Inclisiran: A Novel Therapeutic for Long-Term Lowering of LDL Cholesterol?

By Connor Emdin
May 18, 2017

Elevated low-density lipoprotein cholesterol (LDL cholesterol) is a leading cause of coronary heart disease and death worldwide.1 When LDL cholesterol particles become oxidized, they can invade the endothelium of blood vessels and attract macrophages, forming atherosclerotic plaques. Over a lifetime, high levels of LDL cholesterol can lead to the formation of numerous unstable atherosclerotic plaques, potentially leading to myocardial infarction, stroke, and death from cardiovascular disease (CVD).2 Continue reading “Inclisiran: A Novel Therapeutic for Long-Term Lowering of LDL Cholesterol?”

Safety and Efficacy of Prolonged Rivaroxaban to Prevent Recurrent Venous Thromboembolism

By Martina M. McGrath, MD
March 30, 2017

Venous thromboembolism (VTE) remains an important cause of vascular death.1 Treatment options have greatly expanded in recent years with the introduction of Wektnovel oral anticoagulants including apixaban, rivaroxaban and dabigatran and several large clinical trials have demonstrated similar efficacy and safety to warfarin in the initial treatment of VTE.2 Continue reading “Safety and Efficacy of Prolonged Rivaroxaban to Prevent Recurrent Venous Thromboembolism”

A Thiazide a Day to Keep Fractures Away?

By Martina M. McGrath, MD
March 7, 2017

Observational data have indicated a reduction in fracture risk in patients treated for hypertension with thiazide diuretics.1 Thiazides reduce urinary calcium losses (hence their use in patients with calcium-based renal calculi) and have been postulated to have a stimulatory effect on osteoblasts, leading to improvements in bone density. However, there have been no randomized trials to demonstrate benefit of one antihypertensive class over another in protection against fractures. Patients with hypertension are at increased risk of falls and fractures, making this an important consideration, particularly in the elderly. Continue reading “A Thiazide a Day to Keep Fractures Away?”

Treatment Choice Influences Malignancy Risk in Patients with ANCA Vasculitis

By Martina M. McGrath, MD
March 2, 2017

Publication of the RAVE and Rituxivas trials ushered in a new era of treatment of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Previously, cyclophosphamide was first-line therapy, but treatment was commonly complicated by infection and malignancy, leading to the search for less toxic alternative regimens. RAVE and Rituxivas demonstrated equivalent efficacy in treatment of AAV with either cyclophosphamide or rituximab, with similar numbers of adverse events.1,2 Unexpectedly, more malignancies were observed in rituximab-treated patients in both studies. However, absolute numbers were small, and the significance of this finding was unclear. Follow-up data and clinical experience would suggest that rituximab is well tolerated for treatment of AAV, including when used as maintenance therapy.3,4 Continue reading “Treatment Choice Influences Malignancy Risk in Patients with ANCA Vasculitis”

Does High-Sensitivity Cardiac Troponin Predict Future Cardiac Events?

By Martina M. McGrath, MD
February 23, 2017

Cardiac troponins are highly sensitive biomarkers of myocardial injury, and acute rises are a central feature in diagnosis of acute myocardial ischemia. However, observational studies have also suggested that increased levels of high-sensitivity troponin are associated with increased cardiovascular mortality in population-based studies.1,2  This raises the question as to whether the level of high-sensitivity troponin could usefully predict a patient’s future risk of cardiovascular events. Continue reading “Does High-Sensitivity Cardiac Troponin Predict Future Cardiac Events?”

Immune Checkpoint Inhibitors: Collateral Damage and Organ Toxicities

By Martina M. McGrath, MD
February 3, 2017

Cancer immunotherapy has led to a paradigm shift in the treatment of a range of malignancies. Recently developed, immune checkpoint inhibitors (ICPI) are monoclonal antibodies, which specifically block immunological pathways involved in the control of T cell-mediated immune responses. Anti-CTLA4 (ipilimumab) blocks the interaction of CTLA-4, expressed by regulatory T cells, with its ligand, B7, allowing for increased T cell activation via CD28-B7 signalling. Similarly anti-PD-1 (nivolumab, pembrolizumab, pidilizumab) prevents interaction between PD-1 and its ligand PD-L1, another critical negative T cell costimulatory pathway. By ‘removing the brake’ for T cell activation, these agents increase anti-tumor immunity and overcome some of the mechanisms by which tumors evade the immune response. Management of diseases such as metastatic melanoma have been transformed by the availability of these agents and studies continue to show benefit in an increasing number of malignancies. Continue reading “Immune Checkpoint Inhibitors: Collateral Damage and Organ Toxicities”

Two Promising New Diabetes Drugs

Reducing cardiovascular complications in patients with diabetes: exciting new drug therapy on the horizon.

By Ajay K. Singh, MBBS, FRCP, MBA
December 7, 2016

Diabetes mellitus is in epidemic proportions in many parts of the world. Its most consequential and debilitating complications are cardiovascular disease, retinopathy, and nephropathy. Newer agents are now emerging and have the potential to transform the management of diabetes. Continue reading “Two Promising New Diabetes Drugs”