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Was ist neu in der Kardiologie? Innovative Ideen 2009

Was ist neu in der Kardiologie? Innovative Ideen 2009. Einleitung. erland.erdmann@uni-koeln.de. Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates. 20 15 65 20 25 55

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Was ist neu in der Kardiologie? Innovative Ideen 2009

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  1. Was ist neu in der Kardiologie?Innovative Ideen 2009 Einleitung erland.erdmann@uni-koeln.de

  2. Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates • 20 15 65 • 20 25 55 • 40 15 45 • 40 25 35 Fat Protein Carbohydrates (%) n = 811 overweight adults, BMI 33, individual instructional sessions

  3. Conclusion: Reduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize Sacks et al., NEJM 360 (2009) 859

  4. Metabolismus von Clopidogrel Simon et al., NEJM 2009;360:363-75

  5. The PPI-clopidogrel interaction has been the subject of much study and debate in a relatively short period of time. There is no doubt that a pharmacodynamic interaction exists; at issue is its clinical relevance. For the majority of patients, the interaction likely poses no serious threat. However, for an unidentifiable subset of patients carrying the wrong mix of drugs, doses, comorbidities, and genetics, a clinically important drug interaction remains a real possibility. Circulation. 2009;120:2310-2312

  6. Overall noncompliance rate was 22% (n = 138), while such risks were significantly higher in stroke survivors (n = 79, or 38%) Am Heart J 2009;158:925-32

  7. Was tun? sicherstellen, dass der Pat. seine Aggregationshemmer auch nimmt Strenge Indikationsstellung für PPI Eventuell H2-Rezeptorantagonisten Prasugrel zeigt die Interaktion nicht

  8. Intima-Media Thickness of the Carotid Artery during 24 and 14 Months of Therapy ENHANCE-Trial ARBITER-6 HALTS Kastelein J et al. N Engl J Med 2008;358:1431-1443 Taylor A et al. N Engl J Med 2009;361:2113-2122

  9. Incident Cancer (Safety Population) Rossebo A et al. N Engl J Med 2008;359:1343-1356

  10. Ezetimibe and Cancer — An Uncertain Association „When the cancer mortality data from the SEAS, SHARP, and IMPROVE-IT trials were combined, there was an increase in cancer mortality risk in the combined ezetimibe groups (134 deaths, as compared with 92 deaths in controls; risk ratio, 1.45; 95% CI, 1.02 to 2.05; uncorrected P=0.007). Because this P value was obtained from one of several data-driven analyses rather than from a test of a single prespecified hypothesis, it should be interpreted cautiously. The Oxford researchers believe that this finding is due entirely to the play of chance rather than to a true increase in cancer mortality.“ Drazen et al., NEJM 2008;359:1398

  11. Ezetimibe

  12. Ezetimibe “During the trial, investigators reported an increased number of cancers and cancer-related deaths in patients using Vytorin compared to placebo. Cancer was reported in 105 patients (11.1%) in the Vytorin group and in 70 patients (7.5%) in the placebo group. The number of deaths from cancer was also higher in the Vytorin group, with 39 deaths compared to 23 deaths in the placebo group. A large body of long-term clinical data indicates that simvastatin is not associated with an increased risk of cancer, but long-term clinical data on ezetimibe is insufficient to definitely rule out a cancer risk at this time.” FDA Statement 22.12.2009

  13. 16.12.2009 JUPITER – Trial N Engl J Med 2008;359:2195

  14. Rosuvastatin and Cardiovascular Eventsin Patients Undergoing Hemodialysis Fellström et al., AURORA – Study NEJM 360 (2009) 1395

  15. ConclusionsWith the exception of the extra protective effect of β blockers given shortly after a myocardial infarction and the minor additional effect of calcium channel blockers in preventing stroke, all the classes of blood pressure lowering drugs have a similar effect in reducing CHD events and stroke for a given reduction in blood pressure so excluding material pleiotropic effects. The proportional reduction in cardiovascular disease events was the same or similar regardless of pretreatment blood pressure and the presence or absence of existing cardiovascular disease. Guidelines on the use of blood pressure lowering drugs can be simplified so that drugs are offered to people with all levels of blood pressure.

  16. Die Senkung des Blutdruckes ist die Hauptsache ! Law et al., BMJ 2009,

  17. Das Vorderwandaneurysma outcome of patients randomised to CABG with or without surgical ventricular reconstruction Ergebnis ?????

  18. Die optimale medikamentöse Therapie ist nicht schlecht! Nienaber et al., Circulation 2009;120:2519-2528

  19. 77 years, NYHA III, EF 30%, Crea 1,33, BNP ~4000 Conclusion: Heart failure therapy guided by N-terminal BNP did not improve overall clinical outcomes or quality of life compared with symptom-guided treatment. Pfisterer et al., JAMA. 2009;301:383-392

  20. Defibrillator Implantation Early after Myocardial Infarction Steinbeck et al., NEJM 361(2009)1427 n = 898 von 62944 Pat., 5-31 Tage nach MI, EF <40%, VT >150/min

  21. Ihnen Allen ein gesundes neues Jahr! erland.erdmann@uni-koeln.de

  22. The Obesity Paradox, Weight Loss, and Coronary Disease Lavie et al., The American Journal of Medicine (2009) 122, 1106-1114

  23. RE-LY - Study

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