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Hello Health Rounds readers! Today we present three new studies that were presented at one of the most important cardiac meetings of the year, the American Heart Association Scientific Sessions () which concluded this week in Chicago.
Low-risk adults with atrial fibrillation receive no benefit from blood thinners
According to a Canadian study, young patients with atrial fibrillation, a common heart rhythm disorder, but without other risk factors for stroke, have no interest in taking anticoagulants.
In a trial of 1,235 healthy adults under 65 years of age with atrial fibrillation, prescribing anticoagulants did not reduce the risk of cognitive decline, stroke, or transient ischemic attack ( TIAs), sometimes called a mini-stroke.
None of the study participants had stroke risk factors such as diabetes, heart failure, high blood pressure, or a prior stroke or TIA. Half of them received 15 milligrams per day of rivaroxaban, sold by Johnson & Johnson JNJ.N as Xarelto. The others received a placebo.
The trial was initially planned to continue for 5 years, but was stopped after an average follow-up of 3.7 years, after an independent monitoring committee found that the drug provided no benefit.
Researchers reported at the AHA meeting that there was no difference between patients taking rivaroxaban and those receiving a placebo in cognitive decline, stroke or stroke. (AIT). The annual rates of these conditions combined were 7% with rivaroxaban and 6.4% with placebo.
“Although many observational studies have reported an association between atrial fibrillation and cognitive decline, we found that anticoagulation treatment initiated in relatively young adults with atrial fibrillation did not reduce this risk,” said Dr. Lena Rivard of the University of Montreal, leader of the study, in a press release.
“In clinical practice, people younger than 65 years of age with atrial fibrillation tend to be overtreated with anticoagulant therapy, whereas older people who have indications for anticoagulation are undertreated,” said the Dr. Rivard.
“Our study supports current guidelines by confirming that younger people with atrial fibrillation but no other risk factors for stroke have a low rate of stroke and that anticoagulation does not is not useful in reducing the risk of cognitive decline
Recycled American pacemakers can save lives abroad
Previously used remanufactured pacemakers worked as well as new devices in a study of nearly 300 people in seven low- and middle-income countries, according to data presented at the cardiology meeting.
Reuse of pacemakers is prohibited in the United States, but the U.S. Food and Drug Administration allows the export of sterilized devices for reuse, the researchers note.
Pacemakers with at least six years of battery life and functioning properly were sterilized for reuse after being recovered from patients who had died or had undergone surgeries involving the removal of their existing devices.
Study participants were randomly assigned to a new device or a refurbished device.
Three months later, three cases of infection requiring implant removal were identified in the new pacemaker group and two in the reconditioned pacemaker group.
Five patients with new pacemakers and six with refurbished pacemakers required surgery to move or replace the pacemaker leads.
“In some high-income countries, up to 1,000 people per million population may receive a pacemaker each year. In low-income countries, it could be 3 people per million population or even less , who receive a pacemaker every year,” Dr. Thomas Crawford of the University of Michigan Medical School, who led the study, said in a statement.
Three deaths unrelated to device implantation occurred in the reconditioned pacemaker group and none in the new pacemaker group.
No dysfunction was observed in both groups.
Although larger and longer studies are needed to determine the long-term safety and effectiveness of remanufactured pacemakers, this trial suggests positive outcomes for cardiac patients with lower financial resources who need pacemakers. , concluded his team.
Tighter blood pressure control is advised for type 2 diabetes
Tighter blood pressure control appears to protect adults with type 2 diabetes from major cardiovascular events, according to a study by Chinese researchers presented at the AHA meeting.
In their study of nearly 13,000 adults with type 2 diabetes and hypertension, keeping systolic blood pressure – the highest number – at 120 mm Hg or lower helped reduce the risk of heart attack , stroke, heart failure, and cardiovascular death compared with the standard approach of maintaining blood pressure below 140 mm Hg.
Four years after the start of the study, the average systolic blood pressure was 120.6 mm Hg in the intensive treatment group and 132.1 mm Hg in the standard treatment group.
The combined rate of nonfatal stroke, nonfatal heart attack, hospitalization or treatment for heart failure, and heart-related death was 1.65% per year in the intensive treatment group and 2. 09% per year in the standard treatment group.
The average age of patients at enrollment was 64 years. After accounting for individual patient risk factors, the intensive treatment group had a 21% lower risk of major cardiovascular events, according to a study report published in The New England Journal of Medicine.
Most participants in the intensive treatment group first received a two- or three-drug regimen that included a diuretic and other types of medications to lower blood pressure. Medication doses were increased or additional medications were added at monthly intervals until the systolic pressure was below 120 mm Hg.
The group that received intensive treatment, however, had more non-serious symptoms related to low blood pressure.
Weaknesses of the study include that participants sometimes used the home blood pressure monitoring system to self-report their blood pressure levels over the phone, particularly during the pandemic lockdown. The researchers also noted that the results of this Chinese study may not be generalizable to other ethnic populations.
Nevertheless, the results “strongly argue for a more intensive systolic blood pressure target in people with type 2 diabetes for the prevention of major cardiovascular events,” Dr. Guang Ning, head of the study, said in a statement. study at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine.
