Aspirin and clopidogrel are important components of medical therapy for patients with acute coronary syndromes, for those who received coronary artery stents and in the secondary prevention of ischaemic stroke. Despit...Aspirin and clopidogrel are important components of medical therapy for patients with acute coronary syndromes, for those who received coronary artery stents and in the secondary prevention of ischaemic stroke. Despite their use, a significant number of patients experience recurrent adverse ischaemic events. Interindividual variability of platelet aggregation in response to these antiplatelet agents may be an explanation for some of these recurrent events, and small trials have linked "aspirin and/or clopidogrel resistance", as measured by platelet function tests, to adverse events. We systematically reviewed all available evidence on the prevalence of aspirin/clopidogrel resistance, their possible risk factors and their association with clinical outcomes. We also identified articles showing possible treatments. After analyzing the data on different laboratory methods, we found that aspirin/clopidogrel resistance seems to be associated with poor clinical outcomes and there is currently no standardized or widely accepted definition of clopidogrel resistance. Therefore, we conclude that specific treatment recommendations are not established for patients who exhibit high platelet reactivity during aspirin/clopidogrel therapy or who have poor platelet inhibition by clopidogrel.展开更多
Background In the past of China,both doctors and patients have historically been reluctant to pursue cardiac surgery in the elderly because of various reasons. Nowadays,this situation is changing. However,few studies ...Background In the past of China,both doctors and patients have historically been reluctant to pursue cardiac surgery in the elderly because of various reasons. Nowadays,this situation is changing. However,few studies have been performed to assess quality of life(QoL)in elderly patients after cardiac surgery in China. In this study,we evaluated long-term surgical outcomes and QoL and identified the factors associated with each in elderly patients who underwent cardiac surgery. Methods We recruited 320 patients aged ≥70 years old who underwent cardiac surgery in our hospital from January 2003 to December 2018. Risk factors for mortality were identified using a logistic regression analysis. Among survivors,QoL was assessed using the Short Form 36,and the results were compared to those in an age-matched population cohort in China. Results Overall hospital mortality was 7.2%. However,it has dropped to 3.7% in the last five years. The 1-,3-,5-,and 10-year survival rates were 95.5%,85.7%,74.7%,and 30.5%,respectively. Cardiopulmonary bypass time and Euro SCOREs significantly predicted in-hospital mortality. Chronic pulmonary disease was the only risk factor for long-term mortality. Scores for bodily pain and role emotional were significantly higher in our population than in the general Chinese aged population. However,scores were lower for physical functions and vitality in our population than in the controls. Conclusions Cardiac surgery in elderly patients (≥70 years old)can have low in-hospital mortality,excellent long-term survival and high QoL,which are associated with comprehensive preoperative evaluation assesses and excellent perioperative management and post-surgery cardiac rehabilitation.[S Chin J Cardiol 2019;20(3):182-189]展开更多
Lack of conclusive beneficial effects of strict glycemic control on macrovascular complications has been very frustrating for clinicians involved in care of patients with diabetes mellitus (DM). Highly publicized cont...Lack of conclusive beneficial effects of strict glycemic control on macrovascular complications has been very frustrating for clinicians involved in care of patients with diabetes mellitus (DM). Highly publicized controversy surrounding cardiovascular (CV) safety of rosiglitazone resulted in major changes in United States Food and Drug Administration policy in 2008 regarding approval process of new antidiabetic medications, which has resulted in revolutionary data from several large CV outcome trials over the last few years. All drugs in glucagon-like peptide-1 receptor agonist (GLP-1 RA) and sodium-glucose cotransporter-2 (SGLT-2) inhibitor classes have shown to be CV safe with heterogeneous results on CV efficacy. Given twofold higher CV disease mortality in patients with DM than without DM, GLP-1 RAs and SGLT-2-inhibitors are important additions to clinician’s armamentarium and should be second line-therapy particularly in patients with T2DM and established atherosclerotic CV disease or high risks for CV disease. Abundance of data and heterogeneity in CV outcome trials results can make it difficult for clinicians, particularly primary care physicians, to stay updated with all the recent evidence. The scope of this comprehensive review will focus on all major CV outcome studies evaluating CV safety and efficacy of GLP-1 RAs and SGLT-2 inhibitors.展开更多
基金Supported by The University of Pecs (PTE AOK KA-34039-16/2009)
文摘Aspirin and clopidogrel are important components of medical therapy for patients with acute coronary syndromes, for those who received coronary artery stents and in the secondary prevention of ischaemic stroke. Despite their use, a significant number of patients experience recurrent adverse ischaemic events. Interindividual variability of platelet aggregation in response to these antiplatelet agents may be an explanation for some of these recurrent events, and small trials have linked "aspirin and/or clopidogrel resistance", as measured by platelet function tests, to adverse events. We systematically reviewed all available evidence on the prevalence of aspirin/clopidogrel resistance, their possible risk factors and their association with clinical outcomes. We also identified articles showing possible treatments. After analyzing the data on different laboratory methods, we found that aspirin/clopidogrel resistance seems to be associated with poor clinical outcomes and there is currently no standardized or widely accepted definition of clopidogrel resistance. Therefore, we conclude that specific treatment recommendations are not established for patients who exhibit high platelet reactivity during aspirin/clopidogrel therapy or who have poor platelet inhibition by clopidogrel.
基金supported by the National Key R&D Program of China(No.2017YFC1105000)the City of Nanchong Strategic Cooperation with Local Universities Foundation of technology(No.18SXHZ0521)
文摘Background In the past of China,both doctors and patients have historically been reluctant to pursue cardiac surgery in the elderly because of various reasons. Nowadays,this situation is changing. However,few studies have been performed to assess quality of life(QoL)in elderly patients after cardiac surgery in China. In this study,we evaluated long-term surgical outcomes and QoL and identified the factors associated with each in elderly patients who underwent cardiac surgery. Methods We recruited 320 patients aged ≥70 years old who underwent cardiac surgery in our hospital from January 2003 to December 2018. Risk factors for mortality were identified using a logistic regression analysis. Among survivors,QoL was assessed using the Short Form 36,and the results were compared to those in an age-matched population cohort in China. Results Overall hospital mortality was 7.2%. However,it has dropped to 3.7% in the last five years. The 1-,3-,5-,and 10-year survival rates were 95.5%,85.7%,74.7%,and 30.5%,respectively. Cardiopulmonary bypass time and Euro SCOREs significantly predicted in-hospital mortality. Chronic pulmonary disease was the only risk factor for long-term mortality. Scores for bodily pain and role emotional were significantly higher in our population than in the general Chinese aged population. However,scores were lower for physical functions and vitality in our population than in the controls. Conclusions Cardiac surgery in elderly patients (≥70 years old)can have low in-hospital mortality,excellent long-term survival and high QoL,which are associated with comprehensive preoperative evaluation assesses and excellent perioperative management and post-surgery cardiac rehabilitation.[S Chin J Cardiol 2019;20(3):182-189]
文摘Lack of conclusive beneficial effects of strict glycemic control on macrovascular complications has been very frustrating for clinicians involved in care of patients with diabetes mellitus (DM). Highly publicized controversy surrounding cardiovascular (CV) safety of rosiglitazone resulted in major changes in United States Food and Drug Administration policy in 2008 regarding approval process of new antidiabetic medications, which has resulted in revolutionary data from several large CV outcome trials over the last few years. All drugs in glucagon-like peptide-1 receptor agonist (GLP-1 RA) and sodium-glucose cotransporter-2 (SGLT-2) inhibitor classes have shown to be CV safe with heterogeneous results on CV efficacy. Given twofold higher CV disease mortality in patients with DM than without DM, GLP-1 RAs and SGLT-2-inhibitors are important additions to clinician’s armamentarium and should be second line-therapy particularly in patients with T2DM and established atherosclerotic CV disease or high risks for CV disease. Abundance of data and heterogeneity in CV outcome trials results can make it difficult for clinicians, particularly primary care physicians, to stay updated with all the recent evidence. The scope of this comprehensive review will focus on all major CV outcome studies evaluating CV safety and efficacy of GLP-1 RAs and SGLT-2 inhibitors.
