Publications
565 results found
Bertrand ME, Ferrari R, Remme WJ, et al., 2015, Perindopril and β-blocker for the prevention of cardiac events and mortality in stable coronary artery disease patients: A EUropean trial on Reduction Of cardiac events with Perindopril in stable coronary Artery disease (EUROPA) subanalysis, AMERICAN HEART JOURNAL, Vol: 170, Pages: 1092-1098, ISSN: 0002-8703
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- Citations: 18
Fox K, Haxby E, Fox I, et al., 2015, How should the UK pioneer innovative and untested procedures?, LANCET, Vol: 386, Pages: 1446-1446, ISSN: 0140-6736
Fox KM, Ford I, Steg PG, et al., 2015, Bradycardia and atrial fibrillation in patients with stable CAD treated with Ivabradine: The SIGNIFY Study, European Heart Journal, Vol: 46, ISSN: 1522-9645
Aim To determine the impact of emergent bradycardia and atrial fibrillation (AF) on cardiovascular outcomes in 19 083 patients with stable coronary artery disease (CAD) receiving ivabradine or placebo (SIGNIFY).Methods and Results Emergent bradycardia (resting heart rate <50 bpm on 12-lead electrocardiogram) with ivabradine was reported in 3572 patients (37.4%) overall, and in 2242 (37.2%) of patients with Canadian Cardiovascular Society (CCS) class ≥2 angina. There was no difference in outcomes over the course of the study in ivabradine-treated patients with and without emergent bradycardia in the whole population (2.5% versus 2.9% per year, respectively, for primary composite endpoint of cardiovascular death or nonfatal myocardial infarction) or in the angina subgroup (2.5% versus 3.2% per year). Neither was there an increase in the rate of primary endpoint after emergent bradycardia was recorded compared with those without emergent bradycardia. There were 754 cases of emergent AF on treatment (2.2% per year ivabradine versus 1.5% per year placebo) and 469 in the patients with angina (2.2% versus 1.5% per year). While outcomes occurred more frequently in patients in whom emergent AF had been recorded, there was no treatment-placebo difference in outcomes, including stroke, and no difference in treatment effect in patients with limiting angina. Conclusion Both in the overall population as well as in the angina subset, bradycardia was common in ivabradine-treated patients, but did not appear to impact outcomes. Emergent AF was relatively rare and did not appear to have an impact on outcomes relative to placebo.
Ferrari R, Fox KM, 2015, The role of heart rate may differ according to pathophysiological setting: from SHIFT to SIGNIFY, EUROPEAN HEART JOURNAL, Vol: 36, Pages: 2042-2046, ISSN: 0195-668X
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- Citations: 15
Ferrari R, Ford I, Greenlaw N, et al., 2015, Geographical variations in the prevalence and management of cardiovascular risk factors in outpatients with CAD: Data from the contemporary CLARIFY registry, EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY, Vol: 22, Pages: 1056-1065, ISSN: 2047-4873
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- Citations: 45
Hamill V, Ford I, Fox K, et al., 2015, Repeated Heart Rate Measurement and Cardiovascular Outcomes in Left Ventricular Systolic Dysfunction., American Journal of Medicine, Vol: 128, Pages: 1102-1108.e6, ISSN: 1555-7162
BACKGROUND: Elevated resting heart rate is associated with increased cardiovascular risk, particularly in patients with left ventricular systolic dysfunction. Heart rate is not routinely monitored in these patients. We hypothesized that routine monitoring of heart rate would increase its prognostic value in patients with left ventricular systolic dysfunction. METHODS: We analyzed the relationship between heart rate measurements and a range of adverse cardiovascular outcomes, including hospitalization for worsening heart failure, in the pooled placebo-treated patients from BEAUTIFUL and SHIFT, using standard and time-varying covariate Cox proportional hazards models. Adjusting for other prognostic factors, models were fitted for baseline heart rate alone or for time-updated heart rate (latest heart rate) alone or corrected for baseline heart rate or for immediate previous time-updated heart rate. RESULTS: Baseline heart rate was strongly associated with all outcomes apart from hospitalization for myocardial infarction. Time-updated heart rate increased the strengths of associations for all outcomes. Adjustment for baseline heart rate or immediate previous time-updated heart rate modestly reduced the prognostic importance of time-updated heart rate. For hospitalization for worsening heart failure, each 5 beats per minute increase in baseline heart rate and time-updated heart rate was associated with a 15% (95% CI 12%-18%) and 22% (19%-40%) increase in risk, respectively. Even after correction, the prognostic value of time-updated heart rate remained greater. CONCLUSIONS: In patients with LVSD, time-updated heart rate is more strongly related with adverse cardiovascular outcomes than baseline heart rate. Heart rate should be measured to assess cardiovascular risk at all assessments of patients with left ventricular systolic dysfunction.
Mourad JJ, Bertrand M, Fox K, 2015, LIFELONG BENEFITS OF ACE INHIBITORS ON CARDIOVASCULAR EVENTS AND MORTALITY IN HYPERTENSIVE PATIENTS, Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: E455-E455, ISSN: 0263-6352
Fauchier L, Greenlaw N, Ferrari R, et al., 2015, Use of Anticoagulants and Antiplatelet Agents in Stable Outpatients with Coronary Artery Disease and Atrial Fibrillation. International CLARIFY Registry, PLOS One, Vol: 10, ISSN: 1932-6203
BackgroundFew data are available regarding the use of antithrombotic strategies in coronary artery diseasepatients with atrial fibrillation (AF) in everyday practice. We sought to describe theprevalence of AF and its antithrombotic management in a contemporary population of patientswith stable coronary artery disease.Methods and FindingsCLARIFY is an international, prospective, longitudinal registry of outpatients with stable coronaryartery disease, defined as prior ( 12 months) myocardial infarction, revascularizationprocedure, coronary stenosis >50%, or chest pain associated with evidence of myocardialischemia. Overall, 33,428 patients were screened, of whom 32,954 had data available foranalysis at baseline; of these 2,229 (6.7%) had a history of AF. Median (interquartile range)CHA2DS2-VASc score was 4 (3, 5). Oral anticoagulation alone was used in 25.7%, antiplatelettherapy alone in 52.8% (single 41.8%, dual 11.0%), and both in 21.5%. OAC usewas independently associated with permanent AF (p<0.001), CHA2DS2-VASc score(p=0.006), pacemaker (p<0.001), stroke (p=0.04), absence of angina (p=0.004), decreasedleft ventricular ejection fraction (p<0.001), increased waist circumference (p=0.005), andlonger history of coronary artery disease (p=0.008). History of percutaneous coronary intervention(p=0.004) and no/partial reimbursement for cardiovascular medication (p=0.01,p<0.001, respectively) were associated with reduced oral anticoagulant use.ConclusionsIn this contemporary cohort of patients with stable coronary artery disease and AF, most ofwhom are theoretical candidates for anticoagulation, oral anticoagulants were used in only47.2%. Half of the patients received antiplatelet therapy alone and one-fifth received bothantiplatelets and oral anticoagulants. Efforts are needed to improve adherence to guidelinesin these patients.Trial RegistrationISRCTN registry of clinical trials: ISRCTN43070564
Antonio Alcocer-Gamba M, Martinez-Sanchez C, Verdejo-Paris J, et al., 2015, Heart rate and use of β-blockers in Mexican stable outpatients with coronary artery disease, ARCHIVOS DE CARDIOLOGIA DE MEXICO, Vol: 85, Pages: 270-277, ISSN: 1405-9940
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- Citations: 5
Ying A, Arima H, Czernichow S, et al., 2015, Effects of blood pressure lowering on cardiovascular risk according to baseline body-mass index: a meta-analysis of randomised trials, The Lancet, Vol: 385, Pages: 867-874, ISSN: 0140-6736
BackgroundThe cardiovascular benefits of blood pressure lowering in obese people compared with people of normal weight might depend on choice of drug. We compared the effects of blood pressure-lowering regimens on cardiovascular risk in groups of patients categorised by baseline body-mass index (BMI).MethodsWe used individual patient data from trials included in the Blood Pressure Lowering Treatment Trialists' Collaboration to compare the effects of different classes of blood pressure-lowering regimens for the primary outcome of total major cardiovascular events (stroke, coronary heart disease, heart failure, and cardiovascular death). We used meta-analyses and meta-regressions to assess interactions between treatment and BMI when fitted as either a categorical variable (<25 kg/m 2, 25 to <30 kg/m 2, and ≥30 kg/m 2) or a continuous variable.FindingsAnalyses were based on 135 715 individuals from 22 trials who had 14 353 major cardiovascular events. None of the six primary comparisons showed evidence that protection varied by drug class across the three BMI groups (all p for trend >0·20). When analysed as a continuous variable, angiotensin-converting-enzyme inhibitors gave slightly greater protection for each 5 kg/m 2 higher BMI than did calcium antagonists (hazard ratio 0·93, 95% CI 0·89–0·98; p=0·004) or diuretics (0·93, 0·89–0·98; p=0·002). The meta-regressions showed no relation between BMI category and the risk reduction for a given fall in systolic blood pressure. By contrast with a previous report, we noted no relation between BMI and the efficacy of calcium antagonists compared with diuretics.InterpretationWe found little evidence that selection of a particular class of blood pressure-lowering drug will lead to substantially different outcomes for individuals who are obese compared with those who are lean.
van der Leeuw J, Oemrawsingh RM, van der Graaf Y, et al., 2015, Prediction of absolute risk reduction of cardiovascular events with perindopril for individual patients with stable coronary artery disease - Results from EUROPA, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 182, Pages: 194-199, ISSN: 0167-5273
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- Citations: 8
Sbarouni E, Voudris V, Georgiadou P, et al., 2015, Heart Rate and B-Blockade in Stable Coronary Artery Disease in Greece, HELLENIC JOURNAL OF CARDIOLOGY, Vol: 56, Pages: 112-117, ISSN: 1109-9666
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- Citations: 4
de Silva R, Tsujioka H, Gaze D, et al., 2015, Serial Changes in High-Sensitivity Cardiac Troponin, N-terminal Pro-B-Type Natriuretic Peptide, and Heart Fatty Acid Binding Protein during Exercise Echocardiography in Patients with Suspected Angina Pectoris and Normal Resting Left Ventricular Function, CLINICAL CHEMISTRY, Vol: 61, Pages: 554-556, ISSN: 0009-9147
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- Citations: 2
Brugts JJ, van Vark L, Akkerhuis M, et al., 2015, Impact of renin-angiotensin system inhibitors on mortality and major cardiovascular endpoints in hypertension: A number-needed-to-treat analysis, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 181, Pages: 425-429, ISSN: 0167-5273
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- Citations: 38
Ferrari R, Fox K, Cleland JGF, 2015, The evolving scene of cardiac remodeling, Dialogues in Cardiovascular Medicine, Vol: 20, Pages: 83-84, ISSN: 1272-9949
Fox K, Ford I, Ferrari R, 2014, Ivabradine in Stable Coronary Artery Disease REPLY, NEW ENGLAND JOURNAL OF MEDICINE, Vol: 371, Pages: 2435-2435, ISSN: 0028-4793
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- Citations: 14
Vaishnava P, Huang W, Anderson F, et al., 2014, International Variation in 30-day Unscheduled Cardiovascular Rehospitalization Rates Following Acute Myocardial Infarction in the Global Registry of Acute Coronary Events (GRACE), Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0009-7322
Sbarouni E, Voudris V, Georgiadou P, et al., 2014, Clinical Presentation and Management of Stable Coronary Artery Disease: Insights from the International Prospective CLARIFY Registry - Results from the Greek National Cohort, HELLENIC JOURNAL OF CARDIOLOGY, Vol: 55, Pages: 442-447, ISSN: 1109-9666
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- Citations: 9
Brugts JJ, Arima H, Remme W, et al., 2014, The incidence and clinical predictors of ACE-inhibitor induced dry cough by perindopril in 27,492 patients with vascular disease, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 176, Pages: 718-723, ISSN: 0167-5273
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- Citations: 39
Steg PG, Greenlaw N, Tendera M, et al., 2014, Prevalence of anginal symptoms and myocardial ischemia and their effect on clinical outcomes in outpatients with stable coronary artery disease data from the International Observational CLARIFY Registry, JAMA Internal Medicine, Vol: 174, Pages: 1651-1659, ISSN: 2168-6106
Importance In the era of widespread revascularization and effective antianginals, the prevalence and prognostic effect of anginal symptoms and myocardial ischemia among patients with stable coronary artery disease (CAD) are unknown.Objective To describe the current clinical patterns among patients with stable CAD and the association of anginal symptoms or myocardial ischemia with clinical outcomes.Design, Setting, and Participants The Prospective Observational Longitudinal Registry of Patients With Stable Coronary Artery Disease (CLARIFY) registry enrolled outpatients in 45 countries with stable CAD in 2009 to 2010 with 2-year follow-up (median, 24.1 months; range, 1 day to 3 years). Enrollees included 32 105 outpatients with prior myocardial infarction, chest pain, and evidence of myocardial ischemia, evidence of CAD on angiography, or prior revascularization. Of these, 20 291 (63.2%) had undergone a noninvasive test for myocardial ischemia within 12 months of enrollment and were categorized into one of the following 4 groups: no angina or ischemia (n = 13 207 [65.1%]); evidence of myocardial ischemia without angina (silent ischemia) (n = 3028 [14.9%]); anginal symptoms alone (n = 1842 [9.1%]); and angina and ischemia (n = 2214 [10.9%]).Exposures Stable CAD.Main Outcome and Measure The composite of cardiovascular (CV)–related death or nonfatal myocardial infarction.Results Overall, 4056 patients (20.0%) had anginal symptoms and 5242 (25.8%) had evidence of myocardial ischemia on results of noninvasive testing. Of 469 CV-related deaths or myocardial infarctions, 58.2% occurred in patients without angina or ischemia, 12.4% in patients with ischemia alone, 12.2% in patients with angina alone, and 17.3% in patients with both. The hazard ratios for the primary outcome relative to patients without angina or ischemia and adjusted for age, sex, geographic region, smoking status, hypert
Fox K, Ford I, Steg PG, et al., 2014, Ivabradine in stable coronary artery disease without clinical heart failure, New England Journal of Medicine, Vol: 371, Pages: 1091-1099, ISSN: 0028-4793
BackgroundAn elevated heart rate is an established marker of cardiovascular risk. Previous analyses have suggested that ivabradine, a heart-rate–reducing agent, may improve outcomes in patients with stable coronary artery disease, left ventricular dysfunction, and a heart rate of 70 beats per minute or more.MethodsWe conducted a randomized, double-blind, placebo-controlled trial of ivabradine, added to standard background therapy, in 19,102 patients who had both stable coronary artery disease without clinical heart failure and a heart rate of 70 beats per minute or more (including 12,049 patients with activity-limiting angina [class ≥II on the Canadian Cardiovascular Society scale, which ranges from I to IV, with higher classes indicating greater limitations on physical activity owing to angina]). We randomly assigned patients to placebo or ivabradine, at a dose of up to 10 mg twice daily, with the dose adjusted to achieve a target heart rate of 55 to 60 beats per minute. The primary end point was a composite of death from cardiovascular causes or nonfatal myocardial infarction.ResultsAt 3 months, the mean (±SD) heart rate of the patients was 60.7±9.0 beats per minute in the ivabradine group versus 70.6±10.1 beats per minute in the placebo group. After a median follow-up of 27.8 months, there was no significant difference between the ivabradine group and the placebo group in the incidence of the primary end point (6.8% and 6.4%, respectively; hazard ratio, 1.08; 95% confidence interval, 0.96 to 1.20; P=0.20), nor were there significant differences in the incidences of death from cardiovascular causes and nonfatal myocardial infarction. Ivabradine was associated with an increase in the incidence of the primary end point among patients with activity-limiting angina but not among those without activity-limiting angina (P=0.02 for interaction). The incidence of bradycardia was higher with ivabradine than with placebo (18.0% vs. 2.3%, P<0
Tendera M, Fox K, Ferrari R, et al., 2014, Inadequate heart rate control despite widespread use of beta-blockers in outpatients with stable CAD: findings from the international prospective CLARIFY registry, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 176, Pages: 119-124, ISSN: 0167-5273
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- Citations: 24
Sundstrom J, Arima H, Woodward M, et al., 2014, Blood pressure-lowering treatment based on cardiovascular risk: a meta-analysis of individual patient data, The Lancet, Vol: 384, Pages: 591-598, ISSN: 0140-6736
BackgroundWe aimed to investigate whether the benefits of blood pressure-lowering drugs are proportional to baseline cardiovascular risk, to establish whether absolute risk could be used to inform treatment decisions for blood pressure-lowering therapy, as is recommended for lipid-lowering therapy.MethodsThis meta-analysis included individual participant data from trials that randomly assigned patients to either blood pressure-lowering drugs or placebo, or to more intensive or less intensive blood pressure-lowering regimens. The primary outcome was total major cardiovascular events, consisting of stroke, heart attack, heart failure, or cardiovascular death. Participants were separated into four categories of baseline 5-year major cardiovascular risk using a risk prediction equation developed from the placebo groups of the included trials (<11%, 11–15%, 15–21%, >21%).Findings11 trials and 26 randomised groups met the inclusion criteria, and included 67 475 individuals, of whom 51 917 had available data for the calculation of the risk equations. 4167 (8%) had a cardiovascular event during a median of 4·0 years (IQR 3·4–4·4) of follow-up. The mean estimated baseline levels of 5-year cardiovascular risk for each of the four risk groups were 6·0% (SD 2·0), 12·1% (1·5), 17·7% (1·7), and 26·8% (5·4). In each consecutive higher risk group, blood pressure-lowering treatment reduced the risk of cardiovascular events relatively by 18% (95% CI 7–27), 15% (4–25), 13% (2–22), and 15% (5–24), respectively (p=0·30 for trend). However, in absolute terms, treating 1000 patients in each group with blood pressure-lowering treatment for 5 years would prevent 14 (95% CI 8–21), 20 (8–31), 24 (8–40), and 38 (16–61) cardiovascular events, respectively (p=0·04 for trend).InterpretationLowering blood pressure provides similar relati
Kalra PR, Garcia-Moll X, Zamorano J, et al., 2014, Impact of Chronic Kidney Disease on Use of Evidence-Based Therapy in Stable Coronary Artery Disease: A Prospective Analysis of 22,272 Patients, PLOS ONE, Vol: 9, ISSN: 1932-6203
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- Citations: 19
Lavallee PC, Labreuche J, Fox KM, et al., 2014, Influenza vaccination and cardiovascular risk in patients with recent TIA and stroke, NEUROLOGY, Vol: 82, Pages: 1905-1913, ISSN: 0028-3878
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- Citations: 27
Sirimarco G, Labreuche J, Bruckert E, et al., 2014, Atherogenic Dyslipidemia and Residual Cardiovascular Risk in Statin-Treated Patients, STROKE, Vol: 45, Pages: 1429-1436, ISSN: 0039-2499
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- Citations: 64
Cooper C, Fox KM, Borer JS, 2014, Ischaemic cardiac events and use of strontium ranelate in postmenopausal osteoporosis: a nested case-control study in the CPRD, OSTEOPOROSIS INTERNATIONAL, Vol: 25, Pages: 737-745, ISSN: 0937-941X
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- Citations: 42
Dobre D, Borer JS, Fox K, et al., 2014, Heart rate: a prognostic factor and therapeutic target in chronic heart failure. The distinct roles of drugs with heart rate-lowering properties, EUROPEAN JOURNAL OF HEART FAILURE, Vol: 16, Pages: 76-85, ISSN: 1388-9842
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- Citations: 60
Sirimarco G, Labreuche J, Bruckert E, et al., 2014, Atherogenic Dyslipidemia and Residual Cardiovascular Risk in Statin-Treated Patients, CEREBROVASCULAR DISEASES, Vol: 37, Pages: 90-90, ISSN: 1015-9770
Winnik S, Speer T, Raptis DA, et al., 2013, The wealth of nations and the dissemination of cardiovascular research, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 169, Pages: 190-195, ISSN: 0167-5273
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- Citations: 7
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