Publications by authors named "Braunwald E"
Aims: The temporal changes in clinical profiles and outcomes of high-risk myocardial infarction survivors enrolled in clinical trials are poorly described. This study compares mortality rates, baseline characteristics, and the prognostic impact of therapies among participants of the VALIANT and PARADISE-MI trials.
Methods And Results: Exclusively VALIANT participants who matched the inclusion criteria of the PARADISE-MI trial were included in the analysis.
Article Synopsis
- Heart failure is a common issue for patients with atrial fibrillation, making risk assessment crucial for clinicians.
- This study analyzed data from three large trials to evaluate how well NT-proBNP, hs-cTnT, and GDF-15 predict heart failure risk in these patients.
- Results showed that higher levels of these biomarkers correlate with a higher risk for cardiovascular death and heart failure-related hospitalization, enhancing the predictive accuracy of clinical assessments.
Article Synopsis
- Sudden death is a significant concern following acute myocardial infarction (AMI), and this study compares recent and older patient data from two clinical trials (PARADISE-MI and VALIANT) focusing on sudden death or resuscitated cardiac arrest (RCA).
- The analysis involved roughly 5,661 patients from PARADISE-MI and 9,617 patients from the VALIANT trial's specific cohort, with key demographics indicating a large proportion of male participants and an average age in the mid-60s.
- Results showed a notably higher rate of sudden death/RCA in the VALIANT cohort (7.4%) compared to the PARADISE-MI cohort (2.6%), suggesting a possible improvement in outcomes
Article Synopsis
- Clonal hematopoiesis of indeterminate potential (CHIP) is linked to a higher risk of cardiovascular (CV) disease in general populations, but its impact on patients with existing CV conditions in clinical trials was unclear.
- A study of 63,700 patients from five randomized CV therapy trials found that while CHIP+ patients had a 30% higher risk of a first myocardial infarction (heart attack), their risk for recurrent heart attacks showed no significant increase.
- The research also indicated that CHIP does not significantly affect the effectiveness of standard CV treatments, suggesting that both CHIP+ and CHIP- patients benefit similarly from these therapies.
A key area of therapeutic progress in obstructive hypertrophic cardiomyopathy revolves around the emergence of cardiac myosin inhibitors, of which mavacamten and aficamten represent the first and second molecules. We summarize the key research evidence, including many similarities and potential differences between various clinical trials studying these molecules.
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- * The ENGAGE AF-TIMI 48 trial involved a global double-blind study with 2966 older participants, comparing two dosing regimens of edoxaban and warfarin, focusing on those without dose-reduction criteria.
- * Key findings included a higher incidence of gastrointestinal hemorrhage associated with the 60 mg edoxaban dose, indicating the need for careful dose management in older patients on anticoagulants.
Article Synopsis
- * Keeping LDL cholesterol levels low reduces the number of LDL particles in arteries, which slows atherosclerosis progression and lowers lifetime ASCVD risk.
- * The concept of LDL cumulative exposure, combining the amount and duration of LDL levels, serves as a unique risk marker for cardiovascular events and can guide strategies for ASCVD prevention in clinical practice.
Background: Cardiovascular trials often use a composite end point and a time-to-first event model. We sought to compare edoxaban versus warfarin using the win ratio, which offers data complementary to time-to-first event analysis, emphasizing the most severe clinical events.
Methods: ENGAGE AF-TIMI 48 (Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction 48) was a double-blind, randomized trial in which patients with atrial fibrillation were assigned 1:1:1 to a higher dose edoxaban regimen (60/30 mg daily), a lower dose edoxaban regimen (30/15 mg daily), or warfarin.
Article Synopsis
- In the PARAGLIDE-HF trial, sacubitril/valsartan showed better results than valsartan alone in reducing NT-proBNP levels in patients with ejection fraction over 40% after heart failure, but increased instances of symptomatic hypotension (SH) were noted.
- Of the 466 patients studied, 19.7% experienced SH, with a higher occurrence in those treated with sacubitril/valsartan compared to valsartan, though the timing of SH events was similar in both groups.
- Patients with SH were more likely to be white, have lower baseline systolic blood pressure, and have a higher left ventricular ejection fraction, but the drug's effectiveness in lowering NT-proBNP
Background: The efficacy and safety of sacubitril/valsartan in patients hospitalized with heart failure (HF) across the spectrum of left ventricular ejection fraction (EF) has not been described.
Objectives: Data from randomized trials of sacubitril/valsartan in HF patients with EF ≤40% (PIONEER-HF [Comparison of Sacubitril/Valsartan Versus Enalapril on Effect of NT-proBNP in Patients Stabilized From an Acute Heart Failure Episode] trial) and >40% (PARAGLIDE-HF [Prospective comparison of ARNI with ARB Given following stabiLization In DEcompensated HFpEF] trial) following recent worsening heart failure (WHF) were pooled to examine treatment effect across the EF spectrum.
Methods: The PIONEER-HF and PARAGLIDE-HF trials were double-blind, randomized trials of sacubitril/valsartan vs control therapy (enalapril or valsartan, respectively).
Article Synopsis
- * Urokinase and tissue plasminogen activator (tPA) were later discovered, with tPA being cloned and developed into various derivatives like alteplase, tenecteplase, and reteplase to improve effectiveness.
- * Alteplase is FDA-approved for conditions such as pulmonary embolism, STEMI, and acute ischemic stroke, while reteplase and tenecteplase are also approved for STEMI treatment; the review highlights their
Background: Patients who sustain an acute myocardial infarction (AMI), including ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI), remain at high risk for heart failure (HF), coronary events, and death. Angiotensin-converting enzyme inhibitors have been shown to significantly decrease the risk for cardiovascular events in both STEMI and NSTEMI patients.
Objectives: The objectives were to determine whether angiotensin-receptor blockade and neprilysin inhibition with sacubitril/valsartan, compared with ramipril, has impact on reducing cardiovascular events according to the type of AMI.
Article Synopsis
- A study was conducted to develop a polygenic risk score (PRS) specifically for aortic stenosis and compare its effectiveness against traditional clinical risk factors.
- This research involved analyzing data from large cohorts, including over 135,000 participants from the Million Veteran Program and various clinical trials between 2011 and 2020.
- The findings indicated that the new aortic stenosis PRS, which utilized millions of genetic variants, may provide significant risk estimation for the condition compared to established clinical methods.
Article Synopsis
- - Hypertrophic cardiomyopathy (HCM) is a common heart disorder, affecting about 1 in 500 people globally, with around 750,000 cases in the U.S.
- - The condition involves asymmetrical thickening of the heart's left ventricle, leading to disorganized heart muscle cells, and approximately 60% of patients experience obstruction in blood flow from the heart.
- - While many patients with HCM experience few or no symptoms, some may suffer from significant issues like shortness of breath, chest pain, fainting, advanced heart failure, or even sudden death.
Article Synopsis
- Elevated lipoprotein(a) (Lp[a]) levels are considered a potential risk factor for atherosclerotic cardiovascular disease (ASCVD), but there is debate about the role of inflammation in this relationship.
- The study aims to determine if Lp(a) increases cardiovascular risk independently of high-sensitivity C-reactive protein (hs-CRP) among diverse patient populations.
- Results show that higher Lp(a) levels are associated with increased risk of major cardiovascular events, regardless of the presence of high or low hs-CRP levels, indicating that Lp(a) is a significant risk factor on its own.
Article Synopsis
- The study investigates the effectiveness and safety of non-vitamin-K antagonist oral anticoagulants (NOACs) in patients with varying body mass index (BMI) and body weight (BW), using data from the COMBINE AF trials.
- Results show that while the risk of stroke or embolic events decreases with higher BMI, the risk of major bleeding with NOACs remains stable across BMI levels, unlike with warfarin where it decreases.
- Overall, NOACs demonstrate a reduced risk for both stroke/SEE and major bleeding compared to warfarin, with consistent results across different BMI groups, although benefits diminish at higher BMI for major bleeding.