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Coronary Artery Disease: HELP
Articles by Sidney C. Smith
Based on 21 articles published since 2008
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Between 2008 and 2019, Sidney Smith wrote the following 21 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 / Anonymous1570783. · ·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 / Anonymous5090775. · ·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 / Anonymous3170709. · ·Circulation · Pubmed #22052934.

ABSTRACT: -- No abstract --

10 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 / Anonymous24340882. ·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.

11 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 --

12 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 / Anonymous4800786. ·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.

13 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 / Anonymous4080738. ·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.

14 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 / Anonymous6290679. ·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.

15 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 / Anonymous9600671. ·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.

16 Article Three-year follow-up and event rates in the international REduction of Atherothrombosis for Continued Health Registry. 2009

Alberts, Mark J / Bhatt, Deepak L / Mas, Jean-Louis / Ohman, E Magnus / Hirsch, Alan T / Röther, Joachim / Salette, Geneviève / Goto, Shinya / Smith, Sidney C / Liau, Chiau-Suong / Wilson, Peter W F / Steg, Ph Gabriel / Anonymous2690637. ·Department of Neurology, Northwestern University Medical School, 710 N Lake Shore Drive, Room 1420, Chicago, IL 60611, USA. m-alberts@northwestern.edu ·Eur Heart J · Pubmed #19720633.

ABSTRACT: AIMS: To determine 3-year event rates in outpatients with vascular disease enrolled in the REduction of Atherothrombosis for Continued Health (REACH) Registry. METHODS AND RESULTS: REACH enrolled 67 888 outpatients with atherothrombosis [established coronary artery disease (CAD), cerebrovascular disease, or peripheral arterial disease (PAD)], or with at least three atherothrombotic risk factors, from 44 countries. Among the 55 499 patients at baseline with symptomatic disease, 39 675 were eligible for 3-year follow-up, and 32 247 had data available (81% retention rate). Among the symptomatic patients at 3 years, 92% were taking an antithrombotic agent, 91% an antihypertensive, and 76% were on lipid-lowering therapy. For myocardial infarction (MI)/stroke/vascular death, 1- and 3-year event rates for all patients were 4.2 and 11.0%, respectively. Event rates (MI/stroke/vascular death) were significantly higher for patients with symptomatic disease vs. those with risk factors only at 1 year (4.7 vs. 2.3%, P < 0.001) and at 3 years (12.0 vs. 6.0%, P < 0.001). One and 3-year rates of MI/stroke/vascular death/rehospitalization were 14.4 and 28.4%, respectively, for patients with symptomatic disease. Rehospitalization for a vascular event other than MI/stroke/vascular death was common at 3 years (19.0% overall; 33.6% for PAD; 23.0% for CAD). For patients with symptomatic vascular disease in one vascular bed vs. multiple vascular beds, 3-year event rates for MI/stroke/vascular death/rehospitalization were 25.5 vs. 40.5% (P < 0.001). CONCLUSION: Despite contemporary therapy, outpatients with symptomatic atherothrombotic vascular disease experience high rates of recurrent vascular events and rehospitalizations.

17 Article The paradoxical use of cardiac catheterization in patients with non-ST-elevation acute coronary syndromes: lessons from the Can Rapid Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC /AHA Guidelines (CRUSADE) Quality Improvement Initiative. 2009

Cohen, Mauricio G / Filby, Steven J / Roe, Matthew T / Chen, Anita Y / Menon, Venu / Stouffer, George A / Gibler, W Brian / Smith, Sidney C / Pollack, Charles V / Peterson, Eric D / Ohman, E Magnus. ·Miller School of Medicine, University of Miami, 1400 N.W. 12th Avenue, Room 1179, Miami, FL 33136, USA. mgcohen@med.miami.edu ·Am Heart J · Pubmed #19619704.

ABSTRACT: BACKGROUND: The long-term benefits of coronary revascularization are proportional to the severity of underlying coronary artery disease (CAD). We sought to identify patients with a greater probability of severe CAD to target those who could receive the greatest benefit from revascularization. METHODS: We used multivariable logistic generalized estimating equations modeling to identify clinical factors associated with severe CAD in 83,490 patients, without prior bypass surgery, who underwent coronary angiography after presenting with non-ST-segment elevation acute coronary syndromes enrolled in CRUSADE. We then compared actual patterns of cardiac catheterization use relative to patients' probability of severe CAD in those who underwent catheterization and those who did not. RESULTS: Independent factors associated with severe CAD included older age, male sex, diabetes, no prior percutaneous coronary intervention, signs or history of heart failure, prior myocardial infarction, ST-segment depression, and family history of CAD. Cardiac catheterization rates were inversely related to the probability of severe CAD as estimated by the model. CONCLUSIONS: There is a misalignment in the use of cardiac catheterization in patients with non-ST-segment elevation acute coronary syndromes relative to their predicted probability of severe CAD. The use of catheterization appears to target patients who would derive less benefit from revascularization. Further quality improvement efforts should promote appropriate use of cardiac catheterization procedures among patients with the greatest potential benefit.

18 Article Prior polyvascular disease: risk factor for adverse ischaemic outcomes in acute coronary syndromes. 2009

Bhatt, Deepak L / Peterson, Eric D / Harrington, Robert A / Ou, Fang-Shu / Cannon, Christopher P / Gibson, C Michael / Kleiman, Neal S / Brindis, Ralph G / Peacock, W Frank / Brener, Sorin J / Menon, Venu / Smith, Sidney C / Pollack, Charles V / Gibler, W Brian / Ohman, E Magnus / Roe, Matthew T / Anonymous40630625. ·VA Boston Healthcare System and Brigham and Women's Hospital, Boston, MA, USA. dlbhattmd@alum.mit.edu ·Eur Heart J · Pubmed #19339264.

ABSTRACT: AIMS: The presence of peripheral arterial disease (PAD) or cerebrovascular disease (CVD) is associated with higher likelihood of significant coronary artery disease (CAD). We sought to assess the prevalence of PAD, CVD, prior CAD, or pre-existent disease in multiple arterial territories ('polyvascular' disease) in patients presenting with non-ST-segment elevation acute coronary syndrome and its impact on adverse events. METHODS AND RESULTS: Data from 95 749 patients enrolled from February 2003 to September 2006 at 484 sites in the CRUSADE registry were analysed. Patients were categorized as having prior 0, 1, 2, or 3 affected arterial beds. The rates of in-hospital mortality, myocardial infarction, stroke, and congestive heart failure were analysed, as were the rates of non-bypass surgery-related red blood cell transfusion and major bleeding. On presentation, 11,345 (11.9%) patients had established PAD, 9973 (10.4%) had documented CVD, and 41,404 (43.2%) had prior CAD. In this cohort, 0, 1, 2, and 3 arterial bed disease before presentation was present in 46 814 (48.9%, 95% CI 48.6-49.2%), 36 704 (38.3%, 95% CI 37.8-39.0%), 10 675 (11.2%, 95% CI 10.9-11.9%), and 1556 (1.6%, 95% CI 1.5-1.8%) patients, respectively. The rates of ischaemic events increased with the number of affected vascular beds. The adjusted odds ratio for the composite of in-hospital ischaemic events for pre-existent disease in 1, 2, or 3 arterial beds (compared with 0 arterial bed involvement) increased from 1.07 to 1.26 to 1.31 (P < 0.001). Similarly, the adjusted odds ratio for transfusion increased with greater disease burden from 1.11 to 1.28 to 1.30 (P < 0.001), although the adjusted rates of protocol-defined non-bypass surgery-related major bleeding did not. CONCLUSION: Prior polyvascular disease increases the risk of in-hospital adverse events, including mortality. Identification of these patients in clinical trial and real world populations may provide an opportunity to reduce their excess risk with intensive secondary prevention efforts.

19 Article Lipid levels in patients hospitalized with coronary artery disease: an analysis of 136,905 hospitalizations in Get With The Guidelines. 2009

Sachdeva, Amit / Cannon, Christopher P / Deedwania, Prakash C / Labresh, Kenneth A / Smith, Sidney C / Dai, David / Hernandez, Adrian / Fonarow, Gregg C. ·Department of Medicine, UCLA Medical Center, Los Angeles, CA90095-1679, USA. ·Am Heart J · Pubmed #19081406.

ABSTRACT: BACKGROUND: Lipid levels among contemporary patients hospitalized with coronary artery disease (CAD) have not been well studied. This study aimed to analyze admission lipid levels in a broad contemporary population of patients hospitalized with CAD. METHODS: The Get With The Guidelines database was analyzed for CAD hospitalizations from 2000 to 2006 with documented lipid levels in the first 24 hours of admission. Patients were divided into low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), and triglyceride categories. Factors associated with LDL and HDL levels were assessed along with temporal trends. RESULTS: Of 231,986 hospitalizations from 541 hospitals, admission lipid levels were documented in 136,905 (59.0%). Mean lipid levels were LDL 104.9 +/- 39.8, HDL 39.7 +/- 13.2, and triglyceride 161 +/- 128 mg/dL. Low-density lipoprotein cholesterol <70 mg/dL was observed in 17.6% and ideal levels (LDL <70 with HDL > or =60 mg/dL) in only 1.4%. High-density lipoprotein cholesterol was <40 mg/dL in 54.6% of patients. Before admission, only 28,944 (21.1%) patients were receiving lipid-lowering medications. Predictors for higher LDL included female gender, no diabetes, history of hyperlipidemia, no prior lipid-lowering medications, and presenting with acute coronary syndrome. Both LDL and HDL levels declined over time (P < .0001). CONCLUSIONS: In a large cohort of patients hospitalized with CAD, almost half have admission LDL levels <100 mg/dL. More than half the patients have admission HDL levels <40 mg/dL, whereas <10% have HDL > or =60 mg/dL. These findings may provide further support for recent guideline revisions with even lower LDL goals and for developing effective treatments to raise HDL.

20 Article Patterns and prognostic implications of low high-density lipoprotein levels in patients with non-ST-segment elevation acute coronary syndromes. 2008

Roe, Matthew T / Ou, Fang-Shu / Alexander, Karen P / Newby, Laura Kristin / Foody, Joanne M / Gibler, W Brian / Boden, William E / Ohman, Erik Magnus / Smith, Sidney C / Peterson, Eric D. ·Department of Medicine, Division of Cardiovascular Medicine, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27705, USA. matthew.roe@duke.edu ·Eur Heart J · Pubmed #18716006.

ABSTRACT: AIMS: The patterns and prognostic significance of low high-density lipoprotein (HDL) cholesterol levels have not been well characterized. We sought to determine the prevalence and prognostic significance of low HDL cholesterol levels in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS). METHODS AND RESULTS: We evaluated HDL levels among NSTE ACS patients [ischaemic ECG (electrocardiogram) changes and/or positive cardiac markers] from the CRUSADE [Can Rapid Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC(American College of Cardiology)/AHA(American Heart Association) Guidelines] initiative treated at 555 US hospitals from January 2001 through June 2006. Clinical and angiographic characteristics, treatments, and in-hospital outcomes were analysed by categories of HDL levels measured during hospitalization. Among 93 263 NSTE ACS patients with HDL measurements, 16 854 (18.1%) had very low HDL levels (10-29 mg/dL), 32 185 (34.5%) had low HDL levels (30-39 mg/dL), 35 875 (38.5%) had normal HDL levels (40-59 mg/dL), and 8349 (9.0%) had high HDL levels (60-100 mg/dL). Patients with very low HDL levels were younger, more often male, and more commonly obese and diabetic. Patients with very low HDL levels had the greatest risk of multi-vessel coronary disease on angiography and in-hospital mortality compared with patients with normal and high HDL levels. CONCLUSION: Almost one-fifth of patients with NSTE ACS have very low HDL levels--a finding that adds incrementally to a greater burden of atherosclerosis and a higher risk of mortality. Consequently, strategies for mitigating the adverse prognosis associated with very low HDL levels warrant further exploration in patients with ACS.

21 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 --