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Ezetimibe reduces cardiovascular events in diabetics with recent acute coronary syndrome

( London, UK - 30 Aug 2015: Ezetimibe reduces cardiovascular events in patients with diabetes and a recent acute coronary syndrome, according to a subgroup analysis of the IMPROVE-IT trial presented at ESC Congress today by co-principal investigator Dr Robert Giugliano, physician in cardiovascular medicine at Brigham and Women's Hospital in Boston, US.1 Ezetimibe achieved greater reductions in LDL cholesterol than statins alone, resulting in lower risks of cardiovascular events in patients with diabetes. The benefits observed in diabetics were greater than in those without diabetes.

"Acute coronary syndromes, including myocardial infarction (heart attack) and unstable angina (threatened heart attack), are a leading cause of death and disability worldwide," said Dr Giugliano. "In addition to lifestyle changes, medications to lower blood cholesterol are helpful to prevent future cardiac and vascular events such as myocardial infarction and stroke. Statins are recommended for patients with and without diabetes, but the benefit of adding a non-statin has been less clear."

Improved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) is the largest and longest study with ezetimibe. The six year trial included 18 144 patients who had been hospitalised with an acute coronary syndrome within the previous ten days, were not being treated with ezetimibe or the highest dose of potent statins, and who had an LDL cholesterol between 1.3 and 3.2 mmol/L (50-125 mg/dL). Patients were randomised to ezetimibe (10 mg) or placebo. All patients received 40 mg simvastatin, which was increased to 80 mg if LDL cholesterol on treatment was greater than 2.04 mmol/L (79 mg/dL).

Patients were followed for a median of six years for the primary composite of cardiovascular death, myocardial infarction (MI), hospitalisation for unstable angina, coronary revascularization ?30 days, and stroke. The main finding of the trial was that ezetimibe significantly reduced the chances of a future major cardiac or vascular event by 6.4% compared to placebo, with no increase in adverse safety events.2

The analysis presented today provides the outcomes in the 4 933 (27%) patients with diabetes, one of the prespecified subgroups. The investigators found that in diabetics, ezetimibe added to a statin lowered LDL cholesterol at 1 year by 1.1 mmol/L (43 mg/dL) compared with 0.6 mmol/L (23 mg/dL) with a statin alone. Diabetics receiving ezetimibe had a 14% relative risk reduction (5.5% absolute reduction; number needed to treat [NNT] = 18) over placebo for the primary composite endpoint (hazard ratio [HR] = 0.86; 95% confidence interval [CI] = 0.78-0.94) compared with a 2% relative reduction for non-diabetics (HR = 0.98; 95% CI = 0.91-1.04).

"The non-statin, cholesterol-lowering drug ezetimibe, when added to background therapy with a statin, was particularly effective in patients with diabetes who had been admitted to the hospital with an acute coronary syndrome," said Dr Giugliano. "Ezetimibe is an oral drug taken once daily that reduces LDL (or 'bad') cholesterol) by blocking cholesterol absorption in the gut. This is a different action than that of statins, which block cholesterol production in the liver and have been shown to be highly effective in preventing cardiac and vascular events in a wide variety of patients."

In diabetics, the greatest reductions in cardiovascular events were in ischaemic stroke (39%), myocardial infarction (24%), and the composite of death due to cardiovascular causes, myocardial infarction, or stroke (20%). In diabetics and non-diabetics, there were no differences between ezetimibe and placebo in safety outcomes including liver test abnormalities, muscle side effects, gall bladder related events and cancer.

Dr Giugliano concluded: "Our results are particularly good news for patients with diabetes who have coronary artery disease. We found that in diabetics with recent acute coronary syndrome, ezetimibe added to simvastatin reduced LDL cholesterol by (0.5 mmol/L) (20 mg/dL) more than simvastatin alone and achieved an average LDL cholesterol of 1.4 mmol/L (54 mg/dL). This greater reduction resulted in lower risks of future cardiovascular events relative to placebo."



Air pollution associated with increased heart attack risk despite 'safe' levels

London, UK - 30 Aug 2015: Particulate matter and NO2 air pollution are associated with increased risk of severe heart attacks despite being within European recommended levels, according to research presented at ESC Congress today by Dr Jean-Francois Argacha, a cardiologist at University Hospital Brussels (UZ Brussel-Vrije Universiteit Brussel), in Belgium.1 "Dramatic health consequences of air pollution were first described in Belgium in 1930 after the Meuse Valley fog," said Dr Argacha. "Nowadays, the World Health Organization (WHO) considers air pollution as one of ...

Young adults living in polluted city show early signs of cardiovascular risk

London, UK - 30 Aug 2015: Young adults living in a polluted city show early signs of cardiovascular risk, according to research presented at ESC Congress today by Dr Krzysztof Bryniarski from Jagiellonian University, Collegium Medicum in Krakow, Poland.1 Residing in a polluted city was associated with higher levels of inflammatory markers in otherwise healthy adolescents and young adults, which indicate a greater risk of having a heart attack in future. Dr Bryniarski said: "This study was conducted by a group of medical students from Jagiellonian University in Krakow, ...

Cold weather associated with higher risk of severe heart attack

London, UK - 30 Aug 2015: Cold weather is associated with a higher risk of severe heart attack, according to research presented at ESC Congress today by Dr Shuangbo Liu, adult cardiology resident at the University of Manitoba in Winnipeg, Canada.1 The six year study found that each 10°C drop in temperature was associated with a 7% increased risk of ST-elevation myocardial infarction (STEMI), the most severe form of heart attack. "We studied the effects of temperature on the risk of heart attacks in Winnipeg, Canada, one of the coldest large cities in the world," said ...

CPR for out-of-hospital cardiac arrest should be conducted for at least 35 minutes

London, UK - 30 Aug 2015: Cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest should be conducted for at least 35 minutes, according to research presented at ESC Congress today by Dr Yoshikazu Goto, associate professor and director of the Department of Emergency and Critical Care Medicine at Kanazawa University Hospital in Kanazawa, Japan.1 The study in more than 17 000 patients found that nearly all survivals were achieved within 35 minutes and longer CPR achieved little benefit. Dr Goto said: "The decision regarding when to stop resuscitation efforts ...

Cold weather linked to increased stroke risk in atrial fibrillation patients

London, UK - 30 Aug 2015: Cold weather is associated with increased risk of ischaemic stroke in patients with atrial fibrillation, according to research presented at ESC Congress today by Dr Tze-Fan Chao, cardiologist at Taipei Veterans General Hospital and the National Yang-Ming University in Taiwan.1 The study in nearly 290 000 patients suggests that cool climate may be an underrated issue for health that deserves more attention. "Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and it increases the risk of ischaemic stroke by four- to five-fold," ...

Treating left atrial appendage could dampen long standing persistent AF

LONDON, UK - In patients with long-standing persistent atrial fibrillation (AF) despite standard treatment, additional electrical isolation of an area called the left atrial appendage (LAA) can improve freedom from AF without increasing complications, results of the BELIEF study show. The findings were presented today in a Hot Line session at ESC Congress 2015. "Empirical left atrial appendage isolation, along with the standard approach of pulmonary vein isolation (PVI) and ablation of extra-pulmonary triggers is superior to the standard approach alone in enhancing the ...

Patient education does not impact apixaban adherence

LONDON, UK - Adherence to the oral anticoagulant apixaban among patients with atrial fibrillation (AF) was no better for those who received an educational program compared to those who did not, results of the international, randomised AEGEAN trial show. The results, presented today at ESC Congress 2015, were nevertheless "quite encouraging," according to lead investigator Gilles Montalescot, MD, PhD, from the Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtri?re, in Paris, France. "We used the best possible tools for the educational program, ...

Adenosine triphosphate does not improve efficacy of pulmonary vein isolation

LONDON, UK - Late recurrence of atrial fibrillation (AF) is not reduced in patients whose pulmonary vein isolation (PVI) treatment incorporates the addition of adenosine triphosphate (ATP), according to results of the UNDER-ATP trial. Results of the trial, presented at ESC Congress 2015, add to the ongoing debate about ATP use in this setting. The major cause of AF recurrence after PVI has been reported to be electrical reconnection between the left atrium and pulmonary veins, which re-establishes abnormal rhythm, said study investigator Atsushi Kobori, MD, from Kobe ...

Leadless pacemaker study assesses safety and efficacy

LONDON, UK - A leadless cardiac pacemaker showed "good safety and reliable function" during the initial six months of follow-up in the LEADLESS II study, investigators reported during a Hot Line presentation at the ESC congress 2015. The findings, published simultaneously in the New England Journal of Medicine, suggest the device is effective and safe, and can serve as an alternative to conventional transvenous pacemakers in patients with indications for permanent pacing, said principal investigator Vivek Reddy, MD. "Leadless cardiac pacemakers have the potential to ...

Antiarrhythmia drugs no impact on late AF recurrence

LONDON, UK - In patients with atrial fibrillation (AF) treated with radiofrequency catheter ablation, the addition of antiarrhythmic drugs (AADs) for 90 days after the procedure did not reduce arrhythmia recurrence rates at one year, according to results of the Efficacy of Antiarrhythmic Drugs Short-Term Use after Catheter Ablation for Atrial Fibrillation (EAST-AF) trial. Results of the study, presented as a Hot Line at ESC Congress 2015 The study did show a temporary benefit of AAD, but the effect disappeared as soon as medication was stopped, suggesting no benefit to ...


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