Risks and Benefits of Dual Antiplatelet Therapy Beyond 12 Months After Coronary Stenting: A Prospective Randomized Cohort Study.

The optimal duration of dual antiplatelet therapy (DAT) after coronary stenting remains poorly define. The aim of this study was to evaluate the impact of longer than 24 months DAT in patients who received drug-eluting and bare-metal stents.A total of 1010 individuals who underwent elective, urgent or emergency coronary angioplasty with intended stent implantation at reference or specialized cardiac hospitals were randomized to receive long-term and short-term DAT to determine the benefits and adverse effects of long-term DAT. Total of 508 patients were randomized to long-term and 502 patients to <1 year DAT, and all of them were followed for more than 36 months for major adverse cardiac and cerebvascular events and bleeding major adverse cardiac and cerebvascular events (MACCE)Mean age of the 1010 patients (364 women and 646 men) was 60 years. Stent reocclusion occurred in 15 patients. Mean Syntax score was 23.00 ±â€Š5.08 for whole samples, 25.00 ±â€Š5.27 in 28 patients with MACCE and 23 ±â€Š5.00 in 982 patients without MACCE (P = 0.057). According to all specified bleeding definitions, clopidogrel therapy for >12 months was not associated with a greater risk of hemorrhage. A regimen of >12 months of clopidogrel therapy in patients who had received drug-eluting or bare-metal stents did not differ significantly from a regimen of <12 months on clopidogrel with regard to MACCE.Long-term DAT might not significantly affect the reduction in the risk of death from any cause, myocardial infarction, or stroke, and not associated with minor or major bleeding events.

The impact of health-related quality of life on the incidence of ischaemic heart disease and stroke; a cohort study in an Iranian population.

OBJECTIVE: The aim of study was to evaluate the impact of health-related quality of life (QoL) on the occurrence of ischaemic heart disease (IHD) and stroke using a validated questionnaire. METHODS: We followed the 3,283 subjects, aged ≥ 35 years and without history of cardiovascular events (CVE) over four years from 2007 to 2011 from the Isfahan cohort study. The World Health Organization QoL questionnaire (WHOQOL-BREF), which contains four separate domains, was used to assess QoL. Incidence rates of IHD and stroke were recorded during follow-up. Socioeconomic demographic data including marital state, educational level, occupation, income and place of living and metabolic risk factors such as diabetes mellitus (DM), hypertension (HTN), dyslipidaemia, body mass index and smoking were also recorded. RESULTS: More IHD (42%) and stroke (57%) patients were illiterate; while the educational status was significantly different only in the IHD group (P = 0.000). Differences in income and occupation were notable in patients with stroke and IHD, respectively, compared to subjects without them (P < 0.050). DM and HTN were significantly higher in IHD and stroke patients in comparison with subjects without CVE (P = 0.000). Two-way multivariate analyses of covariance test after age, educational status and metabolic risk factors adjustment showed that subjects with stroke had a significantly higher score in all QoL domains in comparison with individuals without stroke (P < 0.050). There was no significant association between QoL domains and IHD incidence (P > 0.050). CONCLUSION: This study indicates that there is no association between QoL and IHD incidence although there was a significant relationship between higher QoL and incidence of stroke.

Antioxidant Activity of Heracleum persicum Fruit Extract: Evidence from a Randomized Controlled Trial.

Oxidative stress is a unifying feature of several cardiometabolic risk factors, and has been suggested to be implicated in atherogenesis. This study aimed to investigate the efficacy of supplementation with Heracleum persicum fruit-a common dietary spice-in modulating systemic biomarkers of oxidative stress in subjects undergoing coronary angiography. Twenty-seven subjects with minimal coronary artery disease (CAD; defined as < 50% obstruction in the coronary arteries) were selected for this trial and were randomly allocated to Heracleum persicum hydroalcoholic fruit extract (n = 15; 300 mg/day) or placebo (n = 12) for a period of six months. Patients were visited monthly and asked to report the adverse events during the treatment period. Serum levels of malondialdehyde (MDA), reduced glutathione (GSH) and total antioxidant capacity (TAC), and enzymatic activities of glutathione peroxidase (GPx), superoxide dismutase (SOD), and catalase (CAT) were determined at baseline and at the end of trial. Comparison of changes in the evaluated biomarkers of oxidative stress indicated a significantly greater effect of H. persicum extract versus placebo in reducing serum MDA (p = .001), and elevating GSH (p = .001), and TAC (p = .001) concentrations, as well as activities of GPx (p = .001) and CAT (p = .001). The groups were comparable with respect to changes in serum SOD activities during the course of trial (p = .255). The findings of the present randomized double-blind placebo-controlled trial clearly support the efficacy of H. persicum fruit extract as a safe antioxidant supplement in subjects with minimal CAD.

Efficacy and Safety of Dorocontin(®) versus Sustac(®) in the Treatment of Stable Angina Pectoris: A Randomized, Double-Blind Comparative Trial.

BACKGROUND: Development of generic drugs has numerous benefits in terms of cost-efficiency and availability. Slow-release nitroglycerin is a vasodilator drug commonly prescribed for patients with angina pectoris. OBJECTIVE: The objective of this study was to compare the efficacy and safety of generic slow-release nitroglycerin (Dorocontin(®)) with that of the innovator brand (Sustac(®)) in patients with stable angina pectoris. METHODS: In this randomized, double-blind comparative trial, 110 patients were allocated to Dorocontin(®) (n=67) or Sustac(®) (n=43) at a dose of 6.4 mg TID, for a total period of two months. Maximum endurable MET (metabolic equivalent of task), MPI (myocardial perfusion imaging), along with changes in the ECG and biomarkers of renal (serum creatinine, BUN) and hepatic (AST, ALT, and ALP) function, lipid profile (total cholesterol, LDL-C, HDL-C, VLDL-C, and triglycerides), electrolytes (Na(+) and K(+)), CBC-diff (RBC, WBC, Plt, Hb, Hct, MCV, MCH, MCHC, and RDW), and FBS were assessed at the baseline and at the end of the trial. The frequency of adverse events during the course of the trial was also recorded. RESULTS: Apart from a significantly greater reduction in maximum ST depression in the Sustac(®) versus the Dorocontin(®) group (p=0.03), none of the functional (MET, MPI, and ECG) and paraclinical (renal function, hepatic function, lipid profile, electrolytes, and FBS) parameters significantly differed between the study groups. The mean Hb (p=0.035), Hct (p=0.045), and MCH (p=0.032) were decreased by the end of the trial in the Sustac(®), but not in the Dorocontin(®) group, whilst there was no change in other CBC-diff parameters. Reported adverse events were not serious and included headache, vertigo, gastrointestinal upset, and orthostatic hypotension. The frequency of these adverse events was comparable between the study groups. CONCLUSION: The findings of the present trial showed comparable efficacy and safety of the generic and innovator products of slow-release nitroglycerin in the management of stable angina pectoris.

Atorvastatin therapy is not associated with slowing the progression of aortic stenosis: findings of a randomized controlled trial.

BACKGROUND: Aortic stenosis (AS) is the most common type of valvular cardiac disorders. AS has many risk factors in common with atherosclerosis. Hypercholesterolemia is an important pathomechanism for AS. However, the impact of statin drugs on slowing AS progression has not yet been well established. OBJECTIVE: To investigate the impact of statin therapy on slowing AS progression. METHODS: This was a randomized double-blind placebo-controlled trial in which 75 patients with mild to moderate AS were randomized to receive either simvastatin (20 mg/day) or placebo for a period of one year. Serum lipid profile, C-reactive protein (CRP), and echocardiographic parameters were evaluated at baseline as well as at the end of trial. RESULTS: Treatment with atorvastatin was associated with significant decreases in total cholesterol, triglycerides, and LDL-C and an elevation of HDL-C. None of the lipid profile parameters changed in the placebo group. Serum CRP was not significantly altered in any of the groups. Left ventricular end-systolic volume was significantly increased by the end of trial in the statin group (p = 0.012). In the placebo group, significant increases were observed for aortic valve mean (p = 0.017) and peak (p < 0.001) gradient. Other echocardiographic measures remained statistically unchanged in the statin and placebo groups. The number of patients whose disease progressed into severe stage was comparable between the groups and post-trial echocardiographic assessment did not reveal any significant change in the severity of AS between atorvastatin and placebo (p > 0.05). CONCLUSIONS: The findings of the present randomized trial did not support a beneficial effect of statin therapy (20 mg/day) against AS progression in Iranian patients with mild to moderate disease.

A very rare case of single coronary artery anomaly, with left anterior descending and left circumflex arteries originating separately from proximal right coronary artery.

Coronary artery anomalies are rare, with the reported prevalence of 0.2% to 1% in routine angiographic studies. Among them, presence of a single coronary artery is one of the rarest anomalies, comprising less than 3% of all coronary anomalies. In this article we report a case of single coronary artery anomaly with left anterior descending and left circumflex arteries arising separately from proximal right coronary artery, and left anterior descending artery reaching atrioventricular sulcus by passing between aortic and pulmonary artery trunci. The patient underwent off-pump coronary artery bypass grafting and is currently symptom-free.