Focusing the spotlight

It has been a tumultuous week with challenges to recently released prevention guidelines that target cardiovascular disease, particularly atherosclerosis. But don’t let that overshadow some important findings that may influence practice in the near and long term.

Let’s start with findings that may compel physicians to reassess their use of some treatments. The American Heart Association’s scientific session in Dallas unveiled results this week from key clinical trials, including:

  • VISTA-16, which concluded that varespladib significantly increased heart attack risk in patients with acute coronary syndrome;
  • CORAL, which may put the debate on renal artery stenting to rest. In a study that avoided design flaws in previous trials, researchers concluded that renal artery stenting failed to offer incremental benefit over medical management for patients with renal artery stenosis and hypertension or chronic kidney disease;
  • ENGAGE AF-TIMI 48, where edoxaban appeared to be as effective as warfarin in preventing strokes or systemic embolism with less risk of bleeding and cardiovascular death;
  • COAG, which showed that incorporating genetic information with clinical variables to determine  warfarin dose did not lead to better control of therapeutic level; and
  • The Cardiothoracic Surgical Trials Network’s study that compared mitral valve repair with valve replacement in patients with severe ischemic mitral regurgitation. Researchers found no significant difference at 12 months with the exception that the repair group had a higher rate of recurrence of moderate or severe regurgitation.

Conferences such as the AHA’s meeting, the recently concluded Transcatheter Cardiovascular Therapeutics event in San Francisco and the approaching American College of Cardiology scientific session in Washington, D.C., help spotlight critical trials with the potential to change practice for years to come. They also lay the foundation for further research.

For instance, one group at the AHA conference used DECAAF data to assess whether selectively ablating patients with atrial fibrillation reduces costs. It did in their model, at a tune of $2,910 per patient compared with the current standard of care.

The simultaneous publication of AHA trial results in leading journals reflects the importance of the findings. But just as the controversy over a risk assessment calculator developed as part of a new approach for identifying and managing patients at risk of cardiovascular disease sometimes drew attention from conference highlights, the large amount of information released during the conference may have made it difficult to catch some nonconference findings.

Those include a research letter that shows the FDA’s assessment of gastrointestinal tract bleeding rates associated with dabigatran contradicts results from a meta-analysis of clinical trials and a warning from the FDA on two cardiac nuclear stress test drugs.

There is more in store next week. Please be sure to check out website for the latest news.

Candace Stuart

Cardiovascular Business, editor