CLINICAL
NEWS JACC in a FLASH
Featured topics in the current and recent
issues of the JACC family of journals
“There has been
increasing
interest in the
importance
of heart rate
lowering in HF
patients.”
—Christopher M. O’Connor, MD
The High Risk of Low-Dose BB in HF
In heart failure patients, higher doses
of beta-blockers may be associated
with a significant reduction in allcause hospitalization and all-cause
death compared to reduced heart
rate, according to a study published in
JACC: Heart Failure.
The study, led by Mona Fiuzat,
PharmD, from Duke University and
Duke Clinical Research Institute,
examined data from the HF-ACTION
trial. Patients receiving angiotensinconverting enzyme (ACE)-inhibitors
and/or angiotensin receptor blockers
and beta-adrenergic blockade for six
or more weeks were eligible. The HFACTION trial included 2,331 patients
and only 128 (5.5%) were not on
beta-blockers. The currently analysis
included 2,320 patients. The primary
endpoint was all-cause mortality or
all-cause hospitalization.
Researchers found a significant
inverse relationship between either
higher beta-blocker dose or lower
heart rate and all-cause death or hospitalization. However, after adjusting
20 CardioSource WorldNews
for variables found to be significantly
associated with the primary endpoint,
only higher beta-blocker dose remained significantly associated with
improved outcomes regardless of high
or low heart rate. There did not appear to be a difference in N-terminal
of the prohormone brain natriuretic
peptide changes between the two
groups, although the researchers did
observe a greater absolute change in
the higher dose groups.
According to the study authors,
these findings suggest that titrating
beta-blockers may offer a greater
benefit to heart failure patients than
reducing heart rate.
“There has been increasing interest in the importance of heart rate
lowering in heart failure patients,”
said Christopher M. O’Connor, MD,
editor-in-chief of JACC: Heart Failure
and a co-author of the study. “However, data has shown that beta-blockers are often not titrated to target
doses, and that doing so may improve
outcomes. Our study supports the
concept that titrating to target betablocker dose should be first line in
improving outcomes.”
Fiuzat M, Wojdyla D, Pina I, et al.
JCHF. 2016;4(2):109-15.
Coronary Artery
Calcium and Risk of
Dementia
Patients aged 80 and older are much
more likely to suffer from dementia
than coronary heart disease (CHD),
according to a study published in
JACC. These findings highlight the
important association between risks
of dementia and CHD.
The prevention and treatment
of cardiovascular disease has led
to greater longevity, which, in turn,
has resulted in an increasingly
older population at greater risk
for dementia. An important unanswered question is whether older
subjects who survive to the age of
80 and older with minimal atherosclerosis have a reduced risk of
dementia.
Researchers led by Lewis H.
Keller, MD, DrPH, examined participants of the Cardiovascular StudyCognition study to determine whether
coronary artery calcium (CAC) and
other measures of subclinical vascular
disease predict the risk of death and
the risk of dementia and CHD. The
final analysis included 311 patients
free of clinical coronary artery disease (CAD) at baseline.
CHD was determined to be the
cause of 25% of deaths, while stroke
accounted for 6% and dementia for
16% of deaths. About 64% of those
who died had a prior diagnosis of
dementia, on an average of 5 years
before death. CAC scores were significantly related to mortality in white
men and black women, and showed a
nonsignificant trend in white women.
CAC scores > 400 were an independent significant predictor of mortality compared to CAC scores <10.
In white women, the incidence of
dementia with a CAC score of 0 was
March 2016