Over the past few years, the American Heart Association's scientific sessions have become increasingly focused on the effectiveness of various medicinal methods—as suggested by the Classical Roman poet Ovid—as a means for treating various cardiovascular disease states. In other words, pharma dominated the AHA conference again this year.
The first late-breaking clinical trial session on Sunday launched a flurry of pharmaceutical data, and all four trials in some way probed clopidogrel.
First, POPular found that three out of six platelet function tests can identify heart patients whose platelet reactivity will increase heart risk, despite being pretreated with aspirin and clopidogrel before being stented.
Next, the new, reversible antiplatelet drug cangrelor came up a little short compared with clopidogrel in two randomized, controlled CHAMPION trials. However, some commentators questioned the design of the trials, particularly the higher clopidogrel loading dose as adversely effecting outcomes for cangrelor.
In the ever-widening field of antiplatelet research, PLATO STEMI results showed that reversible ticagrelor had fewer cardiac events and less mortality, compared with the irreversible clopidogrel in the STEMI population.
Many cardiologists at AHA09 speculated that ticagrelor will be the next antiplatelet to reach the U.S. market, presenting cath labs with more options since prasugrel gained FDA approval in July.
Incidentally, in the fast-tracked ACC/AHA guideline update issued this week from the conference, prasugrel received a Class 1 recommendation. The updates also focused on other areas of STEMI patient management, and presented new treatment options for PCI.
Among the other clinical trials presented at AHA09 this past week, the ARBITER 6-HALTS trial found that the use of statins to reduce LDL-C is more effective with the subsequent addition of extended-release niacin, which lowers LDL and increases HDL, compared with the subsequent administration of ezetimibe in reducing the progression of atherosclerosis.
Finally, the HEAAL trial found that using a higher dose of the angiotensin-receptor blocker (ARB) losartan reduces death or hospital admission for heart failure. The trial’s commentators were so convinced by HEAAL’s results, that they suggested all patients on ARBs should be re-evaluated for up-titration.
Please review additional clinical data that emerged from AHA09, including studies conducted on medical devices.
On these topics, or any others, please feel free to contact me.