December 8, 2017
Since the introduction of direct oral anticoagulants (DOACs) less than a decade ago, use of this class has expanded beyond the prevention and treatment of venous thromboembolism and stroke prevention in the setting of atrial fibrillation. The potential role of DOACs in the secondary prevention of coronary artery disease (CAD) has been of considerable interest. In the setting of CAD, warfarin has resulted in significant more major bleeding when given either alone or in combination with antiplatelet agents when compared to aspirin alone. Therefore, clinicians have been reluctant to embrace the combination of an anticoagulant plus an antiplatelet agent. However, could DOACs have a role in stable CAD? The COMPASS trial aimed to find an answer.
Guest Authors: Candyce Bryant, Pharm.D., Joy Hoffman, Pharm.D., and M. Shawn McFarland, Pharm.D.
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August 25, 2017
Statins reduce atherosclerotic cardiovascular disease (ASCVD) risk. However, the utility of statin therapy in older adults — particularly in those age 75 years and older — remains controversial. The need for additional evidence to guide clinical practice is underscored by the fact that one-in-three older Americans report taking a statin. Given the paucity of prospective data, a post-hoc analysis of the ALLHAT-LLT (Antihypertensive and Lipid Lowering treatment to prevent Heart Attack Trial - Lipid Lowering Trial) was recently published. Does this new analysis really help inform the decision?
Guest Author: Leo Buckley, Pharm.D.
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July 27, 2017
Although statins have a proven benefit and are widely used, ASCVD continues to be the leading cause of death in the US. In 2015, two proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, alirocumab (Praluent®) and evolocumab (Repatha®), were approved to treat elevated cholesterol when added to maximally-tolerated statin therapy in patients with familial hypercholesterolemia or history of ASCVD. However, the lack of long-term CV outcomes data, high cost, and uncertainty regarding place in therapy have limited their wide-spread use. The recently published FOURIER Study provides compelling new evidence.
Guest Author: Kelly Starman, Pharm.D., BCPS
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April 14, 2017
More than 15 million Americans have coronary heart disease and most should be taking aspirin daily. Given aspirin’s ubiquity in cardiovascular medicine and patients’ pill boxes, it is shocking that there are still so many unanswered questions about aspirin use. Which dose and dosage forms should be prescribed? How common is aspirin resistance? What is the relationship between platelet inhibition and clinical outcomes?
Guest Author: Daniela Valencia, Pharm.D.
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March 24, 2017
Many patients with atrial fibrillation (AF) received triple antithrombotic therapy after undergoing a percutaneous coronary intervention (PCI) and receiving cardiac stent. Triple therapy consists of warfarin plus dual antiplatelet therapy (DAPT) with a P2Y12 inhibitor and low-dose aspirin. But is triple therapy the best approach? This practice, while widely employed, is not entirely evidence-based. Moreover, the effectiveness and safety of the direct oral anticoagulants (DOACs) in this patient population is unknown.
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September 15, 2016
The HOPE-3 trial sought to determine if blood pressure (BP) and cholesterol-lowering therapies are effective and safe as primary prevention strategies in intermediate risk patients. The American College of Cardiology and American Heart Association (ACC/AHA) guidelines support a risk-based approach to statin use but in intermediate risk patients the tradeoffs between benefit and risk were deemed “less clear.” Do the results of HOPE-3 trial provide enough evidence to support routinely treating intermediate risk patients?
February 26, 2016
With over 75% of people using mobile phones worldwide, text messaging might be a simple, cost-effective platform to encourage lifestyle changes. Several healthcare-related applications and mobile phone text messaging systems have already been designed; yet, very few have undergone rigorous testing to confirm clinical benefit. The investigators of the Tobacco, Exercise, and Diet Messages (TEXT ME) trial designed a text message-based intervention to encourage lifestyle modifications and evaluated its impact on cardiovascular risk in patients with established CHD. The TEXT ME study provides robust findings to support a simple, inexpensive intervention to modify cardiovascular risk … at least over the short term.
September 5, 2015
Two new mAbs, alirocumab and
evolocumab, have been approved to treat elevated cholesterol when
added to maximally tolerated statin therapy in patients with familial
hypercholesterolemia or history of atherosclerotic cardiovascular disease
(ASCVD). This new class of drugs, the proprotein convertase subtilisin/kexin
type 9 (PCSK9) inhibitors, is considered to be the biggest breakthrough in
cholesterol treatment since statins were approved 3 decades ago. But are they
July 28, 2015
How well do cardiovascular disease risk calculators really perform? Do they over or underestimate risk? Should we rely on them to make treatment decisions?
June 21, 2015
Our guests - Dr. Cortney Mospan and Dr. Augustus (Rob) Hough - critically examine the results of the DAPT and PEGASUS-TIMI 54 studies and explain how the results should be applied in practice.