The modern definition of Global Health has expanded its scope beyond neglected diseases and low-income and underdeveloped countries. The current initiatives focus on improvement of health, reduction of disparities and protection against global threats, seeking for interaction with health practices, policies and systems. There has been a growing interest on Global Health research, given the epidemiological transition currently underway in low and mid-income countries and the increasing epidemiological importance of cardiovascular and other non-communicable diseases, to the detriment of infectious diseases and nutritional deficiencies. Various aspects – formerly neglected – of these diseases, such as epidemiology, prevention, diagnosis and therapy, have been addressed in Global Health publications, leading to a better understanding of the importance of health as a public good, beyond borders. Scientific evidence supports broader initiatives in which governments, foundations and the civil society must share responsibilities and funding to achieve health equity, the main goal of Global Health.
The aim – to compare hemorrhagic events between clopidogrel and ticagrelor in the Platelet Inhibition and Patient Outcomes (PLATO) trial.
Material and methods. We examined the FDA Medical Review.
Results. Compared to clopidogrel, ticagrelor significantly increased spontaneous bleeds, major bleeds, major plus minor bleeds, and major plus minor plus minimal bleeds. Ticagrelor also increased both major and fatal/life-threatening bleeds versus clopidogrel when CABG was performed between 24 and 96 h after stopping medication, which was also accompanied by a larger volume of chest tube drainage and transfusions. Moreover, ticagrelor increased CABG-related bleeding versus clopidogrel in those patients who did not wait until day 5 after stopping treatment to have CABG. Additionally, compared to clopidogrel, ticagrelor increased the risk of hematuria (RR 1.91; 95 % CI 0.95–3.83), intracranial hemorrhage or subdural or other hematoma (RR 1.87; 95 % CI 1.02–3.42), subcutaneous hemorrhage, ecchymosis, hematoma (RR 1.63; 95 % CI 0.84–3.17), epistaxis (RR 1.49; 95 % CI 0.67–3.32), retroperitoneal hematoma or hemorrhage (RR 1.49; 95 % CI 0.53–4.19), gastrointestinal/anal bleed (RR 1.23; 95 % CI 0.93–1.64) and bleed/hematoma (RR 1.21, 95 % CI 1.02–1.43).
Conclusions. Clopidogrel is safer than ticagrelor in regard to bleeding. Additionally, ticagrelor’s purported faster antiplatelet ‘offset’ is substantially longer than its pharmacokinetics indicate. Considering the fact that the mortality, stent thrombosis and myocardial infarction ‘benefit’ of ticagrelor have recently been challenged, and that the increase in stroke on ticagrelor has recently been shown to be worse than originally published, the decision to use ticagrelor over clopidogrel in the face of a higher risk for bleeds is not advised.
Cardiomyopathies are myocardial disorders that are not explained by abnormal loading conditions and coronary artery disease. They are classified into a number of morphological and functional phenotypes that can be caused by genetic and non-genetic mechanisms. The dominant themes in papers published in 2012–2013 are similar to those reported in Almanac 2011, namely, the use (and interpretation) of genetic testing, development and application of novel non-invasive imaging techniques and use of serum biomarkers for diagnosis and prognosis. An important innovation since the last Almanac is the development of more sophisticated models for predicting adverse clinical events.
S. Islam, A. Timmis
Almanac 2013: stable coronary artery disease.
This almanac highlights more than 80 papers on stable coronary artery diseases (CAD). The certain aspects of CAD epidemiology over the past 40 years are highlighted. This review covers the major recent advances in such areas, related to CAD patients’ management, as diagnosis (including magnetic resonance imaging and computer tomography), treatment (optimal pharmacotherapy and invasive, such as coronary stenting and coronary artery bypass grafting) and prevention. The novel methods of CAD treatment (remote ischaemic preconditioning and novel lipid-lowering drugs) are discussed separately. The role of some prognostic biomarkers in CAD patients is also discussed.
This almanac highlights about 50 papers on heart failure in the major cardiac journals, including the current evidence base for traditional and novel treatment options: pharmacological (relaxin, levosimendan, neprilysin inhibitors, ivabradine. aliskiren, aldosterone antagonists) and devices (defibrillators, vagal stimulators etc.).
Important advances have been made in the past few years in the fields of clinical cardiac electrophysiology and pacing. Researchers and clinicians have a greater understanding of the pathophysiological mechanisms underlying atrial fibrillation (AF), which has transpired into improved methods of detection, risk stratification, and treatments. The introduction of novel oral anticoagulants has provided clinicians with alternative options in managing patients with AF at moderate to high thromboembolic risk and further data has been emerging on the use of catheter ablation for the treatment of symptomatic AF. Another area of intense research in the field of cardiac arrhythmias and pacing is in the use of cardiac resynchronisation therapy (CRT) for the treatment of patients with heart failure. Following the publication of major landmark randomised controlled trials reporting that CRT confers a survival advantage in patients with severe heart failure and improves symptoms, many subsequent studies have been performed to further refine the selection of patients for CRT and determine the clinical characteristics associated with a favourable response. The field of sudden cardiac death and implantable cardioverter defibrillators also continues to be actively researched, with important new epidemiological and clinical data emerging on improved methods for patient selection, risk stratification, and management. This review covers the major recent advances in these areas related to cardiac arrhythmias and pacing.