Journal Review​

Apixaban Dosing in Patients With AF and Severe CKD (Circulation)

• This observational study reports a 1.6 times risk of bleeding with 5 mg apixaban (vs. 2.5 mg) twice daily in patients with AF and CKD stage 4/5, with no differences in stroke/systemic embolism or death.
• These findings suggest that 2.5 mg apixaban may be a better choice than 5 mg for patients with AF and severe CKD.
• Given several limitations of the current analysis and the unclear benefits of anticoagulation in severe CKD and AF, prospective RCTs are required to provide guidance on the decision to initiate anticoagulation and which anticoagulant and what dose to use in this population at very high risk for death.

Carvedilol vs. Metoprolol and Risk of Arrhythmias Among ICD Recipients (JACC EP)

• In patients with HF who receive a primary prevention ICD, the risk of developing atrial arrhythmia is significantly influenced by the type of beta-blocker treatment. Carvedilol can significantly reduce the risk of atrial arrhythmias when compared to metoprolol.
• Among HF patients receiving an ICD therapy, carvedilol may have antiarrhythmic properties associated with decreased risk of developing atrial arrhythmias and inappropriate ICD shocks when compared to metoprolol.

When Does a Calcium Score Equate to Secondary Prevention?(JACC CV Imaging)

• In adults with no history of ASCVD, rates of CV risk factors increased with increases in CAC scores.
• The prevalence of hyperlipidemia, hypertension, diabetes mellitus, and smoking was similar among those with CAC score >300 and those with established ASCVD.
• Adults with no history of ASCVD but with a CAC >300 have event rates comparable to those with established ASCVD, while lower CAC among those without a history of ASCVD was associated with a significantly lower risk for MACE compared to those with established ASCVD.

Coronary Plaque Regression and Risk of Adverse CV Events(JAMA)

• Coronary atherosclerotic plaque volume reduction from a baseline 36% to 55% has the potential to be a surrogate marker for major atherosclerotic events, but given heterogeneity in this meta-regression analysis, additional data are needed.
• Among the trials that had both treatment and comparator arms, for each 1% reduction of percent atheroma volume change between treatment groups, the odds of experiencing CV events were significant at 25%.
• The findings provide further support for the utility of CT angiography to estimate value of new therapeutics for ASCVD.