Cardiology News Roundup

June 1, 2009

Read recent news about beta-blockers and hypertension, aspirin and primary prevention, anemia and heart failure risk, and more.

The latest news, study results, and information published online and in the clinical literature.

FDA Approves New Treatment for Pulmonary Arterial Hypertension

On May 26, the FDA approved Eli Lilly’s Adcirca (tadalafil) tablets for the treatment of pulmonary arterial hypertension (WHO Group I) to improve exercise ability. Adcirca will be marketed in the US by United Therapeutics Corporation. Results from the Pulmonary Arterial Hypertension and Response to Tadalafil (PHIRST) Study Group were published on the website of the journal Circulation. The 16-week study involved “405 patients with pulmonary arterial hypertension (idiopathic or associated), either treatment-naive or on background therapy with the endothelin receptor antagonist bosentan” who were” randomized to placebo or tadalafil 2.5, 10, 20, or 40 mg orally once daily.” The primary endpoint was “the change from baseline to week 16 in the distance walked in 6 minutes.” The authors report that tadalafil 40mg “improved the time to clinical worsening, incidence of clinical worsening, and health-related quality of life.”

In a press release, United Therapeutics Chairman and Chief Executive Officer Martine Rothblatt, PhD, said, “The FDA’s action in approving once-a-day ADCIRCA is a big plus for all three P’s: patients, physicians and payors.” Prescribing information is available here.

Beta-blockers No Longer Recommended for First-line Treatment of Uncomplicated Hypertension

According to Mary Parker, PharmD, BCPS, at Cardiology Today, “Joint National Committee 7 hypertension treatment guidelines recognize beta blockers as one of five first-line therapy options. However, their use for uncomplicated hypertension has recently decreased due to concerns over increased morbidity and mortality demonstrated in a number of clinical trials as well as meta-analyses.”

Aspirin of Little Value in Primary Prevention?

The May 30 issue of The Lancet features “Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials,” a meta-analysis of serious vascular events (including myocardial infarction, stroke, or vascular death) and major bleeds in six primary prevention trials and 16 secondary prevention trials that looked at long-term aspirin therapy. The authors report that “in primary prevention without previous disease, aspirin is of uncertain net value as the reduction in occlusive events needs to be weighed against any increase in major bleeds.”

• Commentary on this study is available here.

• Read additional commentary and analysis from Halran Krumholtz and Sanjay Kaul at CardioBrief.

Anemia Increases Heart Failure Risk

A study in the May/June issue of Congestive Heart Failure reports the results of a meta-analysis and systemic review of 20 published English-language articles selected from Medline, PubMed, and the ISI Database. The authors report that “anemia is associated with an increased risk of mortality and rate of hospitalization for heart failure.”

Enoxaparin Safe, Effective for Prevention of Radial Artery Occlusion after Transradial Cardiac Catheterization

In an article published online at the website for the Journal of Thrombosis and Thrombolysis, researchers from Turkey reported “a low rate of RA occlusion with use of enoxaparin during transradial access,” leading them to conclude that “enoxaparin is safe and effective in transradial procedures with a RA occlusion rate comparable to use of unfractionated heparin.” The researchers analyzed outcomes from 50 transradial catheterizations performed for diagnostic and/or interventional cardiac procedures in 39 patients. Patients received 60mg enoxaparin through the radial sheath at the beginning of the procedure for prevention of RA occlusion. The authors evaluated RA patency by Doppler examination. Patients were assessed for postprocedural RA occlusion at discharge and 5+ days follow-up. RA occlusion was detected after two of the 50 transradial accesses.