Prurigo Nodularis Associated With Elevated

Cardiovascular, Mortality Risks

 Patients with PN showed a higher risk for death and MACE
 PN was also associated with a higher risk for heart failure , thrombotic
venous disease, angina pectoris, and peripheral arterial diseases and
for acute MI and valve disorders
 White patients with PN had a significantly increased risk for MACE,
death, heart failure, cardiac arrest, vascular diseases, and acute MI,
but this was not observed in people of color.
 Women exhibited a higher risk for MACE, heart failure, peripheral
artery disease, acute MI, conduction disease, and valve disorders,
while men did not have an increased risk for major or acute
cardiovascular events. Both men and women had a higher risk for
death, chronic ischemic heart disease, and venous disease.

Complete Revascularization Not Superior to Culprit-

Only PCI After MI (FULL REVASC trial )
In patients with ST-elevation myocardial infarction (STEMI) and
multivessel disease, fractional flow reserve (FFR)-guided complete
nonculprit revascularization did not reduce death, myocardial
infarction (MI) or unplanned revascularization compared with
culprit lesion-only percutaneous coronary intervention (PCI).

Adding ACEI to Chemotherapy Does Not Prevent

Cardiotoxicity (PROACT study)
The addition of an angiotensin-converting enzyme (ACE) inhibitor did not
decrease risk for chemotherapy-related cardiac damage in patients being
treated for breast cancer and non-Hodgkin lymphoma (NHL)
The starting dose of enalapril was 2.5 mg twice a day, which was titrated
up to a maximum of 10 mg twice a day. The ACE inhibitor was started at
least 2 days before chemotherapy began and finished 3 weeks after the
last anthracycline dose.

A majority of patients experienced elevations in troponin (78% in the

enalapril group and 83% in the standard of care group), but there was no
statistically significant difference between groups (adjusted odds ratio
[OR], 0.65; 95% CI, 0.23-1.78; P = .405).

There was also no significant difference between groups in terms of cTnI, a

secondary endpoint. However, the proportion of patients testing positive
for cTnI (47% in the enalapril group and 45% in controls) was substantially
lower than that for cTnT.

IVUS Bests Angiography to Guide PCI in ACS( IVUS-

ACS study)
The primary endpoint was the one-year composite of target vessel failure
(TVF), including cardiac death, target vessel myocardial infarction (TVMI)
and clinically driven target vessel revascularization (TVR).

"We found that the TVF endpoint was 7.3% in the angiography-guided
group compared to only 4.0% in the IVUS-guided group, which is a 45%
reduction in the hazard rate,"

Coronary Sinus Reducer an Option for Intractable

Angina? (ORBITA-COSMIC)
one of the two co-primary endpoints was a change in myocardial
blood flow. It was measured at baseline and at end of the study in
ischemic segments identified with adenosine stress perfusion on a
cardiac magnetic resonance scan.
The other primary endpoint was the number of daily angina
episodes as recorded by patients on a smartphone app
At the end of 6 months, there was a 40% increase in the odds ratio
(OR) of having days free of angina
Despite this reduction in angina, the study was not able to prove
the hypothesis that angina is relieved by improved perfusion,
which was the other primary endpoint. the exception was an
improvement in the endocardial-to-epicardial ratio, which was
unchanged on imaging in nonischemic segments, but did improve
significantly in ischemic segments. The probability of improvement
on this measure was 98.2%

New Data Question Beta-Blockers Post-MI With

Preserved EF (REDUCE-AMI trial)
After an average follow-up of 3.5 years, the rate of all-cause death
or MI was 7.9% in the beta-blocker group and 8.3% in the no beta-
blocker group,
The results mean that cardiologists can consider subtracting long-
term beta-blocker therapy from the medication list for a large
number of patients with post-MI

What Treatment Reduces Cardiac Risk in

Hyperthyroidism?
 The majority of patients (93.9%) received ATDs (anti thyroid drugs) as
the first-line treatment for hyperthyroidism, while 5.1% had surgery
and 1.1% got RAI.
 The risk for long-term MACE was 55% lower in patients treated with
RAI than in those treated with ATDs (P = .03).
 Surgery was associated with a 24% lower risk for long-term MACE (P =
.04) and a 47% lower risk for all-cause mortality (P < .001) than ATDs.
  The group of patients who received ATDs showed the highest rate of
hyperthyroidism relapse (63.5%), followed by those treated with RAI
(38.2%) and surgery (17.3%).
These findings suggest that surgery or RAI [radioactive iodine]
may be better options than long-term ATD [antithyroid drugs]
treatment in patients with hyperthyroidism who are at risk of
MACE,"

Preventive PCI for Vulnerable Plaques Reduces

Cardiac Events (PREVENT trial)
In the post hoc analysis, the composite rate of death from any
cause or target vessel MI was consistently lower at 2 years with
preventive PCI than with optimal medical therapy alone, as was
the composite rate of death from cardiac causes or target vessel
MI.

Indeed, serious clinical or adverse events did not differ between the PCI
and medical therapy groups: At 2 years, four (0.5%) vs 10 (1.3%) patients
died and nine (1.1%) vs 13 (1.7%) had an MI.

In addition, the authors noted that in the post hoc as-treated analysis, the
durability of preventive PCI seemed to be more sustained with cobalt-
chromium everolimus-eluting metallic stents than with bioresorbable
vascular scaffolds.

Ticagrelor Alone Cuts Bleeding Without More Events

Post-PCI (ULTIMATE-DAPT trial)
After one month of dual antiplatelet therapy (DAPT)
with aspirin and ticagrelor (Brilinta) post-percutaneous coronary
intervention for an acute coronary syndrome, dropping aspirin cut
bleeding risk without any increase in the risk for ischemic events
Up to 12 months after PCI, clinically relevant bleeding occurred in
2.1% of the ticagrelor plus placebo group and 4.6% of the
ticagrelor plus aspirin group

Major bleeding (BARC types 3 or 5) also occurred less frequently with

ticagrelor plus placebo compared with ticagrelor plus aspirin (0.7% vs
1.7%). This was also the case for other measures of bleeding, including
Thrombolysis in Myocardial Infarction (TIMI) major or minor bleeding (0.7%
vs 16%), Global Utilization of Streptokinase and
Tissue Plasminogen Activator for Occluded Arteries (GUSTO) moderate,
severe or life-threatening bleeding (0.5% vs 1.1%), and International
Society on Thrombosis and Hemostasis (ISTH) major bleeding (0.5% vs
1.2%)

MACCE rates were similar, occurring in 3.6% of those treated with

ticagrelor plus placebo and 3.7% in those treated with ticagrelor
plus aspirin
There was no significant interaction for age with respect to
clinically relevant bleeding. However, among patients older than
65, those in the ticagrelor monotherapy group had elevated rates
of MACCE (5.3%) compared to the ticagrelor plus aspirin group
(3.7%) in contrast to younger patients.

TACT2 trial : Chelation Therapy Provides No Benefit

Post-MI
Chelation therapy to remove potentially toxic levels of lead from
the blood was not associated with a reduction in cardiovascular
events in post-myocardial infarction (MI) patients with diabetes in
the TACT2 trial.
(TELE-ACS trial ) : Telemedicine Reduces
Rehospitalization, Revascularization in Post-PCI ACS
Patients
Patients with acute coronary syndrome (ACS) who had
a myocardial infarction or unstable angina and
underwent percutaneous coronary intervention (PCI) had a 76%
lower rate of hospital readmission after 6 months if they
participated in a remote monitoring protocol compared with
similar patients who had standard post-discharge care
The telemedicine protocol consisted of 12-lead electrocardiogram belt, an
automated blood-pressure monitor, and a pulse oximeter.

Results showed that at 6 months, telemedicine patients had statistically

significantly lower rates of post-discharge emergency department visits
(25% vs. 37%, P < .001), unplanned coronary revascularizations (3% vs.
9%, P < .01) and cardiovascular symptoms, such as chest pain, shortness
of breath and dizziness (a 13% to 18% difference for each
symptom, P < .01).

MACE rates were similar between the two groups.

( DanGer Shock trial) : Impella CP Improves Survival

in STEMI, Cardiogenic Shock
Use of a microaxial flow pump (Impella CP) with standard care led
to a lower risk for death than standard care alone in patients with
ST-elevation myocardial infarction (STEMI)-related cardiogenic
shock
Results at 180 days showed that mortality was significantly lower
among patients in the mAFP group compared with those receiving
standard care alone (45.8% vs 58.5%, respectively
There was also a reduction in the composite cardiac endpoint
among those who received the pump (52.5% mAFP vs 63.6%
standard of care).

A composite safety endpoint event occurred in 24% of patients in the mAFP

group vs only 6.2% in the standard-care group

Specifically, the relative risk (mAFP group vs standard care) of moderate or

severe bleeding was 2.06; of limb ischemia, 5.15; of renal-replacement
therapy, 1.98; and of sepsis with a positive blood culture, 2.79.

Seventy-five patients (41.9%) in the pump group underwent renal

replacement therapy vs 47 patients (26.7%) in the standard-care group

(EMPACT-MI trial ) : Empagliflozin Fails to Reduce

Events After Acute MI
Empagliflozin, a sodium–glucose cotransporter 2 (SGLT2) inhibitor,
did not show significant benefit in reducing a first heart
failure (HF) hospitalization or death from any cause in patients at
high risk for HF after an acute myocardial infarction (MI)
empagliflozin did not reduce the risk of the composite primary
endpoint event. A first hospitalization for HF or death from any
cause occurred in 267 (8.2%) versus 298 (9.1%) of patients in the
empagliflozin versus placebo groups, respectively

However, Butler told attendees, there was a significant 23% relative risk
reduction in first HF hospitalization, and for total HF hospitalizations (first
and recurrent HF hospitalizations combined) there was a highly significant
33% relative risk reduction.

Among patients who were not taking HF therapies such as diuretics,

angiotensin-converting enzyme inhibitors, and angiotensin
receptor/neprilysin inhibitors at the time of their initial hospital discharge,
those taking empagliflozin were significantly less likely to start such
therapies within 6 months compared with those receiving placebo.

( AEGIS-II trial ) : ApoA1 Trial Misses Endpoint, But

HDL Hypothesis Still Alive?
A human apolipoprotein A1 (ApoA1) product, which is the key
constituent of high-density lipoprotein (HDL) cholesterol and
removes excess lipid from atherosclerotic plaques, did not bring
about a significant reduction in the primary endpoint of
cardiovascular death, myocardial infarction (MI), or stroke in
patients with MI and additional risk factors
But the trial did show some suggestion of benefit of the ApoA1
product, known as CSL112, with numerically lower rates of
cardiovascular death and MI.
In addition, an exploratory analysis showed significant benefits in
patients who had higher levels of LDL at baseline, but no benefit in
patients with lower LDL levels.

In patients with baseline LDL levels below 100 mg/dL, there was no effect
of CSL112 on the primary composite endpoint at any timepoint.

However, in patients with baseline LDL levels above 100 mg/dL, CSL112
was associated with significant reductions in the primary composite
endpoint at all timepoints (Table 1).

(REDUCE-IT trial ) : Lp(a) Tied to Higher CVD

Events; Risk Reduction With IPE
compared IPE with placebo in those with cardiovascular disease (CVD) or
diabetes and other cardiovascular risk factors, as well as elevated
triglycerides despite statin therapy.
Baseline lipoprotein a, or Lp(a), levels are strongly associated with
major adverse cardiovascular events (MACE) in high-risk patients
with elevated triglyceride levels receiving statin therapy
also showed icosapent ethyl (IPE; Vascepa, Amarin), a refined
version of omega-3 fatty acid eicosapentaenoic acid (EPA), was
associated with a reduction in this risk across a range of Lp(a)
levels.