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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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Approximately one in three patients with diabetes in the United States have chronic kidney disease (CKD).  The Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes (EMPA-REG OUTCOME) trial, published in 2015, demonstrated a reduction in cardiovascular and all-cause mortality in patients treated with empagliflozin. More recent data from the EMPA-REG OUTCOME trial suggests that empagliflozin may also confer significant renal protection. 

According to the current (2016) ADA guidelines, no agent is “the preferred” second line therapy after metformin monotherapy — instead the benefits, risks, cost, and convenience of each option should be considered and treatment should be individualized.  The liraglutide and cardiovascular outcomes in type 2 diabetes (LEADER) trial, which assessed the long-term cardiovascular effects of liraglutide, a GLP-1 receptor agonist, comes at an interesting time shortly after the publication of the empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes (EMPA-REG OUTCOME) trial.  Both studies found a cardiovascular benefit. How, then, will the results of these trials affect the algorithm for type 2 diabetes management and more importantly, clinical practice?

The Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes (EMPA-REG OUTCOME) study sought to determine the effects of empagliflozin on cardiovascular morbidity and mortality in patients with type 2 diabetes at high risk for CVD. Does the evidence from the EMPA-REG OUTCOME study coupled with the other benefits of SGLT2 inhibitors (reduction in weight and blood pressure, mild adverse effects) make empagliflozin the preferred second-line agent from the treatment of type 2 diabetes? 

Many clinicians are questioning the role pharmacists play in anticoagulation therapy management as direct oral anticoagulants (DOACs) increasingly replace warfarin for a variety of indications. A recent study examined medication adherence and therapy management practices at Veterans Health Administration (VHA) patient care sites. Although this study does not have all the answers, it does reveal the importance of patient selection and ongoing patient monitoring – potentially key roles for pharmacists.

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 worth it?

How well do cardiovascular disease risk calculators really perform?  Do they over or underestimate risk?  Should we rely on them to make treatment decisions?

The ORBIT-AF study raises questions about anticoagulation therapy bridging practices.  Do the risks outweigh the benefits?