Therapeutic Updates
Innovations in Cardiovascular Devices Will Offer Potential Benefits as Well as Challenges
Innovative cardiovascular (CV) devices are poised to offer substantial benefit. Despite the potential to substantially reduce the morbidity and mortality that are associated with CV diseases, these products also raise a variety of challenges in research as well as clinical practice. David R. Holmes, Jr., MD, Mayo Clinic, Rochester, Minnesota, USA, addressed the challenges that are associated with some devices that have been evaluated in clinical trials.
Emerging Evidence of Intensive Risk Factor Control to Prevent CVD in Diabetic Patients
Blood Pressure-Lowering Strategies
Approximately 70% of diabetics aged >40 years have concomitant hypertension (HTN). Diabetes and HTN share several physiological traits, and both independently predict cardiovascular (CV) morbidity and mortality. However, until recently, the systolic blood pressure (SBP) targets that are currently recommended by major guidelines diabetics (< 130 mm Hg) had little supporting evidence from large-scale randomized trials.
Selected Updates in Heart Failure
Until the recent Rythmol Atrial Fibrillation (RAFT) Trial, it was unclear whether cardiac resynchronization therapy (CRT) was beneficial in patients with mild to moderate congestive heart failure (HF). The cumulative evidence to date indicates that the addition of CRT to optimal medical or defibrillator therapy significantly reduces mortality among patients with HF [Wells G et al. CMAJ 2011]. John Cleland, MD, University of Hull, Kingston-upon-Hull, UK, discussed the role and guidelines for CRT therapy in HF patients.
Systems of Care Are Integral to Improving STEMI Treatment
Timing has long been recognized as the most crucial aspect in the care of people with ST-segment elevation myocardial infarction (STEMI). A session on state-of-the-art STEMI care provided an opportunity to discuss the influence of ischemia time and explore ways to improve treatment quality with organized systems of care.
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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?