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Bansal A, Hiwale K. Updates in the Management of Coronary Artery Disease: A Review Article. Cureus 2023; 15:e50644. [PMID: 38229816 PMCID: PMC10790113 DOI: 10.7759/cureus.50644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/16/2023] [Indexed: 01/18/2024] Open
Abstract
Coronary artery disease (CAD) remains a significant health challenge, imposing substantial burdens on individuals and healthcare systems worldwide. CAD's impact stems from artery narrowing and blockage, leading to severe complications like heart attacks and heart failure. Collaborative efforts by researchers, professionals, and governments have fostered advancements in comprehending and managing this cardiovascular ailment. Evolving CAD management embraces modern diagnostics, cutting-edge pharmaceuticals, invasive procedures, lifestyle modifications, and cardiac rehabilitation. This comprehensive approach aims to amplify outcomes and elevate the quality of life for CAD-affected individuals. This review delves into innovative treatments, pivotal breakthroughs, and recent trends in clinical practices that collectively shape CAD management. The exploration encompasses novel diagnostic technologies enabling early detection and risk assessment. Moreover, it investigates recent breakthroughs in medications that profoundly impact platelet disorders, lipid reduction, and angina. Precision medicine's role in tailoring treatment strategies based on patient characteristics is thoroughly examined. Advances in invasive procedures, like percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), have revolutionised coronary revascularisation, substantially improved long-term outcomes, and reduced restenosis rates. The increasing significance of lifestyle changes and cardiac rehabilitation in CAD management, augmenting treatment options and patient recovery, are meticulously scrutinized. While these strides are pivotal, research continues to chart new paths in CAD management, from innovative drugs to collaborative multidisciplinary care models. Staying attuned to the latest advancements and embracing a patient-centric approach can collectively reduce CAD's impact and facilitate the lives of those grappling with this chronic cardiovascular disorder.
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Affiliation(s)
- Archit Bansal
- Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Kishore Hiwale
- Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Wang H, Xie X, Zu Q, Lu M, Chen R, Yang Z, Gao Y, Tang Z. Treatment of the New Era: Long-Term Ticagrelor Monotherapy for the Treatment of Patients with Type 2 Diabetes Mellitus following Percutaneous Coronary Intervention: A Meta-analysis. Diabetes Ther 2023; 14:47-61. [PMID: 36484899 PMCID: PMC9880125 DOI: 10.1007/s13300-022-01350-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/24/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) is a risk factor for the development of coronary artery disease (CAD). In patients with acute coronary syndrome (ACS), guidelines recommend a potent P2Y12 inhibitor in addition to aspirin. For those with complicated and advanced CAD requiring complex percutaneous coronary intervention (PCI), the risk for adverse ischemic events is even higher. Prolonged dual antiplatelet therapy (DAPT) use is controversial. A new antiplatelet regimen after PCI should be considered. In this analysis, we aimed to systematically show the impact of long-term ticagrelor monotherapy after a short course of DAPT use on the outcomes in patients with T2DM following PCI. METHODS Electronic databases were searched for relevant publications. Studies that were based on patients with T2DM and that included patients with T2DM were selected on the basis of the inclusion and exclusion criteria. Statistical analysis was carried out with RevMan software. The data are presented as risk ratios (RR) with 95% confidence intervals (CI). RESULTS A total of 8621 patients were included in this analysis, whereby 4357 participants with T2DM were assigned to ticagrelor monotherapy and 4264 were assigned to DAPT. Our results showed long-term ticagrelor monotherapy after a short course of DAPT use to be associated with a significantly lower risk of major adverse cardiac events (RR 0.86, 95% CI 0.77-0.98; P = 0.02) and all-cause mortality (RR 0.77, 95% CI 0.60-0.98; P = 0.03). However, no significant difference was observed in cardiac death, myocardial infarction, stroke, stent thrombosis, or repeated revascularization. Ticagrelor monotherapy was associated with significantly lower risk of thrombolysis in myocardial infarction (TIMI) defined minor or major bleeding (RR 0.71, 95% CI 0.54-0.93; P = 0.01) compared with the DAPT regimen. CONCLUSION Long-term ticagrelor monotherapy after a short course of DAPT use showed better results in patients with T2DM following PCI. Therefore, ticagrelor monotherapy after a short course of DAPT use could be considered an evolution in antiplatelet therapy of this decade for the treatment of patients with T2DM after PCI. However, newer studies with a larger population size and cost-effectiveness are factors that should further be considered.
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Affiliation(s)
- Hong Wang
- Jinan University, Guangzhou, 510632 Guangdong People’s Republic of China
- Department of Cardiology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021 Guangxi People’s Republic of China
| | - Xiaoya Xie
- Macau University of Science and Technology, Macau, People’s Republic of China
| | - Quannan Zu
- College of Management and Economics, Tianjin University, Tianjin, 300072 People’s Republic of China
| | - Ming Lu
- College of Management and Economics, Tianjin University, Tianjin, 300072 People’s Republic of China
| | - Rongfa Chen
- The State Key Laboratory Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190 People’s Republic of China
| | - Zhiren Yang
- The State Key Laboratory Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190 People’s Republic of China
| | - Yongqiang Gao
- Department of Cardiology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021 Guangxi People’s Republic of China
| | - Zhangui Tang
- Department of Cardiology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Tongji, Wuhan, People’s Republic of China
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Dhurjati R, Sagar V, Kanukula R, Rehana N, Mohanan PP, Huffman MD, Bhaumik S, Salam A. Quality of the Indian clinical practice guidelines for the management of cardiovascular conditions. JRSM Open 2022; 13:20542704221127178. [PMID: 36506268 PMCID: PMC9730011 DOI: 10.1177/20542704221127178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
To assess the quality of Indian clinical practice guidelines (CPG)s for the management of cardiovascular conditions, MEDLINE, Embase, Google Scholar and websites of relevant medical associations and government organisations were searched, from inception until August 2020, to identify Indian CPGs for the management of cardiovascular disease (CVD) conditions, produced in or between 2010 and 2019. Excluded were CPGs that were not specific to India, focused on alternative systems of medicine, of non-CVD conditions (even if they included a component of CVD), and those related to the electronic devices, cardiac biomarkers, or diagnostic procedures. Quality of the each included CPG was assessed using the AGREE II tool by four reviewers in duplicate, independently. Each AGREE II domain score and overall quality score was considered low (≤40%), moderate (40.1%-59.9%), and high (≥60%). Of the 23 CPGs included, six (26%) were reported to be adapted from other CPGs. Fourteen (61%) CPGs were produced by medical associations, six (26%) by individual authors and three (13%) by government agencies. Based on the AGREE II overall quality score, two (9%) CPGs were of high quality, four (17%) and seventeen (74%) CPGs were of moderate and low quality, respectively. Except for scope and purpose, and clarity of presentation all other domains were rated low. The quality of most Indian CPGs for managing CVD conditions assessed using the AGREE II tool was moderate-to-low. Combined efforts from different stakeholders are needed to develop, disseminate and implement high-quality CPGs while identifying and addressing barriers to their uptake to optimize patient care and improve outcomes.
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Affiliation(s)
| | - Vidya Sagar
- The George Institute for Global Health, New Delhi, Delhi, India
| | - Raju Kanukula
- The George Institute for Global Health, New Delhi, Delhi, India
| | - Nusrath Rehana
- The George Institute for Global Health, New Delhi, Delhi, India
| | | | - Mark D. Huffman
- Washington University in St. Louis, St Louis, MO, USA,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Soumyadeep Bhaumik
- The George Institute for Global Health, New Delhi, Delhi, India,Meta-research & Evidence Synthesis Unit, The George Institute for Global Health, New Delhi, Delhi, India
| | - Abdul Salam
- The George Institute for Global Health, New Delhi, Delhi, India,Manipal Academy of Higher Education, Manipal, Karnataka, India,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia,Abdul Salam.
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Romagnoli A, Santoleri F, Costantini A. Adherence and persistence analysis in patients treated with double antiplatelet therapy (DAPT) at two years in real life. PATIENT EDUCATION AND COUNSELING 2021; 104:2012-2017. [PMID: 33461875 DOI: 10.1016/j.pec.2021.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/09/2020] [Accepted: 01/05/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Double antiplatelet therapy (DAPT) is indicated for the treatment of coronary artery diseases (CAD). The optimal duration of therapy with DAPT continues to be a subject of debate in the scientific community. To improve adherence to DAPT, the FDC (fixed dose combination) of Acetylsalicylic acid (ASA) and clopidogrel was developed into a single pill instead of two separate pills thus facilitating the dosage and administration of the therapy and increasing compliance. The aim of this study was to assess adherence and persistence over a period of two years in patients treated with DAPT composed of: ASA/clopidogrel, ASA/prasugrel, ASA/ticagrelor and FDC with ASA and clopidogrel in real life and to assess whether the use of ASA and clopidogrel FDC is associated with improved adherence. MATERIALS AND METHODS In the following retrospective pharmacological-observational non-interventional study, all patients treated with DAPT in the Hospital of Pescara from January 2010 to October 2019 were considered. Persistence to treatment is defined as the duration of time from initiation to discontinuation of treatment. Adherence was calculated as the ratio between Received Daily Dose (RDD) and Prescribed Daily Dose (PDD). RESULTS 277 patients treated with ASA/clopidogrel, 77 patients treated with ASA/prasugrel, 57 patients treated with ASA/ticagrelor and 108 patients treated with FDC of ASA/clopidogrel were analysed. Persistence curves at two years showed a statistically significant difference (p < 0.001). Adherence to therapy was optimal with an absolute value at two years of 0.96. Adherence was better in patients treated with ASA/prasugrel with a value of 0.98 and with 97 % of patients with an adherence value greater than or equal to 0.8, while, it was worse in patients treated with FDC ASA/clopidogrel with an absolute value of 0.94 and with 88 % of patients with an optimal adherence value. No statistically significant difference was found between the ASA/clopidogrel FDC in comparison to each component taken as a separate pill (p = 0.0752). CONCLUSION DAPT along with ASA/clopidogrel showed a statistically significant better persistence than ASA/ticagrelor and ASA/prasugrel. Whereas, to our knowledge and as per the current literature no statistically significant differences were found, in terms of adherence in real life, between the use of ASA/Clopidogrel FDC and the use of two different pills.
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Affiliation(s)
- Alessia Romagnoli
- Hospital Pharmacy of "SS. Spirito" Hospital of Pescara, Address Renato Paolini 47, 65124, Pescara, Italy.
| | - Fiorenzo Santoleri
- Hospital Pharmacy of "SS. Spirito" Hospital of Pescara, Address Renato Paolini 47, 65124, Pescara, Italy.
| | - Alberto Costantini
- Hospital Pharmacy of "SS. Spirito" Hospital of Pescara, Address Renato Paolini 47, 65124, Pescara, Italy.
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Khan MY, Pandit S, Guha S, Jadhav U, Rao MS, Gaurav K, Mane A, Dubey A, Bhagwatkar H, Venkataswamy K, Shah S. Demographic profile, clinical characteristics and medical management patterns of Indian coronary artery disease patients: a nationwide urban-based, real-world, retrospective, observational electronic medical record study- report of baseline data. Expert Rev Cardiovasc Ther 2021; 19:769-775. [PMID: 34126829 DOI: 10.1080/14779072.2021.1941872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: This is the first detailed Indian electronic medical record (EMR)-based real-world observational study to understand the clinical characteristics, associated comorbidities/risk factors and treatment(s) of CAD patients across India.Methods: EMR data of adult Indians (aged ≥ 18 years) diagnosed with CAD was retrospectively analyzed.Results: The majority of the participants had stable IHD (93%), were men (68.5% in ACS, 59.8% in stable IHD), most common age group was 40-64 years in ACS (56.6%) and stable IHD (51.4%). Both are common in metros (ACS 52%, 62% stable IHD). There is a high frequency of hypertension (38.2% in ACS, 59% in stable IHD) and diabetes mellitus (32.3% in ACS, 57.6% in stable IHD). Most common treatments are antiplatelet drugs and lipid-lowering drugs (96%).Conclusions: In India, stable IHD is the most prevalent form in vast majority of patients. The patients with CAD are mostly males, are mainly located in metros and majority fall between the age group of 40-64. The major comorbidities are hypertension and diabetes mellitus. Sociodemographic and clinical characteristics for CAD in India may not be similar to what is reported from the west. There is a significant difference in drug usage and adherence to guidelines in India for CAD.
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Affiliation(s)
- Mohammed Yunus Khan
- Department of Cardiology, Dr. Reddy's Laboratories Ltd, Hyderabad, Telangana, India
| | - Sucheta Pandit
- Department of Cardiology, Dr. Reddy's Laboratories Ltd, Hyderabad, Telangana, India
| | - Santanu Guha
- Medical College and Hospital, Kolkata, West Bengal, India
| | | | | | - Kumar Gaurav
- Department of Cardiology, Dr. Reddy's Laboratories Ltd, Hyderabad, Telangana, India
| | - Amey Mane
- Department of Cardiology, Dr. Reddy's Laboratories Ltd, Hyderabad, Telangana, India
| | - Akhilesh Dubey
- Prime Health Clinic and Galaxy Hospital, Jabalpur, India
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Changing patterns in the prevalence and management of cardiovascular risk factors in India and their comparison with the rest of the world along with clinical outcomes at 5-year: An analysis of stable coronary artery disease patients from The Prospective Observational Longitudinal Registry of patients with stable coronary artery disease (CLARIFY) registry. Indian Heart J 2018; 70 Suppl 3:S36-S42. [PMID: 30595290 PMCID: PMC6309139 DOI: 10.1016/j.ihj.2018.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/21/2018] [Accepted: 04/05/2018] [Indexed: 02/01/2023] Open
Abstract
Objective Present paper describes trends in prevalence and control of cardiovascular risk factors and clinical outcomes at 5-years for CLARIFY Indian cohort compared with rest of the world (ROW). Method CLARIFY is an international, prospective-observational, longitudinal cohort study in stable coronary artery disease outpatients. The 5-year data of both cohorts were compared, and evaluated. Results In Indian cohort, the angina prevalence declined significantly. There are few favorable changes in the pattern of receiving guideline-recommended therapy over 5 years, and the Indian cohort exhibited significantly lower adverse clinical outcomes than ROW. Conclusion The 5-year trend of CLARIFY India registry indicate varying trends in prevalence and control of cardiovascular risk factors, the need for approaches to improve control of all modifiable risk factors, and increase in long-term use of essential primary and secondary prevention medications in clinical practice as emphasized in the latest Indian guidelines for management of stable CAD.
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Ozcan Cetin EH, Ozeke O, Ilkay E, Aras D, Topaloglu S, Golbasi Z, Aydogdu S, Ozer C. Palliative treatment of coronary "atherosclerotic cancer" by drug-eluting or bare-metal stents: From oculo-stenotic reflex period to age of precision medicine. Indian Heart J 2018; 70:191-193. [PMID: 29455777 PMCID: PMC5902819 DOI: 10.1016/j.ihj.2017.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 07/04/2017] [Accepted: 07/13/2017] [Indexed: 02/07/2023] Open
Abstract
Medications and treatments are said to have a palliative effect if they relieve symptoms without having a curative effect on the underlying disease such as atherosclerosis or cancer. Some authors speculated that atherosclerotic coronary artery disease (CAD) could be considered a "cancer of the coronary arterial wall". Although the percutaneous coronary intervention (PCI) has proven to be effective in decreasing mortality rates among patients with acute coronary syndromes, the previous meta-analyses of PCI versus optimal medical therapy for stable CAD have not been able to demonstrate a reduction in major adverse cardiac outcomes. However, few cardiologists discussed the evidence-based benefits of angiogram and PCI for stable CAD, and some implicitly or explicitly overstated the benefits. Recently, the precision medicine is defined as an evidence-based approach that uses innovative tools and biological and data science to customize disease prevention, detection, and treatment, and improve the effectiveness and quality of patient care. Providing patients with accurate and complete information appears to be an effective way to combat the reliance on the oculostenotic reflex. The foundation of precision medicine is the ability to tailor therapy based upon the expected risks and benefits of treatment for each individual patient. As said by Doctor William Osler, "The good physician treats the disease; the great physician treats the patient who has the disease."
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Affiliation(s)
- Elif Hande Ozcan Cetin
- Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital , Department of Cardiology, Ankara, Turkey
| | - Ozcan Ozeke
- Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital , Department of Cardiology, Ankara, Turkey.
| | - Erdogan Ilkay
- Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital , Department of Cardiology, Ankara, Turkey
| | - Dursun Aras
- Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital , Department of Cardiology, Ankara, Turkey
| | - Serkan Topaloglu
- Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital , Department of Cardiology, Ankara, Turkey
| | - Zehra Golbasi
- Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital , Department of Cardiology, Ankara, Turkey
| | - Sinan Aydogdu
- Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital , Department of Cardiology, Ankara, Turkey
| | - Can Ozer
- Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital , Department of Cardiology, Ankara, Turkey
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Han CL, Wu CF, Lin GM. Microvascular dysfunction in silent myocardial ischemia. Indian Heart J 2017; 69:288. [PMID: 28460785 PMCID: PMC5414964 DOI: 10.1016/j.ihj.2017.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 02/16/2017] [Indexed: 11/16/2022] Open
Affiliation(s)
- Chih-Lu Han
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ching-Fen Wu
- GraceGrace Clinic, Chaozhou Township, Pingtung County, Taiwan
| | - Gen-Min Lin
- Departments of Medicine, Hualien-Armed Forces General Hospital, Hualien, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Gupta PN, Velappan P, Bhaskara Pillai KK, Salam RA. Re chronic stable angina guidelines. Indian Heart J 2017; 69:129-132. [PMID: 28228298 PMCID: PMC5319125 DOI: 10.1016/j.ihj.2017.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 01/09/2017] [Indexed: 11/16/2022] Open
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