Download Innovative Ideen 2009

Was ist neu in der Kardiologie?
Innovative Ideen 2009
Einleitung
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Comparison of Weight-Loss Diets with Different
Compositions of Fat, Protein, and Carbohydrates
Fat
1.
2.
3.
4.
20
20
40
40
Protein
15
25
15
25
Carbohydrates (%)
65
55
45
35
n = 811 overweight adults, BMI 33, individual instructional sessions
Conclusion: Reduced-calorie diets result in clinically meaningful
weight loss regardless of which macronutrients they emphasize
Sacks et al., NEJM 360 (2009) 859
Metabolismus von Clopidogrel
Simon et al., NEJM
2009;360:363-75
The PPI-clopidogrel interaction has been the subject of much study and
debate in a relatively short period of time. There is no doubt that a
pharmacodynamic interaction exists; at issue is its clinical relevance. For
the majority of patients, the interaction likely poses no serious threat.
However, for an unidentifiable subset of patients carrying the wrong mix
of drugs, doses, comorbidities, and genetics, a clinically important drug
interaction remains a real possibility.
Circulation. 2009;120:2310-2312
Overall noncompliance rate was 22% (n = 138), while such risks were
significantly higher in stroke survivors (n = 79, or 38%)
Am Heart J 2009;158:925-32
Was tun?
1. sicherstellen, dass der Pat. seine
Aggregationshemmer auch nimmt
2. Strenge Indikationsstellung für PPI
3. Eventuell H2-Rezeptorantagonisten
4. Prasugrel zeigt die Interaktion nicht
Intima-Media Thickness of the Carotid Artery
during 24 and 14 Months of Therapy
ENHANCE-Trial
ARBITER-6 HALTS
Kastelein J et al. N Engl J Med 2008;358:1431-1443
Taylor A et al. N Engl J Med 2009;361:2113-2122
Incident Cancer (Safety Population)
Rossebo A et al. N Engl J Med 2008;359:1343-1356
Ezetimibe and Cancer — An Uncertain Association
„When the cancer mortality data from the SEAS, SHARP,
and IMPROVE-IT trials were combined, there was an
increase in cancer mortality risk in the combined ezetimibe
groups (134 deaths, as compared with 92 deaths in controls;
risk ratio, 1.45; 95% CI, 1.02 to 2.05; uncorrected P=0.007).
Because this P value was obtained from one of several datadriven analyses rather than from a test of a single
prespecified hypothesis, it should be interpreted cautiously.
The Oxford researchers believe that this finding is due
entirely to the play of chance rather than to a true increase in
cancer mortality.“
Drazen et al., NEJM 2008;359:1398
Ezetimibe
Ezetimibe
“During the trial, investigators reported an increased number of
cancers and cancer-related deaths in patients using Vytorin
compared to placebo. Cancer was reported in 105 patients
(11.1%) in the Vytorin group and in 70 patients (7.5%) in the
placebo group. The number of deaths from cancer was also
higher in the Vytorin group, with 39 deaths compared to 23
deaths in the placebo group.
A large body of long-term clinical data indicates that simvastatin
is not associated with an increased risk of cancer, but longterm clinical data on ezetimibe is insufficient to definitely rule
out a cancer risk at this time.”
FDA Statement 22.12.2009
16.12.2009
JUPITER – Trial N Engl J Med 2008;359:2195
Rosuvastatin and Cardiovascular Events
in Patients Undergoing Hemodialysis
Fellström et al., AURORA – Study NEJM 360 (2009) 1395
Conclusions With the exception of the extra protective effect of β blockers given
shortly after a myocardial infarction and the minor additional effect of calcium
channel blockers in preventing stroke, all the classes of blood pressure lowering
drugs have a similar effect in reducing CHD events and stroke for a given
reduction in blood pressure so excluding material pleiotropic effects.
The proportional reduction in cardiovascular disease events was the same or
similar regardless of pretreatment blood pressure and the presence or absence of
existing cardiovascular disease. Guidelines on the use of blood pressure lowering
drugs can be simplified so that drugs are offered to people with all levels of blood
pressure.
Die Senkung des Blutdruckes ist
die Hauptsache !
Law et al., BMJ 2009,
Das Vorderwandaneurysma
outcome of patients randomised to CABG with
or without surgical ventricular reconstruction
Ergebnis ?????
Die optimale medikamentöse
Therapie ist nicht schlecht!
Nienaber et al., Circulation 2009;120:2519-2528
77 years, NYHA III, EF 30%, Crea 1,33, BNP ~4000
Conclusion: Heart failure therapy guided by N-terminal BNP did not improve
overall clinical outcomes or quality of life compared with symptom-guided
treatment. Pfisterer et al., JAMA. 2009;301:383-392
Defibrillator Implantation Early after
Myocardial Infarction
Steinbeck et al., NEJM 361(2009)1427
n = 898 von 62944 Pat., 5-31 Tage nach MI, EF <40%, VT >150/min
Ihnen Allen ein gesundes neues Jahr!
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The Obesity Paradox, Weight Loss,
and Coronary Disease
Lavie et al., The American Journal of Medicine (2009) 122, 1106-1114
RE-LY - Study