A paclitaxel eluting stent for the prevention of coronary restenosis Restenosis occurs in 20–40% of cases after coronary stent implantation, and remains the major drawback of percutaneous coronary intervention. However, the sirolimus eluting stent (Cypher) released last year suggested dramatic reductions in this problem. Now similar data has arrived for the Taxus stent (eluting paclitaxel). These data showed that > 50% restenosis occurred in 4% of the Taxus group versus 27% in the placebo bare stent group (p < 0.001). Although expensive, these stents may represent a cost saving if recurrent procedures are dramatically reduced in real clinical practice.
Park S-J, Shim WH, Ho DS, Raizner AE, Park S-W, Hong M-K, Lee CW, Choi D, Jang Y, Lam R, Weissman NJ, Mintz GS. A paclitaxel-eluting stent for the prevention of coronary restenosis. N Engl J Med 2003;348:1537–45. [PubMed]
Morice M-C, Serruys PW, Sousa JE, et al. A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. N Engl J Med 2002;346:1773–80. [PubMed]
Give atorvastatin 80 mg if there is no revascularisation possible The AVERT trial suggested that atorvastatin 80 mg/day produced a greater reduction in coronary heart disease (CHD) events than did angioplasty with a lower level of statin. It comes as no surprise that in 60 patients in whom revascularisation was not possible, after 12 weeks of treatment, patients in the aggressive lipid lowering treatment group had a significantly greater decrease in mean (SD) low density lipoprotein (LDL) cholesterol concentration than those in the usual care group (29 (38) mg/dl v 7 (24) mg/dl, p = 0.03). Patients in the aggressive treatment group also had a reduction in the number of ischaemic wall segments on stress echocardiography (mean between group difference of 1.3, 95% confidence interval (CI) 0.1 to 2.0; p = 0.04) and angina score after 12 weeks. There were no significant changes in atherosclerotic burden in either group.
Fathi R, Haluska B, Short L, Marwick TH. A randomized trial of aggressive lipid reduction for improvement of myocardial ischemia, symptom status, and vascular function in patients with coronary artery disease not amenable to intervention. Am J Med 2003;114:445–53. [PubMed]
Pitt B, Waters D, Brown WV, et al. Aggressive lipid-lowering therapy compared with angioplasty in stable coronary artery disease. Atorvastatin versus revascularization treatment investigators. N Engl J Med 1999;341:70–6. [PubMed]
Irbesartan does not reduce CVS end points compared to placebo or amlodipine The primary outcomes of the irbesartan diabetic nephropathy trial were doubling of serum creatinine values, end stage renal disease, and death from any cause. The trial recruited 1715 adults with type 2 diabetic nephropathy and hypertension, serum creatinine concentrations of 89 μmol/l to 266 μmol/l, and urinary protein excretion rates of at least 900 mg/day. Data on cardiovascular end points suggests no specific benefit of irbesartan, although marginally fewer patients on amlodipine had myocardial infarction and marginally fewer patients on irbesartan had congestive cardiac failure.
Berl T, Hunsicker LG, Lewis JB, Pfeffer MA, Porush JG, Rouleau J-L, Drury PL, Esmatjes E, Hricik D, Parikh CR, Raz I, Vanhille P, Wiegmann TB, Wolfe BM, Locatelli F, Goldhaber SZ, Lewis EJ, for the Collaborative Study Group. Cardiovascular outcomes in the irbesartan diabetic nephropathy trial of patients with type 2 diabetes and overt nephropathy. Ann Intern Med 2003;138:542–9. [PubMed]
No need for routine transaminase and CK measurements in patients on statins In this study of statin use in > 1000 patients in a primary care practice, routine monitoring revealed no cases of significantly or moderately abnormal transaminase values attributable to statins. No significantly abnormal and only two moderately abnormal creatine kinase (CK) values were potentially attributable to statin use. This study questions the usefulness of routine measurement of transaminase and CK concentrations in all patients taking statins.
Smith CC, Bernstein LI, Davis RB, Rind DM, Shmerling RH. Screening for statin-related toxicity: the yield of transaminase and creatine kinase measurements in a primary care setting. Arch Intern Med 2003;163:688–92. [PubMed]