Updates 8 Mar 2016
Individualised Risk Benefit Approach to Statin Therapy
A study of 2134 individuals potentially eligible for statin therapy for primary prevention of cardiovascular disease has been reported by Thanassoulis et al in the latest preprint of Circulation. The authors compared eligibility for statin therapy and expected outcomes according to two criteria – a 10-year risk-based approach (≥7.5% 10-year risk) and an individualized benefit approach (based on predicted absolute risk reduction over 10 years ≥2.3%). The individualised approach identified 64% more eligible patients with an estimated benefit of 266,508 cardiovascular events prevented over ten years in the US population. The authors conclude that initiating statin therapy based upon absolute individual risk-benefit can identify lower-risk individuals who have equal or greater expected benefit from statins in primary prevention than higher-risk individuals.
Chelation Therapy for Coronary Artery Disease: TACT and TACT2
In the Feb 26th issue of JACC, Gervasio Lamas provides a challenging summary of the evidence underpinning EDTA chelation therapy in coronary artery disease and summarizes the key results of the TACT trial reported in 2013. The apparent benefit of EDTA chelation in reducing a composite endpoint of adverse events in individuals with coronary disease was unexpected. The benefit was particularly evident in diabetic patients. As Lamas notes, chelation therapy remains outside main therapeutic options and a new trial, TACT2, has planning approval for assessment of benefit in post-MI diabetic patients. The results of this trial will be awaited keenly, as if the results are concordant with the original TACT study, clinicians may need to reappraise the role of chelation therapy.
Not all Atrial Fibrillation is Equal
Current guidelines for management of AF, including anticoagulant therapy, do not
specifically distinguish between types of AF, although anticoagulation is recommended for both paroxysmal and persistent AF. The question remains as to whether persistent AF is worse than paroxysmal AF and this issue was addressed by an Australian group whose findings are published in European Heart Journal on 16th February (Ganesan et al). Meta-analysis of published outcomes in nearly 100,000 patients shows that persistent AF was associated with greater risk of thromboembolism, even in those patients receiving anticoagulation, and all cause mortality was also greater in the persistent AF group. The authors concluded that new therapies to prevent AF progression are required and that risk stratification should consider the type of AF.
Update on Long QT Syndrome
A useful clinical update on Long QT syndrome in now available on-line in Heart Lung and Circulation. This paper addresses developments in diagnosis, management and the role of clinical genetics for physicians caring for affected individuals. The manuscript is a timely addition to the evidence base for clinical decision making in the continually evolving field of cardiac genetics.