Was war neu in der Kardiologie 2010 ? 15. Januar 2011 Einleitung

Predictors of Thrombosis After Successful Implantation of DES 1.Diabetes 2.5 % 2.Unprotected LMCA 3.3 % 3.Bifurcation lesion 3.6 % 4.Renal failure 6.2 % 5.Premature antiplatelet 29.0 % therapy discontinuation Vinall, M. (ESC Stockholm 2010)

Park, S.-J. et al. NEJM 362; 2010: 1374 n = 2701, median duration of follow-up was 19.2 months

n = 6595, chol 272, LDL 192, current smokers 44%; Death from any cause : 135 (4.1%) 106 (3.2%) p= CV Death + Mi (7.9 vs. 5.5 % p< 0.001)

N Engl J Med 2007;357: NNT = 56

Treatment Problems „Most of the women receiving statins had no CHD and a 10-year risk for coronary events of less than 10%. This finding strongly suggests that the bulk of German doctors in private practice do not base their treatment decisions on risk estimation.“ Assmann et al., Eu J Cardiovasc Preven & Rehab 13 (2006) 776

Die Statintherapie in der Primärprophylaxe zeigt hinsichtlich der Reduktion von Tod, Myokardinfarkt und Schlaganfall einen mäßigen Erfolg (< 1%/Jahr).

Versorgungssituation - Lipidtherapie 1.Statine Inegy ,2 3.Ezetrol 29 15,6 4.Fenofibrat 41 16,4 5.Bezafibrat 20 8,8 6.Quantalan/ 5,1 10,9 Niaspan/Omacor Wirkstoffe DDD (Mio.) Umsatz (Mio. €) Quelle: Arzneiverordnungsreport 2010

Effect of fish oil on arrhythmias and mortality: a systematic review ( Leon et al., BMJ 2009;338:a2931 ) Effect of fish oil on death from cardiac causes

Effect of fish oil on arrhythmias and mortality: a systematic review ( Leon et al., BMJ 2009;338:a2931 ) Effect of fish oil on all cause mortality

Conclusions: Fish oil supplementation was associated with a significant reduction in deaths from cardiac causes but had no effect on arrhythmias or all cause mortality. Evidence to recommend an optimal formulation of EPA or DHA to reduce these outcomes is insufficient. Fish oils are a heterogeneous product, and the optimal formulations for DHA and EPA remain unclear. Effect of fish oil on arrhythmias and mortality: a systematic review ( Leon et al., BMJ 2009;338:a2931 )

BMJ 2010;341:c patients with a history of myocardial infarction, unstable angina, or ischaemic stroke (600 mg of eicosapentanoic acid and docosahexaenoic acid at a ratio of 2:1)

Low-dose supplementation with EPA–DHA or ALA did not significantly reduce the rate of major cardiovascular events among patients who had had a myocardial infarction and who were receiving state-of-the-art antihypertensive, antithrombotic, and lipid- modifying therapy. NEJM 363 (2010)2015 Age: 60 – 80 years 78 % men, marine EPA: Eicosapentaenoic acid, marine DHA: Docosahexaenoic acid plant ALA: Alphalinoic acid

Efficacy and Safety of Prescription Omega-3 Fatty Acids for the Prevention of Recurrent Symptomatic Atrial Fibrillation A Randomized Controlled Trial (Kowey et al., JAMA 2010;304:2363)

N Engl J Med 2010;362:

N Engl J Med 2005;353:

Fellstrom et al., N Engl J Med 2009;360:

Kjekshus et al., N Engl J Med 2007;357:2248 KHK 72%, Mi 60%, CABG/PCI 26%, DM 30%

Ergebnisse: Vergleich der Lipidparameter Niacin: 126 mg/dl (1,44 mmol/l) Ezetimib: 122 mg/dl (1,39 mmol/l) Ausgangswerte: Niacin: 145,6 mg/dl (3,77 mmol/l) Ezetimib: 146,6 mg/dl (3,79 mmol/l) -7% - 13% -7% - 29% nach Taylor, N Engl J Med 2009;361

Ergebnisse: Veränderung mittlere IMD Taylor, N Engl J Med 2009;361 Ausgangswerte IMD: Ezetimib: 0,8957 mm Niacin: 0,9001 mm -0,0142 mm -0,0007 mm

Taylor, N Engl J Med 2009;361 Supplementary Appendix to Taylor, NEJM 2009; 361 Ergebnisse: Schwerwiegende kardiovaskuläre Ereignisse n = 9 n = 2 Pro Patient können mehrere Endpunkte aufgetreten sein

J Am Coll Cardiol 2010;55:000

Lancet 2010; 376: 1658–69 Compared with two (0·03%) cases of myopathy in patients taking 20 mg simvastatin daily, there were 53 (0·9%) cases in the 80 mg group. over 7 years

Die lipidsenkende Therapie (2010) ist nicht indiziert mit Fibraten mit Fischöl mit Ezetimib bei Dialysepatienten bei Herzinsuffizienz ● Statine bleiben die evidenzbasierten Pharmaka ● die Primärprophylaxe hat geringe Wirkung ● der Vorteil der stärkeren LDL-Senkung ist marginal hat mehr Nebenwirkungen

Lung Function in Rescue Workers at the World Trade Center after 7 Years Aldrich et al., NEJM 2010;362:1263

Adverse Events Associated with Testosterone Administration Testosterone gel, 65 or older, mean 74 Improvement of Mobility and strength Testosterone levels: 574 ng/dl vs. 292 ng/dl Basaria et al., N Engl J Med 2010;363:109

Dose Comparisons of Clopidogrel and Aspirin in Acute Coronary Syndromes The CURRENT–OASIS 7 Investigators* NEJM 2010;363: 930

Gait Speed and Survival in Older Adults Studenski et al., JAMA. 2011;305(1):50-58 n = , follow up 6 – 21 years, mean age 74 years

Ihnen allen ein gesundes Jahr 2011 Wie üblich mit full speed !