1,721,118 research outputs found
Alcohol consumption and subclinical and clinical coronary heart disease: New insight into potential causal mechanisms
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Response to Madias Je “can currently available data on takotsubo syndrome therapies guide us to manage future cases?
No full textSacubitril/Valsartan and Cognitive Outcomes in Heart Failure With Reduced Ejection: A New Pharmacological Indication?
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Budget impact analysis of PCSK9 inhibitors costs from a community payers' perspective in Apulia, Italy
No full textIntroduction: Despite established clinical efficacy of PCSK9 inhibitors (PCSK9i) in reducing cardiovascular events, their cost still represents a big matter of debate. We therefore sought to estimate possible impact of PCSK9i therapy from a community taxpayers' perspective with a budget impact analysis based on data coming from two randomised trials (FOURIER (Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects with Elevated Risk), ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab)). Methods: The analysis focused on Apulia region, South-Eastern Italy (4 million inhabitants). Costs per cardiovascular event saved were calculated from randomised trials data and annually indexed per Apulia's inhabitants. Results: On the base of actual cost in Apulia, individual costs per saved adverse event ranged from €0.12 to €0.78, with just €1 annually spent per Apulia's inhabitant, 2-8.3 events could be avoided thanks to the use of PCSK9i. When considering high-risk subgroups (baseline cholesterol levels >100 mg/dL, multivessel coronary disease), the annual cost per Apulia's inhabitant for one death avoided was more than halved to €0.19 and the cost for a saved major adverse cardiovascular event was €0.07. With €1 annually spent per Apulia's inhabitant, 10.9-15 major adverse cardiovascular events and 5.3 deaths could be saved. Conclusions: When considered from a large taxpayers' community perspective, relevant costs per cardiovascular event saved with PCSK9i may turn into very small individual costs per year. The selection of high-risk subgroups may further reduce individual costs
Optimization of Drug Therapy for Heart Failure With Reduced Ejection Fraction Based on Gender
No full textPurpose of Review: Over the last decades, several classes of drugs have been introduced for the treatment of patients with heart failure with reduced ejection fraction (HFrEF). Their use has been supported by randomized controlled trials that have demonstrated improved patient outcomes. However, these trials enrolled a small number of female patients and sometimes have reported gender-related differences regarding the efficacy of the treatments. The aim of this review is to revise the available data about the influence of gender on the optimal treatment and drug dose in patients with HFrEF. Recent Findings: Several gender-related differences in terms of pharmacokinetic and pharmacodynamic characteristics of the drugs have been described. These characteristics could be responsible for a different response and tolerability in men and women also when current recommended treatment of HFrEF is considered. Some studies have shown that, in women, lower doses of beta-blockers and inhibitors of renin angiotensin aldosterone system could be equally effective than higher doses in men, whereas sacubitril/valsartan could exert its favorable effect at greater values of left ventricular ejection fraction. Summary: Although there is evidence about differences in the response to treatment of HFrEF in men and women, this has not been sufficient for differentiating current recommended therapy. Further studies should better clarify if the treatment of HFrEF should be based also on the patients’ gender
Reply to fever, Covid-19 vaccination, and Brugada syndrome—Incidence and management: Correspondence
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