Skip Navigation
Department of Health and Human Services www.hhs.gov
Agency for Healthcare Research Quality www.ahrq.gov
AHRQ Home | Questions? | Contact Us | Site Map | What's New | Browse | Información en español | E-mail UpdatesE-mail Updates
 
Slide Tray
0 slides

Return to Slide Library

Slides

Add Search Results to Slide Tray Search:

"cardiovascular events"

Slides: 1–12 of 25
Add to tray Remove from tray

Explanation of Distal Filter Embolic Protection Devices Included in the CER

Presentation: Adjunctive Devices for Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention
Keywords: embolic protection | MACE | major adverse cardiovascular event | PCI | percutaneous coronary intervention | ST-segment elevation myocardial infarction | STEMI | current practice
Add to tray Remove from tray

Current Practice for Patients Undergoing PCI

Presentation: Adjunctive Devices for Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention
Keywords: embolic protection | MACE | major adverse cardiovascular event | PCI | percutaneous coronary intervention | ST-segment elevation myocardial infarction | STEMI | current practice
Add to tray Remove from tray

Overall Conclusions

Presentation: Adjunctive Devices for Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention
Keywords: conclusions | ST-segment elevation myocardial infarction | STEMI | percutaneous coronary intervention | PCI | catheter aspiration | mechanical thrombectomy | future research
Add to tray Remove from tray

Rationale for Update

Presentation: Angiotensin-Converting Enzyme Inhibitors (ACEIs), Angiotensin II Receptor Antagonists (ARBs), or Direct Renin Inhibitors (DRI) for Adults With Hypertension
Keywords: systematic review | comparative effectiveness | ACEI | ARB | hypertension | aliskiren | DRI
Add to tray Remove from tray

Evidence of Benefits: Clinical Outcomes

Presentation: Angiotensin-Converting Enzyme Inhibitors (ACEIs), Angiotensin II Receptor Antagonists (ARBs), or Direct Renin Inhibitors (DRI) for Adults With Hypertension
Keywords: clinical outcomes | ACEIs | ARBs | mortality | cardiovascular events | serum lipid levels | renal disease | quality of life
In patients with stable ischemic heart disease, antiplatelet therapy with a single agent (aspirin or clopidogrel) and statin therapy (if the concentrations of low-density lipoprotein and non–high-density lipoprotein are above 100 mg/dL and 130 mg/dL, respectively) can reduce the risk of cardiovascular events. Other drugs — such as fast-acting nitrates (nitroglycerin tablets or spray), negative chronotropic agents (?-blockers; nondihydropyridine calcium channel blockers), and vasodilators (calcium channel blockers; long-acting nitrates) — can be used in patients with stable ischemic heart disease to relieve symptoms but do not impact the risk of cardiovascular events. For this reason, it is important to evaluate new therapeutic modalities that may impact cardiovascular events in patients with stable ischemic heart disease in addition to standard medical therapy.
Add to tray Remove from tray

Standard Therapy for Stable Ischemic Heart Disease

Presentation: Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors and/or Angiotensin II Receptor Blockers Added to Standard Medical Therapy for Treating Patients With Stable Ischemic Heart Disease and Preserved Left Ventricular Systolic Function
Keywords: cardiovascular events | standard therapy | stable ischemic heart disease
A closer look at the current American College of Cardiology and American Heart Association guidelines reveals that angiotensin-converting enzyme inhibitors (ACEIs) are indicated for patients who have chronic heart failure or myocardial infarction and left ventricular dysfunction, which is defined as a left ventricular ejection fraction ?40%. Angiotensin II receptor blockers (ARBs) are reserved for patients who cannot tolerate ACEIs. In patients with heart failure, combining an ACEI with an ARB has been shown to provide additional benefits over an ACEI alone. However, it is unclear if ACEIs or ARBs impact the risk of future cardiovascular events in patients without left ventricular systolic dysfunction (LVSD).
Add to tray Remove from tray

Guidelines for the Use of ACEIs, ARBs, or Both to Treat Patients With Cardiac Disease (1)

Presentation: Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors and/or Angiotensin II Receptor Blockers Added to Standard Medical Therapy for Treating Patients With Stable Ischemic Heart Disease and Preserved Left Ventricular Systolic Function
Keywords: American Heart Association | angiotensin II-receptor blocker | angiotensin-converting enzyme inhibitor | cardiac disease | guidelines | heart failure | American College of Cardiology
Despite standard therapy, patients with stable ischemic heart disease and preserved left ventricular systolic function continue to be at risk for future cardiovascular events. The Renin-Angiotensin-Aldosterone System (RAAS) is critical for regulating blood pressure, electrolyte balance, and fluid volume homeostasis and plays a pivotal role in the pathogenesis of hypertension, congestive heart failure, and diabetic nephropathy. Pharmacological agonists of this system include angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs). These drugs block adverse effects of the RAAS by blocking the activity of angiotensin II. Through the stimulation of angiotensin II type-1 receptors, angiotensin II may have several potentially harmful activities including induction of aldosterone production, which can cause sodium retention and increased fluid retention that, in turn, leads to an increase in blood pressure, increased aldosterone production, which can possibly lead to promotion of pathogenic remodeling (i.e., atherosclerosis and fibrosis), constriction of blood vessels, which can lead to increased blood pressure, and potential reduction in the availability of nitric oxide through the production of free radicals and the induction of endothelial dysfunction that may impact endothelial wall integrity. ACEIs act on the RAAS by blocking the conversion of angiotensin I into angiotensin II and inhibiting the breakdown of bradykinin, which is a potent vasodilator. ARBs block the angiotensin II type-1 receptor and reduce the pharmacologic effects of angiotensin II, regardless of whether angiotensin II is created by the angiotensin-converting enzyme or by pathways that do not include this enzyme. ACEIs and ARBs may potentially provide several pharmacological effects over and above that of blood pressure reduction alone, which may impact cardiovascular events.
Add to tray Remove from tray

Pharmacologic Effects of Antagonists on the Renin-Angiotensin-Aldosterone System

Presentation: Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors and/or Angiotensin II Receptor Blockers Added to Standard Medical Therapy for Treating Patients With Stable Ischemic Heart Disease and Preserved Left Ventricular Systolic Function
Keywords: angiotensin II-receptor blocker | angiotensin-converting enzyme inhibitor | renin-angiotensin-aldosterone system | pharmacology
This slide summarizes the most pertinent results from the Comparative Effectiveness Review (CER) on the benefits and harms of adding an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin II receptor blocker (ARB) to standard medical therapy for stable ischemic heart disease with preserved left ventricular systolic function as compared to standard medical therapy alone or with a placebo. The next several slides will discuss these data in greater detail. When considered together, the benefits and harms of adding an ACEI or an ARB to standard medical therapy indicate that there may be a clinical benefit from such therapy for some patients with stable ischemic heart disease and preserved left ventricular systolic function (LVSF). However, the potential risks of cough, syncope, or hyperkalemia should be considered for each individual patient before adding an ACEI or an ARB to his or her treatment regimen. Very few of the trials evaluated for the CER compared the addition of an ACEI or an ARB or both to an active control. Only two trials compared the addition of an ACEI or a calcium channel blocker to standard medical therapy (Nissen et al., 2004; Yiu et al., 2004). In both trials, the clinical benefits were similar between the two treatment arms, and there was some limited evidence that ACEIs may increase the risk for hypotension and cough. Additional trials are required to make any definitive clinical recommendations with regard to the addition of calcium channel blockers over ACEIs to standard medical therapy. Cardiovascular events are the leading cause of death in patients treated with hemodialysis for chronic kidney disease. Among these patients, left ventricular hypertrophy is considered to be an ischemic heart disease equivalent, as defined by the National Kidney Foundation. In a clinical trial conducted by Zannad et al. (2006), however, there was no impact on cardiovascular mortality after fosinopril, an ACEI, was added to standard therapy for patients with end-stage renal disease and left ventricular hypertrophy.
Add to tray Remove from tray

Results of Trials Evaluating the Addition of an ACEI or an ARB to Standard Therapy for Stable Ischemic Heart Disease and Preserved Left Ventricular Systolic Function

Presentation: Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors and/or Angiotensin II Receptor Blockers Added to Standard Medical Therapy for Treating Patients With Stable Ischemic Heart Disease and Preserved Left Ventricular Systolic Function
Keywords: angiotensin II-receptor blocker | benefit | cough | hyperkalemia | renal disease | stable ischemic heart disease | syncope | angiotensin-converting enzyme inhibitor
The Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease (TRANSCEND) trial (Yusuf et al., 2008) was the only trial that met the inclusion criteria for the addition of an angiotensin II receptor blocker (ARB) to standard medical therapy for patients with stable ischemic heart disease (IHD) and preserved left ventricular function (LVSF) as compared to standard medical therapy alone or with a placebo. Patients who could not tolerate angiotensin-converting enzyme inhibitors (ACEIs) were enrolled in the study and were treated with telmisartan. The results of this trial showed that the difference in event rates between the two treatment groups to be less than 2. On average, 56 patients who have stable IHD and preserved LVSF and cannot tolerate ACEIs will need to be treated with an ARB over 5 years to prevent one or more of the following events: cardiovascular death, nonfatal myocardial infarction, or stroke. In other words, on average, 14.8 of every 100 patients will experience one or more of these cardiovascular events in the next 5 years. If an ARB were to be added to the treatment regimens of 100 patients, 13 of them would have a risk of suffering one or more of these cardiovascular events. The relative risk reduction in the combined risk for cardiovascular death, nonfatal myocardial infarction, or stroke is 12%. All of these data were determined to be at a high level of evidence, meaning that future trials are unlikely to change the estimated differences between these treatment groups.
Add to tray Remove from tray

Benefits With HIGH Levels of Evidence That Result From Adding an ARB to Standard Medical Therapy for Stable Ischemic Heart Disease With Preserved Left Ventricular Systolic Function*

Presentation: Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors and/or Angiotensin II Receptor Blockers Added to Standard Medical Therapy for Treating Patients With Stable Ischemic Heart Disease and Preserved Left Ventricular Systolic Function
Keywords: evidence-based benefits | number needed to treat | relative risk | stable ischemic heart disease | angiotensin II-receptor blocker
Add to tray Remove from tray

Background: Management

Presentation: Comparing Medications for Adults With Type 2 Diabetes
Keywords: management of hyperglycemia | treatment for type 2 diabetes | outcomes | blood glucose | antidiabetic medications
Add to tray Remove from tray

Overview of Adverse Events and Side Effects

Presentation: Comparing Medications for Adults With Type 2 Diabetes
Keywords: congestive heart failure | fracture | gastrointestinal | hypoglycemia | metformin | second-generation sulfonylureas | side effect | thiazolidinedione | adverse event
Pages: [1] 2 3 Next
 
 
 
 
www.ahrq.gov AHRQ Home | Contact AHRQ | Site Map | Accessibility | Privacy Policy | Freedom of Information Act | Disclaimers
U.S. Department of Health & Human Services | The White House | USA.gov: The U.S. Government's Official Web Portal

Agency for Healthcare Research and Quality • 540 Gaither Road Rockville, MD 20850 • Telephone: (301) 427-1364