Dylan Steen

Epidemiology and survival of the five stages of chronic kidney disease in a systolic heart failure population

The epidemiology of the five stages of chronic kidney disease (CKD) in systolic heart failure (HF) patients has predominantly been described in hospitalized White patients, with little known about the prevalence in outpatient Blacks and Hispanics. The purpose of this study was to compare the prevalence of the five stages of CKD by race, ethnicity (Whites, Blacks, and Hispanics), and gender in an outpatient systolic HF population and also to evaluate the impact of CKD on mortality.

Prognostic Evaluation of Catalytic Iron in Patients With Acute Coronary Syndromes

The potential of iron to generate reactive oxygen species has motivated a long‐standing interest in whether excess iron is causally linked to atherosclerotic heart disease. Circulating catalytic iron (“free” iron) is that which is not bound to transferrin or ferritin and is available to generate reactive oxygen species that may have deleterious vascular effects.

Open Access to an Outpatient Intravenous Diuresis Program in a Systolic Heart Failure Disease Management Program

In order to provide efficient utilization of resources in an outpatient setting for acute exacerbation of heart failure (HF), the authors piloted an open-access outpatient intravenous (IV) diuretic program (IVDP) to evaluate utilization in an HF disease management program (HFDMP), patient characteristics for users of the program, and safety. An outpatient HFDMP at Jackson Memorial Hospital in Miami, Florida, enrolling 577 patients 18 years and older with an ejection fraction ≤40% was implemented. For symptoms or weight gain ≥5 pounds, patients were eligible to use an open-access IVDP during clinic hours. A total of 130 HFDM patients (22.5%) used the IVDP. IVDP users were more likely to be diabetic, with lower body mass indices than non-IVDP users. New York Heart Association class IV patients and previously hospitalized patients were more likely to use the IVDP. There were no documented adverse reactions for patients receiving treatment and no difference in mortality between groups. This open-access outpatient IVDP model for patients with HF was readily utilized by the HFDMP participants and appears safe for use in this population. This unique model may provide alternative access for acute HF treatment. Congest Heart Fail.

Prevalence of conduction abnormalities in a systolic heart failure population by race, ethnicity, and gender.

Background: There is paucity of data regarding conduction abnormalities in the Hispanic population with systolic heart failure (HF). We aimed to evaluate the prevalence of electrocardiogram (ECG) abnormalities in a systolic HF population, with attention to the Hispanic population.

Lp-PLA2 Inhibitors for the Reduction of Cardiovascular Events

Evidence suggests that inflammation plays a central role in the pathogenesis of atherosclerosis (Libby, Nature 420:868–874, 2002). Inflammation is a physiologic process with highly regulated and often redundant mechanisms to balance pro-inflammatory and anti-inflammatory responses. The complexity of these networks has made it challenging to identify those specific pathways or key enzymes that contribute directly to atherogenesis and could act as a valuable therapeutic target. Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a member of the phospholipase A2 family of enzymes and is believed to contribute to atherosclerotic plaque progression and instability by promoting inflammation. A large number of epidemiologic studies have demonstrated that elevated levels of Lp-PLA2 are associated with an increased risk of cardiovascular events across diverse patient populations, independent of established risk factors including low-density lipoprotein cholesterol. Further, a growing number of preclinical and genetic studies support a causal role for Lp-PLA2 in atherosclerosis. The development of a novel therapeutic agent that directly inhibits the Lp-PLA2 enzyme has provided a unique opportunity to directly test the hypothesis that inhibition of this inflammatory enzyme will translate into improved clinical outcomes. In this article, we will review the evidence to support the notion that Lp-PLA2 is causally implicated in the pathobiology of atherogenesis and discuss the potential utility of inhibiting this enzyme as a therapeutic target.

CARDIOVASCULAR EVENT RATES IN A HIGH-RISK MANAGED CARE POPULATION IN THE UNITED STATES

Healthcare policy for reducing cardiovascular (CV) event burden should be guided by current and generalizable data. The objective was to determine the CV event risk in US patients with established atherosclerotic CV disease (ASCVD) and/or diabetes mellitus. The MarketScan Research Database was used

Prevalence of Electrocardiographic Abnormalities in a Systolic Heart Failure Disease Management Population by Race, Ethnicity, and Sex

The prevalence of electrocardiographic (ECG) abnormalities in systolic heart failure patients have predominantly been described in white patients, with relatively little known about their prevalence in black and Hispanic populations. The purpose of this study is to compare the prevalence of ECG abnormalities by race, ethnicity, and sex. The authors conducted an observational prospective study that included 926 patients from 2 hospital facilities. A systolic heart failure disease management program implemented in both sites enrolled patients with an ejection fraction < or =40% by echocardiography. Black patients had less evidence of myocardial infarction than whites and Hispanics. Black patients had more evidence of left ventricular hypertrophy than Hispanics and whites. Hispanics evidenced more ischemic changes than blacks and whites. Among black patients, left ventricular hypertrophy was more prevalent in women. ECG abnormalities vary across race, ethnicity, and sex. These variations may have implications for further diagnostic testing and potential treatment regimens.

Statin potency associated with incident diabetes in a real-world evaluation

Context For widely prescribed medications, such as statins, even the development of uncommon adverse events may have significant public health ramifications. Recent meta-analyses of randomised controlled trials (RCTs) have demonstrated an increased incidence of diabetes in patients taking statins. These have demonstrated a dose–effect relationship, but whether different statins have differential effects on the risk of diabetes is still unclear. In this study, Carter and colleagues further investigate the dose– effect relationship of statin-induced diabetes and whether different statins carry distinct risks of diabetes in a large, real-world population. Methods The authors examined healthcare records of more than 1.5 million adults aged 66 years or above in Ontario, Canada from August 1997 to March 2010. The analysis excluded patients with established diabetes and those prescribed a statin within 1 year prior to the start of the study. Linked administrative healthcare databases were used to provide information on demographics, clinical characteristics, diagnostic and procedural information, physician billing, vital status and diagnosis of diabetes. Cox proportional hazards regression was used to estimate the relationship between statins and incident diabetes. For statistical analyses, pravastatin was used as the reference comparator. Findings The authors identified 471 250 patients without a history of diabetes who were newly treated with a statin. Of the baseline characteristics reported, the year of cohort entry and history of prior coronary disease differed between subgroups prescribed individual statins. The crude incidence of diabetes per 1000 person-years in those prescribed rosuvastatin, atorvastatin and simvastatin was 34.2, 30.7 and 26.2, respectively. This was significantly higher than for pravastatin, fluvastatin or lovastatin, which had incidences of 22.6, 21.5 and 21.8, respectively. After adjustment for baseline differences, rosuvastatin, atorvastatin and simvastatin were associated with 18%, 22% and 10%, respectively, increased risk of incident diabetes compared with pravastatin. The association of statins with incident diabetes was similar when analysed by indication for primary versus secondary prevention. High-potency statins (ie, atorvastatin and rosuvastatin) were associated with a 22% increased risk of diabetes compared with pravastatin, while a moderate potency statin (ie, simvastatin) demonstrated an 11% increase.

Anacetrapib: potential for the prevention and treatment of coronary heart disease

Correspondence: Christopher P Cannon; Dylan L Steen TIMI Study Group, 1st floor, 350 Longwood Avenue, Boston, MA 02115, USA Tel +1 617 525 6888 Fax +1 617 734 7329 Email steendy@gmail.com Abstract: Despite major advances in cardiovascular care in recent decades, atherosclerotic cardiovascular disease remains the leading cause of morbidity and mortality worldwide. Statins have been shown to reduce cardiovascular events by 25%–40% in a dose-dependent fashion; yet additional therapies are needed to reduce vascular disease progression and acute thrombotic events. In addition to low-density lipoprotein cholesterol (LDL-C) reduction, other lipid risk factors, such as low high-density lipoprotein cholesterol (HDL-C), have created interest as therapeutic targets to lower cardiovascular risk. However, the absence of compelling data for incremental benefit of non-LDL-centric therapies in the statin era has limited their clinical use. A novel class of compounds, cholesteryl ester transfer protein (CETP) inhibitors, has demonstrated many potentially beneficial lipid-modifying effects. While in vitro and animal data for CETP inhibition have been encouraging, the initial enthusiasm for the class has been tempered by the failure of two CETP inhibitors (torcetrapib and dalcetrapib) in Phase III trials to reduce cardiovascular outcomes. Anacetrapib, a compound that causes near-complete CETP inhibition, has among its effects, robust reductions in LDL-C and lipoprotein(a) as well as dramatic increases in HDL-C. The ability of anacetrapib to reduce coronary disease events is being tested in the Randomized EValuation of the Effects of Anacetrapib Through Lipid-modification (REVEAL) trial (NCT01252953).