Revascularization improved myocardial ischemia vs. medical therapy in BARI 2D substudy
American Heart Association Scientific Sessions 2010
CHICAGO — Compared with intensive medical therapy, revascularization was associated with near-term improvements in myocardial ischemia in patients with type 2 diabetes and stable coronary artery disease, according to new data from the BARI 2D trial.
Although previous study results demonstrated similar clinical efficacy between revascularization and intensive medical therapy, little information exists regarding their respective influence on postintervention ischemic burden, researchers said.
For the substudy, researchers examined differences in stress myocardial perfusion SPECT abnormalities at 1 year in 1,505 patients enrolled in the BARI 2D trial. All patients who were randomly assigned to revascularization in BARI 2D underwent stress myocardial perfusion SPECT at 1 year compared with 16% of patients assigned to intensive medical therapy.
Results indicated that stress perfusion abnormalities were absent more often in patients who received revascularization compared with patients assigned to intensive medical therapy (P=.002). In addition, patients receiving intensive medical therapy experienced more extensive ischemia involving at least three myocardial segments (P<.001), according to the researchers.
At 3%, patients in the revascularization arm had a lower median quantitative percentage of the myocardium with stress perfusion compared with 9% in patients receiving intensive medical therapy (P=.01). The researchers also noted comparable differences in the percentage of ischemic myocardium among the treatment arms. The percentage of scarred myocardium, however, did not differ between groups.
Fifty-nine percent of patients who underwent revascularization had no inducible ischemia after 1 year compared with 49% of patients receiving intensive medical therapy (P<.001), the researchers said. Data demonstrated a relationship between ischemic burden and higher death rates and major CV events (HR=2.19 for ≥10% stress abnormality vs. 0%; P<.001).
When the researchers adjusted for demographic and clinical factors, analysis revealed a significant association between selected myocardial perfusion SPECT variables and an increased hazard of cardiac death or MI (HR=1.8 for ≥10% stress abnormality vs. 0%; P=.01).
Based on these results, “patient management strategies that focus on ischemia resolution can be useful to guide efficacy of near-term therapeutic approaches,” the researchers concluded.
For more information:
Shaw LJ. Abstract 12697. Presented at: American Heart Association Scientific Sessions 2010; Nov. 13-17, 2010; Chicagо
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Prehypertension linked to low vitamin D
American Heart Association Scientific Sessions 2010
CHICAGO — Low serum vitamin D levels appear to be independently associated with the development of prehypertension, new data suggest.
Researchers conducted a cross-sectional study of 9,215 participants included in the National Health and Nutrition Examination Survey (NHANES) III who were free of hypertension at baseline. Participants were divided into quartiles based on serum vitamin D levels. The main outcome of interest was prehypertension (n=3,712), which was defined as systolic BP of 120 mm Hg to 139 mm Hg or diastolic BP of 80 mm Hg to 89 mm Hg.
According to the results, low serum vitamin D levels were associated with the development of prehypertension, independent of risk factors such as age, sex, race, smoking, alcohol intake, BMI, physical inactivity, diabetes, HDL ratio, CRP and glomerular filtration rate.
When compared with the highest quartile of serum vitamin D (>32.4 ng/mL), the odds of developing prehypertension were increased in the lowest quartile (≤17.7 ng/mL; OR=1.48; 95% CI, 1.16-1.90). On continuous analysis, each standard deviation decrease in vitamin D was associated with an odds ratio of 1.14 (95% CI, 1.05-1.24) for prehypertension.
“These findings are largely consistent with previous studies that examine the association [between low vitamin D levels] and prehypertension,” Charumath Sabanayagam, MD, PhD, of West Virginia University, said during his presentation.
The researchers concluded that future randomized trials are needed to determine if vitamin D supplementation during the prehypertension stage can prevent the onset of full-blown hypertension.
Sabanayagam reported no relevant disclosures. – by Eric Raible
For more information:
Sabanayagam C. Abstract 21058. Presented at: American Heart Association Scientific Sessions 2010; Nov. 13-17; Chicago.
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