MI rate fell nearly 75% in London cohort during 20-year period
Hardoon S. Eur Heart J. 2011;doi:10.1093/eurheartj/ehr142.
From 1985 to 2004, the rate of MI among participants of a cohort in London decreased 74%, with declining non-HDL cholesterol levels and increased HDL cited as the main reasons for the decline. However, the study, appearing in the European Heart Journal, also found that rising BMI could potentially reverse the trend in the future.
The researchers performing the study looked at men (n=6,379) and women (n=3,074) from the Whitehall II cohort. All participants were from 20 civil service departments in London between 1985 and 1988, aged 35 to 55 years and had clinic visits every 5 years. Participants completed questionnaires and examinations on health and lifestyle during four periods: 1985 to 1988, 1991 to 1993, 1997 to 1999 and 2002 to 2004.
During the 20 years, 256 first MI events were reported, of which 81.3% occurred in men. The age-sex adjusted hazard for MI decreased by 74% (95% CI, 48-87) during this time, which corresponded to a mean decline of 6.5% (95% CI, 3.2-9.7) per year.
According to the researchers, 56% of this decline could be attributed to percent decreases in non-HDL levels (34%), systolic BP (13%) and cigarette smoking (6%), as well as increases in HDL levels (17%) and fruit and vegetable consumption (7%). Also noteworthy, rising BMI reduced the scale of the decline by 11%.
These findings, the researchers wrote, highlight what can be achieved and emphasize the value of measures to reduce exposure to risk factors in the population.
“Further research is needed to determine whether the residual unexplained portion of the decline in MI may be explained by early treatment, underestimated contributions of the major risk factors (reflecting imprecision in the analyses) or the influence of other risk factors,” they said, while adding that the rising BMI in the UK and other countries still needs urgent attention.
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SPARCL: Statin treatment did not affect outcomes in patients with type 2 diabetes, metabolic syndrome
Callahan A. Arch Neurol. 2011;doi:10.1001/archneurol.2011.146.
A cohort of patients with type 2 diabetes mellitus or metabolic syndrome did not benefit from statin treatment, according to recent results.
The secondary analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial aimed to determine whether treatment with atorvastatin (Lipitor, Pfizer) could reduce stroke in patients with type 2 diabetes or metabolic syndrome who had recently had a stroke or transient ischemic attack.
There were 794 patients with type 2 diabetes at enrollment; 642 patients retrospectively included in a metabolic syndrome cohort; and 3,295 patients in a reference group who belonged to neither category.
Compared with the reference group, those with type 2 diabetes were at an increased risk for stroke (HR=1.62; 95% CI, 1.33-1.98), major CV events (HR=1.66; 95% CI, 1.39-1.97) and revascularization procedures (HR=2.39; 95% CI, 1.78-3.19).
There was no increased risk for stroke (P=.78) or major CV events (P=.38) among patients with metabolic syndrome compared with those in the reference group. However, patients with metabolic syndrome were more likely to undergo revascularization procedures (HR=1.78; 95% CI, 1.26-2.5).
No significant treatment interactions were observed for the SPARCL primary endpoint (P=.47), according to the results.
The primary endpoint was combined risk for nonfatal and fatal stroke, and secondary endpoints included major coronary events, major CV events, any coronary disease event and any revascularization procedure. Regression analysis was conducted to determine whether the effect of treatment varied based on the presence of type 2 diabetes or metabolic syndrome.
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SIRTAX LATE: Comparable outcomes for sirolimus-, paclitaxel-eluting stents at 5 years
Räber L. Circulation. 2011;123:2819-2828. Su
New randomized trial data have indicated that patients treated with first generation sirolimus-eluting stents had no significant differences in clinical and angiographic outcomes at 5 years compared with patients receiving paclitaxel-eluting stents.
The Sirolimus-Eluting Versus Paclitaxel-Eluting Stents for Coronary Revascularization (SIRTAX LATE) trial involved 1,012 patients randomly assigned to receive either sirolimus-eluting stents (SES; Cypher, Cordis; n=503) or paclitaxel-eluting stents (PES; Taxus, Boston Scientific; n=509). In addition, all patients had at leastone lesion in a vessel with a reference diameter between 2.25 and 4.00 mm.
At 5 years, 97.6% of SES and 96.1% of PES patients had obtainable clinical follow-up. Major adverse cardiac events (a composite of cardiac death, MI and ischemia-driven target lesion revascularization) occurred in 19.7% of SES patients and 21.4% of PES patients (HR=0.89; 95% CI, 0.68-1.17). Individually, there were no statistically significant differences in the rates of cardiac death (SES, 5.8% vs. PES, 5.7%), MI (SES, 6.6% vs. PES, 6.9%) or target lesion revascularization (TLR; SES, 13.1% vs. PES, 15.1%).
Also reported, the annual rate of TLR between 1 and 5 years was 2.0% for the SES group and 1.4% for PES group, while delayed lumen loss for those undergoing paired angiography between 8 months and 5 years was 0.37 ± 0.73 mm for SES and 0.29 ± 0.59 mm for PES patients.
Among the clinical implications of the study, the researchers wrote, were the low risk of repeat revascularization with first-generation drug-eluting stents (DES) and the observation that very late stent thrombosis remains an important liSIRTAX LATE: Comparable outcomes for sirolimus-, paclitaxel-eluting stents at 5 years
Räber L. Circulation. 2011;123:2819-2828.
New randomized trial data have indicated that patients treated with first generation sirolimus-eluting stents had no significant differences in clinical and angiographic outcomes at 5 years compared with patients receiving paclitaxel-eluting stents.
The Sirolimus-Eluting Versus Paclitaxel-Eluting Stents for Coronary Revascularization (SIRTAX LATE) trial involved 1,012 patients randomly assigned to receive either sirolimus-eluting stents (SES; Cypher, Cordis; n=503) or paclitaxel-eluting stents (PES; Taxus, Boston Scientific; n=509). In addition, all patients had at leastone lesion in a vessel with a reference diameter between 2.25 and 4.00 mm.
At 5 years, 97.6% of SES and 96.1% of PES patients had obtainable clinical follow-up. Major adverse cardiac events (a composite of cardiac death, MI and ischemia-driven target lesion revascularization) occurred in 19.7% of SES patients and 21.4% of PES patients (HR=0.89; 95% CI, 0.68-1.17). Individually, there were no statistically significant differences in the rates of cardiac death (SES, 5.8% vs. PES, 5.7%), MI (SES, 6.6% vs. PES, 6.9%) or target lesion revascularization (TLR; SES, 13.1% vs. PES, 15.1%).
Also reported, the annual rate of TLR between 1 and 5 years was 2.0% for the SES group and 1.4% for PES group, while delayed lumen loss for those undergoing paired angiography between 8 months and 5 years was 0.37 ± 0.73 mm for SES and 0.29 ± 0.59 mm for PES patients.
Among the clinical implications of the study, the researchers wrote, were the low risk of repeat revascularization with first-generation drug-eluting stents (DES) and the observation that very late stent thrombosis remains an important liSIRTAX LATE: Comparable outcomes for sirolimus-, paclitaxel-eluting stents at 5 years
Räber L. Circulation. 2011;123:2819-2828. Submit a Comment Print Email
New randomized trial data have indicated that patients treated with first generation sirolimus-eluting stents had no significant differences in clinical and angiographic outcomes at 5 years compared with patients receiving paclitaxel-eluting stents.
The Sirolimus-Eluting Versus Paclitaxel-Eluting Stents for Coronary Revascularization (SIRTAX LATE) trial involved 1,012 patients randomly assigned to receive either sirolimus-eluting stents (SES; Cypher, Cordis; n=503) or paclitaxel-eluting stents (PES; Taxus, Boston Scientific; n=509). In addition, all patients had at leastone lesion in a vessel with a reference diameter between 2.25 and 4.00 mm.
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At 5 years, 97.6% of SES and 96.1% of PES patients had obtainable clinical follow-up. Major adverse cardiac events (a composite of cardiac death, MI and ischemia-driven target lesion revascularization) occurred in 19.7% of SES patients and 21.4% of PES patients (HR=0.89; 95% CI, 0.68-1.17). Individually, there were no statistically significant differences in the rates of cardiac death (SES, 5.8% vs. PES, 5.7%), MI (SES, 6.6% vs. PES, 6.9%) or target lesion revascularization (TLR; SES, 13.1% vs. PES, 15.1%).
Also reported, the annual rate of TLR between 1 and 5 years was 2.0% for the SES group and 1.4% for PES group, while delayed lumen loss for those undergoing paired angiography between 8 months and 5 years was 0.37 ± 0.73 mm for SES and 0.29 ± 0.59 mm for PES patients.
Among the clinical implications of the study, the researchers wrote, were the low risk of repeat revascularization with first-generation drug-eluting stents (DES) and the observation that very late stent thrombosis remains an important limitation of first-generation DES, accounting for more than half of all MIs between 1 and 5 years.