Pick Topic
Review Topic
List Experts
Examine Expert
Save Expert
  Site Guide ··   
Coronary Artery Disease: HELP
Articles by Sidney C. Smith
Based on 19 articles published since 2010
(Why 19 articles?)
||||

Between 2010 and 2020, Sidney Smith wrote the following 19 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Guideline 2017 Focused Update of the 2016 ACC Expert Consensus Decision Pathway on the Role of Non-Statin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. 2017

Lloyd-Jones, Donald M / Morris, Pamela B / Ballantyne, Christie M / Birtcher, Kim K / Daly, David D / DePalma, Sondra M / Minissian, Margo B / Orringer, Carl E / Smith, Sidney C. · ·J Am Coll Cardiol · Pubmed #28886926.

ABSTRACT: In 2016, the American College of Cardiology published the first expert consensus decision pathway (ECDP) on the role of non-statin therapies for low-density lipoprotein (LDL)-cholesterol lowering in the management of atherosclerotic cardiovascular disease (ASCVD) risk. Since the publication of that document, additional evidence and perspectives have emerged from randomized clinical trials and other sources, particularly considering the longer-term efficacy and safety of proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitors in secondary prevention of ASCVD. Most notably, the FOURIER (Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects with Elevated Risk) trial and SPIRE-1 and -2 (Studies of PCSK9 Inhibition and the Reduction of Vascular Events), assessing evolocumab and bococizumab, respectively, have published final results of cardiovascular outcomes trials in patients with clinical ASCVD and in a smaller number of high-risk primary prevention patients. In addition, further evidence on the types of patients most likely to benefit from the use of ezetimibe in addition to statin therapy after acute coronary syndrome has been published. Based on results from these important analyses, the ECDP writing committee judged that it would be desirable to provide a focused update to help guide clinicians more clearly on decision making regarding the use of ezetimibe and PCSK9 inhibitors in patients with clinical ASCVD with or without comorbidities. In the following summary table, changes from the 2016 ECDP to the 2017 ECDP Focused Update are highlighted, and a brief rationale is provided. The content of the full document has been changed accordingly, with more extensive and detailed guidance regarding decision making provided both in the text and in the updated algorithms. Revised recommendations are provided for patients with clinical ASCVD with or without comorbidities on statin therapy for secondary prevention. The ECDP writing committee judged that these new data did not warrant changes to the decision pathways and algorithms regarding the use of ezetimibe or PCSK9 inhibitors in primary prevention patients with LDL-C <190 mg/dL with or without diabetes mellitus or patients without ASCVD and LDL-C ≥190 mg/dL not due to secondary causes. Based on feedback and further deliberation, the ECDP writing committee down-graded recommendations regarding bile acid sequestrant use, recommending bile acid sequestrants only as optional secondary agents for consideration in patients intolerant to ezetimibe. For clarification, the writing committee has also included new information on diagnostic categories of heterozygous and homozygous familial hypercholesterolemia, based on clinical criteria with and without genetic testing. Other changes to the original document were kept to a minimum to provide consistent guidance to clinicians, unless there was a compelling reason or new evidence, in which case justification is provided.

2 Guideline 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. 2016

Levine, Glenn N / Bates, Eric R / Bittl, John A / Brindis, Ralph G / Fihn, Stephan D / Fleisher, Lee A / Granger, Christopher B / Lange, Richard A / Mack, Michael J / Mauri, Laura / Mehran, Roxana / Mukherjee, Debabrata / Newby, L Kristin / O'Gara, Patrick T / Sabatine, Marc S / Smith, Peter K / Smith, Sidney C / Halperin, Jonathan L / Levine, Glenn N / Al-Khatib, Sana M / Birtcher, Kim K / Bozkurt, Biykem / Brindis, Ralph G / Cigarroa, Joaquin E / Curtis, Lesley H / Fleisher, Lee A / Gentile, Federico / Gidding, Samuel / Hlatky, Mark A / Ikonomidis, John S / Joglar, José A / Pressler, Susan J / Wijeysundera, Duminda N. · ·J Thorac Cardiovasc Surg · Pubmed #27751237.

ABSTRACT: -- No abstract --

3 Guideline 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. 2016

Levine, Glenn N / Bates, Eric R / Bittl, John A / Brindis, Ralph G / Fihn, Stephan D / Fleisher, Lee A / Granger, Christopher B / Lange, Richard A / Mack, Michael J / Mauri, Laura / Mehran, Roxana / Mukherjee, Debabrata / Newby, L Kristin / O'Gara, Patrick T / Sabatine, Marc S / Smith, Peter K / Smith, Sidney C. · ·J Am Coll Cardiol · Pubmed #27036918.

ABSTRACT: -- No abstract --

4 Guideline Treatment of blood cholesterol to reduce atherosclerotic cardiovascular disease risk in adults: synopsis of the 2013 American College of Cardiology/American Heart Association cholesterol guideline. 2014

Stone, Neil J / Robinson, Jennifer G / Lichtenstein, Alice H / Goff, David C / Lloyd-Jones, Donald M / Smith, Sidney C / Blum, Conrad / Schwartz, J Sanford / Anonymous1600783. · ·Ann Intern Med · Pubmed #24474185.

ABSTRACT: DESCRIPTION: In November 2013, the American College of Cardiology and American Heart Association (ACC/AHA) released a clinical practice guideline on the treatment of blood cholesterol to reduce cardiovascular risk in adults. This synopsis summarizes the major recommendations. METHODS: In 2008, the National Heart, Lung, and Blood Institute convened the Adult Treatment Panel (ATP) IV to update the 2001 ATP-III cholesterol guidelines using a rigorous process to systematically review randomized, controlled trials (RCTs) and meta-analyses of RCTs that examined cardiovascular outcomes. The panel commissioned independent systematic evidence reviews on low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol goals in secondary and primary prevention and the effect of lipid drugs on atherosclerotic cardiovascular disease events and adverse effects. In September 2013, the panel's draft recommendations were transitioned to the ACC/AHA. RECOMMENDATIONS: This synopsis summarizes key features of the guidelines in 8 areas: lifestyle, groups shown to benefit from statins, statin safety, decision making, estimation of cardiovascular disease risk, intensity of statin therapy, treatment targets, and monitoring of statin therapy.

5 Guideline 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2014

Stone, Neil J / Robinson, Jennifer G / Lichtenstein, Alice H / Bairey Merz, C Noel / Blum, Conrad B / Eckel, Robert H / Goldberg, Anne C / Gordon, David / Levy, Daniel / Lloyd-Jones, Donald M / McBride, Patrick / Schwartz, J Sanford / Shero, Susan T / Smith, Sidney C / Watson, Karol / Wilson, Peter W F / Anonymous5120775. · ·J Am Coll Cardiol · Pubmed #24239923.

ABSTRACT: -- No abstract --

6 Guideline AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation endorsed by the World Heart Federation and the Preventive Cardiovascular Nurses Association. 2011

Smith, Sidney C / Benjamin, Emelia J / Bonow, Robert O / Braun, Lynne T / Creager, Mark A / Franklin, Barry A / Gibbons, Raymond J / Grundy, Scott M / Hiratzka, Loren F / Jones, Daniel W / Lloyd-Jones, Donald M / Minissian, Margo / Mosca, Lori / Peterson, Eric D / Sacco, Ralph L / Spertus, John / Stein, James H / Taubert, Kathryn A. · ·J Am Coll Cardiol · Pubmed #22055990.

ABSTRACT: -- No abstract --

7 Editorial Protecting a billion hearts. 2014

Baliga, Ragavendra R / Smith, Sidney C / Narula, Jagat. ·Division of Cardiovascular Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH, USA. · Division of Cardiology, University of North Carolina, Chapel Hill, NC, USA. · Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Electronic address: jagat.narula@mountsinai.org. ·Glob Heart · Pubmed #25592787.

ABSTRACT: -- No abstract --

8 Review 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease, 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes, and 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery. 2016

Levine, Glenn N / Bates, Eric R / Bittl, John A / Brindis, Ralph G / Fihn, Stephan D / Fleisher, Lee A / Granger, Christopher B / Lange, Richard A / Mack, Michael J / Mauri, Laura / Mehran, Roxana / Mukherjee, Debabrata / Newby, L Kristin / O'Gara, Patrick T / Sabatine, Marc S / Smith, Peter K / Smith, Sidney C. ·Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative. Society for Cardiovascular Angiography and Interventions Representative. ·Circulation · Pubmed #27026020.

ABSTRACT: -- No abstract --

9 Guideline AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. 2011

Smith, Sidney C / Benjamin, Emelia J / Bonow, Robert O / Braun, Lynne T / Creager, Mark A / Franklin, Barry A / Gibbons, Raymond J / Grundy, Scott M / Hiratzka, Loren F / Jones, Daniel W / Lloyd-Jones, Donald M / Minissian, Margo / Mosca, Lori / Peterson, Eric D / Sacco, Ralph L / Spertus, John / Stein, James H / Taubert, Kathryn A / Anonymous3200709. · ·Circulation · Pubmed #22052934.

ABSTRACT: -- No abstract --

10 Article Mechanisms of ST Elevation Myocardial Infarction in Patients Hospitalized for Noncardiac Conditions. 2019

Tahir, Khola / Pauley, Eric / Dai, Xuming / Smith, Sidney C / Sweeney, Craig / Stouffer, George A. ·Division of Cardiology University of North Carolina, Chapel Hill, North Carolina. · Division of Cardiology, New York-Presbyterian Medical Group-Queens, New York, New York. · Division of Cardiology University of North Carolina, Chapel Hill, North Carolina; McAllister Heart Institute, University of North Carolina, Chapel Hill, North Carolina. Electronic address: rstouff@med.unc.edu. ·Am J Cardiol · Pubmed #30773247.

ABSTRACT: ST elevation myocardial infarction (STEMI) occurring in patients hospitalized for a noncardiac condition is associated with a high mortality rate and thus we sought to determine the mechanisms underlying STEMI in this patient population. This is a single center retrospective study of 70 patients who had STEMI while hospitalized on a noncardiac service and underwent coronary angiography. Thrombotic in-hospital STEMI was defined by angiographic or intravascular imaging evidence of intracoronary thrombus, plaque rupture, or stent thrombosis. Thirty-six (51%) inpatient STEMIs developed in the operating room or various postoperative stages and 6 (9%) after endoscopy or a percutaneous procedure. Thrombotic etiologies were found in 39 (56%) patients. Nonthrombotic etiologies included vasospasm, supply-demand mismatch, and takotsubo cardiomyopathy. Patients in the thrombotic group were more likely to have antiplatelet medications discontinued on admission, had higher peak troponin levels and were more likely to undergo percutaneous coronary intervention than patients in the nonthrombotic group. Exposure to vasopressors, time from ECG to angiography, post-STEMI ejection fraction, length of stay, and in-hospital mortality were similar in both groups. There was no difference in the use of percutaneous coronary intervention in patients but longer ECG to coronary angiography times and fivefold higher in-hospital mortality in thrombotic inpatient STEMI compared with 643 patients who presented with an out-of-hospital STEMI during the same time period. In conclusion, thrombotic and nonthrombotic mechanisms cause STEMI in hospitalized patients and are associated with a high mortality.

11 Article Use of Risk Assessment Tools to Guide Decision-Making in the Primary Prevention of Atherosclerotic Cardiovascular Disease: A Special Report From the American Heart Association and American College of Cardiology. 2019

Lloyd-Jones, Donald M / Braun, Lynne T / Ndumele, Chiadi E / Smith, Sidney C / Sperling, Laurence S / Virani, Salim S / Blumenthal, Roger S. · ·J Am Coll Cardiol · Pubmed #30423392.

ABSTRACT: Risk assessment is a critical step in the current approach to primary prevention of atherosclerotic cardiovascular disease. Knowledge of the 10-year risk for atherosclerotic cardiovascular disease identifies patients in higher-risk groups who are likely to have greater net benefit and lower number needed to treat for both statins and antihypertensive therapy. Current U.S. prevention guidelines for blood pressure and cholesterol management recommend use of the pooled cohort equations to start a process of shared decision-making between clinicians and patients in primary prevention. The pooled cohort equations have been widely validated and are broadly useful for the general U.S. clinical population. But, they may systematically underestimate risk in patients from certain racial/ethnic groups, those with lower socioeconomic status or with chronic inflammatory diseases, and overestimate risk in patients with higher socioeconomic status or who have been closely engaged with preventive healthcare services. If uncertainty remains for patients at borderline or intermediate risk, or if the patient is undecided after a patient-clinician discussion with consideration of risk enhancing factors (e.g., family history), additional testing with measurement of coronary artery calcium can be useful to reclassify risk estimates and improve selection of patients for use or avoidance of statin therapy. This special report summarizes the rationale and evidence base for quantitative risk assessment, reviews strengths and limitations of existing risk scores, discusses approaches for refining individual risk estimates for patients, and provides practical advice regarding implementation of risk assessment and decision-making strategies in clinical practice.

12 Article Angina and Future Cardiovascular Events in Stable Patients With Coronary Artery Disease: Insights From the Reduction of Atherothrombosis for Continued Health (REACH) Registry. 2016

Eisen, Alon / Bhatt, Deepak L / Steg, P Gabriel / Eagle, Kim A / Goto, Shinya / Guo, Jianping / Smith, Sidney C / Ohman, E Magnus / Scirica, Benjamin M / Anonymous20760882. ·Brigham and Women's Hospital, Boston, MA Harvard Medical School, Boston, MA. · Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodeling), Université Paris-Diderot, Sorbonne Paris Cité, Paris, France FACT (French Alliance for Cardiovascular Clinical Trials), Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France INSERM U-1148, Paris, France National Heart and Lung Institute, Royal Brompton Hospital, Imperial College, London, United Kingdom. · University of Michigan Health System, Ann Arbor, MI. · Department of Medicine, Tokai University School of Medicine, Isehara, Japan. · Heart and Vascular Center, University of North Carolina at Chapel Hill, NC. · Duke University Medical Center, Durham, NC. · Brigham and Women's Hospital, Boston, MA Harvard Medical School, Boston, MA bscirica@partners.org. ·J Am Heart Assoc · Pubmed #27680665.

ABSTRACT: BACKGROUND: The extent to which angina is associated with future cardiovascular events in patients with coronary artery disease has long been debated. METHODS AND RESULTS: Included were outpatients with established coronary artery disease who were enrolled in the REACH registry and were followed for 4 years. Angina at baseline was defined as necessitating episodic or permanent antianginal treatment. The primary end point was the composite of cardiovascular death, myocardial infarction, or stroke. Secondary end points included heart failure, cardiovascular hospitalizations, and coronary revascularization. The independent association between angina and first/total events was examined using Cox and logistic regression models. Out of 26 159 patients with established coronary artery disease, 13 619 (52%) had angina at baseline. Compared with patients without angina, patients with angina were more likely to be older, female, and had more heart failure and polyvascular disease (P<0.001 for each). Compared with patients without angina, patients with angina had higher rates of first primary end-point event (14.2% versus 16.3%, unadjusted hazard ratio 1.19, CI 1.11-1.27, P<0.001; adjusted hazard ratio 1.06, CI 0.99-1.14, P=0.11), and total primary end-point events (adjusted risk ratio 1.08, CI 1.01-1.16, P=0.03). Patients with angina were at increased risk for heart failure (adjusted odds ratio 1.17, CI 1.06-1.28, P=0.002), cardiovascular hospitalizations (adjusted odds ratio 1.29, CI 1.21-1.38, P<0.001), and coronary revascularization (adjusted odds ratio 1.23, CI 1.13-1.34, P<0.001). CONCLUSIONS: Patients with stable coronary artery disease and angina have higher rates of future cardiovascular events compared with patients without angina. After adjustment, angina was only weakly associated with cardiovascular death, myocardial infarction, or stroke, but significantly associated with heart failure, cardiovascular hospitalization, and coronary revascularization.

13 Article Focused Update on Duration of Dual Antiplatelet Therapy for Patients With Coronary Artery Disease. 2016

Mauri, Laura / Smith, Sidney C. ·Brigham and Women's Hospital, Department of Cardiovascular Medicine, Harvard Medical School, Boston, Massachusetts2Harvard Clinical Research Institute, Boston, Massachusetts. · University of North Carolina School of Medicine, Chapel Hill, North Carolina4University of North Carolina Center for Heart and Vascular Care, Chapel Hill, North Carolina. ·JAMA Cardiol · Pubmed #27548911.

ABSTRACT: -- No abstract --

14 Article Impact of Diabetes Mellitus on Hospitalization for Heart Failure, Cardiovascular Events, and Death: Outcomes at 4 Years From the Reduction of Atherothrombosis for Continued Health (REACH) Registry. 2015

Cavender, Matthew A / Steg, Ph Gabriel / Smith, Sidney C / Eagle, Kim / Ohman, E Magnus / Goto, Shinya / Kuder, Julia / Im, Kyungah / Wilson, Peter W F / Bhatt, Deepak L / Anonymous4350835. ·From TIMI Study Group, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (M.A.C., J.K., K.I., D.L.B.) · French Alliance for Cardiovascular Clinical Trials, Département Hospitalo-Universitaire, Fibrosis, Inflammation, Remodeling, Université Paris-Diderot, Sorbonne Paris-Cité, Laboratory of Vascular Translational Science, INSERM U-1148, Hôpital Bichat, Hopitaux Universitaires Paris-Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, Paris, France (P.G.S.) · National Heart Lung Institute, Imperial College, Royal Brompton Hospital, London, UK (P.G.S.) · University of North Carolina, Chapel Hill (S.C.S.) · University of Michigan, Ann Arbor (K.E.) · Duke Clinical Research Institute, Durham, NC (E.M.O.) · Tokai University, Kanagawa, Japan (S.G.) · and Emory University and the Atlanta VA Medical Center, Atlanta, GA (P.W.F.W.). ·Circulation · Pubmed #26152709.

ABSTRACT: BACKGROUND: Despite the known association of diabetes mellitus with cardiovascular events, there are few contemporary data on the long-term outcomes from international cohorts of patients with diabetes mellitus. We sought to describe cardiovascular outcomes at 4 years and to identify predictors of these events in patients with diabetes mellitus. METHODS AND RESULTS: The Reduction of Atherothrombosis for Continued Health (REACH) registry is an international registry of patients at high risk of atherothrombosis or established atherothrombosis. Four-year event rates in patients with diabetes mellitus were determined with the corrected group prognosis method. Of the 45 227 patients in the REACH registry who had follow-up at 4 years, 43.6% (n=19 699) had diabetes mellitus at baseline. The overall risk and hazard ratio (HR) of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke were greater in patients with diabetes compared with patients without diabetes (16.5% versus 13.1%; adjusted HR, 1.27; 95% confidence interval [CI] 1.19-1.35). There was also an increase in both cardiovascular death (8.9% versus 6.0%; adjusted HR, 1.38; 95% CI, 1.26-1.52) and overall death (14.3% versus 9.9%; adjusted HR, 1.40; 95% CI, 1.30-1.51). Diabetes mellitus was associated with a 33% greater risk of hospitalization for heart failure (9.4% versus 5.9%; adjusted odds ratio, 1.33; 95% CI, 1.18-1.50). In patients with diabetes mellitus, heart failure at baseline was independently associated with cardiovascular death (adjusted HR, 2.45; 95% CI, 2.17-2.77; P<0.001) and hospitalization for heart failure (adjusted odds ratio, 4.72; 95% CI, 4.22-5.29; P<0.001). CONCLUSIONS: Diabetes mellitus substantially increases the risk of death, ischemic events, and heart failure. Patients with both diabetes mellitus and heart failure are at particularly elevated risk of cardiovascular death, highlighting the need for additional therapies in this high-risk population.

15 Article Statin therapy and long-term adverse limb outcomes in patients with peripheral artery disease: insights from the REACH registry. 2014

Kumbhani, Dharam J / Steg, Ph Gabriel / Cannon, Christopher P / Eagle, Kim A / Smith, Sidney C / Goto, Shinya / Ohman, E Magnus / Elbez, Yedid / Sritara, Piyamitr / Baumgartner, Iris / Banerjee, Subhash / Creager, Mark A / Bhatt, Deepak L / Anonymous4810786. ·Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9047, USA dharam@post.harvard.edu. · Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France INSERM U-1148, Paris, France Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK. · Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA TIMI Study Group, Boston, MA, USA. · University of Michigan Cardiovascular Center, Ann Arbor, MI, USA. · Center for Cardiovascular Science and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. · Department of Medicine, Tokai University School of Medicine, Isehara, Japan. · Division of Cardiology, Duke University, Durham, NC, USA. · Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France INSERM U-1148, Paris, France Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France. · Faculty of Medicine, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. · Swiss Cardiovascular Center Bern, University Hospital Bern, Switzerland. · Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9047, USA. · Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. · Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA TIMI Study Group, Boston, MA, USA VA Boston Healthcare System, Boston, MA, USA. ·Eur Heart J · Pubmed #24585266.

ABSTRACT: AIMS: Due to a high burden of systemic cardiovascular events, current guidelines recommend the use of statins in all patients with peripheral artery disease (PAD). We sought to study the impact of statin use on limb prognosis in patients with symptomatic PAD enrolled in the international REACH registry. METHODS: Statin use was assessed at study enrolment, as well as a time-varying covariate. Rates of the primary adverse limb outcome (worsening claudication/new episode of critical limb ischaemia, new percutaneous/surgical revascularization, or amputation) at 4 years and the composite of cardiovascular death/myocardial infarction/stroke were compared among statin users vs. non-users. RESULTS: A total of 5861 patients with symptomatic PAD were included. Statin use at baseline was 62.2%. Patients who were on statins had a significantly lower risk of the primary adverse limb outcome at 4 years when compared with those who were not taking statins [22.0 vs. 26.2%; hazard ratio (HR), 0.82; 95% confidence interval (CI), 0.72-0.92; P = 0.0013]. Results were similar when statin use was considered as a time-dependent variable (P = 0.018) and on propensity analysis (P < 0.0001). The composite of cardiovascular death/myocardial infarction/stroke was similarly reduced (HR, 0.83; 95% CI, 0.73-0.96; P = 0.01). CONCLUSION: Among patients with PAD in the REACH registry, statin use was associated with an ∼18% lower rate of adverse limb outcomes, including worsening symptoms, peripheral revascularization, and ischaemic amputations. These findings suggest that statin therapy not only reduces the risk of adverse cardiovascular events, but also favourably affects limb prognosis in patients with PAD.

16 Article β-Blocker use and clinical outcomes in stable outpatients with and without coronary artery disease. 2012

Bangalore, Sripal / Steg, Gabriel / Deedwania, Prakash / Crowley, Kevin / Eagle, Kim A / Goto, Shinya / Ohman, E Magnus / Cannon, Christopher P / Smith, Sidney C / Zeymer, Uwe / Hoffman, Elaine B / Messerli, Franz H / Bhatt, Deepak L / Anonymous4110738. ·Cardiovascular Clinical Research Center, New York University School of Medicine, 550 First Ave, New York, NY 10016, USA. sripalbangalore@gmail.com ·JAMA · Pubmed #23032550.

ABSTRACT: CONTEXT: β-Blockers remain the standard of care after a myocardial infarction (MI). However, the benefit of β-blocker use in patients with coronary artery disease (CAD) but no history of MI, those with a remote history of MI, and those with only risk factors for CAD is unclear. OBJECTIVE: To assess the association of β-blocker use with cardiovascular events in stable patients with a prior history of MI, in those with CAD but no history of MI, and in those with only risk factors for CAD. DESIGN, SETTING, AND PATIENTS: Longitudinal, observational study of patients in the Reduction of Atherothrombosis for Continued Health (REACH) registry who were divided into 3 cohorts: known prior MI (n = 14,043), known CAD without MI (n = 12,012), or those with CAD risk factors only (n = 18,653). Propensity score matching was used for the primary analyses. The last follow-up data collection was April 2009. MAIN OUTCOME MEASURES: The primary outcome was a composite of cardiovascular death, nonfatal MI, or nonfatal stroke. The secondary outcome was the primary outcome plus hospitalization for atherothrombotic events or a revascularization procedure. RESULTS: Among the 44,708 patients, 21,860 were included in the propensity score-matched analysis. With a median follow-up of 44 months (interquartile range, 35-45 months), event rates were not significantly different in patients with β-blocker use compared with those without β-blocker use for any of the outcomes tested, even in the prior MI cohort (489 [16.93%] vs 532 [18.60%], respectively; hazard ratio [HR], 0.90 [95% CI, 0.79-1.03]; P = .14). In the CAD without MI cohort, the associated event rates were not significantly different in those with β-blocker use for the primary outcome (391 [12.94%]) vs without β-blocker use (405 [13.55%]) (HR, 0.92 [95% CI, 0.79-1.08]; P = .31), with higher rates for the secondary outcome (1101 [30.59%] vs 1002 [27.84%]; odds ratio [OR], 1.14 [95% CI, 1.03-1.27]; P = .01) and for the tertiary outcome of hospitalization (870 [24.17%] vs 773 [21.48%]; OR, 1.17 [95% CI, 1.04-1.30]; P = .01). In the cohort with CAD risk factors only, the event rates were higher for the primary outcome with β-blocker use (467 [14.22%]) vs without β-blocker use (403 [12.11%]) (HR, 1.18 [95% CI, 1.02-1.36]; P = .02), for the secondary outcome (870 [22.01%] vs 797 [20.17%]; OR, 1.12 [95% CI, 1.00-1.24]; P = .04) but not for the tertiary outcomes of MI (89 [2.82%] vs 68 [2.00%]; HR, 1.36 [95% CI, 0.97-1.90]; P = .08) and stroke (210 [6.55%] vs 168 [5.12%]; HR, 1.22 [95% CI, 0.99-1.52]; P = .06). However, in those with recent MI (≤1 year), β-blocker use was associated with a lower incidence of the secondary outcome (OR, 0.77 [95% CI, 0.64-0.92]). CONCLUSION: In this observational study of patients with either CAD risk factors only, known prior MI, or known CAD without MI, the use of β-blockers was not associated with a lower risk of composite cardiovascular events.

17 Article Metformin use and mortality among patients with diabetes and atherothrombosis. 2010

Roussel, Ronan / Travert, Florence / Pasquet, Blandine / Wilson, Peter W F / Smith, Sidney C / Goto, Shinya / Ravaud, Philippe / Marre, Michel / Porath, Avi / Bhatt, Deepak L / Steg, P Gabriel / Anonymous6300679. ·INSERM, Department of Diabetology, Bichat Hospital, Paris, France. ronan.roussel@bch.aphp.fr ·Arch Intern Med · Pubmed #21098347.

ABSTRACT: BACKGROUND: Metformin is recommended in type 2 diabetes mellitus because it reduced mortality among overweight participants in the United Kingdom Prospective Diabetes Study when used mainly as a means of primary prevention. However, metformin is often not considered in patients with cardiovascular conditions because of concerns about its safety. METHODS: We assessed whether metformin use was associated with a difference in mortality among patients with atherothrombosis. The study sample comprised 19 691 patients having diabetes with established atherothrombosis participating in the Reduction of Atherothrombosis for Continued Health (REACH) Registry between December 1, 2003, and December 31, 2004, treated with or without metformin. Multivariable adjustment and propensity score were used to account for baseline differences. The main outcome measure was 2-year mortality. RESULTS: The mortality rates were 6.3% (95% confidence interval [CI], 5.2%-7.4%) with metformin and 9.8% 8.4%-11.2%) without metformin; the adjusted hazard ratio (HR) was 0.76 (0.65-0.89; P < .001). Association with lower mortality was consistent among subgroups, noticeably in patients with a history of congestive heart failure (HR, 0.69; 95% CI, 0.54-0.90; P = .006), patients older than 65 years (0.77; 0.62-0.95; P = .02), and patients with an estimated creatinine clearance of 30 to 60 mL/min/1.73 m(2) (0.64; 95% CI, 0.48-0.86; P = .003) (to convert creatinine clearance to mL/s/m(2), multiply by 0.0167). CONCLUSIONS: Metformin use may decrease mortality among patients with diabetes when used as a means of secondary prevention, including subsets of patients in whom metformin use is not now recommended. Metformin use should be tested prospectively in this population to confirm its effect on survival.

18 Article Attained educational level and incident atherothrombotic events in low- and middle-income compared with high-income countries. 2010

Goyal, Abhinav / Bhatt, Deepak L / Steg, P Gabriel / Gersh, Bernard J / Alberts, Mark J / Ohman, E Magnus / Corbalán, Ramón / Eagle, Kim A / Gaxiola, Efrain / Gao, Runlin / Goto, Shinya / D'Agostino, Ralph B / Califf, Robert M / Smith, Sidney C / Wilson, Peter W F / Anonymous10040671. ·Emory Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, USA. agoyal4@emory.edu ·Circulation · Pubmed #20823388.

ABSTRACT: BACKGROUND: Studies report a protective effect of higher attained educational level (AEL) on cardiovascular outcomes. However, most of these studies have been conducted in high-income countries (HICs) and lack representation from low- and middle-income countries (LMICs), which bear >80% of the global burden of cardiovascular disease. METHODS AND RESULTS: The Reduction of Atherothrombosis for Continued Health (REACH) Registry is a prospective study of 67 888 subjects with either established atherothrombotic (coronary, cerebrovascular, and/or peripheral arterial) disease or multiple atherothrombotic risk factors enrolled from 5587 physician practices in 44 countries. At baseline, AEL (0 to 8 years, 9 to 12 years, trade or technical school, and university) was self-reported for 61 332 subjects. Outcomes included the baseline prevalence of atherothrombotic risk factors and the rate of incident cardiovascular events (cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke) through 23 months across AEL groups, stratified by sex and world region (LMICs or HICs). Educational attainment was inversely associated with age and diabetes mellitus and directly associated with hypercholesterolemia in all subjects. However, for other risk factors such as obesity, smoking, hypertension, and baseline burden of vascular disease, AEL was protective (inversely associated) in HICs but not protective in LMICs. The protective effect of greater AEL on incident cardiovascular events was strongest in men from HICs (P<0.0001), more modest in women from HICs (P=0.0026) and in men from LMICs (P=0.082), and essentially absent in women from LMICs (P=0.32). CONCLUSION: In contrast to HICs, higher AEL may not be protective against cardiovascular events in LMICs, particularly in women.

19 Minor Getting What the Guidelines Stated Matters. 2016

Stone, Neil J / Lloyd-Jones, Donald / Smith, Sidney. · ·J Am Coll Cardiol · Pubmed #26764076.

ABSTRACT: -- No abstract --