Formulary Watch |

Microalbuminuria associated with development and progression of coronary calcium

New Orleans-Subjects without symptoms of heart disease who have microalbuminuria are more likely to have coronary artery calcium and are more likely to have progression of coronary artery calcium over time than those without microalbuminuria, says Andrew P. DeFilippis, MD.

New stent entices progenitor cells, has low rate of thrombosis

New Orleans-A new type of stent coated with an antibody that binds circulating endothelial progenitor cells (EPCs) is associated with a low rate of stent thrombosis and requires only 1 month of dual antiplatelet therapy. Drug-eluting stents require at least 6 months of dual antiplatelet therapy to reduce the risk of stent thrombosis.

Studies assess decisions to seek care among patients with chest pain

New Orleans-Early reperfusion is crucial to maintaining cardiac myocytes in patients suffering a heart attack yet many patients refuse to seek medical care until hours after symptom onset, if at all.

ARB ineffective in HF with preserved ejection fraction

New Orleans-The use of irbesartan for heart failure with preserved ejection fraction (HFPEF) failed to improve outcomes compared to placebo, says Barry Massie, MD, investigator for the Irbesartan in Heart Failure with Preserved EF (I-PRESERVE) trial. These results are consistent with two previous trials (CHARM PRESERVED, PEP-CHF) that failed to show a positive effect with an angiotensin-receptor blocker (ARB) for these patients, explains Dr. Massie, University of California, San Francisco.

Exercise may be the prescription for heart failure

New Orleans-An aerobic exercise program modestly reduces death and hospitalization in patients with chronic heart failure, according to results from a study funded by the National Heart, Lung, and Blood Institute.

‘Vascular age’ of obese children similar to that of middle-aged men

New Orleans-Obese children, particularly those with elevated triglycerides, have a “vascular age” similar to those of 45-year-old white men, says Geetha Raghuveer, MD, University of Missouri-Kansas City School of Medicine. “I think this is a wake up call,” she says. “These children may need intensive management including pharmacological management of risk factors.

MR-proADM strong short-term prognosticator of mortality in heart failure

New Orleans-Mid-regional pro-adrenomedullin (MR-proADM) is a better biomarker for predicting short-term mortality in patients presenting with shortness of breath who are diagnosed with heart failure, according to results of the Biomarkers in the Assessment of Congestive Heart Failure (BACH) trial. Use of this marker was significantly more accurate than brain natriuretic peptide (BNP) or N-terminal prohormone BNP (NT-proBNP) in detecting which heart failure patients were likely to die.

Stratification beyond Framingham criteria is possible using coronary calcium score

Precisely defining intermediate cardiovascular-event risk using the Framingham Risk Score (FRS) is a challenge for clinicians. This is magnified when one considers that the number of patients who fall under the intermediate risk category outnumbers those considered low or high risk.

Electronic health records alone don’t improve care in heart failure

By itself, use of electronic health records (EHRs) does not improve the quality of care for heart failure, says Mary Norine Walsh, MD.

New anticoagulant is promising in treatment of ACS

An investigational oral anticoagulant-the factor Xa inhibitor rivaroxaban-performed well enough in a Phase II study in patients with acute coronary syndromes (ACS) to support a pivotal Phase III trial in patients with ACS, reports C. Michael Gibson, MD.

Anticoagulation can be maintained during invasive procedures

A patient on chronic warfarin is scheduled for a pacemaker implantation, so naturally you discontinue the warfarin several days prior to the procedure to reduce the chance of bleeding. That may not be necessary, says Peter H. Belott, MD, who contends that “we can keep the patient [at a] therapeutic INR [international normalized ratio] and will not incur any deleterious effects.”

Drug-eluting stents show increased safety in diabetics

Drug-eluting stents (DES) were associated with decreased rates of death, myocardial infarction (MI), and revascularization at 3 years of follow up in diabetic patients compared to bare-metal stents (BMS), according to results of a large observational study. “Our primary concern was to look at safety,” says Laura Mauri, MD (pictured) Brigham and Women’s Hospital and Harvard Medical School, Boston. “Considering the safety concerns surrounding DES recently, it was to our surprise that we found a significant difference in the opposite direction.

Lack of sleep associated with increased heart disease risk in elderly hypertensive patients

Getting less than 7.5 hours of sleep daily is a predictor of incident cardiovascular disease in elderly patients with hypertension, reports Kazuo Eguchi, MD, Jichi Medical University, Tochigi, Japan. “Reflecting changing lifestyles, people are sleeping less in modern societies,” he says.

Race affects hospitalization rates for AF in the United States

African Americans are half as likely to be hospitalized for atrial fibrillation (AF) as whites, according to Paul Tabereaux, MD, MPH, and colleagues.

Transition from pediatric to adult cardiac care should start early

The process of transitioning pediatric cardiology patients into adult cardiac care should begin in late childhood or early adolescence, says Arwa Saidi, MD (pictured) department of internal medicine and pediatric cardiology, University of Florida. The 2008 American College of Cardiology/American Heart Association guidelines recommend preparing young people for the transition beginning at age 12.

Human heart valve grown from stem cells offers hope for prenatal infants with defects

Researchers have successfully used umbilical cord stem cells to build a functional heart valve that may someday be perfected so that infants born with valve abnormalities could receive a new valve derived from their own stem cells, reports Philipp Schaefermeier, MD, University Hospital of Munich, Germany.

Resistant hypertension is multifactorial in etiology, requires combinations of drugs

A coalescence of factors usually conspires to cause resistant hypertension, which is defined as the failure to reach goal blood pressure in patients adhering to full doses of an appropriate three-drug antihypertensive treatment regimen, says Domenic Sica, MD.

No effect of B vitamins on vascular risk

The final nail has been driven into the homocysteine-lowering coffin as a means to prevent recurrent coronary events. The results from the homocysteine-lowering arm of the SEARCH (Study of the Effectiveness of Additional Reductions in Cholesterol and Homocysteine) trial found no benefit to folic acid combined with vitamin B12

Mixed results with low-dose aspirin as primary prevention of vascular events in type 2 diabetes

Low-dose aspirin did not result in a significant reduction in first atherosclerotic events in patients with type 2 diabetes, reports Hisao Ogawa, MD, PhD (pictured), lead investigator of the Japanese Primary Prevention of Atherosclerosis with Aspirin for Diabetes (JPAD) trial.

Vitamin E and C show no cardiovascular benefit; vitamin E associated with increased hemorrhagic stroke

Neither vitamin C nor vitamin E is effective for primary prevention of cardiovascular events in men, according to results of the Physician’s Health Study II, which evaluated the risk and benefits of both vitamins as well as a multivitamin in preventing cardiovascular disease and cancer. Results relating to cancer prevention will be presented November 17 at the Frontiers in Cancer Prevention Research conference.

JUPITER: Rosuvastatin reduces events in patients without hyperlipidemia but with elevated hsCRP

Rosuvastatin treatment of patients with better than average lipid profiles but with elevated high-sensitivity C-reactive protein (hsCRP) resulted in a 44% relative risk reduction in cardiovascular events and a 20% reduction in all-cause mortality, reports Paul Ridker, MD (pictured), lead investigator for the JUPITER Trial Study Group. JUPITER was an investigator-initiated trial sponsored by AstraZeneca.

Ischemia-specific serum biomarkers identified, may lead to blood test that will predict MI

Johns Hopkins researchers have identified five proteins that may serve as an early warning of impending myocardial infarction (MI) in patients presenting to emergency rooms with ischemia symptoms. A blood test to detect all, or a subset of these proteins, could be used by physicians and paramedics in the 12- to 24-hour window before ischemia causes tissue damage or death.

Look at recovery following an acute coronary syndrome as a continuum

Recovery following an acute coronary syndrome is a phase in a larger cardiovascular disease continuum, and prevention of downstream complications needs to begin immediately following the event, says Shirley M. Moore, PhD, RN.

FDA modernizes drug development through public-private partnerships

After spending 4 years laying a foundation that will streamline clinical testing and drug development, FDA leaders are poised to move the agency's Critical Path Initiative (CPI) from concept to implementation. Despite public concerns about drug safety, dangerous imports, and rising pharmaceutical costs, CPI has not fallen by the wayside.

Labeling updates and warnings through November 2008 for efalizumab (Raptiva)

Labeling updates and warnings through November 2008 for efalizumab (Raptiva)

Finasteride not associated with increased risk of hip fracture in men

A study published in the Journal of the American Medical Association reported that use of finasteride, a 5-alpha reductase inhibitor commonly used to treat benign prostatic hyperplasia (BPH), does not appear to be associated with an increased incidence of hip fractures in men; in fact, the agent appears to decrease the risk of hip fracture.

Beta-blockers are associated with reduced mortality in patients with COPD undergoing vascular surgery

An observational retrospective study published in the American Journal of Respiratory and Critical Care Medicine demonstrated that mortality is reduced when patients with chronic obstructive pulmonary disease (COPD) are treated with cardioselective beta-blockers before major vascular surgery.

Bivalirudin superior as adjunct antithrombotic therapy in patients with acute MI undergoing PCI

As a pharmacologic adjunct to stenting in patients with acute myocardial infarction (AMI), bivalirudin monotherapy outperformed the combination of a glycoprotein (GP) IIb/IIIa inhibitor and unfractionated heparin (UFH) over 1 year of follow-up, reported investigators at the 2008 Transcatheter Cardiovascular Therapeutics conference.

Alemtuzumab effective in treating early MS but associated with autoimmunity

A phase 2 study published in the New England Journal of Medicine reported that alemtuzumab was more effective than interferon beta-1a in treating early, relapsing-remitting multiple sclerosis (MS), but the agent was also associated with higher rates of autoimmunity, including cases of immune thrombocytopenic purpura (ITP).

Spotlight on pharmaceutical pipeline database products: A useful resource for PBMs and MCOs

To effectively gauge the potential clinical and economic impact of drug and biologic therapies that are pending FDA approval, the monitoring of pharmaceutical pipelines has become an essential function of pharmacy benefit management (PBM) companies and managed care organizations (MCOs); one source of pharmaceutical pipeline information is subscription-based pharmaceutical pipeline databases. Examples of some of these databases, along with the types of information provided and advantages and disadvantages of such products, are presented.