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The release of important new
ESC guidelines will no doubt
influence Australian experts as
our own guidelines are revised.
Professor Garry Jennings discusses the
SAVE, NORSTENT, ENSURE-AF and
DANISH trials
Garry Jennings, AM, MBBS, MD, FRCP, FRACP, Chief Medical Adviser of the Heart Foundation of Australia.
Clinical trial updates:
•
The SAVE study was presented
by Doug McEvoy from Flinders
University in Adelaide and
coordinated from the George
Institute in Sydney. This
international study, with over 2000
people with moderately severe sleep
apnoea, examined whether CPAP
reduced cardiovascular endpoints
shown to be associated with sleep
apnoea in observational studies.
The result was that CPAP reduced
snoring and improved quality of life
but had no effect on the combined
cardiovascular endpoints or on
mortality. Blood pressure was also
similar in CPAP and control subjects.
Published simultaneously in the
New England Journal of Medicine
with a supplementary editorial, the
study showed that CPAP improves
symptoms of sleep apnoea but not
outcomes.
•
The DANISH trial casts doubts
on previously accepted guidelines
for the use of ICDs in people with
nonischaemic heart failure.
•
NORSTENT showed no difference
in outcomes in a comparison of
drug-eluting and bare metal stents.
However, revascularisation rates
over the next 2 years were less
with the former. PRAGUE-18 did
not detect a difference between
prasugrel and ticagrelor but, like
a number of studies where no
differences were seen, recruitment
failed to meet targets and the study
was underpowered.
•
ENSURE-AF found that edoxaban
was equivalent to warfarin in the
prevention of stroke around the time
of electrical cardioversion.
•
A study was presented showing
that the CHADS-DS2-Vasc score
for defining risk in people with
atrial fibrillation overestimates the
number of people with low risk.
GARFIELD-AF, a new score was
proposed.
There was also much interest in
some new drug classes including
PCSK9 inhibitors, powerful LDL-
cholesterol lowering agents, dual
angiotension receptor blocker/
neprilysin inhibitors for heart failure,
new oral anticoagulants (NOACs) and
their inhibitors, and SGLT2 inhibitors
for diabetes.
The meeting also saw the release of
important new ESC guidelines that
will no doubt influence Australian
experts as our own guidelines are
revised: revised atrial fibrillation
guidelines recommended NOACs
over warfarin; heart failure guidelines
were updated; dyslipidaemia
guidelines took a different line to the
US in recommending statins, lifestyle
for everyone with dyslipidaemia
but not providing targets based on
risk level; and the CVD prevention
guidelines put great emphasis on the
Mediterranean diet, amongst other
lifestyle measures.
PRACTICEUPDATE CARDIOLOGY
EUROPEAN SOCIETY OF CARDIOLOGY CONGRESS
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