Hassan Fares

Publications (3)11.06 Total impact

• Article: L-Carnitine in the Secondary Prevention of Cardiovascular Disease: Systematic Review and Meta-analysis.

  James J Dinicolantonio, Carl J Lavie, Hassan Fares, Arthur R Menezes, James H O'Keefe
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  ABSTRACT: OBJECTIVE: To evaluate the effects of L-carnitine compared with placebo or control on morbidity and mortality in the setting of acute myocardial infarction. METHODS: A systematic review and meta-analysis of 13 controlled trials (N=3629) was conducted to determine the effects of L-carnitine vs placebo or control on mortality, ventricular arrhythmias (VAs), angina, heart failure, and reinfarction. These trials were identified via searches of the Ovid MEDLINE, PubMed, and Excerpta Medica (Embase) databases between May 1, 2012, and August 31, 2012. RESULTS: Compared with placebo or control, L-carnitine was associated with a significant 27% reduction in all-cause mortality (odds ratio, 0.73; 95% CI, 0.54-0.99; P=.05; risk ratio [RR], 0.78; 95% CI, 0.60-1.00; P=.05), a highly significant 65% reduction in VAs (RR, 0.35; 95% CI, 0.21-0.58; P<.0001), and a significant 40% reduction in the development of angina (RR, 0.60; 95% CI, 0.50-0.72; P<.00001), with no reduction in the development of heart failure (RR, 0.85; 95% CI, 0.67-1.09; P=.21) or myocardial reinfarction (RR, 0.78; 95% CI, 0.41-1.48; P=.45). CONCLUSION: Compared with placebo or control, L-carnitine is associated with a 27% reduction in all-cause mortality, a 65% reduction in VAs, and a 40% reduction in anginal symptoms in patients experiencing an acute myocardial infarction. Further study with large randomized controlled trials of this inexpensive and safe therapy in the modern era is warranted.
  Mayo Clinic Proceedings 04/2013; · 5.70 Impact Factor
• Article: Meta-Analysis of Carvedilol Versus Beta 1 Selective Beta-Blockers (Atenolol, Bisoprolol, Metoprolol, and Nebivolol).

  James J Dinicolantonio, Carl J Lavie, Hassan Fares, Arthur R Menezes, James H O'Keefe
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  ABSTRACT: Because carvedilol is a unique vasodilating β blocker (BB) exerting antioxidant activity and pleiotropic effects, it was theorized that it may confer more potent beneficial effects on cardiovascular mortality and morbidity in acute myocardial infarction (AMI) and heart failure (HF) settings. A systematic review and meta-analysis was performed of randomized, controlled, direct-comparison trials that included adults receiving atenolol, bisoprolol, metoprolol, nebivolol, or carvedilol to evaluate the effects of carvedilol compared to other BBs on mortality, cardiovascular events, and hospital readmissions in the setting of AMI or systolic HF. Compared to β(1)-selective BBs used in HF (8 trials, n = 4,563), carvedilol significantly reduced all-cause mortality (risk ratio 0.85, 95% confidence interval 0.78 to 0.93, p = 0.0006). In 3 trials of patients with AMI (n = 644), carvedilol significantly reduced all-cause mortality by 45% (fixed-effects model: risk ratio 0.55, 95% confidence interval 0.32 to 0.94, p = 0.03, random-effects model: risk ratio 0.56, 95% confidence interval 0.26 to 1.12, p = 0.10), with no reduction in non-fatal MI (risk ratio 0.61, 95% confidence interval 0.31 to 1.22, p = 0.16). In conclusion, carvedilol, as compared against atenolol, bisoprolol, metoprolol and nebivolol in randomized direct comparison trials, significantly reduced all-cause mortality in systolic HF patients. Additionally, carvedilol significantly reduced all-cause mortality compared with β(1)-selective BBs in AMI patients using the fixed-effects model but not using the random-effects model.
  The American journal of cardiology 01/2013; · 3.58 Impact Factor
• Article: Vasodilating versus first-generation β-blockers for cardiovascular protection.

  Hassan Fares, Carl J Lavie, Hector O Ventura
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  ABSTRACT: The utility of β-blockers in the treatment of hypertension has created much speculation as to their efficacy in patients with comorbid conditions, and there are concerns regarding their adverse metabolic effects. It is important to note that these findings were observed with traditional β-blockers, such as atenolol and metoprolol. The newer generation of β-blockers, namely carvedilol and nebivolol, is changing the manner in which β-blockers are viewed in hypertension management. Their ability to inhibit A1 adrenoreceptors and influence nitric oxide leads to vasodilation, which traditional β-blockers fail to do. These agents have been shown to have favorable metabolic effects while maintaining the beneficial cardiovascular effects of this drug class in post-myocardial infarction patients and the heart failure population.
  Postgraduate Medicine 03/2012; 124(2):7-15. · 1.78 Impact Factor