Featured topics in the current and recent issues of the JACC family of journals
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Featured topics in the current and recent issues of the JACC family of journals
Study Explores Prescribing Habits for AF Patients at Risk for Stroke
More than one-in-three patients with atrial fibrillation ( AF ), or irregular heartbeat , with an intermediate-tohigh risk of stroke are prescribed aspirin instead of oral anticoagulants , despite guidelines recommending the use of oral anticoagulants for this group of patients , according to a study published June 20 in JACC .
Using data from the ACC ’ s PIN- NACLE Registry ®, researchers looked at records from 210,380 patients with a CHADS2 score greater than or equal to two between Jan . 2008 , and Dec . 2012 . In a secondary analysis , the researchers assessed records from 294,642 patients with a comparable CHA2DS2-VASc score during the same timeframe .
Results showed that among the CHADS2 group , 38 % were treated with aspirin , and nearly 62 % were treated with oral anticoagulants . Among the CHA2DS2-VASc group , 40 % were treated with aspirin , while 60 % were treated with oral anticoagulants .
For both groups , AF patients who were prescribed aspirin were younger , had a lower body mass index , were more likely to be female , and were more likely to have another medical condition , including diabetes , hypertension , high cholesterol , coronary artery disease , prior heart attack , prior coronary artery bypass graft surgery or peripheral artery disease . Those prescribed oral anticoagulants were more likely to be male , have a higher body mass index , a history of a prior stroke or blood clot , or a history of congestive heart failure .
Jonathan C . Hsu , MD , MAS , the study ’ s lead author and assistant clinical professor of medicine , cardiology and cardiac electrophysiology at the University of California , San Diego , CA , said cardiovascular specialists may be prescribing aspirin instead of oral anticoagulants because they have “ the misperception that aspirin exhibits adequate efficacy compared to oral anticoagulants .” He also noted that men had a 6 % greater likelihood of being prescribed anticoagulants despite the fact that women have an increased risk of stroke .
In an accompanying editorial , Sanjay Deshpande , MD , medical director of electrophysiology at Columbia St . Mary ’ s Hospital , in Milwaukee , WI , and L . Samuel Wann , MD , a cardiologist at Columbia St . Mary ’ s Hospital , said that clinicians may not realize that aspirin puts patients at risk for bleeding with “ virtually no protection from stroke .”
“ It is concerning that the highly motivated , conscientious , and talented cardiologists working in quality-conscious institutions that contribute their data to the NCDR ® are not prescribing anti-coagulation in one-third of their qualifying patients , as defined by our guidelines ,” the editorial authors wrote .
Deshpande and Wann said “ new and definitive evidence ” demonstrates that anticoagulation , not aspirin , is the treatment of choice to prevent strokes related to atrial fibrillation , but they acknowledged that anticoagulation is difficult , “ entailing compliance with a long-term regimen that many patients and their physicians find burdensome .”
Hsu JC , Maddox TM , Kennedy K , et al . J Am Coll Cardiol . 2016 ; 67 ( 25 ): 2914-23 .
Before You Turn on that Cigarette …
Electronic cigarettes may increase aortic stiffness and blood pressure ( BP ), according to a recent study published in JACC .
Charalambos Vlachopoulos , MD , and colleagues studied 24 smokers aged 30 ± 8 years who were free of other cardiovascular risk factors . The participants were examined on four occasions where they were given tobacco cigarettes over 5 minutes , electronic cigarettes over 5 minutes , electronic cigarettes over 30 minutes , and nothing ( sham procedure ) for 60 minutes . Smoking electronic cigarettes for 5 minutes was chosen as a direct comparison with tobacco cigarettes as the nicotine delivery is far slower , while smoking electronic cigarettes for 30 minutes mimics the common pattern of electronic cigarette smoking . Carotid-femoral pulse-wave velocity ( PWV ) was used to assess aortic stiffness .
Results found that heart rates increased in tobacco and 30-minute electronic cigarette smoking sessions by 4.0 beats per minute after five minutes ( p < 0.05 ) and by 3.1 beats per minute after 30 minutes , respectively , but the effects of smoking electronic cigarettes for 5 minutes was minimal . Both types of cigarettes increased systolic BP and the differences between the two were not significant . Similar changes were observed for diastolic BP . PWV increased immediately , by 0.44 m / s , after the end of tobacco smoking and remained increased throughout the whole period . Smoking electronic cigarettes for 5 minutes induced a 0.19 m / s increase after 15 minutes and smoking them for 30 minutes saw a 0.36 m / s increase immediately after .
Study authors noted that compared with tobacco cigarettes , smoking electronic cigarettes for 5 minutes resulted in a less potent PWV increase throughout the study ( F = 4.425 , p = 0.005 ), while smoking electronic cigarettes for 30 minutes lead to a PWV increase similar to that of tobacco smoking during the same period ( F = 0.268 , p = 0.615 ).
With the spread of electronic cigarette smoking spreading worldwide , especially among younger ages , the study authors say their findings “ have important implications that could
Anticoagulation , not aspirin , is the treatment of choice to prevent strokes related to atrial fibrillation .
aid recommendations regarding the use of [ electronic cigarette ] smoking .” In particular , they highlight the prognostic role of aortic stiffness and increased BP for future cardiovascular events and mortality and the results showing impacts of prolonged exposure to electronic cigarette smoking throughout the day .
Vlachopoulos C , Ioakeimidis N , Abdelrasoul M , et al . J Am Coll Cardiol . 2016 ; 67 ( 23 ): 2802-03 .
Pharmacists ’ Interventions May Cut CVD Risk
Pharmacists may be able to identify patients with poorly controlled cardiovascular disease ( CVD ) risk factors , helping to significantly reduce the risk of cardiovascular events in these patients , according to a study published June 13 in JACC .
Poor control of CVD risk factors is still prevalent , and community pharmacists frequently see patients with
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