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American College of Cardiology 59th Annual Scientific Session, March 14-16, 2010

Last Updated: March 19, 2010.

 

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American College of Cardiology 59th Annual Scientific Session

The American College of Cardiology's 59th Annual Scientific Session took place March 14 to 16 in Atlanta and attracted over 20,000 participants from around the world. The conference focused on advances in cardiovascular disease prevention and management.

Highlights included results from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study, the Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) study, as well as a sub-study of the Platelet Inhibition and Patient Outcomes (PLATO) trial. In addition, presentations focused on novel therapeutic agents as well as the optimization of currently available drugs and interventional cardiology approaches.

"The theme of the 59th Annual Scientific Session was better communication. We had implemented audience response systems and a Twitter feed to improve communication between presenters and attendees. The same is true for the data presented, better communication about therapies that have already been established to improve clinical outcomes for our patients," said conference co-chair, Michael J. Barrett, M.D., of the Temple University School of Medicine in Philadelphia.

Robert S. Epstein, M.D., of the Medco Research Institute in Franklin Lakes, N.J., presented findings from the Medco-Mayo Warfarin Effectiveness Study (MM-WES), which examined the impact of pharmacogenetic testing for warfarin on clinical outcomes. The researchers recruited 896 patients starting warfarin therapy and participating in a prescription benefits plan managed by Medco Health Solutions. The test was used to find the patients' CYP2C9 and VKORC1 genotype and phenotype results.

During the first six months of warfarin therapy, the researchers found that patients who underwent pharmacogenetic testing were 31 percent less likely to be hospitalized for any cause and 29 percent less likely to be hospitalized for bleeding or thromboembolism. In an additional analysis that included only hospitalizations that occurred after genotyping, the researchers found that the patients who underwent genetic testing had a 33 percent lower risk of hospitalization for any cause and a 43 percent lower risk of hospitalization for bleeding or thromboembolism.

"Genetic testing is a tool clinicians can use to more accurately predict the best warfarin dose early on. Patients may get to a stable dose more quickly and, therefore, have a lower risk of negative outcomes," Epstein said in a statement.

Genotyping and data collection were funded by Medco Health Solutions.

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A study presented by Rhonda M. Cooper-Dehoff, of the University of Florida in Gainesville, showed that tight blood pressure control was no more effective than standard blood pressure control in preventing heart attack, stroke or death in patients with diabetes and cardiovascular disease, and may result in more harm than benefit in some patients.

The International Verapamil SR-Trandolapril (INVEST) study evaluated 6,400 patients with diabetes and cardiovascular disease who were randomized to a antihypertensive therapy based either on a calcium-channel blocker or a beta blocker, plus an angiotensin-converting-enzyme inhibitor and/or a thiazide diuretic.

The researchers found that subjects in the uncontrolled blood pressure group (systolic blood pressure of 140 mm Hg or higher) had almost a 50 percent higher combined risk of death, heart attack or stroke compared with the usual-control group (130 to 139 mm Hg). Subjects in the tight-control group (below 130 mm Hg) had a similar risk to those in the usual-control group, and they also had an increased risk of all-cause death. When they analyzed blood pressure in 5 mm Hg increments, the researchers found that systolic blood pressure lower than 115 mm Hg was associated with increased mortality.

"Our data suggest that in patients with both diabetes and coronary artery disease, there is a blood pressure threshold below which cardiovascular risk increases," Cooper-DeHoff said in a statement.

The INVEST trial was supported by Abbott Laboratories.

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In another study presented at the conference, the Diuretic Optimization Strategies Evaluation (DOSE) study, researchers randomized 308 patients with acute decompensated heart failure and fluid overload to high-dose intravenous furosemide (delivered at 2.5 times the patient's usual daily oral dose) or low-dose intravenous furosemide (delivered at the same level as the patient's usual daily oral dose). In addition, patients were then randomized to intravenous dosing either every 12 hours or to a continuous infusion.

The researchers observed a trend that suggested greater global symptom resolution over three days with the high-dose regimen. This trend was not associated with a significant decline in renal function. In addition, several secondary measures of furosemide's effectiveness in relieving fluid overload, including change in body weight and a net volume loss, also tended to favor the high-dose regimen.

"These findings suggest that high-dose furosemide may be preferable to low-dose. The price seems to be a transient and relatively small deterioration in kidney function," co-principal investigator of the study, G. Michael Felker, M.D., of Duke University School of Medicine in Durham, N.C., said in a statement.

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ACC: Ticagrelor Is Promising Alternative to Clopidogrel

TUESDAY, March 16 (HealthDay News) -- The use of ticagrelor instead of clopidogrel in patients with acute coronary syndrome who undergo coronary artery bypass graft (CABG) surgery is associated with a lower likelihood of fatal outcomes, according to research presented at the Annual Scientific Session of the American College of Cardiology, held from March 14 to 16 in Atlanta.

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ACC: New Dual-Acting Drug Lowers Blood Pressure

TUESDAY, March 16 (HealthDay News) -- The dual actions of the novel inhibitor LCZ696 provides additional lowering of blood pressure, compared to the angiotensin II receptor blocker valsartan, according to research published online March 16 in The Lancet. The findings were released to coincide with the Annual Scientific Session of the American College of Cardiology, held from March 14 to 16 in Atlanta.

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ACC: Several Atrial Fibrillation Approaches Assessed

MONDAY, March 15 (HealthDay News) -- Both cryoablation and catheter ablation appear to be effective in treating atrial fibrillation, while betrixaban seems to be well-tolerated and safe, according to the results of three studies presented at the Annual Scientific Session of the American College of Cardiology, held from March 14 to 16 in Atlanta.

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ACC: Sirolimus Stent Beats Zotarolimus Stent for Low-Risk Patients

MONDAY, March 15 (HealthDay News) -- In everyday clinical practice, the sirolimus-eluting stent may be superior to the zotarolimus-eluting stent in low-risk patients with coronary artery disease, according to the results of the SORT OUT III study published online March 15 in The Lancet. The findings were released to coincide with the Annual Scientific Session of the American College of Cardiology, held from March 14 to 16 in Atlanta.

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ACC: Aspirin as Effective as Dual Antiplatelet Therapy for Stents

MONDAY, March 15 (HealthDay News) -- In patients who have received drug-eluting stents, dual antiplatelet therapy longer than 12 months is no more effective than aspirin monotherapy in decreasing the rate of heart attack or death from cardiovascular causes, according to a study published online March 15 in the New England Journal of Medicine. The study was released to coincide with the Annual Scientific Session of the American College of Cardiology, held from March 14 to 16 in Atlanta.

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ACC: Two Type 2 Diabetes Approaches Don't Help Heart

MONDAY, March 15 (HealthDay News) -- In type 2 diabetes patients at high risk for cardiovascular events, combination lipid therapy with fenofibrate and simvastatin does not reduce the rate of cardiovascular events compared with simvastatin alone, and intensive blood pressure control, compared to standard blood pressure control, also does not reduce the rate of adverse cardiovascular events, according to the results of two analyses of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study. The findings were published online March 14 in the New England Journal of Medicine to coincide with the Annual Scientific Session of the American College of Cardiology, held from March 14 to 16 in Atlanta.

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ACC: Lenient Rate Control Studied in Atrial Fibrillation

MONDAY, March 15 (HealthDay News) -- While current guidelines recommend strict rate control in patients with permanent atrial fibrillation, lenient rate control is just as effective in preventing cardiovascular morbidity and mortality, according to a study published online March 15 in the New England Journal of Medicine to coincide with the Annual Scientific Session of the American College of Cardiology, held from March 14 to 16 in Atlanta.

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ACC: New Drug Shows Promise in Rare Cholesterol Disorder

MONDAY, March 15 (HealthDay News) -- In individuals with homozygous familial hypercholesterolemia already undergoing treatment with lipid-lowering drugs, inhibition of apolipoprotein B synthesis by a new drug, mipomersen, may be effective in reducing low-density lipoprotein (LDL) cholesterol, according to a study published online March 14 in The Lancet to coincide with the Annual Scientific Session of the American College of Cardiology, held from March 14 to 16 in Atlanta.

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ACC: Valsartan, Nateglinide Do Not Reduce Cardio Events

MONDAY, March 15 (HealthDay News) -- In patients with impaired glucose tolerance and cardiovascular disease or cardiovascular risk factors, neither valsartan nor nateglinide reduces the incidence of cardiovascular outcome measures, but valsartan does lead to a modest reduction in the incidence of diabetes, according to the results of two analyses from the Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) study group. The findings were published online March 14 in the New England Journal of Medicine to coincide with the Annual Scientific Session of the American College of Cardiology, held from March 14 to 16 in Atlanta.

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