Dr. Christopher Cannon highlights his top 3 CV news picks for the week of October 25, 2010.
With this week’s cardiology countdown will begin with the stock market the investigators aduke looked in the duke database of patients undergoing angiography and found that the rate of mi increased as the stock market fell they observe this over the period of 2006 to 2009 and focused in particular on the stock market crash that was between october of 2008 and april
Of 2009 where they saw a significant increase in the risk of mi and that was true even after adjusting for other confounding factors it’s certainly something that we’ve heard about with individual acute stresses such as earthquakes scud missiles or losing a super bowl but now a more chronic one seeing to relate to an increase in heart attack risk the good news
Of course is that the stock market has been rising lately and the rate of mi has been falling in there more recent data now at this week’s number two spot is a study that’s a collaborative meta-analysis our group was part of it looking at clopidogrel and the to see 19 reduced function alleles this has been a hot topic in part because the fda has added a black box
Warning about reduced function poor metabolizers that is homozygous for the to see 19 reduced function alleles warning of reduced effectiveness so this collaborative meta-analysis looked at the question of whether the risk is present if you have just one allele or whether both alleles are necessary for the increased risk what was seen in this observational study was
That even just one reduce function allele was associated with an increased risk but there was a dose response with a higher risk seen with to reduce function deals now the other thing is that these studies identifying the wrist have been seen in patients largely with acute coronary syndromes undergoing pci which would be the highest risk group and those at risk of
Stent thrombosis and so the notion is that that may be the group where this is most important recently there have been data published from the cure trial that had a minority of patients undergoing pci where the two c19 reduced function allele either heterozygous or homozygous was not that important a factor and so certainly more evolving information in this field
In this week’s topic is a study that looked at warfarin discontinuation we’ve talked a lot about in many studies with clopidogrel discontinuation but warfarin discontinuation and atrial fibrillation may be just as serious with an increase in stroke risk and so out of a database from kaiser permanente with over 13,500 individuals followed for about six years they
Found that one in four patients discontinued their warfarin many of them were low risk patients and younger patients and so they couldn’t tell but thought that perhaps they were low enough risk felt that it was safe for them to discontinue but but they did note that many of these may have been inappropriate discontinuations in that those who had poor inr control
Were one of the predictors of an increased chance of stopping medication and so this ties into the whole issue of medication compliance that we need to work with our patients for all medications and also does touch upon the recent approval this past week of an alternate agent dabbagh atra nor dabigatran which is an agent that does not require inr monitoring and
We’ll have to see how that plays out as it is approved in clinical practice as to whether that could be a way improve compliance with oral anticoagulation so with this week’s cardiology countdown i’m chris cannon you
Transcribed from video
Cardiology Countdown | Stock Market, Clopidogrel and Warfarin By American College of Cardiology Video Archive
