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Br J Cardiol 2019;26:52 Leave a comment
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This new high-sensitivity troponin 1 assay (Vitros®, Ortho, pictured below) can deliver first troponin results in 15 minutes and can also identify low-risk patients who may be safely discharged. It is hoped it will help reduce the cost of care and alleviate the burden on hospital resources.

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Stat tests loaded into the VITROS XT 7600
Stat tests loaded into the VITROS XT 7600

Moderate alcohol consumption does not protect against stroke

Blood pressure and stroke risk increase steadily with increasing alcohol intake, and previous claims that one to two alcoholic drinks a day might protect against stroke are not borne out by new evidence from a genetic study involving 160,000 adults.

Studies of East Asian genes, where two common genetic variants strongly affect what people choose to drink, show that alcohol itself directly increases blood pressure and the chances of having a stroke, according to a new study published in The Lancet (doi: 10.1016/S0140-6736(18)31772-0).

Researchers from Oxford University, Peking University, and the Chinese Academy of Medical Sciences led a large collaborative study of over 500,000 men and women in China who were asked about their alcohol intake and followed for 10 years. In over 160,000 of these adults the researchers measured two genetic variants (rs671 and rs1229984) that substantially reduce alcohol intake.

Among men, these genetic variants caused a 50-fold difference in average alcohol intake, from near zero to about four units (drinks) per day. The genetic variants that decreased alcohol intake also decreased blood pressure and stroke risk.

From this evidence, the authors conclude that alcohol increases the risk of having a stroke by about one-third (35%) for every four additional drinks per day (280 g of alcohol a week), with no protective effects of light or moderate drinking.

CREDENCE: renal failure reduced in diabetes and CKD patients

Kidney disease develops in approximately 40% of people with type 2 diabetes. A new study has shown that the SGLT2 inhibitor, canaglifozin (Invokana®, Napp) reduces the risk of renal and cardiovascular (CV) events when added to the standard of care in subjects with type 2 diabetes.

The primary end point (the risk of composite of doubling of serum creatinine, end-stage kidney disease (ESKD) and renal or CV death) was reduced by 30% with canagliflozin compared to placebo in the CREDENCE (Canagliflozin and Renal Endpoints in Diabetes with Established Nephropathy Clinical Evaluation) study.

Several secondary end points were also achieved including a reduction in the risk of the secondary renal end point composite of doubling of serum creatinine, ESKD, and renal death by 34%; a reduction in the the risk of major adverse cardiac events (MACE) (composite of non-fatal myocardial infarction, non-fatal stroke and CV death) by 20%; the risk of CV death and hospitalisation for heart failure by 31%; and the risk of hospitalisation for heart failure alone by 39%.

Canaglifozin also showed an acceptable safety profile consistent with previous studies. The incidence rates of adverse events and serious adverse events were numerically lower for patients treated with canagliflozin compared to placebo, and there was no difference in the number of lower limb amputations or adjudicated fractures.

The study was published in the New England Journal of Medicine (doi: 10.1056/NEJMoa1811744).

Call for more cardio-oncology specialists

The number of cardiologists trained in cardio-oncology, the treatment of cardiovascular disease in patients treated for cancer, does not currently meet the needs of this rapidly growing population, according to a review paper in the Journal of the American College of Cardiology (doi: 10.1016/j.jacc.2019.02.041)

Advances in early detection and treatment of cancer have led to a rise in the number of cancer survivors. It is estimated that by 2026 there will be 20 million cancer survivors in the US and half will be 70 years old or older. The combination of an ageing population of cancer survivors with co-morbid cardiovascular disease and growing list of cancer treatments that effect the cardiovascular system have led to the need for cardiovascular specialists with an in-depth understanding of the intersection of these diseases.

“Inclusion of cardio-oncology as a component of general cardiology training programs is the first step at establishing a workforce capable of recognising and managing the complex cardiovascular burdens associated with cancer in every community,” said study author Dr Bonnie Ky (Associate Professor of Medicine and Epidemiology at the Perelman School of Medicine at the University of Pennsylvania, US). 

In the UK, cancer survival has doubled over the last 40 years.

Statins found to be safe in rheumatoid arthritis

Patients with rheumatoid arthritis have an approximately 50% higher risk of experiencing cardiovascular events compared with the general population but it has been unclear whether statins are safe for people with inflammatory conditions, such as rheumatoid arthritis.

Results from a large clinical trial indicate that patients with rheumatoid arthritis are likely to experience the same level of cardiovascular benefits from statins as other individuals, without additional risks.

TRACE RA (Trial of Atorvastatin for the Primary Prevention of Cardiovascular Events in Patients with Rheumatoid Arthritis) compared the statin atorvastatin 40 mg with placebo in 3,002 patients with rheumatoid arthritis who were over aged 50 years or had rheumatoid arthritis for more than 10 years, without clinical atherosclerosis, diabetes, or myopathy.

During a median follow-up of 2.5 years, 1.6% of patients who received atorvastatin and 2.4% of patients receiving placebo experienced cardiovascular death, heart attack, stroke, transient ischaemic attack, or any arterial revascularisation, a 40% lower risk of cardiovascular events for patients taking atorvastatin, although the difference was not statistically significant since the overall rate of events was low.

Patients taking atorvastatin, however, had significantly lower low-density lipoprotein (LDL) cholesterol as well as significantly lower levels of the inflammatory marker C-reactive protein, with patients taking placebo. Adverse events in the atorvastatin and placebo groups were similar.

The study was published in Arthritis & Rheumatology (doi: 10.1002/art.40892).

AF now the leading cause of cardiovascular hospitalisation

Research in Australia has shown that hospitalisations for atrial fibrillation (AF) have now overtaken those for myocardial infarction (MI) and heart failure.

Researchers at the University of Adelaide Centre for Heart Rhythm Disorders analysed data from the Australian Institute of Health and Welfare between 1993–2013. In 1993, heart failure was the most common cause of hospitalisation followed by MI and AF. In 2013, hospitalisations for AF had increased to 61,000 from 15,000 in 1993 (295% increase) compared to MI (73% increase) and heart failure (39% increase).

The study is published The Lead (http://theleadsouthaustralia.com.au/?p=8338).

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