Sirolimus- and probucol-eluting stent shows promise
Massberg S. Circulation. 2011;124:624-632.
A sirolimus- and probucol-eluting stent demonstrated noninferiority to a zotarolimus-eluting stent regarding a host of clinical endpoints, according to study results.
The current trial involved 3,002 patients randomly assigned to the dual-drug stent or the zotarolimus-eluting stent. The aim was to demonstrate noninferiority of the dual-drug stent by evaluating for a composite primary endpoint of the combined incidence of cardiac death, target vessel-related MI or target lesion revascularization. The overall follow-up period was 1 year, with angiography scheduled at 6 to 8 months.
The sirolimus- and probucol-eluting stent yielded a 13.1% incidence rate for the combined primary endpoint vs. 13.5% for the zotarolimus-eluting stent, which the researchers said was noninferior (HR=0.97, 95% CI, 0.78-1.19).
The dual-drug stent was linked to a 1.1% incidence rate of definite/probable stent thrombosis vs. a 1.2% rate in the zotarolimus group (HR=0.91; 95% CI, 0.45-1.84).
No differences were observed in terms of angiographic efficacy. In-segment binary angiographic restenosis was 13.3% in the dual-drug group and 13.4% in the zotarolimus group (P=.95); in-stent late luminal loss was 0.31 ± 0.58 mm in the dual-drug group and 0.29 ± 0.56 mm in the zotarolimus group (P=.46).
Researchers from sites in Germany said two stents — the polymer-free dual-drug sirolimus- and probucol-eluting stent and a new generation permanent polymer zotarolimus-eluting stent — have demonstrated encouraging results in light of adverse events associated with durable polymer coatings after drug-eluting stent implantation.
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IRS1 gene variant improved insulin control for patients on certain diets
Qi Q. Circulation. 2011;124:563-571.
A high-carbohydrate, low-fat diet may improve insulin control among patients with a specific variant in the IRS1 gene, according to recent results.
The aim of the Preventing Overweight Using Novel Dietary Strategies (POUNDS LOST) trial was to investigate whether the rs2943641 variant in the IRS1 gene, which has recently been linked to insulin resistance and hyperinsulinemia, modifies the long-term changes in insulin resistance and body weight in response to weight-loss diets.
Researchers from several sites in the United States genotyped this variant in 738 overweight adults. Eligible participants had been randomly assigned to one of four diets varying in macronutrient contents. The diet lasted 2 years, during which progress in fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR) and weight loss by genotypes were assessed.
Among patients in the high-carbohydrate diet group, 6-month results indicated that participants with the risk-conferring CC genotype experienced greater decreases in insulin (P=.009), HOMA-IR (P=.015) and weight loss (P=.018) than those without this genotype. Among patients in the low-carbohydrate diet group, an opposite genotype effect on changes in insulin and HOMA-IR (P≤.05) was observed.
The other two diet groups did not experience significant differences across genotypes. “The tests for genotype by intervention interactions were all significant (P<.05),” the researchers said.
The genotype effect on changes in insulin and HOMA-IR continued to be significant at 2 years among those on the diet with the highest carbohydrate content (P<.05). The 2-year results also indicated that the high-carbohydrate diet yielded greater improvements in insulin and HOMA-IR (P for genotype-time interaction ≤.009) in participants with the CC genotype than those without this genotype.
“Individuals with the IRS1 rs2943641 CC genotype might obtain more benefits in weight loss and improvement of insulin resistance than those without this genotype by choosing a high-carbohydrate and low-fat diet,” the researchers wrote.
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