In brief

Br J Cardiol 2018;25:53 Leave a comment
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Osteoporosis drug may have CV benefits

The osteoporosis drug alendronate was linked with a reduced risk of cardiovascular (CV) death, heart attack, and stroke according to a study in patients with hip fractures. The association was seen for up to 10 years.








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In the study, patients newly diagnosed with hip fracture from 2005 –2013 were followed until late 2016. Among 34,991 patients, 4602 (13%) received osteoporosis treatment during follow-up.

Alendronate was associated with 67% and 45% lower risks of one-year CV death and heart attack, respectively. It was associated with an 18% reduced risk of stroke within five years and a 17% reduced risk of stroke within 10 years. Protective effects were not evident for other classes of osteoporosis treatments.

“There is a world-wide crisis in the treatment of osteoporosis, due to patients’ awareness of the extremely rare side effects,” said senior author Dr Ching-Lung Cheung, of the University of Hong Kong. “Our findings show that alendronate is potentially cardioprotective in hip fracture patients.”

The study was published in the Journal of Bone and Mineral Research (https://onlinelibrary.wiley.com/doi/10.1002/jbmr.3448).

Much anticoagulation is ‘out of range’

‘Out of range’, an audit of anticoagulation management in secondary care in England, has been published by the charity, Anticoagulation UK. Gathering information obtained through Freedom of Information (FOI) Act requests to 149 secondary care NHS Trusts in England, the audit contains the findings and analysis based on 91 Trusts’ who responded either fully or partially to the FOI request made in 2017.

Key findings included:

  • Up to 37,878 warfarin patients have been identified as having suboptimal anticoagulation control leaving them at an increased risk of stroke or bleeding
  • 29,305 warfarin patients are recorded as spending less than 65% of time in therapeutic range (TTR), putting them at an increased risk of stroke
  • 62% of responding Trusts have no written clinical protocols in place for reassessing anticoagulation in atrial fibrillation patients who have poor anticoagulation control.

The report is not intended to directly compare anticoagulation services but to increase understanding about the policies and processes used by providers of anticoagulation services in secondary care, and to identify what more can be done to ensure all patients with atrial fibrillation receive safe and effective treatment and support after being diagnosed.

The audit, which was financially supported by Bayer UK, can be accessed at http://www.anticoagulationeurope.org/

Enoxaparin subtherapeutic in obese patients?

The low molecular weight heparin enoxaparin is widely used for prophylaxis and treatment of venous thromboembolism (VTE). Its pharmacokinetic properties are predictable and well characterised in healthy non-obese individuals, but In obese individuals, these parameters may be affected.

A study has now evaluated the degree of anticoagulation achieved with different enoxaparin dosing regimens used in 419 adult obese or morbidly obese patients in a hospital setting in Jordan. The majority of patients were found to have nontherapeutic anti-Xa levels, alarmingly putting patients at risk of VTE. The authors recommend individualised enoxaparin dosing regimens and dosing adjustment based on anti-Xa levels in order to achieve therapeutic anti-Xa levels, to optimise efficacy and reduce side effects.

The study was published online on May 19th 2018 in Clinical Pharmacology: Advances and Applications (doi: 10.2147/CPAA.S161599).

EC extends evolocumab licence

The European Commission (EC) has granted a licence update for REPATHA evolocumab (Repatha®,Amgen) a PCSK9 inhibitor for adults with established atherosclerotic cardiovascular disease (myocardial infarction, stroke or peripheral arterial disease) to reduce cardiovascular risk by lowering low-density lipoprotein cholesterol) levels as an adjunct to correction of other risk factors.

This licence update is based largely on the FOURIER (Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease) trial outcomes data. Carried out in 27,564-patients, this demonstrated that adding evolocumab to optimised statin therapy resulted in a statistically significant 15 % reduction (p<0.001) in the risk of the primary composite end point, which included hospitalisation for unstable angina, coronary revascularisation, heart attack, stroke or cardiovascular death. The study also found a statistically significant 20 % (p<0.001) reduction in major adverse cardiovascular events represented in the key secondary composite end point.

Get your cardiology life in order!

A new website, The Cardiology Calendar (www.cardiologycalendar.co.uk) aims to make it easier to find and plan continuing professional development/training. It collates cardiology conferences, events and courses from across the UK and beyond in one place to allow quick and easy searching. It is curated by Sarah Hudson, a Severn cardiology registrar with a passion for health informatics and process optimisation.

Any event relevant to UK cardiologists can be included free of charge.

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