EPCCS Primary Care Cardiovascular Literature

Room for improvement in smoking cessation treatment in GP practices

Selected literature
Mallaina P, Lionis C, Rol H, et al.
CV-ASPIRE confirms that smoking is a significant predictor of long-term CV events thus underscores the importance of addressing this modifiable risk factor
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The benefits of regular exercise training are clear but exploited too little

Selected literature
Schuler G, Adams V, Goto Y.
We summarise the molecular consequences of exercise and strategies to increase compliance to frequent exercise.
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Extent of second-hand tobacco smoke exposure predicts coronary artery calcification

Selected literature
JACC, March 2013. Exposure to second-hand tobacco smoke is a risk factor for coronary artery calcification, at least as strong as other well-established risk factors. Read more...

Dabigatran and bleeding risk – new FDA analysis

Selected Literature
NEJM, March 2013. Reassuring results on the rates of gastrointestinal and intracranial bleeds with dabigatran from a new analysis of an FDA database. Read more...

CV outcomes in hypertensive patients are affected by BMI

Selected literature
Lancet, february 2013. Calcium-channel blocker-based therapy gives more protection to non-obese patients than does diuretic-based therapy, whereas both regimes are effective in obese patients. Read more...

Support for prescribing statins as primary prevention

Selected literature
Eur J Prev Cardiol. 2013 Statins reduce all-cause mortality and major coronary events both in patients with cardiovascular disease and in high-risk individuals without disease. Read more...

Mediterranean diet diminishes cardiovascular risk

Selected Literature
NEJM Feb 2013, Suggested protective effect of Mediterranean diet on cardiovascular disease now confirmed in randomised trial. Read more...

Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing PCI

Selected Literature
Dewilde WJ et al. for the WOEST study investigators
Lancet. Feb 2013. Omitting aspirin from antiplatelet regimen reduces the incidence of bleeding, without compromising safety in patients receiving oral anticoagulants undergoing PCI Read more...

Novel use for new anticoagulant dabigatran

Selected Literature
Schulman S, Kearon O, Kakkar AK, et al
NEJM, Feb 2013. New information about the risks and benefits of extended prophylaxis with dabigatran in patients who have had venous thromboembolism (VTE) Read more...

Apixaban for prevention of venous thromboembolism

Selected Literature
NEJM, Feb 2013. New oral factor Xa inhibitor studied for prevention of recurrent venous thromboembolism
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ARISTOTLE: Consistent benefit of apixaban across range of patient risk scores

Lopes RD, Al-Khatib SM, Wallentin L, et al. Lancet. 2012 Oct 1
According to an analysis of the ARISTOTLE trial in patients with nonvalvular atrial fibrillation, apixaban was associated with consistent reductions in stroke or systemic embolism and mortality, compared with warfarin, irrespective of the patient’s risk for stroke or bleeding. Read more...

Global call for action to reduce cardiovascular risk

Smith SC Jr, Collins A, Ferrari R, et al. EHJ. 2012 Sep 17.
International cardiology group calls for aggressive public health goals. The Global Cardiovascular Disease Taskforce have proposed a set of aggressive measures to help achieve the goal to reduce premature mortality from non-communicable diseases by 25% by the year 2025. Read more...

New ESC guideline: CVD prevention in clinical practice

EPCCS Guidelines
The European guidelines on cardiovascular disease prevention in clinical practice (version 2012) have been developed by the the Fifth Join Task Force of the European Society of Cardiology along with other societies with a focus on Cardiovascular Disease Prevention in Clinical Practice ... Read more...

New oral anticoagulants for preventing venous thromboembolism

Selected literature
Gómez-Outes A et al. BMJ. 2012;344:e3675. doi: 10.1136/bmj.e3675.
In this study, data from randomised controlled trials of the new oral anticoagulants for prophylaxis against venous thromboembolism in patients undergoing total hip or knee replacement were systematically reviewed and meta-analysed.
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Online treatment beneficial to heart disease patients

Selected Literature
Vernooij J W P et al. BMJ 2012;344:bmj.e3750
Patients with vascular disease are at higher risk of suffering a further event or death. Treatment of vascular risk factors by nurse practitioners is proven to be very effective in reducing this risk. This study looks at one year effect in a relatively large group of patients. The primary end point of the study was the relative change in Framingham risk score (FRS) after one year. Read more...

Heart rate as risk factor in patients with chronic heart failure

Selected literature
Cullington D, Goode KM, Clark AL, Cleland JG. Eur J Heart Fail. 2012 May 22.
Heart rate reduction is important to decrease the risk of cardiovascular events and improve prognosis. This study evaluated whether beta-blocker dose or heart rate was more strongly associated with mortality in patients with stable chronic heart failure. Read more...

Residual risk in secondary prevention of CVD

Selected Literature
Mora S, Enger NK, et al., Circulation. 2012;125(16):1979-87
This analysis of the Treating to New Targets (TNT) trial aimed to identify determinants of residual risk above and beyond lipid-related risk factors among patients with stable coronary disease treated to low LDL-cholesterol targets.
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New oral anticoagulants vs warfarin in patients with AF

Selected Literature
Miller SC et al. Am J Cardiol 2012
This meta-analysis examined the long-term efficacy and safety of the new oral anticoagulants compared to warfarin in preventing stroke and systemic embolism in patients with atrial fibrillation.
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ADA/EASD New Hyperglycemia Management Guidelines

Selected Literature
Diabetes Care. 2012 Apr 19
The American Diabetes Association and the European Association for the Study of Diabetes have updated guidelines on the management of hyperglycemia in nonpregnant adults with type 2 diabetes. Individualized treatment is the cornerstone of success Read more...

Treatment of stable angina

EPCCS Literature review & commentary
In contrast to treatment of acute coronary syndrome in which coronary atherosclerosis is complicated by plaque rupture followed by thrombocyte clotting, there is mounting evidence for lack of PCI benefit in stable ischemic heart disease (not complicated by thrombocyte clotting). This meta-analysis is the last in a row of studies and meta-analyses showing that optimal medical therapy (OMT) alone is non-inferior to OMT in addition to coronary revascularization with PCI Read more...

Dual antiplatelet therapy

EPCCS Literature review & commentary
Based on previous studies, guidelines advocated to treat patients after stenting with dual antiplatelet therapy for at least one year. This large trial, including patients receiving a bare metal stent as well as different types of coated stents shows that 6 months of dual antiplatelet therapy would be sufficient.
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Dabigatran summary. Meta-analysis of noninferiority randomized controlled trials

EPCCS Literature review & commentary
This analysis is driven primarily by the RE-LY trial,(1) which contributes 75% of the weight to the overall effect size. It is noteworthy that the results are rendered non-significant (OR 1.16; 95%CI 0.69 to 1.94) when RE-LY is excluded from the analysis. Read more...

Efficacy of Omega-3 fatty acid supplements

EPCCS Literature reviews & commentary
Sometimes ‘evidence is tumbling over evidence’. In an overview Kromhout and al in the March 2012 issue of Eur Heart Journal the authors “encourage the use of omega-3 fatty acids supplementation in patients with coronary artery disease or after myocardial infarction and possibly in those with heart failure, as suggested by the current guideline.” Read more...

Resistant hypertension: Incidence and prognosis

Selected Literature
Daugherty SL et al. Circulation. 2012 Apr 3
This retrospective cohort study provides insight into the incidence and prognosis of resistant hypertension. Greater efforts should be made to improve outcomes in patients with resistant hypertension to decrease the risk of cardiovascular events.
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Association between chlorthalidone treatment of systolic hypertension and long-term survival

Kostis JB et al, JAMA. 2011;306(23):2588-93
In the SHEP trial, treatment of isolated systolic hypertension with chlorthalidone stepped-care therapy for 4.5 years was associated with longer life expectancy at 22 years of follow-up.
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ACE-I/ARBs beneficial in normotensive atherosclerotic patients

It is unclear whether angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB) are beneficial in individuals with, or at increased risk for, atherosclerotic vascular disease who are normotensive. This study attempted to answer this question. McAlister FA, Eur Heart J. 2011 Oct 31. [Epub ahead of print]
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Hypertension and Heart Failure - the ALLHAT trial

A long-term follow-up of the ALLHAT shows that hypertension control to prevent heart failure can be achieved in most patients; diuretics can be an effective part of the antihypertensive treatment regimen. Circulation. 2011;124:1811-1818
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Cost-effectiveness in diagnosing hypertension

Ambulatory blood pressure monitoring is more accurate than both clinic and home monitoring in diagnosing hypertension. This study compared the cost-effectiveness of different diagnostic strategies for hypertension. Lancet. 2011 Oct 1;378(9798):1219-30.
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The EURIKA Study

Excess risk attributable to traditional cardiovascular risk factors in clinical practice settings across Europe
The objective of this study was to estimate the excess risk attributable, firstly, to the presence of CVD risk factors and, secondly, to the lack of control of these risk factors in primary prevention care across Europe. BMC Public Health. 2011 Sep 18
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New NICE guidelines for hypertension

The recent updated guidance from the National Institute for Health and Clinical Excellence (NICE) on the management of hypertension in adults will have far reaching implications for day to day practice in the United Kingdom. Read more...

The role of the primary care physician in managing early stages of chronic kidney disease

Recent increases in obesity, diabetes, and hypertension, along with the aging of the population, are driving a dramatic rise in the prevalence of chronic kidney disease (CKD). Primary care practices are at the forefront of detection and management of early CKD. Read more...

Withdrawal of Antithrombotic Agents and Its Impact on Ischemic Stroke Occurrence

One in 20 ischemic strokes occurs soon after withdrawal of antithrombotic agents, warn researchers. Read more...

Hypertension and type 2 diabetes: What family physicians can do to improve control of blood pressure

Family practice survey which identifies key factors for improvinh risk reduction in combination hypertension + T2DM - FREE PUBLICATION ATTACHED Read more...

Primary prevention of cardiovascular diseases (Dutch study)

A  cost study in family practices - FREE PUBLICATION ATTACHED Read more...

CVPC: Epidemiological Cardio-Vascular Study in Primary Care (Greek study)

Prevalence of target organ damage in hypertensive subjects attending primary care
FREE PUBLICATION ATTACHED
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ADDITION-Europe (Denmark/Netherlands/UK)

Diabetes screening and early intensive intervention in general practice - SLIDES ATTACHED
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© 2011 Medcon International/EPCCS