Featured Coverage

• COURAGE: Revascularization and Aggressive Drug Evaluation in Stable Coronary Artery Disease -- Mortality, Quality of Life, and Cost-EffectivenessThese results have spawned considerable attention, and at times, controversy, over the way that we treat patients with stable coronary artery disease.

HDL-Targeted Therapies: Still the Best Way Forward?

• Novel HDL-Targeted Therapies -- The Search ContinuesWith the initial failure of CETP inhibition as an HDL therapeutic agent, PPAR-alpha agonists or ApoA-I mimetics are the next classes of agents to show promise.
• ILLUSTRATE, RADIANCE, and ERASE: What Do the Imaging Trials With Torcetrapib Tell Us?The clinical endpoints trial with torcetrapib, ILLUMINATE, was canceled early because of too many deaths. Can the results of 3 imaging studies tell us what happened?
• Niacin (Nicotinic Acid) -- The Old Drug Making a Comeback With a New ActNiacin is the only currently approved drug shown to be effective in raising HDL cholesterol levels -- but how effective, and can the flushing effect be controlled?

Statins and Beyond: Good News About Lowering LDL Cholesterol

• Heart Protection Study Follow-up Confirms Consistent Benefit and Long-term Safety of Statin TreatmentHPS documented the benefits of statin therapy, even in individuals thought to be at low risk. New examination of the trial's long-term follow-up provides more support for simvastatin therapy.
• Statin Therapy Slows Progression of Arterial Thickening in People at Low Risk for Coronary Heart DiseaseThese trial results seem to show that aggressive statin therapy slows progression of atherosclerosis, even in low-risk individuals; but do they support a new strategy?
• Study Identifies Patients Less Likely to Respond to Statins vs EzetimibeElevated LDL cholesterol can be treated by inhibiting either production or absorption -- but are there different patient phenotypes who respond differentially to these 2 approaches?
• Long-term Beneficial Effect of Rosuvastatin on Renal FunctionContrary to 'common knowledge,' it turns out high-dose statin therapy (with rosuvastatin) may actually be renoprotective.
• Antisense Drug ISIS 301012 Lowers LDL Cholesterol Alone and in Combination With StatinsFamilial hypercholesterolemia remains a therapeutic challenge, and so positive results with a new therapeutic approach are promising.

Lowering Blood Pressure: New Approaches via Renin-Angiotensin System Inhibition

• Continued Debate About "Benefit Beyond Blood Pressure Control"Was it the blood pressure (lowering), or was it the drug? With the presentation of this meta-analysis, the debate continues.
• Aliskiren as Monotherapy and in Combination With Other AgentsThe initial results with the direct renin inhibitor aliskiren are good -- but are they definitive?
• Dual Inhibition of the RAAS With Valsartan and Aliskiren, the New Direct Renin InhibitorThe goal of more complete inhibition of the renin-angiotensin-aldosterone system appears to take a step closer with addition of a direct renin inhibitor, alone or in combination.
• The VALsartan In Diastolic Dysfunction (VALIDD) TrialClinicians will be aware that about 50% of all HF patients have preserved LV function -- but few trials have addressed their therapy -- so the VALIDD results have a special validity.
• Chronic Treatment of Resistant Hypertension With the Rheos Baroreflex Hypertension Therapy SystemDevice-based therapy has proven effective in many aspects of cardiovascular disease -- but can a device offer control of resistant hypertension?

Heart Failure

• Nesiritide Infusions for the Management of Decompensated Heart Failure -- Safety and Efficacy Results of the FUSION II TrialThe safety of nesiritide in patients with acutely decompensated heart failure has been a concern. The results of FUSION II may help put some of those concerns to rest.
• Efficacy of Vasopressin Antagonism in Decompensated Heart Failure -- Results of the EVEREST TrialThe addition of tolvaptan, a V₂ receptor antagonist, to standard medical therapy in HF patients with signs of fluid overload improved symptoms of HF, but was there a mortality benefit?
• SPICE: The Use of Hawthorn Extract in Congestive Heart FailureThese results may be a great source for future research; however, until then, the use of hawthorn extract remains only a homeopathic treatment with no proven beneficial effect in congestive heart failure patients.
• ALPHA: The Use of T-Wave Alternans to Assess Risk in Patients With Nonischemic Heart FailureALPHA extends the earlier findings suggesting that a negative predictive value in patients with ischemic cardiomyopathy can also be applied to a nonischemic patient population.

Drug-Eluting Stents

• ABSORB: First-in-Man Evaluation of a Fully Bioabsorbable Everolimus-Eluting Coronary Stent -- 6-Month Angiographic and IVUS ResultsAlthough only preliminary, the ABSORB results serve us to understand and improve the design of bioabsorbable stents.
• ISAR-PEACE: The Addition of Estradiol to a Rapamycin-Eluting StentThe results from ISAR-PEACE are similar to those seen previously with estradiol-alone eluting stents.
• SPIRIT III: Evaluation of the XIENCE V Everolimus-Eluting Stent -- Clinical, Angiographic, and IVUS ResultsDo the results from this pivotal trial suggest that another drug-eluting stent may be entering the US market soon?
• Western Denmark Heart Registry: Rate of Stent Thrombosis With Drug-Eluting vs Bare-Metal StentsThis large, real-world experience suggests that a follow-up period of 12 months after drug-eluting stent implantation may be too brief to draw exact conclusions on the safety of these devices.
• RE-CLOSE: Low Responsiveness to Clopidogrel and Sirolimus- or Paclitaxel-Eluting Stent ThrombosisIs nonresponsiveness to clopidogrel a strong, independent predictor of stent thrombosis in patients treated with drug-eluting stents?

Acute Coronary Syndromes

• ACUITY: Bivalirudin in Acute Coronary Syndromes -- 1-Year ResultsThe long-term follow-up of these patients further establishes bivalirudin as the anticoagulant of choice during percutaneous coronary interventions in ACS patients.
• ARISE: Effects of Succinobucol, an Antioxidant and Anti-inflammatory, on Clinical Events in Patients With Acute Coronary SyndromeAlthough the results of ARISE failed to achieve their primary endpoint, the use of succinobucol had a beneficial effect on other hard endpoints that warrant further study.
• MERLIN-TIMI 36: Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST Elevation Acute Coronary SyndromesThe MERLIN-TIMI 36 trial shows that the use of ranolazine can be extended to a broader population of patients than previously studied who present with an acute coronary syndrome.

Renal Function

• MEENA: Prevention of Contrast-Induced Nephropathy With Sodium Bicarbonate in Persons Undergoing Coronary AngiographyContrast-induced nephropathy and its prevention continue to be an area of intense research and, at the same time, of controversy due to conflicting results from different studies, including this one.
• RESIST: Embolic Protection and Platelet Inhibition During Renal Artery StentingRESIST is a small, but certainly interesting study that may help us improve the outcomes of patients who undergo renal artery revascularization with stents.

Conference News

• Higher Levels of Inflammatory Marker Associated with Depression in HFA new study shows that heart failure patients with higher levels of tumor necrosis factor receptor 1, a marker of inflammation, had an increased risk for depression, up to almost 5-fold for those with levels in the highest quartile.
  Medscape Medical News, April 11, 2007
• Calcium Scores May Be More Meaningful in Lower-Risk PatientsNew recommendations for CAC scoring suggest the test may meaningfully reclassify "intermediate"-risk patients as high-risk if their scores are >400, but a new analysis from the Dallas Heart Study says this strategy is inefficient and may miss patients in whom a CAC test might lead to important changes in CVD prevention strategies.
  Heartwire, April 4, 2007
• Two-Year Results From ENDEAVOR III Point to Safety, EfficacyRates of major adverse cardiac events and target lesion revascularizations at two years were the same for the two drug-eluting stents, although fewer patients randomized to the Endeavor experienced periprocedural non-Q-wave MI, a difference that was maintained over the two years of follow-up.
  Heartwire, April 4, 2007
• EXACT/CAPTURE-2: Postmarketing Carotid Stent Registry DataResearchers are reporting low rates of death, stroke, and MI and a trend to better outcomes with increased operator experience in FDA-mandated postmarketing data for carotid stent and embolic-protection systems.
  Medscape Medical News, April 3, 2007
• UNLOAD Raises Questions About How Ultrafiltration, Diuretics Work in Acute Heart FailureDo the clinical effects of volume reduction depend on how it's achieved? A post hoc analysis shows different outcomes even after comparable fluid loss.
  Heartwire, April 3, 2007
• Both Mediterranean and AHA-Recommended Diets Reduce Events Post-MIBoth the omega-3-rich Mediterranean diet and the low-fat AHA diet produced impressive reductions in adverse events, as compared with standard care, over 24 months, investigators say. The findings underscore the value of intensively--and repeatedly--offering patients dietary advice.
  Heartwire, March 30, 2007
• No Nesiritide Kidney Protection or Toxicity Seen in Acute HF With Renal DysfunctionA small placebo-controlled study finds no evidence that the controversial drug affects renal function in an especially high-risk population.
  Heartwire, March 30, 2007
• Hawthorn Extract for Systolic HF Shows No Clinical Effect in Rare Placebo-Controlled Test of Herbal DrugBut it did show that the commercial preparation, derived from a medicinal plant used widely for centuries, was safe when added to conventional HF medications. The study also hinted that the drug may confer some protection against sudden death.
  Heartwire, March 28, 2007
• COURAGE Day Two: Experts Ponder Implications, ApplicabilityOne day after the early release of the COURAGE trial results, debate among doctors about the applicability of the trial findings suggests the study, while putting to rest some important questions, leaves many more unanswered.
  Heartwire, March 28, 2007
• STARR: Rosiglitazone Shows Trend Toward Reduced Atherosclerosis Progression in Prediabetes PatientsThe thiazolidinedione showed a trend toward reduced carotid IMT, but no effect of ramipril was seen in this substudy of the DREAM trial. These results are consistent with those of the main trial, in which rosiglitazone prevented the development of diabetes but ramipril did not.
  Heartwire, March 28, 2007
• Clevidipine: A Viable Alternative to Nitroglycerin, Nitroprusside?The investigational intravenous antihypertensive clevidipine is as safe as conventional treatments--including nitroglycerin, sodium nitroprusside, and nicardipine--when used in the pre-, peri-, and postoperative period of cardiac surgery, and it might also give superior blood-pressure control, according to new data reported here.
  Heartwire, March 28, 2007
• Succinobucol Misses Primary End Point, but Investigators Say Drug Still Has PotentialFull data from the ARISE study were presented this week, and although the study missed its primary end point, investigators say the drug has promise for the reduction of hard cardiovascular events. One expert, however, called the findings neutral and raised questions about certain signals going in the wrong direction.
  Heartwire, March 27, 2007
• MERLIN: No Role for Ranolazine in ACS but First-Line Indication in Stable Angina Now LikelyThe trial failed to show any disease-modifying effect in either ACS or stable disease. But the results did provide reassurance that the drug is not proarrhythmic and suggested that it actually has some antiarrhythmic effects.
  Heartwire, March 27, 2007
• Life After Katrina: A Long Way From Normal in New OrleansReturning to New Orleans for the ACC meeting, with the French Quarter looking much the same as ever and the convention center restored, attendees could be forgiven for thinking that nothing much has changed. But doctors who lived through the horror that was Katrina reminded the meeting that life here is far from normal and it will be many years before this is the case.
  Heartwire, March 27, 2007
• The Trouble With Torcetrapib: Imaging Studies Shed Little Light on Why HDL-Raising Drug FailedThe neutral imaging studies provide a flicker of hope for investigators who believe the drug class still might prove to be a beneficial addition to the toolbox of clinicians looking to raise HDL-cholesterol levels.
  Heartwire, March 27, 2007
• FUSION 2: No Advantage to Outpatient Nesiritide Infusions in Advanced Chronic Heart Failure, but No Harm EitherThe trial quashes the idea that repeated outpatient nesiritide infusions can help patients with the chronic syndrome and, unexpectedly, casts a vote of confidence in the disease-management model of heart-failure care, according to its investigators. There was no evidence that the drug hurt the kidneys, but the trial may have little to say about the safety of nesiritide when given for its labeled indication, acute decompensated HF.
  Heartwire, March 27, 2007
• ERASE: New HDL Mimetic Shows PromiseTorcetrapib may be dead, but the HDL field is not, with efforts now moving to other methods of increasing this lipoprotein. One such idea, using a new reconstituted HDL product, has shown some promising effects in reducing coronary atherosclerosis, and experts in the field say that further studies of this agent are warranted.
  Heartwire, March 27, 2007
• Aliskiren Plus ARB Boosts Antihypertensive EffectsThe first trial to look at the effect of combining a new direct renin inhibitor, aliskiren, with an angiotensin receptor blocker in a difficult-to-treat hypertensive population finds the two drugs together are more effective at lowering blood pressure than either alone.
  Heartwire, March 27, 2007
• BioABSORBable Stents: A New Era or Pie in the Sky?First-in-human results with a new bioabsorbable everolimus-eluting stent in the ABSORB trial have prompted expert Dr Patrick Serruys to declare that they may constitute "a new era" in the stent world. But a fault in the stent design means a second-generation device will need to be tested before any firm conclusions can be drawn, he admitted.
  Heartwire, March 27, 2007
• Despite DEDICATION, Filter Protection Fails Again in STEMIYet another distal-protection trial has failed its primary end point, showing no differences in infarct size as measured by ST resolution 30 to 90 minutes postprocedure between a strategy of filter-based distal protection and stenting vs no distal protection in stenting.
  Heartwire, March 27, 2007
• Danish Registry Points to Increased MI After 12 Months With DES, but Optimism PrevailsDES use has dropped but stabilized in the US, while staying relatively constant elsewhere, even as new registry results from western Denmark point to an increased risk of stent thrombosis and MI after 12 months in DES-treated patients. Experts say there is still more to the story.
  Heartwire, March 26, 2007
• SPIRITs Buoyed With New XIENCE V Data: Bests Taxus in Head-to-Head StudyThe XIENCE V stent, a second-generation everolimus-eluting stent, was significantly better than the Taxus paclitaxel-eluting stent in preventing in-segment late loss. In addition, the XIENCE stent was shown to be noninferior to the Taxus stent in terms of preventing a number of clinically important end points.
  Heartwire, March 26, 2007
• Novel Antiplatelet "May Reduce Events Without Increasing Bleeding"A phase 2 study in patients undergoing elective PCI has shown encouraging results with a new oral drug that blocks the activation of platelets by thrombin when given on top of aspirin and clopidogrel.
  Heartwire, March 26, 2007
• Medical Therapy Takes COURAGE: No Benefit of PCI Over Optimal Drugs for Preventing Events in Stable CADThe two treatment strategies were no different for deaths, MI, stroke, or composite outcomes over a median of 4.6 years, although freedom from angina rates were higher for PCI at earlier time points. Experts stress that PCI still has a role for symptom management in stable CAD, but not for preventing future events.
  Heartwire, March 26, 2007
• CRP Levels Predict Events in Stable CHD PatientsLevels of CRP are predictive of future risk of cardiovascular events in patients with stable coronary artery disease, and risk starts to increase at lower levels of CRP than previously thought, a new study has shown.
  Heartwire, March 26, 2007
• VALIDD: Lowering Blood Pressure Improves Diastolic DysfunctionBut the trial did not show any additional benefit on diastolic dysfunction of using an antihypertensive therapy based on inhibiting the renin angiotensin system over a regimen using non-RAS inhibitor drugs.
  Heartwire, March 26, 2007
• Novel PPAR-Alpha Agonist Shows No Advantage Over Fenofibrate and Raises Safety ConcernsDespite being more potent and selective, the novel peroxisome proliferator-activated receptor-alpha agonist failed to deliver in two concomitant studies presented today. The drug also raised safety concerns when it was shown to increase serum creatinine levels.
  Heartwire, March 26, 2007
• METEOR: Rosuvastatin Slows Progression of CIMT in Low-Risk SubjectsResults of a randomized trial of rosuvastatin in low-risk individuals--those with a Framingham risk score of less than 10%--show that treatment slowed progression of carotid intima-media thickness vs placebo, although it did not cause disease regression.
  Heartwire, March 26, 2007
• ALPHA Lends Support for TWA Testing in Nonischemic HFDifficult-to-manage nonischemic cardiomyopathy patients are now added to the list of people in whom a normal noninvasive microvolt T-wave alternans test will predict a low likelihood of sudden cardiac death. The findings of the ALPHA study show that this simple test can be used to weed out patients who have a good prognosis and are unlikely to benefit from an ICD, said the lead investigator.
  Heartwire, March 26, 2007
• EVEREST: "Modest" Gains, No Apparent Harm From Vasopressin Antagonist in Acute Heart FailureAdding tolvaptan to standard acute therapy helped manage volume overload and relieve dyspnea, but the benefits were small and there were no improvements in long-term clinical outcome. Is the glass half full or half empty?
  Heartwire, March 26, 2007