Coronary Artery Disease and Cardiovascular General Information

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Coronary Artery Disease and Cardiovascular General Information

Daily Treatment Report

Cognitive Therapy-CBT-Psychotherapy

Device Therapy

Late Clinical Events After Clopidogrel Discontinuation May Limit the Benefit of Drug-Eluting Stents (Journal of the American College of Cardiology 2006) "After the discontinuation of clopidogrel, the benefit of DES in reducing target vessel revascularization is maintained but has to be balanced against an increase in late cardiac death or nonfatal MI, possibly related to late stent thrombosis."

Cognitive performance after carotid angioplasty and stenting with brain protection devices. (Neurol Res. 2006)

Stopping Clopidogrel Therapy Increases Mortality in Patients With Drug-Eluting Stents

Small, strong magnets hazardous to cardiac devices "Magnets made from three elements - neodymium, iron and boron (NdFeB), sometimes referred to as "rare earth" magnets -- have the potential to interfere with cardiac pacemakers and implantable cardioverter-defibrillators (ICDs), investigators from Switzerland warn in the current issue of the medical journal Heart Rhythm."

FDA: Heart Stents Don't Up Risk of Death "Drug-coated stents that buttress the arteries are safe when used as directed, health advisers say, even though the risks they may pose to the majority of patients with the devices remains an open question."

FDA has stent ‘safety concerns’ for off-label use

2 Studies Find Drug-Eluting Stents Risky Without Blood Thinner: Heart patients with such stents face higher sudden-death risk, cardiologists report. "There has been growing concern about the long-term safety of drug-eluting stents, which hold 80 percent or more of the American market. Both studies link the danger of heart attack or sudden death to discontinuation of Plavix (clopidogrel), a drug commonly prescribed for patients who have stents implanted after the artery-opening procedure called angioplasty. … The Swiss study of 746 people who had 1,113 stents implanted did show that the drug-eluting stents did a better job of keeping arteries open. But the incidence of death or heart attack for those patients was 4.9 percent, compared to 1.9 percent for patients with bare-metal stents. The reason was a higher incidence of thrombosis, which is sudden blockage of an artery by a blood clot. The findings were published in the Dec. 19 issue of the Journal of the American College of Cardiology."

Cause of death with bare metal and sirolimus-eluting stents. (Eur Heart J. 2006)

Sirolimus-Eluting Stent Versus Paclitaxel-Eluting Stent for Patients With Long Coronary Artery Disease (Circulation. 2006) "Conclusions— For patients with long native coronary artery disease, SES implantation was associated with a reduced incidence of angiographic restenosis and a reduced need for target-lesion revascularization compared with PES implantation."

Three-Year Clinical Follow-Up of the Unrestricted Use of Sirolimus-Eluting Stents as Part of the Rapamycin-Eluting Stent Evaluated at Rotterdam Cardiology Hospital (RESEARCH) Registry (The American Journal of Cardiology 2006)

Doctors Rethink Widespread Use of Heart Stents " … some doctors are rethinking their faith in the devices, driven by emerging evidence that the newest and most common type — drug-coated stents — can sometimes cause potentially fatal blood clots months or even years after they are implanted. … There is no question that stents have saved countless lives in the short term by preventing impending heart attacks or opening arteries while an attack is being treated. But neither type of stent, no matter how much better it may make a patient feel, has been shown in rigorous clinical trials to improve long-term survival compared with other forms of treatment."

Heart stents could lead to strokes "Propping open clogged arteries with little mesh tubes called stents is more likely to cause strokes than the old-fashioned method of simply cleaning out the arteries surgically, a French study showed on Wednesday. … Based on results from 30 medical centers in France, the Mas team found that at the one-month mark, 9.6 percent of 247 stent recipients had died or suffered a stroke, against 3.9 percent of 257 who received the surgery, known as endarterectomy."

Vessel size and outcome after coronary drug-eluting stent placement: results from a large cohort of patients treated with sirolimus- or paclitaxel-eluting stents. (J Am Coll Cardiol. 2006) "CONCLUSIONS: The influence of vessel size on restenosis is related to the specific DES used, with SESs providing better outcomes than PESs in small but not in large coronary vessels."

FDA Statement on Coronary Drug-Eluting Stents "New data were released recently that suggest a small but significant increased risk of stent thrombosis in patients who have drug-eluting stents. The agency is keenly interested in this issue because of the potential for serious harm to patients—even though stent thrombosis occurs at low rates."

Expensive, Drug-Coated Stents Offer Modest Benefit: Based on studies, bare-metal stents may be just as good, experts say

Sirolimus-eluting versus uncoated stents in acute myocardial infarction. (N Engl J Med. 2006) CONCLUSIONS: Among selected patients with acute myocardial infarction, the use of sirolimus-eluting stents significantly reduced the rate of target-vessel revascularization at 1 year.

Paclitaxel-eluting versus uncoated stents in primary percutaneous coronary intervention. (N Engl J Med. 2006) "CONCLUSIONS: Although the use of paclitaxel-eluting stents in acute myocardial infarction with ST-segment elevation reduced the incidence of serious adverse cardiac events at 1 year by 4.0 percentage points, as compared with uncoated stents, the difference was not statistically significant."

Doubt Raised on Drug-Coated Heart Stents "A Swiss-Dutch study tracked 8,146 patients and found that recipients of drug-coated stents were at increased risk of thrombosis, or blood clots, that can occasionally result in death. … Drug-coated stents were previously viewed as a great advance since the drugs they emitted prevented cells that could block the arteries from growing. A thick growth of cells is undesirable, but a thin layer of cells lining the artery is essential. In some instances, drug-coated stents have prevented this minimal protective cell layer from growing, leaving exposed metal, which essentially can act as a clot magnet."

Double jeopardy: balance between bleeding and stent thrombosis with prolonged dual antiplatelet therapy after drug-eluting stent implantation. (Cardiovasc Revasc Med. 2006)

Frequency of and Risk Factors for Stent Thrombosis After Drug-Eluting Stent Implantation During Long-Term Follow-Up (The American Journal of Cardiology 2006)

Growing Debate as Doctors Train on New Devices "The growing use of the costly defibrillators is drawing particular attention. Until recently, such units were typically implanted by highly trained heart device specialists. But since last year, when the government agreed to pay for tens of thousands more patients annually to get such devices, many new practitioners like those in Rock Hill have entered the field. One result is that patients do not realize that the training and experience of doctors can vary widely."

Drug-Eluting Stents in the Treatment of Intermediate Lesions. Pooled Analysis From Four Randomized Trials (J Am Coll Cardiol. 2006) "Conclusions: Compared with BMS, treatment of intermediate lesions with DES appears safe and results in a marked reduction in clinical and angiographic restenosis. The efficacy of DES may require a reevaluation of current treatment paradigms for intermediate lesions."

Drug-eluting stents: A multidisciplinary success story (Advanced Drug Delivery Reviews ) "Coronary stenting is the most common form of interventional treatment for symptomatic coronary artery disease. In-stent restenosis following bare metal stent (BMS) placement is the most common cause of procedural failure and occurs as a result of vessel wall trauma secondary to balloon angioplasty and stent deployment that results in an overly aggressive healing response (neointimal hyperplasia) that overgrows the stent lumen and causes vascular narrowing. Drug-eluting stents (DES) are specialized vascular stents capable of delivering drugs to the arterial wall in a controlled manner such that neointimal hyperplasia is reduced or prevented, luminal patency is preserved, coronary blood flow is maintained and the patient is spared a repeat procedure to re-open the vessel."

Effect of Exercise on Frequency of Stent Fracture in the Superficial Femoral Artery (The American Journal of Cardiology 2006)

Mechanisms of controlled drug release from drug-eluting stents (Advanced Drug Delivery Reviews 2006) "The current DESs deliver a single drug aiming to prevent or minimize proliferation of smooth muscle cells."

Restenosis following implantation of bare metal coronary stents: Pathophysiology and pathways involved in the vascular response to injury (Advanced Drug Delivery Reviews 2006)

Drug-eluting stents: Beyond the hyperbole "Drug-eluting stents (DES) promised to reduce the clinical and economic cost of failed bare metal stents (BMS) by locally delivering a therapeutic agent to the injured artery, reducing or eliminating the development of neointimal hyperplasia and reducing the need for repeat interventions to re-open the obstructed artery."

Narrative review: drug-eluting stents for the management of restenosis: a critical appraisal of the evidence. (Ann Intern Med. 2006) "A critical reassessment of the published evidence, however, suggests that the putative superiority of intravascular drug-eluting stents is founded on questionable premises, including 1) overestimation of restenosis benefit, 2) underestimation of the risk for stent thrombosis, 3) overreliance on "soft" rather than "hard" outcomes (need for repeated revascularization vs. death or myocardial infarction), and 4) the attendant overestimation of cost-effectiveness. Because the long-term incremental risks, benefits, and costs of drug-eluting stents have not yet been optimally evaluated in a broad spectrum of patient and lesion cohorts, the rational role of these devices in clinical management warrants reappraisal."

Drug-eluting stents in the treatment of intermediate lesions: pooled analysis from four randomized trials. (J Am Coll Cardiol. 2006) "CONCLUSIONS: Compared with BMS, treatment of intermediate lesions with DES appears safe and results in a marked reduction in clinical and angiographic restenosis. The efficacy of DES may require a reevaluation of current treatment paradigms for intermediate lesions."

Higher price for defibrillator implants "One of every 10 Medicare patients fitted with implantable defibrillators have complications that prolong hospital visits and add millions in costs, a new analysis shows. The study of 31,000 cases is the largest of its kind and the first to examine complication rates among the full range of doctors and hospitals that implant defibrillators, not just the top doctors and major medical centers that typically conduct research trials. Complications such as kidney failure and blood clots prolong hospital visits by more than three days each ."

Bare metal stent restenosis is not a benign clinical entity. (Am Heart J. 2006) "CONCLUSIONS: More than one third of bare metal ISR episodes presented as MI or unstable angina requiring hospitalization. The acuity of the clinical presentation of bare metal ISR appears to be more severe than has been previously thought. Aggressive efforts, such as drug-eluting stents to decrease the incidence of unstable angina due to bare metal ISR, are warranted."

Depression and anxiety status of patients with implantable cardioverter defibrillator and precipitating factors. (Pacing Clin Electrophysiol. 2006) "Conclusion: Our study indicates presence of depression and anxiety in nearly half of the patients with ICD. Consultation with psychiatry should be a part of the treatment for patients with ICD, especially for those who constitute high-risk groups."

Effect of fish oil on ventricular tachyarrhythmia and death in patients with implantable cardioverter defibrillators: the Study on Omega-3 Fatty Acids and Ventricular Arrhythmia (SOFA) randomized trial. (JAMA. 2006) "CONCLUSION: Our findings do not indicate evidence of a strong protective effect of intake of omega-3 PUFAs from fish oil against ventricular arrhythmia in patients with ICDs."

Causes and Consequences of Heart Failure After Prophylactic Implantation of a Defibrillator in the Multicenter Automatic Defibrillator Implantation Trial II (Circulation. 2006) "Conclusions- Patients with chronic ischemic heart disease who are treated with either single-chamber or dual-chamber ICDs have improved survival but an increased risk of HF. The present data suggest that ICD therapy transforms sudden death risk to a subsequent HF risk. These findings should direct more attention to the prevention of HF in patients who receive an ICD."

Medication Use Crucial After Stent Placement "Patients who receive a drug-emitting stent after heart attack but don't follow their prescribed drug regimen boost their risk for death nine-fold, a new study finds."

Defibrillator Recipients Face Increased Heart-Failure Risk

Very late thrombosis after drug-eluting stents. (Catheter Cardiovasc Interv. 2006) "Stent thrombosis is a rare but potentially fatal complication of percutaneous treatment of coronary disease. Its occurrence after drug eluting stent (DES) placement has raised concerns, especially when it occurs late after the stent implantation."

Incomplete Neointimal Coverage of Sirolimus-Eluting Stents (Journal of the American College of Cardiology 2006)

Drug-eluting stent era: will we improve 5-year outcomes? (Coron Artery Dis. 2006) "Five-year outcomes after coronary stenting are determined by restenosis of the original stented lesion during the first year and, later, by disease progression at non-stented segments, owing to either gradual progression of atherosclerosis or instability of vulnerable plaques. Drug-eluting stents have demonstrated potent anti-restenosis benefits in a variety of lesion types and high-risk patients, including complex long lesions and diabetic patients. It is likely that this benefit will translate into improved 5-year outcomes, with reduction in need for repeat revascularization in many patients and possibly reduced incidence of myocardial infarction and death, especially in diabetic patients, in whom the risk for occlusive restenosis and 5-year death and myocardial infarction rates are known to be higher after bare-metal stents."

Timing of Defibrillator Implantation Influences Outcomes

Impact of Completeness of Percutaneous Coronary Intervention Revascularization on Long-Term Outcomes in the Stent Era. (Circulation. 2006) "The objective of this study is to compare long-term mortality and subsequent revascularization for percutaneous coronary intervention patients receiving stents who were completely revascularized (CR) with those who were incompletely revascularized (IR). . CONCLUSIONS: IR with stenting is associated with an adverse impact on long-term mortality, and consideration should be given to either achieving CR, opting for surgery, or monitoring percutaneous coronary intervention patients with IR more closely after discharge."

Two-Year Outcomes After Sirolimus-Eluting Stent Implantation (Journal of the American College of Cardiology 2006) "Conclusions: Clinical outcomes two years after implantation of SES continue to demonstrate significant reduction in the need for repeat target lesion (and vessel) revascularization compared with BMS without evidence for either disproportionate late restenosis or late stent thrombosis."

Studies Gauge Safety of Replacing Implanted Defibrillators "Physicians need to carefully weigh the dangers of replacing an implantable cardioverter defibrillator -- a device that delivers a shock to restart a malfunctioning heart -- against the potential risk that the current implanted device will fail."

Boston Scientific Finds Battery Problem in Some Devices

Comparison of Long-Term (Seven Year) Outcomes Among Patients Undergoing Percutaneous Coronary Revascularization With Versus Without Stenting (AMERICAN JOURNAL OF CARDIOLOGY 2006) "In conclusion, compared with angioplasty alone, revascularization with coronary stents provides a significant early and sustained decrease in the need for repeat revascularization, but stents do not influence long-term survival."

Comparison of Effects of Bare Metal Versus Drug-Eluting Stent Implantation on Biomarker Levels Following Percutaneous Coronary Intervention for Non-ST-Elevation Acute Coronary Syndrome (AMERICAN JOURNAL OF CARDIOLOGY 2006) "In conclusion, patients undergoing DES implantation achieved more reductions in periprocedural markers of inflammation and necrosis than patients receiving bare metal stents among those with non-ST-elevation acute coronary syndrome."

Stents Boost Walking Ability for Patients With Blocked Leg Arteries "A new kind of stent did a better job than the artery-opening procedure called angioplasty in improving the walking ability of people with blocked leg arteries, a new European study found. . But the trial was not an unalloyed success, he said. While those people who got stents were able to walk farther both six months and one year after the implants, the rate at which PAD worsened and the need for further intervention was the same as for people who had angioplasty. And three of the people who received stents later required bypass surgery. None of those who had angioplasty did."

Pacemaker, Defibrillator Reliability Can Be Improved

New Guidelines Recommended for Implanted Heart Devices

Comparison of Safety and Efficacy of Sirolimus-Eluting Stents Versus Bare Metal Stents in Patients With ST-Segment Elevation Myocardial Infarction (The American Journal of Cardiology 2006) "In conclusion, the acute postprocedural systemic inflammatory response induced by drug-eluting stent implantation appears to be similar to that induced by bare metal stents. However, the restenosis rate is lower for SESs and PESs than for DEXs and bare metal stents."

Pacemaker and ICD Generator Reliability (JAMA. 2006) "Conclusions Pacemaker reliability has improved markedly. In contrast, after more than a decade of improving device reliability, the ICD malfunction rate transiently increased before experiencing substantial reductions in the latter 2 study years. Whether increasing device sophistication accounts for the observed decrease in reliability is not known. Continued monitoring of pacemaker and ICD performance is required."

Complications Associated With Implantable Cardioverter-Defibrillator Replacement in Response to Device Advisories (JAMA. 2006) "Conclusions ICD generator replacement in patients with advisory devices is associated with a substantial rate of complications, including death. These complications need to be considered in the development of guidelines determining the appropriate treatment of patients with advisory devices."

Replacing heart device riskier than leaving it in

Biodegradable Stents: They Do Their Job and Disappear (J Invasive Cardiol. 2006) "Despite the development and progression of metallic stents, many concerns still remain because of their permanent nature. Although metallic stents are effective in preventing recoil and late restenosis after coronary angioplasty, they continue to have limitations such as stent thrombosis and mismatch of the stent to the vessel size. Thus, the concept of bioabsorbable stents has emerged as an alternative to permanent metal stents. This review will outline concepts, material designs, preclinical, and initial clinical experimental studies with bioabsorbable stents."

The future of drug eluting stents (Heart 2006)

Report from SIR: Carotid stenting improves cognition

Clinical effectiveness of bare-metal stenting compared with balloon angioplasty in total coronary occlusions: insights from a systematic overview of randomized trials in light of the drug-eluting stent era. (Am Heart J. 2006) "CONCLUSIONS: In total coronary occlusions, stenting yields an important benefit over balloon angioplasty in reduction of MACE, repeated revascularizations, and angiographic restenosis and reocclusion. However, these events remain frequent. Moreover, the finding of an increased rate of periprocedural minor myocardial damage after stenting casts caution. New strategies aimed to reduce the need of repeated revascularizations and periprocedural MIs should be further investigated."

Paclitaxel-eluting stents vs vascular brachytherapy for in-stent restenosis within bare-metal stents: the TAXUS V ISR randomized trial. (JAMA. 2006) "CONCLUSION: Treatment of bare-metal in-stent restenotic lesions with paclitaxel-eluting stents rather than angioplasty followed by VBT reduces clinical and angiographic restenosis at 9 months and improves event-free survival."

Sirolimus-eluting stents vs vascular brachytherapy for in-stent restenosis within bare-metal stents: the SISR randomized trial. (JAMA. 2006) "CONCLUSION: Sirolimus-eluting stents result in superior clinical and angiographic outcomes compared with vascular brachytherapy for the treatment of restenosis within a bare-metal stent."

Carotid Stenting Safe Alternative to Surgery

Current status of carotid artery stenting (Journal of Vascular Surgery 2006) "In 12 industry-sponsored registries (none were published in peer-reviewed journals), 30-day stroke rates varied from 2% to 7%, and 30-day combined adverse events, including stroke, death, and myocardial infarction, were 3% to 9%. More than 12 randomized trials comparing CAS and carotid endarterectomy (CEA) have been initiated since 1998. Results have varied over time, depending on the population studied and the technology used. However, the largest and most recent results of the completed SAPPHIRE trial in high-risk patients undergoing CAS with the use of EPDs demonstrated that CAS is at least not inferior to CEA, with a 1-year combined adverse event rate of 12% for CAS and 20% for CEA (P = .05). Other ongoing trials will address not only whether CAS could be superior to CEA in high-risk patients but also, more importantly, whether CAS is beneficial in other subgroups, such as low-risk and asymptomatic patients."

[Long-term clinical results of the treatment with bare metal stents of chronic total occlusions] (G Ital Cardiol (Rome). 2006) "Conclusions. The results of current practice of stenting of CTO are encouraging. Only angiographic variables are predictive of long-term clinical outcome."

Implantable cardioverter-defibrillators: expanding indications and technologies. (JAMA. 2006) "CONCLUSIONS: ICDs have been shown to improve survival as both primary and secondary prophylaxis in an expanding population of patients. Ongoing ICD research may continue to delineate groups with survival benefit from ICDs, and the use and indications of these devices in clinical practice will continue to expand."

Impact of Aspirin Treatment on Long-Term Outcome (Over 10Years) After Percutaneous Coronary Intervention. (Int Heart J. 2006) "Aspirin treatment at the time of PCI significantly reduced the risk of death from any cause and cardiac death. The administration of aspirin had a positive impact on the over 10-year long-term outcomes of patients who underwent PCI."

Defining the high-risk patient for carotid endarterectomy: An analysis of the prospective National Surgical Quality Improvement Program database. (J Vasc Surg. 2006)

Carotid artery stenting in octogenarians is associated with increased adverse outcomes. (J Vasc Surg. 2006) "CONCLUSIONS: Octogenarians undergoing carotid artery stenting are at higher risk than nonoctogenarians for periprocedural complications, including neurologic events and death. Major event-free survival at 1 year is also significantly better in nonoctogenarians. These risks should be weighed when considering carotid stenting in elderly patients."

Coronary stenting is safe and effective in a high-risk octogenarian patient cohort. (Conn Med. 2006)

Implantable cardioverter-defibrillators: expanding indications and technologies. (JAMA. 2006)

Analysis of Emboli during Carotid Stenting with Distal Protection Device (Cerebrovascular Diseases 2006)

Cognitive Function Remains Unchanged After Endarterectomy of Unilateral Internal Carotid Artery Stenosis Under Local Anaesthesia. (Eur J Vasc Endovasc Surg. 2006) "OBJECTIVE: To assess changes in cognitive function and affective state following carotid endarterctomy (CEA) for high-degree unilateral internal carotid artery stenosis. . CONCLUSION: Cognitive function does not change following CEA of a unilateral internal carotid stenosis."

Are Implantable Cardioverter Defibrillator Shocks a Surrogate for Sudden Cardiac Death in Patients With Nonischemic Cardiomyopathy? (Circulation 2006)

Guidant warns physicians about more faulty pacemakers

Spontaneous improvement of peristent ulceration after carotid artery stenting. (AJNR Am J Neuroradiol. 2006) "BACKGROUND AND PURPOSE: Because carotid plaque ulceration is associated with an increased risk of cerebral embolism, residual carotid plaque ulceration directly around a stent (peristent ulceration) after carotid angioplasty and stent placement (CAS) could still be a risk factor for a stroke. The purpose of this study is to understand the morphologic and clinical prognosis of peristent ulceration. . CONCLUSION: We conclude that peristent ulceration after CAS improves spontaneously and is not a risk factor for cerebral embolism."

Comparison of sirolimus-eluting stent, paclitaxel-eluting stent, and bare metal stent in the treatment of long coronary lesions. (Catheter Cardiovasc Interv. 2006) "Objective: This study compared the efficacy of the sirolimus-eluting stent (SES), the paclitaxel-eluting stent (PES), and the bare metal stent (BMS) for long coronary lesions. Background: The outcome of drug-eluting stent (DES) implantation in long coronary lesions remains unclear. . Conclusions: The use of DESs for long coronary lesions appears to be safe and more effective than the use of BMSs in terms of restenosis and adverse clinical events. SES use was associated with lower late luminal loss and a lower angiographic restenosis rate compared with PES use."

Is There Any Benefit From Staged Carotid and Coronary Revascularization Using Carotid Stents? A Single-Center Experience Highlights the Need for a Randomized Controlled Trial. (Stroke. 2005) "BACKGROUND AND PURPOSE: To assess the benefits of carotid artery stenting before coronary artery bypass surgery to reduce the risk of stroke occurring during the cardiac procedure. ... CONCLUSIONS: Our results are comparable to those in patients that undergo staged or combined carotid endarterectomy before cardiac surgery. Our small cohort study adds to the limited world literature on the subject but is not sufficiently powered to recommend alterations in practice."

Drug Side-Effects and Interactions

How useful are b-blockers in cardiovascular disease? (Anadolu Kardiyol Derg. 2006) " The review of the currently available literature shows that for patients with uncomplicated hypertension, there is paucity of data or absence of evidence to support use of b-blockers as monotherapy or as first line agent. Given the risk of stroke and numerous unacceptable adverse effects, the risk benefit ratio for b-blockers is not acceptable for this indication. However, b-blockers are very efficacious agents for the treatment of heart failure, certain types of arrhythmia, and post myocardial infarction."

Dietary vitamin K intake and anticoagulation in elderly patients. (Curr Opin Clin Nutr Metab Care. 2007) "RECENT FINDINGS: Recent prospective evidences suggest that dietary vitamin K plays an essential role in anticoagulation stability. Vitamin K intake of more than 250 mug/day was shown to decrease warfarin sensitivity in anticoagulated patients consuming regular diets. In a randomized crossover study, brief periods of changes on vitamin K intake also had significant effects on coagulation parameters. Patients that were allocated to an 80% decrease of intake increased International Normalized Ratio (INR) by almost 30% 7 days after the intervention. … SUMMARY: Contemporary data strengthen the concept that the interaction between dietary vitamin K and coumarin derivatives is clinically relevant and plays a major role in INR fluctuations in chronic anticoagulated patients."

Fracture risk in users of oral anticoagulants: A nationwide case-control study. (Int J Cardiol. 2006)

FDA: Coumadin (warfarin sodium)

Black box for warfarin "At the request of the FDA, Bristol-Myers Squibb has strengthened its US label for warfarin (Coumadin) to include a black-box warning about the risk of major or fatal bleeding [1]. The previous label also warned about bleeding risk, but this was not highlighted in a black box. The new black box notes that warfarin can cause major or fatal bleeding. It says that bleeding is more likely to occur during the starting period and with a higher dose (resulting in a higher INR). "

Ibuprofen and Aspirin Taken Together "[Posted 09/08/2006] FDA notified consumers and healthcare professionals that taking Ibuprofen for pain relief and aspirin at the same time may interfere with the benefits of aspirin taken for the heart."

Management of Grapefruit-Drug Interactions (Am Fam Physician 2006) "Prominent medications known to interact with grapefruit include statins, antiarrhythmic agents, immunosuppressive agents, and calcium channel blockers. There are equally effective alternatives to these drug classes that do not have the potential to interact with grapefruit. These alternative drugs may be substituted if a patient experiences or is at risk of a grapefruit-drug interaction. Patients also may choose to exclude grapefruit from their diets and consume other fruits, including other types of citrus, to avoid an interaction."

Systematic review and meta-analysis of adverse events of low-dose aspirin and clopidogrel in randomized controlled trials. (Am J Med. 2006)

Potential drug-herb interaction with antiplatelet/anticoagulant drugs (Complementary Therapies in Clinical Practice 2006) "Overall, almost 31% (n=23, N=76) of patients were taking one or more of the specified herbal medicines [ginseng (Panax ginseng), garlic (Allium sativum), ginkgo (Gingko biloba) thought to interact with antiplatelet or anticoagulant therapy. The study showed that 21% (n=16, N=76) of patients co-ingested specified herbs with antiplatelet or anticoagulant therapy, of which half of them were at risk of potential drug-herb interactions. A large proportion of respondents involved in potential drug-herb interaction were elderly people (62.5%, n=5)."

Chronic Aspirin Therapy for the Prevention of Cardiovascular Events: A Waste of Time, or Worse? "Few therapies in cardiovascular medicine have been studied so intently and adopted so widely into clinical practice as aspirin, especially with so little evidence of long-term benefit for people with or at risk of coronary artery disease. A series of studies has shown that long-term aspirin therapy is ineffective, or worse, for the primary, secondary or tertiary prevention of cardiovascular events; however, distorted reporting of these studies, in a way that would not be tolerated for other pharmacologic agents, has led many readers to misinterpret neutral studies as showing benefit with aspirin . Aspirin should be used to treat or prevent medical problems only when the effective dose and duration of therapy is known-that is, for short-term treatment of acute vascular events and relief of pain. Aspirin should not be given to patients to achieve misguided health-service targets. International guidelines now recommend aspirin withdrawal in some patients with coronary disease, and such recommendations should be extended to other patient groups after scientific review of the relevant evidence."

Reducing Warfarin Medication Interactions (Arch Intern Med. 2006) "The treatment of modifiable vascular risk factors - hypertension, diabetes mellitus, hypercholesterolemia and heart disease - is an important strategy for the reduction of the risk of dementia, and is likely to slow the progress of cognitive decline."

Warfarin interaction with Matricaria chamomilla (CMAJ 2006) "To the best of our knowledge, this is the first documented report of an interaction between warfarin and M. chamomilla; only a potential for interaction has been noted before. We believe that patients should be educated about the potential risk of using herbal products in general, and chamomile products in particular, while being treated with warfarin."

Chamomile plus warfarin:a potentially dangerous mix "People taking warfarin to prevent blood clots should stay away from chamomile products, Canadian doctors caution. They describe the case of a 70-year-old woman, while being treated with warfarin, who developed severe internal bleeding after drinking chamomile tea to soothe a sore throat and applying chamomile lotion to relieve chest congestion and reduce foot swelling. . While warfarin is known to interact with garlic, onion, and ginger, this is believed to be the first documented case of a drug-herb interaction between warfarin and chamomile. In the U.S., warfarin is sold under the trade name Coumadin. Warfarin is derived from coumarin -- a naturally occurring chemical compound with anti-clotting properties found in many plants, including chamomile. It's believed that the chamomile tea and lotion acted in concert with the warfarin in this case to cause bleeding. . "

Aspirin reduces risk of cardiovascular events, increases risk of bleeding (Cleveland Clinic Journal of Medicine)

Doctors Rethinking Aspirin-Plavix Combination "The conclusion: The tandem therapy was of some benefit to those with diagnosed heart disease, but it nearly doubled the risk of death, heart attack or stroke in patients with heart-threatening conditions such as high cholesterol and high blood pressure."

Questions Are Raised About the Safety of a Major Heart Drug

Digoxin Toxicity: A Review (US Pharm. 2006)

Risk of osteoporotic fracture in elderly patients taking warfarin: results from the National Registry of Atrial Fibrillation 2. (Arch Intern Med. 2006) "CONCLUSIONS: Long-term use of warfarin was associated with osteoporotic fractures, at least in men with atrial fibrillation. Beta-adrenergic antagonists may protect against osteoporotic fractures."

Comparative cardiovascular safety of traditional nonsteroidal anti-inflammatory drugs. (Expert Opin Drug Saf. 2006) "Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for their anti-inflammatory and analgesic effects. Unfortunately, these drugs are not without toxicity, namely on the gastric mucosa, but also on the cardiovascular system. In this context, the marketing of the coxibs, a new series of NSAIDs that selectively inhibit COX-2, resulted in a large debate around their cardiovascular safety, because they may increase the incidence of myocardial infarction and stroke."

Study questions safety of heart surgery drug

Risk of Osteoporotic Fracture in Elderly Patients Taking Warfarin (Arch Intern Med. 2006) "Conclusions Long-term use of warfarin was associated with osteoporotic fractures, at least in men with atrial fibrillation."

Study Finds Risk to Kidneys In Drug That Limits Bleeding " . drug given to more than a million people since 1993 to limit blood loss during heart surgery doubles a patient's risk of kidney failure and substantially increases the risk of a heart attack . Bayer Corp.'s aprotinin -- causes more than 11,000 patients worldwide to need kidney dialysis each year."

Outcomes in 45 Patients With Statin-Associated Myopathy "Conclusions: Patients with statin-associated myopathy experienced full resolution of muscle pain on cessation of statin therapy. Although no deaths occurred, 13% of the patients required hospitalization for rhabdomyolysis. Recurrent muscle pain was common on statin rechallenge."

Drugs

Interaction Between Warfarin and Cranberry Juice "Review and analysis of the literature revealed that ingestion of large volumes of cranberry juice destabilize warfarin therapy. Small amounts of juice are not expected to cause such an interaction. Clinicians should be aware of this potential interaction and monitor and counsel patients accordingly."

A systematic review and meta-analysis on the hazards of discontinuining or not adhering to aspirin among 50 279 patients at risk for coronary artery disease. (Eur Heart J. 2006) "CONCLUSION: Non-compliance or withdrawal of aspirin treatment has ominous prognostic implication in subjects with or at moderate-to-high risk for CAD. Aspirin discontinuation in such patients should be advocated only when bleeding risk clearly overwhelms that of atherothrombotic events."

Warfarin vs aspirin for symptomatic intracranial stenosis: subgroup analyses from WASID. (Neurology. 2006) "The WASID trial showed no advantage of warfarin over aspirin for preventing the primary endpoint of ischemic stroke, brain hemorrhage, or vascular death."

The Effect of Early, Intensive Statin Therapy on Acute Coronary Syndrome (Arch Intern Med. 2006)

Reduction of low-density lipoprotein cholesterol in patients with coronary heart disease and metabolic syndrome: analysis of the Treating to New Targets study. (Lancet.) "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."

Study: Cheaper blood thinner just as effective

Stroke Risk Lower Among Statin Users "Statin use is associated with a lower risk of stroke -- but not stroke severity or mortality -- in patients with coronary heart disease ."

Effects of Obesity on Lipid-Lowering, Anti-Inflammatory, and Antiatherosclerotic Benefits of Atorvastatin or Pravastatin in Patients With Coronary Artery Disease (from the REVERSAL Study) (The American Journal of Cardiology)

Effect of Lowering LDL Cholesterol Substantially Below Currently Recommended Levels in Patients With Coronary Heart Disease and Diabetes (Diabetes Care 2006)

Biological efficacy of low versus medium dose aspirin after coronary surgery: results from a randomized trial [NCT00262275]. (BMC Med. 2006) "CONCLUSIONS: Contrary to recent findings, low dose aspirin is effective and medium dose aspirin did not prove superior for inhibiting platelet aggregation after coronary surgery."

Effect of statins on the mortality of patients with ischaemic heart disease: population based cohort study with nested case-control analysis (Heart 2006) "Conclusions: The benefits of statins found in randomised controlled trials extend to unselected community based patients. The benefits can be seen within the first two years of treatment and continue to accrue over time. Since patients in the community are likely to be at higher risk than those in trials, the potential benefits from statins are likely to be greater than expected."

Combination Therapy With Aspirin, Clopidogrel and Warfarin Following Coronary Stenting is Associated With a Significant Risk of Bleeding (J Invasive Cardiol. 2006)

Blood Pressure Drugs Help Prevent Stroke, Heart Attack "Common blood pressure drugs called angiotensin-coverting enzyme ("ACE") inhibitors may also reduce risks for heart attack, stroke, and death in people with coronary artery disease, a new analysis finds."

ACE Inhibitors may Reduce Risk of Cardiovascular Disease and Death

Blood Thinner Protects Heart Patients

Intensive statin therapy reduces clinical events at 30 days and after six months in acute coronary syndromes (Evidence-based Cardiovascular Medicine 2006)

Cholesterol Drug Can Reverse Heart Disease

Statin and beta-blocker therapy and the initial presentation of coronary heart disease. (Ann Intern Med. 2006) "CONCLUSION: Statin and beta-blocker use was associated with lower odds of presenting with an acute myocardial infarction than with stable angina. Additional studies are needed to confirm that these therapies protect against unstable, higher-risk clinical presentations of coronary disease."

New Anticoagulants: Anti IIa vs Anti Xa-Is One Better? (J Thromb Thrombolysis. 2006)

Gains and losses of warfarin therapy as performed in an anticoagulation clinic. (J Intern Med. 2006)

Medical treatment of peripheral arterial disease. (JAMA. 2006) "CONCLUSION: The substantial and increasing burden of PAD, and its local and systemic complications, can be reduced by lifestyle modification (smoking cessation, exercise) and medical therapies (nicotine replacement therapy, bupropion, antihypertensive drugs, statins, and antiplatelet drugs)."

EDTA chelation therapy for cardiovascular disease: a systematic review (BMC Cardiovascular Disorders 2005) "Conclusion: The best available evidence does not support the therapeutic use of EDTA chelation therapy in the treatment of cardiovascular disease. Although not considered to be a highly invasive or harmful therapy, it is possible that the use of EDTA chelation therapy in lieu of proven therapy may result in causing indirect harm to the patient."

Sex-Related Differences in Response to Aspirin in Cardiovascular Disease: An Untested Hypothesis (Nat Clin Pract Cardiovasc Med. 2006) "It is our view, however, that any conclusion that there are sex-related differences in response to aspirin for the prevention of cardiovascular disease in apparently healthy men and women might be premature. . In summary, the hypothesis formulated in the editorial accompanying the aspirin component of the WHS warrants further investigation; however, it is not supported by evidence from randomized trials in secondary prevention, nor is it plausibly explained by differences in the sex-specific pharmacokinetic or pharmacodynamic profile of aspirin. To paraphrase TH Huxley, the idea might yet prove to be another beautiful hypothesis slain by ugly facts,[10] but this will not emerge until we have the results of large-scale, randomized trials of aspirin versus placebo in primary prevention of cardiovascular disease in elderly people."

Clopidogrel use in coronary artery disease. (Expert Rev Cardiovasc Ther. 2006)

Antibiotic therapy for coronary heart disease: The myth and the reality. (Timely Top Med Cardiovasc Dis. 2006)

Long-term anticoagulant therapy in patients with coronary artery disease. (Eur Heart J. 2006) "Secondary prevention of coronary events in coronary artery disease (CAD) patients with aspirin is generally accepted because of ease of administration, predictable safety, and proven efficacy. The use of long-term anticoagulant therapy with heparins, vitamin-K antagonists (VKAs), or thrombin inhibitors is, however, more controversial. During the last 40 years, several trials have been conducted in order to evaluate the role of anticoagulant therapy in patients with CAD as a protection against subsequent death and thrombo-embolic complications."

Statins

The Role of the New beta-Blockers in Treating Cardiovascular Disease (American Journal of Hypertension 2005) " Published randomized, controlled, multicenter studies with nebivolol have shown that once-daily treatment significantly reduces systolic and diastolic blood pressure in patients with mild-to-moderate hypertension, compared with placebo, in a dose-dependent manner, and is well tolerated, with an adverse event profile similar to that of placebo. When compared with other beta-blockers as well as with other antihypertensive classes of agents in head-to-head trials, nebivolol demonstrated similar antihypertensive efficacy and a lower incidence of adverse events. Nebivolol has also been shown to significantly reduce morbidity and mortality in a large population of elderly patients with chronic heart failure, independent of left ventricular ejection fraction. Nebivolol is currently available in Europe for the management of hypertension and is expected to be available soon in the United States."

Comparative cardiovascular safety of traditional nonsteroidal anti-inflammatory drugs. (Expert Opin Drug Saf 2006) "Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for their anti-inflammatory and analgesic effects. Unfortunately, these drugs are not without toxicity, namely on the gastric mucosa, but also on the cardiovascular system. In this context, the marketing of the coxibs, a new series of NSAIDs that selectively inhibit COX-2, resulted in a large debate around their cardiovascular safety, because they may increase the incidence of myocardial infarction and stroke. The recent suspension of a large, randomised, controlled trial comparing celecoxib, naproxen and placebo in Alzheimer patients (the ADAPT trial) because of an apparent elevated cardiovascular risk in the naproxen group revived the debate on the cardiovascular safety of these drugs, but this time with special emphasis on the effect of traditional nonselective NSAIDs (tNSAIDs). . in the absence of clear cut data, physicians will have to use traditional NSAIDs (or coxibs) in patients with a high cardiovascular risk on the basis of their common sense rather than on evidence-based medicine. For these patients, one should not forget that an inadequate long-term control of cardiovascular risk factors such as a hypertension, dyslipidaemia, diabetes, smoking and weight excess is more deleterious in terms of cardiovascular mortality than the administration of NSAIDs itself."

Exercise

Does supervised exercise after deep venous thrombosis improve recanalization of occluded vein segments? A randomized study. (J Thromb Thrombolysis. 2006)

[Benefits and risks of exercise training in coronary artery disease patients] (Ann Cardiol Angeiol (Paris). 2006)

Seniors Shouldn't Fear Exercise, Study Finds "A Johns Hopkins study should ease older adults' concern that exercise could harm their hearts, even if they have mild high blood pressure. Results of the research on 104 men and women age 55 to 75 showed that a moderate program of physical exertion had no ill effects on the heart's ability to pump blood nor does it produce a harmful increase in heart size."

Consequence of resistance training on body composition and coronary artery disease risk. (Cardiovasc J S Afr. 2006) "In conclusion, resistance training improved four of the six measured body composition variables, therefore implying that resistance training does in fact improve the majority of body composition variables and therefore CAD risk."

Chronobiological considerations for exercise and heart disease. (Sports Med. 2006)

Effect of exercise training on myocardial blood flow in patients with stable coronary artery disease. (Am Heart J. 2006) "CONCLUSIONS: Exercise training increased CFR in normal and diseased segments, and increased hyperemic flow in diseased segments. These data provide preliminary evidence in support of a favorable effect of exercise training on blood flow to ischemic myocardium."

[Exercise Training in the Treatment of Coronary Artery Disease and Obesity.] (Herz. 2006) "Regular physical activity, either alone or as part of a multifactorial intervention consisting of diet and exercise training, is known to promote effective weight loss. Especially in patients with metabolic syndrome, weight reduction beneficially effects blood glucose control. It increases the levels of vasculoprotective high-density lipoprotein and augments the physical exercise capacity of these individuals. Additionally, regular physical activity attenuates the diet-induced loss in fat-free body mass by 50%, improves body composition and counteracts the reduction in basal energy expenditure, which is another big advantage compared to diet alone in the treatment of obesity. Moreover, physical exercise training is essential to maintain a body weight that has been achieved by caloric restriction."

Effects of exercise training on mortality in patients with coronary heart disease. (Coron Artery Dis. 2006)

A 10-week Tai-Chi program improved the blood pressure, lipid profile and SF-36 scores in Hong Kong Chinese women. (Med Sci Monit. 2006) "Conclusions: A 10-week Tai-Chi exercise program improved systolic blood pressure, lipid profiles and some of the parameters of health-related QOL in Hong Kong Chinese women. Tai-Chi is likely to be a useful choice of physical activity."

Influence of Physical Activity on Mortality in Elderly with Coronary Artery Disease. (Medicine & Science in Sports & Exercise 2006) "Conclusion: This study highlights the inverse graded relationship between physical activity and all-cause mortality in men and women with CAD. Physical inactivity was a risk factor for mortality regardless of whether the subjects were men or women, old or very old, smokers or nonsmokers, lean or overweight, or otherwise healthy or unhealthy."

Exercise training improves low-density lipoprotein oxidability in untrained subjects with coronary artery disease. (Arch Phys Med Rehabil. 2006) "CONCLUSIONS: Aerobic training enhances the resistance of LDL to oxidation in patients with coronary artery disease, which may play a role in the favorable effects of exercise."

Exercise Can Prevent and Reverse the Severity of Hypertrophic Cardiomyopathy (Circulation Research. 2006) "Thus, not only was exercise not harmful but also it was able to prevent and even reverse established cardiac disease phenotypes in this HCM model."

Relative tolerance to upper- and lower-limb aerobic exercise in patients with peripheral arterial disease. (Eur J Vasc Endovasc Surg. 2006) "CONCLUSION: Upper-limb aerobic conditioning could be a useful exercise stimulus for maintaining or improving cardiorespiratory function in patients with severe PAD as they have a greater relative upper-limb aerobic power."

Physical activity for people with cardiovascular disease: recommendations of the National Heart Foundation of Australia. (Med J Aust. 2006) "Benefits from regular moderate physical activity for people with cardiovascular disease include augmented physiological functioning, lessening of cardiovascular symptoms, enhanced quality of life, improved coronary risk profile, superior muscle fitness and, for survivors of acute myocardial infarction, lower mortality."

Physical Performance in Peripheral Arterial Disease: A Slower Rate of Decline in Patients Who Walk More (Annals 2006) "Conclusion: Among patients with PAD, self-directed walking exercise performed at least 3 times weekly is associated with significantly less functional decline during the subsequent year. Similar trends were observed in the subset of asymptomatic patients with PAD."

General Information

Interventions for heart disease and their effects on Alzheimer's disease. (Neurol Res. 2006)

Treating Chest Pain in the Average Woman Tops $1 Million over Lifetime

The evidence for medicine versus surgery for carotid stenosis. (Eur J Radiol. 2006) "Carotid endarterectomy has a risk of causing stroke or death at the time of surgery in symptomatic patients of around 5-7%, but in patients with recently symptomatic stenosis of more than 70%, the benefits of endarterectomy outweigh the risks. In patients with moderate stenosis of between 50 and 69%, the benefits may justify surgery in patients with very recent symptoms, and in patients older than 75 years within a few months of symptoms. Patients with less than 50% stenosis do not benefit from surgery. In asymptomatic patients, or those whose symptoms occurred more than 6 months ago, the benefits of surgery are considerably less. Patients with asymptomatic stenosis treated medically only have a small risk of future stroke when treated medically of about 2% per annum."

Progressive coronary calcification despite intensive lipid-lowering treatment: a randomised controlled trial (Heart 2006) "Conclusion: In contrast to previous observational studies, this randomised controlled trial has shown that, despite reducing systemic inflammation and halving serum low density lipoprotein cholesterol concentrations, statin treatment does not have a major effect on the rate of progression of coronary artery calcification."

Lowering Blood Pressure Can Stop or Reverse Heart Disease

Dogma disputed: can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous? (Ann Intern Med. 2006) "CONCLUSIONS: The risk for the primary outcome, all-cause death, and MI, but not stroke, progressively increased with low diastolic blood pressure. Excessive reduction in diastolic pressure should be avoided in patients with CAD who are being treated for hypertension."

Targeting C-reactive protein for the treatment of cardiovascular disease. (Nature. 2006)

Goal: Intensify Treatment for Heart Patients

High-Density Lipoprotein Cholesterol-Raising Strategies. (Journal of Cardiovascular Pharmacology 2006)

Statin Safety: A Systematic Review (The American Journal of Cardiology 2006)

Homocysteine Lowering with Folic Acid and B Vitamins in Vascular Disease (NEJM 2006)

Self-monitoring of oral anticoagulation: a systematic review and meta-analysis (The Lancet 2006) "Self-management improves the quality of oral anticoagulation. Patients capable of self-monitoring and self-adjusting therapy have fewer thromboembolic events and lower mortality than those who self-monitor alone. However, self-monitoring is not feasible for all patients, and requires identification and education of suitable candidates."

Selection of optimal therapy for chronic stable angina. (Curr Treat Options Cardiovasc Med. 2006) "Patients with chronic stable angina (CSA) seek a medical opinion for relief of their symptoms and because of fear of having a heart attack. The underlying lesion responsible for CSA is often a severe narrowing of one or more coronary arteries. In addition, the coronary arteries of patients with CSA contain many more nonobstructive lesions, which progress at variable rates, and are prone to rupture and may manifest as acute coronary syndromes (myocardial infarction , unstable angina , or sudden ischemic death). . To reduce the incidence of MI, UA, and sudden ischemic death, treatment strategies should include smoking cessation, daily aspirin, daily exercise, and pharmacologic therapy for dyslipidemias, and for elevated blood pressure. Patients who remain symptomatic despite medical therapy and those not willing to take or unable to tolerate antianginal drugs should be considered for percutaneous or surgical coronary revascularization."

Medical treatment of peripheral arterial disease. (JAMA. 2006) "CONCLUSION: The substantial and increasing burden of PAD, and its local and systemic complications, can be reduced by lifestyle modification (smoking cessation, exercise) and medical therapies (nicotine replacement therapy, bupropion, antihypertensive drugs, statins, and antiplatelet drugs)."

Secondary prevention of coronary heart disease in older patients after the national service framework: population based study (BMJ 2006) "Uptake of secondary prevention increased markedly between 1998-2001 and 2003; by 2003 half of patients with myocardial infarction were using a combination of antiplatelet medication, statins, and blood pressure lowering drugs"

Aspirin and clopidogrel resistance: an emerging clinical entity. (Eur Heart J. 2005) "Antiplatelet therapy is a cornerstone of cardiovascular medicine. Aspirin and clopidogrel have emerged as critical therapies in the treatment of cardiovascular disease. Despite their efficacy, patients on these medications continue to suffer complications. Millions of patients are currently on low-dose antiplatelet therapy but it is unknown how many of these patients are under-treated or on the wrong medication. Aspirin and clopidogrel resistance are emerging clinical entities with potentially severe consequences such as recurrent myocardial infarction, stroke, or death."

Guidelines

NGC - Guidance on the use of glycoprotein IIb/IIIa inhibitors in the treatment of acute coronary syndromes. (2006)

U.S. Experts Issue New Heart Disease Treatment Guidelines

NGC - Anticoagulation therapy supplement. (2006)

NGC - Clopidogrel and modified-release dipyridamole in the prevention of occlusive vascular events. (2005)

ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention

NGC - Carotid endarterectomy - an evidence-based review. Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. (2005)

NGC - Diagnosis and treatment of chest pain and acute coronary syndrome (ACS). (2005)

Immunotherapy

Internet Sites

Treatment Information

Anticoagulation Resource

DrugBank (drug structure)

FDA - MedWatch (Drug Alerts)

warfarin

Warfarin

Warfarin: Can certain foods decrease its effectiveness?

Warfarin - From Wikipedia, the free encyclopedia

Warfarin (Coumadin) - Children

Drug-Food-Supplement Information

Drug Information Online

Drug Interaction Checker

DrugDigest (drug interactions)

FDA - Drug Interactions: What You Should Know

NIH - Botanical Dietary Supplements: Background Information

NIH - Drug, Supplements, and Herbal Information

NIH - Herbal Supplements: Consider Safety, Too

NIH - Medicines

NIH - Vitamin and Mineral Supplement Fact Sheets

Nutrition

Higher plasma docosahexaenoic acid is associated with reduced progression of coronary-artery atherosclerosis in women with established coronary artery disease. (J Lipid Res. 2006) "Consistent with higher reported fish intake, higher levels of plasma triglyceride and phospholipid DHA is associated with less progression of coronary atherosclerosis in postmenopausal women with established CAD."

n-3 Fatty acids from fish or fish-oil supplements, but not {alpha}-linolenic acid, benefit cardiovascular disease outcomes in primary- and secondary-prevention studies: a systematic review. (Am J Clin Nutr. 2006) Evidence suggests that increased consumption of n-3 FAs from fish or fish-oil supplements, but not of alpha-linolenic acid, reduces the rates of all-cause mortality, cardiac and sudden death, and possibly stroke. The evidence for the benefits of fish oil is stronger in secondary- than in primary-prevention settings. Adverse effects appear to be minor.

The relationship between adherence to the Mediterranean diet and the severity and short-term prognosis of acute coronary syndromes (ACS): The Greek Study of ACS (The GREECS) (Nutrition 2006) "Background dietary habits close to the Mediterranean diet seem to be associated with lower severity of coronary heart disease."

Suppression of LDL Oxidation by Garlic Compounds Is a Possible Mechanism of Cardiovascular Health Benefit. (J Nutr. 2006)

Supplemental conditionally essential nutrients in cardiovascular disease therapy. (J Cardiovasc Nurs. 2006)

Other

Other Treatments

Experimental

Radiotherapy

Supplements-Vitamins-CAM

Use of Complementary Therapies in Patients With Cardiovascular Disease. (Am J Cardiol. 2006)

Secondary prevention of coronary artery disease with omega-3 Fatty acids. (Am J Cardiol. 2006) "The totality of evidence supports a strong role for omega-3 fatty acids derived from fish oil in secondary prevention through a presumptive role as an antiarrhythmic agent and through an ability to promote plaque stabilization."

Oral magnesium therapy, exercise heart rate, exercise tolerance, and myocardial function in coronary artery disease patients. (Br J Sports Med. 2006) "CONCLUSION: The present study supports the intake of oral Mg and its favorable effects on exercise tolerance and left ventricular function during rest and exercise in stable CAD patients."

Supplementation with omega-3 polyunsaturated fatty acids augments brachial artery dilation and blood flow during forearm contraction. (Eur J Appl Physiol. 2006) "Results indicate that treatment with DHA and EPA enhances brachial artery blood flow and conductance during exercise. These findings may have implications for individuals with cardiovascular disease and exercise intolerance (e.g., heart failure)."

Effect of Fish Oil on Ventricular Tachyarrhythmia and Death in Patients With Implantable Cardioverter Defibrillators: The Study on Omega-3 Fatty Acids and Ventricular Arrhythmia (SOFA) Randomized Trial (JAMA 2006) "Conclusion Our findings do not indicate evidence of a strong protective effect of intake of omega-3 PUFAs from fish oil against ventricular arrhythmia in patients with ICDs."

Risks and benefits of omega 3 fats for mortality, cardiovascular disease, and cancer: systematic review (BMJ 2006) "Conclusion Long chain and shorter chain omega 3 fats do not have a clear effect on total mortality, combined cardiovascular events, or cancer."

Effects of Selenium Supplementation on Cardiovascular Disease Incidence and Mortality: Secondary Analyses in a Randomized Clinical Trial (American Journal of Epidemiology 2006) "These findings indicate no overall effect of selenium supplementation on the primary prevention of cardiovascular disease in this population."

omega-3 Fatty Acids for the Prevention of Atrial Fibrillation After Coronary Artery Bypass Surgery: A Randomized, Controlled Trial (Nutrition in Clinical Practice 2006) "Conclusions: This study first demonstrates that PUFA administration during hospitalization in patients undergoing CABG substantially reduced the incidence of postoperative AF (54.4%) and was associated with a shorter hospital stay."

Homocysteine Lowering with Folic Acid and B Vitamins in Vascular Disease. (N Engl J Med. 2006) "Conclusions Supplements combining folic acid and vitamins B6 and B12 did not reduce the risk of major cardiovascular events in patients with vascular disease."

Dietary intake of calcium in relation to mortality from cardiovascular disease: the JACC Study. (Stroke. 2006)

Garlic and cardiovascular disease: a critical review. (J Nutr. 2006) "Epidemiologic studies show an inverse correlation between garlic consumption and progression of cardiovascular disease. Cardiovascular disease is associated with multiple factors such as raised serum total cholesterol, raised LDL and an increase in LDL oxidation, increased platelet aggregation, hypertension, and smoking. Numerous in vitro studies have confirmed the ability of garlic to reduce these parameters. . This review analyzes in vitro and in vivo studies published since 1993 and concludes that although garlic appears to hold promise in reducing parameters associated with cardiovascular disease, more in-depth and appropriate studies are required."

Aged garlic extract retards progression of coronary artery calcification. (J Nutr. 2006)

Aged garlic extract improves homocysteine-induced endothelial dysfunction in macro- and microcirculation. (J Nutr. 2006)

Aged garlic extract may be safe for patients on warfarin therapy. (J Nutr. 2006)

Surgery

A Review of the Management of Patients after Percutaneous Coronary Intervention (Int J Clin Pract. 2006)

Risk factors for restenosis after carotid artery angioplasty and stenting. (J Vasc Surg. 2006)

30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial (The Lancet 2006) "The results of this trial do not justify the widespread use in the short-term of carotid-artery stenting for treatment of carotid-artery stenoses."

Bypass Best for Clogged Arteries "Coronary artery bypass surgery is more effective at extending the lives of patients with severe coronary artery disease than either angioplasty or heart medications, Duke University researchers report."

Angioplasty is cheaper than surgery and is just as effective "Percutaneous coronary intervention, also known as angioplasty, is as effective as coronary artery bypass grafting in treating patients with refractory angina who are at high risk of adverse outcomes, a new US study has concluded. It found that over five years angioplasty is nearly 20% cheaper."

Brain injury from cardiac bypass procedures. (Semin Neurol. 2006)

Risk of Cognitive Decline in Older Patients After Carotid Endarterectomy: An Observational Study (Journal of the American Geriatrics Society 2006) "CONCLUSION: Patients undergoing CE for symptomatic LICA disease appear to be at greater risk of cognitive decline than other subjects. These findings suggest that future studies should evaluate the effects on cognitive function of different timing for CE in patients with LICA and RICA disease."

Using statins to reduce cardiovascular risk after carotid endarterectomy (Evidence-based Cardiovascular Medicine 2006) "People undergoing carotid endarterectomy are at high risk for stroke and cardiovascular complications. Inhibitors of HMG-CoA reductase (statins) can prevent adverse events.1-5 This guest editorial examines the value of preoperative statin treatment for reducing mortality due to the stroke and cardiovascular complications."

Contribution of Infection to Increased Mortality in Women After Cardiac Surgery (Arch Intern Med 2006)

Predicting and preventing adverse neurologic outcomes with cardiac surgery. (J Card Surg. 2006)

Transplantation

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