Browsing by Subject "Peripheral Vascular Disease"

Now showing 1 - 6 of 6
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    Changes in Medical Therapy and Lifestyle After Anatomical Versus Functional Testing for Coronary Artery Disease: The PROMISE Trial (PROspective Multicenter Imaging Study for Evaluation of Chest Pain)
    (CIRCULATION, 2015-11-10) Ladapo, JA; Hoffman, U; Lee, KL; Coles, AL; Huang, M; Mark, DB; Dolor, RL; Pelberg, RA; Budoff, M; Sigurdsson, G; Severance, HW; Douglas, PS
    Introduction: Diagnostic testing may represent a “teachable moment” for patients newly presenting with symptoms suggestive of CAD and requiring further evaluation, and may influence risk factor management, independent of test results. However, little is known about changes in medications and lifestyle after anatomical versus functional testing. Hypothesis: Patients assigned to coronary CTA will report greater use of preventive medications and lifestyle practices. Methods: We randomly assigned 10,003 symptomatic patients (53% women; mean age 61 yrs) to anatomical testing with CTA or functional testing (exercise ECG, nuclear stress, or stress echocardiography). We assessed use of preventive medications (aspirin, statin, beta blocker, and ACEi/ARB) and lifestyle practices (heart healthy diet, regular exercise, smoking, and obese/overweight status [BMI>25]) at 60 days. Chi-square tests assessed between-group changes (initiation or discontinuation). Multivariable logistic regression models assessed the association between testing strategy and prevalence of medication use or lifestyle practices. Results: There were no differences in medications or lifestyle practices at baseline. At 60 days, the CTA strategy was associated with a higher proportion of patients newly initiating aspirin (11.6% vs 7.6%), statin (12.7% vs 6.2%), and beta blockers (8.2% vs 5.4%), compared to functional testing (p<0.0001 for each). The CTA strategy was also associated with a higher incidence of weight loss among obese/overweight patients (2.8% vs 2.4%), but the difference was not significant (p=0.051). Overall prevalences of aspirin (aOR=1.55), statin (aOR=2.04), and beta blocker (aOR=1.32) use were higher after CTA (p<0.001 for each). Eating a healthy diet (54.7% vs 50.8%) was increased after CTA (aOR=1.13 p=0.004), whereas obese/overweight status was reduced (aOR=0.79 p=0.047). Exercise and smoking cessation increased similarly in both arms. Benefits of CTA for statin use and weight loss persisted after adjusting for test results. Conclusions: Among patients with suspected CAD, anatomical testing is associated with greater favorable changes in preventive medical and lifestyle practices. This may represent a long term benefit of a CTA testing strategy.
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    Executive Summary: Heart Disease and Stroke Statistics—2011 Update
    (Circulation, 2011-02) Roger, Véronique L; Go, Alan S; Lloyd-Jones, Donald M; Adams, Robert J; Berry, Jarett D; Brown, Todd M; Carnethon, Mercedes R; Dai, Shifan; de Simone, Giovanni; Ford, Earl S; Fox, Caroline S; Fullerton, Heather J; Gillespie, Cathleen; Greenlund, Kurt J; Hailpern, Susan M; Heit, John A; Michael Ho, P; Howard, Virginia J; Kissela, Brett M; Kittner, Steven J; Lackland, Daniel T; Lichtman, Judith H; Lisabeth, Lynda D; Makuc, Diane M; Marcus, Gregory M; Marelli, Ariane; Matchar, David B; McDermott, Mary M; Meigs, James B; Moy, Claudia S; Mozaffarian, Dariush; Mussolino, Michael E; Nichol, Graham; Paynter, Nina P; Rosamond, Wayne D; Sorlie, Paul D; Stafford, Randall S; Turan, Tanya N; Turner, Melanie B; Wong, Nathan D; Wylie-Rosett, Judith
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    More Frequent Self-Testing of Prothrombin Time Results in Improved Time in Target Range
    (CIRCULATION, 2012-11-20) Matchar, David B; Dolor, Rowena; Jacobson, Alan; Love, Sean; Edson, Robert; Uyeda, Lauren
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    P2Y12 Inhibitor Switching in Response to Routine Notification of CYP2C19 Clopidogrel Metabolizer Status Following Acute Coronary Syndromes.
    (JAMA cardiology, 2019-07) Povsic, Thomas J; Ohman, E Magnus; Roe, Matthew T; White, Jennifer; Rockhold, Frank W; Montalescot, Gilles; Cornel, Jan H; Nicolau, Jose C; Steg, P Gabriel; James, Stefan; Bode, Christoph; Welsh, Robert C; Plotnikov, Alexei N; Mundl, Hardi; Gibson, C Michael
    Importance:Physician behavior in response to knowledge of a patient's CYP2C19 clopidogrel metabolizer status is unknown. Objective:To investigate the association of mandatory reporting of CYP2C19 pharmacogenomic testing, provided to investigators with no direct recommendations on how to use these results, with changes in P2Y12 inhibitor use, particularly clopidogrel, in the Randomized Trial to Compare the Safety of Rivaroxaban vs Aspirin in Addition to Either Clopidogrel or Ticagrelor in Acute Coronary Syndrome (GEMINI-ACS-1) clinical trial. Design, Setting, and Participants:The GEMINI-ACS-1 trial compared rivaroxaban, 2.5 mg twice daily, with aspirin, 100 mg daily, plus open-label clopidogrel or ticagrelor (provided), in patients with recent acute coronary syndromes (ACS). The trial included 371 clinical centers in 21 countries and 3037 patients with ACS. Data were analyzed between May 2017 and February 2019. Interventions:Investigators were required to prestipulate their planned response to CYP2C19 metabolizer status. In response to a regulatory mandate, results for all patients were reported to investigators approximately 1 week after randomization. Main Outcomes and Measures:Reasons for switching P2Y12 inhibitors and occurrence of bleeding and ischemic events were collected. Results:Of 3037 patients enrolled (mean [SD] age, 62.8 [9.0] years; 2275 men [74.9%], and 2824 white race/ethnicity [93.0%]), investigators initially treated 1704 (56.1%) with ticagrelor and 1333 (43.9%) with clopidogrel. Investigators prestipulated that they would use CYP2C19 metabolizer status to change P2Y12 inhibitor in 48.5% of genotyped clopidogrel-treated patients (n = 642 of 1324) and 5.5% of genotyped ticagrelor-treated patients (n = 93 of 1692). P2Y12 inhibitor switching for any reason occurred in 197 patients and was more common in patients treated with ticagrelor (146 of 1704 [8.6%]) compared with clopidogrel (51 of 1333 [3.8%]). Of patients initially treated with ticagrelor, only 1 (0.1% overall; 0.7% of all who switched) was switched based on CYP2C19 status. Of patients initially treated with clopidogrel, 23 (1.7% overall,;45.1% of all who switched) were switched owing to metabolizer status. Of 48 patients (3.6%) with reduced metabolizer status treated initially with clopidogrel, 15 (31.3%) were switched based on metabolizer status, including 48.1% (13 of 27) in which switching was prestipulated. Conclusions and Relevance:Physicians were evenly split on how to respond to knowledge of CYP2C19 metabolizer status in clopidogrel-treated patients. Mandatory provision of this information rarely prompted P2Y12 inhibitor switching overall, including a minority of patients with reduced metabolizer status. These findings highlight the clinical equipoise among physicians regarding use of this information and the reluctance to use information from routine genotyping in the absence of definitive clinical trial data demonstrating the efficacy of this approach. Clinical Trial Registration:ClinicalTrials.gov identifier: NCT02293395.
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    Radiofrequency Ablation Duration per Tumor Volume May Correlate with Overall Survival in Solitary Hepatocellular Carcinoma Patients Treated with Radiofrequency Ablation Plus Lyso-Thermosensitive Liposomal Doxorubicin
    (JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY, 2019-12-01) Celik, Haydar; Wakim, Paul; Pritchard, William F; Castro, Meryll; Leonard, Shelby; Karanian, John W; Dewhirst, Mark W; Lencioni, Riccardo; Wood, Bradford J