Non-inferior cardiovascular outcome for DPP-4 inhibitor Results from the CAROLINA cardiovascular outcome study show that the DPP-4 inhibitor linagliptin (Trajenta®, Boehringer Ingelheim and Eli Lilly) is non-inferior to the sulphonylurea glimepiride in the treatment of adults with type 2 diabetes and cardiovascular risk. The study met its primary end point – defined as the non-inferiority … Continue reading In brief
Non-inferior cardiovascular outcome for DPP-4 inhibitor
Results from the CAROLINA cardiovascular outcome study show that the DPP-4 inhibitor linagliptin (Trajenta®, Boehringer Ingelheim and Eli Lilly) is non-inferior to the sulphonylurea glimepiride in the treatment of adults with type 2 diabetes and cardiovascular risk.
The study met its primary end point – defined as the non-inferiority of linagliptin versus glimepiride in time to first occurrence of cardiovascular death, non-fatal myocardial infarction or non-fatal stroke. The study, carried out over six years in 6,033 adults with type 2 diabetes and increased cardiovascular risk or established cardiovascular disease, add to the evidence base for the long-term safety of linagliptin. The full results will be presented at the American Diabetes Association 79th Scientific Sessions in June 2019 in San Francisco, USA.
Statins reduce major cardiovascular events irrespective of age
A new meta-analysis summarising evidence from 28 randomised controlled trials, which included older patients, has shown that statins reduce major vascular events irrespective of age.
There has been uncertainty about the efficacy and safety of statins in older patients, particularly in those over 75 years, often leading to older patients having statins discontinued. The meta-analysis which included 186,854 patients, of whom 14,483 were over 75 years, showed that the reduction in major vascular events – 21% per 1 mmol/L reduction in low-density lipoprotein (LDL) cholesterol overall – was similar and significant in all age groups. For major coronary events, the overall reduction was 24% per 1 mmol/L reduction in LDL, but this decreased slightly with age leading the investigators to conclude that there was less direct evidence of benefit in older patients who did not already have evidence of occlusive vascular disease.
The meta-analysis – carried out by the Cholesterol Treatment Trailists’ Collaboration and published in The Lancet (doi: 10.1016/S0140-6736(18)31942-1) – also showed no increased risk of non-vascular mortality or cancer in any age group.
Mixed benefit of exercise rehab in heart failure?
Compared to no exercise, cardiac rehabilitation appears to have no impact on mortality in the short term (less than 12 months’ follow-up) but it probably reduces the risk of all-cause hospital admissions and may reduce heart failure-specific hospital admissions in the short term (up to 12 months). It may also confer a clinically important improvement in health-related quality of life.
These are the findings of a new updated Cochrane systematic review (doi: 10.1002/14651858.CD003331.pub5), which looked at the effects of exercise-based cardiac rehabilitation on mortality, hospital admission, and health-related quality of life of people with heart failure. The review includes 44 trials (5783 participants with heart failure) with a median of six months’ follow-up. The reviewers highlighted, however, that there were differences in the quality of evidence in the various studies reviewed, making comparisons difficult.
New imaging reduces examination times by 20%
A new ultrasound imaging technology for vascular assessment is able to reduce exam time by 20%, according to Philips, the manufacturer. The new technology – The EPIQ Elite Ultrasound System – enables clinicians to acquire two planes simultaneously to improve accuracy of data collection. Philips also says the system has enhanced 3D vascular images allowing clinicians to easily see directly into a vessel to evaluate plaque spatial location and composition, as well as view 3D flow data to quickly assess stenotic conditions.
“There is now a case to be made for ultrasound solutions to be used as a potential alternative to other imaging modalities in the current standard of care,” says Dr Muhammad Hasan (Miami Cardiac & Vascular Institute, Baptist Hospital of Miami, USA).
Study shows ultrasound reduces cardiovascular risk
Sharing visulisation of personalised scans showing the extent of atherosclerosis to patients and their doctors results in a decreased risk of cardiovascular disease one year later, compared to people receiving usual information about their risk. This has been shown in a randomised trial carried out by researchers at Umea University on over 3,500 people in Västerbotten county, Sweden. The rearchers believe the personalised images may potentially prompt behaviour change. The study was published in The Lancet (doi: 10.1016/S0140-6736(18)32818-6).
Giving birth associated with higher risk of heart disease
Giving birth is associated with a 14% higher risk of heart disease and stroke compared to having no children, reports a recent study published in the European Journal of Preventive Cardiology (doi: 10.1177/2047487318818265).
“The mechanisms underlying the associations we observed are complex,” says study author Dr Dongming Wang (School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China). “Pregnancy may lead to inflammation in the body, and the accumulation of fat around the abdomen, in the blood, and in the arteries. These changes could have permanent effects on the cardiovascular system, leading to a higher risk of heart and stroke later in life.”
The authors compiled data from around the world to conduct a meta-analysis. Ten studies were included involving 3,089,929 women, of whom 150,512 developed heart disease or stroke during an average follow-up of 6 to 52 years.
The overall analysis identified a significant association between ever giving birth and the risk of cardiovascular disease. Women who had given birth had a 14% higher chance of developing heart disease or stroke than those who had never given birth.
Other news from BJC Issue 1, 2019:
British Geriatrics Society Cardiovascular Section partners with the BJC
London begins NHS video consultations in cardiology
New anticoagulant drug class in development
Guidelines for the safe practice of total intravenous anaesthesia
Cytokine removal in sepsis and endocarditis