Another Attempt to ARRIVE at an Answer Using Aspirin for Primary Prevention

December 14, 2018

Daily low-dose aspirin has long been considered a “wonder drug” for its cardioprotective effects, particularly in patients with pre-existing cardiovascular and cerebrovascular disease; however, despite decades of research, the use of aspirin to prevent a first event is less certain. In 2014, the Food and Drug Administration (FDA) responded to a citizen petition requesting the labeled indications for low dose aspirin be updated to include primary prevention. The FDA concluded that the evidence “fail[ed] to establish that aspirin reduces the risk of primary myocardial infarction (MI) in patients with a coronary heart disease (CHD) risk of 10% or more for over 10 years.” The Asprin to Reduce Risk of Initial Vascular Events (ARRIVE) study is intended to address this gap in our knowledge.

Guest Authors:  Amy St. Amand, PharmD, BCPS and Christine Borowy, PharmD, BCPS

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Does a “One-Size-Fits-All” Aspirin Dosing Approach Still Hold WEIGHT?

December 7, 2018

Personalized medicine is at the forefront of health care today, focusing on how best to tailor the treatment approach to each person. But should we be thinking about personalizing the approach for prevention as well?  The one-dose-fits-all approach has been used in nearly all aspirin studies.  What is poorly understood is the influence of body weight.  Perhaps the reason why aspirin has resulted in only modest benefits in clinical trials might be related to under (and over) dosing based on patient weight.

Podcast Case:  Weight-based Dosing of Aspirin

Guest Author:  Marina Maes, PharmD, BCPS

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Where is the COMPASS Taking Us? Rivaroxaban, Aspirin, or Both for Stable CVD ?

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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Are Statins ALL THAT for Primary Prevention in Older Adults? A Second Look at ALLHAT-LLT

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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All for One and FOURIER for All!

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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Peeling Back the Layers on Coated Aspirin

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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Antithrombotic Therapy Following Stent Placement in Patients with A-Fib: Should DOACs Be Preferred?

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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HIP-HIP-HOPE-3! Expanded role for statin therapy for primary prevention

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?

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TEXT ME — Text Messaging to Promote Behavior Change

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.
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PCSK9 Inhibitors: Blockbusters or Bust?

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 worth it?

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