Publications
adverse effects atrial fibrillation cardiovascular health diagnosis drug therapy epidemiology etiology evidence knowledge translation meta-analysis mortality myocardial infarction nonobstructive coronary artery disease patient outcomes physiopathology premature acute coronary syndrome research SCAD sex differences stroke TAVR women's heart health
2013 |
Andrade, Jason G; Deyell, Marc W; Khoo, Clarence; Lee, May; Humphries, Karin; Cairns, John A Risk of Bleeding on Triple Antithrombotic Therapy After Percutaneous Coronary Intervention/Stenting: A Systematic Review and Meta-Analysis. Journal Article The Canadian Journal of Cardiology, 29 , pp. 204–212, 2013. Abstract | Links | Tags: adverse effects, bleeding, drug therapy, epidemiology, meta-analysis, PCI, premature acute coronary syndrome, risk factors, systematic review @article{b, title = {Risk of Bleeding on Triple Antithrombotic Therapy After Percutaneous Coronary Intervention/Stenting: A Systematic Review and Meta-Analysis.}, author = { Jason G Andrade and Marc W Deyell and Clarence Khoo and May Lee and Karin Humphries and John A Cairns}, doi = {10.1016/j.cjca.2012.06.012}, year = {2013}, date = {2013-02-01}, journal = {The Canadian Journal of Cardiology}, volume = {29}, pages = {204--212}, abstract = {There are no reported randomized controlled trials of triple antithrombotic therapy (TT; aspirin plus a thienopyridine plus vitamin K antagonist) vs dual antiplatelet therapy (DAPT; aspirin plus a thienopyridine) among patients undergoing percutaneous coronary intervention with stenting (PCI-S). A systematic review and meta-analysis was undertaken to assess the risk of bleeding among patients receiving TT after PCI-S. Electronic databases were searched for studies reporting bleeding among patients receiving TT after PCI-S. Of the 4108 articles screened, 18 met study inclusion criteria and underwent detailed data extraction: of these, 6 reported in-hospital outcomes, 14 reported 30-day outcomes, and 9 reported 6-month outcomes. At each time point, pooled estimates of bleeding with TT were ascertained and where possible summary odds ratios (ORs) for comparative risks vs DAPT were calculated. The pooled estimate of major bleeding rate with TT post PCI-S was 2.38% by 30 days postprocedure (95% confidence interval [CI], 0.98-3.77%) and 4.55% by 6 months postdischarge (95% CI, 0.56-8.53%). At 30 days and 6 months the rates of major bleeding with TT were significantly higher than those observed with DAPT: OR, 2.38 at 30 days (95% CI, 1.05-5.38) and OR, 2.87 at 6 months (95% CI, 1.47-5.62). This systematic review and meta-analysis of reports of triple therapy with a vitamin K antagonist, aspirin, and clopidogrel after PCI-S provides precise and valid bleeding risk data. Based on existing observational studies the rates of major and any bleeding associated with TT are clinically important and significantly greater than those reported with DAPT.}, keywords = {adverse effects, bleeding, drug therapy, epidemiology, meta-analysis, PCI, premature acute coronary syndrome, risk factors, systematic review}, pubstate = {published}, tppubtype = {article} } There are no reported randomized controlled trials of triple antithrombotic therapy (TT; aspirin plus a thienopyridine plus vitamin K antagonist) vs dual antiplatelet therapy (DAPT; aspirin plus a thienopyridine) among patients undergoing percutaneous coronary intervention with stenting (PCI-S). A systematic review and meta-analysis was undertaken to assess the risk of bleeding among patients receiving TT after PCI-S. Electronic databases were searched for studies reporting bleeding among patients receiving TT after PCI-S. Of the 4108 articles screened, 18 met study inclusion criteria and underwent detailed data extraction: of these, 6 reported in-hospital outcomes, 14 reported 30-day outcomes, and 9 reported 6-month outcomes. At each time point, pooled estimates of bleeding with TT were ascertained and where possible summary odds ratios (ORs) for comparative risks vs DAPT were calculated. The pooled estimate of major bleeding rate with TT post PCI-S was 2.38% by 30 days postprocedure (95% confidence interval [CI], 0.98-3.77%) and 4.55% by 6 months postdischarge (95% CI, 0.56-8.53%). At 30 days and 6 months the rates of major bleeding with TT were significantly higher than those observed with DAPT: OR, 2.38 at 30 days (95% CI, 1.05-5.38) and OR, 2.87 at 6 months (95% CI, 1.47-5.62). This systematic review and meta-analysis of reports of triple therapy with a vitamin K antagonist, aspirin, and clopidogrel after PCI-S provides precise and valid bleeding risk data. Based on existing observational studies the rates of major and any bleeding associated with TT are clinically important and significantly greater than those reported with DAPT. |
Toggweiler, Stefan; Humphries, Karin H; Lee, May; Binder, Ronald K; Moss, Robert R; Freeman, Melanie; Ye, Jian; Cheung, Anson; Wood, David A; Webb, John G 5-Year Outcome After Transcatheter Aortic Valve Implantation. Journal Article Journal of the American College of Cardiology, 61 , pp. 413–419, 2013. Abstract | Links | Tags: adverse effects, diagnosis, epidemiology, methods, mortality, patient outcomes, physiopathology, surgery, TAVR @article{b, title = {5-Year Outcome After Transcatheter Aortic Valve Implantation.}, author = { Stefan Toggweiler and Karin H Humphries and May Lee and Ronald K Binder and Robert R Moss and Melanie Freeman and Jian Ye and Anson Cheung and David A Wood and John G Webb}, doi = {10.1016/j.jacc.2012.11.010}, year = {2013}, date = {2013-01-01}, journal = {Journal of the American College of Cardiology}, volume = {61}, pages = {413--419}, abstract = {The purpose of this study was to investigate the 5-year outcome following transcatheter aortic valve implantation (TAVI). Little is known about long-term outcomes following TAVI. The 5-year outcomes following successful TAVI with a balloon-expandable valve were evaluated in 88 patients. Patients who died within 30 days after TAVI were excluded. Mean aortic valve gradient decreased from 46 ± 18 mm Hg to 10 ± 4.5 mm Hg after TAVI and 11.8 ± 5.7 mm Hg at 5 years (p for post-TAVI trend = 0.06). Mean aortic valve area increased from 0.62 ± 0.17 cm(2) to 1.67 ± 0.41 cm(2) after TAVI and 1.40 ± 0.25 cm(2) at 5 years (p for post-TAVI trend <0.01). At 5 years, 3 patients (3.4%) had moderate prosthetic valve dysfunction (moderate transvalvular regurgitation in 1, moderate stenosis in 1, and moderate mixed disease in 1). Survival rates at 1 to 5 years were 83%, 74%, 53%, 42%, and 35%, respectively. Median survival time after TAVI was 3.4 years (95% confidence interval [CI]: 2.6 to 4.3), and the risk of death was significantly increased in patients with chronic obstructive pulmonary disease (adjusted hazard ratio [HR]: 2.17; 95% CI: 1.28 to 3.70) and at least moderate paravalvular regurgitation (adjusted HR: 2.98; 95% CI: 1.44 to 6.17). Our study demonstrated favorable long-term outcomes after TAVI. Signs of moderate prosthetic valve failure were observed in 3.4% of patients. No patients developed severe prosthetic regurgitation or stenosis. Comorbidities, notably chronic lung disease and at least moderate paravalvular regurgitation, were associated with reduced long-term survival.}, keywords = {adverse effects, diagnosis, epidemiology, methods, mortality, patient outcomes, physiopathology, surgery, TAVR}, pubstate = {published}, tppubtype = {article} } The purpose of this study was to investigate the 5-year outcome following transcatheter aortic valve implantation (TAVI). Little is known about long-term outcomes following TAVI. The 5-year outcomes following successful TAVI with a balloon-expandable valve were evaluated in 88 patients. Patients who died within 30 days after TAVI were excluded. Mean aortic valve gradient decreased from 46 ± 18 mm Hg to 10 ± 4.5 mm Hg after TAVI and 11.8 ± 5.7 mm Hg at 5 years (p for post-TAVI trend = 0.06). Mean aortic valve area increased from 0.62 ± 0.17 cm(2) to 1.67 ± 0.41 cm(2) after TAVI and 1.40 ± 0.25 cm(2) at 5 years (p for post-TAVI trend <0.01). At 5 years, 3 patients (3.4%) had moderate prosthetic valve dysfunction (moderate transvalvular regurgitation in 1, moderate stenosis in 1, and moderate mixed disease in 1). Survival rates at 1 to 5 years were 83%, 74%, 53%, 42%, and 35%, respectively. Median survival time after TAVI was 3.4 years (95% confidence interval [CI]: 2.6 to 4.3), and the risk of death was significantly increased in patients with chronic obstructive pulmonary disease (adjusted hazard ratio [HR]: 2.17; 95% CI: 1.28 to 3.70) and at least moderate paravalvular regurgitation (adjusted HR: 2.98; 95% CI: 1.44 to 6.17). Our study demonstrated favorable long-term outcomes after TAVI. Signs of moderate prosthetic valve failure were observed in 3.4% of patients. No patients developed severe prosthetic regurgitation or stenosis. Comorbidities, notably chronic lung disease and at least moderate paravalvular regurgitation, were associated with reduced long-term survival. |
Juren, Andrew J; Sarwal, Gautamn; Al-Sarraf, Ahmad; Vrablik, Michal; Chan, Darren; Humphries, Karin H; Frohlich, Jiri J Low Prevalence of Type 2 Diabetes Mellitus Among Patients with High Levels of High-Density Lipoprotein Cholesterol. Journal Article Journal of Clinical Lipidology, 7 , pp. 194–198, 2013. Abstract | Links | Tags: diabetes, evidence, HDL, patient outcomes, research @article{b, title = {Low Prevalence of Type 2 Diabetes Mellitus Among Patients with High Levels of High-Density Lipoprotein Cholesterol.}, author = { Andrew J Juren and Gautamn Sarwal and Ahmad Al-Sarraf and Michal Vrablik and Darren Chan and Karin H Humphries and Jiri J Frohlich}, doi = {10.1016/j.jacl.2013.02.003}, year = {2013}, date = {2013-01-01}, journal = {Journal of Clinical Lipidology}, volume = {7}, pages = {194--198}, abstract = {Diabetes mellitus and low levels of high-density lipoprotein cholesterol (HDL-C) are among several known risk factors for coronary artery disease. Recent research has shown potential mechanistic links between these two diseases. The aim of our study was to characterize, by examining particular coronary artery disease risk factors, patients with extremely high and low levels of HDL-C who were referred to a prevention clinic. We compared the phenotypes of 113 patients with HDL-C levels greater than the 90th percentile with 212 patients with levels less than the 10th percentile by using a retrospective chart review. The cohort with high HDL-C had a remarkable difference in the incidence of type 2 diabetes (1.8% vs 21.7%). The high HDL-C cohort also had a greater age (52.1 years vs 46.7 years), more light or moderate alcohol consumption (70.8% vs 49.4%), more healthy diet (30.1% vs 22.4%), more light or moderate exercise (90.8% vs 52.2%), and a lower body mass index (25.2 kg/m² vs 28.1 kg/m²). Compared with the low HDL-C group--and also the general population--the high HDL-C cohort had a remarkably low prevalence of diabetes mellitus.}, keywords = {diabetes, evidence, HDL, patient outcomes, research}, pubstate = {published}, tppubtype = {article} } Diabetes mellitus and low levels of high-density lipoprotein cholesterol (HDL-C) are among several known risk factors for coronary artery disease. Recent research has shown potential mechanistic links between these two diseases. The aim of our study was to characterize, by examining particular coronary artery disease risk factors, patients with extremely high and low levels of HDL-C who were referred to a prevention clinic. We compared the phenotypes of 113 patients with HDL-C levels greater than the 90th percentile with 212 patients with levels less than the 10th percentile by using a retrospective chart review. The cohort with high HDL-C had a remarkable difference in the incidence of type 2 diabetes (1.8% vs 21.7%). The high HDL-C cohort also had a greater age (52.1 years vs 46.7 years), more light or moderate alcohol consumption (70.8% vs 49.4%), more healthy diet (30.1% vs 22.4%), more light or moderate exercise (90.8% vs 52.2%), and a lower body mass index (25.2 kg/m² vs 28.1 kg/m²). Compared with the low HDL-C group--and also the general population--the high HDL-C cohort had a remarkably low prevalence of diabetes mellitus. |