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Coronary Artery Disease: HELP
Articles from Kentucky
Based on 91 articles published since 2009
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These are the 91 published articles about Coronary Artery Disease that originated from Kentucky during 2009-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4
1 Guideline Antithrombotic Therapy in Patients With Atrial Fibrillation Treated With Oral Anticoagulation Undergoing Percutaneous Coronary Intervention. 2018

Angiolillo, Dominick J / Goodman, Shaun G / Bhatt, Deepak L / Eikelboom, John W / Price, Matthew J / Moliterno, David J / Cannon, Christopher P / Tanguay, Jean-Francois / Granger, Christopher B / Mauri, Laura / Holmes, David R / Gibson, C Michael / Faxon, David P. ·Division of Cardiology, University of Florida College of Medicine-Jacksonville (D.J.A.). · St. Michael's Hospital, University of Toronto, and the Canadian Heart Research Centre, Canada (S.G.G.). · Canadian Virtual Coordinating Centre for Global Collaborative Cardiovascular Research Centre, University of Alberta, Canada (S.G.G.). · Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B., C.P.C., L.M., D.P.F.). · Department of Medicine, Population Health Research Institute, Thrombosis & Atherosclerosis Research Institute, Hamilton, Canada (J.W.E.). · Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, CA (M.J.P.). · Division of Cardiovascular Medicine and Gill Heart Institute, University of Kentucky, Lexington (D.J.M.). · Department of Medicine, Montreal Heart Institute, Université de Montréal, Canada (J.-F.T.). · Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.). · Mayo Clinic, Rochester, MN (D.R.H.). · Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.M.G.). ·Circulation · Pubmed #30571525.

ABSTRACT: The optimal antithrombotic treatment regimen for patients with atrial fibrillation undergoing percutaneous coronary intervention with stent implantation represents a challenge in clinical practice. In 2016, an updated opinion of selected experts from the United States and Canada on the treatment of patients with atrial fibrillation undergoing percutaneous coronary intervention was reported. After the 2016 North American consensus statement on the management of antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention, results of pivotal clinical trials assessing the type of oral anticoagulant agent and the duration of antiplatelet treatment have been published. On the basis of these results, this focused update on the antithrombotic management of patients with atrial fibrillation undergoing percutaneous coronary intervention recommends that a non-vitamin K antagonist oral anticoagulant be preferred over a vitamin K antagonist as the oral anticoagulant of choice. Moreover, a double-therapy regimen (oral anticoagulant plus single antiplatelet therapy with a P2Y

2 Guideline ACR Appropriateness Criteria 2017

Anonymous3940905 / Akers, Scott R / Panchal, Vandan / Ho, Vincent B / Beache, Garth M / Brown, Richard K J / Ghoshhajra, Brian B / Greenberg, S Bruce / Hsu, Joe Y / Kicska, Gregory A / Min, James K / Stillman, Arthur E / Stojanovska, Jadranka / Abbara, Suhny / Jacobs, Jill E. ·Principal Author, VA Medical Center, Philadelphia, Pennsylvania. Electronic address: akerssco@me.com. · Research Author, Internal Medicine Resident, Henry Ford Allegiance Health, Jackson, Michigan. · Panel Vice-Chair, Uniformed Services University of the Health Sciences, Bethesda, Maryland. · University of Louisville School of Medicine, Louisville, Kentucky. · University Hospital, Ann Arbor, Michigan. · Massachusetts General Hospital, Boston, Massachusetts. · Arkansas Children's Hospital, Little Rock, Arkansas. · Kaiser Permanente, Los Angeles, California. · University of Washington, Seattle, Washington. · Cedars Sinai Medical Center, Los Angeles, California; American College of Cardiology. · Emory University Hospital, Atlanta, Georgia. · University of Michigan Health System, Ann Arbor, Michigan. · Specialty Chair, UT Southwestern Medical Center, Dallas, Texas. · Panel Chair, New York University Medical Center, New York, New York. ·J Am Coll Radiol · Pubmed #28473096.

ABSTRACT: In patients with chronic chest pain in the setting of high probability of coronary artery disease (CAD), imaging has major and diverse roles. First, imaging is valuable in determining and documenting the presence, extent, and severity of myocardial ischemia, hibernation, scarring, and/or the presence, site, and severity of obstructive coronary lesions. Second, imaging findings are important in determining the course of management of patients with suspected chronic myocardial ischemia and better defining those patients best suited for medical therapy, angioplasty/stenting, or surgery. Third, imaging is also necessary to determine the long-term prognosis and likely benefit from various therapeutic options by evaluating ventricular function, diastolic relaxation, and end-systolic volume. Imaging studies are also required to demonstrate other abnormalities, such as congenital/acquired coronary anomalies and severe left ventricular hypertrophy, that can produce angina in the absence of symptomatic coronary obstructive disease due to atherosclerosis. Clinical risk assessment is necessary to determine the pretest probability of CAD. Multiple methods are available to categorize patients as low, medium, or high risk for developing CAD. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

3 Guideline Antithrombotic Therapy in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A North American Perspective-2016 Update. 2016

Angiolillo, Dominick J / Goodman, Shaun G / Bhatt, Deepak L / Eikelboom, John W / Price, Matthew J / Moliterno, David J / Cannon, Christopher P / Tanguay, Jean-Francois / Granger, Christopher B / Mauri, Laura / Holmes, David R / Gibson, C Michael / Faxon, David P. ·From the Division of Cardiology, University of Florida College of Medicine-Jacksonville (D.J.A.) · St Michael's Hospital, University of Toronto, and the Canadian Heart Research Centre · Canadian VIGOUR Centre, University of Alberta, Edmonton (S.G.G.) · Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B., D.P.F.) · Department of Medicine, Population Health Research Institute, Thrombosis & Atherosclerosis Research Institute, Hamilton, ON, Canada (J.W.E.) · Division of Cardiovascular Diseases, Scripps Clinic, La Jolla CA (M.J.P.) · Division of Cardiovascular Medicine and Gill Heart Institute, University of Kentucky, Lexington (D.J.M.) · Brigham and Women's Hospital, Harvard Clinical Research Institute, Harvard Medical School, Boston, MA (C.P.C., L.M.) · Department of Medicine, Montreal Heart Institute, Université de Montréal, QC, Canada (J.-F.T.) · Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.) · Mayo Clinic, Rochester, MN (D.R.H.) · and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.M.G.). ·Circ Cardiovasc Interv · Pubmed #27803042.

ABSTRACT: The optimal antithrombotic treatment regimen for patients with atrial fibrillation undergoing percutaneous coronary intervention with stent implantation is an emerging clinical problem. Currently, there is limited evidenced-based data on the optimal antithrombotic treatment regimen, including antiplatelet and anticoagulant therapies, for these high-risk patients with practice guidelines, thus, providing limited recommendations. Over the past years, expert consensus documents have provided guidance to clinicians on how to manage patients with atrial fibrillation undergoing percutaneous coronary intervention. Given the recent advancements in the field, the current document provides an updated opinion of selected North American experts from the United States and Canada on the treatment of patients with atrial fibrillation undergoing percutaneous coronary intervention. In particular, this document provides the current views on (1) embolic/stroke risk, (2) ischemic/thrombotic cardiac risk, and (3) bleeding risk, which are pivotal for discerning the choice of antithrombotic therapy. In addition, we describe the recent advances in pharmacology, stent designs, and clinical trials relevant to the field. Ultimately, we provide expert consensus-derived recommendations, using a pragmatic approach, on the management of patients with atrial fibrillation undergoing percutaneous coronary intervention.

4 Editorial Imaging Characteristics and Significance of Coronary Artery Mismatch Lesions. 2019

Whayne, Thomas F / Shelton, Julie E / Deutsch, Christian R / Messerli, Adrian. ·1 Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, USA. ·Angiology · Pubmed #31137941.

ABSTRACT: -- No abstract --

5 Editorial Hybrid coronary revascularization: Time for a new comparator? 2018

Misumida, Naoki / Moliterno, David J. ·Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky. ·Catheter Cardiovasc Interv · Pubmed #29405596.

ABSTRACT: The present meta-analysis found no significant difference between hybrid coronary revascularization (HCR) and bypass surgery (CABG) regarding intermediate-term major adverse cardiac and cerebrovascular events. HCR is feasible, historically with higher revascularization rates but less perioperative morbidity With a comparable frequency of repeat revascularization between current-generation drug-eluting stents and CABG, future trials of HCR are considering multi-vessel PCI as the new comparator.

6 Editorial Impact of Diabetes Mellitus on Percutaneous Coronary Intervention Outcomes: Real-World Lessons From a Large Chinese Single-Center Registry. 2018

Messerli, Adrian / Whayne, Thomas F. ·1 Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, USA. ·Angiology · Pubmed #29130317.

ABSTRACT: -- No abstract --

7 Editorial Prognosis for Women With Multivessel Coronary Artery Disease. 2016

Wells, Gretchen / Whayne, Thomas F. ·Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA. · Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA twhayn0@uky.edu. ·Angiology · Pubmed #26543074.

ABSTRACT: -- No abstract --

8 Editorial Multiple Coronary Artery Interventions. 2016

Whayne, Thomas F. ·Gill Heart Institute, University of Kentucky, Lexington, KY, USA twhayn0@uky.edu. ·Angiology · Pubmed #26187641.

ABSTRACT: -- No abstract --

9 Editorial Microparticles: the good, the bad, and the ugly. 2015

Ferraris, Victor A. ·Department of Cardiothoracic Surgery, University of Kentucky, Lexington, Ky. Electronic address: Ferraris@earthlink.net. ·J Thorac Cardiovasc Surg · Pubmed #25263714.

ABSTRACT: -- No abstract --

10 Editorial The impact of left anterior descending coronary artery length on survival following myocardial infarction: to the apex and beyond. 2014

Randall, Morgan H / Moliterno, David J. ·Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, Kentucky. ·Catheter Cardiovasc Interv · Pubmed #25045098.

ABSTRACT: -- No abstract --

11 Editorial Revascularisation for patients with stable coronary artery disease. 2014

Ziada, Khaled / Moliterno, David J. ·Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA. · Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA Moliterno@uky.edu. ·BMJ · Pubmed #24958028.

ABSTRACT: -- No abstract --

12 Review Management Strategies for Noncardiac Surgery Following a Coronary Artery Event. 2018

Whayne, Thomas F / Saha, Sibu P. ·Gill Heart and Vascular Institute, University of Kentucky, 326 Wethington Building, 900 South Limestone Street, Lexington, KY, 40536-0200, USA. twhayn0@uky.edu. · Gill Heart and Vascular Institute, University of Kentucky, 326 Wethington Building, 900 South Limestone Street, Lexington, KY, 40536-0200, USA. ·Curr Cardiol Rep · Pubmed #29353319.

ABSTRACT: PURPOSE OF REVIEW: Coronary artery event includes acute coronary syndrome (ACS), percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) surgery. Following such an event, risk of noncardiac surgery is increased. Of major concern is what can make this surgery safer? RECENT FINDINGS: High functional capacity improves cardiovascular (CV) risk; at least 4.0 metabolic equivalents (METs) on stress test are favorable. Risk scores can suggest need for further evaluation. Coronary angiography prior to surgery usually is not indicated since revascularization shows disappointing CV risk reduction results. Due to high association of peripheral arterial disease (PAD) with coronary artery disease (CAD), low ankle-brachial index (ABI) indicates increased CV risk. New perioperative beta blockade has shown disappointing benefit, but if ongoing should be continued. De novo perioperative beta blockade is for the highest CV risk patient undergoing noncardiac vascular surgery. Good evidence supports CV risk reduction from new or existing statin in the perioperative period, especially for the diabetic. Diabetics should also be on an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) secondarily, during the perioperative period to decrease 30-day perioperative mortality. Optimal timing of elective noncardiac surgery following a coronary artery event appears to be 180 days with CV risk decreased by a statin and an ACEI or an ARB.

13 Review Coronary Computed Tomography Angiography vs Functional Stress Testing for Patients With Suspected Coronary Artery Disease: A Systematic Review and Meta-analysis. 2017

Foy, Andrew J / Dhruva, Sanket S / Peterson, Brandon / Mandrola, John M / Morgan, Daniel J / Redberg, Rita F. ·Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania. · Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania. · Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut. · Louisville Cardiology Group, Baptist Health, Louisville, Kentucky. · Department of Medicine, University of Maryland School of Medicine, Baltimore. · Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. · Editor. ·JAMA Intern Med · Pubmed #28973101.

ABSTRACT: Importance: Coronary computed tomography angiography (CCTA) is a new approach for the diagnosis of anatomical coronary artery disease (CAD), but it is unclear how CCTA performs compared with the standard approach of functional stress testing. Objective: To compare the clinical effectiveness of CCTA with that of functional stress testing for patients with suspected CAD. Data Sources: A systematic literature search was conducted in PubMed and MEDLINE for English-language randomized clinical trials of CCTA published from January 1, 2000, to July 10, 2016. Study Selection: Researchers selected randomized clinical trials that compared a primary strategy of CCTA with that of functional stress testing for patients with suspected CAD and reported data on patient clinical events and changes in therapy. Data Extraction and Synthesis: Two reviewers independently extracted data from and assessed the quality of the trials. This analysis followed the PRISMA statement for reporting systematic reviews and meta-analyses and used the Cochrane Collaboration's tool for assessing risk of bias in randomized trials. The Mantel-Haenszel method was used to conduct the primary analysis. Summary relative risks were calculated with a random-effects model. Main Outcomes and Measures: The outcomes of interest were all-cause mortality, cardiac hospitalization, myocardial infarction, invasive coronary angiography, coronary revascularization, new CAD diagnoses, and change in prescription for aspirin and statins. Results: Thirteen trials were included, with 10 315 patients in the CCTA arm and 9777 patients in the functional stress testing arm who were followed up for a mean duration of 18 months. There were no statistically significant differences between CCTA and functional stress testing in death (1.0% vs 1.1%; risk ratio [RR], 0.93; 95% CI, 0.71-1.21) or cardiac hospitalization (2.7% vs 2.7%; RR, 0.98; 95% CI, 0.79-1.21), but CCTA was associated with a reduction in the incidence of myocardial infarction (0.7% vs 1.1%; RR, 0.71; 95% CI, 0.53-0.96). Patients undergoing CCTA were significantly more likely to undergo invasive coronary angiography (11.7% vs 9.1%; RR, 1.33; 95% CI, 1.12-1.59) and revascularization (7.2% vs 4.5%; RR, 1.86; 95% CI, 1.43-2.43). They were also more likely to receive a diagnosis of new CAD and to have initiated aspirin or statin therapy. Conclusions and Relevance: Compared with functional stress testing, CCTA is associated with a reduced incidence of myocardial infarction but an increased incidence of invasive coronary angiography, revascularization, CAD diagnoses, and new prescriptions for aspirin and statins. Despite these differences, CCTA is not associated with a reduction in mortality or cardiac hospitalizations.

14 Review Meta-analysis of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Left Main Coronary Artery Disease. 2017

Khan, Abdur R / Golwala, Harsh / Tripathi, Avnish / Riaz, Haris / Kumar, Arnav / Flaherty, Michael P / Bhatt, Deepak L. ·Division of Cardiovascular Medicine, Department of Internal Medicine, University of Louisville, Louisville, Kentucky. · Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts. · Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio. · Heart and Vascular Center, Cleveland Clinic, Cleveland, Ohio. · Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts. Electronic address: dlbhattmd@post.harvard.edu. ·Am J Cardiol · Pubmed #28442067.

ABSTRACT: Despite the increase in use of percutaneous coronary intervention (PCI) in left main coronary disease, its efficacy compared with coronary artery bypass grafting (CABG) is unclear. We performed a meta-analysis of randomized controlled trials to assess the optimal revascularization strategy. Our search yielded 8 studies reporting relevant outcomes that were pooled using the inverse variance method, and the hazard ratio (HR) was calculated. The primary outcome was all-cause mortality, myocardial infarction (MI), or stroke (major adverse cardiac events [MACE]), and the secondary outcome was death/MI/stroke/repeat revascularization (expanded MACE). Differences in outcomes classified by follow-up duration (early: 0 to 1 year; late: 3 to 5 years) or anatomical complexity of coronary artery disease (SYNTAX score) were investigated. Our results suggest no difference in either early or late MACE (early: HR 0.81; 95% confidence interval [CI] 0.63 to 1.05; late: HR 1.12; 95% CI 0.80 to 1.56) or expanded MACE (early: HR 1.03; 95% CI 0.69 to 1.52; late: HR 1.16; 95% CI 0.95 to 1.43) between the 2 groups. There was an increased risk of expanded MACE with a high SYNTAX score for PCI (HR 1.47; 95% CI 1.13 to 1.92) at late follow-up. There were comparable rates of all-cause mortality and nonprocedural MI between the 2 groups with increased rates of repeat revascularization with PCI throughout the follow-up and higher rates of stroke with coronary artery bypass grafting early in the follow-up period. In conclusion, our analysis suggests that CABG may be preferable in patients with left main disease and high SYNTAX scores, assuming they are at low surgical risk, and PCI may be an acceptable alternative in patients with low-intermediate SYNTAX scores.

15 Review Low-Density Lipoprotein Cholesterol (LDL-C): How Low? 2017

Whayne, Thomas F. ·Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200. United States. ·Curr Vasc Pharmacol · Pubmed #28245773.

ABSTRACT: Low-density lipoprotein cholesterol (LDL-C) is a well-established major cardiovascular (CV) risk factor supported by clinical evidence showing decreased atherosclerotic disease events when LDL-C is therapeutically lowered. A reasonable approach is to tailor each patient's LDL-C target level depending on the initial LDL-C level and the perceived risk. Multiple clinical entities such as the newborn, hypobetalipoproteinemia, proprotein convertase subtilisin/kexin type 9 (PCSK9) missense mutations, and an unexpected excess response to a statin or other medications, are associated with very low LDL-C levels in otherwise healthy individuals. Therefore, an issue of major interest to clinicians who buy into "lower is better" for LDL-C in the high-risk CV patient is how low can and should the LDL-C be taken? Available information is discussed and placed into context. A definite safe lowest LDL-C level cannot be specified but there appears to be support that a level as low as 20 mg/dL (0.52 mmol/l) can be justified in the highest CV risk patients with extensive atherosclerosis where plaque stabilization and regression are necessary.

16 Review Clinical outcomes associated with per-operative discontinuation of aspirin in patients with coronary artery disease: A systematic review and meta-analysis. 2017

Luni, Faraz Khan / Riaz, Haris / Khan, Abdur Rahman / Riaz, Talha / Husnain, Muhammad / Riaz, Irbaz Bin / Khan, Muhammad Shahzeb / Taleb, Mohammed / Kanjwal, Yusuf / Cooper, Christopher J / Khuder, Sadik A. ·Mercy Saint Vincent Medical Center, Toledo, Ohio. · Cleveland Clinic, Cleveland, Ohio. · University of Louisville, Louisville, Kentucky. · Bronx Lebanon Hospital, New York, New York. · University of Arizona, Tucson, Arizona. · Dow University of Health Sciences, Karachi, Pakistan. · University of Toledo Medical Center, Toledo, Ohio. ·Catheter Cardiovasc Interv · Pubmed #27663179.

ABSTRACT: BACKGROUND: Postoperative state is characterized by increased thrombotic risk by virtue of platelet activation. Whether aspirin ameliorates this risk in patients with established coronary artery disease undergoing cardiac or noncardiac surgery is unknown. We conducted a systematic review and meta-analysis to compare the risk of major adverse cardiac events (MACE) and the risk of bleeding in patients with early (3-5 or more days before surgery) vs. late discontinuation(<3-5 days)/no discontinuation of aspirin. METHODS: Multiple databases were searched from inception of these databases until March 2015 to identify studies that reported discontinuation of aspirin in patients undergoing surgery. The outcomes measured were all cause mortality, nonfatal myocardial infarction and other relevant thrombotic events (MACE) which also may include, fatal and nonfatal MI, stent thrombosis and restenosis, stroke, perioperative cardiovascular complications (heart failure, MI, VTE, acute stroke) and perioperative bleeding during the perioperative period to up to 30 days after surgery. RESULTS: A total of 1,018 titles were screened, after which six observational studies met the inclusion criteria. Our analysis suggests that there is no difference in MACE with planned discontinuation of aspirin (OR = 1.17, 95% CI = 0.76-1.81; P = 0.05; I CONCLUSION: Our analysis suggests that planned short-term discontinuation in the appropriate clinical setting appears to be safe in the correct clinical setting with no increased risk of thrombotic events and with a decreased risk of bleeding. © 2016 Wiley Periodicals, Inc.

17 Review Increased Exercise Favorably Modifies Coronary Artery Disease and Peripheral Arterial Disease Outcomes. 2016

Whayne, Thomas F / Mukherjee, Debabrata. ·Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, Kentucky, USA 326 Wethington Building 900 South Limestone Street Lexington, KY 40536-0200, USA. twhayn0@uky.edu. ·Curr Vasc Pharmacol · Pubmed #27456103.

ABSTRACT: Exercise therapy, especially when supervised on-site in a clinical facility or directed off-site for a home-based program, is an essential component of the management of coronary artery disease (CAD) and peripheral arterial disease (PAD). In the case of both atherosclerotic diseases, it can decrease adverse cardiovascular (CV) events. There has been a recent push toward invasive management of both CAD and PAD but accumulating clinical experience has shown the limitation of invasive management and emphasized the importance of medications, CV risk reduction, conditioning, and exercise, especially when supervised. Exercise results in increased peak oxygen consumption (V02), improvement of wellestablished CV risk factors such as plasma lipids, and an improvement in indicators of inflammation and of various metabolic factors. Fortunately, there is generally good third-party coverage of medications and vascular interventions but unfortunately, poor insurance coverage for supervised or directed exercise programs for which significant patient benefit has been established.

18 Review Safety of an abbreviated duration of dual antiplatelet therapy (≤6 months) following second-generation drug-eluting stents for coronary artery disease: A systematic review and meta-analysis of randomized trials. 2016

Ziada, Khaled M / Abdel-Latif, Ahmed K / Charnigo, Richard / Moliterno, David J. ·Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky and the Lexington VA Medical Center, Lexington, KY. ·Catheter Cardiovasc Interv · Pubmed #26309050.

ABSTRACT: BACKGROUND: Dual antiplatelet therapy (DAPT) is recommended for ≥12 months following coronary drug-eluting stents (DES) to reduce risk of major adverse ischemic events. Randomized trials suggest an abbreviated DAPT duration (≤6 months) is adequately protective. However, these trials are individually underpowered to detect differences in rare but serious events such as stent thrombosis (ST). OBJECTIVES: We performed a meta-analysis of published randomized trials to define the impact of abbreviated DAPT (≤6 months) on death, myocardial infarction (MI), stent thrombosis (ST), and bleeding complications compared to standard-duration DAPT (≥12 months). METHODS: Seven randomized controlled trials comparing abbreviated vs. standard DAPT regimens following DES use were identified by two independent investigators. Study characteristics were reviewed and clinical endpoint data were abstracted and analyzed in aggregate using fixed and random-effects models. RESULTS: The seven trials included 15,874 randomized patients. Second-generation DES were used in most patients. Compared to standard-duration DAPT, abbreviated DAPT was not associated with an increase in mortality (OR 0.93; CI: 0.73 to 1.17; P = 0.52), MI (OR 1.14; CI: 0.89 to 1.45; P = 0.30) or ST (OR 1.25; CI: 0.81 to 1.93; P = 0.31). Abbreviated DAPT was associated with significantly fewer major bleeding complications (OR 0.52; CI: 0.34 to 0.82; P = 0.005). The results were consistent between fixed and random-effects models, with no heterogeneity. Sensitivity analyses adjusting for inclusion of bare metal stents, 1st generation DES and/or abbreviated DAPT regimens of 3 months resulted in similar conclusions. CONCLUSIONS: In a meta-analysis of >15,000 patients primarily treated with second-generation DES, abbreviated-duration DAPT (≤6 months) was associated with a significant reduction in major bleeding complications with no evidence of a significant increase in risk of death, MI or ST. Accordingly, abbreviated DAPT should be strongly considered for patients receiving second generation DES.

19 Review Lysophospholipids in coronary artery and chronic ischemic heart disease. 2015

Abdel-Latif, Ahmed / Heron, Paula M / Morris, Andrew J / Smyth, Susan S. ·aDepartment of Veterans Affairs Medical Center bDivision of Cardiovascular Medicine, The Gill Heart Institute cUniversity of Kentucky, Lexington, Kentucky, USA. ·Curr Opin Lipidol · Pubmed #26270808.

ABSTRACT: PURPOSE OF REVIEW: The bioactive lysophospholipids, lysophosphatidic acid (LPA) and sphingosine 1 phosphate (S1P), have potent effects on blood and vascular cells. This review focuses their potential contributions to the development of atherosclerosis, acute complications such as acute myocardial infarction, and chronic ischemic cardiac damage. RECENT FINDINGS: Exciting recent developments have provided insight into the molecular underpinnings of LPA and S1P receptor signaling. New lines of evidence suggest roles for these pathways in the development of atherosclerosis. In experimental animal models, the production, signaling, and metabolism of LPA may be influenced by environmental factors in the diet that synergize to promote the progression of atherosclerotic vascular disease. This is supported by observations of human polymorphisms in the lysophospholipid-metabolizing enzyme PPAP2B, which are associated with risk of coronary artery disease and myocardial infarction. S1P signaling protects from myocardial damage that follows acute and chronic ischemia, both by direct effects on cardiomyocytes and through stem cell recruitment to ischemic tissue. SUMMARY: This review will suggest novel strategies to prevent the complications of coronary artery disease by targeting LPA production and signaling. Additionally, ways in which S1P signaling pathways may be harnessed to attenuate ischemia-induced cardiac dysfunction will be explored.

20 Review Women, the menopause, hormone replacement therapy and coronary heart disease. 2015

Whayne, Thomas F / Mukherjee, Debabrata. ·aDivision of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, Kentucky bDivision of Cardiovascular Medicine, Texas Tech University HSC, and Paul Foster School of Medicine, El Paso, Texas, USA. ·Curr Opin Cardiol · Pubmed #25695898.

ABSTRACT: PURPOSE OF REVIEW: Cardiovascular disease considerations are associated with the menopause. Despite a misconception that women have a minimal risk for coronary heart disease (CHD), it is the major cause of female deaths. This review highlights issues of hormone replacement therapy (HRT) and CHD in women. RECENT FINDINGS: A woman under age 60, who suffers a myocardial infarction (MI), has a 2-year post-MI mortality of 28.9%; it is 19.6% in men. CHD and MI in women are subtle. In addition, female mortality from CHD increases after the menopause. The increased inflammatory risk factor status of women plays a role in development of atherosclerosis, before and after the menopause. Until after the menopause, women overall have a lower CHD mortality rate. Menopause is associated with unique symptoms, especially vasomotor ones; preexisting cardiovascular disease further exacerbates problems associated with the menopause. Use of HRT after the menopause is a major issue. Early menopause at age 39 years or younger and late menopause at age 56 years or older increase cardiovascular risk. HRT should not be prescribed for cardiovascular risk prevention, but when less than 10 years from menopause at a normal age, women can be reassured that cardiovascular risk from HRT is very low. SUMMARY: Prescription of HRT should never be made only for cardiovascular risk reduction. However, when symptom-related and other indications are present, HRT is appropriate and well tolerated in the early years after menopause with onset at a normal age.

21 Review Ischemic heart disease and the Mediterranean diet. 2014

Whayne, Thomas F. ·Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, 326 Wethington Building, 900 South Limestone Street, Lexington, KY, 40536-0200, USA, twhayn0@uky.edu. ·Curr Cardiol Rep · Pubmed #24743900.

ABSTRACT: Lifestyle modification is primary in cardiovascular (CV) disease prevention. A major contribution is the Mediterranean diet (MedDiet), defined by two of seven components. Italian investigators determined a significant decrease in peripheral arterial disease of 56 % for a high score. Multiple specific CV risk factors are also favorably modified by the MedDiet. This includes beneficial effect on inflammation, vascular endothelium, and insulin resistance. There is also evidence that coronary heart disease, diabetes mellitus, and metabolic syndrome are decreased. Benefit appears to extend to new migrants in France. The economics of dietary adherence are favorable with decreased total lifetime health costs. Although mixed nuts appear to be a major factor in the MedDiet, special emphasis goes to extra virgin olive oil. Benefit also extends to other noncommunicable diseases with a decrease in cancer, Parkinson's disease, and Alzheimer's disease. Further quantitation of benefit and understanding of mechanisms involved in dietary benefit is essential.

22 Review Arguing the case for the autotaxin-lysophosphatidic acid-lipid phosphate phosphatase 3-signaling nexus in the development and complications of atherosclerosis. 2014

Smyth, Susan S / Mueller, Paul / Yang, Fanmuyi / Brandon, J Anthony / Morris, Andrew J. ·From the Veterans Affairs Medical Center, Cardiovascular Medicine Service, Lexington, KY (S.S.S., A.J.M.) · and Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY (S.S.S., P.M., F.Y., J.A.B., A.J.M.). ·Arterioscler Thromb Vasc Biol · Pubmed #24482375.

ABSTRACT: The structurally simple glycero- and sphingo-phospholipids, lysophosphatidic acid (LPA) and sphingosine-1-phosphate, serve as important receptor-active mediators that influence blood and vascular cell function and are positioned to influence the events that contribute to the progression and complications of atherosclerosis. Growing evidence from preclinical animal models has implicated LPA, LPA receptors, and key enzymes involved in LPA metabolism in pathophysiologic events that may underlie atherosclerotic vascular disease. These observations are supported by genetic analysis in humans implicating a lipid phosphate phosphatase as a novel risk factor for coronary artery disease. In this review, we summarize current understanding of LPA production, metabolism, and signaling as may be relevant for atherosclerotic and other vascular disease.

23 Review Adiposopathy, diabetes mellitus, and primary prevention of atherosclerotic coronary artery disease: treating "sick fat" through improving fat function with antidiabetes therapies. 2012

Bays, Harold E. ·Louisville Metabolic and Atherosclerosis Research Center, Louisville, Kentucky, USA. HBaysMD@aol.com ·Am J Cardiol · Pubmed #23062567.

ABSTRACT: Both obesity and type 2 diabetes mellitus (DM) are worldwide epidemics, an association that is neither incidental nor coincidental. Adipose tissue is as an active endocrine and immune organ whose dysfunction (adiposopathy or "sick fat") is promoted by excessive caloric balance in genetically and environmentally susceptible patients. The resultant adiposopathic responses directly and indirectly contribute to pathologies leading to hyperglycemia, high blood pressure, and dyslipidemia--all major cardiovascular risk factors--as well as to cardiovascular disease (CVD) itself. Toward the goal of primary prevention of CVD among DM patients, clinical trial outcomes evidence support the use of antihypertensive agents, lipid-altering drugs, and antiplatelet agents. Some of the most proactive measures to reduce the onset of cardiovascular risk factors and potentially prevent the onset of DM are early and aggressive nutritional, physical activity, and lifestyle interventions. Such measures improve the functionality of adipose tissue, reduce adiposopathic responses, and thus improve glycemic, blood pressure, and lipid parameters--all of which would be expected to reduce CVD risk. Finally, if nutritional, physical activity, and lifestyle interventions are not successful, and if DM pharmacologic therapies are indicated, then the choice of anti-DM medications should take into consideration the effects of such agents on adipose tissue function and dysfunction, which in turn, affects major CVD risk factors and CVD.

24 Review Platelet protease-activated receptor antagonism in cardiovascular medicine. 2012

Wiisanen, Matthew E / Moliterno, David J. ·Gill Heart Institute, Division of Cardiovascular Medicine, University of Kentucky, Lexington, 40536, USA. ·Coron Artery Dis · Pubmed #22781741.

ABSTRACT: Ischemic heart disease remains the number one cause of death in the world despite advances in invasive and pharmacologic therapies. An ongoing area of research is the central role of platelets in atherothrombosis. Many therapeutic strategies have been developed over the last few decades affecting different platelet receptors to alter platelet-mediated thrombosis including targeting the receptors for thromboxane A(2), adenosine diphosphate, and fibrinogen. However, despite the use of pharmacologic agents directed at these pathways, residual morbidity and mortality still exist. Therefore, identifying agents that more favorably balance a reduction in ischemic events while minimizing bleeding events is an ongoing mission. Thrombin is known to be the most potent stimulant of platelet-mediated thrombosis whose action on the platelet is through a family of receptors known as the protease-activated receptors (PARs). Activation through the PAR-1 receptor, in particular, results in an early and intense response by the platelet to thrombin, and it is the primary thrombin receptor on platelets, thus making it a potentially desirable target for therapy. Most recently, two PAR-1 antagonists, atopaxar and vorapaxar, have been tested in clinical trials. Generally, the results show a reduction in ischemic event rates, but an increase in bleeding event rates. This article will summarize the current state of the literature and consider the role these drugs might play in the future for the prevention of ischemic heart disease events.

25 Review Optimal medical therapy for coronary artery disease in 2011 - perspectives from the STICH Trial. 2011

Whayne, Thomas F / Saha, Sibu P / Quevedo, Karla / Mukherjee, Debabrata. ·Divisions of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA. twhayn0@uky.edu ·Cardiovasc Hematol Agents Med Chem · Pubmed #21902655.

ABSTRACT: Medical, percutaneous interventional, and surgical treatments for the management of coronary heart disease have progressed markedly during the past decade. There is evidence to suggest that for patients with stable coronary heart disease optimal medical therapy is equal in effectiveness for lowering the risk of major cardiovascular events, such as cardiovascular death, myocardial infarction, and stroke, as are revascularization procedures, such as coronary artery bypass grafting or percutaneous coronary intervention. The landmark Surgical Treatment for Ischemic Heart Failure (STICH) trial found no significant difference between medical therapy alone and medical therapy plus coronary artery bypass grafting with respect to the primary end point of death from any cause (all-cause mortality). However, secondary outcomes showed fewer deaths from cardiovascular causes in the surgical group versus the medical group. Medical therapy has improved over time, as have surgical techniques including myocardial preservation, and both approaches have their place, especially since chest pain relief and quality of life may benefit more in some cases by revascularization. Certainly, coronary artery bypass grafting has general acceptance for three-vessel coronary heart disease, and percutaneous coronary artery intervention is the standard of care for the involved artery in acute ST-segment elevation myocardial infarction when the intervention can be accomplished rapidly. Medical management includes lifestyle changes that benefit coronary heart disease, drug therapy to improve prognosis, and drug therapy to improve symptoms. The key to clinical management is the selection of the procedure and/or medical management strategy that is in the best interest of the individual cardiovascular patient. In addition, discussing with patients their options and considering what best fits their wishes is especially critical when there is no clear-cut best strategy. Continued collaboration between cardiologists concentrating on medical approaches with interventionists and cardiac surgeons (heart team approach) is essential for optimal management for each individual patient.

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