Probstfield, Jeffrey L., Atisso, Charles Messan, Shaw, Jonathan E., Conget, Ignacio, Cushman, William C., Lopez-Jaramillo, Patricio, Lanas, Fernando, Cordona Munoz, Ernesto German, Pirags, Valdis, Pogosova, Nana, Basile, Jan, Sheu, Wayne H. H., Temelkova-Kurktschiev, Theodora, Raubenheimer, Peter J., Keltai, Matyas, Hall, Stephanie, Pais, Prem, Colhoun, Helen M., Riddle, Matthew C., Gerstein, Hertzel C., and Everest
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Digital, Background The Researching cardiovascular Events with a Weekly INcretin in Diabetes (REWIND) double blind randomized trial demonstrated that weekly subcutaneous dulaglutide 1.5 mg, a glucagon like peptide-1 receptor agonist, versus matched placebo reduced the first outcome of major adverse cardiovascular event (MACE), cardiovascular death, nonfatal myocardial infarction or nonfatal stroke (594 versus 663 events) in 9901 persons with type 2 diabetes and either chronic cardiovascular disease or risk factors, and followed during 5.4 years. These findings were based on a time-to-first-event analysis and preclude relevant information on the burden of total major events occurring during the trial. This analysis reports on the total cardiovascular or fatal events in the REWIND participants Methods We compared the total incidence of MACE or non-cardiovascular deaths, and the total incidence of expanded MACE (MACE, unstable angina, heart failure or revascularization) or non-cardiovascular deaths between participants randomized to dulaglutide and those randomized to placebo. Incidences were expressed as number per 1000 person-years. Hazard ratios (HR) were calculated using the conditional time gap and proportional means models. Results Participants had a mean age of 66.2 years, 46.3% were women and 31% had previous cardiovascular disease. During the trial there were 1972 MACE or non-cardiovascular deaths and 3673 expanded MACE or non-cardiovascular deaths. The incidence of total MACE or non-cardiovascular deaths in the dulaglutide and placebo groups was 35.8 and 40.3 per 1000 person-years, respectively [absolute reduction = 4.5 per 1000 person-years; conditional time gap HR 0.90 (95% CI, 0.82–0.98) p = 0.020, and proportional means HR 0.89 (95% CI, 0.80–0.98) p = 0.022]. The incidence of total expanded MACE or non-cardiovascular deaths in the dulaglutide and placebo groups was 67.1 and 74.7 per 1000 person-years, respectively [absolute reduction = 7.6 per 1000 person-years; conditional time gap HR 0.93 (95% CI, 0.87–0.99) p = 0.023, and proportional means HR 0.90 (95% CI, 0.82–0.99) p = 0.028]. Conclusions These findings suggest that weekly subcutaneous dulaglutide reduced total cardiovascular or fatal event burden in people with type 2 diabetes at moderate cardiovascular risk., Ciencias Médicas y de la Salud
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- 2020
25. Apixaban vs. warfarin with concomitant aspirin in patients with atrial fibrillation: insights from the ARISTOTLE trial
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Alexander, John H., Lopes, Renato D., Thomas, Laine, Alings, Marco, Atar, Dan, Aylward, Philip, Goto, Shinya, Hanna, Michael, Huber, Kurt, Husted, Steen, Lewis, Basil S., McMurray, John J.V., Pais, Prem, Pouleur, Hubert, Steg, Philippe Gabriel, Verheugt, Freek W.A., Wojdyla, Daniel M., Granger, Christopher B., and Wallentin, Lars
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- 2014
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26. Additional file 1 of Total cardiovascular or fatal events in people with type 2 diabetes and cardiovascular risk factors treated with dulaglutide in the REWIND trail: a post hoc analysis
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Dagenais, Gilles R., Rydén, Lars, Leiter, Lawrence A., Lakshmanan, Mark, Dyal, Leanne, Probstfield, Jeffrey L., Atisso, Charles Messan, Shaw, Jonathan E., Conget, Ignacio, Cushman, William C., Lopez-Jaramillo, Patricio, Lanas, Fernando, Munoz, Ernesto German Cordona, Pirags, Valdis, Pogosova, Nana, Basile, Jan, Sheu, Wayne H. H., Temelkova-Kurktschiev, Theodora, Raubenheimer, Peter J., Matyas Keltai, Hall, Stephanie, Pais, Prem, Colhoun, Helen M., Riddle, Matthew C., and Hertzel C. Gerstein
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Additional file 1: Table S1. Number of Participants who Experienced Varying Numbers of CV Events. Table S2. Effect of dulaglutide on Total MACE or non-Cardiovascular Death in subgroups. Table S3. Number of Participants who Experienced Varying Numbers of CV Events or on non CV deaths.
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- 2020
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27. In patients with stable coronary heart disease, low-density lipoprotein-cholesterol levels < 70 mg/dL and glycosylated hemoglobin A1c < 7% are associated with lower major cardiovascular events
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White, Harvey D., Stewart, Ralph A. H., Dolby, Anthony J., Stebbins, Amanda, Cannon, Christopher P., Budaj, Andrzej, Linhart, Ales, Pais, Prem, Diaz, Rafael, Steg, Philippe Gabriel, Krug-Gourley, Sue, Granger, Christopher B., Hochman, Judith S., Koenig, Wolfgang, Harrington, Robert A., Held, Claes, Wallentin, Lars, White, Harvey D., Stewart, Ralph A. H., Dolby, Anthony J., Stebbins, Amanda, Cannon, Christopher P., Budaj, Andrzej, Linhart, Ales, Pais, Prem, Diaz, Rafael, Steg, Philippe Gabriel, Krug-Gourley, Sue, Granger, Christopher B., Hochman, Judith S., Koenig, Wolfgang, Harrington, Robert A., Held, Claes, and Wallentin, Lars
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Background In patients with stable coronary heart disease, it is not known whether achievement of standard of care (SOC) targets in addition to evidence-based medicine (EBM) is associated with lower major adverse cardiovascular events (MACE): cardiovascular death, myocardial infarction, and stroke. Methods EBM use was recommended in the STabilisation of Atherosclerotic plaque By Initiation of darapLadIb TherapY trial. SOC targets were blood pressure (BP) <140/90 mm Hg and low-density lipoprotein-cholesterol (LDL-C) <100 mg/dL and <70 mg/dL. In patients with diabetes, glycosylated hemoglobin A1c (HbA1c) < 7% and BP of <130/80 mm Hg were recommended. Feedback to investigators about rates of EBM and SOC was provided regularly. Results In 13,623 patients, 1-year landmark analysis assessed the association between EBM, SOC targets, and MACE during follow-up of 2.7 years (median) after adjustment in a Cox proportional hazards model. At 1 year, aspirin was prescribed in 92.5% of patients, statins in 97.2%, β-blockers in 79.0%, and angiotensin-converting enzyme inhibitors/angiotensin-II receptor blockers in 76.9%. MACE was lower with LDL-C < 100 mg/dL (70-99 mg/dL) compared with LDL-C ≥ 100 mg/dL (hazard ratio [HR] 0.694, 95% CI 0.594-0.811) and lower with LDL-C < 70 mg/dL compared with LDL-C < 100 mg/dL (70-99 mg/dL) (HR 0.834, 95% CI 0.708-0.983). MACE was lower with HbA1c < 7% compared with HbA1c ≥ 7% (HR 0.705, 95% CI 0.573-0.866). There was no effect of BP targets on MACE. Conclusions MACE was lower with LDL-C < 100 mg/dL (70-99 mg/dL) and even lower with LDL-C < 70 mg/dL. MACE in patients with diabetes was lower with HbA1c < 7%. Achievement of targets is associated with improved patient outcomes.
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- 2020
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28. A qualitative, grounded theory exploration of the determinants of self-care behavior among Indian patients with a lived experience of chronic heart failure
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Kamath, Deepak Y., primary, Bhuvana, K. B., additional, Salazar, Luke Joshua, additional, Varghese, Kiron, additional, Kamath, Anant, additional, Idiculla, Jyoti, additional, Pais, Prem, additional, Kulkarni, Shruthi, additional, Granger, Bradi B., additional, and Xavier, Denis, additional
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- 2021
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29. Similar cardiovascular outcomes in patients with diabetes and established or high risk for coronary vascular disease treated with dulaglutide with and without baseline metformin
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Ferrannini, Giulia, primary, Gerstein, Hertzel, additional, Colhoun, Helen Martina, additional, Dagenais, Gilles R, additional, Diaz, Rafael, additional, Dyal, Leanne, additional, Lakshmanan, Mark, additional, Mellbin, Linda, additional, Probstfield, Jeffrey, additional, Riddle, Matthew Casey, additional, Shaw, Jonathan Edward, additional, Avezum, Alvaro, additional, Basile, Jan Neil, additional, Cushman, William C, additional, Jansky, Petr, additional, Keltai, Mátyás, additional, Lanas, Fernando, additional, Leiter, Lawrence Alan, additional, Lopez-Jaramillo, Patricio, additional, Pais, Prem, additional, Pīrāgs, Valdis, additional, Pogosova, Nana, additional, Raubenheimer, Peter Johann, additional, Sheu, Wayne Huey-Herng, additional, and Rydén, Lars, additional
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- 2020
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30. Dabigatran Versus Warfarin: Effects on Ischemic and Hemorrhagic Strokes and Bleeding in Asians and Non-Asians With Atrial Fibrillation
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Hori, Masatsugu, Connolly, Stuart J., Zhu, Jun, Liu, Li Sheng, Lau, Chu-Pak, Pais, Prem, Xavier, Denis, Kim, Sung Soon, Omar, Razali, Dans, Antonio L., Tan, Ru San, Chen, Jyh-Hong, Tanomsup, Supachai, Watanabe, Mitsunori, Koyanagi, Masahide, Ezekowitz, Michael D., Reilly, Paul A., Wallentin, Lars, and Yusuf, Salim
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- 2013
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31. New evidence for gender disparities in cardiac interventions: ‘CREATE’-ing some clarity
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Sigamani, Alben, Kamath, Deepak, Xavier, Denis, and Pais, Prem
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- 2013
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32. Effects of fondaparinux in patients with ST-segment elevation acute myocardial infarction not receiving reperfusion treatment
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Oldgren, Jonas, Wallentin, Lars, Afzal, Rizwan, Bassand, Jean-Pierre, Budaj, Andrzej, Chrolavicius, Susan, Fox, Keith A.A., Granger, Christopher B., Mehta, Shamir R., Pais, Prem, Peters, Ron J.G., Xavier, Denis, Zhu, Jun, and Yusuf, Salim
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- 2008
33. Impact of Diabetes Mellitus and Chronic Kidney Disease on Cardiovascular Outcomes and Platelet P2Y 12 Receptor Antagonist Effects in Patients With Acute Coronary Syndromes: Insights From the PLATO Trial
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Franchi, Francesco, James, Stefan, Ghukasyan, Tatevik, Budaj, Andrzej J., Cornel, Jan H., Katus, Hugo A., Keltai, Matyas, Kontny, Frederic, Lewis, Basil S., Storey, Robert F., Himmelmann, Anders, Wallentin, Lars, Angiolillo, Dominick J., Parkhomenko, Alexander Nikolaevich, Oto, Ali, Skene, Allan, Budaj, Andrzej, Freij, Anneli, Santoso, Anwar, Armando, A, Meier, Bernhard, Yu, Cheuk Man, Cannon, Christopher P., Zambahari, Dato Seri Robaayah, Wu, Delon Wu, Ardissino, Diego, Raev, Dimitar, Kremastinos, Dimitrios, Weaver, Douglas, Paolasso, Ernesto, Giannitsis, Evangelos, Verheugt, Freek, Maurer, Gerald, Katus, Hugo, Emanuelsson, Hakan, Horrow, Jay, Bassand, Jean-Pierre, Spinar, Jindrich, Morais, Joao, Lopez Sendon, Jose, Nicolau, Jose, Seung, Ki-Bae, Teik, Lim Soo, Heras, Magda, Claeys, Marc J., Sabatine, Marc, Vintila, Marius, Ruda, Mikhail, Thorsen, Mona, Kleiman, Neil, Babilonia, Noe, Commerford, Patrick, Gurbel, Paul, Aylward, Phil, Steg, Philippe Gabriel, Theroux, Pierre, Sritara, Piyamitr, Pais, Prem, Becker, Richard, Lassila, Riitta, Harrington, Robert A., Gao, Runlin, Husted, Steen, Duris, Tibor, Chapichadze, Zaza, HUS Comprehensive Cancer Center, University Management, Department of Oncology, and PLATO Investigators
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Male ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,Comorbidity ,030204 cardiovascular system & hematology ,urologic and male genital diseases ,FUNCTION PROFILES ,RESPONSIVENESS ,Electrocardiography ,0302 clinical medicine ,Risk Factors ,Coronary Heart Disease ,ARTERY-DISEASE ,Medicine ,Cardiac and Cardiovascular Systems ,030212 general & internal medicine ,Myocardial infarction ,Stroke ,Original Research ,Kardiologi ,Absolute risk reduction ,Diabetes, Type 2 ,DUAL ANTIPLATELET THERAPY ,Middle Aged ,Prognosis ,Clopidogrel ,female genital diseases and pregnancy complications ,3. Good health ,Survival Rate ,diabetes mellitus ,Female ,Cardiology and Cardiovascular Medicine ,Ticagrelor ,medicine.drug ,Platelets ,RENAL-FUNCTION ,medicine.medical_specialty ,Acute coronary syndrome ,ANTITHROMBOTIC THERAPY ,INHIBITION ,acute coronary syndrome ,ticagrelor ,03 medical and health sciences ,Internal medicine ,Diabetes mellitus ,Humans ,Renal Insufficiency, Chronic ,Aged ,Retrospective Studies ,Pharmacology ,clopidogrel ,Dose-Response Relationship, Drug ,business.industry ,Thrombosis ,medicine.disease ,United States ,REACTIVITY ,3121 General medicine, internal medicine and other clinical medicine ,Purinergic P2Y Receptor Antagonists ,Human medicine ,business ,Acute Coronary Syndromes ,Platelet Aggregation Inhibitors ,chronic kidney disease ,Follow-Up Studies ,Kidney disease - Abstract
Background There are limited data on how the combination of diabetes mellitus ( DM ) and chronic kidney disease ( CKD ) affects cardiovascular outcomes as well as response to different P2Y 12 receptor antagonists, which represented the aim of the present investigation. Methods and Results In this post hoc analysis of the PLATO (Platelet Inhibition and Patient Outcomes) trial, which randomized acute coronary syndrome patients to ticagrelor versus clopidogrel, patients (n=15 108) with available DM and CKD status were classified into 4 groups: DM +/ CKD + (n=1058), DM +/ CKD − (n=2748), DM −/ CKD + (n=2160), and DM −/ CKD − (n=9142). The primary efficacy end point was a composite of cardiovascular death, myocardial infarction, or stroke at 12 months. The primary safety end point was PLATO major bleeding. DM +/ CKD + patients had a higher incidence of the primary end point compared with DM −/ CKD − patients (23.3% versus 7.1%; adjusted hazard ratio 2.22; 95% CI 1.88–2.63; P DM +/ CKD − and DM −/ CKD + had an intermediate risk profile. The same trend was shown for the individual components of the primary end point and for major bleeding. Compared with clopidogrel, ticagrelor reduced the incidence of the primary end point consistently across subgroups ( P ‐interaction=0.264), but with an increased absolute risk reduction in DM +/ CKD +. The effects on major bleeding were also consistent across subgroups ( P ‐interaction=0.288). Conclusions In acute coronary syndrome patients, a gradient of risk was observed according to the presence or absence of DM and CKD , with patients having both risk factors at the highest risk. Although the ischemic benefit of ticagrelor over clopidogrel was consistent in all subgroups, the absolute risk reduction was greatest in patients with both DM and CKD . Clinical Trial Registration URL : http://www.clinicatrials.gov . Unique identifier: NCT 00391872.
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- 2019
34. Rationale, design and baseline characteristics of the effect of ticagrelor on health outcomes in diabetes mellitus patients Intervention study
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Bhatt, Deepak L., Fox, Kim, Harrington, Robert A., Leiter, Lawrence A., Mehta, Shamir R., Simon, Tabassome, Andersson, Marielle, Himmelmann, Anders, Ridderstrale, Wilhelm, Held, Claes, Steg, Philippe Gabriel, Steg, Gabriel, Diaz, Rafael, Amerena, John, Huber, Kurt, Sinnaeve, Peter, Nicolau, Jose Carlos, Kerr Saraiva, Jose Francisco, Petrov, Ivo, Corbalan, Ramon, Ge, Junbo, Zhao, Qiang, Botero, Rodrigo, Widimsky, Petr, Kristensen, Steen Dalby, Hartikainen, Juha, Danchin, Nicolas, Darius, Harald, Fat, Tse Hung, Kiss, Robert Gabor, Pais, Prem, Lev, Eli, De Luca, Leonardo, Goto, Shinya, Ramos Lopez, Gabriel Arturo, Cornel, Jan Hein, Kontny, Frederic, Medina, Felix, Babilonia, Noe, Opolski, Grzegorz, Vinereanu, Dragos, Zateyshchikov, Dmitry, Ruda, Mikhail, Elamin, Omer, Kovar, Frantisek, Dalby, Anthony John, Jeong, Myung Ho, Bueno, Hector, James, Stefan, Chiang, Chern-En, Tresukosol, Damras, Ongen, Zeki, Ray, Kausik, Parkhomenko, Alexander, McGuire, Darren, Kosiborod, Mikhail, Nguyen, Tuan Quang, Wallentin, Lars, Fox, Keith A. A., Eikelboom, John W., Tuomilehto, Jaakko, Lee, Kerry L., Al-Khalidi, Hussein R., Ellis, Stephen J., Hagström, Emil, Holmgren, Pernilla, Heldestad, Ulrika, Hallberg, Theresa, Renlund Grausne, Karin, Alm, Cristina, Michelgård Palmquist, Åsa, Svanberg, Camilla, Capell, Warren H., Nehler, Mark R., Hiatt, William R., Bonaca, Marc P., Houser, Stacey, Bachler, Susie, Jaeger, Nicole, Aunes, Maria, Brusehed, Asa, Chen, Jersey, Dahlof, Bjorn, Dolezalova, Jitka, Domzol, Maciej, Findley, Magdalena, Holmberg, Niclas, Jahreskog, Marianne, Knutsson, Mikael, Kruszewski, Jakub, Leonsson-Zachrisson, Maria, Stark, Maj, Winder, Elin, and Sinnaeve, P
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Male ,Ticagrelor ,Cardiac & Cardiovascular Systems ,Time Factors ,medicine.medical_treatment ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,Myocardial Infarction ,general clinical cardiology/adult ,Coronary Artery Disease ,Type 2 diabetes ,030204 cardiovascular system & hematology ,Stroke/mortality ,antiplatelet therapy ,Hypoglycemic Agents/adverse effects ,Coronary artery disease ,DOUBLE-BLIND ,0302 clinical medicine ,Risk Factors ,ARTERY-DISEASE ,Medicine ,Cardiac and Cardiovascular Systems ,030212 general & internal medicine ,Myocardial infarction ,1102 Cardiorespiratory Medicine and Haematology ,Stroke ,Randomized Controlled Trials as Topic ,Aspirin ,Kardiologi ,adult ,general clinical cardiology ,60 MG ,Ticagrelor/administration & dosage ,General Medicine ,Middle Aged ,Clopidogrel ,Treatment Outcome ,CLOPIDOGREL ,diabetes mellitus ,Cardiology ,PLATELET INHIBITION ,Drug Therapy, Combination ,Female ,Cardiology and Cardiovascular Medicine ,Life Sciences & Biomedicine ,medicine.drug ,medicine.medical_specialty ,Trial Designs ,03 medical and health sciences ,Diabetes Mellitus, Type 2/diagnosis ,Double-Blind Method ,Internal medicine ,Humans ,Hypoglycemic Agents ,CARDIOVASCULAR EVENTS ,Aspirin/administration & dosage ,Myocardial Infarction/mortality ,Platelet Aggregation Inhibitors/administration & dosage ,Aged ,clinical trials ,Science & Technology ,business.industry ,ACUTE CORONARY SYNDROMES ,Percutaneous coronary intervention ,medicine.disease ,ischemic heart disease ,ASPIRIN ,MYOCARDIAL-INFARCTION ,Cardiovascular System & Hematology ,Clinical Trials, Phase III as Topic ,Diabetes Mellitus, Type 2 ,Cardiovascular System & Cardiology ,Coronary Artery Disease/diagnosis ,business ,THEMIS Steering Committee ,Platelet Aggregation Inhibitors - Abstract
In the setting of prior myocardial infarction, the oral antiplatelet ticagrelor added to aspirin reduced the risk of recurrent ischemic events, especially, in those with diabetes mellitus. Patients with stable coronary disease and diabetes are also at elevated risk and might benefit from dual antiplatelet therapy. The Effect of Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study (THEMIS, NCT01991795) is a Phase 3b randomized, double-blinded, placebo-controlled trial of ticagrelor vs placebo, on top of low dose aspirin. Patients ≥50 years with type 2 diabetes receiving anti-diabetic medications for at least 6 months with stable coronary artery disease as determined by a history of previous percutaneous coronary intervention, bypass grafting, or angiographic stenosis of ≥50% of at least one coronary artery were enrolled. Patients with known prior myocardial infarction (MI) or stroke were excluded. The primary efficacy endpoint is a composite of cardiovascular death, myocardial infarction, or stroke. The primary safety endpoint is Thrombolysis in Myocardial Infarction major bleeding. A total of 19 220 patients worldwide have been randomized and at least 1385 adjudicated primary efficacy endpoint events are expected to be available for analysis, with an expected average follow-up of 40 months (maximum 58 months). Most of the exposure is on a 60 mg twice daily dose, as the dose was lowered from 90 mg twice daily partway into the study. The results may revise the boundaries of efficacy for dual antiplatelet therapy and whether it has a role outside acute coronary syndromes, prior myocardial infarction, or percutaneous coronary intervention. ispartof: CLINICAL CARDIOLOGY vol:42 issue:5 pages:498-505 ispartof: location:United States status: published
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- 2019
35. Perspectives on the management of coronary artery disease in India
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Karthikeyan, Ganesan, Xavier, Denis, Prabhakaran, Doriaraj, and Pais, Prem
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- 2007
36. †Universal definition of myocardial infarction: Kristian Thygesen, Joseph S. Alpert and Harvey D. White on behalf of the Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction
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Thygesen, Kristian, Alpert, Joseph S., White, Harvey D., Jaffe, Allan S., Apple, Fred S., Galvani, Marcello, Katus, Hugo A., Newby, L. Kristin, Ravkilde, Jan, Chaitman, Bernard, Clemmensen, Peter M., Dellborg, Mikael, Hod, Hanoch, Porela, Pekka, Underwood, Richard, Bax, Jeroen J., Beller, George A., Bonow, Robert, Van Der Wall, Ernst E., Bassand, Jean-Pierre, Wijns, William, Ferguson, T. Bruce, Steg, Philippe G., Uretsky, Barry F., Williams, David O., Armstrong, Paul W., Antman, Elliott M., Fox, Keith A., Hamm, Christian W., Ohman, E. Magnus, Simoons, Maarten L., Poole-Wilson, Philip A., Gurfinkel, Enrique P., Lopez-Sendon, José-Luis, Pais, Prem, Mendis, Shanti, Zhu, Jun-Ren, Wallentin, Lars C., Fernández-Avilés, Francisco, Fox, Kim M., Parkhomenko, Alexander N., Priori, Silvia G., Tendera, Michal, Voipio-Pulkki, Liisa-Maria, Vahanian, Alec, Camm, A. John, De Caterina, Raffaele, Dean, Veronica, Dickstein, Kenneth, Filippatos, Gerasimos, Funck-Brentano, Christian, Hellemans, Irene, Kristensen, Steen Dalby, McGregor, Keith, Sechtem, Udo, Silber, Sigmund, Widimsky, Petr, Zamorano, José Luis, Morais, Joao, Brener, Sorin, Harrington, Robert, Morrow, David, Lim, Michael, Martinez-Rios, Marco A., Steinhubl, Steve, Levine, Glen N., Gibler, W. Brian, Goff, David, Tubaro, Marco, Dudek, Darek, and Al-Attar, Nawwar
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- 2007
37. Impact of Diabetes Mellitus and Chronic Kidney Disease on Cardiovascular Outcomes and Platelet P2Y12 Receptor Antagonist Effects in Patients With Acute Coronary Syndromes : Insights From the PLATO Trial
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Franchi, Francesco, James, Stefan, Ghukasyan, Tatevik, Budaj, Andrzej J., Cornel, Jan H., Katus, Hugo A., Keltai, Matyas, Kontny, Frederic, Lewis, Basil S., Storey, Robert F., Himmelmann, Anders, Wallentin, Lars, Angiolillo, Dominick J., Parkhomenko, Alexander Nikolaevich, Oto, Ali, Skene, Allan, Budaj, Andrzej, Freij, Anneli, Santoso, Anwar, Armando, A, Meier, Bernhard, Yu, Cheuk Man, Cannon, Christopher P., Zambahari, Dato Seri Robaayah, Wu, Delon Wu, Ardissino, Diego, Raev, Dimitar, Kremastinos, Dimitrios, Weaver, Douglas, Paolasso, Ernesto, Giannitsis, Evangelos, Verheugt, Freek, Maurer, Gerald, Katus, Hugo, Emanuelsson, Hakan, Horrow, Jay, Bassand, Jean-Pierre, Spinar, Jindrich, Morais, Joao, Lopez Sendon, Jose, Nicolau, Jose, Seung, Ki-Bae, Teik, Lim Soo, Heras, Magda, Claeys, Marc J., Sabatine, Marc, Vintila, Marius, Ruda, Mikhail, Thorsen, Mona, Kleiman, Neil, Babilonia, Noe, Commerford, Patrick, Gurbel, Paul, Aylward, Phil, Steg, Philippe Gabriel, Theroux, Pierre, Sritara, Piyamitr, Pais, Prem, Becker, Richard, Lassila, Riitta, Harrington, Robert A., Gao, Runlin, Husted, Steen, Duris, Tibor, Chapichadze, Zaza, Franchi, Francesco, James, Stefan, Ghukasyan, Tatevik, Budaj, Andrzej J., Cornel, Jan H., Katus, Hugo A., Keltai, Matyas, Kontny, Frederic, Lewis, Basil S., Storey, Robert F., Himmelmann, Anders, Wallentin, Lars, Angiolillo, Dominick J., Parkhomenko, Alexander Nikolaevich, Oto, Ali, Skene, Allan, Budaj, Andrzej, Freij, Anneli, Santoso, Anwar, Armando, A, Meier, Bernhard, Yu, Cheuk Man, Cannon, Christopher P., Zambahari, Dato Seri Robaayah, Wu, Delon Wu, Ardissino, Diego, Raev, Dimitar, Kremastinos, Dimitrios, Weaver, Douglas, Paolasso, Ernesto, Giannitsis, Evangelos, Verheugt, Freek, Maurer, Gerald, Katus, Hugo, Emanuelsson, Hakan, Horrow, Jay, Bassand, Jean-Pierre, Spinar, Jindrich, Morais, Joao, Lopez Sendon, Jose, Nicolau, Jose, Seung, Ki-Bae, Teik, Lim Soo, Heras, Magda, Claeys, Marc J., Sabatine, Marc, Vintila, Marius, Ruda, Mikhail, Thorsen, Mona, Kleiman, Neil, Babilonia, Noe, Commerford, Patrick, Gurbel, Paul, Aylward, Phil, Steg, Philippe Gabriel, Theroux, Pierre, Sritara, Piyamitr, Pais, Prem, Becker, Richard, Lassila, Riitta, Harrington, Robert A., Gao, Runlin, Husted, Steen, Duris, Tibor, and Chapichadze, Zaza
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Background-There are limited data on how the combination of diabetes mellitus (DM) and chronic kidney disease (CKD) affects cardiovascular outcomes as well as response to different P2Y(12) receptor antagonists, which represented the aim of the present investigation. Methods and Results-In this post hoc analysis of the PLATO (Platelet Inhibition and Patient Outcomes) trial, which randomized acute coronary syndrome patients to ticagrelor versus clopidogrel, patients (n=15 108) with available DM and CKD status were classified into 4 groups: DM+/CKD+ (n=1058), DM+/CKD- (n=2748), DM-/CKD+ (n=2160), and DM-/CKD- (n=9142). The primary efficacy end point was a composite of cardiovascular death, myocardial infarction, or stroke at 12 months. The primary safety end point was PLATO major bleeding. DM+/CKD+ patients had a higher incidence of the primary end point compared with DM-/CKD- patients (23.3% versus 7.1%; adjusted hazard ratio 2.22; 95% CI 1.88-2.63; P<0.001). Patients with DM+/CKD- and DM-/CKD+ had an intermediate risk profile. The same trend was shown for the individual components of the primary end point and for major bleeding. Compared with clopidogrel, ticagrelor reduced the incidence of the primary end point consistently across subgroups (P-interaction=0.264), but with an increased absolute risk reduction in DM+/CKD+. The effects on major bleeding were also consistent across subgroups (P-interaction=0.288). Conclusions-In acute coronary syndrome patients, a gradient of risk was observed according to the presence or absence of DM and CKD, with patients having both risk factors at the highest risk. Although the ischemic benefit of ticagrelor over clopidogrel was consistent in all subgroups, the absolute risk reduction was greatest in patients with both DM and CKD.
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- 2019
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38. Novel Approaches in Primary Cardiovascular Disease Prevention: The HOPE-3 Trial Rationale, Design, and Participants' Baseline Characteristics
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Lonn, Eva, Bosch, Jackie, Pogue, Janice, Avezum, Alvaro, Chazova, Irina, Dans, Antonio, Diaz, Rafael, Fodor, George J., Held, Claes, Jansky, Petr, Keltai, Matyas, Keltai, Katalin, Kunti, Kamlesh, Kim, Jae Hyung, Leiter, Lawrence A., Lewis, Basil S., Liu, Lisheng, Lopez-Jaramillo, Patricio, Pais, Prem, Parkhomenko, Alexander, Peters, Ron J.G., Piegas, Leopoldo S., Reid, Christopher M., Sliwa, Karen, Toff, William D., Varigos, John, Xavier, Denis, Yusoff, Khalid, Zhu, Jun, Dagenais, Gilles, Yusuf, Salim, The HOPE-3 Investigators, Amsterdam Cardiovascular Sciences, Amsterdam Public Health, and Cardiology
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Male ,Tetrazoles ,Blood Pressure ,030204 cardiovascular system & hematology ,Global Health ,law.invention ,0302 clinical medicine ,Randomized controlled trial ,Risk Factors ,law ,030212 general & internal medicine ,Myocardial infarction ,Rosuvastatin Calcium ,Diuretics ,Incidence ,Middle Aged ,Primary Prevention ,Cholesterol ,Hydrochlorothiazide ,Treatment Outcome ,Cardiovascular Diseases ,Population Surveillance ,Blood pressure ,Drug Therapy, Combination ,Female ,Cardiology and Cardiovascular Medicine ,Cardiovascular Disease Prevention ,medicine.drug ,medicine.medical_specialty ,Statin ,medicine.drug_class ,COLESTEROL ,Placebo ,03 medical and health sciences ,Double-Blind Method ,Internal medicine ,medicine ,Humans ,Rosuvastatin ,Risk factor ,Contraindication ,Aged ,Dose-Response Relationship, Drug ,business.industry ,Biphenyl Compounds ,Cholesterol, LDL ,medicine.disease ,Surgery ,Clinical trial ,Benzimidazoles ,business ,Angiotensin II Type 1 Receptor Blockers - Abstract
8 p., Résumé Introduction Il est possible de faire baisser efficacement et en toute sécurité le cholestérol et la pression artérielle (PA) avec les statines et les antihypertenseurs tout en réduisant de 20 à 30 % les manifestations cardiovasculaires majeures en l’espace de cinq ans chez les personnes à risque élevé. Les données obtenues dans les populations exposées à un risque plus faible sont néanmoins limitées. L’essai HOPE-3 (Heart Outcomes Prevention Evaluation-3) tâche de déterminer si l’abaissement du cholestérol à l’aide d’une statine, l’abaissement de la pression artérielle à l’aide de deux agents antihypertenseurs administrés à raison d’une faible dose et leur association permettent de réduire en toute sécurité les manifestations cardiovasculaires majeures chez les personnes exposées à un risque intermédiaire qui n’ont pas d’antécédents d’événements vasculaires et dont le taux de cholestérol et la PA se situent dans la moyenne. Méthodes Au total, 12 705 femmes et hommes, les unes âgées de 65 ans et plus et les autres de 55 ans et plus, qui présentent au moins un facteur de risque cardiovasculaire et qui n’ont pas de maladie cardiovasculaire connue ni aucune indication ou contre-indication claires aux médicaments à l’étude, ont été répartis aléatoirement pour recevoir de la rosuvastatine à raison de 10 mg par jour ou un placebo et l’association candésartan/hydrochlorothiazide à raison de 16/12,5 mg par jour ou un placebo (plan factoriel 2 × 2). Ces patients seront suivis pendant une moyenne de 5,8 ans. Les principaux paramètres d’évaluation de l’étude combinent le décès d’origine cardiovasculaire, l’infarctus du myocarde non mortel et l’AVC non mortel d’une part, et le décès d’origine cardiovasculaire, l’infarctus du myocarde non mortel, l’AVC non mortel, la réanimation après arrêt cardiaque, l’insuffisance cardiaque et la revascularisation artérielle d’autre part. Résultats Les participants ont été recrutés dans 21 pays situés en Amérique du Nord, en Amérique du Sud, en Europe, en Asie et en Australie. L’âge moyen au moment de la répartition aléatoire était de 66 ans, et 46 % des sujets étaient des femmes. Conclusions L’essai HOPE-3 fournira de nouveaux renseignements sur l’abaissement du taux de cholestérol et de la PA dans des populations exposées à un risque intermédiaire dont le taux de cholestérol et la PA se situent dans la moyenne. Il devrait également fournir des données à l’appui des stratégies de prévention primaire mises en place partout dans le monde (HOPE-3 ClinicalTrials.gov NCT00468923)., Cholesterol and blood pressure (BP) can be effectively and safely lowered with statin drugs and BP-lowering drugs, reducing major cardiovascular (CV) events by 20%-30% within 5 years in high-risk individuals. However, there are limited data in lower-risk populations. The Heart Outcomes Prevention Evaluation-3 (HOPE-3) trial is evaluating whether cholesterol lowering with a statin drug, BP lowering with low doses of 2 antihypertensive agents, and their combination safely reduce major CV events in individuals at intermediate risk who have had no previous vascular events and have average cholesterol and BP levels. Methods A total of 12,705 women 65 years or older and men 55 years or older with at least 1 CV risk factor, no known CV disease, and without any clear indication or contraindication to the study drugs were randomized to rosuvastatin 10 mg/d or placebo and to candesartan/hydrochlorothiazide 16/12.5 mg/d or placebo (2 × 2 factorial design) and will be followed for a mean of 5.8 years. The coprimary study outcomes are the composite of CV death, nonfatal myocardial infarction (MI), and nonfatal stroke and the composite of CV death, nonfatal MI, nonfatal stroke, resuscitated cardiac arrest, heart failure, and arterial revascularization. Results Participants were recruited from 21 countries in North America, South America, Europe, Asia, and Australia. Mean age at randomization was 66 years and 46% were women. Conclusions The HOPE-3 trial will provide new information on cholesterol and BP lowering in intermediate-risk populations with average cholesterol and BP levels and is expected to inform approaches to primary prevention worldwide (HOPE-3 ClinicalTrials.gov NCT00468923).
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- 2016
39. Similar cardiovascular outcomes in patients with diabetes and established or high risk for coronary vascular disease treated with dulaglutide with and without baseline metformin.
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Ferrannini, Giulia, Gerstein, Hertzel, Colhoun, Helen Martina, Dagenais, Gilles R, Diaz, Rafael, Dyal, Leanne, Lakshmanan, Mark, Mellbin, Linda, Probstfield, Jeffrey, Riddle, Matthew Casey, Shaw, Jonathan Edward, Avezum, Alvaro, Basile, Jan Neil, Cushman, William C, Jansky, Petr, Keltai, Mátyás, Lanas, Fernando, Leiter, Lawrence Alan, Lopez-Jaramillo, Patricio, and Pais, Prem
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TREATMENT of diabetes ,DIABETES risk factors ,CARDIOVASCULAR disease treatment ,PATIENT management ,GLUCOSE metabolism - Abstract
Objective Recent European Guidelines for Diabetes, Prediabetes and Cardiovascular Diseases introduced a shift in managing patients with type 2 diabetes at high risk for or established cardiovascular (CV) disease by recommending GLP-1 receptor agonists and SGLT-2 inhibitors as initial glucose-lowering therapy. This is questioned since outcome trials of these drug classes had metformin as background therapy. In this post hoc analysis, the effect of dulaglutide on CV events was investigated according to the baseline metformin therapy by means of a subgroup analysis of the Researching Cardiovascular Events with a Weekly Incretin in Diabetes (REWIND) trial. Research design and methods Patients in REWIND (n = 9901; women: 46.3%; mean age: 66.2 years) had type 2 diabetes and either a previous CV event (31%) or high CV risk (69%). They were randomized (1:1) to sc. dulaglutide (1.5 mg/weekly) or placebo in addition to standard of care. The primary outcome was the first of a composite of nonfatal myocardial infarction, nonfatal stroke, and death from cardiovascular or unknown causes. Key secondary outcomes included a microvascular composite endpoint, all-cause death, and heart failure. The effect of dulaglutide in patients with and without baseline metformin was evaluated by a Cox regression hazard model with baseline metformin, dulaglutide assignment, and their interaction as independent variables. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by a Cox regression model with adjustments for factors differing at baseline between people with vs. without metformin, identified using the backward selection. Results Compared to patients with metformin at baseline (n = 8037; 81%), those without metformin (n = 1864; 19%) were older and slightly less obese and had higher proportions of women, prior CV events, heart failure, and renal disease. The primary outcome occurred in 976 (12%) participants with baseline metformin and in 281 (15%) without. There was no significant difference in the effect of dulaglutide on the primary outcome in patients with vs. without metformin at baseline [HR 0.92 (CI 0.81–1.05) vs. 0.78 (CI 0.61–0.99); interaction P = 0.18]. Findings for key secondary outcomes were similar in patients with and without baseline metformin. Conclusion This analysis suggests that the cardioprotective effect of dulaglutide is unaffected by the baseline use of metformin therapy. [ABSTRACT FROM AUTHOR]
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- 2021
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40. Design and Baseline Characteristics of Participants in the Researching cardiovascular Events with a Weekly INcretin in Diabetes (REWIND) Trial of Dulaglutide's Cardiovascular Effects
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Gerstein, Hertzel C, Colhoun, Helen M, Dagenais, Gilles R, Diaz, Rafael, Lakshmanan, Mark, Pais, Prem, Probstfield, Jeffrey, Riddle, Matthew C, Rydén, Lars, Xavier, Denis, Atisso, Charles Messan, Avezum, Alvaro, Basile, Jan, Chung, Namsik, Conget, Ignacio, Cushman, William C, Franek, Edward, Hancu, Nicolae, Hanefeld, Markolf, Holt, Shaun, Jansky, Petr, Keltai, Matyas, Lanas, Fernando, Leiter, Lawrence A, Lopez-Jaramillo, Patricio, Munoz, Ernesto German Cardona, Pirags, Valdis, Pogosova, Nana, Raubenheimer, Peter J, Shaw, Jonathan, Sheu, Wayne H-H, and Temelkova-Kurktschiev, Theodora
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Journal Article - Abstract
BACKGROUND: Dulaglutide, a synthetic once-weekly, injectable human glucagon-like peptide 1 (GLP1) analogue lowers blood glucose, body weight, appetite, and blood pressure. Its effect on cardiovascular outcomes is unknown.METHODS: People with type 2 diabetes, aged 50 or older, a HbA1c ≤9.5%, and either a previous cardiovascular (CV) event, evidence of CV disease or ≥ 2 CV risk factors were randomly allocated to a weekly subcutaneous injection of either dulaglutide (1.5 mg) or placebo and followed within the Researching cardiovascular Events with a Weekly INcretin in Diabetes (REWIND) trial every 3 to 6 months. The primary cardiovascular outcome is the first occurrence of the composite of cardiovascular death or non-fatal MI or nonfatal stroke. Secondary outcomes include each component of the primary composite cardiovascular outcome, a composite clinical microvascular outcome comprising retinal or renal disease, hospitalization for unstable angina, heart failure requiring hospitalization or an urgent heart failure visit, and all-cause mortality. Follow-up will continue until the accrual of 1200 confirmed primary outcomes.RESULTS: Recruitment of 9901 participants (mean age 66, 46% women) occurred in 370 sites located in 24 countries over a period of 2 years. The mean duration of diabetes was 10 years, mean baseline HbA1c was 7.3 %, and 31% had prior cardiovascular disease.CONCLUSION: The REWIND trial's international scope, high proportion of women, high proportion of people without prior cardiovascular disease, and inclusion of participants whose mean baseline HbA1c was 7.3% suggests that its cardiovascular and safety findings will be directly relevant to the typical middle-aged patient seen in general practice throughout the world.
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- 2018
41. Treadmill stress tests should not be part of “routine health check package”
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Pais, Prem, primary
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- 2018
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42. HIV and India: looking into the abyss
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Pais, Prem
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- 1996
43. Design and baseline characteristics of participants in the Researching cardiovascular Events with a Weekly INcretin in Diabetes (REWIND) trial on the cardiovascular effects of dulaglutide
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Gerstein, Hertzel C., Colhoun, Helen M., Dagenais, Gilles R., Diaz, Rafael, Lakshmanan, Mark, Pais, Prem, Probstfield, Jeffrey, Riddle, Matthew C., Ryden, Lars, Xavier, Denis, Atisso, Charles M., Avezum, Alvaro, Basile, Jan, Chung, Namsik, Conget, Ignacio, Cushman, William C., Franek, Edward, Hancu, Nicolae, Hanefeld, Markolf, Holt, Shaun, Jansky, Petr, Keltai, Matyas, Lanas, Fernando, Leiter, Lawrence A., Lopez-Jaramillo, Patricio, Cardona-Munoz, Ernesto G., Pirags, Valdis, Pogosova, Nana, Raubenheimer, Peter J., Shaw, Jonathan, Sheu, Wayne H-H., Temelkova-Kurktschiev, Theodora, The REWIND Trial Investigators, and Masira
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Clinical trial ,Diabetes complications ,GLP-1 receptor agonist ,Antidiabetic drug ,Cardiovascular disease - Abstract
Digital, The aim was to determine the effects of dulaglutide, a synthetic once-weekly, injectable human glucagon-like peptide 1 analogue that lowers blood glucose, body weight, appetite and blood pressure, on cardiovascular outcomes. People with type 2 diabetes, aged ≥50 years, with glycated haemoglobin (HbA1c) ≤9.5%, and either a previous cardiovascular event, evidence of cardiovascular disease or ≥2 cardiovascular risk factors were randomly allocated to a weekly subcutaneous injection of either dulaglutide (1.5 mg) or placebo and followed within the ongoing Researching cardiovascular Events with a Weekly INcretin in Diabetes (REWIND) trial every 3 to 6 months. The primary cardiovascular outcome is the first occurrence of the composite of cardiovascular death or non-fatal myocardial infarction or non-fatal stroke. Secondary outcomes include each component of the primary composite cardiovascular outcome, a composite clinical microvascular outcome comprising retinal or renal disease, hospitalization for unstable angina, heart failure requiring hospitalization or an urgent heart failure visit, and all-cause mortality. Follow-up will continue until the accrual of 1200 confirmed primary outcomes. Recruitment of 9901 participants (mean age 66 years, 46% women) occurred in 370 sites located in 24 countries over a period of 2 years. The mean duration of diabetes was 10 years, mean baseline HbA1c was 7.3%, and 31% had prior cardiovascular disease. The REWIND trial's international scope, high proportion of women, high proportion of people without prior cardiovascular disease and inclusion of participants whose mean baseline HbA1c was 7.3% suggests that its cardiovascular and safety findings will be directly relevant to the typical middle-aged patient seen in general practice throughout the world., Ciencias Médicas y de la Salud
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- 2017
44. Abstract 104: First Stroke Reduced 44 Percent by Well Tolerated Medications. Stroke Outcomes From the Heart Outcomes Prevention Evaluation 3 Study
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Bosch, Jackie, primary, Lonn, Eva, additional, Zhu, Jun, additional, Pais, Prem, additional, Xavier, Denis, additional, Dans, Antonio, additional, Diaz, Rafael, additional, Hart, Robert, additional, and Yusuf, Salim, additional
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- 2018
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45. Lipoprotein‐Associated Phospholipase A 2 Activity Is a Marker of Risk But Not a Useful Target for Treatment in Patients With Stable Coronary Heart Disease
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Wallentin, Lars, Held, Claes, Armstrong, Paul W., Cannon, Christopher P., Davies, Richard Y., Granger, Christopher B., Hagström, Emil, Harrington, Robert A., Hochman, Judith S., Koenig, Wolfgang, Krug‐Gourley, Sue, Mohler, Emile R., Siegbahn, Agneta, Tarka, Elizabeth, Steg, Philippe Gabriel, Stewart, Ralph A. H., Weiss, Robert, Östlund, Ollie, White, Harvey D., Budaj, Andrzej, Ardissino, Diego, Avezum, Alvaro, Aylward, Philip E., Bryce, Alfonso, Chen, Hong, Chen, Ming‐Fong, Corbalan, Ramon, Dalby, Anthony J., Danchin, Nicolas, De Winter, Robbert J., Denchev, Stefan, Diaz, Rafael, Elisaf, Moses, Flather, Marcus D., Goudev, Assen R., Grinfeld, Liliana, Husted, Steen, Kim, Hyo‐Soo, Linhart, Ales, Lonn, Eva, López‐Sendón, José, Manolis, Athanasios J., Nicolau, José C., Pais, Prem, Parkhomenko, Alexander, Pedersen, Terje R., Pella, Daniel, Ramos‐Corrales, Marco A., Ruda, Mikhail, Sereg, Mátyás, Siddique, Saulat, Sinnaeve, Peter, Sritara, Piyamitr, Swart, Henk P., Sy, Rody G., Teramoto, Tamio, Tse, Hung‐Fat, Weaver, W. Douglas, Viigimaa, Margus, Vinereanu, Dragos, Zhu, Junren, ACS - Amsterdam Cardiovascular Sciences, and Cardiology
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Male ,medicine.medical_specialty ,Phospholipase A2 Inhibitors ,Myocardial Infarction ,Coronary Disease ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,stomatognathic system ,Double-Blind Method ,Risk Factors ,Interquartile range ,Darapladib ,Internal medicine ,Oximes ,medicine ,Coronary Heart Disease ,Humans ,Prospective Studies ,030212 general & internal medicine ,Myocardial infarction ,Stroke ,Original Research ,Aged ,Pharmacology ,business.industry ,Lipoprotein-associated phospholipase A2 ,lipoprotein ,Hazard ratio ,respiratory system ,Middle Aged ,medicine.disease ,Treatment ,STABILITY Investigators ,inflammation ,Benzaldehydes ,Heart failure ,1-Alkyl-2-acetylglycerophosphocholine Esterase ,Cardiology ,Female ,lipids (amino acids, peptides, and proteins) ,atherosclerosis ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers - Abstract
Background We evaluated lipoprotein‐associated phospholipase A 2 (Lp‐ PLA 2 ) activity in patients with stable coronary heart disease before and during treatment with darapladib, a selective Lp‐ PLA 2 inhibitor, in relation to outcomes and the effects of darapladib in the STABILITY trial. Methods and Results Plasma Lp‐ PLA 2 activity was determined at baseline (n=14 500); at 1 month (n=13 709); serially (n=100) at 3, 6, and 18 months; and at the end of treatment. Adjusted Cox regression models evaluated associations between Lp‐ PLA 2 activity levels and outcomes. At baseline, the median Lp‐ PLA 2 level was 172.4 μmol/min per liter (interquartile range 143.1–204.2 μmol/min per liter). Comparing the highest and lowest Lp‐ PLA 2 quartile groups, the hazard ratios were 1.50 (95% CI 1.23–1.82) for the primary composite end point (cardiovascular death, myocardial infarction, or stroke), 1.95 (95% CI 1.29–2.93) for hospitalization for heart failure, 1.42 (1.07–1.89) for cardiovascular death, and 1.37 (1.03–1.81) for myocardial infarction after adjustment for baseline characteristics, standard laboratory variables, and other prognostic biomarkers. Treatment with darapladib led to a ≈65% persistent reduction in median Lp‐ PLA 2 activity. There were no associations between on‐treatment Lp‐ PLA 2 activity or changes of Lp‐ PLA 2 activity and outcomes, and there were no significant interactions between baseline and on‐treatment Lp‐ PLA 2 activity or changes in Lp‐ PLA 2 activity levels and the effects of darapladib on outcomes. Conclusions Although high Lp‐ PLA 2 activity was associated with increased risk of cardiovascular events, pharmacological lowering of Lp‐ PLA 2 activity by ≈65% did not significantly reduce cardiovascular events in patients with stable coronary heart disease, regardless of the baseline level or the magnitude of change of Lp‐ PLA 2 activity. Clinical Trial Registration URL : https://www.clinicaltrials.gov . Unique identifier: NCT 00799903.
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- 2016
46. Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease
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Lonn, Eva M, Bosch, Jackie, López-Jaramillo, Patricio, Zhu, Jun, Liu, Lisheng, Pais, Prem, Diaz, Rafael, Xavier, Denis, Sliwa, Karen, Dans, Antonio, Avezum, Álvaro, Piegas, Leopoldo S, Keltai, Katalin, Keltai, Matyas, Chazova, Irina, Peters, Ron JG, Held, Claes, Yusoff, Khalid, Lewis, Basil S, Jansky, Petr, Parkhomenko, Alexander, Khunti, Kamlesh, Toff, William D, Reid, Christopher M, Varigos, John, Leiter, Lawrence A, Molina, Dora I, McKelvie, Robert, Pogue, Janice, Wilkinson, Joanne, Jung, Hyejung, Dagenais, Gilles, Department of Medicine, and Faculty of Health Sciences
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Male ,Incidence ,Tetrazoles ,Blood Pressure ,Kaplan-Meier Estimate ,Middle Aged ,Hydrochlorothiazide ,candesartan ,Double-Blind Method ,Cardiovascular Diseases ,Risk Factors ,Hypertension ,Humans ,Benzimidazoles ,Drug Therapy, Combination ,Female ,Hypotension ,Antihypertensive Agents ,Aged - Abstract
Antihypertensive therapy reduces the risk of cardiovascular events among high-risk persons and among those with a systolic blood pressure of 160 mm Hg or higher, but its role in persons at intermediate risk and with lower blood pressure is unclear. In one comparison from a 2-by-2 factorial trial, we randomly assigned 12,705 participants at intermediate risk who did not have cardiovascular disease to receive either candesartan at a dose of 16 mg per day plus hydrochlorothiazide at a dose of 12.5 mg per day or placebo. The first coprimary outcome was the composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke; the second coprimary outcome additionally included resuscitated cardiac arrest, heart failure, and revascularization. The median follow-up was 5.6 years. The mean blood pressure of the participants at baseline was 138.1/81.9 mm Hg; the decrease in blood pressure was 6.0/3.0 mm Hg greater in the active-treatment group than in the placebo group. The first coprimary outcome occurred in 260 participants (4.1%) in the active-treatment group and in 279 (4.4%) in the placebo group (hazard ratio, 0.93; 95% confidence interval [CI], 0.79 to 1.10; P=0.40); the second coprimary outcome occurred in 312 participants (4.9%) and 328 participants (5.2%), respectively (hazard ratio, 0.95; 95% CI, 0.81 to 1.11; P=0.51). In one of the three prespecified hypothesis-based subgroups, participants in the subgroup for the upper third of systolic blood pressure (>143.5 mm Hg) who were in the active-treatment group had significantly lower rates of the first and second coprimary outcomes than those in the placebo group; effects were neutral in the middle and lower thirds (P=0.02 and P=0.009, respectively, for trend in the two outcomes). Therapy with candesartan at a dose of 16 mg per day plus hydrochlorothiazide at a dose of 12.5 mg per day was not associated with a lower rate of major cardiovascular events than placebo among persons at intermediate risk who did not have cardiovascular disease. (Funded by the Canadian Institutes of Health Research and AstraZeneca; ClinicalTrials.gov number, NCT00468923.)
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- 2016
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47. Blood-Pressure and Cholesterol Lowering in Persons without Cardiovascular Disease
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Yusuf, Salim, Lonn, Eva, Pais, Prem, Bosch, Jackie, Lopez-Jaramillo, Patricio, Zhu, Jun, Xavier, Denis, Avezum, Alvaro, Leiter, Lawrence A., Piegas, Leopoldo S., Parkhomenko, Alexander, Keltai, Matyas, Keltai, Katalin, Sliwa, Karen, Chazova, Irina, Peters, Ron J. G., Held, Claes, Yusoff, Khalid, Lewis, Basil S., Jansky, Petr, Khunti, Kamlesh, Toff, William D., Reid, Christopher M., Varigos, John, Accini, Jose L., McKelvie, Robert, Pogue, Janice, Jung, Hyejung, Liu, Lisheng, Diaz, Rafael, Dans, Antonio, Dagenais, Gilles, Yusuf, Salim, Lonn, Eva, Pais, Prem, Bosch, Jackie, Lopez-Jaramillo, Patricio, Zhu, Jun, Xavier, Denis, Avezum, Alvaro, Leiter, Lawrence A., Piegas, Leopoldo S., Parkhomenko, Alexander, Keltai, Matyas, Keltai, Katalin, Sliwa, Karen, Chazova, Irina, Peters, Ron J. G., Held, Claes, Yusoff, Khalid, Lewis, Basil S., Jansky, Petr, Khunti, Kamlesh, Toff, William D., Reid, Christopher M., Varigos, John, Accini, Jose L., McKelvie, Robert, Pogue, Janice, Jung, Hyejung, Liu, Lisheng, Diaz, Rafael, Dans, Antonio, and Dagenais, Gilles
- Abstract
BACKGROUND Elevated blood pressure and elevated low-density lipoprotein (LDL) cholesterol increase the risk of cardiovascular disease. Lowering both should reduce the risk of cardiovascular events substantially. METHODS In a trial with 2-by-2 factorial design, we randomly assigned 12,705 participants at intermediate risk who did not have cardiovascular disease to rosuvastatin (10 mg per day) or placebo and to candesartan (16 mg per day) plus hydrochlorothiazide (12.5 mg per day) or placebo. In the analyses reported here, we compared the 3180 participants assigned to combined therapy (with rosuvastatin and the two antihypertensive agents) with the 3168 participants assigned to dual placebo. The first coprimary outcome was the composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke, and the second coprimary outcome additionally included heart failure, cardiac arrest, or revascularization. The median follow-up was 5.6 years. RESULTS The decrease in the LDL cholesterol level was 33.7 mg per deciliter (0.87 mmol per liter) greater in the combined-therapy group than in the dual-placebo group, and the decrease in systolic blood pressure was 6.2 mm Hg greater with combined therapy than with dual placebo. The first coprimary outcome occurred in 113 participants (3.6%) in the combined-therapy group and in 157 (5.0%) in the dual-placebo group (hazard ratio, 0.71; 95% confidence interval [CI], 0.56 to 0.90; P=0.005). The second coprimary outcome occurred in 136 participants (4.3%) and 187 participants (5.9%), respectively (hazard ratio, 0.72; 95% CI, 0.57 to 0.89; P=0.003). Muscle weakness and dizziness were more common in the combined-therapy group than in the dual-placebo group, but the overall rate of discontinuation of the trial regimen was similar in the two groups. CONCLUSIONS The combination of rosuvastatin (10 mg per day), candesartan (16 mg per day), and hydrochlorothiazide (12.5 mg per day) was associated with a significantly
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- 2016
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48. Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease
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Lonn, Eva M., Bosch, Jackie, Lopez-Jaramillo, Patricio, Zhu, Jun, Liu, Lisheng, Pais, Prem, Diaz, Rafael, Xavier, Denis, Sliwa, Karen, Dans, Antonio, Avezum, Alvaro, Piegas, Leopoldo S., Keltai, Katalin, Keltai, Matyas, Chazova, Irina, Peters, Ron J. G., Held, Claes, Yusoff, Khalid, Lewis, Basil S., Jansky, Petr, Parkhomenko, Alexander, Khunti, Kamlesh, Toff, William D., Reid, Christopher M., Varigos, John, Leiter, Lawrence A., Molina, Dora I., McKelvie, Robert, Pogue, Janice, Wilkinson, Joanne, Jung, Hyejung, Dagenais, Gilles, Yusuf, Salim, Lonn, Eva M., Bosch, Jackie, Lopez-Jaramillo, Patricio, Zhu, Jun, Liu, Lisheng, Pais, Prem, Diaz, Rafael, Xavier, Denis, Sliwa, Karen, Dans, Antonio, Avezum, Alvaro, Piegas, Leopoldo S., Keltai, Katalin, Keltai, Matyas, Chazova, Irina, Peters, Ron J. G., Held, Claes, Yusoff, Khalid, Lewis, Basil S., Jansky, Petr, Parkhomenko, Alexander, Khunti, Kamlesh, Toff, William D., Reid, Christopher M., Varigos, John, Leiter, Lawrence A., Molina, Dora I., McKelvie, Robert, Pogue, Janice, Wilkinson, Joanne, Jung, Hyejung, Dagenais, Gilles, and Yusuf, Salim
- Abstract
BACKGROUND Antihypertensive therapy reduces the risk of cardiovascular events among high-risk persons and among those with a systolic blood pressure of 160 mm Hg or higher, but its role in persons at intermediate risk and with lower blood pressure is unclear. METHODS In one comparison from a 2-by-2 factorial trial, we randomly assigned 12,705 participants at intermediate risk who did not have cardiovascular disease to receive either candesartan at a dose of 16 mg per day plus hydrochlorothiazide at a dose of 12.5 mg per day or placebo. The first coprimary outcome was the composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke; the second coprimary outcome additionally included resuscitated cardiac arrest, heart failure, and revascularization. The median follow-up was 5.6 years. RESULTS The mean blood pressure of the participants at baseline was 138.1/81.9 mm Hg; the decrease in blood pressure was 6.0/3.0 mm Hg greater in the active-treatment group than in the placebo group. The first coprimary outcome occurred in 260 participants (4.1%) in the active-treatment group and in 279 (4.4%) in the placebo group (hazard ratio, 0.93; 95% confidence interval [CI], 0.79 to 1.10; P = 0.40); the second coprimary outcome occurred in 312 participants (4.9%) and 328 participants (5.2%), respectively (hazard ratio, 0.95; 95% CI, 0.81 to 1.11; P = 0.51). In one of the three prespecified hypothesis-based subgroups, participants in the subgroup for the upper third of systolic blood pressure (>143.5 mm Hg) who were in the active-treatment group had significantly lower rates of the first and second coprimary outcomes than those in the placebo group; effects were neutral in the middle and lower thirds (P = 0.02 and P = 0.009, respectively, for trend in the two outcomes). CONCLUSIONS Therapy with candesartan at a dose of 16 mg per day plus hydrochlorothiazide at a dose of 12.5 mg per day was not associated with a lower rate of major cardiovascul
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- 2016
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49. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE):a case-control study
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O'Donnell, Martin J, Chin, Siu Lim, Rangarajan, Sumathy, Xavier, Denis, Liu, Lisheng, Zhang, Hongye, Rao-Melacini, Purnima, Zhang, Xiaohe, Pais, Prem, Agapay, Steven, Lopez-Jaramillo, Patricio, Damasceno, Albertino, Langhorne, Peter, McQueen, Matthew J, Rosengren, Annika, Dehghan, Mahshid, Hankey, Graeme J, Dans, Antonio L, Elsayed, Ahmed, Avezum, Alvaro, Mondo, Charles, Diener, Hans-Christoph, Ryglewicz, Danuta, Czlonkowska, Anna, Pogosova, Nana, Weimar, Christian, Iqbal, Romaina, Diaz, Rafael, Yusoff, Khalid, Yusufali, Afzalhussein, Oguz, Aytekin, Wang, Xingyu, Penaherrera, Ernesto, Lanas, Fernando, Ogah, Okechukwu S, Ogunniyi, Adesola, Iversen, Helle K, Malaga, German, Rumboldt, Zvonko, Oveisgharan, Shahram, Al Hussain, Fawaz, Magazi, Daliwonga, Nilanont, Yongchai, Ferguson, John, Pare, Guillaume, Yusuf, Salim, O'Donnell, Martin J, Chin, Siu Lim, Rangarajan, Sumathy, Xavier, Denis, Liu, Lisheng, Zhang, Hongye, Rao-Melacini, Purnima, Zhang, Xiaohe, Pais, Prem, Agapay, Steven, Lopez-Jaramillo, Patricio, Damasceno, Albertino, Langhorne, Peter, McQueen, Matthew J, Rosengren, Annika, Dehghan, Mahshid, Hankey, Graeme J, Dans, Antonio L, Elsayed, Ahmed, Avezum, Alvaro, Mondo, Charles, Diener, Hans-Christoph, Ryglewicz, Danuta, Czlonkowska, Anna, Pogosova, Nana, Weimar, Christian, Iqbal, Romaina, Diaz, Rafael, Yusoff, Khalid, Yusufali, Afzalhussein, Oguz, Aytekin, Wang, Xingyu, Penaherrera, Ernesto, Lanas, Fernando, Ogah, Okechukwu S, Ogunniyi, Adesola, Iversen, Helle K, Malaga, German, Rumboldt, Zvonko, Oveisgharan, Shahram, Al Hussain, Fawaz, Magazi, Daliwonga, Nilanont, Yongchai, Ferguson, John, Pare, Guillaume, and Yusuf, Salim
- Abstract
BACKGROUND: Stroke is a leading cause of death and disability, especially in low-income and middle-income countries. We sought to quantify the importance of potentially modifiable risk factors for stroke in different regions of the world, and in key populations and primary pathological subtypes of stroke.METHODS: We completed a standardised international case-control study in 32 countries in Asia, America, Europe, Australia, the Middle East, and Africa. Cases were patients with acute first stroke (within 5 days of symptom onset and 72 h of hospital admission). Controls were hospital-based or community-based individuals with no history of stroke, and were matched with cases, recruited in a 1:1 ratio, for age and sex. All participants completed a clinical assessment and were requested to provide blood and urine samples. Odds ratios (OR) and their population attributable risks (PARs) were calculated, with 99% confidence intervals.FINDINGS: Between Jan 11, 2007, and Aug 8, 2015, 26 919 participants were recruited from 32 countries (13 447 cases [10 388 with ischaemic stroke and 3059 intracerebral haemorrhage] and 13 472 controls). Previous history of hypertension or blood pressure of 140/90 mm Hg or higher (OR 2·98, 99% CI 2·72-3·28; PAR 47·9%, 99% CI 45·1-50·6), regular physical activity (0·60, 0·52-0·70; 35·8%, 27·7-44·7), apolipoprotein (Apo)B/ApoA1 ratio (1·84, 1·65-2·06 for highest vs lowest tertile; 26·8%, 22·2-31·9 for top two tertiles vs lowest tertile), diet (0·60, 0·53-0·67 for highest vs lowest tertile of modified Alternative Healthy Eating Index [mAHEI]; 23·2%, 18·2-28·9 for lowest two tertiles vs highest tertile of mAHEI), waist-to-hip ratio (1·44, 1·27-1·64 for highest vs lowest tertile; 18·6%, 13·3-25·3 for top two tertiles vs lowest), psychosocial factors (2·20, 1·78-2·72; 17·4%, 13·1-22·6), current smoking (1·67, 1·49-1·87; 12·4%, 10·2-14·9), cardiac causes (3·17, 2·68-3·75; 9·1%, 8·0-10·2), alcohol consumption (2·09, 1·64-2·67 for high
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- 2016
50. Commercial conflict of interest and medical publication: What should the practising physician do about it?
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Pais, Prem, primary
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- 2016
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