Other News
Vitamin D and the Heart
Although vitamin D supplementation appears to be a provocative intervention for reducing the risk of cardiovascular disease (CVD) and other chronic diseases, existing evidence of its benefits and risks is limited. Recruitment is now underway for the Vitamin D and Omega-3 Trial (VITAL; NCT01169259), the first large-scale, prospective, randomized clinical trial of these nutritional agents for the prevention of cancer and CVD. Thomas Wang, MD, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA, presented information on the VITAL Trial (NCT01169259) on behalf of JoAnn Manson, MD, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts, USA, primary investigator of the trial.
A Look into the Future: Elinogrel, Cangrelor, PAR Antagonists, and Aptamers
There are several antiplatelet agents with diverse mechanisms of action that are or will be available for treatment of the growing population of patients with cardiovascular disease (CVD; Figure 1). The challenge, according to Robert A. Harrington, MD, Duke University, Durham, North Carolina, USA, will be to understand which patients may benefit from these therapies in combination with current treatment regimens and in the context of increasingly complex patients (eg, the elderly and diabetics). Although it is generally agreed that a personalized approach to therapy that is based on genetics and the phenotype of response is the future for selecting platelet therapy, "we are not there yet," said Dr. Harrington.
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Official Peer-Reviewed Highlights from the |
ACC.11
60th Annual Scientific Session and i2 Summit 2011
Is It Time for Antiplatelet Therapy to Enter Personalized Medicine?
Since its approval in 1997, clopidogrel has been a cornerstone of therapy in patients with acute coronary syndrome (ACS) and those undergoing percutaneous coronary intervention (PCI) to reduce future ischemic events. Although the drug has led to significantly better outcomes, high variability in the antiplatelet effect has been demonstrated. A number of factors are responsible for this variability as demonstrated through pharmacodynamic and pharmacokinetic studies, including clinical factors and the presence of CYP2C19 loss-of-function alleles and reduced metabolism of clopidogrel to its active metabolite leading to attenuation of the intended anti-platelet effect [Brandt JT et al. J Thromb Haemost 2007]. See summary: Is It Time for Antiplatelet Therapy to Enter Personalized Medicine?