39 results on '"Deedwania, Prakash"'
Search Results
2. Prediction of cardiovascular events in statin-treated stable coronary patients of the treating to new targets randomized controlled trial by lipid and non-lipid biomarkers.
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Arsenault BJ, Barter P, DeMicco DA, Bao W, Preston GM, LaRosa JC, Grundy SM, Deedwania P, Greten H, Wenger NK, Shepherd J, Waters DD, and Kastelein JJ
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- Biomarkers blood, Coronary Disease diagnosis, Female, Humans, Male, Middle Aged, Prognosis, Time Factors, Coronary Disease blood, Coronary Disease drug therapy, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Lipids blood, Molecular Targeted Therapy
- Abstract
Unlabelled: Several plasma non-lipid biomarkers have been shown to predict major cardiovascular events (MCVEs) in population studies. Our objective was to investigate the relationship between lipid and non-lipid biomarkers levels achieved during statin therapy and the incidence of MCVEs in patients with stable coronary heart disease (CHD). We conducted a substudy of the TNT (Treating to New Targets) study, which was a randomized trial that compared the efficacy of high (80 mg) versus low (10 mg) dose atorvastatin for the secondary prevention of CHD. Fasting plasma levels of standard lipids and of 18 non-lipid biomarkers were obtained after an 8-week run-in period on atorvastatin 10 mg in 157 patients who experienced MCVEs during the 4.9 years of study follow-up and in 1349 controls. MCVE was defined as CHD death, nonfatal, non-procedure-related myocardial infarction, resuscitated cardiac arrest, and fatal or nonfatal stroke. After adjusting for age, sex and treatment arm, plasma levels of high-density lipoprotein (HDL) cholesterol, triglycerides, high-sensitivity C-reactive protein (hsCRP), insulin, neopterin, N-terminal pro-brain natriuretic peptide (BNP), lipoprotein(a) [Lp(a)], and the soluble receptor for advanced glycation end products (sRAGE) were predictive of recurrent MCVEs (P ≤ 0.02 for each doubling of plasma concentration). However, no significant association was observed between the risk of recurrent MCVEs and plasma levels of low-density lipoprotein cholesterol, adiponectin, cystatin C, lipoprotein-associated phospholipase A2, monocyte chemotactic protein-1, matrix metalloproteinase-9, myeloperoxidase, osteopontin, soluble CD40 ligand, soluble intercellular adhesion molecule-1, or soluble vascular cell adhesion molecule-1. After further adjustment for diabetes, hypertension, smoking, and BMI, the relationship between hsCRP, insulin and MCVE were no longer significant, while the relationship between Lp(a), neopterin, NT-proBNP and sRAGE and MCVE remained statistically significant. In conclusion, in patients with CHD treated with atorvastatin, plasma levels of Lp(a), neopterin, NT-proBNP, and sRAGE are associated with the risk of recurrent MCVEs., Trial Registration: ClinicalTrials.gov NCT00327691.
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- 2014
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3. Prevalence, predictors, and outcomes in treatment-resistant hypertension in patients with coronary disease.
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Bangalore S, Fayyad R, Laskey R, Demicco DA, Deedwania P, Kostis JB, and Messerli FH
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- Adrenergic beta-Antagonists therapeutic use, Adult, Aged, Angiotensin Receptor Antagonists therapeutic use, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Antihypertensive Agents administration & dosage, Atorvastatin, Calcium Channel Blockers therapeutic use, Diuretics therapeutic use, Double-Blind Method, Drug Administration Schedule, Drug Resistance, Female, Heptanoic Acids therapeutic use, Humans, Hypertension physiopathology, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Predictive Value of Tests, Prevalence, Pyrroles therapeutic use, Risk Factors, Treatment Outcome, Antihypertensive Agents therapeutic use, Blood Pressure drug effects, Coronary Disease complications, Coronary Disease mortality, Hypertension complications, Hypertension drug therapy
- Abstract
Background: Increasingly, apparent treatment-resistant hypertension has been recognized. However, much of the prevalence, predictors, and outcomes are largely unknown, especially in patients with coronary artery disease., Methods: We evaluated 10,001 patients with coronary artery disease who were enrolled in the Treating to New Targets trial. Apparent treatment-resistant hypertension was defined as blood pressure ≥ 140 mm Hg despite 3 antihypertensive agents or <140 mm Hg with ≥ 4 antihypertensive agents. The primary outcome was major cardiovascular events (composite of fatal coronary heart disease, nonfatal myocardial infarction, resuscitated cardiac arrest, and stroke)., Results: Among the 10,001 patients in the trial, 1112 (11.1%) had apparent treatment-resistant hypertension. In a multivariable model adjusting for baseline differences, the treatment-resistant hypertension group had a 64% increase in primary outcome (hazard ratio [HR], 1.64; 95% confidence interval [CI], 1.39-1.94; P < .001), driven by a 69% increase in coronary heart disease death (HR, 1.69; 95% CI, 1.22, 2.34; P = .001) and 73% increase in nonfatal myocardial infarction (HR, 1.73; 95% CI, 1.39-2.16, P < .0001) when compared with the no apparent treatment-resistant hypertension group. In addition, patients with apparent treatment-resistant hypertension had a 71% increase in major coronary event (P < .0001), 45% increase in death (P = .001), 33% increase in heart failure (P = .05), 53% increase in any cardiovascular event (P < .0001), 60% increase in any coronary event (P < .0001), 68% increase in angina (P < .0001), and 51% increase in coronary revascularization (P < .0001) when compared with the no apparent treatment-resistant hypertension group. Results were largely similar whether the definition of apparent treatment-resistant hypertension was based on a blood pressure ≥ 140 mm Hg despite 3 agents or a blood pressure <140 mm Hg with ≥ 4 agents., Conclusions: In patients with coronary artery disease, apparent treatment-resistant hypertension is associated with a marked increase in the risk of cardiovascular morbidity and mortality, including an increase in all-cause death., (Copyright © 2014 Elsevier Inc. All rights reserved.)
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- 2014
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4. Relation of increased prebeta-1 high-density lipoprotein levels to risk of coronary heart disease.
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Guey LT, Pullinger CR, Ishida BY, O'Connor PM, Zellner C, Francone OL, Laramie JM, Naya-Vigne JM, Siradze KA, Deedwania P, Redberg RF, Frost PH, Seymour AB, Kane JP, and Malloy MJ
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- Adult, Aged, Cohort Studies, Coronary Disease diagnosis, Coronary Disease epidemiology, Female, Humans, Likelihood Functions, Male, Middle Aged, Myocardial Infarction diagnosis, Myocardial Infarction epidemiology, Predictive Value of Tests, Risk Factors, Coronary Disease blood, High-Density Lipoproteins, Pre-beta blood, Myocardial Infarction blood
- Abstract
Preβ-1 high-density lipoprotein (HDL) plays a key role in reverse cholesterol transport by promoting cholesterol efflux. Our aims were (1) to test previous associations between preβ-1 HDL and coronary heart disease (CHD) and (2) to investigate whether preβ-1 HDL levels also are associated with risk of myocardial infarction (MI). Plasma preβ-1 HDL was measured by an ultrafiltration-isotope dilution technique in 1,255 subjects recruited from the University of California-San Francisco Lipid and Cardiovascular Clinics and collaborating cardiologists. Preβ-1 HDL was significantly and positively associated with CHD and MI even after adjustment for established risk factors. Inclusion of preβ-1 HDL in a multivariable model for CHD led to a modest improvement in reclassification of subjects (net reclassification index 0.15, p = 0.01; integrated discrimination improvement 0.003, p = 0.2). In contrast, incorporation of preβ-1 HDL into a risk model of MI alone significantly improved reclassification of subjects (net reclassification index 0.21, p = 0.008; integrated discrimination improvement 0.01, p = 0.02), suggesting that preβ-1 HDL has more discriminatory power for MI than for CHD in our study population. In conclusion, these results confirm previous associations between preβ-1 HDL and CHD in a large well-characterized clinical cohort. Also, this is the first study in which preβ-1 HDL was identified as a novel and independent predictor of MI above and beyond traditional CHD risk factors., (Copyright © 2011. Published by Elsevier Inc.)
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- 2011
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5. Medical therapy versus myocardial revascularization in chronic coronary syndrome and stable angina.
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Deedwania PC and Carbajal EV
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- Acetanilides therapeutic use, Adrenergic beta-Antagonists therapeutic use, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Benzazepines therapeutic use, Calcium Channel Blockers therapeutic use, Cardiovascular Agents adverse effects, Cardiovascular Agents pharmacology, Drug Therapy, Combination, Humans, Hypolipidemic Agents therapeutic use, Ivabradine, Nitrates therapeutic use, Piperazines therapeutic use, Ranolazine, Treatment Outcome, Angina Pectoris drug therapy, Angina Pectoris surgery, Cardiovascular Agents therapeutic use, Coronary Disease drug therapy, Coronary Disease surgery, Myocardial Revascularization statistics & numerical data, Myocardial Revascularization trends
- Abstract
Coronary artery disease is a leading cause of death in the United States. Angina is encountered frequently in clinical practice. Effective management of patients with coronary artery disease and stable angina should consist of therapy aimed at symptom control and reduction of adverse clinical outcomes. Therapeutic options for angina include antianginal drugs: nitrates, beta-blockers, calcium channel blockers, ranolazine, and myocardial revascularization. Recent trials have shown that although revascularization is slightly better in controlling symptoms, optimal medical therapy that includes aggressive risk factor modification is equally effective in reducing the risk of future coronary events and death. On the basis of the available data, it seems appropriate to prescribe optimal medical therapy in most patients with coronary artery disease and stable angina, and reserve myocardial revascularization for selected patients with disabling symptoms despite optimal medical therapy., (Published by Elsevier Inc.)
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- 2011
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6. Prediction of cardiovascular events in statin-treated stable coronary patients by lipid and nonlipid biomarkers.
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Arsenault BJ, Barter P, DeMicco DA, Bao W, Preston GM, LaRosa JC, Grundy SM, Deedwania P, Greten H, Wenger NK, Shepherd J, Waters DD, and Kastelein JJ
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- Atorvastatin, C-Reactive Protein metabolism, Cholesterol, HDL blood, Cholesterol, LDL blood, Coronary Disease blood, Coronary Disease diagnosis, Death, Sudden, Cardiac epidemiology, Dose-Response Relationship, Drug, Double-Blind Method, Female, Follow-Up Studies, Heptanoic Acids administration & dosage, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors administration & dosage, Incidence, Male, Middle Aged, Myocardial Infarction blood, Myocardial Infarction epidemiology, Prognosis, Pyrroles administration & dosage, Retrospective Studies, Stroke blood, Stroke epidemiology, Time Factors, Biomarkers blood, Coronary Disease drug therapy, Death, Sudden, Cardiac prevention & control, Heptanoic Acids therapeutic use, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Myocardial Infarction prevention & control, Pyrroles therapeutic use, Stroke prevention & control
- Abstract
Objectives: The aim of this study was to investigate the relationship between lipid and nonlipid biomarker levels achieved during statin therapy and the incidence of major cardiovascular events (MCVEs) in patients with stable coronary heart disease (CHD)., Background: Several plasma nonlipid biomarkers have been shown to predict MCVEs in population studies., Methods: This is a nested case-control study in the TNT (Treating to New Targets) study population, a randomized trial that compared the efficacy of high- (80 mg) versus low-dose (10 mg) atorvastatin for the secondary prevention of CHD. Fasting plasma levels of standard lipids and of 18 nonlipid biomarkers were obtained after an 8-week run-in period on atorvastatin 10 mg and again 1 year after being randomized to 10 or 80 mg atorvastatin in 507 patients who experienced MCVEs during the 4.9 years of study follow-up and in 1,020 control subjects. An MCVE was defined as CHD death; nonfatal, non-procedure-related myocardial infarction; resuscitated cardiac arrest; or fatal or nonfatal stroke., Results: Low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides were all predictive of recurrent MCVEs (p ≤ 0.009). Concentrations of many of the 18 nonlipid biomarkers were lowered by atorvastatin therapy (independent of dose). However, almost none of the nonlipid biomarker levels, whether measured after the 8-week run-in period or after 1 year of treatment with 10 or 80 mg atorvastatin, were predictive of recurrent MCVEs., Conclusions: In patients with stable CHD, atorvastatin improved plasma levels of an expanded panel of nonlipid biomarkers. However, independently of atorvastatin dose, the achieved levels of the vast majority of nonlipid biomarkers did not predict MCVEs. (A Study to Determine the Degree of Additional Reduction in CV Risk in Lowering LDL Below Minimum Target Levels [TNT]; NCT00327691)., (Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2011
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7. Low high-density lipoprotein cholesterol: current status and future strategies for management.
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Singh V, Sharma R, Kumar A, and Deedwania P
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- Animals, Atherosclerosis blood, Atherosclerosis genetics, Atherosclerosis prevention & control, Cholesterol, HDL blood, Cholesterol, HDL metabolism, Cholesterol, LDL blood, Cholesterol, LDL drug effects, Cholesterol, LDL metabolism, Coronary Disease blood, Coronary Disease epidemiology, Drug Therapy, Combination, Humans, Hypoalphalipoproteinemias complications, Hypoalphalipoproteinemias etiology, Hypoalphalipoproteinemias prevention & control, Hypolipidemic Agents pharmacology, Practice Guidelines as Topic, Randomized Controlled Trials as Topic, Atherosclerosis drug therapy, Cholesterol, HDL drug effects, Coronary Disease prevention & control, Hypoalphalipoproteinemias drug therapy, Hypolipidemic Agents therapeutic use
- Abstract
Atherosclerotic cardiovascular disease is the foremost cause of death and disability in the Western world, and it is rapidly becoming so in the developing nations. Even though the use of statin therapy aiming at the low-density lipoprotein cholesterol (LDL) has significantly reduced cardiovascular events and mortality, substantial residual cardiac events still occur in those being treated to the currently recommended targets. In fact, residual risk is also seen in those who are treated "aggressively" such as the "high risk" patients so defined by the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III). Consequently, one must look for the predictors of risk beyond LDL reduction. High-density lipoprotein cholesterol (HDL) is the next frontier. The protectiveness of elevated HDL against atherosclerosis is well described in the literature. HDL subdues several atherogenic processes, such as oxidation, inflammation, cell proliferation and thrombosis. It also helps mobilize the excess LDL via reverse cholesterol transport. Low levels of HDL have been shown to be independent predictors of risk. Thus, therapies to raise the HDL hold promise for additional cardiac risk reduction. In this regard, several randomized trials have recently tested this hypothesis, especially in patients at high risk. In addition to the use of aggressive lifestyle modification, clinical outcomes have been measured following augmentation of HDL levels with various treatment modalities, including aggressive statin therapy, combination therapy with fibrates and niacin, and direct HDL-raising drug treatments. These data for low HDL as an independent risk factor and as the new treatment target are reviewed in this paper.
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- 2010
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8. Usefulness of heart rate at rest as a predictor of mortality, hospitalization for heart failure, myocardial infarction, and stroke in patients with stable coronary heart disease (Data from the Treating to New Targets [TNT] trial).
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Ho JE, Bittner V, Demicco DA, Breazna A, Deedwania PC, and Waters DD
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- Female, Follow-Up Studies, Heart Failure etiology, Hospitalization, Humans, Male, Middle Aged, Myocardial Infarction etiology, Rest, Stroke etiology, Coronary Disease complications, Heart Failure mortality, Heart Rate, Myocardial Infarction mortality, Stroke mortality
- Abstract
The heart rate at rest (HR) is a predictor of cardiovascular (CV) mortality. However, its effect on nonfatal CV events is unknown. The aim of the present post hoc analysis of the Treating New Targets (TNT) trial was to assess the effect of the HR at rest on major CV events in patients with stable coronary heart disease. A total of 9,580 subjects were included in the present analysis and were followed up for a median of 4.9 years. The rate of major CV events was 11.9% in those with a baseline HR of > or =70 beats/min versus 8.8% in those with a baseline HR of <70 beats/min. An increased HR at rest was associated with CV events, even after adjustment for differences in baseline characteristics (unadjusted hazard ratio 1.16 for every 10-beats/min increase, 95% confidence interval [CI] 1.10 to 1.23, p <0.0001; adjusted hazard ratio 1.08 per 10-beats/min increase, 95% CI 1.02 to 1.16, p = 0.018). A HR > or =70 beats/min was a significant independent predictor of all-cause mortality (hazard ratio 1.40, 95% CI 1.14 to 1.71, p = 0.001) and heart failure hospitalization (hazard ratio 2.30, 95% CI 1.80 to 2.95, p > or =0.0001). However, this association was not observed for stroke or myocardial infarction (p = 0.11 and p = 0.68, respectively). In conclusion, in patients with stable coronary heart disease, every 10-beats/min increase in the HR at rest was associated with an 8% increase in major CV events. In particular, a HR at rest of > or =70 beats/min was associated with a 40% increased risk of all-cause mortality and more than doubled the risk of heart failure hospitalization, but not the risk of stroke or myocardial infarction., (Copyright 2010 Elsevier Inc. All rights reserved.)
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- 2010
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9. Comparison of 80 versus 10 mg of atorvastatin on occurrence of cardiovascular events after the first event (from the Treating to New Targets [TNT] trial).
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LaRosa JC, Deedwania PC, Shepherd J, Wenger NK, Greten H, DeMicco DA, and Breazna A
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- Aged, Atorvastatin, Coronary Disease complications, Diabetes Complications drug therapy, Double-Blind Method, Drug Administration Schedule, Heart Diseases prevention & control, Humans, Metabolic Syndrome complications, Risk Factors, Treatment Outcome, Anticholesteremic Agents administration & dosage, Coronary Disease drug therapy, Coronary Restenosis prevention & control, Heart Failure prevention & control, Heptanoic Acids administration & dosage, Metabolic Syndrome drug therapy, Pyrroles administration & dosage
- Abstract
Analyses of randomized clinical trials are usually restricted to examination of time to first event. However, because many patients have multiple events, this approach precludes much potentially useful clinical and economic data. To assess the effect on overall disease burden in the Treating to New Targets (TNT) study, we evaluated the effect of treatment with atorvastatin 80 versus 10 mg in the period after the occurrence of a first cardiovascular event. In TNT, 10,001 patients with stable coronary heart disease received double-blind therapy with atorvastatin 80 or 10 mg and were followed for 4.9 years. Post hoc time-to-event analysis was used to estimate separate hazard ratios for time to any first, second, third, fourth, and fifth recurrent cardiovascular events. During TNT, 3,082 patients had a first recurrent cardiovascular event, with 1,516, 698, 345, and 197 developing second, third, fourth, and fifth recurrent events, respectively. In patients receiving atorvastatin 80 mg, the relative risk of a first recurrent event was significantly decreased compared to those receiving atorvastatin 10 mg. Significant benefit with the 80-mg dose was also observed for second, third, fourth, and fifth recurrent events. Similar findings were recorded in 5,854 patients with type 2 diabetes mellitus and/or metabolic syndrome and in 3,809 patients > or = 65 years of age compared to younger patients. In conclusion, treatment with atorvastatin 80 mg continued to significantly decrease the risk of any cardiovascular event over time compared to atorvastatin 10 mg in patients who had survived previous events. In TNT, analyses limited to the primary end point significantly underestimated the decrease in total cardiovascular disease burden achieved by intensive low-density lipoprotein cholesterol lowering., (Copyright 2010 Elsevier Inc. All rights reserved.)
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- 2010
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10. Low use of statins and other coronary secondary prevention therapies in primary and secondary care in India.
- Author
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Sharma KK, Gupta R, Agrawal A, Roy S, Kasliwal A, Bana A, Tongia RK, and Deedwania PC
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- Adrenergic beta-Antagonists therapeutic use, Adult, Aged, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Aspirin therapeutic use, Coronary Disease epidemiology, Drug Prescriptions, Drug Therapy, Combination, Drug Utilization, Evidence-Based Medicine, Female, Guideline Adherence, Humans, India epidemiology, Male, Middle Aged, Platelet Aggregation Inhibitors therapeutic use, Practice Guidelines as Topic, Coronary Disease prevention & control, Coronary Disease therapy, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Practice Patterns, Physicians' statistics & numerical data, Primary Health Care statistics & numerical data, Secondary Prevention statistics & numerical data
- Abstract
Objective: To determine the frequency of use of pharmacotherapy with aspirin, beta blocker, statin, and angiotensin-converting enzyme (ACE) inhibitor in patients with stable coronary heart disease (CHD) among physicians at different levels of health care in Rajasthan state, India., Methods: Physicians practicing at tertiary hospitals and clinics at tertiary, secondary and primary levels were contacted. Prescriptions of CHD patients were audited and descriptive statistics reported., Results: We evaluated 2,993 prescriptions (tertiary hospital discharge 711, tertiary 688, secondary 1,306, and primary 288). Use of aspirin was in 2,713 (91%) of prescriptions, beta blockers 2,057 (69%), ACE inhibitors or angiotensin receptor blockers (ARBs) 2,471 (82%), and statins 2,059 (69%). Any one of these drugs was prescribed in 2,991 (100%), any two in 2,880 (96%), any three in 1,740 (58%), and all four in 1,062 (35.5%) (P < 0.001). As compared to tertiary hospital, prescriptions at tertiary, secondary, and primary levels were lower: aspirin (96% vs 95%, 91%, 67%), beta blockers (80% vs 62%, 66%, 70%), statins (87% vs 82%, 62%, 21%): two drugs (98% vs 96%, 98%, 85%), three drugs (75% vs 58%, 55%, 28%), or four drugs (54% vs 44%, 28%, 7%) (P < 0.01). Use of ACE inhibitors/ARBs was similar while nitrates (43% vs 23%, 43%, 70%), dihydropyridine calcium channel blockers (12% vs 15%, 30%, 47%), and multivitamins (6% vs 26%, 37%, 47%) use was more in secondary and primary care., Conclusions: There is suboptimal use of various evidence-based drugs (aspirin, beta blockers, ACE inhibitors, and statins) for secondary prevention of CHD in India.
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- 2009
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11. Reducing morbidity and mortality in high risk patients with statins.
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Singh V and Deedwania P
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- Atorvastatin, Cardiovascular Diseases complications, Cardiovascular Diseases drug therapy, Coronary Disease complications, Diabetes Complications drug therapy, Dose-Response Relationship, Drug, Heptanoic Acids administration & dosage, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors administration & dosage, Intracranial Arteriosclerosis complications, Intracranial Arteriosclerosis drug therapy, Kidney Failure, Chronic complications, Kidney Failure, Chronic drug therapy, Metabolic Diseases complications, Metabolic Diseases drug therapy, Practice Guidelines as Topic, Pyrroles administration & dosage, Randomized Controlled Trials as Topic, Risk Factors, Cholesterol, LDL drug effects, Coronary Disease drug therapy, Coronary Disease mortality, Heptanoic Acids therapeutic use, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Pyrroles therapeutic use
- Abstract
Residual coronary heart disease remains a significant problem even after adequate statin therapy for cardiovascular risk reduction as currently recommended by the Adult Treatment Panel III (ATP-III) of the National Cholesterol Education Program (NCEP). This is particularly true for the high risk patients as defined by ATP-III that includes those patients who have a greater than 20% 10-year risk of adverse cardiac events. For such patients the current goal of a low-density lipoprotein cholesterol (LDL-cholesterol) maintenance level of < or =100 mg/dL plasma appears to be suboptimal. Accumulating data from several recent randomized studies of more aggressive LDL-cholesterol reduction to levels below 70 mg/dL in the high risk patients favor acceptance of such a new lower target for LDL-cholesterol using more intensive statin therapy which would affect the treatment strategy for patients with coronary heart disease pre-percutaneous intervention, metabolic syndrome, diabetes mellitus, congestive heart failure, cerebrovascular disease and chronic kidney disease.
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- 2009
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12. Intensive lipid lowering with atorvastatin in patients with coronary artery disease, diabetes, and chronic kidney disease.
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Shepherd J, Kastelein JP, Bittner VA, Carmena R, Deedwania PC, Breazna A, Dobson S, Wilson DJ, Zuckerman AL, and Wenger NK
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- Adult, Aged, Analysis of Variance, Atorvastatin, Cardiovascular Diseases epidemiology, Coronary Disease prevention & control, Double-Blind Method, Female, Follow-Up Studies, Glomerular Filtration Rate, Humans, Male, Middle Aged, Proportional Hazards Models, Risk, Treatment Outcome, United States epidemiology, Anticholesteremic Agents administration & dosage, Cardiovascular Diseases prevention & control, Coronary Disease complications, Diabetes Mellitus, Type 2 complications, Heptanoic Acids administration & dosage, Kidney Failure, Chronic complications, Lipids blood, Pyrroles administration & dosage
- Abstract
Objective: To investigate the effect of intensive lipid lowering with high-dose atorvastatin on the incidence of major cardiovascular events compared with low-dose atorvastatin in patients with coronary artery disease and type 2 diabetes, with and without chronic kidney disease (CKD)., Patients and Methods: Following 8 weeks' open-label therapy with atorvastatin (10 mg/d), 10,001 patients with coronary artery disease were randomized to receive double-blind therapy with either 80 mg/d or 10 mg/d of atorvastatin between July 1, 1998, and December 31, 1999. Of 1501 patients with diabetes, renal data were available for 1431. Patients with CKD were defined as having a baseline estimated glomerular filtration rate (eGFR) below 60 mL/min per 1.73 m2, using the Modification of Diet in Renal Disease equation., Results: After a median follow-up of 4.8 years, 95 (17.4%) of 546 patients with diabetes and CKD experienced a major cardiovascular event vs 119 (13.4%) of 885 patients with diabetes and normal eGFRs (hazard ratio [HR], 1.32; 95% confidence interval [CI], 1.00-1.72; P<.05). Compared with 10 mg of atorvastatin, 80 mg of atorvastatin reduced the relative risk of major cardiovascular events by 35% in patients with diabetes and CKD (20.9% [57/273] vs 13.9% [38/273]; HR, 0.65; 95% CI, 0.43-0.98; P=.04) and by 10% in patients with diabetes and normal eGFR (14.1% [62/441] vs 12.8% [57/444]; HR, 0.90; 95% CI, 0.63-1.29; P=.56). The absolute risk reduction in patients with diabetes and CKD was substantial, yielding a number needed to treat of 14 to prevent 1 major cardiovascular event over 4.8 years. Both treatments were well tolerated., Conclusion: Patients with diabetes, stable coronary artery disease, and mild to moderate CKD experience marked reduction in cardiovascular events with intensive lipid lowering, in contrast to previous observations in patients with diabetes and end-stage renal disease., Trial Registration: clinicaltrials.gov identifier: NCT00327691.
- Published
- 2008
13. Lipids, apolipoproteins, and their ratios in relation to cardiovascular events with statin treatment.
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Kastelein JJ, van der Steeg WA, Holme I, Gaffney M, Cater NB, Barter P, Deedwania P, Olsson AG, Boekholdt SM, Demicco DA, Szarek M, LaRosa JC, Pedersen TR, and Grundy SM
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- Aged, Apolipoprotein A-I blood, Cholesterol, HDL blood, Cholesterol, LDL blood, Coronary Disease epidemiology, Databases, Factual, Dyslipidemias blood, Dyslipidemias drug therapy, Female, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Male, Middle Aged, Proportional Hazards Models, Randomized Controlled Trials as Topic, Risk, Triglycerides blood, Apolipoproteins B blood, Coronary Disease blood, Coronary Disease prevention & control, Lipids blood
- Abstract
Background: Low-density lipoprotein (LDL) cholesterol is the principal target of lipid-lowering therapy, but recent evidence has suggested more appropriate targets. We compared the relationships of on-treatment levels of LDL cholesterol, non-high-density lipoprotein (HDL) cholesterol, and apolipoprotein B, as well as ratios of total/HDL cholesterol, LDL/HDL cholesterol, and apolipoprotein B/A-I, with the occurrence of cardiovascular events in patients receiving statin therapy., Methods and Results: A post hoc analysis was performed that combined data from 2 prospective, randomized clinical trials in which 10,001 ("Treating to New Targets") and 8888 ("Incremental Decrease in End Points through Aggressive Lipid Lowering") patients with established coronary heart disease were assigned to usual-dose or high-dose statin treatment. In models with LDL cholesterol, non-HDL cholesterol and apolipoprotein B were positively associated with cardiovascular outcome, whereas a positive relationship with LDL cholesterol was lost. In a model that contained non-HDL cholesterol and apolipoprotein B, neither was significant owing to collinearity. Total/HDL cholesterol ratio and the apolipoprotein B/A-I ratio in particular were each more closely associated with outcome than any of the individual proatherogenic lipoprotein parameters., Conclusions: In patients receiving statin therapy, on-treatment levels of non-HDL cholesterol and apolipoprotein B were more closely associated with cardiovascular outcome than levels of LDL cholesterol. Inclusion of measurements of the antiatherogenic lipoprotein fraction further strengthened the relationships. These data support the use of non-HDL cholesterol or apolipoprotein B as novel treatment targets for statin therapy. Given the absence of interventions that have been proven to consistently reduce cardiovascular disease risk through raising plasma levels of HDL cholesterol or apolipoprotein A-I, it seems premature to consider the ratio variables as clinically useful.
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- 2008
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14. The benefits of intensive lipid lowering in patients with stable coronary heart disease with normal or high systolic blood pressure: an analysis of the Treating to New Targets (TNT) study.
- Author
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Kostis JB, Breazna A, Deedwania PC, and LaRosa JC
- Subjects
- Adult, Aged, Atorvastatin, Coronary Disease blood, Coronary Disease etiology, Double-Blind Method, Female, Follow-Up Studies, Humans, Hypercholesterolemia blood, Hypercholesterolemia complications, Hypertension drug therapy, Hypertension physiopathology, Male, Middle Aged, Systole, Time Factors, Treatment Outcome, Anticholesteremic Agents therapeutic use, Blood Pressure physiology, Cholesterol, LDL blood, Coronary Disease drug therapy, Heptanoic Acids therapeutic use, Hypercholesterolemia drug therapy, Hypertension complications, Pyrroles therapeutic use
- Abstract
This post-hoc analysis of the Treating to New Targets (TNT) study evaluated the joint effects of managing low-density lipoprotein cholesterol (LDL-C) and systolic blood pressure (SBP) on cardiovascular outcomes. Patients (N=9739) with clinically evident, stable coronary heart disease (CHD) were randomized to atorvastatin 10 or 80 mg/d. The primary end point was occurrence of a first major cardiovascular event. At 3 months' follow-up, patients were stratified according to SBP (< 140 mm Hg vs > or = 140 mm Hg) and tertiles of LDL-C. At 4.9 years' median follow-up, the rate of major cardiovascular events was reduced most in patients with lower LDL-C (P < .001) and in patients with SBP < 140 mm Hg (P = .014). A 42% relative risk reduction was observed for patients in the lowest LDL-C tertile with an SBP < 140 mm Hg, compared with patients in the highest LDL-C tertile with an SBP > or = 140 mm Hg. The effect of lower SBP on stroke was most pronounced in the lowest LDL-C tertile.
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- 2008
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15. Effect of intensive lipid lowering with atorvastatin on renal function in patients with coronary heart disease: the Treating to New Targets (TNT) study.
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Shepherd J, Kastelein JJ, Bittner V, Deedwania P, Breazna A, Dobson S, Wilson DJ, Zuckerman A, and Wenger NK
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- Adult, Aged, Atorvastatin, Blood Pressure drug effects, Cholesterol, HDL blood, Cholesterol, LDL blood, Coronary Disease blood, Coronary Disease physiopathology, Double-Blind Method, Female, Glomerular Filtration Rate drug effects, Heptanoic Acids adverse effects, Humans, Kidney physiopathology, Kidney Diseases prevention & control, Male, Middle Aged, Pyrroles adverse effects, Anticholesteremic Agents therapeutic use, Coronary Disease drug therapy, Heptanoic Acids therapeutic use, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Kidney drug effects, Pyrroles therapeutic use
- Abstract
Background and Objectives: Data suggest that atorvastatin may be nephroprotective. This subanalysis of the Treating to New Targets study investigated how intensive lipid lowering with 80 mg of atorvastatin affects renal function when compared with 10 mg in patients with coronary heart disease., Design, Setting, Participants, & Measurements: A total of 10,001 patients with coronary heart disease and LDL cholesterol levels of <130 mg/dl were randomly assigned to double-blind therapy with 10 or 80 mg/d atorvastatin. Estimated GFR using the Modification of Diet in Renal Disease equation was compared at baseline and at the end of follow-up in 9656 participants with complete renal data., Results: Mean estimated GFR at baseline was 65.6 +/- 11.4 ml/min per 1.73 m2 in the 10-mg group and 65.0 +/- 11.2 ml/min per 1.73 m2 in the 80-mg group. At the end of follow-up (median time to final creatinine measurement 59.5 months), mean change in estimated GFR showed an increase of 3.5 +/- 0.14 ml/min per 1.73 m2 with 10 mg and 5.2 +/- 0.14 ml/min per 1.73 m2 with 80 mg (P < 0.0001 for treatment difference). In the 80-mg arm, estimated GFR improved to > or = 60 ml/min per 1.73 m2 in significantly more patients and declined to < 60 ml/min per 1.73 m2 in significantly fewer patients than in the 10-mg arm., Conclusions: The expected 5-yr decline in renal function was not observed. Estimated GFR improved in both treatment groups but was significantly greater with 80 mg than with 10 mg, suggesting this benefit may be dosage related.
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- 2007
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16. Comparison of rosuvastatin versus atorvastatin in South-Asian patients at risk of coronary heart disease (from the IRIS Trial).
- Author
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Deedwania PC, Gupta M, Stein M, Ycas J, and Gold A
- Subjects
- Adult, Aged, Analysis of Variance, Anticholesteremic Agents therapeutic use, Apolipoprotein A-I blood, Apolipoprotein A-I drug effects, Atorvastatin, Biomarkers blood, Canada epidemiology, Cholesterol, HDL blood, Cholesterol, HDL drug effects, Cholesterol, LDL blood, Cholesterol, LDL drug effects, Coronary Disease blood, Female, Fluorobenzenes adverse effects, Heptanoic Acids adverse effects, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors adverse effects, Hypercholesterolemia blood, Hypercholesterolemia drug therapy, Male, Middle Aged, Pyrimidines adverse effects, Pyrroles adverse effects, Risk Factors, Rosuvastatin Calcium, Sulfonamides adverse effects, Treatment Outcome, United States epidemiology, Asian People, Coronary Disease drug therapy, Coronary Disease epidemiology, Fluorobenzenes therapeutic use, Heptanoic Acids therapeutic use, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Pyrimidines therapeutic use, Pyrroles therapeutic use, Sulfonamides therapeutic use
- Abstract
In a large randomized trial of statin therapy in patients of South-Asian origin with hypercholesterolemia, 740 patients in the United States and Canada received 6 weeks of treatment with rosuvastatin 10 or 20 mg or atorvastatin 10 or 20 mg. A total of 485 patients (66%) were categorized as being at high risk of coronary heart disease and had a National Cholesterol Education Program Adult Treatment Panel III treatment goal of low-density lipoprotein (LDL) cholesterol <100 mg/dl (<2.6 mmol/L). LDL cholesterol decreased by 45% with rosuvastatin 10 mg versus 40% with atorvastatin 10 mg (p = 0.0023) and by 50% with rosuvastatin 20 mg versus 47% with atorvastatin 20 mg (p = NS). National Cholesterol Education Program Adult Treatment Panel III LDL cholesterol goal achievement rates in high-risk patients (all patients) were 76% (79%) and 88% (89%) with rosuvastatin 10 and 20 mg, respectively, compared with 70% (76%) and 81% (85%) with atorvastatin 10 and 20 mg, respectively. Rosuvastatin and atorvastatin were well tolerated. There were no clinically relevant differences between statins in adverse events or incidence of creatine kinase >10 times the upper limit of normal, alanine aminotransferase >3 times the upper limit of normal on 2 consecutive occasions, or proteinuria or hematuria over the relatively short duration of treatment. In conclusion, statin therapy was well tolerated and effective in decreasing LDL cholesterol in patients of South-Asian origin, with the 10- and 20-mg doses of rosuvastatin and atorvastatin allowing most patients to reach recommended LDL cholesterol goals.
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- 2007
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17. Effects of intensive versus moderate lipid-lowering therapy on myocardial ischemia in older patients with coronary heart disease: results of the Study Assessing Goals in the Elderly (SAGE).
- Author
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Deedwania P, Stone PH, Bairey Merz CN, Cosin-Aguilar J, Koylan N, Luo D, Ouyang P, Piotrowicz R, Schenck-Gustafsson K, Sellier P, Stein JH, Thompson PL, and Tzivoni D
- Subjects
- Aged, Aged, 80 and over, Atorvastatin, Cholesterol, HDL blood, Cholesterol, LDL blood, Coronary Disease blood, Coronary Disease mortality, Female, Heptanoic Acids adverse effects, Humans, Pravastatin adverse effects, Pyrroles adverse effects, Sex Characteristics, Anticholesteremic Agents therapeutic use, Coronary Disease drug therapy, Heptanoic Acids therapeutic use, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Myocardial Ischemia prevention & control, Pravastatin therapeutic use, Pyrroles therapeutic use
- Abstract
Background: Clinical trials have demonstrated that, compared with placebo, intensive statin therapy reduces ischemia in patients with acute coronary syndromes and in patients with stable coronary artery disease. However, no studies to date have assessed intensive versus moderate statin therapy in older patients with stable coronary syndromes., Methods and Results: A total of 893 ambulatory coronary artery disease patients (30% women) 65 to 85 years of age with > or = 1 episode of myocardial ischemia that lasted > or = 3 minutes during 48-hour ambulatory ECG at screening were randomized to atorvastatin 80 mg/d or pravastatin 40 mg/d and followed up for 12 months. The primary efficacy parameter (absolute change from baseline in total duration of ischemia at month 12) was significantly reduced in both groups at month 3 and month 12 (both P<0.001 for each treatment group) with no significant difference between the treatment groups. Atorvastatin-treated patients experienced greater low-density lipoprotein cholesterol reductions than did pravastatin-treated patients, a trend toward fewer major acute cardiovascular events (hazard ratio, 0.71; 95% confidence interval, 0.46, 1.09; P=0.114), and a significantly greater reduction in all-cause death (hazard ratio, 0.33; 95% confidence interval, 0.13, 0.83; P=0.014)., Conclusions: Compared with moderate pravastatin therapy, intensive atorvastatin therapy was associated with reductions in cholesterol, major acute cardiovascular events, and death in addition to the reductions in ischemia observed with both therapies. The contrast between the therapies' differing efficacy for major acute cardiovascular events and death and their nonsignificant difference in efficacy for reduction of ischemia suggests that low-density lipoprotein cholesterol-lowering thresholds for ischemia and major acute cardiovascular events may differ. The Study Assessing Goals in the Elderly (SAGE) demonstrates that older men and women with coronary artery disease benefit from intensive statin therapy.
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- 2007
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18. Reduction of low-density lipoprotein cholesterol in patients with coronary heart disease and metabolic syndrome: analysis of the Treating to New Targets study.
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Deedwania P, Barter P, Carmena R, Fruchart JC, Grundy SM, Haffner S, Kastelein JJ, LaRosa JC, Schachner H, Shepherd J, and Waters DD
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- Adult, Aged, Anticholesteremic Agents administration & dosage, Atorvastatin, Cardiovascular Diseases etiology, Cardiovascular Diseases mortality, Cholesterol, LDL drug effects, Coronary Disease blood, Diabetes Complications, Dose-Response Relationship, Drug, Double-Blind Method, Female, Heptanoic Acids administration & dosage, Humans, Male, Metabolic Syndrome blood, Middle Aged, Pyrroles administration & dosage, Risk Factors, Anticholesteremic Agents therapeutic use, Cardiovascular Diseases prevention & control, Cholesterol, LDL blood, Coronary Disease complications, Heptanoic Acids therapeutic use, Metabolic Syndrome complications, Metabolic Syndrome drug therapy, Pyrroles therapeutic use
- Abstract
Background: Despite the prognostic value of metabolic syndrome for predicting cardiovascular events, few trials have investigated the effects of statin therapy on cardiovascular morbidity and mortality in patients with the metabolic syndrome. Our post hoc analysis of the Treating to New Targets (TNT) study assessed whether intensive lowering of low-density lipoprotein cholesterol with high-dose atorvastatin therapy results in cardiovascular benefits for patients with both coronary heart disease and the metabolic syndrome., Methods: The TNT study was a prospective, double blind, parallel-group trial done at 256 sites in 14 countries between April, 1998, and August, 2004, with a median follow-up of 4.9 years. 10,001 patients were enrolled aged 35-75 years with clinically evident coronary heart disease. Our analysis includes 5584 patients with metabolic syndrome based on the 2005 NCEP ATP III criteria. Patients were randomly assigned to receive either atorvastatin 10 mg per day (n=2820) or 80 mg per day (n=2764). The primary outcome measure was time to first major cardiovascular event, defined as death from coronary heart disease, non-fatal non-procedure-related myocardial infarction, resuscitated cardiac arrest, or fatal or non-fatal stroke., Findings: In patients with coronary heart disease and metabolic syndrome, mean on-treatment low-density lipoprotein cholesterol concentrations at 3 months were 2.6 mmol/L (99.3 mg/dL) with atorvastatin 10 mg, and 1.9 mmol/L (72.6 mg/dL) with atorvastatin 80 mg. At a median follow-up of 4.9 years, major cardiovascular events occurred in 367 (13%) patients receiving atorvastatin 10 mg, compared with 262 (9.5%) receiving atorvastatin 80 mg (hazard ratio 0.71; 95% CI 0.61-0.84; p<0.0001). Irrespective of treatment assignment, significantly more patients with metabolic syndrome (11.3%) had a major cardiovascular event at a median of 4.9 years than those without metabolic syndrome (8.0%; hazard ratio 1.44; 95% CI 1.26-1.64; p<0.0001). This increased risk was significantly reduced by intensive therapy with atorvastatin 80 mg beyond that achieved with atorvastatin 10 mg., Interpretation: These data indicate that patients with coronary heart disease and metabolic syndrome derive incremental benefit from high-dose atorvastatin therapy, irrespective of the presence of diabetes.
- Published
- 2006
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19. Effect of lowering LDL cholesterol substantially below currently recommended levels in patients with coronary heart disease and diabetes: the Treating to New Targets (TNT) study.
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Shepherd J, Barter P, Carmena R, Deedwania P, Fruchart JC, Haffner S, Hsia J, Breazna A, LaRosa J, Grundy S, and Waters D
- Subjects
- Aged, Atorvastatin, Blood Pressure, Cholesterol, HDL blood, Coronary Disease complications, Coronary Disease drug therapy, Coronary Disease physiopathology, Diabetes Mellitus, Type 2 physiopathology, Diabetic Angiopathies drug therapy, Diabetic Angiopathies physiopathology, Dose-Response Relationship, Drug, Female, Humans, Male, Middle Aged, Triglycerides blood, Cholesterol, LDL blood, Coronary Disease blood, Diabetes Mellitus, Type 2 blood, Diabetic Angiopathies blood, Heptanoic Acids therapeutic use, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Pyrroles therapeutic use
- Abstract
Objective: The Treating to New Targets study showed that intensive lipid-lowering therapy with atorvastatin 80 mg/day provides significant clinical benefit beyond that afforded by atorvastatin 10 mg/day in patients with stable coronary heart disease (CHD). The objective of our study was to investigate whether similar benefits of high-dose intensive atorvastatin therapy can be achieved in patients with CHD and diabetes., Research Design and Methods: A total of 1,501 patients with diabetes and CHD, with LDL cholesterol levels of <130 mg/dl, were randomized to double-blind therapy with either atorvastatin 10 (n = 753) or 80 (n = 748) mg/day. Patients were followed for a median of 4.9 years. The primary end point was the time to first major cardiovascular event, defined as death from CHD, nonfatal non-procedure-related myocardial infarction, resuscitated cardiac arrest, or fatal or nonfatal stroke., Results: End-of-treatment mean LDL cholesterol levels were 98.6 mg/dl with atorvastatin 10 mg and 77.0 mg/dl with atorvastatin 80 mg. A primary event occurred in 135 patients (17.9%) receiving atorvastatin 10 mg, compared with 103 patients (13.8%) receiving atorvastatin 80 mg (hazard ratio 0.75 [95% CI 0.58-0.97], P = 0.026). Significant differences between the groups in favor of atorvastatin 80 mg were also observed for time to cerebrovascular event (0.69 [0.48-0.98], P = 0.037) and any cardiovascular event (0.85 [0.73-1.00], P = 0.044). There were no significant differences between the treatment groups in the rates of treatment-related adverse events and persistent elevations in liver enzymes., Conclusions: Among patients with clinically evident CHD and diabetes, intensive therapy with atorvastatin 80 mg significantly reduced the rate of major cardiovascular events by 25% compared with atorvastatin 10 mg.
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- 2006
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20. Coronary artery disease in South Asians: evolving strategies for treatment and prevention.
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Deedwania P and Singh V
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- Asia epidemiology, Cholesterol blood, Coronary Disease ethnology, Diet, Exercise physiology, Female, Humans, Hyperlipidemias prevention & control, Male, Prevalence, Prognosis, Risk Assessment, Severity of Illness Index, Survival Rate, Treatment Outcome, Asian People statistics & numerical data, Coronary Disease prevention & control, Coronary Disease therapy, Primary Prevention methods
- Published
- 2005
21. Effect of aggressive versus moderate lipid-lowering therapy on myocardial ischemia: the rationale, design, and baseline characteristics of the Study Assessing Goals in the Elderly (SAGE).
- Author
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Deedwania PC
- Subjects
- Aged, Aged, 80 and over, Anticholesteremic Agents therapeutic use, Atorvastatin, Cholesterol, LDL blood, Double-Blind Method, Female, Heptanoic Acids therapeutic use, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Male, Middle Aged, Multicenter Studies as Topic, Pravastatin therapeutic use, Prospective Studies, Pyrroles therapeutic use, Randomized Controlled Trials as Topic, Research Design, Anticholesteremic Agents administration & dosage, Coronary Disease drug therapy, Heptanoic Acids administration & dosage, Hydroxymethylglutaryl-CoA Reductase Inhibitors administration & dosage, Myocardial Ischemia prevention & control, Pravastatin administration & dosage, Pyrroles administration & dosage
- Abstract
Background: Patients with stable CHD who experience episodes of ischemia during routine daily activities are at increased risk of coronary events. Older patients are at a particularly high risk. Few trials have specifically investigated the effects of lipid-lowering therapy with statins in older patients., Methods: The SAGE trial is a prospective, randomized, double-blind, parallel-arm study enrolling men and women with stable CHD at 192 centers worldwide. Qualifying participants (aged 65-85 years; low-density lipoprotein cholesterol 100-250 mg/dL) have had at least 1 episode of myocardial ischemia with total ischemia duration >or=3 minutes on 48-hour ambulatory electrocardiographic (AECG) monitoring performed during routine daily activities. Participants have been randomized to either atorvastatin 80 mg/day (aggressive lipid lowering) or pravastatin 40 mg/day (moderate lipid lowering). The primary efficacy measure is the absolute change in the total duration of myocardial ischemic events on 48-hour AECG monitoring from baseline to month 12., Results: SAGE is fully enrolled and 893 patients have been randomized. The majority of the study participants are white (97%) men (69%). The mean age of the participants is 72 years. Most participants (94%) have a history of angina. Other high-risk patient groups included in the study are patients with hypertension (65%), patients with diabetes (23%), and patients with peripheral vascular disease (12%)., Conclusions: SAGE will evaluate the effect of aggressive versus moderate lipid lowering on the total duration of myocardial ischemia in older ambulatory patients with CHD. It is likely to provide valuable data on the benefits of statins in this patient population.
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- 2004
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22. Treating dyslipidemia in high-risk patients: case reviews and discussion.
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Deedwania PC, Davidson MH, and Ballantyne CM
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- Diabetes Complications, Diabetes Mellitus blood, Female, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Male, Metabolic Syndrome blood, Middle Aged, Risk Factors, Cholesterol, LDL blood, Coronary Disease etiology, Metabolic Syndrome complications
- Abstract
The inclusion of coronary heart disease (CHD) risk equivalents in the highest CHD risk category, in addition to the lowest low-density lipoprotein cholesterol (LDL-C) targets, has dramatically increased the number of persons eligible for highly effective risk reduction and lipid-lowering treatment. Two such high-risk groups are persons with diabetes and those with metabolic syndrome. These patients typically have a number of lipid and nonlipid risk factors that require aggressive intervention. In patients with diabetes, treatment with 3-hydroxy-3-methyglutaryl coenzyme A reductase inhibitors ("statins") to lower LDL-C levels and improve other lipid measures has been shown to produce protective benefits at least equal to those observed in nondiabetic patients. Although metabolic syndrome is not yet recognized as a CHD risk equivalent and use of Framingham risk scoring may not place some patients with the syndrome in the highest risk category, there is accumulating evidence that these patients are at very elevated risk and should be treated aggressively. Particular problems in risk assessment arise in immigrant groups such as South Asians, in whom traditional risk assessment may be inaccurate. In this article, Dr Deedwania examines the clinical evidence regarding cardiovascular risk associated with diabetes and metabolic syndrome and discusses current therapeutic options. Two case reports are presented, followed by roundtable discussions among the contributors to this Special Report.
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- 2004
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23. Effects of lipid-altering treatment in diabetes mellitus and the metabolic syndrome.
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Deedwania PC, Hunninghake DB, and Bays H
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- Adult, Cholesterol, HDL analysis, Cholesterol, HDL drug effects, Cholesterol, LDL analysis, Cholesterol, LDL drug effects, Comorbidity, Diabetes Mellitus diagnosis, Drug Therapy, Combination, Female, Follow-Up Studies, Humans, Male, Metabolic Syndrome diagnosis, Middle Aged, Randomized Controlled Trials as Topic, Risk Assessment, Severity of Illness Index, Treatment Outcome, Coronary Disease prevention & control, Diabetes Mellitus drug therapy, Diabetes Mellitus epidemiology, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Metabolic Syndrome drug therapy, Metabolic Syndrome epidemiology
- Abstract
The metabolic syndrome (MS) poses an increased risk for the development of diabetes mellitus and cardiovascular events. The syndrome typically includes dyslipidemia, characterized by elevated plasma triglycerides and low high-density lipoprotein cholesterol concentrations. Retrospective analyses of coronary artery disease outcomes trials in patient subpopulations with diabetes or the MS indicate that lipid-altering therapies provide benefits for patients with the MS at least as much as observed in patients without diabetes or the MS. Analyses of the effects of lipid-altering therapy on the lipid profile in patients with the MS also indicate that beneficial lipid changes are similar in patients with the MS compared with those in patients without the MS. The benefits of statin treatment in patients with the MS have become increasingly clear, and it is likely that further improvements in treatment may be achieved with newer statins or a combination of lipid-altering drugs. Prospective data from clinical trials examining the preventive effects of lipid-altering therapy in MS patients are needed to better define potential benefits and optimal treatment in this population.
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- 2004
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24. Improvement in Renal Function and Reduction in Serum Uric Acid with Intensive Statin Therapy in Older Patients: A Post Hoc Analysis of the SAGE Trial
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Deedwania, Prakash C, Stone, Peter H, Fayyad, Rana S, Laskey, Rachel E, and Wilson, Daniel J
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Biomedical and Clinical Sciences ,Clinical Sciences ,Cardiovascular ,Kidney Disease ,Atherosclerosis ,Clinical Trials and Supportive Activities ,Clinical Research ,6.1 Pharmaceuticals ,Evaluation of treatments and therapeutic interventions ,Renal and urogenital ,Aged ,Aged ,80 and over ,Atorvastatin ,Cholesterol ,LDL ,Coronary Disease ,Double-Blind Method ,Dyslipidemias ,Female ,Glomerular Filtration Rate ,Humans ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,Kidney ,Male ,Pravastatin ,Renal Insufficiency ,Chronic ,Uric Acid ,Pharmacology and Pharmaceutical Sciences ,Geriatrics ,Clinical sciences ,Pharmacology and pharmaceutical sciences - Abstract
BackgroundImprovement in renal function and decreases in serum uric acid (SUA) have been reported following prolonged high-intensity statin (HMG-CoA reductase inhibitor) therapy. This post hoc analysis of the SAGE trial examined the effect of intensive versus less intensive statin therapy on renal function, safety, and laboratory parameters, including SUA, in elderly coronary artery disease (CAD) patients (65-85 years) with or without chronic kidney disease (CKD).MethodsPatients were randomized to atorvastatin 80 mg/day or pravastatin 40 mg/day and treated for 12 months. Patients were stratified using Modification of Diet in Renal Disease (MDRD) estimated glomerular filtration rates (eGFRs) in CKD (eGFR 3 times the upper limit of normal occurred in 4.4% of atorvastatin- and 0.2% of pravastatin-treated patients.ConclusionIntensive management of dyslipidemia in older patients with stable coronary heart disease may have beneficial effects on renal function and SUA.
- Published
- 2015
25. Low use of statins and other coronary secondary prevention therapies in primary and secondary care in India
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Sharma, Krishna K, Gupta, Rajeev, Agrawal, Aachu, Roy, Sanjeeb, Kasliwal, Atul, Bana, Ajeet, Tongia, Ravindra K, and Deedwania, Prakash C
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Heart Disease ,Heart Disease - Coronary Heart Disease ,Clinical Research ,Cardiovascular ,Health Services ,Evaluation of treatments and therapeutic interventions ,6.1 Pharmaceuticals ,Good Health and Well Being ,Adrenergic beta-Antagonists ,Adult ,Aged ,Angiotensin-Converting Enzyme Inhibitors ,Aspirin ,Coronary Disease ,Drug Prescriptions ,Drug Therapy ,Combination ,Drug Utilization ,Evidence-Based Medicine ,Female ,Guideline Adherence ,Humans ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,India ,Male ,Middle Aged ,Platelet Aggregation Inhibitors ,Practice Guidelines as Topic ,Practice Patterns ,Physicians' ,Primary Health Care ,Secondary Prevention ,statins ,coronary heart disease ,aspirin ,beta blockers ,angiotensin-converting enzyme inhibitor ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
ObjectiveTo determine the frequency of use of pharmacotherapy with aspirin, beta blocker, statin, and angiotensin-converting enzyme (ACE) inhibitor in patients with stable coronary heart disease (CHD) among physicians at different levels of health care in Rajasthan state, India.MethodsPhysicians practicing at tertiary hospitals and clinics at tertiary, secondary and primary levels were contacted. Prescriptions of CHD patients were audited and descriptive statistics reported.ResultsWe evaluated 2,993 prescriptions (tertiary hospital discharge 711, tertiary 688, secondary 1,306, and primary 288). Use of aspirin was in 2,713 (91%) of prescriptions, beta blockers 2,057 (69%), ACE inhibitors or angiotensin receptor blockers (ARBs) 2,471 (82%), and statins 2,059 (69%). Any one of these drugs was prescribed in 2,991 (100%), any two in 2,880 (96%), any three in 1,740 (58%), and all four in 1,062 (35.5%) (P < 0.001). As compared to tertiary hospital, prescriptions at tertiary, secondary, and primary levels were lower: aspirin (96% vs 95%, 91%, 67%), beta blockers (80% vs 62%, 66%, 70%), statins (87% vs 82%, 62%, 21%): two drugs (98% vs 96%, 98%, 85%), three drugs (75% vs 58%, 55%, 28%), or four drugs (54% vs 44%, 28%, 7%) (P < 0.01). Use of ACE inhibitors/ARBs was similar while nitrates (43% vs 23%, 43%, 70%), dihydropyridine calcium channel blockers (12% vs 15%, 30%, 47%), and multivitamins (6% vs 26%, 37%, 47%) use was more in secondary and primary care.ConclusionsThere is suboptimal use of various evidence-based drugs (aspirin, beta blockers, ACE inhibitors, and statins) for secondary prevention of CHD in India.
- Published
- 2009
26. Prediction of cardiovascular events in statin-treated stable coronary patients of the treating to new targets randomized controlled trial by lipid and non-lipid biomarkers
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Arsenault, Benoit J, Barter, Philip, DeMicco, David A, Bao, Weihang, Preston, Gregory M, LaRosa, John C, Grundy, Scott M, Deedwania, Prakash, Greten, Heiner, Wenger, Nanette K, Shepherd, James, Waters, David D, Kastelein, John JP, Treating to New Targets (TNT) Investigators, ACS - Amsterdam Cardiovascular Sciences, Vascular Medicine, and Berger, Jeffrey S
- Subjects
Male ,Time Factors ,Physiology ,Epidemiology ,Atorvastatin ,lcsh:Medicine ,Coronary Disease ,Coronary Artery Disease ,Cardiovascular Physiology ,Pathology and Laboratory Medicine ,Cardiovascular ,Biochemistry ,Vascular Medicine ,Gastroenterology ,chemistry.chemical_compound ,Medicine and Health Sciences ,Molecular Targeted Therapy ,Myocardial infarction ,lcsh:Science ,Immune Response ,education.field_of_study ,Multidisciplinary ,Neopterin ,Middle Aged ,Prognosis ,Lipids ,Heart Disease ,Research Design ,6.1 Pharmaceuticals ,Blood Circulation ,Female ,lipids (amino acids, peptides, and proteins) ,Anatomy ,Research Article ,medicine.drug ,medicine.medical_specialty ,Drug Research and Development ,Statin ,Clinical Research Design ,General Science & Technology ,medicine.drug_class ,Immunology ,Clinical Trials and Supportive Activities ,Population ,Cardiology ,Research and Analysis Methods ,Treating to New Targets (TNT) Investigators ,Diagnostic Medicine ,Clinical Research ,Diabetes mellitus ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,education ,Cardiovascular Disease Epidemiology ,Heart Disease - Coronary Heart Disease ,Inflammation ,Pharmacology ,Adiponectin ,Cholesterol ,business.industry ,Pharmacoepidemiology ,Prevention ,lcsh:R ,Immunity ,Biology and Life Sciences ,Evaluation of treatments and therapeutic interventions ,Atherosclerosis ,medicine.disease ,Biomarker Epidemiology ,Endocrinology ,chemistry ,Cardiovascular Anatomy ,Clinical Immunology ,lcsh:Q ,Clinical Medicine ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,business ,Biomarkers - Abstract
Several plasma non-lipid biomarkers have been shown to predict major cardiovascular events (MCVEs) in population studies. Our objective was to investigate the relationship between lipid and non-lipid biomarkers levels achieved during statin therapy and the incidence of MCVEs in patients with stable coronary heart disease (CHD). We conducted a substudy of the TNT (Treating to New Targets) study, which was a randomized trial that compared the efficacy of high (80 mg) versus low (10 mg) dose atorvastatin for the secondary prevention of CHD. Fasting plasma levels of standard lipids and of 18 non-lipid biomarkers were obtained after an 8-week run-in period on atorvastatin 10 mg in 157 patients who experienced MCVEs during the 4.9 years of study follow-up and in 1349 controls. MCVE was defined as CHD death, nonfatal, non-procedure-related myocardial infarction, resuscitated cardiac arrest, and fatal or nonfatal stroke. After adjusting for age, sex and treatment arm, plasma levels of high-density lipoprotein (HDL) cholesterol, triglycerides, high-sensitivity C-reactive protein (hsCRP), insulin, neopterin, N-terminal pro-brain natriuretic peptide (BNP), lipoprotein(a) [Lp(a)], and the soluble receptor for advanced glycation end products (sRAGE) were predictive - 2014 Arsenault et al. This Funding: This study was funded by Pfizer Inc. Benoit J. Arsenault is supported by a post-doctoral fellowship from the Fonds de la recherche en santé du Québec and the Fondation de l9Institut universitaire de cardiologie et de pneumologie de Québec. Two authors are Pfizer employees and may hold stock in the company. As sponsor, Pfizer in cooperation with the steering committee had a role in all aspects of the study. The secondary biomarker analysis was funded by Pfizer. However, the decision to publish and preparation of the manuscript was driven solely by the authors. of recurrent MCVEs (P#0.02 for each doubling of plasma concentration). However, no significant association was observed between the risk of recurrent MCVEs and plasma levels of low-density lipoprotein cholesterol, adiponectin, cystatin C, lipoprotein-associated phospholipase A2, monocyte chemotactic protein-1, matrix metalloproteinase-9, myeloperoxidase, osteopontin, soluble CD40 ligand, soluble intercellular adhesion molecule-1, or soluble vascular cell adhesion molecule-1. After further adjustment for diabetes, hypertension, smoking, and BMI, the relationship between hsCRP, insulin and MCVE were no longer significant, while the relationship between Lp(a), neopterin, NT-proBNP and sRAGE and MCVE remained statistically significant. In conclusion, in patients with CHD treated with atorvastatin, plasma levels of Lp(a), neopterin, NT-proBNP, and sRAGE are associated with the risk of recurrent MCVEs.
- Published
- 2014
27. Dangers of Hypoglycemia in Cardiac Patients With Diabetes: Time to Switch to Safer, Newer Drugs.
- Author
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Deedwania, Prakash
- Subjects
- *
CORONARY disease , *HYPOGLYCEMIA , *HYPOGLYCEMIC agents , *TROPONIN - Published
- 2018
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28. Interview: A career spanning from heart failure to preventative cardiology and lipidology.
- Author
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Deedwania, Prakash C
- Subjects
- *
DIABETES , *PHYSIOLOGICAL effects of glucose - Abstract
Prakash C Deedwania* speaks to Simi Thankaraj, Assistant Commissioning Editor: Prakash C Deedwania, MD, FACC, FAHA, FACP, FCCP, is Professor of Medicine at the University of California-San Francisco (UCSF) School of Medicine (CA, USA), Chief of the Cardiology Division for the Veterans Administration Central California Health Care System/UCSF Program in Fresno (CA, USA), Director of Cardiovascular Research for the UCSF Fresno-Central San Joaquin Valley Medical Education Program and Clinical Professor of Medicine at Stanford University in Palo Alto (CA, USA). Dr Deedwania is a fellow of the American Heart Association (AHA), American College of Cardiology (ACC), American College of Chest Physician and American College of Physician, and a member of the American Thoracic Society, American Federation of Clinical Research, Council on Silent Myocardial Ischemia and Infarction, International Society of Ambulatory Science and New York Trudeau Society. He has served as Chair of the Executive Committee of the Laennec Society of the AHA and is currently President of the California Chapter of the American Society of Hypertension and is Past President of the International Society for Holter and Noninvasive Electrocardiology. He is a member of several writing groups, including the ACC/AHA Practice Guidelines on Chronic Stable Angina and Ambulatory ECG Monitoring. Dr Deedwania also serves on the Practice Guidelines Committee of the Heart Failure Society of America and recently served on the joint writing group of AHA/American Diabetes Association (ADA)/ACC for the position statement on intensive glucose control in patients with diabetes. Dr Deedwania has authored numerous landmark clinical trials, has authored or coauthored more than 350 publications and serves on the editorial boards of numerous journals, and lectures regularly both nationally and internationally. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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29. Selective and Specific Inhibition of I with Ivabradine for the Treatment of Coronary Artery Disease or Heart Failure.
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Deedwania, Prakash
- Subjects
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ARTERIOSCLEROSIS prevention , *ISCHEMIA prevention , *CARDIOTONIC agents , *CLINICAL trials , *CORONARY disease , *HEART failure , *HEALTH outcome assessment , *RESEARCH funding , *TREATMENT effectiveness , *PHARMACODYNAMICS , *THERAPEUTICS - Abstract
Heart rate is an important contributor in the pathophysiology of both coronary artery disease (CAD) and heart failure (HF). Ivabradine is an anti-anginal and anti-ischaemic agent, which selectively and specifically inhibits the I current in the sino-atrial node and provides pure heart rate reduction without altering other cardiac parameters, including conduction, and without directly affecting other haemodynamic parameters. It is approved for the treatment of CAD and HF. This article summarises the pharmacological properties, pharmacokinetics, clinical efficacy and tolerability of ivabradine in the treatment of CAD and HF, and presents evidence demonstrating that the pharmacological and clinical properties and clinical efficacy of ivabradine make it an important therapeutic choice for patients with stable CAD or HF. The positive effect of ivabradine on angina pectoris symptoms and its ability to reduce myocardial ischemia make it an important agent in the management of patients with stable CAD or chronic HF. Further studies are underway to add to the already robust evidence of ivabradine for the prevention of cardiovascular events in patients with CAD but without clinical HF. The SIGNIFY (Study assessInG the morbidity-mortality beNefits of the I inhibitor ivabradine in patients with coronarY artery disease) trial includes patients with stable CAD and an LVEF above 40 %, with no clinical sign of HF, and is investigating the long-term effects (over a period of 48 months) of ivabradine in a large study population. So far, this study has included more than 19,000 patients from 51 countries. [ABSTRACT FROM AUTHOR]
- Published
- 2013
- Full Text
- View/download PDF
30. Primary Prevention of Atrial Fibrillation - The Path Untread.
- Author
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Lardizabal, Joel A. and Deedwania, Prakash C.
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ATRIAL fibrillation prevention , *EPIDEMIOLOGY , *CLINICAL trials , *HYPERTENSION , *DIABETES , *CORONARY disease , *HEART failure , *STATINS (Cardiovascular agents) - Abstract
The prevalence and incidence of atrial fibrillation (AF) is on the rapid rise. To slow down the AF epidemic, effective primary prevention strategies need to be instituted. Unfortunately, this is an area that has not been well-explored. There is a multitude of risk factors that predispose to the development of AF. Of these, the most common from an epidemiologic perspective are advanced age, hypertension, diabetes, ischemic heart disease, and heart failure. The first-line pharmacologic therapies for these predisposing conditions (e.g. beta blockers, renin-angiotensin system inhibitors, statins, and omega-3 fatty acids) appear to also have potential roles in the primary prevention of AF. Definitive data, however, is lacking as to efficacy of these drugs for this particular purpose. Large-scale, high-quality randomized clinical trials on AF primary preventive strategies are urgently required in order to guide clinical practice. For now, adherence to the guideline-based therapies of each individual risk factor appears to be the most reasonable approach for the primary prevention of AF. [ABSTRACT FROM AUTHOR]
- Published
- 2013
31. The 719Arg Variant of KIF6 and Cardiovascular Outcomes in Statin-Treated, Stable Coronary Patients of the Treating to New Targets and Incremental Decrease in End Points Through Aggressive Lipid-Lowering Prospective Studies.
- Author
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Arsenault, Benoit J., Boekholdt, S. Matthijs, Hovingh, G. Kees, Hyde, Craig L., DeMicco, David A., Chatterjee, Aurobindo, Barter, Philip, Deedwania, Prakash, Waters, David D., LaRosa, John C., Pedersen, Terje R., and Kastelein, John J. P.
- Subjects
STATINS (Cardiovascular agents) ,CORONARY disease ,DIAGNOSIS ,CORONARY arteries ,ALLELES ,PATIENTS ,DISEASES - Abstract
The article discusses a study to determine if patients with stable coronary artery disease carrying the KIF6 719Arg allele are at an increased risk of future events and whether they obtain more benefit from high-dose statin therapy.The occurrence of major cardiovascular events (MCVE) was chosen as primary outcome measure. It concludes that carriers of the KIF6 719 Arg allele were not at increased cardiovascular risk and have no consistent cardiovascular benefit from high-dose statin therapy. INSET: CLINICAL PERSPECTIVE.
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- 2012
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32. Global Risk Assessment in the Presymptomatic Patient.
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Deedwania, Prakash
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CORONARY disease , *DIAGNOSIS , *MEDICAL screening - Abstract
Discusses the need for aggressive screening of the healthy population at risk of developing coronary artery disease. Overview of the presymptomatic patient; Development of atherosclerosis; Coronary risk factors.
- Published
- 2001
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33. Intensive Lipid Lowering with Atorvastatin Is Associated with Significant Cardiovascular Benefits in Coronary Patients with Type 2 Diabetes and Chronic Kidney Disease: The TNT Study.
- Author
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Shepherd, James, Wenger, Nanette K., Carmena, Rafael, and Deedwania, Prakash
- Subjects
STATINS (Cardiovascular agents) ,LIPIDS ,CORONARY disease ,TYPE 2 diabetes ,CHRONIC kidney failure ,PATIENTS - Abstract
The article presents a study on the effect of intensive lipid lowering with atorvastatin on the incidence of major cardiovascular events in coronary patients with type 2 diabetes (T2DM) and chronic kidney disease (CKD). 10,001 patients with coronary heart disease were randomized to either atorvastatin 80 mg or 10 mg therapy. Compared with 10 mg therapy, atorvastatin 80 mg reduced the risk of cardiovascular events by 35% in T2DM patients with CKD.
- Published
- 2007
34. Clinical Management of Stable Coronary Artery Disease in Patients With Type 2 Diabetes Mellitus: A Scientific Statement From the American Heart Association.
- Author
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Arnold, Suzanne V., Bhatt, Deepak L., Barsness, Gregory W., Beatty, Alexis L., Deedwania, Prakash C., Inzucchi, Silvio E., Kosiborod, Mikhail, Leiter, Lawrence A., Lipska, Kasia J., Newman, Jonathan D., Welty, Francine K., and American Heart Association Council on Lifestyle and Cardiometabolic Health and Council on Clinical Cardiology
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TYPE 2 diabetes , *CORONARY disease , *GLYCEMIC control - Abstract
Although cardiologists have long treated patients with coronary artery disease (CAD) and concomitant type 2 diabetes mellitus (T2DM), T2DM has traditionally been considered just a comorbidity that affected the development and progression of the disease. Over the past decade, a number of factors have shifted that have forced the cardiology community to reconsider the role of T2DM in CAD. First, in addition to being associated with increased cardiovascular risk, T2DM has the potential to affect a number of treatment choices for CAD. In this document, we discuss the role that T2DM has in the selection of testing for CAD, in medical management (both secondary prevention strategies and treatment of stable angina), and in the selection of revascularization strategy. Second, although glycemic control has been recommended as a part of comprehensive risk factor management in patients with CAD, there is mounting evidence that the mechanism by which glucose is managed can have a substantial impact on cardiovascular outcomes. In this document, we discuss the role of glycemic management (both in intensity of control and choice of medications) in cardiovascular outcomes. It is becoming clear that the cardiologist needs both to consider T2DM in cardiovascular treatment decisions and potentially to help guide the selection of glucose-lowering medications. Our statement provides a comprehensive summary of effective, patient-centered management of CAD in patients with T2DM, with emphasis on the emerging evidence. Given the increasing prevalence of T2DM and the accumulating evidence of the need to consider T2DM in treatment decisions, this knowledge will become ever more important to optimize our patients' cardiovascular outcomes. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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35. Association of 30-Day All-Cause Readmission with Long-Term Outcomes in Hospitalized Older Medicare Beneficiaries with Heart Failure.
- Author
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Arundel, Cherinne, Lam, Phillip H, Khosla, Rahul, Blackman, Marc R, Fonarow, Gregg C, Morgan, Charity, Zeng, Qing, Fletcher, Ross D, Butler, Javed, Wu, Wen-Chih, Deedwania, Prakash, Love, Thomas E, White, Michel, Aronow, Wilbert S, Anker, Stefan D, Allman, Richard M, and Ahmed, Ali
- Subjects
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HEART failure treatment , *CHRONIC kidney failure , *CORONARY disease , *DIABETES , *HEART failure , *HOSPITAL care , *LONGITUDINAL method , *OBSTRUCTIVE lung diseases , *MEDICARE , *MORTALITY , *MULTIVARIATE analysis , *PROBABILITY theory , *PROGNOSIS , *RESEARCH funding , *COMORBIDITY , *TREATMENT effectiveness , *PROPORTIONAL hazards models , *CASE-control method , *PATIENT readmissions - Abstract
Background: Heart failure is the leading cause for 30-day all-cause readmission. We examined the impact of 30-day all-cause readmission on long-term outcomes and cost in a propensity score-matched study of hospitalized patients with heart failure.Methods: Of the 7578 Medicare beneficiaries discharged with a primary diagnosis of heart failure from 106 Alabama hospitals (1998-2001) and alive at 30 days after discharge, 1519 had a 30-day all-cause readmission. Using propensity scores for 30-day all-cause readmission, we assembled a matched cohort of 1516 pairs of patients with and without a 30-day all-cause readmission, balanced on 34 baseline characteristics (mean age 75 years, 56% women, 24% African American).Results: During 2-12 months of follow-up after discharge from index hospitalization, all-cause mortality occurred in 41% and 27% of matched patients with and without a 30-day all-cause readmission, respectively (hazard ratio 1.68; 95% confidence interval 1.48-1.90; P <.001). This harmful association of 30-day all-cause readmission with mortality persisted during an average follow-up of 3.1 (maximum, 8.7) years (hazard ratio 1.33; 95% confidence interval 1.22-1.45; P <.001). Patients with a 30-day all-cause readmission had higher cumulative all-cause readmission (mean, 6.9 vs 5.1; P <.001), a longer cumulative length of stay (mean, 51 vs 43 days; P <.001), and a higher cumulative cost (mean, $38,972 vs $34,025; P = .001) during 8.7 years of follow-up.Conclusions: Among Medicare beneficiaries hospitalized for heart failure, 30-day all-cause readmission was associated with a higher risk of subsequent all-cause mortality, higher number of cumulative all-cause readmission, longer cumulative length of stay, and higher cumulative cost. [ABSTRACT FROM AUTHOR]- Published
- 2016
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36. Intensive Lipid Lowering With Atorvastatin in Patients With Coronary Heart Disease and Chronic Kidney Disease: The TNT (Treating to New Targets) Study
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Shepherd, James, Kastelein, John J.P., Bittner, Vera, Deedwania, Prakash, Breazna, Andrei, Dobson, Stephen, Wilson, Daniel J., Zuckerman, Andrea, and Wenger, Nanette K.
- Subjects
- *
LIPIDS , *CORONARY disease , *KIDNEY diseases , *CORONARY heart disease treatment , *KIDNEY disease treatments - Abstract
Objectives: This subanalysis of the TNT (Treating to New Targets) study investigates the effects of intensive lipid lowering with atorvastatin in patients with coronary heart disease (CHD) with and without pre-existing chronic kidney disease (CKD). Background: Cardiovascular disease is a major cause of morbidity and mortality in patients with CKD. Methods: A total of 10,001 patients with CHD were randomized to double-blind therapy with atorvastatin 80 mg/day or 10 mg/day. Patients with CKD were identified at baseline on the basis of an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 using the Modification of Diet in Renal Disease equation. The primary efficacy outcome was time to first major cardiovascular event. Results: Of 9,656 patients with complete renal data, 3,107 had CKD at baseline and demonstrated greater cardiovascular comorbidity than those with normal eGFR (n = 6,549). After a median follow-up of 5.0 years, 351 patients with CKD (11.3%) experienced a major cardiovascular event, compared with 561 patients with normal eGFR (8.6%) (hazard ratio [HR] = 1.35; 95% confidence interval [CI] 1.18 to 1.54; p < 0.0001). Compared with atorvastatin 10 mg, atorvastatin 80 mg reduced the relative risk of major cardiovascular events by 32% in patients with CKD (HR = 0.68; 95% CI 0.55 to 0.84; p = 0.0003) and 15% in patients with normal eGFR (HR = 0.85; 95% CI 0.72 to 1.00; p = 0.049). Both doses of atorvastatin were well tolerated in patients with CKD. Conclusions: Aggressive lipid lowering with atorvastatin 80 mg was both safe and effective in reducing the excess of cardiovascular events in a high-risk population with CKD and CHD. (Treating to New Targets Study; NCT00327691) [Copyright &y& Elsevier]
- Published
- 2008
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37. Improving Outcomes in Post–Acute Myocardial Infarction Heart Failure: Incorporation of Aldosterone Blockade into Combination Therapy to Optimize Neurohormonal Blockade
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Pitt, Bertram, Fonarow, Gregg C., Gheorghiade, Mihai, Deedwania, Prakash C., and Duprez, Daniel A.
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MYOCARDIAL infarction , *CARDIAC arrest , *CORONARY disease , *ACE inhibitors - Abstract
Although angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and β-blockers have been proved to reduce mortality in patients with heart failure post–acute myocardial infarction (AMI), studies show that these agents are consistently underused in this population. Further, morbidity and mortality remain high even when standard-of-care therapies are applied. Thus, new strategies have been sought to better counteract the maladaptive effects of neurohormonal stimulation in post-AMI heart failure. The Eplerenone Post–Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) demonstrated that the selective aldosterone blocker eplerenone, when used in addition to standard therapy, results in significant incremental improvements in survival and morbidity and is safe and well tolerated in this setting. Based on this, major therapeutic guidelines in the United States and Europe now strongly recommend that all eligible patients with concomitant heart failure post-AMI be treated with an aldosterone blocker in addition to an ACE inhibitor (or an ARB) and a β-blocker. To achieve needed improvements in outcomes in this population, early and consistent initiation of these evidence-based, guideline-recommended therapies in all eligible patients is crucial. [Copyright &y& Elsevier]
- Published
- 2006
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- View/download PDF
38. EFFICACY AND SAFETY OF LONG-TERM EVOLOCUMAB USE IN ASIAN VERSUS OTHER SUBJECTS: THE FOURIER TRIAL.
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Keech, Anthony C., Sever, Peter, Jiang, Lixin, Hirayama, Atsushi, Lu, Chen, Tay, Leslie, Deedwania, Prakash, Siu, Chung-Wah, Pineda, Armando Lira, Choi, Donghoon, Charng, Min-Ji, Amerena, John, Ahmad, Wan Azman Wan, Chopra, Vijay Kumar, Pedersen, Terje, Giugliano, Robert, and Sabatine, Marc
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- *
SAFETY , *CORONARY disease - Published
- 2019
- Full Text
- View/download PDF
39. The American College of Physicians guidelines for screening blood cholesterol levels: a commentary.
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Criqui, Michael H., Kinosian, Bruce, Glick, Henry, Deedwania, Prakash C., Krauss, Ronald M., Criqui, M H, Kinosian, B, Glick, H, Deedwania, P C, and Krauss, R M
- Subjects
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BLOOD cholesterol , *PHYSICIANS , *CORONARY heart disease prevention , *CHOLESTEROL , *CORONARY disease , *MEDICAL protocols , *MEDICAL screening , *MEDICAL societies , *PREDICTIVE tests - Abstract
Opinion. Comments on the revised guidelines issued by the American College of Physicians (ACP) regarding the screening of blood cholesterol levels. Why there is insufficient evidence to recommend high-density lipoprotein (HDL) cholesterol; What the value of determining HDL cholesterol for risk stratification is based on; Suggestion that triglycerides should not be routinely screened for preventing coronary disease.
- Published
- 1998
- Full Text
- View/download PDF
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