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Journal: European heart journal. Cardiovascular pharmacotherapy


Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used and have been associated with increased cardiovascular risk. Nonetheless, it remains unknown whether use of NSAIDs is associated with out-of-hospital cardiac arrest (OHCA).

Concepts: Non-steroidal anti-inflammatory drug, Anti-inflammatory, Paracetamol


Loop diuretics are recommended for relieving symptoms and signs of congestion in patients with chronic heart failure and are administered to more than 80% of them. However, several of their effects have not systematically been studied. Numerous cohort and four interventional studies have addressed the effect of diuretics on renal function; apart from one prospective study, which showed that diuretics withdrawal is accompanied by increase in some markers of early-detected renal injury, all others converge to the conclusion that diuretics receipt, especially in high doses is associated with increased rates of renal dysfunction. Although a long standing perception has attributed a beneficial effect to diuretics in the setting of chronic heart failure, many cohort studies support that their use, especially in high doses is associated with adverse outcome. Several studies have used propensity scores in order to match diuretic and non-diuretic receiving patients; their results reinforce the notion that diuretics use and high diuretics dose are true risk factors and not disease severity markers, as some have suggested. One small, randomized study has demonstrated that diuretics decrease is feasible and safe and accompanied by a better prognosis. In conclusion, until elegantly designed, randomized trials, powered for clinical endpoints answer the unsettled issues in the field, the use of diuretics in CHF will remain subject to physicians' preferences and biases and not evidence-based.

Concepts: Epidemiology, Clinical trial, Medical terms, Hypertension, Randomized controlled trial, Cultural studies, Diuretic, Loop diuretic


The 2016 European Society of Cardiology Heart Failure society as well as the 2016 American Heart Association/American College of Cardiology/Heart Failure Society of America heart failure (HF) guidelines confirm the class I indication for mineralocorticoid receptor antagonists (MRAs) in patients with chronic HF and a reduced left ventricular ejection fraction (HF-REF). MRAs in addition to an angiotensin converting enzyme inhibitor (ACEi), or an angiotensin receptor antagonist if an ACEi is not tolerated, along with a beta receptor antagonist and a diuretic (if required for congestion relief) make up the baseline therapy for all patients with chronic HF-REF. However, despite the finding that MRAs have been shown to reduce mortality as well as total and repeated hospitalizations in all patients with chronic HF-REF, as well as their class I indication in international guidelines, their use in guideline eligible patients remains suboptimal. Although much has been written about the mechanisms and role of MRAs in HF, this article will review the clinical studies and mechanisms thought responsible for their benefits in an attempt to increase their use in guideline eligible patients with HF as well as to provide the basis for understanding potential new opportunities for their use in patients with HF.

Concepts: Myocardial infarction, Cardiology, Heart failure, Ejection fraction, Receptor, Ligand, Receptor antagonist, Inverse agonist


Patient response to statin treatment is individual and varied. As a consequence, when using a specific-dose approach, as recommended in the 2013 American College of Cardiology/American Heart Association guideline, there will be a range of reductions in the concentration of low-density lipoprotein cholesterol (LDL-C). The aim of this study was to use individual patient data from the VOYAGER meta-analysis to determine the extent of the variability in LDL-C reduction in response to treatment across the recommended doses of different statins.

Concepts: Cholesterol, Myocardial infarction, Atherosclerosis, Low-density lipoprotein, Statin, Atheroma, Hypercholesterolemia, Statins


The impact of preadmission antiplatelet treatment on prognosis after stroke is poorly understood. We therefore investigated whether preadmission use of aspirin and clopidogrel was associated with mortality in patients hospitalized with ischemic stroke, intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH).

Concepts: Cohort study, Myocardial infarction, Stroke, Platelet, Clopidogrel, Subarachnoid hemorrhage, Aspirin, Cerebral hemorrhage


The impact of the quality of warfarin therapy on cardiovascular outcomes excluding stroke is largely unknown. The aims of this study were to evaluate the association between the warfarin control and the incidence and outcome of myocardial infarction (MI), and to validate the predictive value of the CHA2DS2-VASc score for MI in AF patients taking warfarin.

Concepts: Myocardial infarction, Heart, Stroke, Atrial fibrillation, Warfarin, Circulatory system, Thrombus, Anticoagulant


High resting heart rate (HR; ≥70 beats/minute) is associated with worse clinical outcomes in heart failure with reduced ejection fraction (HFrEF).

Concepts: Myocardial infarction, Hypertension, Cardiology, Heart failure, Ejection fraction, Heart rate, Beta blocker


Optimal medical therapy (OMT) is recommended in acute coronary syndrome (ACS) patients. Few studies present temporal trends of OMT prescription and its impact on outcomes in a real-world setting. We aimed to evaluate OMT prescription in a real-world ACS population and its relation to mortality during almost a decade.

Concepts: Medicine, Therapy, Acute coronary syndrome


We investigated baseline characteristics, antithrombotic use, and clinical outcomes of patients with atrial fibrillation (AF) and a thromboembolic event in the ARISTOTLE study to better inform the care of these high-risk patients.

Concepts: Heart, Atrial fibrillation, Atrial flutter


The circadian variation of platelet aggregation is well demonstrated. However, whether this has an impact on antiplatelet inhibition therapy is poorly documented. We aimed to observe whether ticagrelor-induced platelet inhibition follows a circadian rhythm.

Concepts: Platelet, Circadian rhythm, Circadian rhythm sleep disorder