Advances in cardiology (Adv Cardiol)

Publisher: Karger

Journal description

This series is devoted to current problems in clinical and preventive cardiology. Edited or authored by renowned specialists, volumes in this series are designed to provide up-to-date and comprehensive coverage of a particular subject. Some volumes record the proceedings of important symposia. Special emphasis is given to new findings relating to diagnostic and therapeutic measures, cardiac pharmacology, and drug-disease interactions, and to the fundamental cellular and molecular pathophysiology underlying cardiovascular disease processes. Areas of interest range throughout the field of cardiology to include coronary artery disease, congenital and acquired valvular and other structural heart diseases, primary myocardial diseases and primary and secondary electrophysiological dysfunction.

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Additional details

5-year impact 0.00
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Website Advances in Cardiology website
Other titles Advances in cardiology
ISSN 0065-2326
OCLC 3490010
Material type Periodical
Document type Journal / Magazine / Newspaper

Publisher details

Karger

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • On author's server or institutional server
    • Server must be non-commercial
    • Publisher's version/PDF cannot be used
    • Publisher copyright and source must be acknowledged
    • Must link to publisher version
  • Classification
    green

Publications in this journal


  • No preview · Article · Apr 2015 · Advances in cardiology

  • No preview · Article · Apr 2015 · Advances in cardiology

  • No preview · Article · Apr 2015 · Advances in cardiology

  • No preview · Article · Apr 2015 · Advances in cardiology

  • No preview · Article · Apr 2015 · Advances in cardiology
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    ABSTRACT: For many years clopidogrel was the 'gold standard' ADP receptor antagonist in patients with coronary artery disease in combination with acetylsalicylic acid, i.e. in elective/stable patients after coronary stent implantation and in patients with acute coronary syndromes with/without percutaneous coronary intervention. For the latter group, in which the risk of atherothrombotic events is increased, the new ADP receptor-antagonists, e.g. prasugrel and ticagrelor, have shown their superiority over clopidogrel. This is mainly based on the fact that up to 30% of patients with acute coronary syndromes tend to be low- or non-responders to therapy due to non-genetic and/or genetic causes. Nevertheless, there is still room for the use of clopidogrel in the majority of patients with coronary artery disease. This review summarizes the latest knowledge of clopidogrel and its current indications.
    No preview · Article · Aug 2012 · Advances in cardiology
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    ABSTRACT: Ticagrelor is a direct-acting, oral, reversibly binding P2Y(12) receptor antagonist. As a cyclopentyltriazolopyrimidine, ticagrelor represents a new chemical class of agents that do not require metabolic activation and have consistent ability to inhibit platelet aggregation. The phase III PLATO study evaluated ticagrelor compared with clopidogrel in 18,624 patients with acute coronary syndromes, and demonstrated a significant reduction in the risk of death from vascular causes/myocardial infarction (MI)/stroke with ticagrelor (9.8 vs. 11.7% with clopidogrel; HR: 0.84; 95% CI: 0.77-0.92; p < 0.001) without a significant increase in PLATO-defined major bleeding (11.6 vs. 11.2%, respectively; p = 0.43). MI and death from vascular causes were separately significantly reduced, and death from any cause and stent thrombosis reductions achieved nominal statistical significance. Ticagrelor showed benefit over clopidogrel in almost all patient subgroups, including patients who had received clopidogrel at randomization, patients with both planned invasive or noninvasive treatment; patients with ST elevation myocardial infarction (STEMI) referred for primary percutaneous coronary intervention, patients with non-STEMI, and patients who underwent bypass surgery. Hence, the PLATO population reflected specifically those patients who would ordinarily receive thienopyridine-based antiplatelet therapy in a clinical setting.
    No preview · Article · Aug 2012 · Advances in cardiology
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    ABSTRACT: Because platelet activation plays an important pathophysiological role in acute coronary syndromes, antiplatelet agents are a mainstay of cardiovascular therapy, both in high-risk primary prevention and in secondary prevention. This is usually done with aspirin in all such cases, and adding a P2Y(12) inhibitor in secondary prevention usually for 1 year after an acute coronary syndrome, especially after stent implantation. P2Y(12) inhibitors include ticlopidine (now rarely used), clopidogrel, prasugrel, and ticagrelor. In the setting of high-risk acute coronary syndromes treated with percutaneous coronary interventions, the addition of a glycoprotein IIb/IIIa antagonist, especially abciximab, is contemplated. Conversely, the role of antiplatelet therapy in preventing stroke after atrial fibrillation has been recently downgraded in most risk classes, in favor of anticoagulants. This chapter provides a general overview of the use of antiplatelet agents in heart disease.
    No preview · Article · Aug 2012 · Advances in cardiology
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    ABSTRACT: Platelets play a critical role in the pathophysiology of acute coronary syndromes (ACS) and thromboembolic complications associated with atrial fibrillation. Anticoagulant and antiplatelet therapies are central to the treatment of ACS and atrial fibrillation. Over the last several decades, a better understanding of the pathogenesis of coronary heart disease and atrial fibrillation has led to refinements in antithrombotic strategies and clinical outcomes. With this in mind, some of the issues outlined in this book are new insights in genetic testing and modification of individualized antiplatelet therapy based on rapid bedside platelet analyzers. Most importantly, the current update of pros and cons of novel antiplatelet agents such as prasugrel and ticagrelor are provided in detail. Conventional antiplatelet strategies with aspirin and clopidogrel are also discussed. Special attention is devoted to experimental antiplatelet agents like PAR-1 thrombin receptor antagonists or aptamers. The ability to focus on different diseases beyond ACS, including heart failure and atrial fibrillation, distinguishes this publication. Each chapter was written by top experts in the field and scientists with the utmost authority and expertise to provide cardiologists, internists, and clinical pharmacologists with the latest updates.
    No preview · Article · Aug 2012 · Advances in cardiology
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    ABSTRACT: Atrial fibrillation (AF) is an extremely prevalent dynamic chronic disease often associated with underlying heart disease, making the management of AF challenging. The antithrombotic management - and in particular the use of antiplatelet agents herein - is challenging as it depends on the (adequate) assessment of the risk of stroke and major bleeding. We therefore focus on the current (recommended) use of antiplatelet agents, address the caveats, and provide clinical tools to assess risk of stroke and major bleeding. Furthermore, we discuss novel antithrombotic agents to provide a future perspective of the role of antiplatelet agents in the antithrombotic management of AF patients.
    No preview · Article · Aug 2012 · Advances in cardiology
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    ABSTRACT: Antiplatelet therapy serves an important role in the management of acute coronary syndromes and in reducing the risk of thrombotic complications from atrial fibrillation. There has been rapid development of newer and more potent antiplatelet therapies over the last several years that have further reduced ischemic complications, but with a trade-off of increased bleeding risk. Bleeding complications associated with antiplatelet and anticoagulant therapies are associated with significantly increased risk of adverse outcomes, including death. Understanding the risk of bleeding associated with antiplatelet agents is critical to developing strategies to mitigate this risk.
    No preview · Article · Aug 2012 · Advances in cardiology
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    ABSTRACT: Platelets play a critical role in the pathophysiology of acute coronary syndrome and thromboembolic complications associated with atrial fibrillation. Despite the development of newer and more potent antiplatelet agents, aspirin remains the cornerstone of antithrombotic therapy. Clinical trials conducted over the past decades have clearly established the safety and efficacy of aspirin therapy for the acute treatment and secondary prevention of acute myocardial infarction, ischemic stroke, and vascular death among patients at high risk for cardiovascular events. Although the absolute benefit of aspirin for primary prevention is lower than seen in secondary prevention trials, it is nevertheless an accepted preventive. This chapter provides a comprehensive overview of the clinical utility of aspirin in the setting of acute coronary syndrome and atrial fibrillation.
    No preview · Article · Aug 2012 · Advances in cardiology
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    ABSTRACT: The antithrombotic activity of dipyridamole was initially discovered in an in vivo experiment about half a century ago. At that time science had not appreciated the complexity of the regulation of local thrombus formation. Inhibition of platelets has been the main focus for the prevention of arterial thrombus formation. Unfortunately, established in vitro test systems have to take away several important components of the hemostatic system. Rather than directly inhibiting platelet aggregation, dipyridamole amplifies endogenous antithrombotic systems and modulates or downregulates prothrombotic processes. While for many years the main focus had been on preventing acute thrombus formation in the case of a rupture of an atherosclerotic plaque in large coronary arteries, it now has been appreciated that perfusion of tissue and patency of small vessels and capillaries is equally important for preventing further damage to the tissue. Here dipyridamole was experimentally shown to improve perfusion and function in chronic hypoperfused tissue unrelated to its vasodilatory properties. Recently, several clinical trials have shown the benefit of dipyridamole when given in a formulation that assures a sufficient plasma concentration. Its potential to scavenge particularly peroxy radicals, its direct reduction of innate inflammation, and a chronic elevation of interstitial adenosine seems to be of more importance for the prevention of vascular and tissue damage than its adenosine- and prostacyclin-mediated antithrombotic effect. In its extended-release preparation with the tartaric acid nucleus, not only does it not seem to add significantly to the risk of bleeding, but seems to hold potential for protecting tissue from oxidative and metabolic stress.
    No preview · Article · Aug 2012 · Advances in cardiology
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    ABSTRACT: Ischemic stroke is a major cause of death and disability worldwide. Determination of the underlying stroke mechanism is critical for the optimization of treatment. The role of antiplatelet therapy in primary and secondary stroke prevention is of major significance. Antiplatelet agents predominantly in use are aspirin, clopidogrel, and combination regimens. Novel antiplatelet agents either in use or in advance clinical development seek an indication in the management of stroke patients; yet data are limited. The present review focuses on the optimization of antithrombotic therapy in the field of primary and secondary prevention of stroke, based on data obtained from randomized controlled trials and systemic reviews of the literature.
    No preview · Article · Aug 2012 · Advances in cardiology
  • Article: Conclusion

    No preview · Article · Aug 2012 · Advances in cardiology
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    ABSTRACT: Dual antiplatelet therapy with aspirin and a P2Y(12) receptor antagonist improves outcomes in patients with acute coronary syndrome and in those treated with percutaneous coronary intervention (PCI) and a coronary stent. Candidate gene and genome-wide association studies have found that common genetic polymorphisms of the cytochrome P450 (CYP) 2C19 isoenzyme that result in a loss of functional activity are associated with less exposure of clopidogrel active metabolite and a diminished antiplatelet effect. Meta-analyses of registries and genetic substudies of randomized clinical trials demonstrate that carriers of these polymorphisms who are treated with clopidogrel are at an increased risk of cardiovascular events, particularly stent thrombosis, compared with noncarriers. This deleterious effect appears to be attenuated in patients not treated with PCI. The influence of polymorphisms of other genes, such as ABCB1, is inconsistent across clinical studies. The clinical efficacy of the newer P2Y(12) antagonists prasugrel and ticagrelor do not appear to be affected by the CYP2C19 genotype, but these agents increase major bleeding not related to coronary artery bypass surgery. Although data from randomized clinical trials are currently lacking, these observations suggest that a pharmacogenomic-guided approach to antiplatelet therapy in acute coronary syndrome could potentially maximize ischemic benefit while minimizing bleeding risk.
    No preview · Article · Aug 2012 · Advances in cardiology
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    ABSTRACT: The unifying basis of acute coronary syndrome (ACS) is the complication of a vulnerable coronary plaque, an event primarily mediated by platelet activation. Three major pathways are predominantly involved in this process: thromboxane A(2) via the thromboxane A(2) receptor, adenosine diphosphate via the P2Y(12) receptor, and thrombin via the protease-activated receptor (PAR)-1, with the latter being the most potent platelet activator. Despite the effective inhibition of the first two pathways with aspirin and an expanding family of P2Y(12) inhibitors, respectively, the recurrence of ischemic events in patients with ACS remains high. There is also a growing concern regarding the safety profile in terms of bleeding with more powerful antiplatelet agents, which has tempered expectations of newly developed compounds. PAR-1 inhibitors are a novel class of antiplatelet agents that inhibit thrombin-mediated platelet activation. Preliminary data indicate that these compounds have the potential to improve ischemic prognosis without increasing the bleeding risk. In this chapter we will discuss the rationale for developing this novel class of antiplatelet agents and specifically, the two compounds in most advanced clinical development, vorapaxar and atopaxar.
    No preview · Article · Aug 2012 · Advances in cardiology
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    ABSTRACT: Epidemiological, longitudinal and therapeutic studies have produced convincing evidence that obstructive sleep apnea (OSA) is associated with an increased risk of cardiovascular morbidity and mortality. The strongest evidence supports an independent causal link between OSA and arterial hypertension. OSA may be independently associated with an increased risk for ischemic heart disease, stroke, arrhythmias and mortality. It remains to be determined whether OSA is an independent cause of congestive heart failure and pulmonary hypertension. Confounders and methodological biases are the main reasons for the lack of definitive conclusions in causality studies. Longitudinal studies, adequately powered randomized controlled studies and therapeutic studies involving well-defined participants are all needed to definitively answer the questions surrounding the relationship between OSA and clinical cardiovascular outcomes, comorbidities and intermediate pathogenic mechanisms. OSA is a modifiable risk factor: continuous positive airway pressure administration, the gold standard treatment of OSA, may reduce the early signs of endothelial dysfunction and atherosclerosis, and improve cardiovascular outcomes, such as the mortality related to cardiovascular events, blood pressure, nonfatal coronary events and cardiac function in heart failure patients. However, cardiac patients may not display the typical signs and symptoms of OSA, such as an excessive body mass index and sleepiness. This fact, and the cardiovascular risk associated with OSA, underlines the need for collaborative guidelines to define a diagnostic strategy specifically oriented toward the evaluation of OSA in cardiovascular patients.
    No preview · Article · Jan 2011 · Advances in cardiology