Tag Archives: aspirin

ACCORD/INVEST: do not aim for normal blood pressure in diabetes patients with CAD The results of two trials comparing intensive versus more conventional blood pressure lowering in patients with diabetes at high cardiovascular risk have suggested that intensive treatment is not necessary and may be harmful in this population. In the ACCORD BP (Action to Control Cardiovascular Risk in Diabetes – Blood Pressure) trial, while intensive blood pressure treatment did reduce the risk of stroke, it failed to reduce the overall risk of cardiovascular events in patients and was associated with an increase in adverse events due to antihypertensive ther

Identifying targets in the thrombosis pathway Figure 1. Central role of platelets and interaction with coagulation in the genesis of thrombosis (1) Figure 1 summarises the central role of platelets in the genesis of thrombosis.1 The platelet is initially activated in response to shear stress, events such as percutaneous coronary intervention (PCI) or plaque rupture, and the release of local agonists and exposure of the subendothelial components to flowing blood. Tissue factor ‘lights the fire’ by producing minute quantities of thrombin which then amplify the process. Binding of platelets to collagen and von Willebrand

Mechanisms Figure 1. Platelet-fibrin thrombus in a coronary artery of a patient with acute coronary syndrome The mechanism of action of aspirin differs from that of other antiplatelet agents. Aspirin irreversibly acetylates platelet cyclooxygenase-1 (COX-1), completely inhibiting COX-1- dependent synthesis of thromboxane A2 (TXA2), a substance which is a potent vasoconstrictor and promoter of platelet aggregation. Whether low-dose aspirin also exerts a significant anti-inflammatory effect is uncertain: a retrospective sub-analysis suggested that it was more effective in primary prevention in individuals who had high levels of C-reacti

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Polypill could cut cardiovascular risk by half The strategy of giving a ‘polypill’, consisting of three antihypertensive drugs, a statin, and aspirin, to vast amounts of people who have not yet developed heart disease, could cut cardiovascular risk by half, according to the first major clinical trial of such an approach. The Indian Polycap Study (TIPS), presented at the ACC meeting by Dr Salim Yusuf (McMaster University, Hamilton, Ontario, Canada), included 2,053 patients aged 45–80 years without cardiovascular disease but with one risk factor (type 2 diabetes, high blood pressure, smoker within the past five years, increased waist-to-

Introduction Over the past five years, clopidogrel, often in combination with aspirin, has become standard therapy for patients with a number of cardiovascular disorders. Dual therapy with aspirin and clopidogrel is particularly important in the management of ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI) and following intra-coronary stent placement. Evidence from clinical trials has demonstrated that the benefits of dual therapy are greatest where aspirin and clopidogrel are initiated early following an acute event or prior to a percutaneous coronary intervention (PCI). The optimal duration of clo

New data on intensive glucose lowering in type 2 diabetes The results of three large trials investigating the clinical effects of intensive glucose lowering in patients with type II diabetes were presented at the recent American Diabetes Association meeting in San Francisco, USA, and have shown somewhat conflicting results. The ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial was stopped earlier this year because of an increased mortality in the intensive glucose lowering group. The two other trials – ADVANCE (Action in Diabetes and Vascular Disease – Preterax and Diamicron MR Controlled Evaluation) and VADT (Veteran’s A

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