Door Remains Ajar for RAS Inhibition
for Hypertrophic Cardiomyopathy
According to Anna Axelsson, MD, Harvard Medical
School, who presented the data, the double-blind,
randomized INHERIT trial ”did not demonstrate an
effect of losartan on left ventricular mass compared
to placebo in patients with overt hypertrophic cardiomyopathy and there was no effect on maximal
wall thickness, connective tissue in the heart wall,
exercise capacity or ability of the heart to relax.”
Despite the negative trial results, Euan Ashley, MD,
PhD, Stanford Center for Inherited Cardiovascular
Disease, Palo Alto, California and the trial discussant,
told the press that INHERIT doesn’t close the door
on renin-angiotensin system (RAS) blockade in
hypertrophic cardiomyopathy. “It may be that a drop
of 12 g/m2 was an ambitious aim in this study and I
certainly don’t think these findings close the door on
the idea of blocking the renin-angiotensin system for
therapeutic benefit in this disease.”
Dementia in Patients on Chronic
Antiplatelet/Anticoagulant Therapy
Although the mechanism is not clear, patients with
atrial fibrillation (AF) are at higher risk of developing
all forms of dementia. Investigators evaluated 1,031
patients on aspirin plus chronic warfarin therapy
(target international normalized ratio [INR] of 2-3)
who were managed by the Intermountain Healthcare Clinical Pharmacist Anticoagulation Service
(CPAS). The study patients had AF but no history
of dementia or stroke/transient ischemic attack.
Percent time with an INR above 3.0 was determined, and the primary outcome was the presence
of dementia defined by neurology determined ICD9 codes. After adjusting for traditional stroke and
bleeding risk factors, patients who had abnormally
slow blood clotting times — INRs >3 — on 25%
or more of their monitoring tests were more than
twice as likely to be diagnosed with dementia than
patients whose tests showed overtreatment <10%
of the time. The increase is higher than what has
been previously reported in patients on warfarin
alone.
According to T. Jared Bunch, MD, lead author
of the study and director of electrophysiology at
the Intermountain Medical Center Heart Institute
in Murray, Utah, “Even at skilled centers, it’s very
common to have INR outside the ideal range up to
40% of the time, and over the years there may be an
accumulative negative impact on cognitive ability.”
Oxygen vs. Air: Air Wins
When a patient suffering a possible MI is routinely
given oxygen, the patient in that mask looks sick,
but will the oxygen actually make them better than
bre