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Coronary Artery Disease: HELP
Articles by Dan Atar
Based on 7 articles published since 2010
(Why 7 articles?)

Between 2010 and 2020, Dan Atar wrote the following 7 articles about Coronary Artery Disease.
+ Citations + Abstracts
1 Editorial Sudden cardiac death--the challenge to cardiology. 2010

Kjeldsen, Keld / Atar, Dan / Hallén, Jonas / Vardas, Panos / Zannad, Faiez / Haunsø, Stig. · ·Fundam Clin Pharmacol · Pubmed #20854303.

ABSTRACT: -- No abstract --

2 Review The myth of 'stable' coronary artery disease. 2020

Fox, Keith A A / Metra, Marco / Morais, João / Atar, Dan. ·British Heart Foundation Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK. k.a.a.fox@ed.ac.uk. · University of Brescia, Brescia, Italy. · Leiria Hospital Centre, Leiria, Portugal. · Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway. · Institute of Clinical Sciences, University of Oslo, Oslo, Norway. ·Nat Rev Cardiol · Pubmed #31358978.

ABSTRACT: Patients with known cardiovascular disease who have not had a recent acute event are often referred to as having stable coronary artery disease (CAD). The concept of 'stable' CAD is misleading for two important reasons: the continuing risks of cardiovascular events over the longer term and the diverse spectrum of powerful risk characteristics. The risks of cardiovascular events are frequently underestimated and continue to exist, despite current standards of care for secondary prevention, including lifestyle changes, optimal medical therapy, myocardial revascularization and the use of antiplatelet agents to limit thrombosis. In dispelling the myth of 'stable' CAD, we explore the pathophysiology of the disease and the relative contribution of plaque and systemic factors to cardiovascular events. A broader concept of the vulnerable patient, not just the vulnerable plaque, takes into account the diversity and future risks of atherothrombotic events. We also evaluate new and ongoing research into medical therapies aimed at further reducing the risks of cardiovascular events in patients with chronic - but not stable - atherothrombotic disease.

3 Review Choosing a particular oral anticoagulant and dose for stroke prevention in individual patients with non-valvular atrial fibrillation: part 1. 2017

Diener, Hans-Christoph / Aisenberg, James / Ansell, Jack / Atar, Dan / Breithardt, Günter / Eikelboom, John / Ezekowitz, Michael D / Granger, Christopher B / Halperin, Jonathan L / Hohnloser, Stefan H / Hylek, Elaine M / Kirchhof, Paulus / Lane, Deirdre A / Verheugt, Freek W A / Veltkamp, Roland / Lip, Gregory Y H. ·Department of Neurology, University Hospital Essen, Essen, Germany. · Icahn School of Medicine at Mount Sinai, New York, USA. · Hofstra North Shore/LIJ School of Medicine, Hempstead, USA. · Division of Medicine, Oslo University Hospital, Ullevål and University of Oslo, Oslo, Norway. · Division of Rhythmology, Department of Cardiovascular Medicine, Hospital of the University Münster, Münster, Germany. · Population Health Research Institute, McMaster University, Hamilton, ON, Canada. · Cardiovascular Research Foundation, New York, NY, USA. · Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, PA, USA. · Lankenau Medical Center, Wynnewood, PA, USA. · Department of Medicine, Duke University, Durham, NC, USA. · Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, New York, NY, USA. · Division of Clinical Electrophysiology, Department of Cardiology, J. W. Goethe University, Frankfurt, Germany. · Boston Medical Center, Boston University School of Medicine, Boston, MA, USA. · Institute of Cardiovascular Sciences, University of Birmingham, SWBH and UHB NHS Trusts, Birmingham, UK. · Department of Cardiovascular Medicine, Hospital of the University of Münster, Münster, Germany. · University of Birmingham, Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK. · Afdeling Cardiologie, Hartcentrum OLVG, Amsterdam, The Netherlands. · Stroke Medicine, Imperial College London, London, UK. · University of Birmingham, Birmingham, UK. · Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. ·Eur Heart J · Pubmed #26848149.

ABSTRACT: Patients with atrial fibrillation (AF) have a high risk of stroke and mortality, which can be considerably reduced by oral anticoagulants (OAC). Recently, four non-vitamin-K oral anticoagulants (NOACs) were compared with warfarin in large randomized trials for the prevention of stroke and systemic embolism. Today's clinician is faced with the difficult task of selecting a suitable OAC for a patient with a particular clinical profile or a particular pattern of risk factors and concomitant diseases. We reviewed analyses of subgroups of patients from trials of vitamin K antagonists vs. NOACs for stroke prevention in AF with the aim to identify patient groups who might benefit from a particular OAC more than from another. In the first of a two-part review, we discuss the choice of NOAC for stroke prevention in the following subgroups of patients with AF: (i) stable coronary artery disease or peripheral artery disease, including percutaneous coronary intervention with stenting and triple therapy; (ii) cardioversion, ablation and anti-arrhythmic drug therapy; (iii) mechanical valves and rheumatic valve disease, (iv) patients with time in therapeutic range of >70% on warfarin; (v) patients with a single stroke risk factor (CHA2DS2VASc score of 1 in males, 2 in females); and (vi) patients with a single first episode of paroxysmal AF. Although there are no major differences in terms of efficacy and safety between the NOACs for some clinical scenarios, in others we are able to suggest that particular drugs and/or doses be prioritized for anticoagulation.

4 Clinical Trial B-type natriuretic peptide trumps other prognostic markers in patients assessed for coronary disease. 2019

Kotecha, Dipak / Flather, Marcus D / Atar, Dan / Collins, Peter / Pepper, John / Jenkins, Elizabeth / Reid, Christopher M / Eccleston, David / Anonymous201118. ·Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK. d.kotecha@bham.ac.uk. · Monash Centre of Cardiovascular Research and Education in Therapeutics, School of Public Health and Preventive Medicine, Melbourne, Australia. d.kotecha@bham.ac.uk. · Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK. · Department of Cardiology, Oslo University Hospital Ulleval, University of Oslo, Oslo, Norway. · Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK. · Baker Heart and Diabetes Institute, Melbourne, Australia. · Monash Centre of Cardiovascular Research and Education in Therapeutics, School of Public Health and Preventive Medicine, Melbourne, Australia. · Faculty of Health Sciences, School of Public Health, Curtin University, Perth, Australia. ·BMC Med · Pubmed #30943979.

ABSTRACT: BACKGROUND: Risk prediction for patients with suspected coronary artery disease is complex due to the common occurrence of prior cardiovascular disease and extensive risk modification in primary care. Numerous markers have the potential to predict prognosis and guide management, but we currently lack robust 'real-world' evidence for their use. METHODS: Prospective, multicentre observational study of consecutive patients referred for elective coronary angiography. Clinicians were blinded to all risk assessments, consisting of conventional factors, radial artery pulse wave analysis, 5-minute heart rate variability, high-sensitivity C-reactive protein and B-type natriuretic peptide (BNP). Blinded, independent adjudication was performed for all-cause mortality and the composite of death, myocardial infarction or stroke, analysed with Cox proportional hazards regression. RESULTS: Five hundred twenty-two patients were assessed with median age 66 years and 21% prior revascularization. Median baseline left ventricular ejection fraction was 64%, and 62% had ≥ 50% stenosis on angiography. During 5.0 years median follow-up, 30% underwent percutaneous and 16% surgical revascularization. In multivariate analysis, only age and BNP were independently associated with outcomes. The adjusted hazard ratio per log unit increase in BNP was 2.15 for mortality (95% CI 1.45-3.19; p = 0.0001) and 1.27 for composite events (1.04-1.54; p = 0.018). Patients with baseline BNP > 100 pg/mL had substantially higher mortality and composite events (20.9% and 32.2%) than those with BNP ≤ 100 pg/mL (5.6% and 15.5%). BNP improved both classification and discrimination of outcomes (p ≤ 0.003), regardless of left ventricular systolic function. Conversely, high-sensitivity C-reactive protein, pulse wave analysis and heart rate variability were unrelated to prognosis at 5 years after risk modification and treatment of coronary disease. CONCLUSIONS: Conventional risk factors and other markers of arterial compliance, inflammation and autonomic function have limited value for prediction of outcomes in risk-modified patients assessed for coronary disease. BNP can independently identify patients with subtle impairment of cardiac function that might benefit from more intensive management. TRIAL REGISTRATION: Clinicaltrials.gov, NCT00403351 Registered on 22 November 2006.

5 Article Cost effectiveness of drug-eluting stents as compared with bare metal stents in patients with coronary artery disease. 2013

Wisløff, Torbjørn / Atar, Dan / Sønbø Kristiansen, Ivar. ·1Health Economics and Drug Unit, Norwegian Knowledge Centre for the Health Services; 2Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Norway; 3Department of Cardiology B, Oslo University Hospital Ullevål; and 4Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway. ·Am J Ther · Pubmed #21822114.

ABSTRACT: The aim of this study was to estimate the incremental cost effectiveness of replacing bare metal stents (BMS) by drug-eluting stents (DES) when using trial data and registry data. We developed a Markov model (model of cost effectiveness of coronary artery disease) in which 60-year-old patients started by undergoing percutaneous coronary intervention for acute or subacute coronary artery disease. The patients are followed until death or 100 years of age. Data on the occurrence of events (revascularization, acute myocardial infarction, and death) were based on Scandinavian registry data. Separate analyses were conducted with data on effectiveness based on randomized controlled trials and patient registries. On using trial data, it was found that sirolimus-eluting stents (SES) yield 0.003 greater life expectancy and $3300 lower costs than do BMS (dominant strategy). Paclitaxel-eluting stents (PES) yield 0.148 more life years than do SES at additional lifetime costs of $2800 ($21,400 per life year gained). On using registry data, the cost per life year gained was found to be $4900 when replacing BMS with DES. Probabilistic sensitivity analyses, on the other hand, indicate that PES only has a 50%-75% probability of being cost effective, regardless of the type of effectiveness data. DESs are cost effective with current willingness to pay for life year gains. Whether PES or SES is the most effective DES remains uncertain.

6 Article Early impact of prescription Omega-3 fatty acids on platelet biomarkers in patients with coronary artery disease and hypertriglyceridemia. 2011

Serebruany, Victor L / Miller, Michael / Pokov, Alex N / Lynch, Donald / Jensen, Jesper K / Hallén, Jonas / Atar, Dan. ·HeartDrug™ Research LLC, Johns Hopkins University, Towson, Md., USA. Heartdrug @ aol.com ·Cardiology · Pubmed #21701167.

ABSTRACT: BACKGROUND: Prescription omega-3-acid ethyl esters (PO-3A) have been tested for outcome benefits in patients with coronary artery disease (CAD), arrhythmias and heart failure. Some evidence suggests that PO-3A may exert their benefit via inhibiting platelets. We tested the hypothesis that PO-3A may inhibit platelet activity in patients with documented stable CAD, beyond the antiplatelet properties of aspirin and statins. METHODS: Thirty patients with documented CAD and triglycerides over 250 mg/dl treated with aspirin (70-160 mg/daily) and statins (simvastatin equivalence dose: 5-40 mg/daily) were randomized 1:1:1 to Omacor™ 1 g/day (DHA/EPA ratio 1.25:1.0), Omacor 2 g/day, or a placebo for 2 weeks. Platelet tests including aggregometry and flow cytometry and cartridge analyzer readings were performed at baseline and at 1 and 2 weeks following PO-3A therapy. RESULTS: ADP-induced platelet aggregation (p = 0.037), GP IIb/IIIa antigen (p = 0.031) and activity (p = 0.024), and P-selectin (p = 0.041) were significantly reduced after PO-3A, while platelet/endothelial cell adhesion molecule (p = 0.09), vitronectin receptor (p = 0.16), formation of platelet-monocyte microparticles (p = 0.19) and the VerifyNow IIb/IIIa test (p = 0.27) only exhibited nonsignificant trends suggestive of reduced platelet activity. Finally, collagen- and arachidonic acid-induced aggregation, closure time with the PFA-100 device and expression of thrombospondin (CD36), GP Ib (CD42b), LAMP-3 (CD63), LAMP-1 (CD107a), CD40-ligand (CD154), GP37 (CD165), and PAR-1 receptor intact (SPAN 12) and cleaved (WEDE-15) epitopes were not affected by 2 weeks of PO-3A. CONCLUSION: Independently of the dose and already at 1 week, short-term therapy with PO-3A provided a modest reduction of platelet activity biomarkers, despite concomitant aspirin and statin therapy, when compared to a placebo. The effect of PO-3A is unique, differs from other known antiplatelet agents and suggests potential pleiotropism. These preliminary randomized data call for confirmation in prospective studies.

7 Article A window into your heart: taking cardiac troponin to the next level. 2010

Hallén, Jonas / Atar, Dan. ·Department of Cardiology, Oslo University Hospital, Aker & Ullevål, Oslo, Norway. jonashallen@gmail.com ·Biomark Med · Pubmed #21133709.

ABSTRACT: The cardiac troponins are important cardiovascular biomarkers for myocardial necrosis and are measured in thousands of patients daily. In parallel with the widespread adoption of troponin testing for the diagnosis of myocardial infarction during the last two decades, the analytical sensitivity of assays has progressively improved, which has allowed the identification of more acute coronary syndrome patients at risk of future cardiac events. In addition, using novel high-sensitivity assays, circulating troponin can be observed not only in acute settings, but also in many patients suffering from chronic diseases such as coronary artery disease, heart failure and diabetes. We believe that these findings provide a compelling case for exploring whether troponin levels may be a useful tool for guiding clinical decision-making directly in the management of some of these chronic conditions. Sampling of troponin in such patient populations may allow for more refined risk stratification and, importantly, help clinicians individualize care beyond what is currently possible.