{"generated":"2026-08-28T16:42:09Z","year":"2016","count":322,"licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","articles":[{"id":"84c9d3ee98e7","type":"article","url":"https://hartvaat.nl/2016/12/29/bilaterale-versus-enkelvoudige-a-mammaria-interna-grafts-nejm-art-trial/","title":"Bilaterale versus enkelvoudige a. mammaria interna-grafts: NEJM ART-trial","title_en":"Randomized Trial of Bilateral versus Single Internal-Thoracic-Artery Grafts.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1610021","source_url":"https://doi.org/10.1056/NEJMoa1610021","authors":["David P Taggart","Douglas G Altman","Alastair M Gray","Belinda Lees","Stephen Gerry","Umberto Benedetto","Marcus Flather"],"significance":9,"published":"2016-12-29","source_date":"2016-12-29","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/cabg-bypasschirurgie/","https://hartvaat.nl/kennis/coronairlijden/pci-vs-cabg-afweging/"],"congress":"","summary_en":"The ART trial compared bilateral versus single internal thoracic artery grafts in patients undergoing CABG. At 5 years, bilateral grafting did not significantly improve survival over single grafting, though the study was underpowered due to crossover. The results informed but did not resolve the debate over bilateral mammary artery use.","created":"2026-07-03T10:26:29Z","updated":"2026-07-03T13:25:48Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM ART-trial die bilaterale versus enkelvoudige a. mammaria interna-grafts vergeleek bij CABG. Definitieve trial over de meerwaarde van bilaterale arteriële revascularisatie.","abstract_original":"BACKGROUND: The use of bilateral internal thoracic (mammary) arteries for coronary-artery bypass grafting (CABG) may improve long-term outcomes as compared with the use of a single internal-thoracic-artery plus vein grafts. METHODS: We randomly assigned patients scheduled for CABG to undergo single or bilateral internal-thoracic-artery grafting in 28 cardiac surgical centers in seven countries. The primary outcome was death from any cause at 10 years. The composite of death from any cause, myocardial infarction, or stroke was a secondary outcome. Interim analyses were prespecified at 5 years of follow-up. RESULTS: A total of 3102 patients were enrolled; 1554 were randomly assigned to undergo single internal-thoracic-artery grafting (the single-graft group) and 1548 to undergo bilateral internal-thoracic-artery grafting (the bilateral-graft group). At 5 years of follow-up, the rate of death was 8.7% in the bilateral-graft group and 8.4% in the single-graft group (hazard ratio, 1.04; 95% confidence interval [CI], 0.81 to 1.32; P=0.77), and the rate of the composite of death from any cause, myocardial infarction, or stroke was 12.2% and 12.7%, respectively (hazard ratio, 0.96; 95% CI, 0.79 to 1.17; P=0.69). The rate of sternal wound complication was 3.5% in the bilateral-graft group versus 1.9% in the single-graft group (P=0.005), and the rate of sternal reconstruction was 1.9% versus 0.6% (P=0.002). CONCLUSIONS: Among patients undergoing CABG, there was no significant difference between those receiving single internal-thoracic-artery grafts and those receiving bilateral internal-thoracic-artery grafts with regard to mortality or the rates of cardiovascular events at 5 years of follow-up. There were more sternal wound complications with bilateral internal-thoracic-artery grafting than with single internal-thoracic-artery grafting. Ten-year follow-up is ongoing. (Funded by the British Heart Foundation and others; ART Current Controlled Trials number, ISRCTN46552265 .)."},{"id":"c7d2cd719175","type":"article","url":"https://hartvaat.nl/2016/12/27/hotballoon-pulmonaalvene-ablatie-bij-paroxysmaal-af-japanse-multicenter-trial/","title":"HotBalloon pulmonaalvene-ablatie bij paroxysmaal AF: Japanse multicenter trial","title_en":"HotBalloon Ablation of the Pulmonary Veins for Paroxysmal AF: A Multicenter Randomized Trial in Japan.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["katheterablatie"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.10.037","source_url":"https://doi.org/10.1016/j.jacc.2016.10.037","authors":["Hiroshi Sohara","Tohru Ohe","Ken Okumura","Shigeto Naito","Kenzo Hirao","Morio Shoda","Youichi Kobayashi","Yasuteru Yamauchi","Yoshio Yamaguchi","Taishi Kuwahara","Haruo Hirayama","Chun YeongHwa","Kengo Kusano","Kazuaki Kaitani","Kimikazu Banba","Satoki Fujii","Koichiro Kumagai","Hisashi Yoshida","Masashi Matsushita","Shutaro Satake","Kazutaka Aonuma"],"significance":6,"published":"2016-12-27","source_date":"2016-12-27","image":"","kennis":[],"congress":"","summary_en":"This Japanese multicenter randomized trial compared HotBalloon ablation with radiofrequency ablation for pulmonary vein isolation in paroxysmal AF, evaluating a thermal balloon technology developed as an alternative to cryoballoon.","created":"2026-07-03T10:26:29Z","updated":"2026-07-03T13:25:48Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde multicenter trial uit Japan die HotBalloon-ablatie vergeleek met radiofrequentieablatie voor pulmonaalvene-isolatie bij paroxysmaal AF. Alternatieve energiebron voor AF-ablatie.","abstract_original":"BACKGROUND: Point-by-point catheter ablation is an established treatment for drug-refractory paroxysmal atrial fibrillation (PAF). However, it is time consuming, requires excellent technique to achieve complete pulmonary vein (PV) isolation, and is associated with severe complications. OBJECTIVES: The purpose of this study was to evaluate the safety and effectiveness of a HotBalloon ablation (HBA) compared with antiarrhythmic drug therapy (ADT) for the treatment of PAF. METHODS: A prospective multicenter randomized controlled study was conducted in Japan. Patients with symptomatic PAF refractory to antiarrhythmic drugs (Class I to IV) were randomized to HBA or ADT at a 2:1 ratio and assessed for effectiveness in a comparable 9-month follow-up period. RESULTS: A total of 100 patients in the HBA group and 43 patients in the ADT group received treatment at 17 sites. HBA procedure produced acute complete PV isolation in 98.0% (392 of 400) of the PVs and in 93.0% (93 of 100) of patients in the HBA group. The chronic success rates after the 9-month effective evaluation period were 59.0% in the HBA group (n = 100) and 4.7% in the ADT group (n = 43; p < 0.001). The incidence of major complications was 11.2% (15 of 134 patients). The incidences of PV stenosis (>70%) and transient phrenic nerve injury were 5.2% and 3.7%, respectively. The mean fluoroscopy time was 49.4 ± 26.6 min (n = 134), and the mean procedure duration was 113.9 ± 31.9 min (n = 133). CONCLUSIONS: This study demonstrates the superiority of HBA compared with ADT for treatment of patients with PAF, and a favorable safety profile."},{"id":"ae008871c396","type":"article","url":"https://hartvaat.nl/2016/12/27/hoog-sensitief-troponine-statinetherapie-en-risico-op-coronairlijden/","title":"Hoog-sensitief troponine, statinetherapie en risico op coronairlijden","title_en":"High-Sensitivity Cardiac Troponin, Statin Therapy, and Risk of Coronary Heart Disease.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts"],"tags":["slaapapneu","troponine"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.10.020","source_url":"https://doi.org/10.1016/j.jacc.2016.10.020","authors":["Ian Ford","Anoop S V Shah","Ruiqi Zhang","David A McAllister","Fiona E Strachan","Muriel Caslake","David E Newby","Chris J Packard","Nicholas L Mills"],"significance":6,"published":"2016-12-27","source_date":"2016-12-27","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/"],"congress":"","summary_en":"This study explored the relationship between high-sensitivity troponin levels, statin use, and coronary heart disease risk, investigating whether troponin can serve as a biomarker to guide statin therapy initiation.","created":"2026-07-03T10:26:29Z","updated":"2026-07-03T13:25:48Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de relatie tussen hoog-sensitief troponine, statinegebruik en het risico op coronairlijden. Onderzoekt troponine als biomarker voor subclinische myocardschade en therapiemonitoring.","abstract_original":"BACKGROUND: Cardiac troponin is an independent predictor of cardiovascular mortality in individuals without symptoms or signs of cardiovascular disease. The mechanisms for this association are uncertain, and a role for troponin testing in the prevention of coronary heart disease has yet to be established. OBJECTIVES: This study sought to determine whether troponin concentration could predict coronary events, be modified by statins, and reflect response to therapy in a primary prevention population. METHODS: WOSCOPS (West of Scotland Coronary Prevention Study) randomized men with raised low-density lipoprotein cholesterol and no history of myocardial infarction to pravastatin 40 mg once daily or placebo for 5 years. Plasma cardiac troponin I concentration was measured with a high-sensitivity assay at baseline and at 1 year in 3,318 participants. RESULTS: Baseline troponin was an independent predictor of myocardial infarction or death from coronary heart disease (hazard ratio [HR]: 2.3; 95% confidence interval [CI]: 1.4 to 3.7) for the highest (≥5.2 ng/l) versus lowest (≤3.1 ng/l) quarter of troponin (p < 0.001). There was a 5-fold greater reduction in coronary events when troponin concentrations decreased by more than a quarter, rather than increased by more than a quarter, for both placebo (HR: 0.29; 95% CI: 0.12 to 0.72 vs. HR: 1.95; 95% CI: 1.09 to 3.49; p < 0.001 for trend) and pravastatin (HR: 0.23; 95% CI: 0.10 to 0.53 vs. HR: 1.08; 95% CI: 0.53 to 2.21; p < 0.001 for trend). Pravastatin reduced troponin concentration by 13% (10% to 15%; placebo adjusted, p < 0.001) and doubled the number of men whose troponin fell more than a quarter (p < 0.001), which identified them as having the lowest risk for future coronary events (1.4% over 5 years). CONCLUSIONS: Troponin concentration predicts coronary events, is reduced by statin therapy, and change at 1 year is associated with future coronary risk independent of cholesterol lowering. Serial troponin measurements have major potential to assess cardiovascular risk and monitor the impact of therapeutic interventions."},{"id":"d8a3b4a49cb0","type":"article","url":"https://hartvaat.nl/2016/12/22/preventie-van-bloedingen-bij-af-patienten-die-pci-ondergaan-nejm-pioneer-af-pci/","title":"Preventie van bloedingen bij AF-patiënten die PCI ondergaan: NEJM PIONEER AF-PCI","title_en":"Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1611594","source_url":"https://doi.org/10.1056/NEJMoa1611594","authors":["C Michael Gibson","Roxana Mehran","Christoph Bode","Jonathan Halperin","Freek W Verheugt","Peter Wildgoose","Mary Birmingham","Juliana Ianus","Paul Burton","Martin van Eickels","Serge Korjian","Yazan Daaboul","Gregory Y H Lip","Marc Cohen","Steen Husted","Eric D Peterson","Keith A Fox"],"significance":10,"published":"2016-12-22","source_date":"2016-12-22","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/","https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"The PIONEER AF-PCI trial demonstrated that rivaroxaban-based regimens significantly reduced clinically significant bleeding compared with standard triple therapy in patients with atrial fibrillation undergoing PCI with stenting. This was the first randomized trial to challenge the triple antithrombotic paradigm in AF patients requiring coronary stenting.","created":"2026-07-03T10:26:29Z","updated":"2026-07-03T13:25:48Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Landmark NEJM PIONEER AF-PCI-trial die strategieën met rivaroxaban vergeleek met standaard triple-therapie bij AF-patiënten die PCI ondergaan. Bepalend voor het antitromboticabeleid bij AF + stenting.","abstract_original":"BACKGROUND: In patients with atrial fibrillation undergoing percutaneous coronary intervention (PCI) with placement of stents, standard anticoagulation with a vitamin K antagonist plus dual antiplatelet therapy (DAPT) with a P2Y12 inhibitor and aspirin reduces the risk of thrombosis and stroke but increases the risk of bleeding. The effectiveness and safety of anticoagulation with rivaroxaban plus either one or two antiplatelet agents are uncertain. METHODS: We randomly assigned 2124 participants with nonvalvular atrial fibrillation who had undergone PCI with stenting to receive, in a 1:1:1 ratio, low-dose rivaroxaban (15 mg once daily) plus a P2Y12 inhibitor for 12 months (group 1), very-low-dose rivaroxaban (2.5 mg twice daily) plus DAPT for 1, 6, or 12 months (group 2), or standard therapy with a dose-adjusted vitamin K antagonist (once daily) plus DAPT for 1, 6, or 12 months (group 3). The primary safety outcome was clinically significant bleeding (a composite of major bleeding or minor bleeding according to Thrombolysis in Myocardial Infarction [TIMI] criteria or bleeding requiring medical attention). RESULTS: The rates of clinically significant bleeding were lower in the two groups receiving rivaroxaban than in the group receiving standard therapy (16.8% in group 1, 18.0% in group 2, and 26.7% in group 3; hazard ratio for group 1 vs. group 3, 0.59; 95% confidence interval [CI], 0.47 to 0.76; P<0.001; hazard ratio for group 2 vs. group 3, 0.63; 95% CI, 0.50 to 0.80; P<0.001). The rates of death from cardiovascular causes, myocardial infarction, or stroke were similar in the three groups (Kaplan-Meier estimates, 6.5% in group 1, 5.6% in group 2, and 6.0% in group 3; P values for all comparisons were nonsignificant). CONCLUSIONS: In participants with atrial fibrillation undergoing PCI with placement of stents, the administration of either low-dose rivaroxaban plus a P2Y12 inhibitor for 12 months or very-low-dose rivaroxaban plus DAPT for 1, 6, or 12 months was associated with a lower rate of clinically significant bleeding than was standard therapy with a vitamin K antagonist plus DAPT for 1, 6, or 12 months. The three groups had similar efficacy rates, although the observed broad confidence intervals diminish the surety of any conclusions regarding efficacy. (Funded by Janssen Scientific Affairs and Bayer Pharmaceuticals; PIONEER AF-PCI ClinicalTrials.gov number, NCT01830543 .)."},{"id":"c344da29b5d5","type":"article","url":"https://hartvaat.nl/2016/12/21/alirocumab-bij-heterozygoot-fh-met-lipoproteine-aferese-odyssey-escape/","title":"Alirocumab bij heterozygoot FH met lipoproteïne-aferese: ODYSSEY ESCAPE","title_en":"Alirocumab in patients with heterozygous familial hypercholesterolaemia undergoing lipoprotein apheresis: the ODYSSEY ESCAPE trial.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["familiaire-hypercholesterolemie","familiaire-hypercholesterolemie-screening","lipide-aferese"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw388","source_url":"https://doi.org/10.1093/eurheartj/ehw388","authors":["Patrick M Moriarty","Klaus G Parhofer","Stephan P Babirak","Marc-Andre Cornier","P Barton Duell","Bernd Hohenstein","Josef Leebmann","Wolfgang Ramlow","Volker Schettler","Vinaya Simha","Elisabeth Steinhagen-Thiessen","Paul D Thompson","Anja Vogt","Berndt von Stritzky","Yunling Du","Garen Manvelian"],"significance":7,"published":"2016-12-21","source_date":"2016-12-21","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/familiaire-hypercholesterolemie/"],"congress":"","summary_en":"The ODYSSEY ESCAPE trial showed that alirocumab reduced the frequency of lipoprotein apheresis treatments by 75% in patients with heterozygous FH, demonstrating a pharmaceutical alternative to this burdensome procedure.","created":"2026-07-03T10:26:28Z","updated":"2026-07-03T13:25:48Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde ODYSSEY ESCAPE-trial die alirocumab onderzocht bij patiënten met heterozygote familiaire hypercholesterolemie die lipoproteïne-aferese ondergaan. Toonde reductie in aferese-frequentie.","abstract_original":"AIM: To evaluate the effect of alirocumab on frequency of standard apheresis treatments [weekly or every 2 weeks (Q2W)] in heterozygous familial hypercholesterolaemia (HeFH). METHODS AND RESULTS: ODYSSEY ESCAPE (NCT02326220) was a double-blind study in 62 HeFH patients undergoing regular weekly or Q2W lipoprotein apheresis. Patients were randomly assigned (2:1, respectively) to receive alirocumab 150 mg (n = 41) or placebo (n = 21) Q2W subcutaneously for 18 weeks. From day 1 to week 6, apheresis rate was fixed according to the patient's established schedule; from weeks 7 to 18, apheresis rate was adjusted based on the patient's low-density lipoprotein cholesterol (LDL-C) response in a blinded fashion. Apheresis was not performed when the LDL-C value was ≥30% lower than the baseline (pre-apheresis) value. The primary efficacy endpoint was the rate of apheresis treatments over 12 weeks (weeks 7-18), standardized to number of planned treatments. In the alirocumab group the least square (LS) mean ± SE (95% confidence interval [CI]) per cent change in pre-apheresis LDL-C from baseline at week 6 was -53.7 ± 2.3 (-58.2 to - 49.2) compared with 1.6 ± 3.1 (-4.7 to 7.9) in the placebo group. The primary efficacy endpoint showed statistically significant benefit in favour of alirocumab (Hodges-Lehmann median estimate of treatment difference: 0.75; 95% CI 0.67-0.83; P < 0.0001). Therefore, alirocumab-treated patients had a 0.75 (75%) additional reduction in the standardized rate of apheresis treatments vs. placebo-treated patients. During this period, 63.4% of patients on alirocumab avoided all and 92.7% avoided at least half of the apheresis treatments. Adverse event rates were similar (75.6% of patients on alirocumab vs. 76.2% on placebo). CONCLUSIONS: Lipoprotein apheresis was discontinued in 63.4% of patients on alirocumab who were previously undergoing regular apheresis, and the rate was at least halved in 92.7% of patients. Alirocumab was generally safe and well tolerated."},{"id":"a1df67a5c7ec","type":"article","url":"https://hartvaat.nl/2016/12/21/ezetimibe-bij-post-cabg-patienten-met-acs-improve-it-subanalyse/","title":"Ezetimibe bij post-CABG patiënten met ACS: IMPROVE-IT-subanalyse","title_en":"The benefit of adding ezetimibe to statin therapy in patients with prior coronary artery bypass graft surgery and acute coronary syndrome in the IMPROVE-IT trial.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog"],"tags":["acuut-hartfalen","ouderen"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw377","source_url":"https://doi.org/10.1093/eurheartj/ehw377","authors":["Alon Eisen","Christopher P Cannon","Michael A Blazing","Erin A Bohula","Jeong-Gun Park","Sabina A Murphy","Jennifer A White","Robert P Giugliano","Eugene Braunwald"],"significance":6,"published":"2016-12-21","source_date":"2016-12-21","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/"],"congress":"","summary_en":"This IMPROVE-IT subanalysis showed that patients with prior CABG derive particular benefit from adding ezetimibe to statin therapy after ACS, reflecting their higher baseline cardiovascular risk and greater potential for LDL lowering.","created":"2026-07-03T10:26:28Z","updated":"2026-07-03T13:25:48Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse van IMPROVE-IT naar het voordeel van ezetimibe-toevoeging bij ACS-patiënten met eerdere CABG. Deze subgroep heeft een verhoogd risico en mogelijk meer baat bij intensieve LDL-verlaging.","abstract_original":"AIMS: To examine the efficacy and safety of ezetimibe added to statin in patients with prior coronary artery bypass graft surgery (CABG) following hospitalization for an acute coronary syndrome (ACS). METHODS AND RESULTS: In the IMPROVE-IT trial, post-ACS patients with mean low density lipoprotein cholesterol (LDL-C) of 93.8 mg/dL at presentation were randomized to simvastatin/ezetimibe or simvastatin/placebo. The primary endpoint was cardiovascular death, major coronary event or stroke, and the median follow-up was 6 years. Efficacy and safety endpoints were examined by prior CABG status. Among 18 134 patients, 1684 (9.3%) had a prior CABG (median age 69 years, 82% male). During the trial, the median time-weighted LDL-C level was 55.0 mg/dL with simvastatin/ezetimibe vs. 69.9 mg/dL with simvastatin/placebo in patients with prior CABG (P < 0.001), and it was 53.6 mg/dL vs. 69.5 mg/dL, respectively, in patients without prior CABG (P < 0.001). The rate of the primary endpoint was higher in patients with vs. without prior CABG [56% vs. 32%, adj. hazard ratio 1.45, 95% confidence interval (CI) 1.33-1.58]. Patients with prior CABG receiving simvastatin/ezetimibe had an 8.8% (95% CI 3.1-14.6%) lower absolute risk over simvastatin/placebo in the primary endpoint, whereas patients without prior CABG had a 1.3% (95% CI 0-2.6%) lower absolute risk (P-interaction = 0.02). There were no between-group significant differences in safety endpoints. CONCLUSION: The clinical benefit of adding ezetimibe to statin appears to be enhanced in patients with prior CABG, supporting the use of intensive lipid lowering therapy in these high-risk patients following ACS."},{"id":"cd61c05af021","type":"article","url":"https://hartvaat.nl/2016/12/21/statines-voor-primaire-preventie-bij-hiv-positieve-patienten-systematische-revie/","title":"Statines voor primaire preventie bij HIV-positieve patiënten: systematische review","title_en":"Comparative safety and efficacy of statins for primary prevention in human immunodeficiency virus-positive patients: a systematic review and meta-analysis.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["primaire-preventie","statines","vrouwen"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehv734","source_url":"https://doi.org/10.1093/eurheartj/ehv734","authors":["Sebastiano Gili","Walter Grosso Marra","Fabrizio D'Ascenzo","Enrica Lonni","Andrea Calcagno","Margherita Cannillo","Flavia Ballocca","Enrico Cerrato","Martina Pianelli","Umberto Barbero","Massimo Mancone","James J DiNicolantonio","Carl J Lavie","Pierluigi Omedè","Antonio Montefusco","Stefano Bonora","Mauro Gasparini","Giuseppe Biondi-Zoccai","Claudio Moretti","Fiorenzo Gaita"],"significance":6,"published":"2016-12-21","source_date":"2016-12-21","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/"],"congress":"","summary_en":"This systematic review and meta-analysis evaluated the comparative safety and efficacy of different statins for primary cardiovascular prevention in HIV-positive patients, addressing the drug interaction challenges unique to antiretroviral therapy.","created":"2026-07-03T10:26:28Z","updated":"2026-07-03T13:25:48Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse naar de veiligheid en werkzaamheid van statines voor primaire cardiovasculaire preventie bij HIV-positieve patiënten. Relevant gezien het verhoogde CV-risico bij HIV.","abstract_original":"The efficacy and safety of different statins for human immunodeficiency virus (HIV)-positive patients in the primary prevention setting remain to be established. In the present meta-analysis, 18 studies with 736 HIV-positive patients receiving combination antiretroviral therapy (cART) and treated with statins in the primary prevention setting were included (21.0% women, median age 44.1 years old). The primary endpoint was the effect of statin therapy on total cholesterol (TC) levels. Rosuvastatin 10 mg and atorvastatin 10 mg provided the largest reduction in TC levels [mean -1.67, 95% confidence interval (CI) (-1.99, -1.35) mmol/L; and mean -1.44, 95% CI (-1.85, -1.02) mmol/L, respectively]. Atorvastatin 80 mg and simvastatin 20 mg provided the largest reduction in low-density lipoprotein (LDL) [mean -2.10, 95% CI (-3.39, -0.81) mmol/L; and mean -1.57, 95% CI (-2.67, -0.47) mmol/L, respectively]. Pravastatin 10-20 mg [mean 0.24, 95% CI (0.10, 0.38) mmol/L] and atorvastatin 10 mg [mean 0.15, 95% CI (0.007, 0.23) mmol/L] had the largest increase in high-density lipoprotein, whereas atorvastatin 80 mg [mean -0.60, 95% CI (-1.09, -0.11) mmol/L] and simvastatin 20 mg [mean -0.61, 95% CI (-1.14, -0.08) mmol/L] had the largest reduction in triglycerides. The mean discontinuation rate was 0.12 per 100 person-years [95% CI (0.05, 0.20)], and was higher with atorvastatin 10 mg [26.5 per 100 person-years, 95% CI (-13.4, 64.7)]. Meta-regression revealed that nucleoside reverse transcriptase inhibitors-sparing regimens were associated with reduced efficacy for statin's ability to lower TC. Statin therapy significantly lowers plasma TC and LDL levels in HIV-positive patients and is associated with low rates of adverse events. Statins are effective and safe when dose-adjusted for drug-drug interactions with cART."},{"id":"211a599e0459","type":"article","url":"https://hartvaat.nl/2016/12/20/ticagrelor-versus-clopidogrel-bij-comateuze-overlevenden-van-reanimatie-met-pci/","title":"Ticagrelor versus clopidogrel bij comateuze overlevenden van reanimatie met PCI","title_en":"Ticagrelor Versus Clopidogrel in Comatose Survivors of Out-of-Hospital Cardiac Arrest Undergoing Percutaneous Coronary Intervention and Hypothermia: A Randomized Study.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["trombocytenaggregatieremmers"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.024872","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.024872","authors":["Klemen Steblovnik","Ales Blinc","Mojca Bozic Mijovski","Misa Fister","Ursa Mikuz","Marko Noc"],"significance":6,"published":"2016-12-20","source_date":"2016-12-20","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This study compared ticagrelor with clopidogrel in comatose survivors of out-of-hospital cardiac arrest undergoing PCI, addressing the specific pharmacological challenge of antiplatelet dosing in unconscious patients.","created":"2026-07-03T10:26:28Z","updated":"2026-07-03T13:25:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die ticagrelor vergeleek met clopidogrel bij comateuze patiënten na buiten-ziekenhuis hartstilstand die PCI ondergingen. Specifieke populatie waar orale plaatjesremming via maagsonde wordt gegeven.","abstract_original":""},{"id":"58d50558e8e8","type":"article","url":"https://hartvaat.nl/2016/12/20/bloedingen-voor-coronairangiografie-bij-nste-acs/","title":"Bloedingen vóór coronairangiografie bij NSTE-ACS","title_en":"Bleeding Events Before Coronary Angiography in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["acuut-coronair-syndroom"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.09.957","source_url":"https://doi.org/10.1016/j.jacc.2016.09.957","authors":["Björn Redfors","Ajay J Kirtane","Stuart J Pocock","Girma Minalu Ayele","Efthymios N Deliargyris","Roxana Mehran","Gregg W Stone","Philippe Généreux"],"significance":5,"published":"2016-12-20","source_date":"2016-12-20","image":"","kennis":[],"congress":"","summary_en":"This study characterized the incidence and prognostic impact of bleeding events occurring before coronary angiography in NSTE-ACS, showing that upstream antithrombotic-related bleeding significantly worsens outcomes.","created":"2026-07-03T10:26:28Z","updated":"2026-07-03T13:25:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de incidentie en impact van bloedingscomplicaties die optreden vóór coronairangiografie bij patiënten met NSTE-ACS. Vroege bloedingen zijn geassocieerd met ongunstiger uitkomsten.","abstract_original":"BACKGROUND: Upstream administration of antithrombotic drugs to patients with non-ST-segment elevation acute coronary syndromes before coronary angiography is a common practice despite an incomplete understanding of the risks and benefits. OBJECTIVES: The authors analyzed the incidence of bleeding and ischemic events occurring before angiography and assessed their association with antithrombotic drugs and mortality risk. METHODS: All patients from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial with planned angiography after enrollment were included. Bleeding events were classified according to the ACUITY scale as major or nonmajor bleeding. Kaplan-Meier and Cox proportional hazards analyses were performed. RESULTS: Of 13,726 patients, 275 (2.0%) bled before angiography, including 52 (0.4%) with major bleeding. Forty-four (0.3%) experienced myocardial infarction. The median time from randomization to coronary angiography was 4.5 h (interquartile ratio [IQR]: 1.7 to 19.7 h) for patients who did not bleed while waiting for angiography and 27.9 h (IQR: 21.9 to 65.6 h) for patients who bled while waiting for angiography (p < 0.001). Bleeding events accrued linearly over time, reaching 10.4% at 96 h post-randomization. Independent predictors of bleeding before angiography included age (adjusted hazard ratio [HR]: 1.03 per year of age; 95% confidence interval [CI]: 1.01 to 1.04; p < 0.001), renal insufficiency (adjusted HR: 1.48; 95% CI: 1.07 to 2.04; p = 0.02), and use of multiple antithrombotic drugs (adjusted HR: 1.33; 95% CI: 1.14 to 1.56; p < 0.001). Bleeding before coronary angiography was associated with longer hospitalization (4.8 days [IQR: 3.0 to 8.9 days] vs. 3.0 days [IQR: 1.9 to 5.9 days]; p < 0.001). Patients who bled before angiography were more likely to die within 1 year than patients who did not bleed (8.5% vs. 4.1%; p < 0.001; adjusted HR: 1.89 (95% CI: 1.23 to 2.90; p = 0.004). CONCLUSIONS: Upstream antithrombotic treatment of patients with non-ST-segment elevation acute coronary syndromes awaiting coronary angiography is associated with excess bleeding with mortality implications. Bleeding avoidance strategies before angiogram, including early angiography, may negate the need to prolong upstream antithrombotic treatment and improve the overall risk-benefit balance for these patients. (Acute Catheterization and Urgent Intervention Triage Strategy [ACUITY]; NCT00093158)."},{"id":"d3fa3a3f0ecd","type":"article","url":"https://hartvaat.nl/2016/12/20/off-label-doac-dosering-en-ongunstige-uitkomsten-orbit-af-ii-register/","title":"Off-label DOAC-dosering en ongunstige uitkomsten: ORBIT-AF II-register","title_en":"Off-Label Dosing of Non-Vitamin K Antagonist Oral Anticoagulants and Adverse Outcomes: The ORBIT-AF II Registry.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","huisarts"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.09.966","source_url":"https://doi.org/10.1016/j.jacc.2016.09.966","authors":["Benjamin A Steinberg","Peter Shrader","Laine Thomas","Jack Ansell","Gregg C Fonarow","Bernard J Gersh","Peter R Kowey","Kenneth W Mahaffey","Gerald Naccarelli","James Reiffel","Daniel E Singer","Eric D Peterson","Jonathan P Piccini"],"significance":8,"published":"2016-12-20","source_date":"2016-12-20","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/atriumfibrilleren/perioperatief-beleid-af/"],"congress":"","summary_en":"This ORBIT-AF II registry analysis showed that off-label DOAC dosing — both underdosing and overdosing — was common in clinical practice and associated with worse outcomes. The findings highlighted the importance of adherence to recommended dosing criteria for NOACs.","created":"2026-07-03T10:26:28Z","updated":"2026-07-03T13:25:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ORBIT-AF II registeranalyse die aantoont dat off-label dosering van DOAC's (zowel te laag als te hoog) geassocieerd is met ongunstige uitkomsten bij AF-patiënten. Klinisch relevant voor correct DOAC-doseringsbeleid.","abstract_original":"BACKGROUND: Although non-vitamin K antagonist oral anticoagulants (NOACs) do not require frequent laboratory monitoring, each compound requires dose adjustments on the basis of certain clinical criteria. OBJECTIVES: This study assessed the frequency of off-label NOAC doses among AF patients and the associations between off-label dose therapy and clinical outcomes in community practice. METHODS: We evaluated 5,738 patients treated with a NOAC at 242 ORBIT-AF II (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation phase II) sites. NOAC doses were classified as either underdosed or overdosed, consistent with Food and Drug Administration labeling. Longitudinal outcomes (median follow-up: 0.99 years) included stroke or systemic embolism, myocardial infarction, major bleeding (International Society of Thrombosis and Haemostasis criteria), cause-specific hospitalization, and all-cause mortality. RESULTS: Overall, 541 NOAC-treated patients (9.4%) were underdosed, 197 were overdosed (3.4%), and 5,000 were dosed according to U.S. labeling (87%). Compared with patients receiving the recommended dose, those who were receiving off-label doses were older (median: 79 and 80 years of age vs. 70 years of age, respectively; p < 0.0001), more likely female (48% and 67% vs. 40%, respectively; p < 0.0001), less likely to be treated by an electrophysiologist (18% and 19% vs. 27%, respectively; p < 0.0001), and had higher CHA2DS2-VASc scores (96% and 97% ≥2 vs. 86%, respectively; p < 0.0001) and higher ORBIT bleeding scores (25% and 31% >4 vs. 11%, respectively; p < 0.0001). After dose adjustment, NOAC overdosing was associated with increased all-cause mortality compared with recommended doses (adjusted hazard ratio: 1.91; 95% confidence interval [CI]: 1.02 to 3.60; p = 0.04). Underdosing was associated with increased cardiovascular hospitalization (adjusted hazard ratio: 1.26; 95% CI: 1.07 to 1.50; p = 0.007). CONCLUSIONS: A significant minority (almost 1 in 8) of U.S. patients in the community received NOAC doses inconsistent with labeling. NOAC over- and underdosing are associated with increased risk for adverse events. (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II [ORBIT-AF II]; NCT01701817)."},{"id":"cb91e7d60898","type":"article","url":"https://hartvaat.nl/2016/12/15/off-pump-versus-on-pump-cabg-5-jaarsresultaten-nejm-coronary-trial/","title":"Off-pump versus on-pump CABG: 5-jaarsresultaten NEJM CORONARY-trial","title_en":"Five-Year Outcomes after Off-Pump or On-Pump Coronary-Artery Bypass Grafting.","category":"chronische nierziekte","category_label":"Nierziekte","professions":["cardioloog"],"tags":["coronaire-bypass"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1601564","source_url":"https://doi.org/10.1056/NEJMoa1601564","authors":["André Lamy","P J Devereaux","Dorairaj Prabhakaran","David P Taggart","Shengshou Hu","Zbynek Straka","Leopoldo S Piegas","Alvaro Avezum","Ahmet R Akar","Fernando Lanas Zanetti","Anil R Jain","Nicolas Noiseux","Chandrasekar Padmanabhan","Juan-Carlos Bahamondes","Richard J Novick","Liang Tao","Pablo A Olavegogeascoechea","Balram Airan","Toomas-Andres Sulling","Richard P Whitlock","Yongning Ou","Peggy Gao","Shirley Pettit","Salim Yusuf"],"significance":8,"published":"2016-12-15","source_date":"2016-12-15","image":"","kennis":[],"congress":"","summary_en":"The 5-year CORONARY results showed no significant difference between off-pump and on-pump CABG for the composite of death, stroke, MI, or renal failure. The large-scale, long-term data supported both surgical approaches as equivalent in skilled centers.","created":"2026-07-03T10:26:28Z","updated":"2026-07-03T13:25:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM 5-jaarsresultaten van de CORONARY-trial die off-pump vergeleek met on-pump coronaire bypasschirurgie. Een van de grootste gerandomiseerde trials op dit gebied.","abstract_original":"BACKGROUND: We previously reported that there was no significant difference at 30 days or at 1 year in the rate of the composite outcome of death, stroke, myocardial infarction, or renal failure between patients who underwent coronary-artery bypass grafting (CABG) performed with a beating-heart technique (off-pump) and those who underwent CABG performed with cardiopulmonary bypass (on-pump). We now report the results at 5 years (the end of the trial). METHODS: A total of 4752 patients (from 19 countries) who had coronary artery disease were randomly assigned to undergo off-pump or on-pump CABG. For this report, we analyzed a composite outcome of death, stroke, myocardial infarction, renal failure, or repeat coronary revascularization (either CABG or percutaneous coronary intervention). The mean follow-up period was 4.8 years. RESULTS: There were no significant differences between the off-pump group and the on-pump group in the rate of the composite outcome (23.1% and 23.6%, respectively; hazard ratio with off-pump CABG, 0.98; 95% confidence interval [CI], 0.87 to 1.10; P=0.72) or in the rates of the components of the outcome, including repeat coronary revascularization, which was performed in 2.8% of the patients in the off-pump group and in 2.3% of the patients in the on-pump group (hazard ratio, 1.21; 95% CI, 0.85 to 1.73; P=0.29). The secondary outcome for the overall period of the trial - the mean cost in U.S. dollars per patient - also did not differ significantly between the off-pump group and the on-pump group ($15,107 and $14,992, respectively; between-group difference, $115; 95% CI, -$697 to $927). There were no significant between-group differences in quality-of-life measures. CONCLUSIONS: In our trial, the rate of the composite outcome of death, stroke, myocardial infarction, renal failure, or repeat revascularization at 5 years of follow-up was similar among patients who underwent off-pump CABG and those who underwent on-pump CABG. (Funded by the Canadian Institutes of Health Research; CORONARY ClinicalTrials.gov number, NCT00463294 .)."},{"id":"4c27fc26dcde","type":"article","url":"https://hartvaat.nl/2016/12/15/infarctgrootte-en-linkerkamerremodellering-na-preventieve-pci/","title":"Infarctgrootte en linkerkamerremodellering na preventieve PCI","title_en":"Infarct size and left ventricular remodelling after preventive percutaneous coronary intervention.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["acuut-hartfalen","bloeddrukbehandeling","farmaco-economie","hartrevalidatie","inflammatie","laminopathie","myocardinfarct","ouderen","percutane-coronaire-interventie","primaire-preventie","secundaire-preventie","stemi"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2015-308660","source_url":"https://doi.org/10.1136/heartjnl-2015-308660","authors":["Kenneth Mangion","David Carrick","Barry W Hennigan","Alexander R Payne","John McClure","Maureen Mason","Rajiv Das","Rebecca Wilson","Richard J Edwards","Mark C Petrie","Margaret McEntegart","Hany Eteiba","Keith G Oldroyd","Colin Berry"],"significance":5,"published":"2016-12-15","source_date":"2016-12-15","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"This study examined the effect of preventive PCI of non-culprit lesions on infarct size and LV remodeling, comparing complete with culprit-only revascularization on myocardial tissue-level outcomes.","created":"2026-07-03T10:26:28Z","updated":"2026-07-03T13:25:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar het effect van preventieve PCI op infarctgrootte en linkerkamerremodellering. Onderzoekt of vroege interventie bij niet-culprit laesies de myocardschade kan beperken.","abstract_original":"OBJECTIVE: We hypothesised that, compared with culprit-only primary percutaneous coronary intervention (PCI), additional preventive PCI in selected patients with ST-elevation myocardial infarction with multivessel disease would not be associated with iatrogenic myocardial infarction, and would be associated with reductions in left ventricular (LV) volumes in the longer term. METHODS: In the preventive angioplasty in myocardial infarction trial (PRAMI; ISRCTN73028481), cardiac magnetic resonance (CMR) was prespecified in two centres and performed (median, IQR) 3 (1, 5) and 209 (189, 957) days after primary PCI. RESULTS: From 219 enrolled patients in two sites, 84% underwent CMR. 42 (50%) were randomised to culprit-artery-only PCI and 42 (50%) were randomised to preventive PCI. Follow-up CMR scans were available in 72 (86%) patients. There were two (4.8%) cases of procedure-related myocardial infarction in the preventive PCI group. The culprit-artery-only group had a higher proportion of anterior myocardial infarctions (MIs) (55% vs 24%). Infarct sizes (% LV mass) at baseline and follow-up were similar. At follow-up, there was no difference in LV ejection fraction (%, median (IQR), (culprit-artery-only PCI vs preventive PCI) 51.7 (42.9, 60.2) vs 54.4 (49.3, 62.8), p=0.23), LV end-diastolic volume (mL/m2, 69.3 (59.4, 79.9) vs 66.1 (54.7, 73.7), p=0.48) and LV end-systolic volume (mL/m2, 31.8 (24.4, 43.0) vs 30.7 (23.0, 36.3), p=0.20). Non-culprit angiographic lesions had low-risk Syntax scores and 47% had non-complex characteristics. CONCLUSIONS: Compared with culprit-only PCI, non-infarct-artery MI in the preventive PCI strategy was uncommon and LV volumes and ejection fraction were similar."},{"id":"292482b16c77","type":"article","url":"https://hartvaat.nl/2016/12/13/csl112-gereconstitueerd-apoliproteine-a-i-na-acuut-mi-veiligheid-en-verdraagbaar/","title":"CSL112: gereconstitueerd apoliproteïne A-I na acuut MI — veiligheid en verdraagbaarheid","title_en":"Safety and Tolerability of CSL112, a Reconstituted, Infusible, Plasma-Derived Apolipoprotein A-I, After Acute Myocardial Infarction: The AEGIS-I Trial (ApoA-I Event Reducing in Ischemic Syndromes I).","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog"],"tags":["bempedoïnezuur","cetp-remmers","hdl-cholesterol","lipide-aferese","lipoproteïne-a","lipoproteïne-a-therapeutisch-doel"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.025687","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.025687","authors":["C Michael Gibson","Serge Korjian","Pierluigi Tricoci","Yazan Daaboul","Megan Yee","Purva Jain","John H Alexander","P Gabriel Steg","A Michael Lincoff","John J P Kastelein","Roxana Mehran","Denise M D'Andrea","Lawrence I Deckelbaum","Bela Merkely","Maciej Zarebinski","Ton Oude Ophuis","Robert A Harrington"],"significance":6,"published":"2016-12-13","source_date":"2016-12-13","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/hdl-functie-en-reverse-cholesterol/"],"congress":"","summary_en":"This study established the safety and tolerability of CSL112, a reconstituted plasma-derived apoA-I infusion, after acute MI, providing the foundation for the subsequent AEGIS cardiovascular outcomes trial.","created":"2026-07-03T10:26:27Z","updated":"2026-07-03T13:25:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de veiligheid en verdraagbaarheid van CSL112, een infuseerbaar plasma-afgeleid apoliproteïne A-I, na acuut myocardinfarct. Onderzoekt reverse cholesteroltransport als therapeutisch concept.","abstract_original":"BACKGROUND: Human or recombinant apolipoprotein A-I (apoA-I) has been shown to increase high-density lipoprotein-mediated cholesterol efflux capacity and to regress atherosclerotic disease in animal and clinical studies. CSL112 is an infusible, plasma-derived apoA-I that has been studied in normal subjects or those with stable coronary artery disease. This study aimed to characterize the safety, tolerability, pharmacokinetics, and pharmacodynamics of CSL112 in patients with a recent acute myocardial infarction. METHODS: The AEGIS-I trial (Apo-I Event Reducing in Ischemic Syndromes I) was a multicenter, randomized, double-blind, placebo-controlled, dose-ranging phase 2b trial. Patients with myocardial infarction were stratified by renal function and randomized 1:1:1 to CSL112 (2 g apoA-I per dose) and high-dose CSL112 (6 g apoA-I per dose), or placebo for 4 consecutive weekly infusions. Coprimary safety end points were occurrence of either a hepatic safety event (an increase in alanine transaminase >3 times the upper limit of normal or an increase in total bilirubin >2 times the upper limit of normal) or a renal safety event (an increase in serum creatinine >1.5 times the baseline value or a new requirement for renal replacement therapy). RESULTS: A total of 1258 patients were randomized, and 91.2% received all 4 infusions. The difference in incidence rates for an increase in alanine transaminase or total bilirubin between both CSL112 arms and placebo was within the protocol-defined noninferiority margin of 4%. Similarly, the difference in incidence rates for an increase in serum creatinine or a new requirement for renal replacement therapy was within the protocol-defined noninferiority margin of 5%. CSL112 was associated with increases in apoA-I and ex vivo cholesterol efflux similar to that achieved in patients with stable coronary artery disease. In regard to the secondary efficacy end point, the risk for the composite of major adverse cardiovascular events among the groups was similar. CONCLUSIONS: Among patients with acute myocardial infarction, 4 weekly infusions of CSL112 are feasible, well tolerated, and not associated with any significant alterations in liver or kidney function or other safety concern. The ability of CSL112 to acutely enhance cholesterol efflux was confirmed. The potential benefit of CSL112 to reduce major adverse cardiovascular events needs to be assessed in an adequately powered phase 3 trial. CLINICAL TRIAL REGISTRATION: URL: https://clinicaltrials.gov. Unique identifier: NCT02108262."},{"id":"043df58d55ca","type":"article","url":"https://hartvaat.nl/2016/12/13/evolocumab-en-progressie-van-coronairlijden-bij-statinebehandelde-patienten-jama/","title":"Evolocumab en progressie van coronairlijden bij statinebehandelde patiënten: JAMA GLAGOV-trial","title_en":"Effect of Evolocumab on Progression of Coronary Disease in Statin-Treated Patients: The GLAGOV Randomized Clinical Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["aperitif-trial","clear-outcomes","ouderen","yellow-iii"],"journal":"JAMA","doi":"10.1001/jama.2016.16951","source_url":"https://doi.org/10.1001/jama.2016.16951","authors":["Stephen J Nicholls","Rishi Puri","Todd Anderson","Christie M Ballantyne","Leslie Cho","John J P Kastelein","Wolfgang Koenig","Ransi Somaratne","Helina Kassahun","Jingyuan Yang","Scott M Wasserman","Robert Scott","Imre Ungi","Jakub Podolec","Antonius Oude Ophuis","Jan H Cornel","Marilyn Borgman","Danielle M Brennan","Steven E Nissen"],"significance":9,"published":"2016-12-13","source_date":"2016-12-13","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/","https://hartvaat.nl/kennis/lipiden/ezetimib/"],"congress":"","summary_en":"The GLAGOV trial demonstrated using intravascular ultrasound that evolocumab, added to statin therapy, significantly reduced atherosclerotic plaque volume in coronary arteries. This provided direct imaging evidence that PCSK9 inhibition induces plaque regression, supporting the concept that lower LDL cholesterol levels translate to plaque stabilization.","created":"2026-07-03T10:26:27Z","updated":"2026-07-03T13:25:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Landmark JAMA GLAGOV-trial die met intravasculaire echografie aantoonde dat evolocumab de atheroscleroseprogressie significant vermindert bij statinebehandelde patiënten. Beeldvormend bewijs voor het voordeel van PCSK9-remming.","abstract_original":"IMPORTANCE: Reducing levels of low-density lipoprotein cholesterol (LDL-C) with intensive statin therapy reduces progression of coronary atherosclerosis in proportion to achieved LDL-C levels. Proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors produce incremental LDL-C lowering in statin-treated patients; however, the effects of these drugs on coronary atherosclerosis have not been evaluated. OBJECTIVE: To determine the effects of PCSK9 inhibition with evolocumab on progression of coronary atherosclerosis in statin-treated patients. DESIGN, SETTING, AND PARTICIPANTS: The GLAGOV multicenter, double-blind, placebo-controlled, randomized clinical trial (enrollment May 3, 2013, to January 12, 2015) conducted at 197 academic and community hospitals in North America, Europe, South America, Asia, Australia, and South Africa and enrolling 968 patients presenting for coronary angiography. INTERVENTIONS: Participants with angiographic coronary disease were randomized to receive monthly evolocumab (420 mg) (n = 484) or placebo (n = 484) via subcutaneous injection for 76 weeks, in addition to statins. MAIN OUTCOMES AND MEASURES: The primary efficacy measure was the nominal change in percent atheroma volume (PAV) from baseline to week 78, measured by serial intravascular ultrasonography (IVUS) imaging. Secondary efficacy measures were nominal change in normalized total atheroma volume (TAV) and percentage of patients demonstrating plaque regression. Safety and tolerability were also evaluated. RESULTS: Among the 968 treated patients (mean age, 59.8 years [SD, 9.2]; 269 [27.8%] women; mean LDL-C level, 92.5 mg/dL [SD, 27.2]), 846 had evaluable imaging at follow-up. Compared with placebo, the evolocumab group achieved lower mean, time-weighted LDL-C levels (93.0 vs 36.6 mg/dL; difference, -56.5 mg/dL [95% CI, -59.7 to -53.4]; P < .001). The primary efficacy parameter, PAV, increased 0.05% with placebo and decreased 0.95% with evolocumab (difference, -1.0% [95% CI, -1.8% to -0.64%]; P < .001). The secondary efficacy parameter, normalized TAV, decreased 0.9 mm3 with placebo and 5.8 mm3 with evolocumab (difference, -4.9 mm3 [95% CI, -7.3 to -2.5]; P < .001). Evolocumab induced plaque regression in a greater percentage of patients than placebo (64.3% vs 47.3%; difference, 17.0% [95% CI, 10.4% to 23.6%]; P < .001 for PAV and 61.5% vs 48.9%; difference, 12.5% [95% CI, 5.9% to 19.2%]; P < .001 for TAV). CONCLUSIONS AND RELEVANCE: Among patients with angiographic coronary disease treated with statins, addition of evolocumab, compared with placebo, resulted in a greater decrease in PAV after 76 weeks of treatment. Further studies are needed to assess the effects of PCSK9 inhibition on clinical outcomes. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01813422."},{"id":"9c4c02456823","type":"article","url":"https://hartvaat.nl/2016/12/13/alirocumab-en-reductie-in-atherogene-lipiden-en-cardiovasculaire-events-10-odyss/","title":"Alirocumab en reductie in atherogene lipiden en cardiovasculaire events: 10 ODYSSEY-trials","title_en":"Reductions in Atherogenic Lipids and Major Cardiovascular Events: A Pooled Analysis of 10 ODYSSEY Trials Comparing Alirocumab With Control.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["lipide-aferese","lipidenverlaging"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.024604","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.024604","authors":["Kausik K Ray","Henry N Ginsberg","Michael H Davidson","Robert Pordy","Laurence Bessac","Pascal Minini","Robert H Eckel","Christopher P Cannon"],"significance":7,"published":"2016-12-13","source_date":"2016-12-13","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/pcsk9-remmers-evolocumab-alirocumab/","https://hartvaat.nl/kennis/lipiden/omega3-vetzuren-cardiologie/"],"congress":"","summary_en":"This pooled analysis of 10 ODYSSEY trials demonstrated a continuous relationship between alirocumab-induced reductions in atherogenic lipids and major cardiovascular events, supporting the LDL-lowering hypothesis with PCSK9 inhibitor-specific data.","created":"2026-07-03T10:26:27Z","updated":"2026-07-03T13:25:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gepoolde analyse van 10 ODYSSEY-trials die de relatie onderzocht tussen alirocumab-geïnduceerde reductie in atherogene lipiden en vermindering van cardiovasculaire events.","abstract_original":"BACKGROUND: A continuous relationship between reductions in low-density lipoprotein cholesterol (LDL-C) and major adverse cardiovascular events (MACE) has been observed in statin and ezetimibe outcomes trials down to achieved levels of 54 mg/dL. However, it is uncertain whether this relationship extends to LDL-C levels <50 mg/dL. We assessed the relationship between additional LDL-C, non-high-density lipoprotein cholesterol, and apolipoprotein B100 reductions and MACE among patients within the ODYSSEY trials that compared alirocumab with controls (placebo/ezetimibe), mainly as add-on therapy to maximally tolerated statin. METHODS: Data were pooled from 10 double-blind trials (6699 patient-years of follow-up). Randomization was to alirocumab 75/150 mg every 2 weeks or control for 24 to 104 weeks, added to background statin therapy in 8 trials. This analysis included 4974 patients (3182 taking alirocumab, 1174 taking placebo, 618 taking ezetimibe). In a post hoc analysis, the relationship between average on-treatment lipid levels and percent reductions in lipids from baseline were correlated with MACE (coronary heart disease death, nonfatal myocardial infarction, ischemic stroke, or unstable angina requiring hospitalization) in multivariable analyses. RESULTS: Overall, 33.1% of the pooled cohort achieved average LDL-C <50 mg/dL (44.7%-52.6% allocated to alirocumab, 6.5% allocated to ezetimibe, and 0% allocated to placebo). In total, 104 patients experienced MACE (median time to event, 36 weeks). For every 39 mg/dL lower achieved LDL-C, the risk of MACE appeared to be 24% lower (adjusted hazard ratio, 0.76; 95% confidence interval, 0.63-0.91; P=0.0025). Percent reductions in LDL-C from baseline were inversely correlated with MACE rates (hazard ratio, 0.71; 95% confidence interval, 0.57-0.89 per additional 50% reduction from baseline; P=0.003). Strengths of association materially similar to those described for LDL-C were observed with achieved non-high-density lipoprotein cholesterol and apolipoprotein B100 levels or percentage reductions. CONCLUSIONS: In a post hoc analysis from 10 ODYSSEY trials, greater percentage reductions in LDL-C and lower on-treatment LDL-C were associated with a lower incidence of MACE, including very low levels of LDL-C (<50 mg/dL). These findings require further validation in the ongoing prospective ODYSSEY OUTCOMES trial. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifiers: NCT01507831, NCT01623115, NCT01709500, NCT01617655, NCT01644175, NCT01644188, NCT01644474, NCT01730040, NCT01730053, and NCT01709513."},{"id":"faae645dde00","type":"article","url":"https://hartvaat.nl/2016/12/10/omecamtiv-mecarbil-bij-chronisch-hartfalen-lancet-cosmic-hf-fase-2-trial/","title":"Omecamtiv mecarbil bij chronisch hartfalen: Lancet COSMIC-HF fase-2-trial","title_en":"Chronic Oral Study of Myosin Activation to Increase Contractility in Heart Failure (COSMIC-HF): a phase 2, pharmacokinetic, randomised, placebo-controlled trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":["aficamten","emperor-trials","hfref","mavacamten","step-hfpef"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(16)32049-9","source_url":"https://doi.org/10.1016/S0140-6736(16)32049-9","authors":["John R Teerlink","G Michael Felker","John J V McMurray","Scott D Solomon","Kirkwood F Adams","John G F Cleland","Justin A Ezekowitz","Assen Goudev","Peter Macdonald","Marco Metra","Veselin Mitrovic","Piotr Ponikowski","Pranas Serpytis","Jindrich Spinar","János Tomcsányi","Hans J Vandekerckhove","Adriaan A Voors","Maria Laura Monsalvo","James Johnston","Fady I Malik","Narimon Honarpour"],"significance":7,"published":"2016-12-10","source_date":"2016-12-10","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/","https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"The COSMIC-HF phase 2 trial of omecamtiv mecarbil in chronic heart failure demonstrated dose-dependent improvements in cardiac function (systolic ejection time, stroke volume) without dose-limiting adverse effects, advancing this novel mechanism toward phase 3 development.","created":"2026-07-03T10:26:27Z","updated":"2026-07-03T18:38:29Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet fase-2-trial van omecamtiv mecarbil, een cardiale myosineactivator, bij chronisch hartfalen. Farmacokinetische en farmacodynamische optimalisatie als voorbereiding op de fase-3 GALACTIC-HF trial.","abstract_original":"BACKGROUND: Impaired contractility is a feature of heart failure with reduced ejection fraction. We assessed the pharmacokinetics and effects on cardiac function and structure of the cardiac myosin activator, omecamtiv mecarbil. METHODS: In this randomised, double-blind study, done at 87 sites in 13 countries, we recruited patients with stable, symptomatic chronic heart failure and left ventricular ejection fraction 40% or lower. Patients were randomly assigned equally, via an interactive web response system, to receive 25 mg oral omecamtiv mecarbil twice daily (fixed-dose group), 25 mg twice daily titrated to 50 mg twice daily guided by pharmacokinetics (pharmacokinetic-titration group), or placebo for 20 weeks. We assessed the maximum concentration of omecamtiv mecarbil in plasma (primary endpoint) and changes in cardiac function and ventricular diameters. This trial is registered with ClinicalTrials.gov, number NCT01786512. FINDINGS: From March 17, 2014, to March 5, 2015, we enrolled 150 patients in the fixed-dose omecamtiv mecarbil group and 149 in the pharmacokinetic-titration and placebo groups. Mean maximum concentration of omecamtiv mecarbil at 12 weeks was 200 (SD 71) ng/mL in the fixed-dose group and 318 (129) ng/mL in the pharmacokinetic-titration group. For the pharmacokinetic-titration group versus placebo group at 20 weeks, least square mean differences were as follows: systolic ejection time 25 ms (95% CI 18-32, p<0·0001), stroke volume 3·6 mL (0·5-6·7, p=0·0217), left ventricular end-systolic diameter -1·8 mm (-2·9 to -0·6, p=0·0027), left ventricular end-diastolic diameter -1·3 mm, (-2·3 to 0·3, p=0·0128), heart rate -3·0 beats per min (-5·1 to -0·8, p=0·0070), and N-terminal pro B-type natriuretic peptide concentration in plasma -970 pg/mL (-1672 to -268, p=0·0069). The frequency of adverse clinical events did not differ between groups. INTERPRETATION: Omecamtiv mecarbil dosing guided by pharmacokinetics achieved plasma concentrations associated with improved cardiac function and decreased ventricular diameter. FUNDING: Amgen."},{"id":"84a75f476cf5","type":"article","url":"https://hartvaat.nl/2016/12/08/everolimus-eluting-stents-of-bypasschirurgie-bij-hoofdstamcoronairlijden-nejm-ex/","title":"Everolimus-eluting stents of bypasschirurgie bij hoofdstamcoronairlijden: NEJM EXCEL-trial","title_en":"Everolimus-Eluting Stents or Bypass Surgery for Left Main Coronary Artery Disease.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1610227","source_url":"https://doi.org/10.1056/NEJMoa1610227","authors":["Gregg W Stone","Joseph F Sabik","Patrick W Serruys","Charles A Simonton","Philippe Généreux","John Puskas","David E Kandzari","Marie-Claude Morice","Nicholas Lembo","W Morris Brown","David P Taggart","Adrian Banning","Béla Merkely","Ferenc Horkay","Piet W Boonstra","Ad J van Boven","Imre Ungi","Gabor Bogáts","Samer Mansour","Nicolas Noiseux","Manel Sabaté","José Pomar","Mark Hickey","Anthony Gershlick","Pawel Buszman","Andrzej Bochenek","Erick Schampaert","Pierre Pagé","Ovidiu Dressler","Ioanna Kosmidou","Roxana Mehran","Stuart J Pocock","A Pieter Kappetein"],"significance":10,"published":"2016-12-08","source_date":"2016-12-08","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/cabg-bypasschirurgie/"],"congress":"","summary_en":"The EXCEL trial compared everolimus-eluting stents with CABG in patients with left main coronary artery disease of low-to-intermediate complexity. PCI was noninferior to CABG for the composite of death, stroke, or MI at 3 years, establishing percutaneous intervention as a viable alternative in selected left main disease.","created":"2026-07-03T10:26:27Z","updated":"2026-07-03T13:25:46Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Landmark NEJM EXCEL-trial die EES vergeleek met CABG bij linker-hoofdstamcoronairlijden. Samen met NOBLE bepalend voor de revascularisatiestrategie bij hoofdstamziekte.","abstract_original":"BACKGROUND: Patients with obstructive left main coronary artery disease are usually treated with coronary-artery bypass grafting (CABG). Randomized trials have suggested that drug-eluting stents may be an acceptable alternative to CABG in selected patients with left main coronary disease. METHODS: We randomly assigned 1905 eligible patients with left main coronary artery disease of low or intermediate anatomical complexity to undergo either percutaneous coronary intervention (PCI) with fluoropolymer-based cobalt-chromium everolimus-eluting stents (PCI group, 948 patients) or CABG (CABG group, 957 patients). Anatomic complexity was assessed at the sites and defined by a Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score of 32 or lower (the SYNTAX score reflects a comprehensive angiographic assessment of the coronary vasculature, with 0 as the lowest score and higher scores [no upper limit] indicating more complex coronary anatomy). The primary end point was the rate of a composite of death from any cause, stroke, or myocardial infarction at 3 years, and the trial was powered for noninferiority testing of the primary end point (noninferiority margin, 4.2 percentage points). Major secondary end points included the rate of a composite of death from any cause, stroke, or myocardial infarction at 30 days and the rate of a composite of death, stroke, myocardial infarction, or ischemia-driven revascularization at 3 years. Event rates were based on Kaplan-Meier estimates in time-to-first-event analyses. RESULTS: At 3 years, a primary end-point event had occurred in 15.4% of the patients in the PCI group and in 14.7% of the patients in the CABG group (difference, 0.7 percentage points; upper 97.5% confidence limit, 4.0 percentage points; P=0.02 for noninferiority; hazard ratio, 1.00; 95% confidence interval, 0.79 to 1.26; P=0.98 for superiority). The secondary end-point event of death, stroke, or myocardial infarction at 30 days occurred in 4.9% of the patients in the PCI group and in 7.9% in the CABG group (P<0.001 for noninferiority, P=0.008 for superiority). The secondary end-point event of death, stroke, myocardial infarction, or ischemia-driven revascularization at 3 years occurred in 23.1% of the patients in the PCI group and in 19.1% in the CABG group (P=0.01 for noninferiority, P=0.10 for superiority). CONCLUSIONS: In patients with left main coronary artery disease and low or intermediate SYNTAX scores by site assessment, PCI with everolimus-eluting stents was noninferior to CABG with respect to the rate of the composite end point of death, stroke, or myocardial infarction at 3 years. (Funded by Abbott Vascular; EXCEL ClinicalTrials.gov number, NCT01205776 .)."},{"id":"f53099d021c5","type":"article","url":"https://hartvaat.nl/2016/12/07/linker-hartoorsluiting-uitkomsten-en-kosten-van-trial-en-real-world-versus-orale/","title":"Linker-hartoorsluiting: uitkomsten en kosten van trial en real-world versus orale antistolling","title_en":"Outcomes and costs of left atrial appendage closure from randomized controlled trial and real-world experience relative to oral anticoagulation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["anticoagulantia","anticoagulatie-kwetsbare-ouderen"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw048","source_url":"https://doi.org/10.1093/eurheartj/ehw048","authors":["Sandeep Panikker","Joanne Lord","Julian W E Jarman","Shannon Armstrong","David G Jones","Shouvik Haldar","Charles Butcher","Habib Khan","Lilian Mantziari","Edward Nicol","Wajid Hussain","Jonathan R Clague","John P Foran","Vias Markides","Tom Wong"],"significance":7,"published":"2016-12-07","source_date":"2016-12-07","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doacs-overzicht/"],"congress":"","summary_en":"This analysis compared outcomes and costs of percutaneous left atrial appendage closure versus oral anticoagulation in AF patients from both randomized trial and real-world data, informing the value proposition of structural stroke prevention.","created":"2026-07-03T10:26:27Z","updated":"2026-07-03T13:25:46Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Vergelijkende analyse van uitkomsten en kosten van percutane linker-hartoorsluiting versus orale anticoagulantia bij AF, zowel uit gerandomiseerde trials als real-world data.","abstract_original":"AIMS: The aim of this study was to analyse randomized controlled study and real-world outcomes of patients with non-valvular atrial fibrillation (NVAF) undergoing left atrial appendage closure (LAAC) with the Watchman device and to compare costs with available antithrombotic therapies. METHODS AND RESULTS: Registry data of LAAC from two centres were prospectively collected from 110 patients with NVAF at risk of stroke, suitable and unsuitable for long-term anticoagulation (age 71.3 ± 9.2 years, CHADS2 2.8 ± 1.2, CHA2DS2-VASc 4.5 ± 1.6, and HAS-BLED 3.8 ± 1.1). Outcomes from PROTECT AF and registry study LAAC were compared with warfarin, dabigatran, rivaroxaban, apixaban, aspirin, and no treatment using a network meta-analysis. Costs were estimated over a 10-year horizon. Uncertainty was assessed using sensitivity analyses. The procedural success rate was 92% (103/112). Follow-up was 24.1 ± 4.6 months, during which annual rates of stroke, major bleeding, and all-cause mortality were 0.9% (2/223 patient-years), 0.9% (2/223 patient-years), and 1.8% (4/223 patient-years), respectively. Anticoagulant therapy was successfully stopped in 91.2% (93/102) of implanted patients by 12 months. Registry study LAAC stroke and major bleeding rates were significantly lower than PROTECT AF results: mean absolute difference of stroke, 0.89% (P = 0.02) and major bleeding, 5.48% (P < 0.001). Left atrial appendage closure achieved cost parity between 4.9 years vs. dabigatran 110 mg and 8.4 years vs. warfarin. At 10 years, LAAC was cost-saving against all therapies (range £1162-£7194). CONCLUSION: Left atrial appendage closure in NVAF in a real-world setting may result in lower stroke and major bleeding rates than reported in LAAC clinical trials. Left atrial appendage closure in both settings achieves cost parity in a relatively short period of time and may offer substantial savings compared with current therapies. Savings are most pronounced among higher risk patients and those unsuitable for anticoagulation."},{"id":"3401cad6836c","type":"article","url":"https://hartvaat.nl/2016/12/06/dalcetrapib-wijzigt-de-relatie-tussen-hdl-cholesterol-en-crp/","title":"Dalcetrapib wijzigt de relatie tussen HDL-cholesterol en CRP","title_en":"Treatment With Dalcetrapib Modifies the Relationship Between High-Density Lipoprotein Cholesterol and C-Reactive Protein.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["cetp-remmers","ezetimibe","hdl-cholesterol","ldl-cholesterol","obicetrapib","pcsk9-remmers","statines"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.09.932","source_url":"https://doi.org/10.1016/j.jacc.2016.09.932","authors":["Reynaria Pitts","Elise Gunzburger","Christie M Ballantyne","Philip J Barter","David Kallend","Lawrence A Leiter","Eran Leitersdorf","John J V McMurray","Stephen J Nicholls","Eric J Niesor","Anders G Olsson","Prediman K Shah","Jean-Claude Tardif","John Kittelson","Gregory G Schwartz"],"significance":5,"published":"2016-12-06","source_date":"2016-12-06","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/hdl-functie-en-reverse-cholesterol/"],"congress":"","summary_en":"This analysis showed that dalcetrapib (a CETP modulator) modifies the relationship between HDL cholesterol and CRP, suggesting that HDL-inflammation interaction may explain the variable cardiovascular effects of CETP inhibition.","created":"2026-07-03T10:26:27Z","updated":"2026-07-03T13:25:46Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse die aantoont dat behandeling met dalcetrapib (CETP-remmer) de relatie tussen HDL-cholesterol en ontstekingsmarker CRP wijzigt. Inzicht in de complexe biologie van HDL-verhoging.","abstract_original":""},{"id":"5e28fb0a3fb0","type":"article","url":"https://hartvaat.nl/2016/12/06/prognostische-implicaties-van-nt-probnp-veranderingen-bij-hartfalen/","title":"Prognostische implicaties van NT-proBNP-veranderingen bij hartfalen","title_en":"Prognostic Implications of Changes in N-Terminal Pro-B-Type Natriuretic Peptide in Patients With Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","nt-probnp"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.09.931","source_url":"https://doi.org/10.1016/j.jacc.2016.09.931","authors":["Michael R Zile","Brian L Claggett","Margaret F Prescott","John J V McMurray","Milton Packer","Jean L Rouleau","Karl Swedberg","Akshay S Desai","Jianjian Gong","Victor C Shi","Scott D Solomon"],"significance":6,"published":"2016-12-06","source_date":"2016-12-06","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/bnp-en-nt-probnp/","https://hartvaat.nl/kennis/hartfalen/acuut-hartfalen/"],"congress":"","summary_en":"This study demonstrated that serial NT-proBNP changes in heart failure patients provide incremental prognostic information beyond single baseline measurements, supporting dynamic biomarker monitoring for risk stratification.","created":"2026-07-03T10:26:27Z","updated":"2026-07-03T18:38:29Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de prognostische waarde van seriële NT-proBNP-metingen bij hartfalenpatiënten. Veranderingen in natriuretische peptiden als dynamische risicomarker voor het sturen van behandeling.","abstract_original":"BACKGROUND: Natriuretic peptides (NP) have prognostic value in heart failure (HF), although the clinical importance of changes in NP from baseline is unclear. OBJECTIVES: The authors assessed whether a reduction in N-terminal pro-B-type NP (NT-proBNP) was associated with a decrease in HF hospitalization and cardiovascular mortality (primary endpoint) in patients with HF and reduced ejection fraction, whether treatment with sacubitril/valsartan reduced NT-proBNP below specific partition values more than enalapril, and whether the relationship between changes in NT-proBNP and changes in the primary endpoint were dependent on assigned treatment. METHODS: In PARADIGM-HF (Prospective Comparison of ARNI [Angiotensin Receptor-Neprilysin Inhibitor] with ACEI [Angiotensin-Converting-Enzyme Inhibitor] to Determine Impact on Global Mortality and Morbidity in Heart Failure Trial), baseline NT-proBNP was measured in 2,080 patients; 1,292 had baseline values >1,000 pg/ml and were reassessed at 1 and 8 months. We related change in NT-proBNP to outcomes. RESULTS: One month after randomization, 24% of the baseline NT-proBNP levels >1,000 pg/ml had fallen to ≤1,000 pg/ml. Risk of the primary endpoint was 59% lower in patients with a fall in NT-proBNP to ≤1,000 pg/ml than in those without such a fall. In sacubitril/valsartan-treated patients, median NT-proBNP was significantly lower 1 month after randomization than in enalapril-treated patients, and it fell to ≤1,000 pg/ml in 31% versus 17% of patients treated with sacubitril/valsartan and enalapril, respectively. There was no significant interaction between treatment and the relationship between change in NT-proBNP and the subsequent risk of the primary endpoint. CONCLUSIONS: Patients who attained a significant reduction in NT-proBNP had a lower subsequent rate of cardiovascular death or HF hospitalization independent of the treatment group. Treatment with sacubitril/valsartan was nearly twice as likely as enalapril to reduce NT-proBNP to values ≤1,000 pg/ml. (Prospective Comparison of ARNI [Angiotensin Receptor-Neprilysin Inhibitor] with ACEI [Angiotensin-Converting-Enzyme Inhibitor] to Determine Impact on Global Mortality and Morbidity in Heart Failure Trial) [PARADIGM-HF]; NCT01035255.)."},{"id":"4e4166a4a535","type":"article","url":"https://hartvaat.nl/2016/12/06/comorbiditeiten-bij-hartfalen-hypertensie-obesitas-diabetes-hyperlipidemie-en-me/","title":"Comorbiditeiten bij hartfalen: hypertensie, obesitas, diabetes, hyperlipidemie en metabool syndroom","title_en":"Contributory Risk and Management of Comorbidities of Hypertension, Obesity, Diabetes Mellitus, Hyperlipidemia, and Metabolic Syndrome in Chronic Heart Failure: A Scientific Statement From the American Heart Association.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":["acuut-hartfalen","bisoprolol","cardio-renaal-metabool","diabetes-en-hart","dyslipidemie","obesitas","select-trial","vrouwen"],"journal":"Circulation","doi":"10.1161/CIR.0000000000000450","source_url":"https://doi.org/10.1161/CIR.0000000000000450","authors":["Biykem Bozkurt","David Aguilar","Anita Deswal","Sandra B Dunbar","Gary S Francis","Tamara Horwich","Mariell Jessup","Mikhail Kosiborod","Allison M Pritchett","Kumudha Ramasubbu","Clive Rosendorff","Clyde Yancy"],"significance":7,"published":"2016-12-06","source_date":"2016-12-06","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/","https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This AHA scientific statement addressed the contributory role and management of comorbidities (hypertension, obesity, diabetes, dyslipidemia, and sleep apnea) in heart failure, providing an integrated framework for comorbidity-driven heart failure prevention and treatment.","created":"2026-07-03T10:26:26Z","updated":"2026-07-03T18:38:29Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"AHA scientific statement over de bijdrage en het management van comorbiditeiten bij hartfalen. Integrale benadering van het cardiometabole risicoprofiel bij HF-patiënten.","abstract_original":""},{"id":"52e463f177ac","type":"article","url":"https://hartvaat.nl/2016/12/03/pci-versus-cabg-bij-onbeschermde-hoofdstamstenose-lancet-noble-trial/","title":"PCI versus CABG bij onbeschermde hoofdstamstenose: Lancet NOBLE-trial","title_en":"Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(16)32052-9","source_url":"https://doi.org/10.1016/S0140-6736(16)32052-9","authors":["Timo Mäkikallio","Niels R Holm","Mitchell Lindsay","Mark S Spence","Andrejs Erglis","Ian B A Menown","Thor Trovik","Markku Eskola","Hannu Romppanen","Thomas Kellerth","Jan Ravkilde","Lisette O Jensen","Gintaras Kalinauskas","Rikard B A Linder","Markku Pentikainen","Anders Hervold","Adrian Banning","Azfar Zaman","Jamen Cotton","Erlend Eriksen","Sulev Margus","Henrik T Sørensen","Per H Nielsen","Matti Niemelä","Kari Kervinen","Jens F Lassen","Michael Maeng","Keith Oldroyd","Geoff Berg","Simon J Walsh","Colm G Hanratty","Indulis Kumsars","Peteris Stradins","Terje K Steigen","Ole Fröbert","Alastair N J Graham","Petter C Endresen","Matthias Corbascio","Olli Kajander","Uday Trivedi","Juha Hartikainen","Vesa Anttila","David Hildick-Smith","Leif Thuesen","Evald H Christiansen"],"significance":9,"published":"2016-12-03","source_date":"2016-12-03","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/cabg-bypasschirurgie/","https://hartvaat.nl/kennis/coronairlijden/pci-vs-cabg-afweging/"],"congress":"","summary_en":"The NOBLE trial showed that CABG was superior to PCI for the composite of all-cause mortality, nonprocedural MI, stroke, or repeat revascularization at 5 years in patients with unprotected left main stenosis. Together with EXCEL, NOBLE informed the ongoing debate about optimal revascularization strategy for left main disease.","created":"2026-07-03T10:26:26Z","updated":"2026-07-03T13:25:46Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet gerandomiseerde NOBLE-trial die PCI vergeleek met CABG bij onbeschermde linker-hoofdstamstenose. Samen met EXCEL een van de twee landmark trials voor deze complexe revascularisatiebeslissing.","abstract_original":"BACKGROUND: Coronary artery bypass grafting (CABG) is the standard treatment for revascularisation in patients with left main coronary artery disease, but use of percutaneous coronary intervention (PCI) for this indication is increasing. We aimed to compare PCI and CABG for treatment of left main coronary artery disease. METHODS: In this prospective, randomised, open-label, non-inferiority trial, patients with left main coronary artery disease were enrolled in 36 centres in northern Europe and randomised 1:1 to treatment with PCI or CABG. Eligible patients had stable angina pectoris, unstable angina pectoris, or non-ST-elevation myocardial infarction. Exclusion criteria were ST-elevation myocardial infarction within 24 h, being considered too high risk for CABG or PCI, or expected survival of less than 1 year. The primary endpoint was major adverse cardiac or cerebrovascular events (MACCE), a composite of all-cause mortality, non-procedural myocardial infarction, any repeat coronary revascularisation, and stroke. Non-inferiority of PCI to CABG required the lower end of the 95% CI not to exceed a hazard ratio (HR) of 1·35 after up to 5 years of follow-up. The intention-to-treat principle was used in the analysis if not specified otherwise. This trial is registered with ClinicalTrials.gov identifier, number NCT01496651. FINDINGS: Between Dec 9, 2008, and Jan 21, 2015, 1201 patients were randomly assigned, 598 to PCI and 603 to CABG, and 592 in each group entered analysis by intention to treat. Kaplan-Meier 5 year estimates of MACCE were 29% for PCI (121 events) and 19% for CABG (81 events), HR 1·48 (95% CI 1·11-1·96), exceeding the limit for non-inferiority, and CABG was significantly better than PCI (p=0·0066). As-treated estimates were 28% versus 19% (1·55, 1·18-2·04, p=0·0015). Comparing PCI with CABG, 5 year estimates were 12% versus 9% (1·07, 0·67-1·72, p=0·77) for all-cause mortality, 7% versus 2% (2·88, 1·40-5·90, p=0·0040) for non-procedural myocardial infarction, 16% versus 10% (1·50, 1·04-2·17, p=0·032) for any revascularisation, and 5% versus 2% (2·25, 0·93-5·48, p=0·073) for stroke. INTERPRETATION: The findings of this study suggest that CABG might be better than PCI for treatment of left main stem coronary artery disease. FUNDING: Biosensors, Aarhus University Hospital, and participating sites."},{"id":"f5edc6cb8c6f","type":"article","url":"https://hartvaat.nl/2016/12/01/tienjaarsuitkomsten-van-eerste-generatie-drug-eluting-stents-ses-versus-pes/","title":"Tienjaarsuitkomsten van eerste-generatie drug-eluting stents: SES versus PES","title_en":"Ten-year clinical outcomes of first-generation drug-eluting stents: the Sirolimus-Eluting vs. Paclitaxel-Eluting Stents for Coronary Revascularization (SIRTAX) VERY LATE trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw343","source_url":"https://doi.org/10.1093/eurheartj/ehw343","authors":["Kyohei Yamaji","Lorenz Räber","Thomas Zanchin","Ernest Spitzer","Christian Zanchin","Thomas Pilgrim","Stefan Stortecky","Aris Moschovitis","Michael Billinger","Christa Schönenberger","Franz Eberli","Peter Jüni","Thomas F Lüscher","Dik Heg","Stephan Windecker"],"significance":6,"published":"2016-12-01","source_date":"2016-12-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/pci-percutane-coronaire-interventie/"],"congress":"","summary_en":"This 10-year comparison of first-generation sirolimus- versus paclitaxel-eluting stents provided historical long-term data on the earliest DES platforms, documenting the late risks that drove the development of newer-generation devices.","created":"2026-07-03T10:26:26Z","updated":"2026-07-03T13:25:46Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"10-jaarsresultaten van de vergelijking tussen sirolimus- en paclitaxel-eluting stents. Historisch perspectief op de eerste generatie DES en hun langetermijnveiligheid.","abstract_original":"AIMS: Compared with bare metal stents, first-generation drug-eluting stents (DES) are associated with an increased risk of late restenosis and stent thrombosis (ST). Whether this risk continues or attenuates during long-term follow-up remains unknown. METHODS AND RESULTS: We extended the follow-up of 1012 patients [sirolimus-eluting stent (SES): N = 503 and paclitaxel-eluting stent (PES): N = 509] included in the all-comers, randomized Sirolimus-Eluting vs. Paclitaxel-Eluting Stents for Coronary Revascularization (SIRTAX) trial to 10 years. Follow-up was complete in 895 patients (88.4%) at 10 years. At 1, 5, and 10 years of follow-up, rates of ischaemia-driven target lesion revascularization (ID-TLR) were 8.1%, 14.6% and 17.7%, respectively, and rates of ST were 1.9%, 4.5% and 5.6%, respectively. The annual risks of ID-TLR and definite ST were significantly higher between 1 and 5 years as compared with the 5- to 10-year period [ID-TLR: 1.8% vs. 0.7%/year, hazard ratio (HR) 0.36, 95% confidence intervals (95% CI) 0.21-0.62, P < 0.001; definite ST: 0.67% vs. 0.23%/year, HR 0.31, 95% CI 0.13-0.75, P = 0.01]. The attenuation of the risk of ID-TLR and ST beyond 5 years was independent of age. Major adverse events (cardiac death, myocardial infarction, and ID-TLR) occurred in 33.7% of SES- and 33.8% of PES-treated patients (P = 0.72). CONCLUSIONS: During long-term follow-up through 10 years, the annual risks of ID-TLR and definite ST significantly decreased beyond 5 years after first-generation DES implantation. These findings may have important implications for secondary prevention after percutaneous coronary intervention with first-generation DES including long-term antiplatelet therapy. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT00297661."},{"id":"002311ba8042","type":"article","url":"https://hartvaat.nl/2016/12/01/empagliflozine-en-bloeddruk-bij-diabetes-type-2-met-hypertensie-naar-achtergrond/","title":"Empagliflozine en bloeddruk bij diabetes type 2 met hypertensie naar achtergrondtherapie","title_en":"Impact of Empagliflozin on Blood Pressure in Patients With Type 2 Diabetes Mellitus and Hypertension by Background Antihypertensive Medication.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","canagliflozine","dapagliflozine","diabetes-type-2","empagliflozine","emperor-trials","ezetimibe","sglt2-remmers"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.07703","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.07703","authors":["Giuseppe Mancia","Christopher P Cannon","Ilkka Tikkanen","Cordula Zeller","Ludwin Ley","Hans J Woerle","Uli C Broedl","Odd Erik Johansen"],"significance":7,"published":"2016-12-01","source_date":"2016-12-01","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/"],"congress":"","summary_en":"This analysis of the EMPA-REG BP trial showed that empagliflozin significantly reduces blood pressure in patients with type 2 diabetes and hypertension, with the effect maintained across different background antihypertensive regimens.","created":"2026-07-03T10:26:26Z","updated":"2026-07-03T18:38:29Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van het bloeddrukverlagend effect van empagliflozine bij patiënten met diabetes type 2 en hypertensie, gestratificeerd naar achtergrond-antihypertensiva. Onderbouwt het dubbele voordeel van SGLT2-remmers.","abstract_original":"UNLABELLED: In the EMPA-REG BP trial, empagliflozin 10 mg and 25 mg once daily reduced glycohemoglobin, blood pressure (BP), and weight versus placebo in patients with type 2 diabetes mellitus and hypertension. Patients received placebo (n=271), empagliflozin 10 mg (n=276), or empagliflozin 25 mg (n=276) for 12 weeks (n=full analysis set). This present analysis investigated changes from baseline to week 12 in mean 24-hour systolic BP (SBP) and diastolic BP (DBP) in patients receiving 0, 1, or ≥2 antihypertensive medications and patients receiving/not receiving diuretics or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers. Compared with placebo, empagliflozin 10 mg and 25 mg reduced mean 24-hour SBP/DBP in patients receiving 0 (10 mg: -3.89/-2.58 mm Hg; 25 mg: -3.77/-2.45 mm Hg), 1 (10 mg: -4.74/-1.97 mm Hg; 25 mg: -4.27/-1.81 mm Hg), or ≥2 (10 mg: -2.36/-0.68 mm Hg; 25 mg: -4.17/-1.54 mm Hg) antihypertensives. The effect of empagliflozin was not significantly different between subgroups by number of antihypertensives for changes in SBP (interaction P value 0.448) or DBP (interaction P value 0.498). Empagliflozin reduced 24-hour mean SBP/DBP irrespective of diuretic or angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use, with no significant difference between subgroups by use/no use of diuretics (interaction P values 0.380 [systolic]; 0.240 [diastolic]) or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (interaction P values 0.900 [systolic]; 0.359 [diastolic]). In conclusion, in patients with type 2 diabetes mellitus and hypertension, empagliflozin for 12 weeks reduced SBP and DBP versus placebo, irrespective of the number of antihypertensives and use of diuretics or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers. CLINICAL TRIAL REGISTRATION: URL: https://clinicaltrials.gov. Unique identifier: NCT01370005."},{"id":"da4f4cc87c37","type":"article","url":"https://hartvaat.nl/2016/12/01/associaties-tussen-foetale-geimprinte-genen-en-maternale-bloeddruk-in-de-zwanger/","title":"Associaties tussen foetale geïmprinte genen en maternale bloeddruk in de zwangerschap","title_en":"Associations Between Fetal Imprinted Genes and Maternal Blood Pressure in Pregnancy.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog"],"tags":["vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.08261","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.08261","authors":["Clive J Petry","Nuria Sanz Marcos","Gracielle Pimentel","M Geoffrey Hayes","Michael Nodzenski","Denise M Scholtens","Ieuan A Hughes","Carlo L Acerini","Ken K Ong","William L Lowe","David B Dunger"],"significance":4,"published":"2016-12-01","source_date":"2016-12-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This genetic-epidemiological study examined associations between fetal imprinted gene polymorphisms and maternal blood pressure during pregnancy in two birth cohorts. The findings provide insight into feto-maternal interactions in gestational blood pressure regulation.","created":"2026-07-03T10:26:26Z","updated":"2026-07-03T13:25:46Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar het verband tussen foetale geïmprinte genen en maternale bloeddruk tijdens de zwangerschap. Genetisch-epidemiologisch onderzoek naar de foeto-maternale interactie bij bloeddrukregulatie.","abstract_original":"In addition to maternal genes and environmental exposures, variation in fetal imprinted genes could also affect maternal blood pressure during pregnancy. Our objective was to test the associations between polymorphic variants in 16 imprinted genes and maternal mean arterial blood pressures in 1160 DNA trios from 2 established birth cohorts (the Cambridge Baby Growth and Wellbeing Studies) and seek replication in 1367 Hyperglycemia and Adverse Pregnancy Outcome Study participants. Significant univariate associations, all independent of fetal sex, were observed in the Cambridge cohorts, including FAM99A rs1489945 transmitted from the mother (P=2×10-4), DLK1 rs10139403 (mother; P=9×10-4), DLK1 rs12147008 (mother; P=1×10-3), H19 rs217222 (father; P=1×10-3), SNRPN rs1453556 (father; P=1×10-3), IGF2 rs6356 (father; P=1×10-3), and NNAT rs6066671 (father; P=1×10-3). In meta-analysis including additional independent Hyperglycemia and Adverse Pregnancy Outcome Study data, the association with maternally transmitted fetal DLK1 rs10139403 reached genome-wide significance (P=6.3×10-10). With the exception of fetal rs1489945 and rs217222, all of other associations were unidirectional and most were statistically significant. To further explore the significance of these relationships, we developed an allele score based on the univariate findings. The score was strongly associated with maternal blood pressure at 31 weeks (P=4.1×10-8; adjusted r2=5.6%) and 37 weeks of pregnancy (P=1.1×10-4; r2=3.6%), and during the last 2 weeks before parturition (P=1.1×10-10; r2=8.7%). It was also associated with gestational hypertension (odds ratio, 1.54 [range, 1.14-2.09] per allele; P=0.005; 45 cases and 549 controls). These data support the concept that fetal imprinted genes are related to the development of gestational hypertension."},{"id":"170abbb0c9d3","type":"article","url":"https://hartvaat.nl/2016/12/01/vasculaire-disfunctiemarkers-na-hypertensieve-zwangerschapsaandoeningen-meta-ana/","title":"Vasculaire disfunctiemarkers na hypertensieve zwangerschapsaandoeningen: meta-analyse","title_en":"Markers of Vascular Dysfunction After Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-Analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["biomarkers-cardiovasculair","bloeddrukbehandeling","endotheel","perifeer-vaatlijden","vrouwen","zwangerschap-hart"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.07907","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.07907","authors":["Sophie Grand'Maison","Louise Pilote","Marisa Okano","Tara Landry","Natalie Dayan"],"significance":7,"published":"2016-12-01","source_date":"2016-12-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-zwangerschap/","https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/"],"congress":"","summary_en":"This systematic review and meta-analysis identified markers of persistent vascular dysfunction after hypertensive disorders of pregnancy, supporting the concept that preeclampsia and gestational hypertension cause lasting vascular damage linked to future cardiovascular risk.","created":"2026-07-03T10:26:26Z","updated":"2026-07-03T18:38:29Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse naar markers van vasculaire disfunctie na hypertensieve zwangerschapsaandoeningen. Onderbouwt het langetermijn cardiovasculaire risico na pre-eclampsie.","abstract_original":"Women with prior hypertensive disorders of pregnancy (HDP) are at twice the risk of cardiovascular disease compared with women with prior normotensive pregnancy, possibly because of sustained vascular dysfunction after delivery. The aim of this systematic review and meta-analysis is to summarize evidence of vascular dysfunction at least 3 months after HDP. Articles in all languages were retrieved from principal databases. Studies included were observational, with HDP as the main exposure and measurements of vascular dysfunction via imaging modalities or serum biomarkers as the main outcome, assessed at least 3 months postpartum. We pooled results of modalities reported in >3 studies using a random effects model. Of 6109 potentially relevant studies, 72 were included that evaluated 10 imaging modalities and 11 serum biomarkers in 8702 women. There was evidence of vascular dysfunction in women post HDP compared with women with prior normal pregnancy when measured by carotid-femoral pulse wave velocity (0.64 m/s [0.17-1.11]), carotid intima-media thickness (0.025 mm [0.004-0.045]), and augmentation index (5.48% [1.58-9.37]), as well as mean levels of soluble fms-like tyrosine kinase (6.12 pg/mL [1.91-10.33]). Between-groups differences in measures of vascular dysfunction were more pronounced when assessments were performed in younger women (<40 years) or closer to the index pregnancy for almost all modalities. In conclusion, pooled data from studies evaluating vascular imaging suggest that some vascular dysfunction persists after HDP as compared with women with prior normal pregnancy."},{"id":"5a8dedc9e0eb","type":"article","url":"https://hartvaat.nl/2016/12/01/lacunes-in-hypertensierichtlijnen-in-lage-en-middeninkomenslanden-systematische-/","title":"Lacunes in hypertensierichtlijnen in lage- en middeninkomenslanden: systematische review","title_en":"Gaps in Hypertension Guidelines in Low- and Middle-Income Versus High-Income Countries: A Systematic Review.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","anemie-ckd","bloeddrukbehandeling","hypertrofische-cardiomyopathie","laminopathie","perifeer-vaatlijden","slaapapneu","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.08290","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.08290","authors":["Mayowa Owolabi","Paul Olowoyo","J Jaime Miranda","Rufus Akinyemi","Wuwei Feng","Joseph Yaria","Tomiwa Makanjuola","Sanni Yaya","Janusz Kaczorowski","Lehana Thabane","Josefien Van Olmen","Prashant Mathur","Clara Chow","Andre Kengne","Raelle Saulson","Amanda G Thrift","Rohina Joshi","Gerald S Bloomfield","Mulugeta Gebregziabher","Gary Parker","Charles Agyemang","Pietro Amedeo Modesti","Shane Norris","Luqman Ogunjimi","Temitope Farombi","Ezinne Sylvia Melikam","Ezinne Uvere","Babatunde Salako","Bruce Ovbiagele"],"significance":6,"published":"2016-12-01","source_date":"2016-12-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/nhg-standaard-cvr-2019/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/"],"congress":"","summary_en":"This systematic review identified gaps in hypertension guidelines for low- and middle-income countries compared with high-income settings, highlighting the need for locally adapted recommendations that address resource constraints.","created":"2026-07-03T10:26:26Z","updated":"2026-07-03T18:38:29Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review die lacunes identificeerde in hypertensierichtlijnen voor lage- en middeninkomenslanden vergeleken met hoge-inkomenslanden. Relevant voor mondiale cardiovasculaire gezondheid.","abstract_original":""},{"id":"bc09bdb47486","type":"article","url":"https://hartvaat.nl/2016/12/01/rivaroxaban-versus-vka-bij-periprocedurele-antistolling-rond-af-ablatie/","title":"Rivaroxaban versus VKA bij periprocedurele antistolling rond AF-ablatie","title_en":"Efficacy and safety of rivaroxaban compared with vitamin K antagonists for peri-procedural anticoagulation in catheter ablation of atrial fibrillation: a systematic review and meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["anticoagulantia","rivaroxaban","warfarine"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euv408","source_url":"https://doi.org/10.1093/europace/euv408","authors":["Mate Vamos","Riccardo Cappato","Francis E Marchlinski","Andrea Natale","Stefan H Hohnloser"],"significance":6,"published":"2016-12-01","source_date":"2016-12-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/antistolling/doacs-overzicht/"],"congress":"","summary_en":"This study compared rivaroxaban with VKA for periprocedural anticoagulation during AF catheter ablation, providing early comparative safety and efficacy data for DOAC use in the ablation setting.","created":"2026-07-03T10:26:26Z","updated":"2026-07-03T13:25:45Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die rivaroxaban vergeleek met vitamine K-antagonisten voor periprocedurele antistolling bij katheterablatie voor AF. Onderzoekt de veiligheid van ononderbroken DOAC-gebruik rond de procedure.","abstract_original":"Rivaroxaban is increasingly used in patients undergoing catheter ablation of atrial fibrillation (AF). In the absence of large controlled trials, a comprehensive meta-analysis of the literature appears to be the best way to obtain reliable evidence on rare peri-procedural outcomes such as thromboembolic or bleeding events. We aimed to provide a detailed analysis of currently available data on safety and efficacy of peri-procedural rivaroxaban in patients undergoing AF ablation. We performed a systematic search of the English language literature for studies comparing peri-procedural rivaroxaban therapy with vitamin K antagonists (VKAs) and reporting detailed data on bleeding and/or thromboembolic complications. The Peto odds ratio (POR) was used to pool data into a fixed-effect meta-analysis. A total of 7400 patients undergoing catheter ablation were included in 15 observational and 1 randomized studies of which 1994 were receiving rivaroxaban and 5406 VKA. The risk of thromboembolism trended to be lower in the rivaroxaban group [4/1954 vs. 19/5219, POR 0.40, 95% confidence interval (CI), 0.16-1.01, P = 0.052]. Major bleeding events occurred in 23 of 1994 cases (1.15%) in the rivaroxaban and 90 of 5406 (1.66%) in the VKA group (POR 0.74, 95% CI, 0.46-1.21, P = 0.23). A total of 87 minor bleeding events were reported in 1753 patients (4.96%) in the rivaroxaban group and in 165 of 4009 patients (4.12%) in the VKA group (POR 0.84, 95% CI 0.63-1.11, p = 0.22). In patients undergoing AF ablation, rivaroxaban appears to be an effective and safe alternative to VKA."},{"id":"d736dc3f974f","type":"article","url":"https://hartvaat.nl/2016/11/29/bmi-en-nauwkeurigheid-van-nt-probnp-en-bnp-voor-diagnose-van-acuut-hartfalen/","title":"BMI en nauwkeurigheid van NT-proBNP en BNP voor diagnose van acuut hartfalen","title_en":"Impact of Body Mass Index on the Accuracy of N-Terminal Pro-Brain Natriuretic Peptide and Brain Natriuretic Peptide for Predicting Outcomes in Patients With Chronic Heart Failure and Reduced Ejection Fraction: Insights From the PARADIGM-HF Study (Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure Trial).","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":["acuut-hartfalen","nt-probnp","obesitas"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.024976","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.024976","authors":["Wilson Nadruz","Brian L Claggett","John J McMurray","Milton Packer","Michael R Zile","Jean L Rouleau","Akshay S Desai","Karl Swedberg","Martin Lefkowitz","Victor C Shi","Margaret F Prescott","Scott D Solomon"],"significance":6,"published":"2016-11-29","source_date":"2016-11-29","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/diagnose-hartfalen-stappenplan/","https://hartvaat.nl/kennis/hartfalen/bnp-en-nt-probnp/"],"congress":"","summary_en":"This study showed that BMI significantly impacts the diagnostic accuracy of natriuretic peptides for acute heart failure, with obese patients having lower BNP and NT-proBNP levels at equivalent disease severity, requiring adjusted diagnostic thresholds.","created":"2026-07-03T10:26:26Z","updated":"2026-07-03T13:25:45Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de invloed van BMI op de diagnostische nauwkeurigheid van natriuretische peptiden (NT-proBNP en BNP) bij acuut hartfalen. Relevant voor de interpretatie bij obese patiënten.","abstract_original":""},{"id":"b4cab9d6e9ab","type":"article","url":"https://hartvaat.nl/2016/11/29/natuurlijk-beloop-van-coronaire-atherosclerose-met-ffr-prospectieve-studie/","title":"Natuurlijk beloop van coronaire atherosclerose met FFR: prospectieve studie","title_en":"A Prospective Natural History Study of Coronary Atherosclerosis Using Fractional Flow Reserve.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["atherosclerose","fractional-flow-reserve","stabiel-coronairlijden"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.08.055","source_url":"https://doi.org/10.1016/j.jacc.2016.08.055","authors":["Emanuele Barbato","Gabor G Toth","Nils P Johnson","Nico H J Pijls","William F Fearon","Pim A L Tonino","Nick Curzen","Zsolt Piroth","Gilles Rioufol","Peter Jüni","Bernard De Bruyne"],"significance":7,"published":"2016-11-29","source_date":"2016-11-29","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/coronaire-angiografie-hartkatheterisatie/","https://hartvaat.nl/kennis/coronairlijden/coronaire-ct-angiografie/"],"congress":"","summary_en":"This prospective natural history study used fractional flow reserve to characterize the progression of coronary atherosclerosis over time, providing insights into which lesions progress to cause clinical events.","created":"2026-07-03T10:26:25Z","updated":"2026-07-03T13:25:45Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Prospectieve studie naar het natuurlijk beloop van coronaire atherosclerose beoordeeld met fractional flow reserve (FFR). Biedt inzicht in de progressie van functioneel niet-significante laesies.","abstract_original":"BACKGROUND: In patients with coronary artery disease, clinical outcome depends on the extent of reversible myocardial ischemia. Whether the outcome also depends on the severity of the stenosis as determined by fractional flow reserve (FFR) remains unknown. OBJECTIVES: This study sought to investigate the relationship between FFR values and vessel-related clinical outcome. METHODS: We prospectively studied major adverse cardiovascular events (MACE) at 2 years in 607 patients in whom all stenoses were assessed by FFR and who were treated with medical therapy alone. The relationship between FFR and 2-year MACE was assessed as a continuous function. Logistic and Cox proportional hazards regression models were used to calculate the average decrease in the risk of MACE per 0.05-U increase in FFR. RESULTS: MACE occurred in 272 (26.5%) of 1,029 lesions. Target lesions with diameter stenosis ≥70% were more often present in the MACE group (p < 0.01). Median FFR was significantly lower in the MACE group versus the non-MACE group (0.68 [interquartile range: 0.54 to 0.77] vs. 0.80 [interquartile range: 0.70 to 0.88]; p < 0.01). The cumulative incidence of MACE significantly increased with increasing FFR quartiles. An average decrease in MACE per 0.05-unit increase in FFR was statistically significant even after adjustment for all clinical and angiographic features (odds ratio: 0.81; 95% confidence interval: 0.76 to 0.86]). The strongest increase in MACE occurred for FFR values between 0.80 and 0.60. In multivariable Cox regression analysis, FFR was significantly associated with MACE up to 2 years (hazard ratio: 0.87; 95% confidence interval: 0.83 to 0.91]). CONCLUSIONS: In patients with stable coronary disease, stenosis severity as assessed by FFR is a major and independent predictor of lesion-related outcome. (FAME II - Fractional Flow Reserve [FFR] Guided Percutaneous Coronary Intervention [PCI] Plus Optimal Medical Treatment [OMT] Verses OMT; NCT01132495)."},{"id":"bb83d2a4d936","type":"article","url":"https://hartvaat.nl/2016/11/29/presentatie-buiten-kantoortijden-versus-tijdens-kantoortijden-bij-stemi-champion/","title":"Presentatie buiten kantoortijden versus tijdens kantoortijden bij STEMI: CHAMPION PHOENIX","title_en":"\"Off-Hours\" Versus \"On-Hours\" Presentation in ST-Segment Elevation Myocardial Infarction: CHAMPION PHOENIX Findings.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.08.023","source_url":"https://doi.org/10.1016/j.jacc.2016.08.023","authors":["Senthil Selvaraj","Deepak L Bhatt","Gregg W Stone","C Michael Gibson","Ph Gabriel Steg","Christian W Hamm","Matthew J Price","Efthymios N Deliargyris","Jayne Prats","Kenneth W Mahaffey","Harvey D White","Robert A Harrington"],"significance":5,"published":"2016-11-29","source_date":"2016-11-29","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/cardiometabool/bloedsuikerdoelen-cardiovasculair/"],"congress":"","summary_en":"This CHAMPION PHOENIX analysis compared outcomes of STEMI patients presenting during off-hours versus on-hours, evaluating whether presentation timing affects PCI quality and clinical results in the contemporary era.","created":"2026-07-03T10:26:25Z","updated":"2026-07-03T13:25:45Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de CHAMPION PHOENIX-trial naar het effect van presentatietijdstip (buiten versus tijdens kantooruren) op uitkomsten bij STEMI. Onderzoekt de 'weekend-effect'-hypothese.","abstract_original":""},{"id":"b8bc65442b52","type":"article","url":"https://hartvaat.nl/2016/11/29/biomarkergebaseerde-cva-risicoscore-bij-atriumfibrilleren-validatie/","title":"Biomarkergebaseerde CVA-risicoscore bij atriumfibrilleren: validatie","title_en":"Performance and Validation of a Novel Biomarker-Based Stroke Risk Score for Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["biomarkers-cardiovasculair"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.022802","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.022802","authors":["Jonas Oldgren","Ziad Hijazi","Johan Lindbäck","John H Alexander","Stuart J Connolly","John W Eikelboom","Michael D Ezekowitz","Christopher B Granger","Elaine M Hylek","Renato D Lopes","Agneta Siegbahn","Salim Yusuf","Lars Wallentin"],"significance":6,"published":"2016-11-29","source_date":"2016-11-29","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/wat-is-atriumfibrilleren/","https://hartvaat.nl/kennis/atriumfibrilleren/af-en-beroerte/"],"congress":"","summary_en":"This validation study confirmed that the biomarker-based ABC stroke risk score (incorporating troponin and NT-proBNP) improves stroke prediction in AF patients beyond the CHA₂DS₂-VASc score, supporting biomarker-enhanced risk stratification.","created":"2026-07-03T10:26:25Z","updated":"2026-07-03T13:25:45Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Validatiestudie van een nieuwe biomarkergebaseerde CVA-risicoscore bij AF-patiënten. Onderzoekt of biomarkers de risicostratificatie boven CHA₂DS₂-VASc kunnen verbeteren.","abstract_original":"BACKGROUND: Atrial fibrillation is associated with increased but variable risk of stroke. Our aim was to validate the recently developed biomarker-based ABC (age, biomarkers [high-sensitivity troponin and N-terminal fragment B-type natriuretic peptide], and clinical history of prior stroke/transient ischemic attack)-stroke risk score and compare its performance with the CHA2DS2VASc and ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) risk scores. METHODS: The ABC-stroke score includes age, biomarkers (N-terminal fragment B-type natriuretic peptide and high-sensitivity cardiac troponin), and clinical history (prior stroke). This validation was based on 8356 patients, 16 137 person-years of follow-up, and 219 adjudicated stroke or systemic embolic events in anticoagulated patients with atrial fibrillation in the RE-LY study (Randomized Evaluation of Long-Term Anticoagulation Therapy). Levels of N-terminal fragment B-type natriuretic peptide, high-sensitivity cardiac troponin T (hs-cTnT), and high-sensitivity cardiac troponin I (hs-cTnI) were determined in plasma samples obtained at study entry. RESULTS: The ABC-stroke score was well calibrated with 0.76 stroke/systemic embolic events per 100 person-years in the predefined low (<1%/y) risk group, 1.48 in the medium (1%-2%/y) risk group, and 2.60 in the high (>2%/y) risk group for the ABC-stroke score with hs-cTnT. Hazard ratios for stroke/systemic embolic events were 1.95 for medium- versus low-risk groups, and 3.44 for high- versus low-risk groups. ABC-stroke score achieved C indices of 0.65 with both hs-cTnT and hs-cTnI, in comparison with 0.60 for CHA2DS2VASc (P=0.004 for hs-cTnT and P=0.022 hs-cTnI) and 0.61 for ATRIA scores (P=0.005 hs-cTnT and P=0.034 for hs-cTnI). CONCLUSIONS: The biomarker-based ABC-stroke score was well calibrated and consistently performed better than both the CHA2DS2VASc and ATRIA stroke scores. The ABC score should be considered an improved decision support tool in the care of patients with atrial fibrillation. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifiers: ARISTOTLE, NCT00412984; RE-LY, NCT00262600."},{"id":"141610fa7e82","type":"article","url":"https://hartvaat.nl/2016/11/26/ultradunne-biodegradeerbare-versus-duurzame-polymer-des-lancet-gerandomiseerde-t/","title":"Ultradunne biodegradeerbare versus duurzame polymer DES: Lancet gerandomiseerde trial","title_en":"Very thin strut biodegradable polymer everolimus-eluting and sirolimus-eluting stents versus durable polymer zotarolimus-eluting stents in allcomers with coronary artery disease (BIO-RESORT): a three-arm, randomised, non-inferiority trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(16)31920-1","source_url":"https://doi.org/10.1016/S0140-6736(16)31920-1","authors":["Clemens von Birgelen","Marlies M Kok","Liefke C van der Heijden","Peter W Danse","Carl E Schotborgh","Martijn Scholte","R Melvyn Tjon Joe Gin","Samer Somi","K G van Houwelingen","M G Stoel","Frits H A F de Man","J Hans W Louwerenburg","Marc Hartmann","Paolo Zocca","Gerard C M Linssen","Job van der Palen","Carine J M Doggen","Marije M Löwik"],"significance":7,"published":"2016-11-26","source_date":"2016-11-26","image":"","kennis":[],"congress":"","summary_en":"This Lancet trial compared ultra-thin biodegradable polymer drug-eluting stents with durable polymer stents, evaluating whether newer stent designs with shorter polymer exposure reduce late adverse events after PCI.","created":"2026-07-03T10:26:25Z","updated":"2026-07-03T13:25:45Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet gerandomiseerde trial die ultradunne biodegradeerbare polymer everolimus- en sirolimus-eluting stents vergeleek met duurzame polymer zotarolimus-eluting stents. Evolutie van stenttechnologie.","abstract_original":"BACKGROUND: In patients with coronary artery disease, treated with durable polymer-coated drug-eluting stents, the life-long presence of the polymer might delay arterial healing. Novel very thin strut biodegradable polymer stents, which leave only a bare metal stent after polymer resorption, might improve long-term outcome. We investigated in allcomers the safety and efficacy of three stents eluting either everolimus, sirolimus, or zotarolimus, often clinically used but never compared, of which the biodegradable polymer everolimus-eluting stent was never before assessed in allcomers. METHODS: The large-scale, investigator-initiated, multicentre, assessor and patient blinded, three-arm, randomised, BIO-RESORT non-inferiority trial was done at four clinical sites in the Netherlands. All-comer patients were aged 18 years or older, capable of providing informed consent, and required a percutaneous coronary intervention with drug-eluting stent implantation according to clinical guidelines or the operators' judgment. Exclusion criteria were: participation in another randomised drug or device study before reaching the primary endpoint of that study; planned surgery necessitating interruption of dual antiplatelet therapy within the first 6 months; known intolerance to components of the investigational product or medication required; uncertainty about the adherence to follow-up procedures or an assumed life expectancy of less than 1 year; or known pregnancy. Web-based computer-generated allocation sequences randomly assigned patients (1:1:1) to treatment with very thin strut biodegradable polymer everolimus-eluting or sirolimus-eluting stents (which differ substantially in type, amount, distribution, and resorption speed of their respective coating), or thin strut durable polymer zotarolimus-eluting stents. The primary endpoint was a composite of safety (cardiac death or target vessel-related myocardial infarction) and efficacy (target vessel revascularisation) at 12 months of follow up with a very thin strut biodegradable polymer of either everolimus-eluting or sirolimus-eluting stents, compared with durable polymer zotarolimus-eluting stents, analysed by intention to treat (non-inferiority margin 3·5%). This trial was registered with ClinicalTrials.gov, number NCT01674803. FINDINGS: From Dec 21, 2012, to Aug 24, 2015, 3514 patients were enrolled and analysed, of whom 2449 (70%) had acute coronary syndromes, which included 1073 (31%) ST-elevation myocardial infarctions. 12 month follow-up of 3490 (99%) patients (three lost to follow-up; 21 withdrawals) was available. The primary endpoint was met by 55 (5%) of 1172 patients assigned to everolimus-eluting stents, 55 (5%) of 1169 assigned to sirolimus-eluting stents and 63 (5%) of 1173 assigned to zotarolimus-eluting stents. Non-inferiority of the everolimus-eluting stents and sirolimus-eluting stents compared with zotarolimus-eluting stents was confirmed (both -0·7% absolute risk difference, 95% CI -2·4 to 1·1; upper limit of one sided 95% CI 0·8%, pnon-inferiority<0·0001). Definite stent thrombosis (defined by the Academic Research Consortium) occurred in four (0·3%) of 1172 patients who were allocated to everolimus-eluting stents, four (0·3%) of 1169 patients who were allocated to sirolimus-eluting stents, and three (0·3%) of 1173 patients who were allocated to zotarolimus-eluting stents (log-rank p=0·70 for both comparisons with zotarolimus-eluting stents). INTERPRETATION: At 12 month follow-up, both very thin strut drug-eluting stents with dissimilar biodegradable polymer coatings (eluting either everolimus or sirolimus) were non-inferior to the durable polymer stent (eluting zotarolimus) in treating allcomers with a high proportion of patients with acute coronary syndromes. The absence of a loss of 1 year safety and efficacy with the use of these two biodegradable polymer-coated stents is a prerequisite before assessing their potential longer-term benefits. FUNDING: Biotronik, Boston Scientific, and Medtronic."},{"id":"3608113ecfd7","type":"article","url":"https://hartvaat.nl/2016/11/26/oct-versus-ivus-versus-angiografie-bij-coronaire-stentimplantatie-lancet-ilumien/","title":"OCT versus IVUS versus angiografie bij coronaire stentimplantatie: Lancet ILUMIEN III-trial","title_en":"Optical coherence tomography compared with intravascular ultrasound and with angiography to guide coronary stent implantation (ILUMIEN III: OPTIMIZE PCI): a randomised controlled trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["intracoronaire-beeldvorming"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(16)31922-5","source_url":"https://doi.org/10.1016/S0140-6736(16)31922-5","authors":["Ziad A Ali","Akiko Maehara","Philippe Généreux","Richard A Shlofmitz","Franco Fabbiocchi","Tamim M Nazif","Giulio Guagliumi","Perwaiz M Meraj","Fernando Alfonso","Habib Samady","Takashi Akasaka","Eric B Carlson","Massoud A Leesar","Mitsuaki Matsumura","Melek Ozgu Ozan","Gary S Mintz","Ori Ben-Yehuda","Gregg W Stone"],"significance":8,"published":"2016-11-26","source_date":"2016-11-26","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/intravasculaire-echografie-ivus-oct/","https://hartvaat.nl/kennis/coronairlijden/coronaire-angiografie-hartkatheterisatie/"],"congress":"","summary_en":"The ILUMIEN III trial compared OCT, IVUS, and angiography guidance for coronary stent implantation and found that OCT-guided PCI achieved minimum stent expansion comparable to IVUS and superior to angiography. The first large randomized comparison of all three imaging modalities.","created":"2026-07-03T10:26:25Z","updated":"2026-07-03T13:25:45Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet ILUMIEN III-trial die OCT vergeleek met IVUS en angiografie voor het sturen van stentimplantatie. Eerste grote gerandomiseerde vergelijking van drie beeldvormingsmodaliteiten.","abstract_original":"BACKGROUND: Percutaneous coronary intervention (PCI) is most commonly guided by angiography alone. Intravascular ultrasound (IVUS) guidance has been shown to reduce major adverse cardiovascular events (MACE) after PCI, principally by resulting in a larger postprocedure lumen than with angiographic guidance. Optical coherence tomography (OCT) provides higher resolution imaging than does IVUS, although findings from some studies suggest that it might lead to smaller luminal diameters after stent implantation. We sought to establish whether or not a novel OCT-based stent sizing strategy would result in a minimum stent area similar to or better than that achieved with IVUS guidance and better than that achieved with angiography guidance alone. METHODS: In this randomised controlled trial, we recruited patients aged 18 years or older undergoing PCI from 29 hospitals in eight countries. Eligible patients had one or more target lesions located in a native coronary artery with a visually estimated reference vessel diameter of 2·25-3·50 mm and a length of less than 40 mm. We excluded patients with left main or ostial right coronary artery stenoses, bypass graft stenoses, chronic total occlusions, planned two-stent bifurcations, and in-stent restenosis. Participants were randomly assigned (1:1:1; with use of an interactive web-based system in block sizes of three, stratified by site) to OCT guidance, IVUS guidance, or angiography-guided stent implantation. We did OCT-guided PCI using a specific protocol to establish stent length, diameter, and expansion according to reference segment external elastic lamina measurements. All patients underwent final OCT imaging (operators in the IVUS and angiography groups were masked to the OCT images). The primary efficacy endpoint was post-PCI minimum stent area, measured by OCT at a masked independent core laboratory at completion of enrolment, in all randomly allocated participants who had primary outcome data. The primary safety endpoint was procedural MACE. We tested non-inferiority of OCT guidance to IVUS guidance (with a non-inferiority margin of 1·0 mm2), superiority of OCT guidance to angiography guidance, and superiority of OCT guidance to IVUS guidance, in a hierarchical manner. This trial is registered with ClinicalTrials.gov, number NCT02471586. FINDINGS: Between May 13, 2015, and April 5, 2016, we randomly allocated 450 patients (158 [35%] to OCT, 146 [32%] to IVUS, and 146 [32%] to angiography), with 415 final OCT acquisitions analysed for the primary endpoint (140 [34%] in the OCT group, 135 [33%] in the IVUS group, and 140 [34%] in the angiography group). The final median minimum stent area was 5·79 mm2 (IQR 4·54-7·34) with OCT guidance, 5·89 mm2 (4·67-7·80) with IVUS guidance, and 5·49 mm2 (4·39-6·59) with angiography guidance. OCT guidance was non-inferior to IVUS guidance (one-sided 97·5% lower CI -0·70 mm2; p=0·001), but not superior (p=0·42). OCT guidance was also not superior to angiography guidance (p=0·12). We noted procedural MACE in four (3%) of 158 patients in the OCT group, one (1%) of 146 in the IVUS group, and one (1%) of 146 in the angiography group (OCT vs IVUS p=0·37; OCT vs angiography p=0·37). INTERPRETATION: OCT-guided PCI using a specific reference segment external elastic lamina-based stent optimisation strategy was safe and resulted in similar minimum stent area to that of IVUS-guided PCI. These data warrant a large-scale randomised trial to establish whether or not OCT guidance results in superior clinical outcomes to angiography guidance. FUNDING: St Jude Medical."},{"id":"d2ccd36008ee","type":"article","url":"https://hartvaat.nl/2016/11/22/plasma-lipidomiek-verbetert-cardiovasculaire-risicovoorspelling-bij-diabetes-typ/","title":"Plasma-lipidomiek verbetert cardiovasculaire risicovoorspelling bij diabetes type 2","title_en":"Plasma Lipidomic Profiles Improve on Traditional Risk Factors for the Prediction of Cardiovascular Events in Type 2 Diabetes Mellitus.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["biomarkers-cardiovasculair","diabetes-en-hart","diabetes-type-1","diabetes-type-2","dyslipidemie","ezetimibe","lipoproteïne-a"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.023233","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.023233","authors":["Zahir H Alshehry","Piyushkumar A Mundra","Christopher K Barlow","Natalie A Mellett","Gerard Wong","Malcolm J McConville","John Simes","Andrew M Tonkin","David R Sullivan","Elizabeth H Barnes","Paul J Nestel","Bronwyn A Kingwell","Michel Marre","Bruce Neal","Neil R Poulter","Anthony Rodgers","Bryan Williams","Sophia Zoungas","Graham S Hillis","John Chalmers","Mark Woodward","Peter J Meikle"],"significance":6,"published":"2016-11-22","source_date":"2016-11-22","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"This study demonstrated that plasma lipidomic profiling improves cardiovascular event prediction beyond traditional risk factors in type 2 diabetes, advancing the concept of comprehensive lipid phenotyping for risk assessment.","created":"2026-07-03T10:26:25Z","updated":"2026-07-03T13:25:45Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die aantoont dat plasma-lipidomische profielen de cardiovasculaire risicovoorspelling verbeteren bovenop traditionele risicofactoren bij diabetes type 2.","abstract_original":"BACKGROUND: Clinical lipid measurements do not show the full complexity of the altered lipid metabolism associated with diabetes mellitus or cardiovascular disease. Lipidomics enables the assessment of hundreds of lipid species as potential markers for disease risk. METHODS: Plasma lipid species (310) were measured by a targeted lipidomic analysis with liquid chromatography electrospray ionization-tandem mass spectrometry on a case-cohort (n=3779) subset from the ADVANCE trial (Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation). The case-cohort was 61% male with a mean age of 67 years. All participants had type 2 diabetes mellitus with ≥1 additional cardiovascular risk factors, and 35% had a history of macrovascular disease. Weighted Cox regression was used to identify lipid species associated with future cardiovascular events (nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death) and cardiovascular death during a 5-year follow-up period. Multivariable models combining traditional risk factors with lipid species were optimized with the Akaike information criteria. C statistics and NRIs were calculated within a 5-fold cross-validation framework. RESULTS: Sphingolipids, phospholipids (including lyso- and ether- species), cholesteryl esters, and glycerolipids were associated with future cardiovascular events and cardiovascular death. The addition of 7 lipid species to a base model (14 traditional risk factors and medications) to predict cardiovascular events increased the C statistic from 0.680 (95% confidence interval [CI], 0.678-0.682) to 0.700 (95% CI, 0.698-0.702; P<0.0001) with a corresponding continuous NRI of 0.227 (95% CI, 0.219-0.235). The prediction of cardiovascular death was improved with the incorporation of 4 lipid species into the base model, showing an increase in the C statistic from 0.740 (95% CI, 0.738-0.742) to 0.760 (95% CI, 0.757-0.762; P<0.0001) and a continuous net reclassification index of 0.328 (95% CI, 0.317-0.339). The results were validated in a subcohort with type 2 diabetes mellitus (n=511) from the LIPID trial (Long-Term Intervention With Pravastatin in Ischemic Disease). CONCLUSIONS: The improvement in the prediction of cardiovascular events, above traditional risk factors, demonstrates the potential of plasma lipid species as biomarkers for cardiovascular risk stratification in diabetes mellitus. CLINICAL TRIAL REGISTRATION: URL: https://clinicaltrials.gov. Unique identifier: NCT00145925."},{"id":"3ed41ee539c4","type":"article","url":"https://hartvaat.nl/2016/11/22/management-van-klinisch-significante-geneesmiddelinteracties-met-statines-aha-aa/","title":"Management van klinisch significante geneesmiddelinteracties met statines: AHA-aanbevelingen","title_en":"Recommendations for Management of Clinically Significant Drug-Drug Interactions With Statins and Select Agents Used in Patients With Cardiovascular Disease: A Scientific Statement From the American Heart Association.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts"],"tags":["gepersonaliseerde-geneeskunde","laminopathie","statines","vrouwen"],"journal":"Circulation","doi":"10.1161/CIR.0000000000000456","source_url":"https://doi.org/10.1161/CIR.0000000000000456","authors":["Barbara S Wiggins","Joseph J Saseen","Robert L Page","Brent N Reed","Kevin Sneed","John B Kostis","David Lanfear","Salim Virani","Pamela B Morris"],"significance":8,"published":"2016-11-22","source_date":"2016-11-22","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/ezetimib/"],"congress":"","summary_en":"This AHA scientific statement provided recommendations for managing clinically significant drug interactions with statins, covering interactions with commonly used cardiovascular medications and strategies to minimize the risk of myopathy and rhabdomyolysis.","created":"2026-07-03T10:26:25Z","updated":"2026-07-03T13:25:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"AHA scientific statement met aanbevelingen voor het management van klinisch significante geneesmiddelinteracties met statines bij cardiovasculaire patiënten. Praktijkgids voor veilig combinatiegebruik.","abstract_original":""},{"id":"c89de15e248d","type":"article","url":"https://hartvaat.nl/2016/11/22/prasugrel-versus-ticagrelor-bij-acuut-mi-met-primaire-pci-multicenter-trial/","title":"Prasugrel versus ticagrelor bij acuut MI met primaire PCI: multicenter trial","title_en":"Prasugrel Versus Ticagrelor in Patients With Acute Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: Multicenter Randomized PRAGUE-18 Study.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.024823","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.024823","authors":["Zuzana Motovska","Ota Hlinomaz","Roman Miklik","Milan Hromadka","Ivo Varvarovsky","Jaroslav Dusek","Jiri Knot","Jiri Jarkovsky","Petr Kala","Richard Rokyta","Frantisek Tousek","Petra Kramarikova","Bohumil Majtan","Stanislav Simek","Marian Branny","Jan Mrozek","Pavel Cervinka","Jiri Ostransky","Petr Widimsky"],"significance":7,"published":"2016-11-22","source_date":"2016-11-22","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/coronairlijden/trombocytenaggregatieremmers-bij-acs/"],"congress":"","summary_en":"This head-to-head comparison of prasugrel versus ticagrelor in acute MI patients treated with primary PCI was among the first direct comparative effectiveness studies of these newer P2Y12 inhibitors, preceding the definitive ISAR-REACT 5 trial.","created":"2026-07-03T10:26:25Z","updated":"2026-07-03T13:25:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Head-to-head vergelijking van prasugrel versus ticagrelor bij patiënten met acuut myocardinfarct behandeld met primaire PCI. Een van de eerste directe vergelijkingen van nieuwe P2Y12-remmers.","abstract_original":"BACKGROUND: No randomized head-to-head comparison of the efficacy and safety of ticagrelor and prasugrel has been published in the 7 years since the higher efficacy of these newer P2Y12 inhibitors were first demonstrated relative to clopidogrel. METHODS: This academic study was designed to compare the efficacy and safety of prasugrel and ticagrelor in acute myocardial infarction treated with primary or immediate percutaneous coronary intervention. A total of 1230 patients were randomly assigned across 14 sites to either prasugrel or ticagrelor, which was initiated before percutaneous coronary intervention. Nearly 4% were in cardiogenic shock, and 5.2% were on mechanical ventilation. The primary end point was defined as death, reinfarction, urgent target vessel revascularization, stroke, or serious bleeding requiring transfusion or prolonging hospitalization at 7 days (to reflect primarily the in-hospital phase). This analysis presents data from the first 30 days (key secondary end point). The total follow-up will be 1 year for all patients and will be completed in 2017. RESULTS: The study was prematurely terminated for futility. The occurrence of the primary end point did not differ between groups receiving prasugrel and ticagrelor (4.0% and 4.1%, respectively; odds ratio, 0.98; 95% confidence interval, 0.55-1.73; P=0.939). No significant difference was found in any of the components of the primary end point. The occurrence of key secondary end point within 30 days, composed of cardiovascular death, nonfatal myocardial infarction, or stroke, did not show any significant difference between prasugrel and ticagrelor (2.7% and 2.5%, respectively; odds ratio, 1.06; 95% confidence interval, 0.53-2.15; P=0.864). CONCLUSIONS: This head-to-head comparison of prasugrel and ticagrelor does not support the hypothesis that one is more effective or safer than the other in preventing ischemic and bleeding events in the acute phase of myocardial infarction treated with a primary percutaneous coronary intervention strategy. The observed rates of major outcomes were similar but with broad confidence intervals around the estimates. These interesting observations need to be confirmed in a larger trial. CLINICAL TRIAL REGISTRATION: URL: http://www.ClinicalTrials.gov. Unique identifier: NCT02808767."},{"id":"53c1644b92d7","type":"article","url":"https://hartvaat.nl/2016/11/15/statines-voor-primaire-cardiovasculaire-preventie-uspstf-aanbeveling/","title":"Statines voor primaire cardiovasculaire preventie: USPSTF-aanbeveling","title_en":"Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: US Preventive Services Task Force Recommendation Statement.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["secundaire-preventie"],"journal":"JAMA","doi":"10.1001/jama.2016.15450","source_url":"https://doi.org/10.1001/jama.2016.15450","authors":["Kirsten Bibbins-Domingo","David C Grossman","Susan J Curry","Karina W Davidson","John W Epling","Francisco A R García","Matthew W Gillman","Alex R Kemper","Alex H Krist","Ann E Kurth","C Seth Landefeld","Michael L LeFevre","Carol M Mangione","William R Phillips","Douglas K Owens","Maureen G Phipps","Michael P Pignone"],"significance":9,"published":"2016-11-15","source_date":"2016-11-15","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/statines-primaire-preventie/"],"congress":"","summary_en":"The USPSTF recommendation endorsed statin use for primary cardiovascular prevention in adults aged 40–75 with at least one CVD risk factor and a 10-year risk of 10% or greater. The guideline defined evidence-based thresholds for initiating statin therapy in adults without established cardiovascular disease.","created":"2026-07-03T10:26:24Z","updated":"2026-07-03T13:25:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"USPSTF-aanbeveling voor statinegebruik bij de primaire preventie van cardiovasculaire ziekte bij volwassenen. Definieert drempelwaarden en indicaties voor statine-initiatie.","abstract_original":"IMPORTANCE: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the United States, accounting for 1 of every 3 deaths among adults. OBJECTIVE: To update the 2008 US Preventive Services Task Force (USPSTF) recommendation on screening for lipid disorders in adults. EVIDENCE REVIEW: The USPSTF reviewed the evidence on the benefits and harms of screening for and treatment of dyslipidemia in adults 21 years and older; the benefits and harms of statin use in reducing CVD events and mortality in adults without a history of CVD events; whether the benefits of statin use vary by subgroup, clinical characteristics, or dosage; and the benefits of various treatment strategies in adults 40 years and older without a history of CVD events. CONCLUSIONS AND RECOMMENDATIONS: The USPSTF recommends initiating use of low- to moderate-dose statins in adults aged 40 to 75 years without a history of CVD who have 1 or more CVD risk factors (dyslipidemia, diabetes, hypertension, or smoking) and a calculated 10-year CVD event risk of 10% or greater (B recommendation). The USPSTF recommends that clinicians selectively offer low- to moderate-dose statins to adults aged 40 to 75 years without a history of CVD who have 1 or more CVD risk factors and a calculated 10-year CVD event risk of 7.5% to 10% (C recommendation). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of initiating statin use in adults 76 years and older (I statement)."},{"id":"fefc222dda36","type":"article","url":"https://hartvaat.nl/2016/11/15/statines-voor-primaire-cardiovasculaire-preventie-uspstf-evidence-report/","title":"Statines voor primaire cardiovasculaire preventie: USPSTF evidence report","title_en":"Statins for Prevention of Cardiovascular Disease in Adults: Evidence Report and Systematic Review for the US Preventive Services Task Force.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["biomarkers-cardiovasculair","primaire-preventie","secundaire-preventie"],"journal":"JAMA","doi":"10.1001/jama.2015.15629","source_url":"https://doi.org/10.1001/jama.2015.15629","authors":["Roger Chou","Tracy Dana","Ian Blazina","Monica Daeges","Thomas L Jeanne"],"significance":8,"published":"2016-11-15","source_date":"2016-11-15","image":"","kennis":["https://hartvaat.nl/kennis/preventie/aspirine-primaire-preventie/","https://hartvaat.nl/kennis/preventie/statines-primaire-preventie/"],"congress":"","summary_en":"This JAMA systematic review and evidence report for the USPSTF evaluated the benefits and harms of statin therapy for primary prevention of cardiovascular disease, providing the evidence base for the recommendation to use statins in adults with elevated CVD risk.","created":"2026-07-03T10:26:24Z","updated":"2026-07-03T13:25:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA evidence report en systematische review voor de USPSTF over statines voor primaire preventie van cardiovasculaire ziekte bij volwassenen. Bewijsbasis voor het Amerikaanse screenings- en behandelbeleid.","abstract_original":"IMPORTANCE: Cardiovascular disease (CVD), the leading cause of mortality and morbidity in the United States, may be potentially preventable with statin therapy. OBJECTIVE: To systematically review benefits and harms of statins for prevention of CVD to inform the US Preventive Services Task Force. DATA SOURCES: Ovid MEDLINE (from 1946), Cochrane Central Register of Controlled Trials (from 1991), and Cochrane Database of Systematic Reviews (from 2005) to June 2016. STUDY SELECTION: Randomized clinical trials of statins vs placebo, fixed-dose vs titrated statins, and higher- vs lower-intensity statins in adults without prior cardiovascular events. DATA EXTRACTION AND SYNTHESIS: One investigator abstracted data, a second checked data for accuracy, and 2 investigators independently assessed study quality using predefined criteria. Data were pooled using random-effects meta-analysis. MAIN OUTCOMES AND MEASURES: All-cause mortality, CVD-related morbidity or mortality, and harms. RESULTS: Nineteen trials (n = 71 344 participants [range, 95-17 802]; mean age, 51-66 years) compared statins vs placebo or no statin. Statin therapy was associated with decreased risk of all-cause mortality (risk ratio [RR], 0.86 [95% CI, 0.80 to 0.93]; I2 = 0%; absolute risk difference [ARD], -0.40% [95% CI, -0.64% to -0.17%]), cardiovascular mortality (RR, 0.69 [95% CI, 0.54 to 0.88]; I2 = 54%; ARD, -0.43% [95% CI, -0.75% to -0.11%]), stroke (RR, 0.71 [95% CI, 0.62 to 0.82]; I2 = 0; ARD, -0.38% [95% CI, -0.53% to -0.23%]), myocardial infarction (RR, 0.64 [95% CI, 0.57 to 0.71]; I2 = 0%; ARD, -0.81% [95% CI, -1.19 to -0.43%]), and composite cardiovascular outcomes (RR, 0.70 [95% CI, 0.63 to 0.78]; I2 = 36%; ARD, -1.39% [95% CI, -1.79 to -0.99%]). Relative benefits appeared consistent in demographic and clinical subgroups, including populations without marked hyperlipidemia (total cholesterol level <200 mg/dL); absolute benefits were higher in subgroups at higher baseline risk. Statins were not associated with increased risk of serious adverse events (RR, 0.99 [95% CI, 0.94 to 1.04]), myalgias (RR, 0.96 [95% CI, 0.79 to 1.16]), or liver-related harms (RR, 1.10 [95% CI, 0.90 to 1.35]). In pooled analysis, statins were not associated with increased risk of diabetes (RR, 1.05 [95% CI, 0.91 to 1.20]), although statistical heterogeneity was present (I2 = 52%), and 1 trial found high-intensity statins associated with increased risk (RR, 1.25 [95% CI, 1.05 to 1.49]). No trial directly compared titrated vs fixed-dose statins, and there were no clear differences based on statin intensity. CONCLUSIONS AND RELEVANCE: In adults at increased CVD risk but without prior CVD events, statin therapy was associated with reduced risk of all-cause and cardiovascular mortality and CVD events, with greater absolute benefits in patients at greater baseline risk."},{"id":"92a6da75f28b","type":"article","url":"https://hartvaat.nl/2016/11/10/semaglutide-en-cardiovasculaire-uitkomsten-bij-diabetes-type-2-nejm-sustain-6/","title":"Semaglutide en cardiovasculaire uitkomsten bij diabetes type 2: NEJM SUSTAIN-6","title_en":"Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["diabetes-en-hart","diabetes-type-2","flow-trial","select-trial","soul-trial","step-hfpef","stride-trial","summit-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1607141","source_url":"https://doi.org/10.1056/NEJMoa1607141","authors":["Steven P Marso","Stephen C Bain","Agostino Consoli","Freddy G Eliaschewitz","Esteban Jódar","Lawrence A Leiter","Ildiko Lingvay","Julio Rosenstock","Jochen Seufert","Mark L Warren","Vincent Woo","Oluf Hansen","Anders G Holst","Jonas Pettersson","Tina Vilsbøll"],"significance":10,"published":"2016-11-10","source_date":"2016-11-10","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/"],"congress":"","summary_en":"The SUSTAIN-6 trial showed that once-weekly semaglutide significantly reduced the composite of cardiovascular death, nonfatal MI, and nonfatal stroke versus placebo in patients with type 2 diabetes. Together with LEADER, this study established the GLP-1 receptor agonist class as a pillar of cardiovascular prevention in diabetes.","created":"2026-07-03T10:26:24Z","updated":"2026-07-03T13:25:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Landmark NEJM SUSTAIN-6-trial die aantoonde dat semaglutide cardiovasculaire events significant vermindert bij patiënten met diabetes type 2. Samen met LEADER de basis voor GLP-1-agonisten als cardiovasculaire therapie.","abstract_original":"BACKGROUND: Regulatory guidance specifies the need to establish cardiovascular safety of new diabetes therapies in patients with type 2 diabetes in order to rule out excess cardiovascular risk. The cardiovascular effects of semaglutide, a glucagon-like peptide 1 analogue with an extended half-life of approximately 1 week, in type 2 diabetes are unknown. METHODS: We randomly assigned 3297 patients with type 2 diabetes who were on a standard-care regimen to receive once-weekly semaglutide (0.5 mg or 1.0 mg) or placebo for 104 weeks. The primary composite outcome was the first occurrence of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. We hypothesized that semaglutide would be noninferior to placebo for the primary outcome. The noninferiority margin was 1.8 for the upper boundary of the 95% confidence interval of the hazard ratio. RESULTS: At baseline, 2735 of the patients (83.0%) had established cardiovascular disease, chronic kidney disease, or both. The primary outcome occurred in 108 of 1648 patients (6.6%) in the semaglutide group and in 146 of 1649 patients (8.9%) in the placebo group (hazard ratio, 0.74; 95% confidence interval [CI], 0.58 to 0.95; P<0.001 for noninferiority). Nonfatal myocardial infarction occurred in 2.9% of the patients receiving semaglutide and in 3.9% of those receiving placebo (hazard ratio, 0.74; 95% CI, 0.51 to 1.08; P=0.12); nonfatal stroke occurred in 1.6% and 2.7%, respectively (hazard ratio, 0.61; 95% CI, 0.38 to 0.99; P=0.04). Rates of death from cardiovascular causes were similar in the two groups. Rates of new or worsening nephropathy were lower in the semaglutide group, but rates of retinopathy complications (vitreous hemorrhage, blindness, or conditions requiring treatment with an intravitreal agent or photocoagulation) were significantly higher (hazard ratio, 1.76; 95% CI, 1.11 to 2.78; P=0.02). Fewer serious adverse events occurred in the semaglutide group, although more patients discontinued treatment because of adverse events, mainly gastrointestinal. CONCLUSIONS: In patients with type 2 diabetes who were at high cardiovascular risk, the rate of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke was significantly lower among patients receiving semaglutide than among those receiving placebo, an outcome that confirmed the noninferiority of semaglutide. (Funded by Novo Nordisk; SUSTAIN-6 ClinicalTrials.gov number, NCT01720446 .)."},{"id":"c4aa7382ac4c","type":"article","url":"https://hartvaat.nl/2016/11/08/onbehandelde-hypertensie-als-risicofactor-voor-lobaire-en-non-lobaire-hersenbloe/","title":"Onbehandelde hypertensie als risicofactor voor lobaire en non-lobaire hersenbloeding naar etniciteit","title_en":"Untreated Hypertension: A Powerful Risk Factor for Lobar and Nonlobar Intracerebral Hemorrhage in Whites, Blacks, and Hispanics.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["anemie-ckd","aprocitentan","bloeddrukbehandeling","hypertrofische-cardiomyopathie","renale-denervatie","resistente-hypertensie"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.024073","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.024073","authors":["Kyle B Walsh","Daniel Woo","Padmini Sekar","Jennifer Osborne","Charles J Moomaw","Carl D Langefeld","Opeolu Adeoye"],"significance":7,"published":"2016-11-08","source_date":"2016-11-08","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/"],"congress":"","summary_en":"This study showed that untreated hypertension is a powerful risk factor for both lobar and nonlobar intracerebral hemorrhage across white, Black, and Hispanic populations, with racial/ethnic differences in the attributable risk.","created":"2026-07-03T10:26:24Z","updated":"2026-07-03T18:38:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar onbehandelde hypertensie als risicofactor voor intracereberale bloedingen bij witte, zwarte en Hispanische populaties. Benadrukt de noodzaak van vroegtijdige hypertensiebehandeling.","abstract_original":"BACKGROUND: Hypertension is a significant risk factor for intracerebral hemorrhage (ICH). Although ethnic/racial disparities related to hypertension and ICH have been reported, these previous studies were limited by a lack of Hispanics and inadequate power to analyze by ICH location. In the current study, while overcoming these prior limitations, we investigated whether there was variation by ethnicity/race of treated and untreated hypertension as risk factors for ICH. METHODS: The ERICH study (Ethnic/Racial Variations of Intracerebral Hemorrhage) is a prospective, multicenter, case-control study of ICH among whites, blacks, and Hispanics. Cases were enrolled from 42 recruitment sites. Controls matched to cases 1:1 by age (±5 years), sex, ethnicity/race, and metropolitan area were identified by random-digit dialing. Subjects were interviewed to determine history of hypertension and use of antihypertensive medications. Cases and controls within ethnic groups were compared by using conditional logistic regression. Multivariable conditional logistic regression models were computed for ICH as an overall group and separately for the location subcategories deep, lobar, and infratentorial (brainstem/cerebellar). RESULTS: Nine hundred fifty-eight white, 880 black, and 766 Hispanic ICH patients were enrolled. For ICH cases, untreated hypertension was higher in blacks (43.6%, P<0.0001) and Hispanics (46.9%, P<0.0001) versus whites (32.7%). In multivariable analyses adjusted for alcohol use, anticoagulation, hypercholesterolemia, education, and medical insurance status, treated hypertension was a significant risk factor across all locations of ICH in whites (odds ratio [OR], 1.57; 95% confidence interval [CI], 1.24-1.98; P<0.0001), blacks (OR, 3.02; 95% CI, 2.16-4.22; P<0.0001), and Hispanics (OR, 2.50; 95% CI, 1.73-3.62; P<0.0001). Untreated hypertension was a substantially greater risk factor for all 3 racial/ethnic groups across all locations of ICH: whites (OR, 8.79; 95% CI, 5.66-13.66; P<0.0001), blacks (OR, 12.46; 95% CI, 8.08-19.20; P<0.0001), and Hispanics (OR, 10.95; 95% CI, 6.58-18.23; P<0.0001). There was an interaction between race/ethnicity and ICH risk (P<0.0001). CONCLUSIONS: Untreated hypertension confers a greater ICH risk in blacks and Hispanics relative to whites across all anatomic locations of ICH. Accelerated research efforts are needed to improve overall hypertension treatment rates and to monitor the impact of such efforts on racial/ethnic disparities in stroke. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01202864."},{"id":"bc2138655c8e","type":"article","url":"https://hartvaat.nl/2016/11/08/residueel-vasculair-risico-bij-secundaire-preventie-verdeling-van-10-jaarsrisico/","title":"Residueel vasculair risico bij secundaire preventie: verdeling van 10-jaarsrisico","title_en":"Distribution of Estimated 10-Year Risk of Recurrent Vascular Events and Residual Risk in a Secondary Prevention Population.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts","internist"],"tags":["hartrevalidatie","perifeer-vaatlijden","roken","secundaire-preventie","voeding-hart"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.021314","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.021314","authors":["Lotte Kaasenbrood","S Matthijs Boekholdt","Yolanda van der Graaf","Kausik K Ray","Ron J G Peters","John J P Kastelein","Pierre Amarenco","John C LaRosa","Maarten J M Cramer","Jan Westerink","L Jaap Kappelle","Gert J de Borst","Frank L J Visseren"],"significance":7,"published":"2016-11-08","source_date":"2016-11-08","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/residueel-cardiovasculair-risico/"],"congress":"","summary_en":"This analysis quantified the distribution of residual cardiovascular risk in secondary prevention patients, identifying the proportion who remain at high risk despite optimal therapy and the factors that contribute to residual risk.","created":"2026-07-03T10:26:24Z","updated":"2026-07-03T13:25:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse die het resterende cardiovasculaire risico in kaart bracht bij patiënten in secundaire preventie. Kwantificeert hoeveel risico overblijft ondanks standaardbehandeling.","abstract_original":"BACKGROUND: Among patients with clinically manifest vascular disease, the risk of recurrent vascular events is likely to vary. We assessed the distribution of estimated 10-year risk of recurrent vascular events in a secondary prevention population. We also estimated the potential risk reduction and residual risk that can be achieved if patients reach guideline-recommended risk factor targets. METHODS: The SMART score (Second Manifestations of Arterial Disease) for 10-year risk of myocardial infarction, stroke, or vascular death was applied to 6904 patients with vascular disease. The risk score was externally validated in 18 436 patients with various manifestations of vascular disease from the TNT (Treating to New Targets), IDEAL (Incremental Decrease in End Points Through Aggressive Lipid Lowering), SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol Levels), and CAPRIE (Clopidogrel Versus Aspirin in Patients at Risk of Ischemic Events) trials. The residual risk at guideline-recommended targets was estimated by applying relative risk reductions from meta-analyses to the estimated risk for targets for systolic blood pressure, low-density lipoprotein cholesterol, smoking, physical activity, and use of antithrombotic agents. RESULTS: The external performance of the SMART risk score was reasonable, apart from overestimation of risk in patients with 10-year risk >40%. In patients with various manifestations of vascular disease, median 10-year risk of a recurrent major vascular event was 17% (interquartile range, 11%-28%), varying from <10% in 18% to >30% in 22% of the patients. If risk factors were at guideline-recommended targets, the residual 10-year risk would be <10% in 47% and >30% in 9% of the patients (median, 11%; interquartile range, 7%-17%). CONCLUSIONS: Among patients with vascular disease, there is very substantial variation in estimated 10-year risk of recurrent vascular events. If all modifiable risk factors were at guideline-recommended targets, half of the patients would have a 10-year risk <10%. These data suggest that even with optimal treatment, many patients with vascular disease will remain at >20% and even >30% 10-year risk, clearly delineating an area of substantial unmet medical need."},{"id":"4d09ea33ce0e","type":"article","url":"https://hartvaat.nl/2016/11/07/ace-remmer-en-groeisnelheid-van-kleine-abdominale-aorta-aneurysmata-gerandomisee/","title":"ACE-remmer en groeisnelheid van kleine abdominale aorta-aneurysmata: gerandomiseerde trial","title_en":"An evaluation of the effect of an angiotensin-converting enzyme inhibitor on the growth rate of small abdominal aortic aneurysms: a randomized placebo-controlled trial (AARDVARK).","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["ace-remmers","aortainsufficiëntie","fidelio-dkd","figaro-dkd","ramipril","ras-remmers"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw257","source_url":"https://doi.org/10.1093/eurheartj/ehw257","authors":["Colin D Bicknell","Gaia Kiru","Emanuela Falaschetti","Janet T Powell","Neil R Poulter"],"significance":6,"published":"2016-11-07","source_date":"2016-11-07","image":"","kennis":[],"congress":"","summary_en":"The AARDVARK trial showed that ACE inhibitor therapy does not reduce the growth rate of small abdominal aortic aneurysms, a negative result for pharmacological aneurysm management.","created":"2026-07-03T10:26:24Z","updated":"2026-07-03T13:25:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial die het effect van een ACE-remmer onderzocht op de groeisnelheid van kleine abdominale aorta-aneurysmata. Onderzoekt of farmacologische interventie de progressie kan vertragen.","abstract_original":"AIMS: The AARDVARK (Aortic Aneurysmal Regression of Dilation: Value of ACE-Inhibition on RisK) trial investigated whether ACE-inhibition reduces small abdominal aortic aneurysms (AAA) growth rate, independent of blood pressure (BP) lowering. METHODS AND RESULTS: A three-arm, multi-centre, single-blind, and randomized controlled trial (ISRCTN51383267) was conducted in 14 hospitals in England. Subjects aged ≥55 years with AAA diameter 3.0-5.4 cm were randomized 1:1:1 to receive perindopril arginine 10 mg, or amlodipine 5 mg, or placebo and followed 3-6 monthly over 2 years. The primary outcome was aneurysm growth rate (based on external antero-posterior ultrasound measurements in the longitudinal plane), determined by multi-level modelling to provide maximum likelihood estimates. Two hundred and twenty-four subjects were randomized (2011-2013) to placebo (n = 79), perindopril (n = 73), or amlodipine (n = 72). Mean (SD) changes in mid-trial systolic BP (12 months) were 0.5 (14.3) mmHg, P = 0.78 compared with baseline, -9.5 (13.1) mmHg (P < 0.001), and -6.7 (12.0) mmHg (P < 0.001), respectively. No significant differences in the modelled annual growth rates were apparent [1.68 mm (SE 0.2), 1.77 mm (0.2), and 1.81 mm (0.2), respectively]. The estimated difference in annual growth between the perindopril and placebo groups was 0.08 mm (CI -0.50, 0.65). Similar numbers of AAAs in each group reached 5.5 cm diameter and/or underwent elective surgery: 11 receiving placebo, 10 perindopril, and 11 amlodipine. CONCLUSION: Small AAA growth rates were lower than anticipated, but there was no significant impact of perindopril compared with placebo or placebo and amlodipine, combined despite more effective BP lowering."},{"id":"655220875cf5","type":"article","url":"https://hartvaat.nl/2016/11/01/linker-hartoorisolatie-bij-langdurig-persisterend-af-de-belief-trial/","title":"Linker-hartoorisolatie bij langdurig persisterend AF: de BELIEF-trial","title_en":"Left Atrial Appendage Isolation in Patients With Longstanding Persistent AF Undergoing Catheter Ablation: BELIEF Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.07.770","source_url":"https://doi.org/10.1016/j.jacc.2016.07.770","authors":["Luigi Di Biase","J David Burkhardt","Prasant Mohanty","Sanghamitra Mohanty","Javier E Sanchez","Chintan Trivedi","Mahmut Güneş","Yalçın Gökoğlan","Carola Gianni","Rodney P Horton","Sakis Themistoclakis","G Joseph Gallinghouse","Shane Bailey","Jason D Zagrodzky","Richard H Hongo","Salwa Beheiry","Pasquale Santangeli","Michela Casella","Antonio Dello Russo","Amin Al-Ahmad","Patrick Hranitzky","Dhanunjaya Lakkireddy","Claudio Tondo","Andrea Natale"],"significance":7,"published":"2016-11-01","source_date":"2016-11-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/elektrisch-remodellering-atrium/","https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/"],"congress":"","summary_en":"The BELIEF randomized trial investigated whether adding electrical left atrial appendage isolation to standard catheter ablation improves outcomes in patients with longstanding persistent AF, the most challenging AF subtype.","created":"2026-07-03T10:26:24Z","updated":"2026-07-03T13:25:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial die de toevoeging van elektrische linker-hartoorisolatie onderzocht bij katheterablatie voor langdurig persisterend AF. BELIEF is een belangrijke trial voor het bepalen van de ablatiestrategie.","abstract_original":"BACKGROUND: Longstanding persistent (LSP) atrial fibrillation (AF) is the most challenging type of AF. In addition to pulmonary vein isolation, substrate modification and triggers ablation have been reported to improve freedom from AF in patients with LSPAF. OBJECTIVES: This study sought to assess whether the empirical electrical isolation of the left atrial appendage (LAA) could improve success at follow-up. METHODS: This was an open-label, randomized study assessing the effectiveness of empirical electrical left atrial appendage isolation for the treatment of LSPAF. Patients were randomly assigned to undergo empirical electrical left atrial appendage isolation along with extensive ablation (group 1; n = 85) or extensive ablation alone (group 2; n = 88). Recurrence of atrial arrhythmias was the primary endpoint. Secondary endpoints included cardiac-related hospitalization, all-cause mortality, and stroke at follow-up. RESULTS: Major clinical characteristics were not different between the 2 groups. At 12-month follow-up, 48 (56%) patients in group 1 and 25 (28%) in group 2 were recurrence free after a single procedure (unadjusted hazard ratio [HR] for recurrence with standard ablation: 1.92; 95% confidence interval [CI]: 1.3 to 2.9; log-rank p = 0.001). After adjusting for age, sex, and left atrial size, standard ablation was predictive of recurrence (HR: 2.22; 95% CI: 1.29 to 3.81; p = 0.004). During repeat procedures, empirical electrical left atrial appendage isolation was performed in all patients. After an average of 1.3 procedures, cumulative success at 24-month follow-up was reported in 65 (76%) in group 1 and in 49 (56%) in group 2 (unadjusted HR: 2.24; 95% CI: 1.3 to 3.8; log-rank p = 0.003). CONCLUSIONS: This randomized study showed that both after a single procedure and after redo procedures in patients with LSPAF, empirical electrical isolation of the LAA improved long-term freedom from atrial arrhythmias without increasing complications. (Effect of Empirical Left Atrial Appendage Isolation on Long-term Procedure Outcome in Patients With Persistent or Longstanding Persistent Atrial Fibrillation Undergoing Catheter Ablation [BELIEF]; NCT01362738)."},{"id":"54ef033998b9","type":"article","url":"https://hartvaat.nl/2016/11/01/intensieve-bloeddrukbehandeling-120-80-mmhg-antagonist-standpunt/","title":"Intensieve bloeddrukbehandeling <120/80 mmHg: antagonist-standpunt","title_en":"Should Patients With Cardiovascular Risk Factors Receive Intensive Treatment of Hypertension to <120/80 mm Hg Target? An Antagonist View From the HOPE-3 Trial (Heart Outcomes Evaluation-3).","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.023264","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.023264","authors":["Eva M Lonn","Salim Yusuf"],"significance":7,"published":"2016-11-01","source_date":"2016-11-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"This contra perspective argued against universal intensive blood pressure targets of <120/80 mmHg, citing risks of overtreatment, adverse effects, and the limited applicability of SPRINT to many patient populations.","created":"2026-07-03T10:26:24Z","updated":"2026-07-03T13:25:43Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Contra-argumentatie tegen universele intensieve bloeddrukbehandeling tot <120/80 mmHg. Wijst op risico's van overbehandeling, bijwerkingen en beperkte generaliseerbaarheid van SPRINT.","abstract_original":""},{"id":"6ccc91fc60d0","type":"article","url":"https://hartvaat.nl/2016/11/01/intensieve-bloeddrukbehandeling-120-80-mmhg-bij-cardiovasculair-risico-protagoni/","title":"Intensieve bloeddrukbehandeling <120/80 mmHg bij cardiovasculair risico: protagonist-standpunt","title_en":"Should Patients With Cardiovascular Risk Factors Receive Intensive Treatment of Hypertension to <120/80 mm Hg Target? A Protagonist View From the SPRINT Trial (Systolic Blood Pressure Intervention Trial).","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["biomarkers-cardiovasculair","bloeddrukbehandeling","obesitas"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.023263","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.023263","authors":["Suzanne Oparil","Cora E Lewis"],"significance":7,"published":"2016-11-01","source_date":"2016-11-01","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/hypertensie/cardiovasculaire-risicoschatting-score2/"],"congress":"","summary_en":"This pro perspective argued for intensive blood pressure treatment to <120/80 mmHg in patients with cardiovascular risk factors, based on SPRINT evidence and the continuous relationship between blood pressure and cardiovascular risk.","created":"2026-07-03T10:26:24Z","updated":"2026-07-03T13:25:43Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Pro-argumentatie voor intensieve bloeddrukbehandeling tot <120/80 mmHg bij patiënten met cardiovasculaire risicofactoren, gebaseerd op de SPRINT-resultaten.","abstract_original":""},{"id":"d740b1810607","type":"article","url":"https://hartvaat.nl/2016/11/01/tienjaarsuitkomsten-na-cabg-naar-leeftijd-bij-hartfalen-met-lv-systolische-disfu/","title":"Tienjaarsuitkomsten na CABG naar leeftijd bij hartfalen met LV-systolische disfunctie: STICH","title_en":"Ten-Year Outcomes After Coronary Artery Bypass Grafting According to Age in Patients With Heart Failure and Left Ventricular Systolic Dysfunction: An Analysis of the Extended Follow-Up of the STICH Trial (Surgical Treatment for Ischemic Heart Failure).","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","hfref","vericiguat"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.024800","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.024800","authors":["Mark C Petrie","Pardeep S Jhund","Lilin She","Christopher Adlbrecht","Torsten Doenst","Julio A Panza","James A Hill","Kerry L Lee","Jean L Rouleau","David L Prior","Imtiaz S Ali","Jyotsna Maddury","Krzysztof S Golba","Harvey D White","Peter Carson","Lukasz Chrzanowski","Alexander Romanov","Alan B Miller","Eric J Velazquez"],"significance":7,"published":"2016-11-01","source_date":"2016-11-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/","https://hartvaat.nl/kennis/hartfalen/hfpef-hartfalen-met-behouden-ejectie/"],"congress":"","summary_en":"This STICH 10-year analysis examined the interaction between patient age and the survival benefit of CABG in ischemic heart failure with reduced ejection fraction, informing revascularization decision-making in older heart failure patients.","created":"2026-07-03T10:26:23Z","updated":"2026-07-03T18:38:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"STICH-trial 10-jaarsanalyse naar de interactie tussen leeftijd en het voordeel van CABG bij patiënten met ischemisch hartfalen en verminderde ejectiefractie.","abstract_original":"BACKGROUND: Advancing age is associated with a greater prevalence of coronary artery disease in heart failure with reduced ejection fraction and with a higher risk of complications after coronary artery bypass grafting (CABG). Whether the efficacy of CABG compared with medical therapy (MED) in patients with heart failure caused by ischemic cardiomyopathy is the same in patients of different ages is unknown. METHODS: A total of 1212 patients (median follow-up, 9.8 years) with ejection fraction ≤35% and coronary disease amenable to CABG were randomized to CABG or MED in the STICH trial (Surgical Treatment for Ischemic Heart Failure). RESULTS: Mean age at trial entry was 60 years; 12% were women; 36% were nonwhite; and the baseline ejection fraction was 28%. For the present analyses, patients were categorized by age quartiles: quartile 1, ≤54 years; quartile, 2 >54 and ≤60 years; quartile 3, >60 and ≤67 years; and quartile 4, >67 years. Older versus younger patients had more comorbidities. All-cause mortality was higher in older compared with younger patients assigned to MED (79% versus 60% for quartiles 4 and 1, respectively; log-rank P=0.005) and CABG (68% versus 48% for quartiles 4 and 1, respectively; log-rank P<0.001). In contrast, cardiovascular mortality was not statistically significantly different across the spectrum of age in the MED group (53% versus 49% for quartiles 4 and 1, respectively; log-rank P=0.388) or CABG group (39% versus 35% for quartiles 4 and 1, respectively; log-rank P=0.103). Cardiovascular deaths accounted for a greater proportion of deaths in the youngest versus oldest quartile (79% versus 62%). The effect of CABG versus MED on all-cause mortality tended to diminish with increasing age (Pinteraction=0.062), whereas the benefit of CABG on cardiovascular mortality was consistent over all ages (Pinteraction=0.307). There was a greater reduction in all-cause mortality or cardiovascular hospitalization with CABG versus MED in younger compared with older patients (Pinteraction=0.004). In the CABG group, cardiopulmonary bypass time or days in intensive care did not differ for older versus younger patients. CONCLUSIONS: CABG added to MED has a more substantial benefit on all-cause mortality and the combination of all-cause mortality and cardiovascular hospitalization in younger compared with older patients. CABG added to MED has a consistent beneficial effect on cardiovascular mortality regardless of age. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00023595."},{"id":"ccd74d4eb41f","type":"article","url":"https://hartvaat.nl/2016/11/01/vochtstatustelemonitoring-bij-hartfalen-gerandomiseerde-trial/","title":"Vochtstatustelemonitoring bij hartfalen: gerandomiseerde trial","title_en":"Fluid status telemedicine alerts for heart failure: a randomized controlled trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["pathfinder-trial","step-hfpef"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw099","source_url":"https://doi.org/10.1093/eurheartj/ehw099","authors":["Michael Böhm","Helmut Drexler","Hanno Oswald","Karin Rybak","Ralph Bosch","Christian Butter","Gunnar Klein","Bart Gerritse","Joao Monteiro","Carsten Israel","Dieter Bimmel","Stefan Käab","Burkhard Huegl","Johannes Brachmann"],"significance":6,"published":"2016-11-01","source_date":"2016-11-01","image":"","kennis":[],"congress":"","summary_en":"This randomized trial evaluated telemonitoring of fluid status for early detection of heart failure decompensation, testing whether automated alerts based on thoracic impedance changes prevent hospitalizations.","created":"2026-07-03T10:26:23Z","updated":"2026-07-03T18:38:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial naar telemonitoring van vochtbalans als signalering voor hartfalendecompensatie. Onderzoekt of remote vochtstatusdetectie hospitalisaties kan voorkomen.","abstract_original":"AIMS: Hospital admissions are frequently preceded by increased pulmonary congestion in heart failure (HF) patients. This study evaluated whether early automated fluid status alert notification via telemedicine improves outcome in HF patients. METHODS AND RESULTS: Patients recently implanted with an implantable cardioverter defibrillator (ICD) with or without cardiac resynchronization therapy were eligible if one of three conditions was met: prior HF hospitalization, recent diuretic treatment, or recent brain natriuretic peptide increase. Eligible patients were randomized (1:1) to have fluid status alerts automatically transmitted as inaudible text message alerts to the responsible physician or to receive standard care (no alerts). In the intervention arm, following a telemedicine alert, a protocol-specified algorithm with remote review of device data and telephone contact was prescribed to assess symptoms and initiate treatment. The primary endpoint was a composite of all-cause death and cardiovascular hospitalization. We followed 1002 patients for an average of 1.9 years. The primary endpoint occurred in 227 patients (45.0%) in the intervention arm and 239 patients (48.1%) in the control arm [hazard ratio, HR, 0.87; 95% confidence interval (CI), 0.72-1.04; P = 0.13]. There were 59 (11.7%) deaths in the intervention arm and 63 (12.7%) in the control arm (HR, 0.89; 95% CI, 0.62-1.28; P = 0.52). Twenty-four per cent of alerts were not transmitted and 30% were followed by a medical intervention. CONCLUSION: Among ICD patients with advanced HF, fluid status telemedicine alerts did not significantly improve outcomes. Adherence to treatment protocols by physicians and patients might be challenge for further developments in the telemedicine field."},{"id":"c3d3329af499","type":"article","url":"https://hartvaat.nl/2016/11/01/rol-van-het-autonome-zenuwstelsel-bij-regulatie-van-aortastijfheid/","title":"Rol van het autonome zenuwstelsel bij regulatie van aortastijfheid","title_en":"The Role of the Autonomic Nervous System in the Regulation of Aortic Stiffness.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["aortainsufficiëntie","perifeer-vaatlijden"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.08035","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.08035","authors":["Kaisa M Mäki-Petäjä","Sharon M L Barrett","Sarah V Evans","Joseph Cheriyan","Carmel M McEniery","Ian B Wilkinson"],"significance":5,"published":"2016-11-01","source_date":"2016-11-01","image":"","kennis":[],"congress":"","summary_en":"This series of three studies investigated the autonomic nervous system's role in regulating aortic stiffness, showing that sympathetic activity directly contributes to arterial stiffening beyond its blood pressure effects.","created":"2026-07-03T10:26:23Z","updated":"2026-07-03T13:25:43Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de bijdrage van het autonome zenuwstelsel aan de regulatie van arteriële stijfheid. Mechanistisch inzicht in de neurale controle van vasculaire compliance.","abstract_original":"The autonomic nervous system is important in regulating blood pressure, but whether it regulates aortic stiffness is more contentious. We conducted 3 studies in young, healthy individuals to address this important question. Study 1 was a cross-sectional study of 347 subjects with detailed measurements of hemodynamics and heart rate variability. In study 2, 9 subjects were given a bolus of intravenous nicotinic ganglion blocker, pentolinium, or saline in a random order and hemodynamics and heart rate variability were assessed before and after. In study 3, changes in hemodynamics and heart rate variability were assessed during stimulation of the sympathetic nervous system with the use of isometric handgrip exercise in 12 subjects. Study 1: aortic pulse wave velocity (P=0.003) was lowest in the subjects with the highest parasympathetic activity, but after adjusting for mean arterial pressure, the effect was abolished (P=0.3). Study 2: after pentolinium, sympathetic and parasympathetic activity fell (P=0.001 for both), mean arterial pressure, and heart rate increased (P=0.004 and P=0.04, respectively), but there was no change in pulse wave velocity in comparison to placebo (P=0.1). Study 3: during handgrip exercise, sympathetic activity (P=0.003), mean arterial pressure (P<0.0001), and aortic pulse wave velocity increased (P=0.013). However, pulse wave velocity adjusted for mean arterial pressure did not change (P=0.1). The main finding of these studies is that in young healthy subjects, the autonomic nervous system does not have a pressure-independent role in the regulation of aortic stiffness. However, these findings may not apply to patients with increased sympathetic tone or hypertension."},{"id":"21a338a40026","type":"article","url":"https://hartvaat.nl/2016/11/01/chips-trial-is-ernstige-hypertensie-in-de-zwangerschap-meer-dan-alleen-verhoogde/","title":"CHIPS-trial: is ernstige hypertensie in de zwangerschap meer dan alleen verhoogde bloeddruk?","title_en":"The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study): Is Severe Hypertension Just an Elevated Blood Pressure?","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["bloeddrukbehandeling"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.07862","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.07862","authors":["Laura A Magee","Peter von Dadelszen","Joel Singer","Terry Lee","Evelyne Rey","Susan Ross","Elizabeth Asztalos","Kellie E Murphy","Jennifer Menzies","Johanna Sanchez","Amiram Gafni","Michael Helewa","Eileen Hutton","Gideon Koren","Shoo K Lee","Alexander G Logan","Wessel Ganzevoort","Ross Welch","Jim G Thornton","Jean-Marie Moutquin"],"significance":6,"published":"2016-11-01","source_date":"2016-11-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/esc-richtlijn-hypertensie-2024/","https://hartvaat.nl/kennis/hypertensie/classificatie-bloeddruk-esc-2024/"],"congress":"","summary_en":"This CHIPS analysis examined whether severe hypertension during pregnancy represents a distinct clinical phenotype with different treatment responses, providing nuanced guidance for managing the most dangerous pregnancy-related blood pressure elevations.","created":"2026-07-03T10:26:23Z","updated":"2026-07-03T18:38:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"CHIPS-analyse die onderzocht of ernstige hypertensie in de zwangerschap een ander klinisch fenotype vertegenwoordigt met specifieke risico's bovenop de bloeddrukhoogte.","abstract_original":"UNLABELLED: To determine whether clinical outcomes differed by occurrence of severe hypertension in the international CHIPS trial (Control of Hypertension in Pregnancy Study), adjusting for the interventions of \"less tight\" (target diastolic blood pressure [dBP] 100 mm Hg) versus \"tight\" control (target dBP 85 mm Hg). In this post-hoc analysis of CHIPS data from 987 women with nonsevere nonproteinuric preexisting or gestational hypertension, mixed effects logistic regression was used to compare the following outcomes according to occurrence of severe hypertension, adjusting for allocated group and the influence of baseline factors: CHIPS primary (perinatal loss or high-level neonatal care for >48 hours) and secondary outcomes (serious maternal complications), birth weight <10th percentile, preeclampsia, delivery at <34 or <37 weeks, platelets <100×109/L, elevated liver enzymes with symptoms, maternal length of stay ≥10 days, and maternal readmission before 6 weeks postpartum. Three hundred and thirty-four (34.1%) women in CHIPS developed severe hypertension that was associated with all outcomes examined except for maternal readmission (P=0.20): CHIPS primary outcome, birth weight <10th percentile, preeclampsia, preterm delivery, elevated liver enzymes (all P<0.001), platelets <100×109/L (P=0.006), and prolonged hospital stay (P=0.03). The association between severe hypertension and serious maternal complications was seen only in less tight control (P=0.02). Adjustment for preeclampsia (464, 47.3%) did not negate the relationship between severe hypertension and the CHIPS primary outcome (P<0.001), birth weight <10th percentile (P=0.005), delivery at <37 (P<0.001) or <34 weeks (P<0.001), or elevated liver enzymes with symptoms (P=0.02). Severe hypertension is a risk marker for adverse maternal and perinatal outcomes, independent of BP control or preeclampsia co-occurrence. CLINICAL TRIAL REGISTRATION: URL: http://pre-empt.cfri.ca/. Unique identifier: ISRCTN 71416914. URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01192412."},{"id":"f1db1229c69a","type":"article","url":"https://hartvaat.nl/2016/11/01/langetermijnmortaliteit-bij-hypertensie-met-coronairlijden-invest-us-cohort/","title":"Langetermijnmortaliteit bij hypertensie met coronairlijden: INVEST US-cohort","title_en":"Long-Term Mortality in Hypertensive Patients With Coronary Artery Disease: Results From the US Cohort of the International Verapamil (SR)/Trandolapril Study.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["bloeddrukbehandeling","farmaco-economie","sacubitril-valsartan"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.07854","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.07854","authors":["Islam Y Elgendy","Anthony A Bavry","Yan Gong","Eileen M Handberg","Rhonda M Cooper-DeHoff","Carl J Pepine"],"significance":6,"published":"2016-11-01","source_date":"2016-11-01","image":"","kennis":[],"congress":"","summary_en":"This long-term analysis of the US INVEST cohort showed that both excessively high and low achieved systolic blood pressure levels are associated with increased mortality in hypertensive coronary disease patients, informing the J-curve debate.","created":"2026-07-03T10:26:23Z","updated":"2026-07-03T18:38:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Langetermijnresultaten van het Amerikaanse INVEST-cohort naar mortaliteit bij hypertensieve patiënten met coronairlijden behandeld met verapamil versus atenolol.","abstract_original":"UNLABELLED: The dyad of hypertension and coronary artery disease is prevalent; however, data on systolic blood pressure (SBP) control and long-term all-cause mortality are lacking. Using extended follow-up data from the US cohort of the International Verapamil (SR)/Trandolapril Study (mean 11.6 years), subjects were categorized by age at enrollment (50 to <60 and ≥60 years). Cox proportional adjusted hazard ratios (HRs) were constructed for time to all-cause mortality according to achieved mean SBP. In those 50 to <60 years and using a referent SBP of <130 mm Hg, an achieved SBP of 130 to 140 mm Hg was associated with a similar risk of mortality (HR, 1.03; 95% confidence interval [CI], 0.87-1.23), whereas an achieved SBP of ≥140 mm Hg was associated with an increased risk of mortality (HR, 1.80; 95% CI, 1.53-2.11). Among subjects aged ≥60 years and using a referent SBP of <130 mm Hg, an achieved SBP 130 to 140 mm Hg was associated with a lower mortality risk (HR, 0.92; 95% CI, 0.85-0.98). There was an increased risk of mortality with an achieved SBP ≥150 mm Hg (HR, 1.34; 95% CI, 1.23-1.45), but not with an achieved SBP 140 to 150 mm Hg (HR, 1.02; 95% CI, 0.94-1.11). In hypertensive patients with coronary artery disease, achieving a SBP of 130 to 140 mm Hg seems to be associated with lower all-cause mortality after ≈11.6 years of follow-up. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00133692."},{"id":"aac19a011d29","type":"article","url":"https://hartvaat.nl/2016/11/01/arts-apotheker-samenwerkingsmodel-verkleint-sociaaleconomische-bloeddrukverschil/","title":"Arts-apotheker samenwerkingsmodel verkleint sociaaleconomische bloeddrukverschillen","title_en":"Physician-Pharmacist Collaborative Management: Narrowing the Socioeconomic Blood Pressure Gap.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","huisarts"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.08043","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.08043","authors":["Maxwell D Anderegg","Tyler H Gums","Liz Uribe","Christopher S Coffey","Paul A James","Barry L Carter"],"significance":6,"published":"2016-11-01","source_date":"2016-11-01","image":"","kennis":[],"congress":"","summary_en":"This study demonstrated that physician-pharmacist collaborative management improves blood pressure control specifically in socioeconomically disadvantaged populations, narrowing the disparities gap through team-based care.","created":"2026-07-03T10:26:23Z","updated":"2026-07-03T13:25:43Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die aantoont dat een samenwerkingsmodel tussen arts en apotheker de sociaaleconomische bloeddrukverschillen kan verkleinen. Pleit voor interdisciplinaire hypertensiezorg.","abstract_original":"UNLABELLED: Physician-pharmacist collaboration improves blood pressure, but there is little information on whether this model can reduce the gap in healthcare disparities. This trial involved 32 medical offices in 15 states. A clinical pharmacist was embedded within each office and made recommendations to physicians and patients in intervention offices. The purpose of the present analysis was to evaluate whether the pharmacist intervention could reduce healthcare disparities by improving blood pressure in high-risk racial and socioeconomic subjects compared with the control group. The analyses in minority subjects were prespecified secondary analyses, but all other comparisons were secondary, post hoc analyses. The 9-month visit was completed by 539 patients: 345 received the intervention, and 194 were in the control group. Following the intervention, mean systolic blood pressure was found to be 7.3 mm Hg (95% confidence interval 2.4, 12.3) lower in subjects from racial minority groups who received the intervention compared with the control group (P=0.0042). Subjects with ≤12 years of education in the intervention group had a systolic blood pressure 8.1 mm Hg (95% confidence interval 3.2, 13.1) lower than the control group with lower education (P=0.0001). Similar reductions in blood pressure occurred in patients with low incomes, those receiving Medicaid, or those without insurance. This study demonstrated that a pharmacist intervention reduced racial and socioeconomic disparities in the treatment of blood pressure. Although disparities in blood pressure were reduced by the intervention, there were still nonsignificant gaps in mean systolic blood pressure when compared with intervention subjects not at risk. CLINICAL TRIAL REGISTRATION: URL: http://clinicaltrials.gov. Unique identifier: NCT00935077."},{"id":"af7652afc086","type":"article","url":"https://hartvaat.nl/2016/11/01/therapieresistente-hypertensie-na-sprint-evaluatie-en-management/","title":"Therapieresistente hypertensie na SPRINT: evaluatie en management","title_en":"Resistant Hypertension: Insights on Evaluation and Management in the Post-SPRINT (Systolic Blood Pressure Intervention Trial) Era.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","farmaco-economie","niet-statine-therapie","resistente-hypertensie"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.07316","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.07316","authors":["Raymond R Townsend","Murray Epstein"],"significance":7,"published":"2016-11-01","source_date":"2016-11-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/"],"congress":"","summary_en":"This review discussed the evaluation and management of resistant hypertension in the context of SPRINT results, integrating intensive blood pressure targets with the diagnostic and therapeutic approach to treatment-resistant blood pressure.","created":"2026-07-03T10:26:23Z","updated":"2026-07-03T18:38:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Review over de evaluatie en behandeling van therapieresistente hypertensie in het post-SPRINT-tijdperk. Integreert de SPRINT-resultaten in het beleid bij patiënten die niet reageren op standaardbehandeling.","abstract_original":""},{"id":"63e1078adc2c","type":"article","url":"https://hartvaat.nl/2016/11/01/2016-esc-af-richtlijn-europace-editie/","title":"2016 ESC AF-richtlijn: Europace-editie","title_en":"2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["richtlijnen-esc"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euw295","source_url":"https://doi.org/10.1093/europace/euw295","authors":["Paulus Kirchhof","Stefano Benussi","Dipak Kotecha","Anders Ahlsson","Dan Atar","Barbara Casadei","Manuel Castella","Hans-Christoph Diener","Hein Heidbuchel","Jeroen Hendriks","Gerhard Hindricks","Antonis S Manolis","Jonas Oldgren","Bogdan Alexandru Popescu","Ulrich Schotten","Bart Van Putte","Panagiotis Vardas","Stefan Agewall","John Camm","Gonzalo Baron Esquivias","Werner Budts","Scipione Carerj","Filip Casselman","Antonio Coca","Raffaele De Caterina","Spiridon Deftereos","Dobromir Dobrev","José M Ferro","Gerasimos Filippatos","Donna Fitzsimons","Bulent Gorenek","Maxine Guenoun","Stefan H Hohnloser","Philippe Kolh","Gregory Y H Lip","Athanasios Manolis","John McMurray","Piotr Ponikowski","Raphael Rosenhek","Frank Ruschitzka","Irina Savelieva","Sanjay Sharma","Piotr Suwalski","Juan Luis Tamargo","Clare J Taylor","Isabelle C Van Gelder","Adriaan A Voors","Stephan Windecker","Jose Luis Zamorano","Katja Zeppenfeld"],"significance":8,"published":"2016-11-01","source_date":"2016-11-01","image":"","kennis":[],"congress":"","summary_en":"Simultaneous Europace publication of the 2016 ESC atrial fibrillation guidelines, ensuring broad dissemination to the electrophysiology community alongside the European Heart Journal publication.","created":"2026-07-03T10:26:23Z","updated":"2026-07-03T13:25:42Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Volledige publicatie van de 2016 ESC-richtlijn voor atriumfibrilleren in Europace. Gelijktijdige publicatie met de EHJ-versie voor maximale toegankelijkheid.","abstract_original":""},{"id":"a855a62c732d","type":"article","url":"https://hartvaat.nl/2016/11/01/flecainide-metoprolol-combinatie-vermindert-af-recidieven-1-jaarsresultaten/","title":"Flecaïnide-metoprolol combinatie vermindert AF-recidieven: 1-jaarsresultaten","title_en":"Flecainide-metoprolol combination reduces atrial fibrillation clinical recurrences and improves tolerability at 1-year follow-up in persistent symptomatic atrial fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euv462","source_url":"https://doi.org/10.1093/europace/euv462","authors":["Alessandro Capucci","Luca Piangerelli","Jenny Ricciotti","Domenico Gabrielli","Federico Guerra"],"significance":6,"published":"2016-11-01","source_date":"2016-11-01","image":"","kennis":[],"congress":"","summary_en":"This study showed that the flecainide-metoprolol combination reduces AF recurrence and improves tolerability compared with either agent alone, supporting a synergistic antiarrhythmic approach for paroxysmal atrial fibrillation.","created":"2026-07-03T10:26:22Z","updated":"2026-07-03T13:25:42Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die aantoont dat de combinatie flecaïnide-metoprolol het klinisch recidief van AF vermindert en de verdraagbaarheid verbetert na 1 jaar follow-up. Praktisch relevant voor de farmacologische ritmecontrolestrategie.","abstract_original":"AIMS: Atrial fibrillation (AF) affects ∼2% of the total population. In order to prevent AF recurrences, many anti-arrhythmic drugs are currently available, but most of them are burdened by serious side effects and suboptimal efficacy. The aim of the present study was to test efficacy and safety of a combination of flecainide and metoprolol in preventing AF clinical recurrences. METHODS AND RESULTS: This study is a monocentric, prospective, randomized, open-blinded trial on 173 patients with a recent episode of paroxysmal or persistent AF. Patients were randomized into group A (flecainide + metoprolol; n = 80), group B (flecainide only; n = 72), or group C (metoprolol only; n = 21). Main exclusion criteria were recent acute coronary syndrome, heart failure New York Heart Association class III-IV, left ventricular ejection fraction <0.40, atrioventricular conduction disorders, and severe bradycardia. Primary endpoint was symptomatic recurrence over 1-year follow-up. Secondary endpoint was quality of life (QoL) over 1-year follow-up, as assessed by the SF-36 and Atrial Fibrillation Severity Scale questionnaires. Combination therapy with flecainide and metoprolol significantly reduced recurrences at 1-year follow-up when compared with flecainide alone in the whole population (66.7 vs. 46.8%; P < 0.001) and in patients with persistent AF (71.1 vs. 43.6%; P = 0.025) while adding beta-blocker therapy to paroxysmal AF showed no benefit over IC anti-arrhythmic drug-only. Patients randomized to combination therapy experienced a significant improvement of QoL when compared with those assigned to a flecainide-only regimen irrespective of AF type. CONCLUSION: Flecainide-metoprolol combination therapy improves effectiveness of rhythm control in persistent symptomatic AF and increases tolerability, with a concomitant reduction of side effects and a better compliance."},{"id":"94f0bf17a7e3","type":"article","url":"https://hartvaat.nl/2016/10/25/aldosteronantagonisme-en-inspanningstolerantie-bij-hfpef/","title":"Aldosteronantagonisme en inspanningstolerantie bij HFpEF","title_en":"Effect of Aldosterone Antagonism on Exercise Tolerance in Heart Failure With Preserved Ejection Fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","bloeddrukbehandeling","eplerenon","hfpef","hfref","mra-aldosteronantagonisten","resistente-hypertensie","step-hfpef"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.07.763","source_url":"https://doi.org/10.1016/j.jacc.2016.07.763","authors":["Wojciech Kosmala","Aleksandra Rojek","Monika Przewlocka-Kosmala","Leah Wright","Andrzej Mysiak","Thomas H Marwick"],"significance":6,"published":"2016-10-25","source_date":"2016-10-25","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfpef-hartfalen-met-behouden-ejectie/","https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/"],"congress":"","summary_en":"This study evaluated the effect of aldosterone antagonism on exercise tolerance in HFpEF, showing modest improvement in functional capacity with spironolactone, supporting a role for MRA therapy in improving HFpEF symptoms.","created":"2026-07-03T10:26:22Z","updated":"2026-07-03T18:38:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar het effect van aldosteronantagonisme op inspanningstolerantie bij hartfalen met behouden ejectiefractie. Onderzoekt of mineralocorticoïdreceptorblokkade de functionele capaciteit bij HFpEF verbetert.","abstract_original":"BACKGROUND: Impaired functional capacity is a hallmark of patients with heart failure with preserved ejection fraction (HFpEF). Despite the association of HFpEF with reduced myocardial compliance attributed to fibrosis, spironolactone has not been shown to alter outcomes-perhaps reflecting the heterogeneity of underlying pathological mechanisms. OBJECTIVES: The authors sought to identify improvement in exercise capacity with spironolactone in the subset of patients with HFpEF with exercise-induced increase in ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e') reflecting elevation of left ventricular (LV) filling pressure. METHODS: In this randomized, blinded, parallel-group, placebo-controlled trial, 150 subjects (age 67 ± 9 years) with exertional dyspnea (New York Heart Association functional class II to III, left ventricular ejection fraction >50%, diastolic dysfunction, and exertional E/e' >13), excluding those with ischemic heart disease, were recruited in a tertiary cardiology center. Patients were randomized to 6 months of oral spironolactone 25 mg/day or matching placebo. Primary outcomes were improvements in peak oxygen uptake (VO2) and exertional E/e' ratio, and secondary outcomes were improvements in exercise blood pressure response and global LV longitudinal strain. RESULTS: At follow-up, 131 patients completed therapy-64 taking spironolactone and 67 placebo. At baseline, subjects had substantial exercise limitation (peak VO2 64 ± 17% predicted). The spironolactone group showed improvement in exercise capacity (increment in peak VO2 [2.9 ml/min/kg (95% confidence interval [CI]: 1.9 to 3.9 ml/min/kg) vs. 0.3 ml/min/kg (95% CI: -0.5 to 1.1 ml/min/kg); p < 0.001], anaerobic threshold [2.0 ml/min/kg (95% CI: 0.9 to 3.2 ml/min/kg) vs. -0.9 ml/min/kg (95% CI: -3.4 to 1.6 ml/min/kg); p = 0.03], and O2 uptake efficiency [0.19 (95% CI: 0.06 to 0.31) vs. -0.07 (95% CI: -0.17 to 0.04); p = 0.002]), with reduction in exercise-induced increase in E/e' (-3.0 [95% CI: -3.9 to -2.0] vs. 0.5 [95% CI: -0.6 to 1.6]; p < 0.001). There was a significant interaction of spironolactone and change in E/e' on VO2 (p = 0.039). CONCLUSIONS: In patients with HFpEF and abnormal diastolic response to exertion, improvement in exercise E/e' mediates the beneficial effect of spironolactone on exercise capacity. Identification of exercise-induced increase in LV filling pressure in patients with HFpEF may define a subgroup with warranting trial of spironolactone."},{"id":"b8136f2c0d44","type":"article","url":"https://hartvaat.nl/2016/10/22/edoxaban-versus-enoxaparine-warfarine-bij-cardioversie-van-af-ensure-af-trial/","title":"Edoxaban versus enoxaparine-warfarine bij cardioversie van AF: ENSURE-AF-trial","title_en":"Edoxaban versus enoxaparin-warfarin in patients undergoing cardioversion of atrial fibrillation (ENSURE-AF): a randomised, open-label, phase 3b trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["emperor-trials"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(16)31474-X","source_url":"https://doi.org/10.1016/S0140-6736(16)31474-X","authors":["Andreas Goette","Jose L Merino","Michael D Ezekowitz","Dmitry Zamoryakhin","Michael Melino","James Jin","Michele F Mercuri","Michael A Grosso","Victor Fernandez","Naab Al-Saady","Natalya Pelekh","Bela Merkely","Sergey Zenin","Mykola Kushnir","Jindrich Spinar","Valeriy Batushkin","Joris R de Groot","Gregory Y H Lip"],"significance":7,"published":"2016-10-22","source_date":"2016-10-22","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doacs-overzicht/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"The ENSURE-AF randomized trial demonstrated that edoxaban is comparable to enoxaparin-warfarin for the prevention of cardiovascular events in patients with AF undergoing cardioversion, simplifying the anticoagulation approach around electrical cardioversion.","created":"2026-07-03T10:26:22Z","updated":"2026-07-03T13:25:42Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet gerandomiseerde ENSURE-AF-trial die edoxaban vergeleek met enoxaparine-warfarine bij patiënten die cardioversie voor AF ondergaan. Onderbouwt het gebruik van DOAC's rond cardioversie.","abstract_original":"BACKGROUND: Edoxaban, an oral factor Xa inhibitor, is non-inferior for prevention of stroke and systemic embolism in patients with atrial fibrillation and is associated with less bleeding than well controlled warfarin therapy. Few safety data about edoxaban in patients undergoing electrical cardioversion are available. METHODS: We did a multicentre, prospective, randomised, open-label, blinded-endpoint evaluation trial in 19 countries with 239 sites comparing edoxaban 60 mg per day with enoxaparin-warfarin in patients undergoing electrical cardioversion of non-valvular atrial fibrillation. The dose of edoxaban was reduced to 30 mg per day if one or more factors (creatinine clearance 15-50 mL/min, low bodyweight [≤60 kg], or concomitant use of P-glycoprotein inhibitors) were present. Block randomisation (block size four)-stratified by cardioversion approach (transoesophageal echocardiography [TEE] or not), anticoagulant experience, selected edoxaban dose, and region-was done through a voice-web system. The primary efficacy endpoint was a composite of stroke, systemic embolic event, myocardial infarction, and cardiovascular mortality, analysed by intention to treat. The primary safety endpoint was major and clinically relevant non-major (CRNM) bleeding in patients who received at least one dose of study drug. Follow-up was 28 days on study drug after cardioversion plus 30 days to assess safety. This trial is registered with ClinicalTrials.gov, number NCT02072434. FINDINGS: Between March 25, 2014, and Oct 28, 2015, 2199 patients were enrolled and randomly assigned to receive edoxaban (n=1095) or enoxaparin-warfarin (n=1104). The mean age was 64 years (SD 10·54) and mean CHA2DS2-VASc score was 2·6 (SD 1·4). Mean time in therapeutic range on warfarin was 70·8% (SD 27·4). The primary efficacy endpoint occurred in five (<1%) patients in the edoxaban group versus 11 (1%) in the enoxaparin-warfarin group (odds ratio [OR] 0·46, 95% CI 0·12-1·43). The primary safety endpoint occurred in 16 (1%) of 1067 patients given edoxaban versus 11 (1%) of 1082 patients given enoxaparin-warfarin (OR 1·48, 95% CI 0·64-3·55). The results were independent of the TEE-guided strategy and anticoagulation status. INTERPRETATION: ENSURE-AF is the largest prospective randomised clinical trial of anticoagulation for cardioversion of patients with non-valvular atrial fibrillation. Rates of major and CRNM bleeding and thromboembolism were low in the two treatment groups. FUNDING: Daiichi Sankyo provided financial support for the study."},{"id":"68f428612808","type":"article","url":"https://hartvaat.nl/2016/10/22/plaatjesfunctiemonitoring-voor-antiplaatjesaanpassing-bij-oudere-acs-patienten-a/","title":"Plaatjesfunctiemonitoring voor antiplaatjesaanpassing bij oudere ACS-patiënten: ANTARCTIC-trial","title_en":"Platelet function monitoring to adjust antiplatelet therapy in elderly patients stented for an acute coronary syndrome (ANTARCTIC): an open-label, blinded-endpoint, randomised controlled superiority trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(16)31323-X","source_url":"https://doi.org/10.1016/S0140-6736(16)31323-X","authors":["Guillaume Cayla","Thomas Cuisset","Johanne Silvain","Florence Leclercq","Stephane Manzo-Silberman","Christophe Saint-Etienne","Nicolas Delarche","Anne Bellemain-Appaix","Grégoire Range","Rami El Mahmoud","Didier Carrié","Loic Belle","Geraud Souteyrand","Pierre Aubry","Pierre Sabouret","Xavier Halna du Fretay","Farzin Beygui","Jean-Louis Bonnet","Benoit Lattuca","Christophe Pouillot","Olivier Varenne","Ziad Boueri","Eric Van Belle","Patrick Henry","Pascal Motreff","Simon Elhadad","Joe-Elie Salem","Jérémie Abtan","Hélène Rousseau","Jean-Philippe Collet","Eric Vicaut","Gilles Montalescot"],"significance":7,"published":"2016-10-22","source_date":"2016-10-22","image":"","kennis":[],"congress":"","summary_en":"The ANTARCTIC randomized trial showed that platelet function-guided adjustment of antiplatelet therapy in elderly patients with ACS after stenting did not improve clinical outcomes compared with standard treatment, arguing against routine platelet function monitoring.","created":"2026-07-03T10:26:22Z","updated":"2026-07-03T13:25:42Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet gerandomiseerde ANTARCTIC-trial die plaatjesfunctiegeleide aanpassing van antiplaatjestherapie vergeleek met standaardbehandeling bij oudere (≥75 jaar) ACS-patiënten na stenting.","abstract_original":"BACKGROUND: Elderly patients are at high risk of ischaemic and bleeding events. Platelet function monitoring offers the possibility to individualise antiplatelet therapy to improve the therapeutic risk-benefit ratio. We aimed to assess the effect of platelet function monitoring with treatment adjustment in elderly patients stented for an acute coronary syndrome. METHODS: We did this multicentre, open-label, blinded-endpoint, randomised controlled superiority study at 35 centres in France. Patients aged 75 years or older who had undergone coronary stenting for acute coronary syndrome were randomly assigned (1:1), via a central interactive voice-response system based on a computer-generated permuted-block randomisation schedule with randomly selected block sizes, to receive oral prasugrel 5 mg daily with dose or drug adjustment in case of inadequate response (monitoring group) or oral prasugrel 5 mg daily with no monitoring or treatment adjustment (conventional group). Randomisation was stratified by centre. Platelet function testing was done 14 days after randomisation and repeated 14 days after treatment adjustment in patients in the monitoring group. Study investigators and patients were not masked to treatment allocation, but allocation was concealed from an independent clinical events committee responsible for endpoint adjudication. The primary endpoint was a composite of cardiovascular death, myocardial infarction, stroke, stent thrombosis, urgent revascularisation, and Bleeding Academic Research Consortium-defined bleeding complications (types 2, 3, or 5) at 12 months' follow-up. We did analysis by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01538446. FINDINGS: Between March 27, 2012, and May 19, 2015, we randomly assigned 877 patients to the monitoring group (n=442) or the conventional group (n=435). The primary endpoint occurred in 120 (28%) patients in the monitoring group compared with 123 (28%) patients in the conventional group (hazard ratio [HR], 1·003, 95% CI 0·78-1·29; p=0·98). Rates of bleeding events did not differ significantly between groups. INTERPRETATION: Platelet function monitoring with treatment adjustment did not improve the clinical outcome of elderly patients treated with coronary stenting for an acute coronary syndrome. Platelet function testing is still being used in many centres and international guidelines still recommend platelet function testing in high-risk situations. Our study does not support this practice or these recommendations. FUNDING: Eli Lilly and Company, Daiichi Sankyo, Stentys, Accriva Diagnostics, Medtronic, and Fondation Coeur et Recherche."},{"id":"e679a1f8052c","type":"article","url":"https://hartvaat.nl/2016/10/18/canakinumab-en-arteriele-effecten-bij-atherosclerose-met-diabetes-of-glucosetole/","title":"Canakinumab en arteriële effecten bij atherosclerose met diabetes of glucosetolerantiestoornis","title_en":"Arterial Effects of Canakinumab in Patients With Atherosclerosis and Type 2 Diabetes or Glucose Intolerance.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["canagliflozine","diabetes-en-hart","diabetes-type-1","diabetes-type-2","ezetimibe","figaro-dkd","soul-trial"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.07.768","source_url":"https://doi.org/10.1016/j.jacc.2016.07.768","authors":["Robin P Choudhury","Jacqueline S Birks","Venkatesh Mani","Luca Biasiolli","Matthew D Robson","Philippe L L'Allier","Marc-Alexandre Gingras","Nadia Alie","Mary Ann McLaughlin","Craig T Basson","Alison D Schecter","Eric C Svensson","Yiming Zhang","Denise Yates","Jean-Claude Tardif","Zahi A Fayad"],"significance":7,"published":"2016-10-18","source_date":"2016-10-18","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"This study examined the arterial effects of canakinumab (IL-1β inhibitor) in patients with atherosclerosis and type 2 diabetes, assessing whether anti-inflammatory therapy produces measurable changes in arterial wall inflammation and plaque composition.","created":"2026-07-03T10:26:22Z","updated":"2026-07-03T13:25:42Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de arteriële effecten van canakinumab (IL-1β-remmer) bij patiënten met atherosclerose en diabetes of gestoorde glucosetolerantie. Voorbode van de latere CANTOS-trial die de inflammatiehypothese bevestigde.","abstract_original":"BACKGROUND: Evidence suggests that interleukin (IL)-1β is important in the pathogenesis of atherosclerosis and its complications and that inhibiting IL-1β may favorably affect vascular disease progression. OBJECTIVES: The goal of this study was to evaluate the effects of IL-1β inhibition with canakinumab versus placebo on arterial structure and function, determined by magnetic resonance imaging. METHODS: Patients (N = 189) with atherosclerotic disease and either type 2 diabetes mellitus or impaired glucose tolerance were randomized to receive placebo (n = 94) or canakinumab 150 mg monthly (n = 95) for 12 months. They underwent magnetic resonance imaging of the carotid arteries and aorta. RESULTS: There were no statistically significant differences between canakinumab compared with placebo in the primary efficacy and safety endpoints. There was no statistically significant change in mean carotid wall area and no effect on aortic distensibility, measured at 3 separate anatomic sites. The change in mean carotid artery wall area was -3.37 mm2 after 12 months with canakinumab versus placebo. High-sensitivity C-reactive protein was significantly reduced by canakinumab compared with placebo at 3 months (geometric mean ratio [GMR]: 0.568; 95% confidence interval [CI]: 0.436 to 0.740; p < 0.0001) and 12 months (GMR: 0.56; 95% CI: 0.414 to 0.758; p = 0.0002). Lipoprotein(a) levels were reduced by canakinumab compared with placebo (-4.30 mg/dl [range: -8.5 to -0.55 mg/dl]; p = 0.025] at 12 months), but triglyceride levels increased (GMR: 1.20; 95% CI: 1.046 to 1.380; p = 0.01). In these patients with type 2 diabetes mellitus or impaired glucose tolerance, canakinumab had no effect compared with placebo on any of the measures assessed by using a standard oral glucose tolerance test. CONCLUSIONS: There were no statistically significant effects of canakinumab on measures of vascular structure or function. Canakinumab reduced markers of inflammation (high-sensitivity C-reactive protein and interleukin-6), and there were modest increases in levels of total cholesterol and triglycerides. (Safety & Effectiveness on Vascular Structure and Function of ACZ885 in Atherosclerosis and Either T2DM or IGT Patients; NCT00995930)."},{"id":"45df390f6c97","type":"article","url":"https://hartvaat.nl/2016/10/18/high-flow-neuscanule-versus-non-invasieve-ventilatie-na-extubatie-jama-trial/","title":"High-flow neuscanule versus non-invasieve ventilatie na extubatie: JAMA-trial","title_en":"Effect of Postextubation High-Flow Nasal Cannula vs Noninvasive Ventilation on Reintubation and Postextubation Respiratory Failure in High-Risk Patients: A Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2016.14194","source_url":"https://doi.org/10.1001/jama.2016.14194","authors":["Gonzalo Hernández","Concepción Vaquero","Laura Colinas","Rafael Cuena","Paloma González","Alfonso Canabal","Susana Sanchez","Maria Luisa Rodriguez","Ana Villasclaras","Rafael Fernández"],"significance":7,"published":"2016-10-18","source_date":"2016-10-18","image":"","kennis":[],"congress":"","summary_en":"This JAMA trial compared high-flow nasal cannula with noninvasive ventilation for preventing reintubation and postextubation respiratory failure, informing respiratory support strategies in critically ill patients including those with cardiac conditions.","created":"2026-07-03T10:26:22Z","updated":"2026-07-03T13:25:42Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA-trial die high-flow neuscanule vergeleek met non-invasieve ventilatie voor preventie van reïntubatie en respiratoir falen na extubatie. Relevant voor de IC-setting bij hartfalenpatiënten.","abstract_original":"IMPORTANCE: High-flow conditioned oxygen therapy delivered through nasal cannulae and noninvasive mechanical ventilation (NIV) may reduce the need for reintubation. Among the advantages of high-flow oxygen therapy are comfort, availability, lower costs, and additional physiopathological mechanisms. OBJECTIVE: To test if high-flow conditioned oxygen therapy is noninferior to NIV for preventing postextubation respiratory failure and reintubation in patients at high risk of reintubation. DESIGN, SETTING, AND PARTICIPANTS: Multicenter randomized clinical trial in 3 intensive care units in Spain (September 2012-October 2014) including critically ill patients ready for planned extubation with at least 1 of the following high-risk factors for reintubation: older than 65 years; Acute Physiology and Chronic Health Evaluation II score higher than 12 points on extubation day; body mass index higher than 30; inadequate secretions management; difficult or prolonged weaning; more than 1 comorbidity; heart failure as primary indication for mechanical ventilation; moderate to severe chronic obstructive pulmonary disease; airway patency problems; or prolonged mechanical ventilation. INTERVENTIONS: Patients were randomized to undergo either high-flow conditioned oxygen therapy or NIV for 24 hours after extubation. MAIN OUTCOMES AND MEASURES: Primary outcomes were reintubation and postextubation respiratory failure within 72 hours. Noninferiority margin was 10 percentage points. Secondary outcomes included respiratory infection, sepsis, and multiple organ failure, length of stay and mortality; adverse events; and time to reintubation. RESULTS: Of 604 patients (mean age, 65 [SD, 16] years; 388 [64%] men), 314 received NIV and 290 high-flow oxygen. Sixty-six patients (22.8%) in the high-flow group vs 60 (19.1%) in the NIV group were reintubation (absolute difference, -3.7%; 95% CI, -9.1% to ∞); 78 patients (26.9%) in the high-flow group vs 125 (39.8%) in the NIV group experienced postextubation respiratory failure (risk difference, 12.9%; 95% CI, 6.6% to ∞) [corrected]. Median time to reintubation did not significantly differ: 26.5 hours (IQR, 14-39 hours) in the high-flow group vs 21.5 hours (IQR, 10-47 hours) in the NIV group (absolute difference, -5 hours; 95% CI, -34 to 24 hours). Median postrandomization ICU length of stay was lower in the high-flow group, 3 days (IQR, 2-7) vs 4 days (IQR, 2-9; P=.048). Other secondary outcomes were similar in the 2 groups. Adverse effects requiring withdrawal of the therapy were observed in none of patients in the high-flow group vs 42.9% patients in the NIV group (P < .001). CONCLUSIONS AND RELEVANCE: Among high-risk adults who have undergone extubation, high-flow conditioned oxygen therapy was not inferior to NIV for preventing reintubation and postextubation respiratory failure. High-flow conditioned oxygen therapy may offer advantages for these patients. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01191489."},{"id":"ab71ee9deb1c","type":"article","url":"https://hartvaat.nl/2016/10/15/vroeg-invasief-versus-conservatief-bij-nste-acs-15-jaarsfollow-up-frisc-ii/","title":"Vroeg invasief versus conservatief bij NSTE-ACS: 15-jaarsfollow-up FRISC-II","title_en":"Early invasive versus non-invasive treatment in patients with non-ST-elevation acute coronary syndrome (FRISC-II): 15 year follow-up of a prospective, randomised, multicentre study.","category":"preventie","category_label":"Preventie","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(16)31276-4","source_url":"https://doi.org/10.1016/S0140-6736(16)31276-4","authors":["Lars Wallentin","Lars Lindhagen","Elisabet Ärnström","Steen Husted","Magnus Janzon","Søren Paaske Johnsen","Frederic Kontny","Tibor Kempf","Lars-Åke Levin","Bertil Lindahl","Mats Stridsberg","Elisabeth Ståhle","Per Venge","Kai C Wollert","Eva Swahn","Bo Lagerqvist"],"significance":8,"published":"2016-10-15","source_date":"2016-10-15","image":"","kennis":[],"congress":"","summary_en":"The 15-year FRISC-II follow-up, one of the longest from any ACS trial, demonstrated sustained survival benefit of an early invasive strategy in patients with non-ST-elevation acute coronary syndrome. The durable result reinforced the importance of early invasive management.","created":"2026-07-03T10:26:22Z","updated":"2026-07-03T13:25:42Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet 15-jaarsfollow-up van de FRISC-II-trial — een van de langste follow-upperiodes voor de vergelijking van vroeg invasieve versus conservatieve strategie bij NSTE-ACS. Historisch perspectief op de waarde van vroege interventie.","abstract_original":"BACKGROUND: The FRISC-II trial was the first randomised trial to show a reduction in death or myocardial infarction with an early invasive versus a non-invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome. Here we provide a remaining lifetime perspective on the effects on all cardiovascular events during 15 years' follow-up. METHODS: The FRISC-II prospective, randomised, multicentre trial was done at 58 Scandinavian centres in Sweden, Denmark, and Norway. Between June 17, 1996, and Aug 28, 1998, we randomly assigned (1:1) 2457 patients with non-ST-elevation acute coronary syndrome to an early invasive treatment strategy, aiming for revascularisation within 7 days, or a non-invasive strategy, with invasive procedures at recurrent symptoms or severe exercise-induced ischaemia. Plasma for biomarker analyses was obtained at randomisation. For long-term outcomes, we linked data with national health-care registers. The primary endpoint was a composite of death or myocardial infarction. Outcomes were compared as the average postponement of the next event, including recurrent events, calculated as the area between mean cumulative count-of-events curves. Analyses were done by intention to treat. FINDINGS: At a minimum of 15 years' follow-up on Dec 31, 2014, data for survival status and death were available for 2421 (99%) of the initially recruited 2457 patients, and for other events after 2 years for 2182 (89%) patients. During follow-up, the invasive strategy postponed death or next myocardial infarction by a mean of 549 days (95% CI 204-888; p=0·0020) compared with the non-invasive strategy. This effect was larger in non-smokers (mean gain 809 days, 95% CI 402-1175; pinteraction=0·0182), patients with elevated troponin T (778 days, 357-1165; pinteraction=0·0241), and patients with high concentrations of growth differentiation factor-15 (1356 days, 507-1650; pinteraction=0·0210). The difference was mainly driven by postponement of new myocardial infarction, whereas the early difference in mortality alone was not sustained over time. The invasive strategy led to a mean of 1128 days (95% CI 830-1366) postponement of death or next readmission to hospital for ischaemic heart disease, which was consistent in all subgroups (p<0·0001). INTERPRETATION: During 15 years of follow-up, an early invasive treatment strategy postponed the occurrence of death or next myocardial infarction by an average of 18 months, and the next readmission to hospital for ischaemic heart disease by 37 months, compared with a non-invasive strategy in patients with non-ST-elevation acute coronary syndrome. This remaining lifetime perspective supports that an early invasive treatment strategy should be the preferred option in most patients with non-ST-elevation acute coronary syndrome. FUNDING: Swedish Heart-Lung Foundation, Swedish Foundation for Strategic Research, and Uppsala Clinical Research Center."},{"id":"b439ebe42083","type":"article","url":"https://hartvaat.nl/2016/10/14/de-tien-geboden-van-de-2016-esc-eas-dyslipidemierichtlijn/","title":"De 'Tien Geboden' van de 2016 ESC/EAS dyslipidemierichtlijn","title_en":"'Ten Commandments' from the 2016 ESC/EAS Guidelines for the management of dyslipidaemias.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts","internist"],"tags":["dyslipidemie","ezetimibe","familiaire-hypercholesterolemie-screening","ldl-cholesterol","lipidenverlaging","niet-statine-therapie","statines"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw415","source_url":"https://doi.org/10.1093/eurheartj/ehw415","authors":[],"significance":8,"published":"2016-10-14","source_date":"2016-10-14","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/esc-richtlijn-dyslipidemie-2019/"],"congress":"","summary_en":"This concise summary distilled the ten key clinical messages from the 2016 ESC/EAS dyslipidaemia guidelines, covering risk-based LDL targets, statin intensity, and the role of emerging non-statin therapies including PCSK9 inhibitors.","created":"2026-07-03T10:26:22Z","updated":"2026-07-03T13:25:42Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Beknopte samenvatting van de tien belangrijkste boodschappen uit de 2016 ESC/EAS-richtlijn voor dyslipidemieën. Kernboodschappen voor de dagelijkse lipidenpraktijk.","abstract_original":""},{"id":"07638eda30e9","type":"article","url":"https://hartvaat.nl/2016/10/14/2016-esc-eas-richtlijn-voor-het-management-van-dyslipidemieen/","title":"2016 ESC/EAS-richtlijn voor het management van dyslipidemieën","title_en":"2016 ESC/EAS Guidelines for the Management of Dyslipidaemias.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["dyslipidemie","ezetimibe","ldl-cholesterol","lipidenverlaging","niet-statine-therapie","richtlijnen-esc","statines"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw272","source_url":"https://doi.org/10.1093/eurheartj/ehw272","authors":["Alberico L Catapano","Ian Graham","Guy De Backer","Olov Wiklund","M John Chapman","Heinz Drexel","Arno W Hoes","Catriona S Jennings","Ulf Landmesser","Terje R Pedersen","Željko Reiner","Gabriele Riccardi","Marja-Riita Taskinen","Lale Tokgozoglu","W M Monique Verschuren","Charalambos Vlachopoulos","David A Wood","Jose Luis Zamorano","Marie-Therese Cooney"],"significance":10,"published":"2016-10-14","source_date":"2016-10-14","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/esc-richtlijn-dyslipidemie-2019/","https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/"],"congress":"","summary_en":"The 2016 ESC/EAS Guidelines for dyslipidaemia management defined risk-stratified LDL-cholesterol targets and treatment strategies including high-intensity statins and emerging therapies such as PCSK9 inhibitors. This framework established the treat-to-target paradigm that underpins contemporary lipid-lowering practice.","created":"2026-07-03T10:26:22Z","updated":"2026-07-03T13:25:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De ESC/EAS-richtlijn 2016 voor dyslipidemie — het standaardwerk dat streefwaarden en behandelstrategieën definieerde voor LDL-cholesterolverlaging. Introduceerde risicogecategoriseerde doelen en nieuwe medicamenteuze opties.","abstract_original":""},{"id":"ec47fea92ad2","type":"article","url":"https://hartvaat.nl/2016/10/14/geen-effect-van-pcsk9-remmer-alirocumab-op-diabetes-incidentie-odyssey-analyse/","title":"Geen effect van PCSK9-remmer alirocumab op diabetes-incidentie: ODYSSEY-analyse","title_en":"No effect of PCSK9 inhibitor alirocumab on the incidence of diabetes in a pooled analysis from 10 ODYSSEY Phase 3 studies.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["diabetes-en-hart","fidelio-dkd","figaro-dkd","pcsk9-remmers-nieuwe-generatie","select-trial","soul-trial"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw292","source_url":"https://doi.org/10.1093/eurheartj/ehw292","authors":["Helen M Colhoun","Henry N Ginsberg","Jennifer G Robinson","Lawrence A Leiter","Dirk Müller-Wieland","Robert R Henry","Bertrand Cariou","Marie T Baccara-Dinet","Robert Pordy","Laurence Merlet","Robert H Eckel"],"significance":7,"published":"2016-10-14","source_date":"2016-10-14","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/pcsk9-remmers-evolocumab-alirocumab/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This pooled analysis of 10 ODYSSEY phase 3 studies found no increased incidence of diabetes with alirocumab, providing reassurance that PCSK9 inhibitors do not share the diabetogenic effect observed with statins.","created":"2026-07-03T10:26:21Z","updated":"2026-07-03T13:25:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gepoolde analyse van 10 ODYSSEY fase-3-studies die geen verhoogde incidentie van diabetes aantoonde bij alirocumabgebruik. Geruststellend voor de metabole veiligheid van PCSK9-remmers.","abstract_original":"AIMS: Statins have modest adverse effects on glycaemic control. Alirocumab, a proprotein convertase subtilisin/kexin type 9 inhibitor, lowers low-density lipoprotein cholesterol. This study assessed the effects of alirocumab on new-onset diabetes and pre-diabetes incidence in individuals without diabetes at baseline. METHODS AND RESULTS: Pooled analysis of 10 ODYSSEY Phase 3 trials (n = 4974) of 24-104 weeks duration. Six trials (n = 4211) were ≥52 weeks in length. Most patients received background maximally tolerated statin. Alirocumab effect on the rate of diabetes-related treatment-emergent adverse events (TEAEs), and/or fasting plasma glucose (FPG) and glycated haemoglobin A1C (HbA1C) was measured at baseline and every 12-24 weeks. Transition to diabetes analysis combined TEAE and FPG/HbA1C laboratory data. At baseline, 30.7% of individuals had diabetes and were excluded from the current analysis. The remaining 3448 individuals without diabetes had pre-diabetes (39.6%) or were normoglycaemic (29.7%). The hazard ratio (HR; 95% confidence interval) for diabetes-related TEAEs in alirocumab was 0.64 (0.36-1.14) vs. placebo and 0.55 (0.22-1.41) vs. ezetimibe. The HR associated for transition from pre-diabetes to new-onset diabetes for alirocumab was 0.90 (0.63-1.29) vs. placebo and 1.10 (0.57-2.12) vs. ezetimibe. Mean change in FPG/HbA1C over time showed no difference between treatment groups in patients without diabetes. CONCLUSIONS: There was no evidence of an effect of alirocumab on transition to new-onset diabetes in 3448 individuals without diabetes at baseline with a follow-up period of 6-18 months, compared to either placebo or ezetimibe. Longer follow-up with larger number of individuals is needed to conclusively rule out an effect."},{"id":"5afd70b80e4b","type":"article","url":"https://hartvaat.nl/2016/10/11/pci-van-chronische-totale-occlusie-bij-stemi-met-multivatenlijden-explore-trial/","title":"PCI van chronische totale occlusie bij STEMI met multivatenlijden: EXPLORE-trial","title_en":"Percutaneous Intervention for Concurrent Chronic Total Occlusions in Patients With STEMI: The EXPLORE Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.07.744","source_url":"https://doi.org/10.1016/j.jacc.2016.07.744","authors":["José P S Henriques","Loes P Hoebers","Truls Råmunddal","Peep Laanmets","Erlend Eriksen","Matthijs Bax","Dan Ioanes","Maarten J Suttorp","Bradley H Strauss","Emanuele Barbato","Robin Nijveldt","Albert C van Rossum","Koen M Marques","Joëlle Elias","Ivo M van Dongen","Bimmer E P M Claessen","Jan G Tijssen","René J van der Schaaf"],"significance":7,"published":"2016-10-11","source_date":"2016-10-11","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/coronairlijden/wat-is-coronairlijden/"],"congress":"","summary_en":"The EXPLORE trial investigated whether PCI of a concurrent chronic total occlusion in a non-infarct-related artery improves outcomes in STEMI patients who have already undergone primary PCI of the culprit lesion.","created":"2026-07-03T10:26:21Z","updated":"2026-07-03T13:25:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde EXPLORE-trial die onderzocht of aanvullende PCI van een chronische totale occlusie voordeel biedt bij STEMI-patiënten met multivatencoronairlijden.","abstract_original":"BACKGROUND: In 10% to 15% of patients with ST-segment elevation myocardial infarction (STEMI), concurrent coronary chronic total occlusion (CTO) in a non-infarct-related artery is present and is associated with increased morbidity and mortality. OBJECTIVES: The EXPLORE (Evaluating Xience and Left Ventricular Function in Percutaneous Coronary Intervention on Occlusions After ST-Elevation Myocardial Infarction) trial evaluated whether patients with STEMI and concurrent CTO in a non-infarct-related artery benefit from additional percutaneous coronary intervention (PCI) of CTO shortly after primary PCI. METHODS: From November 2007 through April 2015, we enrolled 304 patients with acute STEMI who underwent primary PCI and had concurrent CTO in 14 centers in Europe and Canada. A total of 150 patients were randomly assigned to early PCI of the CTO (CTO PCI), and 154 patients were assigned to conservative treatment without PCI of the CTO (no CTO PCI). Primary outcomes were left ventricular ejection fraction (LVEF) and left ventricular end diastolic volume (LVEDV) on cardiac magnetic resonance imaging after 4 months. RESULTS: The investigator-reported procedural success rate in the CTO PCI arm of the trial was 77%, and the adjudicated success rate was 73%. At 4 months, mean LVEF did not differ between the 2 groups (44.1 ± 12.2% vs. 44.8 ± 11.9%, respectively; p = 0.60). Mean LVEDV at 4 months was 215.6 ± 62.5 ml in the CTO PCI arm versus 212.8 ± 60.3 ml in the no-CTO PCI arm (p = 0.70). Subgroup analysis revealed that patients with CTO located in the left anterior descending coronary artery who were randomized to the CTO PCI strategy had significantly higher LVEF compared with patients randomized to the no-CTO PCI strategy (47.2 ± 12.3% vs. 40.4 ± 11.9%; p = 0.02). There were no differences in terms of 4-month major adverse coronary events (5.4% vs. 2.6%; p = 0.25). CONCLUSIONS: Additional CTO PCI within 1 week after primary PCI for STEMI was feasible and safe. In patients with STEMI and concurrent CTO, we did not find an overall benefit for CTO PCI in terms of LVEF or LVEDV. The finding that early CTO PCI in the left anterior descending coronary artery subgroup was beneficial warrants further investigation. (Evaluating Xience and Left Ventricular Function in Percutaneous Coronary Intervention on Occlusions After ST-Segment Elevation Myocardial Infarction; NTR1108)."},{"id":"fba6d363061a","type":"article","url":"https://hartvaat.nl/2016/10/11/natriuminname-en-totale-mortaliteit-over-20-jaar-trials-of-hypertension-preventi/","title":"Natriuminname en totale mortaliteit over 20 jaar: Trials of Hypertension Prevention","title_en":"Sodium Intake and All-Cause Mortality Over 20 Years in the Trials of Hypertension Prevention.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.07.745","source_url":"https://doi.org/10.1016/j.jacc.2016.07.745","authors":["Nancy R Cook","Lawrence J Appel","Paul K Whelton"],"significance":8,"published":"2016-10-11","source_date":"2016-10-11","image":"","kennis":[],"congress":"","summary_en":"This 20-year follow-up from the Trials of Hypertension Prevention demonstrated a direct relationship between sodium intake and all-cause mortality, providing among the longest-term evidence linking dietary sodium to cardiovascular outcomes.","created":"2026-07-03T10:26:21Z","updated":"2026-07-03T13:25:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Langetermijnfollow-up (20 jaar) van de Trials of Hypertension Prevention naar het verband tussen natriuminname en totale mortaliteit. Een van de langste follow-upstudies over zoutconsumptie en overleving.","abstract_original":"BACKGROUND: The relationship between lower sodium intake and total mortality remains controversial. OBJECTIVES: This study examined the relationship between well-characterized measures of sodium intake estimated from urinary sodium excretion and long-term mortality. METHODS: Two trials, phase I (1987 to 1990), over 18 months, and phase II (1990 to 1995), over 36 months, were undertaken in TOHP (Trials of Hypertension Prevention), which implemented sodium reduction interventions. The studies included multiple 24-h urine samples collected from pre-hypertensive adults 30 to 54 years of age during the trials. Post-trial deaths were ascertained over a median 24 years, using the National Death Index. The associations between mortality and the randomized interventions as well as with average sodium intake were examined. RESULTS: Among 744 phase I and 2,382 phase II participants randomized to sodium reduction or control, 251 deaths occurred, representing a nonsignificant 15% lower risk in the active intervention (hazard ratio [HR]: 0.85; 95% confidence interval [CI]: 0.66 to 1.09; p = 0.19). Among 2,974 participants not assigned to an active sodium intervention, 272 deaths occurred. There was a direct linear association between average sodium intake and mortality, with an HR of 0.75, 0.95, and 1.00 (references) and 1.07 (p trend = 0.30) for <2,300, 2,300 to <3,600, 3,600 to <4,800, and ≥4,800 mg/24 h, respectively; and with an HR of 1.12 per 1,000 mg/24 h (95% CI: 1.00 to 1.26; p = 0.05). There was no evidence of a J-shaped or nonlinear relationship. The HR per unit increase in sodium/potassium ratio was 1.13 (95% CI: 1.01 to 1.27; p = 0.04). CONCLUSIONS: We found an increased risk of mortality for high-sodium intake and a direct relationship with total mortality, even at the lowest levels of sodium intake. These results are consistent with a benefit of reduced sodium and sodium/potassium intake on total mortality over a 20-year period."},{"id":"640ce72886c1","type":"article","url":"https://hartvaat.nl/2016/10/07/de-tien-geboden-van-de-2016-esc-af-richtlijn/","title":"De 'Tien Geboden' van de 2016 ESC AF-richtlijn","title_en":"'Ten Commandments' of 2016 ESC Guidelines for the management of atrial fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw370","source_url":"https://doi.org/10.1093/eurheartj/ehw370","authors":["Dan Atar","Stefano Benussi","Paulus Kirchhof"],"significance":8,"published":"2016-10-07","source_date":"2016-10-07","image":"","kennis":[],"congress":"","summary_en":"This concise summary of the 2016 ESC AF guidelines distilled the ten most important clinical messages for day-to-day management of atrial fibrillation, covering anticoagulation, rate and rhythm control, and comorbidity management.","created":"2026-07-03T10:26:21Z","updated":"2026-07-03T13:25:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Beknopte samenvatting van de tien belangrijkste boodschappen uit de 2016 ESC-richtlijn voor atriumfibrilleren. Kernboodschappen voor de dagelijkse praktijk.","abstract_original":""},{"id":"29192a97c022","type":"article","url":"https://hartvaat.nl/2016/10/07/2016-esc-richtlijn-voor-atriumfibrilleren-in-samenwerking-met-eacts/","title":"2016 ESC-richtlijn voor atriumfibrilleren (in samenwerking met EACTS)","title_en":"2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts","internist"],"tags":["richtlijnen-esc"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw210","source_url":"https://doi.org/10.1093/eurheartj/ehw210","authors":["Paulus Kirchhof","Stefano Benussi","Dipak Kotecha","Anders Ahlsson","Dan Atar","Barbara Casadei","Manuel Castella","Hans-Christoph Diener","Hein Heidbuchel","Jeroen Hendriks","Gerhard Hindricks","Antonis S Manolis","Jonas Oldgren","Bogdan Alexandru Popescu","Ulrich Schotten","Bart Van Putte","Panagiotis Vardas"],"significance":10,"published":"2016-10-07","source_date":"2016-10-07","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/esc-richtlijn-af-2024/","https://hartvaat.nl/kennis/atriumfibrilleren/elektrisch-remodellering-atrium/"],"congress":"","summary_en":"The 2016 ESC Guidelines for atrial fibrillation management introduced the integrated AF-BETTER approach, covering anticoagulation, rate and rhythm control, and comorbidity management. This foundational document shaped modern AF care with structured pathways for DOAC use, catheter ablation referral, and comprehensive upstream therapy.","created":"2026-07-03T10:26:21Z","updated":"2026-07-03T18:38:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De ESC-richtlijn 2016 voor het management van atriumfibrilleren — het standaardwerk dat de basis legde voor de huidige AF-behandeling met geïntegreerde benadering van frequentie-/ritmecontrole, anticoagulatie en comorbiditeitenmanagement.","abstract_original":""},{"id":"32ec931b8d35","type":"article","url":"https://hartvaat.nl/2016/10/07/cryoballon-versus-radiofrequentieablatie-bij-paroxysmaal-af-herinterventierate-e/","title":"Cryoballon versus radiofrequentieablatie bij paroxysmaal AF: herinterventierate en kwaliteit van leven","title_en":"Cryoballoon or radiofrequency ablation for symptomatic paroxysmal atrial fibrillation: reintervention, rehospitalization, and quality-of-life outcomes in the FIRE AND ICE trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["cryoablatie"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw285","source_url":"https://doi.org/10.1093/eurheartj/ehw285","authors":["Karl-Heinz Kuck","Alexander Fürnkranz","K R Julian Chun","Andreas Metzner","Feifan Ouyang","Michael Schlüter","Arif Elvan","Hae W Lim","Fred J Kueffer","Thomas Arentz","Jean-Paul Albenque","Claudio Tondo","Michael Kühne","Christian Sticherling","Josep Brugada"],"significance":7,"published":"2016-10-07","source_date":"2016-10-07","image":"","kennis":[],"congress":"","summary_en":"This FIRE AND ICE follow-up analysis compared reintervention rates, rehospitalization, and quality of life after cryoballoon versus radiofrequency ablation for paroxysmal AF, providing extended outcome data beyond the primary efficacy endpoint.","created":"2026-07-03T10:26:21Z","updated":"2026-07-03T13:25:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Follow-upanalyse van de FIRE AND ICE-trial met focus op herinterventierate, rehospitalisatie en kwaliteit van leven na cryoballon- versus radiofrequentieablatie bij paroxysmaal AF.","abstract_original":"AIMS: The primary safety and efficacy endpoints of the randomized FIRE AND ICE trial have recently demonstrated non-inferiority of cryoballoon vs. radiofrequency current (RFC) catheter ablation in patients with drug-refractory symptomatic paroxysmal atrial fibrillation (AF). The aim of the current study was to assess outcome parameters that are important for the daily clinical management of patients using key secondary analyses. Specifically, reinterventions, rehospitalizations, and quality-of-life were examined in this randomized trial of cryoballoon vs. RFC catheter ablation. METHODS AND RESULTS: Patients (374 subjects in the cryoballoon group and 376 subjects in the RFC group) were evaluated in the modified intention-to-treat cohort. After the index ablation, log-rank testing over 1000 days of follow-up demonstrated that there were statistically significant differences in favour of cryoballoon ablation with respect to repeat ablations (11.8% cryoballoon vs. 17.6% RFC; P = 0.03), direct-current cardioversions (3.2% cryoballoon vs. 6.4% RFC; P = 0.04), all-cause rehospitalizations (32.6% cryoballoon vs. 41.5% RFC; P = 0.01), and cardiovascular rehospitalizations (23.8% cryoballoon vs. 35.9% RFC; P < 0.01). There were no statistical differences between groups in the quality-of-life surveys (both mental and physical) as measured by the Short Form-12 health survey and the EuroQol five-dimension questionnaire. There was an improvement in both mental and physical quality-of-life in all patients that began at 6 months after the index ablation and was maintained throughout the 30 months of follow-up. CONCLUSION: Patients treated with cryoballoon as opposed to RFC ablation had significantly fewer repeat ablations, direct-current cardioversions, all-cause rehospitalizations, and cardiovascular rehospitalizations during follow-up. Both patient groups improved in quality-of-life scores after AF ablation. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01490814."},{"id":"233697203892","type":"article","url":"https://hartvaat.nl/2016/10/04/ldl-cholesterolverlagende-genetische-varianten-en-risico-op-diabetes-type-2-jama/","title":"LDL-cholesterolverlagende genetische varianten en risico op diabetes type 2: JAMA meta-analyse","title_en":"Association Between Low-Density Lipoprotein Cholesterol-Lowering Genetic Variants and Risk of Type 2 Diabetes: A Meta-analysis.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["diabetes-type-2","dyslipidemie","ezetimibe","familiaire-hypercholesterolemie","familiaire-hypercholesterolemie-screening","ldl-cholesterol","lipidenverlaging","lipoproteïne-a","pcsk9-remmers","pelacarsen","statines"],"journal":"JAMA","doi":"10.1001/jama.2016.14568","source_url":"https://doi.org/10.1001/jama.2016.14568","authors":["Luca A Lotta","Stephen J Sharp","Stephen Burgess","John R B Perry","Isobel D Stewart","Sara M Willems","Jian'an Luan","Eva Ardanaz","Larraitz Arriola","Beverley Balkau","Heiner Boeing","Panos Deloukas","Nita G Forouhi","Paul W Franks","Sara Grioni","Rudolf Kaaks","Timothy J Key","Carmen Navarro","Peter M Nilsson","Kim Overvad","Domenico Palli","Salvatore Panico","Jose-Ramón Quirós","Elio Riboli","Olov Rolandsson","Carlotta Sacerdote","Elena C Salamanca","Nadia Slimani","Annemieke Mw Spijkerman","Anne Tjonneland","Rosario Tumino","Daphne L van der A","Yvonne T van der Schouw","Mark I McCarthy","Inês Barroso","Stephen O'Rahilly","David B Savage","Naveed Sattar","Claudia Langenberg","Robert A Scott","Nicholas J Wareham"],"significance":8,"published":"2016-10-04","source_date":"2016-10-04","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/","https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/"],"congress":"","summary_en":"This JAMA meta-analysis demonstrated that genetic variants in NPC1L1 and HMGCR that lower LDL cholesterol are associated with increased type 2 diabetes risk, mirroring the diabetogenic effect observed with statin therapy. The finding established a causal link between LDL-lowering mechanisms and diabetes susceptibility.","created":"2026-07-03T10:26:21Z","updated":"2026-07-03T13:25:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA meta-analyse die aantoont dat genetische varianten die LDL-cholesterol verlagen geassocieerd zijn met een verhoogd risico op diabetes type 2. Verklaart deels het diabetesrisico van statines via een gedeeld mechanisme.","abstract_original":"IMPORTANCE: Low-density lipoprotein cholesterol (LDL-C)-lowering alleles in or near NPC1L1 or HMGCR, encoding the respective molecular targets of ezetimibe and statins, have previously been used as proxies to study the efficacy of these lipid-lowering drugs. Alleles near HMGCR are associated with a higher risk of type 2 diabetes, similar to the increased incidence of new-onset diabetes associated with statin treatment in randomized clinical trials. It is unknown whether alleles near NPC1L1 are associated with the risk of type 2 diabetes. OBJECTIVE: To investigate whether LDL-C-lowering alleles in or near NPC1L1 and other genes encoding current or prospective molecular targets of lipid-lowering therapy (ie, HMGCR, PCSK9, ABCG5/G8, LDLR) are associated with the risk of type 2 diabetes. DESIGN, SETTING, AND PARTICIPANTS: The associations with type 2 diabetes and coronary artery disease of LDL-C-lowering genetic variants were investigated in meta-analyses of genetic association studies. Meta-analyses included 50 775 individuals with type 2 diabetes and 270 269 controls and 60 801 individuals with coronary artery disease and 123 504 controls. Data collection took place in Europe and the United States between 1991 and 2016. EXPOSURES: Low-density lipoprotein cholesterol-lowering alleles in or near NPC1L1, HMGCR, PCSK9, ABCG5/G8, and LDLR. MAIN OUTCOMES AND MEASURES: Odds ratios (ORs) for type 2 diabetes and coronary artery disease. RESULTS: Low-density lipoprotein cholesterol-lowering genetic variants at NPC1L1 were inversely associated with coronary artery disease (OR for a genetically predicted 1-mmol/L [38.7-mg/dL] reduction in LDL-C of 0.61 [95% CI, 0.42-0.88]; P = .008) and directly associated with type 2 diabetes (OR for a genetically predicted 1-mmol/L reduction in LDL-C of 2.42 [95% CI, 1.70-3.43]; P < .001). For PCSK9 genetic variants, the OR for type 2 diabetes per 1-mmol/L genetically predicted reduction in LDL-C was 1.19 (95% CI, 1.02-1.38; P = .03). For a given reduction in LDL-C, genetic variants were associated with a similar reduction in coronary artery disease risk (I2 = 0% for heterogeneity in genetic associations; P = .93). However, associations with type 2 diabetes were heterogeneous (I2 = 77.2%; P = .002), indicating gene-specific associations with metabolic risk of LDL-C-lowering alleles. CONCLUSIONS AND RELEVANCE: In this meta-analysis, exposure to LDL-C-lowering genetic variants in or near NPC1L1 and other genes was associated with a higher risk of type 2 diabetes. These data provide insights into potential adverse effects of LDL-C-lowering therapy."},{"id":"429828894b71","type":"article","url":"https://hartvaat.nl/2016/10/04/impact-van-optimale-medicamenteuze-therapie-in-de-dapt-studie/","title":"Impact van optimale medicamenteuze therapie in de DAPT-studie","title_en":"Impact of Optimal Medical Therapy in the Dual Antiplatelet Therapy Study.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["bloeddrukbehandeling","dubbele-trombocytenremming","farmaco-economie","lipidenverlaging"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.024531","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.024531","authors":["Charles D Resor","Ashwin Nathan","Dean J Kereiakes","Robert W Yeh","Joseph M Massaro","Donald E Cutlip","P Gabriel Steg","Wen-Hua Hsieh","Laura Mauri"],"significance":6,"published":"2016-10-04","source_date":"2016-10-04","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/esc-richtlijn-chronisch-coronairlijden-2024/"],"congress":"","summary_en":"This DAPT study analysis examined the interaction between background medical therapy (statins, ACE inhibitors, beta-blockers) and the benefit of extended DAPT, assessing whether optimal medical therapy modifies the antiplatelet duration decision.","created":"2026-07-03T10:26:21Z","updated":"2026-07-03T13:25:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de DAPT-studie naar de interactie tussen optimale achtergrondtherapie (statines, ACE-remmers, bètablokkers) en de effectiviteit van verlengde DAPT.","abstract_original":"BACKGROUND: Continued dual antiplatelet therapy and optimal medical therapy (OMT) improve outcomes in selected patient populations with established coronary heart disease, but whether OMT modifies the treatment effect of dual antiplatelet therapy is unknown. METHODS: The DAPT (Dual Antiplatelet Therapy) Study, a double-blind trial, randomly assigned 11 648 patients who had undergone coronary stenting and completed 1 year of dual antiplatelet therapy without major bleeding or ischemic events to an additional 18 months of continued thienopyridine or placebo. OMT was defined as a combination of statin, β-blocker, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use in patients with an American College of Cardiology/American Heart Association class I indication for each medication. Per protocol, all patients were treated with 75 to 325 mg aspirin daily. End points included myocardial infarction, major adverse cardiovascular and cerebrovascular events, and Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Arteries moderate or severe bleeding events. RESULTS: Of 11 643 randomly assigned patients with complete medication data, 63% were on OMT. Between 12 and 30 months, continued thienopyridine reduced myocardial infarction in comparison with placebo in both groups (on OMT 2.1% versus 3.3%, hazard ratio [HR], 0.64; 95% confidence interval [CI], 0.48-0.86; P=0.003; off OMT 2.2% versus 5.2%, HR, 0.41; CI, 0.29-0.58; P<0.001; interaction P=0.103). Comparing continued thienopyridine versus placebo, rates of major adverse cardiovascular and cerebrovascular events were 4.2% versus 5.0% among patients on OMT (HR, 0.82; CI, 0.66-1.02; P=0.077) and 4.5% versus 7.0% among those off OMT (HR, 0.63; CI, 0.49-0.82; P<0.001; interaction P=0.250); rates of bleeding for thienopyridine versus placebo in patients on OMT were 2.2% versus 1.0% (HR, 2.13; CI, 1.43-3.17; P<0.001), and in patients off OMT were 2.8% versus 2.2% (HR, 1.30; CI, 0.88-1.92; P=0.189; interaction P=0.073). Overall, patients on OMT had lower rates of myocardial infarction (2.7% versus 3.7%, P=0.003), major adverse cardiovascular and cerebrovascular events (4.6% versus 5.7%, P=0.007), and bleeding (1.6% versus 2.5%, P<0.001) in comparison with patients off OMT. Rates of stent thrombosis (0.8% versus 1.0%, P=0.171) and death (1.6% versus 1.9%, P=0.155) did not differ. CONCLUSIONS: Continued thienopyridine therapy reduced the rate of myocardial infarction regardless of OMT status and had consistent effects on reduction in major adverse cardiovascular and cerebrovascular events and increased bleeding. CLINICAL TRIAL REGISTRATION: URL: http://clinicaltrials.gov. Unique identifier: NCT00977938."},{"id":"a33b433ce362","type":"article","url":"https://hartvaat.nl/2016/10/01/langere-versus-korte-dapt-na-pci-met-en-zonder-periprocedureel-mi-jama-cardiolog/","title":"Langere versus korte DAPT na PCI met en zonder periprocedureel MI: JAMA Cardiology","title_en":"Prolonged vs Short Duration of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention in Patients With or Without Peripheral Arterial Disease: A Subgroup Analysis of the PRODIGY Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2016.2811","source_url":"https://doi.org/10.1001/jamacardio.2016.2811","authors":["Anna Franzone","Raffaele Piccolo","Giuseppe Gargiulo","Sara Ariotti","Marcello Marino","Andrea Santucci","Andrea Baldo","Giulia Magnani","Aris Moschovitis","Stephan Windecker","Marco Valgimigli"],"significance":6,"published":"2016-10-01","source_date":"2016-10-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/dual-antiplatelet-therapy-dapt/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This JAMA Cardiology analysis examined whether optimal DAPT duration differs in patients with versus without periprocedural MI after PCI, exploring whether procedural complications modify the benefit of extended antiplatelet therapy.","created":"2026-07-03T10:26:20Z","updated":"2026-07-03T13:25:40Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology analyse die onderzocht of de optimale DAPT-duur verschilt bij patiënten met versus zonder periprocedureel MI. Relevant voor gepersonaliseerd antitromboticabeleid.","abstract_original":"IMPORTANCE: Patients with concomitant peripheral arterial disease (PAD) experience worse cardiovascular outcomes after percutaneous coronary intervention (PCI). OBJECTIVE: To assess the efficacy and safety of prolonged (24 months) vs short (≤6 months) dual antiplatelet therapy (DAPT) in patients with PAD undergoing PCI. DESIGN, SETTING, AND PARTICIPANTS: This subanalysis of the randomized Prolonging Dual Antiplatelet Treatment After Grading Stent-Induced Intimal Hyperplasia Study (PRODIGY) trial assessed unselected patients from tertiary care hospitals with stable coronary artery disease or acute coronary syndromes with or without concomitant PAD from December 2006 to December 2008. Data analysis was performed from January 7 to April 4, 2016. INTERVENTIONS: Percutaneous coronary intervention. MAIN OUTCOMES AND MEASURES: Rates of the primary efficacy end point, composite of death, myocardial infarction, or cerebrovascular accidents, and occurrence of the key safety end point, a composite of Bleeding Academic Research Consortium type 2, 3, or 5. RESULTS: This analysis comprised 246 and 1724 patients with and without PAD, respectively. In the patients with PAD, mean (SD) age was 73.2 (9.2) in the prolonged group and 75.7 (8.7) years in the short DAPT group, and 97 (82.2%) were male in the prolonged group and 92 (71.9%) were male in the short DAPT group. In the patients without PAD, mean (SD) age was 67.1 (11.2) years in the prolonged group and 66.8 (11.3) years in the short DAPT group, and 667 (76.8%) were male in the prolonged group and 655 (76.6%) were male in the short DAPT group. Status of PAD was associated with a higher risk of death and ischemic events (hazard ratio [HR], 2.80; 95% CI, 2.05-3.83; P < .001). Prolonged vs short DAPT conveyed a lower risk of the primary efficacy end point in patients with PAD (19 [16.1%] vs 35 [27.3%]; HR, 0.54; 95% CI, 0.31-0.95; P = .03) but not in patients without PAD (81 [9.3%] vs 63 [7.4%]; HR, 1.28; 95% CI, 0.92-1.77; P = .15), with positive interaction (P = .01). The risk of definite or probable stent thrombosis was significantly lower in patients with PAD treated with prolonged compared with short DAPT (HR, 0.07; 95% CI, 0-1.21; P = .01). Bleeding Academic Research Consortium type 2, 3, or 5 bleeding occurred in 6 patients with PAD (5.2%) receiving prolonged DAPT relative to 8 (6.9%) of those receiving short DAPT (HR, 0.77; 95% CI, 0.27-2.21; P = .62), with a significant interaction (P = .04) compared with patients without PAD. CONCLUSIONS AND RELEVANCE: Peripheral artery disease confers a poor prognosis in patients undergoing PCI in the setting of stable coronary artery disease or acute coronary syndromes. Prolonged DAPT lowers the risk of ischemic events with no apparent bleeding liability in this high-risk group. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00611286."},{"id":"db4aa8999e1c","type":"article","url":"https://hartvaat.nl/2016/10/01/volwassen-stamceltherapie-bij-hartfalen-2000-2016-jama-cardiology-systematische-/","title":"Volwassen stamceltherapie bij hartfalen 2000-2016: JAMA Cardiology systematische review","title_en":"Adult Stem Cell Therapy and Heart Failure, 2000 to 2016: A Systematic Review.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","bisoprolol","vrouwen"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2016.2225","source_url":"https://doi.org/10.1001/jamacardio.2016.2225","authors":["Patricia K Nguyen","June-Wha Rhee","Joseph C Wu"],"significance":7,"published":"2016-10-01","source_date":"2016-10-01","image":"","kennis":[],"congress":"","summary_en":"This systematic review evaluated 16 years of clinical research on adult stem cell therapy for heart failure, summarizing the evidence for different cell types, delivery methods, and clinical outcomes in this evolving field.","created":"2026-07-03T10:26:20Z","updated":"2026-07-03T18:38:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Uitgebreide systematische review van 16 jaar klinisch onderzoek naar stamceltherapie bij hartfalen. Evalueert de stand van zaken van regeneratieve cardiologie.","abstract_original":"IMPORTANCE: Stem cell therapy is a promising treatment strategy for patients with heart failure, which accounts for more than 10% of deaths in the United States annually. Despite more than a decade of research, further investigation is still needed to determine whether stem cell regenerative therapy is an effective treatment strategy and can be routinely implemented in clinical practice. OBJECTIVE: To describe the progress in cardiac stem cell regenerative therapy using adult stem cells and to highlight the merits and limitations of clinical trials performed to date. EVIDENCE REVIEW: Information for this review was obtained through a search of PubMed and the Cochrane database for English-language studies published between January 1, 2000, and July 26, 2016. Twenty-nine randomized clinical trials and 7 systematic reviews and meta-analyses were included in this review. FINDINGS: Although adult stem cells were once believed to have the ability to create new heart tissue, preclinical studies suggest that these cells release cardioprotective paracrine factors that activate endogenous pathways, leading to myocardial repair. Subsequent randomized clinical trials, most of which used autologous bone marrow mononuclear cells, have found only a modest benefit in patients receiving stem cell therapy. The lack of a significant benefit may result from variations in trial methods, discrepancies in reporting, and an overreliance on surrogate end points. CONCLUSIONS AND RELEVANCE: Although stem cell therapy for cardiovascular disease is not yet ready for routine clinical application, significant progress continues to be made. Physicians should be aware of the current status of this treatment so that they can better inform their patients who may be in search of alternative therapies."},{"id":"e4fadbe6d509","type":"article","url":"https://hartvaat.nl/2016/10/01/katheterablatie-bij-af-met-hypertrofische-cardiomyopathie-systematische-review-e/","title":"Katheterablatie bij AF met hypertrofische cardiomyopathie: systematische review en meta-analyse","title_en":"Catheter ablation for atrial fibrillation in hypertrophic cardiomyopathy: a systematic review and meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["acuut-hartfalen","aficamten","alcoholgebruik","aritmogene-cardiomyopathie","atriale-cardiomyopathie","cardio-renaal-metabool","cardiomyopathie-gerichte-therapie","gedilateerde-cardiomyopathie","hypertrofische-cardiomyopathie","iaso-dcm","immunoadsorptie","laminopathie","summit-trial","vrouwen"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2016-309406","source_url":"https://doi.org/10.1136/heartjnl-2016-309406","authors":["Rui Providencia","Perry Elliott","Kiran Patel","Jack McCready","Girish Babu","Neil Srinivasan","Kostantinos Bronis","Nikolaos Papageorgiou","Anthony Chow","Edward Rowland","Martin Lowe","Oliver R Segal","Pier D Lambiase"],"significance":6,"published":"2016-10-01","source_date":"2016-10-01","image":"","kennis":["https://hartvaat.nl/kennis/ritmestoornissen/katheterablatie-vt/"],"congress":"","summary_en":"This systematic review and meta-analysis evaluated catheter ablation for AF in HCM patients, providing updated evidence on the success rates and safety of this procedure in hypertrophic cardiomyopathy.","created":"2026-07-03T10:26:20Z","updated":"2026-07-03T13:25:40Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse naar de uitkomsten van katheterablatie voor AF bij HCM. Bouwt voort op eerdere analyses met aanvullende studies en langere follow-up.","abstract_original":"OBJECTIVE: Atrial fibrillation (AF) is common in hypertrophic cardiomyopathy (HCM) and is associated with a high risk of stroke. The efficacy and safety of catheter ablation in this setting is poorly characterised. We aimed to systematically review the existing literature and to perform a meta-analysis to determine the efficacy and safety of catheter ablation of AF in patients with HCM. METHODS: Random-effects meta-analysis of studies comparing HCM versus non-HCM controls. The outcomes of freedom from AF/atrial tachycardia, and acute procedure-related complications were assessed. Studies were searched on MEDLINE, EMBASE, COCHRANE and clinicaltrials.gov. RESULTS: Fourteen studies were considered eligible for the systematic review, of which five were included in the meta-analysis. Freedom from AF/atrial tachycardia relapse was higher in patients without HCM (after a single procedure: 38.7% HCM vs 49.8% controls, OR=2.25, 95% CI 1.09 to 4.64, p=0.03; after ≥1 procedure: 51.8% HCM vs 71.2% controls, OR=2.62, 95% CI 1.52 to 4.51, p=0.0006; I(2)=33% and 26%, respectively). Risk of procedure-related adverse events was low. Repeat procedures (mean difference=0.16, 95% CI 0.0 to 0.32, p=0.05, I(2)=53%) and antiarrhythmic drugs (OR=4.70, 95% CI 2.31 to 9.55, p<0.0001, I(2)=0%) are more frequently needed in patients with HCM to prevent arrhythmia relapse. Sensitivity analyses suggested that the outcome in patients with HCM with less dilated atria and paroxysmal AF may be more comparable to the general population. CONCLUSIONS: The observed complication rate of catheter ablation of AF in patients with HCM was low. Even though the risk of relapse is twofold higher, catheter ablation can be effective in patients with HCM and AF, particularly in patients with paroxysmal AF and smaller atria."},{"id":"34b84751b939","type":"article","url":"https://hartvaat.nl/2016/10/01/kostenimplicaties-van-minder-strikte-versus-strikte-bloeddrukcontrole-bij-zwange/","title":"Kostenimplicaties van minder strikte versus strikte bloeddrukcontrole bij zwangerschap: CHIPS-trial","title_en":"The Cost Implications of Less Tight Versus Tight Control of Hypertension in Pregnancy (CHIPS Trial).","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.07466","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.07466","authors":["Rashid J Ahmed","Amiram Gafni","Eileen K Hutton","Zheng Jing Hu","Eleanor Pullenayegum","Peter von Dadelszen","Evelyne Rey","Susan Ross","Elizabeth Asztalos","Kellie E Murphy","Jennifer Menzies","J Johanna Sanchez","Wessel Ganzevoort","Michael Helewa","Shoo K Lee","Terry Lee","Alexander G Logan","Jean-Marie Moutquin","Joel Singer","Jim G Thornton","Ross Welch","Laura A Magee"],"significance":6,"published":"2016-10-01","source_date":"2016-10-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This cost analysis of the CHIPS trial showed that less tight versus tight blood pressure control in pregnancy does not significantly differ in healthcare costs, informing resource allocation for obstetric hypertension management.","created":"2026-07-03T10:26:20Z","updated":"2026-07-03T13:25:40Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Kosteneffectiviteitsanalyse van de CHIPS-trial die minder strikte versus strikte bloeddrukcontrole vergeleek bij hypertensie in de zwangerschap. Relevant voor de economische onderbouwing van het behandelbeleid.","abstract_original":"UNLABELLED: The CHIPS randomized controlled trial (Control of Hypertension in Pregnancy Study) found no difference in the primary perinatal or secondary maternal outcomes between planned \"less tight\" (target diastolic 100 mm Hg) and \"tight\" (target diastolic 85 mm Hg) blood pressure management strategies among women with chronic or gestational hypertension. This study examined which of these management strategies is more or less costly from a third-party payer perspective. A total of 981 women with singleton pregnancies and nonsevere, nonproteinuric chronic or gestational hypertension were randomized at 14 to 33 weeks to less tight or tight control. Resources used were collected from 94 centers in 15 countries and costed as if the trial took place in each of 3 Canadian provinces as a cost-sensitivity analysis. Eleven hospital ward and 24 health service costs were obtained from a similar trial and provincial government health insurance schedules of medical benefits. The mean total cost per woman-infant dyad was higher in less tight versus tight control, but the difference in mean total cost (DM) was not statistically significant in any province: Ontario ($30 191.62 versus $24 469.06; DM $5723, 95% confidence interval, -$296 to $12 272; P=0.0725); British Columbia ($30 593.69 versus $24 776.51; DM $5817; 95% confidence interval, -$385 to $12 349; P=0.0725); or Alberta ($31 510.72 versus $25 510.49; DM $6000.23; 95% confidence interval, -$154 to $12 781; P=0.0637). Tight control may benefit women without increasing risk to neonates (as shown in the main CHIPS trial), without additional (and possibly lower) cost to the healthcare system. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01192412."},{"id":"b9042554346a","type":"article","url":"https://hartvaat.nl/2016/10/01/autonome-blokkade-herstelt-endotheeldisfunctie-bij-obesitasgerelateerde-hyperten/","title":"Autonome blokkade herstelt endotheeldisfunctie bij obesitasgerelateerde hypertensie","title_en":"Autonomic Blockade Reverses Endothelial Dysfunction in Obesity-Associated Hypertension.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["bloeddrukbehandeling","bradycardie","hypertrofische-cardiomyopathie","obesitas","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.07681","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.07681","authors":["Alfredo Gamboa","Rocío Figueroa","Sachin Y Paranjape","Ginnie Farley","Andre Diedrich","Italo Biaggioni"],"significance":5,"published":"2016-10-01","source_date":"2016-10-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/pathofysiologie-hypertensie/","https://hartvaat.nl/kennis/nierziekte/raas-blokkade-bij-nierziekte/"],"congress":"","summary_en":"This study demonstrated that combined autonomic blockade reverses endothelial dysfunction in obesity-associated hypertension, providing mechanistic evidence that sympathetic overactivity mediates vascular impairment in obese hypertensive patients.","created":"2026-07-03T10:26:20Z","updated":"2026-07-03T18:38:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die aantoont dat autonome blokkade de endotheeldisfunctie bij obesitasgerelateerde hypertensie kan omkeren. Mechanistisch bewijs voor de rol van het sympathisch zenuwstelsel bij vaatdysfunctie.","abstract_original":"Impaired nitric oxide (NO) vasodilation (endothelial dysfunction) is associated with obesity and thought to be a factor in the development of hypertension. We previously found that NO synthesis inhibition had similar pressor effects in obese hypertensives compared with healthy control during autonomic blockade, suggesting that impaired NO vasodilation is secondary to sympathetic activation. We tested this hypothesis by determining the effect of autonomic blockade (trimethaphan 4 mg/min IV) on NO-mediated vasodilation (increase in forearm blood flow to intrabrachial acetylcholine) compared with endothelial-independent vasodilation (intrabrachial sodium nitroprusside) in obese hypertensive subjects (30<body mass index<40 kg/m(2)). Acetylcholine and sodium nitroprusside were given at equipotent doses (10, 30, and 50 μg/min and 1, 2, and 3 μg/min, respectively) to 14 obese subjects (49±3.6 years, 34±1 kg/m(2), 165/94±7/6 mm Hg), on separate occasions 1 month apart, randomly assigned. Autonomic blockade increased basal forearm blood flow (from 3.9±0.7 to 5.2±1.2 mL/100 mL per minute, P=0.078). As expected, NO-mediated vasodilation was blunted on the intact day compared with NO-independent vasodilation; forearm blood flow increased from 3.6±0.6 to 10.1±1.1 with the highest dose of nitroprusside, but only from 3.7±0.4 to 7.2±0.8 mL/100 mL per minute with the highest dose of acetylcholine, P<0.05. In contrast, forearm blood flow responses to acetylcholine were restored by autonomic blockade and were no longer different to nitroprusside (from 6.2±1.1 to 11.4±1.6 mL/100 mL per minute and from 5.2±0.9 to 12.5±0.9, respectively, P=0.58). Our results support the concept that sympathetic activation contributes to the impairment in NO-mediated vasodilation seen in obesity-associated hypertension and provides further rationale to explore it as a therapeutic target."},{"id":"021d8252ba68","type":"article","url":"https://hartvaat.nl/2016/10/01/bloeddruk-en-darmmicrobioom-veranderde-samenstelling-en-butyraat-bij-hypertensie/","title":"Bloeddruk en darmmicrobioom: veranderde samenstelling en butyraat bij hypertensie","title_en":"Increased Systolic and Diastolic Blood Pressure Is Associated With Altered Gut Microbiota Composition and Butyrate Production in Early Pregnancy.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["bloeddrukbehandeling","microbioom","ras-remmers","tirzepatide"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.07910","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.07910","authors":["Luisa F Gomez-Arango","Helen L Barrett","H David McIntyre","Leonie K Callaway","Mark Morrison","Marloes Dekker Nitert"],"significance":6,"published":"2016-10-01","source_date":"2016-10-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/wat-is-hypertensie/","https://hartvaat.nl/kennis/hypertensie/classificatie-bloeddruk-esc-2024/"],"congress":"","summary_en":"This study demonstrated an association between elevated blood pressure in pregnancy and altered gut microbiota composition with reduced butyrate-producing bacteria, exploring the microbiome-hypertension axis during gestation.","created":"2026-07-03T10:26:20Z","updated":"2026-07-03T18:38:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die een verband aantoont tussen verhoogde systolische en diastolische bloeddruk en een veranderde darmflora met verminderde butyraatproductie. Pionierswerk in de microbioom-hypertensie-as.","abstract_original":"The risk of developing pregnancy-induced hypertension and preeclampsia is higher in obese pregnant women. In obesity, the composition of the gut microbiota is altered. Obesity is also associated with low-grade inflammation. Metabolites from the gut microbiota may contribute to both hypertension and inflammation. The aim of this study is to investigate whether the composition of the gut microbiota in overweight and obese pregnant women is associated with blood pressure and levels of plasminogen activator inhibitor-1. The composition of the gut microbiota was determined with 16S ribosomal RNA sequencing in 205 women at 16 weeks gestation from the SPRING study (the Study of Probiotics in Gestational Diabetes). Expression of butyrate-producing genes in the gut microbiota was assessed by real-time polymerase chain reaction. Plasminogen activator inhibitor-1 levels were measured in fasting serum of a subset of 70 women. Blood pressure was slightly but significantly higher in obese compared with overweight women. The abundance of the butyrate-producing genus Odoribacter was inversely correlated with systolic blood pressure. Butyrate production capacity was decreased, but plasminogen activator inhibitor-1 concentrations increased in obese pregnant women. Plasminogen activator inhibitor-1 levels were inversely correlated with expression of butyrate kinase and Odoribacter abundance. This study shows that in overweight and obese pregnant women at 16 weeks gestation, the abundance of butyrate-producing bacteria and butyrate production in the gut microbiota is significantly negatively associated with blood pressure and with plasminogen activator inhibitor-1 levels. Increasing butyrate-producing capacity may contribute to maintenance of normal blood pressure in obese pregnant women."},{"id":"2bf6ecb54587","type":"article","url":"https://hartvaat.nl/2016/10/01/lijnzaad-verlaagt-centrale-aortabloeddruk-via-veranderingen-in-plasma-oxylipinen/","title":"Lijnzaad verlaagt centrale aortabloeddruk via veranderingen in plasma-oxylipinen","title_en":"Dietary Flaxseed Reduces Central Aortic Blood Pressure Without Cardiac Involvement but Through Changes in Plasma Oxylipins.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","aortainsufficiëntie","bloeddrukbehandeling","bradycardie","endotheel","ezetimibe","figaro-dkd","laminopathie","perifeer-vaatlijden","slaapapneu"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.07834","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.07834","authors":["Stephanie P B Caligiuri","Delfin Rodriguez-Leyva","Harold M Aukema","Amir Ravandi","Wendy Weighell","Randolph Guzman","Grant N Pierce"],"significance":5,"published":"2016-10-01","source_date":"2016-10-01","image":"","kennis":[],"congress":"","summary_en":"This study from the FlaxPAD trial showed that dietary flaxseed reduces central aortic blood pressure through changes in plasma oxylipins rather than cardiac mechanisms, identifying a nutritional approach targeting vascular function.","created":"2026-07-03T10:26:20Z","updated":"2026-07-03T18:38:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die aantoonde dat een lijnzaaddieet de centrale aortabloeddruk verlaagt zonder cardiale effecten, maar via veranderingen in het oxylipinenprofiel. Mechanistisch inzicht in voedingsgebaseerde bloeddrukverlaging.","abstract_original":"UNLABELLED: In the year-long FlaxPAD clinical trial (Flaxseed for Peripheral Artery Disease), dietary flaxseed generated a powerful reduction in brachial systolic and diastolic blood pressure in patients with peripheral artery disease. Oxylipins were implicated as potential mechanistic mediators. However, the ability of flaxseed to impact central aortic hypertension, arterial stiffness, or cardiac performance was not investigated. Additionally, the relationship between central blood pressure (cBP) and oxylipins was not elucidated. Therefore, radial tonometry and pulse wave analysis were used to measure cBP and cardiac function in the FlaxPAD population (n=62). Plasma oxylipins were analyzed with high-performance liquid chromatography mass spectrometry. In patients with high blood pressure at baseline, the average decrease in central systolic and diastolic blood pressures versus placebo was 10 and 6 mm Hg, respectively. Flaxseed did not significantly impact augmentation index or other cardiac function indices. Alternatively, the data support several specific oxylipins as potential mediators in the antihypertensive properties of flaxseed. For example, every 1 nmol/L increase in plasma 16-hydroxyeicosatetraenoic acid increased the odds of higher central systolic and diastolic blood pressures by 12- and 9-fold, respectively. Every 1 nmol/L increase in plasma thromboxane B2 and 5,6-dihydroxyeicosatrienoic acid increased the odds of higher cBP by 33- and 9-fold, respectively. Flaxseed induced a decrease in many oxylipins, which corresponded with a reduced risk of elevated cBP. These data extend the antihypertensive properties of flaxseed to cBP without cardiac involvement but rather through oxylipins. This study provides further support for oxylipins as therapeutic targets in hypertension. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00781950."},{"id":"700199ecd061","type":"article","url":"https://hartvaat.nl/2016/10/01/cardiovasculair-risico-bij-hypertensie-in-relatie-tot-bereikte-bloeddruk-met-gea/","title":"Cardiovasculair risico bij hypertensie in relatie tot bereikte bloeddruk met geautomatiseerde praktijkmeting","title_en":"Cardiovascular Risk in Hypertension in Relation to Achieved Blood Pressure Using Automated Office Blood Pressure Measurement.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","ambulante-bloeddrukmeting","aortainsufficiëntie","biomarkers-cardiovasculair","bloeddrukbehandeling","bradycardie","diabetes-en-hart","diabetes-type-2","endotheel","fractional-flow-reserve","hypertrofische-cardiomyopathie","menopauze","obesitas","ouderen","ras-remmers","richtlijnen-esc","slaapapneu","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.07721","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.07721","authors":["Martin G Myers","Janusz Kaczorowski","Lisa Dolovich","Karen Tu","J Michael Paterson"],"significance":6,"published":"2016-10-01","source_date":"2016-10-01","image":"","kennis":[],"congress":"","summary_en":"This study evaluated cardiovascular risk in hypertensive patients using automated office blood pressure measurement (AOBP), providing data relevant to interpreting SPRINT-era blood pressure targets in clinical practice.","created":"2026-07-03T10:26:20Z","updated":"2026-07-03T18:38:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar cardiovasculair risico bij hypertensie gemeten met geautomatiseerde bloeddrukmeting op de praktijk (AOBP). Relevant voor de interpretatie van bloeddrukwaarden bij verschillende meetmethoden.","abstract_original":"The SPRINT (Systolic Blood Pressure Intervention Trial) reported that some older, higher risk patients might benefit from a target systolic blood pressure (BP) of <120 versus <140 mm Hg. However, it is not yet known how the BP target and measurement methods used in SPRINT relate to cardiovascular outcomes in real-world practice. SPRINT used the automated office BP technique, which requires the patient to be resting quietly and alone, with multiple readings being recorded automatically using an electronic oscillometric sphygmomanometer. We studied the relationship between achieved automated office BP at baseline and cardiovascular events in 6183 community-dwelling residents of Ontario aged ≥66 years who were receiving antihypertensive therapy and followed for a mean of 4.6 years. Adjusted hazard ratios (95% confidence intervals) were computed for 10 mm Hg increments in achieved automated office BP at baseline using Cox proportional hazards regression and the BP category with the lowest event rate as the reference category. Based on 904 fatal and nonfatal cardiovascular events, the nadir of cardiovascular events was at the systolic pressure category of 110 to 119 mm Hg, which was lower than the next highest category of 120 to 129 mm Hg (hazard ratio 1.30 [1.01, 1.66]). The hazard ratio for diastolic pressure was relatively unchanged above 60 mm Hg. Pulse pressure exhibited an increase in hazard ratio (1.33 [1.02, 1.72]) at ≥80 mm Hg. These results using automated office BP measurement in a usual treatment setting extend the finding in SPRINT of an optimum target systolic BP of <120 mm Hg to routine clinical practice."},{"id":"b5e43f2deeb9","type":"article","url":"https://hartvaat.nl/2016/10/01/orthostatische-hypotensie-in-de-accord-bloeddruk-trial-prevalentie-en-klinische-/","title":"Orthostatische hypotensie in de ACCORD bloeddruk-trial: prevalentie en klinische impact","title_en":"Orthostatic Hypotension in the ACCORD (Action to Control Cardiovascular Risk in Diabetes) Blood Pressure Trial: Prevalence, Incidence, and Prognostic Significance.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","figaro-dkd","obesitas","select-trial","soul-trial","summit-trial","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.07474","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.07474","authors":["Jerome L Fleg","Gregory W Evans","Karen L Margolis","Joshua Barzilay","Jan N Basile","J Thomas Bigger","Jeffrey A Cutler","Richard Grimm","Carolyn Pedley","Kevin Peterson","Rodica Pop-Busui","JoAnn Sperl-Hillen","William C Cushman"],"significance":6,"published":"2016-10-01","source_date":"2016-10-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/behandeldoelen-bloeddruk/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/"],"congress":"","summary_en":"This ACCORD analysis characterized orthostatic hypotension in diabetic patients receiving intensive blood pressure therapy, showing that OH is common and associated with adverse events but does not negate the benefit of intensive treatment.","created":"2026-07-03T10:26:19Z","updated":"2026-07-03T18:38:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van orthostatische hypotensie in de ACCORD-trial bij diabetespatiënten. Onderzoekt de prevalentie, incidentie en klinische consequenties van orthostatische hypotensie bij intensieve bloeddrukcontrole.","abstract_original":"Orthostatic hypotension (OH) is associated with hypertension and diabetes mellitus. However, in populations with both hypertension and diabetes mellitus, its prevalence, the effect of intensive versus standard systolic blood pressure (BP) targets on incident OH, and its prognostic significance are unclear. In 4266 participants in the ACCORD (Action to Control Cardiovascular Risk in Diabetes) BP trial, seated BP was measured 3×, followed by readings every minute for 3 minutes after standing. Orthostatic BP change, calculated as the minimum standing minus the mean seated systolic BP and diastolic BP, was assessed at baseline, 12 months, and 48 months. The relationship between OH and clinical outcomes (total and cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, heart failure hospitalization or death and the primary composite outcome of nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death) was assessed using proportional hazards analysis. Consensus OH, defined by orthostatic decline in systolic BP ≥20 mm Hg or diastolic BP ≥10 mm Hg, occurred at ≥1 time point in 20% of participants. Neither age nor systolic BP treatment target (intensive, <120 mm Hg versus standard, <140 mm Hg) was related to OH incidence. Over a median follow-up of 46.9 months, OH was associated with increased risk of total death (hazard ratio, 1.61; 95% confidence interval, 1.11-2.36) and heart failure death/hospitalization (hazard ratio, 1.85, 95% confidence interval, 1.17-2.93), but not with the primary outcome or other prespecified outcomes. In patients with type 2 diabetes mellitus and hypertension, OH was common, not associated with intensive versus standard BP treatment goals, and predicted increased mortality and heart failure events."},{"id":"9b35857cdcdf","type":"article","url":"https://hartvaat.nl/2016/10/01/omega-3-vetzuren-en-p-golfparameters-of-atriale-connexinen-bij-hartchirurgie/","title":"Omega-3-vetzuren en P-golfparameters of atriale connexinen bij hartchirurgie","title_en":"Omega-3 fatty acids do not alter P-wave parameters in electrocardiogram or expression of atrial connexins in patients undergoing coronary artery bypass surgery.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["acuut-hartfalen"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euv398","source_url":"https://doi.org/10.1093/europace/euv398","authors":["Palaniappan Saravanan","Annette L West","Ben Bridgewater","Neil C Davidson","Philip C Calder","Halina Dobrzynsky","Andrew Trafford","Stephen C O'Neill"],"significance":4,"published":"2016-10-01","source_date":"2016-10-01","image":"","kennis":[],"congress":"","summary_en":"This study demonstrated that omega-3 polyunsaturated fatty acid supplementation does not alter ECG P-wave parameters or atrial connexin expression in patients undergoing coronary artery bypass surgery. The findings do not support omega-3 supplementation for perioperative AF prevention.","created":"2026-07-03T10:26:19Z","updated":"2026-07-03T18:38:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die aantoont dat omega-3-vetzuren geen effect hebben op ECG P-golfparameters of expressie van atriale connexinen bij patiënten die hartchirurgie ondergaan. Geen ondersteuning voor omega-3 als AF-preventie rond chirurgie.","abstract_original":"AIMS: We previously reported omega-3 polyunsaturated fatty acids (n-3PUFAs) supplementation does not reduce atrial fibrillation (AF) following coronary artery bypass graft (CABG) surgery. The aim of the present study is to evaluate the impact of n-3 PUFAs on electrocardiogram (ECG) atrial arrhythmic markers and compare with expression of gap-junction proteins, Connexins. METHODS AND RESULTS: Subset of clinical trial subjects with right atrial sampling during CABG surgery included. Twelve-lead ECG performed at recruitment and at surgery [after supplementation with n-3 PUFA (∼1.8 g/day) or matched placebo] for ∼14 days. Electrocardiograms analysed for maximum P-wave duration (P-max) and difference between P-max and minimum P-wave duration, P-wave dispersion (PWD). Right atrial specimens analysed for expression of Connexins 40 and 43 using real-time quantitative polymerase chain reaction (qPCR) and western blot. Serum levels of n-3 PUFA at baseline, at surgery, and atrial tissue levels at surgery collated from file. Postoperative AF was quantified by analysing data from stored continuous electrograms. A total of 61 patients (n-3 PUFA 34, Placebo 27) had ECG analysis and AF burden, of which 52 patients (26 in each group) had qPCR and 16 (8 in each group) had western blot analyses for Connexins 40 and 43. No difference between the two groups in ECG parameters or expression of Connexin 40 or 43. P-wave dispersion in the preoperative ECG independently predicted occurrence of AF following CABG surgery. CONCLUSIONS: Omega-3 polyunsaturated fatty acids supplementation does not alter pro-arrhythmic P-wave parameters in ECG or connexin expression in human atrium with no effect on the incidence of AF following CABG surgery."},{"id":"91b52e10e67a","type":"article","url":"https://hartvaat.nl/2016/09/29/drug-eluting-of-bare-metal-stents-bij-coronairlijden-nejm-norstent-trial/","title":"Drug-eluting of bare-metal stents bij coronairlijden: NEJM NORSTENT-trial","title_en":"Drug-Eluting or Bare-Metal Stents for Coronary Artery Disease.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1607991","source_url":"https://doi.org/10.1056/NEJMoa1607991","authors":["Kaare H Bønaa","Jan Mannsverk","Rune Wiseth","Lars Aaberge","Yngvar Myreng","Ottar Nygård","Dennis W Nilsen","Nils-Einar Kløw","Michael Uchto","Thor Trovik","Bjørn Bendz","Sindre Stavnes","Reidar Bjørnerheim","Alf-Inge Larsen","Morten Slette","Terje Steigen","Ole J Jakobsen","Øyvind Bleie","Eigil Fossum","Tove A Hanssen","Øystein Dahl-Eriksen","Inger Njølstad","Knut Rasmussen","Tom Wilsgaard","Jan E Nordrehaug"],"significance":9,"published":"2016-09-29","source_date":"2016-09-29","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/pci-percutane-coronaire-interventie/"],"congress":"","summary_en":"The NORSTENT trial compared contemporary drug-eluting stents with bare-metal stents in a broad population of patients with coronary artery disease. No significant difference was found in the composite of death and MI at 6 years, though DES significantly reduced repeat revascularization, informing the ongoing debate about stent selection.","created":"2026-07-03T10:26:19Z","updated":"2026-07-03T13:25:39Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Landmark NEJM NORSTENT-trial die DES vergeleek met BMS bij een brede populatie coronairlijdenpatiënten. Onderzocht of het voordeel van DES ook geldt bij routinegebruik in de dagelijkse praktijk.","abstract_original":"BACKGROUND: Limited data are available on the long-term effects of contemporary drug-eluting stents versus contemporary bare-metal stents on rates of death, myocardial infarction, repeat revascularization, and stent thrombosis and on quality of life. METHODS: We randomly assigned 9013 patients who had stable or unstable coronary artery disease to undergo percutaneous coronary intervention (PCI) with the implantation of either contemporary drug-eluting stents or bare-metal stents. In the group receiving drug-eluting stents, 96% of the patients received either everolimus- or zotarolimus-eluting stents. The primary outcome was a composite of death from any cause and nonfatal spontaneous myocardial infarction after a median of 5 years of follow-up. Secondary outcomes included repeat revascularization, stent thrombosis, and quality of life. RESULTS: At 6 years, the rates of the primary outcome were 16.6% in the group receiving drug-eluting stents and 17.1% in the group receiving bare-metal stents (hazard ratio, 0.98; 95% confidence interval [CI], 0.88 to 1.09; P=0.66). There were no significant between-group differences in the components of the primary outcome. The 6-year rates of any repeat revascularization were 16.5% in the group receiving drug-eluting stents and 19.8% in the group receiving bare-metal stents (hazard ratio, 0.76; 95% CI, 0.69 to 0.85; P<0.001); the rates of definite stent thrombosis were 0.8% and 1.2%, respectively (P=0.0498). Quality-of-life measures did not differ significantly between the two groups. CONCLUSIONS: In patients undergoing PCI, there were no significant differences between those receiving drug-eluting stents and those receiving bare-metal stents in the composite outcome of death from any cause and nonfatal spontaneous myocardial infarction. Rates of repeat revascularization were lower in the group receiving drug-eluting stents. (Funded by the Norwegian Research Council and others; NORSTENT ClinicalTrials.gov number, NCT00811772 .)."},{"id":"26e9b1c7b098","type":"article","url":"https://hartvaat.nl/2016/09/29/icd-implantatie-bij-niet-ischemisch-systolisch-hartfalen-nejm-danish-trial/","title":"ICD-implantatie bij niet-ischemisch systolisch hartfalen: NEJM DANISH-trial","title_en":"Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1608029","source_url":"https://doi.org/10.1056/NEJMoa1608029","authors":["Lars Køber","Jens J Thune","Jens C Nielsen","Jens Haarbo","Lars Videbæk","Eva Korup","Gunnar Jensen","Per Hildebrandt","Flemming H Steffensen","Niels E Bruun","Hans Eiskjær","Axel Brandes","Anna M Thøgersen","Finn Gustafsson","Kenneth Egstrup","Regitze Videbæk","Christian Hassager","Jesper H Svendsen","Dan E Høfsten","Christian Torp-Pedersen","Steen Pehrson"],"significance":10,"published":"2016-09-29","source_date":"2016-09-29","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/icd-bij-hartfalen/","https://hartvaat.nl/kennis/diagnostiek/cardiale-mri/"],"congress":"","summary_en":"The DANISH trial found that prophylactic ICD implantation did not significantly reduce all-cause mortality in patients with nonischemic systolic heart failure, though there was a reduction in sudden cardiac death. This result challenged the routine use of primary prevention ICDs in dilated cardiomyopathy and reshaped clinical decision-making for device therapy.","created":"2026-07-03T10:26:19Z","updated":"2026-07-03T13:25:39Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Landmark NEJM DANISH-trial die onderzocht of ICD-implantatie de mortaliteit vermindert bij patiënten met niet-ischemisch systolisch hartfalen. Bepalend voor de ICD-indicatiestelling bij dilaterande cardiomyopathie.","abstract_original":"BACKGROUND: The benefit of an implantable cardioverter-defibrillator (ICD) in patients with symptomatic systolic heart failure caused by coronary artery disease has been well documented. However, the evidence for a benefit of prophylactic ICDs in patients with systolic heart failure that is not due to coronary artery disease has been based primarily on subgroup analyses. The management of heart failure has improved since the landmark ICD trials, and many patients now receive cardiac resynchronization therapy (CRT). METHODS: In a randomized, controlled trial, 556 patients with symptomatic systolic heart failure (left ventricular ejection fraction, ≤35%) not caused by coronary artery disease were assigned to receive an ICD, and 560 patients were assigned to receive usual clinical care (control group). In both groups, 58% of the patients received CRT. The primary outcome of the trial was death from any cause. The secondary outcomes were sudden cardiac death and cardiovascular death. RESULTS: After a median follow-up period of 67.6 months, the primary outcome had occurred in 120 patients (21.6%) in the ICD group and in 131 patients (23.4%) in the control group (hazard ratio, 0.87; 95% confidence interval [CI], 0.68 to 1.12; P=0.28). Sudden cardiac death occurred in 24 patients (4.3%) in the ICD group and in 46 patients (8.2%) in the control group (hazard ratio, 0.50; 95% CI, 0.31 to 0.82; P=0.005). Device infection occurred in 27 patients (4.9%) in the ICD group and in 20 patients (3.6%) in the control group (P=0.29). CONCLUSIONS: In this trial, prophylactic ICD implantation in patients with symptomatic systolic heart failure not caused by coronary artery disease was not associated with a significantly lower long-term rate of death from any cause than was usual clinical care. (Funded by Medtronic and others; DANISH ClinicalTrials.gov number, NCT00542945 .)."},{"id":"d9163a4dd585","type":"article","url":"https://hartvaat.nl/2016/09/27/ldl-c-verlaging-en-cardiovasculaire-risicoreductie-jama-systematische-review-en-/","title":"LDL-C-verlaging en cardiovasculaire risicoreductie: JAMA systematische review en meta-analyse","title_en":"Association Between Lowering LDL-C and Cardiovascular Risk Reduction Among Different Therapeutic Interventions: A Systematic Review and Meta-analysis.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["diabetes-en-hart","dyslipidemie","ezetimibe","farmaco-economie","hdl-cholesterol","ldl-cholesterol","lipide-aferese","lipidenverlaging","lipoproteïne-a","niet-statine-therapie","pcsk9-remmers","pelacarsen","statines"],"journal":"JAMA","doi":"10.1001/jama.2016.13985","source_url":"https://doi.org/10.1001/jama.2016.13985","authors":["Michael G Silverman","Brian A Ference","Kyungah Im","Stephen D Wiviott","Robert P Giugliano","Scott M Grundy","Eugene Braunwald","Marc S Sabatine"],"significance":9,"published":"2016-09-27","source_date":"2016-09-27","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/","https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/"],"congress":"","summary_en":"This JAMA systematic review and meta-analysis examined the relationship between LDL cholesterol lowering and cardiovascular risk reduction across different therapeutic interventions. The findings supported the principle that clinical benefit is proportional to the absolute LDL reduction achieved, regardless of the mechanism of lowering.","created":"2026-07-03T10:26:19Z","updated":"2026-07-03T13:25:39Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA systematische review en meta-analyse die het verband onderzocht tussen LDL-C-verlaging en cardiovasculaire risicoreductie over verschillende therapeutische interventies (statines, ezetimibe, PCSK9-remmers). Bevestigt dat het voordeel proportioneel is aan de absolute LDL-verlaging.","abstract_original":"IMPORTANCE: The comparative clinical benefit of nonstatin therapies that reduce low-density lipoprotein cholesterol (LDL-C) remains uncertain. OBJECTIVE: To evaluate the association between lowering LDL-C and relative cardiovascular risk reduction across different statin and nonstatin therapies. DATA SOURCES AND STUDY SELECTION: The MEDLINE and EMBASE databases were searched (1966-July 2016). The key inclusion criteria were that the study was a randomized clinical trial and the reported clinical outcomes included myocardial infarction (MI). Studies were excluded if the duration was less than 6 months or had fewer than 50 clinical events. Studies of 9 different types of LDL-C reduction approaches were included. DATA EXTRACTION AND SYNTHESIS: Two authors independently extracted and entered data into standardized data sheets and data were analyzed using meta-regression. MAIN OUTCOMES AND MEASURES: The relative risk (RR) of major vascular events (a composite of cardiovascular death, acute MI or other acute coronary syndrome, coronary revascularization, or stroke) associated with the absolute reduction in LDL-C level; 5-year rate of major coronary events (coronary death or MI) associated with achieved LDL-C level. RESULTS: A total of 312 175 participants (mean age, 62 years; 24% women; mean baseline LDL-C level of 3.16 mmol/L [122.3 mg/dL]) from 49 trials with 39 645 major vascular events were included. The RR for major vascular events per 1-mmol/L (38.7-mg/dL) reduction in LDL-C level was 0.77 (95% CI, 0.71-0.84; P < .001) for statins and 0.75 (95% CI, 0.66-0.86; P = .002) for established nonstatin interventions that work primarily via upregulation of LDL receptor expression (ie, diet, bile acid sequestrants, ileal bypass, and ezetimibe) (between-group difference, P = .72). For these 5 therapies combined, the RR was 0.77 (95% CI, 0.75-0.79, P < .001) for major vascular events per 1-mmol/L reduction in LDL-C level. For other interventions, the observed RRs vs the expected RRs based on the degree of LDL-C reduction in the trials were 0.94 (95% CI, 0.89-0.99) vs 0.91 (95% CI, 0.90-0.92) for niacin (P = .24); 0.88 (95% CI, 0.83-0.92) vs 0.94 (95% CI, 0.93-0.94) for fibrates (P = .02), which was lower than expected (ie, greater risk reduction); 1.01 (95% CI, 0.94-1.09) vs 0.90 (95% CI, 0.89-0.91) for cholesteryl ester transfer protein inhibitors (P = .002), which was higher than expected (ie, less risk reduction); and 0.49 (95% CI, 0.34-0.71) vs 0.61 (95% CI, 0.58-0.65) for proprotein convertase subtilisin/kexin type 9 inhibitors (P = .25). The achieved absolute LDL-C level was significantly associated with the absolute rate of major coronary events (11 301 events, including coronary death or MI) for primary prevention trials (1.5% lower event rate [95% CI, 0.5%-2.6%] per each 1-mmol/L lower LDL-C level; P = .008) and secondary prevention trials (4.6% lower event rate [95% CI, 2.9%-6.4%] per each 1-mmol/L lower LDL-C level; P < .001). CONCLUSIONS AND RELEVANCE: In this meta-regression analysis, the use of statin and nonstatin therapies that act via upregulation of LDL receptor expression to reduce LDL-C were associated with similar RRs of major vascular events per change in LDL-C. Lower achieved LDL-C levels were associated with lower rates of major coronary events."},{"id":"dce04e2cf197","type":"article","url":"https://hartvaat.nl/2016/09/27/intensieve-glucoseregulatie-bij-hyperglycemisch-acs-langetermijnfollow-up-biomar/","title":"Intensieve glucoseregulatie bij hyperglycemisch ACS: langetermijnfollow-up BIOMArCS-2","title_en":"Long-Term Follow-Up of the Randomized (BIOMArCS-2) Glucose Trial: Intensive Glucose Regulation in Hyperglycemic Acute Coronary Syndrome.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","internist"],"tags":["diabetes-en-hart","soul-trial"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.023480","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.023480","authors":["Victor J van den Berg","Victor A W M Umans","Frank Stam","Maarten de Mulder","K Martijn Akkerhuis","Jan H Cornel","Isabella Kardys","Eric Boersma"],"significance":6,"published":"2016-09-27","source_date":"2016-09-27","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/bloedsuikerdoelen-cardiovasculair/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"Long-term follow-up of the BIOMArCS-2 Glucose Trial showed that intensive glucose regulation in hyperglycemic MI patients does not provide lasting cardiovascular benefit compared with standard care.","created":"2026-07-03T10:26:19Z","updated":"2026-07-03T13:25:39Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Langetermijnfollow-up van de BIOMArCS-2 Glucose Trial die intensieve glucoseregulatie vergeleek met standaardzorg bij patiënten met hyperglycemie en ACS. Onderzoekt of acute glucosecontrole langetermijnuitkomsten beïnvloedt.","abstract_original":""},{"id":"343dc974d249","type":"article","url":"https://hartvaat.nl/2016/09/27/oct-geleide-pci-optimalisatie-bij-nste-acs-gerandomiseerde-trial/","title":"OCT-geleide PCI-optimalisatie bij NSTE-ACS: gerandomiseerde trial","title_en":"Optical Coherence Tomography to Optimize Results of Percutaneous Coronary Intervention in Patients with Non-ST-Elevation Acute Coronary Syndrome: Results of the Multicenter, Randomized DOCTORS Study (Does Optical Coherence Tomography Optimize Results of Stenting).","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["intracoronaire-beeldvorming"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.024393","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.024393","authors":["Nicolas Meneveau","Geraud Souteyrand","Pascal Motreff","Christophe Caussin","Nicolas Amabile","Patrick Ohlmann","Olivier Morel","Yoann Lefrançois","Vincent Descotes-Genon","Johanne Silvain","Nassim Braik","Romain Chopard","Marion Chatot","Fiona Ecarnot","Hélène Tauzin","Eric Van Belle","Loïc Belle","François Schiele"],"significance":6,"published":"2016-09-27","source_date":"2016-09-27","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/","https://hartvaat.nl/kennis/cardiometabool/cardiometabool-spreekuur/"],"congress":"","summary_en":"This randomized trial showed that OCT-guided PCI optimization does not significantly improve clinical outcomes compared with angiography-guided PCI in NSTE-ACS patients, an early negative result for routine OCT guidance.","created":"2026-07-03T10:26:19Z","updated":"2026-07-03T13:25:39Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial die onderzocht of OCT (optical coherence tomography) de PCI-resultaten verbetert bij patiënten met NSTE-ACS. Onderzocht de meerwaarde van intracoronaire beeldvorming.","abstract_original":"BACKGROUND: No randomized study has investigated the value of optical coherence tomography (OCT) in optimizing the results of percutaneous coronary intervention (PCI) for non-ST-segment elevation acute coronary syndromes. METHODS: We conducted a multicenter, randomized study involving 240 patients with non-ST-segment elevation acute coronary syndromes to compare OCT-guided PCI (use of OCT pre- and post-PCI; OCT-guided group) to fluoroscopy-guided PCI (angiography-guided group). The primary end point was the functional result of PCI assessed by the measure of post PCI fractional flow reserve. Secondary end points included procedural complications and type 4a periprocedural myocardial infarction. Safety was assessed by the rate of acute kidney injury. RESULTS: OCT use led to a change in procedural strategy in 50% of the patients in the OCT-guided group. The primary end point was improved in the OCT-guided group, with a significantly higher fractional flow reserve value (0.94±0.04 versus 0.92±0.05, P=0.005) compared with the angiography-guided group. There was no significant difference in the rate of type 4a myocardial infarction (33% in the OCT-group versus 40% in the angiography-guided group, P=0.28). The rates of procedural complications (5.8%) and acute kidney injury (1.6%) were identical in each group despite longer procedure time and use of more contrast medium in the OCT-guided group. Post-PCI OCT revealed stent underexpansion in 42% of patients, stent malapposition in 32%, incomplete lesion coverage in 20%, and edge dissection in 37.5%. This led to the more frequent use of poststent overdilation in the OCT-guided group versus the angiography-guided group (43% versus 12.5%, P<0.0001) with lower residual stenosis (7.0±4.3% versus 8.7±6.3%, P=0.01). CONCLUSIONS: In patients with non-ST-segment elevation acute coronary syndromes, OCT-guided PCI is associated with higher postprocedure fractional flow reserve than PCI guided by angiography alone. OCT did not increase periprocedural complications, type 4a myocardial infarction, or acute kidney injury. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01743274."},{"id":"e5e6729671c0","type":"article","url":"https://hartvaat.nl/2016/09/27/2016-acc-aha-hfsa-gerichte-update-nieuwe-farmacologische-hartfalentherapie/","title":"2016 ACC/AHA/HFSA gerichte update: nieuwe farmacologische hartfalentherapie","title_en":"2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure: An Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["acuut-hartfalen","sacubitril-valsartan"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.05.011","source_url":"https://doi.org/10.1016/j.jacc.2016.05.011","authors":["Clyde W Yancy","Mariell Jessup","Biykem Bozkurt","Javed Butler","Donald E Casey","Monica M Colvin","Mark H Drazner","Gerasimos Filippatos","Gregg C Fonarow","Michael M Givertz","Steven M Hollenberg","JoAnn Lindenfeld","Frederick A Masoudi","Patrick E McBride","Pamela N Peterson","Lynne Warner Stevenson","Cheryl Westlake"],"significance":9,"published":"2016-09-27","source_date":"2016-09-27","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/","https://hartvaat.nl/kennis/hartfalen/arni-sacubitril-valsartan/"],"congress":"","summary_en":"The 2016 ACC/AHA/HFSA focused update introduced new recommendations for pharmacological heart failure therapy, most notably endorsing sacubitril-valsartan (ARNI) for HFrEF based on the PARADIGM-HF results. This update marked the entry of neprilysin inhibition into guideline-directed heart failure treatment.","created":"2026-07-03T10:26:19Z","updated":"2026-07-03T18:38:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerichte richtlijnupdate met nieuwe aanbevelingen voor farmacologische hartfalentherapie, waaronder sacubitril/valsartan (ARNI). Integratie van PARADIGM-HF-resultaten in de praktijkrichtlijnen.","abstract_original":""},{"id":"6d211758b704","type":"article","url":"https://hartvaat.nl/2016/09/20/volledig-linkszijdig-reverse-remodelling-bij-crt-madit-crt-substudie/","title":"Volledig linkszijdig reverse remodelling bij CRT: MADIT-CRT-substudie","title_en":"Clinical Implications of Complete Left-Sided Reverse Remodeling With Cardiac Resynchronization Therapy: A MADIT-CRT Substudy.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["cardiale-resynchronisatie"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.06.051","source_url":"https://doi.org/10.1016/j.jacc.2016.06.051","authors":["Andrew Mathias","Arthur J Moss","Scott McNitt","Wojciech Zareba","Ilan Goldenberg","Scott D Solomon","Valentina Kutyifa"],"significance":6,"published":"2016-09-20","source_date":"2016-09-20","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/cardiale-remodellering/","https://hartvaat.nl/kennis/farmacologie/betablokkers-farmacologie/"],"congress":"","summary_en":"This MADIT-CRT substudy characterized the clinical implications of complete left-sided reverse remodeling with CRT, showing that super-responders who normalize LV volumes and function have excellent long-term prognosis.","created":"2026-07-03T10:26:18Z","updated":"2026-07-03T13:25:39Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"MADIT-CRT-substudie naar de klinische implicaties van volledig linkszijdig reverse remodelling bij patiënten met CRT. Super-responders met normalisatie van LV-functie hebben een uitstekende prognose.","abstract_original":"BACKGROUND: Clinical implications of complete left-sided reverse remodeling due to cardiac resynchronization therapy with a defibrillator (CRT-D), defined as reduction in both left ventricular end-systolic volume (LVESV) and left atrial volume (LAV), are unknown. OBJECTIVES: This study aimed to evaluate the rate and predictive value of complete left-sided reverse remodeling on heart failure (HF) and death events in CRT-D patients with left bundle branch block (LBBB) enrolled in MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy). METHODS: The study population comprised 533 CRT-D patients with LBBB, 212 (40%) with complete left-sided reverse remodeling (above-median change in both LAV and LVESV), 115 (22%) with discordant reverse remodeling (above-median change in only LAV or LVESV), and 206 (38%) with lesser reverse remodeling (below-median LAV and LVESV change). The primary endpoint was HF or death; secondary endpoints included HF alone and death alone during long-term follow-up. RESULTS: Patients with complete left-sided reverse remodeling had a significantly lower rate of HF or death than those with discordant reverse remodeling or lesser reverse remodeling (p < 0.001). Multivariate Cox proportional hazard models consistently showed a decreased risk for HF and death in patients with complete reverse remodeling compared with discordant reverse remodeling or lesser reverse remodeling (hazard ratio: 0.66 per each group; 95% CI: 0.50 to 0.85; p = 0.002). This finding was similar for HF alone and death alone. CONCLUSIONS: In MADIT-CRT, >20% of CRT-D patients exhibited discordant reverse remodeling in the left ventricle and the left atrium. CRT-D patients with LBBB and complete left-sided reverse remodeling had a significantly lower risk of HF and death, HF alone, and death alone during long-term follow-up than patients with discordant or lesser reverse remodeling. (MADIT-CRT: Multicenter Automatic Defibrillator Implantation With Cardiac Resynchronization Therapy [MADIT-CRT]; NCT00180271)."},{"id":"f26b8d650c72","type":"article","url":"https://hartvaat.nl/2016/09/20/medicatietrouw-en-bloeddrukeffecten-van-renale-denervatie-rsd-pathway-2-analyse/","title":"Medicatietrouw en bloeddrukeffecten van renale denervatie: RSD PATHWAY-2-analyse","title_en":"Adherence to Antihypertensive Treatment and the Blood Pressure-Lowering Effects of Renal Denervation in the Renal Denervation for Hypertension (DENERHTN) Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["bloeddrukbehandeling","cardiorenal-behandelstrategie","figaro-dkd","flow-trial","renale-denervatie"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.022922","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.022922","authors":["Michel Azizi","Helena Pereira","Idir Hamdidouche","Philippe Gosse","Matthieu Monge","Guillaume Bobrie","Pascal Delsart","Claire Mounier-Véhier","Pierre-Yves Courand","Pierre Lantelme","Thierry Denolle","Caroline Dourmap-Collas","Xavier Girerd","Jean Michel Halimi","Faiez Zannad","Olivier Ormezzano","Bernard Vaïsse","Daniel Herpin","Jean Ribstein","Bernard Chamontin","Jean-Jacques Mourad","Emile Ferrari","Pierre-François Plouin","Vincent Jullien","Marc Sapoval","Gilles Chatellier"],"significance":7,"published":"2016-09-20","source_date":"2016-09-20","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/esc-richtlijn-hypertensie-2024/"],"congress":"","summary_en":"This DENERHTN analysis examined the relationship between antihypertensive medication adherence and the blood pressure-lowering effects of renal denervation, highlighting that non-adherence is a major confounder in renal denervation trials.","created":"2026-07-03T10:26:18Z","updated":"2026-07-03T18:38:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse naar de relatie tussen antihypertensieve medicatietrouw en de bloeddrukverlagende effecten van renale denervatie. Benadrukt dat non-adherentie het effect van devicetherapie kan verklaren.","abstract_original":"BACKGROUND: The DENERHTN trial (Renal Denervation for Hypertension) confirmed the blood pressure-lowering efficacy of renal denervation added to a standardized stepped-care antihypertensive treatment for resistant hypertension at 6 months. We report the influence of adherence to antihypertensive treatment on blood pressure control. METHODS: One hundred six patients with hypertension resistant to 4 weeks of treatment with indapamide 1.5 mg/d, ramipril 10 mg/d (or irbesartan 300 mg/d), and amlodipine 10 mg/d were randomly assigned to renal denervation plus standardized stepped-care antihypertensive treatment, or the same antihypertensive treatment alone. For standardized stepped-care antihypertensive treatment, spironolactone 25 mg/d, bisoprolol 10 mg/d, prazosin 5 mg/d, and rilmenidine 1 mg/d were sequentially added at monthly visits if home blood pressure was ≥135/85 mm Hg after randomization. We assessed adherence to antihypertensive treatment at 6 months by drug screening in urine/plasma samples from 85 patients. RESULTS: The numbers of fully adherent (20/40 versus 21/45), partially nonadherent (13/40 versus 20/45), or completely nonadherent patients (7/40 versus 4/45) to antihypertensive treatment were not different in the renal denervation and the control groups, respectively (P=0.3605). The difference in the change in daytime ambulatory systolic blood pressure from baseline to 6 months between the 2 groups was -6.7 mm Hg (P=0.0461) in fully adherent and -7.8 mm Hg (P=0.0996) in nonadherent (partially nonadherent plus completely nonadherent) patients. The between-patient variability of daytime ambulatory systolic blood pressure was greater for nonadherent than for fully adherent patients. CONCLUSIONS: In the DENERHTN trial, the prevalence of nonadherence to antihypertensive drugs at 6 months was high (≈50%) but not different in the renal denervation and control groups. Regardless of adherence to treatment, renal denervation plus standardized stepped-care antihypertensive treatment resulted in a greater decrease in blood pressure than standardized stepped-care antihypertensive treatment alone. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01570777."},{"id":"5516d86f62f7","type":"article","url":"https://hartvaat.nl/2016/09/20/cva-preventie-met-ticagrelor-na-myocardinfarct-pegasus-timi-54-inzichten/","title":"CVA-preventie met ticagrelor na myocardinfarct: PEGASUS-TIMI 54-inzichten","title_en":"Prevention of Stroke with Ticagrelor in Patients with Prior Myocardial Infarction: Insights from PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis in Myocardial Infarction 54).","category":"preventie","category_label":"Preventie","professions":["cardioloog"],"tags":["trombocytenaggregatieremmers"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.024637","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.024637","authors":["Marc P Bonaca","Shinya Goto","Deepak L Bhatt","P Gabriel Steg","Robert F Storey","Marc Cohen","Erica Goodrich","Laura Mauri","Ton Oude Ophuis","Mikhail Ruda","Jindřich Špinar","Ki-Bae Seung","Dayi Hu","Anthony J Dalby","Eva Jensen","Peter Held","David A Morrow","Eugene Braunwald","Marc S Sabatine"],"significance":6,"published":"2016-09-20","source_date":"2016-09-20","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This PEGASUS-TIMI 54 analysis showed that ticagrelor reduces stroke risk in patients with prior MI, demonstrating a cerebrovascular benefit of extended P2Y12 inhibitor therapy beyond coronary event reduction.","created":"2026-07-03T10:26:18Z","updated":"2026-07-03T13:25:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"PEGASUS-TIMI 54-analyse naar het effect van ticagrelor op CVA-preventie bij patiënten met een eerder myocardinfarct. Onderzoekt het cerebrovasculaire voordeel van verlengde P2Y12-remming.","abstract_original":"BACKGROUND: In the PEGASUS-TIMI 54 trial (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis in Myocardial Infarction 54), ticagrelor reduced the risk of major adverse cardiovascular events when added to low-dose aspirin in stable patients with prior myocardial infarction, resulting in the approval of ticagrelor 60 mg twice daily for long-term secondary prevention. We investigated the incidence of stroke, outcomes after stroke, and the efficacy of ticagrelor focusing on the approved 60 mg twice daily dose for reducing stroke in this population. METHODS: Patients were followed for a median of 33 months. Stroke events were adjudicated by a central committee. Data from similar trials were combined using meta-analysis. RESULTS: Of 14 112 patients randomly assigned to placebo or ticagrelor 60 mg, 213 experienced a stroke; 85% of these strokes were ischemic. A total of 18% of strokes were fatal and another 15% led to either moderate or severe disability at 30 days. Ticagrelor significantly reduced the risk of stroke (hazard ratio, 0.75; 95% confidence interval, 0.57-0.98; P=0.034), driven by a reduction in ischemic stroke (hazard ratio, 0.76; 95% confidence interval, 0.56-1.02). Hemorrhagic stroke occurred in 9 patients on placebo and 8 patients on ticagrelor. A meta-analysis across 4 placebo-controlled trials of more intensive antiplatelet therapy in 44 816 patients with coronary disease confirmed a marked reduction in ischemic stroke (hazard ratio, 0.66; 95% confidence interval, 0.54-0.81; P=0.0001). CONCLUSIONS: High-risk patients with prior myocardial infarction are at risk for stroke, approximately one-third of which are fatal or lead to moderate-to-severe disability. The addition of ticagrelor 60 mg twice daily significantly reduced this risk without an excess of hemorrhagic stroke but with more major bleeding. In high-risk patients with coronary disease, more intensive antiplatelet therapy should be considered not only to reduce the risk of coronary events, but also of stroke. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique Identifier: NCT01225562."},{"id":"cef16c11a015","type":"article","url":"https://hartvaat.nl/2016/09/15/intensieve-bloeddrukverlaging-bij-acute-hersenbloeding-nejm-atach-2-trial/","title":"Intensieve bloeddrukverlaging bij acute hersenbloeding: NEJM ATACH-2-trial","title_en":"Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1603460","source_url":"https://doi.org/10.1056/NEJMoa1603460","authors":["Adnan I Qureshi","Yuko Y Palesch","William G Barsan","Daniel F Hanley","Chung Y Hsu","Renee L Martin","Claudia S Moy","Robert Silbergleit","Thorsten Steiner","Jose I Suarez","Kazunori Toyoda","Yongjun Wang","Haruko Yamamoto","Byung-Woo Yoon"],"significance":9,"published":"2016-09-15","source_date":"2016-09-15","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/behandeldoelen-bloeddruk/"],"congress":"","summary_en":"The ATACH-2 trial showed that intensive blood pressure lowering to a target of 110–139 mmHg did not improve outcomes compared with standard treatment (140–179 mmHg) in patients with acute intracerebral hemorrhage and was associated with more renal adverse events. The results established that very aggressive blood pressure reduction is not beneficial in acute ICH.","created":"2026-07-03T10:26:18Z","updated":"2026-07-03T13:25:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM ATACH-2-trial die intensieve bloeddrukverlaging vergeleek met standaardbehandeling bij patiënten met acute intracereberale bloeding. Definitieve trial over bloeddrukstreefwaarden bij hemorrhagisch CVA.","abstract_original":"BACKGROUND: Limited data are available to guide the choice of a target for the systolic blood-pressure level when treating acute hypertensive response in patients with intracerebral hemorrhage. METHODS: We randomly assigned eligible participants with intracerebral hemorrhage (volume, <60 cm(3)) and a Glasgow Coma Scale (GCS) score of 5 or more (on a scale from 3 to 15, with lower scores indicating worse condition) to a systolic blood-pressure target of 110 to 139 mm Hg (intensive treatment) or a target of 140 to 179 mm Hg (standard treatment) in order to test the superiority of intensive reduction of systolic blood pressure to standard reduction; intravenous nicardipine to lower blood pressure was administered within 4.5 hours after symptom onset. The primary outcome was death or disability (modified Rankin scale score of 4 to 6, on a scale ranging from 0 [no symptoms] to 6 [death]) at 3 months after randomization, as ascertained by an investigator who was unaware of the treatment assignments. RESULTS: Among 1000 participants with a mean (±SD) systolic blood pressure of 200.6±27.0 mm Hg at baseline, 500 were assigned to intensive treatment and 500 to standard treatment. The mean age of the patients was 61.9 years, and 56.2% were Asian. Enrollment was stopped because of futility after a prespecified interim analysis. The primary outcome of death or disability was observed in 38.7% of the participants (186 of 481) in the intensive-treatment group and in 37.7% (181 of 480) in the standard-treatment group (relative risk, 1.04; 95% confidence interval, 0.85 to 1.27; analysis was adjusted for age, initial GCS score, and presence or absence of intraventricular hemorrhage). Serious adverse events occurring within 72 hours after randomization that were considered by the site investigator to be related to treatment were reported in 1.6% of the patients in the intensive-treatment group and in 1.2% of those in the standard-treatment group. The rate of renal adverse events within 7 days after randomization was significantly higher in the intensive-treatment group than in the standard-treatment group (9.0% vs. 4.0%, P=0.002). CONCLUSIONS: The treatment of participants with intracerebral hemorrhage to achieve a target systolic blood pressure of 110 to 139 mm Hg did not result in a lower rate of death or disability than standard reduction to a target of 140 to 179 mm Hg. (Funded by the National Institute of Neurological Disorders and Stroke and the National Cerebral and Cardiovascular Center; ATACH-2 ClinicalTrials.gov number, NCT01176565 .)."},{"id":"0378084cf033","type":"article","url":"https://hartvaat.nl/2016/09/13/clopidogrel-versus-ticagrelor-bij-diabetes-na-pci-gerandomiseerde-trial/","title":"Clopidogrel versus ticagrelor bij diabetes na PCI: gerandomiseerde trial","title_en":"Clopidogrel Versus Ticagrelor for Antiplatelet Maintenance in Diabetic Patients Treated With Percutaneous Coronary Intervention: Results of the CLOTILDIA Study (Clopidogrel High Dose Versus Ticagrelor for Antiplatelet Maintenance in Diabetic Patients).","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog"],"tags":["credence-trial","soul-trial","trombocytenaggregatieremmers"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.023743","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.023743","authors":["Fabio Mangiacapra","Elena Panaioli","Iginio Colaiori","Elisabetta Ricottini","Angelo Lauria Pantano","Paolo Pozzilli","Emanuele Barbato","Germano Di Sciascio"],"significance":6,"published":"2016-09-13","source_date":"2016-09-13","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/cardiometabool-spreekuur/"],"congress":"","summary_en":"This randomized comparison of clopidogrel versus ticagrelor for antiplatelet maintenance in diabetic PCI patients provided head-to-head data on these P2Y12 inhibitors in the diabetic population.","created":"2026-07-03T10:26:18Z","updated":"2026-07-03T13:25:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde vergelijking van clopidogrel versus ticagrelor voor antiplaatjesonderhoud bij diabetespatiënten behandeld met PCI. Onderzoekt de optimale P2Y12-remmerkeuze bij diabetes.","abstract_original":""},{"id":"bebc59e8d21c","type":"article","url":"https://hartvaat.nl/2016/09/13/edoxaban-versus-warfarine-bij-af-patienten-met-valrisico-engage-af-timi-48-analy/","title":"Edoxaban versus warfarine bij AF-patiënten met valrisico: ENGAGE AF-TIMI 48-analyse","title_en":"Edoxaban Versus Warfarin in Atrial Fibrillation Patients at Risk of Falling: ENGAGE AF-TIMI 48 Analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","huisarts"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.06.034","source_url":"https://doi.org/10.1016/j.jacc.2016.06.034","authors":["Jan Steffel","Robert P Giugliano","Eugene Braunwald","Sabina A Murphy","Michele Mercuri","Youngsook Choi","Phil Aylward","Harvey White","Jose Luis Zamorano","Elliott M Antman","Christian T Ruff"],"significance":7,"published":"2016-09-13","source_date":"2016-09-13","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/antistolling/antistolling-bij-ouderen/"],"congress":"","summary_en":"This ENGAGE AF-TIMI 48 analysis showed that edoxaban maintains a favorable risk-benefit profile compared with warfarin even in AF patients at increased risk of falling, providing evidence against withholding anticoagulation based solely on perceived fall risk.","created":"2026-07-03T10:26:18Z","updated":"2026-07-03T13:25:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van ENGAGE AF-TIMI 48 bij AF-patiënten met verhoogd valrisico. Relevant voor de antistollingsafweging bij ouderen waarbij valincidenten het bloedingsrisico verhogen.","abstract_original":"BACKGROUND: Anticoagulation is often avoided in patients with atrial fibrillation who are at an increased risk of falling. OBJECTIVES: This study assessed the relative efficacy and safety of edoxaban versus warfarin in the ENGAGE AF-TIMI 48 (Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis In Myocardial Infarction 48) trial in patients with atrial fibrillation judged to be at increased risk of falling. METHODS: We performed a pre-specified analysis of the ENGAGE AF-TIMI 48, comparing patients with versus without increased risk of falling. RESULTS: Nine hundred patients (4.3%) were judged to be at increased risk of falling. These patients were older (median, 77 vs. 72 years; p < 0.001), and had a higher prevalence of comorbidities including prior stroke/transient ischemic attack, diabetes, and coronary artery disease. After multivariable adjustment, patients at increased risk of falling experienced more bone fractures caused by falling (adjusted hazard ratio [HRadj]: 1.88; 95% confidence interval [CI]: 1.49 to 2.38; p < 0.001), major bleeding (HRadj: 1.30; 95% CI: 1.04 to 1.64; p = 0.023), life-threatening bleeding (HRadj: 1.67; 95% CI: 1.11 to 2.50; p = 0.013), and all-cause death (HRadj: 1.45; 95% CI: 1.23 to 1.70; p < 0.001), but not ischemic events including stroke/systemic embolic event (HRadj: 1.16; 95% CI: 0.89 to 1.51; p = 0.27). No treatment interaction was observed between either dosing regimens of edoxaban and warfarin for the efficacy and safety outcomes. Treatment with edoxaban resulted in a greater absolute risk reduction in severe bleeding events and all-cause mortality compared with warfarin. CONCLUSIONS: Edoxaban is an attractive alternative to warfarin in patients at increased risk of falling, because it is associated with an even greater absolute reduction in severe bleeding events and mortality. (Effective aNticaoGulation with factor xA next Generation in Atrial Fibrillation [ENGAGE AF-TIMI 48]; NCT00781391)."},{"id":"761052b1a32a","type":"article","url":"https://hartvaat.nl/2016/09/13/ganglionplexusablatie-bij-gevorderd-atriumfibrilleren-de-afact-studie/","title":"Ganglionplexusablatie bij gevorderd atriumfibrilleren: de AFACT-studie","title_en":"Ganglion Plexus Ablation in Advanced Atrial Fibrillation: The AFACT Study.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.06.036","source_url":"https://doi.org/10.1016/j.jacc.2016.06.036","authors":["Antoine H G Driessen","Wouter R Berger","Sébastien P J Krul","Nicoline W E van den Berg","Jolien Neefs","Femke R Piersma","Dean R P P Chan Pin Yin","Jonas S S G de Jong","WimJan P van Boven","Joris R de Groot"],"significance":6,"published":"2016-09-13","source_date":"2016-09-13","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/pathofysiologie-af/","https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"The AFACT study showed that additional ganglion plexus ablation during AF catheter ablation does not improve outcomes in patients with advanced AF, while increasing procedural complications.","created":"2026-07-03T10:26:18Z","updated":"2026-07-03T18:38:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde studie die onderzocht of aanvullende ganglionplexusablatie de uitkomsten verbetert bij patiënten met gevorderd AF die PVI ondergaan. Onderzoekt autonome modulatie als AF-therapie.","abstract_original":"BACKGROUND: Patients with long duration of atrial fibrillation (AF), enlarged atria, or failed catheter ablation have advanced AF and may require more extensive treatment than pulmonary vein isolation. OBJECTIVES: The aim of this study was to investigate the efficacy and safety of additional ganglion plexus (GP) ablation in patients undergoing thoracoscopic AF surgery. METHODS: Patients with paroxysmal AF underwent pulmonary vein isolation. Patients with persistent AF also received additional lines (Dallas lesion set). Patients were randomized 1:1 to additional epicardial ablation of the 4 major GPs and Marshall's ligament (GP group) or no extra ablation (control) and followed every 3 months for 1 year. After a 3-month blanking period, all antiarrhythmic drugs were discontinued. RESULTS: Two hundred forty patients with a mean AF duration of 5.7 ± 5.1 years (59% persistent) were included. Mean procedure times were 185 ± 54 min and 168 ± 54 min (p = 0.015) in the GP (n = 117) and control groups (n = 123), respectively. GP ablation abated 100% of evoked vagal responses; these responses remained in 87% of control subjects. Major bleeding occurred in 9 patients (all in the GP group; p < 0.001); 8 patients were managed thoracoscopically, and 1 underwent sternotomy. Sinus node dysfunction occurred in 12 patients in the GP group and 4 control subjects (p = 0.038), and 6 pacemakers were implanted (all in the GP group; p = 0.013). After 1 year, 4 patients had died (all in the GP group, not procedure related; p = 0.055), and 9 were lost to follow-up. Freedom from AF recurrence in the GP and control groups was not statistically different whether patients had paroxysmal or persistent AF. At 1 year, 82% of patients were not taking antiarrhythmic drugs. CONCLUSIONS: GP ablation during thoracoscopic surgery for advanced AF has no detectable effect on AF recurrence but causes more major adverse events, major bleeding, sinus node dysfunction, and pacemaker implantation. (Atrial Fibrillation Ablation and Autonomic Modulation via Thoracoscopic Surgery [AFACT]; NCT01091389)."},{"id":"d6151e5249dc","type":"article","url":"https://hartvaat.nl/2016/09/13/prasugrel-versus-ticagrelor-bij-diabetes-type-2-met-coronairlijden-optimus-4-stu/","title":"Prasugrel versus ticagrelor bij diabetes type 2 met coronairlijden: OPTIMUS-4-studie","title_en":"Pharmacodynamic Comparison of Prasugrel Versus Ticagrelor in Patients With Type 2 Diabetes Mellitus and Coronary Artery Disease: The OPTIMUS (Optimizing Antiplatelet Therapy in Diabetes Mellitus)-4 Study.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.023402","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.023402","authors":["Francesco Franchi","Fabiana Rollini","Niti Aggarwal","Jenny Hu","Megha Kureti","Ashwin Durairaj","Valeria E Duarte","Jung Rae Cho","Latonya Been","Martin M Zenni","Theodore A Bass","Dominick J Angiolillo"],"significance":6,"published":"2016-09-13","source_date":"2016-09-13","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"This pharmacodynamic comparison showed that both prasugrel and ticagrelor effectively overcome the enhanced platelet reactivity seen in diabetic patients, with prasugrel providing slightly greater inhibition in this high-risk population.","created":"2026-07-03T10:26:18Z","updated":"2026-07-03T13:25:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Farmacodynamische vergelijking van prasugrel versus ticagrelor bij diabetespatiënten met coronairlijden. Onderzoekt welke P2Y12-remmer de sterkste plaatjesremming biedt bij deze hoogrisicopopulatie.","abstract_original":"BACKGROUND: Patients with diabetes mellitus (DM) are at increased risk of atherothrombotic events, underscoring the importance of effective platelet inhibiting therapies. Prasugrel and ticagrelor reduce thrombotic complications to a greater extent than clopidogrel. Subgroup analyses of pivotal clinical trials testing prasugrel and ticagrelor versus clopidogrel showed DM patients to have benefits that were consistent with the overall trial populations, although the magnitude of the ischemic risk reduction appeared to be enhanced with prasugrel. Whether these findings may be attributed to differences in the pharmacodynamic profiles of these drugs in DM patients remains poorly explored and represented the aim of this study. METHODS: In this prospective, randomized, double-blind, double-dummy, crossover pharmacodynamic study, aspirin-treated DM patients (n=50) with coronary artery disease were randomly assigned to receive prasugrel (60 mg loading dose [LD]/10 mg maintenance dose once daily) or ticagrelor (180 mg LD/90 mg maintenance dose twice daily) for 1 week. Pharmacodynamic assessments were conducted using 4 different assays, including VerifyNow P2Y12, vasodilator-stimulated phosphoprotein, light transmittance aggregometry, and Multiplate, which allowed us to explore ADP- and non-ADP-induced (arachidonic acid-, collagen-, thrombin receptor-activating, peptide-induced) platelet signaling pathways. The acute (baseline, 30 minutes, and 2 hours post-LD) and maintenance (1 week) effects of therapy were assessed. The primary end point of the study was the comparison of P2Y12 reaction units determined by VerifyNow P2Y12 at 1 week between prasugrel and ticagrelor. RESULTS: ADP- and non-ADP-induced measures of platelet reactivity reduced significantly with both prasugrel and ticagrelor LD and maintenance dose. P2Y12 reaction units defined by VerifyNow were similar between prasugrel and ticagrelor at 30 minutes and 2 hours post-LD. At 1 week, P2Y12 reaction units were significantly lower with ticagrelor than with prasugrel (52 [32-72] versus 83 [63-103]; least-square means difference: -31; 95% confidence interval, -57 to -4; P=0.022; primary end point). Pharmacodynamic assessments measured by vasodilator-stimulated phosphoprotein, light transmittance aggregometry, and Multiplate were similar between prasugrel and ticagrelor at each time point, including at 1 week. Rates of high on-treatment platelet reactivity were similar between groups with all assays at all time points. CONCLUSIONS: In DM patients with coronary artery disease, ticagrelor exerts similar or greater inhibition of ADP-induced platelet reactivity in comparison with prasugrel in the acute and chronic phases of treatment, whereas the inhibition of measures of non-ADP-induced platelet reactivity was not significantly different between the 2 agents. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01852214."},{"id":"152a9870a03b","type":"article","url":"https://hartvaat.nl/2016/09/06/pci-versus-cabg-bij-onbeschermde-hoofdstamziekte-uitkomsten/","title":"PCI versus CABG bij onbeschermde hoofdstamziekte: uitkomsten","title_en":"Outcomes After Percutaneous Coronary Intervention or Bypass Surgery in Patients With Unprotected Left Main Disease.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.06.024","source_url":"https://doi.org/10.1016/j.jacc.2016.06.024","authors":["Rafael Cavalcante","Yohei Sotomi","Cheol W Lee","Jung-Min Ahn","Vasim Farooq","Hiroki Tateishi","Erhan Tenekecioglu","Yaping Zeng","Pannipa Suwannasom","Carlos Collet","Felipe N Albuquerque","Yoshinobu Onuma","Seung-Jung Park","Patrick W Serruys"],"significance":7,"published":"2016-09-06","source_date":"2016-09-06","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/pci-vs-cabg-afweging/","https://hartvaat.nl/kennis/coronairlijden/cabg-bypasschirurgie/"],"congress":"","summary_en":"This study compared outcomes after PCI versus CABG for unprotected left main coronary disease using contemporary data, contributing to the evolving evidence base for revascularization strategy selection in this high-risk anatomy.","created":"2026-07-03T10:26:18Z","updated":"2026-07-03T13:25:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die uitkomsten vergeleek na PCI versus CABG bij patiënten met onbeschermde linker-hoofdstamcoronairlijden. Relevant voor het Heart Team-overleg bij deze complexe revascularisatiebeslissing.","abstract_original":"BACKGROUND: Currently available randomized data on the comparison between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) for the treatment of unprotected left main coronary disease (LMD) lacks statistical power due to low numbers of patients enrolled. OBJECTIVES: This study assessed long-term outcomes of PCI and CABG for the treatment of LMD in specific subgroups according to disease anatomic complexity. METHODS: We conducted a pooled analysis of individual patient-level data of the LMD patients included in the PRECOMBAT (Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease) and SYNTAX (Synergy Between PCI With TAXUS and Cardiac Surgery) trials. Incidences of major adverse cardiac events were assessed at 5 years follow-up. RESULTS: Study population comprised 1,305 patients. The incidence of major adverse cardiac and cerebrovascular events at 5 years was 28.3% in the PCI group and 23.0% in the CABG group (hazard ratio [HR]: 1.23; 95% confidence interval [CI]: 1.01 to 1.55; p = 0.045). This difference is mainly driven by a higher rate of repeat revascularization associated with PCI (HR: 1.85; 95% CI: 1.38 to 2.47; p < 0.001). The 2 strategies showed similar rates of the safety composite endpoint of death, myocardial infarction, or stroke (p = 0.45). In patients with isolated LM or LM + 1-vessel disease, PCI was associated with a 60% reduction in all-cause mortality (HR: 0.40; 95% CI: 0.20 to 0.83; p = 0.029) and 67% reduction in cardiac mortality (HR: 0.33; 95% CI: 0.12 to 0.88; p = 0.025) when compared with CABG. CONCLUSIONS: In patients with unprotected LMD, CABG, and PCI result in similar rates of the safety composite endpoint of death, myocardial infarction, or stroke. In patients with isolated LM or LM + 1-vessel disease, PCI is associated with lower all-cause and cardiac mortality when compared to CABG."},{"id":"53e15fd4af3f","type":"article","url":"https://hartvaat.nl/2016/09/06/consistente-reductie-in-periprocedureel-mi-met-cangrelor-champion-analyses/","title":"Consistente reductie in periprocedureel MI met cangrelor: CHAMPION-analyses","title_en":"Consistent Reduction in Periprocedural Myocardial Infarction With Cangrelor as Assessed by Multiple Definitions: Findings From CHAMPION PHOENIX (Cangrelor Versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition).","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.115.020829","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.115.020829","authors":["Matthew A Cavender","Deepak L Bhatt","Gregg W Stone","Harvey D White","Ph Gabriel Steg","C Michael Gibson","Christian W Hamm","Matthew J Price","Sergio Leonardi","Jayne Prats","Efthymios N Deliargyris","Kenneth W Mahaffey","Robert A Harrington"],"significance":6,"published":"2016-09-06","source_date":"2016-09-06","image":"","kennis":[],"congress":"","summary_en":"This pooled CHAMPION analysis confirmed that cangrelor consistently reduces periprocedural MI compared with clopidogrel across multiple MI definitions, supporting the use of this intravenous P2Y12 inhibitor during PCI.","created":"2026-07-03T10:26:17Z","updated":"2026-07-03T13:25:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gepoolde analyse van de CHAMPION-trials die een consistente reductie in periprocedureel myocardinfarct aantoonde met cangrelor, ongeacht de gebruikte MI-definitie.","abstract_original":"BACKGROUND: Cangrelor is an intravenous P2Y12 inhibitor approved to reduce periprocedural ischemic events in patients undergoing percutaneous coronary intervention not pretreated with a P2Y12 inhibitor. METHODS: A total of 11 145 patients were randomized to cangrelor or clopidogrel in the CHAMPION PHOENIX trial (Cangrelor versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition). We explored the effects of cangrelor on myocardial infarction (MI) using different definitions and performed sensitivity analyses on the primary end point of the trial. RESULTS: A total of 462 patients (4.2%) undergoing percutaneous coronary intervention had an MI as defined by the second universal definition. The majority of these MIs (n=433, 93.7%) were type 4a. Treatment with cangrelor reduced the incidence of MI at 48 hours (3.8% versus 4.7%; odds ratio [OR], 0.80; 95% confidence interval [CI], 0.67-0.97; P=0.02). When the Society of Coronary Angiography and Intervention definition of periprocedural MI was applied to potential ischemic events, there were fewer total MIs (n=134); however, the effects of cangrelor on MI remained significant (OR, 0.65; 95% CI, 0.46-0.92; P=0.01). Similar effects were seen in the evaluation of the effects of cangrelor on MIs with peak creatinine kinase-MB ≥10 times the upper limit of normal (OR, 0.64; 95% CI, 0.45-0.91) and those with peak creatinine kinase-MB ≥10 times the upper limit of normal, ischemic symptoms, or ECG changes (OR, 0.63; 95% CI, 0.48-0.84). MIs defined by any of these definitions were associated with increased risk of death at 30 days. Treatment with cangrelor reduced the composite end point of death, MI (Society of Coronary Angiography and Intervention definition), ischemia-driven revascularization, or Academic Research Consortium definite stent thrombosis (1.4% versus 2.1%; OR, 0.69; 95% CI, 0.51-0.92). CONCLUSIONS: MI in patients undergoing percutaneous coronary intervention, regardless of definition, remains associated with increased risk of death in the current era. Cangrelor compared with clopidogrel significantly reduces MI regardless of the definition. CLINICAL TRIAL REGISTRATION: URL: http://clinicaltrials.gov. Unique identifier: NCT01156571."},{"id":"04c713cc644f","type":"article","url":"https://hartvaat.nl/2016/09/06/duur-van-dapt-systematische-review-voor-de-acc-aha-gerichte-update-2016/","title":"Duur van DAPT: systematische review voor de ACC/AHA gerichte update 2016","title_en":"Duration of Dual Antiplatelet Therapy: A Systematic Review for the 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.03.512","source_url":"https://doi.org/10.1016/j.jacc.2016.03.512","authors":["John A Bittl","Usman Baber","Steven M Bradley","Duminda N Wijeysundera"],"significance":8,"published":"2016-09-06","source_date":"2016-09-06","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/dual-antiplatelet-therapy-dapt/"],"congress":"","summary_en":"This systematic review provided the evidence foundation for the 2016 ACC/AHA focused update on DAPT duration after PCI, evaluating the benefits and risks of extended versus standard dual antiplatelet therapy across different stent generations and clinical scenarios.","created":"2026-07-03T10:26:17Z","updated":"2026-07-03T13:25:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review die de bewijsbasis leverde voor de ACC/AHA gerichte richtlijnupdate over de optimale duur van duale antiplaatjestherapie na PCI. Referentiedocument voor DAPT-duurbeleid.","abstract_original":"BACKGROUND: The optimal duration of dual antiplatelet therapy (DAPT) after implantation of newer-generation drug-eluting stents (DES) remains uncertain. Similarly, questions remain about the role of DAPT in long-term therapy of stable post-myocardial infarction (MI) patients. AIM: Our objective was to compare the incidence of death, major hemorrhage, MI, stent thrombosis, and major adverse cardiac events in patients randomized to prolonged or short-course DAPT after implantation of newer-generation DES and in secondary prevention after MI. METHODS: We used traditional frequentist statistical and Bayesian approaches to address the following questions: Q1) What is the minimum duration of DAPT required after DES implantation? Q2) What is the clinical benefit of prolonging DAPT up to 18 to 48 months? Q3) What is the clinical effect of DAPT in stable patients who are >1 year past an MI? RESULTS: We reviewed evidence from 11 randomized controlled trials (RCTs) that enrolled 33 051 patients who received predominantly newer-generation DES to answer: A1) Use of DAPT for 12 months, as compared with use for 3 to 6 months, resulted in no significant differences in incidence of death (odds ratio [OR]: 1.17; 95% confidence interval [CI]: 0.85 to 1.63), major hemorrhage (OR: 1.65; 95% CI: 0.97 to 2.82), MI (OR: 0.87; 95% CI: 0.65 to 1.18), or stent thrombosis (OR: 0.87; 95% CI: 0.49 to 1.55). Bayesian models confirmed the primary analysis. A2) Use of DAPT for 18 to 48 months, compared with use for 6 to 12 months, was associated with no difference in incidence of all-cause death (OR: 1.14; 95% CI: 0.92 to 1.42) but was associated with increased major hemorrhage (OR: 1.58; 95% CI: 1.20 to 2.09), decreased MI (OR: 0.67; 95% CI: 0.47 to 0.95), and decreased stent thrombosis (OR: 0.45; 95% CI: 0.24 to 0.74). A risk-benefit analysis found 3 fewer stent thromboses (95% CI: 2 to 5) and 6 fewer MIs (95% CI: 2 to 11) but 5 more major bleeds (95% CI: 3 to 9) per 1000 patients treated with prolonged DAPT per year. Post hoc analyses provided weak evidence of increased mortality with prolonged DAPT. We reviewed evidence from 1 RCT of 21 162 patients and a post hoc analysis of 1 RCT of 15 603 patients to answer: A3): Use of DAPT >1 year after MI reduced the composite risk of cardiovascular death, MI, or stroke (hazard ratio: 0.84; 95% CI: 0.74 to 0.95) but increased major bleeding (hazard ratio: 2.32; 95% CI: 1.68 to 3.21). A meta-analysis and a post hoc analysis of an RCT in patients with stable cardiovascular disease produced similar findings. CONCLUSIONS: The primary analysis provides moderately strong evidence that prolonged DAPT after implantation of newer-generation DES entails a tradeoff between reductions in stent thrombosis and MI and increases in major hemorrhage. Secondary analyses provide weak evidence of increased mortality with prolonged DAPT after DES implantation. In patients whose coronary thrombotic risk was defined by a prior MI rather than by DES implantation, the primary analysis provides moderately strong evidence of reduced cardiovascular events at the expense of increased bleeding."},{"id":"c6cbd99068d7","type":"article","url":"https://hartvaat.nl/2016/09/01/apixaban-5-mg-bij-af-met-hoge-leeftijd-laag-gewicht-of-hoog-creatinine-aristotle/","title":"Apixaban 5 mg bij AF met hoge leeftijd, laag gewicht of hoog creatinine: ARISTOTLE-analyse","title_en":"Apixaban 5 mg Twice Daily and Clinical Outcomes in Patients With Atrial Fibrillation and Advanced Age, Low Body Weight, or High Creatinine: A Secondary Analysis of a Randomized Clinical Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","huisarts"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2016.1829","source_url":"https://doi.org/10.1001/jamacardio.2016.1829","authors":["John H Alexander","Ulrika Andersson","Renato D Lopes","Ziad Hijazi","Stefan H Hohnloser","Justin A Ezekowitz","Sigrun Halvorsen","Michael Hanna","Patrick Commerford","Witold Ruzyllo","Kurt Huber","Sana M Al-Khatib","Christopher B Granger","Lars Wallentin"],"significance":8,"published":"2016-09-01","source_date":"2016-09-01","image":"","kennis":[],"congress":"","summary_en":"This ARISTOTLE subanalysis showed that standard-dose apixaban 5 mg twice daily maintained favorable outcomes in AF patients with characteristics that would typically prompt dose reduction (advanced age, low body weight, or renal impairment), raising concerns about unnecessary off-label dose reduction.","created":"2026-07-03T10:26:17Z","updated":"2026-07-03T13:25:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology analyse van ARISTOTLE naar uitkomsten met standaarddosis apixaban 5 mg bij AF-patiënten met kenmerken die normaliter dosisreductie indiceren (≥80 jaar, ≤60 kg, creatinine ≥1.5). Relevant voor doseringsbeslissingen.","abstract_original":"IMPORTANCE: In the Apixaban for Reduction of Stroke and Other Thromboembolic Complications in Atrial Fibrillation (ARISTOTLE) trial, the standard dose of apixaban was 5 mg twice daily; patients with at least 2 dose-reduction criteria-80 years or older, weight 60 kg or less, and creatinine level 1.5 mg/dL or higher-received a reduced dose of apixaban of 2.5 mg twice daily. Little is known about patients with 1 dose-reduction criterion who received the 5 mg twice daily dose of apixaban. OBJECTIVE: To determine the frequency of 1 dose-reduction criterion and whether the effects of the 5 mg twice daily dose of apixaban on stroke or systemic embolism and bleeding varied among patients with 1 or no dose-reduction criteria. DESIGN, SETTING, AND PARTICIPANTS: Among 18 201 patients in the ARISTOTLE trial, 17 322 were included in this analysis. Annualized event rates of stroke or systemic embolism and major bleeding and hazard ratios (HRs) and 95% CIs were evaluated. Interactions between the effects of apixaban vs warfarin and the presence of 1 or no dose-reduction criteria were assessed. The first patient was enrolled in the ARISTOTLE trial on December 19, 2006, and follow-up was completed on January 30, 2011. Data were analyzed from January 2015 to May 30, 2016. MAIN OUTCOMES AND MEASURES: Analysis of major bleeding included events during study drug treatment. Analysis of stroke or systemic embolism was based on intention to treat. RESULTS: Of the patients with 1 or no dose-reduction criteria assigned to receive the 5 mg twice daily dose of apixaban or warfarin, 3966 had 1 dose-reduction criterion; these patients had higher rates of stroke or systemic embolism (HR, 1.47; 95% CI, 1.20-1.81) and major bleeding (HR, 1.89; 95% CI, 1.62-2.20) compared with those with no dose-reduction criteria (n = 13 356). The benefit of the 5 mg twice daily dose of apixaban (n = 8665) compared with warfarin (n = 8657) on stroke or systemic embolism in patients with 1 dose-reduction criterion (HR, 0.94; 95% CI, 0.66-1.32) and no dose-reduction criterion (HR, 0.77; 95% CI, 0.62-0.97) were similar (P for interaction = .36). Similarly, the benefit of 5 mg twice daily dose of apixaban compared with warfarin on major bleeding in patients with 1 dose-reduction criterion (HR, 0.68; 95% CI, 0.53-0.87) and no dose-reduction criterion (HR, 0.72; 95% CI, 0.60-0.86) were similar (P for interaction = .71). Similar patterns were seen for each dose-reduction criterion and across the spectrum of age, body weight, creatinine level, and creatinine clearance. CONCLUSIONS AND RELEVANCE: Patients with atrial fibrillation and isolated advanced age, low body weight, or renal dysfunction have a higher risk of stroke or systemic embolism and major bleeding but show consistent benefits with the 5 mg twice daily dose of apixaban vs warfarin compared with patients without these characteristics. The 5 mg twice daily dose of apixaban is safe, efficacious, and appropriate for patients with only 1 dose-reduction criterion. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00412984."},{"id":"20b957805b4a","type":"article","url":"https://hartvaat.nl/2016/09/01/polyfenolrijk-dieet-en-cardiovasculair-risico-gerandomiseerde-trial/","title":"Polyfenolrijk dieet en cardiovasculair risico: gerandomiseerde trial","title_en":"Beneficial effect of a polyphenol-rich diet on cardiovascular risk: a randomised control trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["biomarkers-cardiovasculair","diabetes-type-2","farmaco-economie","figaro-dkd","ouderen"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2015-309218","source_url":"https://doi.org/10.1136/heartjnl-2015-309218","authors":["Rebecca L Noad","Ciara Rooney","Damian McCall","Ian S Young","David McCance","Michelle C McKinley","Jayne V Woodside","Pascal P McKeown"],"significance":6,"published":"2016-09-01","source_date":"2016-09-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/cardiovasculaire-risicoschatting-score2/","https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/"],"congress":"","summary_en":"This randomized trial demonstrated that a polyphenol-rich diet reduces cardiovascular risk factors including blood pressure and inflammatory markers, supporting dietary polyphenol intake as a modifiable component of cardiovascular prevention.","created":"2026-07-03T10:26:17Z","updated":"2026-07-03T13:25:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial die het gunstige effect van een polyfenolrijk dieet op cardiovasculaire risicofactoren aantoonde. Onderbouwt het belang van voedingspatronen voor cardiovasculaire preventie.","abstract_original":"OBJECTIVES: There is previous epidemiological evidence that intake of polyphenol-rich foods has been associated with reduced cardiovascular disease risk. We aimed to investigate the effect of increasing dietary polyphenol intake on microvascular function in hypertensive participants. METHODS: All participants completed a 4-week run-in phase, consuming <2 portions of fruit and vegetables (F&V) daily and avoiding berries and dark chocolate. Subjects were then randomised to continue with the low-polyphenol diet for 8 weeks or to consume a high-polyphenol diet of six portions F&V (including one portion of berries/day and 50 g of dark chocolate). Endothelium-dependent (acetylcholine, ACh) and endothelium-independent (sodium nitroprusside) vasodilator responses were assessed by venous occlusion plethysmography. Compliance with the intervention was measured using food diaries and biochemical markers. RESULTS: Final analysis of the primary endpoint was conducted on 92 participants. Between-group comparison of change in maximum % response to ACh revealed a significant improvement in the high-polyphenol group (p=0.02). There was a significantly larger increase in vitamin C, carotenoids and epicatechin in the high-polyphenol group (between-group difference p<0.001; p<0.001; p=0.008, respectively). CONCLUSIONS: This study has shown that increasing the polyphenol content of the diet via consumption of F&V, berries and dark chocolate results in a significant improvement in an established marker of cardiovascular risk in hypertensive participants. TRIAL REGISTRATION NUMBER: NCT01319786."},{"id":"90eef828702c","type":"article","url":"https://hartvaat.nl/2016/09/01/ace-remmers-en-cardiovasculaire-uitkomsten-bij-diabetes-type-2-met-dpp-4-remmers/","title":"ACE-remmers en cardiovasculaire uitkomsten bij diabetes type 2 met DPP-4-remmers","title_en":"Angiotensin-Converting Enzyme Inhibitor Use and Major Cardiovascular Outcomes in Type 2 Diabetes Mellitus Treated With the Dipeptidyl Peptidase 4 Inhibitor Alogliptin.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","internist"],"tags":["ace-remmers","bloeddrukbehandeling","canagliflozine","cardiorenal-behandelstrategie","diabetes-en-hart","diabetes-type-1","diabetes-type-2","ezetimibe","fidelio-dkd","figaro-dkd","obesitas","pcsk9-remmers-nieuwe-generatie","ramipril","ras-remmers","semaglutide","soul-trial","tirzepatide"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.07797","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.07797","authors":["William B White","Craig A Wilson","George L Bakris","Richard M Bergenstal","Christopher P Cannon","William C Cushman","Simon K Heller","Cyrus R Mehta","Steven E Nissen","Faiez Zannad","Stuart Kupfer"],"significance":5,"published":"2016-09-01","source_date":"2016-09-01","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"This study examined the interaction between ACE inhibitors and DPP-4 inhibitors on cardiovascular outcomes in type 2 diabetes, investigating whether concomitant RAAS-incretin therapy provides synergistic or antagonistic effects.","created":"2026-07-03T10:26:17Z","updated":"2026-07-03T13:25:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de interactie tussen ACE-remmers en DPP-4-remmers op cardiovasculaire uitkomsten bij diabetes type 2. Onderzoekt of gelijktijdig gebruik synergistisch werkt via het bradykininesysteem.","abstract_original":"Activation of the sympathetic nervous system when there is dipeptidyl peptidase 4 inhibition in the presence of high-dose angiotensin-converting enzyme (ACE) inhibition has led to concerns of potential increases in cardiovascular events when the 2 classes of drugs are coadministered. We evaluated cardiovascular outcomes from the EXAMINE (Examination of Cardiovascular Outcomes With Alogliptin versus Standard of Care) trial according to ACE inhibitor use. Patients with type 2 diabetes mellitus and a recent acute coronary syndrome were randomly assigned to receive the dipeptidyl peptidase 4 inhibitor alogliptin or placebo added to existing antihyperglycemic and cardiovascular prophylactic therapies. Risks of adjudicated cardiovascular death, nonfatal myocardial infarction and stroke, and hospitalized heart failure were analyzed using a Cox proportional hazards model in patients according to ACE inhibitor use and dose. There were 3323 (62%) EXAMINE patients treated with an ACE inhibitor (1681 on alogliptin and 1642 on placebo). The composite rates of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke were comparable for alogliptin and placebo with ACE inhibitor (11.4% versus 11.8%; hazard ratio, 0.97; 95% confidence interval, 0.79-1.19; P=0.76) and without ACE inhibitor use (11.2% versus 11.9%; hazard ratio, 0.94; 95% confidence interval, 0.73-1.21; P=0.62). Composite rates for cardiovascular death and heart failure in patients on ACE inhibitor occurred in 6.8% of patients on alogliptin versus 7.2% on placebo (hazard ratio, 0.93; 95% confidence interval, 0.72-1.2; P=0.57). There were no differences for these end points nor for blood pressure or heart rate in patients on higher doses of ACE inhibitor. Cardiovascular outcomes were similar for alogliptin and placebo in patients with type 2 diabetes mellitus and coronary disease treated with ACE inhibitors."},{"id":"da3e6ec27ebd","type":"article","url":"https://hartvaat.nl/2016/09/01/intensievere-versus-minder-intensieve-bloeddrukverlaging-cumulatief-bewijs-en-tr/","title":"Intensievere versus minder intensieve bloeddrukverlaging: cumulatief bewijs en trial sequential analysis","title_en":"More Versus Less Intensive Blood Pressure-Lowering Strategy: Cumulative Evidence and Trial Sequential Analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.07608","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.07608","authors":["Paolo Verdecchia","Fabio Angeli","Giorgio Gentile","Gianpaolo Reboldi"],"significance":7,"published":"2016-09-01","source_date":"2016-09-01","image":"","kennis":[],"congress":"","summary_en":"This cumulative meta-analysis with trial sequential analysis provided robust evidence that intensive blood pressure lowering reduces major cardiovascular events and death compared with less intensive treatment, confirming that the evidence threshold for benefit has been definitively crossed.","created":"2026-07-03T10:26:17Z","updated":"2026-07-03T13:25:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Cumulatieve meta-analyse met trial sequential analysis die het bewijs voor intensieve versus standaard bloeddrukverlaging samenvoegt. Kwantificeert het punt waarop voldoende bewijs bereikt is.","abstract_original":"Several randomized trials compared a more versus less intensive blood pressure-lowering strategy on the risk of major cardiovascular events and death. Cumulative meta-analyses and trial sequential analyses can establish whether and when firm evidence favoring a specific intervention has been reached from accrued literature. Therefore, we conducted a cumulative trial sequential analysis of 18 trials that randomly allocated 53 405 patients to a more or less intensive blood pressure-lowering strategy. We sought to ascertain the extent to which trial evidence added to previously accrued data. Outcome measures were stroke, myocardial infarction, heart failure, cardiovascular death, and all-cause death. Achieved blood pressure was 7.6/4.5 mm Hg lower with the more intensive than the less intensive blood pressure-lowering strategy. For stroke and myocardial infarction, the cumulative Z curve crossed the efficacy monitoring boundary solely after the SPRINT (Systolic Blood Pressure Intervention Trial) study, thereby providing firm evidence of superiority of a more intensive over a less intensive blood pressure-lowering strategy. For cardiovascular death and heart failure, the cumulative Z curve crossed the conventional significance boundary, but not the sequential monitoring boundary, after SPRINT. For all-cause death, the SPRINT trial pushed the cumulative Z curve away from the futility area, without reaching the conventional significance boundary. We conclude that evidence accrued to date strongly supports the superiority of a more intensive versus a less intensive blood pressure-lowering strategy for prevention of stroke and myocardial infarction. Cardiovascular death and heart failure are likely to be reduced by a more intensive blood pressure-lowering strategy, but evidence is not yet conclusive."},{"id":"1e2b3e84ef53","type":"article","url":"https://hartvaat.nl/2016/09/01/patiromer-verlaagt-aldosteron-bij-ckd-patienten-met-hyperkaliemie-op-raas-remmer/","title":"Patiromer verlaagt aldosteron bij CKD-patiënten met hyperkaliëmie op RAAS-remmers","title_en":"Treatment with patiromer decreases aldosterone in patients with chronic kidney disease and hyperkalemia on renin-angiotensin system inhibitors.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","internist"],"tags":["aldosteronsynthaseremmers","anemie-ckd","cardiorenal-behandelstrategie","chronische-nierziekte","dapagliflozine","diabetische-nefropathie","figaro-dkd","ijzertekort","lorundrostat","mra-aldosteronantagonisten","ras-remmers","renale-denervatie","resistente-hypertensie","resistente-hypertensie-aldosteronremmers","spironolacton"],"journal":"Kidney international","doi":"10.1016/j.kint.2016.04.019","source_url":"https://doi.org/10.1016/j.kint.2016.04.019","authors":["Matthew R Weir","George L Bakris","Coleman Gross","Martha R Mayo","Dahlia Garza","Yuri Stasiv","Jinwei Yuan","Lance Berman","Gordon H Williams"],"significance":6,"published":"2016-09-01","source_date":"2016-09-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/"],"congress":"","summary_en":"This study showed that patiromer, in addition to lowering potassium, reduces aldosterone levels in CKD patients with hyperkalemia on RAAS inhibitor therapy, suggesting a secondary benefit through aldosterone suppression.","created":"2026-07-03T10:26:17Z","updated":"2026-07-03T18:38:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die aantoont dat de kaliumverlager patiromer ook aldosteronniveaus verlaagt bij CKD-patiënten met hyperkaliëmie op RAAS-remmers. Dubbel mechanisme dat optimalisatie van RAAS-blokkade mogelijk maakt.","abstract_original":"Elevated serum aldosterone can be vasculotoxic and facilitate cardiorenal damage. Renin-angiotensin system inhibitors reduce serum aldosterone levels and/or block its effects but can cause hyperkalemia. Patiromer, a nonabsorbed potassium binder, decreases serum potassium in patients with chronic kidney disease on renin-angiotensin system inhibitors. Here we examined the effect of patiromer treatment on serum aldosterone, blood pressure, and albuminuria in patients with chronic kidney disease on renin-angiotensin system inhibitors with hyperkalemia (serum potassium 5.1-6.5 mEq/l). We analyzed data from the phase 3 OPAL-HK study (4-week initial treatment phase of 243 patients; 8-week randomized withdrawal phase of 107 patients). In the treatment phase, the (mean ± standard error) serum potassium was decreased concordantly with the serum aldosterone (-1.99 ± 0.51 ng/dl), systolic/diastolic blood pressure (-5.64 ± 1.04 mm Hg/-3.84 ± 0.69 mm Hg), and albumin-to-creatinine ratio (-203.7 ± 54.7 mg/g), all in a statistically significant manner. The change in the plasma renin activity (-0.44 ± 0.63 μg/l/hr) was not significant. In the withdrawal phase, mean aldosterone levels were sustained with patiromer (+0.23 ± 1.07 ng/dl) and significantly increased with placebo (+2.78 ± 1.25 ng/dl). Patients on patiromer had significant reductions in mean systolic/diastolic blood pressure (-6.70 ± 1.59/-2.15 ± 1.06 mm Hg), whereas those on placebo did not (-1.21 ± 1.89 mm Hg/+1.72 ± 1.26 mm Hg). Significant changes in plasma renin activity were found only in the placebo group (-3.90 ± 1.41 μg/l/hr). Thus, patiromer reduced serum potassium and aldosterone levels independent of plasma renin activity in patients with chronic kidney disease and hyperkalemia on renin-angiotensin system inhibitors."},{"id":"3a1975a0edcf","type":"article","url":"https://hartvaat.nl/2016/08/23/dabigatran-versus-warfarine-bij-af-met-kleplijden-re-ly-analyse/","title":"Dabigatran versus warfarine bij AF met kleplijden: RE-LY-analyse","title_en":"Comparison of Dabigatran and Warfarin in Patients With Atrial Fibrillation and Valvular Heart Disease: The RE-LY Trial (Randomized Evaluation of Long-Term Anticoagulant Therapy).","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["rivaroxaban","warfarine"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.115.020950","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.115.020950","authors":["Michael D Ezekowitz","Rangadham Nagarakanti","Herbert Noack","Martina Brueckmann","Claire Litherland","Mark Jacobs","Andreas Clemens","Paul A Reilly","Stuart J Connolly","Salim Yusuf","Lars Wallentin"],"significance":7,"published":"2016-08-23","source_date":"2016-08-23","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/","https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This RE-LY subanalysis confirmed that dabigatran maintains its favorable efficacy and safety compared with warfarin in AF patients with concomitant valvular heart disease (excluding mechanical valves and significant mitral stenosis), supporting DOAC use in this population.","created":"2026-07-03T10:26:17Z","updated":"2026-07-03T13:25:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse van de RE-LY-trial die dabigatran vergeleek met warfarine bij AF-patiënten met begeleidend kleplijden. Relevant voor het DOAC-beleid bij de groeiende groep patiënten met zowel AF als klepafwijkingen.","abstract_original":"BACKGROUND: The RE-LY trial (Randomized Evaluation of Long-Term Anticoagulant Therapy) compared dabigatran 150 and 110 mg twice daily with warfarin in 18 113 patients with atrial fibrillation. Those with prosthetic heart valves, significant mitral stenosis, and valvular heart disease (VHD) requiring intervention were excluded. Others with VHD were included. METHODS: This is a post hoc analysis of the RE-LY trial. RESULTS: There were 3950 patients with any VHD: 3101 had mitral regurgitation, 1179 with tricuspid regurgitation, 817 had aortic regurgitation, 471 with aortic stenosis, and 193 with mild mitral stenosis. At baseline, patients with any VHD had more heart failure, coronary disease, renal impairment, and persistent atrial fibrillation. Patients with any VHD had higher rates of major bleeds (hazard ratio [HR], 1.32; 95% confidence interval [CI], 1.16-1.5) but similar stroke or systemic embolism event rates (HR, 1.09; 95% CI, 0.88-1.33). For patients receiving dabigatran 110 mg, major bleed rates were lower than for patients taking warfarin (HR, 0.73; 95% CI, 0.56-0.95 with VHD; HR, 0.84; 95% CI, 0.71-0.99 without VHD), and major bleed rates for dabigatran 150 mg were similar to those for warfarin in patients with VHD (HR, 0.82; 95% CI, 0.64-1.06) or without VHD (HR, 0.98; 95% CI, 0.83-1.15). For dabigatran 150 mg, stroke/systemic embolic event rates were lower compared with warfarin in those with VHD (HR, 0.59; 95% CI, 0.37-0.93) and those without VHD (HR, 0.67; 95% CI, 0.52-0.86), and stroke/systemic embolic event rates were similar for warfarin and dabigatran 110 mg regardless of the presence of VHD (HR, 0.97; 95% CI, 0.65-1.45; and HR, 0.88; 95% CI, 0.70-1.10). Intracranial bleeds and death rates for dabigatran 150 and 110 mg were lower compared with warfarin independently of the presence of VHD. CONCLUSIONS: The presence of any VHD did not influence the comparison of dabigatran with warfarin. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00262600."},{"id":"c004dbcb9ad9","type":"article","url":"https://hartvaat.nl/2016/08/16/acute-aortadissectie-en-intramuraal-hematoom-jama-systematische-review/","title":"Acute aortadissectie en intramuraal hematoom: JAMA systematische review","title_en":"Acute Aortic Dissection and Intramural Hematoma: A Systematic Review.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2016.10026","source_url":"https://doi.org/10.1001/jama.2016.10026","authors":["Firas F Mussa","Joshua D Horton","Rameen Moridzadeh","Joseph Nicholson","Santi Trimarchi","Kim A Eagle"],"significance":8,"published":"2016-08-16","source_date":"2016-08-16","image":"","kennis":[],"congress":"","summary_en":"This comprehensive JAMA systematic review of acute aortic dissection and intramural hematoma covered diagnosis, management, and prognosis, providing a reference framework for this life-threatening cardiovascular emergency.","created":"2026-07-03T10:26:17Z","updated":"2026-07-03T13:25:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Uitgebreide JAMA systematische review over diagnostiek, behandeling en prognose van acute aortadissectie en intramuraal hematoom. Referentiepublicatie voor het acute aortasyndroom.","abstract_original":"IMPORTANCE: Acute aortic syndrome (AAS), a potentially fatal pathologic process within the aortic wall, should be suspected in patients presenting with severe thoracic pain and hypertension. AAS, including aortic dissection (approximately 90% of cases) and intramural hematoma, may be complicated by poor perfusion, aneurysm, or uncontrollable pain and hypertension. AAS is uncommon (approximately 3.5-6.0 per 100,000 patient-years) but rapid diagnosis is imperative as an emergency surgical procedure is frequently necessary. OBJECTIVE: To systematically review the current evidence on diagnosis and treatment of AAS. EVIDENCE REVIEW: Searches of MEDLINE, EMBASE, and the Cochrane Register of Controlled Trials for articles on diagnosis and treatment of AAS from June 1994 to January 29, 2016, were performed. Only clinical trials and prospective observational studies of 10 or more patients were included. Eighty-two studies (2 randomized clinical trials and 80 observational) describing 57,311 patients were reviewed. FINDINGS: Chest or back pain was the most commonly reported presenting symptom of AAS (61.6%-84.8%). Patients were typically aged 60 to 70 years, male (50%-81%), and had hypertension (45%-100%). Sensitivities of computerized tomography and magnetic resonance imaging for diagnosis of AAS were 100% and 95% to 100%, respectively. Transesophageal echocardiography was 86% to 100% sensitive, whereas D-dimer was 51.7% to 100% sensitive and 32.8% to 89.2% specific among 6 studies (n = 876). An immediate open surgical procedure is needed for dissection of the ascending aorta, given the high mortality (26%-58%) and proximity to the aortic valve and great vessels (with potential for dissection complications such as tamponade). An RCT comparing endovascular surgical procedure to medical management for uncomplicated AAS in the descending aorta (n = 61) revealed no dissection-related deaths in either group. Endovascular surgical procedure was better than medical treatment (97% vs 43%, P < .001) for the primary end point of \"favorable aortic remodeling\" (false lumen thrombosis and no aortic dilation or rupture). The remaining evidence on therapies was observational, introducing significant selection bias. CONCLUSIONS AND RELEVANCE: Because of the high mortality rate, AAS should be considered and diagnosed promptly in patients presenting with acute chest or back pain and high blood pressure. Computerized tomography, magnetic resonance imaging, and transesophageal echocardiography are reliable tools for diagnosing AAS. Available data suggest that open surgical repair is optimal for treating type A (ascending aorta) AAS, whereas thoracic endovascular aortic repair may be optimal for treating type B (descending aorta) AAS. However, evidence is limited by the paucity of randomized trials."},{"id":"dff8a3d6ddf1","type":"article","url":"https://hartvaat.nl/2016/08/16/intracoronair-abciximab-bij-diabetespatienten-met-primaire-pci-1-jaarsresultaten/","title":"Intracoronair abciximab bij diabetespatiënten met primaire PCI: 1-jaarsresultaten","title_en":"1-Year Outcomes With Intracoronary Abciximab in Diabetic Patients Undergoing Primary Percutaneous Coronary Intervention.","category":"preventie","category_label":"Preventie","professions":["cardioloog"],"tags":["diabetes-en-hart","diabetes-type-1","diabetes-type-2","fidelio-dkd","figaro-dkd","soul-trial"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.05.078","source_url":"https://doi.org/10.1016/j.jacc.2016.05.078","authors":["Raffaele Piccolo","Ingo Eitel","Gennaro Galasso","Alberto Dominguez-Rodriguez","Allan Zeeberg Iversen","Pedro Abreu-Gonzalez","Stephan Windecker","Holger Thiele","Federico Piscione"],"significance":5,"published":"2016-08-16","source_date":"2016-08-16","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/bloedsuikerdoelen-cardiovasculair/"],"congress":"","summary_en":"This study examined 1-year outcomes of intracoronary abciximab administration in diabetic STEMI patients undergoing primary PCI, testing targeted antiplatelet delivery for a high-risk population.","created":"2026-07-03T10:26:16Z","updated":"2026-07-03T13:25:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de 1-jaarsuitkomsten van intracoronaire abciximabtoediening bij diabetespatiënten die primaire PCI ondergaan. Onderzoekt of lokale GPIIb/IIIa-blokkade voordelen biedt boven systemische toediening.","abstract_original":"BACKGROUND: Diabetic patients are at increased risk for future cardiovascular events after ST-segment elevation myocardial infarction (STEMI). Administration of an intracoronary abciximab bolus during primary percutaneous coronary intervention (PCI) may be beneficial in this high-risk subgroup. OBJECTIVES: This study sought to report the 1-year clinical outcomes and cardiac magnetic resonance (CMR) findings in STEMI patients with and without diabetes randomized to intracoronary or intravenous abciximab bolus at the time of primary PCI. METHODS: Patient-level data from 3 randomized trials were pooled. The primary endpoint was the composite of death or reinfarction. Comprehensive CMR imaging was performed in 1 study. RESULTS: Of 2,470 patients, 473 (19%) had diabetes and 1,997 (81%) did not. At 1 year, the primary endpoint was significantly reduced in diabetic patients randomized to intracoronary abciximab compared with those randomized to intravenous bolus (9.2% vs. 17.6%; hazard ratio [HR]: 0.49; 95% confidence interval [CI]: 0.28 to 0.83; p = 0.009). The intracoronary abciximab bolus did not reduce the primary endpoint in patients without diabetes (7.4% vs. 7.5%; HR: 0.95; 95% CI: 0.68 to 1.33; p = 0.77), resulting in a significant interaction (p = 0.034). Among diabetic patients, intracoronary versus intravenous abciximab bolus was associated with a significantly reduced risk of death (5.8% vs. 11.2%; HR: 0.51; 95% CI: 0.26 to 0.98; p = 0.043) and definite/probable stent thrombosis (1.3% vs. 4.8%; HR: 0.27; 95% CI: 0.08 to 0.98; p = 0.046). At CMR (n = 792), the myocardial salvage index was significantly increased only in diabetic patients randomized to intracoronary compared with intravenous abciximab (54.4; interquartile range: 35.1 to 78.2 vs. 39.0, interquartile range: 24.7 to 61.7; p = 0.011; p for interaction vs. no diabetes = 0.016). CONCLUSIONS: In diabetic patients with STEMI, the administration of intracoronary abciximab improved the effectiveness of primary PCI compared with the intravenous bolus."},{"id":"9d94daa05e4f","type":"article","url":"https://hartvaat.nl/2016/08/16/bio-absorbeerbare-intracoronaire-matrix-ter-preventie-van-ventriculaire-remodell/","title":"Bio-absorbeerbare intracoronaire matrix ter preventie van ventriculaire remodellering na MI","title_en":"Bioabsorbable Intracoronary Matrix for Prevention of Ventricular Remodeling After Myocardial Infarction.","category":"preventie","category_label":"Preventie","professions":["cardioloog"],"tags":["aficamten","laminopathie","myocardinfarct"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.05.053","source_url":"https://doi.org/10.1016/j.jacc.2016.05.053","authors":["Sunil V Rao","Uwe Zeymer","Pamela S Douglas","Hussein Al-Khalidi","Jennifer A White","Jingyu Liu","Howard Levy","Victor Guetta","C Michael Gibson","Jean-Francois Tanguay","Paul Vermeersch","Jérôme Roncalli","Jaroslaw D Kasprzak","Timothy D Henry","Norbert Frey","Oscar Kracoff","Jay H Traverse","Derek P Chew","Jose Lopez-Sendon","Reinilde Heyrman","Mitchell W Krucoff"],"significance":5,"published":"2016-08-16","source_date":"2016-08-16","image":"","kennis":[],"congress":"","summary_en":"This study evaluated a bioabsorbable intracoronary matrix designed to prevent LV remodeling after large MI, testing a novel injectable biomaterial approach for structural myocardial support.","created":"2026-07-03T10:26:16Z","updated":"2026-07-03T13:25:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar een bio-absorbeerbare intracoronaire matrix om linkerkamerremodellering te voorkomen na myocardinfarct. Innovatieve benadering voor mechanische ondersteuning van het geïnfarceerde myocard.","abstract_original":"BACKGROUND: Bioabsorbable cardiac matrix (BCM) is a novel device that attenuates adverse left ventricular (LV) remodeling after large myocardial infarctions in experimental models. OBJECTIVES: This study aimed to analyze whether BCM, compared with saline control, would result in less LV dilation and fewer adverse clinical events between baseline and 6 months. METHODS: In an international, randomized, double-blind, controlled trial, 303 subjects with large areas of infarction despite successful primary percutaneous coronary intervention (PCI) of ST-segment elevation myocardial infarction (STEMI) were randomized 2:1 to BCM or saline injected into the infarct-related artery 2 to 5 days after primary PCI. The primary outcome was mean change from baseline in LV end-diastolic volume index (LVEDVI) at 6 months. Secondary outcomes included change in Kansas City Cardiomyopathy Questionnaire score, 6-minute walk time, and New York Heart Association functional class at 6 months. The primary safety endpoint was a composite of cardiovascular death, recurrent MI, target-vessel revascularization, stent thrombosis, significant arrhythmia requiring therapy, or myocardial rupture through 6 months. RESULTS: In total, 201 subjects were assigned to BCM and 102 to saline control. There was no significant difference in change in LVEDVI from baseline to 6 months between the groups (mean change ± SD: BCM 14.1 ± 28.9 ml/m(2) vs. saline 11.7 ± 26.9 ml/m(2); p = 0.49). There was also no significant difference in the secondary endpoints. The rates of the primary safety outcome were similar between the 2 groups (BCM 11.6% vs. saline 9.1%; p = 0.37). CONCLUSIONS: Intracoronary deployment of BCM 2 to 5 days after successful reperfusion in subjects with large myocardial infarction did not reduce adverse LV remodeling or cardiac clinical events at 6 months. (IK-5001 for the Prevention of Remodeling of the Ventricle and Congestive Heart Failure After Acute Myocardial Infarction [PRESERVATION I]; NCT01226563)."},{"id":"fdd0b5d11df6","type":"article","url":"https://hartvaat.nl/2016/08/09/lipidescreening-bij-kinderen-voor-familiaire-hypercholesterolemie-uspstf-evidenc/","title":"Lipidescreening bij kinderen voor familiaire hypercholesterolemie: USPSTF evidence report","title_en":"Lipid Screening in Childhood and Adolescence for Detection of Familial Hypercholesterolemia: Evidence Report and Systematic Review for the US Preventive Services Task Force.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","huisarts","internist"],"tags":["dyslipidemie","ezetimibe","familiaire-hypercholesterolemie","familiaire-hypercholesterolemie-screening","ldl-cholesterol","lipidenverlaging","plaquekarakterisatie","primaire-preventie","statines","vrouwen","yellow-iii"],"journal":"JAMA","doi":"10.1001/jama.2016.6176","source_url":"https://doi.org/10.1001/jama.2016.6176","authors":["Paula Lozano","Nora B Henrikson","John Dunn","Caitlin C Morrison","Matt Nguyen","Paula R Blasi","Melissa L Anderson","Evelyn P Whitlock"],"significance":7,"published":"2016-08-09","source_date":"2016-08-09","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/cascadescreening-fh/","https://hartvaat.nl/kennis/preventie/screeningsprogramma-hart-en-vaatziekten/"],"congress":"","summary_en":"This systematic evidence review for the USPSTF focused on detecting familial hypercholesterolemia through lipid screening in childhood and adolescence, evaluating the sensitivity and specificity of different screening approaches and the benefits of early treatment.","created":"2026-07-03T10:26:16Z","updated":"2026-07-03T13:25:36Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review voor de USPSTF specifiek gericht op detectie van familiaire hypercholesterolemie via lipidescreening op kinderleeftijd. Ondersteunt vroegtijdige identificatie van FH.","abstract_original":"IMPORTANCE: Familial hypercholesterolemia (FH) is characterized by elevated cholesterol concentrations early in life. Untreated FH is associated with premature cardiovascular disease in adulthood. OBJECTIVE: To systematically review the evidence on benefits and harms of screening adolescents and children for heterozygous FH for the US Preventive Services Task Force (USPSTF). DATA SOURCES: MEDLINE, the Cochrane Central Register of Controlled Trials, and PubMed were searched for studies published between January 1, 2005, and June 2, 2015; studies included in a previous USPSTF report were also searched. Surveillance was conducted through April 8, 2016. STUDY SELECTION: Fair- and good-quality studies in English with participants 0 to 20 years of age. DATA EXTRACTION AND SYNTHESIS: Two investigators independently reviewed abstracts and full-text articles and extracted data into evidence tables. Results were qualitatively summarized. MAIN OUTCOMES AND MEASURES: Myocardial infarction and ischemic stroke in adulthood; lipid concentrations and atherosclerosis in childhood; diagnostic yield of screening; any harm of screening or treatment. RESULTS: Based on 2 studies (n = 83,241), the diagnostic yield of universal screening for FH in childhood is 1.3 to 4.8 cases per 1000 screened. There was no eligible evidence on the benefits or harms of FH screening in childhood. Eight placebo trials of statin drugs (n = 1071, 6-104 weeks) found low-density lipoprotein cholesterol (LDL-C) decreases of 20% to 40%; 1 trial (n = 214) showed a 2.01% decrease in carotid intima-media thickness with statins, compared with 1.02% with placebo (P = .02). Three placebo trials of bile acid-sequestering agents (n = 332, 8-52 weeks) showed LDL-C reductions of 10% to 20%. In 1 trial (n = 248), ezetimibe with simvastatin resulted in greater LDL-C reductions compared with simvastatin alone at 33 weeks (mean, -54.0% [SD, 1.4%] vs -38.1% [SD, 1.4%]). One trial of ezetimibe monotherapy (n = 138) showed mean LDL-C decreases of 28% (95% CI, -31% to -25%) from baseline and negligible change with placebo at 12 weeks. Eighteen studies found statins generally well tolerated. One observational study found lower, but still normal, dehydroepiandrosterone sulfate concentrations in statin-treated males with FH at 10-year follow-up. Bile acid-sequestering agents were commonly associated with adverse gastrointestinal symptoms and poor palatability. There was no eligible evidence on the effect of FH treatment on myocardial infarction or stroke in adulthood. CONCLUSIONS AND RELEVANCE: Screening can detect FH in children, and lipid-lowering treatment in childhood can reduce lipid concentrations in the short term, with little evidence of harm. There is no evidence for the effect of screening for FH in childhood on lipid concentrations or cardiovascular outcomes in adulthood, or on the long-term benefits or harms of beginning lipid-lowering treatment in childhood."},{"id":"ed1ab5e3f251","type":"article","url":"https://hartvaat.nl/2016/08/09/lipidescreening-bij-kinderen-voor-multifactoriele-dyslipidemie-uspstf-evidence-r/","title":"Lipidescreening bij kinderen voor multifactoriële dyslipidemie: USPSTF evidence report","title_en":"Lipid Screening in Childhood and Adolescence for Detection of Multifactorial Dyslipidemia: Evidence Report and Systematic Review for the US Preventive Services Task Force.","category":"cholesterol","category_label":"Cholesterol","professions":["huisarts","internist"],"tags":["dyslipidemie","ezetimibe","familiaire-hypercholesterolemie","familiaire-hypercholesterolemie-screening","ldl-cholesterol","lipidenverlaging","plaquekarakterisatie","primaire-preventie","vrouwen","yellow-iii"],"journal":"JAMA","doi":"10.1001/jama.2016.6423","source_url":"https://doi.org/10.1001/jama.2016.6423","authors":["Paula Lozano","Nora B Henrikson","Caitlin C Morrison","John Dunn","Matt Nguyen","Paula R Blasi","Evelyn P Whitlock"],"significance":6,"published":"2016-08-09","source_date":"2016-08-09","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/cascadescreening-fh/","https://hartvaat.nl/kennis/preventie/screeningsprogramma-hart-en-vaatziekten/"],"congress":"","summary_en":"This USPSTF evidence report evaluated lipid screening in children and adolescents for detecting multifactorial dyslipidemia, assessing the diagnostic yield and downstream health effects of universal versus selective childhood lipid testing.","created":"2026-07-03T10:26:16Z","updated":"2026-07-03T13:25:36Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review voor de USPSTF over de opbrengst van lipidescreening bij kinderen en adolescenten voor detectie van multifactoriële dyslipidemie. Bewijsbasis voor screeningsbeleid.","abstract_original":"IMPORTANCE: Multifactorial dyslipidemia, characterized by elevated total cholesterol (TC) or low-density lipoprotein cholesterol (LDL-C), is associated with dyslipidemia and markers of atherosclerosis in young adulthood. Screening for dyslipidemia in childhood could delay or reduce cardiovascular events in adulthood. OBJECTIVE: To systematically review the evidence on benefits and harms of screening adolescents and children for multifactorial dyslipidemia for the US Preventive Services Task Force (USPSTF). DATA SOURCES: MEDLINE, Cochrane Central Register of Controlled Trials, and PubMed were searched for studies published between January 1, 2005, and June 2, 2015; studies included in a previous USPSTF evidence report and reference lists of relevant studies and ongoing trials were also searched. Surveillance was conducted through April 9, 2016. STUDY SELECTION: Fair- and good-quality studies in English with participants 0 to 20 years of age. DATA EXTRACTION AND SYNTHESIS: Two investigators independently reviewed abstracts and full-text articles and extracted data into evidence tables. Results were qualitatively summarized. MAIN OUTCOMES AND MEASURES: Outcomes included dyslipidemia (TC≥200 mg/dL or LDL-C≥130 mg/dL) and atherosclerosis in childhood; myocardial infarction and ischemic stroke in adulthood; diagnostic yield (number of confirmed cases per children screened); and harms of screening or treatment. Simulated diagnostic yield was calculated as initial screening yield × positive predictive value from a study with confirmatory testing. RESULTS: Screening of children for multifactorial dyslipidemia has not been evaluated in randomized clinical trials. Based on 1 observational study (n = 6500) and nationally representative prevalence estimates, the simulated diagnostic yield of screening for elevated TC varies between 4.8% and 12.3% (higher in obese children [12.3%] and at the ages when TC naturally peaks-7.2% at age 9-11 years and 7.2% at age 16-19 years). One good-quality randomized clinical trial (n = 663) found a modest effect of intensive dietary counseling for a low-fat, low-cholesterol diet on lipid levels at 1 year in children aged 8 to 10 years with mild to moderate dyslipidemia; mean between-group difference in TC change from baseline was -6.1 mg/dL (95% CI, -9.1 to -3.2 mg/dL; P < .001). Between-group differences dissipated by year 5. The intervention did not adversely affect nutritional status, growth, or development over the 18-year study period. One observational study (n = 9245) found that TC concentration at age 12 to 39 years was not associated with death before age 55 years. CONCLUSIONS AND RELEVANCE: The diagnostic yield of lipid screening varies by age and body mass index. No direct evidence was identified for benefits or harms of childhood screening or treatment on outcomes in adulthood. Intensive dietary interventions may be safe, with modest short-term benefit of uncertain clinical significance."},{"id":"1afd83c4fde8","type":"article","url":"https://hartvaat.nl/2016/08/09/lipidescreening-bij-kinderen-en-adolescenten-uspstf-aanbeveling/","title":"Lipidescreening bij kinderen en adolescenten: USPSTF-aanbeveling","title_en":"Screening for Lipid Disorders in Children and Adolescents: US Preventive Services Task Force Recommendation Statement.","category":"cholesterol","category_label":"Cholesterol","professions":["huisarts","internist"],"tags":["dyslipidemie","lipidenverlaging","primaire-preventie"],"journal":"JAMA","doi":"10.1001/jama.2016.9852","source_url":"https://doi.org/10.1001/jama.2016.9852","authors":["Kirsten Bibbins-Domingo","David C Grossman","Susan J Curry","Karina W Davidson","John W Epling","Francisco A R García","Matthew W Gillman","Alex R Kemper","Alex H Krist","Ann E Kurth","C Seth Landefeld","Michael LeFevre","Carol M Mangione","Douglas K Owens","William R Phillips","Maureen G Phipps","Michael P Pignone","Albert L Siu"],"significance":7,"published":"2016-08-09","source_date":"2016-08-09","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"The USPSTF recommendation statement on lipid screening in children and adolescents addressed the evidence for universal versus selective screening and the potential for identifying familial hypercholesterolemia and other lipid disorders in the pediatric population.","created":"2026-07-03T10:26:16Z","updated":"2026-07-03T13:25:36Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Aanbevelingsverklaring van de US Preventive Services Task Force over lipidescreening bij kinderen en adolescenten. Standpunt over universele versus gerichte screening op dyslipidemie op jonge leeftijd.","abstract_original":"IMPORTANCE: Elevations in levels of total, low-density lipoprotein, and non-high-density lipoprotein cholesterol; lower levels of high-density lipoprotein cholesterol; and, to a lesser extent, elevated triglyceride levels are associated with risk of cardiovascular disease in adults. OBJECTIVE: To update the 2007 US Preventive Services Task Force (USPSTF) recommendation on screening for lipid disorders in children, adolescents, and young adults. EVIDENCE REVIEW: The USPSTF reviewed the evidence on screening for lipid disorders in children and adolescents 20 years or younger--1 review focused on screening for heterozygous familial hypercholesterolemia, and 1 review focused on screening for multifactorial dyslipidemia. FINDINGS: Evidence on the quantitative difference in diagnostic yield between universal and selective screening approaches, the effectiveness and harms of long-term treatment and the harms of screening, and the association between changes in intermediate outcomes and improvements in adult cardiovascular health outcomes are limited. Therefore, the USPSTF concludes that the balance of benefits and harms cannot be determined. CONCLUSIONS AND RECOMMENDATION: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for lipid disorders in children and adolescents 20 years or younger. (I statement)."},{"id":"86b88df764bd","type":"article","url":"https://hartvaat.nl/2016/08/07/il-6-receptorantagonist-tocilizumab-bij-nstemi-effect-op-inflammatie-en-troponin/","title":"IL-6-receptorantagonist tocilizumab bij NSTEMI: effect op inflammatie en troponine","title_en":"Effect of a single dose of the interleukin-6 receptor antagonist tocilizumab on inflammation and troponin T release in patients with non-ST-elevation myocardial infarction: a double-blind, randomized, placebo-controlled phase 2 trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["inflammatie"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw171","source_url":"https://doi.org/10.1093/eurheartj/ehw171","authors":["Ola Kleveland","Gabor Kunszt","Marte Bratlie","Thor Ueland","Kaspar Broch","Espen Holte","Annika E Michelsen","Bjørn Bendz","Brage H Amundsen","Terje Espevik","Svend Aakhus","Jan Kristian Damås","Pål Aukrust","Rune Wiseth","Lars Gullestad"],"significance":7,"published":"2016-08-07","source_date":"2016-08-07","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/cardiale-biomarkers-overzicht/","https://hartvaat.nl/kennis/coronairlijden/wat-is-coronairlijden/"],"congress":"","summary_en":"This study showed that a single dose of tocilizumab, an IL-6 receptor antagonist, significantly reduced inflammation markers and attenuated troponin T release in patients with acute STEMI, providing proof-of-concept for targeted anti-inflammatory therapy in acute MI.","created":"2026-07-03T10:26:16Z","updated":"2026-07-03T13:25:36Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die het effect onderzocht van een enkele dosis tocilizumab, een IL-6-receptorantagonist, op inflammatiemarkers en troponine T bij NSTEMI. Mechanistisch bewijs voor de inflammatiehypothese bij acuut coronair syndroom.","abstract_original":"AIMS: Interleukin-6 (IL-6) contributes to atherosclerotic plaque destabilization and is involved in myocardial injury during ischaemia-reperfusion. Interleukin-6 is therefore a potential therapeutic target in myocardial infarction (MI). We hypothesized that the IL-6 receptor antagonist tocilizumab would attenuate inflammation, and secondarily reduce troponin T (TnT) release in non-ST-elevation MI (NSTEMI). METHODS AND RESULTS: In a two-centre, double-blind, placebo-controlled trial, 117 patients with NSTEMI were randomized at a median of 2 days after symptom onset to receive placebo (n = 59) or tocilizumab (n = 58), administered as a single dose prior to coronary angiography. High sensitivity (hs) C-reactive protein and hsTnT were measured at seven consecutive timepoints between Days 1 and 3. The area under the curve (AUC) for high-sensitivity C-reactive protein was the primary endpoint. The median AUC for high-sensitivity C-reactive protein during hospitalization was 2.1 times higher in the placebo than in the tocilizumab group (4.2 vs. 2.0 mg/L/h, P < 0.001). Also, the median AUC for hsTnT during hospitalization was 1.5 times higher in the placebo group compared with the tocilizumab group (234 vs. 159 ng/L/h, P = 0.007). The differences between the two treatment groups were observed mainly in (i) patients included ≤2 days from symptom onset and (ii) patients treated with percutaneous coronary intervention (PCI). No safety issues in the tocilizumab group were detected during 6 months of follow-up. CONCLUSION: Tocilizumab attenuated the inflammatory response and primarily PCI-related TnT release in NSTEMI patients."},{"id":"14c10aed5e67","type":"article","url":"https://hartvaat.nl/2016/08/02/liraglutide-en-klinische-stabiliteit-bij-gevorderd-hartfalen-met-verminderde-ef-/","title":"Liraglutide en klinische stabiliteit bij gevorderd hartfalen met verminderde EF: JAMA FIGHT-trial","title_en":"Effects of Liraglutide on Clinical Stability Among Patients With Advanced Heart Failure and Reduced Ejection Fraction: A Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["answer-hf","dapa-hf","emperor-trials","pathfinder-trial","select-trial","soul-trial","step-hfpef","summit-trial"],"journal":"JAMA","doi":"10.1001/jama.2016.10260","source_url":"https://doi.org/10.1001/jama.2016.10260","authors":["Kenneth B Margulies","Adrian F Hernandez","Margaret M Redfield","Michael M Givertz","Guilherme H Oliveira","Robert Cole","Douglas L Mann","David J Whellan","Michael S Kiernan","G Michael Felker","Steven E McNulty","Kevin J Anstrom","Monica R Shah","Eugene Braunwald","Thomas P Cappola"],"significance":8,"published":"2016-08-02","source_date":"2016-08-02","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/","https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/"],"congress":"","summary_en":"This JAMA trial showed that liraglutide did not improve clinical stability in patients with advanced HFrEF, contrary to expectations from the diabetes cardiovascular trials. The results highlighted that the cardiac benefits of GLP-1 agonists may not extend to the most advanced heart failure populations.","created":"2026-07-03T10:26:16Z","updated":"2026-07-03T18:38:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA gerandomiseerde trial die liraglutide onderzocht bij patiënten met gevorderd HFrEF. In tegenstelling tot het cardiovasculaire voordeel bij diabetes was er geen verbetering van klinische stabiliteit bij gevorderd hartfalen.","abstract_original":"IMPORTANCE: Abnormal cardiac metabolism contributes to the pathophysiology of advanced heart failure with reduced left ventricular ejection fraction (LVEF). Glucagon-like peptide 1 (GLP-1) agonists have shown cardioprotective effects in early clinical studies of patients with advanced heart failure, irrespective of type 2 diabetes status. OBJECTIVE: To test whether therapy with a GLP-1 agonist improves clinical stability following hospitalization for acute heart failure. DESIGN, SETTING, AND PARTICIPANTS: Phase 2, double-blind, placebo-controlled randomized clinical trial of patients with established heart failure and reduced LVEF who were recently hospitalized. Patients were enrolled between August 2013 and March 2015 at 24 US sites. INTERVENTIONS: The GLP-1 agonist liraglutide (n = 154) or placebo (n = 146) via a daily subcutaneous injection; study drug was advanced to a dosage of 1.8 mg/d during the first 30 days as tolerated and continued for 180 days. MAIN OUTCOMES AND MEASURES: The primary end point was a global rank score in which all patients, regardless of treatment assignment, were ranked across 3 hierarchical tiers: time to death, time to rehospitalization for heart failure, and time-averaged proportional change in N-terminal pro-B-type natriuretic peptide level from baseline to 180 days. Higher values indicate better health (stability). Exploratory secondary outcomes included primary end point components, cardiac structure and function, 6-minute walk distance, quality of life, and combined events. RESULTS: Among the 300 patients who were randomized (median age, 61 years [interquartile range {IQR}, 52-68 years]; 64 [21%] women; 178 [59%] with type 2 diabetes; median LVEF of 25% [IQR, 19%-33%]; median N-terminal pro-B-type natriuretic peptide level of 2049 pg/mL [IQR, 1054-4235 pg/mL]), 271 completed the study. Compared with placebo, liraglutide had no significant effect on the primary end point (mean rank of 146 for the liraglutide group vs 156 for the placebo group, P = .31). There were no significant between-group differences in the number of deaths (19 [12%] in the liraglutide group vs 16 [11%] in the placebo group; hazard ratio, 1.10 [95% CI, 0.57-2.14]; P = .78) or rehospitalizations for heart failure (63 [41%] vs 50 [34%], respectively; hazard ratio, 1.30 [95% CI, 0.89-1.88]; P = .17) or for the exploratory secondary end points. Prespecified subgroup analyses in patients with diabetes did not reveal any significant between-group differences. The number of investigator-reported hyperglycemic events was 16 (10%) in the liraglutide group vs 27 (18%) in the placebo group and hypoglycemic events were infrequent (2 [1%] vs 4 [3%], respectively). CONCLUSIONS AND RELEVANCE: Among patients recently hospitalized with heart failure and reduced LVEF, the use of liraglutide did not lead to greater posthospitalization clinical stability. These findings do not support the use of liraglutide in this clinical situation. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01800968."},{"id":"130d31d63dc2","type":"article","url":"https://hartvaat.nl/2016/08/02/omega-3-vetzuren-en-linkerkamerremodellering-na-acuut-mi-omega-remodel-trial/","title":"Omega-3-vetzuren en linkerkamerremodellering na acuut MI: OMEGA-REMODEL-trial","title_en":"Effect of Omega-3 Acid Ethyl Esters on Left Ventricular Remodeling After Acute Myocardial Infarction: The OMEGA-REMODEL Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["emperor-trials"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.115.019949","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.115.019949","authors":["Bobak Heydari","Shuaib Abdullah","James V Pottala","Ravi Shah","Siddique Abbasi","Damien Mandry","Sanjeev A Francis","Heidi Lumish","Brian B Ghoshhajra","Udo Hoffmann","Evan Appelbaum","Jiazhuo H Feng","Ron Blankstein","Michael Steigner","Joseph P McConnell","William Harris","Elliott M Antman","Michael Jerosch-Herold","Raymond Y Kwong"],"significance":6,"published":"2016-08-02","source_date":"2016-08-02","image":"","kennis":[],"congress":"","summary_en":"The OMEGA-REMODEL trial demonstrated that omega-3 fatty acid supplementation after acute MI reduces left ventricular remodeling, with improvements in myocardial fibrosis and systolic function detected by cardiac MRI beyond standard post-MI therapy.","created":"2026-07-03T10:26:16Z","updated":"2026-07-03T13:25:36Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial die het effect van omega-3-ethylesters onderzocht op linkerkamerremodellering na een acuut myocardinfarct. Mechanistische studie met MRI-eindpunten naar het cardioprotectieve potentieel van omega-3.","abstract_original":"BACKGROUND: Omega-3 fatty acids from fish oil have been associated with beneficial cardiovascular effects, but their role in modifying cardiac structures and tissue characteristics in patients who have had an acute myocardial infarction while receiving current guideline-based therapy remains unknown. METHODS: In a multicenter, double-blind, placebo-controlled trial, participants presenting with an acute myocardial infarction were randomly assigned 1:1 to 6 months of high-dose omega-3 fatty acids (n=180) or placebo (n=178). Cardiac magnetic resonance imaging was used to assess cardiac structure and tissue characteristics at baseline and after study therapy. The primary study endpoint was change in left ventricular systolic volume index. Secondary endpoints included change in noninfarct myocardial fibrosis, left ventricular ejection fraction, and infarct size. RESULTS: By intention-to-treat analysis, patients randomly assigned to omega-3 fatty acids experienced a significant reduction of left ventricular systolic volume index (-5.8%, P=0.017), and noninfarct myocardial fibrosis (-5.6%, P=0.026) in comparison with placebo. Per-protocol analysis revealed that those patients who achieved the highest quartile increase in red blood cell omega-3 index experienced a 13% reduction in left ventricular systolic volume index in comparison with the lowest quartile. In addition, patients in the omega-3 fatty acid arm underwent significant reductions in serum biomarkers of systemic and vascular inflammation and myocardial fibrosis. There were no adverse events associated with high-dose omega-3 fatty acid therapy. CONCLUSIONS: Treatment of patients with acute myocardial infarction with high-dose omega-3 fatty acids was associated with reduction of adverse left ventricular remodeling, noninfarct myocardial fibrosis, and serum biomarkers of systemic inflammation beyond current guideline-based standard of care. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00729430."},{"id":"c17ebfd57ff0","type":"article","url":"https://hartvaat.nl/2016/08/02/impact-van-coronaire-laesielengte-op-uitkomsten-bij-ivus-geleide-pci/","title":"Impact van coronaire laesielengte op uitkomsten bij IVUS-geleide PCI","title_en":"Does the Baseline Coronary Lesion Length Impact Outcomes With IVUS-Guided Percutaneous Coronary Intervention?","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["intracoronaire-beeldvorming"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.05.042","source_url":"https://doi.org/10.1016/j.jacc.2016.05.042","authors":["Islam Y Elgendy","Ahmed N Mahmoud","Akram Y Elgendy","Anthony A Bavry"],"significance":5,"published":"2016-08-02","source_date":"2016-08-02","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/intravasculaire-echografie-ivus-oct/"],"congress":"","summary_en":"This study examined whether baseline coronary lesion length impacts outcomes with IVUS-guided PCI, addressing the role of lesion complexity in determining the value of intravascular imaging guidance.","created":"2026-07-03T10:26:15Z","updated":"2026-07-03T13:25:36Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de invloed van de uitgangscoronairlaesielengte op uitkomsten bij PCI geleid door intravasculaire echografie (IVUS). Onderzoekt de meerwaarde van IVUS bij langere laesies.","abstract_original":""},{"id":"b8159db26ab4","type":"article","url":"https://hartvaat.nl/2016/08/01/digitale-gezondheidsinterventie-voor-cardiovasculaire-risicoverlaging-gerandomis/","title":"Digitale gezondheidsinterventie voor cardiovasculaire risicoverlaging: gerandomiseerde trial","title_en":"A Digital Health Intervention to Lower Cardiovascular Risk: A Randomized Clinical Trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts"],"tags":["atleten","biomarkers-cardiovasculair","diabetes-type-2","farmaco-economie","fidelio-dkd","figaro-dkd","hartrevalidatie","menopauze","obesitas","ouderen","roken","secundaire-preventie"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2016.1035","source_url":"https://doi.org/10.1001/jamacardio.2016.1035","authors":["Sonia S Anand","Zainab Samaan","Catherine Middleton","Jane Irvine","Dipika Desai","Karleen M Schulze","Stena Sothiratnam","Fathima Hussain","Baiju R Shah","Guillaume Pare","Joseph Beyene","Scott A Lear"],"significance":6,"published":"2016-08-01","source_date":"2016-08-01","image":"","kennis":["https://hartvaat.nl/kennis/preventie/levenslang-cardiovasculair-risico/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"This JAMA Cardiology trial showed that a digital health intervention using text messaging and lifestyle coaching reduces cardiovascular risk factors in South Asian individuals, demonstrating the potential of mobile technology for CVD prevention in high-risk populations.","created":"2026-07-03T10:26:15Z","updated":"2026-07-03T13:25:36Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology gerandomiseerde trial van een digitale gezondheidsinterventie voor verlaging van cardiovasculair risico. Pionierswerk in het gebruik van technologie voor cardiovasculaire preventie.","abstract_original":"IMPORTANCE: South Asian individuals have a high burden of premature myocardial infarction (MI). OBJECTIVES: To test whether a digital health intervention (DHI) designed to change diet and physical activity improves MI risk among a South Asian population. DESIGN, SETTING, AND PARTICIPANTS: This single-blind, community-based, randomized clinical trial with 1-year follow-up was performed among South Asian men and women 30 years or older and living in Ontario and British Columbia who were free of cardiovascular disease. Data analysis was by intention to treat. Data were collected from June 3, 2012, to October 27, 2013. Final follow-up was completed on December 2, 2014, and data were analyzed from April 2, 2015, to February 29, 2016. INTERVENTIONS: Participants were randomized 1:1 to the DHI or control condition. The goal-setting DHI used emails or text messages and focused on improving diet and physical activity that was tailored to the participant's self-reported stage of change. MAIN OUTCOMES AND MEASURES: The change in an MI risk score from baseline to 1 year was the primary outcome. Secondary outcomes included the change in each objectively measured component of the MI risk score (ie, blood pressure, waist to hip ratio, hemoglobin A1c level, and the ratio of apolipoprotein B to apolipoprotein A). Genetic risk for MI was determined by counting the 9p21 risk alleles; results were provided to each participant at baseline. RESULTS: A total of 343 South Asian men and women (178 men [51.9%]; mean [SD] age, 50.6 [11.4] years) who were free of cardiovascular disease were randomized to the control condition (n = 174) or the DHI (n = 169). The mean (SD) MI risk score was 13.3 (6.6) at baseline. No significant difference was found in the change in MI score after 1 year between the DHI and control groups (-0.27; 95% CI, -1.12 to 0.58; P = .53) after adjusting for baseline scores, and no difference was found in the fully adjusted model (-0.39; 95% CI, -1.24 to 0.45; P = .36). No association between knowledge of the genetic risk status at baseline and the change in MI risk score was found (0.19; 95% CI, -0.40 to 0.78; P = .53). CONCLUSIONS AND RELEVANCE: Among South Asian individuals, a DHI was not associated with a reduction in MI risk score after 12 months and was not influenced by knowledge of genetic risk status. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01841398."},{"id":"373f3cc7b9bb","type":"article","url":"https://hartvaat.nl/2016/08/01/sedentair-gedrag-en-cardiovasculair-risico-continue-dosis-responsrelatie-in-meta/","title":"Sedentair gedrag en cardiovasculair risico: continue dosis-responsrelatie in meta-analyse","title_en":"Continuous Dose-Response Association Between Sedentary Time and Risk for Cardiovascular Disease: A Meta-analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":["diabetes-type-2","hartrevalidatie","menopauze","roken","slaapapneu","voeding-hart"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2016.1567","source_url":"https://doi.org/10.1001/jamacardio.2016.1567","authors":["Ambarish Pandey","Usman Salahuddin","Sushil Garg","Colby Ayers","Jacquelyn Kulinski","Vidhu Anand","Helen Mayo","Dharam J Kumbhani","James de Lemos","Jarett D Berry"],"significance":7,"published":"2016-08-01","source_date":"2016-08-01","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"This JAMA Cardiology meta-analysis established a continuous dose-response relationship between sedentary time and cardiovascular disease risk, with each additional hour of daily sitting time incrementally increasing cardiovascular events and mortality.","created":"2026-07-03T10:26:15Z","updated":"2026-07-03T13:25:36Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology meta-analyse die een continue dosis-responsrelatie aantoonde tussen zittijd en cardiovasculair risico. Elk uur extra zitten verhoogt het risico — relevant voor leefstijladvies.","abstract_original":"IMPORTANCE: Prior studies suggest that higher sedentary time is associated with a greater risk for cardiovascular disease (CVD). However, the quantitative, dose-response association between sedentary time and CVD risk is not known. OBJECTIVE: To determine the categorical and quantitative dose-response association between sedentary time and CVD risk. DATA SOURCES: Two independent investigators searched the MEDLINE and EMBASE databases for all studies published before July 6, 2015, that evaluated the association between sedentary time and incident CVD. STUDY SELECTION: Prospective cohort studies with participants 18 years or older that reported the association between sedentary time and incident CVD were included. DATA EXTRACTION AND SYNTHESIS: Two independent investigators performed the data extraction and collection using a standardized form. The study quality was assessed using the Newcastle-Ottawa Scale. The categorical dose-response association was evaluated by comparing the pooled hazard ratio (HR) for incident CVD associated with different levels of sedentary time (vs lowest sedentary time) across studies. The continuous dose-response association was assessed using random-effects generalized least squares spline models. Data were collected from April 5 to July 6, 2015. MAIN OUTCOMES AND MEASURES: Incident CVD (coronary heart disease, including nonfatal myocardial infarction, stroke, and cardiovascular mortality). RESULTS: Nine prospective cohort studies with 720 425 unique participants (57.1% women; 42.9% men; mean age, 54.5 years) and 25 769 unique cardiovascular events and a median follow-up of 11 years were included. In categorical analyses, compared with the lowest sedentary time category (median, 2.5 h/d), participants in the highest sedentary time category (median, 12.5 h/d) had an increased risk for CVD (HR, 1.14; 95% CI, 1.09-1.19). However, no apparent risk associated with intermediate levels of sedentary time (HR for 7.5 h/d, 1.02; 95% CI, 0.96-1.08) was found. In continuous analyses, a nonlinear association between sedentary time and incident CVD was found (P for nonlinearity < .001), with an increased risk observed for more than 10 hours of sedentary time per day (pooled HR, 1.08; 95% CI, 1.00-1.14). CONCLUSIONS AND RELEVANCE: The association between sedentary time and the risk for CVD is nonlinear with an increased risk only at very high levels. These findings could have implications for guideline recommendations regarding the risks related to sedentary behavior."},{"id":"5932f0e2e50b","type":"article","url":"https://hartvaat.nl/2016/08/01/2016-europese-richtlijnen-voor-cardiovasculaire-preventie-in-de-klinische-prakti/","title":"2016 Europese richtlijnen voor cardiovasculaire preventie in de klinische praktijk","title_en":"2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR).","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["biomarkers-cardiovasculair","diabetes-type-2","farmaco-economie","hartrevalidatie","menopauze","obesitas","ouderen","primaire-preventie","richtlijnen-esc","secundaire-preventie"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw106","source_url":"https://doi.org/10.1093/eurheartj/ehw106","authors":["Massimo F Piepoli","Arno W Hoes","Stefan Agewall","Christian Albus","Carlos Brotons","Alberico L Catapano","Marie-Therese Cooney","Ugo Corrà","Bernard Cosyns","Christi Deaton","Ian Graham","Michael Stephen Hall","F D Richard Hobbs","Maja-Lisa Løchen","Herbert Löllgen","Pedro Marques-Vidal","Joep Perk","Eva Prescott","Josep Redon","Dimitrios J Richter","Naveed Sattar","Yvo Smulders","Monica Tiberi","H Bart van der Worp","Ineke van Dis","W M Monique Verschuren","Simone Binno"],"significance":10,"published":"2016-08-01","source_date":"2016-08-01","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/gewichtsreductie-leefstijl-hart/","https://hartvaat.nl/kennis/preventie/levenslang-cardiovasculair-risico/"],"congress":"","summary_en":"The Sixth Joint European Guidelines on cardiovascular disease prevention provided a comprehensive framework for risk stratification using the SCORE system, lifestyle interventions, and pharmacological prevention. This multi-society document established risk-category-specific treatment targets and remains the standard reference for preventive cardiology in Europe.","created":"2026-07-03T10:26:15Z","updated":"2026-07-03T13:25:35Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De zesde gezamenlijke Europese richtlijn voor cardiovasculaire preventie. Omvat risicostratificatie (SCORE), leefstijlinterventies, medicamenteuze preventie en doelgroepspecifieke aanbevelingen. Standaardwerk voor preventieve cardiologie.","abstract_original":""},{"id":"62c7fc929377","type":"article","url":"https://hartvaat.nl/2016/08/01/eerder-clopidogrelgebruik-en-uitkomsten-bij-conservatief-behandeld-acs/","title":"Eerder clopidogrelgebruik en uitkomsten bij conservatief behandeld ACS","title_en":"Effect of prior clopidogrel use on outcomes in medically managed acute coronary syndrome patients.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["acuut-coronair-syndroom"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2015-308840","source_url":"https://doi.org/10.1136/heartjnl-2015-308840","authors":["Chee Tang Chin","William E Boden","Matthew T Roe","Benjamin Neely","Megan L Neely","Jose L Leiva-Pons","Ramón Corbalán","Shmuel Gottlieb","Anthony J Dalby","Paul W Armstrong","Dorairaj Prabhakaran","Keith A A Fox","Harvey D White","E Magnus Ohman","Kenneth J Winters","Francois Schiele"],"significance":5,"published":"2016-08-01","source_date":"2016-08-01","image":"","kennis":[],"congress":"","summary_en":"This study examined how prior clopidogrel use affects long-term outcomes in conservatively managed ACS patients, evaluating whether antiplatelet treatment history modifies the benefit of continued therapy.","created":"2026-07-03T10:26:15Z","updated":"2026-07-03T13:25:35Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar het effect van eerder clopidogrelgebruik op uitkomsten bij ACS-patiënten die conservatief (zonder revascularisatie) worden behandeld. Onderzoekt of voorbehandeling de prognose beïnvloedt.","abstract_original":"OBJECTIVE: We investigated whether prior clopidogrel influenced long-term ischaemic and bleeding risks and modified the randomised treatment effect of clopidogrel versus prasugrel among medically managed patients with acute coronary syndromes (ACS) treated with dual antiplatelet therapy. METHODS: Medically managed patients with ACS in the Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes (TRILOGY ACS) trial were randomised to clopidogrel versus prasugrel (plus aspirin), stratified by prior clopidogrel use. From the analysis population (n=8927), we compared two groups: 'clopidogrel in-hospital (n=6513)' (clopidogrel started ≤72 h of presentation for index ACS event) and 'prior-clopidogrel (n=2414)' (on clopidogrel ≥5 days before index hospitalisation). Treatment-related differences in ischaemic (all-cause death, cardiovascular (CV) death, myocardial infarction (MI), stroke and the composite of CV death/MI/stroke) and bleeding outcomes (severe/life-threatening or moderate bleeding events based on Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) criteria) through 30 months were analysed between patients in the two groups. RESULTS: Compared with 'clopidogrel in-hospital,' 'prior clopidogrel' patients were younger (median 64 years vs 66 years, p<0.001), more likely to have prior CV events/revascularisation, and had a higher frequency of CV death, MI or stroke through 30 months (20.8% vs 18.2%, p=0.002), with no difference in bleeding events (2.3% vs 3.4%, p=0.50). Randomised treatment effect (prasugrel vs clopidogrel) was similar for ischaemic and bleeding outcomes in both groups (all pinteraction>0.05). CONCLUSIONS: Patients receiving clopidogrel before admission for ACS and subsequently treated only medically are at higher risk for CV events versus those not previously receiving clopidogrel. More potent antiplatelet inhibition with prasugrel versus clopidogrel did not significantly reduce this risk. TRIAL REGISTRATION NUMBER: NCT00699998."},{"id":"07c362526d84","type":"article","url":"https://hartvaat.nl/2016/08/01/magnesiumsuppletie-en-bloeddruk-meta-analyse-van-dubbelblinde-placebogecontrolee/","title":"Magnesiumsuppletie en bloeddruk: meta-analyse van dubbelblinde placebogecontroleerde trials","title_en":"Effects of Magnesium Supplementation on Blood Pressure: A Meta-Analysis of Randomized Double-Blind Placebo-Controlled Trials.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","lipidenverlaging"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.07664","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.07664","authors":["Xi Zhang","Yufeng Li","Liana C Del Gobbo","Andrea Rosanoff","Jiawei Wang","Wen Zhang","Yiqing Song"],"significance":7,"published":"2016-08-01","source_date":"2016-08-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/ace-remmers-hypertensie/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This meta-analysis of randomized double-blind placebo-controlled trials demonstrated that magnesium supplementation significantly lowers blood pressure, with dose-dependent effects. The findings support magnesium as an adjunctive nutritional strategy for blood pressure management.","created":"2026-07-03T10:26:15Z","updated":"2026-07-03T18:38:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse die aantoont dat magnesiumsuppletie de bloeddruk significant verlaagt. Kwantificeert het bloeddrukverlagend effect en ondersteunt magnesium als aanvulling op antihypertensieve behandeling.","abstract_original":"The antihypertensive effect of magnesium (Mg) supplementation remains controversial. We aimed to quantify the effect of oral Mg supplementation on blood pressure (BP) by synthesizing available evidence from randomized, double-blind, placebo-controlled trials. We searched trials of Mg supplementation on normotensive and hypertensive adults published up to February 1, 2016 from MEDLINE and EMBASE databases; 34 trials involving 2028 participants were eligible for this meta-analysis. Weighted mean differences of changes in BP and serum Mg were calculated by random-effects meta-analysis. Mg supplementation at a median dose of 368 mg/d for a median duration of 3 months significantly reduced systolic BP by 2.00 mm Hg (95% confidence interval, 0.43-3.58) and diastolic BP by 1.78 mm Hg (95% confidence interval, 0.73-2.82); these reductions were accompanied by 0.05 mmol/L (95% confidence interval, 0.03, 0.07) elevation of serum Mg compared with placebo. Using a restricted cubic spline curve, we found that Mg supplementation with a dose of 300 mg/d or duration of 1 month is sufficient to elevate serum Mg and reduce BP; and serum Mg was negatively associated with diastolic BP but not systolic BP (all P<0.05). In the stratified analyses, a greater reduction in BP tended to be found in trials with high quality or low dropout rate (all P values for interaction <0.05). However, residual heterogeneity may still exist after considering these possible factors. Our findings indicate a causal effect of Mg supplementation on lowering BPs in adults. Further well-designed trials are warranted to validate the BP-lowering efficacy of optimal Mg treatment."},{"id":"ade7276ae9ff","type":"article","url":"https://hartvaat.nl/2016/08/01/apol1-nierrisicovarianten-en-cerebrale-wittestoflaesies/","title":"APOL1-nierrisicovarianten en cerebrale wittestoflaesies","title_en":"APOL1 renal-risk variants associate with reduced cerebral white matter lesion volume and increased gray matter volume.","category":"preventie","category_label":"Preventie","professions":["internist"],"tags":[],"journal":"Kidney international","doi":"10.1016/j.kint.2016.04.027","source_url":"https://doi.org/10.1016/j.kint.2016.04.027","authors":["Barry I Freedman","Crystal A Gadegbeku","R Nick Bryan","Nicholette D Palmer","Pamela J Hicks","Lijun Ma","Michael V Rocco","S Carrie Smith","Jianzhao Xu","Christopher T Whitlow","Benjamin C Wagner","Carl D Langefeld","Amret T Hawfield","Jeffrey T Bates","Alan J Lerner","Dominic S Raj","Mohammad S Sadaghiani","Robert D Toto","Jackson T Wright","Donald W Bowden","Jeff D Williamson","Kaycee M Sink","Joseph A Maldjian","Nicholas M Pajewski","Jasmin Divers"],"significance":5,"published":"2016-08-01","source_date":"2016-08-01","image":"","kennis":[],"congress":"","summary_en":"This study showed that APOL1 renal risk variants are associated with altered cerebral white and gray matter volumes, suggesting that the genetic risk for kidney disease also affects brain structure through shared vascular mechanisms.","created":"2026-07-03T10:26:15Z","updated":"2026-07-03T13:25:35Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar het verband tussen APOL1-genrisicovarianten, verminderd cerebaal wittestofvolume en vergroot grijzestofvolume. Onderzoekt de neurovasculaire implicaties van genetisch nierdisease risico.","abstract_original":"To assess apolipoprotein L1 gene (APOL1) renal-risk-variant effects on the brain, magnetic resonance imaging (MRI)-based cerebral volumes and cognitive function were assessed in 517 African American-Diabetes Heart Study (AA-DHS) Memory IN Diabetes (MIND) and 2568 hypertensive African American Systolic Blood Pressure Intervention Trial (SPRINT) participants without diabetes. Within these cohorts, 483 and 197 had cerebral MRI, respectively. AA-DHS participants were characterized as follows: 60.9% female, mean age of 58.6 years, diabetes duration 13.1 years, estimated glomerular filtration rate of 88.2 ml/min/1.73 m(2), and a median spot urine albumin to creatinine ratio of 10.0 mg/g. In additive genetic models adjusting for age, sex, ancestry, scanner, intracranial volume, body mass index, hemoglobin A1c, statins, nephropathy, smoking, hypertension, and cardiovascular disease, APOL1 renal-risk-variants were positively associated with gray matter volume (β = 3.4 × 10(-3)) and negatively associated with white matter lesion volume (β = -0.303) (an indicator of cerebral small vessel disease) and cerebrospinal fluid volume (β= -30707) (all significant), but not with white matter volume or cognitive function. Significant associations corresponding to adjusted effect sizes (β/SE) were observed with gray matter volume (0.16) and white matter lesion volume (-0.208), but not with cerebrospinal fluid volume (-0.251). Meta-analysis results with SPRINT Memory and Cognition in Decreased Hypertension (MIND) participants who had cerebral MRI were confirmatory. Thus, APOL1 renal-risk-variants are associated with larger gray matter volume and lower white matter lesion volume suggesting lower intracranial small vessel disease."},{"id":"36686aa1e3ff","type":"article","url":"https://hartvaat.nl/2016/08/01/cabg-versus-pci-en-risico-op-myocardinfarct-en-revascularisatie-bij-ckd-patiente/","title":"CABG versus PCI en risico op myocardinfarct en revascularisatie bij CKD-patiënten","title_en":"Reduced risk of myocardial infarct and revascularization following coronary artery bypass grafting compared with percutaneous coronary intervention in patients with chronic kidney disease.","category":"chronische nierziekte","category_label":"Nierziekte","professions":["cardioloog","internist"],"tags":["coronaire-bypass","myocardinfarct"],"journal":"Kidney international","doi":"10.1016/j.kint.2016.03.033","source_url":"https://doi.org/10.1016/j.kint.2016.03.033","authors":["David M Charytan","Manisha Desai","Maya Mathur","Noam M Stern","Maria M Brooks","Lukasz J Krzych","Gerhard C Schuler","Jan Kaehler","Alfredo M Rodriguez-Granillo","Whady Hueb","Barnaby C Reeves","Holger Thiele","Alfredo E Rodriguez","Piotr P Buszman","Paweł E Buszman","Rie Maurer","Wolfgang C Winkelmayer"],"significance":6,"published":"2016-08-01","source_date":"2016-08-01","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/nierziekte/nsaids-en-nierziekte/"],"congress":"","summary_en":"This study compared the risk of MI and revascularization after CABG versus PCI in patients with chronic kidney disease, showing that CABG provides superior protection against recurrent coronary events in this high-risk renal population.","created":"2026-07-03T10:26:15Z","updated":"2026-07-03T13:25:35Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die het risico op myocardinfarct en herrevascularisatie vergeleek na CABG versus PCI bij patiënten met chronische nierziekte. Relevant voor revascularisatiebeslissingen bij deze hoogrisicopopulatie.","abstract_original":"Coronary atherosclerotic disease is highly prevalent in chronic kidney disease (CKD). Although revascularization improves outcomes, procedural risks are increased in CKD, and unbiased data comparing coronary artery bypass grafting (CABG) and percutaneous intervention (PCI) in CKD are sparse. To compare outcomes of CABG and PCI in stage 3 to 5 CKD, we identified randomized trials comparing these procedures. Investigators were contacted to obtain individual, patient-level data. Ten of 27 trials meeting inclusion criteria provided data. These trials enrolled 3993 patients encompassing 526 patients with stage 3 to 5 CKD of whom 137 were stage 3b-5 CKD. Among individuals with stage 3 to 5 CKD, mortality through 5 years was not different after CABG compared with PCI (hazard ratio [HR] 0.99, 95% confidence interval [CI] 0.67-1.46) or stage 3b-5 CKD (HR 1.29, CI 0.68-2.46). However, CKD modified the impact on survival free of myocardial infarction: it was not different between CABG and PCI for individuals with preserved kidney function (HR 0.97, CI 0.80-1.17), but was significantly lower after CABG in stage 3-5 CKD (HR 0.49, CI 0.29-0.82) and stage 3b-5 CKD (HR 0.23, CI 0.09-0.58). Repeat revascularization was reduced after CABG compared with PCI regardless, of baseline kidney function. Results were limited by unavailability of data from several trials and paucity of enrolled patients with stage 4-5 CKD. Thus, our patient-level meta-analysis of individuals with CKD randomized to CABG versus PCI suggests that CABG significantly reduces the risk of subsequent myocardial infarction and revascularization without affecting survival in these patients."},{"id":"26cf9dd7aaba","type":"article","url":"https://hartvaat.nl/2016/08/01/hospitalisaties-bij-atriumfibrilleren-analyse-uit-rocket-af/","title":"Hospitalisaties bij atriumfibrilleren: analyse uit ROCKET AF","title_en":"Hospitalizations in patients with atrial fibrillation: an analysis from ROCKET AF.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euv404","source_url":"https://doi.org/10.1093/europace/euv404","authors":["Adam D DeVore","Anne S Hellkamp","Richard C Becker","Scott D Berkowitz","Guenter Breithardt","Werner Hacke","Jonathan L Halperin","Graeme J Hankey","Kenneth W Mahaffey","Christopher C Nessel","Daniel E Singer","Keith A A Fox","Manesh R Patel","Jonathan P Piccini"],"significance":5,"published":"2016-08-01","source_date":"2016-08-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This ROCKET AF analysis characterized hospitalization patterns in AF patients, finding that hospitalizations are frequent, predominantly for cardiovascular causes, and represent a major driver of healthcare costs in the AF population.","created":"2026-07-03T10:26:14Z","updated":"2026-07-03T13:25:35Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ROCKET AF-analyse die het patroon en de determinanten van hospitalisaties bij AF-patiënten in kaart bracht. Hospitalisaties zijn een belangrijke uitkomstmaat en kostendrijver bij AF.","abstract_original":"AIMS: The high costs associated with treatment for atrial fibrillation (AF) are primarily due to hospital care, but there are limited data to understand the reasons for and predictors of hospitalization in patients with AF. METHODS AND RESULTS: The ROCKET AF trial compared rivaroxaban with warfarin for stroke prophylaxis in AF. We described the frequency of and reasons for hospitalization during study follow-up and utilized Cox proportional hazards models to assess for baseline characteristics associated with all-cause hospitalization. Of 14 171 patients, 14% were hospitalized at least once. Of 2614 total hospitalizations, 41% were cardiovascular including 4% for AF; of the remaining, 12% were for bleeding. Compared with patients not hospitalized, hospitalized patients were older (74 vs. 72 years), and more frequently had diabetes (46 vs. 39%), prior MI (23 vs. 16%), and paroxysmal AF (19 vs. 17%), but less frequently had prior transient ischaemic attack/stroke (49 vs. 56%). After multivariable adjustment, lung disease [hazard ratio (HR) 1.46, 95% confidence interval (CI) 1.29-1.66], diabetes [1.22, (1.11-1.34)], prior MI [1.27, (1.13-1.42)], and renal dysfunction [HR 1.07 per 5 unit GFR < 65 mL/min, (1.04-1.10)] were associated with increased hospitalization risk. Treatment assignment was not associated with differential rates of hospitalization. CONCLUSION: Nearly 1 in 7 of the moderate-to-high-risk patients with AF enrolled in this trial was hospitalized within 2 years, and both AF and bleeding were rare causes of hospitalization. Further research is needed to determine whether care pathways directed at comorbid conditions among AF patients could reduce the need for and costs associated with hospitalization."},{"id":"010b2dc521de","type":"article","url":"https://hartvaat.nl/2016/08/01/vitamine-d-en-incidentie-van-atriumfibrilleren-de-aric-studie/","title":"Vitamine D en incidentie van atriumfibrilleren: de ARIC-studie","title_en":"Serum 25-hydroxyvitamin D and the incidence of atrial fibrillation: the Atherosclerosis Risk in Communities (ARIC) study.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts","internist"],"tags":["menopauze"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euv395","source_url":"https://doi.org/10.1093/europace/euv395","authors":["Alvaro Alonso","Jeffrey R Misialek","Erin D Michos","John Eckfeldt","Elizabeth Selvin","Elsayed Z Soliman","Lin Y Chen","Myron D Gross","Pamela L Lutsey"],"significance":5,"published":"2016-08-01","source_date":"2016-08-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/chadsvasc-score/"],"congress":"","summary_en":"This ARIC cohort analysis found no significant prospective association between serum vitamin D levels and incident atrial fibrillation, contributing to the negative evidence for vitamin D as a modifiable AF risk factor.","created":"2026-07-03T10:26:14Z","updated":"2026-07-03T13:25:35Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de ARIC-cohortstudie naar het verband tussen serum 25-hydroxyvitamine D en het risico op het ontwikkelen van atriumfibrilleren. Onderzoekt vitamine D als modifieerbare risicofactor voor AF.","abstract_original":"AIMS: To assess the prospective association between circulating 25-hydroxyvitamin D [25(OH)D] and atrial fibrillation (AF) risk. METHODS AND RESULTS: We studied 12 303 participants from the Atherosclerosis Risk in Communities study without baseline AF (1990-92). Baseline serum total 25(OH)D was measured using mass spectrometry. Incident AF cases were identified from electrocardiograms, hospital discharge codes, and death certificates through 2012. We estimated hazard ratios (HRs) and 95% confidence intervals (95% CIs) of AF across clinical categories of serum 25(OH)D concentrations with multivariable Cox models, and tested interactions by age, race, and sex. We meta-analysed our results with those from published prospective studies that reported associations between 25(OH)D and AF risk. During a median follow-up of 21 years, we identified 1866 AF events. In multivariable models, deficient 25(OH)D status (<20 ng/mL), compared with optimal levels (≥30 ng/mL), was not associated with AF risk (HR, 95% CI: 1.10, 0.96-1.26). A significant interaction of 25(OH)D concentrations with age (P = 0.01), but not with race or sex (P > 0.40), was identified, with higher risk of AF among those with deficient 25(OH)D status in younger (HR, 95% CI: 1.35, 1.05-1.73) but not older individuals (HR, 95% CI: 1.02, 0.86-1.21). A meta-analysis of these results and four prospective studies did not support a clinically relevant association of circulating 25(OH)D with AF risk [pooled HR, 95%CI: 1.04, 1.00-1.08, per 1 SD lower 25(OH)D]. CONCLUSION: Low serum 25(OH)D was not associated with incident AF in a community-based cohort and in a meta-analysis of prospective studies. A possible association in younger individuals warrants further investigation."},{"id":"9f5b7b9d738d","type":"article","url":"https://hartvaat.nl/2016/07/28/empagliflozine-en-progressie-van-nierziekte-bij-diabetes-type-2-nejm-empa-reg-re/","title":"Empagliflozine en progressie van nierziekte bij diabetes type 2: NEJM EMPA-REG RENAL","title_en":"Empagliflozin and Progression of Kidney Disease in Type 2 Diabetes.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["credence-trial","cystatine-c","dapa-hf","dapagliflozine","empagliflozine","emperor-trials","fidelio-dkd","flow-trial","soul-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1515920","source_url":"https://doi.org/10.1056/NEJMoa1515920","authors":["Christoph Wanner","Silvio E Inzucchi","John M Lachin","David Fitchett","Maximilian von Eynatten","Michaela Mattheus","Odd Erik Johansen","Hans J Woerle","Uli C Broedl","Bernard Zinman"],"significance":10,"published":"2016-07-28","source_date":"2016-07-28","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"A prespecified renal analysis from the EMPA-REG OUTCOME trial showed that empagliflozin significantly slowed the progression of kidney disease in patients with type 2 diabetes, reducing incident or worsening nephropathy and the need for renal-replacement therapy. These findings, alongside the cardiovascular benefits, launched the SGLT2 inhibitor revolution in cardiorenal medicine.","created":"2026-07-03T10:26:14Z","updated":"2026-07-03T13:25:35Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM-analyse van de EMPA-REG OUTCOME-trial die aantoonde dat empagliflozine de progressie van nierziekte bij diabetes type 2 significant vertraagt. Samen met de cardiovasculaire data de basis voor de revolutie van SGLT2-remmers.","abstract_original":"BACKGROUND: Diabetes confers an increased risk of adverse cardiovascular and renal events. In the EMPA-REG OUTCOME trial, empagliflozin, a sodium-glucose cotransporter 2 inhibitor, reduced the risk of major adverse cardiovascular events in patients with type 2 diabetes at high risk for cardiovascular events. We wanted to determine the long-term renal effects of empagliflozin, an analysis that was a prespecified component of the secondary microvascular outcome of that trial. METHODS: We randomly assigned patients with type 2 diabetes and an estimated glomerular filtration rate of at least 30 ml per minute per 1.73 m(2) of body-surface area to receive either empagliflozin (at a dose of 10 mg or 25 mg) or placebo once daily. Prespecified renal outcomes included incident or worsening nephropathy (progression to macroalbuminuria, doubling of the serum creatinine level, initiation of renal-replacement therapy, or death from renal disease) and incident albuminuria. RESULTS: Incident or worsening nephropathy occurred in 525 of 4124 patients (12.7%) in the empagliflozin group and in 388 of 2061 (18.8%) in the placebo group (hazard ratio in the empagliflozin group, 0.61; 95% confidence interval, 0.53 to 0.70; P<0.001). Doubling of the serum creatinine level occurred in 70 of 4645 patients (1.5%) in the empagliflozin group and in 60 of 2323 (2.6%) in the placebo group, a significant relative risk reduction of 44%. Renal-replacement therapy was initiated in 13 of 4687 patients (0.3%) in the empagliflozin group and in 14 of 2333 patients (0.6%) in the placebo group, representing a 55% lower relative risk in the empagliflozin group. There was no significant between-group difference in the rate of incident albuminuria. The adverse-event profile of empagliflozin in patients with impaired kidney function at baseline was similar to that reported in the overall trial population. CONCLUSIONS: In patients with type 2 diabetes at high cardiovascular risk, empagliflozin was associated with slower progression of kidney disease and lower rates of clinically relevant renal events than was placebo when added to standard care. (Funded by the Boehringer Ingelheim and Eli Lilly and Company Diabetes Alliance; EMPA-REG OUTCOME ClinicalTrials.gov number, NCT01131676.)."},{"id":"2f3c090734a8","type":"article","url":"https://hartvaat.nl/2016/07/28/liraglutide-en-cardiovasculaire-uitkomsten-bij-diabetes-type-2-nejm-leader-trial/","title":"Liraglutide en cardiovasculaire uitkomsten bij diabetes type 2: NEJM LEADER-trial","title_en":"Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["diabetes-en-hart","diabetes-type-1","diabetes-type-2","figaro-dkd","obesitas","pathfinder-trial","select-trial","soul-trial","summit-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1603827","source_url":"https://doi.org/10.1056/NEJMoa1603827","authors":["Steven P Marso","Gilbert H Daniels","Kirstine Brown-Frandsen","Peter Kristensen","Johannes F E Mann","Michael A Nauck","Steven E Nissen","Stuart Pocock","Neil R Poulter","Lasse S Ravn","William M Steinberg","Mette Stockner","Bernard Zinman","Richard M Bergenstal","John B Buse"],"significance":10,"published":"2016-07-28","source_date":"2016-07-28","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"The LEADER trial demonstrated that liraglutide, a GLP-1 receptor agonist, significantly reduced cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke compared with placebo in patients with type 2 diabetes at high cardiovascular risk. This landmark study established GLP-1 receptor agonists as a cornerstone of cardiovascular risk reduction in diabetes.","created":"2026-07-03T10:26:14Z","updated":"2026-07-03T13:25:35Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Landmark NEJM LEADER-trial die aantoonde dat liraglutide cardiovasculaire events en mortaliteit significant vermindert bij patiënten met diabetes type 2 en hoog cardiovasculair risico. Baanbrekend voor de rol van GLP-1-agonisten in cardiovasculaire preventie.","abstract_original":"BACKGROUND: The cardiovascular effect of liraglutide, a glucagon-like peptide 1 analogue, when added to standard care in patients with type 2 diabetes, remains unknown. METHODS: In this double-blind trial, we randomly assigned patients with type 2 diabetes and high cardiovascular risk to receive liraglutide or placebo. The primary composite outcome in the time-to-event analysis was the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. The primary hypothesis was that liraglutide would be noninferior to placebo with regard to the primary outcome, with a margin of 1.30 for the upper boundary of the 95% confidence interval of the hazard ratio. No adjustments for multiplicity were performed for the prespecified exploratory outcomes. RESULTS: A total of 9340 patients underwent randomization. The median follow-up was 3.8 years. The primary outcome occurred in significantly fewer patients in the liraglutide group (608 of 4668 patients [13.0%]) than in the placebo group (694 of 4672 [14.9%]) (hazard ratio, 0.87; 95% confidence interval [CI], 0.78 to 0.97; P<0.001 for noninferiority; P=0.01 for superiority). Fewer patients died from cardiovascular causes in the liraglutide group (219 patients [4.7%]) than in the placebo group (278 [6.0%]) (hazard ratio, 0.78; 95% CI, 0.66 to 0.93; P=0.007). The rate of death from any cause was lower in the liraglutide group (381 patients [8.2%]) than in the placebo group (447 [9.6%]) (hazard ratio, 0.85; 95% CI, 0.74 to 0.97; P=0.02). The rates of nonfatal myocardial infarction, nonfatal stroke, and hospitalization for heart failure were nonsignificantly lower in the liraglutide group than in the placebo group. The most common adverse events leading to the discontinuation of liraglutide were gastrointestinal events. The incidence of pancreatitis was nonsignificantly lower in the liraglutide group than in the placebo group. CONCLUSIONS: In the time-to-event analysis, the rate of the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke among patients with type 2 diabetes mellitus was lower with liraglutide than with placebo. (Funded by Novo Nordisk and the National Institutes of Health; LEADER ClinicalTrials.gov number, NCT01179048.)."},{"id":"18ffe098608f","type":"article","url":"https://hartvaat.nl/2016/07/26/atherotrombotische-risicostratificatie-en-vorapaxar-bij-stabiel-ischemisch-hartl/","title":"Atherotrombotische risicostratificatie en vorapaxar bij stabiel ischemisch hartlijden en PAV","title_en":"Atherothrombotic Risk Stratification and the Efficacy and Safety of Vorapaxar in Patients With Stable Ischemic Heart Disease and Previous Myocardial Infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","anticoagulantia","atherosclerose","bloeddrukbehandeling","dubbele-trombocytenremming","ezetimibe","hartkatheterisatie","harttransplantatie","hfpef","lipidenverlaging","ouderen","pathfinder-trial","perifeer-vaatlijden","rivaroxaban","statines","trombocytenaggregatieremmers"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.115.019861","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.115.019861","authors":["Erin A Bohula","Marc P Bonaca","Eugene Braunwald","Philip E Aylward","Ramon Corbalan","Gaetano M De Ferrari","Ping He","Basil S Lewis","Piera A Merlini","Sabina A Murphy","Marc S Sabatine","Benjamin M Scirica","David A Morrow"],"significance":5,"published":"2016-07-26","source_date":"2016-07-26","image":"","kennis":[],"congress":"","summary_en":"This analysis stratified the efficacy and safety of vorapaxar by atherothrombotic risk in patients with stable ischemic heart disease, identifying which risk profiles derive the greatest net benefit from PAR-1 antagonism.","created":"2026-07-03T10:26:14Z","updated":"2026-07-03T18:38:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse naar de werkzaamheid en veiligheid van vorapaxar gestratificeerd naar atherotrombotisch risico bij patiënten met stabiel ischemisch hartlijden en eerder PAV. Onderzoekt gepersonaliseerde antitrombotische therapie.","abstract_original":"BACKGROUND: Patients with stable ischemic heart disease and previous myocardial infarction (MI) vary in their risk for recurrent cardiovascular events. Atherothrombotic risk assessment may be useful to identify high-risk patients who have the greatest potential to benefit from more intensive secondary preventive therapy such as treatment with vorapaxar. METHODS: We identified independent clinical indicators of atherothrombotic risk among 8598 stable, placebo-treated patients with a previous MI followed up for 2.5 years (median) in TRA 2°P-TIMI 50 [Thrombin Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events-TIMI 50]. The efficacy and safety of vorapaxar (SCH 530348; MK-5348) were assessed by baseline risk among patients with previous MI without prior stroke or transient ischemic attack for whom there is a clinical indication for vorapaxar. End points were cardiovascular death, MI, or ischemic stroke and GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) severe bleeding. RESULTS: The 9 independent risk predictors were age, diabetes mellitus, hypertension, smoking, peripheral arterial disease, previous stroke, previous coronary bypass grafting, heart failure, and renal dysfunction. A simple integer-based scheme using these predictors showed a strong graded relationship with the rate of cardiovascular death/MI/ischemic stroke and the individual components (P for trend <0.001 for all). High-risk patients (≥3 risk indicators; 20% of population) had a 3.2% absolute risk reduction in cardiovascular disease/MI/ischemic stroke with vorapaxar, and intermediate-risk patients (1-2 risk indicators; 61%) had a 2.1% absolute risk reduction (P<0.001 each), translating to a number needed to treat of 31 and 48. Bleeding increased across risk groups (P for trend<0.01); however, net clinical outcome was increasingly favorable with vorapaxar across risk groups. Fatal bleeding or intracranial hemorrhage was 0.9% with both treatments in high-risk patients. CONCLUSIONS: Stratification of baseline atherothrombotic risk can assist with therapeutic decision making for vorapaxar use for secondary prevention after MI. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00526474."},{"id":"d512bc438edc","type":"article","url":"https://hartvaat.nl/2016/07/19/visit-to-visit-ldl-cholesterolvariabiliteit-en-cognitieve-functie/","title":"Visit-to-visit LDL-cholesterolvariabiliteit en cognitieve functie","title_en":"Higher Visit-to-Visit Low-Density Lipoprotein Cholesterol Variability Is Associated With Lower Cognitive Performance, Lower Cerebral Blood Flow, and Greater White Matter Hyperintensity Load in Older Subjects.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["bempedoïnezuur","cetp-remmers","dyslipidemie","ezetimibe","familiaire-hypercholesterolemie","familiaire-hypercholesterolemie-screening","hdl-cholesterol","ldl-cholesterol","lipide-aferese","lipidenverlaging","niet-statine-therapie","statines"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.115.020627","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.115.020627","authors":["Roelof A J Smit","Stella Trompet","Behnam Sabayan","Saskia le Cessie","Jeroen van der Grond","Mark A van Buchem","Anton J M de Craen","J Wouter Jukema"],"significance":6,"published":"2016-07-19","source_date":"2016-07-19","image":"","kennis":[],"congress":"","summary_en":"This study showed that higher visit-to-visit variability in LDL cholesterol is associated with lower cognitive performance and increased white matter hyperintensities, linking lipid instability to neurocognitive outcomes.","created":"2026-07-03T10:26:14Z","updated":"2026-07-03T13:25:34Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die aantoont dat hogere visit-to-visit variabiliteit in LDL-cholesterol geassocieerd is met lagere cognitieve prestaties en kleiner hersenvolume. Pleit voor stabiele cholesterolcontrole boven fluctuerende niveaus.","abstract_original":"BACKGROUND: Recently, it was shown that intraindividual variation in low-density lipoprotein cholesterol (LDL-C) predicts both cerebrovascular and cardiovascular events. We aimed to examine whether this extends to cognitive function and examined possible pathways using a magnetic resonance imaging substudy. METHODS: We investigated the association between LDL-C variability and 4 cognitive domains at month 30 in 4428 participants of PROSPER (PROspective Study of Pravastatin in the Elderly at Risk). Additionally, we assessed the association of LDL-C variability with neuroimaging outcomes in a subset of 535 participants. LDL-C variability was defined as the intraindividual standard deviation over 4 postbaseline LDL-C measurements, and all analyses were adjusted for mean LDL-C levels and cardiovascular risk factors. RESULTS: Higher LDL-C variability was associated with lower cognitive function in both the placebo and pravastatin treatment arms. Associations were present for selective attention (P=0.017 and P=0.11, respectively), processing speed (P=0.20 and P=0.029), and memory (immediate recall, P=0.002 and P=0.006; delayed recall, P=0.001 and P≤0.001). Furthermore, higher LDL-C variability was associated with lower cerebral blood flow in both trial arms (P=0.031 and P=0.050) and with greater white matter hyperintensity load in the pravastatin arm (P=0.046). No evidence was found for interaction between LDL-C variability and pravastatin treatment for both cognitive and magnetic resonance imaging outcomes. CONCLUSIONS: We found that higher visit-to-visit variability in LDL-C, independently of mean LDL-C levels and statin treatment, is associated with lower cognitive performance, lower cerebral blood flow, and greater white matter hyperintensity load."},{"id":"0b5f9c4a01e8","type":"article","url":"https://hartvaat.nl/2016/07/19/glucoseverlagende-medicatie-en-cardiovasculaire-events-bij-diabetes-type-2-jama-/","title":"Glucoseverlagende medicatie en cardiovasculaire events bij diabetes type 2: JAMA meta-analyse","title_en":"Comparison of Clinical Outcomes and Adverse Events Associated With Glucose-Lowering Drugs in Patients With Type 2 Diabetes: A Meta-analysis.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["diabetes-en-hart","diabetes-type-2"],"journal":"JAMA","doi":"10.1001/jama.2016.9400","source_url":"https://doi.org/10.1001/jama.2016.9400","authors":["Suetonia C Palmer","Dimitris Mavridis","Antonio Nicolucci","David W Johnson","Marcello Tonelli","Jonathan C Craig","Jasjot Maggo","Vanessa Gray","Giorgia De Berardis","Marinella Ruospo","Patrizia Natale","Valeria Saglimbene","Sunil V Badve","Yeoungjee Cho","Annie-Claire Nadeau-Fredette","Michael Burke","Labib Faruque","Anita Lloyd","Nasreen Ahmad","Yuanchen Liu","Sophanny Tiv","Natasha Wiebe","Giovanni F M Strippoli"],"significance":9,"published":"2016-07-19","source_date":"2016-07-19","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"This comprehensive JAMA network meta-analysis compared clinical outcomes and adverse events across all glucose-lowering drug classes in type 2 diabetes. The analysis provided a reference framework for comparing the relative efficacy and safety of metformin, sulfonylureas, DPP-4 inhibitors, SGLT2 inhibitors, GLP-1 agonists, and insulin.","created":"2026-07-03T10:26:14Z","updated":"2026-07-03T13:25:34Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Uitgebreide JAMA meta-analyse die klinische uitkomsten en bijwerkingen vergeleek van alle glucoseverlagende medicijnklassen bij diabetes type 2. Referentiepublicatie voor de cardiovasculaire veiligheid van diabetesmedicatie.","abstract_original":"IMPORTANCE: Numerous glucose-lowering drugs are used to treat type 2 diabetes. OBJECTIVE: To estimate the relative efficacy and safety associated with glucose-lowering drugs including insulin. DATA SOURCES: Cochrane Library Central Register of Controlled Trials, MEDLINE, and EMBASE databases through March 21, 2016. STUDY SELECTION: Randomized clinical trials of 24 weeks' or longer duration. DATA EXTRACTION AND SYNTHESIS: Random-effects network meta-analysis. MAIN OUTCOMES AND MEASURES: The primary outcome was cardiovascular mortality. Secondary outcomes included all-cause mortality, serious adverse events, myocardial infarction, stroke, hemoglobin A1c (HbA1C) level, treatment failure (rescue treatment or lack of efficacy), hypoglycemia, and body weight. RESULTS: A total of 301 clinical trials (1,417,367 patient-months) were included; 177 trials (56,598 patients) of drugs given as monotherapy; 109 trials (53,030 patients) of drugs added to metformin (dual therapy); and 29 trials (10,598 patients) of drugs added to metformin and sulfonylurea (triple therapy). There were no significant differences in associations between any drug class as monotherapy, dual therapy, or triple therapy with odds of cardiovascular or all-cause mortality. Compared with metformin, sulfonylurea (standardized mean difference [SMD], 0.18 [95% CI, 0.01 to 0.34]), thiazolidinedione (SMD, 0.16 [95% CI, 0.00 to 0.31]), DPP-4 inhibitor (SMD, 0.33 [95% CI, 0.13 to 0.52]), and α-glucosidase inhibitor (SMD, 0.35 [95% CI, 0.12 to 0.58]) monotherapy were associated with higher HbA1C levels. Sulfonylurea (odds ratio [OR], 3.13 [95% CI, 2.39 to 4.12]; risk difference [RD], 10% [95% CI, 7% to 13%]) and basal insulin (OR, 17.9 [95% CI, 1.97 to 162]; RD, 10% [95% CI, 0.08% to 20%]) were associated with greatest odds of hypoglycemia. When added to metformin, drugs were associated with similar HbA1C levels, while SGLT-2 inhibitors offered the lowest odds of hypoglycemia (OR, 0.12 [95% CI, 0.08 to 0.18]; RD, -22% [-27% to -18%]). When added to metformin and sulfonylurea, GLP-1 receptor agonists were associated with the lowest odds of hypoglycemia (OR, 0.60 [95% CI, 0.39 to 0.94]; RD, -10% [95% CI, -18% to -2%]). CONCLUSIONS AND RELEVANCE: Among adults with type 2 diabetes, there were no significant differences in the associations between any of 9 available classes of glucose-lowering drugs (alone or in combination) and the risk of cardiovascular or all-cause mortality. Metformin was associated with lower or no significant difference in HbA1C levels compared with any other drug classes. All drugs were estimated to be effective when added to metformin. These findings are consistent with American Diabetes Association recommendations for using metformin monotherapy as initial treatment for patients with type 2 diabetes and selection of additional therapies based on patient-specific considerations."},{"id":"d8c755d6e770","type":"article","url":"https://hartvaat.nl/2016/07/19/serieel-cardiaal-troponine-met-hoog-sensitieve-assay-bij-stabiel-ischemisch-hart/","title":"Serieel cardiaal troponine met hoog-sensitieve assay bij stabiel ischemisch hartlijden","title_en":"Serial Cardiac Troponin Measured Using a High-Sensitivity Assay in Stable Patients With Ischemic Heart Disease.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":["stabiel-coronairlijden","troponine"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.04.046","source_url":"https://doi.org/10.1016/j.jacc.2016.04.046","authors":["Marc P Bonaca","Ryan G O'Malley","Petr Jarolim","Benjamin M Scirica","Sabina A Murphy","Michael J Conrad","Christopher P Cannon","Harvey D White","Eugene Braunwald","David A Morrow","Marc S Sabatine"],"significance":6,"published":"2016-07-19","source_date":"2016-07-19","image":"","kennis":[],"congress":"","summary_en":"This study evaluated the prognostic value of serial high-sensitivity troponin measurements in stable patients with ischemic heart disease, exploring whether dynamic troponin changes predict future cardiovascular events beyond single measurements.","created":"2026-07-03T10:26:14Z","updated":"2026-07-03T13:25:34Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de prognostische waarde van seriële troponinemetingen met hoog-sensitieve assay bij stabiele patiënten met ischemisch hartlijden. Onderzocht of subtiele troponine-veranderingen klinisch relevante voorspellers zijn.","abstract_original":""},{"id":"3daf77481b26","type":"article","url":"https://hartvaat.nl/2016/07/19/immatuur-plaatjesaantal-versus-gevestigde-voorspellers-van-plaatjesreactiviteit-/","title":"Immatuur plaatjesaantal versus gevestigde voorspellers van plaatjesreactiviteit bij thienopyridinetherapie","title_en":"Comparison of Immature Platelet Count to Established Predictors of Platelet Reactivity During Thienopyridine Therapy.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["biomarkers-cardiovasculair"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.04.056","source_url":"https://doi.org/10.1016/j.jacc.2016.04.056","authors":["Christian Stratz","Timo Bömicke","Iris Younas","Anja Kittel","Michael Amann","Christian M Valina","Thomas Nührenberg","Dietmar Trenk","Franz-Josef Neumann","Willibald Hochholzer"],"significance":4,"published":"2016-07-19","source_date":"2016-07-19","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This study compared the immature platelet count with established predictors of platelet reactivity during thienopyridine loading. The novel biomarker showed predictive value for antiplatelet response, potentially informing personalised antiplatelet therapy.","created":"2026-07-03T10:26:14Z","updated":"2026-07-03T13:25:34Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die het immatuur plaatjesaantal vergeleek met gevestigde voorspellers van plaatjesreactiviteit bij patiënten op thienopyridinetherapie. Onderzoekt een nieuwe biomarker voor therapiemonitoring.","abstract_original":"BACKGROUND: Previous data suggest that reticulated platelets significantly affect antiplatelet response to thienopyridines. It is unknown whether parameters describing reticulated platelets can predict antiplatelet response to thienopyridines. OBJECTIVES: The authors sought to determine the extent to which parameters describing reticulated platelets can predict antiplatelet response to thienopyridine loading compared with established predictors. METHODS: This study randomized 300 patients undergoing elective coronary stenting to loading with clopidogrel 600 mg, prasugrel 30 mg, or prasugrel 60 mg. Adenosine diphosphate (ADP)-induced platelet reactivity was assessed by impedance aggregometry before loading (intrinsic platelet reactivity) and again on day 1 after loading. Multiple parameters of reticulated platelets were assessed by automated whole blood flow cytometry: absolute immature platelet count (IPC), immature platelet fraction, and highly fluorescent immature platelet fraction. RESULTS: Each parameter of reticulated platelets correlated significantly with ADP-induced platelet reactivity (p < 0.01 for all 3 parameters). In a multivariable model including all 3 parameters, only IPC remained a significant predictor of platelet reactivity (p < 0.001). In models adjusting each of the 3 parameters for known predictors of on-treatment platelet reactivity including cytochrome P450 2C19 (CYP2C19) polymorphisms, age, body mass index, diabetes, and intrinsic platelet reactivity, only IPC prevailed as an independent predictor (p = 0.001). In this model, IPC was the strongest predictor of on-treatment platelet reactivity followed by intrinsic platelet reactivity. CONCLUSIONS: IPC is the strongest independent platelet count-derived predictor of antiplatelet response to thienopyridine treatment. Given its easy availability, together with its even stronger association with on-treatment platelet reactivity compared with known predictors, including the CYP2C19*2 polymorphism, IPC may become the preferred predictor of antiplatelet response to thienopyridine treatment. (Impact of Extent of Clopidogrel-Induced Platelet Inhibition During Elective Stent Implantation on Clinical Event Rate-Advanced Loading Strategies [ExcelsiorLOAD]; DRKS00006102)."},{"id":"116395003d41","type":"article","url":"https://hartvaat.nl/2016/07/19/sacubitril-valsartan-en-30-daagse-heropname-na-hartfalenhospitalisatie/","title":"Sacubitril/valsartan en 30-daagse heropname na hartfalenhospitalisatie","title_en":"Influence of Sacubitril/Valsartan (LCZ696) on 30-Day Readmission After Heart Failure Hospitalization.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":["acuut-hartfalen","answer-hf","sacubitril-valsartan"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.04.047","source_url":"https://doi.org/10.1016/j.jacc.2016.04.047","authors":["Akshay S Desai","Brian L Claggett","Milton Packer","Michael R Zile","Jean L Rouleau","Karl Swedberg","Victor Shi","Martin Lefkowitz","Randall Starling","John Teerlink","John J V McMurray","Scott D Solomon"],"significance":7,"published":"2016-07-19","source_date":"2016-07-19","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/arni-sacubitril-valsartan/"],"congress":"","summary_en":"This analysis showed that sacubitril-valsartan reduces 30-day heart failure readmission rates after hospitalization, addressing a high-priority quality metric in heart failure care.","created":"2026-07-03T10:26:13Z","updated":"2026-07-03T18:38:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van het effect van sacubitril/valsartan (LCZ696) op 30-daagse heropnames na een hartfalenhospitalisatie. Klinisch relevant voor het acute-naar-chronisch hartfalentraject.","abstract_original":"BACKGROUND: Patients with heart failure (HF) are at high risk for hospital readmission in the first 30 days following HF hospitalization. OBJECTIVES: This study sought to determine if treatment with sacubitril/valsartan (LCZ696) reduces rates of hospital readmission at 30-days following HF hospitalization compared with enalapril. METHODS: We assessed the risk of 30-day readmission for any cause following investigator-reported hospitalizations for HF in the PARADIGM-HF trial, which randomized 8,399 participants with HF and reduced ejection fraction to treatment with LCZ696 or enalapril. RESULTS: Accounting for multiple hospitalizations per patient, there were 2,383 investigator-reported HF hospitalizations, of which 1,076 (45.2%) occurred in subjects assigned to LCZ696 and 1,307 (54.8%) occurred in subjects assigned to enalapril. Rates of readmission for any cause at 30 days were 17.8% in LCZ696-assigned subjects and 21.0% in enalapril-assigned subjects (odds ratio: 0.74; 95% confidence interval: 0.56 to 0.97; p = 0.031). Rates of readmission for HF at 30-days were also lower in subjects assigned to LCZ696 (9.7% vs. 13.4%; odds ratio: 0.62; 95% confidence interval: 0.45 to 0.87; p = 0.006). The reduction in both all-cause and HF readmissions with LCZ696 was maintained when the time window from discharge was extended to 60 days and in sensitivity analyses restricted to adjudicated HF hospitalizations. CONCLUSIONS: Compared with enalapril, treatment with LCZ696 reduces 30-day readmissions for any cause following discharge from HF hospitalization."},{"id":"10d93514481a","type":"article","url":"https://hartvaat.nl/2016/07/15/transitional-palliatieve-zorg-bij-eindstadium-hartfalen-gerandomiseerde-trial/","title":"Transitional palliatieve zorg bij eindstadium hartfalen: gerandomiseerde trial","title_en":"Effects of a transitional palliative care model on patients with end-stage heart failure: a randomised controlled trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["step-hfpef"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2015-308638","source_url":"https://doi.org/10.1136/heartjnl-2015-308638","authors":["Frances Kam Yuet Wong","Alina Yee Man Ng","Paul Hong Lee","Po-Tin Lam","Jeffrey Sheung Ching Ng","Nancy Hiu Yim Ng","Michael Mau Kwong Sham"],"significance":6,"published":"2016-07-15","source_date":"2016-07-15","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"This randomized trial demonstrated that a home-based transitional palliative care model for end-stage heart failure patients reduces symptom burden and improves quality of life after hospital discharge, supporting integrated palliative care delivery.","created":"2026-07-03T10:26:13Z","updated":"2026-07-03T18:38:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial naar een transitional palliatief zorgmodel bij patiënten met eindstadium hartfalen. Onderzocht of gestructureerde overgang naar palliatieve zorg de kwaliteit van leven en symptoomlast verbetert.","abstract_original":"OBJECTIVE: To examine the effects of home-based transitional palliative care for patients with end-stage heart failure (ESHF) after hospital discharge. METHODS: This was a randomised controlled trial conducted in three hospitals in Hong Kong. The recruited subjects were patients with ESHF who had been discharged home from hospitals and referred for palliative service, and who met the specified inclusion criteria. The interventions consisted of weekly home visits/telephone calls in the first 4 weeks then monthly follow-up, provided by a nurse case manager supported by a multidisciplinary team. The primary outcome measures were any readmission and count of readmissions within 4 and 12 weeks after index discharge, compared using χ(2) tests and Poisson regression, respectively. Secondarily, change in symptoms over time between control and intervention groups were evaluated using generalised estimating equation analyses of data collected using the Edmonton Symptom Assessment Scale (ESAS). RESULTS: The intervention group (n=43) had a significantly lower readmission rate than the control group (n=41) at 12 weeks (intervention 33.6% vs control 61.0% χ(2)=6.8, p=0.009). The mean number (SE) of readmissions for the intervention and control groups was, respectively, 0.42 (0.10) and 1.10 (0.16) and the difference was significant (p=0.001). The relative risk (CI) for 12-week readmissions for the intervention group was 0.55 (0.35 to 0.88). There was no significant difference in readmissions between groups at 4 weeks. However, when compared with the control group, the intervention group experienced significantly higher clinical improvement in depression (45.9% vs 16.1%, p<0.05), dyspnoea (62.2% vs 29.0%, p<0.05) and total ESAS score (73.0% vs 41.4%, p<0.05) at 4 weeks. There were significant differences between groups in changes over time in quality of life (QOL) measured by McGill QOL (p<0.05) and chronic HF (p<0.01) questionnaires. CONCLUSIONS: This study provides evidence of the effectiveness of a postdischarge transitional care palliative programme in reducing readmissions and improving symptom control among patients with ESHF. TRIAL REGISTRATION NUMBER: HKCTR-1562; Results."},{"id":"c61c5d3c40be","type":"article","url":"https://hartvaat.nl/2016/07/14/2016-esc-richtlijn-voor-diagnostiek-en-behandeling-van-acuut-en-chronisch-hartfa/","title":"2016 ESC-richtlijn voor diagnostiek en behandeling van acuut en chronisch hartfalen","title_en":"2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":["acuut-hartfalen","hfmref","hfref","richtlijnen-esc"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw128","source_url":"https://doi.org/10.1093/eurheartj/ehw128","authors":["Piotr Ponikowski","Adriaan A Voors","Stefan D Anker","Héctor Bueno","John G F Cleland","Andrew J S Coats","Volkmar Falk","José Ramón González-Juanatey","Veli-Pekka Harjola","Ewa A Jankowska","Mariell Jessup","Cecilia Linde","Petros Nihoyannopoulos","John T Parissis","Burkert Pieske","Jillian P Riley","Giuseppe M C Rosano","Luis M Ruilope","Frank Ruschitzka","Frans H Rutten","Peter van der Meer"],"significance":10,"published":"2016-07-14","source_date":"2016-07-14","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/acuut-hartfalen/","https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/"],"congress":"","summary_en":"The 2016 ESC Guidelines established a comprehensive framework for diagnosing and treating acute and chronic heart failure. This landmark document introduced the HFmrEF category (LVEF 40–49%), structured pharmacological treatment algorithms, and laid the foundation for the quadruple therapy approach that defines modern heart failure management.","created":"2026-07-03T10:26:13Z","updated":"2026-07-03T18:38:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De ESC-richtlijn 2016 voor hartfalen — het standaardwerk dat de basis legde voor de huidige hartfalenbehandeling met viervoudige medicamenteuze therapie. Introduceerde de HFmrEF-categorie en gestructureerde behandelalgoritmen.","abstract_original":""},{"id":"c3eb3ebc70ac","type":"article","url":"https://hartvaat.nl/2016/07/14/ablatie-versus-escalatie-van-antiaritmica-bij-ventriculaire-tachycardie-nejm-van/","title":"Ablatie versus escalatie van antiaritmica bij ventriculaire tachycardie: NEJM VANISH-trial","title_en":"Ventricular Tachycardia Ablation versus Escalation of Antiarrhythmic Drugs.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["ventriculaire-tachycardie"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1513614","source_url":"https://doi.org/10.1056/NEJMoa1513614","authors":["John L Sapp","George A Wells","Ratika Parkash","William G Stevenson","Louis Blier","Jean-Francois Sarrazin","Bernard Thibault","Lena Rivard","Lorne Gula","Peter Leong-Sit","Vidal Essebag","Pablo B Nery","Stanley K Tung","Jean-Marc Raymond","Laurence D Sterns","George D Veenhuyzen","Jeff S Healey","Damian Redfearn","Jean-Francois Roux","Anthony S L Tang"],"significance":9,"published":"2016-07-14","source_date":"2016-07-14","image":"","kennis":["https://hartvaat.nl/kennis/ritmestoornissen/katheterablatie-vt/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This randomized trial demonstrated that catheter ablation of ventricular tachycardia was superior to escalation of antiarrhythmic drugs for reducing recurrent VT in patients with ischemic cardiomyopathy and an ICD. The findings support an ablation-first strategy for sustained VT despite initial antiarrhythmic therapy.","created":"2026-07-03T10:26:13Z","updated":"2026-07-03T13:25:34Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Landmark NEJM-trial die katheterablatie vergeleek met escalatie van antiaritmische medicatie bij patiënten met ventriculaire tachycardie ondanks initiële antiaritmicatherapie. Bepalend voor de behandelstrategie bij refractaire VT.","abstract_original":"BACKGROUND: Recurrent ventricular tachycardia among survivors of myocardial infarction with an implantable cardioverter-defibrillator (ICD) is frequent despite antiarrhythmic drug therapy. The most effective approach to management of this problem is uncertain. METHODS: We conducted a multicenter, randomized, controlled trial involving patients with ischemic cardiomyopathy and an ICD who had ventricular tachycardia despite the use of antiarrhythmic drugs. Patients were randomly assigned to receive either catheter ablation (ablation group) with continuation of baseline antiarrhythmic medications or escalated antiarrhythmic drug therapy (escalated-therapy group). In the escalated-therapy group, amiodarone was initiated if another agent had been used previously. The dose of amiodarone was increased if it had been less than 300 mg per day or mexiletine was added if the dose was already at least 300 mg per day. The primary outcome was a composite of death, three or more documented episodes of ventricular tachycardia within 24 hours (ventricular tachycardia storm), or appropriate ICD shock. RESULTS: Of the 259 patients who were enrolled, 132 were assigned to the ablation group and 127 to the escalated-therapy group. During a mean (±SD) of 27.9±17.1 months of follow-up, the primary outcome occurred in 59.1% of patients in the ablation group and 68.5% of those in the escalated-therapy group (hazard ratio in the ablation group, 0.72; 95% confidence interval, 0.53 to 0.98; P=0.04). There was no significant between-group difference in mortality. There were two cardiac perforations and three cases of major bleeding in the ablation group and two deaths from pulmonary toxic effects and one from hepatic dysfunction in the escalated-therapy group. CONCLUSIONS: In patients with ischemic cardiomyopathy and an ICD who had ventricular tachycardia despite antiarrhythmic drug therapy, there was a significantly lower rate of the composite primary outcome of death, ventricular tachycardia storm, or appropriate ICD shock among patients undergoing catheter ablation than among those receiving an escalation in antiarrhythmic drug therapy. (Funded by the Canadian Institutes of Health Research and others; VANISH ClinicalTrials.gov number, NCT00905853.)."},{"id":"ea3919a99631","type":"article","url":"https://hartvaat.nl/2016/07/14/finerenon-versus-eplerenon-bij-hartfalen-met-diabetes-en-verslechterende-nierfun/","title":"Finerenon versus eplerenon bij hartfalen met diabetes en verslechterende nierfunctie: ARTS-HF","title_en":"A randomized controlled study of finerenone vs. eplerenone in patients with worsening chronic heart failure and diabetes mellitus and/or chronic kidney disease.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["fidelio-dkd","fidelity","figaro-dkd","finearts-hf","finerenon-hartfalen-nierziekte"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw132","source_url":"https://doi.org/10.1093/eurheartj/ehw132","authors":["Gerasimos Filippatos","Stefan D Anker","Michael Böhm","Mihai Gheorghiade","Lars Køber","Henry Krum","Aldo P Maggioni","Piotr Ponikowski","Adriaan A Voors","Faiez Zannad","So-Young Kim","Christina Nowack","Giovanni Palombo","Peter Kolkhof","Nina Kimmeskamp-Kirschbaum","Alexander Pieper","Bertram Pitt"],"significance":7,"published":"2016-07-14","source_date":"2016-07-14","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/mineralocorticoid-antagonisten-farmacologie/"],"congress":"","summary_en":"This early randomized comparison of finerenone with eplerenone in patients with worsening heart failure and diabetes showed that finerenone was well tolerated with a dose-dependent reduction in NT-proBNP. The study provided the foundation for the subsequent FIDELIO and FIGARO programs.","created":"2026-07-03T10:26:13Z","updated":"2026-07-03T18:38:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde studie die finerenon vergeleek met eplerenon bij patiënten met verslechterd chronisch hartfalen en diabetes mellitus en/of CKD. Vroege evaluatie van de nieuwe niet-steroïdale MRA die later in FIDELIO en FIGARO werd getest.","abstract_original":"AIMS: To evaluate oral doses of the non-steroidal mineralocorticoid receptor antagonist finerenone given for 90 days in patients with worsening heart failure and reduced ejection fraction and chronic kidney disease and/or diabetes mellitus. METHODS AND RESULTS: Miner Alocorticoid Receptor antagonist Tolerability Study-Heart Failure (ARTS-HF) was a randomized, double-blind, phase 2b multicentre study (ClinicalTrials.gov: NCT01807221). Of 1286 screened patients, 1066 were randomized. Patients received oral, once-daily finerenone (2.5, 5, 7.5, 10, or 15 mg, uptitrated to 5, 10, 15, 20, or 20 mg, respectively, on Day 30) or eplerenone (25 mg every other day, increased to 25 mg once daily on Day 30, and to 50 mg once daily on Day 60) for 90 days. The primary endpoint was the percentage of individuals with a decrease of >30% in plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) from baseline to Day 90. A key exploratory endpoint was a composite clinical endpoint of death from any cause, cardiovascular hospitalizations, or emergency presentation for worsening HF until Day 90. Mean age ranged from 69.2 to 72.5 years in different treatment groups (standard deviation 9.7-10.6 years). Decreases in NT-proBNP of >30% from baseline occurred in 37.2% of patients in the eplerenone group and 30.9, 32.5, 37.3, 38.8, and 34.2% in the 2.5→5, 5→10, 7.5→15, 10→20, and 15→20 mg finerenone groups, respectively (P = 0.42-0.88). Except for the 2.5→5 mg finerenone group, the composite clinical endpoint occurred numerically less frequently in finerenone-treated patients compared with eplerenone; this difference reached nominal statistical significance in the 10→20 mg group (hazard ratio 0.56, 95% confidence interval, CI, 0.35; 0.90; nominal P = 0.02), despite the fact that this phase 2 study was not designed to detect statistical significant differences. A potassium level increase to ≥5.6 mmol/L at any time point occurred in 4.3% of patients, with a balanced distribution among all treatment groups. CONCLUSION: Finerenone was well tolerated and induced a 30% or greater decrease in NT-proBNP levels in a similar proportion of patients to eplerenone. The finding of reduced clinical events in the finerenone 10→20 mg group should be further explored in a large outcomes trial."},{"id":"18171fba37c3","type":"article","url":"https://hartvaat.nl/2016/07/12/prasugrel-versus-clopidogrel-en-coronaire-microvasculaire-functie-bij-electieve-/","title":"Prasugrel versus clopidogrel en coronaire microvasculaire functie bij electieve PCI","title_en":"Effects of Prasugrel Versus Clopidogrel on Coronary Microvascular Function in Patients Undergoing Elective PCI.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["percutane-coronaire-interventie"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.04.039","source_url":"https://doi.org/10.1016/j.jacc.2016.04.039","authors":["Fabio Mangiacapra","Giuseppe Di Gioia","Mariano Pellicano","Luigi Di Serafino","Edoardo Bressi","Aaron J Peace","Jozef Bartunek","William Wijns","Bernard De Bruyne","Emanuele Barbato"],"significance":5,"published":"2016-07-12","source_date":"2016-07-12","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This study compared the effects of prasugrel versus clopidogrel on coronary microvascular function in patients undergoing elective PCI, exploring differential pleiotropic effects of P2Y12 inhibitors on the microvasculature.","created":"2026-07-03T10:26:13Z","updated":"2026-07-03T13:25:33Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar het differentiële effect van prasugrel versus clopidogrel op de coronaire microvasculaire functie bij patiënten die electieve PCI ondergaan. Farmacodynamisch voordeel boven het macrovasculaire niveau.","abstract_original":""},{"id":"ac53a01bf187","type":"article","url":"https://hartvaat.nl/2016/07/12/nervus-vagus-stimulatie-bij-hartfalen-de-inovate-hf-trial/","title":"Nervus vagus-stimulatie bij hartfalen: de INOVATE-HF-trial","title_en":"Vagus Nerve Stimulation for the Treatment of Heart Failure: The INOVATE-HF Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["answer-hf","bisoprolol","empagliflozine","emperor-trials","finearts-hf","hfref","step-hfpef","vericiguat"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.03.525","source_url":"https://doi.org/10.1016/j.jacc.2016.03.525","authors":["Michael R Gold","Dirk J Van Veldhuisen","Paul J Hauptman","Martin Borggrefe","Spencer H Kubo","Randy A Lieberman","Goran Milasinovic","Brett J Berman","Sanja Djordjevic","Suresh Neelagaru","Peter J Schwartz","Randall C Starling","Douglas L Mann"],"significance":7,"published":"2016-07-12","source_date":"2016-07-12","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/","https://hartvaat.nl/kennis/hartfalen/hfmref-hartfalen-met-matig-verminderde-ejectie/"],"congress":"","summary_en":"The INOVATE-HF trial of chronic vagus nerve stimulation in HFrEF showed no benefit on mortality or heart failure events despite promising preclinical data on autonomic modulation. The negative result tempered enthusiasm for neural stimulation as a heart failure therapy.","created":"2026-07-03T10:26:13Z","updated":"2026-07-03T18:38:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial van chronische nervus vagus-stimulatie bij patiënten met hartfalen met verminderde ejectiefractie. Onderzocht een nieuw neuromodulatoir aangrijpingspunt voor de behandeling van hartfalen.","abstract_original":"BACKGROUND: Heart failure (HF) is increasing in prevalence and is a major cause of morbidity and mortality despite advances in medical and device therapy. Autonomic imbalance, with excess sympathetic activation and decreased vagal tone, is an integral component of the pathophysiology of HF. OBJECTIVES: The INOVATE-HF (Increase of Vagal Tone in Heart Failure) trial assessed the safety and efficacy of vagal nerve stimulation (VNS) among patients with HF and a reduced ejection fraction. METHODS: INOVATE-HF was a multinational, randomized trial involving 85 centers including patients with chronic HF, New York Heart Association functional class III symptoms and ejection fraction ≤40%. Patients were assigned to device implantation to provide VNS (active) or continued medical therapy (control) in a 3:2 ratio. The primary efficacy endpoint was composite of death from any cause or first event for worsening HF. RESULTS: Patients (n = 707) were randomized and followed up for a mean of 16 months. The primary efficacy outcome occurred in 132 of 436 patients in the VNS group, compared to 70 of 271 in the control group (30.3% vs. 25.8%; hazard ratio: 1.14; 95% confidence interval: 0.86 to 1.53; p = 0.37). During the trial, the estimated annual mortality rates were 9.3% and 7.1%, respectively (p = 0.19). Quality of life, New York Heart Association functional class, and 6-min walking distance were favorably affected by VNS (p < 0.05), but left ventricular end-systolic volume index was not different (p = 0.49). CONCLUSIONS: VNS does not reduce the rate of death or HF events in chronic HF patients. (INcrease Of VAgal TonE in CHF [INOVATE-HF]; NCT01303718)."},{"id":"e097e0787db7","type":"article","url":"https://hartvaat.nl/2016/07/05/advance-care-planning-video-bij-gevorderd-hartfalen-gerandomiseerde-trial/","title":"Advance care planning video bij gevorderd hartfalen: gerandomiseerde trial","title_en":"Randomized, Controlled Trial of an Advance Care Planning Video Decision Support Tool for Patients With Advanced Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["pathfinder-trial","step-hfpef"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.021937","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.021937","authors":["Areej El-Jawahri","Michael K Paasche-Orlow","Dan Matlock","Lynne Warner Stevenson","Eldrin F Lewis","Garrick Stewart","Marc Semigran","Yuchiao Chang","Kimberly Parks","Elizabeth S Walker-Corkery","Jennifer S Temel","Hacho Bohossian","Henry Ooi","Eileen Mann","Angelo E Volandes"],"significance":6,"published":"2016-07-05","source_date":"2016-07-05","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"This randomized trial of a video decision support tool for advance care planning in advanced heart failure showed that video-based education improves patient understanding and changes preferences regarding resuscitation and end-of-life care.","created":"2026-07-03T10:26:13Z","updated":"2026-07-03T13:25:33Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial naar een video-beslissingsondersteunend instrument voor advance care planning bij patiënten met gevorderd hartfalen. Pionierend onderzoek naar het verbeteren van palliatieve besluitvorming.","abstract_original":"BACKGROUND: Conversations about goals of care and cardiopulmonary resuscitation (CPR)/intubation for patients with advanced heart failure can be difficult. This study examined the impact of a video decision support tool and patient checklist on advance care planning for patients with heart failure. METHODS: This was a multisite, randomized, controlled trial of a video-assisted intervention and advance care planning checklist versus a verbal description in 246 patients ≥64 years of age with heart failure and an estimated likelihood of death of >50% within 2 years. Intervention participants received a verbal description for goals of care (life-prolonging care, limited care, and comfort care) and CPR/intubation plus a 6-minute video depicting the 3 levels of care, CPR/intubation, and an advance care planning checklist. Control subjects received only the verbal description. The primary analysis compared the proportion of patients preferring comfort care between study arms immediately after the intervention. Secondary outcomes were CPR/intubation preferences and knowledge (6-item test; range, 0-6) after intervention. RESULTS: In the intervention group, 27 (22%) chose life-prolonging care, 31 (25%) chose limited care, 63 (51%) selected comfort care, and 2 (2%) were uncertain. In the control group, 50 (41%) chose life-prolonging care, 27 (22%) selected limited care, 37 (30%) chose comfort care, and 8 (7%) were uncertain (P<0.001). Intervention participants (compared with control subjects) were more likely to forgo CPR (68% versus 35%; P<0.001) and intubation (77% versus 48%; P<0.001) and had higher mean knowledge scores (4.1 versus 3.0; P<0.001). CONCLUSIONS: Patients with heart failure who viewed a video were more informed, more likely to select a focus on comfort, and less likely to desire CPR/intubation compared with patients receiving verbal information only. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01589120."},{"id":"91ae79c77bf3","type":"article","url":"https://hartvaat.nl/2016/07/05/verslechterende-nierfunctie-en-uitkomsten-met-rivaroxaban-versus-warfarine-rocke/","title":"Verslechterende nierfunctie en uitkomsten met rivaroxaban versus warfarine: ROCKET AF","title_en":"On-Treatment Outcomes in Patients With Worsening Renal Function With Rivaroxaban Compared With Warfarin: Insights From ROCKET AF.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.021890","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.021890","authors":["Christopher B Fordyce","Anne S Hellkamp","Yuliya Lokhnygina","Samuel M Lindner","Jonathan P Piccini","Richard C Becker","Scott D Berkowitz","Günter Breithardt","Keith A A Fox","Kenneth W Mahaffey","Christopher C Nessel","Daniel E Singer","Manesh R Patel"],"significance":7,"published":"2016-07-05","source_date":"2016-07-05","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/","https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This ROCKET AF analysis examined outcomes in AF patients with worsening renal function, showing that rivaroxaban maintains its favorable profile compared with warfarin even when kidney function declines during treatment.","created":"2026-07-03T10:26:12Z","updated":"2026-07-03T13:25:33Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ROCKET AF-analyse naar uitkomsten bij AF-patiënten met verslechterende nierfunctie behandeld met rivaroxaban versus warfarine. Klinisch relevant voor DOAC-beleid bij dynamische nierfunctie.","abstract_original":"BACKGROUND: Despite rapid clinical adoption of novel anticoagulants, it is unknown whether outcomes differ among patients with worsening renal function (WRF) taking these new drugs compared with warfarin. We aimed to determine whether the primary efficacy (stroke or systemic embolism) and safety (major bleeding and nonmajor clinically relevant bleeding) end points from the ROCKET AF trial (Rivaroxaban Once-Daily, Oral, Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation trial) differed among participants with WRF taking rivaroxaban and those taking warfarin. METHODS: After excluding patients without at least 1 follow-up creatinine measurement (n=1624), we included all remaining patients (n=12 612) randomly assigned to either rivaroxaban or dose-adjusted warfarin. On-treatment WRF (a decrease of >20% from screening creatinine clearance measurement at any time point during the study) was evaluated as a time-dependent covariate in Cox proportional hazards models. RESULTS: Baseline characteristics were generally similar between patients with stable renal function (n=9292) and WRF (n=3320). Rates of stroke or systemic embolism, myocardial infarction, and bleeding were also similar, but WRF patients experienced a higher incidence of vascular death versus stable renal function (2.21 versus 1.41 events per 100 patient-years; P=0.026). WRF patients who were randomized to receive rivaroxaban had a reduction in stroke or systemic embolism compared with those taking warfarin (1.54 versus 3.25 events per 100 patient-years) that was not seen in patients with stable renal function who were randomized to receive rivaroxaban (P=0.050 for interaction). There was no difference in major or nonmajor clinically relevant bleeding among WRF patients randomized to warfarin versus rivaroxaban. CONCLUSIONS: Among patients with on-treatment WRF, rivaroxaban was associated with lower rates of stroke and systemic embolism compared with warfarin, without an increase in the composite bleeding end point. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00403767."},{"id":"9c6f9a0d0be4","type":"article","url":"https://hartvaat.nl/2016/07/05/nierfunctie-en-uitkomsten-met-edoxaban-in-de-engage-af-timi-48-trial/","title":"Nierfunctie en uitkomsten met edoxaban in de ENGAGE AF-TIMI 48-trial","title_en":"Impact of Renal Function on Outcomes With Edoxaban in the ENGAGE AF-TIMI 48 Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.022361","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.022361","authors":["Erin A Bohula","Robert P Giugliano","Christian T Ruff","Julia F Kuder","Sabina A Murphy","Elliott M Antman","Eugene Braunwald"],"significance":7,"published":"2016-07-05","source_date":"2016-07-05","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/edoxaban/","https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This ENGAGE AF-TIMI 48 analysis showed that edoxaban maintains favorable efficacy and safety compared with warfarin across different levels of renal function, with dose reduction providing appropriate adjustment for patients with renal impairment.","created":"2026-07-03T10:26:12Z","updated":"2026-07-03T13:25:33Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van ENGAGE AF-TIMI 48 naar het effect van nierfunctie op de werkzaamheid en veiligheid van edoxaban bij AF. Completeert het bewijs voor DOAC-gebruik bij nierinsufficiëntie.","abstract_original":"BACKGROUND: Edoxaban, an oral factor Xa inhibitor with 50% renal clearance, was noninferior to well-managed warfarin for stroke or systemic embolism (S/SE) prevention and reduced bleeding in patients with atrial fibrillation. We evaluated the efficacy and safety of edoxaban versus warfarin across the range of baseline creatinine clearance (CrCl) in the ENGAGE AF-TIMI 48 trial (Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction Study 48) with a focus on the higher-dose edoxaban regimen (HDER) and the upper range of CrCl. METHODS: A total of 14 071 patients with atrial fibrillation at moderate to high risk for stroke were randomized to warfarin or HDER (60 mg daily or a 50% dose reduction to 30 mg daily for CrCl 30-50 mL/min, body weight of ≤60 kg, or use of a potent phosphorylated glycoprotein inhibitor). CrCl <30 mL/min was exclusionary. End points of S/SE, International Society on Thrombosis and Haemostasis major bleeding, and the net clinical outcome of S/SE/major bleeding or death were evaluated by intention-to-treat analysis using the prespecified CrCl cut point of 50 mL/min and additional exploratory cut points with the Cockcroft-Gault formula. A sensitivity analysis was performed with the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) formula for estimating renal function. RESULTS: The relative risk of S/SE with HDER versus warfarin in patients with CrCl >50 mL/min (hazard ratio [HR], 0.87; 95% confidence interval [CI], 0.72-1.04) was similar to that in patients with CrCl ≤50 mL/min (HR, 0.87; 95% CI, 0.65-1.18; P for interaction=0.94). Several exploratory analyses suggested lower relative efficacy for the prevention of S/SE with HDER compared with warfarin at higher levels of CrCl (CrCl ≤50 mL/min: HR, 0.87; 95% CI, 0.65-1.18; CrCl >50-95 mL/min: HR, 0.78; 95% CI, 0.64-0.96; CrCl >95 mL/min: HR, 1.36; 95% CI, 0.88-2.10; P for interaction=0.08). Bleeding rates were lower at all levels of CrCl with HDER (P for interaction=0.11). Because of the preserved effect on bleeding, the net clinical outcome was more favorable with HDER across the range of CrCl (P for interaction=0.73). Similar findings were observed in the sensitivity analysis using the CKD-EPI formula. CONCLUSIONS: Although there was an apparent decrease in relative efficacy to prevent arterial thromboembolism in the upper range of CrCl, the safety and net clinical benefit of HDER compared with warfarin are consistent across the range of renal function. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00781391."},{"id":"4724ee4ddc15","type":"article","url":"https://hartvaat.nl/2016/07/01/apixaban-versus-warfarine-bij-af-in-relatie-tot-nierfunctie-aristotle-analyse/","title":"Apixaban versus warfarine bij AF in relatie tot nierfunctie: ARISTOTLE-analyse","title_en":"Efficacy and Safety of Apixaban Compared With Warfarin in Patients With Atrial Fibrillation in Relation to Renal Function Over Time: Insights From the ARISTOTLE Randomized Clinical Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","internist"],"tags":["anticoagulatie-kwetsbare-ouderen"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2016.1170","source_url":"https://doi.org/10.1001/jamacardio.2016.1170","authors":["Ziad Hijazi","Stefan H Hohnloser","Ulrika Andersson","John H Alexander","Michael Hanna","Matyas Keltai","Alexander Parkhomenko","José L López-Sendón","Renato D Lopes","Agneta Siegbahn","Christopher B Granger","Lars Wallentin"],"significance":7,"published":"2016-07-01","source_date":"2016-07-01","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/","https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This ARISTOTLE subanalysis demonstrated that apixaban maintains its favorable efficacy and safety profile compared with warfarin across different levels of renal function in AF patients, providing dosing confidence in mild-to-moderate renal impairment.","created":"2026-07-03T10:26:12Z","updated":"2026-07-03T13:25:33Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology analyse van ARISTOTLE naar werkzaamheid en veiligheid van apixaban versus warfarine bij AF-patiënten gestratificeerd naar nierfunctie. Relevant voor DOAC-dosering bij nierinsufficiëntie.","abstract_original":"IMPORTANCE: Renal impairment confers an increased risk of stroke, bleeding, and death in patients with atrial fibrillation. Little is known about the efficacy and safety of apixaban in relation to renal function changes over time. OBJECTIVES: To evaluate changes of renal function over time and their interactions with outcomes during a median of 1.8 years of follow-up in patients with atrial fibrillation randomized to apixaban vs warfarin treatment. DESIGN, SETTING, AND PARTICIPANTS: The prospective, randomized, double-blind Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) clinical trial randomized 18 201 patients with atrial fibrillation to apixaban or warfarin. Serial creatinine measurements were available in 16 869 patients. Worsening of renal function was defined as an annual decrease in estimated glomerular filtration more than 20%. The relations between treatment, outcomes, and renal function were investigated using Cox regression models, with renal function as a time-dependent covariate. MAIN OUTCOMES AND MEASURES: Stroke or systemic embolism (primary outcome), major bleeding (safety outcome), and mortality were examined in relation to renal function over time estimated with both the Cockcroft-Gault and Chronic Kidney Disease Epidemiology Collaboration equations. RESULTS: Among 16 869 patients, the median age was 70 years and 65.2% of patients were men. Worsening in estimated glomerular filtration more than 20% was observed in 2294 patients (13.6%) and was associated with older age and more cardiovascular comorbidities. The risks of stroke or systemic embolism, major bleeding, and mortality were higher in patients with worsening renal function (HR, 1.53; 95% CI, 1.17-2.01 for stroke or systemic embolism; HR, 1.56; 95% CI, 1.27-1.93 for major bleeding; and HR, 2.31; 95% CI, 1.98-2.68 for mortality). The beneficial effects of apixaban vs warfarin on rates of stroke or systemic embolism and major bleeding were consistent in patients with normal or poor renal function over time and also in those with worsening renal function. CONCLUSIONS AND RELEVANCE: In patients with atrial fibrillation, declining renal function was more common in elderly patients and those with cardiovascular comorbidities. Worsening renal function was associated with a higher risk of subsequent cardiovascular events and bleeding. The superior efficacy and safety of apixaban as compared with warfarin were similar in patients with normal, poor, and worsening renal function. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00412984."},{"id":"b48823d9bcd0","type":"article","url":"https://hartvaat.nl/2016/07/01/langetermijnverdraagbaarheid-van-ticagrelor-voor-secundaire-cardiovasculaire-pre/","title":"Langetermijnverdraagbaarheid van ticagrelor voor secundaire cardiovasculaire preventie: PEGASUS-TIMI 54","title_en":"Long-term Tolerability of Ticagrelor for the Secondary Prevention of Major Adverse Cardiovascular Events: A Secondary Analysis of the PEGASUS-TIMI 54 Trial.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog"],"tags":["ouderen","richtlijnen-esc"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2016.1017","source_url":"https://doi.org/10.1001/jamacardio.2016.1017","authors":["Marc P Bonaca","Deepak L Bhatt","Ton Oude Ophuis","P Gabriel Steg","Robert Storey","Marc Cohen","Julia Kuder","Kyungah Im","Giulia Magnani","Andrzej Budaj","Pierre Theroux","Christian Hamm","Jindrich Špinar","Robert G Kiss","Anthony J Dalby","Felix A Medina","Frederic Kontny","Philip E Aylward","Eva C Jensen","Peter Held","Eugene Braunwald","Marc S Sabatine"],"significance":6,"published":"2016-07-01","source_date":"2016-07-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/"],"congress":"","summary_en":"This PEGASUS-TIMI 54 tolerability analysis showed that long-term ticagrelor therapy is generally well tolerated, with dyspnea and bleeding as the main reasons for discontinuation, informing the practical management of extended antiplatelet therapy.","created":"2026-07-03T10:26:12Z","updated":"2026-07-03T13:25:33Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology analyse van de langetermijnverdraagbaarheid van ticagrelor bij patiënten met eerder MI. Onderzoekt bijwerkingen, therapietrouw en redenen voor voortijdig staken bij verlengde DAPT.","abstract_original":"IMPORTANCE: In the PEGASUS-TIMI 54 trial, treatment with ticagrelor reduced the incidence of cardiovascular death, myocardial infarction, or stroke by 15% to 16% among stable patients compared with placebo. However, more patients prematurely discontinued treatment with ticagrelor than with placebo. OBJECTIVE: To investigate the reasons and timing of discontinuation of treatment with ticagrelor among stable patients prior myocardial infarction. DESIGN, SETTING, AND PARTICIPANTS: In the PEGASUS-TIMI 54 trial, 21 162 stable outpatients with prior myocardial infarction were randomly assigned to 90 mg of ticagrelor twice daily, 60 mg of ticagrelor twice daily, or placebo, with all of the patients receiving a low dose of aspirin. These participants were followed up for a median of 33 months (study start date: October 2010; completion date: December 2014). Discontinuation of treatment was evaluated by treatment arm, cause, and timing. This analysis was initiated in May 2015. MAIN OUTCOME AND MEASURE: Discontinuation of treatment. RESULTS: Over 33 months, 32%, 29%, and 21% of patients receiving 90 mg of ticagrelor, 60 mg of ticagrelor, and placebo, respectively, discontinued treatment (P < .001). Discontinuation of treatment due to an adverse event occurred in 19%, 16%, and 9% of patients, respectively (P < .001). The most frequent adverse events leading to discontinuation of treatment were bleeding (with Kaplan-Meier event rates of 7.8%, 6.2%, and 1.5% of patients, respectively; P < .001) and dyspnea (6.5%, 4.6%, and 0.8% of patients, respectively; P < .001). Eighty-six percent of bleeding events that led to the discontinuation of treatment with ticagrelor were nonmajor, and 86% of adverse events due to dyspnea that led to discontinuation of treatment with ticagrelor were mild or moderate in severity. The discontinuation rates are annualized for patients who received 90 mg of ticagrelor twice daily (hazard ratio [HR], 2.00 [95% CI, 1.84-2.16] for the first year; HR, 1.12 [95% CI, 1.00-1.26] for the second and third years) and patients who received 60 mg of ticagrelor twice daily (HR, 1.59 [95% CI, 1.46-1.73] for the first year; HR, 1.18 [95% CI, 1.06-1.32] for the second and third years) compared with patients who received placebo. CONCLUSIONS AND RELEVANCE: When initiated among stable patients with prior myocardial infarction, discontinuation of treatment with ticagrelor was driven primarily by nonserious adverse events occurring primarily early after randomization. For patients completing 1 year of treatment, the subsequent discontinuation rate was low. These data demonstrate how adverse events considered \"nonserious\" by traditional trial criteria may have an effect on quality of life and, thus, may precipitate the discontinuation of treatments and underscore the need for patient education and counseling on the timing and nature of adverse effects with the aim of improving adherence when appropriate. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01225562."},{"id":"cb4097e07ef6","type":"article","url":"https://hartvaat.nl/2016/07/01/chocoladeconsumptie-en-risico-op-myocardinfarct-prospectieve-studie-en-meta-anal/","title":"Chocoladeconsumptie en risico op myocardinfarct: prospectieve studie en meta-analyse","title_en":"Chocolate consumption and risk of myocardial infarction: a prospective study and meta-analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","aficamten","anemie-ckd","aperitif-trial","biomarkers-cardiovasculair","bradycardie","cardio-renaal-metabool","colcot-trial","diabetes-en-hart","diabetes-type-2","dyslipidemie","ezetimibe","farmaco-economie","fidelity","figaro-dkd","hdl-cholesterol","laminopathie","menopauze","microbioom","myocardinfarct","obesitas","ouderen","roken","voeding-hart","vrouwen"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2015-309203","source_url":"https://doi.org/10.1136/heartjnl-2015-309203","authors":["Susanna C Larsson","Agneta Åkesson","Bruna Gigante","Alicja Wolk"],"significance":5,"published":"2016-07-01","source_date":"2016-07-01","image":"","kennis":[],"congress":"","summary_en":"This prospective study and meta-analysis examined the association between chocolate consumption and myocardial infarction risk, evaluating the cardiovascular implications of dietary cocoa flavanoid intake.","created":"2026-07-03T10:26:12Z","updated":"2026-07-03T18:38:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Prospectieve studie en meta-analyse naar het verband tussen chocoladeconsumptie en het risico op myocardinfarct. Ondanks de populariteit van dit onderwerp bieden de resultaten genuanceerd inzicht in voeding en cardiovasculair risico.","abstract_original":"OBJECTIVE: To examine whether chocolate consumption is associated with a reduced risk of ischaemic heart disease, we used data from a prospective study of Swedish adults and we performed a meta-analysis of available prospective data. METHODS AND RESULTS: The Swedish prospective study included 67 640 women and men from the Cohort of Swedish Men and the Swedish Mammography Cohort who had completed a food-frequency questionnaire and were free of cardiovascular disease at baseline. Myocardial infarction (MI) cases were ascertained through linkage with the Swedish National Patient and Cause of Death Registers. PubMed and EMBASE databases were searched from inception until 4 February 2016 to identify prospective studies on chocolate consumption and risk of ischaemic heart disease. RESULTS: The results from eligible studies were combined using a random-effects model. During follow-up (1998-2010), 4417 MI cases were ascertained in the Swedish study. Chocolate consumption was inversely associated with MI risk. Compared with non-consumers, the multivariable relative risk for those who consumed ≥3-4 servings/week of chocolate was 0.87 (95% CI 0.77 to 0.98; p for trend =0.04). Five prospective studies on chocolate consumption and ischaemic heart disease were identified. Together with the Swedish study, the meta-analysis included six studies with a total of 6851 ischaemic heart disease cases. The overall relative risk for the highest versus lowest category of chocolate consumption was 0.90 (95% CI 0.82 to 0.97), with little heterogeneity among studies (I(2)=24.3%). CONCLUSIONS: Chocolate consumption is associated with lower risk of MI and ischaemic heart disease."},{"id":"820a3e0a8f44","type":"article","url":"https://hartvaat.nl/2016/07/01/remote-ischemische-conditionering-en-vertraging-van-het-zorgsysteem-bij-stemi/","title":"Remote ischemische conditionering en vertraging van het zorgsysteem bij STEMI","title_en":"Remote ischaemic conditioning and healthcare system delay in patients with ST-segment elevation myocardial infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2015-308980","source_url":"https://doi.org/10.1136/heartjnl-2015-308980","authors":["Kasper Pryds","Christian Juhl Terkelsen","Astrid Drivsholm Sloth","Kim Munk","Søren Steen Nielsen","Michael Rahbek Schmidt","Hans Erik Bøtker"],"significance":5,"published":"2016-07-01","source_date":"2016-07-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"This study investigated whether remote ischemic conditioning mitigates the detrimental effect of healthcare system delay on myocardial salvage in STEMI, exploring cardioprotection specifically in prolonged ischemia scenarios.","created":"2026-07-03T10:26:12Z","updated":"2026-07-03T13:25:32Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar het effect van remote ischemische conditionering in de setting van langere vertragingen in het zorgsysteem bij STEMI-patiënten. Onderzoekt of conditionering het tijdsvenster voor myocardprotectie kan verlengen.","abstract_original":"OBJECTIVE: We investigated influence of remote ischaemic conditioning (RIC) on the detrimental effect of healthcare system delay on myocardial salvage in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). METHODS: A post-hoc analysis of a randomised controlled trial in patients with STEMI randomised to treatment with pPCI or RIC+pPCI. RIC was performed as four cycles of intermittent 5 min upper arm ischaemia and reperfusion. Healthcare system delay was defined as time from emergency medical service call to pPCI-wire. Myocardial salvage index (MSI) was assessed by single photon emission computerised tomography. RESULTS: Data for healthcare system delay and MSI were available for 129 patients. MSI was negatively associated with healthcare system delay in patients treated with pPCI alone (-0.003 decrease in MSI/min of healthcare system delay; 95% CI -0.005 to -0.001, r(2)=0.11, p=0.008) but not in patients treated with RIC+pPCI (-0.0002 decrease in MSI/min of healthcare system delay; 95% CI -0.001 to 0.001, r(2)=0.002, p=0.74). In patients with healthcare system delay ≤120 min, RIC+pPCI did not affect median MSI compared with pPCI alone (0.75 (IQR: 0.49-0.99) and 0.70 (0.45-0.94), p=1.00). However, in patients with healthcare system delay >120 min, RIC+pPCI increased median MSI compared with pPCI alone (0.74 (0.52-0.93) vs 0.42 (0.22-0.68), p=0.02). Adjusting for potential confounders did not affect the results. CONCLUSIONS: RIC as adjunctive to pPCI attenuated the detrimental effect of healthcare system delay on myocardial salvage in patients with STEMI, suggesting that the cardioprotective effect of RIC increases with the duration of ischaemia. TRIAL REGISTRATION NUMBER: NCT00435266; post-results."},{"id":"1829e7828f3a","type":"article","url":"https://hartvaat.nl/2016/07/01/natief-kleplijden-bij-af-patienten-op-warfarine-of-rivaroxaban/","title":"Natief kleplijden bij AF-patiënten op warfarine of rivaroxaban","title_en":"Native valve disease in patients with non-valvular atrial fibrillation on warfarin or rivaroxaban.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["answer-hf","rivaroxaban"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2015-308120","source_url":"https://doi.org/10.1136/heartjnl-2015-308120","authors":["Günter Breithardt","Helmut Baumgartner","Scott D Berkowitz","Anne S Hellkamp","Jonathan P Piccini","Yuliya Lokhnygina","Jonathan L Halperin","Daniel E Singer","Graeme J Hankey","Werner Hacke","Richard C Becker","Christopher C Nessel","Kenneth W Mahaffey","Robert M Califf","Keith A A Fox","Manesh R Patel"],"significance":5,"published":"2016-07-01","source_date":"2016-07-01","image":"","kennis":[],"congress":"","summary_en":"This study characterized the prevalence and impact of native valve disease in patients classified as having non-valvular AF treated with warfarin or rivaroxaban, informing DOAC prescribing in borderline valvular conditions.","created":"2026-07-03T10:26:12Z","updated":"2026-07-03T13:25:32Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de prevalentie en impact van natief kleplijden bij niet-valvulair AF-patiënten behandeld met warfarine of rivaroxaban. Relevant voor de behandelstrategie bij AF met begeleidend kleplijden.","abstract_original":"OBJECTIVE: To compare the characteristics and outcomes of patients with atrial fibrillation (AF) and aortic stenosis (AS) with patients with AF with mitral regurgitation (MR) or aortic regurgitation (AR) and patients without significant valve disease (no SVD). METHODS: Using Rivaroxaban Once-Daily, Oral, Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) data, we analysed efficacy and safety outcomes, adjusting hazard ratios (HRs) for potential confounders using Cox regression analysis. RESULTS: Among 14 119 intention-to-treat ROCKET AF trial patients, a trial that excluded patients with mitral stenosis or artificial valve prosthesis, 214 had AS with or without other valve abnormalities, 1726 had MR or AR and 12 179 had no SVD. After adjusting for prognostic factors, the composite of stroke, systemic embolism or vascular death increased approximately twofold in patients with AS (AS 10.84, MR or AR 4.54 and no SVD 4.31 events per 100 patient-years, p=0.0001). All-cause death also significantly increased (AS 11.22, MR or AR 4.90 and no SVD 4.39 events per 100 patient-years, p=0.0003). Major bleeding occurred more frequently in AS (adjusted HR 1.61, confidence intervals (CI) 1.03 to 2.49, p<0.05) and MR or AR (HR 1.30, 1.07 to 1.57, p<0.01) than in no SVD, but there was no difference between AS and MR or AR (HR 1.24, 0.78 to 1.97). The relative efficacy of rivaroxaban versus warfarin was consistent among patients with and without valvular disease. Rivaroxaban was associated with higher rates of major bleeding than warfarin in patients with MR or AR (HR 1.63, 1.15 to 2.31). CONCLUSIONS: We found that patients with AF and AS on oral anticoagulants may have distinctly different efficacy and safety outcomes than patients with MR or AR or no SVD. TRIAL REGISTRATION NUMBER: NCT00403767; Post-results."},{"id":"dad916733c1b","type":"article","url":"https://hartvaat.nl/2016/07/01/luchtvervuiling-en-hypertensie-systematische-review-en-meta-analyse/","title":"Luchtvervuiling en hypertensie: systematische review en meta-analyse","title_en":"Associations of Short-Term and Long-Term Exposure to Ambient Air Pollutants With Hypertension: A Systematic Review and Meta-Analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["acuut-hartfalen","bloeddrukbehandeling","cardio-renaal-metabool","luchtvervuiling","ras-remmers","renale-denervatie","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.07218","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.07218","authors":["Yuanyuan Cai","Bo Zhang","Weixia Ke","Baixiang Feng","Hualiang Lin","Jianpeng Xiao","Weilin Zeng","Xing Li","Jun Tao","Zuyao Yang","Wenjun Ma","Tao Liu"],"significance":7,"published":"2016-07-01","source_date":"2016-07-01","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/hypertensie/cardiovasculaire-risicoschatting-score2/"],"congress":"","summary_en":"This systematic review and meta-analysis examined the association between short-term and long-term air pollution exposure and hypertension risk, providing evidence that ambient air pollutants may be a modifiable environmental risk factor for blood pressure elevation.","created":"2026-07-03T10:26:12Z","updated":"2026-07-03T18:38:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse naar het verband tussen korte- en langetermijnblootstelling aan luchtvervuiling en het risico op hypertensie. Onderbouwt de rol van milieufactoren bij cardiovasculaire risicostratificatie.","abstract_original":"Hypertension is a major disease of burden worldwide. Previous studies have indicated that air pollution might be a risk factor for hypertension, but the results were controversial. To fill this gap, we performed a meta-analysis of epidemiological studies to investigate the associations of short-term and long-term exposure to ambient air pollutants with hypertension. We searched all of the studies published before September 1, 2015, on the associations of ozone (O3), carbon monoxide (CO), nitrogen oxide (NO2 and NOX), sulfur dioxide (SO2), and particulate matter (PM10 and PM2.5) with hypertension in the English electronic databases. A pooled odds ratio (OR) for hypertension in association with each 10 μg/m(3) increase in air pollutant was calculated by a random-effects model (for studies with significant heterogeneity) or a fixed-effect model (for studies without significant heterogeneity). A total of 17 studies examining the effects of short-term (n=6) and long-term exposure (n=11) to air pollutants were identified. Short-term exposure to SO2 (OR=1.046, 95% confidence interval [CI]: 1.012-1.081), PM2.5 (OR=1.069, 95% CI: 1.003-1.141), and PM10 (OR=1.024, 95% CI: 1.016-1.032) were significantly associated with hypertension. Long-term exposure (a 10 μg/m(3) increase) to NO2 (OR=1.034, 95% CI: 1.005-1.063) and PM10 (OR=1.054, 95% CI: 1.036-1.072) had significant associations with hypertension. Exposure to other ambient air pollutants (short-term exposure to NO2, O3, and CO and long-term exposure to NOx, PM2.5, and SO2) also had positive relationships with hypertension, but lacked statistical significance. Our results suggest that short-term or long-term exposure to some air pollutants may increase the risk of hypertension."},{"id":"79ccceca1bf6","type":"article","url":"https://hartvaat.nl/2016/07/01/polsgolfsnelheid-en-bloeddrukcontrole-als-onafhankelijke-voorspellers-van-cva-bi/","title":"Polsgolfsnelheid en bloeddrukcontrole als onafhankelijke voorspellers van CVA bij hypertensie","title_en":"Independent and Joint Effect of Brachial-Ankle Pulse Wave Velocity and Blood Pressure Control on Incident Stroke in Hypertensive Adults.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","bloeddrukbehandeling","perifeer-vaatlijden","ras-remmers","renale-denervatie","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.115.07023","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.115.07023","authors":["Yun Song","Benjamin Xu","Richard Xu","Renee Tung","Eric Frank","Wayne Tromble","Tong Fu","Weiyi Zhang","Tao Yu","Chunyan Zhang","Fangfang Fan","Yan Zhang","Jianping Li","Huihui Bao","Xiaoshu Cheng","Xianhui Qin","Genfu Tang","Yundai Chen","Tianlun Yang","Ningling Sun","Xiaoying Li","Lianyou Zhao","Fan Fan Hou","Junbo Ge","Qiang Dong","Binyan Wang","Xiping Xu","Yong Huo"],"significance":6,"published":"2016-07-01","source_date":"2016-07-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/hypertensie/alfa-blokkers-hypertensie/"],"congress":"","summary_en":"This study demonstrated the independent and joint effects of arterial stiffness (pulse wave velocity) and blood pressure control on stroke risk, showing that vascular stiffness adds prognostic information beyond blood pressure levels.","created":"2026-07-03T10:26:12Z","updated":"2026-07-03T18:38:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die het onafhankelijke en gezamenlijke effect van arteriële stijfheid (polsgolfsnelheid) en bloeddrukcontrole op het CVA-risico onderzocht bij hypertensieve volwassenen. Arteriële stijfheid als aanvullende risicostratificator.","abstract_original":"Pulse wave velocity (PWV) has been shown to influence the effects of antihypertensive drugs in the prevention of cardiovascular diseases. Data are limited on whether PWV is an independent predictor of stroke above and beyond hypertension control. This longitudinal analysis examined the independent and joint effect of brachial-ankle PWV (baPWV) with hypertension control on the risk of first stroke. This report included 3310 hypertensive adults, a subset of the China Stroke Primary Prevention Trial (CSPPT) with baseline measurements for baPWV. During a median follow-up of 4.5 years, 111 participants developed first stroke. The risk of stroke was higher among participants with baPWV in the highest quartile than among those in the lower quartiles (6.3% versus 2.4%; hazard ratio, 1.66; 95% confidence interval, 1.06-2.60). Similarly, the participants with inadequate hypertension control had a higher risk of stroke than those with adequate control (5.1% versus 1.8%; hazard ratio, 2.32; 95% confidence interval, 1.49-3.61). When baPWV and hypertension control were examined jointly, participants in the highest baPWV quartile and with inadequate hypertension control had the highest risk of stroke compared with their counterparts (7.5% versus 1.3%; hazard ratio, 3.57; 95% confidence interval, 1.88-6.77). There was a significant and independent effect of high baPWV on stroke as shown among participants with adequate hypertension control (4.2% versus 1.3%; hazard ratio, 2.29, 95% confidence interval, 1.09-4.81). In summary, among hypertensive patients, baPWV and hypertension control were found to independently and jointly affect the risk of first stroke. Participants with high baPWV and inadequate hypertension control had the highest risk of stroke compared with other groups."},{"id":"7a179c136cd6","type":"article","url":"https://hartvaat.nl/2016/07/01/medicatie-non-adherentie-en-visit-to-visit-bloeddrukvariabiliteit-target-bp-stud/","title":"Medicatie-non-adherentie en visit-to-visit bloeddrukvariabiliteit: TARGET BP-studie","title_en":"The Association Between Antihypertensive Medication Nonadherence and Visit-to-Visit Variability of Blood Pressure: Findings From the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.115.06960","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.115.06960","authors":["Ian M Kronish","Amy I Lynch","Suzanne Oparil","Jeff Whittle","Barry R Davis","Lara M Simpson","Marie Krousel-Wood","William C Cushman","Tara I Chang","Paul Muntner"],"significance":6,"published":"2016-07-01","source_date":"2016-07-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/mineralocorticoid-antagonisten-hypertensie/"],"congress":"","summary_en":"This TARGET BP analysis showed that non-adherence to antihypertensive medication is a significant contributor to visit-to-visit blood pressure variability, linking a modifiable factor to this emerging cardiovascular risk predictor.","created":"2026-07-03T10:26:11Z","updated":"2026-07-03T18:38:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie uit de TARGET BP-trial die het verband onderzocht tussen non-adherentie aan antihypertensiva en visit-to-visit bloeddrukvariabiliteit. Niet-trouw aan medicatie is een belangrijke oorzaak van schijnbaar therapieresistente hypertensie.","abstract_original":"Low adherence to antihypertensive medication has been hypothesized to increase visit-to-visit variability (VVV) of blood pressure (BP). We assessed the association between antihypertensive medication adherence and VVV of BP in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). VVV of BP was calculated using SD independent of mean, SD, and average real variability across study visits conducted 6 to 28 months after randomization. Participants who reported taking <80% of their antihypertensive medication at ≥1 study visits were categorized as nonadherent. Participants were followed up for cardiovascular events and mortality after the assessment of adherence and VVV of BP. SD independent of mean of BP was higher for nonadherent (n=2912) versus adherent (n=16 878) participants; 11.4±4.9 versus 10.5±4.5 for systolic BP; 6.8±2.8 versus 6.2±2.6 for diastolic BP (each P<0.001). SD independent of mean of BP remained higher among nonadherent than among adherent participants after multivariable adjustment (0.8 [95% confidence interval, 0.7-1.0] higher for systolic BP and 0.4 [95% confidence interval, 0.3-0.5] higher for diastolic BP]. SD and average real variability of systolic BP and diastolic BP were also higher among nonadherent than among adherent participants. Adjustment for nonadherence did not explain the association of VVV of BP with higher fatal coronary heart disease or nonfatal myocardial infarction, stroke, heart failure, or mortality risk. In conclusion, improving medication adherence may lower VVV of BP. However, VVV of BP is associated with cardiovascular outcomes independent of medication adherence."},{"id":"6c43df73c02e","type":"article","url":"https://hartvaat.nl/2016/07/01/bewegingsadvies-als-behandeling-van-prehypertensie-en-hypertensie-bij-jongvolwas/","title":"Bewegingsadvies als behandeling van prehypertensie en hypertensie bij jongvolwassenen: meta-analyse","title_en":"Will Exercise Advice Be Sufficient for Treatment of Young Adults With Prehypertension and Hypertension? A Systematic Review and Meta-Analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["bloeddrukbehandeling","vrouwen","zwangerschap-hart"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.07431","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.07431","authors":["Wilby Williamson","Charlie Foster","Hamish Reid","Paul Kelly","Adam James Lewandowski","Henry Boardman","Nia Roberts","David McCartney","Odaro Huckstep","Julia Newton","Helen Dawes","Stephen Gerry","Paul Leeson"],"significance":6,"published":"2016-07-01","source_date":"2016-07-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/nierziekte/kdigo-richtlijn-ckd-2024/"],"congress":"","summary_en":"This systematic review and meta-analysis examined whether exercise advice alone is sufficient for treating prehypertension and hypertension in young adults, evaluating the effectiveness of lifestyle modification without pharmacotherapy in this demographic.","created":"2026-07-03T10:26:11Z","updated":"2026-07-03T18:38:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse die onderzocht of bewegingsadvies alleen voldoende is voor de behandeling van prehypertensie en hypertensie bij jongvolwassenen. Relevant voor niet-farmacologische eerste-stapstherapie.","abstract_original":"Previous studies report benefits of exercise for blood pressure control in middle age and older adults, but longer-term effectiveness in younger adults is not well established. We performed a systematic review and meta-analysis of published randomized control trials with meta-regression of potential effect modifiers. An information specialist completed a comprehensive search of available data sources, including studies published up to June 2015. Authors applied strict inclusion and exclusion criteria to screen 9524 titles. Eligible studies recruited younger adults with a cardiovascular risk factor (with at least 25% of cohort aged 18-40 years); the intervention had a defined physical activity strategy and reported blood pressure as primary or secondary outcome. Meta-analysis included 14 studies randomizing 3614 participants, mean age 42.2±6.3 (SD) years. At 3 to 6 months, exercise was associated with a reduction in systolic blood pressure of -4.40 mm Hg (95% confidence interval, -5.78 to -3.01) and in diastolic blood pressure of -4.17 mm Hg (95% confidence interval, -5.42 to -2.93). Intervention effect was not significantly influenced by baseline blood pressure, body weight, or subsequent weight loss. Observed intervention effect was lost after 12 months of follow-up with no reported benefit over control, mean difference in systolic blood pressure -1.02 mm Hg (95% confidence interval, -2.34 to 0.29), and in diastolic blood pressure -0.91 mm Hg (95% confidence interval, -1.85 to 0.02). Current exercise guidance provided to reduce blood pressure in younger adults is unlikely to benefit long-term cardiovascular risk. There is need for continued research to improve age-specific strategies and recommendations for hypertension prevention and management in young adults."},{"id":"a3661ad2babf","type":"article","url":"https://hartvaat.nl/2016/07/01/langetermijnevaluatie-van-dabigatran-150-versus-110-mg-bij-niet-valvulair-af/","title":"Langetermijnevaluatie van dabigatran 150 versus 110 mg bij niet-valvulair AF","title_en":"Long-term evaluation of dabigatran 150 vs. 110 mg twice a day in patients with non-valvular atrial fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","huisarts"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euv312","source_url":"https://doi.org/10.1093/europace/euv312","authors":["Michael D Ezekowitz","John Eikelboom","Jonas Oldgren","Paul A Reilly","Martina Brueckmann","Anthony P Kent","Janice Pogue","Judith Spahr","Andreas Clemens","Herbert Noack","Hans-Christoph Diener","Lars Wallentin","Salim Yusuf","Stuart J Connolly"],"significance":7,"published":"2016-07-01","source_date":"2016-07-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/atriumfibrilleren/ecg-herkenning-af/"],"congress":"","summary_en":"This long-term comparison of dabigatran 150 mg versus 110 mg twice daily in patients with non-valvular AF from the RE-LY extension study provided insights into the sustained efficacy and safety of both dose levels over extended follow-up.","created":"2026-07-03T10:26:11Z","updated":"2026-07-03T13:25:32Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Langetermijnvergelijking van twee doseringen dabigatran bij niet-valvulair atriumfibrilleren. Relevant voor de optimale doseringsstrategie, met name bij oudere patiënten met verhoogd bloedingsrisico.","abstract_original":"AIMS: The Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) trial allowed patients who completed the trial receiving their assigned dabigatran 150 mg (D150) or 110 mg (D110) twice a day to continue into the Long-term Multicenter Extension of Dabigatran Treatment in Patients with Atrial Fibrillation (RELY-ABLE) trial. This permitted assessment of outcomes over a median of 4.6 and a maximum of 6.7 years, respectively. METHODS AND RESULTS: The analysed population included only those patients who completed RE-LY on dabigatran and continued into RELY-ABLE without interruption of assigned dabigatran. Cumulative risk was expressed as Kaplan-Meier plots. Outcomes were compared using Cox proportional hazard modelling. Stroke or systemic embolization rates were 1.25 and 1.54% per year (D150 and D110, respectively); hazard ratio (HR) 0.81 [95% confidence interval (CI): 0.68-0.96] (P = 0.02). Ischaemic stroke was 1.03 (D150) and 1.29%/year (D110); HR 0.79 (95% CI: 0.66-0.95) (P = 0.01). Haemorrhagic stroke rates were 0.11 (D150) and 0.13%/year (D110); HR 0.91 (95% CI: 0.51-1.62) (P = 0.75). Rates of major haemorrhage were 3.34 (D150) and 2.76%/year (D110); HR 1.22 (95% CI: 1.08-1.37) (P = 0.0008). Intracranial haemorrhage rates were 0.32 (D150) and 0.23%/year (D110); HR 1.37 (95% CI: 0.93-2.01) (P = 0.11). Mortality was 3.43 (D150) and 3.55%/year (D110); HR 0.97 (95% CI: 0.87-1.08) (P = 0.54). CONCLUSION: Annualized rates of all outcomes were constant with better efficacy of D150, less major bleeding with D110, and low intracerebral haemorrhage rates for both doses. There were no additional safety concerns. This is the longest continuous randomized experience of a novel anticoagulant."},{"id":"aeedbdb99d91","type":"article","url":"https://hartvaat.nl/2016/07/01/implanteerbare-monitors-als-goudstandaard-voor-af-detectie-gerandomiseerde-verge/","title":"Implanteerbare monitors als goudstandaard voor AF-detectie: gerandomiseerde vergelijking","title_en":"Are implantable cardiac monitors the 'gold standard' for atrial fibrillation detection? A prospective randomized trial comparing atrial fibrillation monitoring using implantable cardiac monitors and DDDRP permanent pacemakers in post atrial fibrillation ablation patients.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euv367","source_url":"https://doi.org/10.1093/europace/euv367","authors":["Steven J Podd","Conn Sugihara","Stephen S Furniss","Neil Sulke"],"significance":6,"published":"2016-07-01","source_date":"2016-07-01","image":"","kennis":["https://hartvaat.nl/kennis/ritmestoornissen/implanteerbare-loop-recorder/"],"congress":"","summary_en":"This prospective randomized trial compared implantable cardiac monitors with other AF detection methods, testing the assumption that continuous implantable monitoring is the gold standard for arrhythmia surveillance.","created":"2026-07-03T10:26:11Z","updated":"2026-07-03T13:25:32Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Prospectieve gerandomiseerde trial die implanteerbare cardiale monitors vergeleek met andere detectiemethoden voor atriumfibrilleren. Onderzoekt de diagnostische opbrengst van continue monitoring.","abstract_original":"AIMS: Implantable devices are widely accepted, but not proven, to be the most reliable monitoring method to assess atrial fibrillation (AF) therapies. We compared REVEAL(®)XT implantable cardiac monitors (ICMs) and permanent pacemakers (PPMs). METHODS AND RESULTS: Fifty patients with paroxysmal AF were randomized to ICM or PPM implant 6 weeks prior to pulmonary vein isolation. Permanent pacemakers were programmed to monitoring only (ODO). Device downloads were performed at 0, 3, 6, 9, and 12 months. All patients underwent 7-day external loop recorder. Device ECGs and EGMs were compared for AF burden. A total of 20 744 and 11 238 arrhythmia episodes were identified in the ICM and PPM groups, respectively. Correct identification of AF was significantly better in the PPM group (97 vs. 55% P < 0.001). In the ICM group, 26% of ECGs were un-interpretable. Sensitivity and specificity for each episode of AF was significantly better in the PPM group (100 vs. 79% and 98 vs. 66%, respectively, P < 0.001). The positive predictive value for the detection of any AF was significantly better in the PPM than the ICM (100 vs. 58%, P = 0.03). The negative predictive value for the absence of all AF was not significantly different between the PPM and ICM (100% vs. 92%, P = 0.76). CONCLUSION: Permanent pacemakers Holters are the most accurate method of evaluating arrhythmia burden and the therapeutic efficacy of novel AF therapies. ICM has a high degree of artefact, which reduces its specifity and sensitivity. Despite the deficiencies of ICM monitoring the negative predictive value of the ICM is satisfactory if zero AF burden is the aim of therapy."},{"id":"211046a3dd37","type":"article","url":"https://hartvaat.nl/2016/06/28/escitalopram-bij-hartfalen-en-depressie-de-mood-hf-trial/","title":"Escitalopram bij hartfalen en depressie: de MOOD-HF-trial","title_en":"Effect of Escitalopram on All-Cause Mortality and Hospitalization in Patients With Heart Failure and Depression: The MOOD-HF Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","answer-hf","bisoprolol","carvedilol","dapa-hf","emperor-trials","sacubitril-valsartan","step-hfpef"],"journal":"JAMA","doi":"10.1001/jama.2016.7635","source_url":"https://doi.org/10.1001/jama.2016.7635","authors":["Christiane E Angermann","Götz Gelbrich","Stefan Störk","Hilka Gunold","Frank Edelmann","Rolf Wachter","Heribert Schunkert","Tobias Graf","Ingrid Kindermann","Markus Haass","Stephan Blankenberg","Sabine Pankuweit","Christiane Prettin","Martin Gottwik","Michael Böhm","Hermann Faller","Jürgen Deckert","Georg Ertl"],"significance":7,"published":"2016-06-28","source_date":"2016-06-28","image":"","kennis":[],"congress":"","summary_en":"This JAMA trial showed that escitalopram did not reduce all-cause mortality or hospitalization in heart failure patients with comorbid depression, despite evidence that depression worsens heart failure outcomes. The negative result argued against routine SSRI use for cardiovascular benefit in this population.","created":"2026-07-03T10:26:11Z","updated":"2026-07-03T18:38:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA gerandomiseerde trial die onderzocht of escitalopram de mortaliteit en hospitalisatie vermindert bij hartfalenpatiënten met comorbide depressie. Bespreekt de complexe interactie tussen hartfalen en mentale gezondheid.","abstract_original":"IMPORTANCE: Depression is frequent in patients with heart failure and is associated with adverse clinical outcomes. Long-term efficacy and safety of selective serotonin reuptake inhibitors in these patients are unknown. OBJECTIVE: To determine whether 24 months of treatment with escitalopram improves mortality, morbidity, and mood in patients with chronic systolic heart failure and depression. DESIGN, SETTING, AND PARTICIPANTS: The Effects of Selective Serotonin Re-Uptake Inhibition on Morbidity, Mortality, and Mood in Depressed Heart Failure Patients (MOOD-HF) study was a double-blind, placebo-controlled randomized clinical trial conducted at 16 tertiary medical centers in Germany. Between March 2009 and February 2014, patients at outpatient clinics with New York Heart Association class II-IV heart failure and reduced left ventricular ejection fraction (<45%) were screened for depression using the 9-item Patient Health Questionnaire. Patients with suspected depression were then invited to undergo a Structured Clinical Interview based on the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) to establish the diagnosis. INTERVENTIONS: Patients were randomized 1:1 to receive escitalopram (10-20 mg) or matching placebo in addition to optimal heart failure therapy. Study duration was 24 months. MAIN OUTCOMES AND MEASURES: The composite primary outcome was time to all-cause death or hospitalization. Prespecified secondary outcomes included safety and depression severity at 12 weeks of treatment (including the titration period), which were determined using the 10-item Montgomery-Åsberg Depression Rating Scale (total possible score, 0 to 60; higher scores indicate more severe depression). RESULTS: A total of 372 patients (mean age, 62 years; 24% female) were randomized and had taken at least 1 dose of study medication when the data and safety monitoring committee recommended the trial be stopped early. During a median participation time of 18.4 months (n = 185) for the escitalopram group and 18.7 months (n = 187) for the placebo group, the primary outcome of death or hospitalization occurred in 116 (63%) patients and 119 (64%) patients, respectively (hazard ratio, 0.99 [95% CI, 0.76 to 1.27]; P = .92). The mean Montgomery-Åsberg Depression Rating Scale sum score changed from 20.2 at baseline to 11.2 at 12 weeks in the escitalopram group and from 21.4 to 12.5 in the placebo group (between-group difference, -0.9 [95% CI,-2.6 to 0.7]; P = .26). Safety parameters were comparable between groups. CONCLUSIONS AND RELEVANCE: In patients with chronic heart failure with reduced ejection fraction and depression, 18 months of treatment with escitalopram compared with placebo did not significantly reduce all-cause mortality or hospitalization, and there was no significant improvement in depression. These findings do not support the use of escitalopram in patients with chronic systolic heart failure and depression. TRIAL REGISTRATION: isrctn.com Identifier: ISRCTN33128015."},{"id":"d86cfbf51a20","type":"article","url":"https://hartvaat.nl/2016/06/28/intensieve-versus-standaard-bloeddrukcontrole-bij-75-plussers-sprint-subanalyse/","title":"Intensieve versus standaard bloeddrukcontrole bij 75-plussers: SPRINT subanalyse","title_en":"Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years: A Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","ouderen"],"journal":"JAMA","doi":"10.1001/jama.2016.7050","source_url":"https://doi.org/10.1001/jama.2016.7050","authors":["Jeff D Williamson","Mark A Supiano","William B Applegate","Dan R Berlowitz","Ruth C Campbell","Glenn M Chertow","Larry J Fine","William E Haley","Amret T Hawfield","Joachim H Ix","Dalane W Kitzman","John B Kostis","Marie A Krousel-Wood","Lenore J Launer","Suzanne Oparil","Carlos J Rodriguez","Christianne L Roumie","Ronald I Shorr","Kaycee M Sink","Virginia G Wadley","Paul K Whelton","Jeffrey Whittle","Nancy F Woolard","Jackson T Wright","Nicholas M Pajewski"],"significance":9,"published":"2016-06-28","source_date":"2016-06-28","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/colchicine-cardiovasculair/"],"congress":"","summary_en":"This SPRINT subgroup analysis in adults aged 75 years and older showed that intensive blood pressure control (systolic <120 mmHg) significantly reduced cardiovascular events and all-cause mortality compared with standard treatment. The results provided the first strong evidence for aggressive blood pressure targets in the elderly.","created":"2026-07-03T10:26:11Z","updated":"2026-07-03T13:25:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA gerandomiseerde analyse van SPRINT specifiek bij volwassenen ≥75 jaar die aantoonde dat intensieve bloeddrukcontrole cardiovasculaire events en mortaliteit significant vermindert, ook in de oudste leeftijdsgroep.","abstract_original":"IMPORTANCE: The appropriate treatment target for systolic blood pressure (SBP) in older patients with hypertension remains uncertain. OBJECTIVE: To evaluate the effects of intensive (<120 mm Hg) compared with standard (<140 mm Hg) SBP targets in persons aged 75 years or older with hypertension but without diabetes. DESIGN, SETTING, AND PARTICIPANTS: A multicenter, randomized clinical trial of patients aged 75 years or older who participated in the Systolic Blood Pressure Intervention Trial (SPRINT). Recruitment began on October 20, 2010, and follow-up ended on August 20, 2015. INTERVENTIONS: Participants were randomized to an SBP target of less than 120 mm Hg (intensive treatment group, n = 1317) or an SBP target of less than 140 mm Hg (standard treatment group, n = 1319). MAIN OUTCOMES AND MEASURES: The primary cardiovascular disease outcome was a composite of nonfatal myocardial infarction, acute coronary syndrome not resulting in a myocardial infarction, nonfatal stroke, nonfatal acute decompensated heart failure, and death from cardiovascular causes. All-cause mortality was a secondary outcome. RESULTS: Among 2636 participants (mean age, 79.9 years; 37.9% women), 2510 (95.2%) provided complete follow-up data. At a median follow-up of 3.14 years, there was a significantly lower rate of the primary composite outcome (102 events in the intensive treatment group vs 148 events in the standard treatment group; hazard ratio [HR], 0.66 [95% CI, 0.51-0.85]) and all-cause mortality (73 deaths vs 107 deaths, respectively; HR, 0.67 [95% CI, 0.49-0.91]). The overall rate of serious adverse events was not different between treatment groups (48.4% in the intensive treatment group vs 48.3% in the standard treatment group; HR, 0.99 [95% CI, 0.89-1.11]). Absolute rates of hypotension were 2.4% in the intensive treatment group vs 1.4% in the standard treatment group (HR, 1.71 [95% CI, 0.97-3.09]), 3.0% vs 2.4%, respectively, for syncope (HR, 1.23 [95% CI, 0.76-2.00]), 4.0% vs 2.7% for electrolyte abnormalities (HR, 1.51 [95% CI, 0.99-2.33]), 5.5% vs 4.0% for acute kidney injury (HR, 1.41 [95% CI, 0.98-2.04]), and 4.9% vs 5.5% for injurious falls (HR, 0.91 [95% CI, 0.65-1.29]). CONCLUSIONS AND RELEVANCE: Among ambulatory adults aged 75 years or older, treating to an SBP target of less than 120 mm Hg compared with an SBP target of less than 140 mm Hg resulted in significantly lower rates of fatal and nonfatal major cardiovascular events and death from any cause. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01206062."},{"id":"dc8a8f3fd6b4","type":"article","url":"https://hartvaat.nl/2016/06/21/strategieen-om-microvasculaire-obstructie-te-verminderen-bij-primaire-pci-relief/","title":"Strategieën om microvasculaire obstructie te verminderen bij primaire PCI: RELIEF-MI-trial","title_en":"Strategies to attenuate micro-vascular obstruction during P-PCI: the randomized reperfusion facilitated by local adjunctive therapy in ST-elevation myocardial infarction trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["acuut-hartfalen","farmaco-economie","microcirculatie","ouderen","secundaire-preventie"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw136","source_url":"https://doi.org/10.1093/eurheartj/ehw136","authors":["Sheraz A Nazir","Gerry P McCann","John P Greenwood","Vijay Kunadian","Jamal N Khan","Islam Z Mahmoud","Daniel J Blackman","Martin Been","Keith R Abrams","Lorraine Shipley","Robert Wilcox","A A Jennifer Adgey","Anthony H Gershlick"],"significance":6,"published":"2016-06-21","source_date":"2016-06-21","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This randomized trial tested local adjuvant therapies to reduce microvascular obstruction during primary PCI for STEMI, exploring whether intracoronary treatments can improve myocardial salvage beyond mechanical reperfusion alone.","created":"2026-07-03T10:26:11Z","updated":"2026-07-03T13:25:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial naar lokale adjuvante therapie ter vermindering van microvasculaire obstructie tijdens primaire PCI bij STEMI. Onderzocht of lokale behandeling de no-reflow na reperfusie kan beperken.","abstract_original":"BACKGROUND: Microvascular obstruction (MVO) following primary percutaneous coronary intervention (PPCI) treatment of ST-segment elevation myocardial infarction (STEMI) contributes to infarct expansion, left ventricular (LV) remodelling, and worse clinical outcomes. The REFLO-STEMI trial tested whether intra-coronary (IC) high-dose adenosine or sodium nitroprusside (SNP) reduce infarct size and/or MVO determined by cardiac magnetic resonance (CMR). METHODS AND RESULTS: REFLO-STEMI, a prospective, open-label, multi-centre trial with blinded endpoints, randomized (1:1:1) 247 STEMI patients with single vessel disease presenting within 6 h of symptom onset to IC adenosine (2-3 mg total) or SNP (500 μg total) immediately following thrombectomy and again following stenting, or to standard PPCI. The primary endpoint was infarct size % LV mass (%LVM) on CMR undertaken 24-96 h after PPCI (n = 197). Clinical follow-up was to 6 months. There was no significant difference in infarct size (%LVM, median, interquartile range, IQR) between adenosine (10.1, 4.7-16.2), SNP (10.0, 4.2-15.8), and control (8.3, 1.9-14.0), P = 0.062 and P = 0.160, respectively, vs. CONTROL: MVO (% LVM, median, IQR) was similar across groups (1.0, 0.0-3.7, P = 0.205 and 0.6, 0.0-2.4, P = 0.244 for adenosine and SNP, respectively, vs. control 0.3, 0.0-2.8). On per-protocol analysis, infarct size (%LV mass, 12.0 vs. 8.3, P = 0.031), major adverse cardiac events (hazard ratio, HR, 5.39 [1.18-24.60], P = 0.04) at 30 days and 6 months (HR 6.53 [1.46-29.2], P = 0.01) were increased and ejection fraction reduced (42.5 ± 7.2% vs. 45.7 ± 8.0%, P = 0.027) in adenosine-treated patients compared with control. CONCLUSIONS: High-dose IC adenosine and SNP during PPCI did not reduce infarct size or MVO measured by CMR. Furthermore, adenosine may adversely affect mid-term clinical outcome. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01747174; https://clinicaltrials.gov/ct2/show/NCT01747174."},{"id":"51215fcf3c9a","type":"article","url":"https://hartvaat.nl/2016/06/21/myocardiale-blush-en-microvasculaire-reperfusie-na-handmatige-trombectomie-bij-s/","title":"Myocardiale blush en microvasculaire reperfusie na handmatige trombectomie bij STEMI","title_en":"Myocardial blush and microvascular reperfusion following manual thrombectomy during percutaneous coronary intervention for ST elevation myocardial infarction: insights from the TOTAL trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["microcirculatie","microvasculaire-angina"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw157","source_url":"https://doi.org/10.1093/eurheartj/ehw157","authors":["Vinoda Sharma","Sanjit S Jolly","Tahir Hamid","Divyesh Sharma","Joseph Chiha","William Chan","Felipe Fuchs","Sanh Bui","Peggy Gao","Saleem Kassam","Raymond C M Leung","David Horák","Hannu O Romppanen","Magdi El-Omar","Saqib Chowdhary","Goran Stanković","Saško Kedev","Michael J Rokoss","Tej Sheth","Vladimír Džavík","Christopher B Overgaard"],"significance":5,"published":"2016-06-21","source_date":"2016-06-21","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"This study examined the effect of manual thrombectomy on myocardial blush grade and microvascular reperfusion during primary PCI for STEMI, assessing whether mechanical clot removal improves microvascular flow.","created":"2026-07-03T10:26:11Z","updated":"2026-07-03T13:25:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar het effect van handmatige trombectomie op myocardiale blush en microvasculaire reperfusie bij primaire PCI voor STEMI. Onderzoekt of trombusverwijdering de microvasculaire doorstroming verbetert.","abstract_original":"AIMS: Thrombectomy during primary percutaneous coronary intervention (PPCI) for ST elevation myocardial infarction (STEMI) has been thought to be an effective therapy to prevent distal embolization and improve microvascular perfusion. The TOTAL trial (N = 10 732), a randomized trial of routine manual thrombectomy vs. PCI alone in STEMI, showed no difference in the primary efficacy outcome. This angiographic sub-study was performed to determine if thrombectomy improved microvascular perfusion as measured by myocardial blush grade (MBG). METHODS AND RESULTS: Of the 10 732 patients randomized, 1610 randomly selected angiograms were analysable by the angiographic core laboratory. Primary outcomes included MBG and post-PCI thrombolysis in myocardial infarction (TIMI) flow grade. Secondary outcomes included distal embolization, PPCI complications, and each component of the complications. The primary end point of final myocardial blush (221 [28%] 0/1 for thrombectomy vs. 246 {30%} 0/1 for PCI alone group, P = 0.38) and TIMI flow (712 [90%] TIMI 3 for thrombectomy vs. 733 [89.5%] TIMI 3 for PCI alone arm, P = 0.73) was similar in the two groups. Thrombectomy was associated with a significantly reduced incidence of distal embolization compared with PCI alone (56 [7.1%] vs. 87 [10.7%], P = 0.01). In multivariable analysis, distal embolization was an independent predictor of mortality (HR 3.00, 95% CI 1.19-7.58) while MBG was not (HR 2.73, 95% CI 0.94-5.3). CONCLUSIONS: Routine thrombectomy during PPCI did not result in improved MBG or post-PCI TIMI flow grade but did reduce distal embolization compared with PCI alone. Distal embolization and not blush grade is independently associated with mortality."},{"id":"c1273e35c4be","type":"article","url":"https://hartvaat.nl/2016/06/21/apothekerinterventies-en-cardiovasculair-risico-de-multicenter-rxeach-trial/","title":"Apothekerinterventies en cardiovasculair risico: de multicenter RxEACH-trial","title_en":"The Effectiveness of Pharmacist Interventions on Cardiovascular Risk: The Multicenter Randomized Controlled RxEACH Trial.","category":"preventie","category_label":"Preventie","professions":["apotheker","huisarts"],"tags":["aperitif-trial","biomarkers-cardiovasculair","colcot-trial","diabetes-type-2","farmaco-economie","figaro-dkd","inflammatie","menopauze","ouderen","richtlijnen-esc","secundaire-preventie","slaapapneu"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.03.528","source_url":"https://doi.org/10.1016/j.jacc.2016.03.528","authors":["Ross T Tsuyuki","Yazid N Al Hamarneh","Charlotte A Jones","Brenda R Hemmelgarn"],"significance":7,"published":"2016-06-21","source_date":"2016-06-21","image":"","kennis":["https://hartvaat.nl/kennis/preventie/levenslang-cardiovasculair-risico/","https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/"],"congress":"","summary_en":"This multicenter randomized trial demonstrated that pharmacist-led interventions targeting cardiovascular risk factors (hypertension, diabetes, dyslipidemia, smoking) significantly improved risk factor control compared with usual care. The results supported interprofessional collaborative care models.","created":"2026-07-03T10:26:10Z","updated":"2026-07-03T13:25:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde multicenter trial die de effectiviteit van apothekergestuurde cardiovasculaire risico-interventies onderzocht. Toonde significante verbeteringen in risicofactoren door gestructureerde apothekerzorg.","abstract_original":"BACKGROUND: Despite the cardiovascular disease (CVD) risk associated with hypertension, diabetes, dyslipidemia, and smoking, these risk factors remain poorly identified and controlled. OBJECTIVES: The study sought to evaluate the effectiveness of a community pharmacy-based case finding and intervention on cardiovascular risk. METHODS: The RxEACH (Alberta Vascular Risk Reduction Community Pharmacy Project) study was a randomized trial conducted in 56 community pharmacies. Participants were recruited by their pharmacist, who enrolled adults at high risk for CVD. Patients were randomized to usual care (usual pharmacist care with no specific intervention) or intervention, comprising a Medication Therapy Management review from their pharmacist and CVD risk assessment and education. Pharmacists prescribed medications and ordered laboratory tests as per their scope of practice to achieve treatment targets. Subjects received monthly follow-up visits for 3 months. The primary outcome was difference in change in estimated CVD risk between groups at 3 months. CVD risk was estimated using the greater of the Framingham, International, or United Kingdom Prospective Diabetes Study risk scores. RESULTS: We enrolled 723 patients (mean 62 years of age; 58% male, and 27% smokers). After adjusting for baseline values and center effect, there was a 21% difference in change in risk for CVD events (p < 0.001) between the intervention and usual care groups. The intervention group had greater improvements in low-density lipoprotein cholesterol (-0.2 mmol/l; p < 0.001), systolic blood pressure (-9.37 mm Hg; p < 0.001), glycosylated hemoglobin (-0.92%; p < 0.001), and smoking cessation (20.2%; p = 0.002). CONCLUSIONS: The RxEACH study was the first large randomized trial of CVD risk reduction by community pharmacists, demonstrating a significant reduction in risk for CVD events. Engagement of community pharmacists with an expanded scope of practice could have significant public health implications. (The Alberta Vascular Risk Reduction Community Pharmacy Project: RxEACH [RxEACH]; NCT01979471)."},{"id":"63bc4e4d4fec","type":"article","url":"https://hartvaat.nl/2016/06/16/lage-versus-standaarddosis-alteplase-bij-acuut-ischemisch-cva-nejm-enchanted-tri/","title":"Lage versus standaarddosis alteplase bij acuut ischemisch CVA: NEJM ENCHANTED-trial","title_en":"Low-Dose versus Standard-Dose Intravenous Alteplase in Acute Ischemic Stroke.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1515510","source_url":"https://doi.org/10.1056/NEJMoa1515510","authors":["Craig S Anderson","Thompson Robinson","Richard I Lindley","Hisatomi Arima","Pablo M Lavados","Tsong-Hai Lee","Joseph P Broderick","Xiaoying Chen","Guofang Chen","Vijay K Sharma","Jong S Kim","Nguyen H Thang","Yongjun Cao","Mark W Parsons","Christopher Levi","Yining Huang","Verónica V Olavarría","Andrew M Demchuk","Philip M Bath","Geoffrey A Donnan","Sheila Martins","Octavio M Pontes-Neto","Federico Silva","Stefano Ricci","Christine Roffe","Jeyaraj Pandian","Laurent Billot","Mark Woodward","Qiang Li","Xia Wang","Jiguang Wang","John Chalmers"],"significance":8,"published":"2016-06-16","source_date":"2016-06-16","image":"","kennis":[],"congress":"","summary_en":"This NEJM trial comparing low-dose with standard-dose intravenous alteplase in acute ischemic stroke found that the lower dose was not noninferior for functional outcome, settling the question of whether dose reduction could improve the safety-efficacy balance of thrombolysis.","created":"2026-07-03T10:26:10Z","updated":"2026-07-03T13:25:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM-trial die lagere dosering alteplase vergeleek met standaarddosering bij acuut ischemisch herseninfarct. Relevant voor de optimale dosering van trombolyse, vooral in Aziatische populaties.","abstract_original":"BACKGROUND: Thrombolytic therapy for acute ischemic stroke with a lower-than-standard dose of intravenous alteplase may improve recovery along with a reduced risk of intracerebral hemorrhage. METHODS: Using a 2-by-2 quasi-factorial open-label design, we randomly assigned 3310 patients who were eligible for thrombolytic therapy (median age, 67 years; 63% Asian) to low-dose intravenous alteplase (0.6 mg per kilogram of body weight) or the standard dose (0.9 mg per kilogram); patients underwent randomization within 4.5 hours after the onset of stroke. The primary objective was to determine whether the low dose would be noninferior to the standard dose with respect to the primary outcome of death or disability at 90 days, which was defined by scores of 2 to 6 on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]). Secondary objectives were to determine whether the low dose would be superior to the standard dose with respect to centrally adjudicated symptomatic intracerebral hemorrhage and whether the low dose would be noninferior in an ordinal analysis of modified Rankin scale scores (testing for an improvement in the distribution of scores). The trial included 935 patients who were also randomly assigned to intensive or guideline-recommended blood-pressure control. RESULTS: The primary outcome occurred in 855 of 1607 participants (53.2%) in the low-dose group and in 817 of 1599 participants (51.1%) in the standard-dose group (odds ratio, 1.09; 95% confidence interval [CI], 0.95 to 1.25; the upper boundary exceeded the noninferiority margin of 1.14; P=0.51 for noninferiority). Low-dose alteplase was noninferior in the ordinal analysis of modified Rankin scale scores (unadjusted common odds ratio, 1.00; 95% CI, 0.89 to 1.13; P=0.04 for noninferiority). Major symptomatic intracerebral hemorrhage occurred in 1.0% of the participants in the low-dose group and in 2.1% of the participants in the standard-dose group (P=0.01); fatal events occurred within 7 days in 0.5% and 1.5%, respectively (P=0.01). Mortality at 90 days did not differ significantly between the two groups (8.5% and 10.3%, respectively; P=0.07). CONCLUSIONS: This trial involving predominantly Asian patients with acute ischemic stroke did not show the noninferiority of low-dose alteplase to standard-dose alteplase with respect to death and disability at 90 days. There were significantly fewer symptomatic intracerebral hemorrhages with low-dose alteplase. (Funded by the National Health and Medical Research Council of Australia and others; ENCHANTED ClinicalTrials.gov number, NCT01422616.)."},{"id":"cc3d1110bbf8","type":"article","url":"https://hartvaat.nl/2016/06/14/vroege-intraveneuze-betablokkade-voor-primaire-pci-bij-stemi/","title":"Vroege intraveneuze bètablokkade vóór primaire PCI bij STEMI","title_en":"Early Intravenous Beta-Blockers in Patients With ST-Segment Elevation Myocardial Infarction Before Primary Percutaneous Coronary Intervention.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["ouderen","stemi"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.03.522","source_url":"https://doi.org/10.1016/j.jacc.2016.03.522","authors":["Vincent Roolvink","Borja Ibáñez","Jan Paul Ottervanger","Gonzalo Pizarro","Niels van Royen","Alonso Mateos","Jan-Henk E Dambrink","Noemi Escalera","Erik Lipsic","Agustín Albarran","Antonio Fernández-Ortiz","Francisco Fernández-Avilés","Javier Goicolea","Javier Botas","Wouter Remkes","Victoria Hernandez-Jaras","Elvin Kedhi","José L Zamorano","Felipe Navarro","Fernando Alfonso","Alberto García-Lledó","Joaquin Alonso","Maarten van Leeuwen","Robin Nijveldt","Sonja Postma","Evelien Kolkman","Marcel Gosselink","Bart de Smet","Saman Rasoul","Jan J Piek","Valentin Fuster","Arnoud W J van 't Hof"],"significance":6,"published":"2016-06-14","source_date":"2016-06-14","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This study evaluated the impact of early intravenous beta-blockers administered before primary PCI in STEMI on infarct size and clinical outcomes, contributing data on the timing of beta-blocker therapy in the reperfusion era.","created":"2026-07-03T10:26:10Z","updated":"2026-07-03T13:25:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar het effect van vroege intraveneuze bètablokkers vóór primaire PCI bij STEMI op infarctgrootte en klinische uitkomsten. Onderzoekt de timing van bètablokkade in de acute fase.","abstract_original":"BACKGROUND: The impact of intravenous (IV) beta-blockers before primary percutaneous coronary intervention (PPCI) on infarct size and clinical outcomes is not well established. OBJECTIVES: This study sought to conduct the first double-blind, placebo-controlled international multicenter study testing the effect of early IV beta-blockers before PPCI in a general ST-segment elevation myocardial infarction (STEMI) population. METHODS: STEMI patients presenting <12 h from symptom onset in Killip class I to II without atrioventricular block were randomized 1:1 to IV metoprolol (2 × 5-mg bolus) or matched placebo before PPCI. Primary endpoint was myocardial infarct size as assessed by cardiac magnetic resonance imaging (CMR) at 30 days. Secondary endpoints were enzymatic infarct size and incidence of ventricular arrhythmias. Safety endpoints included symptomatic bradycardia, symptomatic hypotension, and cardiogenic shock. RESULTS: A total of 683 patients (mean age 62 ± 12 years; 75% male) were randomized to metoprolol (n = 336) or placebo (n = 346). CMR was performed in 342 patients (54.8%). Infarct size (percent of left ventricle [LV]) by CMR did not differ between the metoprolol (15.3 ± 11.0%) and placebo groups (14.9 ± 11.5%; p = 0.616). Peak and area under the creatine kinase curve did not differ between both groups. LV ejection fraction by CMR was 51.0 ± 10.9% in the metoprolol group and 51.6 ± 10.8% in the placebo group (p = 0.68). The incidence of malignant arrhythmias was 3.6% in the metoprolol group versus 6.9% in placebo (p = 0.050). The incidence of adverse events was not different between groups. CONCLUSIONS: In a nonrestricted STEMI population, early intravenous metoprolol before PPCI was not associated with a reduction in infarct size. Metoprolol reduced the incidence of malignant arrhythmias in the acute phase and was not associated with an increase in adverse events. (Early-Beta blocker Administration before reperfusion primary PCI in patients with ST-elevation Myocardial Infarction [EARLY-BAMI]; EudraCT no: 2010-023394-19)."},{"id":"853582883bfc","type":"article","url":"https://hartvaat.nl/2016/06/14/ticagrelor-ter-preventie-van-ischemische-events-bij-mi-patienten-met-perifeer-va/","title":"Ticagrelor ter preventie van ischemische events bij MI-patiënten met perifeer vaatlijden","title_en":"Ticagrelor for Prevention of Ischemic Events After Myocardial Infarction in Patients With Peripheral Artery Disease.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["perifeer-vaatlijden","secundaire-preventie","stride-trial"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.03.524","source_url":"https://doi.org/10.1016/j.jacc.2016.03.524","authors":["Marc P Bonaca","Deepak L Bhatt","Robert F Storey","Ph Gabriel Steg","Marc Cohen","Julia Kuder","Erica Goodrich","José C Nicolau","Alexander Parkhomenko","José López-Sendón","Mikael Dellborg","Anthony Dalby","Jindřich Špinar","Philip Aylward","Ramón Corbalán","Maria Teresa B Abola","Eva C Jensen","Peter Held","Eugene Braunwald","Marc S Sabatine"],"significance":6,"published":"2016-06-14","source_date":"2016-06-14","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"This PEGASUS-TIMI 54 analysis in patients with prior MI and peripheral artery disease showed that ticagrelor provides significant ischemic risk reduction in this high-risk dual-vascular-disease population.","created":"2026-07-03T10:26:10Z","updated":"2026-07-03T13:25:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"PEGASUS-TIMI 54-analyse bij patiënten met eerder MI en perifeer arterieel vaatlijden — een hoog-risicopopulatie met verhoogde ischemische events. Onderzoekt de absolute voordelen van langetermijn ticagrelor.","abstract_original":"BACKGROUND: Peripheral artery disease (PAD) is associated with heightened ischemic and bleeding risk in patients with prior myocardial infarction (MI). OBJECTIVES: This study evaluated the efficacy and safety of ticagrelor on major cardiovascular (CV) events and major adverse limb events in patients with PAD and a prior MI. METHODS: PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis In Myocardial Infarction 54) randomized 21,162 patients with prior MI (1 to 3 years) to ticagrelor 90 mg twice daily, ticagrelor 60 mg twice daily, or placebo, all on a background of low-dose aspirin. History of PAD was obtained at baseline. Occurrences of major adverse cardiovascular events (MACE) (defined as CV death, MI, or stroke) and major adverse limb events (MALE) (defined as acute limb ischemia or peripheral revascularization for ischemia) were recorded in follow-up. RESULTS: A total of 1,143 patients (5%) had known PAD. In the placebo arm, those with PAD (n = 404) had higher rates of MACE at 3 years than those without (n = 6,663; 19.3% vs. 8.4%; p < 0.001), which persisted after adjusting for baseline differences (adjusted hazard ratio: 1.60; 95% confidence interval: 1.20 to 2.13; p = 0.0013), and higher rates of acute limb ischemia (1.0% vs. 0.1%) and peripheral revascularization procedures (9.15% vs. 0.46%). Whereas the relative risk reduction in MACE with ticagrelor was consistent, regardless of PAD, patients with PAD had a greater absolute risk reduction of 4.1% (number needed to treat: 25) due to their higher absolute risk. The absolute excess of TIMI major bleeding was 0.12% (number needed to harm: 834). The 60-mg dose had particularly favorable outcomes for CV and all-cause mortality. Ticagrelor (pooled doses) reduced the risk of MALE (hazard ratio: 0.65; 95% confidence interval: 0.44 to 0.95; p = 0.026). CONCLUSIONS: Among stable patients with prior MI, those with concomitant PAD have heightened ischemic risk. In these patients, ticagrelor reduced MACE, with a large absolute risk reduction, and MALE. (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin [PEGASUS-TIMI 54]; NCT01225562)."},{"id":"049fba1f7943","type":"article","url":"https://hartvaat.nl/2016/06/14/reductie-van-ischemische-events-met-ticagrelor-bij-diabetes-na-myocardinfarct-pe/","title":"Reductie van ischemische events met ticagrelor bij diabetes na myocardinfarct: PEGASUS-TIMI 54","title_en":"Reduction in Ischemic Events With Ticagrelor in Diabetic Patients With Prior Myocardial Infarction in PEGASUS-TIMI 54.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["diabetes-en-hart","diabetes-type-2"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.03.529","source_url":"https://doi.org/10.1016/j.jacc.2016.03.529","authors":["Deepak L Bhatt","Marc P Bonaca","Sameer Bansilal","Dominick J Angiolillo","Marc Cohen","Robert F Storey","Kyungah Im","Sabina A Murphy","Peter Held","Eugene Braunwald","Marc S Sabatine","Ph Gabriel Steg"],"significance":7,"published":"2016-06-14","source_date":"2016-06-14","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/cardiovasculair-risico-begrippen/"],"congress":"","summary_en":"This PEGASUS-TIMI 54 subanalysis showed that ticagrelor added to aspirin provides particular benefit in diabetic patients with prior MI, with a greater absolute reduction in ischemic events reflecting their higher baseline risk.","created":"2026-07-03T10:26:10Z","updated":"2026-07-03T13:25:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse van PEGASUS-TIMI 54 naar het voordeel van ticagrelor bij diabetespatiënten met een eerder myocardinfarct. Diabetes versterkt het ischemisch risico en de absolute risicoreductie met ticagrelor.","abstract_original":"BACKGROUND: Patients with diabetes appear to be at elevated risk of atherothrombotic events. OBJECTIVES: The purpose of this study was to determine the effect of antiplatelet therapy with ticagrelor on recurrent ischemic events in patients with diabetes and prior myocardial infarction (MI). METHODS: We examined the subgroups of patients with diabetes (n = 6,806) and without diabetes (n = 14,355) from PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis In Myocardial Infarction 54), in which 21,162 patients with a history of MI 1 to 3 years prior and with additional risk factors were randomized to ticagrelor (90 or 60 mg twice daily) or placebo. Patients were followed for a median of 33 months. The primary efficacy endpoint was major adverse cardiovascular events (MACE) (cardiovascular death, MI, stroke) and the primary safety endpoint was TIMI (Thrombolysis In Myocardial Infarction) major bleeding. RESULTS: The relative risk reduction in MACE with ticagrelor was consistent for the pooled doses versus placebo in patients with diabetes (hazard ratio [HR]: 0.84; 95% confidence interval [CI]: 0.72 to 0.99; p = 0.035) and without diabetes (HR: 0.84; 95% CI: 0.74 to 0.96; p = 0.013; p interaction = 0.99). As patients with diabetes were at higher risk of MACE, the absolute risk reduction tended to be greater in patients with versus without diabetes (1.5% vs. 1.1%, with corresponding 3-year number needed to treat of 67 vs. 91). In patients with diabetes requiring pharmacological therapy (n = 5,960), the absolute risk reduction was 1.9% with a 3-year number needed to treat of 53. Additionally, in patients with diabetes, ticagrelor reduced cardiovascular death by 22% and coronary heart disease death by 34%. Similar to patients without diabetes, there was increased TIMI major bleeding in patients with diabetes (HR: 2.56; 95% CI: 1.52 to 4.33; p = 0.0004). CONCLUSIONS: In patients with diabetes with prior MI, adding ticagrelor to aspirin significantly reduces the risk of recurrent ischemic events, including cardiovascular and coronary heart disease death. (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin [PEGASUS]; NCT01225562)."},{"id":"47905335cb19","type":"article","url":"https://hartvaat.nl/2016/06/11/ixmyelocel-t-bij-ischemisch-hartfalen-lancet-dubbelblinde-gerandomiseerde-trial/","title":"Ixmyelocel-T bij ischemisch hartfalen: Lancet dubbelblinde gerandomiseerde trial","title_en":"Ixmyelocel-T for patients with ischaemic heart failure: a prospective randomised double-blind trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(16)30137-4","source_url":"https://doi.org/10.1016/S0140-6736(16)30137-4","authors":["Amit N Patel","Timothy D Henry","Arshed A Quyyumi","Gary L Schaer","R David Anderson","Catalin Toma","Cara East","Ann E Remmers","James Goodrich","Akshay S Desai","David Recker","Anthony DeMaria"],"significance":7,"published":"2016-06-11","source_date":"2016-06-11","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This Lancet trial of ixmyelocel-T, an autologous bone marrow-derived cell therapy, in patients with ischemic heart failure explored regenerative medicine as a treatment approach for myocardial repair.","created":"2026-07-03T10:26:10Z","updated":"2026-07-03T13:25:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet gerandomiseerde trial van ixmyelocel-T (autologe celtherapie) bij patiënten met ischemisch hartfalen. Onderzocht de werkzaamheid van een cel-gebaseerde therapie die het myocardiale herstelvermogen beoogt te versterken.","abstract_original":"BACKGROUND: Ixmyelocel-T is an expanded, multicellular therapy produced from a patient's own bone marrow by selectively expanding two key types of bone marrow mononuclear cells: CD90+ mesenchymal stem cells and CD45+ CD14+ auto-fluorescent+ activated macrophages. Early phase clinical trials suggest that intramyocardial delivery of ixmyelocel-T might improve clinical, functional, symptomatic, and quality-of-life outcomes in patients with heart failure due to ischaemic dilated cardiomyopathy. We aimed to assess the safety and efficacy of catheter-based transendocardial injection of ixmyelocel-T cell therapy in patients with heart failure and reduced ejection fractions. METHODS: In this randomised, double-blind, placebo-controlled phase 2B trial (ixCELL-DCM), patients from 31 sites in North America with New York Heart Association class III or IV symptomatic heart failure due to ischaemic dilated cardiomyopathy, who had left ventricular ejection fraction 35% or less, an automatic implantable cardioverter defibrillator, and who were ineligible for revascularisation procedures were randomly assigned (1:1) to receive ixmyelocel-T or placebo at the time of bone marrow aspiration and followed for 12 months. Randomisation was done through an interactive (voice/web) response system. The pharmacist, treating physician, and coordinator at each site were unblinded, but the the follow-up team was completely blinded. The primary endpoint was a composite of all-cause death, cardiovascular admission to hospital, and unplanned clinic visits to treat acute decompensated heart failure based on the blinded adjudication of an independent clinical endpoint committee. Primary efficacy endpoint analyses and safety analyses were done by modified intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01670981. FINDINGS: Between April 2, 2013, and Jan 28, 2015, 126 participants were randomly assigned to receive either ixmyelocel-T (n=66) or placebo (n=60). 114 (90%) patients comprised the modified intention-to-treat population and 109 (87%) patients were included in the per-protocol primary efficacy analysis (58 in the ixmyelocel-T group and 51 in the placebo group). The primary efficacy endpoint was observed in 47 patients: 50 events in 25 (49%) of 51 patients in the placebo group and 38 events in 22 (38%) of 58 patients in the ixmyelocel-T group, which represents a 37% reduction in cardiac events compared with placebo (risk ratio 0·63 [95% CI 0·42-0·97]; p=0·0344). 41 (75%) of 51 participants in the placebo group had serious adverse events versus 31 (53%) of 58 in the ixmyelocel-T group (p=0·0197). INTERPRETATION: To the best of our knowledge, ixCELL-DCM is the largest cell therapy study done in patients with heart failure so far. The transendocardial delivery of ixmyelocel-T in patients with heart failure and reduced ejection fraction due to ischaemic dilated cardiomyopathy resulted in a significant reduction in adjudicated clinical cardiac events compared with placebo leading to improved patient outcomes. FUNDING: Vericel Corporation."},{"id":"a82854742d03","type":"article","url":"https://hartvaat.nl/2016/06/09/cryoballon-versus-radiofrequentieablatie-bij-paroxysmaal-atriumfibrilleren-nejm-/","title":"Cryoballon- versus radiofrequentieablatie bij paroxysmaal atriumfibrilleren: NEJM FIRE AND ICE-trial","title_en":"Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["cryoablatie","pulsed-field-ablatie-atriumfibrilleren"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1602014","source_url":"https://doi.org/10.1056/NEJMoa1602014","authors":["Karl-Heinz Kuck","Josep Brugada","Alexander Fürnkranz","Andreas Metzner","Feifan Ouyang","K R Julian Chun","Arif Elvan","Thomas Arentz","Kurt Bestehorn","Stuart J Pocock","Jean-Paul Albenque","Claudio Tondo"],"significance":9,"published":"2016-06-09","source_date":"2016-06-09","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/katheterablatie-af/","https://hartvaat.nl/kennis/atriumfibrilleren/ecg-herkenning-af/"],"congress":"","summary_en":"The FIRE AND ICE trial demonstrated that cryoballoon ablation was noninferior to radiofrequency ablation for pulmonary vein isolation in patients with drug-refractory paroxysmal atrial fibrillation. The study established cryoablation as an equally effective and potentially simpler alternative for the treatment of paroxysmal AF.","created":"2026-07-03T10:26:10Z","updated":"2026-07-03T13:25:30Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Landmark NEJM-trial die cryoballonablatie vergeleek met radiofrequentieablatie voor pulmonaalvene-isolatie bij paroxysmaal AF. Toonde non-inferioriteit van de cryoballontechniek — bepalend voor de hedendaagse ablatiepraktijk.","abstract_original":"BACKGROUND: Current guidelines recommend pulmonary-vein isolation by means of catheter ablation as treatment for drug-refractory paroxysmal atrial fibrillation. Radiofrequency ablation is the most common method, and cryoballoon ablation is the second most frequently used technology. METHODS: We conducted a multicenter, randomized trial to determine whether cryoballoon ablation was noninferior to radiofrequency ablation in symptomatic patients with drug-refractory paroxysmal atrial fibrillation. The primary efficacy end point in a time-to-event analysis was the first documented clinical failure (recurrence of atrial fibrillation, occurrence of atrial flutter or atrial tachycardia, use of antiarrhythmic drugs, or repeat ablation) following a 90-day period after the index ablation. The noninferiority margin was prespecified as a hazard ratio of 1.43. The primary safety end point was a composite of death, cerebrovascular events, or serious treatment-related adverse events. RESULTS: A total of 762 patients underwent randomization (378 assigned to cryoballoon ablation and 384 assigned to radiofrequency ablation). The mean duration of follow-up was 1.5 years. The primary efficacy end point occurred in 138 patients in the cryoballoon group and in 143 in the radiofrequency group (1-year Kaplan-Meier event rate estimates, 34.6% and 35.9%, respectively; hazard ratio, 0.96; 95% confidence interval [CI], 0.76 to 1.22; P<0.001 for noninferiority). The primary safety end point occurred in 40 patients in the cryoballoon group and in 51 patients in the radiofrequency group (1-year Kaplan-Meier event rate estimates, 10.2% and 12.8%, respectively; hazard ratio, 0.78; 95% CI, 0.52 to 1.18; P=0.24). CONCLUSIONS: In this randomized trial, cryoballoon ablation was noninferior to radiofrequency ablation with respect to efficacy for the treatment of patients with drug-refractory paroxysmal atrial fibrillation, and there was no significant difference between the two methods with regard to overall safety. (Funded by Medtronic; FIRE AND ICE ClinicalTrials.gov number, NCT01490814.)."},{"id":"f02927c43f1a","type":"article","url":"https://hartvaat.nl/2016/06/07/ischemie-en-infarct-bij-stemi-met-multivatenlijden-cvlprit-nucleaire-substudie/","title":"Ischemie en infarct bij STEMI met multivatenlijden: CvLPRIT nucleaire substudie","title_en":"Ischemia and Infarction in STEMI Patients With Multivessel Disease: Insights From the CvLPRIT Nuclear Substudy.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["myocardinfarct"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.03.544","source_url":"https://doi.org/10.1016/j.jacc.2016.03.544","authors":["Andrew D Kelion","Mini V Pakkal","Fahmid U Chowdhury","James D Birchall","Katherine L Dixon","Florence Y Lai","Damian J Kelly","Marcus Flather","Gerry P McCann","Anthony H Gershlick"],"significance":6,"published":"2016-06-07","source_date":"2016-06-07","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This CvLPRIT nuclear imaging substudy characterized the extent of ischemia and infarction in STEMI patients with multivessel disease, informing the discussion about complete revascularization by quantifying the ischemic burden in nonculprit territories.","created":"2026-07-03T10:26:10Z","updated":"2026-07-03T13:25:30Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Nucleaire beeldvormingssubstudie van CvLPRIT die de omvang van ischemie en infarct onderzocht bij STEMI-patiënten met multivatencoronairlijden. Draagt bij aan de discussie over complete versus culprit-only revascularisatie.","abstract_original":""},{"id":"485f827f8a24","type":"article","url":"https://hartvaat.nl/2016/06/07/klinische-verslechtering-van-poliklinisch-behandeld-hartfalen-paradigm-hf-analys/","title":"Klinische verslechtering van poliklinisch behandeld hartfalen: PARADIGM-HF-analyse","title_en":"Importance of Clinical Worsening of Heart Failure Treated in the Outpatient Setting: Evidence From the Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure Trial (PARADIGM-HF).","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","hfmref","hfpef","hfref","nt-probnp","step-hfpef","vrouwen"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.115.020729","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.115.020729","authors":["Naoki Okumura","Pardeep S Jhund","Jianjian Gong","Martin P Lefkowitz","Adel R Rizkala","Jean L Rouleau","Victor C Shi","Karl Swedberg","Michael R Zile","Scott D Solomon","Milton Packer","John J V McMurray"],"significance":7,"published":"2016-06-07","source_date":"2016-06-07","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/arni-farmacologie/","https://hartvaat.nl/kennis/hartfalen/acuut-hartfalen/"],"congress":"","summary_en":"This PARADIGM-HF analysis highlighted the prognostic importance of clinical worsening events managed in the outpatient setting, demonstrating that non-hospitalized heart failure deterioration carries significant risk and should be included in outcome assessment.","created":"2026-07-03T10:26:09Z","updated":"2026-07-03T18:38:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de PARADIGM-HF-trial die het belang van klinische verslechtering onderstreept bij poliklinisch behandelde hartfalenpatiënten. Verslechtering is een sterk ongunstige prognostische marker, ook bij behandeling met sacubitril/valsartan.","abstract_original":"BACKGROUND: Many episodes of worsening of heart failure (HF) are treated by increasing oral therapy or temporary intravenous treatment in the community or emergency department (ED), without hospital admission. We studied the frequency and prognostic importance of these episodes of worsening in the Prospective Comparison of ARNI (angiotensin-receptor-neprilysin inhibitor) with ACEI (angiotensin-converting enzyme inhibitor) to Determine Impact on Global Mortality and Morbidity in Heart Failure Trial (PARADIGM-HF). METHODS AND RESULTS: Outpatient intensification of HF therapy was added to an expanded composite outcome with ED visits, HF hospitalizations, and cardiovascular deaths. In an examination of first nonfatal events, 361 of 8399 patients (4.3%) had outpatient intensification of HF therapy without a subsequent event (ie, ED visit/HF hospitalizations) within 30 days; 78 of 8399 (1.0%) had an ED visit without previous outpatient intensification of HF therapy or a subsequent event within 30 days; and 1107 of 8399 (13.2%) had HF hospitalizations without a preceding event. The risk of death (in comparison with no-event patients) was similar after each manifestation of worsening: outpatient intensification of HF therapy (hazard ratio, 4.8; 95% confidence interval, 3.9-5.9); ED visit (hazard ratio, 4.5; 95% confidence interval, 3.0-6.7); HF hospitalizations (hazard ratio, 5.9; 95% confidence interval, 5.2-6.6). The expanded composite added 14% more events and shortened time to accrual of a fixed number of events. The benefit of sacubitril/valsartan over enalapril was similar to the primary outcome for the expanded composite (hazard ratio, 0.79; 95% confidence interval, 0.73-0.86) and was consistent across the components of the latter. CONCLUSIONS: Focusing only on HF hospitalizations underestimates the frequency of worsening and the serious implications of all manifestations of worsening. For clinical trials conducted in an era of heightened efforts to avoid HF hospitalizations, inclusion of episodes of outpatient treatment intensification (and ED visits) in a composite outcome adds an important number of events and shortens the time taken to accrue a target number of end points in an event-driven trial. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01035255."},{"id":"8cde6143e9f8","type":"article","url":"https://hartvaat.nl/2016/06/07/vitamine-d-bij-chronisch-hartfalen-de-vindicate-studie/","title":"Vitamine D bij chronisch hartfalen: de VINDICATE-studie","title_en":"Effects of Vitamin D on Cardiac Function in Patients With Chronic HF: The VINDICATE Study.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.03.508","source_url":"https://doi.org/10.1016/j.jacc.2016.03.508","authors":["Klaus K Witte","Rowena Byrom","John Gierula","Maria F Paton","Haqeel A Jamil","Judith E Lowry","Richard G Gillott","Sally A Barnes","Hemant Chumun","Lorraine C Kearney","John P Greenwood","Sven Plein","Graham R Law","Sue Pavitt","Julian H Barth","Richard M Cubbon","Mark T Kearney"],"significance":6,"published":"2016-06-07","source_date":"2016-06-07","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"The VINDICATE study showed that vitamin D supplementation improves left ventricular function in patients with chronic heart failure and documented vitamin D deficiency, suggesting a role for vitamin D repletion as an adjunct to standard HF therapy.","created":"2026-07-03T10:26:09Z","updated":"2026-07-03T13:25:30Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde studie naar het effect van vitamine D-suppletie op de hartfunctie bij patiënten met chronisch hartfalen. Onderzocht of correctie van vitamine D-deficiëntie de cardiale structuur en functie verbetert.","abstract_original":"BACKGROUND: Patients with chronic heart failure (HF) secondary to left ventricular systolic dysfunction (LVSD) are frequently deficient in vitamin D. Low vitamin D levels are associated with a worse prognosis. OBJECTIVES: The VINDICATE (VitamIN D treatIng patients with Chronic heArT failurE) study was undertaken to establish safety and efficacy of high-dose 25 (OH) vitamin D3 (cholecalciferol) supplementation in patients with chronic HF due to LVSD. METHODS: We enrolled 229 patients (179 men) with chronic HF due to LVSD and vitamin D deficiency (cholecalciferol <50 nmol/l [<20 ng/ml]). Participants were allocated to 1 year of vitamin D3 supplementation (4,000 IU [100 μg] daily) or matching non-calcium-based placebo. The primary endpoint was change in 6-minute walk distance between baseline and 12 months. Secondary endpoints included change in LV ejection fraction at 1 year, and safety measures of renal function and serum calcium concentration assessed every 3 months. RESULTS: One year of high-dose vitamin D3 supplementation did not improve 6-min walk distance at 1 year, but was associated with a significant improvement in cardiac function (LV ejection fraction +6.07% [95% confidence interval (CI): 3.20 to 8.95; p < 0.0001]); and a reversal of LV remodeling (LV end diastolic diameter -2.49 mm [95% CI: -4.09 to -0.90; p = 0.002] and LV end systolic diameter -2.09 mm [95% CI: -4.11 to -0.06 p = 0.043]). CONCLUSIONS: One year of 100 μg daily vitamin D3 supplementation does not improve 6-min walk distance but has beneficial effects on LV structure and function in patients on contemporary optimal medical therapy. Further studies are necessary to determine whether these translate to improvements in outcomes. (VitamIN D Treating patIents With Chronic heArT failurE [VINDICATE]; NCT01619891)."},{"id":"951a2f47e36b","type":"article","url":"https://hartvaat.nl/2016/06/04/abc-bloedingsscore-bij-atriumfibrilleren-de-nieuwe-biomarkergebaseerde-risicosco/","title":"ABC-bloedingsscore bij atriumfibrilleren: de nieuwe biomarkergebaseerde risicoscore","title_en":"The novel biomarker-based ABC (age, biomarkers, clinical history)-bleeding risk score for patients with atrial fibrillation: a derivation and validation study.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","huisarts"],"tags":["biomarkers-cardiovasculair"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(16)00741-8","source_url":"https://doi.org/10.1016/S0140-6736(16)00741-8","authors":["Ziad Hijazi","Jonas Oldgren","Johan Lindbäck","John H Alexander","Stuart J Connolly","John W Eikelboom","Michael D Ezekowitz","Claes Held","Elaine M Hylek","Renato D Lopes","Agneta Siegbahn","Salim Yusuf","Christopher B Granger","Lars Wallentin"],"significance":8,"published":"2016-06-04","source_date":"2016-06-04","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/hasbled-score/","https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This Lancet study derived and validated the ABC (Age, Biomarkers, Clinical history) bleeding risk score for patients with atrial fibrillation on anticoagulation. The biomarker-based score improved prediction of major bleeding beyond the conventional HAS-BLED score.","created":"2026-07-03T10:26:09Z","updated":"2026-07-03T13:25:30Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet-publicatie met derivatie en validatie van de ABC-bloedingsscore (Age, Biomarkers, Clinical history) bij AF-patiënten. Nieuwe biomarkergebaseerde risicoscore die de bestaande HAS-BLED kan aanvullen.","abstract_original":"BACKGROUND: The benefit of oral anticoagulation in atrial fibrillation is based on a balance between reduction in ischaemic stroke and increase in major bleeding. We aimed to develop and validate a new biomarker-based risk score to improve the prognostication of major bleeding in patients with atrial fibrillation. METHODS: We developed and internally validated a new biomarker-based risk score for major bleeding in 14,537 patients with atrial fibrillation randomised to apixaban versus warfarin in the ARISTOTLE trial and externally validated it in 8468 patients with atrial fibrillation randomised to dabigatran versus warfarin in the RE-LY trial. Plasma samples for determination of candidate biomarker concentrations were obtained at randomisation. Major bleeding events were centrally adjudicated. The predictive values of biomarkers and clinical variables were assessed with Cox regression models. The most important variables were included in the score with weights proportional to the model coefficients. The ARISTOTLE and RE-LY trials are registered with ClinicalTrials.gov, numbers NCT00412984 and NCT00262600, respectively. FINDINGS: The most important predictors for major bleeding were the concentrations of the biomarkers growth differentiation factor-15 (GDF-15), high-sensitivity cardiac troponin T (cTnT-hs) and haemoglobin, age, and previous bleeding. The ABC-bleeding score (age, biomarkers [GDF-15, cTnT-hs, and haemoglobin], and clinical history [previous bleeding]) score yielded a higher c-index than the conventional HAS-BLED and the newer ORBIT scores for major bleeding in both the derivation cohort (0·68 [95% CI 0·66-0·70] vs 0·61 [0·59-0·63] vs 0·65 [0·62-0·67], respectively; ABC-bleeding vs HAS-BLED p<0·0001 and ABC-bleeding vs ORBIT p=0·0008). ABC-bleeding score also yielded a higher c-index score in the the external validation cohort (0·71 [95% CI 0·68-0·73] vs 0·62 [0·59-0·64] for HAS-BLED vs 0·68 [0·65-0·70] for ORBIT; ABC-bleeding vs HAS-BLED p<0·0001 and ABC-bleeding vs ORBIT p=0·0016). A modified ABC-bleeding score using alternative biomarkers (haematocrit, cTnI-hs, cystatin C, or creatinine clearance) also outperformed the HAS-BLED and ORBIT scores. INTERPRETATION: The ABC-bleeding score, using age, history of bleeding, and three biomarkers (haemoglobin, cTn-hs, and GDF-15 or cystatin C/CKD-EPI) was internally and externally validated and calibrated in large cohorts of patients with atrial fibrillation receiving anticoagulation therapy. The ABC-bleeding score performed better than HAS-BLED and ORBIT scores and should be useful as decision support on anticoagulation treatment in patients with atrial fibrillation. FUNDING: BMS, Pfizer, Boehringer Ingelheim, Roche Diagnostics."},{"id":"d1eff9e96ac6","type":"article","url":"https://hartvaat.nl/2016/06/01/familiaire-belasting-en-statine-initiatie-bij-intermediair-cardiovasculair-risic/","title":"Familiaire belasting en statine-initiatie bij intermediair cardiovasculair risico: HOPE-3-analyse","title_en":"Association of a Family History of Coronary Heart Disease With Initiation of Statin Therapy in Individuals at Intermediate Risk: Post Hoc Analysis of a Randomized Clinical Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","ouderen"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2016.0227","source_url":"https://doi.org/10.1001/jamacardio.2016.0227","authors":["Maya S Safarova","Kent R Bailey","Iftikhar J Kullo"],"significance":6,"published":"2016-06-01","source_date":"2016-06-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This HOPE-3 analysis examined the role of family history in the decision to initiate statin therapy in intermediate-risk individuals, exploring whether genetic predisposition modifies the benefit of primary prevention.","created":"2026-07-03T10:26:09Z","updated":"2026-07-03T13:25:30Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology analyse van HOPE-3 naar de rol van familiaire belasting bij de beslissing om statinetherapie te starten bij personen met intermediair risico. Onderzoekt de meerwaarde van familieanamnese voor risicostratificatie.","abstract_original":""},{"id":"4c2d718ab35a","type":"article","url":"https://hartvaat.nl/2016/06/01/pci-bij-insulinebehandelde-versus-niet-insulinebehandelde-diabetes-freedom-trial/","title":"PCI bij insulinebehandelde versus niet-insulinebehandelde diabetes: FREEDOM-trial","title_en":"Percutaneous Coronary Intervention in Patients With Insulin-Treated and Non-Insulin-Treated Diabetes Mellitus: Secondary Analysis of the TUXEDO Trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["diabetes-en-hart","select-trial","soul-trial"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2016.0305","source_url":"https://doi.org/10.1001/jamacardio.2016.0305","authors":["Sripal Bangalore","Ajit Bhagwat","Brian Pinto","Praveen K Goel","Prashant Jagtap","Shireesh Sathe","Priyadarshini Arambam","Upendra Kaul"],"significance":6,"published":"2016-06-01","source_date":"2016-06-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/bloedsuikerdoelen-cardiovasculair/"],"congress":"","summary_en":"This FREEDOM secondary analysis showed that PCI outcomes differ between insulin-treated and non-insulin-treated diabetic patients, with insulin-dependent diabetes conferring particularly high risk and greater relative benefit from CABG.","created":"2026-07-03T10:26:09Z","updated":"2026-07-03T13:25:30Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology secundaire analyse van de FREEDOM-trial naar uitkomsten van PCI bij diabetespatiënten gestratificeerd naar insulinegebruik. Insulinebehandeling als risicomodificator bij revascularisatiebeslissingen.","abstract_original":"IMPORTANCE: Prior studies have shown that patients with insulin-treated diabetes mellitus (ITDM) have a higher risk of cardiovascular events. However, this finding is controversial, as other studies have shown that the increased risk of cardiovascular events disappears after risk adjustment. In addition, the choice of a drug-eluting stent (limus- vs taxol-eluting) in ITDM is controversial, with studies showing worse outcomes with an everolimus-eluting stent compared with a paclitaxel-eluting stent. OBJECTIVES: To assess the outcomes of patients with ITDM vs non-ITDM who underwent percutaneous coronary intervention and to assess the efficacy and safety of an everolimus-eluting stent vs a paclitaxel-eluting stent based on insulin use status. DESIGN, SETTING, AND PARTICIPANTS: A prespecified analysis was conducted of the Taxus Element vs Xience Prime in a Diabetic Population (TUXEDO) clinical trial, which enrolled 1830 patients with ITDM and non-ITDM from June 23, 2011, to March 12, 2014. Patients were randomized 1:1 to receive either a paclitaxel-eluting stent or an everolimus-eluting stent. MAIN OUTCOMES AND MEASURES: The primary end point was target vessel failure, defined as the composite of cardiac death, target vessel myocardial infarction, or ischemia-driven target vessel revascularization at 1 year after the intervention. RESULTS: Among the 1830 patients (1377 male) in the TUXEDO trial, 747 patients (40.8%) were receiving insulin (ITDM group). Compared with the 1083 patients with non-ITDM, those with ITDM had a significant increase in target vessel failure (42 [5.6%] vs 36 [3.3%]; P = .02), death or myocardial infarction (43 [5.8%] vs 35 [3.2%]; P = .009), death (26 [3.5%] vs 18 [1.7%]; P = .01), and subacute stent thrombosis (8 [1.1%] vs 3 [0.3%]; P = .03). However, in a propensity score-adjusted analysis to account for baseline differences between the 2 groups, the differences in outcomes were no longer significant. In patients with ITDM, everolimus-eluting stents reduced the rate of target vessel failure (13 of 382 [3.4%] vs 29 of 365 [7.9%]; P = .007), major adverse cardiac events (15 of 382 [3.9%] vs 30 of 365 [8.2%]; P = .01), myocardial infarction (5 of 382 [1.3%] vs 16 of 365 [4.4%]; P = .01), stent thrombosis (2 of 382 [0.5%] vs 11 of 365 [3.0%]; P = .009), target lesion revascularization (4 of 382 [1.0%] vs 19 of 365 [5.2%]; P = .001), and target vessel revascularization (4 of 382 [1.0%] vs 19 of 365 [5.2%]; P = .001) when compared with paclitaxel-eluting stents. The results largely trended in the same direction in patients with non-ITDM (P > .05 for the interaction). CONCLUSIONS AND RELEVANCE: Patients with ITDM had a significant increase in the risk of cardiovascular events in unadjusted models that was largely attenuated after propensity score adjustment. Everolimus-eluting stents reduced the rate of cardiovascular events, including stent thrombosis, when compared with paclitaxel-eluting stents in patients with ITDM. TRIAL REGISTRATION: ctri.nic.in Identifier: CTRI/2011/06/001830."},{"id":"ce264f25924c","type":"article","url":"https://hartvaat.nl/2016/06/01/preventie-van-cardiale-disfunctie-bij-borstkankerbehandeling-de-prada-trial/","title":"Preventie van cardiale disfunctie bij borstkankerbehandeling: de PRADA-trial","title_en":"Prevention of cardiac dysfunction during adjuvant breast cancer therapy (PRADA): a 2 × 2 factorial, randomized, placebo-controlled, double-blind clinical trial of candesartan and metoprolol.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","answer-hf","aspirine","bloeddrukbehandeling","bradycardie","colchicine","figaro-dkd","obesitas","pathfinder-trial","primaire-preventie","secundaire-preventie","select-trial","slaapapneu","soul-trial","step-hfpef"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw022","source_url":"https://doi.org/10.1093/eurheartj/ehw022","authors":["Geeta Gulati","Siri Lagethon Heck","Anne Hansen Ree","Pavel Hoffmann","Jeanette Schulz-Menger","Morten W Fagerland","Berit Gravdehaug","Florian von Knobelsdorff-Brenkenhoff","Åse Bratland","Tryggve H Storås","Tor-Arne Hagve","Helge Røsjø","Kjetil Steine","Jürgen Geisler","Torbjørn Omland"],"significance":7,"published":"2016-06-01","source_date":"2016-06-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"The PRADA 2×2 factorial trial investigated cardioprotective strategies (candesartan and metoprolol) during adjuvant breast cancer therapy with anthracyclines and trastuzumab, exploring pharmacological prevention of cancer treatment-related cardiotoxicity.","created":"2026-07-03T10:26:09Z","updated":"2026-07-03T13:25:30Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde 2×2 factoriële placebogecontroleerde PRADA-trial die cardioprotectieve strategieën onderzocht tijdens adjuvante borstkankerbehandeling. Pionierswerk in cardio-oncologische preventie.","abstract_original":"AIMS: Contemporary adjuvant treatment for early breast cancer is associated with improved survival but at the cost of increased risk of cardiotoxicity and cardiac dysfunction. We tested the hypothesis that concomitant therapy with the angiotensin receptor blocker candesartan or the β-blocker metoprolol will alleviate the decline in left ventricular ejection fraction (LVEF) associated with adjuvant, anthracycline-containing regimens with or without trastuzumab and radiation. METHODS AND RESULTS: In a 2 × 2 factorial, randomized, placebo-controlled, double-blind trial, we assigned 130 adult women with early breast cancer and no serious co-morbidity to the angiotensin receptor blocker candesartan cilexetil, the β-blocker metoprolol succinate, or matching placebos in parallel with adjuvant anticancer therapy. The primary outcome measure was change in LVEF by cardiac magnetic resonance imaging. A priori, a change of 5 percentage points was considered clinically important. There was no interaction between candesartan and metoprolol treatments (P = 0.530). The overall decline in LVEF was 2.6 (95% CI 1.5, 3.8) percentage points in the placebo group and 0.8 (95% CI -0.4, 1.9) in the candesartan group in the intention-to-treat analysis (P-value for between-group difference: 0.026). No effect of metoprolol on the overall decline in LVEF was observed. CONCLUSION: In patients treated for early breast cancer with adjuvant anthracycline-containing regimens with or without trastuzumab and radiation, concomitant treatment with candesartan provides protection against early decline in global left ventricular function."},{"id":"1e330f23431e","type":"article","url":"https://hartvaat.nl/2016/06/01/herhaalde-intracoronaire-beenmergcelinjectie-bij-hartfalen-resultaten-uit-een-re/","title":"Herhaalde intracoronaire beenmergcelinjectie bij hartfalen: resultaten uit een register","title_en":"Improved outcome with repeated intracoronary injection of bone marrow-derived cells within a registry: rationale for the randomized outcome trial REPEAT.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","hfref","ijzersuppletie","ivabradine"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehv559","source_url":"https://doi.org/10.1093/eurheartj/ehv559","authors":["Birgit Assmus","Samer Alakmeh","Salvatore De Rosa","Halvard Bönig","Eva Hermann","Wayne C Levy","Stefanie Dimmeler","Andreas M Zeiher"],"significance":5,"published":"2016-06-01","source_date":"2016-06-01","image":"","kennis":[],"congress":"","summary_en":"This registry analysis suggested that repeated intracoronary bone marrow cell injections improve outcomes in post-infarction heart failure, providing the rationale for a dose-escalation approach to cardiac regenerative therapy.","created":"2026-07-03T10:26:09Z","updated":"2026-07-03T18:38:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Registeranalyse die verbeterde uitkomsten toont bij herhaalde intracoronaire beenmergcelinjecties bij hartfalen. Biedt rationale voor de gerandomiseerde REPEAT-trial.","abstract_original":"AIMS: Regenerative therapies have evolved as a promising new option in the treatment of post-infarction heart failure. A major limitation of intracoronary application of autologous bone marrow-derived mononuclear cells (BM-MNCs) is that homing of the applied cells is profoundly reduced in patients with post-infarction heart failure compared with patients with acute myocardial infarction. However, early pilot and also randomized controlled trials have demonstrated significant improvements in overall cardiac function. The aim of the present analysis was to quantify a potential mortality risk reduction and reduced hospitalization in order to provide data for a prospective outcome trial. METHODS AND RESULTS: The results of an ongoing single-centre registry including 297 post-infarction heart failure patients suggest that repeated intracoronary application of autologous bone marrow-derived cells is associated with a significant better 2-year survival compared with a single BM-MNC application (2-year survival 93.6 vs. 84.0%, P = 0.03). Likewise, mortality is significantly lower at 2-year follow-up compared with the mortality estimated by the use of the Seattle Heart Failure Model (SHFM) in patients receiving repeated BM-MNC application (observed mortality 6.4%, predicted mortality 16.2%, P = 0.02). Although the trend persisted at 3-year follow-up, the mortality reduction was no longer statistically significant between single and repeated treatment (mortality 21.9 vs. 13.7%, P = 0.06). CONCLUSION: Repeated intracoronary administration of BM-MNC appears to be associated with improved clinical outcome compared with single treatment at 2 years. This registry provides the rationale for the design of the multicentre randomized, controlled, open-label REPEAT trial, which prospectively compares the effects of single vs. repeated intracoronary application of autologous BM-MNC on total and SHFM-predicted mortality in patients with chronic post-infarction heart failure."},{"id":"ae6fd1c0fe63","type":"article","url":"https://hartvaat.nl/2016/06/01/matige-zoutreductie-verlaagt-bloeddruk-en-albuminurie-bij-gestoorde-glucosetoler/","title":"Matige zoutreductie verlaagt bloeddruk en albuminurie bij gestoorde glucosetolerantie en diabetes type 2","title_en":"Modest Salt Reduction Lowers Blood Pressure and Albumin Excretion in Impaired Glucose Tolerance and Type 2 Diabetes Mellitus: A Randomized Double-Blind Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","canagliflozine","chronische-nierziekte","diabetes-en-hart","diabetes-type-2","ezetimibe","figaro-dkd","select-trial","soul-trial"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.115.06637","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.115.06637","authors":["Rebecca J Suckling","Feng J He","Nirmala D Markandu","Graham A MacGregor"],"significance":6,"published":"2016-06-01","source_date":"2016-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/"],"congress":"","summary_en":"This randomized trial demonstrated that modest salt restriction lowers blood pressure and urinary albumin excretion in patients with impaired glucose tolerance and type 2 diabetes, supporting dietary sodium reduction in the diabetic population.","created":"2026-07-03T10:26:09Z","updated":"2026-07-03T18:38:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial die aantoont dat bescheiden zoutbeperking de bloeddruk en albumine-excretie verlaagt bij patiënten met gestoorde glucosetolerantie of diabetes type 2. Niet-farmacologische interventie met dubbel cardiovasculair en renaal voordeel.","abstract_original":"The role of salt restriction in patients with impaired glucose tolerance and diabetes mellitus is controversial, with a lack of well controlled, longer term, modest salt reduction trials in this group of patients, in spite of the marked increase in cardiovascular risk. We carried out a 12-week randomized double-blind, crossover trial of salt restriction with salt or placebo tablets, each for 6 weeks, in 46 individuals with diet-controlled type 2 diabetes mellitus or impaired glucose tolerance and untreated normal or high normal blood pressure (BP). From salt to placebo, 24-hour urinary sodium was reduced by 49±9 mmol (2.9 g salt). This reduction in salt intake led to fall in clinic BP from 136/81±2/1 mm Hg to 131/80±2/1 mm Hg, (systolic BP; P<0.01). Mean ambulatory 24-hour BP was reduced by 3/2±1/1 mm Hg (systolic BP, P<0.01 and diastolic BP, P<0.05), and albumin/creatinine ratio was reduced from 0.73 mg/mmol (0.5-1.5) to 0.64 mg/mmol (0.3-1.1; P<0.05). There was no significant change in fasting glucose, hemoglobin A1c, or insulin sensitivity. These results demonstrate that a modest reduction in salt intake, to approximately the amount recommended in public health guidelines, leads to significant and clinically relevant falls in BP in individuals who are early on in the progression of diabetes mellitus with normal or mildly raised BP. The reduction in urinary albumin excretion may carry additional benefits in reducing cardiovascular disease above the effects on BP."},{"id":"9f56df8b6471","type":"article","url":"https://hartvaat.nl/2016/06/01/chronische-nebivololbehandeling-onderdrukt-endotheline-1-gemedieerde-vasoconstri/","title":"Chronische nebivololbehandeling onderdrukt endotheline-1-gemedieerde vasoconstrictie bij verhoogde bloeddruk","title_en":"Chronic Nebivolol Treatment Suppresses Endothelin-1-Mediated Vasoconstrictor Tone in Adults With Elevated Blood Pressure.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["anemie-ckd","aprocitentan","bloeddrukbehandeling","chronische-nierziekte","diuretica","dubbele-trombocytenremming","endotheel","endothelineantagonisten","nt-probnp","rosuvastatine","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.115.06979","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.115.06979","authors":["Kyle J Diehl","Brian L Stauffer","Caitlin A Dow","Tyler D Bammert","Danielle L Brunjes","Jared J Greiner","Christopher A DeSouza"],"significance":5,"published":"2016-06-01","source_date":"2016-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/preventie/preventie-bij-ckd/"],"congress":"","summary_en":"This study showed that chronic nebivolol treatment suppresses endothelin-1-mediated vasoconstriction in adults with elevated blood pressure, characterizing a vasodilatory mechanism specific to this third-generation beta-blocker.","created":"2026-07-03T10:26:09Z","updated":"2026-07-03T18:38:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die aantoont dat chronische nebivololbehandeling de endotheline-1-gemedieerde vasoconstrictortonus onderdrukt bij volwassenen met verhoogde bloeddruk. Mechanistisch inzicht in de vasodilaterende eigenschappen van nebivolol.","abstract_original":"UNLABELLED: Endothelin-1 (ET-1) plays a major role in the pathophysiology of hypertension and its associated cardiovascular risk. We tested the hypothesis that chronic nebivolol treatment reduces ET-1-mediated vasoconstrictor tone in adult humans with elevated blood pressure (BP). Furthermore, reducing ET-1 vasoconstrictor activity contributes to the improvement in endothelial vasodilator function associated with nebivolol treatment. Forty-two middle-aged adults with elevated BP (systolic BP ≥130 mm Hg or diastolic BP ≥85 mm Hg) completed a 3-month, double-blind, randomized, placebo controlled trial: 14 received nebivolol (8 men/6 women; 5 mg per day); 14 received metoprolol succinate (9 men/5 women; 100 mg per day); and 14 received placebo (9 men/5 women). Forearm blood flow (plethysmography) responses to selective (BQ-123: 100 nmol/min; 60 minutes) and nonselective (BQ-123+BQ-788 [50 nmol/min]; 60 minutes) ET-1 receptor blockade, as well as acetylcholine (4.0, 8.0, and 16.0 μg per 100 mL of tissue per minute) in the absence and presence of nonselective ET-1 receptor blockade were determined before and after each treatment intervention. Forearm blood flow responses to BQ-123 and BQ-123+BQ-788 were similarly and significantly elevated (≈30% and 60%, respectively) from baseline in all 3 groups. Nebivolol, but not metoprolol or placebo, therapy resulted in a marked (≈25% and 45%; P<0.05) reduction in forearm blood flow response to BQ-123 and BQ-123+BQ-788. Moreover, after nebivolol therapy only, vasodilator response to acetylcholine was not significantly increased by ET-1 receptor blockade. These results demonstrate that nebivolol, but not metoprolol, treatment reduces ET-1-mediated vasoconstrictor tone in adult humans with elevated BP. In addition, nebivolol-induced reduction in ET-1-mediated vasoconstrictor tone underlies the favorable effects of this β-blocker on endothelial vasodilation. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01395329."},{"id":"964f77456252","type":"article","url":"https://hartvaat.nl/2016/06/01/selectieve-hartfrequentieverlaging-met-ivabradine-verhoogt-centrale-bloeddruk-bi/","title":"Selectieve hartfrequentieverlaging met ivabradine verhoogt centrale bloeddruk bij stabiel coronairlijden","title_en":"Selective Heart Rate Reduction With Ivabradine Increases Central Blood Pressure in Stable Coronary Artery Disease.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog"],"tags":["aficamten","bloeddrukbehandeling","hfpef","hfref","ivabradine","stabiel-coronairlijden"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.07250","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.07250","authors":["Stefano F Rimoldi","Franz H Messerli","David Cerny","Steffen Gloekler","Tobias Traupe","Stéphane Laurent","Christian Seiler"],"significance":6,"published":"2016-06-01","source_date":"2016-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/witte-jas-hypertensie/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/"],"congress":"","summary_en":"This study showed that ivabradine paradoxically increases central blood pressure despite reducing heart rate in patients with stable coronary disease, raising questions about the hemodynamic consequences of selective heart rate reduction.","created":"2026-07-03T10:26:08Z","updated":"2026-07-03T13:25:29Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die aantoonde dat ivabradine de centrale bloeddruk verhoogt bij stabiel coronairlijden, in tegenstelling tot de verwachte gunstige hemodynamische effecten. Klinisch relevante bevinding voor het ivabradinebeleid.","abstract_original":"Heart rate (HR) lowering by β-blockade was shown to be beneficial after myocardial infarction. In contrast, HR lowering with ivabradine was found to confer no benefits in 2 prospective randomized trials in patients with coronary artery disease. We hypothesized that this inefficacy could be in part related to ivabradine's effect on central (aortic) pressure. Our study included 46 patients with chronic stable coronary artery disease who were randomly allocated to placebo (n=23) or ivabradine (n=23) in a single-blinded fashion for 6 months. Concomitant baseline medication was continued unchanged throughout the study except for β-blockers, which were stopped during the study period. Central blood pressure and stroke volume were measured directly by left heart catheterization at baseline and after 6 months. For the determination of resting HR at baseline and at follow-up, 24-hour ECG monitoring was performed. Patients on ivabradine showed an increase of 11 mm Hg in central systolic pressure from 129±22 mm Hg to 140±26 mm Hg (P=0.02) and in stroke volume by 86±21.8 to 107.2±30.0 mL (P=0.002). In the placebo group, central systolic pressure and stroke volume remained unchanged. Estimates of myocardial oxygen consumption (HR×systolic pressure and time-tension index) remained unchanged with ivabradine.The decrease in HR from baseline to follow-up correlated with the concomitant increase in central systolic pressure (r=-0.41, P=0.009) and in stroke volume (r=-0.61, P<0.001). In conclusion, the decrease in HR with ivabradine was associated with an increase in central systolic pressure, which may have antagonized possible benefits of HR lowering in coronary artery disease patients. CLINICAL TRIALSURL: http://www.clinicaltrials.gov. Unique identifier NCT01039389."},{"id":"f66abff57310","type":"article","url":"https://hartvaat.nl/2016/06/01/langetermijneffecten-van-atorvastatine-bij-diabetes-type-2-op-hemodialyse-4d-tri/","title":"Langetermijneffecten van atorvastatine bij diabetes type 2 op hemodialyse: 4D-trial follow-up","title_en":"Long-term effects following 4 years of randomized treatment with atorvastatin in patients with type 2 diabetes mellitus on hemodialysis.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["fidelio-dkd","figaro-dkd","soul-trial","statines"],"journal":"Kidney international","doi":"10.1016/j.kint.2015.12.033","source_url":"https://doi.org/10.1016/j.kint.2015.12.033","authors":["Vera Krane","Kay-Renke Schmidt","Lena J Gutjahr-Lengsfeld","Johannes F E Mann","Winfried März","Florian Swoboda","Christoph Wanner"],"significance":6,"published":"2016-06-01","source_date":"2016-06-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This long-term follow-up of the 4D trial showed no delayed cardiovascular benefit of atorvastatin in diabetic hemodialysis patients, contributing to the evidence that statin therapy has limited efficacy in the end-stage kidney disease population.","created":"2026-07-03T10:26:08Z","updated":"2026-07-03T13:25:29Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Langetermijnfollow-up van de 4D-trial naar het effect van atorvastatine bij diabetespatiënten op hemodialyse. Relevant voor de discussie over de rol van statines bij eindstadium nierziekte met diabetes.","abstract_original":"The 4D (Die Deutsche Diabetes Dialyse) Study was a randomized, double-blind trial comparing 4 years of treatment with atorvastatin to placebo in 1255 hemodialysis patients with type 2 diabetes. The primary end point of cardiovascular events (cardiac death, myocardial infarction, and stroke) was non-significantly reduced by 8%. However, long-term effects remained uncertain. Therefore, surviving patients were invited to a follow-up survey done by questionnaire. Post-trial statin therapy was at nephrologist discretion, and outcomes were centrally adjudicated and analyzed by intention to treat and time to first event in the original treatment groups. Median overall follow-up was 11.5 years. Post-trial statin use and low-density lipoprotein cholesterol levels did not differ between groups. Statin treatment non-significantly affected the former primary outcome (relative risk, 0.91; 95% confidence interval, 0.78-1.07). The risk of all cardiac events combined and the risk of cardiac death were significantly lower in the original statin group compared to placebo (0.83, 0.70-0.97, and 0.80, 0.66-0.97). No significant effect was detected on cerebrovascular events, fatal stroke, fatal cancer, non-vascular, or all-cause death. No rhabdomyolysis was reported. Thus, after 4 years of atorvastatin treatment in diabetic hemodialysis patients, similar effects on outcomes were found after 11.5 years of follow-up as were found at the end of the original study. There was no evidence of emerging hazards in the long term, confirming current clinical practice guidelines."},{"id":"ef0c3a7fec92","type":"article","url":"https://hartvaat.nl/2016/06/01/crt-super-responders-met-en-zonder-pacing-middellangetermijnresultaten/","title":"CRT super-responders met en zonder pacing: middellangetermijnresultaten","title_en":"Mid-term clinical and echocardiographic evaluation of super responders with and without pacing: the preliminary results of a prospective, randomized, single-centre study.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["cardiale-resynchronisatie","supraventriculaire-tachycardie"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euv129","source_url":"https://doi.org/10.1093/europace/euv129","authors":["Serkan Cay","Ozcan Ozeke","Firat Ozcan","Dursun Aras","Serkan Topaloglu"],"significance":5,"published":"2016-06-01","source_date":"2016-06-01","image":"","kennis":[],"congress":"","summary_en":"This preliminary study evaluated CRT super-responders with and without continued pacing, investigating whether patients who achieve near-normal LV function can safely reduce pacing dependency.","created":"2026-07-03T10:26:08Z","updated":"2026-07-03T13:25:29Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Preliminaire resultaten van een prospectieve studie naar CRT super-responders — patiënten met substantiële verbetering van de LV-functie. Onderzocht of pacing veilig gestopt kan worden bij deze groep.","abstract_original":"AIMS: Super response to cardiac resynchronization therapy (CRT) is related to excellent long-term prognosis. However, it is not known whether super responders (SRs) are in remission or have made a complete recovery. In other words, is CRT a destination therapy or a bridge to recovery? The objective was to assess the evolution of the clinical and echocardiographic data of SRs without pacemaker activity at the mid-term follow-up. METHODS AND RESULTS: A total of 19 SRs were randomly assigned to a deactivated pacemaker function (Off-Pace group) or a continued pacemaker activity (On-Pace group). Clinical and echocardiographic parameters were evaluated before implantation, at randomization, and after 6 and 12 months of this randomization. Patients assigned to the Off-Pace group deteriorated in terms of the New York Heart Association class (from 1.3 ± 0.5 to 2.4 ± 0.7), 6-min walk distance (from 569 ± 68 to 343 ± 162 m), and echocardiographic data, including left ventricular ejection fraction (from 55 ± 3 to 36 ± 12%), left ventricular end-systolic volume (from 61 ± 10 to 117 ± 36 mL), left ventricular end-diastolic diameter (from 53 ± 3 to 61 ± 6 mm), and left ventricular end-systolic diameter (from 40 ± 3 to 53 ± 8 mm) at 12 months, whereas no change was observed in the On-Pace group. Turning off the pacemaker function was also related to hospitalization for heart failure and appropriate cardioverter-defibrillator device intervention. CONCLUSION: Super responders without pacing had poor clinical and echocardiographic outcomes at the mid-term follow-up."},{"id":"01952acc0537","type":"article","url":"https://hartvaat.nl/2016/05/31/diagnostische-ultrageluidspulsen-verbeteren-microvasculaire-flow-bij-stemi-met-m/","title":"Diagnostische ultrageluidspulsen verbeteren microvasculaire flow bij STEMI met microbellen","title_en":"Diagnostic Ultrasound Impulses Improve Microvascular Flow in Patients With STEMI Receiving Intravenous Microbubbles.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["microcirculatie"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.03.542","source_url":"https://doi.org/10.1016/j.jacc.2016.03.542","authors":["Wilson Mathias","Jeane M Tsutsui","Bruno G Tavares","Feng Xie","Miguel O D Aguiar","Diego R Garcia","Mucio T Oliveira","Alexandre Soeiro","Jose C Nicolau","Pedro A Lemos","Carlos E Rochitte","José A F Ramires","Roberto Kalil","Thomas R Porter"],"significance":5,"published":"2016-05-31","source_date":"2016-05-31","image":"","kennis":[],"congress":"","summary_en":"This study demonstrated that diagnostic ultrasound impulses during intravenous microbubble infusion can improve microvascular flow in STEMI patients, exploring sonothrombolysis as an adjunctive reperfusion strategy.","created":"2026-07-03T10:26:08Z","updated":"2026-07-03T13:25:29Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die aantoonde dat diagnostische ultrageluidspulsen de microvasculaire doorstroming verbeteren bij STEMI-patiënten die intraveneus microbellen ontvangen. Innovatieve benadering voor reperfusie-augmentatie.","abstract_original":"BACKGROUND: Pre-clinical trials have demonstrated that, during intravenous microbubble infusion, high mechanical index (HMI) impulses from a diagnostic ultrasound (DUS) transducer might restore epicardial and microvascular flow in acute ST-segment elevation myocardial infarction (STEMI). OBJECTIVES: The purpose of this study was to test the safety and efficacy of this adjunctive approach in humans. METHODS: From May 2014 through September 2015, patients arriving with their first STEMI were randomized to either DUS intermittent HMI impulses (n = 20) just prior to emergent percutaneous coronary intervention (PCI) and for an additional 30 min post-PCI (HMI + PCI), or low mechanical index (LMI) imaging only (n = 10) for perfusion assessments before and after PCI (LMI + PCI). All studies were conducted during an intravenous perflutren lipid microsphere infusion. A control reference group (n = 70) arrived outside of the time window of ultrasound availability and received emergent PCI alone (PCI only). Initial epicardial recanalization rates prior to emergent PCI and improvements in microvascular flow were compared between ultrasound-treated groups. RESULTS: Median door-to-dilation times were 82 ± 26 min in the LMI + PCI group, 72 ± 15 min in the HMI + PCI group, and 103 ± 42 min in the PCI-only group (p = NS). Angiographic recanalization prior to PCI was seen in 12 of 20 HMI + PCI patients (60%) compared with 10% of LMI + PCI and 23% of PCI-only patients (p = 0.002). There were no differences in microvascular obstructed segments prior to treatment, but there were significantly smaller proportions of obstructed segments in the HMI + PCI group at 1 month (p = 0.001) and significant improvements in left ventricular ejection fraction (p < 0.005). CONCLUSIONS: HMI impulses from a diagnostic transducer, combined with a commercial microbubble infusion, can prevent microvascular obstruction and improve functional outcome when added to the contemporary PCI management of acute STEMI. (Therapeutic Use of Ultrasound in Acute Coronary Artery Disease; NCT02410330)."},{"id":"4409d2f8ac0e","type":"article","url":"https://hartvaat.nl/2016/05/31/dapt-score-validatie-bij-patienten-met-en-zonder-eerder-myocardinfarct/","title":"DAPT Score: validatie bij patiënten met en zonder eerder myocardinfarct","title_en":"DAPT Score Utility for Risk Prediction in Patients With or Without Previous Myocardial Infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.03.485","source_url":"https://doi.org/10.1016/j.jacc.2016.03.485","authors":["Dean J Kereiakes","Robert W Yeh","Joseph M Massaro","Donald E Cutlip","P Gabriel Steg","Stephen D Wiviott","Laura Mauri"],"significance":6,"published":"2016-05-31","source_date":"2016-05-31","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/dual-antiplatelet-therapy-dapt/","https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"This validation study showed that the DAPT score can identify patients who benefit from extended dual antiplatelet therapy regardless of prior MI history, supporting its use as a clinical decision tool for antiplatelet duration.","created":"2026-07-03T10:26:08Z","updated":"2026-07-03T13:25:29Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Validatiestudie van de DAPT-score voor risicostratificatie bij de beslissing over verlenging van duale antiplaatjestherapie. Onderzoekt de bruikbaarheid bij patiënten met en zonder eerder MI.","abstract_original":"BACKGROUND: The DAPT (Dual Antiplatelet Therapy) study enrolled patients after coronary stenting. Patients randomized to continued thienopyridine and aspirin after 12 months had lower ischemic risk but higher bleeding risk than those treated with placebo and aspirin. OBJECTIVES: This study sought to determine whether a decision tool (DAPT score) aids prescription of dual antiplatelet therapy duration in patients with or without prior myocardial infarction (MI) treated with coronary stents. METHODS: Patients were categorized according to any history of MI before the index procedure or no history of MI. Risk differences during the randomized treatment period (12 to 30 months) for ischemic (MI and/or stent thrombosis) and bleeding (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Arteries moderate/severe) events were compared according to DAPT score. RESULTS: Rates of MI were 3.8% versus 2.4% (p = 0.01) for patients with any MI versus no MI. Continued thienopyridine reduced late MI compared with placebo regardless of MI history (hazard ratio [HR] for any MI: 0.46; p < 0.001; HR for no MI: 0.60; p = 0.003) and increased bleeding (HR: 1.86, p = 0.01 any MI; HR: 1.58, p = 0.01 no MI). DAPT scores ≥2 were associated with reductions in MI/stent thrombosis with continued thienopyridine compared with placebo (2.7% vs. 6.0%, p < 0.001 any MI; 2.6% vs. 5.2%, p = 0.002 no MI), with comparable bleeding rates. Among patients with DAPT scores <2 in both groups, continued thienopyridine was associated with significantly increased bleeding but similar rates of ischemia. CONCLUSIONS: Patients with previous MI have greater risk of late ischemic events than those with no MI history. The DAPT score improves prediction of patient benefit and harm from continued dual antiplatelet therapy beyond assessment of MI history alone. (The Dual Antiplatelet Therapy Study; NCT00977938)."},{"id":"b1137b88ae55","type":"article","url":"https://hartvaat.nl/2016/05/28/uitgestelde-versus-conventionele-stentimplantatie-bij-stemi-danami-3-defer-trial/","title":"Uitgestelde versus conventionele stentimplantatie bij STEMI: DANAMI 3-DEFER-trial","title_en":"Deferred versus conventional stent implantation in patients with ST-segment elevation myocardial infarction (DANAMI 3-DEFER): an open-label, randomised controlled trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(16)30072-1","source_url":"https://doi.org/10.1016/S0140-6736(16)30072-1","authors":["Henning Kelbæk","Dan Eik Høfsten","Lars Køber","Steffen Helqvist","Lene Kløvgaard","Lene Holmvang","Erik Jørgensen","Frants Pedersen","Kari Saunamäki","Ole De Backer","Lia E Bang","Klaus F Kofoed","Jacob Lønborg","Kiril Ahtarovski","Niels Vejlstrup","Hans E Bøtker","Christian J Terkelsen","Evald H Christiansen","Jan Ravkilde","Hans-Henrik Tilsted","Anton B Villadsen","Jens Aarøe","Svend E Jensen","Bent Raungaard","Lisette O Jensen","Peter Clemmensen","Peer Grande","Jan K Madsen","Christian Torp-Pedersen","Thomas Engstrøm"],"significance":7,"published":"2016-05-28","source_date":"2016-05-28","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/farmacologie/betablokkers-farmacologie/"],"congress":"","summary_en":"The DANAMI-3-DEFER trial compared deferred versus immediate stent implantation after thrombus aspiration in STEMI patients, testing whether delaying stenting reduces microvascular obstruction and improves outcomes.","created":"2026-07-03T10:26:08Z","updated":"2026-07-03T13:25:29Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet gerandomiseerde trial die uitgestelde stentimplantatie vergeleek met directe stenting bij STEMI. Onderzocht of uitstel de microvasculaire functie en klinische uitkomsten verbetert.","abstract_original":"BACKGROUND: Despite successful treatment of the culprit artery lesion by primary percutaneous coronary intervention (PCI) with stent implantation, thrombotic embolisation occurs in some cases, which impairs the prognosis of patients with ST-segment elevation myocardial infarction (STEMI). We aimed to assess the clinical outcomes of deferred stent implantation versus standard PCI in patients with STEMI. METHODS: We did this open-label, randomised controlled trial at four primary PCI centres in Denmark. Eligible patients (aged >18 years) had acute onset symptoms lasting 12 h or less, and ST-segment elevation of 0·1 mV or more in at least two or more contiguous electrocardiographic leads or newly developed left bundle branch block. Patients were randomly assigned (1:1), via an electronic web-based system with permuted block sizes of two to six, to receive either standard primary PCI with immediate stent implantation or deferred stent implantation 48 h after the index procedure if a stabilised flow could be obtained in the infarct-related artery. The primary endpoint was a composite of all-cause mortality, hospital admission for heart failure, recurrent infarction, and any unplanned revascularisation of the target vessel within 2 years' follow-up. Patients, investigators, and treating clinicians were not masked to treatment allocation. We did analysis by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01435408. FINDINGS: Between March 1, 2011, and Feb 28, 2014, we randomly assigned 1215 patients to receive either standard PCI (n=612) or deferred stent implantation (n=603). Median follow-up time was 42 months (IQR 33-49). Events comprising the primary endpoint occurred in 109 (18%) patients who had standard PCI and in 105 (17%) patients who had deferred stent implantation (hazard ratio 0·99, 95% CI 0·76-1·29; p=0·92). Procedure-related myocardial infarction, bleeding requiring transfusion or surgery, contrast-induced nephopathy, or stroke occurred in 28 (5%) patients in the conventional PCI group versus 27 (4%) patients in the deferred stent implantation group, with no significant differences between groups. INTERPRETATION: In patients with STEMI, routine deferred stent implantation did not reduce the occurrence of death, heart failure, myocardial infarction, or repeat revascularisation compared with conventional PCI. Results from ongoing randomised trials might shed further light on the concept of deferred stenting in this patient population. FUNDING: Danish Agency for Science, Technology and Innovation, and Danish Council for Strategic Research."},{"id":"5bdc511cfb3b","type":"article","url":"https://hartvaat.nl/2016/05/26/bloeddrukverlaging-bij-personen-met-intermediair-risico-zonder-cardiovasculaire-/","title":"Bloeddrukverlaging bij personen met intermediair risico zonder cardiovasculaire ziekte: HOPE-3","title_en":"Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["acuut-hartfalen","bloeddrukbehandeling","ramipril"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1600175","source_url":"https://doi.org/10.1056/NEJMoa1600175","authors":["Eva M Lonn","Jackie Bosch","Patricio López-Jaramillo","Jun Zhu","Lisheng Liu","Prem Pais","Rafael Diaz","Denis Xavier","Karen Sliwa","Antonio Dans","Alvaro Avezum","Leopoldo S Piegas","Katalin Keltai","Matyas Keltai","Irina Chazova","Ron J G Peters","Claes Held","Khalid Yusoff","Basil S Lewis","Petr Jansky","Alexander Parkhomenko","Kamlesh Khunti","William D Toff","Christopher M Reid","John Varigos","Lawrence A Leiter","Dora I Molina","Robert McKelvie","Janice Pogue","Joanne Wilkinson","Hyejung Jung","Gilles Dagenais","Salim Yusuf"],"significance":9,"published":"2016-05-26","source_date":"2016-05-26","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/hypertensie/cardiovasculaire-risicoschatting-score2/"],"congress":"","summary_en":"The blood pressure-lowering arm of HOPE-3 showed that candesartan/hydrochlorothiazide did not significantly reduce cardiovascular events overall in intermediate-risk persons, but did reduce events in those with the highest tertile of baseline systolic blood pressure. The findings support targeting blood pressure treatment to those with elevated levels even in primary prevention.","created":"2026-07-03T10:26:08Z","updated":"2026-07-03T13:25:29Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM HOPE-3-publicatie over bloeddrukverlaging (candesartan/hydrochloorthiazide versus placebo) bij intermediair-risicopersonen. Onderscheidt wie wel en niet baat heeft bij antihypertensieve behandeling bij primaire preventie.","abstract_original":"BACKGROUND: Antihypertensive therapy reduces the risk of cardiovascular events among high-risk persons and among those with a systolic blood pressure of 160 mm Hg or higher, but its role in persons at intermediate risk and with lower blood pressure is unclear. METHODS: In one comparison from a 2-by-2 factorial trial, we randomly assigned 12,705 participants at intermediate risk who did not have cardiovascular disease to receive either candesartan at a dose of 16 mg per day plus hydrochlorothiazide at a dose of 12.5 mg per day or placebo. The first coprimary outcome was the composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke; the second coprimary outcome additionally included resuscitated cardiac arrest, heart failure, and revascularization. The median follow-up was 5.6 years. RESULTS: The mean blood pressure of the participants at baseline was 138.1/81.9 mm Hg; the decrease in blood pressure was 6.0/3.0 mm Hg greater in the active-treatment group than in the placebo group. The first coprimary outcome occurred in 260 participants (4.1%) in the active-treatment group and in 279 (4.4%) in the placebo group (hazard ratio, 0.93; 95% confidence interval [CI], 0.79 to 1.10; P=0.40); the second coprimary outcome occurred in 312 participants (4.9%) and 328 participants (5.2%), respectively (hazard ratio, 0.95; 95% CI, 0.81 to 1.11; P=0.51). In one of the three prespecified hypothesis-based subgroups, participants in the subgroup for the upper third of systolic blood pressure (>143.5 mm Hg) who were in the active-treatment group had significantly lower rates of the first and second coprimary outcomes than those in the placebo group; effects were neutral in the middle and lower thirds (P=0.02 and P=0.009, respectively, for trend in the two outcomes). CONCLUSIONS: Therapy with candesartan at a dose of 16 mg per day plus hydrochlorothiazide at a dose of 12.5 mg per day was not associated with a lower rate of major cardiovascular events than placebo among persons at intermediate risk who did not have cardiovascular disease. (Funded by the Canadian Institutes of Health Research and AstraZeneca; ClinicalTrials.gov number, NCT00468923.)."},{"id":"0e839b59e0d6","type":"article","url":"https://hartvaat.nl/2016/05/26/cholesterolverlaging-bij-personen-met-intermediair-risico-zonder-cardiovasculair/","title":"Cholesterolverlaging bij personen met intermediair risico zonder cardiovasculaire ziekte: HOPE-3","title_en":"Cholesterol Lowering in Intermediate-Risk Persons without Cardiovascular Disease.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["ezetimibe","farmaco-economie","lipidenverlaging","niet-statine-therapie","ouderen","ramipril","rosuvastatine","statines"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1600176","source_url":"https://doi.org/10.1056/NEJMoa1600176","authors":["Salim Yusuf","Jackie Bosch","Gilles Dagenais","Jun Zhu","Denis Xavier","Lisheng Liu","Prem Pais","Patricio López-Jaramillo","Lawrence A Leiter","Antonio Dans","Alvaro Avezum","Leopoldo S Piegas","Alexander Parkhomenko","Katalin Keltai","Matyas Keltai","Karen Sliwa","Ron J G Peters","Claes Held","Irina Chazova","Khalid Yusoff","Basil S Lewis","Petr Jansky","Kamlesh Khunti","William D Toff","Christopher M Reid","John Varigos","Gregorio Sanchez-Vallejo","Robert McKelvie","Janice Pogue","Hyejung Jung","Peggy Gao","Rafael Diaz","Eva Lonn"],"significance":9,"published":"2016-05-26","source_date":"2016-05-26","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"The cholesterol-lowering arm of HOPE-3 demonstrated that rosuvastatin significantly reduced cardiovascular events in intermediate-risk individuals without prior cardiovascular disease. The trial established that statin therapy benefits a broader population than previously tested, including those with modest LDL elevations.","created":"2026-07-03T10:26:08Z","updated":"2026-07-03T13:25:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM HOPE-3-publicatie specifiek over het cholesterolverlagende deel: rosuvastatine versus placebo bij intermediair-risicopersonen. Toont een significante reductie in cardiovasculaire events met statinetherapie bij primaire preventie.","abstract_original":"BACKGROUND: Previous trials have shown that the use of statins to lower cholesterol reduces the risk of cardiovascular events among persons without cardiovascular disease. Those trials have involved persons with elevated lipid levels or inflammatory markers and involved mainly white persons. It is unclear whether the benefits of statins can be extended to an intermediate-risk, ethnically diverse population without cardiovascular disease. METHODS: In one comparison from a 2-by-2 factorial trial, we randomly assigned 12,705 participants in 21 countries who did not have cardiovascular disease and were at intermediate risk to receive rosuvastatin at a dose of 10 mg per day or placebo. The first coprimary outcome was the composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke, and the second coprimary outcome additionally included revascularization, heart failure, and resuscitated cardiac arrest. The median follow-up was 5.6 years. RESULTS: The overall mean low-density lipoprotein cholesterol level was 26.5% lower in the rosuvastatin group than in the placebo group. The first coprimary outcome occurred in 235 participants (3.7%) in the rosuvastatin group and in 304 participants (4.8%) in the placebo group (hazard ratio, 0.76; 95% confidence interval [CI], 0.64 to 0.91; P=0.002). The results for the second coprimary outcome were consistent with the results for the first (occurring in 277 participants [4.4%] in the rosuvastatin group and in 363 participants [5.7%] in the placebo group; hazard ratio, 0.75; 95% CI, 0.64 to 0.88; P<0.001). The results were also consistent in subgroups defined according to cardiovascular risk at baseline, lipid level, C-reactive protein level, blood pressure, and race or ethnic group. In the rosuvastatin group, there was no excess of diabetes or cancers, but there was an excess of cataract surgery (in 3.8% of the participants, vs. 3.1% in the placebo group; P=0.02) and muscle symptoms (in 5.8% of the participants, vs. 4.7% in the placebo group; P=0.005). CONCLUSIONS: Treatment with rosuvastatin at a dose of 10 mg per day resulted in a significantly lower risk of cardiovascular events than placebo in an intermediate-risk, ethnically diverse population without cardiovascular disease. (Funded by the Canadian Institutes of Health Research and AstraZeneca; HOPE-3 ClinicalTrials.gov number, NCT00468923.)."},{"id":"fb16f564e457","type":"article","url":"https://hartvaat.nl/2016/05/26/bloeddruk-en-cholesterolverlaging-bij-personen-zonder-cardiovasculaire-ziekte-ho/","title":"Bloeddruk- en cholesterolverlaging bij personen zonder cardiovasculaire ziekte: HOPE-3","title_en":"Blood-Pressure and Cholesterol Lowering in Persons without Cardiovascular Disease.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","ezetimibe","ouderen","ramipril","soul-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1600177","source_url":"https://doi.org/10.1056/NEJMoa1600177","authors":["Salim Yusuf","Eva Lonn","Prem Pais","Jackie Bosch","Patricio López-Jaramillo","Jun Zhu","Denis Xavier","Alvaro Avezum","Lawrence A Leiter","Leopoldo S Piegas","Alexander Parkhomenko","Matyas Keltai","Katalin Keltai","Karen Sliwa","Irina Chazova","Ron J G Peters","Claes Held","Khalid Yusoff","Basil S Lewis","Petr Jansky","Kamlesh Khunti","William D Toff","Christopher M Reid","John Varigos","Jose L Accini","Robert McKelvie","Janice Pogue","Hyejung Jung","Lisheng Liu","Rafael Diaz","Antonio Dans","Gilles Dagenais"],"significance":9,"published":"2016-05-26","source_date":"2016-05-26","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/"],"congress":"","summary_en":"The HOPE-3 trial showed that combined blood pressure and cholesterol lowering with rosuvastatin plus candesartan/hydrochlorothiazide reduced cardiovascular events by 29% in intermediate-risk persons without cardiovascular disease. The benefit was driven primarily by lipid lowering, with blood pressure lowering adding benefit mainly in those with elevated baseline pressures.","created":"2026-07-03T10:26:07Z","updated":"2026-07-03T18:38:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM HOPE-3-trial die gelijktijdige bloeddruk- en cholesterolverlaging onderzocht bij personen met intermediair risico zonder vastgestelde cardiovasculaire ziekte. Landmark trial voor primaire preventie.","abstract_original":"BACKGROUND: Elevated blood pressure and elevated low-density lipoprotein (LDL) cholesterol increase the risk of cardiovascular disease. Lowering both should reduce the risk of cardiovascular events substantially. METHODS: In a trial with 2-by-2 factorial design, we randomly assigned 12,705 participants at intermediate risk who did not have cardiovascular disease to rosuvastatin (10 mg per day) or placebo and to candesartan (16 mg per day) plus hydrochlorothiazide (12.5 mg per day) or placebo. In the analyses reported here, we compared the 3180 participants assigned to combined therapy (with rosuvastatin and the two antihypertensive agents) with the 3168 participants assigned to dual placebo. The first coprimary outcome was the composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke, and the second coprimary outcome additionally included heart failure, cardiac arrest, or revascularization. The median follow-up was 5.6 years. RESULTS: The decrease in the LDL cholesterol level was 33.7 mg per deciliter (0.87 mmol per liter) greater in the combined-therapy group than in the dual-placebo group, and the decrease in systolic blood pressure was 6.2 mm Hg greater with combined therapy than with dual placebo. The first coprimary outcome occurred in 113 participants (3.6%) in the combined-therapy group and in 157 (5.0%) in the dual-placebo group (hazard ratio, 0.71; 95% confidence interval [CI], 0.56 to 0.90; P=0.005). The second coprimary outcome occurred in 136 participants (4.3%) and 187 participants (5.9%), respectively (hazard ratio, 0.72; 95% CI, 0.57 to 0.89; P=0.003). Muscle weakness and dizziness were more common in the combined-therapy group than in the dual-placebo group, but the overall rate of discontinuation of the trial regimen was similar in the two groups. CONCLUSIONS: The combination of rosuvastatin (10 mg per day), candesartan (16 mg per day), and hydrochlorothiazide (12.5 mg per day) was associated with a significantly lower rate of cardiovascular events than dual placebo among persons at intermediate risk who did not have cardiovascular disease. (Funded by the Canadian Institutes of Health Research and AstraZeneca; ClinicalTrials.gov number, NCT00468923.)."},{"id":"6db4f7387c24","type":"article","url":"https://hartvaat.nl/2016/05/24/papillairspierbenadering-versus-restrictieve-annuloplastiek-bij-ernstige-ischemi/","title":"Papillairspierbenadering versus restrictieve annuloplastiek bij ernstige ischemische MR","title_en":"Papillary Muscle Approximation Versus Restrictive Annuloplasty Alone for Severe Ischemic Mitral Regurgitation.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.03.478","source_url":"https://doi.org/10.1016/j.jacc.2016.03.478","authors":["Francesco Nappi","Mario Lusini","Cristiano Spadaccio","Antonio Nenna","Elvio Covino","Christophe Acar","Massimo Chello"],"significance":6,"published":"2016-05-24","source_date":"2016-05-24","image":"","kennis":[],"congress":"","summary_en":"This randomized study compared papillary muscle approximation plus annuloplasty with restrictive annuloplasty alone for severe ischemic mitral regurgitation, testing whether subvalvular repair reduces MR recurrence after surgery.","created":"2026-07-03T10:26:07Z","updated":"2026-07-03T13:25:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde studie die papillairspierapproximatie plus annuloplastiek vergeleek met restrictieve annuloplastiek alleen bij ernstige ischemische mitralisklepinsufficiëntie.","abstract_original":"BACKGROUND: Guidelines recommend surgery for patients with severe ischemic mitral regurgitation (MR). Nonrandomized studies suggest that subvalvular repair is associated with longer survival, but randomized studies are lacking. OBJECTIVES: This study sought to investigate the benefit of papillary muscle surgery on long-term clinical outcomes of patients with ischemic MR. METHODS: Ninety-six patients with severe ischemic MR were randomized to either undersizing restrictive mitral annuloplasty (RA) or papillary muscle approximation with undersizing restrictive mitral annuloplasty (PMA) associated with complete surgical myocardial revascularization. The primary endpoint was change in left ventricular end-diastolic diameter (LVEDD) after 5 years, measured as the absolute difference from baseline, which was evaluated by paired Student t tests. Secondary endpoints included changes in echocardiographic parameters, overall mortality, the composite cardiac endpoint (major adverse cardiac and cerebrovascular events [MACCE]), and quality of life (QOL) during the 5-year follow-up. RESULTS: At 5 years, mean LVEDD was 56.5 ± 5.7 mm with PMA versus 60.6 ± 4.6 mm with RA (mean change from baseline -5.8 ± 4.1 mm and -0.2 ± 2.3 mm, respectively; p < 0.001). Ejection fraction was 44.1 ± 6% in the PMA group versus 39.9 ± 3.9% in the RA group (mean change from baseline 8.8 ± 5.9% and 2.5 ± 4.3%, respectively; p < 0.001). There was no statistically significant difference in mortality at 5 years, but freedom from MACCE favored PMA in the last year of follow-up. PMA significantly reduced tenting height, tenting area, and interpapillary distance soon after surgery and for the long-term, and significantly lowered moderate-to-severe MR recurrence. No differences were found in QOL measures. CONCLUSIONS: Compared with RA only, PMA exerted a long-term beneficial effect on left ventricular remodeling and more effectively restored the mitral valve geometric configuration in ischemic MR, which improved long-term cardiac outcomes, but did not produce differences in overall mortality and QOL."},{"id":"ae665d1638f1","type":"article","url":"https://hartvaat.nl/2016/05/21/af-type-en-risico-op-trombo-embolie-mortaliteit-en-bloedingen-systematische-revi/","title":"AF-type en risico op trombo-embolie, mortaliteit en bloedingen: systematische review","title_en":"The impact of atrial fibrillation type on the risk of thromboembolism, mortality, and bleeding: a systematic review and meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw007","source_url":"https://doi.org/10.1093/eurheartj/ehw007","authors":["Anand N Ganesan","Derek P Chew","Trent Hartshorne","Joseph B Selvanayagam","Philip E Aylward","Prashanthan Sanders","Andrew D McGavigan"],"significance":7,"published":"2016-05-21","source_date":"2016-05-21","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/classificatie-af/"],"congress":"","summary_en":"This systematic review and meta-analysis examined whether the type of atrial fibrillation (paroxysmal, persistent, or permanent) independently affects the risk of thromboembolism, mortality, and bleeding, informing the debate about AF classification and stroke risk assessment.","created":"2026-07-03T10:26:07Z","updated":"2026-07-03T18:38:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse naar het verband tussen het type atriumfibrilleren (paroxysmaal, persisterend, permanent) en het risico op trombo-embolie, mortaliteit en bloedingscomplicaties.","abstract_original":"AIMS: Thromboembolic risk stratification schemes and clinical guidelines for atrial fibrillation (AF) regard risk as independent of classification into paroxysmal (PAF) and non-paroxysmal atrial fibrillation (NPAF). The aim of the current study was to conduct a systematic review evaluating the impact of AF type on thromboembolism, bleeding, and mortality. METHODS AND RESULTS: PubMed was searched through 27 November 2014 for randomized controlled trials, cohort studies, and case series reporting prospectively collected clinical outcomes stratified by AF type. The incidence of thromboembolism, mortality, and bleeding was extracted. Atrial fibrillation clinical outcome data were extracted from 12 studies containing 99 996 patients. The unadjusted risk ratio (RR) for thromboembolism in NPAF vs. PAF was 1.355 (95% CI: 1.169-1.571, P < 0.001). In the study subset off oral anticoagulation, unadjusted RR was 1.689 (95% CI: 1.151-2.480, P = 0.007). The overall multivariable adjusted hazard ratio (HR) for thromboembolism was 1.384 (95% CI: 1.191-1.608, P < 0.001). The overall unadjusted RR for all-cause mortality was 1.462 (95% CI: 1.255-1.703, P < 0.001). Multivariable adjusted HR for all-cause mortality was 1.217 (95% CI: 1.085-1.365, P < 0.001). Rates of bleeding were similar, with unadjusted RR 1.00 (95% CI: 0.919-1.087, P = 0.994) and adjusted HR 1.025 (95% CI: 0.898-1.170, P = 0.715). CONCLUSION: Non-paroxysmal atrial fibrillation is associated with a highly significant increase in thromboembolism and death. These data suggest the need for new therapies to prevent AF progression and further studies to explore the integration of AF type into models of thromboembolic risk."},{"id":"3f12aa9dde8a","type":"article","url":"https://hartvaat.nl/2016/05/21/stapsgewijze-ablatie-gestuurd-door-laaggedoseerd-ibutilide-bij-chronisch-af-magi/","title":"Stapsgewijze ablatie gestuurd door laaggedoseerd ibutilide bij chronisch AF: MAGIC-AF-studie","title_en":"The modified stepwise ablation guided by low-dose ibutilide in chronic atrial fibrillation trial (The MAGIC-AF Study).","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw003","source_url":"https://doi.org/10.1093/eurheartj/ehw003","authors":["Sheldon M Singh","Andre d'Avila","Young-Hoon Kim","Arash Aryana","J Michael Mangrum","Gregory F Michaud","Srinivas R Dukkipati","Conor D Barrett","E Kevin Heist","Michael K Parides","Kevin E Thorpe","Vivek Y Reddy"],"significance":5,"published":"2016-05-21","source_date":"2016-05-21","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/"],"congress":"","summary_en":"The MAGIC-AF study tested a modified stepwise ablation approach using low-dose ibutilide to unmask genuine CFAE targets during persistent AF ablation, aiming to improve the specificity of substrate modification.","created":"2026-07-03T10:26:07Z","updated":"2026-07-03T13:25:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar een gemodificeerde stapsgewijze ablatiestrategie met laaggedoseerd ibutilide bij chronisch AF. Onderzoekt of farmacologische ondersteuning de effectiviteit van substraatablatie kan verbeteren.","abstract_original":"AIMS: Complex fractionated atrial electrograms (CFAE) are targeted during persistent atrial fibrillation (AF) ablation. However, many CFAE sites are non-specific resulting in extensive ablation. Ibutilide has been shown to reduce left atrial surface area exhibiting CFAE. We hypothesized that ibutilide administration prior to CFAE ablation would identify sites critical for persistent AF maintenance allowing for improved procedural efficacy and long-term freedom from atrial arrhythmias. METHODS AND RESULTS: Two hundred patients undergoing a first-ever persistent AF catheter ablation procedure were randomly assigned to receive either 0.25 mg of intravenous ibutilide or saline placebo upon completion of pulmonary vein isolation. Complex fractionated atrial electrogram sites were then targeted with ablation. The primary efficacy endpoint was the 1-year single procedure freedom from atrial arrhythmia off anti-arrhythmic drugs. Similar procedural characteristics (procedure, fluoroscopy, and ablation times) were observed with both strategies despite a greater reduction in left atrial surface area with CFAE sites (8 vs. 1%, P < 0.0001) and AF termination during CFAE ablation with ibutilide compared with placebo (75 vs. 57%, P = 0.007). The primary efficacy endpoint was achieved in 56% of patients receiving ibutilide and 49% receiving placebo (P = 0.35). No significant differences in peri-procedural complications were observed in both groups. CONCLUSION: Despite a reduction in CFAE area and greater AF termination during CFAE ablation, procedural characteristics and clinical outcomes were unchanged when CFAE ablation was guided by ibutilide administration. CLINICAL TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov number: NCT01014741."},{"id":"f622590b028a","type":"article","url":"https://hartvaat.nl/2016/05/19/frequentiecontrole-versus-ritmecontrole-bij-af-na-hartchirurgie-nejm-trial/","title":"Frequentiecontrole versus ritmecontrole bij AF na hartchirurgie: NEJM-trial","title_en":"Rate Control versus Rhythm Control for Atrial Fibrillation after Cardiac Surgery.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1602002","source_url":"https://doi.org/10.1056/NEJMoa1602002","authors":["A Marc Gillinov","Emilia Bagiella","Alan J Moskowitz","Jesse M Raiten","Mark A Groh","Michael E Bowdish","Gorav Ailawadi","Katherine A Kirkwood","Louis P Perrault","Michael K Parides","Robert L Smith","John A Kern","Gladys Dussault","Amy E Hackmann","Neal O Jeffries","Marissa A Miller","Wendy C Taddei-Peters","Eric A Rose","Richard D Weisel","Deborah L Williams","Ralph F Mangusan","Michael Argenziano","Ellen G Moquete","Karen L O'Sullivan","Michel Pellerin","Kinjal J Shah","James S Gammie","Mary Lou Mayer","Pierre Voisine","Annetine C Gelijns","Patrick T O'Gara","Michael J Mack"],"significance":8,"published":"2016-05-19","source_date":"2016-05-19","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-en-hartfalen/","https://hartvaat.nl/kennis/atriumfibrilleren/ecg-herkenning-af/"],"congress":"","summary_en":"This NEJM trial compared rate control with rhythm control for atrial fibrillation occurring after cardiac surgery, addressing the optimal management strategy for this common postoperative complication. The results informed the standard approach to post-surgical AF.","created":"2026-07-03T10:26:07Z","updated":"2026-07-03T13:25:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM-trial die frequentiecontrole vergeleek met ritmecontrole bij postoperatief atriumfibrilleren. Belangrijk voor het standaardbeleid na hartchirurgie, waar AF een veel voorkomende complicatie is.","abstract_original":"BACKGROUND: Atrial fibrillation after cardiac surgery is associated with increased rates of death, complications, and hospitalizations. In patients with postoperative atrial fibrillation who are in stable condition, the best initial treatment strategy--heart-rate control or rhythm control--remains controversial. METHODS: Patients with new-onset postoperative atrial fibrillation were randomly assigned to undergo either rate control or rhythm control. The primary end point was the total number of days of hospitalization within 60 days after randomization, as assessed by the Wilcoxon rank-sum test. RESULTS: Postoperative atrial fibrillation occurred in 695 of the 2109 patients (33.0%) who were enrolled preoperatively; of these patients, 523 underwent randomization. The total numbers of hospital days in the rate-control group and the rhythm-control group were similar (median, 5.1 days and 5.0 days, respectively; P=0.76). There were no significant between-group differences in the rates of death (P=0.64) or overall serious adverse events (24.8 per 100 patient-months in the rate-control group and 26.4 per 100 patient-months in the rhythm-control group, P=0.61), including thromboembolic and bleeding events. About 25% of the patients in each group deviated from the assigned therapy, mainly because of drug ineffectiveness (in the rate-control group) or amiodarone side effects or adverse drug reactions (in the rhythm-control group). At 60 days, 93.8% of the patients in the rate-control group and 97.9% of those in the rhythm-control group had had a stable heart rhythm without atrial fibrillation for the previous 30 days (P=0.02), and 84.2% and 86.9%, respectively, had been free from atrial fibrillation from discharge to 60 days (P=0.41). CONCLUSIONS: Strategies for rate control and rhythm control to treat postoperative atrial fibrillation were associated with equal numbers of days of hospitalization, similar complication rates, and similarly low rates of persistent atrial fibrillation 60 days after onset. Neither treatment strategy showed a net clinical advantage over the other. (Funded by the National Institutes of Health and the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT02132767.)."},{"id":"bd41ec502073","type":"article","url":"https://hartvaat.nl/2016/05/19/chirurgische-behandeling-van-matige-ischemische-mitralisklepinsufficientie-2-jaa/","title":"Chirurgische behandeling van matige ischemische mitralisklepinsufficiëntie: 2-jaarsresultaten","title_en":"Two-Year Outcomes of Surgical Treatment of Moderate Ischemic Mitral Regurgitation.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1602003","source_url":"https://doi.org/10.1056/NEJMoa1602003","authors":["Robert E Michler","Peter K Smith","Michael K Parides","Gorav Ailawadi","Vinod Thourani","Alan J Moskowitz","Michael A Acker","Judy W Hung","Helena L Chang","Louis P Perrault","A Marc Gillinov","Michael Argenziano","Emilia Bagiella","Jessica R Overbey","Ellen G Moquete","Lopa N Gupta","Marissa A Miller","Wendy C Taddei-Peters","Neal Jeffries","Richard D Weisel","Eric A Rose","James S Gammie","Joseph J DeRose","John D Puskas","François Dagenais","Sandra G Burks","Ismail El-Hamamsy","Carmelo A Milano","Pavan Atluri","Pierre Voisine","Patrick T O'Gara","Annetine C Gelijns"],"significance":8,"published":"2016-05-19","source_date":"2016-05-19","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/peripartum-cardiomyopathie/"],"congress":"","summary_en":"Two-year results from this NEJM trial showed no significant difference between CABG alone and CABG plus mitral valve repair in patients with moderate ischemic mitral regurgitation. The findings supported a conservative approach of CABG alone in moderate functional MR.","created":"2026-07-03T10:26:07Z","updated":"2026-07-03T13:25:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM 2-jaarsresultaten van de gerandomiseerde trial die herstel vergeleek met vervanging bij matige ischemische mitralisklepinsufficiëntie. Complementeert de parallelle trial bij ernstige insufficiëntie.","abstract_original":"BACKGROUND: In a trial comparing coronary-artery bypass grafting (CABG) alone with CABG plus mitral-valve repair in patients with moderate ischemic mitral regurgitation, we found no significant difference in the left ventricular end-systolic volume index (LVESVI) or survival after 1 year. Concomitant mitral-valve repair was associated with a reduced prevalence of moderate or severe mitral regurgitation, but patients had more adverse events. We now report 2-year outcomes. METHODS: We randomly assigned 301 patients to undergo either CABG alone or the combined procedure. Patients were followed for 2 years for clinical and echocardiographic outcomes. RESULTS: At 2 years, the mean (±SD) LVESVI was 41.2±20.0 ml per square meter of body-surface area in the CABG-alone group and 43.2±20.6 ml per square meter in the combined-procedure group (mean improvement over baseline, -14.1 ml per square meter and -14.6 ml per square meter, respectively). The rate of death was 10.6% in the CABG-alone group and 10.0% in the combined-procedure group (hazard ratio in the combined-procedure group, 0.90; 95% confidence interval, 0.45 to 1.83; P=0.78). There was no significant between-group difference in the rank-based assessment of the LVESVI (including death) at 2 years (z score, 0.38; P=0.71). The 2-year rate of moderate or severe residual mitral regurgitation was higher in the CABG-alone group than in the combined-procedure group (32.3% vs. 11.2%, P<0.001). Overall rates of hospital readmission and serious adverse events were similar in the two groups, but neurologic events and supraventricular arrhythmias remained more frequent in the combined-procedure group. CONCLUSIONS: In patients with moderate ischemic mitral regurgitation undergoing CABG, the addition of mitral-valve repair did not lead to significant differences in left ventricular reverse remodeling at 2 years. Mitral-valve repair provided a more durable correction of mitral regurgitation but did not significantly improve survival or reduce overall adverse events or readmissions and was associated with an early hazard of increased neurologic events and supraventricular arrhythmias. (Funded by the National Institutes of Health and Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT00806988.)."},{"id":"707f6df0b2ea","type":"article","url":"https://hartvaat.nl/2016/05/17/biodegradeerbare-sirolimus-eluting-stents-de-panda-iii-trial/","title":"Biodegradeerbare sirolimus-eluting stents: de PANDA III-trial","title_en":"Biodegradable Polymer-Based Sirolimus-Eluting Stents With Differing Elution and Absorption Kinetics: The PANDA III Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.03.475","source_url":"https://doi.org/10.1016/j.jacc.2016.03.475","authors":["Bo Xu","Runlin Gao","Yuejin Yang","Xuebin Cao","Lei Qin","Yi Li","Zhanquan Li","Xueqi Li","Hailong Lin","Yong Guo","Yitong Ma","Jian'an Wang","Shaoping Nie","Liang Xu","Eric Cao","Changdong Guan","Gregg W Stone"],"significance":5,"published":"2016-05-17","source_date":"2016-05-17","image":"","kennis":[],"congress":"","summary_en":"The PANDAS III randomized trial compared two biodegradable polymer sirolimus-eluting stents with different drug elution and polymer absorption kinetics, testing whether these design parameters affect clinical outcomes.","created":"2026-07-03T10:26:07Z","updated":"2026-07-03T13:25:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial die twee biodegradeerbare polymer-gebaseerde sirolimus-eluting stents met verschillende elutie- en absorptiekinetiek vergeleek. Onderzoekt de invloed van stentontwerp op klinische uitkomsten.","abstract_original":"BACKGROUND: Whether the rate of drug elution and polymer absorption affects clinical outcomes of biodegradable polymer-based drug-eluting stents (DES) is unknown. The widely used polylactide polymer-based Excel stent (JW Medical, Weihai, China) elutes sirolimus within 180 days, and the polylactide polymer is completely absorbed within 6 to 9 months. In contrast, the poly-lactide-co-glycolide polymer-based BuMA stent (Sino Medical, Tianjin, China) elutes sirolimus within 30 days, and the poly-lactide-co-glycolide polymer is completely absorbed within 3 months. Thus, both metallic DES elute sirolimus, isolating major differences to the polymer and elution kinetics. OBJECTIVES: The goal of this study was to compare the safety and effectiveness between the BuMA sirolimus-eluting stent (SES) and Excel SES in an \"all-comers\" population. METHODS: PANDA III was a multicenter trial with few exclusion criteria, powered for sequential noninferiority and superiority testing. The primary endpoint was 1-year target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction, or ischemia-driven target lesion revascularization. RESULTS: Between December 2013 and August 2014, 2,348 patients were randomly assigned to treatment with BuMA (n = 1,174) or Excel SES (n = 1,174). The 1-year primary endpoint of TLF occurred in 6.4% of patients in each group (difference: 0.06%; 95% confidence interval: 1.93% to 2.04%; pnoninferiority = 0.0003; psuperiority = 0.95). There were no significant between-group differences in any of the secondary endpoints other than the incidence of definite/probable stent thrombosis, which occurred less frequently with the BuMA stent (0.5% vs. 1.3%; log-rank p = 0.048). CONCLUSIONS: The BuMA SES was demonstrated to be noninferior to the Excel SES for 1-year TLF, with a lower incidence of stent thrombosis. (Comparison of BuMA eG Based BioDegradable Polymer Stent With EXCEL Biodegradable Polymer Sirolimus-eluting Stent in \"Real-World\" Practice [PANDA-III]; NCT02017275)."},{"id":"33601aab02ca","type":"article","url":"https://hartvaat.nl/2016/05/17/verminderde-cardiac-index-is-niet-de-primaire-oorzaak-van-nierdisfunctie-bij-har/","title":"Verminderde cardiac index is niet de primaire oorzaak van nierdisfunctie bij hartfalen","title_en":"Reduced Cardiac Index Is Not the Dominant Driver of Renal Dysfunction in Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.02.058","source_url":"https://doi.org/10.1016/j.jacc.2016.02.058","authors":["Jennifer S Hanberg","Krishna Sury","F Perry Wilson","Meredith A Brisco","Tariq Ahmad","Jozine M Ter Maaten","J Samuel Broughton","Mahlet Assefa","W H Wilson Tang","Chirag R Parikh","Jeffrey M Testani"],"significance":6,"published":"2016-05-17","source_date":"2016-05-17","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hartfalen-en-nierfunctie/","https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/"],"congress":"","summary_en":"This study demonstrated that reduced cardiac index is not the dominant driver of renal dysfunction in heart failure, finding that venous congestion contributes more significantly to kidney impairment than forward flow reduction.","created":"2026-07-03T10:26:07Z","updated":"2026-07-03T13:25:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die aantoont dat verminderd hartminuutvolume niet de dominante oorzaak is van nierfunctiestoornissen bij hartfalen. Veneuze congestie en neurohormonale activatie spelen een grotere rol in het cardiorenal syndroom.","abstract_original":"BACKGROUND: It is widely believed that a reduced cardiac index (CI) is a significant contributor to renal dysfunction in patients with heart failure (HF). However, recent data have challenged this paradigm. OBJECTIVES: This study sought to determine the relationship between CI and renal function in a multicenter population of HF patients undergoing pulmonary artery catheterization (PAC). METHODS: Patients undergoing PAC in either the randomized or registry portions of the ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness) trial were included (n = 575). We evaluated associations between CI and renal function across multiple subgroups and assessed for nonlinear, threshold, and longitudinal relationships. RESULTS: There was a weak but significant inverse correlation between CI and estimated glomerular filtration rate (eGFR), such that higher CI was paradoxically associated with worse eGFR (r = -0.12; p = 0.02). CI was not associated with blood urea nitrogen (BUN) or the BUN to creatinine ratio. Similarly, no associations were observed between CI and better renal function across multiple subgroups defined by indications for PAC or hemodynamic, laboratory, or demographic parameters. A nonlinear or threshold effect could not be identified. In patients with serial assessments of renal function and CI, we were unable to find within-subject associations between change in CI and eGFR using linear mixed modeling. Neither CI nor change in CI was lower in patients developing worsening renal function (p ≥ 0.28). CONCLUSIONS: These results reinforce evidence that reduced CI is not the primary driver for renal dysfunction in patients hospitalized for HF, irrespective of the degree of CI impairment or patient subgroup analyzed."},{"id":"3a196f78000c","type":"article","url":"https://hartvaat.nl/2016/05/17/institutionele-en-operateurvereisten-voor-linker-hartoorocclusie-scai-acc-hrs-st/","title":"Institutionele en operateurvereisten voor linker-hartoorocclusie: SCAI/ACC/HRS-statement","title_en":"SCAI/ACC/HRS Institutional and Operator Requirements for Left Atrial Appendage Occlusion.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2015.12.001","source_url":"https://doi.org/10.1016/j.jacc.2015.12.001","authors":["Clifford J Kavinsky","Fred M Kusumoto","Anthony A Bavry","Steven R Bailey","Kenneth A Ellenbogen","Paul L Hess","Daniel L Lustgarten","Issam D Moussa","Christian Spies"],"significance":7,"published":"2016-05-17","source_date":"2016-05-17","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/linkerhartoorkluiting/"],"congress":"","summary_en":"This SCAI/ACC/HRS document established institutional and operator requirements for left atrial appendage occlusion procedures in AF patients, defining the minimum standards for safe and effective LAAO implantation.","created":"2026-07-03T10:26:06Z","updated":"2026-07-03T13:25:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gezamenlijk expertdocument met vereisten voor centra en operateurs die percutane linker-hartoorafsluiting (LAAO) uitvoeren bij AF-patiënten. Stelt kwaliteitsnormen voor deze groeiende interventie.","abstract_original":""},{"id":"71e76b23e17e","type":"article","url":"https://hartvaat.nl/2016/05/10/biventriculaire-versus-rechterkamerpacing-klinische-verbetering-in-de-block-hf-s/","title":"Biventriculaire versus rechterkamerpacing: klinische verbetering in de BLOCK HF-studie","title_en":"Improvement in Clinical Outcomes With Biventricular Versus Right Ventricular Pacing: The BLOCK HF Study.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["cardiale-resynchronisatie","linkerbundeltakpacing","supraventriculaire-tachycardie"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.02.051","source_url":"https://doi.org/10.1016/j.jacc.2016.02.051","authors":["Anne B Curtis","Seth J Worley","Eugene S Chung","Pei Li","Shelly A Christman","Martin St John Sutton"],"significance":7,"published":"2016-05-10","source_date":"2016-05-10","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-farmacologie/"],"congress":"","summary_en":"The BLOCK HF study demonstrated that biventricular pacing (CRT) is superior to conventional right ventricular pacing in patients with AV block and left ventricular systolic dysfunction, establishing CRT as the preferred pacing modality when ventricular pacing is required in this population.","created":"2026-07-03T10:26:06Z","updated":"2026-07-03T13:25:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de BLOCK HF-studie die aantoonde dat biventriculaire pacing (CRT) superieur is aan conventionele rechterkamerpacing bij patiënten met AV-blok en LV-disfunctie. Bevestigt de rol van CRT bij een bredere patiëntengroep.","abstract_original":"BACKGROUND: Sustained right ventricular (RV) apical pacing may lead to deterioration in ventricular function and an increased risk of heart failure, especially in patients with pre-existing systolic dysfunction. The BLOCK HF (Biventricular Versus Right Ventricular Pacing in Heart Failure Patients With Atrioventricular Block) trial demonstrated that biventricular-paced patients had a reduced incidence of a composite endpoint of death, heart failure-related urgent care, and adverse left ventricular remodeling. OBJECTIVES: In a pre-specified analysis, this study examined clinical outcomes, including clinical composite score, quality of life (QOL), and change in New York Heart Association (NYHA) functional classification. METHODS: The BLOCK HF trial randomized patients with atrioventricular block, NYHA symptom class I to III heart failure, and left ventricular ejection fraction ≤50% to biventricular or RV pacing. NYHA functional classification, QOL, and clinical composite score were assessed at 6, 12, 18, and 24 months. Bayesian statistical methods were used, with the pre-specified metric of benefit being a posterior probability ≥0.95. RESULTS: Patients with biventricular pacing showed greater improvement in NYHA functional class at 12 months, with 19% improved, 61% unchanged, and 17% worsened, compared with 12%/62%/23% in the RV arm. QOL was improved through 12 months. At 6 months, clinical composite score was improved/unchanged/worsened in 53%/24%/24% in the biventricular arm compared with 39%/33%/28% in the RV arm. This improvement in clinical composite score was sustained through 24 months. CONCLUSIONS: For patients with atrioventricular block and systolic dysfunction, biventricular pacing not only reduces the risk of mortality/morbidity, but also leads to better clinical outcomes, including improved QOL and heart failure status, compared with RV pacing. (Biventricular Versus Right Ventricular Pacing in Heart Failure Patients With Atrioventricular Block [BLOCK HF]; NCT00267098)."},{"id":"47be9c25c292","type":"article","url":"https://hartvaat.nl/2016/05/10/validatie-van-barc-bloedingscriteria-bij-acuut-coronair-syndroom-tracer-trial/","title":"Validatie van BARC-bloedingscriteria bij acuut coronair syndroom: TRACER-trial","title_en":"Validation of BARC Bleeding Criteria in Patients With Acute Coronary Syndromes: The TRACER Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["acuut-coronair-syndroom"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.02.056","source_url":"https://doi.org/10.1016/j.jacc.2016.02.056","authors":["Pascal Vranckx","Harvey D White","Zhen Huang","Kenneth W Mahaffey","Paul W Armstrong","Frans Van de Werf","David J Moliterno","Lars Wallentin","Claes Held","Philip E Aylward","Jan H Cornel","Christoph Bode","Kurt Huber","José C Nicolau","Witold Ruzyllo","Robert A Harrington","Pierluigi Tricoci"],"significance":5,"published":"2016-05-10","source_date":"2016-05-10","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/wat-is-coronairlijden/","https://hartvaat.nl/kennis/diagnostiek/cardiale-biomarkers-overzicht/"],"congress":"","summary_en":"This TRACER trial analysis validated the BARC bleeding classification in ACS patients, confirming the clinical utility of standardized bleeding definitions for comparing antithrombotic therapy safety across trials.","created":"2026-07-03T10:26:06Z","updated":"2026-07-03T13:25:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Validatiestudie van de BARC-bloedingsclassificatie bij ACS-patiënten in de TRACER-trial. Bevestigt het klinische nut van gestandaardiseerde bloedingsdefinities voor trial- en registratiestudies.","abstract_original":"BACKGROUND: The Bleeding Academic Research Consortium (BARC) scale has been proposed to standardize bleeding endpoint definitions and reporting in cardiovascular trials. Validation in large cohorts of patients is needed. OBJECTIVES: This study sought to investigate the relationship between BARC-classified bleeding and mortality and compared its prognostic value against 2 validated bleeding scales: TIMI (Thrombolysis In Myocardial Infarction) and GUSTO (Global Use of Strategies to Open Occluded Arteries). METHODS: We analyzed bleeding in 12,944 patients with acute coronary syndromes without ST-segment elevation, with or without early invasive strategy. The main outcome measure was all-cause death. RESULTS: During follow-up (median: 502 days), noncoronary artery bypass graft (CABG) bleeding occurred in 1,998 (15.4%) patients according to BARC (grades 2, 3, or 5), 484 (3.7%) patients according to TIMI minor/major, and 514 (4.0%) patients according to GUSTO moderate/severe criteria. CABG-related bleeding (BARC 4) occurred in 155 (1.2%) patients. Patients with BARC (2, 3, or 4) bleeding had a significant increase in risk of death versus patients without bleeding (BARC 0 or 1); the hazard was highest in the 30 days after bleeding (hazard ratio: 7.35; 95% confidence interval: 5.59 to 9.68; p < 0.0001) and remained significant up to 1 year. The hazard of mortality increased progressively with non-CABG BARC grades. BARC 4 bleeds were significantly associated with mortality within 30 days (hazard ratio: 10.05; 95% confidence interval: 5.41 to 18.69; p < 0.0001), but not thereafter. Inclusion of BARC (2, 3, or 4) bleeding in the 1-year mortality model with baseline characteristics improved it to an extent comparable to TIMI minor/major and GUSTO moderate/severe bleeding. CONCLUSIONS: In patients with acute coronary syndromes without ST-segment elevation, bleeding assessed with the BARC scale was significantly associated with risk of subsequent death up to 1 year after the event and risk of mortality increased gradually with higher BARC grades. Our results support adoption of the BARC bleeding scale in ACS clinical trials. (Trial to Assess the Effects of Vorapaxar [SCH 530348; MK-5348] in Preventing Heart Attack and Stroke in Participants With Acute Coronary Syndrome [TRACER] [Study P04736]; NCT00527943)."},{"id":"a9d4bbd03ebf","type":"article","url":"https://hartvaat.nl/2016/05/10/timing-van-metoprolol-bij-stemi-effect-op-infarctgrootte-en-ventrikelfunctie/","title":"Timing van metoprolol bij STEMI: effect op infarctgrootte en ventrikelfunctie","title_en":"Impact of the Timing of Metoprolol Administration During STEMI on Infarct Size and Ventricular Function.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["stemi"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.02.050","source_url":"https://doi.org/10.1016/j.jacc.2016.02.050","authors":["Jose M García-Ruiz","Rodrigo Fernández-Jiménez","Ana García-Alvarez","Gonzalo Pizarro","Carlos Galán-Arriola","Leticia Fernández-Friera","Alonso Mateos","Mario Nuno-Ayala","Jaume Aguero","Javier Sánchez-González","Jaime García-Prieto","Beatriz López-Melgar","Pedro Martínez-Tenorio","Gonzalo J López-Martín","Angel Macías","Braulio Pérez-Asenjo","José A Cabrera","Antonio Fernández-Ortiz","Valentín Fuster","Borja Ibáñez"],"significance":6,"published":"2016-05-10","source_date":"2016-05-10","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"This study examined the impact of timing of intravenous metoprolol administration during STEMI on infarct size and ventricular function, exploring whether earlier beta-blocker delivery before reperfusion provides greater cardioprotection.","created":"2026-07-03T10:26:06Z","updated":"2026-07-03T13:25:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar het optimale tijdstip van metoprololtoediening tijdens STEMI en het effect op infarctgrootte en ventrikelfunctie. Klinisch relevant voor het vroeg-infarctbeleid.","abstract_original":"BACKGROUND: Pre-reperfusion administration of intravenous (IV) metoprolol reduces infarct size in ST-segment elevation myocardial infarction (STEMI). OBJECTIVES: This study sought to determine how this cardioprotective effect is influenced by the timing of metoprolol therapy having either a long or short metoprolol bolus-to-reperfusion interval. METHODS: We performed a post hoc analysis of the METOCARD-CNIC (effect of METOprolol of CARDioproteCtioN during an acute myocardial InfarCtion) trial, which randomized anterior STEMI patients to IV metoprolol or control before mechanical reperfusion. Treated patients were divided into short- and long-interval groups, split by the median time from 15 mg metoprolol bolus to reperfusion. We also performed a controlled validation study in 51 pigs subjected to 45 min ischemia/reperfusion. Pigs were allocated to IV metoprolol with a long (-25 min) or short (-5 min) pre-perfusion interval, IV metoprolol post-reperfusion (+60 min), or IV vehicle. Cardiac magnetic resonance (CMR) was performed in the acute and chronic phases in both clinical and experimental settings. RESULTS: For 218 patients (105 receiving IV metoprolol), the median time from 15 mg metoprolol bolus to reperfusion was 53 min. Compared with patients in the short-interval group, those with longer metoprolol exposure had smaller infarcts (22.9 g vs. 28.1 g; p = 0.06) and higher left ventricular ejection fraction (LVEF) (48.3% vs. 43.9%; p = 0.019) on day 5 CMR. These differences occurred despite total ischemic time being significantly longer in the long-interval group (214 min vs. 160 min; p < 0.001). There was no between-group difference in the time from symptom onset to metoprolol bolus. In the animal study, the long-interval group (IV metoprolol 25 min before reperfusion) had the smallest infarcts (day 7 CMR) and highest long-term LVEF (day 45 CMR). CONCLUSIONS: In anterior STEMI patients undergoing primary angioplasty, the sooner IV metoprolol is administered in the course of infarction, the smaller the infarct and the higher the LVEF. These hypothesis-generating clinical data are supported by a dedicated experimental large animal study."},{"id":"f02389579a97","type":"article","url":"https://hartvaat.nl/2016/05/05/perioperatief-rosuvastatine-bij-hartchirurgie-nejm-trial/","title":"Perioperatief rosuvastatine bij hartchirurgie: NEJM-trial","title_en":"Perioperative Rosuvastatin in Cardiac Surgery.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1507750","source_url":"https://doi.org/10.1056/NEJMoa1507750","authors":["Zhe Zheng","Raja Jayaram","Lixin Jiang","Jonathan Emberson","Yan Zhao","Qi Li","Juan Du","Silvia Guarguagli","Michael Hill","Zhengming Chen","Rory Collins","Barbara Casadei"],"significance":8,"published":"2016-05-05","source_date":"2016-05-05","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ezetimib/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This NEJM trial showed that perioperative rosuvastatin did not reduce perioperative myocardial damage after cardiac surgery and was associated with a higher incidence of acute kidney injury. The results argued against routine perioperative statin loading in cardiac surgery patients.","created":"2026-07-03T10:26:06Z","updated":"2026-07-03T13:25:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM-trial die perioperatief rosuvastatinegebruik onderzocht bij patiënten die hartchirurgie ondergingen. Onderzoekt of statines perioperatieve complicaties zoals myocardschade en AF kunnen verminderen.","abstract_original":"BACKGROUND: Complications after cardiac surgery are common and lead to substantial increases in morbidity and mortality. Meta-analyses of small randomized trials have suggested that perioperative statin therapy can prevent some of these complications. METHODS: We randomly assigned 1922 patients in sinus rhythm who were scheduled for elective cardiac surgery to receive perioperative rosuvastatin (at a dose of 20 mg daily) or placebo. The primary outcomes were postoperative atrial fibrillation within 5 days after surgery, as assessed by Holter electrocardiographic monitoring, and myocardial injury within 120 hours after surgery, as assessed by serial measurements of the cardiac troponin I concentration. Secondary outcomes included major in-hospital adverse events, duration of stay in the hospital and intensive care unit, left ventricular and renal function, and blood biomarkers. RESULTS: The concentrations of low-density lipoprotein cholesterol and C-reactive protein after surgery were lower in patients assigned to rosuvastatin than in those assigned to placebo (P<0.001). However, the rate of postoperative atrial fibrillation did not differ significantly between the rosuvastatin group and the placebo group (21.1% and 20.5%, respectively; odds ratio 1.04; 95% confidence interval [CI], 0.84 to 1.30; P=0.72), nor did the area under the troponin I-release curve (102 ng×hour per milliliter and 100 ng×hour per milliliter, respectively; between-group difference, 1%; 95% CI, -9 to 13; P=0.80). Subgroup analyses did not indicate benefit in any category of patient. Rosuvastatin therapy did not result in beneficial effects on any of the secondary outcomes but was associated with a significant absolute (±SE) excess of 5.4±1.9 percentage points in the rate of postoperative acute kidney injury (P=0.005). CONCLUSIONS: In this trial, perioperative statin therapy did not prevent postoperative atrial fibrillation or perioperative myocardial damage in patients undergoing elective cardiac surgery. Acute kidney injury was more common with rosuvastatin. (Funded by the British Heart Foundation and others; STICS ClinicalTrials.gov number, NCT01573143.)."},{"id":"033275e5a261","type":"article","url":"https://hartvaat.nl/2016/05/03/gemalen-prasugrel-bij-stemi-met-primaire-pci-de-crush-studie/","title":"Gemalen prasugrel bij STEMI met primaire PCI: de CRUSH-studie","title_en":"Crushed Prasugrel Tablets in Patients With STEMI Undergoing Primary Percutaneous Coronary Intervention: The CRUSH Study.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["stemi"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.02.045","source_url":"https://doi.org/10.1016/j.jacc.2016.02.045","authors":["Fabiana Rollini","Francesco Franchi","Jenny Hu","Megha Kureti","Niti Aggarwal","Ashwin Durairaj","Yongwhi Park","Michael Seawell","Pedro Cox-Alomar","Martin M Zenni","Luis A Guzman","Siva Suryadevara","Patrick Antoun","Theodore A Bass","Dominick J Angiolillo"],"significance":5,"published":"2016-05-03","source_date":"2016-05-03","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"The CRUSH study showed that crushed prasugrel tablets achieve faster platelet inhibition than intact tablets in STEMI patients undergoing primary PCI, providing a practical strategy for overcoming delayed oral drug absorption in acute MI.","created":"2026-07-03T10:26:06Z","updated":"2026-07-03T13:25:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die onderzocht of fijngemalen prasugrel-tabletten de absorptie versnellen bij STEMI-patiënten die primaire PCI ondergaan. Praktisch relevant voor het optimaliseren van plaatjesremming in de acute fase.","abstract_original":"BACKGROUND: Platelet inhibitory effects induced by oral P2Y12 receptor antagonists are delayed in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI), which may be attributed to impaired absorption affecting drug pharmacokinetics (PK) and pharmacodynamics (PD). Crushing tablets has been suggested to lead to more favorable PK/PD profiles. To date, no studies have investigated the PK/PD effects of crushing prasugrel. OBJECTIVES: This study sought to determine whether crushing prasugrel is associated with more favorable drug bioavailability and platelet inhibitory effects compared with whole tablets in STEMI patients undergoing PPCI. METHODS: Our prospective, randomized, open-label study assessed STEMI patients undergoing PPCI (n = 52) who were treated with a prasugrel 60-mg loading dose (LD) either as whole or crushed tablets. PK/PD analyses were performed at 7 time points. PD effects were measured as P2Y12 reaction units and platelet reactivity index, and PK by plasma levels of prasugrel's active metabolite. RESULTS: Compared with whole tablets, crushed prasugrel led to reduced P2Y12 reaction units by 30 min post-LD, which persisted at 1, 2 (164 vs. 95; least square mean difference = 68; 95% confidence interval: 10 to 126; primary endpoint), and 4 h post-LD. Significant differences were no longer present at 6 h post-LD. Parallel findings were shown with platelet reactivity index. Accordingly, high on-treatment platelet reactivity rates were reduced with crushed prasugrel. PK analyses showed a >3-fold faster absorption with crushed compared with whole prasugrel. CONCLUSIONS: In STEMI patients undergoing PPCI, crushed prasugrel leads to faster drug absorption, and consequently, more prompt and potent antiplatelet effects compared with whole tablet ingestion. (Pharmacological Effects of Crushing Prasugrel in STEMI Patients; NCT02212028)."},{"id":"d87539d7846b","type":"article","url":"https://hartvaat.nl/2016/05/03/diabetes-en-preventie-van-laat-myocardinfarct-na-stenting-dapt-studie/","title":"Diabetes en preventie van laat myocardinfarct na stenting: DAPT-studie","title_en":"Diabetes Mellitus and Prevention of Late Myocardial Infarction After Coronary Stenting in the Randomized Dual Antiplatelet Therapy Study.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["diabetes-en-hart","diabetes-type-1","diabetes-type-2","dubbele-trombocytenremming","figaro-dkd","obesitas","soul-trial"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.115.016783","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.115.016783","authors":["Ian T Meredith","Jean-François Tanguay","Dean J Kereiakes","Donald E Cutlip","Robert W Yeh","Kirk N Garratt","David P Lee","P Gabriel Steg","W Douglas Weaver","David R Holmes","Ralph G Brindis","Jaroslaw Trebacz","Joseph M Massaro","Wen-Hua Hsieh","Laura Mauri"],"significance":6,"published":"2016-05-03","source_date":"2016-05-03","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This DAPT study analysis showed that continued thienopyridine therapy beyond 12 months after stenting reduces late MI in diabetic patients, identifying diabetes as a modifier of the benefit from extended dual antiplatelet therapy.","created":"2026-07-03T10:26:06Z","updated":"2026-07-03T13:25:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de DAPT-studie naar het effect van verlengde duale antiplaatjestherapie op laat myocardinfarct bij diabetespatiënten na coronaire stentplaatsing. Diabetes verhoogt het ischemisch risico en kan de DAPT-duur beïnvloeden.","abstract_original":"BACKGROUND: Patients with diabetes mellitus (DM) are at high risk for recurrent ischemic events after coronary stenting. We assessed the effects of continued thienopyridine among patients with DM participating in the Dual Antiplatelet Therapy (DAPT) Study as a prespecified analysis. METHODS AND RESULTS: After coronary stent placement and 12 months treatment with open-label thienopyridine plus aspirin, 11 648 patients free of ischemic or bleeding events and who were medication compliant were randomly assigned to continued thienopyridine or placebo, in addition to aspirin, for 18 more months. After randomization, patients with DM (n=3391), in comparison with patients without DM (n=8257), had increased composite outcome of death, myocardial infarction (MI), or stroke (6.8% versus 4.3%, P<0.001), increased death (2.5% versus 1.4%, P<0.001), and MI (4.2% versus 2.6%, P<0.001). Among patients with DM, in a comparison of continued thienopyridine versus placebo, rates of stent thrombosis were 0.5% versus 1.1%, P=0.06, and rates of MI were 3.5% versus 4.8%, P=0.058; and among patients without DM the rates were 0.4% versus 1.4%, P<0.001 (stent thrombosis, P interaction=0.21) and 1.6% versus 3.6%, P<0.001 (MI, P interaction=0.02). Bleeding risk with continued thienopyridine was similar among patients with or without DM (interaction P=0.61). CONCLUSIONS: In patients with DM, continued thienopyridine beyond 1 year after coronary stenting is associated with reduced risk of MI, although this benefit is attenuated in comparison with patients without DM. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00977938."},{"id":"7ebcdb002993","type":"article","url":"https://hartvaat.nl/2016/05/01/intracoronaire-adenylylcyclase-6-gentherapie-bij-hartfalen-gerandomiseerde-trial/","title":"Intracoronaire adenylylcyclase 6-gentherapie bij hartfalen: gerandomiseerde trial","title_en":"Intracoronary Gene Transfer of Adenylyl Cyclase 6 in Patients With Heart Failure: A Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2016.0008","source_url":"https://doi.org/10.1001/jamacardio.2016.0008","authors":["H Kirk Hammond","William F Penny","Jay H Traverse","Timothy D Henry","Matthew W Watkins","Clyde W Yancy","Ranya N Sweis","Eric D Adler","Amit N Patel","David R Murray","Robert S Ross","Valmik Bhargava","Alan Maisel","Denise D Barnard","N Chin Lai","Nancy D Dalton","Martin L Lee","Sanjiv M Narayan","Daniel G Blanchard","Mei Hua Gao"],"significance":6,"published":"2016-05-01","source_date":"2016-05-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/aldosteron-en-raas-farmacologie/"],"congress":"","summary_en":"This JAMA Cardiology randomized trial of intracoronary adenylyl cyclase 6 gene transfer in heart failure was among the first cardiac gene therapy trials, evaluating the safety and efficacy of direct myocardial gene delivery.","created":"2026-07-03T10:26:06Z","updated":"2026-07-03T13:25:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology gerandomiseerde trial naar intracoronaire transfer van het adenylylcyclase 6-gen bij patiënten met hartfalen. Verkent een nieuw gentherapeutisch aangrijpingspunt voor verbetering van de hartfunctie.","abstract_original":"IMPORTANCE: Gene transfer has rarely been tested in randomized clinical trials. OBJECTIVE: To evaluate the safety and efficacy of intracoronary delivery of adenovirus 5 encoding adenylyl cyclase 6 (Ad5.hAC6) in heart failure. DESIGN, SETTING, AND PARTICIPANTS: A randomized, double-blind, placebo-controlled, phase 2 clinical trial was conducted in US medical centers (randomization occurred from July 19, 2010, to October 30, 2014). Participants 18 to 80 years with symptomatic heart failure (ischemic and nonischemic) and an ejection fraction (EF) of 40% or less were screened; 86 individuals were enrolled, and 56 were randomized. Data analysis was of the intention-to-treat population. Participants underwent exercise testing and measurement of left ventricular EF (echocardiography) and then cardiac catheterization, where left ventricular pressure development (+dP/dt) and decline (-dP/dt) were recorded. Participants were randomized (3:1 ratio) to receive 1 of 5 doses of intracoronary Ad5.hAC6 or placebo. Participants underwent a second catheterization 4 weeks later for measurement of dP/dt. Exercise testing and EF were assessed 4 and 12 weeks after randomization. INTERVENTIONS: Intracoronary administration of Ad5.hAC6 (3.2 × 109 to 1012 virus particles) or placebo. MAIN OUTCOMES AND MEASURES: Primary end points included exercise duration and EF before and 4 and 12 weeks after randomization and peak rates of +dP/dt and -dP/dt before and 4 weeks after randomization. Fourteen placebo participants were compared (intention to treat) with 24 Ad5.hAC6 participants receiving the highest 2 doses (D4 + 5). RESULTS: Fifty-six individuals were randomized and monitored for up to 1 year. Forty-two participants (75%) received Ad5.hAC6 (mean [SE] age, 63 [1] years; EF, 30% [1%]), and 14 individuals (25%) received placebo (age, 62 [1] years; EF, 30% [2%]). Exercise duration showed no significant group differences (4 weeks, P = .27; 12 weeks, P = .47, respectively). The D4 + 5 participants had increased EF at 4 weeks (+6.0 [1.7] EF units; n = 21; P < .004), but not 12 weeks (+3.0 [2.4] EF units; n = 21; P = .16). Placebo participants showed no increase in EF at 4 weeks or 12 weeks. Exercise duration showed no between-group differences (4-week change from baseline: placebo, 27 [36] seconds; D4 + 5, 44 [25] seconds; P = .27; 12-week change from baseline: placebo, 44 [28] seconds; D4 + 5, 58 [29 seconds, P = .47). AC6 gene transfer increased basal left ventricular peak -dP/dt (4-week change from baseline: placebo, +93 [51] mm Hg/s; D4 + 5, -39 [33] mm Hg/s; placebo [n = 21]; P < .03); AC6 did not increase arrhythmias. The admission rate for patients with heart failure was 9.5% (4 of 42) in the AC6 group and 28.6% (4 of 14) in the placebo group (relative risk, 0.33 [95% CI, 0.08-1.36]; P = .10). CONCLUSIONS AND RELEVANCE: AC6 gene transfer safely increased LV function beyond standard heart failure therapy, attainable with one-time administration. Larger trials are warranted. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00787059."},{"id":"1a93665f17e6","type":"article","url":"https://hartvaat.nl/2016/05/01/sitagliptine-en-hartfalenrisico-bij-diabetes-type-2-secundaire-analyse-tecos-tri/","title":"Sitagliptine en hartfalenrisico bij diabetes type 2: secundaire analyse TECOS-trial","title_en":"Association Between Sitagliptin Use and Heart Failure Hospitalization and Related Outcomes in Type 2 Diabetes Mellitus: Secondary Analysis of a Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["diabetes-type-2","select-trial","soul-trial"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2016.0103","source_url":"https://doi.org/10.1001/jamacardio.2016.0103","authors":["Darren K McGuire","Frans Van de Werf","Paul W Armstrong","Eberhard Standl","Joerg Koglin","Jennifer B Green","M Angelyn Bethel","Jan H Cornel","Renato D Lopes","Sigrun Halvorsen","Giuseppe Ambrosio","John B Buse","Robert G Josse","John M Lachin","Michael J Pencina","Jyotsna Garg","Yuliya Lokhnygina","Rury R Holman","Eric D Peterson"],"significance":7,"published":"2016-05-01","source_date":"2016-05-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/sglt2-remmers-cardiovasculaire-trials/"],"congress":"","summary_en":"This TECOS trial subanalysis showed no increased risk of heart failure hospitalization with sitagliptin in patients with type 2 diabetes, providing reassurance about DPP-4 inhibitor safety regarding heart failure in this class.","created":"2026-07-03T10:26:05Z","updated":"2026-07-03T13:25:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology analyse van de TECOS-trial naar het verband tussen sitagliptine en hartfalengerelateerde opnames bij patiënten met diabetes type 2. Relevant voor de cardiovasculaire veiligheid van DPP-4-remmers.","abstract_original":"IMPORTANCE: Previous trial results have suggested that dipeptidyl peptidase 4 inhibitor (DPP4i) use might increase heart failure (HF) risk in type 2 diabetes mellitus (T2DM). The DPP4i sitagliptin has been shown to be noninferior to placebo with regard to primary and secondary composite atherosclerotic cardiovascular (CV) outcomes in the Trial Evaluating Cardiovascular Outcomes With Sitagliptin (TECOS). OBJECTIVE: To assess the association of sitagliptin use with hospitalization for HF (hHF) and related outcomes. DESIGN, SETTING, AND PARTICIPANTS: TECOS was a randomized, double-blind, placebo-controlled study evaluating the CV safety of sitagliptin vs placebo, each added to usual antihyperglycemic therapy and CV care among patients with T2DM and prevalent atherosclerotic vascular disease. The median follow-up was 2.9 years. The setting was 673 sites in 38 countries. Participants included 14 671 patients with T2DM and atherosclerotic vascular disease. The study dates were December 2008 through March 2015. INTERVENTIONS: Patients were randomized to sitagliptin vs placebo added to standard care. MAIN OUTCOMES AND MEASURES: Prespecified secondary analyses compared the effect on hHF, hHF or CV death, and hHF or all-cause death composite outcomes overall and in prespecified subgroups. Supportive analyses included total hHF events (first plus recurrent) and post-hHF death. Meta-analyses evaluated DPP4i effects on hHF and on hHF or CV death. RESULTS: Of 14 671 patients, 7332 were randomized to sitagliptin and 7339 to placebo. Hospitalization for HF occurred in 3.1% (n = 228) and 3.1% (n = 229) of the sitagliptin and placebo groups, respectively (unadjusted hazard ratio, 1.00; 95% CI, 0.83-1.19). There was also no difference in total hHF events between the sitagliptin (n = 345) and placebo (n = 347) groups (unadjusted hazard ratio, 1.00; 95% CI, 0.80-1.25). Post-hHF all-cause death was similar in the sitagliptin and placebo groups (29.8% vs 28.8%, respectively), as was CV death (22.4% vs 23.1%, respectively). No heterogeneity for the effect of sitagliptin on hHF was observed in subgroup analyses across 21 factors (P > .10 for all interactions). Meta-analysis of the hHF results from the 3 reported DPP4i CV outcomes trials revealed moderate heterogeneity (I2 = 44.9, P = .16). CONCLUSIONS AND RELEVANCE: Sitagliptin use does not affect the risk for hHF in T2DM, both overall and among high-risk patient subgroups. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00790205."},{"id":"a94f8df5597c","type":"article","url":"https://hartvaat.nl/2016/05/01/lipoproteinen-insulineresistentie-en-rosuvastatine-bij-incident-type-2-diabetes/","title":"Lipoproteïnen, insulineresistentie en rosuvastatine bij incident type 2 diabetes","title_en":"Association of Lipoproteins, Insulin Resistance, and Rosuvastatin With Incident Type 2 Diabetes Mellitus : Secondary Analysis of a Randomized Clinical Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["atorvastatine","diabetes-en-hart","diabetes-type-2","dyslipidemie","ldl-cholesterol","lipide-aferese","lipoproteïne-a","rosuvastatine","statines"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2016.0096","source_url":"https://doi.org/10.1001/jamacardio.2016.0096","authors":["Sagar B Dugani","Akintunde O Akinkuolie","Nina Paynter","Robert J Glynn","Paul M Ridker","Samia Mora"],"significance":6,"published":"2016-05-01","source_date":"2016-05-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This JAMA Cardiology analysis explored the association between lipoprotein profiles, insulin resistance, and rosuvastatin-associated new-onset diabetes, providing mechanistic insights into the diabetogenic effect of statin therapy.","created":"2026-07-03T10:26:05Z","updated":"2026-07-03T13:25:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology secundaire analyse naar het verband tussen lipoproteïnenprofielen, insulineresistentie en het risico op diabetes type 2 bij rosuvastatinegebruik. Onderzoekt het metabole risicoprofiel van statines.","abstract_original":"IMPORTANCE: Statins decrease levels of low-density lipoprotein (LDL) and triglycerides as well as cardiovascular events but increase the risk for a diagnosis of type 2 diabetes mellitus (T2DM). The risk factors associated with incident T2DM are incompletely characterized. OBJECTIVE: To investigate the association of lipoprotein subclasses and size and a novel lipoprotein insulin resistance (LPIR) score (a composite of 6 lipoprotein measures) with incident T2DM among individuals randomized to a high-intensity statin or placebo. DESIGN, SETTING, AND PARTICIPANTS: This secondary analysis of the JUPITER trial (a placebo-controlled randomized clinical trial) was conducted at 1315 sites in 26 countries and enrolled 17 802 men 50 years or older and women 60 years or older with LDL cholesterol levels less than 130 mg/dL, high-sensitivity C-reactive protein levels of at least 2 mg/L, and triglyceride levels less than 500 mg/dL. Those with T2DM were excluded. A prespecified secondary aim was to assess the effect of rosuvastatin calcium on T2DM. Incident T2DM was monitored for a median of 2.0 years. Data were collected from February 4, 2003, to August 20, 2008, and analyzed (intention-to-treat) from December 1, 2013, to January 21, 2016. INTERVENTIONS: Rosuvastatin calcium, 20 mg/d, or placebo. MAIN OUTCOMES AND MEASURES: Size and concentration of lipids, apolipoproteins, and lipoproteins at baseline (11 918 patients with evaluable plasma samples) and 12 months after randomization (9180 patients). The LPIR score, a correlate of insulin resistance, was calculated as a weighted combination of size and concentrations of LDL, very low-density lipoprotein (VLDL), and high-density lipoprotein (HDL) particles. RESULTS: Among the 11 918 patients (4334 women [36.4%]; median [interquartile range] age, 66 [60-71] years), rosuvastatin lowered the levels of LDL particles (-39.6%; 95% CI, -49.4% to -24.6%), VLDL particles (-19.6%; 95% CI, -40.6% to 10.3%), and VLDL triglycerides (-15.2%; 95% CI, -35.9% to 11.3%) and shifted the lipoprotein subclass distribution toward smaller LDL size (-1.5%; 95% CI, -3.7% to 0.5%), larger VLDL size (2.8%; 95% CI, -5.8% to 12.7%), and lower LPIR score (-3.2%; 95% CI, -20.6% to 16.9%). In analyses adjusted for age, sex, race or ethnic origin, exercise, educational level, family history, and smoking, the hazard ratio (HR) for T2DM per SD of LPIR score in the placebo arm was 1.99 (95% CI, 1.64-2.42); in the rosuvastatin arm, 2.06 (95% CI, 1.74-2.43). After additional adjustment for systolic blood pressure, body mass index, high-sensitivity C-reactive protein, hemoglobin A1c, HDL cholesterol, LDL cholesterol, and triglycerides, the LPIR score remained associated with T2DM in the placebo arm (HR, 1.35; 95% CI, 1.03-1.76) and rosuvastatin arm (HR, 1.60; 95% CI, 1.27-2.03). Similar trends were seen at 12 months. The LPIR score improved the model likelihood ratio (χ2 = 18.23; P < .001) and categorical net reclassification index (0.039; 95% CI, 0.003-0.072). CONCLUSIONS AND RELEVANCE: In apparently healthy people, LPIR score was positively associated with incident T2DM, including during rosuvastatin therapy. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00239681."},{"id":"4c385973eab7","type":"article","url":"https://hartvaat.nl/2016/05/01/procentuele-ldl-verlaging-bij-hoogintensieve-statinetherapie-implicaties-voor-ri/","title":"Procentuele LDL-verlaging bij hoogintensieve statinetherapie: implicaties voor richtlijnen en PCSK9-remmers","title_en":"Percent reduction in LDL cholesterol following high-intensity statin therapy: potential implications for guidelines and for the prescription of emerging lipid-lowering agents.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["anemie-ckd","bempedoïnezuur","cetp-remmers","clear-outcomes","diabetes-en-hart","dyslipidemie","enlicitide","ezetimibe","familiaire-hypercholesterolemie","familiaire-hypercholesterolemie-screening","farmaco-economie","figaro-dkd","gepersonaliseerde-geneeskunde","hdl-cholesterol","hs-crp","ldl-cholesterol","lipidenverlaging","niet-statine-therapie","obicetrapib","ouderen","pcsk9-remmers","pcsk9-remmers-nieuwe-generatie","pelacarsen","perifeer-vaatlijden","richtlijnen-esc","rosuvastatine","soul-trial","statines","vrouwen"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw046","source_url":"https://doi.org/10.1093/eurheartj/ehw046","authors":["Paul M Ridker","Samia Mora","Lynda Rose"],"significance":7,"published":"2016-05-01","source_date":"2016-05-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/","https://hartvaat.nl/kennis/lipiden/pcsk9-mechanisme/"],"congress":"","summary_en":"This analysis examined the variability in percentage LDL cholesterol reduction achieved with high-intensity statin therapy, showing that a significant proportion of patients fail to achieve the expected ≥50% reduction. The findings have implications for guideline-based LDL target strategies.","created":"2026-07-03T10:26:05Z","updated":"2026-07-03T13:25:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de variabiliteit in procentuele LDL-cholesterolreductie bij hoogintensieve statinetherapie. Relevant voor het bepalen welke patiënten baat hebben bij aanvullende PCSK9-remming.","abstract_original":"AIMS: Current statin guidelines in Europe and Canada advocate achieving a fixed LDL target or the attainment of a ≥50% reduction in low-density lipoprotein cholesterol (LDLC), while current US guidelines advocate the use of statin therapies that reduce LDLC by <50% (moderate intensity) or ≥50% (high intensity). Data are limited, however, linking the achievement of these % reduction thresholds to subsequent cardiovascular outcomes particularly for contemporary high-intensity regimens. METHODS AND RESULTS: In a randomized trial of 17 082 initially healthy men and women with median baseline LDLC of 108 mg/dL (interquartile range 94-119), we (i) used waterfall plots to assess the variability in LDLC response to rosuvastatin 20 mg daily and (ii) evaluated the impact of reaching ≥50% reductions in LDLC on risk of developing the first cardiovascular events. Among rosuvastatin allocated participants, 3640 individuals (46.3%) experienced an LDLC reduction ≥50%; 3365 individuals (42.8%) experienced an LDLC reduction >0 but <50%; and 851 individuals (10.8%) experienced no reduction or an increase in LDLC compared with baseline. These % LDLC reductions directly related to the risks of first cardiovascular events; at trial completion, incidence rates for the primary endpoint were 11.2, 9.2, 6.7, and 4.8 per 1000 person-years for those in the placebo, no LDLC reduction, LDLC reduction <50%, and LDLC reduction ≥50% groups, respectively. Compared with placebo, the multivariable adjusted hazard ratios for sequentially greater on-treatment per cent reductions in LDLC were 0.91 (95%CI 0.54-1.53), 0.61 (95%CI 0.44-0.83), and 0.43 (95%CI 0.30-0.60) (P < 0.00001). Similar relationships between % reduction and clinical outcomes were observed in analyses focusing on non-HDLC or apolipoprotein B. CONCLUSIONS: As documented for low- and moderate-intensity regimens, variability in % LDLC reduction following high-intensity statin therapy is wide yet the magnitude of this % reduction directly relates to efficacy. These data support guideline approaches that incorporate % reduction targets for statin therapy as well as absolute targets, and might provide a structure for the allocation of emerging adjunctive lipid-lowering therapies such as PCSK9 inhibitors should these agents prove broadly effective for cardiovascular event reduction."},{"id":"e32449fc5f88","type":"article","url":"https://hartvaat.nl/2016/05/01/ly3015014-een-nieuw-monoklonaal-pcsk9-antilichaam-gerandomiseerde-fase-2-trial/","title":"LY3015014, een nieuw monoklonaal PCSK9-antilichaam: gerandomiseerde fase-2-trial","title_en":"Safety and efficacy of LY3015014, a monoclonal antibody to proprotein convertase subtilisin/kexin type 9 (PCSK9): a randomized, placebo-controlled Phase 2 study.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["alirocumab","enlicitide","evolocumab","ezetimibe","niet-statine-therapie","pcsk9-remmers","pcsk9-remmers-nieuwe-generatie","select-trial","soul-trial"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehv707","source_url":"https://doi.org/10.1093/eurheartj/ehv707","authors":["John J P Kastelein","Steven E Nissen","Daniel J Rader","G Kees Hovingh","Ming-Dauh Wang","Tong Shen","Kathryn A Krueger"],"significance":6,"published":"2016-05-01","source_date":"2016-05-01","image":"","kennis":[],"congress":"","summary_en":"This randomized trial of LY3015014, a PCSK9 monoclonal antibody, demonstrated dose-dependent LDL cholesterol lowering in patients with hypercholesterolemia, expanding the clinical data on PCSK9 inhibitor therapy during early class development.","created":"2026-07-03T10:26:05Z","updated":"2026-07-03T13:25:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde placebogecontroleerde trial van LY3015014, een monoklonaal antilichaam tegen PCSK9, bij hypercholesterolemie. Onderzocht de veiligheid en werkzaamheid van een alternatieve PCSK9-remmer naast evolocumab en alirocumab.","abstract_original":"AIMS: The objective of this study was to evaluate the efficacy, safety, and tolerability of LY3015014 (LY), a neutralizing antibody of proprotein convertase subtilisin/kexin type 9 (PCSK9), administered every 4 or 8 weeks in patients with primary hypercholesterolaemia, when added to a background of standard-of-care lipid-lowering therapy, including statins. METHODS AND RESULTS: Double-blind, placebo-controlled trial randomized 527 patients with primary hypercholesterolaemia from June 2013 to January 2014 at 61 community and academic centres in North America, Europe, and Japan. Patients were randomized to subcutaneous injections of LY 20, 120, or 300 mg every 4 weeks (Q4W); 100 or 300 mg every 8 weeks (Q8W) alternating with placebo Q4W; or placebo Q4W. The primary endpoint was percentage change from baseline in low-density lipoprotein cholesterol (LDL-C) by beta quantification at Week 16. The mean baseline LDL-C by beta quantification was 136.3 (SD, 45.0)mg/dL. LY3015014 dose-dependently decreased LDL-C, with a maximal reduction of 50.5% with 300 mg LY Q4W and 37.1% with 300 mg LY Q8W compared with a 7.6% increase with placebo maintained at the end of the dosing interval. There were no treatment-related serious adverse events (AEs). The most common AE terms (>10% of any treatment group) reported more frequently with LY compared with placebo were injection site (IS) pain and IS erythema. No liver or muscle safety issues emerged. CONCLUSIONS: LY3015014 dosed every 4 or 8 weeks, resulted in robust and durable reductions in LDL-C. No clinically relevant safety issues emerged with the administration of LY. The long-term effects on cardiovascular outcomes require further investigation."},{"id":"19d1fd8b0502","type":"article","url":"https://hartvaat.nl/2016/05/01/genetische-diagnostiek-en-biomarkers-bij-pediatrische-pulmonale-hypertensie-expe/","title":"Genetische diagnostiek en biomarkers bij pediatrische pulmonale hypertensie: expertconsensus","title_en":"Genetic testing and blood biomarkers in paediatric pulmonary hypertension. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and DGPK.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog"],"tags":["biomarkers-cardiovasculair","bloeddrukbehandeling","pulmonale-hypertensie"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2014-307238","source_url":"https://doi.org/10.1136/heartjnl-2014-307238","authors":["Joseph Pattathu","Matthias Gorenflo","Anne Hilgendorff","Juha W Koskenvuo","Christian Apitz","Georg Hansmann","Tero-Pekka Alastalo"],"significance":6,"published":"2016-05-01","source_date":"2016-05-01","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/kdigo-richtlijn-ckd-2024/"],"congress":"","summary_en":"This expert consensus on genetic testing and blood biomarkers in pediatric pulmonary hypertension provided recommendations for the diagnostic evaluation of childhood-onset pulmonary arterial hypertension, including BMPR2 and related gene testing.","created":"2026-07-03T10:26:05Z","updated":"2026-07-03T18:38:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Expertconsensus over genetisch onderzoek en bloedmarkers bij de diagnostiek van pulmonale hypertensie op de kinderleeftijd. Geeft aanbevelingen voor het inzetten van moleculaire diagnostiek bij deze zeldzame aandoening.","abstract_original":"Childhood-onset pulmonary arterial hypertension (PAH) is considered complex and multifactorial, with relatively poor estimates of the natural history of the disease. Strategies allowing earlier detection, establishment of disease aetiology together with more accurate and sensitive biomarkers could enable better estimates of prognosis and individualise therapeutic strategies. Evidence is accumulating that genetic defects play an important role in the pathogenesis of idiopathic and hereditary forms of PAH. Altogether nine genes have been reported so far to be associated with childhood onset PAH suggesting that comprehensive multigene diagnostics can be useful in the assessment. Identification of disease-causing mutations allows estimates of prognosis and forms the most effective way for risk stratification in the family. In addition to genetic determinants the analysis of blood biomarkers are increasingly used in clinical practice to evaluate disease severity and treatment responses. As in genetic diagnostics, a multiplex approach can be helpful, as a single biomarker for PAH is unlikely to meet all requirements. This consensus statement reviews the current evidence for the use of genetic diagnostics and use of blood biomarkers in the assessment of paediatric patients with PAH."},{"id":"74e256b81141","type":"article","url":"https://hartvaat.nl/2016/05/01/cardiale-mri-en-ct-bij-kinderen-met-pulmonale-hypertensie-expertconsensus/","title":"Cardiale MRI en CT bij kinderen met pulmonale hypertensie: expertconsensus","title_en":"Cardiac MR and CT imaging in children with suspected or confirmed pulmonary hypertension/pulmonary hypertensive vascular disease. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and DGPK.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog"],"tags":["pulmonale-hypertensie"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2015-308246","source_url":"https://doi.org/10.1136/heartjnl-2015-308246","authors":["Heiner Latus","Titus Kuehne","Philipp Beerbaum","Christian Apitz","Georg Hansmann","Vivek Muthurangu","Shahin Moledina"],"significance":6,"published":"2016-05-01","source_date":"2016-05-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This expert consensus statement addressed the role of cardiac MRI and CT in diagnosing pulmonary hypertension and pulmonary vascular disease in children, providing imaging guidance for this heterogeneous pediatric condition.","created":"2026-07-03T10:26:05Z","updated":"2026-07-03T13:25:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Expertconsensusverklaring over de rol van cardiale MRI en CT bij de diagnostiek van pulmonale hypertensie en pulmonaal vaatlijden bij kinderen. Richtinggevend voor beeldvormingsprotocollen in de kindercardiologie.","abstract_original":"Childhood pulmonary hypertension (PH) is a heterogenous disease associated with considerable morbidity and mortality. Invasive assessment of haemodynamics is crucial for accurate diagnosis and guidance of medical therapy. However, adequate imaging is increasingly important in children with PH to evaluate the right heart and the pulmonary vasculature. Cardiac MR (CMR) and computed tomography (CT) represent important non-invasive imaging modalities that may enable comprehensive assessment of right ventricular (RV) function and pulmonary haemodynamics. Here, we present graded consensus recommendations for the evaluation of children with PH by CMR and CT. The article provides a structured approach for the use of CMR and CT imaging, emphasises non-invasive variables of RV function, myocardial tissue and afterload parameters that may be useful for initial diagnosis and monitoring. Furthermore, assessment of pulmonary perfusion and characterisation of the lung parenchyma provides structural information about processes that may cause or be due to PH."},{"id":"f855a6089eb7","type":"article","url":"https://hartvaat.nl/2016/05/01/werkzame-mechanismen-van-disease-management-bij-hartfalen-systematische-review/","title":"Werkzame mechanismen van disease management bij hartfalen: systematische review","title_en":"A systematic review of the main mechanisms of heart failure disease management interventions.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2015-308551","source_url":"https://doi.org/10.1136/heartjnl-2015-308551","authors":["Alexander M Clark","Kelly S Wiens","Davina Banner","Jennifer Kryworuchko","Lorraine Thirsk","Lianne McLean","Kay Currie"],"significance":6,"published":"2016-05-01","source_date":"2016-05-01","image":"","kennis":[],"congress":"","summary_en":"This systematic review identified the core mechanisms underlying effective heart failure disease management programs, finding that multidisciplinary coordination, patient education, self-management support, and structured follow-up are the key components.","created":"2026-07-03T10:26:05Z","updated":"2026-07-03T13:25:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review die de kernmechanismen identificeerde van effectieve disease-managementinterventies bij hartfalen. Biedt een raamwerk voor het ontwerpen van optimale hartfalenzorgprogramma's.","abstract_original":"OBJECTIVE: To identify the main mechanisms of heart failure (HF) disease management programmes based in hospitals, homes or the community. METHODS: Systematic review of qualitative and quantitative studies using realist synthesis. The search strategy incorporated general and specific terms relevant to the research question: HF, self-care and programmes/interventions for HF patients. To be included, papers had to be published in English after 1995 (due to changes in HF care over recent years) to May 2014 and contain specific data related to mechanisms of effect of HF programmes. 10 databases were searched; grey literature was located via Proquest Dissertations and Theses, Google and publications from organisations focused on HF or self-care. RESULTS: 33 studies (n=3355 participants, mean age: 65 years, 35% women) were identified (18 randomised controlled trials, three mixed methods studies, six pre-test post-test studies and six qualitative studies). The main mechanisms identified in the studies were associated with increased patient understanding of HF and its links to self-care, greater involvement of other people in this self-care, increased psychosocial well-being and support from health professionals to use technology. CONCLUSION: Future HF disease management programmes should seek to harness the main mechanisms through which programmes actually work to improve HF self-care and outcomes, rather than simply replicating components from other programmes. The most promising mechanisms to harness are associated with increased patient understanding and self-efficacy, involvement of other caregivers and health professionals and improving psychosocial well-being and technology use."},{"id":"b284afaad472","type":"article","url":"https://hartvaat.nl/2016/05/01/therapeutische-hypothermie-bij-stemi-systematische-review-en-meta-analyse/","title":"Therapeutische hypothermie bij STEMI: systematische review en meta-analyse","title_en":"Therapeutic hypothermia in ST elevation myocardial infarction: a systematic review and meta-analysis of randomised control trials.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["acuut-hartfalen","bloeddrukbehandeling","farmaco-economie","fidelity","myocardinfarct","ouderen","select-trial","summit-trial","vrouwen"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2015-308559","source_url":"https://doi.org/10.1136/heartjnl-2015-308559","authors":["Pedro A Villablanca","Gaurav Rao","David F Briceno","Marissa Lombardo","Harish Ramakrishna","Anna Bortnick","Mario García","Mark Menegus","Daniel Sims","Mohammed Makkiya","Farouk Mookadam"],"significance":6,"published":"2016-05-01","source_date":"2016-05-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/kleplijden/endocarditis-profylaxe/"],"congress":"","summary_en":"This systematic review and meta-analysis of randomized trials found that therapeutic hypothermia does not significantly reduce infarct size in STEMI patients, a negative result for this cardioprotective strategy despite promising preclinical data.","created":"2026-07-03T10:26:05Z","updated":"2026-07-03T13:25:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse van gerandomiseerde trials naar het effect van therapeutische hypothermie op infarctgrootte en uitkomsten bij STEMI. Onderzoekt of koeling als adjuvante therapie bij reperfusie de myocardschade beperkt.","abstract_original":"OBJECTIVE: Our objective is to gain a better understanding of the efficacy and safety of therapeutic hypothermia (TH) in patients with acute ST elevation myocardial infarction (STEMI) through an analysis of randomised controlled trials (RCTs). BACKGROUND: Several RCTs have suggested a positive outcome with the use of TH in the prevention of myocardial injury in the setting of an acute STEMI. However, there are currently no clinical trials that have conclusively shown any significant benefit. METHODS: Electronic databases were used to identify RCTs of TH in the patient population with STEMI. The primary efficacy end point was major adverse cardiovascular event (MACE). Secondary efficacy end points included all-cause mortality, infarct size, new myocardial infarction and heart failure/pulmonary oedema (HF/PO). All-bleeding, ventricular arrhythmias and bradycardias were recorded as the safety end points. RESULTS: Six RCTs were included in this meta-analysis, enrolling a total of 819 patients. There was no significant benefit from TH in preventing MACE (OR, 01.04; 95% CI 0.37 to 2.89), all-cause mortality (OR, 1.48; 95% CI 0.68 to 3.19), new myocardial infarction (OR, 0.99; 95% CI 0.20 to 4.94), HF/PO (OR, 0.52; 95% CI 0.15 to 1.77) or infarct size (standard difference of the mean (SDM), -0.1; 95% CI -0.23 to 0.04). However, a significant reduction of infarct size was observed with TH utilisation in anterior wall myocardial infarction (SDM, -0.23; 95% CI -0.45 to -0.02). There was no significant difference seen for the safety end points all-bleeding (OR 1.32; 95% CI 0.77 to 2.24), ventricular arrhythmias (OR, 0.85; 95% CI 0.54 to 1.36) or bradycardias (OR, 1.16; 95% CI 0.74 to 1.83). CONCLUSIONS: Although TH appears to be safe in patients with STEMI, meta-analysis of published RCTs indicates that benefit is limited to reduction of infarct size in patients with anterior wall involvement with no demonstrable effect on all-cause mortality, recurrent myocardial infarction or HF/PO."},{"id":"8d43f3824357","type":"article","url":"https://hartvaat.nl/2016/05/01/katheterablatie-van-af-bij-chronisch-hartfalen-state-of-the-art-en-toekomstpersp/","title":"Katheterablatie van AF bij chronisch hartfalen: state-of-the-art en toekomstperspectieven","title_en":"Catheter ablation of atrial fibrillation in chronic heart failure: state-of-the-art and future perspectives.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["acuut-hartfalen","anemie-ckd","bisoprolol","bradycardie","cardiale-resynchronisatie","chronische-nierziekte","hfmref","hfpef","hfref","ivabradine","pathfinder-trial","pulsed-field-ablatie-atriumfibrilleren","vrouwen"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euv368","source_url":"https://doi.org/10.1093/europace/euv368","authors":["Matteo Anselmino","Mario Matta","Davide Castagno","Carla Giustetto","Fiorenzo Gaita"],"significance":6,"published":"2016-05-01","source_date":"2016-05-01","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doacs-overzicht/","https://hartvaat.nl/kennis/ritmestoornissen/implanteerbare-loop-recorder/"],"congress":"","summary_en":"This comprehensive review of catheter ablation for AF in chronic heart failure summarized the state of the art and future perspectives, covering patient selection, procedural techniques, and the evolving evidence for rhythm control in the HF-AF overlap population.","created":"2026-07-03T10:26:04Z","updated":"2026-07-03T18:38:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Uitgebreid overzichtsartikel over de huidige stand van zaken en toekomstperspectieven van katheterablatie voor atriumfibrilleren bij patiënten met chronisch hartfalen. Bespreekt indicaties, technieken en langetermijnresultaten.","abstract_original":"Catheter ablation of atrial fibrillation (AFCA) is a widely recommended treatment for symptomatic atrial fibrillation (AF) patients refractory to pharmacological treatment. Catheter ablation of AF is becoming a therapeutic option also among patients with chronic heart failure (CHF), on top of optimal medical treatment, being this arrhythmia related to a higher risk of death and/or symptom's worsening. In fact, in this setting, clinical evidences are continuously increasing. The present systematic review pools all published experiences concerning AFCA among CHF patients, or patients with structural cardiomyopathies, in order to summarize procedural safety and efficacy in this specific population. Moreover, the effects of AFCA on functional class and quality of life and the different procedural protocols available are discussed. The present work, therefore, attempts to provide an evidence-based clinical perspective to optimize clinical indication and tailor procedural characteristics and endpoints to patients affected by CHF referred for AFCA."},{"id":"5a19c584e109","type":"article","url":"https://hartvaat.nl/2016/05/01/mineralocorticoidreceptorantagonisten-en-atriumfibrilleren-meta-analyse/","title":"Mineralocorticoïdreceptorantagonisten en atriumfibrilleren: meta-analyse","title_en":"Mineralocorticoid receptor antagonists and atrial fibrillation: a meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":["finerenon","finerenon-hartfalen-nierziekte","mra-aldosteronantagonisten"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euv366","source_url":"https://doi.org/10.1093/europace/euv366","authors":["Tong Liu","Panagiotis Korantzopoulos","Qingmiao Shao","Zhiwei Zhang","Konstantinos P Letsas","Guangping Li"],"significance":6,"published":"2016-05-01","source_date":"2016-05-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/mineralocorticoid-antagonisten-farmacologie/","https://hartvaat.nl/kennis/farmacologie/aldosteron-en-raas-farmacologie/"],"congress":"","summary_en":"This meta-analysis showed that mineralocorticoid receptor antagonists reduce the incidence and recurrence of atrial fibrillation, supporting an anti-remodeling and antifibrotic mechanism that extends to atrial substrate modification.","created":"2026-07-03T10:26:04Z","updated":"2026-07-03T13:25:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse die het effect van mineralocorticoïdreceptorantagonisten (MRA's) op het ontstaan en recidiveren van atriumfibrilleren onderzocht. Ondersteunt een rol voor MRA's in AF-preventie naast hun hartfalenvoordelen.","abstract_original":"AIMS: Aldosterone has been implicated in atrial remodelling representing a potential target for upstream therapies. Accumulating evidence suggests that mineralocorticoid receptor blockade may have favourable effects on atrial fibrillation (AF) development, although some controversial results have been published. We, therefore, conducted a meta-analysis of randomized clinical trials (RCTs) and observational studies in order to examine the protective role of mineralocorticoid receptor antagonists (MRAs) on AF. METHODS AND RESULTS: Of the 1337 initially identified records, 3 RCTs and 2 observational studies with 3640 patients were finally analysed. The pooled analysis of the included studies demonstrated that patients treated with MRAs have 31% lower risk of AF compared with controls [relative ratio (RR): 0.69; 95% confidence interval (CI): 0.58-0.83] without any heterogeneity across the studies (I(2) = 0%). This effect was consistent across RCTs (RR: 0.72; 95% CI: 0.55-0.94) and observational studies (RR: 0.67; 95% CI: 0.53-0.84) without heterogeneity. Also, MRAs reduce the risk of AF in both heart failure (HF) (RR: 0.63; 95% CI: 0.50-0.80) and after cardiac surgery (RR: 0.77; 95% CI: 0.61-0.98). Analysing the relative impact of eplerenone and spironolactone, we showed that only eplerenone significantly reduces AF burden (RR: 0.64; 95% CI: 0.44-0.90). CONCLUSION: Our meta-analysis suggests that MRAs may be effective in AF prevention especially in the HF setting. However, there are insufficient data for the widespread use of aldosterone antagonists solely for AF prevention. Larger RCTs with long-term follow-up in different clinical settings are needed to clarify the impact of MRAs on AF."},{"id":"9843500497a9","type":"article","url":"https://hartvaat.nl/2016/04/30/fluticason-vilanterol-en-overleving-bij-copd-met-verhoogd-cardiovasculair-risico/","title":"Fluticason/vilanterol en overleving bij COPD met verhoogd cardiovasculair risico: SUMMIT-trial","title_en":"Fluticasone furoate and vilanterol and survival in chronic obstructive pulmonary disease with heightened cardiovascular risk (SUMMIT): a double-blind randomised controlled trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts","internist"],"tags":["answer-hf","bloeddrukbehandeling","roken","slaapapneu","summit-trial"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(16)30069-1","source_url":"https://doi.org/10.1016/S0140-6736(16)30069-1","authors":["Jørgen Vestbo","Julie A Anderson","Robert D Brook","Peter M A Calverley","Bartolome R Celli","Courtney Crim","Fernando Martinez","Julie Yates","David E Newby"],"significance":7,"published":"2016-04-30","source_date":"2016-04-30","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"This Lancet trial examined the cardiovascular safety and survival effects of inhaled corticosteroid/LABA combination therapy in COPD patients with heightened cardiovascular risk. The study addressed the important interface between respiratory and cardiovascular disease management.","created":"2026-07-03T10:26:04Z","updated":"2026-07-03T13:25:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet-trial die de cardiovasculaire veiligheid en effecten op overleving onderzocht van inhalatiecorticosteroïden/LABA bij COPD-patiënten met verhoogd cardiovasculair risico. Relevant voor de cardiopulmonale interactie.","abstract_original":"BACKGROUND: Chronic obstructive pulmonary disease (COPD) often coexists with cardiovascular disease. Treatments for airflow limitation might improve survival and both respiratory and cardiovascular outcomes. The aim of this study was to assess whether inhaled treatment with a combined treatment of the corticosteroid, fluticasone furoate, and the long-acting β agonist, vilanterol could improve survival compared with placebo in patients with moderate COPD and heightened cardiovascular risk. METHODS: In this double-blind randomised controlled trial (SUMMIT) done in 1368 centres in 43 countries, eligible patients were aged 40-80 years and had a post-bronchodilator forced expiratory volume in 1 s (FEV1) between 50% and 70% of the predicted value, a ratio of post-bronchodilator FEV1 to forced vital capacity (FVC) of 0·70 or less, a smoking history of at least 10 pack-years, and a score of 2 or greater on the modified Medical Research Council dyspnoea scale. Patients had to have a history, or be at increased risk, of cardiovascular disease. Enrolled patients were randomly assigned (1:1:1:1) through a centralised randomisation service in permuted blocks to receive once daily inhaled placebo, fluticasone furoate (100 μg), vilanterol (25 μg), or the combination of fluticasone furoate (100 μg) and vilanterol (25 μg). The primary outcome was all-cause mortality, and secondary outcomes were on-treatment rate of decline in forced expiratory volume in 1 s (FEV1) and a composite of cardiovascular events. Safety analyses were performed on the safety population (all patients who took at least one dose of study drug) and efficacy analyses were performed on the intention-to-treat population (safety population minus sites excluded with Good Clinical Practice violations). This study is registered with ClinicalTrials.gov, number NCT01313676. FINDINGS: Between Jan 24, 2011, and March 12, 2014, 23 835 patients were screened, of whom 16 590 were randomised. 16 485 patients were included in the intention-to-treat efficacy population; 4111 in the placebo group, 4135 in the fluticasone furoate group, 4118 in the vilanterol group, and 4121 in the combination group. Compared with placebo, all-cause mortality was unaffected by combination therapy (hazard ratio [HR] 0·88 [95% CI 0·74-1·04]; 12% relative reduction; p=0·137) or the components (fluticasone furoate, HR 0·91 [0·77-1·08]; p=0·284; vilanterol, 0·96 [0·81-1·14]; p=0·655), and therefore secondary outcomes should be interpreted with caution. Rate of decline in FEV1 was reduced by combination therapy (38 mL per year [SE 2·4] vs 46 mL per year [2·5] for placebo, difference 8 mL per year [95% CI 1-15]) with similar findings for fluticasone furoate (difference 8 mL per year [95% CI 1-14]), but not vilanterol (difference -2 mL per year [95% CI -8 to 5]). Combination therapy had no effect on composite cardiovascular events (HR 0·93 [95% CI 0·75-1·14]) with similar findings for fluticasone furoate (0·90 [0·72-1·11]) and vilanterol (0·99 [0·80-1·22]). All treatments reduced the rate of moderate and severe exacerbation. No reported excess risks of pneumonia (5% in the placebo group, 6% in the combination group, 5% in the fluticasone furoate group, and 4% in the vilanterol group) or adverse cardiac events (17% in the placebo group, 18% in the combination group, and 17% in the fluticasone furoate group, and 17% in the vilanterol group) were noted in the treatment groups. INTERPRETATION: In patients with moderate COPD and heightened cardiovascular risk, treatment with fluticasone furoate and vilanterol did not affect mortality or cardiovascular outcomes, reduced exacerbations, and was well tolerated. Fluticasone furoate, alone or in combination with vilanterol, seemed to reduce FEV1 decline. FUNDING: GlaxoSmithKline."},{"id":"a4c7de134169","type":"article","url":"https://hartvaat.nl/2016/04/26/ticagrelor-verbetert-perifere-arteriele-functie-bij-acs-relatie-met-adenosinespi/","title":"Ticagrelor verbetert perifere arteriële functie bij ACS: relatie met adenosinespiegels","title_en":"Ticagrelor Improves Peripheral Arterial Function in Acute Coronary Syndrome Patients: Relationship With Adenosine Plasma Level.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["acuut-coronair-syndroom","perifeer-vaatlijden"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.02.023","source_url":"https://doi.org/10.1016/j.jacc.2016.02.023","authors":["Julien Fromonot","Françoise Dignat-Georges","Pascal Rossi","Giovanna Mottola","Nathalie Kipson","Jean Ruf","Laurent Bonello","Régis Guieu","Franck Paganelli"],"significance":5,"published":"2016-04-26","source_date":"2016-04-26","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/cardiometabool-spreekuur/"],"congress":"","summary_en":"This study showed that ticagrelor improves peripheral arterial function in ACS patients, possibly through adenosine-mediated vasodilation — a pleiotropic effect distinct from its antiplatelet mechanism.","created":"2026-07-03T10:26:04Z","updated":"2026-07-03T13:25:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die aantoonde dat ticagrelor de perifere arteriële functie verbetert bij ACS-patiënten, mogelijk via verhoging van adenosinespiegels. Biedt een mechanistische verklaring voor pleiotrope effecten van ticagrelor.","abstract_original":""},{"id":"5da4476874d4","type":"article","url":"https://hartvaat.nl/2016/04/26/vroege-aldosteronblokkade-bij-acuut-myocardinfarct-de-albatross-trial/","title":"Vroege aldosteronblokkade bij acuut myocardinfarct: de ALBATROSS-trial","title_en":"Early Aldosterone Blockade in Acute Myocardial Infarction: The ALBATROSS Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","bradycardie","fidelio-dkd","mra-aldosteronantagonisten","myocardinfarct","select-trial","soul-trial"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.02.033","source_url":"https://doi.org/10.1016/j.jacc.2016.02.033","authors":["Farzin Beygui","Guillaume Cayla","Vincent Roule","François Roubille","Nicolas Delarche","Johanne Silvain","Eric Van Belle","Loic Belle","Michel Galinier","Pascal Motreff","Luc Cornillet","Jean-Philippe Collet","Alain Furber","Patrick Goldstein","Patrick Ecollan","Damien Legallois","Alain Lebon","Hélène Rousseau","Jacques Machecourt","Faiez Zannad","Eric Vicaut","Gilles Montalescot"],"significance":6,"published":"2016-04-26","source_date":"2016-04-26","image":"","kennis":[],"congress":"","summary_en":"The ALBATROSS trial showed that early aldosterone blockade with spironolactone in acute MI does not improve outcomes when given to all patients regardless of heart failure or LV dysfunction status, limiting MRA use in acute MI to the established HF indication.","created":"2026-07-03T10:26:04Z","updated":"2026-07-03T13:25:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial die vroege toevoeging van spironolacton onderzocht bij patiënten met een acuut myocardinfarct. Onderzocht of vroege mineralocorticoïdreceptorblokkade de prognose na MI kan verbeteren.","abstract_original":"BACKGROUND: Mineralocorticoid receptor antagonists (MRA) improve outcome in the setting of post-myocardial infarction (MI) heart failure (HF). OBJECTIVES: The study sought to assess the benefit of an early MRA regimen in acute MI irrespective of the presence of HF or left ventricular (LV) dysfunction. METHODS: We randomized 1,603 patients to receive an MRA regimen with a single intravenous bolus of potassium canrenoate (200 mg) followed by oral spironolactone (25 mg once daily) for 6 months in addition to standard therapy or standard therapy alone. The primary outcome of the study was the composite of death, resuscitated cardiac arrest, significant ventricular arrhythmia, indication for implantable defibrillator, or new or worsening HF at 6-month follow-up. Key secondary/safety outcomes included death and other individual components of the primary outcome and rates of hyperkalemia at 6 months. RESULTS: The primary outcome occurred in 95 (11.8%) and 98 (12.2%) patients in the treatment and control groups, respectively (hazard ratio [HR]: 0.97; 95% confidence interval [CI]: 0.73 to 1.28). Death occurred in 11 (1.4%) and 17 (2.1%) patients in the treatment and control groups, respectively (HR: 0.65; 95% CI: 0.30 to 1.38). In a non-pre-specified exploratory analysis, the odds of death were reduced in the treatment group (3 [0.5%] vs. 15 [2.4%]; HR: 0.20; 95% CI: 0.06 to 0.70) in the subgroup of ST-segment elevation MI (n = 1,229), but not in non-ST-segment elevation MI (p for interaction = 0.01). Hyperkalemia >5.5 mmol/l(-1) occurred in 3% and 0.2% of patients in the treatment and standard therapy groups, respectively (p < 0.0001). CONCLUSIONS: The study failed to show the benefit of early MRA use in addition to standard therapy in patients admitted for MI. (Aldosterone Lethal effects Blockade in Acute myocardial infarction Treated with or without Reperfusion to improve Outcome and Survival at Six months follow-up; NCT01059136)."},{"id":"a7d96834eadb","type":"article","url":"https://hartvaat.nl/2016/04/26/ablatie-versus-amiodaron-bij-persisterend-af-met-hartfalen-en-icd-gerandomiseerd/","title":"Ablatie versus amiodaron bij persisterend AF met hartfalen en ICD: gerandomiseerde trial","title_en":"Ablation Versus Amiodarone for Treatment of Persistent Atrial Fibrillation in Patients With Congestive Heart Failure and an Implanted Device: Results From the AATAC Multicenter Randomized Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","step-hfpef"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.115.019406","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.115.019406","authors":["Luigi Di Biase","Prasant Mohanty","Sanghamitra Mohanty","Pasquale Santangeli","Chintan Trivedi","Dhanunjaya Lakkireddy","Madhu Reddy","Pierre Jais","Sakis Themistoclakis","Antonio Dello Russo","Michela Casella","Gemma Pelargonio","Maria Lucia Narducci","Robert Schweikert","Petr Neuzil","Javier Sanchez","Rodney Horton","Salwa Beheiry","Richard Hongo","Steven Hao","Antonio Rossillo","Giovanni Forleo","Claudio Tondo","J David Burkhardt","Michel Haissaguerre","Andrea Natale"],"significance":7,"published":"2016-04-26","source_date":"2016-04-26","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/icd-bij-hartfalen/","https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This randomized trial comparing catheter ablation with amiodarone in patients with persistent AF, heart failure, and an ICD showed that ablation was superior for maintaining sinus rhythm and improving left ventricular function in this challenging population.","created":"2026-07-03T10:26:04Z","updated":"2026-07-03T18:38:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial die katheterablatie vergeleek met amiodaron bij patiënten met persisterend AF, hartfalen en een implanteerbare defibrillator. Onderzoekt de optimale ritmestrategie bij deze complexe patiëntenpopulatie.","abstract_original":"BACKGROUND: Whether catheter ablation (CA) is superior to amiodarone (AMIO) for the treatment of persistent atrial fibrillation (AF) in patients with heart failure is unknown. METHODS AND RESULTS: This was an open-label, randomized, parallel-group, multicenter study. Patients with persistent AF, dual-chamber implantable cardioverter defibrillator or cardiac resynchronization therapy defibrillator, New York Heart Association II to III, and left ventricular ejection fraction <40% within the past 6 months were randomly assigned (1:1 ratio) to undergo CA for AF (group 1, n=102) or receive AMIO (group 2, n=101). Recurrence of AF was the primary end point. All-cause mortality and unplanned hospitalization were the secondary end points. Patients were followed up for a minimum of 24 months. At the end of follow-up, 71 (70%; 95% confidence interval, 60%-78%) patients in group 1 were recurrence free after an average of 1.4±0.6 procedures in comparison with 34 (34%; 95% confidence interval, 25%-44%) in group 2 (log-rank P<0.001). The success rate of CA in the different centers after a single procedure ranged from 29% to 61%. After adjusting for covariates in the multivariable model, AMIO therapy was found to be significantly more likely to fail (hazard ratio, 2.5; 95% confidence interval, 1.5-4.3; P<0.001) than CA. Over the 2-year follow-up, the unplanned hospitalization rate was (32 [31%] in group 1 and 58 [57%] in group 2; P<0.001), showing 45% relative risk reduction (relative risk, 0.55; 95% confidence interval, 0.39-0.76). A significantly lower mortality was observed in CA (8 [8%] versus AMIO (18 [18%]; P=0.037). CONCLUSIONS: This multicenter randomized study shows that CA of AF is superior to AMIO in achieving freedom from AF at long-term follow-up and reducing unplanned hospitalization and mortality in patients with heart failure and persistent AF. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00729911."},{"id":"245e98cda744","type":"article","url":"https://hartvaat.nl/2016/04/26/predictieregel-voor-voordeel-en-schade-van-dapt-na-1-jaar-pci-jama-validatiestud/","title":"Predictieregel voor voordeel en schade van DAPT na 1 jaar PCI: JAMA-validatiestudie","title_en":"Development and Validation of a Prediction Rule for Benefit and Harm of Dual Antiplatelet Therapy Beyond 1 Year After Percutaneous Coronary Intervention.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2016.3775","source_url":"https://doi.org/10.1001/jama.2016.3775","authors":["Robert W Yeh","Eric A Secemsky","Dean J Kereiakes","Sharon-Lise T Normand","Anthony H Gershlick","David J Cohen","John A Spertus","Philippe Gabriel Steg","Donald E Cutlip","Michael J Rinaldi","Edoardo Camenzind","William Wijns","Patricia K Apruzzese","Yang Song","Joseph M Massaro","Laura Mauri"],"significance":8,"published":"2016-04-26","source_date":"2016-04-26","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/aspirine-primaire-preventie/"],"congress":"","summary_en":"This JAMA study developed and validated the DAPT Score, a clinical decision tool that stratifies the individual risk-benefit balance of extended dual antiplatelet therapy after PCI. The score identifies patients who benefit from prolonged DAPT and those at excess bleeding risk.","created":"2026-07-03T10:26:04Z","updated":"2026-07-03T13:25:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA-studie die een predictieregel ontwikkelde en valideerde voor de individuele afweging van ischemisch voordeel versus bloedingsrisico bij verlenging van duale antiplaatjestherapie na PCI. Ondersteunt gepersonaliseerde besluitvorming.","abstract_original":"IMPORTANCE: Dual antiplatelet therapy after percutaneous coronary intervention (PCI) reduces ischemia but increases bleeding. OBJECTIVE: To develop a clinical decision tool to identify patients expected to derive benefit vs harm from continuing thienopyridine beyond 1 year after PCI. DESIGN, SETTING, AND PARTICIPANTS: Among 11,648 randomized DAPT Study patients from 11 countries (August 2009-May 2014), a prediction rule was derived stratifying patients into groups to distinguish ischemic and bleeding risk 12 to 30 months after PCI. Validation was internal via bootstrap resampling and external among 8136 patients from 36 countries randomized in the PROTECT trial (June 2007-July 2014). EXPOSURES: Twelve months of open-label thienopyridine plus aspirin, then randomized to 18 months of continued thienopyridine plus aspirin vs placebo plus aspirin. MAIN OUTCOMES AND MEASURES: Ischemia (myocardial infarction or stent thrombosis) and bleeding (moderate or severe) 12 to 30 months after PCI. RESULTS: Among DAPT Study patients (derivation cohort; mean age, 61.3 years; women, 25.1%), ischemia occurred in 348 patients (3.0%) and bleeding in 215 (1.8%). Derivation cohort models predicting ischemia and bleeding had c statistics of 0.70 and 0.68, respectively. The prediction rule assigned 1 point each for myocardial infarction at presentation, prior myocardial infarction or PCI, diabetes, stent diameter less than 3 mm, smoking, and paclitaxel-eluting stent; 2 points each for history of congestive heart failure/low ejection fraction and vein graft intervention; -1 point for age 65 to younger than 75 years; and -2 points for age 75 years or older. Among the high score group (score ≥2, n = 5917), continued thienopyridine vs placebo was associated with reduced ischemic events (2.7% vs 5.7%; risk difference [RD], -3.0% [95% CI, -4.1% to -2.0%], P < .001) compared with the low score group (score <2, n = 5731; 1.7% vs 2.3%; RD, -0.7% [95% CI, -1.4% to 0.09%], P = .07; interaction P < .001). Conversely, continued thienopyridine was associated with smaller increases in bleeding among the high score group (1.8% vs 1.4%; RD, 0.4% [95% CI, -0.3% to 1.0%], P = .26) compared with the low score group (3.0% vs 1.4%; RD, 1.5% [95% CI, 0.8% to 2.3%], P < .001; interaction P = .02). Among PROTECT patients (validation cohort; mean age, 62 years; women, 23.7%), ischemia occurred in 79 patients (1.0%) and bleeding in 37 (0.5%), with a c statistic of 0.64 for ischemia and 0.64 for bleeding. In this cohort, the high-score patients (n = 2848) had increased ischemic events compared with the low-score patients and no significant difference in bleeding. CONCLUSION AND RELEVANCE: Among patients not sustaining major bleeding or ischemic events 1 year after PCI, a prediction rule assessing late ischemic and bleeding risks to inform dual antiplatelet therapy duration showed modest accuracy in derivation and validation cohorts. This rule requires further prospective evaluation to assess potential effects on patient care, as well as validation in other cohorts. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00977938."},{"id":"0ea045a913f8","type":"article","url":"https://hartvaat.nl/2016/04/21/aliskiren-enalapril-of-de-combinatie-bij-hartfalen-nejm-atmosphere-trial/","title":"Aliskiren, enalapril of de combinatie bij hartfalen: NEJM ATMOSPHERE-trial","title_en":"Aliskiren, Enalapril, or Aliskiren and Enalapril in Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":["acuut-hartfalen","bisoprolol","hfref","sacubitril-valsartan","step-hfpef"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1514859","source_url":"https://doi.org/10.1056/NEJMoa1514859","authors":["John J V McMurray","Henry Krum","William T Abraham","Kenneth Dickstein","Lars V Køber","Akshay S Desai","Scott D Solomon","Nicola Greenlaw","M Atif Ali","Yanntong Chiang","Qing Shao","Georgia Tarnesby","Barry M Massie"],"significance":8,"published":"2016-04-21","source_date":"2016-04-21","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/","https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/"],"congress":"","summary_en":"This NEJM trial showed that aliskiren (a direct renin inhibitor) was neither superior nor noninferior to enalapril in HFrEF, and the combination increased adverse events without clinical benefit. The results effectively ended development of direct renin inhibition for heart failure.","created":"2026-07-03T10:26:04Z","updated":"2026-07-03T18:38:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM-trial die aliskiren (directe renineremmer) vergeleek met enalapril en de combinatie bij hartfalen met verminderde ejectiefractie. Definitieve trial die de rol van directe renineremming bij hartfalen onderzocht.","abstract_original":"BACKGROUND: Among patients with chronic heart failure, angiotensin-converting-enzyme (ACE) inhibitors reduce mortality and hospitalization, but the role of a renin inhibitor in such patients is unknown. We compared the ACE inhibitor enalapril with the renin inhibitor aliskiren (to test superiority or at least noninferiority) and with the combination of the two treatments (to test superiority) in patients with heart failure and a reduced ejection fraction. METHODS: After a single-blind run-in period, we assigned patients, in a double-blind fashion, to one of three groups: 2336 patients were assigned to receive enalapril at a dose of 5 or 10 mg twice daily, 2340 to receive aliskiren at a dose of 300 mg once daily, and 2340 to receive both treatments (combination therapy). The primary composite outcome was death from cardiovascular causes or hospitalization for heart failure. RESULTS: After a median follow-up of 36.6 months, the primary outcome occurred in 770 patients (32.9%) in the combination-therapy group and in 808 (34.6%) in the enalapril group (hazard ratio, 0.93; 95% confidence interval [CI], 0.85 to 1.03). The primary outcome occurred in 791 patients (33.8%) in the aliskiren group (hazard ratio vs. enalapril, 0.99; 95% CI, 0.90 to 1.10); the prespecified test for noninferiority was not met. There was a higher risk of hypotensive symptoms in the combination-therapy group than in the enalapril group (13.8% vs. 11.0%, P=0.005), as well as higher risks of an elevated serum creatinine level (4.1% vs. 2.7%, P=0.009) and an elevated potassium level (17.1% vs. 12.5%, P<0.001). CONCLUSIONS: In patients with chronic heart failure, the addition of aliskiren to enalapril led to more adverse events without an increase in benefit. Noninferiority was not shown for aliskiren as compared with enalapril. (Funded by Novartis; ATMOSPHERE ClinicalTrials.gov number, NCT00853658.)."},{"id":"c72a62442edb","type":"article","url":"https://hartvaat.nl/2016/04/21/coronaire-bypasschirurgie-bij-ischemische-cardiomyopathie-nejm-stich-trial/","title":"Coronaire bypasschirurgie bij ischemische cardiomyopathie: NEJM STICH-trial","title_en":"Coronary-Artery Bypass Surgery in Patients with Ischemic Cardiomyopathy.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["coronaire-bypass","iaso-dcm","newton-cabg"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1602001","source_url":"https://doi.org/10.1056/NEJMoa1602001","authors":["Eric J Velazquez","Kerry L Lee","Robert H Jones","Hussein R Al-Khalidi","James A Hill","Julio A Panza","Robert E Michler","Robert O Bonow","Torsten Doenst","Mark C Petrie","Jae K Oh","Lilin She","Vanessa L Moore","Patrice Desvigne-Nickens","George Sopko","Jean L Rouleau"],"significance":9,"published":"2016-04-21","source_date":"2016-04-21","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/","https://hartvaat.nl/kennis/hartfalen/ischemische-cardiomyopathie/"],"congress":"","summary_en":"The extended follow-up of the STICH trial showed that CABG plus medical therapy significantly reduced all-cause mortality compared with medical therapy alone in patients with ischemic cardiomyopathy and reduced ejection fraction. This 10-year result established the survival benefit of revascularization in ischemic heart failure.","created":"2026-07-03T10:26:04Z","updated":"2026-07-03T13:25:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM-publicatie van de STICH-trial die CABG plus medicamenteuze therapie vergeleek met medicamenteuze therapie alleen bij patiënten met ischemische cardiomyopathie en lage ejectiefractie. Landmark trial voor de behandeling van ischemisch hartfalen.","abstract_original":"BACKGROUND: The survival benefit of a strategy of coronary-artery bypass grafting (CABG) added to guideline-directed medical therapy, as compared with medical therapy alone, in patients with coronary artery disease, heart failure, and severe left ventricular systolic dysfunction remains unclear. METHODS: From July 2002 to May 2007, a total of 1212 patients with an ejection fraction of 35% or less and coronary artery disease amenable to CABG were randomly assigned to undergo CABG plus medical therapy (CABG group, 610 patients) or medical therapy alone (medical-therapy group, 602 patients). The primary outcome was death from any cause. Major secondary outcomes included death from cardiovascular causes and death from any cause or hospitalization for cardiovascular causes. The median duration of follow-up, including the current extended-follow-up study, was 9.8 years. RESULTS: A primary outcome event occurred in 359 patients (58.9%) in the CABG group and in 398 patients (66.1%) in the medical-therapy group (hazard ratio with CABG vs. medical therapy, 0.84; 95% confidence interval [CI], 0.73 to 0.97; P=0.02 by log-rank test). A total of 247 patients (40.5%) in the CABG group and 297 patients (49.3%) in the medical-therapy group died from cardiovascular causes (hazard ratio, 0.79; 95% CI, 0.66 to 0.93; P=0.006 by log-rank test). Death from any cause or hospitalization for cardiovascular causes occurred in 467 patients (76.6%) in the CABG group and in 524 patients (87.0%) in the medical-therapy group (hazard ratio, 0.72; 95% CI, 0.64 to 0.82; P<0.001 by log-rank test). CONCLUSIONS: In a cohort of patients with ischemic cardiomyopathy, the rates of death from any cause, death from cardiovascular causes, and death from any cause or hospitalization for cardiovascular causes were significantly lower over 10 years among patients who underwent CABG in addition to receiving medical therapy than among those who received medical therapy alone. (Funded by the National Institutes of Health; STICH [and STICHES] ClinicalTrials.gov number, NCT00023595.)."},{"id":"0c11c4b255b8","type":"article","url":"https://hartvaat.nl/2016/04/21/mtp-131-bij-reperfusieschade-na-stemi-de-embrace-stemi-fase-2a-trial/","title":"MTP-131 bij reperfusieschade na STEMI: de EMBRACE STEMI fase-2a-trial","title_en":"EMBRACE STEMI study: a Phase 2a trial to evaluate the safety, tolerability, and efficacy of intravenous MTP-131 on reperfusion injury in patients undergoing primary percutaneous coronary intervention.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehv597","source_url":"https://doi.org/10.1093/eurheartj/ehv597","authors":["C Michael Gibson","Robert P Giugliano","Robert A Kloner","Christoph Bode","Michal Tendera","András Jánosi","Bela Merkely","Jacek Godlewski","Rim Halaby","Serge Korjian","Yazan Daaboul","Anjan K Chakrabarti","Kathryn Spielman","Brandon J Neal","W Douglas Weaver"],"significance":5,"published":"2016-04-21","source_date":"2016-04-21","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"The EMBRACE STEMI phase 2a trial tested MTP-131 (elamipretide), a mitochondria-targeted peptide, for limiting reperfusion injury after STEMI, exploring subcellular cardioprotection during primary PCI.","created":"2026-07-03T10:26:03Z","updated":"2026-07-03T13:25:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Fase 2a-trial van intraveneus MTP-131, een mitochondriaal gericht peptide, voor beperking van reperfusieschade bij STEMI. Onderzocht een nieuw mechanisme voor myocardprotectie tijdens primaire PCI.","abstract_original":"AIMS: Among patients with ST-elevation myocardial infarction (STEMI), reperfusion injury contributes to additional myocardial damage. MTP-131 is a cell-permeable peptide that preserves the integrity of cardiolipin, enhances mitochondrial energetics, and improves myocyte survival during reperfusion. METHODS AND RESULTS: EMBRACE STEMI is a multicentre, randomized, double-blind Phase 2a trial that evaluated the efficacy and safety of MTP-131 vs. placebo infused at a rate of 0.05 mg/kg/h for 1 h among first-time anterior STEMI subjects undergoing primary percutaneous coronary intervention (PCI) for a proximal or mid left anterior descending (LAD) artery occlusion. Administration of MTP-131 was not associated with a significant reduction in the primary endpoint, infarct size by creatine kinase-myocardial band (CK-MB) area under the curve (AUC) over 72 h (5785 ± 426 ng h/mL in placebo vs. 5570 ± 486 ng h/mL in MTP-131; ITALIC! P = NS). MTP-131 was not associated with an improvement in pre-specified magnetic resonance imaging, angiographic, electrocardiographic, or clinical outcomes. CONCLUSION: Among subjects with first-time anterior STEMI due to a proximal or mid LAD lesion who undergo successful PCI, administration of MTP-131 was safe and well tolerated. Treatment with MTP-131 was not associated with a decrease in myocardial infarct size as assessed by AUC0-72 of CK-MB."},{"id":"10e47720c04b","type":"article","url":"https://hartvaat.nl/2016/04/21/gdf-15-voorspelt-bloedingen-en-cardiovasculaire-events-bij-acuut-coronair-syndro/","title":"GDF-15 voorspelt bloedingen en cardiovasculaire events bij acuut coronair syndroom","title_en":"Growth differentiation factor-15 level predicts major bleeding and cardiovascular events in patients with acute coronary syndromes: results from the PLATO study.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["abelacimab","acuut-coronair-syndroom","biomarkers-cardiovasculair"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehv491","source_url":"https://doi.org/10.1093/eurheartj/ehv491","authors":["Emil Hagström","Stefan K James","Maria Bertilsson","Richard C Becker","Anders Himmelmann","Steen Husted","Hugo A Katus","Philippe Gabriel Steg","Robert F Storey","Agneta Siegbahn","Lars Wallentin"],"significance":5,"published":"2016-04-21","source_date":"2016-04-21","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/wat-is-coronairlijden/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"This study identified GDF-15 as a dual predictor of both major bleeding and cardiovascular events in ACS patients, establishing this growth factor as a comprehensive risk biomarker in acute coronary care.","created":"2026-07-03T10:26:03Z","updated":"2026-07-03T13:25:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die growth differentiation factor-15 (GDF-15) identificeerde als voorspeller van zowel ernstige bloedingen als cardiovasculaire events bij ACS-patiënten. Potentiële duale biomarker voor risicostratificatie.","abstract_original":"AIMS: Growth differentiation factor-15 (GDF-15) predicts death and composite cardiovascular (CV) events in patients with acute coronary syndrome (ACS). We investigated the independent associations between GDF-15 levels and major bleeding, the extent of coronary lesions and individual CV events in patients with ACS. METHODS AND RESULTS: Growth differentiation factor-15 was analysed at baseline ( ITALIC! n = 16 876) in patients with ACS randomized to ticagrelor or clopidogrel in the PLATO (PLATelet inhibition and patient Outcomes) trial. Growth differentiation factor-15 levels were related to extent of coronary artery disease (CAD) and to all types of non-coronary artery bypass grafting (CABG)-related major bleeding, spontaneous myocardial infarction (MI), stroke, and death during 12-month follow-up. In Cox proportional hazards models adjusting for established risk factors for CV disease and prognostic biomarkers (N-terminal pro B-type natriuretic peptide, cystatin C, high-sensitive C-reactive protein, and high-sensitive troponin T), 1 SD increase in ln GDF-15 was associated with increased risk of major bleeding with a hazard ratio (HR) 1.37 (95% confidence interval: 1.25-1.51) and with a similar increase in risk across different bleeding locations. For the same increase in ln GDF-15, the HR for the composite of CV death, spontaneous MI, and stroke was 1.29 (1.21-1.37), CV death 1.41 (1.30-1.53), all-cause death 1.41 (1.31-1.53), spontaneous MI 1.15 (1.05-1.26), and stroke 1.19 (1.01-1.42). The ITALIC! C-statistic improved for the prediction of CV death and non-CABG-related major bleeding when adding GDF-15 to established risk factors. CONCLUSIONS: In patients with ACS, higher levels of GDF-15 are associated with raised risks of all types of major non-CABG-related bleeding, spontaneous MI, and stroke as well as CV and total mortality and seem to improve risk stratification for CV-mortality and major bleeding beyond established risk factors. CLINICAL TRIAL REGISTRATION: www.clinicaltrials.gov; NCT00391872."},{"id":"11d6889bb987","type":"article","url":"https://hartvaat.nl/2016/04/19/statinebehandeling-en-plaquesamenstelling-dubbelblinde-gerandomiseerde-studie/","title":"Statinebehandeling en plaquesamenstelling: dubbelblinde gerandomiseerde studie","title_en":"Effect of Statin Treatment on Modifying Plaque Composition: A Double-Blind, Randomized Study.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.02.014","source_url":"https://doi.org/10.1016/j.jacc.2016.02.014","authors":["Seung-Jung Park","Soo-Jin Kang","Jung-Min Ahn","Mineok Chang","Sung-Cheol Yun","Jae Hyung Roh","Pil Hyung Lee","Hyun Woo Park","Sung-Han Yoon","Duk-Woo Park","Seung-Whan Lee","Young-Hak Kim","Cheol Whan Lee","Gary S Mintz","Ki Hoon Han","Seong-Wook Park"],"significance":6,"published":"2016-04-19","source_date":"2016-04-19","image":"","kennis":[],"congress":"","summary_en":"This double-blind randomized study used multimodality intravascular imaging to characterize how statin therapy alters coronary plaque composition, providing direct evidence of plaque stabilization through lipid-core shrinkage and fibrous cap thickening.","created":"2026-07-03T10:26:03Z","updated":"2026-07-03T13:25:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde dubbelblinde studie die het effect van statines op de samenstelling van coronaire plaques onderzocht. Beeldvormende studie die mechanistisch inzicht biedt in hoe statines atherosclerose stabiliseren.","abstract_original":"BACKGROUND: How statins alter the natural course of coronary atherosclerosis with compositional changes remains unclear. OBJECTIVES: This study aimed to determine the effect of statin therapy on modifying plaque composition. METHODS: The STABLE (Statin and Atheroma Vulnerability Evaluation) prospective, single-center, double-blind, randomized study evaluated the effect of statins on functionally insignificant coronary stenoses. We randomly assigned 312 patients with a virtual histology (VH) intravascular ultrasound-defined fibroatheroma-containing index lesion to rosuvastatin 40 mg versus 10 mg (2:1 ratio). In 225 (72%) patients, grayscale- and VH-intravascular ultrasound were completed at baseline and 12 months. The primary endpoint was the change in VH-defined percent compositional volume within the target segment from baseline to follow-up in the per-protocol analysis set. RESULTS: Percent necrotic core (NC) volume within the target segment significantly decreased from 21.3 ± 6.8% to 18.0 ± 7.5% during 1-year follow-up, whereas the percent fibrofatty volume increased (11.7 ± 5.8% vs. 14.8 ± 9.3%; all p < 0.001). Percent fibrous (59.4 ± 7.8% vs. 59.2 ± 8.6%) and dense calcium (7.6 ± 5.1% vs. 7.8 ± 5.6%) volumes were unchanged. Frequencies of VH (55% vs. 29%) decreased significantly. Normalized total (202.9 ± 72.3 mm(3) vs. 188.5 ± 67.8 mm(3); p = 0.001) and percent (51.4 ± 8.3% vs. 50.4 ± 8.8%; p = 0.018) atheroma volumes decreased. Independent predictors of percent NC volume change were body mass index (β = 0.37; 95% confidence interval [CI]: 0.05 to 0.70), high sensitivity C-reactive protein (β = -3.16; 95% CI: -5.64 to -0.69), and baseline percent NC volume (β = -0.44; 95% CI: -0.68 to -0.19; all p < 0.05). VH-defined percent compositional volume changes in the rosuvastatin 40- and 10-mg groups were similar. CONCLUSIONS: Rosuvastatin reduced NC and plaque volume and decreased thin-cap fibroatheroma rate. There were no significant differences between high- versus moderate-intensity rosuvastatin. (Statin and Atheroma Vulnerability Evaluation [STABLE]; NCT00997880)."},{"id":"d1d52c6167f1","type":"article","url":"https://hartvaat.nl/2016/04/19/ct-coronairangiografie-voor-het-sturen-van-beleid-bij-coronairlijden/","title":"CT-coronairangiografie voor het sturen van beleid bij coronairlijden","title_en":"Use of Coronary Computed Tomographic Angiography to Guide Management of Patients With Coronary Disease.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["coronaire-ct-angiografie","stabiel-coronairlijden"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.02.026","source_url":"https://doi.org/10.1016/j.jacc.2016.02.026","authors":["Michelle C Williams","Amanda Hunter","Anoop S V Shah","Valentina Assi","Stephanie Lewis","Joel Smith","Colin Berry","Nicholas A Boon","Elizabeth Clark","Marcus Flather","John Forbes","Scott McLean","Giles Roditi","Edwin J R van Beek","Adam D Timmis","David E Newby"],"significance":6,"published":"2016-04-19","source_date":"2016-04-19","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/esc-richtlijn-chronisch-coronairlijden-2024/"],"congress":"","summary_en":"This randomized trial tested whether adding coronary CT angiography to standard care improves clinical management of patients with coronary disease, evaluating the impact of anatomical information on treatment decisions and outcomes.","created":"2026-07-03T10:26:03Z","updated":"2026-07-03T13:25:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar het gebruik van CT-coronairangiografie voor optimalisatie van het klinisch beleid bij patiënten met coronairlijden. Onderzoekt de waarde van CCTA in de diagnostische work-up.","abstract_original":"BACKGROUND: In a prospective, multicenter, randomized controlled trial, 4,146 patients were randomized to receive standard care or standard care plus coronary computed tomography angiography (CCTA). OBJECTIVES: The purpose of this study was to explore the consequences of CCTA-assisted diagnosis on invasive coronary angiography, preventive treatments, and clinical outcomes. METHODS: In post hoc analyses, we assessed changes in invasive coronary angiography, preventive treatments, and clinical outcomes using national electronic health records. RESULTS: Despite similar overall rates (409 vs. 401; p = 0.451), invasive angiography was less likely to demonstrate normal coronary arteries (20 vs. 56; hazard ratios [HRs]: 0.39 [95% confidence interval (CI): 0.23 to 0.68]; p < 0.001) but more likely to show obstructive coronary artery disease (283 vs. 230; HR: 1.29 [95% CI: 1.08 to 1.55]; p = 0.005) in those allocated to CCTA. More preventive therapies (283 vs. 74; HR: 4.03 [95% CI: 3.12 to 5.20]; p < 0.001) were initiated after CCTA, with each drug commencing at a median of 48 to 52 days after clinic attendance. From the median time for preventive therapy initiation (50 days), fatal and nonfatal myocardial infarction was halved in patients allocated to CCTA compared with those assigned to standard care (17 vs. 34; HR: 0.50 [95% CI: 0.28 to 0.88]; p = 0.020). Cumulative 6-month costs were slightly higher with CCTA: difference $462 (95% CI: $303 to $621). CONCLUSIONS: In patients with suspected angina due to coronary heart disease, CCTA leads to more appropriate use of invasive angiography and alterations in preventive therapies that were associated with a halving of fatal and non-fatal myocardial infarction. (Scottish COmputed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590)."},{"id":"5d6a5c3e024d","type":"article","url":"https://hartvaat.nl/2016/04/19/losmapimod-en-cardiovasculaire-uitkomsten-na-acuut-myocardinfarct-jama-trial/","title":"Losmapimod en cardiovasculaire uitkomsten na acuut myocardinfarct: JAMA-trial","title_en":"Effect of Losmapimod on Cardiovascular Outcomes in Patients Hospitalized With Acute Myocardial Infarction: A Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2016.3609","source_url":"https://doi.org/10.1001/jama.2016.3609","authors":["Michelle L O'Donoghue","Ruchira Glaser","Matthew A Cavender","Philip E Aylward","Marc P Bonaca","Andrzej Budaj","Richard Y Davies","Mikael Dellborg","Keith A A Fox","Jorge Antonio T Gutierrez","Christian Hamm","Robert G Kiss","František Kovar","Julia F Kuder","Kyung Ah Im","John J Lepore","Jose L Lopez-Sendon","Ton Oude Ophuis","Alexandr Parkhomenko","Jennifer B Shannon","Jindrich Spinar","Jean-Francois Tanguay","Mikhail Ruda","P Gabriel Steg","Pierre Theroux","Stephen D Wiviott","Ian Laws","Marc S Sabatine","David A Morrow"],"significance":6,"published":"2016-04-19","source_date":"2016-04-19","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/cardiometabool/bloedsuikerdoelen-cardiovasculair/"],"congress":"","summary_en":"This JAMA trial showed that losmapimod, a p38 MAP kinase inhibitor, did not reduce cardiovascular events after acute MI, a negative result for this anti-inflammatory target that is distinct from the IL-1β pathway targeted by canakinumab.","created":"2026-07-03T10:26:03Z","updated":"2026-07-03T13:25:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde JAMA-trial naar het effect van losmapimod, een p38 MAP-kinaseremmer, op cardiovasculaire uitkomsten bij patiënten opgenomen met een acuut myocardinfarct. Onderzocht de inflammatiehypothese bij ACS.","abstract_original":"IMPORTANCE: p38 Mitogen-activated protein kinase (MAPK)-stimulated inflammation is implicated in atherogenesis, plaque destabilization, and maladaptive processes in myocardial infarction (MI). Pilot data in a phase 2 trial in non-ST elevation MI indicated that the p38 MAPK inhibitor losmapimod attenuates inflammation and may improve outcomes. OBJECTIVE: To evaluate the efficacy and safety of losmapimod on cardiovascular outcomes in patients hospitalized with an acute myocardial infarction. DESIGN, SETTING, AND PATIENTS: LATITUDE-TIMI 60, a randomized, placebo-controlled, double-blind, parallel-group trial conducted at 322 sites in 34 countries from June 3, 2014, until December 8, 2015. Part A consisted of a leading cohort (n = 3503) to provide an initial assessment of safety and exploratory efficacy before considering progression to part B (approximately 22,000 patients). Patients were considered potentially eligible for enrollment if they had been hospitalized with an acute MI and had at least 1 additional predictor of cardiovascular risk. INTERVENTIONS: Patients were randomized to either twice-daily losmapimod (7.5 mg; n = 1738) or matching placebo (n = 1765) on a background of guideline-recommended therapy. Patients were treated for 12 weeks and followed up for an additional 12 weeks. MAIN OUTCOMES AND MEASURES: The primary end point was the composite of cardiovascular death, MI, or severe recurrent ischemia requiring urgent coronary revascularization with the principal analysis specified at week 12. RESULTS: In part A, among the 3503 patients randomized (median age, 66 years; 1036 [29.6%] were women), 99.1% had complete ascertainment for the primary outcome. The primary end point occurred by 12 weeks in 123 patients treated with placebo (7.0%) and 139 patients treated with losmapimod (8.1%; hazard ratio, 1.16; 95% CI, 0.91-1.47; P = .24). The on-treatment rates of serious adverse events were 16.0% with losmapimod and 14.2% with placebo. CONCLUSIONS AND RELEVANCE: Among patients with acute MI, use of losmapimod compared with placebo did not reduce the risk of major ischemic cardiovascular events. The results of this exploratory efficacy study did not justify proceeding to a larger efficacy trial in the existing patient population. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT02145468."},{"id":"6bb3bbb36119","type":"article","url":"https://hartvaat.nl/2016/04/19/evolocumab-versus-ezetimibe-bij-statine-intolerante-patienten-de-gauss-3-trial/","title":"Evolocumab versus ezetimibe bij statine-intolerante patiënten: de GAUSS-3-trial","title_en":"Efficacy and Tolerability of Evolocumab vs Ezetimibe in Patients With Muscle-Related Statin Intolerance: The GAUSS-3 Randomized Clinical Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["clear-outcomes","niet-statine-therapie","statines"],"journal":"JAMA","doi":"10.1001/jama.2016.3608","source_url":"https://doi.org/10.1001/jama.2016.3608","authors":["Steven E Nissen","Erik Stroes","Ricardo E Dent-Acosta","Robert S Rosenson","Sam J Lehman","Naveed Sattar","David Preiss","Eric Bruckert","Richard Ceška","Norman Lepor","Christie M Ballantyne","Ioanna Gouni-Berthold","Mary Elliott","Danielle M Brennan","Scott M Wasserman","Ransi Somaratne","Rob Scott","Evan A Stein"],"significance":8,"published":"2016-04-19","source_date":"2016-04-19","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/ezetimib/"],"congress":"","summary_en":"The GAUSS-3 trial demonstrated that evolocumab was significantly more effective than ezetimibe for LDL cholesterol lowering in patients with confirmed statin-associated muscle symptoms, without causing similar muscle-related adverse events. The study established PCSK9 inhibitors as an effective option for statin-intolerant patients.","created":"2026-07-03T10:26:03Z","updated":"2026-07-03T13:25:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA-trial die evolocumab vergeleek met ezetimibe bij patiënten met spiergerelateerde statine-intolerantie. Eerste head-to-head vergelijking van een PCSK9-remmer met ezetimibe in deze specifieke patiëntengroep.","abstract_original":"IMPORTANCE: Muscle-related statin intolerance is reported by 5% to 20% of patients. OBJECTIVE: To identify patients with muscle symptoms confirmed by statin rechallenge and compare lipid-lowering efficacy for 2 nonstatin therapies, ezetimibe and evolocumab. DESIGN, SETTING, AND PARTICIPANTS: Two-stage randomized clinical trial including 511 adult patients with uncontrolled low-density lipoprotein cholesterol (LDL-C) levels and history of intolerance to 2 or more statins enrolled in 2013 and 2014 globally. Phase A used a 24-week crossover procedure with atorvastatin or placebo to identify patients having symptoms only with atorvastatin but not placebo. In phase B, after a 2-week washout, patients were randomized to ezetimibe or evolocumab for 24 weeks. INTERVENTIONS: Phase A: atorvastatin (20 mg) vs placebo. Phase B: randomization 2:1 to subcutaneous evolocumab (420 mg monthly) or oral ezetimibe (10 mg daily). MAIN OUTCOME AND MEASURES: Coprimary end points were the mean percent change in LDL-C level from baseline to the mean of weeks 22 and 24 levels and from baseline to week 24 levels. RESULTS: Of the 491 patients who entered phase A (mean age, 60.7 [SD, 10.2] years; 246 women [50.1%]; 170 with coronary heart disease [34.6%]; entry mean LDL-C level, 212.3 [SD, 67.9] mg/dL), muscle symptoms occurred in 209 of 491 (42.6%) while taking atorvastatin but not while taking placebo. Of these, 199 entered phase B, along with 19 who proceeded directly to phase B for elevated creatine kinase (N = 218, with 73 randomized to ezetimibe and 145 to evolocumab; entry mean LDL-C level, 219.9 [SD, 72] mg/dL). For the mean of weeks 22 and 24, LDL-C level with ezetimibe was 183.0 mg/dL; mean percent LDL-C change, -16.7% (95% CI, -20.5% to -12.9%), absolute change, -31.0 mg/dL and with evolocumab was 103.6 mg/dL; mean percent change, -54.5% (95% CI, -57.2% to -51.8%); absolute change, -106.8 mg/dL (P < .001). LDL-C level at week 24 with ezetimibe was 181.5 mg/dL; mean percent change, -16.7% (95% CI, -20.8% to -12.5%); absolute change, -31.2 mg/dL and with evolocumab was 104.1 mg/dL; mean percent change, -52.8% (95% CI, -55.8% to -49.8%); absolute change, -102.9 mg/dL (P < .001). For the mean of weeks 22 and 24, between-group difference in LDL-C was -37.8%; absolute difference, -75.8 mg/dL. For week 24, between-group difference in LDL-C was -36.1%; absolute difference, -71.7 mg/dL. Muscle symptoms were reported in 28.8% of ezetimibe-treated patients and 20.7% of evolocumab-treated patients (log-rank P = .17). Active study drug was stopped for muscle symptoms in 5 of 73 ezetimibe-treated patients (6.8%) and 1 of 145 evolocumab-treated patients (0.7%). CONCLUSIONS AND RELEVANCE: Among patients with statin intolerance related to muscle-related adverse effects, the use of evolocumab compared with ezetimibe resulted in a significantly greater reduction in LDL-C levels after 24 weeks. Further studies are needed to assess long-term efficacy and safety. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01984424."},{"id":"ca132c244a62","type":"article","url":"https://hartvaat.nl/2016/04/19/trends-in-behandeling-en-uitkomsten-bij-nste-acs-naar-leeftijd/","title":"Trends in behandeling en uitkomsten bij NSTE-ACS naar leeftijd","title_en":"Trends in Enrollment, Clinical Characteristics, Treatment, and Outcomes According to Age in Non-ST-Segment-Elevation Acute Coronary Syndromes Clinical Trials.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.115.017299","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.115.017299","authors":["Kristian Kragholm","Sarah A Goldstein","Qinghong Yang","Renato D Lopes","Phillip J Schulte","Gwen M Bernacki","Harvey D White","Kenneth W Mahaffey","Robert P Giugliano","Paul W Armstrong","Robert A Harrington","Pierluigi Tricoci","Frans Van de Werf","John H Alexander","Karen P Alexander","L Kristin Newby"],"significance":6,"published":"2016-04-19","source_date":"2016-04-19","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/bloedsuikerdoelen-cardiovasculair/"],"congress":"","summary_en":"This analysis of age-related trends in NSTE-ACS clinical trials documented persistent underrepresentation of older patients alongside improvements in treatment intensity across age groups, highlighting the ongoing evidence gap in the elderly.","created":"2026-07-03T10:26:03Z","updated":"2026-07-03T13:25:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van trends in inclusie, klinische kenmerken, behandeling en uitkomsten bij NSTE-ACS gestratificeerd naar leeftijd. Oudere patiënten worden minder vaak invasief behandeld ondanks vergelijkbaar of hoger risico.","abstract_original":"BACKGROUND: Representation by age ensures appropriate translation of clinical trial results to practice, but, historically, older patients have been underrepresented in clinical trial populations. As the general population has aged, it is unknown whether clinical trial enrollment has changed in parallel. METHODS AND RESULTS: We studied time trends in enrollment, clinical characteristics, treatment, and outcomes by age among 76 141 patients with non-ST-segment-elevation acute coronary syndrome enrolled in 11 phase III clinical trials over 17 years (1994-2010). Overall, 19.7% of patients were ≥75 years; this proportion increased from 16% during 1994 to 1997 to 21% during 1998 to 2001 and 23.2% during 2002 to 2005, but declined to 20.2% in 2006 to 2010. The number of comorbidities increased with successive time periods irrespective of age. There were substantial increases in the use of evidence-based medication in-hospital and at discharge regardless of age. Although predicted 6-month mortality increased slightly over time, observed 6-month mortality declined significantly in all age strata (1994-1997 versus 2006-2010: <65 years: 3.0% versus 1.9%; 65-74 years: 7.5% versus 3.4%; 75-79 years: 13.0% versus 6.5%; 80-84 years: 17.6% versus 8.2%; and ≥85 years: 24.8% versus 12.6%). CONCLUSIONS: The distribution of enrollment by age in phase III non-ST-segment-elevation acute coronary syndrome trials was unchanged over time. Irrespective of age, post-myocardial infarction mortality decreased significantly over time, concurrent with increased evidence-based care and despite increasing comorbidities. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00089895."},{"id":"c1eb09bf7307","type":"article","url":"https://hartvaat.nl/2016/04/12/prognostische-waarde-van-residuele-coronairstenosen-na-functioneel-complete-reva/","title":"Prognostische waarde van residuele coronairstenosen na functioneel complete revascularisatie","title_en":"The Prognostic Value of Residual Coronary Stenoses After Functionally Complete Revascularization.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["biomarkers-cardiovasculair","stabiel-coronairlijden"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.01.056","source_url":"https://doi.org/10.1016/j.jacc.2016.01.056","authors":["Yuhei Kobayashi","Chang-Wook Nam","Pim A L Tonino","Takumi Kimura","Bernard De Bruyne","Nico H J Pijls","William F Fearon"],"significance":6,"published":"2016-04-12","source_date":"2016-04-12","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/galectine-3-st2-hartfalen/","https://hartvaat.nl/kennis/kleplijden/hartgeruisen-herkenning/"],"congress":"","summary_en":"This study examined the prognostic value of residual coronary stenoses after functionally complete revascularization, exploring whether angiographic completeness metrics add predictive value beyond functional assessment.","created":"2026-07-03T10:26:03Z","updated":"2026-07-03T13:25:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de klinische betekenis van resterende angiografische stenosen na functioneel geslaagde revascularisatie. Onderzoekt of anatomisch incomplete maar functioneel adequate revascularisatie acceptabel is.","abstract_original":"BACKGROUND: The residual SYNTAX score (RSS) and SYNTAX revascularization index (SRI) quantitatively assess angiographic completeness of revascularization for patients with multivessel coronary artery disease. Whether residual angiographic disease remains of prognostic importance after \"functionally\" complete revascularization with fractional flow reserve (FFR) guidance is unknown. OBJECTIVES: This study sought to investigate the prognostic value of the RSS and SRI after FFR-guided functionally complete revascularization. METHODS: From the FFR-guided percutaneous coronary intervention (PCI) cohort of the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) trial, the RSS and SRI were calculated in 427 patients after functionally complete revascularization. The RSS was defined as the SYNTAX score (SS) recalculated after PCI. The SRI was calculated as: 100 × (1 - RSS/baseline SS) (%). We compared differences in 1- and 2-year outcomes among patients with RSS of 0, >0 to 4, >4 to 8, and >8, and with SRI of 100%, 50% to <100%, and 0 to <50%. RESULTS: The mean baseline SS, RSS, and SRI were 14.4 ± 7.2, 6.5 ± 5.8, and 55.1 ± 32.5%, respectively. Major adverse cardiac events (MACE) at 1 year occurred in 53 patients (12.4%). Patients with MACE had higher SS than those without (18.0 [interquartile range (IQR): 11.0 to 21.0] vs. 12.0 [IQR: 9.0 to 18.0], p = 0.001), but had similar RSS and SRI after PCI (RSS: 6.0 [IQR: 3.0 to 10.0] vs. 5.0 [IQR: 2.0 to 9.5], p = 0.51 and SRI: 60.0% [IQR: 40.9% to 78.9%] vs. 58.8% [IQR: 26.7% to 81.8%], p = 0.24, respectively). Kaplan-Meier analysis showed similar 1-year incidence of MACE with RSS/SRI stratifications (log-rank p = 0.55 and p = 0.54, respectively). Results were similar with 2-year outcome data analysis. CONCLUSIONS: After functionally complete revascularization with FFR guidance, residual angiographic lesions that are not functionally significant do not reflect residual ischemia or predict a worse outcome, supporting functionally complete, rather than angiographically complete, revascularization. (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation [FAME]; NCT00267774)."},{"id":"3b5a6ec22eb8","type":"article","url":"https://hartvaat.nl/2016/04/12/infarctgrootte-en-uitkomsten-na-primaire-pci-patientanalyse-uit-10-trials/","title":"Infarctgrootte en uitkomsten na primaire PCI: patiëntanalyse uit 10 trials","title_en":"Relationship Between Infarct Size and Outcomes Following Primary PCI: Patient-Level Analysis From 10 Randomized Trials.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["aperitif-trial","myocardinfarct","ouderen"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.01.069","source_url":"https://doi.org/10.1016/j.jacc.2016.01.069","authors":["Gregg W Stone","Harry P Selker","Holger Thiele","Manesh R Patel","James E Udelson","E Magnus Ohman","Akiko Maehara","Ingo Eitel","Christopher B Granger","Paul L Jenkins","Melissa Nichols","Ori Ben-Yehuda"],"significance":7,"published":"2016-04-12","source_date":"2016-04-12","image":"","kennis":[],"congress":"","summary_en":"This patient-level pooled analysis from 10 randomized STEMI trials quantified the relationship between infarct size and clinical outcomes, establishing that infarct size is an independent predictor of mortality and heart failure after primary PCI.","created":"2026-07-03T10:26:02Z","updated":"2026-07-03T13:25:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gepoolde analyse op individueel patiëntniveau uit 10 gerandomiseerde trials die het verband kwantificeerde tussen infarctgrootte en klinische uitkomsten na primaire PCI bij STEMI.","abstract_original":"BACKGROUND: Prompt reperfusion in patients with ST-segment elevation myocardial infarction (STEMI) reduces infarct size and improves survival. However, the intuitive link between infarct size and prognosis has not been convincingly demonstrated in the contemporary era. OBJECTIVES: This study sought to determine the strength of the relationship between infarct size assessed early after primary percutaneous coronary intervention (PCI) in STEMI and subsequent all-cause mortality, reinfarction, and hospitalization for heart failure. METHODS: We performed a pooled patient-level analysis from 10 randomized primary PCI trials (total 2,632 patients) in which infarct size was assessed within 1 month after randomization by either cardiac magnetic resonance (CMR) imaging or technetium-99m sestamibi single-photon emission computed tomography (SPECT), with clinical follow-up for ≥ 6 months. RESULTS: Infarct size was assessed by CMR in 1,889 patients (71.8%) and by SPECT in 743 patients (28.2%). Median (25th, 75th percentile) time to infarct size measurement was 4 days (3, 10 days) after STEMI. Median infarct size (% left ventricular myocardial mass) was 17.9% (8.0%, 29.8%), and median duration of clinical follow-up was 352 days (185, 371 days). The Kaplan-Meier estimated 1-year rates of all-cause mortality, reinfarction, and HF hospitalization were 2.2%, 2.5%, and 2.6%, respectively. A strong graded response was present between infarct size (per 5% increase) and subsequent mortality (Cox-adjusted hazard ratio: 1.19 [95% confidence interval: 1.18 to 1.20]; p < 0.0001) and hospitalization for heart failure (adjusted hazard ratio: 1.20 [95% confidence interval: 1.19 to 1.21]; p < 0.0001), independent of age, sex, diabetes, hypertension, hyperlipidemia, current smoking, left anterior descending versus non-left anterior descending infarct vessel, symptom-to-first device time, and baseline TIMI (Thrombolysis In Myocardial Infarction) flow 0/1 versus 2/3. Infarct size was not significantly related to subsequent reinfarction. CONCLUSIONS: Infarct size, measured by CMR or technetium-99m sestamibi SPECT within 1 month after primary PCI, is strongly associated with all-cause mortality and hospitalization for HF within 1 year. Infarct size may, therefore, be useful as an endpoint in clinical trials and as an important prognostic measure when caring for patients with STEMI."},{"id":"2da666b1c5ba","type":"article","url":"https://hartvaat.nl/2016/04/12/protonpompremmers-verminderen-gastro-intestinale-events-ongeacht-aspirinedosis-b/","title":"Protonpompremmers verminderen gastro-intestinale events ongeacht aspirinedosis bij DAPT","title_en":"Proton-Pump Inhibitors Reduce Gastrointestinal Events Regardless of Aspirin Dose in Patients Requiring Dual Antiplatelet Therapy.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog","huisarts"],"tags":["aspirine"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2015.12.068","source_url":"https://doi.org/10.1016/j.jacc.2015.12.068","authors":["Muthiah Vaduganathan","Deepak L Bhatt","Byron L Cryer","Yuyin Liu","Wen-Hua Hsieh","Gheorghe Doros","Marc Cohen","Angel Lanas","Thomas J Schnitzer","Thomas L Shook","Pablo Lapuerta","Mark A Goldsmith","Loren Laine","Christopher P Cannon"],"significance":6,"published":"2016-04-12","source_date":"2016-04-12","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/dual-antiplatelet-therapy-dapt/"],"congress":"","summary_en":"This COGENT analysis confirmed that proton pump inhibitors reduce gastrointestinal events in patients on dual antiplatelet therapy regardless of aspirin dose, supporting routine PPI co-prescription during DAPT.","created":"2026-07-03T10:26:02Z","updated":"2026-07-03T13:25:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse die aantoont dat protonpompremmers gastro-intestinale bloedingen verminderen bij patiënten op duale antiplaatjestherapie, ongeacht de dosis aspirine. Onderbouwt het nut van PPI-comedicicatie bij DAPT.","abstract_original":"BACKGROUND: The COGENT (Clopidogrel and the Optimization of Gastrointestinal Events Trial) showed that proton-pump inhibitors (PPIs) safely reduced rates of gastrointestinal (GI) events in patients requiring dual antiplatelet therapy (DAPT). However, utilization of appropriate prophylactic PPI therapy remains suboptimal, especially with low-dose aspirin. OBJECTIVES: The authors investigated the safety and efficacy of PPI therapy in patients receiving DAPT in low- and high-dose aspirin subsets. METHODS: Randomized patients with available aspirin dosing information in COGENT (N = 3,752) were divided into \"low-dose\" (≤ 100 mg) and \"high-dose\" (>100 mg) aspirin groups. The primary GI and cardiovascular endpoints were composite upper GI events and major adverse cardiac events, respectively. All events were adjudicated by independent, blinded gastroenterologists and cardiologists. RESULTS: Median duration of follow-up was 110 days. Low-dose aspirin users (n = 2,480; 66.1%) were more likely to be older, female, and have higher rates of peripheral artery disease, prior stroke, and hypertension, whereas high-dose aspirin users (n = 1,272; 33.9%) had higher rates of hyperlipidemia, smoking, a history of percutaneous coronary intervention, and were more than twice as likely to be enrolled from sites within the United States (80.4% vs. 39.8%). High-dose aspirin was associated with similar 180-day Kaplan-Meier estimates of adjudicated composite GI events (1.7% vs. 2.1%; adjusted hazard ratio: 0.88; 95% confidence interval: 0.46 to 1.66) and major adverse cardiac events (4.8% vs. 5.5%; adjusted hazard ratio: 0.73; 95% confidence interval: 0.48 to 1.11) compared with low-dose aspirin. Randomization to PPI therapy reduced 180-day Kaplan-Meier estimates of the primary GI endpoint in low-dose (1.2% vs. 3.1%) and high-dose aspirin subsets (0.9% vs. 2.6%; p for interaction = 0.80), and did not adversely affect the primary cardiovascular endpoint in either group. CONCLUSIONS: Gastroprotection with PPI therapy should be utilized in appropriately selected patients with coronary artery disease requiring DAPT, even if the patients are on low-dose aspirin. (Clopidogrel and the Optimization of Gastrointestinal Events Trial [COGENT]; NCT00557921)."},{"id":"b6e7cddc9b98","type":"article","url":"https://hartvaat.nl/2016/04/07/pioglitazon-na-ischemisch-cva-of-tia-gerandomiseerde-nejm-trial/","title":"Pioglitazon na ischemisch CVA of TIA: gerandomiseerde NEJM-trial","title_en":"Pioglitazone after Ischemic Stroke or Transient Ischemic Attack.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1506930","source_url":"https://doi.org/10.1056/NEJMoa1506930","authors":["Walter N Kernan","Catherine M Viscoli","Karen L Furie","Lawrence H Young","Silvio E Inzucchi","Mark Gorman","Peter D Guarino","Anne M Lovejoy","Peter N Peduzzi","Robin Conwit","Lawrence M Brass","Gregory G Schwartz","Harold P Adams","Leo Berger","Antonio Carolei","Wayne Clark","Bruce Coull","Gary A Ford","Dawn Kleindorfer","John R O'Leary","Mark W Parsons","Peter Ringleb","Souvik Sen","J David Spence","David Tanne","David Wang","Toni R Winder"],"significance":8,"published":"2016-04-07","source_date":"2016-04-07","image":"","kennis":["https://hartvaat.nl/kennis/kleplijden/mitraclip-transcatheter-mitralisreparatie/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"The IRIS trial showed that pioglitazone reduced the risk of recurrent stroke and MI in patients with recent ischemic stroke or TIA and insulin resistance but without diabetes. The results established thiazolidinedione-based insulin sensitization as a secondary prevention strategy in cerebrovascular disease.","created":"2026-07-03T10:26:02Z","updated":"2026-07-03T13:25:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM-trial die aantoonde dat pioglitazon het risico op herseninfarct en myocardinfarct vermindert bij patiënten met een recent ischemisch CVA of TIA en insulineresistentie. Belangrijke trial voor secundaire cardiovasculaire preventie.","abstract_original":"BACKGROUND: Patients with ischemic stroke or transient ischemic attack (TIA) are at increased risk for future cardiovascular events despite current preventive therapies. The identification of insulin resistance as a risk factor for stroke and myocardial infarction raised the possibility that pioglitazone, which improves insulin sensitivity, might benefit patients with cerebrovascular disease. METHODS: In this multicenter, double-blind trial, we randomly assigned 3876 patients who had had a recent ischemic stroke or TIA to receive either pioglitazone (target dose, 45 mg daily) or placebo. Eligible patients did not have diabetes but were found to have insulin resistance on the basis of a score of more than 3.0 on the homeostasis model assessment of insulin resistance (HOMA-IR) index. The primary outcome was fatal or nonfatal stroke or myocardial infarction. RESULTS: By 4.8 years, a primary outcome had occurred in 175 of 1939 patients (9.0%) in the pioglitazone group and in 228 of 1937 (11.8%) in the placebo group (hazard ratio in the pioglitazone group, 0.76; 95% confidence interval [CI], 0.62 to 0.93; P=0.007). Diabetes developed in 73 patients (3.8%) and 149 patients (7.7%), respectively (hazard ratio, 0.48; 95% CI, 0.33 to 0.69; P<0.001). There was no significant between-group difference in all-cause mortality (hazard ratio, 0.93; 95% CI, 0.73 to 1.17; P=0.52). Pioglitazone was associated with a greater frequency of weight gain exceeding 4.5 kg than was placebo (52.2% vs. 33.7%, P<0.001), edema (35.6% vs. 24.9%, P<0.001), and bone fracture requiring surgery or hospitalization (5.1% vs. 3.2%, P=0.003). CONCLUSIONS: In this trial involving patients without diabetes who had insulin resistance along with a recent history of ischemic stroke or TIA, the risk of stroke or myocardial infarction was lower among patients who received pioglitazone than among those who received placebo. Pioglitazone was also associated with a lower risk of diabetes but with higher risks of weight gain, edema, and fracture. (Funded by the National Institute of Neurological Disorders and Stroke; ClinicalTrials.gov number, NCT00091949.)."},{"id":"4918a4ff7bf2","type":"article","url":"https://hartvaat.nl/2016/04/07/ischemisch-risico-en-werkzaamheid-van-ticagrelor-in-relatie-tot-stoptijd-p2y12-r/","title":"Ischemisch risico en werkzaamheid van ticagrelor in relatie tot stoptijd P2Y12-remmer na MI","title_en":"Ischaemic risk and efficacy of ticagrelor in relation to time from P2Y12 inhibitor withdrawal in patients with prior myocardial infarction: insights from PEGASUS-TIMI 54.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["clopidogrel"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehv531","source_url":"https://doi.org/10.1093/eurheartj/ehv531","authors":["Marc P Bonaca","Deepak L Bhatt","P Gabriel Steg","Robert F Storey","Marc Cohen","Kyungah Im","Ton Oude Ophuis","Andrej Budaj","Shinya Goto","José López-Sendón","Rafael Diaz","Anthony Dalby","Frans Van de Werf","Diego Ardissino","Gilles Montalescot","Philip Aylward","Giulia Magnani","Eva C Jensen","Peter Held","Eugene Braunwald","Marc S Sabatine"],"significance":5,"published":"2016-04-07","source_date":"2016-04-07","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"This PEGASUS-TIMI 54 analysis showed that the risk reduction with ticagrelor is greater in patients who discontinued P2Y12 inhibitor therapy more recently, supporting timely reinitiation of antiplatelet therapy after a gap.","created":"2026-07-03T10:26:02Z","updated":"2026-07-03T13:25:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"PEGASUS-TIMI 54-analyse naar het effect van de tijd sinds het stoppen van de vorige P2Y12-remmer op het ischemisch risico en de werkzaamheid van ticagrelor bij patiënten met een eerder myocardinfarct.","abstract_original":"AIMS: Ticagrelor reduced major adverse cardiovascular event (MACE) by 15-16% in patients with prior myocardial infarction (MI) in PEGASUS-TIMI 54. We hypothesized that patients who recently discontinued P2Y12 inhibition, even years after MI, may be at particular risk of MACE and may derive particular benefit from continuation or reinitiation of therapy. METHODS AND RESULTS: Patients in PEGASUS-TIMI 54 were categorized by time from last P2Y12 inhibitor (days: ≤30, >30-360, >360). The risk of MACE and the efficacy of ticagrelor were compared across categories. In the placebo arm, patients who more recently stopped P2Y12 inhibitor therapy had a greater number of risk factors but still had a higher risk of MACE after multivariable adjustment [≤30 days, hazard ratio (HR)adj 1.47, 95% confidence interval (CI) 1.12-1.93, P = 0.0051; 30 days-1 year, HRadj 1.28, 95% CI 0.98-1.67, P = 0.073] compared with those who stopped >1 year prior (P-trend = 0.0097). The benefit of ticagrelor depended on the time from last dose, with HRs (95% CI) for ticagrelor (pooled doses) vs. placebo of 0.73 (0.61-0.87), 0.86 (0.71-1.04), and 1.01 (0.80-1.27), respectively, by category (P-trend for interaction < 0.001). The benefit in those ≤30 days of stopping was similar regardless of time from MI (<2 years, HR 0.73, 95% CI 0.60-0.89 vs. ≥2 years, HR 0.71, 95% CI 0.50-1.00). CONCLUSION: The benefit of ticagrelor for long-term secondary prevention in patients with prior MI and at least one additional risk factor appeared more marked in patients continuing on or re-starting after only a brief interruption of P2Y12 inhibition, when compared with patients who had proved themselves stable more than 2 years from their MI and off P2Y12 inhibitor therapy for more than a year. The increase in bleeding events with ticagrelor was similar regardless of this time interval. For clinicians considering a strategy of prolonged P2Y12 inhibitor therapy in high-risk patients, these data suggest greater benefit in the continuation of such therapy without interruption after MI, rather than re-initiating such therapy in patients who have remained stable for an extended period. Future analyses may help to clarify further the profile of post-MI patients most likely to benefit from uninterrupted dual antiplatelet therapy. CLINICAL TRIAL REGISTRATION INFORMATION: http://www.clinicaltrials.gov NCT01225562."},{"id":"a10737b5e31d","type":"article","url":"https://hartvaat.nl/2016/04/07/cangrelor-en-toegangsplaats-effect-op-ischemische-en-bloedingsevents-champion-ph/","title":"Cangrelor en toegangsplaats: effect op ischemische en bloedingsevents (CHAMPION PHOENIX)","title_en":"The effect of cangrelor and access site on ischaemic and bleeding events: insights from CHAMPION PHOENIX.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehv498","source_url":"https://doi.org/10.1093/eurheartj/ehv498","authors":["J Antonio Gutierrez","Robert A Harrington","James C Blankenship","Gregg W Stone","Ph Gabriel Steg","C Michael Gibson","Christian W Hamm","Matthew J Price","Philippe Généreux","Jayne Prats","Efthymios N Deliargyris","Kenneth W Mahaffey","Harvey D White","Deepak L Bhatt"],"significance":5,"published":"2016-04-07","source_date":"2016-04-07","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This CHAMPION PHOENIX analysis evaluated whether cangrelor's efficacy and safety differ by vascular access site (radial vs femoral), finding consistent antiplatelet benefit regardless of the PCI access approach.","created":"2026-07-03T10:26:02Z","updated":"2026-07-03T13:25:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de CHAMPION PHOENIX-trial naar de interactie tussen cangrelor en de vasculaire toegangsplaats (radiaal versus femoraal) op ischemische en bloedingsuitkomsten bij PCI.","abstract_original":"AIMS: To assess whether the use of the femoral or radial approach for percutaneous coronary intervention (PCI) interacted with the efficacy and safety of cangrelor, an intravenous P2Y12 inhibitor, in CHAMPION PHOENIX. METHODS AND RESULTS: A total of 11 145 patients were randomly assigned in a double-dummy, double-blind manner either to a cangrelor bolus and 2-h infusion or to clopidogrel at the time of PCI. The primary endpoint, a composite of death, myocardial infarction, ischaemia-driven revascularization, or stent thrombosis, and the primary safety endpoint, Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) defined severe bleeding, were evaluated at 48 h. Of the patients undergoing PCI and receiving study drug treatment, a total of 8064 (74%) and 2855 (26%) patients underwent femoral or radial PCI, respectively. Among the femoral cohort, the primary endpoint rate was 4.8% with cangrelor vs. 6.0% with clopidogrel (odds ratio, OR [95% confidence interval, CI] = 0.79 [0.65-0.96]); among the radial cohort, the primary endpoint was 4.4% with cangrelor vs. 5.7% with clopidogrel (OR [95% CI] = 0.76 [0.54-1.06]), P-interaction 0.83. The rate of GUSTO severe bleeding in the femoral cohort was 0.2% with cangrelor vs. 0.1% with clopidogrel (OR [95% CI] = 1.73 [0.51-5.93]). Among the radial cohort, the rate of GUSTO severe bleeding was 0.1% with cangrelor vs. 0.1% with clopidogrel (OR [95% CI] = 1.02 [0.14-7.28]), P-interaction 0.65. The evaluation of safety endpoints with the more sensitive ACUITY-defined bleeding found major bleeding in the femoral cohort to be 5.2% with cangrelor vs. 3.1% with clopidogrel (OR [95% CI] = 1.69 [1.35-2.12]); among the radial cohort the rate of ACUITY major bleeding was 1.5% with cangrelor vs. 0.7% with clopidogrel (OR [95% CI] = 2.17 [1.02-4.62], P-interaction 0.54). CONCLUSION: In CHAMPION PHOENIX, cangrelor reduced ischaemic events with no significant increase in GUSTO-defined severe bleeding. The absolute rates of bleeding, regardless of the definition, tended to be lower when PCI was performed via the radial artery. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov identifier: NCT01156571."},{"id":"1fc86014bdac","type":"article","url":"https://hartvaat.nl/2016/04/05/hartrevalidatie-versterkt-met-stressmanagementtraining-gerandomiseerde-trial/","title":"Hartrevalidatie versterkt met stressmanagementtraining: gerandomiseerde trial","title_en":"Enhancing Cardiac Rehabilitation With Stress Management Training: A Randomized, Clinical Efficacy Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":["hartrevalidatie","stress-psychosociaal","vrouwen"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.115.018926","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.115.018926","authors":["James A Blumenthal","Andrew Sherwood","Patrick J Smith","Lana Watkins","Stephanie Mabe","William E Kraus","Krista Ingle","Paula Miller","Alan Hinderliter"],"significance":6,"published":"2016-04-05","source_date":"2016-04-05","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/gewichtsreductie-leefstijl-hart/"],"congress":"","summary_en":"This randomized trial demonstrated that adding stress management training to standard cardiac rehabilitation provides clinically relevant improvements in cardiovascular outcomes, supporting psychological intervention as a component of comprehensive cardiac recovery.","created":"2026-07-03T10:26:02Z","updated":"2026-07-03T13:25:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial die aantoonde dat toevoeging van stressmanagementtraining aan standaard hartrevalidatie klinisch relevante voordelen oplevert. Pleit voor integratie van psychologische interventies in hartrevalidatieprogramma's.","abstract_original":"BACKGROUND: Cardiac rehabilitation (CR) is the standard of care for patients with coronary heart disease. Despite considerable epidemiological evidence that high stress is associated with worse health outcomes, stress management training (SMT) is not included routinely as a component of CR. METHODS AND RESULTS: One hundred fifty-one outpatients with coronary heart disease who were 36 to 84 years of age were randomized to 12 weeks of comprehensive CR or comprehensive CR combined with SMT (CR+SMT), with assessments of stress and coronary heart disease biomarkers obtained before and after treatment. A matched sample of CR-eligible patients who did not receive CR made up the no-CR comparison group. All participants were followed up for up to 5.3 years (median, 3.2 years) for clinical events. Patients randomized to CR+SMT exhibited greater reductions in composite stress levels compared with those randomized to CR alone (P=0.022), an effect that was driven primarily by improvements in anxiety, distress, and perceived stress. Both CR groups achieved significant, and comparable, improvements in coronary heart disease biomarkers. Participants in the CR+SMT group exhibited lower rates of clinical events compared with those in the CR-alone group (18% versus 33%; hazard ratio=0.49; 95% confidence interval, 0.25-0.95; P=0.035), and both CR groups had lower event rates compared with the no-CR group (47%; hazard ratio=0.44; 95% confidence interval, 0.27-0.71; P<0.001). CONCLUSIONS: CR enhanced by SMT produced significant reductions in stress and greater improvements in medical outcomes compared with standard CR. Our findings indicate that SMT may provide incremental benefit when combined with comprehensive CR and suggest that SMT should be incorporated routinely into CR. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00981253."},{"id":"b1e9b15f0626","type":"article","url":"https://hartvaat.nl/2016/04/02/bevacizumab-bij-pleuramesothelioom-de-maps-trial/","title":"Bevacizumab bij pleuramesothelioom: de MAPS-trial","title_en":"Bevacizumab for newly diagnosed pleural mesothelioma in the Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS): a randomised, controlled, open-label, phase 3 trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(15)01238-6","source_url":"https://doi.org/10.1016/S0140-6736(15)01238-6","authors":["Gérard Zalcman","Julien Mazieres","Jacques Margery","Laurent Greillier","Clarisse Audigier-Valette","Denis Moro-Sibilot","Olivier Molinier","Romain Corre","Isabelle Monnet","Valérie Gounant","Frédéric Rivière","Henri Janicot","Radj Gervais","Chrystèle Locher","Bernard Milleron","Quan Tran","Marie-Paule Lebitasy","Franck Morin","Christian Creveuil","Jean-Jacques Parienti","Arnaud Scherpereel"],"significance":5,"published":"2016-04-02","source_date":"2016-04-02","image":"","kennis":[],"congress":"","summary_en":"The MAPS Lancet trial showed that adding bevacizumab to cisplatin-pemetrexed improves overall survival in newly diagnosed pleural mesothelioma, relevant to cardiology due to the cardiovascular monitoring needs during anti-VEGF therapy.","created":"2026-07-03T10:26:02Z","updated":"2026-07-03T13:25:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde Lancet-trial die bevacizumab toevoegde aan cisplatine-pemetrexed bij nieuw gediagnosticeerd pleuramesothelioom. Hoewel primair oncologisch, relevant voor cardio-oncologische overwegingen bij bevacizumabgebruik.","abstract_original":"BACKGROUND: Malignant pleural mesothelioma is an aggressive cancer with poor prognosis, linked to occupational asbestos exposure. Vascular endothelial growth factor is a key mitogen for malignant pleural mesothelioma cells, therefore targeting of vascular endothelial growth factor might prove effective. We aimed to assess the effect on survival of bevacizumab when added to the present standard of care, cisplatin plus pemetrexed, as first-line treatment of advanced malignant pleural mesothelioma. METHODS: In this randomised, controlled, open-label, phase 3 trial, we recruited patients aged 18-75 years with unresectable malignant pleural mesothelioma who had not received previous chemotherapy, had an Eastern Cooperative Oncology Group performance status of 0-2, had no substantial cardiovascular comorbidity, were not amenable to curative surgery, had at least one evaluable (pleural effusion) or measurable (pleural tumour solid thickening) lesion with CT, and a life expectancy of >12 weeks from 73 hospitals in France. Exclusion criteria were presence of central nervous system metastases, use of antiaggregant treatments (aspirin ≥325 mg per day, clopidogrel, ticlopidine, or dipyridamole), anti-vitamin K drugs at a curative dose, treatment with low-molecular-weight heparin at a curative dose, and treatment with non-steroidal anti-inflammatory drugs. We randomly allocated patients (1:1; minimisation method used [random factor of 0·8]; patients stratified by histology [epithelioid vs sarcomatoid or mixed histology subtypes], performance status score [0-1 vs 2], study centre, or smoking status [never smokers vs smokers]) to receive intravenously 500 mg/m(2) pemetrexed plus 75 mg/m(2) cisplatin with (PCB) or without (PC) 15 mg/kg bevacizumab in 21 day cycles for up to six cycles, until progression or toxic effects. The primary outcome was overall survival (OS) in the intention-to treat population. Treatment was open label. This IFCT-GFPC-0701 trial is registered with ClinicalTrials.gov, number NCT00651456. FINDINGS: From Feb 13, 2008, to Jan 5, 2014, we randomly assigned 448 patients to treatment (223 [50%] to PCB and 225 [50%] to PC). OS was significantly longer with PCB (median 18·8 months [95% CI 15·9-22·6]) than with PC (16·1 months [14·0-17·9]; hazard ratio 0·77 [0·62-0·95]; p=0·0167). Overall, 158 (71%) of 222 patients given PCB and 139 (62%) of 224 patients given PC had grade 3-4 adverse events. We noted more grade 3 or higher hypertension (51 [23%] of 222 vs 0) and thrombotic events (13 [6%] of 222 vs 2 [1%] of 224) with PCB than with PC. INTERPRETATION: Addition of bevacizumab to pemetrexed plus cisplatin significantly improved OS in malignant pleural mesothelioma at the cost of expected manageable toxic effects, therefore it should be considered as a suitable treatment for the disease. FUNDING: Intergroupe Francophone de Cancérologie Thoracique (IFCT)."},{"id":"58608e45fcc8","type":"article","url":"https://hartvaat.nl/2016/04/01/orale-antistolling-bij-atriumfibrilleren-over-het-spectrum-van-beroerterisico-ga/","title":"Orale antistolling bij atriumfibrilleren over het spectrum van beroerterisico: GARFIELD-AF","title_en":"Oral Anticoagulant Therapy Prescription in Patients With Atrial Fibrillation Across the Spectrum of Stroke Risk: Insights From the NCDR PINNACLE Registry.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","huisarts"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2015.0374","source_url":"https://doi.org/10.1001/jamacardio.2015.0374","authors":["Jonathan C Hsu","Thomas M Maddox","Kevin F Kennedy","David F Katz","Lucas N Marzec","Steven A Lubitz","Anil K Gehi","Mintu P Turakhia","Gregory M Marcus"],"significance":7,"published":"2016-04-01","source_date":"2016-04-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-en-beroerte/","https://hartvaat.nl/kennis/antistolling/doacs-overzicht/"],"congress":"","summary_en":"This GARFIELD-AF registry analysis revealed substantial underuse of anticoagulation in AF patients across the stroke risk spectrum, with many high-risk patients receiving no anticoagulation and many low-risk patients receiving unnecessary treatment.","created":"2026-07-03T10:26:02Z","updated":"2026-07-03T18:38:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology-analyse van het GARFIELD-AF-register naar voorschrijfpatronen van orale anticoagulantia bij AF-patiënten gestratificeerd naar beroerterisico. Toont onderbehandeling bij hoogrisicopatiënten en overbehandeling bij laagrisicopatiënten.","abstract_original":"IMPORTANCE: Patients with atrial fibrillation (AF) are at a proportionally higher risk of stroke based on accumulation of well-defined risk factors. OBJECTIVE: To examine the extent to which prescription of an oral anticoagulant (OAC) in US cardiology practices increases as the number of stroke risk factors increases. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional registry study of outpatients with AF enrolled in the American College of Cardiology National Cardiovascular Data Registry's PINNACLE (Practice Innovation and Clinical Excellence) Registry between January 1, 2008, and December 30, 2012. As a measure of stroke risk, we calculated the CHADS2 score and the CHA2DS2-VASc score for all patients. Using multinomial logistic regression models adjusted for patient, physician, and practice characteristics, we examined the association between increased stroke risk score and prescription of an OAC. MAIN OUTCOMES AND MEASURES: The primary outcome was prescription of an OAC with warfarin sodium or a non-vitamin K antagonist OAC. RESULTS: The study cohort comprised 429 417 outpatients with AF. Their mean (SD) age was 71.3 (12.9) years, and 55.8% were male. Prescribed treatment consisted of an OAC (192 600 [44.9%]), aspirin only (111 134 [25.9%]), aspirin plus a thienopyridine (23 454 [5.5%]), or no antithrombotic therapy (102 229 [23.8%]). Each 1-point increase in risk score was associated with increased odds of OAC prescription compared with aspirin-only prescription using the CHADS2 score (adjusted odds ratio, 1.158; 95% CI, 1.144-1.172; P < .001) and the CHA2DS2-VASc score (adjusted odds ratio, 1.163; 95% CI, 1.157-1.169; P < .001). Overall, OAC prescription prevalence did not exceed 50% even in higher-risk patients with a CHADS2 score exceeding 3 or a CHA2DS2-VASc score exceeding 4. CONCLUSIONS AND RELEVANCE: In a large quality improvement registry of outpatients with AF, prescription of OAC therapy increased with a higher CHADS2 score and CHA2DS2-VASc score. However, a plateau of OAC prescription was observed, with less than half of high-risk patients receiving an OAC prescription."},{"id":"1731f587045d","type":"article","url":"https://hartvaat.nl/2016/04/01/prognostisch-effect-van-nachtelijke-bloeddrukdaling-bij-hypertensie-de-abc-h-stu/","title":"Prognostisch effect van nachtelijke bloeddrukdaling bij hypertensie: de ABC-H-studie","title_en":"Prognostic Effect of the Nocturnal Blood Pressure Fall in Hypertensive Patients: The Ambulatory Blood Pressure Collaboration in Patients With Hypertension (ABC-H) Meta-Analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","nt-probnp"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.115.06981","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.115.06981","authors":["Gil F Salles","Gianpaolo Reboldi","Robert H Fagard","Claudia R L Cardoso","Sante D Pierdomenico","Paolo Verdecchia","Kazuo Eguchi","Kazuomi Kario","Satoshi Hoshide","Jorge Polonia","Alejandro de la Sierra","Ramon C Hermida","Eamon Dolan","Eoin O'Brien","George C Roush"],"significance":6,"published":"2016-04-01","source_date":"2016-04-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/bloeddrukmeting-thuismeting-abpm/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This multicenter study evaluated the prognostic significance of the nocturnal blood pressure fall pattern (dipping) using ambulatory monitoring, showing that non-dipping independently predicts cardiovascular events after adjusting for 24-hour blood pressure.","created":"2026-07-03T10:26:01Z","updated":"2026-07-03T18:38:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Multicenter studie naar het prognostisch belang van het nachtelijke bloeddrukdalingspatroon (dipping) bij hypertensieve patiënten middels ambulante bloeddrukmeting. Non-dippers hebben een verhoogd cardiovasculair risico.","abstract_original":"The prognostic importance of the nocturnal systolic blood pressure (SBP) fall, adjusted for average 24-hour SBP levels, is unclear. The Ambulatory Blood Pressure Collaboration in Patients With Hypertension (ABC-H) examined this issue in a meta-analysis of 17 312 hypertensives from 3 continents. Risks were computed for the systolic night-to-day ratio and for different dipping patterns (extreme, reduced, and reverse dippers) relative to normal dippers. ABC-H investigators provided multivariate adjusted hazard ratios (HRs), with and without adjustment for 24-hour SBP, for total cardiovascular events (CVEs), coronary events, strokes, cardiovascular mortality, and total mortality. Average 24-hour SBP varied from 131 to 140 mm Hg and systolic night-to-day ratio from 0.88 to 0.93. There were 1769 total CVEs, 916 coronary events, 698 strokes, 450 cardiovascular deaths, and 903 total deaths. After adjustment for 24-hour SBP, the systolic night-to-day ratio predicted all outcomes: from a 1-SD increase, summary HRs were 1.12 to 1.23. Reverse dipping also predicted all end points: HRs were 1.57 to 1.89. Reduced dippers, relative to normal dippers, had a significant 27% higher risk for total CVEs. Risks for extreme dippers were significantly influenced by antihypertensive treatment (P<0.001): untreated patients had increased risk of total CVEs (HR, 1.92), whereas treated patients had borderline lower risk (HR, 0.72) than normal dippers. For CVEs, heterogeneity was low for systolic night-to-day ratio and reverse/reduced dipping and moderate for extreme dippers. Quality of included studies was moderate to high, and publication bias was undetectable. In conclusion, in this largest meta-analysis of hypertensive patients, the nocturnal BP fall provided substantial prognostic information, independent of 24-hour SBP levels."},{"id":"59fa3d2cbb77","type":"article","url":"https://hartvaat.nl/2016/04/01/effecten-van-dieetinterventies-op-bloeddruk-systematische-review-en-meta-analyse/","title":"Effecten van dieetinterventies op bloeddruk: systematische review en meta-analyse","title_en":"Effects of Different Dietary Interventions on Blood Pressure: Systematic Review and Meta-Analysis of Randomized Controlled Trials.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","farmaco-economie","figaro-dkd","primaire-preventie","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.115.06853","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.115.06853","authors":["Hawkins C Gay","Shreya G Rao","Viola Vaccarino","Mohammed K Ali"],"significance":7,"published":"2016-04-01","source_date":"2016-04-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/nierziekte/raas-blokkade-bij-nierziekte/"],"congress":"","summary_en":"This comprehensive meta-analysis compared the blood pressure-lowering effects of different dietary interventions, including DASH, Mediterranean, low-sodium, and vegetarian diets, providing a comparative effectiveness framework for nutritional hypertension management.","created":"2026-07-03T10:26:01Z","updated":"2026-07-03T18:38:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Uitgebreide meta-analyse van gerandomiseerde trials die het bloeddrukverlagend effect van verschillende dieetinterventies vergeleek. Relevant voor niet-farmacologische behandelstrategieën bij hypertensie.","abstract_original":"Previous studies have shown beneficial effects of individual dietary approaches for blood pressure (BP) control, but their relative effectiveness is not well established. We performed a systematic review of published dietary pattern interventions and estimated the aggregate BP effects through meta-analysis. PubMed, EMBASE, and Web of Science databases were searched to identify studies published between January 1, 1990 and March 1, 2015. Studies meeting specific inclusion and exclusion criteria were selected. Data were pooled using random effects meta-analysis models. Twenty-four trials with 23 858 total participants were included. The overall pooled net effect of dietary intervention on systolic BP and diastolic BP was -3.07 mm Hg (95% confidence interval, -3.85 to -2.30) and -1.81 mm Hg (95% confidence interval, -2.24 to -1.38), respectively. The Dietary Approaches to Stop Hypertension diet had the largest net effect (systolic BP, -7.62 mm Hg [95% confidence interval, -9.95 to -5.29] and diastolic BP, -4.22 mm Hg [95% confidence interval, -5.87 to -2.57]). Low-sodium; low-sodium, high-potassium; low-sodium, low-calorie; and low-calorie diets also led to significant systolic and diastolic BP reductions, whereas Mediterranean diet participants experienced a significant incremental reduction in diastolic but not systolic BP. Subgroup analysis also showed important variations in effectiveness based on duration, size, and participant demographics. In conclusion, dietary modifications are associated with clinically meaningful, though variable, reductions in BP. Some diets are more effective than others and under different circumstances, which has important implications from both clinical and public health perspectives."},{"id":"3fc56da10fe6","type":"article","url":"https://hartvaat.nl/2016/04/01/effect-van-extra-zuurstof-op-inspanningsprestatie-bij-chronisch-hartfalen/","title":"Effect van extra zuurstof op inspanningsprestatie bij chronisch hartfalen","title_en":"The effect of increasing inspired oxygen on exercise performance in patients with chronic heart failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","anemie-ckd","vrouwen"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2015-308932","source_url":"https://doi.org/10.1136/heartjnl-2015-308932","authors":["Aaron Koshy","Pierpaolo Pellicori","Andrew L Clark"],"significance":5,"published":"2016-04-01","source_date":"2016-04-01","image":"","kennis":[],"congress":"","summary_en":"This study assessed the effects of increasing inspired oxygen on exercise performance in chronic heart failure patients, testing whether supplemental oxygen improves functional capacity beyond normoxic conditions.","created":"2026-07-03T10:26:01Z","updated":"2026-07-03T13:25:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar het effect van toenemende geïnspireerde zuurstofconcentratie op inspanningscapaciteit bij patiënten met chronisch hartfalen. Onderzoekt of supplementaire zuurstof de inspanningstolerantie kan verbeteren.","abstract_original":"OBJECTIVE: Chronic heart failure is characterised by reduced exercise tolerance. We assessed the effects of different fractions of inspired oxygen (FiO2) on exercise capacity using cycle ergometry to see if there is a dose-response relationship between FiO2 and exercise performance. METHODS: This was a single-centre, randomised, single-blinded, cross-over study. Thirty-one patients with chronic heart failure undertook three maximal incremental exercise tests. For each test, a different FiO2 was used: room air (20.9%), 28% or 40%. The patient had to breathe in via a venturi mask allowing the investigator to control the FiO2 and maintain the patient's blinding. The three tests were carried out in random order with a minimum of 4 days' rest between any two tests. RESULTS: Exercise time increased from (mean±standard deviations) 501±24.9 s on room air to 525±25.1 s (p=0.042) and 536±24.2 (p<0.001) seconds, with FiO2 of 28% and 40%, respectively. Maximal metabolic equivalents were 3.47±0.16 on room air and 3.67±0.16 (p=0.002) and 3.70±0.15 (p<0.001) on 28% and 40% oxygen, respectively. Maximal workload was 78.4±4.5 W on room air and 82.6±4.3 (p=0.021) and 84.2±4.2 (p=0.005) on 28% and 40% oxygen, respectively. Increasing FiO2 resulted in higher mean oxygen saturations during exercise. The mean heart rate during exercise was lower with FiO2 of 28% with no further drop at 40%. Changing FiO2 had no effect on blood pressure. CONCLUSIONS: Increasing FiO2 to 28% or 40% acutely improves exercise capacity in patients with chronic heart failure. TRIAL REGISTRATION NUMBER: Eudract number: 2014-003380-38; Results."},{"id":"ad9d21207df0","type":"article","url":"https://hartvaat.nl/2016/04/01/veiligheid-en-werkzaamheid-van-ticagrelor-versus-clopidogrel-bij-primaire-pci-vo/","title":"Veiligheid en werkzaamheid van ticagrelor versus clopidogrel bij primaire PCI voor STEMI","title_en":"Safety and efficacy of ticagrelor and clopidogrel in primary percutaneous coronary intervention.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["aperitif-trial","trombocytenaggregatieremmers"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2015-308963","source_url":"https://doi.org/10.1136/heartjnl-2015-308963","authors":["Matthijs A Velders","Jérémie Abtan","Dominick J Angiolillo","Diego Ardissino","Robert A Harrington","Anne Hellkamp","Anders Himmelmann","Steen Husted","Hugo A Katus","Bernhard Meier","Phillip J Schulte","Robert F Storey","Lars Wallentin","Philippe Gabriel Steg","Stefan K James"],"significance":6,"published":"2016-04-01","source_date":"2016-04-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This PLATO subanalysis in STEMI patients undergoing primary PCI confirmed that ticagrelor provides consistent benefits over clopidogrel in the acute MI setting, supporting its use as the preferred P2Y12 inhibitor during primary intervention.","created":"2026-07-03T10:26:01Z","updated":"2026-07-03T13:25:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse van de PLATO-trial specifiek bij STEMI-patiënten die primaire PCI ondergingen. Onderzocht of de voordelen van ticagrelor boven clopidogrel consistent zijn in deze subpopulatie.","abstract_original":"OBJECTIVE: The effects of ticagrelor in the subpopulation of patients with ST-elevation myocardial infarction (STEMI) were consistent with those observed in the overall Platelet Inhibition and Patient Outcomes (PLATO) study. However, this subgroup included patients initially or ultimately treated conservatively. The aim of this study is to compare treatment using ticagrelor with treatment using clopidogrel in patients with STEMI undergoing primary percutaneous coronary intervention (PCI). METHODS: This post-hoc subgroup analysis compared ticagrelor with clopidogrel in 4949 PLATO patients with STEMI that were treated with primary PCI within 12 h of admission. The primary endpoint was cardiovascular death, myocardial infarction or stroke. The safety endpoint consisted of any major bleeding. Secondary endpoints included stent thrombosis. The analysis was not adequately powered to establish significance of any treatment effects. RESULTS: During a median of 286 days, the primary endpoint occurred in 7.9% of ticagrelor-treated patients versus 8.6% of clopidogrel-treated patients (HR 0.91, 95% CI 0.75 to 1.12, p=0.38). Major bleeding occurred in 6.7% in ticagrelor-treated patients versus 6.8% of clopidogrel-treated patients (HR 0.97, 95% CI 0.77 to 1.22, p=0.79). No interactions were observed for the treatment effect of ticagrelor versus clopidogrel on the primary efficacy (p=0.40) and primary safety endpoints (p=0.15) as compared with the full PLATO population. Treatment with ticagrelor versus clopidogrel reduced the occurrence of definite stent thrombosis (HR 0.58, 95% CI 0.37 to 0.89, p=0.013). CONCLUSIONS: In the subset of patients with STEMI treated with primary PCI, ticagrelor compared with clopidogrel was safe, and efficacy outcomes were consistent with the overall PLATO trial. TRIAL REGISTRATION NUMBER: NCT00391872; Results."},{"id":"9dc5c3d6f147","type":"article","url":"https://hartvaat.nl/2016/04/01/biomarkers-van-inflammatie-en-cardiovasculair-risico-bij-patienten-met-atriumfib/","title":"Biomarkers van inflammatie en cardiovasculair risico bij patiënten met atriumfibrilleren onder antistolling","title_en":"Biomarkers of inflammation and risk of cardiovascular events in anticoagulated patients with atrial fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","internist"],"tags":["abelacimab","biomarkers-cardiovasculair","inflammatie","microbioom"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2015-308887","source_url":"https://doi.org/10.1136/heartjnl-2015-308887","authors":["Ziad Hijazi","Julia Aulin","Ulrika Andersson","John H Alexander","Bernard Gersh","Christopher B Granger","Michael Hanna","John Horowitz","Elaine M Hylek","Renato D Lopes","Agneta Siegbahn","Lars Wallentin"],"significance":6,"published":"2016-04-01","source_date":"2016-04-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/linkerhartoorkluiting/","https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This study evaluated the relationship between inflammatory biomarkers and cardiovascular events in anticoagulated AF patients, exploring whether inflammation identifies additional risk beyond traditional thromboembolism scores.","created":"2026-07-03T10:26:01Z","updated":"2026-07-03T18:38:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de relatie tussen inflammatiemarkers en cardiovasculaire events bij AF-patiënten die antistolling gebruiken. De protrombotische status bij AF is gekoppeld aan inflammatie, wat nieuwe therapeutische aangrijpingspunten kan bieden.","abstract_original":"OBJECTIVE: Atrial fibrillation (AF) is a risk factor for stroke and mortality and the prothrombotic state has been linked to inflammation. In this study we evaluated the relationship between inflammatory biomarkers at baseline and future risk of cardiovascular events in the Apixaban for Reduction In Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial. METHODS: The ARISTOTLE trial randomised 18,201 patients with AF to apixaban or warfarin. Interleukin 6 (IL-6) and C reactive protein (CRP) were analysed in plasma obtained at randomisation from 14,954 participants, and median follow-up was 1.9 years. Association between quartile groups of IL-6 and CRP and outcomes were analysed by Cox regression adjusted for clinical risk factors and other cardiovascular biomarkers (NT-proBNP, troponin, GDF-15, cystatin C). RESULTS: The IL-6 median level was 2.3 ng/L (IQR 1.5-3.9), median CRP level was 2.2 mg/L (1.0-4.8). IL-6 and CRP were significantly associated with all-cause mortality independent of clinical risk factors and other biomarkers (HR (95% CI) 1.93 (1.57 to 2.37) and 1.49 (1.24 to 1.79), respectively, Q4 vs Q1). IL-6 was associated with myocardial infarction, cardiovascular mortality, and major bleeding beyond clinical risk factors but not in the presence of cardiovascular biomarkers (NT-proBNP, troponin, GDF-15, cystatin C). Neither inflammatory biomarker was associated with stroke/systemic embolism. Risk prediction for stroke, death and major bleeding was not improved by IL-6 or CRP when added to clinical risk factors and the other cardiovascular biomarkers (NT-proBNP, troponin, GDF-15, cystatin C). CONCLUSIONS: In patients with AF on anticoagulation, after accounting for clinical risk factors and other biomarkers, biomarkers of inflammation were significantly associated with an increased risk of mortality. However, there were no associations with the risk of stroke or major bleeding. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov identifier: NCT00412984 post-results."},{"id":"c4b02d3aec57","type":"article","url":"https://hartvaat.nl/2016/04/01/cardiovasculaire-effecten-en-veiligheid-van-langdurig-colchicinegebruik-cochrane/","title":"Cardiovasculaire effecten en veiligheid van langdurig colchicinegebruik: Cochrane review","title_en":"Cardiovascular effects and safety of long-term colchicine treatment: Cochrane review and meta-analysis.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["aperitif-trial","biomarkers-cardiovasculair","colchicine","colcot-trial","farmaco-economie","menopauze"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2015-308542","source_url":"https://doi.org/10.1136/heartjnl-2015-308542","authors":["Lars G Hemkens","Hannah Ewald","Viktoria L Gloy","Armon Arpagaus","Kelechi K Olu","Mark Nidorf","Dominik Glinz","Alain J Nordmann","Matthias Briel"],"significance":8,"published":"2016-04-01","source_date":"2016-04-01","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/inflammatie-en-atherosclerose/","https://hartvaat.nl/kennis/lipiden/omega3-vetzuren-cardiologie/"],"congress":"","summary_en":"This Cochrane review and meta-analysis of cardiovascular effects of long-term colchicine treatment found substantial reductions in cardiovascular events with an acceptable safety profile. The systematic evidence provided early support for colchicine as an anti-inflammatory cardiovascular therapy.","created":"2026-07-03T10:26:01Z","updated":"2026-07-03T13:25:22Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Cochrane systematische review en meta-analyse van cardiovasculaire voordelen en risico's van colchicine. De oude ontstekingsremmer toont substantiële cardiovasculaire voordelen in recente trials — een herontdekking met breed klinisch potentieel.","abstract_original":"Colchicine is an old anti-inflammatory drug that has shown substantial cardiovascular benefits in recent trials. We systematically reviewed cardiovascular benefits and harms of colchicine in any population and specifically in patients with high cardiovascular risk. We evaluated randomised controlled trials comparing colchicine over at least 6 months versus any control in any adult population. Primary outcomes were all-cause mortality, myocardial infarction and adverse events. Cardiovascular mortality was a secondary outcome. We included 39 trials with 4992 patients. The quality of evidence for mortality outcomes and myocardial infarction was moderate but lower for adverse events. Colchicine had no effect on all-cause mortality (RR 0.94, 95% CI 0.82 to 1.09; I(2)=27%; 30 trials). Cardiovascular mortality was reduced in some but not all meta-analytical models (random-effects RR 0.34, 0.09 to 1.21, I(2)=9%; Peto's OR 0.24, 0.09 to 0.64, I(2)=15%; Mantel-Haenszel fixed-effect RR 0.20, 0.06 to 0.68, I(2)=0%; 7 trials). The risk for myocardial infarction was reduced (RR 0.20, 0.07 to 0.57; 2 trials). There was no effect on total adverse events (RR 1.52, 0.93 to 2.46, I(2)=45%; 11 trials) but gastrointestinal intolerance was increased (RR 1.83, 1.03 to 3.26, I(2)=74%; 11 trials). Reporting of serious adverse events was inconsistent; no event occurred over 824 patient-years (4 trials). Effects in high cardiovascular risk populations were similar (4 trials; 1230 patients). We found no evidence supporting colchicine doses above 1 mg/day. Colchicine may have substantial cardiovascular benefits; however, there is sufficient uncertainty about its benefit and harm to indicate the need for large-scale trials to further evaluate this inexpensive, promising treatment in cardiovascular disease."},{"id":"fdbc251a16ae","type":"article","url":"https://hartvaat.nl/2016/04/01/ischemisch-risicogebied-en-reperfusiemethode-bij-stemi-klinische-implicaties/","title":"Ischemisch risicogebied en reperfusiemethode bij STEMI: klinische implicaties","title_en":"Implications of ischaemic area at risk and mode of reperfusion in ST-elevation myocardial infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2015-308075","source_url":"https://doi.org/10.1136/heartjnl-2015-308075","authors":["Kevin R Bainey","Claudio Fresco","Yinggan Zheng","Sigrun Halvorsen","Antonio Carvalho","Miodrag Ostojic","Patrick Goldstein","Anthony H Gershlick","Cynthia M Westerhout","Frans Van de Werf","Paul W Armstrong"],"significance":5,"published":"2016-04-01","source_date":"2016-04-01","image":"","kennis":["https://hartvaat.nl/kennis/kleplijden/klepprothese-mechanisch-biologisch/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This study examined the implications of ischemic area at risk and reperfusion mode in STEMI, comparing pharmacological and mechanical reperfusion strategies for patients presenting early after symptom onset.","created":"2026-07-03T10:26:01Z","updated":"2026-07-03T13:25:22Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de relatieve verdiensten van farmacologische versus mechanische reperfusie bij STEMI-patiënten die zich vroeg presenteren met een groot ischemisch risicogebied. Draagt bij aan de discussie over optimale reperfusiestrategie.","abstract_original":"OBJECTIVE: Uncertainty exists concerning the relative merits of pharmacological versus mechanical coronary reperfusion in patients presenting early with ST-elevation myocardial infarction (STEMI) with extensive myocardium at risk. Accordingly, we investigated whether the extent of baseline ST-segment shift was related to the response of either reperfusion modality in patients with STEMI presenting within 3 h of symptoms. METHODS: We analysed baseline ECGs from 1859 patients enrolled in the STrategic Reperfusion Early After Myocardial Infarction (STREAM) trial. The sum of ST-segment elevation (∑STE) and ST-segment deviation (∑STD) was categorised into quartiles and associations with the primary endpoint (30-day death/shock/congestive heart failure/re-myocardial infarction) for each reperfusion strategy (early fibrinolysis vs primary percutaneous coronary intervention) were explored. RESULTS: Overall, there was a progressive rise in the 30-day primary endpoint according to quartiles of baseline ∑STE (10.3% (0-5 mm), 12.4% (5.5-8.5 mm), 12.1% (9-13.5 mm), 17.6% (> 14.0 mm), p = 0.008) and ∑STD (9.0% (0-9 mm), 13.5% (9.5-14 mm), 14.7% (14.5-20 mm), 15.3% (> 20 mm), p = 0.019). Both ∑STE and ∑STD were associated with the primary endpoint (∑STE: p = 0.071; ∑STD: p = 0.024). However, there was no interaction between quartiles of baseline ∑STE or ∑STD and efficacy of either reperfusion strategy on the 30-day clinical outcomes (∑STE: p (interaction) = 0.696; ∑STD: p (interaction) = 0.542). CONCLUSIONS: These data demonstrate an association between ∑STE or ∑STD on the baseline ECG and clinical events at 30 days following reperfusion therapy in STEMI. More importantly, the response to different reperfusion strategies was not influenced by the extent of jeopardised myocardium. TRIAL REGISTRATION NUMBER: NCT00623623; Post-results."},{"id":"422a14ae878f","type":"article","url":"https://hartvaat.nl/2016/04/01/katheterablatie-bij-atriumfibrilleren-met-hypertrofische-cardiomyopathie-meta-an/","title":"Katheterablatie bij atriumfibrilleren met hypertrofische cardiomyopathie: meta-analyse","title_en":"Outcomes of catheter ablation of atrial fibrillation in patients with hypertrophic cardiomyopathy: a systematic review and meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["aficamten","aritmogene-cardiomyopathie","atriale-cardiomyopathie","cardiomyopathie-gerichte-therapie","gedilateerde-cardiomyopathie","hypertrofische-cardiomyopathie","laminopathie","vrouwen"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euv339","source_url":"https://doi.org/10.1093/europace/euv339","authors":["Dong-Sheng Zhao","Yi Shen","Qing Zhang","Gang Lin","Yi-Hua Lu","Bang-Tao Chen","Lin-Sheng Shi","Jian-Fei Huang","Hui-He Lu"],"significance":6,"published":"2016-04-01","source_date":"2016-04-01","image":"","kennis":["https://hartvaat.nl/kennis/ritmestoornissen/katheterablatie-vt/","https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This systematic review and meta-analysis evaluated the outcomes of catheter ablation for AF in patients with hypertrophic cardiomyopathy, a condition with high AF prevalence and unique substrate characteristics.","created":"2026-07-03T10:26:01Z","updated":"2026-07-03T18:38:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse naar de uitkomsten van katheterablatie voor AF bij patiënten met hypertrofische cardiomyopathie (HCM). AF komt frequent voor bij HCM en draagt significant bij aan morbiditeit.","abstract_original":"AIMS: Over the past decade, catheter ablation (CA) has become an established therapy for symptomatic atrial fibrillation (AF). Atrial fibrillation is common in hypertrophic cardiomyopathy (HCM) patients, and restoring sinus rhythm is of great clinical benefit to them. Therefore, we conducted a systematic review and meta-analysis of the available data to evaluate the effectiveness and safety of CA for AF in patients with HCM. METHODS AND RESULTS: Six databases were searched to identify studies describing outcomes of CA of AF in HCM patients with a mean follow-up of ≥12 months after the index procedure. The following data were extracted: (i) single-procedure success, (ii) multiple-procedure success, and (iii) drug-free success. Fifteen studies involving 531 patients were included. Single-procedure freedom from atrial arrhythmia at the latest follow-up was 45.5% [95% confidence interval (CI): 34.8-56.2%]. With multiple procedures, the final success rate was 66.1% (95% CI: 55.3-76.9%) overall, 71.8% (95% CI: 61.6-82.0%) in paroxysmal AF, and 47.5% (95% CI: 36.0-59.0%) in non-paroxysmal AF. Without anti-arrhythmic drugs (AADs), single-procedure success rate at latest follow-up was 32.9% (95% CI: 21.7-41.1%); after multiple procedures, this raised to 50.4% (95% CI: 39.2-61.6%). The incidence of serious periprocedural complications was acceptable [5.1% (95% CI: 2.8-9.6%)]. Substantial heterogeneity (I(2)> 50%) was noted in the above groups. CONCLUSIONS: Catheter ablation of AF in patients with HCM is feasible, although more repeat procedures and AAD are needed to prevent AF recurrence."},{"id":"f8992f1d585b","type":"article","url":"https://hartvaat.nl/2016/03/29/drug-eluting-versus-bare-metal-stents-bij-pci-patienten-met-eindstadium-nierziek/","title":"Drug-eluting versus bare-metal stents bij PCI-patiënten met eindstadium nierziekte op dialyse","title_en":"Drug-Eluting Versus Bare-Metal Stents During PCI in Patients With End-Stage Renal Disease on Dialysis.","category":"chronische nierziekte","category_label":"Nierziekte","professions":["cardioloog","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2015.10.104","source_url":"https://doi.org/10.1016/j.jacc.2015.10.104","authors":["Tara I Chang","Maria E Montez-Rath","Thomas T Tsai","Mark A Hlatky","Wolfgang C Winkelmayer"],"significance":6,"published":"2016-03-29","source_date":"2016-03-29","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/nierziekte/nsaids-en-nierziekte/"],"congress":"","summary_en":"This study compared drug-eluting with bare-metal stents specifically in dialysis patients undergoing PCI, testing whether the benefit of DES extends to this high-risk population with accelerated in-stent disease.","created":"2026-07-03T10:26:00Z","updated":"2026-07-03T13:25:22Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die DES vergeleek met BMS bij dialysepatiënten die PCI ondergingen. Onderzocht of het voordeel van drug-eluting stents ook geldt voor deze specifieke hoogrisicopopulatie met eindstadium nierziekte.","abstract_original":"BACKGROUND: In patients undergoing percutaneous coronary intervention (PCI), drug-eluting stents (DES) reduce repeat revascularizations compared with bare-metal stents (BMS), but their effects on death and myocardial infarction (MI) are mixed. Few studies have focused on patients with end-stage renal disease. OBJECTIVES: This study compared mortality and cardiovascular morbidity during percutaneous coronary intervention with DES and with BMS in dialysis patients. METHODS: We identified 36,117 dialysis patients from the USRDS (United States Renal Data System) who had coronary stenting in the United States between April 23, 2003, and December 31, 2010, and examined the association of DES versus BMS with 1-year outcomes: death; death or MI; and death, MI, or repeat revascularization. We also conducted a temporal analysis by dividing the study period into 3 DES eras: Transitional (April 23, 2003, to June 30, 2004); Liberal (July 1, 2004, to December 31, 2006); and Selective (January 1, 2007, to December 31, 2010). RESULTS: One-year event rates were high, with 38 deaths; 55 death or MI events; and 71 death, MI, or repeat revascularization events per 100 person-years. DES, compared with BMS, were associated with a significant 18% lower risk of death; 16% lower risk of death or MI; and 13% lower risk of death, MI, or repeat revascularization. DES use varied, from 56% in the Transitional era to 85% in the Liberal era and 62% in the Selective era. DES outcomes in the Liberal era were significantly better than in the Transitional Era, but not significantly better than in the Selective Era. CONCLUSIONS: DES for percutaneous coronary intervention appears to be safe for use in U.S. dialysis patients and is associated with lower rates of death, MI, and repeat revascularization."},{"id":"96ecc3b175ec","type":"article","url":"https://hartvaat.nl/2016/03/29/omecamtiv-mecarbil-bij-acuut-hartfalen-de-atomic-ahf-studie/","title":"Omecamtiv mecarbil bij acuut hartfalen: de ATOMIC-AHF-studie","title_en":"Acute Treatment With Omecamtiv Mecarbil to Increase Contractility in Acute Heart Failure: The ATOMIC-AHF Study.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":["acuut-hartfalen","aficamten","hfmref","hfpef","hfref","ijzersuppletie","mavacamten","step-hfpef"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.01.031","source_url":"https://doi.org/10.1016/j.jacc.2016.01.031","authors":["John R Teerlink","G Michael Felker","John J V McMurray","Piotr Ponikowski","Marco Metra","Gerasimos S Filippatos","Justin A Ezekowitz","Kenneth Dickstein","John G F Cleland","Jae B Kim","Lei Lei","Beat Knusel","Andrew A Wolff","Fady I Malik","Scott M Wasserman"],"significance":7,"published":"2016-03-29","source_date":"2016-03-29","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/acuut-hartfalen/","https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"The ATOMIC-AHF phase 2 study of omecamtiv mecarbil in acute heart failure demonstrated proof-of-concept for cardiac myosin activation as a treatment strategy, showing dose-dependent improvements in systolic function without adverse hemodynamic effects.","created":"2026-07-03T10:26:00Z","updated":"2026-07-03T18:38:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Fase-II-studie van omecamtiv mecarbil, een selectieve cardiale myosineactivator, bij patiënten met acuut hartfalen. Eerste klinische evaluatie van een nieuw werkingsmechanisme dat de myocardcontractiliteit direct verhoogt.","abstract_original":"BACKGROUND: Omecamtiv mecarbil (OM) is a selective cardiac myosin activator that increases myocardial function in healthy volunteers and in patients with chronic heart failure. OBJECTIVES: This study evaluated the pharmacokinetics, pharmacodynamics, tolerability, safety, and efficacy of OM in patients with acute heart failure (AHF). METHODS: Patients admitted for AHF with left ventricular ejection fraction ≤40%, dyspnea, and elevated plasma concentrations of natriuretic peptides were randomized to receive a double-blind, 48-h intravenous infusion of placebo or OM in 3 sequential, escalating-dose cohorts. RESULTS: In 606 patients, OM did not improve the primary endpoint of dyspnea relief (3 OM dose groups and pooled placebo: placebo, 41%; OM cohort 1, 42%; cohort 2, 47%; cohort 3, 51%; p = 0.33) or any of the secondary outcomes studied. In supplemental, pre-specified analyses, OM resulted in greater dyspnea relief at 48 h (placebo, 37% vs. OM, 51%; p = 0.034) and through 5 days (p = 0.038) in the high-dose cohort. OM exerted plasma concentration-related increases in left ventricular systolic ejection time (p < 0.0001) and decreases in end-systolic dimension (p < 0.05). The adverse event profile and tolerability of OM were similar to those of placebo, without increases in ventricular or supraventricular tachyarrhythmias. Plasma troponin concentrations were higher in OM-treated patients compared with placebo (median difference at 48 h, 0.004 ng/ml), but with no obvious relationship with OM concentration (p = 0.95). CONCLUSIONS: In patients with AHF, intravenous OM did not meet the primary endpoint of dyspnea improvement, but it was generally well tolerated, it increased systolic ejection time, and it may have improved dyspnea in the high-dose group. (Acute Treatment with Omecamtiv Mecarbil to Increase Contractility in Acute Heart Failure [ATOMIC-AHF]; NCT01300013)."},{"id":"096d53f5c42c","type":"article","url":"https://hartvaat.nl/2016/03/22/spontaan-myocardinfarct-na-nstemi-zonder-revascularisatie-trilogy-acs-trial/","title":"Spontaan myocardinfarct na NSTEMI zonder revascularisatie: TRILOGY ACS-trial","title_en":"Spontaneous MI After Non-ST-Segment Elevation Acute Coronary Syndrome Managed Without Revascularization: The TRILOGY ACS Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["acuut-coronair-syndroom","aperitif-trial","myocardinfarct","nstemi"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.01.034","source_url":"https://doi.org/10.1016/j.jacc.2016.01.034","authors":["Renato D Lopes","Sergio Leonardi","Benjamin Neely","Megan L Neely","E Magnus Ohman","Diego Ardissino","Christian W Hamm","Shaun G Goodman","Deepak L Bhatt","Harvey D White","Dorairaj Prabhakaran","Felipe Martinez","Jose C Nicolau","Kenneth J Winters","Keith A A Fox","Paul W Armstrong","Matthew T Roe"],"significance":6,"published":"2016-03-22","source_date":"2016-03-22","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/kleplijden/mitraclip-transcatheter-mitralisreparatie/"],"congress":"","summary_en":"This TRILOGY ACS analysis characterized the incidence and impact of spontaneous recurrent MI in conservatively managed ACS patients, quantifying the residual ischemic risk in the medical-management-only population.","created":"2026-07-03T10:26:00Z","updated":"2026-07-03T13:25:22Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de TRILOGY ACS-trial naar de incidentie en impact van spontaan recidief-myocardinfarct bij conservatief behandelde ACS-patiënten. Deze kwetsbare groep heeft een hoog risico op recidiverende ischemische events.","abstract_original":"BACKGROUND: Patients with acute coronary syndrome (ACS), especially those receiving medical management without revascularization, are at high risk for spontaneous myocardial infarction (MI), but its frequency and predictors are unknown. OBJECTIVES: This study sought to characterize spontaneous MI events in a randomized population during 30 months of follow-up and develop a prediction model for spontaneous MI to assign risk of spontaneous MI events in ACS populations. METHODS: We analyzed data from the randomized TRILOGY ACS (TaRgeted platelet Inhibition to cLarify the Optimal strateGy to medically manage Acute Coronary Syndromes) trial of aspirin plus prasugrel or clopidogrel following ACS. The trial included 9,326 patients with non-ST-segment elevation myocardial infarction (NSTEMI)/unstable angina (UA) who were managed medically without planned revascularization. Our study population included 9,294 patients. A multivariable Cox proportional hazards model was developed to determine predictors of time to first spontaneous MI event through 30 months. After model validation, we developed a calculator for model implementation. RESULTS: Among 9,294 patients, 695 spontaneous MI events occurred over a median of 17 months, representing 94% of adjudicated MI events (n = 737). The Kaplan-Meier event rate of spontaneous MI through 30 months was 10.7%. The strongest predictors of spontaneous MI were older age, NSTEMI versus UA as index event, diabetes mellitus, no pre-randomization angiography, and higher baseline creatinine values. The model exhibited good predictive capabilities (c-index = 0.732) and had good calibration, especially for patients with low-to-moderate risk of spontaneous MI. CONCLUSIONS: Spontaneous MI following a medically managed UA/NSTEMI event is common. Baseline characteristics can be used to predict subsequent risk of spontaneous MI in this population. These findings provide insight into the long-term natural history of medically managed UA/NSTEMI patients and could be used to optimize risk stratification and treatment of these patients. (A Comparison of Prasugrel and Clopidogrel in Acute Coronary Syndrome Subjects [TRILOGY ACS]; NCT00699998)."},{"id":"2e245d45cb8b","type":"article","url":"https://hartvaat.nl/2016/03/22/genetische-risicoscore-en-ldl-cholesterolbehandeling-bij-coronairlijden/","title":"Genetische risicoscore en LDL-cholesterolbehandeling bij coronairlijden","title_en":"Incorporating a Genetic Risk Score Into Coronary Heart Disease Risk Estimates: Effect on Low-Density Lipoprotein Cholesterol Levels (the MI-GENES Clinical Trial).","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts","internist"],"tags":["biomarkers-cardiovasculair","diabetes-type-2","dyslipidemie","ezetimibe","familiaire-hypercholesterolemie","familiaire-hypercholesterolemie-screening","gepersonaliseerde-geneeskunde","hdl-cholesterol","laminopathie","ldl-cholesterol","lipide-aferese","lipidenverlaging","lipoproteïne-a","lipoproteïne-a-therapeutisch-doel","pcsk9-remmers","statines"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.115.020109","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.115.020109","authors":["Iftikhar J Kullo","Hayan Jouni","Erin E Austin","Sherry-Ann Brown","Teresa M Kruisselbrink","Iyad N Isseh","Raad A Haddad","Tariq S Marroush","Khader Shameer","Janet E Olson","Ulrich Broeckel","Robert C Green","Daniel J Schaid","Victor M Montori","Kent R Bailey"],"significance":6,"published":"2016-03-22","source_date":"2016-03-22","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/dyslipidemie-overzicht/"],"congress":"","summary_en":"This study tested whether incorporating a genetic risk score for coronary heart disease into clinical risk assessment changes health behaviors or LDL cholesterol levels, exploring the behavioral impact of genomic risk information.","created":"2026-07-03T10:26:00Z","updated":"2026-07-03T13:25:22Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die onderzocht of kennis van een genetische risicoscore voor coronairlijden effect heeft op gezondheidsuitkomsten, met name LDL-cholesterolniveaus en behandelbeleid. Pionierend onderzoek naar klinische toepassing van polygene risicoscores.","abstract_original":"BACKGROUND: Whether knowledge of genetic risk for coronary heart disease (CHD) affects health-related outcomes is unknown. We investigated whether incorporating a genetic risk score (GRS) in CHD risk estimates lowers low-density lipoprotein cholesterol (LDL-C) levels. METHODS AND RESULTS: Participants (n=203, 45-65 years of age, at intermediate risk for CHD, and not on statins) were randomly assigned to receive their 10-year probability of CHD based either on a conventional risk score (CRS) or CRS + GRS ((+)GRS). Participants in the (+)GRS group were stratified as having high or average/low GRS. Risk was disclosed by a genetic counselor followed by shared decision making regarding statin therapy with a physician. We compared the primary end point of LDL-C levels at 6 months and assessed whether any differences were attributable to changes in dietary fat intake, physical activity levels, or statin use. Participants (mean age, 59.4±5 years; 48% men; mean 10-year CHD risk, 8.5±4.1%) were allocated to receive either CRS (n=100) or (+)GRS (n=103). At the end of the study period, the (+)GRS group had a lower LDL-C than the CRS group (96.5±32.7 versus 105.9±33.3 mg/dL; P=0.04). Participants with high GRS had lower LDL-C levels (92.3±32.9 mg/dL) than CRS participants (P=0.02) but not participants with low GRS (100.9±32.2 mg/dL; P=0.18). Statins were initiated more often in the (+)GRS group than in the CRS group (39% versus 22%, P<0.01). No significant differences in dietary fat intake and physical activity levels were noted. CONCLUSIONS: Disclosure of CHD risk estimates that incorporated genetic risk information led to lower LDL-C levels than disclosure of CHD risk based on conventional risk factors alone. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01936675."},{"id":"e7f5d12ea9ab","type":"article","url":"https://hartvaat.nl/2016/03/22/zelfmanagementinterventies-bij-hartfalen-individuele-patientdata-meta-analyse/","title":"Zelfmanagementinterventies bij hartfalen: individuele patiëntdata meta-analyse","title_en":"Do Self-Management Interventions Work in Patients With Heart Failure? An Individual Patient Data Meta-Analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","pathfinder-trial","vrouwen"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.115.018006","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.115.018006","authors":["Nini H Jonkman","Heleen Westland","Rolf H H Groenwold","Susanna Ågren","Felipe Atienza","Lynda Blue","Pieta W F Bruggink-André de la Porte","Darren A DeWalt","Paul L Hebert","Michele Heisler","Tiny Jaarsma","Gertrudis I J M Kempen","Marcia E Leventhal","Dirk J A Lok","Jan Mårtensson","Javier Muñiz","Haruka Otsu","Frank Peters-Klimm","Michael W Rich","Barbara Riegel","Anna Strömberg","Ross T Tsuyuki","Dirk J van Veldhuisen","Jaap C A Trappenburg","Marieke J Schuurmans","Arno W Hoes"],"significance":7,"published":"2016-03-22","source_date":"2016-03-22","image":"","kennis":[],"congress":"","summary_en":"This individual patient data meta-analysis of self-management interventions in heart failure found modest but significant benefits on mortality and hospitalization, particularly for programs that included phone-based follow-up and individualized education.","created":"2026-07-03T10:26:00Z","updated":"2026-07-03T18:38:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse op individueel patiëntniveau die de effectiviteit van zelfmanagementinterventies bij hartfalen onderzocht. Analyseert welke specifieke patiëntgroepen het meeste baat hebben bij zelfmanagement.","abstract_original":"BACKGROUND: Self-management interventions are widely implemented in the care for patients with heart failure (HF). However, trials show inconsistent results, and whether specific patient groups respond differently is unknown. This individual patient data meta-analysis assessed the effectiveness of self-management interventions in patients with HF and whether subgroups of patients respond differently. METHODS AND RESULTS: A systematic literature search identified randomized trials of self-management interventions. Data from 20 studies, representing 5624 patients, were included and analyzed with the use of mixed-effects models and Cox proportional-hazard models, including interaction terms. Self-management interventions reduced the risk of time to the combined end point of HF-related hospitalization or all-cause death (hazard ratio, 0.80; 95% confidence interval [CI], 0.71-0.89), time to HF-related hospitalization (hazard ratio, 0.80; 95% CI, 0.69-0.92), and improved 12-month HF-related quality of life (standardized mean difference, 0.15; 95% CI, 0.00-0.30). Subgroup analysis revealed a protective effect of self-management on the number of HF-related hospital days in patients <65 years of age (mean, 0.70 versus 5.35 days; interaction P=0.03). Patients without depression did not show an effect of self-management on survival (hazard ratio for all-cause mortality, 0.86; 95% CI, 0.69-1.06), whereas in patients with moderate/severe depression, self-management reduced survival (hazard ratio, 1.39; 95% CI, 1.06-1.83, interaction P=0.01). CONCLUSIONS: This study shows that self-management interventions had a beneficial effect on time to HF-related hospitalization or all-cause death and HF-related hospitalization alone and elicited a small increase in HF-related quality of life. The findings do not endorse limiting self-management interventions to subgroups of patients with HF, but increased mortality in depressed patients warrants caution in applying self-management strategies in these patients."},{"id":"745c237be295","type":"article","url":"https://hartvaat.nl/2016/03/21/cardiovasculaire-uitkomsten-bij-verschillende-bereiktestreefdrukken-in-de-value-/","title":"Cardiovasculaire uitkomsten bij verschillende bereiktestreefdrukken in de VALUE-trial","title_en":"Cardiovascular outcomes at different on-treatment blood pressures in the hypertensive patients of the VALUE trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts","internist"],"tags":["acuut-hartfalen","aperitif-trial","atleten","biomarkers-cardiovasculair","bloeddrukbehandeling","clear-outcomes","dapa-hf","diabetes-en-hart","diabetes-type-2","farmaco-economie","fidelity","figaro-dkd","fractional-flow-reserve","gepersonaliseerde-geneeskunde","hartkatheterisatie","hartrevalidatie","myocardinfarct","obesitas","ouderen","perifeer-vaatlijden","richtlijnen-esc","secundaire-preventie","select-trial","slaapapneu","soul-trial","summit-trial","supraventriculaire-tachycardie","vrouwen"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehv633","source_url":"https://doi.org/10.1093/eurheartj/ehv633","authors":["Giuseppe Mancia","Sverre E Kjeldsen","Dion H Zappe","Björn Holzhauer","Tsushung A Hua","Alberto Zanchetti","Stevo Julius","Michael A Weber"],"significance":7,"published":"2016-03-21","source_date":"2016-03-21","image":"","kennis":[],"congress":"","summary_en":"This VALUE trial analysis examined the relationship between achieved blood pressure levels and cardiovascular outcomes in high-risk hypertensive patients, informing the debate about optimal blood pressure targets and the potential existence of a J-curve.","created":"2026-07-03T10:26:00Z","updated":"2026-07-03T18:38:22Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de VALUE-trial naar de relatie tussen bereikte bloeddruk en cardiovasculaire uitkomsten bij hoogrisico hypertensieve patiënten. Relevant voor het debat over optimale streefwaarden bij hoog cardiovasculair risico.","abstract_original":"AIMS: Recent hypertension guidelines recommend that also in high cardiovascular (CV) risk, hypertensive patients blood pressure (BP) is lowered to <140/90 mmHg as no evidence is available supporting the lower target of <130/80 mmHg recommended in previous guidelines. Whether this represents the optimal treatment strategy is debated, however. METHODS AND RESULTS: The high CV risk hypertensive patients of the Valsartan Antihypertensive Long-term use Evaluation (VALUE) trial were divided into subgroups according to (i) the percentage of on-treatment visits in which BP was reduced to <140/90 or <130/80 mmHg or (ii) the mean systolic or diastolic BP (SBP/DBP) values achieved during the entire treatment period or up to the occurrence of an event. A progressive increase from <25 to ≥75% of the visits in which BP was <140/90 mmHg was accompanied by a significant, progressive marked decrease in the covariate adjusted risk of CV morbidity and mortality, cause specific CV events (myocardial infarction, heart failure, and stroke), and all-cause mortality. Except for a persistent progressive decrease in stroke, no significant trend to a risk decrease occurred for a similar progressive increment of the proportion of visits with BP <130/80 mmHg. Increasing the proportion of visits with a BP <140/90 mmHg (but not <130/80 mmHg) was accompanied by a decreased risk of events also when differences in baseline risk were adjusted using a propensity score. Finally, compared with patients remaining at a mean on-treatment SBP ≥140 or DBP ≥90 mmHg, the risk of all events was markedly reduced when on-treatment mean SBP was lowered to a mean SBP of 130-139 mmHg or a mean DBP of 80-89 mmHg, whereas at on-treatment mean SBP <130 mmHg or DBP <80 mmHg, an additional risk reduction was found for stroke but for any other type of event, the risk of which remained similar or only slightly greater than that seen at the higher BP target. CONCLUSIONS: In the high CV risk, hypertensives of the VALUE trial reducing BP consistently to <140/90 mmHg had marked beneficial effects both when data were calculated as proportion of visits at BP target or as on-treatment mean BP. Reducing BP to <130/80 mmHg led only to some possible further benefit on stroke, whereas the risk of other outcomes remained substantially similar to or slightly greater than that seen at the higher target. Thus, aggressive BP reductions when CV risk is high may not offer substantial advantages, except perhaps in patients or conditions in which stroke risk is particularly common."},{"id":"1bd05454a384","type":"article","url":"https://hartvaat.nl/2016/03/19/serca2a-gentherapie-bij-hartfalen-de-cupid-2-trial/","title":"SERCA2a-gentherapie bij hartfalen: de CUPID 2-trial","title_en":"Calcium upregulation by percutaneous administration of gene therapy in patients with cardiac disease (CUPID 2): a randomised, multinational, double-blind, placebo-controlled, phase 2b trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["empagliflozine"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(16)00082-9","source_url":"https://doi.org/10.1016/S0140-6736(16)00082-9","authors":["Barry Greenberg","Javed Butler","G Michael Felker","Piotr Ponikowski","Adriaan A Voors","Akshay S Desai","Denise Barnard","Alain Bouchard","Brian Jaski","Alexander R Lyon","Janice M Pogoda","Jeffrey J Rudy","Krisztina M Zsebo"],"significance":7,"published":"2016-03-19","source_date":"2016-03-19","image":"","kennis":[],"congress":"","summary_en":"The CUPID 2 trial of intracoronary SERCA2a gene therapy in advanced heart failure showed no improvement in clinical outcomes, despite promising preclinical data. The negative result highlighted the challenges of cardiac gene therapy and the gap between laboratory and clinical benefit.","created":"2026-07-03T10:26:00Z","updated":"2026-07-03T18:38:22Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde Lancet-trial naar intracoronaire toediening van SERCA2a-gentherapie bij patiënten met gevorderd hartfalen. Onderzocht of correctie van deficiënte calciumhomeostase de hartfunctie kan verbeteren.","abstract_original":"BACKGROUND: Sarcoplasmic/endoplasmic reticulum Ca(2+)-ATPase (SERCA2a) activity is deficient in the failing heart. Correction of this abnormality by gene transfer might improve cardiac function. We aimed to investigate the clinical benefits and safety of gene therapy through infusion of adeno-associated virus 1 (AAV1)/SERCA2a in patients with heart failure and reduced ejection fraction. METHODS: We did this randomised, multinational, double-blind, placebo-controlled, phase 2b trial at 67 clinical centres and hospitals in the USA, Europe, and Israel. High-risk ambulatory patients with New York Heart Association class II-IV symptoms of heart failure and a left ventricular ejection fraction of 0·35 or less due to an ischaemic or non-ischaemic cause were randomly assigned (1:1), via an interactive voice and web-response system, to receive a single intracoronary infusion of 1 × 10(13) DNase-resistant particles of AAV1/SERCA2a or placebo. Randomisation was stratified by country and by 6 min walk test distance. All patients, physicians, and outcome assessors were masked to treatment assignment. The primary efficacy endpoint was time to recurrent events, defined as hospital admission because of heart failure or ambulatory treatment for worsening heart failure. Primary efficacy endpoint analyses and safety analyses were done by modified intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01643330. FINDINGS: Between July 9, 2012, and Feb 5, 2014, we randomly assigned 250 patients to receive either AAV1/SERCA2a (n=123) or placebo (n=127); 243 (97%) patients comprised the modified intention-to-treat population. Patients were followed up for at least 12 months; median follow-up was 17·5 months (range 1·8-29·4 months). AAV1/SERCA2a did not improve time to recurrent events compared with placebo (104 vs 128 events; hazard ratio 0·93, 95% CI 0·53-1·65; p=0·81). No safety signals were noted. 20 (16%) patients died in the placebo group and 25 (21%) patients died in the AAV1/SERCA2a group; 18 and 22 deaths, respectively, were adjudicated as being due to cardiovascular causes. INTERPRETATION: CUPID 2 is the largest gene transfer study done in patients with heart failure so far. Despite promising results from previous studies, AAV1/SERCA2a at the dose tested did not improve the clinical course of patients with heart failure and reduced ejection fraction. Although we did not find evidence of improved outcomes at the dose of AAV1/SERCA2a studied, our findings should stimulate further research into the use of gene therapy to treat patients with heart failure and help inform the design of future gene therapy trials. FUNDING: Celladon Corporation."},{"id":"205fbacb93b0","type":"article","url":"https://hartvaat.nl/2016/03/17/veiliger-voorschrijven-educatie-informatica-en-financiele-prikkels-in-de-eerstel/","title":"Veiliger voorschrijven: educatie, informatica en financiële prikkels in de eerstelijn","title_en":"Safer Prescribing--A Trial of Education, Informatics, and Financial Incentives.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","huisarts"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMsa1508955","source_url":"https://doi.org/10.1056/NEJMsa1508955","authors":["Tobias Dreischulte","Peter Donnan","Aileen Grant","Adrian Hapca","Colin McCowan","Bruce Guthrie"],"significance":7,"published":"2016-03-17","source_date":"2016-03-17","image":"","kennis":[],"congress":"","summary_en":"This NEJM trial demonstrated that a combined intervention of education, clinical informatics, and financial incentives significantly reduced high-risk prescribing in primary care, providing a model for improving medication safety at the system level.","created":"2026-07-03T10:26:00Z","updated":"2026-07-03T13:25:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM-trial die onderzocht of een combinatie van educatie, informaticasystemen en financiële prikkels risicovolle voorschrijfpraktijken en vermijdbare geneesmiddelgerelateerde complicaties in de eerstelijn kan verminderen.","abstract_original":"BACKGROUND: High-risk prescribing and preventable drug-related complications are common in primary care. We evaluated whether the rates of high-risk prescribing by primary care clinicians and the related clinical outcomes would be reduced by a complex intervention. METHODS: In this cluster-randomized, stepped-wedge trial conducted in Tayside, Scotland, we randomly assigned participating primary care practices to various start dates for a 48-week intervention comprising professional education, informatics to facilitate review, and financial incentives for practices to review patients' charts to assess appropriateness. The primary outcome was patient-level exposure to any of nine measures of high-risk prescribing of nonsteroidal antiinflammatory drugs (NSAIDs) or selected antiplatelet agents (e.g., NSAID prescription in a patient with chronic kidney disease or coprescription of an NSAID and an oral anticoagulant without gastroprotection). Prespecified secondary outcomes included the incidence of related hospital admissions. Analyses were performed according to the intention-to-treat principle, with the use of mixed-effect models to account for clustering in the data. RESULTS: A total of 34 practices underwent randomization, 33 of which completed the study. Data were analyzed for 33,334 patients at risk at one or more points in the preintervention period and for 33,060 at risk at one or more points in the intervention period. Targeted high-risk prescribing was significantly reduced, from a rate of 3.7% (1102 of 29,537 patients at risk) immediately before the intervention to 2.2% (674 of 30,187) at the end of the intervention (adjusted odds ratio, 0.63; 95% confidence interval [CI], 0.57 to 0.68; P<0.001). The rate of hospital admissions for gastrointestinal ulcer or bleeding was significantly reduced from the preintervention period to the intervention period (from 55.7 to 37.0 admissions per 10,000 person-years; rate ratio, 0.66; 95% CI, 0.51 to 0.86; P=0.002), as was the rate of admissions for heart failure (from 707.7 to 513.5 admissions per 10,000 person-years; rate ratio, 0.73; 95% CI, 0.56 to 0.95; P=0.02), but admissions for acute kidney injury were not (101.9 and 86.0 admissions per 10,000 person-years, respectively; rate ratio, 0.84; 95% CI, 0.68 to 1.09; P=0.19). CONCLUSIONS: A complex intervention combining professional education, informatics, and financial incentives reduced the rate of high-risk prescribing of antiplatelet medications and NSAIDs and may have improved clinical outcomes. (Funded by the Scottish Government Chief Scientist Office; ClinicalTrials.gov number, NCT01425502.)."},{"id":"c5b3b92fb422","type":"article","url":"https://hartvaat.nl/2016/03/17/langetermijnresultaten-van-stenting-versus-endarteriectomie-bij-carotisstenose/","title":"Langetermijnresultaten van stenting versus endarteriëctomie bij carotisstenose","title_en":"Long-Term Results of Stenting versus Endarterectomy for Carotid-Artery Stenosis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","internist"],"tags":["carotisstenose"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1505215","source_url":"https://doi.org/10.1056/NEJMoa1505215","authors":["Thomas G Brott","George Howard","Gary S Roubin","James F Meschia","Ariane Mackey","William Brooks","Wesley S Moore","Michael D Hill","Vito A Mantese","Wayne M Clark","Carlos H Timaran","Donald Heck","Pierre P Leimgruber","Alice J Sheffet","Virginia J Howard","Seemant Chaturvedi","Brajesh K Lal","Jenifer H Voeks","Robert W Hobson"],"significance":8,"published":"2016-03-17","source_date":"2016-03-17","image":"","kennis":["https://hartvaat.nl/kennis/vasculair/carotisstenose/","https://hartvaat.nl/kennis/kleplijden/mitralisregurgitatie/"],"congress":"","summary_en":"Long-term CREST results showed no significant difference between carotid stenting and endarterectomy over 10 years of follow-up for the composite of stroke, MI, and death. The durability data supported both approaches as viable options for carotid revascularization.","created":"2026-07-03T10:26:00Z","updated":"2026-07-03T13:25:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM langetermijnresultaten van de CREST-trial die carotis-stenting vergeleek met endarteriëctomie bij symptomatische en asymptomatische carotisstenose. Geen significant verschil in de primaire eindpunten op lange termijn.","abstract_original":"BACKGROUND: In the Carotid Revascularization Endarterectomy versus Stenting Trial, we found no significant difference between the stenting group and the endarterectomy group with respect to the primary composite end point of stroke, myocardial infarction, or death during the periprocedural period or any subsequent ipsilateral stroke during 4 years of follow-up. We now extend the results to 10 years. METHODS: Among patients with carotid-artery stenosis who had been randomly assigned to stenting or endarterectomy, we evaluated outcomes every 6 months for up to 10 years at 117 centers. In addition to assessing the primary composite end point, we assessed the primary end point for the long-term extension study, which was ipsilateral stroke after the periprocedural period. RESULTS: Among 2502 patients, there was no significant difference in the rate of the primary composite end point between the stenting group (11.8%; 95% confidence interval [CI], 9.1 to 14.8) and the endarterectomy group (9.9%; 95% CI, 7.9 to 12.2) over 10 years of follow-up (hazard ratio, 1.10; 95% CI, 0.83 to 1.44). With respect to the primary long-term end point, postprocedural ipsilateral stroke over the 10-year follow-up occurred in 6.9% (95% CI, 4.4 to 9.7) of the patients in the stenting group and in 5.6% (95% CI, 3.7 to 7.6) of those in the endarterectomy group; the rates did not differ significantly between the groups (hazard ratio, 0.99; 95% CI, 0.64 to 1.52). No significant between-group differences with respect to either end point were detected when symptomatic patients and asymptomatic patients were analyzed separately. CONCLUSIONS: Over 10 years of follow-up, we did not find a significant difference between patients who underwent stenting and those who underwent endarterectomy with respect to the risk of periprocedural stroke, myocardial infarction, or death and subsequent ipsilateral stroke. The rate of postprocedural ipsilateral stroke also did not differ between groups. (Funded by the National Institutes of Health and Abbott Vascular Solutions; CREST ClinicalTrials.gov number, NCT00004732.)."},{"id":"1d8d66a1cb20","type":"article","url":"https://hartvaat.nl/2016/03/15/voorspelling-van-persisterende-lv-disfunctie-na-myocardinfarct-de-predicts-studi/","title":"Voorspelling van persisterende LV-disfunctie na myocardinfarct: de PREDICTS-studie","title_en":"Predicting Persistent Left Ventricular Dysfunction Following Myocardial Infarction: The PREDICTS Study.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["laminopathie","myocardinfarct","ventrikelfibrilleren"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2015.12.042","source_url":"https://doi.org/10.1016/j.jacc.2015.12.042","authors":["Gabriel C Brooks","Byron K Lee","Rajni Rao","Feng Lin","Daniel P Morin","Steven L Zweibel","Alfred E Buxton","Mark J Pletcher","Eric Vittinghoff","Jeffrey E Olgin"],"significance":6,"published":"2016-03-15","source_date":"2016-03-15","image":"","kennis":["https://hartvaat.nl/kennis/kleplijden/aortastenose/","https://hartvaat.nl/kennis/coronairlijden/esc-richtlijn-chronisch-coronairlijden-2024/"],"congress":"","summary_en":"The PREDICTS study identified clinical and imaging predictors of persistent severe LV dysfunction after myocardial infarction, informing the timing and selection of patients for ICD implantation based on early post-MI assessment.","created":"2026-07-03T10:25:59Z","updated":"2026-07-03T13:25:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die voorspellers identificeerde van persisterende ernstige LV-systolische disfunctie na myocardinfarct — een klasse I indicatie voor ICD-implantatie. Klinisch relevant voor optimale timing van devicetherapie.","abstract_original":"BACKGROUND: Persistent severe left ventricular (LV) systolic dysfunction after myocardial infarction (MI) is associated with increased mortality and is a class I indication for implantation of a cardioverter-defibrillator. OBJECTIVES: This study developed models and assessed independent predictors of LV recovery to >35% and ≥50% after 90-day follow-up in patients presenting with acute MI and severe LV dysfunction. METHODS: Our multicenter prospective observational study enrolled participants with ejection fraction (EF) of ≤35% at the time of MI (n = 231). Predictors for EF recovery to >35% and ≥50% were identified after multivariate modeling and validated in a separate cohort (n = 236). RESULTS: In the PREDICTS (PREDiction of ICd Treatment Study) study, 43% of patients had persistent EF ≤35%, 31% had an EF of 36% to 49%, and 26% had an EF ≥50%. The model that best predicted recovery of EF to >35% included EF at presentation, length of stay, prior MI, lateral wall motion abnormality at presentation, and peak troponin. The model that best predicted recovery of EF to ≥50% included EF at presentation, peak troponin, prior MI, and presentation with ventricular fibrillation or cardiac arrest. After predictors were transformed into point scores, the lowest point scores predicted a 9% and 4% probability of EF recovery to >35% and ≥50%, respectively, whereas profiles with the highest point scores predicted an 87% and 49% probability of EF recovery to >35% and ≥50%, respectively. CONCLUSIONS: In patients with severe systolic dysfunction following acute MI with an EF ≤35%, 57% had EF recovery to >35%. A model using clinical variables present at the time of MI can help predict EF recovery."},{"id":"4f688499b0ca","type":"article","url":"https://hartvaat.nl/2016/03/15/plaatjesremming-met-ticagrelor-60-mg-versus-90-mg-in-de-pegasus-timi-54-trial/","title":"Plaatjesremming met ticagrelor 60 mg versus 90 mg in de PEGASUS-TIMI 54-trial","title_en":"Platelet Inhibition With Ticagrelor 60 mg Versus 90 mg Twice Daily in the PEGASUS-TIMI 54 Trial.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog"],"tags":["trombocytenaggregatieremmers"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2015.12.062","source_url":"https://doi.org/10.1016/j.jacc.2015.12.062","authors":["Robert F Storey","Dominick J Angiolillo","Marc P Bonaca","Mark R Thomas","Heather M Judge","Fabiana Rollini","Francesco Franchi","Arif J Ahsan","Deepak L Bhatt","Julia F Kuder","Philippe Gabriel Steg","Marc Cohen","Rangasamy Muthusamy","Eugene Braunwald","Marc S Sabatine"],"significance":6,"published":"2016-03-15","source_date":"2016-03-15","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This PEGASUS-TIMI 54 pharmacodynamic analysis compared platelet inhibition with ticagrelor 60 mg versus 90 mg twice daily, showing that both doses achieve substantial P2Y12 receptor inhibition with a better bleeding profile at the lower dose.","created":"2026-07-03T10:25:59Z","updated":"2026-07-03T13:25:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Vergelijking van twee doseringen ticagrelor (60 versus 90 mg tweemaal daags) op plaatjesremming bij stabiele patiënten met een eerder myocardinfarct. Farmacodynamische basis voor de doseringsaanbeveling bij langetermijnpreventie.","abstract_original":"BACKGROUND: The PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis In Myocardial Infarction 54) trial studied 2 doses of ticagrelor, 90 mg twice a day (bid) and 60 mg bid, for long-term prevention of ischemic events in patients with prior myocardial infarction. Both doses similarly reduced the rate of ischemic events versus placebo. The pharmacokinetics and pharmacodynamics of ticagrelor 60 mg bid have not been studied. OBJECTIVES: In this study, the authors sought to study the pharmacokinetics and pharmacodynamics for ticagrelor 60 mg compared with 90 mg bid. METHODS: A total of 180 patients who received >4 weeks of study medication had blood sampling in the morning pre-maintenance dose and again 2 h post-dose. All patients received aspirin. Plasma levels of ticagrelor and its active metabolite AR-C124910XX were determined. P2Y12 inhibition was assessed by the VerifyNow P2Y12 assay (Accumetrics, Inc., San Diego, California) (P2Y12 reaction units [PRU]), light transmittance aggregometry (adenosine diphosphate 5 and 20 μmol/l and arachidonic acid), and vasodilator-stimulated phosphoprotein phosphorylation assays. VerifyNow Aspirin assays and serum thromboxane B2 measurements were performed. RESULTS: Mean pre- and post-dose plasma levels of ticagrelor were 35% and 38% lower, respectively, with 60 mg versus 90 mg. Both doses achieved high levels of platelet inhibition pre- and post-dose, with numerically slightly more variability with 60 mg: mean (SD) pre-dose PRU values were 59 ± 63 and 47 ± 43 for ticagrelor 60 and 90 mg, respectively (p = 0.34). High platelet reactivity, determined as PRU >208, was rare with the 60-mg pre-dose and was absent post-dose. Platelet reactivity pre- and post-dose, as measured by light transmittance aggregometry or vasodilator-stimulated phosphoprotein assays, was numerically but not significantly lower with 90 mg than with 60 mg. Aspirin response was not affected by either dose. CONCLUSIONS: Ticagrelor 60 mg bid achieved high levels of peak and trough platelet inhibition in nearly all patients, similar to that with 90 mg bid, helping to explain the efficacy of the lower ticagrelor dose in PEGASUS-TIMI 54."},{"id":"90569a1f80ca","type":"article","url":"https://hartvaat.nl/2016/03/15/2015-acc-aha-scai-gerichte-update-primaire-pci-bij-stemi/","title":"2015 ACC/AHA/SCAI gerichte update: primaire PCI bij STEMI","title_en":"2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention and the 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Society for Cardiovascular Angiography and Interventions.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["stemi"],"journal":"Circulation","doi":"10.1161/CIR.0000000000000336","source_url":"https://doi.org/10.1161/CIR.0000000000000336","authors":["Glenn N Levine","Eric R Bates","James C Blankenship","Steven R Bailey","John A Bittl","Bojan Cercek","Charles E Chambers","Stephen G Ellis","Robert A Guyton","Steven M Hollenberg","Umesh N Khot","Richard A Lange","Laura Mauri","Roxana Mehran","Issam D Moussa","Debabrata Mukherjee","Henry H Ting","Patrick T O'Gara","Frederick G Kushner","Deborah D Ascheim","Ralph G Brindis","Donald E Casey","Mina K Chung","James A de Lemos","Deborah B Diercks","James C Fang","Barry A Franklin","Christopher B Granger","Harlan M Krumholz","Jane A Linderbaum","David A Morrow","L Kristin Newby","Joseph P Ornato","Narith Ou","Martha J Radford","Jacqueline E Tamis-Holland","Carl L Tommaso","Cynthia M Tracy","Y Joseph Woo","David X Zhao"],"significance":9,"published":"2016-03-15","source_date":"2016-03-15","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/coronairlijden/pci-percutane-coronaire-interventie/"],"congress":"","summary_en":"The 2015 ACC/AHA/SCAI focused update on primary PCI for STEMI updated recommendations on door-to-balloon time targets, radial access, mechanical thrombectomy, and antithrombotic adjunctive therapy during primary percutaneous coronary intervention.","created":"2026-07-03T10:25:59Z","updated":"2026-07-03T13:25:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerichte update van de ACC/AHA/SCAI-richtlijn voor primaire percutane coronaire interventie bij patiënten met STEMI. Bevat geactualiseerde aanbevelingen voor de acute behandeling van het hartinfarct.","abstract_original":""},{"id":"de88aed16293","type":"article","url":"https://hartvaat.nl/2016/03/12/invasieve-versus-conservatieve-strategie-bij-80-plussers-met-nstemi-gerandomisee/","title":"Invasieve versus conservatieve strategie bij 80-plussers met NSTEMI: gerandomiseerde trial","title_en":"Invasive versus conservative strategy in patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris (After Eighty study): an open-label randomised controlled trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":["clear-outcomes","hartkatheterisatie","ouderen","select-trial"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(15)01166-6","source_url":"https://doi.org/10.1016/S0140-6736(15)01166-6","authors":["Nicolai Tegn","Michael Abdelnoor","Lars Aaberge","Knut Endresen","Pål Smith","Svend Aakhus","Erik Gjertsen","Ola Dahl-Hofseth","Anette Hylen Ranhoff","Lars Gullestad","Bjørn Bendz"],"significance":8,"published":"2016-03-12","source_date":"2016-03-12","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/nstemi-en-instabiele-angina/","https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"This Lancet trial specifically targeted patients aged 80 and older with NSTEMI or unstable angina, comparing invasive versus conservative strategies. As one of the few randomized trials in the very elderly, it provided critical evidence for invasive management decisions in the oldest cardiac patients.","created":"2026-07-03T10:25:59Z","updated":"2026-07-03T13:25:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet-trial specifiek gericht op patiënten ≥80 jaar met NSTEMI of instabiele angina. Een van de weinige gerandomiseerde trials die een invasieve strategie vergeleek met conservatief beleid in deze ondervertegenwoordigde leeftijdsgroep.","abstract_original":"BACKGROUND: Non-ST-elevation myocardial infarction (NSTEMI) and unstable angina pectoris are frequent causes of hospital admission in the elderly. However, clinical trials targeting this population are scarce, and these patients are less likely to receive treatment according to guidelines. We aimed to investigate whether this population would benefit from an early invasive strategy versus a conservative strategy. METHODS: In this open-label randomised controlled multicentre trial, patients aged 80 years or older with NSTEMI or unstable angina admitted to 16 hospitals in the South-East Health Region of Norway were randomly assigned to an invasive strategy (including early coronary angiography with immediate assessment for percutaneous coronary intervention, coronary artery bypass graft, and optimum medical treatment) or to a conservative strategy (optimum medical treatment alone). A permuted block randomisation was generated by the Centre for Biostatistics and Epidemiology with stratification on the inclusion hospitals in opaque concealed envelopes, and sealed envelopes with consecutive inclusion numbers were made. The primary outcome was a composite of myocardial infarction, need for urgent revascularisation, stroke, and death and was assessed between Dec 10, 2010, and Nov 18, 2014. An intention-to-treat analysis was used. This study is registered with ClinicalTrials.gov, number NCT01255540. FINDINGS: During a median follow-up of 1·53 years of participants recruited between Dec 10, 2010, and Feb 21, 2014, the primary outcome occurred in 93 (40·6%) of 229 patients assigned to the invasive group and 140 (61·4%) of 228 patients assigned to the conservative group (hazard ratio [HR] 0·53 [95% CI 0·41-0·69], p=0·0001). Five patients dropped out of the invasive group and one from the conservative group. HRs for the four components of the primary composite endpoint were 0·52 (0·35-0·76; p=0·0010) for myocardial infarction, 0·19 (0·07-0·52; p=0·0010) for the need for urgent revascularisation, 0·60 (0·25-1·46; p=0·2650) for stroke, and 0·89 (0·62-1·28; p=0·5340) for death from any cause. The invasive group had four (1·7%) major and 23 (10·0%) minor bleeding complications whereas the conservative group had four (1·8%) major and 16 (7·0%) minor bleeding complications. INTERPRETATION: In patients aged 80 years or more with NSTEMI or unstable angina, an invasive strategy is superior to a conservative strategy in the reduction of composite events. Efficacy of the invasive strategy was diluted with increasing age (after adjustment for creatinine and effect modification). The two strategies did not differ in terms of bleeding complications. FUNDING: Norwegian Health Association (ExtraStiftelsen) and Inger and John Fredriksen Heart Foundation."},{"id":"5b574a1e8057","type":"article","url":"https://hartvaat.nl/2016/03/08/naltrexon-bupropion-en-cardiovasculaire-events-bij-obesitas-gerandomiseerde-tria/","title":"Naltrexon-bupropion en cardiovasculaire events bij obesitas: gerandomiseerde trial","title_en":"Effect of Naltrexone-Bupropion on Major Adverse Cardiovascular Events in Overweight and Obese Patients With Cardiovascular Risk Factors: A Randomized Clinical Trial.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","internist"],"tags":["obesitas","select-trial"],"journal":"JAMA","doi":"10.1001/jama.2016.1558","source_url":"https://doi.org/10.1001/jama.2016.1558","authors":["Steven E Nissen","Kathy E Wolski","Lisa Prcela","Thomas Wadden","John B Buse","George Bakris","Alfonso Perez","Steven R Smith"],"significance":7,"published":"2016-03-08","source_date":"2016-03-08","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"This JAMA cardiovascular safety trial of naltrexone-bupropion in overweight and obese patients showed no excess cardiovascular risk, though the trial was terminated early. The incomplete data contributed to ongoing uncertainty about the cardiovascular safety of weight-loss medications.","created":"2026-07-03T10:25:59Z","updated":"2026-07-03T13:25:20Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA cardiovasculaire veiligheidstrial van naltrexon-bupropion bij patiënten met overgewicht/obesitas en verhoogd cardiovasculair risico. Onderdeel van het regulatoire kader voor cardiovasculaire veiligheid van obesitasmedicatie.","abstract_original":"IMPORTANCE: Few cardiovascular outcomes trials have been conducted for obesity treatments. Withdrawal of 2 marketed drugs has resulted in controversy about the cardiovascular safety of obesity agents. OBJECTIVE: To determine whether the combination of naltrexone and bupropion increases major adverse cardiovascular events (MACE, defined as cardiovascular death, nonfatal stroke, or nonfatal myocardial infarction) compared with placebo in overweight and obese patients. DESIGN, SETTING, AND PARTICIPANTS: Randomized, multicenter, placebo-controlled, double-blind noninferiority trial enrolling 8910 overweight or obese patients at increased cardiovascular risk from June 13, 2012, to January 21, 2013, at 266 US centers. After public release of confidential interim data by the sponsor, the academic leadership of the study recommended termination of the trial and the sponsor agreed. INTERVENTIONS: An Internet-based weight management program was provided to all participants. Participants were randomized to receive placebo (n=4454) or naltrexone, 32 mg/d, and bupropion, 360 mg/d (n=4456). MAIN OUTCOMES AND MEASURES: Time from randomization to first confirmed occurrence of a MACE. The primary analysis planned to assess a noninferiority hazard ratio (HR) of 1.4 after 378 expected events, with a confidential interim analysis after approximately 87 events (25% interim analysis) to assess a noninferiority HR of 2.0 for consideration of regulatory approval. RESULTS: Among the 8910 participants randomized, mean age was 61.0 years (SD, 7.3 years), 54.5% were female, 32.1% had a history of cardiovascular disease, and 85.2% had diabetes, with a median body mass index of 36.6 (interquartile range, 33.1-40.9). For the 25% interim analysis, MACE occurred in 59 placebo-treated patients (1.3%) and 35 naltrexone-bupropion-treated patients (0.8%; HR, 0.59; 95% CI, 0.39-0.90). After 50% of planned events, MACE occurred in 102 patients (2.3%) in the placebo group and 90 patients (2.0%) in the naltrexone-bupropion group (HR, 0.88; adjusted 99.7% CI, 0.57-1.34). Adverse effects were more common in the naltrexone-bupropion group, including gastrointestinal events in 14.2% vs 1.9% (P < .001) and central nervous system symptoms in 5.1% vs 1.2% (P < .001). CONCLUSIONS AND RELEVANCE: Among overweight or obese patients at increased cardiovascular risk, based on the interim analyses performed after 25% and 50% of planned events, the upper limit of the 95% CI of the HR for MACE for naltrexone-bupropion treatment, compared with placebo, did not exceed 2.0. However, because of the unanticipated early termination of the trial, it is not possible to assess noninferiority for the prespecified upper limit of 1.4. Accordingly, the cardiovascular safety of this treatment remains uncertain and will require evaluation in a new adequately powered outcome trial. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01601704."},{"id":"9f400d623b5c","type":"article","url":"https://hartvaat.nl/2016/03/08/acute-ledischemie-en-vorapaxar-bij-perifeer-arterieel-vaatlijden-tra-2p-timi-50-/","title":"Acute ledischemie en vorapaxar bij perifeer arterieel vaatlijden: TRA 2°P-TIMI 50-resultaten","title_en":"Acute Limb Ischemia and Outcomes With Vorapaxar in Patients With Peripheral Artery Disease: Results From the Trial to Assess the Effects of Vorapaxar in Preventing Heart Attack and Stroke in Patients With Atherosclerosis-Thrombolysis in Myocardial Infarction 50 (TRA2°P-TIMI 50).","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","internist"],"tags":["perifeer-vaatlijden"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.115.019355","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.115.019355","authors":["Marc P Bonaca","J Antonio Gutierrez","Mark A Creager","Benjamin M Scirica","Jeffrey Olin","Sabina A Murphy","Eugene Braunwald","David A Morrow"],"significance":6,"published":"2016-03-08","source_date":"2016-03-08","image":"","kennis":["https://hartvaat.nl/kennis/vasculair/perifeer-arterieel-vaatlijden/","https://hartvaat.nl/kennis/vasculair/claudicatio-intermittens/"],"congress":"","summary_en":"This TRA 2°P-TIMI 50 analysis characterized the incidence and outcomes of acute limb ischemia in peripheral artery disease patients, evaluating whether vorapaxar (a PAR-1 antagonist) reduces this devastating complication.","created":"2026-07-03T10:25:59Z","updated":"2026-07-03T13:25:20Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de TRA 2°P-TIMI 50-trial naar de incidentie en uitkomsten van acute ledischemie bij patiënten met perifeer arterieel vaatlijden behandeld met vorapaxar. Onderzoekt de beschermende werking van PAR-1-antagonisme.","abstract_original":"BACKGROUND: Patients with peripheral artery disease (PAD) are at heightened risk of acute limb ischemia (ALI), a morbid event that may result in limb loss. We investigated the causes, sequelae, and predictors of ALI in a contemporary population with symptomatic PAD and whether protease-activated receptor 1 antagonism with vorapaxar reduced ALI overall and by type. METHODS AND RESULTS: The Trial to Assess the Effects of Vorapaxar in Preventing Heart Attack and Stroke in Patients With Atherosclerosis-Thrombolysis in Myocardial Infarction 50 (TRA2°P-TIMI 50) was a randomized, double-blind, placebo-controlled trial of vorapaxar in stable patients, including 3787 with symptomatic PAD. ALI was a prespecified adjudicated end point using a formal definition. A total of 150 ALI events occurred in 108 patients during follow-up (placebo 3-year rate, 3.9%; 1.3% annualized). For patients with symptomatic PAD, previous peripheral revascularization, smoking, and the ankle-brachial index were predictive of ALI. The majority of ALI events occurred as a result of surgical graft thrombosis (56%), followed by native vessel in situ thrombosis (27%). Stent thrombosis and thromboembolism caused ALI in 13% and 5%, respectively. Amputation occurred in 17.6% presenting with ALI. Vorapaxar reduced first ALI events by 41% (hazard ratio, 0.58; 95% confidence interval, 0.39-0.86; P=0.006) and total ALI events by 41% (94 versus 56 events; risk ratio, 0.59; 95% confidence interval, 0.38-0.93; P=0.022). The efficacy of vorapaxar was consistent across types of ALI. CONCLUSIONS: In selected patients with symptomatic PAD and without atrial fibrillation, ALI occurs at a rate of 1.3%/y, is most frequently caused by acute bypass graft thrombosis or in situ thrombosis of a diseased vessel, and often results in limb loss. Vorapaxar reduces ALI in patients with symptomatic PAD with consistency across type, including PAD resulting from surgical graft thrombosis and in-situ thrombosis. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00526474."},{"id":"ece002304c12","type":"article","url":"https://hartvaat.nl/2016/03/05/bloeddrukverlaging-ter-preventie-van-hart-en-vaatziekten-systematische-review-en/","title":"Bloeddrukverlaging ter preventie van hart- en vaatziekten: systematische review en meta-analyse","title_en":"Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts","internist"],"tags":["abelacimab","acuut-hartfalen","alcoholgebruik","ambulante-bloeddrukmeting","aspirine","atleten","biomarkers-cardiovasculair","bisoprolol","bloeddrukbehandeling","bradycardie","diabetes-en-hart","dyslipidemie","endotheel","farmaco-economie","fidelity","fractional-flow-reserve","hartkatheterisatie","hartrevalidatie","hfpef","hfref","inflammatie","laminopathie","lichaamsbeweging","lipidenverlaging","microbioom","myocardinfarct","nt-probnp","obesitas","ouderen","perifeer-vaatlijden","plotse-hartdood","primaire-preventie","roken","secundaire-preventie","slaapapneu","vrouwen"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(15)01225-8","source_url":"https://doi.org/10.1016/S0140-6736(15)01225-8","authors":["Dena Ettehad","Connor A Emdin","Amit Kiran","Simon G Anderson","Thomas Callender","Jonathan Emberson","John Chalmers","Anthony Rodgers","Kazem Rahimi"],"significance":9,"published":"2016-03-05","source_date":"2016-03-05","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/screenen-op-af/"],"congress":"","summary_en":"This comprehensive Lancet meta-analysis quantified the cardiovascular benefit of blood pressure lowering regardless of baseline blood pressure, showing proportional risk reduction per 10 mmHg decrease in systolic pressure. The findings support treating cardiovascular risk rather than blood pressure thresholds alone.","created":"2026-07-03T10:25:59Z","updated":"2026-07-03T18:38:22Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Omvangrijke Lancet meta-analyse die het effect van bloeddrukverlaging op cardiovasculaire uitkomsten kwantificeerde ongeacht de uitgangsdruk. Belangrijke evidence base voor het behandelen van alle niveaus van verhoogde bloeddruk.","abstract_original":"BACKGROUND: The benefits of blood pressure lowering treatment for prevention of cardiovascular disease are well established. However, the extent to which these effects differ by baseline blood pressure, presence of comorbidities, or drug class is less clear. We therefore performed a systematic review and meta-analysis to clarify these differences. METHOD: For this systematic review and meta-analysis, we searched MEDLINE for large-scale blood pressure lowering trials, published between Jan 1, 1966, and July 7, 2015, and we searched the medical literature to identify trials up to Nov 9, 2015. All randomised controlled trials of blood pressure lowering treatment were eligible for inclusion if they included a minimum of 1000 patient-years of follow-up in each study arm. No trials were excluded because of presence of baseline comorbidities, and trials of antihypertensive drugs for indications other than hypertension were eligible. We extracted summary-level data about study characteristics and the outcomes of major cardiovascular disease events, coronary heart disease, stroke, heart failure, renal failure, and all-cause mortality. We used inverse variance weighted fixed-effects meta-analyses to pool the estimates. RESULTS: We identified 123 studies with 613,815 participants for the tabular meta-analysis. Meta-regression analyses showed relative risk reductions proportional to the magnitude of the blood pressure reductions achieved. Every 10 mm Hg reduction in systolic blood pressure significantly reduced the risk of major cardiovascular disease events (relative risk [RR] 0·80, 95% CI 0·77-0·83), coronary heart disease (0·83, 0·78-0·88), stroke (0·73, 0·68-0·77), and heart failure (0·72, 0·67-0·78), which, in the populations studied, led to a significant 13% reduction in all-cause mortality (0·87, 0·84-0·91). However, the effect on renal failure was not significant (0·95, 0·84-1·07). Similar proportional risk reductions (per 10 mm Hg lower systolic blood pressure) were noted in trials with higher mean baseline systolic blood pressure and trials with lower mean baseline systolic blood pressure (all ptrend>0·05). There was no clear evidence that proportional risk reductions in major cardiovascular disease differed by baseline disease history, except for diabetes and chronic kidney disease, for which smaller, but significant, risk reductions were detected. β blockers were inferior to other drugs for the prevention of major cardiovascular disease events, stroke, and renal failure. Calcium channel blockers were superior to other drugs for the prevention of stroke. For the prevention of heart failure, calcium channel blockers were inferior and diuretics were superior to other drug classes. Risk of bias was judged to be low for 113 trials and unclear for 10 trials. Heterogeneity for outcomes was low to moderate; the I(2) statistic for heterogeneity for major cardiovascular disease events was 41%, for coronary heart disease 25%, for stroke 26%, for heart failure 37%, for renal failure 28%, and for all-cause mortality 35%. INTERPRETATION: Blood pressure lowering significantly reduces vascular risk across various baseline blood pressure levels and comorbidities. Our results provide strong support for lowering blood pressure to systolic blood pressures less than 130 mm Hg and providing blood pressure lowering treatment to individuals with a history of cardiovascular disease, coronary heart disease, stroke, diabetes, heart failure, and chronic kidney disease. FUNDING: National Institute for Health Research and Oxford Martin School."},{"id":"6f7ab3ab388d","type":"article","url":"https://hartvaat.nl/2016/03/01/cyp2c19-metaboliseerdersstatus-en-uitkomsten-bij-acs-prasugrel-versus-clopidogre/","title":"CYP2C19-metaboliseerdersstatus en uitkomsten bij ACS: prasugrel versus clopidogrel","title_en":"Impact of CYP2C19 Metabolizer Status on Patients With ACS Treated With Prasugrel Versus Clopidogrel.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["trombocytenaggregatieremmers"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2015.12.036","source_url":"https://doi.org/10.1016/j.jacc.2015.12.036","authors":["Jacob A Doll","Megan L Neely","Matthew T Roe","Paul W Armstrong","Harvey D White","Dorairaj Prabhakaran","Kenneth J Winters","Suman Duvvuru","Scott S Sundseth","Joseph A Jakubowski","Paul A Gurbel","Deepak L Bhatt","E Magnus Ohman","Keith A A Fox"],"significance":6,"published":"2016-03-01","source_date":"2016-03-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-farmacologie/","https://hartvaat.nl/kennis/coronairlijden/trombocytenaggregatieremmers-bij-acs/"],"congress":"","summary_en":"This study examined the impact of CYP2C19 metabolizer status on platelet reactivity and clinical outcomes in ACS patients treated with prasugrel versus clopidogrel, showing that prasugrel overcomes the genetic resistance that limits clopidogrel efficacy.","created":"2026-07-03T10:25:59Z","updated":"2026-07-03T13:25:20Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de invloed van CYP2C19-genpolymorfismen op plaatjesreactiviteit en klinische uitkomsten bij ACS-patiënten behandeld met prasugrel versus clopidogrel. Onderzoekt de farmacogenetische basis voor gepersonaliseerde antitromboticatherapie.","abstract_original":"BACKGROUND: Certain alleles of the CYP2C19 gene are associated with higher platelet reactivity and increased ischemic events among patients treated with clopidogrel. However, the relationship of CYP2C19 genotype and outcomes in medically managed patients with acute coronary syndromes (ACS) is not known. OBJECTIVES: This study sought to assess the effect of CYP2C19 genotype on ischemic outcomes in patients with ACS initially managed medically without revascularization who were randomized to either clopidogrel or prasugrel. METHODS: We classified patients as extensive metabolizers (EM) or reduced metabolizers (RM) based on CYP2C19 genotype and evaluated ischemic outcomes and platelet reactivity. Among 9,326 patients enrolled from 2008 to 2011, 5,736 participated in the genetics cohort; of these, 2,236 had platelet function testing data. RESULTS: There was no association between CYP2C19 metabolizer status (EM vs. RM) and the primary composite endpoint of cardiovascular death, myocardial infarction (MI), or stroke (hazard ratio [HR]: 0.86). EM and RM patients had similar rates of the primary endpoint whether treated with prasugrel (HR: 0.82) or clopidogrel (HR: 0.91; p for interaction = 0.495). After adjusting for clinical and treatment variables, EM patients had a lower risk of MI versus RM patients (HR: 0.80), but risks of other outcomes were similar. RM patients had significantly higher mean P2Y12 reaction units versus EM patients when treated with clopidogrel (39.93), but not with prasugrel (3.87). CONCLUSIONS: CYP2C19 metabolizer status is not associated with the composite outcome of cardiovascular death, MI, or stroke in medically managed ACS patients treated with clopidogrel or prasugrel. Our findings do not support routine CYP2C19 genetic testing in this population. (A Comparison of Prasugrel and Clopidogrel in Acute Coronary Syndrome Subjects [TRILOGY ACS]; NCT00699998)."},{"id":"7f3c80ef2e27","type":"article","url":"https://hartvaat.nl/2016/03/01/bioresorbeerbare-scaffold-trombose-multicenteranalyse-van-klinische-presentatie-/","title":"Bioresorbeerbare scaffold-trombose: multicenteranalyse van klinische presentatie en mechanismen","title_en":"Bioresorbable Coronary Scaffold Thrombosis: Multicenter Comprehensive Analysis of Clinical Presentation, Mechanisms, and Predictors.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["klepprothese"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2015.12.019","source_url":"https://doi.org/10.1016/j.jacc.2015.12.019","authors":["Serban Puricel","Florim Cuculi","Melissa Weissner","Axel Schmermund","Peiman Jamshidi","Tobias Nyffenegger","Harald Binder","Holger Eggebrecht","Thomas Münzel","Stephane Cook","Tommaso Gori"],"significance":7,"published":"2016-03-01","source_date":"2016-03-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/ischemie-reperfusieschade/"],"congress":"","summary_en":"This multicenter analysis characterized the incidence, mechanisms, and predictors of bioresorbable vascular scaffold thrombosis, identifying key risk factors that contributed to the eventual withdrawal of first-generation bioresorbable devices.","created":"2026-07-03T10:25:58Z","updated":"2026-07-03T13:25:20Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Multicenter analyse die de incidentie, klinische presentatie, mechanismen en voorspellers van bioresorbeerbare vasculaire scaffold-trombose onderzocht. Wijst op een mogelijk verhoogd tromboserisico vergeleken met metallic stents.","abstract_original":"BACKGROUND: Recent reports suggest an elevated incidence of bioresorbable vascular scaffold (BVS) thrombosis (scaffold thrombosis [ScT]). OBJECTIVES: This study investigated occurrence rates, clinical and angiographic characteristics, and possible mechanisms of ScT in all-comer patients undergoing BVS implantation at 2 German and 2 Swiss hospitals. METHODS: A total of 1,305 consecutive patients (mean age 64 years, 78% male) who received 1,870 BVS (mean 1.4 ± 0.8 BVS/patient) were enrolled. Clinical/procedural characteristics, mortality, and ScT data at 485 days (range 312 to 652 days) were examined. RESULTS: ScT occurred in 42 patients. The incidence of probable and definite ScT was 1.8% at 30 days and 3.0% at 12 months, without differences among centers (p = 0.60). A total of 22 (52%) ScTs presented as ST-segment elevation myocardial infarction and 6 (17%) as sudden cardiac death. In multivariable analysis, ostial lesions (p = 0.049) and impaired left ventricular ejection fraction (p = 0.019) were independently associated with ScT. Nine (21%) of the ScTs occurred in patients who had suspended dual antiplatelet therapy, in 6 cases prematurely. Lower post-procedural minimum lumen and reference vessel diameters were hallmarks of ScT (all p < 0.0001). The risk of ScT appeared to rapidly increase for post-procedural minimum lumen diameters below 2.4 mm (for the 2.5- to 3.0-mm BVS) and 2.8 mm (for the 3.5-mm BVS). When a BVS-specific implantation strategy was implemented, 12-month ScT rates fell from 3.3% to 1.0%, an effect that remained significant when adjusted for multivariable propensity score (p = 0.012; hazard ratio: 0.19; 95% confidence interval: 0.05 to 0.70). CONCLUSIONS: The 12-month incidence of ScT reached 3% and could be significantly reduced when an optimized implantation strategy was employed. (retrospective multicentric registry and Mainz Intracoronary Database. The Coronary Slow-flow and Microvascular Diseases Registry [MICAT]; NCT02180178)."},{"id":"9f8a4bdd82b8","type":"article","url":"https://hartvaat.nl/2016/03/01/voorschrijfpatronen-van-thiazidediuretica-in-de-sprint-trial/","title":"Voorschrijfpatronen van thiazidediuretica in de SPRINT-trial","title_en":"Patterns and Correlates of Baseline Thiazide-Type Diuretic Prescription in the Systolic Blood Pressure Intervention Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["stride-trial"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.115.06851","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.115.06851","authors":["Tara I Chang","Gregory Evans","Alfred K Cheung","William C Cushman","Matthew J Diamond","Jamie P Dwyer","Yonghong Huan","Dalane Kitzman","John B Kostis","Suzanne Oparil","Anjay Rastogi","Christianne L Roumie","Rukmani Sahay","Randall S Stafford","Addison A Taylor","Jackson T Wright","Glenn M Chertow"],"significance":5,"published":"2016-03-01","source_date":"2016-03-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/thiazidediuretica-hypertensie/","https://hartvaat.nl/kennis/nierziekte/kdigo-richtlijn-ckd-2024/"],"congress":"","summary_en":"This SPRINT analysis documented that thiazide-type diuretics, despite being recommended first-line agents, are underutilized in clinical practice, with prescribing patterns influenced by provider specialty and patient characteristics.","created":"2026-07-03T10:25:58Z","updated":"2026-07-03T13:25:20Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van prescriptiepatronen en correlaten van thiazide-achtige diuretica in de SPRINT-trial. Hoewel aanbevolen als eerstelijnsbehandeling, worden thiaziden in de praktijk onderbenut of suboptimaal gedoseerd.","abstract_original":"Thiazides and thiazide-type diuretics are recommended as first-line agents for the treatment of hypertension, but contemporary information on their use in clinical practice is lacking. We examined patterns and correlates of thiazide prescription in a cross-sectional analysis of baseline data from participants enrolled in the Systolic Blood Pressure Intervention Trial (SPRINT). We examined baseline prescription of thiazides in 7582 participants receiving at least 1 antihypertensive medication by subgroup, and used log-binomial regression to calculate adjusted prevalence ratios for thiazide prescription (versus no thiazide). Forty-three percent of all participants were prescribed a thiazide at baseline, but among participants prescribed a single agent, the proportion was only 16%. The prevalence of thiazide prescription differed significantly by demographic factors, with younger participants, women, and blacks all having higher adjusted prevalence of thiazide prescription than other corresponding subgroups. Participants in the lowest category of kidney function (estimated glomerular filtration rate <30 mL/min per 1.73 m2) were half as likely to be prescribed a thiazide as participants with preserved kidney function. In conclusion, among persons with hypertension and heightened cardiovascular risk, we found that thiazide prescription varied significantly by demographics and kidney disease status, despite limited evidence about relative differences in effectiveness."},{"id":"aa2cdb27dc55","type":"article","url":"https://hartvaat.nl/2016/03/01/taurinesuppletie-verlaagt-bloeddruk-en-verbetert-vaatfunctie-bij-prehypertensie/","title":"Taurinesuppletie verlaagt bloeddruk en verbetert vaatfunctie bij prehypertensie","title_en":"Taurine Supplementation Lowers Blood Pressure and Improves Vascular Function in Prehypertension: Randomized, Double-Blind, Placebo-Controlled Study.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["abelacimab","bloeddrukbehandeling","dubbele-trombocytenremming","figaro-dkd","lorundrostat","precision-trial","renale-denervatie","sacubitril-valsartan","soul-trial","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.115.06624","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.115.06624","authors":["Qianqian Sun","Bin Wang","Yingsha Li","Fang Sun","Peng Li","Weijie Xia","Xunmei Zhou","Qiang Li","Xiaojing Wang","Jing Chen","Xiangru Zeng","Zhigang Zhao","Hongbo He","Daoyan Liu","Zhiming Zhu"],"significance":5,"published":"2016-03-01","source_date":"2016-03-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/ace-remmers-hypertensie/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This randomized placebo-controlled trial showed that taurine supplementation lowers blood pressure and improves vascular function in individuals with prehypertension, providing the first clinical evidence for this amino acid as an antihypertensive.","created":"2026-07-03T10:25:58Z","updated":"2026-07-03T18:38:22Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Dubbelblinde gerandomiseerde placebogecontroleerde trial die aantoonde dat taurinesuppletie de bloeddruk verlaagt en de vaatfunctie verbetert bij patiënten met prehypertensie. Eerste rigoureuze klinische trial die eerdere dierexperimentele bevindingen valideert.","abstract_original":"Taurine, the most abundant, semiessential, sulfur-containing amino acid, is well known to lower blood pressure (BP) in hypertensive animal models. However, no rigorous clinical trial has validated whether this beneficial effect of taurine occurs in human hypertension or prehypertension, a key stage in the development of hypertension. In this randomized, double-blind, placebo-controlled study, we assessed the effects of taurine intervention on BP and vascular function in prehypertension. We randomly assigned 120 eligible prehypertensive individuals to receive either taurine supplementation (1.6 g per day) or a placebo for 12 weeks. Taurine supplementation significantly decreased the clinic and 24-hour ambulatory BPs, especially in those with high-normal BP. Mean clinic systolic BP reduction for taurine/placebo was 7.2/2.6 mm Hg, and diastolic BP was 4.7/1.3 mm Hg. Mean ambulatory systolic BP reduction for taurine/placebo was 3.8/0.3 mm Hg, and diastolic BP was 3.5/0.6 mm Hg. In addition, taurine supplementation significantly improved endothelium-dependent and endothelium-independent vasodilation and increased plasma H2S and taurine concentrations. Furthermore, changes in BP were negatively correlated with both the plasma H2S and taurine levels in taurine-treated prehypertensive individuals. To further elucidate the hypotensive mechanism, experimental studies were performed both in vivo and in vitro. The results showed that taurine treatment upregulated the expression of hydrogen sulfide-synthesizing enzymes and reduced agonist-induced vascular reactivity through the inhibition of transient receptor potential channel subtype 3-mediated calcium influx in human and mouse mesenteric arteries. In conclusion, the antihypertensive effect of chronic taurine supplementation shows promise in the treatment of prehypertension through improvement of vascular function."},{"id":"7d8ac207b69d","type":"article","url":"https://hartvaat.nl/2016/03/01/effect-van-aanvullende-zuurstoftoediening-op-myocardschade-bij-stemi/","title":"Effect van aanvullende zuurstoftoediening op myocardschade bij STEMI","title_en":"Effect of supplemental oxygen exposure on myocardial injury in ST-elevation myocardial infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2015-308636","source_url":"https://doi.org/10.1136/heartjnl-2015-308636","authors":["Ziad Nehme","Dion Stub","Stephen Bernard","Michael Stephenson","Janet E Bray","Peter Cameron","Ian T Meredith","Bill Barger","Andris H Ellims","Andrew J Taylor","David M Kaye","Karen Smith"],"significance":7,"published":"2016-03-01","source_date":"2016-03-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/diagnostiek/inspanningstest-loopband-fiets/"],"congress":"","summary_en":"This study showed that supplemental oxygen therapy may increase myocardial injury in patients with STEMI who are not hypoxemic, providing evidence for a dose-response relationship between oxygen exposure and troponin release in acute MI.","created":"2026-07-03T10:25:58Z","updated":"2026-07-03T13:25:20Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die aantoonde dat aanvullende zuurstoftherapie de myocardschade na STEMI kan vergroten. Onderzocht de dosis-responsrelatie tussen zuurstofblootstelling en infarctgrootte, met relevantie voor ambulanceprotocollen.","abstract_original":"OBJECTIVE: Supplemental oxygen therapy may increase myocardial injury following ST-elevation myocardial infarction (STEMI). In this study, we aimed to evaluate the effect of the dose and duration of oxygen exposure on myocardial injury after STEMI. METHODS: Descriptive analysis of data from a multicentre, prospective, randomised, controlled trial of 441 patients with STEMI randomised to supplemental oxygen therapy or room air breathing. The primary endpoint was myocardial infarct size as assessed by cardiac biomarkers, troponin (cTnI) and creatine kinase (CK). Oxygen therapy was commenced by paramedics, and continued for up to 12 h postintervention in hospital. Supplemental oxygen exposure was calculated as the area under the dose×time curve for oxygen administration over the first 12 h, and then assessed for its association with cTnI/CK release using multivariable linear regression. RESULTS: The median supplemental oxygen exposure was 1746 L (IQR: 960-2858). After adjustment for potential confounders, every 100 L increase in oxygen exposure in the first 12 h was associated with a 1.4% (95% CI 0.6% to 2.2%, p<0.001) and 1.2% (95% CI 0.7% to 1.8%, p<0.001) increase in the mean peak cTnI and CK, respectively. Excluding patients who developed cardiogenic shock, recurrent myocardial infarction or desaturations (SpO2<94%) during admission, every 100 L increase in oxygen exposure was associated with a 1.2% (95% CI 0.2% to 2.1%, p=0.01) and 1.0% (95% CI 0.3% to 1.7%, p=0.003) increase in the mean peak cTnI and CK, respectively. The median supplemental oxygen exposure of 1746 L would result in a 21% (95% CI 3% to 37%) increase in infarct size according to the cTnI profile. CONCLUSIONS: Supplemental oxygen exposure in the first 12 h after STEMI was associated with a clinically significant increase in cTnI and CK release."},{"id":"278d3540fffd","type":"article","url":"https://hartvaat.nl/2016/03/01/farmacogenomische-meta-analyse-van-bloeddrukrespons-op-betablokkers-bij-afro-ame/","title":"Farmacogenomische meta-analyse van bloeddrukrespons op bètablokkers bij Afro-Amerikanen","title_en":"Pharmacogenomic Genome-Wide Meta-Analysis of Blood Pressure Response to β-Blockers in Hypertensive African Americans.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["bloeddrukbehandeling","familiaire-hypercholesterolemie-screening","ras-remmers","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.115.06345","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.115.06345","authors":["Yan Gong","Zhiying Wang","Amber L Beitelshees","Caitrin W McDonough","Taimour Y Langaee","Karen Hall","Siegfried O F Schmidt","Robert W Curry","John G Gums","Kent R Bailey","Eric Boerwinkle","Arlene B Chapman","Stephen T Turner","Rhonda M Cooper-DeHoff","Julie A Johnson"],"significance":5,"published":"2016-03-01","source_date":"2016-03-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This pharmacogenomic GWAS of blood pressure response to beta-blockers in hypertensive African Americans identified genetic variants that may explain differential drug responsiveness across racial groups.","created":"2026-07-03T10:25:58Z","updated":"2026-07-03T18:38:22Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Genoombrede associatiestudie naar genetische determinanten van bloeddrukrespons op bètablokkers bij Afro-Amerikanen met hypertensie. Onderzoekt farmacogenomische verklaringen voor de verminderde effectiviteit van bètablokkers in deze populatie.","abstract_original":"African Americans suffer a higher prevalence of hypertension compared with other racial/ethnic groups. In this study, we performed a pharmacogenomic genome-wide association study of blood pressure (BP) response to β-blockers in African Americans with uncomplicated hypertension. Genome-wide meta-analysis was performed in 318 African American hypertensive participants in the 2 Pharmacogenomic Evaluation of Antihypertensive Responses studies: 150 treated with atenolol monotherapy and 168 treated with metoprolol monotherapy. The analysis adjusted for age, sex, baseline BP and principal components for ancestry. Genome-wide significant variants with P<5×10(-8) and suggestive variants with P<5×10(-7) were evaluated in an additional cohort of 141 African Americans treated with the addition of atenolol to hydrochlorothiazide treatment. The validated variants were then meta-analyzed in these 3 groups of African Americans. Two variants discovered in the monotherapy meta-analysis were validated in the add-on therapy. African American participants heterozygous for SLC25A31 rs201279313 deletion versus wild-type genotype had better diastolic BP response to atenolol monotherapy, metoprolol monotherapy, and atenolol add-on therapy: -9.3 versus -4.6, -9.6 versus -4.8, and -9.7 versus -6.4 mm Hg, respectively (3-group meta-analysis P=2.5×10(-8), β=-4.42 mm Hg per variant allele). Similarly, LRRC15 rs11313667 was validated for systolic BP response to β-blocker therapy with 3-group meta-analysis P=7.2×10(-8) and β=-3.65 mm Hg per variant allele. In this first pharmacogenomic genome-wide meta-analysis of BP response to β-blockers in African Americans, we identified novel variants that may provide valuable information for personalized antihypertensive treatment in this group."},{"id":"db83f997d9e9","type":"article","url":"https://hartvaat.nl/2016/03/01/intrathoracale-impedantiemonitoring-bij-chronisch-hartfalen-de-limit-chf-studie/","title":"Intrathoracale impedantiemonitoring bij chronisch hartfalen: de LIMIT-CHF-studie","title_en":"The lung impedance monitoring in treatment of chronic heart failure (the LIMIT-CHF study).","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","hfmref","hfpef","hfref"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euv293","source_url":"https://doi.org/10.1093/europace/euv293","authors":["Giulia Domenichini","Tsveta Rahneva","Ihab G Diab","Onkar S Dhillon","Niall G Campbell","Malcolm C Finlay","Victoria Baker","Ross J Hunter","Mark J Earley","Richard J Schilling"],"significance":5,"published":"2016-03-01","source_date":"2016-03-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/lisdiuretica-furosemide-bumetanide/"],"congress":"","summary_en":"The LIMIT-CHF study evaluated intrathoracic impedance monitoring alerts from implantable devices for guiding empirical heart failure treatment, testing whether early congestion detection prevents hospitalizations.","created":"2026-07-03T10:25:58Z","updated":"2026-07-03T18:38:22Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar het nut van intrathoracale impedantiemonitoring (IIM) bij implanteerbare devices voor het vroegtijdig detecteren van decompensatie bij chronisch hartfalen. Onderzocht of IIM-gestuurde behandeling hartfalengerelateerde opnames kan voorkomen.","abstract_original":"AIMS: To assess the usefulness of intrathoracic impedance monitoring (IIM) alerts in guiding empirical treatment of chronic heart failure (CHF) patients to prevent heart failure (HF) hospitalizations and unplanned HF care. METHODS AND RESULTS: Chronic heart failure patients with OptiVol or CorVue capable implantable cardioverter-defibrillators were randomized to either the active group (IIM alarm turned on and diuretic dose increased by 50% for 1 week in the event of alarm sounding) or the control group (IIM alarm turned off). The primary endpoint was the number of HF hospitalizations per patient at 1 year. The NYHA class, 6MWT, B-type natriuretic peptide (BNP), and MLWHF questionnaire score were collected at baseline and follow-up. Eighty patients were included and 71 reached 1-year follow-up. There were 1.7 ± 1.5 alerts in the active group and 1.1 ± 1.0 in the control group, P = 0.07. In the active group, 61% of alerts led to a diuretic dose increase. There was a total of 11 HF hospitalizations in the active group vs. 6 in the control group without significant differences in the number of episodes per patient (0.3 ± 0.9 vs. 0.2 ± 0.4, P = 0.95). There were no unplanned HF visits in the active group vs. 0.1 ± 0.3 per patient in the control group, P = 0.08. The total MLWHF scores were significantly increased at the final follow-up in the control group, whereas a trend towards reduction was observed in the active group. CONCLUSION: In this study, an empirical HF treatment guided by IIM alerts did not reduce emergency treatment of HF. However, it seems to have a positive impact on quality of life. CLINICAL TRIAL REGISTRATIONURL: http://www.clinicaltrials.gov. Unique identifier: NCT01320007."},{"id":"21145b99fe7c","type":"article","url":"https://hartvaat.nl/2016/03/01/aanvullende-cfae-ablatie-en-lineaire-laesies-bij-persistend-atriumfibrilleren-me/","title":"Aanvullende CFAE-ablatie en lineaire laesies bij persistend atriumfibrilleren: meta-analyse","title_en":"The impact of adjunctive complex fractionated atrial electrogram ablation and linear lesions on outcomes in persistent atrial fibrillation: a meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["pulmonaalvenenisolatie"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euv351","source_url":"https://doi.org/10.1093/europace/euv351","authors":["Paul A Scott","John Silberbauer","Francis D Murgatroyd"],"significance":6,"published":"2016-03-01","source_date":"2016-03-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/katheterablatie-af/","https://hartvaat.nl/kennis/atriumfibrilleren/pathofysiologie-af/"],"congress":"","summary_en":"This meta-analysis showed that adding complex fractionated atrial electrogram ablation or linear lesions to pulmonary vein isolation in persistent AF does not consistently improve outcomes, questioning routine substrate modification strategies.","created":"2026-07-03T10:25:58Z","updated":"2026-07-03T18:38:22Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse die onderzocht of toevoeging van complexe gefractioneerde atriale elektrogramablatie (CFAE) en lineaire laesies aan pulmonaalvene-isolatie (PVI) de uitkomsten verbetert bij persisterend AF. De twee meest gebruikte substraatmodificatiestrategieën vergeleken.","abstract_original":"AIMS: In persistent atrial fibrillation (PsAF), success rates for pulmonary vein isolation (PVI) alone are limited and additional substrate modification is often performed. The two most widely used substrate-based strategies are the ablation of complex fractionated atrial electrograms (CFAE) and left atrial linear ablation (LALA) at the roof and mitral isthmus. However, it is unclear whether adjunctive CFAE ablation or LALA add significant benefit to PVI alone. We performed a meta-analysis to better gauge the benefit of adjunctive CFAE ablation and LALA in PsAF. METHODS AND RESULTS: Electronic databases were systematically searched. We included studies that examined the impact of CFAE ablation or LALA in addition to a PVI-based strategy on clinical outcomes in PsAF. We included both randomized and non-randomized studies. Totally 10 studies (n = 1821) were included: 6 evaluating CFAE ablation, 3 LALA, and 1 both approaches. In comparison with PVI alone, the addition of CFAE ablation [RR 0.86; 95% confidence intervals (CI) 0.64, 1.16; P = 0.32] or LALA (RR 0.64; 95% CI 0.37, 1.09; P = 0.10) offered no significant improvement in arrhythmia-free survival. However, adjunctive CFAE ablation was associated with significant increases (P < 0.05) and LALA non-significant increases in procedure and fluoroscopy times. CONCLUSION: In PsAF, the addition of CFAE ablation or LALA, in comparison with PVI alone, offers no significant improvement in arrhythmia-free survival. Furthermore, they are associated with increases in both procedural and fluoroscopy times. The optimal ablation strategy for PsAF is currently unclear and needs further refinement."},{"id":"cf1b91e3ee09","type":"article","url":"https://hartvaat.nl/2016/03/01/eerste-trial-met-specifieke-ikach-blokker-toont-geen-reductie-in-af-last-bij-par/","title":"Eerste trial met specifieke IKACh-blokker toont geen reductie in AF-last bij paroxysmaal atriumfibrilleren","title_en":"First clinical trial of specific IKACh blocker shows no reduction in atrial fibrillation burden in patients with paroxysmal atrial fibrillation: pacemaker assessment of BMS 914392 in patients with paroxysmal atrial fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["acuut-hartfalen","aficamten","aritmogene-cardiomyopathie","atriale-cardiomyopathie","bloeddrukbehandeling","hypertrofische-cardiomyopathie","laminopathie","pathfinder-trial","pulsed-field-ablatie-atriumfibrilleren"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euv263","source_url":"https://doi.org/10.1093/europace/euv263","authors":["Steven J Podd","Nicholas Freemantle","Stephen S Furniss","Neil Sulke"],"significance":5,"published":"2016-03-01","source_date":"2016-03-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/antistolling/doacs-overzicht/"],"congress":"","summary_en":"This first clinical trial of BMS 914392, a selective IKACh channel blocker, in patients with pacemakers and paroxysmal AF showed no significant reduction in AF burden, a negative result for this ion channel target.","created":"2026-07-03T10:25:58Z","updated":"2026-07-03T18:38:22Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Eerste klinische trial van BMS 914392, een selectieve orale IKACh-kanaalblokker, bij 20 patiënten met een pacemaker en paroxysmaal AF. De studie toonde geen significante reductie in AF-last, ondanks het theoretische potentieel van atriumselectieve ionkanaalremming.","abstract_original":"AIMS: To assess the efficacy of BMS 914392 on atrial fibrillation (AF) burden reduction in 20 patients with pacemakers and paroxysmal atrial fibrillation (PAF). BMS 914392 is a potent, selective, oral inhibitor of the IKACh current and has been shown to suppress AF, whilst having no effect on the ventricular refractory period. This is the first efficacy study of BMS 914392 in patients with PAF. METHODS AND RESULTS: The study was a four-way, crossover, double-blind design. A total of 20 patients with PAF and dual-chamber pacemakers were recruited. The pacemakers allowed beat-to-beat monitoring. Anti-arrhythmic drugs were withdrawn. Patients received low-dose (10 mg OD), medium-dose (10 mg TDS), and high-dose (20 mg TDS) BMS 914392 or placebo for 3 weeks before being crossed to the next phase. Patients underwent a washout period, four treatment phases and a final washout phase. Atrial fibrillation burden was downloaded from their pacemakers at the end of each study phase. BMS 914392 did not reduce AF burden when compared with placebo (10 mg OD P = 0.56, 10 mg TDS P = 0.22, 20 mg TDS P = 0.23). Heart rate and corrected QT (QTc) were not affected by BMS 914392. Adverse event (AE) rates did not differ from placebo in any of the treatment groups, with no serious AEs recorded. CONCLUSION: BMS 914932 has not been shown to reduce AF burden in patients with PAF and pacemakers using beat-to-beat pacemaker monitoring throughout the study. BMS 914392 was well tolerated and did not affect QTc or reduce heart rate. TRIAL REGISTRATION: Clinicaltrials.gov: NCT01356914."},{"id":"07f637accf29","type":"article","url":"https://hartvaat.nl/2016/02/23/inspanningstestvariabelen-als-mortaliteitsvoorspellers-bij-chronisch-systolisch-/","title":"Inspanningstestvariabelen als mortaliteitsvoorspellers bij chronisch systolisch hartfalen","title_en":"Variables Measured During Cardiopulmonary Exercise Testing as Predictors of Mortality in Chronic Systolic Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","delirium-cardiologie","hfref","ouderen","plotse-hartdood","ventrikelfibrilleren","vrouwen"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2015.11.050","source_url":"https://doi.org/10.1016/j.jacc.2015.11.050","authors":["Steven J Keteyian","Mahesh Patel","William E Kraus","Clinton A Brawner","Timothy R McConnell","Ileana L Piña","Eric S Leifer","Jerome L Fleg","Gordon Blackburn","Gregg C Fonarow","Paul J Chase","Lucy Piner","Marianne Vest","Christopher M O'Connor","Jonathan K Ehrman","Mary N Walsh","Gregory Ewald","Dan Bensimhon","Stuart D Russell"],"significance":6,"published":"2016-02-23","source_date":"2016-02-23","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/bnp-en-nt-probnp/","https://hartvaat.nl/kennis/hartfalen/echocardiografie-bij-hartfalen/"],"congress":"","summary_en":"This study simultaneously evaluated multiple cardiopulmonary exercise test variables for predicting mortality in chronic systolic heart failure, identifying the most useful prognostic parameters beyond peak oxygen consumption alone.","created":"2026-07-03T10:25:58Z","updated":"2026-07-03T18:38:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die meerdere variabelen uit cardiopulmonale inspanningstesten simultaan vergeleek op prognostische waarde bij chronisch hartfalen. Onderzoekt welke CPX-parameters het sterkst de mortaliteit voorspellen.","abstract_original":"BACKGROUND: Data from a cardiopulmonary exercise (CPX) test are used to determine prognosis in patients with chronic heart failure (HF). However, few published studies have simultaneously compared the relative prognostic strength of multiple CPX variables. OBJECTIVES: The study sought to describe the strength of the association among variables measured during a CPX test and all-cause mortality in patients with HF with reduced ejection fraction (HFrEF), including the influence of sex and patient effort, as measured by respiratory exchange ratio (RER). METHODS: Among patients (n = 2,100, 29% women) enrolled in the HF-ACTION (HF-A Controlled Trial Investigating Outcomes of exercise traiNing) trial, 10 CPX test variables measured at baseline (e.g., peak oxygen uptake [Vo2], exercise duration, percent predicted peak Vo2 [%ppVo2], ventilatory efficiency) were examined. RESULTS: Over a median follow-up of 32 months, there were 357 deaths. All CPX variables, except RER, were related to all-cause mortality (all p < 0.0001). Both %ppVo2 and exercise duration were equally able to predict (Wald chi-square: ∼141) and discriminate (c-index: 0.69) mortality. Peak Vo2 (ml·kg(-1)·min(-1)) was the strongest predictor of mortality among men (Wald chi-square: 129) and exercise duration among women (Wald chi-square: 41). Multivariable analyses showed that %ppVo2, exercise duration, and peak Vo2 (ml·kg(-1)·min(-1)) were similarly able to predict and discriminate mortality. In men, a 10% 1-year mortality rate corresponded to a peak Vo2 of 10.9 ml·kg(-1)·min(-1) versus 5.3 ml·kg(-1)·min(-1) in women. CONCLUSIONS: Peak Vo2, exercise duration, and % ppVo2 carried the strongest ability to predict and discriminate the likelihood of death in patients with HFrEF. The prognosis associated with a given peak Vo2 differed by sex. (Exercise Training Program to Improve Clinical Outcomes in Individuals With Congestive Heart Failure; NCT00047437)."},{"id":"d3894c8ba4dc","type":"article","url":"https://hartvaat.nl/2016/02/23/everolimus-versus-sirolimus-eluting-stents-5-jaarsresultaten-sort-out-iv/","title":"Everolimus- versus sirolimus-eluting stents: 5-jaarsresultaten SORT OUT IV","title_en":"Safety and Efficacy of Everolimus- Versus Sirolimus-Eluting Stents: 5-Year Results From SORT OUT IV.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2015.11.051","source_url":"https://doi.org/10.1016/j.jacc.2015.11.051","authors":["Lisette Okkels Jensen","Per Thayssen","Evald Høj Christiansen","Michael Maeng","Jan Ravkilde","Knud Nørregaard Hansen","Henrik Steen Hansen","Lars Krusell","Anne Kaltoft","Hans Henrik Tilsted","Klara Berencsi","Anders Junker","Jens Flensted Lassen"],"significance":6,"published":"2016-02-23","source_date":"2016-02-23","image":"","kennis":[],"congress":"","summary_en":"Five-year SORT OUT IV results confirmed comparable long-term safety and efficacy between everolimus-eluting and sirolimus-eluting stents, supporting either contemporary DES platform for routine coronary intervention.","created":"2026-07-03T10:25:57Z","updated":"2026-07-03T13:25:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Vijfjaarsresultaten van de SORT OUT IV-trial die everolimus-eluting stents vergeleek met sirolimus-eluting stents. Langetermijndata over veiligheid en effectiviteit van nieuwe versus eerste generatie DES.","abstract_original":"BACKGROUND: Long-term safety and efficacy for everolimus-eluting stents (EES) versus those of sirolimus-eluting stents (SES) are unknown. OBJECTIVES: This study compared 5-year outcomes for EES with those for SES from the SORT OUT IV (Scandinavian Organization for Randomized Trials with Clinical Outcome) trial. METHODS: Five-year follow-up was completed for 2,771 patients (99.9%). Primary endpoint was a composite of major adverse cardiac events (MACE), including cardiac death, myocardial infarction (MI), target vessel revascularization (TVR), and definite stent thrombosis. RESULTS: At 5-years, MACE occurred in 14.0% and 17.4% in the EES and SES groups, respectively (hazard ratio [HR]: 0.80, 95% confidence interval [CI]: 0.66 to 0.97; p = 0.02). The MACE rate did not differ significantly within the first year (HR: 0.96, 95% CI: 0.71 to 1.19; p = 0.79), but from years 1 through 5, the MACE rate was lower with EES (HR: 0.71, 95% CI: 0.55 to 0.90; p = 0.006; p interaction = 0.12). Definite stent thrombosis was lower with EES (0.4%) than with SES (2.0%; HR: 0.18, 95% CI: 0.07 to 0.46), with a lower risk of very late definite stent thrombosis in the EES group (0.2% vs. 1.4%, respectively; HR: 0.16, 95% CI: 0.05 to 0.53). When censoring the patients at the time of stent thrombosis, we found no significant differences between the 2 stent groups for MACE rates (HR: 0.89, 95% CI: 0.73 to 1.08; p = 0.23), target lesion revascularization (HR: 0.90, 95% CI: 0.64 to 1.27; p = 0.55), and MI (HR: 0.93, 95% CI: 0.64 to 1.36; p = 0.72). CONCLUSIONS: At 5-year follow-up, MACE rate was significantly lower with EES- than with SES-treated patients, due largely due to a lower risk of very late definite stent thrombosis. (Randomized Clinical Comparison of the Xience V and the Cypher Coronary Stents in Non-selected Patients With Coronary Heart Disease [SORT OUT IV]; NCT00552877)."},{"id":"3111f8b752a8","type":"article","url":"https://hartvaat.nl/2016/02/16/ticagrelor-versus-clopidogrel-bij-troponine-negatieve-laagrisico-acs-met-ad-hoc-/","title":"Ticagrelor versus clopidogrel bij troponine-negatieve laagrisico-ACS met ad-hoc PCI","title_en":"Effects of Ticagrelor Versus Clopidogrel in Troponin-Negative Patients With Low-Risk ACS Undergoing Ad Hoc PCI.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["trombocytenaggregatieremmers"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2015.11.044","source_url":"https://doi.org/10.1016/j.jacc.2015.11.044","authors":["Dominick J Angiolillo","Francesco Franchi","Ron Waksman","Joseph M Sweeny","Ganesh Raveendran","Renli Teng","Yonggang Zhao","Glenn Carlson","Naeem Khan","Roxana Mehran"],"significance":5,"published":"2016-02-16","source_date":"2016-02-16","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/trombocytenaggregatieremmers-bij-acs/","https://hartvaat.nl/kennis/coronairlijden/dual-antiplatelet-therapy-dapt/"],"congress":"","summary_en":"This pharmacodynamic study compared ticagrelor with clopidogrel in low-risk ACS patients undergoing ad-hoc PCI with negative troponins, evaluating antiplatelet efficacy in the lowest-acuity coronary intervention population.","created":"2026-07-03T10:25:57Z","updated":"2026-07-03T13:25:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de farmacodynamische effecten van ticagrelor versus clopidogrel bij laagrisico ACS-patiënten die een ad-hoc PCI ondergingen zonder voorbehandeling met een P2Y12-remmer.","abstract_original":"BACKGROUND: Many low-risk acute coronary syndrome (ACS) patients are not pre-treated with a P2Y12 receptor inhibitor, and percutaneous coronary interventions (PCIs) are often performed on an ad hoc basis in this population. Pharmacodynamic (PD) studies comparing ticagrelor versus clopidogrel in patients undergoing ad hoc PCI are lacking. OBJECTIVES: This study sought to assess PD effects of ticagrelor versus clopidogrel loading dose (LD) in the peri-procedural period among troponin-negative ACS patients undergoing ad hoc PCI. METHODS: This was a prospective, open-label, randomized, multicenter, parallel-group, phase IV PD study. One hundred P2Y12 inhibitor-naïve patients presenting with biomarker-negative ACS and undergoing ad hoc PCI, on a background of aspirin therapy, were randomized to receive either ticagrelor 180 mg LD or clopidogrel 600 mg LD. Platelet reactivity (P2Y12 reaction units [PRU]; VerifyNow assay) was measured at 5 time points: pre-LD, at 0.5, 2, and 8 h post-LD, and at end of PCI. The primary endpoint was PRU levels 2 h post-LD; secondary endpoints included PRU levels at all other time points and inhibition of platelet aggregation; an exploratory analysis evaluated rates of high on-treatment platelet reactivity (HPR) (PRU >208). RESULTS: At 2 h, PRU levels were significantly lower with ticagrelor versus clopidogrel (98.4 ± 95.4 vs. 257.5 ± 74.5; p < 0.001; primary endpoint). PRU levels diverged as early as 0.5 h post-LD, with significant differences observed by the end of PCI (mean 0.6 h post-LD) and maintained up to 8 h post-LD. HPR rates were also significantly reduced with ticagrelor compared with clopidogrel at the end of PCI (p = 0.030), and at 2 h (p < 0.001) and 8 h (p < 0.001) after LD. CONCLUSIONS: In low-risk ACS patients undergoing ad hoc PCI, ticagrelor LD provides more prompt and potent platelet inhibition, and lower HPR rates, compared with clopidogrel LD. (Ad Hoc Percutaneous Coronary Intervention Study in Acute Coronary Syndrome Patients: NCT01603082)."},{"id":"eac589154cd7","type":"article","url":"https://hartvaat.nl/2016/02/16/bmi-abdominale-adipositas-en-hartfalen-systematische-review-en-dosis-responsmeta/","title":"BMI, abdominale adipositas en hartfalen: systematische review en dosis-responsmeta-analyse","title_en":"Body Mass Index, Abdominal Fatness, and Heart Failure Incidence and Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":["obesitas","vrouwen"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.115.016801","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.115.016801","authors":["Dagfinn Aune","Abhijit Sen","Teresa Norat","Imre Janszky","Pål Romundstad","Serena Tonstad","Lars J Vatten"],"significance":7,"published":"2016-02-16","source_date":"2016-02-16","image":"","kennis":[],"congress":"","summary_en":"This systematic review and dose-response meta-analysis quantified the association between BMI, abdominal fatness, and heart failure incidence and mortality, establishing that both general and central obesity independently predict heart failure risk.","created":"2026-07-03T10:25:57Z","updated":"2026-07-03T13:25:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse van prospectieve studies naar het verband tussen BMI, abdominale adipositas en het risico op hartfalen. Onderzocht of ook overgewicht (niet alleen obesitas) het risico verhoogt.","abstract_original":"BACKGROUND: Obesity has been associated with increased risk of heart failure, but whether overweight also increases risk is unclear. It is also unclear whether abdominal adiposity is more strongly associated with heart failure risk than general adiposity. We conducted a systematic review and meta-analysis of prospective studies to clarify the strength and shape of the dose-response relationship between general and abdominal adiposity and the risk of heart failure. METHODS AND RESULTS: PubMed and Embase databases were searched up to October 10, 2014. Summary relative risks were calculated using random-effects models. A total of 28 studies (27 publications) were included. Twenty-three prospective studies with >15 905 incident cases among 647 388 participants were included in the analysis of body mass index and heart failure incidence, and 4 studies were included for heart failure mortality. The summary relative risk for a 5-unit increment in body mass index was 1.41 (95% confidence interval, 1.34-1.47; I(2)=83%) for heart failure incidence and 1.26 (95% confidence interval, 0.85-1.87; I(2)=95%) heart failure mortality. Although the test for nonlinearity was significant (P<0.0001), this appeared to be attributable to a threshold at a body mass index of ≈23 to 24 kg/m(2); however, there was evidence of increased risk even in the overweight body mass index range. The summary relative risk for a 10-cm increase in waist circumference was 1.29 (95% confidence interval, 1.21-1.37; I(2)=89%) and per 0.1-unit increase in waist-to-hip ratio was 1.29 (95% confidence interval, 1.13-1.47; I(2)=82%). CONCLUSION: Overweight and obesity and abdominal adiposity are associated with increased risk of heart failure."},{"id":"f43bcb247671","type":"article","url":"https://hartvaat.nl/2016/02/14/kortdurend-antiaritmica-na-katheterablatie-voor-atriumfibrilleren-east-af-trial/","title":"Kortdurend antiaritmica na katheterablatie voor atriumfibrilleren: EAST-AF-trial","title_en":"Efficacy of Antiarrhythmic Drugs Short-Term Use After Catheter Ablation for Atrial Fibrillation (EAST-AF) trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["aperitif-trial"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehv501","source_url":"https://doi.org/10.1093/eurheartj/ehv501","authors":["Kazuaki Kaitani","Koichi Inoue","Atsushi Kobori","Yuko Nakazawa","Tomoya Ozawa","Toshiya Kurotobi","Itsuro Morishima","Fumiharu Miura","Tetsuya Watanabe","Masaharu Masuda","Masaki Naito","Hajime Fujimoto","Taku Nishida","Yoshio Furukawa","Takeshi Shirayama","Mariko Tanaka","Katsunori Okajima","Takenori Yao","Yasuyuki Egami","Kazuhiro Satomi","Takashi Noda","Koji Miyamoto","Tetsuya Haruna","Tetsuma Kawaji","Takashi Yoshizawa","Toshiaki Toyota","Mitsuhiko Yahata","Kentaro Nakai","Hiroaki Sugiyama","Yukei Higashi","Makoto Ito","Minoru Horie","Kengo F Kusano","Wataru Shimizu","Shiro Kamakura","Takeshi Morimoto","Takeshi Kimura","Satoshi Shizuta"],"significance":7,"published":"2016-02-14","source_date":"2016-02-14","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/esc-richtlijn-af-2024/"],"congress":"","summary_en":"The EAST-AF trial showed that 90 days of antiarrhythmic drug therapy after catheter ablation for AF did not reduce atrial arrhythmia recurrence at 1 year, questioning the routine use of short-term antiarrhythmic drugs in the post-ablation blanking period.","created":"2026-07-03T10:25:57Z","updated":"2026-07-03T18:38:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial die het nut van 90 dagen antiaritmicagebruik na katheterablatie voor AF onderzocht. Vroege recidieven worden vaak toegeschreven aan irritatie van het linker atrium door de ablatieprocedure zelf.","abstract_original":"AIMS: Substantial portion of early arrhythmia recurrence after catheter ablation for atrial fibrillation (AF) is considered to be due to irritability in left atrium (LA) from the ablation procedure. We sought to evaluate whether 90-day use of antiarrhythmic drug (AAD) following AF ablation could reduce the incidence of early arrhythmia recurrence and thereby promote reverse remodelling of LA, leading to improved long-term clinical outcomes. METHODS AND RESULTS: A total of 2038 patients who had undergone radiofrequency catheter ablation for paroxysmal, persistent, or long-lasting AF were randomly assigned to either 90-day use of Vaughan Williams class I or III AAD (1016 patients) or control (1022 patients) group. The primary endpoint was recurrent atrial tachyarrhythmias lasting for >30 s or those requiring repeat ablation, hospital admission, or usage of class I or III AAD at 1 year, following the treatment period of 90 days post ablation. Patients assigned to AAD were associated with significantly higher event-free rate from recurrent atrial tachyarrhythmias when compared with the control group during the treatment period of 90 days [59.0 and 52.1%, respectively; adjusted hazard ratio (HR) 0.84; 95% confidence interval (CI) 0.73-0.96; P = 0.01]. However, there was no significant difference in the 1-year event-free rates from the primary endpoint between the groups (69.5 and 67.8%, respectively; adjusted HR 0.93; 95% CI 0.79-1.09; P = 0.38). CONCLUSION: Short-term use of AAD for 90 days following AF ablation reduced the incidence of recurrent atrial tachyarrhythmias during the treatment period, but it did not lead to improved clinical outcomes at the later phase."},{"id":"7755bbf33b0a","type":"article","url":"https://hartvaat.nl/2016/02/09/sms-berichten-ter-ondersteuning-van-therapietrouw-bij-hoge-bloeddruk-de-star-tri/","title":"SMS-berichten ter ondersteuning van therapietrouw bij hoge bloeddruk: de StAR-trial","title_en":"Mobile Phone Text Messages to Support Treatment Adherence in Adults With High Blood Pressure (SMS-Text Adherence Support [StAR]): A Single-Blind, Randomized Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["bloeddrukbehandeling","soul-trial"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.115.017530","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.115.017530","authors":["Kirsten Bobrow","Andrew J Farmer","David Springer","Milensu Shanyinde","Ly-Mee Yu","Thomas Brennan","Brian Rayner","Mosedi Namane","Krisela Steyn","Lionel Tarassenko","Naomi Levitt"],"significance":6,"published":"2016-02-09","source_date":"2016-02-09","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/hypertensie/therapietrouw-hypertensie/"],"congress":"","summary_en":"The StAR trial found that automated SMS text messages for treatment adherence support modestly improved blood pressure control in hypertensive patients, demonstrating the potential and limitations of simple mobile health interventions.","created":"2026-07-03T10:25:57Z","updated":"2026-07-03T18:38:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Pragmatische gerandomiseerde trial die het effect onderzocht van geautomatiseerde SMS-herinneringen op bloeddrukcontrole bij patiënten met hypertensie. Onderzoekt digitale interventies voor medicatietrouw.","abstract_original":"BACKGROUND: We assessed the effect of automated treatment adherence support delivered via mobile phone short message system (SMS) text messages on blood pressure. METHODS AND RESULTS: In this pragmatic, single-blind, 3-arm, randomized trial (SMS-Text Adherence Support [StAR]) undertaken in South Africa, patients treated for high blood pressure were randomly allocated in a 1:1:1 ratio to information only, interactive SMS text messaging, or usual care. The primary outcome was change in systolic blood pressure at 12 months from baseline measured with a validated oscillometric device. All trial staff were masked to treatment allocation. Analyses were intention to treat. Between June 26, 2012, and November 23, 2012, 1372 participants were randomized to receive information-only SMS text messages (n=457), interactive SMS text messages (n=458), or usual care (n=457). Primary outcome data were available for 1256 participants (92%). At 12 months, the mean adjusted change in systolic blood pressure compared with usual care was -2.2 mm Hg (95% confidence interval, -4.4 to -0.04) with information-only SMS and -1.6 mm Hg (95% confidence interval, -3.7 to 0.6) with interactive SMS. Odds ratios for the proportion of participants with a blood pressure <140/90 mm Hg were 1.42 (95% confidence interval, 1.03-1.95) for information-only messaging and 1.41 (95% confidence interval, 1.02-1.95) for interactive messaging compared with usual care. CONCLUSIONS: In this randomized trial of an automated adherence support program delivered by SMS text message in a general outpatient population of adults with high blood pressure, we found a small reduction in systolic blood pressure control compared with usual care at 12 months. There was no evidence that an interactive intervention increased this effect. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02019823. South African National Clinical Trials Register, number SANCTR DOH-27-1212-386; Pan Africa Trial Register, number PACTR201411000724141."},{"id":"c3f560945997","type":"article","url":"https://hartvaat.nl/2016/02/09/intensieve-versus-standaard-bloeddrukcontrole-en-nierfunctie-na-lacunair-herseni/","title":"Intensieve versus standaard bloeddrukcontrole en nierfunctie na lacunair herseninfarct","title_en":"Effect of Intensive Versus Usual Blood Pressure Control on Kidney Function Among Individuals With Prior Lacunar Stroke: A Post Hoc Analysis of the Secondary Prevention of Small Subcortical Strokes (SPS3) Randomized Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["abelacimab","acuut-hartfalen","bloeddrukbehandeling","farmaco-economie","fidelio-dkd","flow-trial","myocardinfarct"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.115.019657","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.115.019657","authors":["Carmen A Peralta","Leslie A McClure","Rebecca Scherzer","Michelle C Odden","Carole L White","Michael Shlipak","Oscar Benavente","Pablo Pergola"],"significance":6,"published":"2016-02-09","source_date":"2016-02-09","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/eindorgaanschade-hypertensie/"],"congress":"","summary_en":"This SPS3 post-hoc analysis showed that intensive blood pressure lowering does not accelerate kidney function decline in patients with prior lacunar stroke and preserved eGFR, providing reassurance about renal safety of aggressive BP targets.","created":"2026-07-03T10:25:57Z","updated":"2026-07-03T13:25:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Post-hoc analyse van de SPS3-trial naar het effect van intensieve bloeddrukverlaging op nierfunctie bij patiënten met een lacunair herseninfarct en behouden eGFR. Onderzoekt de renale veiligheid van agressieve bloeddrukbehandeling.","abstract_original":"BACKGROUND: The effect of intensive blood pressure (BP) lowering on kidney function among individuals with established cerebrovascular disease and preserved estimated glomerular filtration rate (eGFR) is not established. METHODS AND RESULTS: Among 2610 participants randomized to a lower (<130 mm Hg) versus higher (130-149 mm Hg) systolic BP target with repeated measures of serum creatinine, we evaluated differences by study arm in annualized eGFR decline and rapid decline (eGFR decline >30%) using linear mixed models and logistic regression, respectively. We assessed associations of both treatment and kidney function decline with stroke, major vascular events, and the composite of stroke, death, major vascular events, or myocardial infarction using multivariable Cox regression, separately and jointly including a test for interaction. Analyses were conducted by treatment arm. Mean age was 63±11 years; 949 participants (36%) were diabetic; and mean eGFR was 80±19 mL·min(-1)·1.73 m(-2). At 9 months, achieved systolic BP was 137±15 versus 127±14 mm Hg in the higher versus lower BP group, and differences were maintained throughout follow-up (mean, 3.2 years). Compared with the higher target, the lower BP target had a -0.50-mL·min(-1)·1.73 m(-2) per year (95% confidence interval [CI], -0.79 to -0.21) faster eGFR decline. Differences were most pronounced during the first year (-2.1 mL·min(-1)·1.73 m(-2); 95% CI, -0.97 to -3.2), whereas rates of eGFR decline did not differ after year 1 (-0.095; 95% CI, -0.47 to 0.23). A total of 313 patients (24%) in the lower BP group had rapid kidney function decline compared with 247 (19%) in the higher BP group (odds ratio, 1.4; 95% CI, 1.1-1.6). Differences in rapid decline by treatment arm were apparent in the first year (odds ratio, 1.4; 95% CI, 1.1-1.8) but were not significant after year 1 (odds ratio, 1.0; 95% CI, 0.73-1.4). Rapid decline was associated with higher risk for stroke, major vascular events, and composite after full adjustment among individuals randomized to the higher BP target (stroke hazard ratio, 1.93; 95% CI, 1.15-3.21) but not the lower BP arm (stroke hazard ratio, 0.93; 95% CI, 0.50-1.75; all P for interaction <0.06). CONCLUSIONS: In patients with prior lacunar stroke and relatively preserved kidney function, intensive BP lowering was associated with a greater likelihood of rapid kidney function decline. Differences were observed primarily during the first year of antihypertensive treatment. Rapid kidney function decline was not associated with increased risk for clinical events among those undergoing intensive BP lowering. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicalTrials.gov. Unique identifier: NCT00059306."},{"id":"4d854f1f2056","type":"article","url":"https://hartvaat.nl/2016/02/09/peergroepinterventie-voor-cardiovasculaire-risicofactoren-de-fifty-fifty-trial/","title":"Peergroepinterventie voor cardiovasculaire risicofactoren: de Fifty-Fifty-trial","title_en":"A Comprehensive Lifestyle Peer Group-Based Intervention on Cardiovascular Risk Factors: The Randomized Controlled Fifty-Fifty Program.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","aperitif-trial","biomarkers-cardiovasculair","diabetes-en-hart","diabetes-type-2","farmaco-economie","fidelity","figaro-dkd","gepersonaliseerde-geneeskunde","hartrevalidatie","inflammatie","menopauze","obesitas","ouderen","pathfinder-trial","richtlijnen-esc","roken","secundaire-preventie","select-trial","slaapapneu","soul-trial","summit-trial"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2015.10.033","source_url":"https://doi.org/10.1016/j.jacc.2015.10.033","authors":["Emilia Gómez-Pardo","Juan Miguel Fernández-Alvira","Marta Vilanova","Domingo Haro","Ramona Martínez","Isabel Carvajal","Vanesa Carral","Carla Rodríguez","Mercedes de Miguel","Patricia Bodega","Gloria Santos-Beneit","Jose Luis Peñalvo","Iñaki Marina","Napoleón Pérez-Farinós","Marian Dal Re","Carmen Villar","Teresa Robledo","Rajesh Vedanthan","Sameer Bansilal","Valentin Fuster"],"significance":6,"published":"2016-02-09","source_date":"2016-02-09","image":"","kennis":["https://hartvaat.nl/kennis/preventie/levenslang-cardiovasculair-risico/","https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/"],"congress":"","summary_en":"This randomized trial demonstrated that a comprehensive lifestyle intervention incorporating peer support achieves significant improvements in cardiovascular risk factors, supporting group-based behavioral change programs for cardiovascular prevention.","created":"2026-07-03T10:25:57Z","updated":"2026-07-03T13:25:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial die een uitgebreide leefstijlinterventie met peersupport onderzocht voor modificatie van cardiovasculaire risicofactoren. Onderzoekt de effectiviteit van groepsgebaseerde preventiestrategieën.","abstract_original":"BACKGROUND: Cardiovascular diseases stem from modifiable risk factors. Peer support is a proven strategy for many chronic illnesses. Randomized trials assessing the efficacy of this strategy for global cardiovascular risk factor modification are lacking. OBJECTIVES: This study assessed the hypothesis that a peer group strategy would help improve healthy behaviors in individuals with cardiovascular risk factors. METHODS: A total of 543 adults 25 to 50 years of age with at least 1 risk factor were recruited; risk factors included hypertension (20%), overweight (82%), smoking (31%), and physical inactivity (81%). Subjects were randomized 1:1 to a peer group-based intervention group (IG) or a self-management control group (CG) for 12 months. Peer-elected leaders moderated monthly meetings involving role-play, brainstorming, and activities to address emotions, diet, and exercise. The primary outcome was mean change in a composite score related to blood pressure, exercise, weight, alimentation, and tobacco (Fuster-BEWAT score, 0 to 15). Multilevel models with municipality as a cluster variable were applied to assess differences between groups. RESULTS: Participants' mean age was 42 ± 6 years, 71% were female, and they had a mean baseline Fuster-BEWAT score of 8.42 ± 2.35. After 1 year, the mean scores were significantly higher in the IG (n = 277) than in the CG (n = 266) (IG mean score: 8.84; 95% confidence interval (CI): 8.37 to 9.32; CG mean score: 8.17; 95% CI: 7.55 to 8.79; p = 0.02). The increase in the overall score was significantly larger in the IG compared with the CG (difference: 0.75; 95% CI: 0.32 to 1.18; p = 0.02). The mean improvement in the individual components was uniformly greater in the IG, with a significant difference for the tobacco component. CONCLUSIONS: The peer group intervention had beneficial effects on cardiovascular risk factors, with significant improvements in the overall score and specifically on tobacco cessation. A follow-up assessment will be performed 1 year after the final assessment reported here to determine long-term sustainability of the improvements associated with peer group intervention. (Peer-Group-Based Intervention Program [Fifty-Fifty]; NCT02367963)."},{"id":"02196c0913b0","type":"article","url":"https://hartvaat.nl/2016/02/09/generaliseerbaarheid-van-sprint-resultaten-naar-de-algemene-bevolking/","title":"Generaliseerbaarheid van SPRINT-resultaten naar de algemene bevolking","title_en":"Generalizability of SPRINT Results to the U.S. Adult Population.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2015.10.037","source_url":"https://doi.org/10.1016/j.jacc.2015.10.037","authors":["Adam P Bress","Rikki M Tanner","Rachel Hess","Lisandro D Colantonio","Daichi Shimbo","Paul Muntner"],"significance":7,"published":"2016-02-09","source_date":"2016-02-09","image":"","kennis":[],"congress":"","summary_en":"This analysis assessed the generalizability of SPRINT results to the broader US adult hypertensive population, estimating how many Americans would be eligible for and potentially benefit from intensive blood pressure treatment.","created":"2026-07-03T10:25:57Z","updated":"2026-07-03T13:25:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse die onderzocht in welke mate de SPRINT-resultaten (intensieve bloeddrukverlaging) generaliseerbaar zijn naar de volwassen bevolking. Essentieel voor de vertaling van trialresultaten naar de klinische praktijk.","abstract_original":"BACKGROUND: In SPRINT (Systolic Blood Pressure Intervention Trial), a systolic blood pressure (SBP) goal of <120 mm Hg resulted in lower cardiovascular disease (CVD) risk compared with an SBP goal of <140 mm Hg. OBJECTIVES: The purpose of this study was to estimate the prevalence, number, and characteristics of U.S. adults meeting SPRINT eligibility criteria and determine the broader population to whom SPRINT could be generalized. METHODS: We conducted a cross-sectional, population-based study using data from the National Health and Nutrition Examination Survey, 2007 to 2012. The SPRINT inclusion criteria were age ≥50 years, SBP 130 to 180 mm Hg depending on the number of antihypertensive medication classes being taken, and high CVD risk (history of coronary heart disease, estimated glomerular filtration rate of 20 to 59 ml/min/1.73 m(2), 10-year CVD risk ≥15%, or age ≥75 years). Exclusion criteria were diabetes, history of stroke, >1 g in 24 h of proteinuria daily, heart failure, estimated glomerular filtration rate <20 ml/min/1.73 m(2), or receiving dialysis. Treated hypertension was defined by self-reported use of medication to lower blood pressure with ≥1 class of antihypertensive medication identified through a pill bottle review. RESULTS: Overall, 7.6% (95% confidence interval [CI]: 7.0% to 8.3%) or 16.8 million (95% CI: 15.7 to 17.8 million) U.S. adults, and 16.7% (95% CI: 15.2% to 18.3%) or 8.2 million (95% CI: 7.6 to 8.8 million) adults with treated hypertension met the SPRINT eligibility criteria. Among both the overall U.S. population and adults with treated hypertension, the percentage meeting SPRINT eligibility criteria increased with older age, was higher among males than females, and was higher among non-Hispanic whites compared with non-Hispanic blacks or Hispanics. Of U.S. adults eligible for SPRINT, 51.0% (95% CI: 47.8% to 54.1%) or 8.6 million (95% CI: 8.0 to 9.1 million) were not treated for hypertension. CONCLUSIONS: A substantial percentage of U.S. adults meet the eligibility criteria for SPRINT."},{"id":"19797ff0b2dc","type":"article","url":"https://hartvaat.nl/2016/02/07/impact-van-pcsk9-remmers-op-lipidenniveaus-en-uitkomsten-netwerkmeta-analyse/","title":"Impact van PCSK9-remmers op lipidenniveaus en uitkomsten: netwerkmeta-analyse","title_en":"The impact of proprotein convertase subtilisin-kexin type 9 serine protease inhibitors on lipid levels and outcomes in patients with primary hypercholesterolaemia: a network meta-analysis.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["dyslipidemie","enlicitide","ezetimibe","farmaco-economie","lipidenverlaging","niet-statine-therapie","pcsk9-remmers","pcsk9-remmers-nieuwe-generatie","statines"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehv563","source_url":"https://doi.org/10.1093/eurheartj/ehv563","authors":["Michael J Lipinski","Umberto Benedetto","Ricardo O Escarcega","Giuseppe Biondi-Zoccai","Thibault Lhermusier","Nevin C Baker","Rebecca Torguson","H Bryan Brewer","Ron Waksman"],"significance":8,"published":"2016-02-07","source_date":"2016-02-07","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/dyslipidemie-overzicht/","https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/"],"congress":"","summary_en":"This network meta-analysis of PCSK9 inhibitor trials quantified the comparative lipid-lowering effects of evolocumab and alirocumab versus placebo and ezetimibe in primary hypercholesterolemia, establishing the magnitude of LDL reduction and early cardiovascular benefit signals.","created":"2026-07-03T10:25:56Z","updated":"2026-07-03T13:25:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Netwerkmeta-analyse van gerandomiseerde trials die PCSK9-remmers vergeleek met placebo en ezetimibe bij primaire hypercholesterolemie. Kwantificeert het effect op LDL-cholesterol en klinische uitkomsten.","abstract_original":"AIMS: We performed a network meta-analysis of randomized controlled trials (RCTs) in patients with primary hypercholesterolaemia to compare the impact of proprotein convertase subtilisin-kexin type 9 serine protease (PCSK9) inhibitors with placebo and ezetimibe on lipid levels and outcomes. METHODS AND RESULTS: MEDLINE/PubMed, Cochrane CENTRAL, and ClinicalTrials.gov were searched for RCTs assessing PCSK9 inhibitors vs. other therapies in patients with primary hypercholesterolaemia. Network meta-analysis with both a frequentist approach and a Bayesian framework was performed to directly and indirectly compare PCSK9 inhibition on lipid levels with ezetimibe and placebo. Odds ratios with 95% confidence intervals (OR [95% CIs]) were generated with random-effects models to compare outcomes. Our meta-analysis included 17 RCTs with 13 083 patients that were randomized to PCSK9 inhibitors (n = 8250), placebo (n = 3957), ezetimibe (n = 846), or PCSK9 inhibitors and ezetimibe (n = 30). The mean age was 59 ± 10, 52% were male, 34% had coronary artery disease, 51% had hypertension, 19% had diabetes mellitus, baseline LDL of 122 ± 36 mg/dL, total cholesterol of 199 ± 39 mg/dL, and HDL of 51 ± 14 mg/dL. inhibitors significantly reduced LDL cholesterol by 57% relative to placebo (P < 0.001) and 36.1% relative to ezetimibe (P < 0.001). Proprotein convertase subtilisin-kexin type 9 serine protease inhibitors reduced the incidence of all-cause mortality [OR 0.43 (95% CI 0.22-0.82), P = 0.01] but was associated with an increased incidence of neurocognitive adverse events [OR 2.34 (95% CI 1.11-4.93), I(2) = 4%, P = 0.02] when compared with placebo. CONCLUSION: Proprotein convertase subtilisin-kexin type 9 serine protease inhibition significantly improved lipid profiles and reduced the incidence of all-cause mortality compared with placebo but had a higher rate of neurocognitive adverse events. Thus, PCSK9 inhibitor therapy may serve as an alternative for patients with statin intolerance and for those who do not respond to other lipid reduction therapy."},{"id":"e5286bb88b18","type":"article","url":"https://hartvaat.nl/2016/02/06/bioresorbeerbare-versus-metallic-stents-meta-analyse-van-gerandomiseerde-trials/","title":"Bioresorbeerbare versus metallic stents: meta-analyse van gerandomiseerde trials","title_en":"Everolimus-eluting bioresorbable vascular scaffolds versus everolimus-eluting metallic stents: a meta-analysis of randomised controlled trials.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(15)00979-4","source_url":"https://doi.org/10.1016/S0140-6736(15)00979-4","authors":["Salvatore Cassese","Robert A Byrne","Gjin Ndrepepa","Sebastian Kufner","Jens Wiebe","Janika Repp","Heribert Schunkert","Massimiliano Fusaro","Takeshi Kimura","Adnan Kastrati"],"significance":7,"published":"2016-02-06","source_date":"2016-02-06","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This meta-analysis of randomized trials comparing bioresorbable scaffolds with metallic everolimus-eluting stents found similar short-term efficacy but raised early safety concerns about scaffold thrombosis that later led to market withdrawal.","created":"2026-07-03T10:25:56Z","updated":"2026-07-03T13:25:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse van gerandomiseerde trials die bioresorbeerbare scaffolds vergeleek met metallic everolimus-eluting stents bij PCI. Onderzocht of bioresorbeerbare technologie vergelijkbare veiligheid en effectiviteit biedt.","abstract_original":"BACKGROUND: Bioresorbable coronary stents might improve outcomes of patients treated with percutaneous coronary interventions. The everolimus-eluting bioresorbable vascular scaffold is the most studied of these stent platforms; however, its performance versus everolimus-eluting metallic stents remains poorly defined. We aimed to assess the efficacy and safety of everolimus-eluting bioresorbable vascular scaffolds versus everolimus-eluting metallic stents in patients with ischaemic heart disease treated with percutaneous revascularisation. METHODS: We searched Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), scientific sessions abstracts, and relevant websites for randomised trials investigating everolimus-eluting bioresorbable vascular scaffolds versus everolimus-eluting metallic stents published or posted between Nov 30, 2006, and Oct 12, 2015. The primary efficacy outcome was target lesion revascularisation and the primary safety outcome was definite or probable stent (scaffold) thrombosis. Secondary outcomes were target lesion failure (the composite of cardiac death, target-vessel myocardial infarction, or ischaemia-driven target lesion revascularisation), myocardial infarction, death, and in-device late lumen loss. We derived odds ratios (ORs) and weighted mean differences with 95% CIs, and calculated the risk estimates for the main outcomes according to a random-effects model. This study is registered with PROSPERO, number CRD42015026374. FINDINGS: We included six trials, comprising data for 3738 patients randomised to receive percutaneous coronary intervention with either an everolimus-eluting bioresorbable vascular scaffold (n=2337) or an everolimus-eluting metallic stent (n=1401). Median follow-up was 12 months (IQR 9-12). Patients treated with bioresorbable vascular scaffolds had a similar risk of target lesion revascularisation (OR 0.97 [95% CI 0.66-1.43]; p=0.87), target lesion failure (1.20 [0.90-1.60]; p=0.21), myocardial infarction (1.36 [0.98-1.89]; p=0.06), and death (0.95 [0.45-2.00]; p=0.89) as those treated with metallic stents. Patients treated with a bioresorbable vascular scaffold had a higher risk of definite or probable stent thrombosis than those treated with a metallic stent (OR 1.99 [95% CI 1.00-3.98]; p=0.05), with the highest risk between 1 and 30 days after implantation (3.11 [1.24-7.82]; p=0.02). Lesions treated with a bioresorbable vascular scaffold had greater in-device late lumen loss than those treated with a metallic stent (weighted mean difference 0.08 [95% CI 0.05-0.12]; p<0.0001). INTERPRETATION: Compared with everolimus-eluting metallic stents, everolimus-eluting bioresorbable vascular scaffolds had similar rates of repeat revascularisation at 1 year of follow-up, despite inferior mid-term angiographic performance. However, patients treated with a bioresorbable vascular scaffold had an increased risk of subacute stent thrombosis. Studies with extended follow-up in a larger number of patients are needed to fully assess the long-term advantages of everolimus-eluting bioresorbable vascular scaffolds. FUNDING: None."},{"id":"a3f34978b064","type":"article","url":"https://hartvaat.nl/2016/02/04/risicoprojectie-voor-nierfalen-bij-levende-nierdonorkandidaten/","title":"Risicoprojectie voor nierfalen bij levende nierdonorkandidaten","title_en":"Kidney-Failure Risk Projection for the Living Kidney-Donor Candidate.","category":"hypertensie","category_label":"Hypertensie","professions":["internist"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1510491","source_url":"https://doi.org/10.1056/NEJMoa1510491","authors":["Morgan E Grams","Yingying Sang","Andrew S Levey","Kunihiro Matsushita","Shoshana Ballew","Alex R Chang","Eric K H Chow","Bertram L Kasiske","Csaba P Kovesdy","Girish N Nadkarni","Varda Shalev","Dorry L Segev","Josef Coresh","Krista L Lentine","Amit X Garg"],"significance":8,"published":"2016-02-04","source_date":"2016-02-04","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This NEJM study developed and validated a kidney-failure risk projection tool for living kidney donor candidates, enabling simultaneous assessment of multiple risk factors for end-stage renal disease. The tool supports evidence-based evaluation of donor candidacy beyond individual risk factor screening.","created":"2026-07-03T10:25:56Z","updated":"2026-07-03T13:25:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM-studie die een empirisch instrument ontwikkelde voor het simultaan beoordelen van risicofactoren voor eindstadium nierziekte bij potentiële levende nierdonoren. Ondersteunt evidence-based donorselectie.","abstract_original":"BACKGROUND: Evaluation of candidates to serve as living kidney donors relies on screening for individual risk factors for end-stage renal disease (ESRD). To support an empirical approach to donor selection, we developed a tool that simultaneously incorporates multiple health characteristics to estimate a person's probable long-term risk of ESRD if that person does not donate a kidney. METHODS: We used risk associations from a meta-analysis of seven general population cohorts, calibrated to the population-level incidence of ESRD and mortality in the United States, to project the estimated long-term incidence of ESRD among persons who do not donate a kidney, according to 10 demographic and health characteristics. We then compared 15-year projections with the observed risk among 52,998 living kidney donors in the United States. RESULTS: A total of 4,933,314 participants from seven cohorts were followed for a median of 4 to 16 years. For a 40-year-old person with health characteristics that were similar to those of age-matched kidney donors, the 15-year projections of the risk of ESRD in the absence of donation varied according to race and sex; the risk was 0.24% among black men, 0.15% among black women, 0.06% among white men, and 0.04% among white women. Risk projections were higher in the presence of a lower estimated glomerular filtration rate, higher albuminuria, hypertension, current or former smoking, diabetes, and obesity. In the model-based lifetime projections, the risk of ESRD was highest among persons in the youngest age group, particularly among young blacks. The 15-year observed risks after donation among kidney donors in the United States were 3.5 to 5.3 times as high as the projected risks in the absence of donation. CONCLUSIONS: Multiple demographic and health characteristics may be used together to estimate the projected long-term risk of ESRD among living kidney-donor candidates and to inform acceptance criteria for kidney donors. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others.)."},{"id":"50d48c86ec56","type":"article","url":"https://hartvaat.nl/2016/02/02/vergelijking-chlorthalidon-en-hydrochloorthiazide-op-24-uurs-ambulante-bloeddruk/","title":"Vergelijking chlorthalidon en hydrochloorthiazide op 24-uurs ambulante bloeddruk","title_en":"Efficacy of Low-Dose Chlorthalidone and Hydrochlorothiazide as Assessed by 24-h Ambulatory Blood Pressure Monitoring.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["diuretica"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2015.10.083","source_url":"https://doi.org/10.1016/j.jacc.2015.10.083","authors":["Anil K Pareek","Franz H Messerli","Nitin B Chandurkar","Shruti K Dharmadhikari","Anil V Godbole","Prasita P Kshirsagar","Manish A Agarwal","Kamal H Sharma","Shyam L Mathur","Mukund M Kumbla"],"significance":7,"published":"2016-02-02","source_date":"2016-02-02","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/bloeddrukmeting-thuismeting-abpm/","https://hartvaat.nl/kennis/hypertensie/ace-remmers-hypertensie/"],"congress":"","summary_en":"This randomized study compared the 24-hour blood pressure-lowering efficacy of low-dose chlorthalidone versus hydrochlorothiazide using ambulatory monitoring, providing comparative pharmacodynamic data for the two most commonly used thiazide-type diuretics.","created":"2026-07-03T10:25:56Z","updated":"2026-07-03T18:38:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde studie die de 24-uurs bloeddrukverlagende effectiviteit vergeleek van lage doseringen chlorthalidon en hydrochloorthiazide. Relevant voor de keuze tussen thiazide-achtige en thiazidediuretica bij hypertensie.","abstract_original":"BACKGROUND: Thiazide and thiazide-like diuretic agents are being increasingly used at lower doses. Hydrochlorothiazide (HCTZ) in the 12.5-mg dose remains the most commonly prescribed antihypertensive agent in the United States. OBJECTIVES: This study compared chlorthalidone, 6.25 mg daily, with HCTZ, 12.5 mg daily, by 24-h ambulatory blood pressure (ABP) monitoring and evaluated efficacy. Because HCTZ has been perceived as a short-acting drug, a third comparison with an extended-release formulation (HCTZ-controlled release [CR]) was added. METHODS: This 12-week comparative, double-blind, outpatient study randomized 54 patients with stage 1 hypertension to receive either chlorthalidone, 6.25 mg, (n = 16); HCTZ 12.5 mg (n = 18); or HCTZ-CR 12.5 mg (n = 20). ABP monitoring was performed at baseline and after 4 and 12 weeks of therapy. RESULTS: All 3 treatments significantly (p < 0.01) lowered office BP at weeks 4 and 12 from baseline. At weeks 4 and 12, significant reductions in systolic and diastolic 24-h ambulatory and nighttime BP (p < 0.01) were observed with chlorthalidone but not with HCTZ. At weeks 4 (p = 0.015) and 12 (p = 0.020), nighttime systolic ABP was significantly lower in the chlorthalidone group than in the the HCTZ group. With HCTZ therapy, sustained hypertension was converted into masked hypertension. In contrast to the HCTZ group, the HCTZ-CR group also showed a significant (p < 0.01) reduction in 24-h ABP. All 3 treatments were generally safe and well tolerated. CONCLUSIONS: Treatment with low-dose chlorthalidone, 6.25 mg daily, significantly reduced mean 24-h ABP as well as daytime and nighttime BP. Due to its short duration of action, no significant 24-h ABP reduction was seen with HCTZ, 12.5 mg daily, which merely converted sustained hypertension into masked hypertension. Thus, low-dose chlorthalidone, 6.25 mg, could be used as monotherapy for treatment of essential hypertension, whereas low-dose HCTZ monotherapy is not an appropriate antihypertensive drug. (Comparative Evaluation of Safety and Efficacy of Hydrochlorothiazide CR with Hydrochlorothiazide and Chlorthalidone in Patients With Stage I Essential Hypertension; CTRI/2013/07/003793)."},{"id":"55677038533e","type":"article","url":"https://hartvaat.nl/2016/02/02/ciclosporine-a-bij-gereperfuseerd-myocardinfarct-de-multicenter-cycle-trial/","title":"Ciclosporine A bij gereperfuseerd myocardinfarct: de multicenter CYCLE-trial","title_en":"Cyclosporine A in Reperfused Myocardial Infarction: The Multicenter, Controlled, Open-Label CYCLE Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["myocardinfarct"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2015.10.081","source_url":"https://doi.org/10.1016/j.jacc.2015.10.081","authors":["Filippo Ottani","Roberto Latini","Lidia Staszewsky","Luigi La Vecchia","Nicola Locuratolo","Marco Sicuro","Serge Masson","Simona Barlera","Valentina Milani","Mario Lombardi","Alessandra Costalunga","Nadia Mollichelli","Andrea Santarelli","Nicoletta De Cesare","Paolo Sganzerla","Alberto Boi","Aldo Pietro Maggioni","Ugo Limbruno"],"significance":6,"published":"2016-02-02","source_date":"2016-02-02","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/revalidatie-na-hartinfarct/"],"congress":"","summary_en":"The CYCLE trial showed that cyclosporine A did not improve ST-segment resolution in patients with reperfused myocardial infarction, adding to the neutral evidence for mitochondrial permeability transition pore inhibition as a cardioprotective strategy.","created":"2026-07-03T10:25:56Z","updated":"2026-07-03T13:25:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde multicenter fase-II-studie die onderzocht of ciclosporine A de ST-segmentresolutie verbetert bij gereperfuseerd myocardinfarct. Onderzoekt het concept van reperfusieschadebeperking.","abstract_original":"BACKGROUND: Whether cyclosporine A (CsA) has beneficial effects in reperfused myocardial infarction (MI) is debated. OBJECTIVES: This study investigated whether CsA improved ST-segment resolution in a randomized, multicenter phase II study. METHODS: The authors randomly assigned 410 patients from 31 cardiac care units, age 63 ± 12 years, with large ST-segment elevation MI within 6 h of symptom onset, Thrombolysis In Myocardial Infarction (TIMI) flow grade 0 to 1 in the infarct-related artery, and committed to primary percutaneous coronary intervention, to 2.5 mg/kg intravenous CsA (n = 207) or control (n = 203) groups. The primary endpoint was incidence of ≥70% ST-segment resolution 60 min after TIMI flow grade 3. Secondary endpoints included high-sensitivity cardiac troponin T (hs-cTnT) on day 4, left ventricular (LV) remodeling, and clinical events at 6-month follow-up. RESULTS: Time from symptom onset to first antegrade flow was 180 ± 67 min; a median of 5 electrocardiography leads showed ST-segment deviation (quartile [Q]1 to Q3: 4 to 6); 49.8% of MIs were anterior. ST-segment resolution ≥70% was found in 52.0% of CsA patients and 49.0% of controls (p = 0.55). Median hs-cTnT on day 4 was 2,160 (Q1 to Q3: 1,087 to 3,274) ng/l in CsA and 2,068 (1,117 to 3,690) ng/l in controls (p = 0.85). The 2 groups did not differ in LV ejection fraction on day 4 and at 6 months. Infarct site did not influence CsA efficacy. There were no acute allergic reactions or nonsignificant excesses of 6-month mortality (5.7% CsA vs. 3.2% controls, p = 0.17) or cardiogenic shock (2.4% CsA vs. 1.5% controls, p = 0.33). CONCLUSIONS: In the CYCLE (CYCLosporinE A in Reperfused Acute Myocardial Infarction) trial, a single intravenous CsA bolus just before primary percutaneous coronary intervention had no effect on ST-segment resolution or hs-cTnT, and did not improve clinical outcomes or LV remodeling up to 6 months. (CYCLosporinE A in Reperfused Acute Myocardial Infarction [CYCLE]; NCT01650662; EudraCT number 2011-002876-18)."},{"id":"3190eab830e5","type":"article","url":"https://hartvaat.nl/2016/02/02/reductie-in-totale-cardiovasculaire-events-met-ezetimibe-simvastatine-na-acs-imp/","title":"Reductie in totale cardiovasculaire events met ezetimibe/simvastatine na ACS: IMPROVE-IT","title_en":"Reduction in Total Cardiovascular Events With Ezetimibe/Simvastatin Post-Acute Coronary Syndrome: The IMPROVE-IT Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["acuut-coronair-syndroom","biomarkers-cardiovasculair","clear-outcomes","diabetes-type-2","ezetimibe","farmaco-economie","hdl-cholesterol","inflammatie","lipidenverlaging","niet-statine-therapie","ouderen","roken","rosuvastatine","secundaire-preventie","statines"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2015.10.077","source_url":"https://doi.org/10.1016/j.jacc.2015.10.077","authors":["Sabina A Murphy","Christopher P Cannon","Michael A Blazing","Robert P Giugliano","Jennifer A White","Yuliya Lokhnygina","Craig Reist","KyungAh Im","Erin A Bohula","Daniel Isaza","Jose Lopez-Sendon","Mikael Dellborg","Uma Kher","Andrew M Tershakovec","Eugene Braunwald"],"significance":9,"published":"2016-02-02","source_date":"2016-02-02","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ezetimib/","https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/"],"congress":"","summary_en":"This IMPROVE-IT analysis demonstrated a significant reduction in total cardiovascular events with ezetimibe added to simvastatin versus simvastatin alone after acute coronary syndrome. The results strengthened the evidence that LDL cholesterol lowering beyond statin monotherapy provides incremental clinical benefit.","created":"2026-07-03T10:25:56Z","updated":"2026-07-03T13:25:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de IMPROVE-IT-trial die een significante reductie in totale cardiovasculaire events aantoonde met ezetimibe/simvastatine bij patiënten na een acuut coronair syndroom. Bevestigt het principe van 'lager is beter' voor LDL-cholesterol.","abstract_original":"BACKGROUND: Intensive low-density lipoprotein cholesterol therapy with ezetimibe/simvastatin in IMPROVE-IT (IMProved Reduction of Outcomes: Vytorin Efficacy International Trial) significantly reduced the first primary endpoint (PEP) in patients post-acute coronary syndrome (ACS) compared to placebo/simvastatin. OBJECTIVES: This analysis tested the hypothesis that total events, including those beyond the first event, would also be reduced with ezetimibe/simvastatin therapy. METHODS: All PEP events (cardiovascular [CV] death, myocardial infarction [MI], stroke, unstable angina [UA] leading to hospitalization, coronary revascularization ≥30 days post-randomization) during a median 6-year follow-up were analyzed in patients randomized to receive ezetimibe/simvastatin or placebo/simvastatin in IMPROVE-IT. Negative binomial regression was used for the primary analysis. RESULTS: Among 18,144 patients, there were 9,545 total PEP events (56% were first events and 44% subsequent events). Total PEP events were significantly reduced by 9% with ezetimibe/simvastatin vs placebo/simvastatin (incidence-rate ratio [RR]: 0.91; 95% confidence interval [CI]: 0.85 to 0.97; p = 0.007), as were the 3 pre-specified secondary composite endpoints and the exploratory composite endpoint of CV death, MI, or stroke (RR: 0.88; 95% CI: 0.81 to 0.96; p = 0.002). The reduction in total events was driven by decreases in total nonfatal MI (RR: 0.87; 95% CI: 0.79 to 0.96; p = 0.004) and total NF stroke (RR: 0.77; 95% CI: 0.65 to 0.93; p = 0.005). CONCLUSIONS: Lipid-lowering therapy with ezetimibe plus simvastatin improved clinical outcomes. Reductions in total PEP events, driven by reductions in MI and stroke, more than doubled the number of events prevented compared with examining only the first event. These data support continuation of intensive combination lipid-lowering therapy after an initial CV event. (IMProved Reduction of Outcomes: Vytorin Efficacy International Trial [IMPROVE-IT]; NCT00202878)."},{"id":"85d2d994ab89","type":"article","url":"https://hartvaat.nl/2016/02/02/aerobe-intervaltraining-vermindert-de-last-van-atriumfibrilleren-gerandomiseerde/","title":"Aerobe intervaltraining vermindert de last van atriumfibrilleren: gerandomiseerde trial","title_en":"Aerobic Interval Training Reduces the Burden of Atrial Fibrillation in the Short Term: A Randomized Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":["atleten","hartrevalidatie"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.115.018220","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.115.018220","authors":["Vegard Malmo","Bjarne M Nes","Brage H Amundsen","Arnt-Erik Tjonna","Asbjorn Stoylen","Ole Rossvoll","Ulrik Wisloff","Jan P Loennechen"],"significance":7,"published":"2016-02-02","source_date":"2016-02-02","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This randomized trial showed that aerobic interval training significantly reduces AF burden in patients with atrial fibrillation, despite the paradoxical association between high-level endurance exercise and AF. The results support structured exercise as a therapeutic intervention for AF.","created":"2026-07-03T10:25:56Z","updated":"2026-07-03T18:38:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial die aantoonde dat aerobe intervaltraining de AF-last significant kan verminderen, ondanks dat intensieve duursporten geassocieerd zijn met een hogere AF-prevalentie. Inspanningstraining als therapeutische interventie bij AF.","abstract_original":"BACKGROUND: Exercise training is an effective treatment for important atrial fibrillation (AF) comorbidities. However, a high level of endurance exercise is associated with an increased AF prevalence. We assessed the effects of aerobic interval training (AIT) on time in AF, AF symptoms, cardiovascular health, and quality of life in AF patients. METHODS AND RESULTS: Fifty-one patients with nonpermanent AF were randomized to AIT (n=26) consisting of four 4-minute intervals at 85% to 95% of peak heart rate 3 times a week for 12 weeks or to a control group (n=25) continuing their regular exercise habits. An implanted loop recorder measured time in AF continuously from 4 weeks before to 4 weeks after the intervention period. Cardiac function, peak oxygen uptake (o2peak), lipid status, quality of life, and AF symptoms were evaluated before and after the 12-week intervention period. Mean time in AF increased from 10.4% to 14.6% in the control group and was reduced from 8.1% to 4.8% in the exercise group (P=0.001 between groups). AF symptom frequency (P=0.006) and AF symptom severity (P=0.009) were reduced after AIT. AIT improved o2peak, left atrial and ventricular ejection fraction, quality-of-life measures of general health and vitality, and lipid values compared with the control group. There was a trend toward fewer cardioversions and hospital admissions after AIT. CONCLUSIONS: AIT for 12 weeks reduces the time in AF in patients with nonpermanent AF. This is followed by a significant improvement in AF symptoms, o2peak, left atrial and ventricular function, lipid levels, and QoL. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01325675."},{"id":"f0af82065f2b","type":"article","url":"https://hartvaat.nl/2016/02/01/regionale-hartdisfunctie-en-prognose-na-myocardinfarct-met-lv-disfunctie-of-hart/","title":"Regionale hartdisfunctie en prognose na myocardinfarct met LV-disfunctie of hartfalen","title_en":"Regional cardiac dysfunction and outcome in patients with left ventricular dysfunction, heart failure, or both after myocardial infarction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","hfmref","hfpef","hfref","laminopathie","myocardinfarct","nt-probnp","troponine"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehv558","source_url":"https://doi.org/10.1093/eurheartj/ehv558","authors":["Na Wang","Chung-Lieh Hung","Sung-Hee Shin","Brian Claggett","Hicham Skali","Jens Jakob Thune","Lars Køber","Amil Shah","John J V McMurray","Marc A Pfeffer","Scott D Solomon"],"significance":5,"published":"2016-02-01","source_date":"2016-02-01","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/speckle-tracking-strain/","https://hartvaat.nl/kennis/hartfalen/echocardiografie-bij-hartfalen/"],"congress":"","summary_en":"This study showed that regional myocardial strain assessed by speckle tracking echocardiography provides incremental prognostic value beyond global LVEF and strain measures in patients with LV dysfunction and heart failure.","created":"2026-07-03T10:25:56Z","updated":"2026-07-03T18:38:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die naast globale LV-functiematen ook regionale myocardiale strain onderzocht als voorspeller van uitkomsten bij patiënten met LV-disfunctie of hartfalen na een myocardinfarct.","abstract_original":"AIMS: Global measures of left ventricular (LV) function, in particular LV ejection fraction (LVEF) and global myocardial strain measures, are powerful predictors of outcomes in patients with LV dysfunction, heart failure, or both. However, less is known about the relationship between regional myocardial function, especially that assessed by strain echocardiography and clinical prognosis. METHODS AND RESULTS: We studied 248 patients with LV dysfunction, heart failure, or both 5 days after first myocardial infarction (MI) from the VALIANT study. We assessed peak longitudinal strain (LS) via B-mode speckle tracking in 12 segments from the apical 4- and 2-chamber views and visually assessed LV wall motion score (WMS). We related these measures of regional myocardial function to each other and to clinical outcomes over 20-month follow-up. Normal reference values for segmental LS were derived from 50 healthy controls. Regional LS (-7.7%, Q1: -11.2%, Q3: -4.9%) was worse in segments with abnormal WMS, although was significantly impaired even in segments scored as normokinetic compared with normal controls (-10.4 ± 5.2% vs. -20.0 ± 7.6%, P < 0.001). In multivariable Cox proportional hazards models, each additional abnormal LS segment was associated with an increased risk of all-cause mortality (hazard ratio: 1.42, 95% confidence interval: 1.06-1.90, P = 0.02) even after adjustment for clinical covariates, including LVEF, LV end-systolic volume, and number of abnormal segments by WMS. CONCLUSION: In patients with LV dysfunction, heart failure, or both after MI, regional LS is significantly depressed even in segments with normal WMS, and this measure was related to adverse outcome."},{"id":"a8219e6306bb","type":"article","url":"https://hartvaat.nl/2016/02/01/rechterkamerseptumpacing-versus-apexpacing-bij-crt-defibrillator-gerandomiseerde/","title":"Rechterkamerseptumpacing versus apexpacing bij CRT-defibrillator: gerandomiseerde trial","title_en":"Comparison of right ventricular septal pacing and right ventricular apical pacing in patients receiving cardiac resynchronization therapy defibrillators: the SEPTAL CRT Study.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehv422","source_url":"https://doi.org/10.1093/eurheartj/ehv422","authors":["Christophe Leclercq","Nicolas Sadoul","Lluis Mont","Pascal Defaye","Joaquim Osca","Elisabeth Mouton","Richard Isnard","Gilbert Habib","Jose Zamorano","Genevieve Derumeaux","Ignacio Fernandez-Lozano"],"significance":6,"published":"2016-02-01","source_date":"2016-02-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-farmacologie/"],"congress":"","summary_en":"This randomized study compared right ventricular septal with apical lead positioning in CRT patients, evaluating whether lead location optimization in the right ventricle improves resynchronization outcomes.","created":"2026-07-03T10:25:56Z","updated":"2026-07-03T13:25:17Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde studie die de optimale positie van de rechterkamerlead bij CRT-patiënten onderzocht. Vergeleek septumpacing met de traditionele apexpositie op klinische en echocardiografische uitkomsten.","abstract_original":"AIMS: Cardiac resynchronization therapy (CRT) is a recommended treatment of heart failure (HF) patients with depressed left ventricular ejection fraction and wide QRS. The optimal right ventricular (RV) lead position being a matter of debate, we sought to examine whether RV septal (RVS) pacing was not inferior to RV apical (RVA) pacing on left ventricular reverse remodelling in patients receiving a CRT-defibrillator. METHODS AND RESULTS: Patients (n = 263, age = 63.4 ± 9.5 years) were randomly assigned in a 1:1 ratio to RVS (n = 131) vs. RVA (n = 132) pacing. Left ventricular end-systolic volume (LVESV) reduction between baseline and 6 months was not different between the two groups (-25.3 ± 39.4 mL in RVS group vs. -29.3 ± 44.5 mL in RVA group, P = 0.79). Right ventricular septal pacing was not non-inferior (primary endpoint) to RVA pacing with regard to LVESV reduction (average difference = -4.06 mL; P = 0.006 with a -20 mL non-inferiority margin). The percentage of 'echo-responders' defined by LVESV reduction >15% between baseline and 6 months was similar in both groups (50%) with no difference in the time to first HF hospitalization or death (P = 0.532). Procedural or device-related serious adverse events occurred in 68 patients (RVS = 37) with no difference between the two groups (P = 0.401). CONCLUSION: This study demonstrates that septal RV pacing in CRT is non-inferior to apical RV pacing for LV reverse remodelling at 6 months with no difference in the clinical outcome. No recommendation for optimal RV lead position can hence be drawn from this study. CLINICALTRIALS GOV NUMBER: NCT 00833352."},{"id":"1ae0cc45eeca","type":"article","url":"https://hartvaat.nl/2016/02/01/invloed-van-ejectiefractie-op-uitkomsten-van-spironolacton-bij-hfpef/","title":"Invloed van ejectiefractie op uitkomsten van spironolacton bij HFpEF","title_en":"Influence of ejection fraction on outcomes and efficacy of spironolactone in patients with heart failure with preserved ejection fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","bloeddrukbehandeling","dapa-hf","echocardiografie","hfmref","hfpef","hfref","step-hfpef","summit-trial"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehv464","source_url":"https://doi.org/10.1093/eurheartj/ehv464","authors":["Scott D Solomon","Brian Claggett","Eldrin F Lewis","Akshay Desai","Inder Anand","Nancy K Sweitzer","Eileen O'Meara","Sanjiv J Shah","Sonja McKinlay","Jerome L Fleg","George Sopko","Bertram Pitt","Marc A Pfeffer"],"significance":7,"published":"2016-02-01","source_date":"2016-02-01","image":"","kennis":[],"congress":"","summary_en":"This subanalysis explored spironolactone efficacy in HFpEF patients stratified by ejection fraction, finding that benefit may be concentrated in those with lower LVEF within the preserved range, informing the debate about MRA use in HFpEF.","created":"2026-07-03T10:25:55Z","updated":"2026-07-03T18:38:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse die de werkzaamheid van spironolacton onderzocht bij HFpEF-patiënten gestratificeerd naar ejectiefractie. Hoewel de primaire TOPCAT-trial geen significant voordeel toonde, suggereert deze analyse differentiële effecten afhankelijk van de LVEF.","abstract_original":"AIMS: While mineralocorticoid receptor antagonists (MRAs) have been shown to benefit patients with reduced left ventricular ejection fraction (LVEF), spironolactone did not reduce the primary endpoint of cardiovascular death, heart failure hospitalization, or aborted cardiac arrest in patients with heart failure with preserved ejection fraction (HFpEF) in the TOPCAT trial, which enrolled patients with LVEF of 45% or greater. We utilized data from TOPCAT to assess the relationship between LVEF as well as outcomes and efficacy of spironolactone. METHODS AND RESULTS: We assessed differences in baseline characteristics and outcomes across LVEF categories in 3444 patients with HFpEF, and determined whether LVEF modified the treatment effect of spironolactone. Ejection fraction ranged from 44 to 85%. Patients with higher ejection fraction were older, more likely to be female, less likely to have a history of myocardial infarction, and more likely to have a history of hypertension and diabetes. The incidence of the primary endpoint and cardiovascular death was highest in patients at the lower end of the ejection fraction spectrum. Ejection fraction modified the spironolactone treatment effect, particularly in the patients enrolled in the Americas, for the primary outcome (P = 0.046) and for heart failure hospitalization (P = 0.039), with stronger estimated benefits of spironolactone at the lower end of the ejection fraction spectrum with respect to the primary endpoint (LVEF <50%: HR 0.72, 95% CI 0.50, 1.05; LVEF ≥60%: HR 0.97, 95% CI 0.76, 1.23) and heart failure hospitalization (LVEF <50%: HR 0.76, 95% CI 0.46, 1.27; LVEF ≥60%: HR 0.98, 95% CI 0.74, 1.30). CONCLUSION: In patients with HFpEF enrolled in TOPCAT, patient characteristics and outcomes varied substantially by LVEF. The potential efficacy of spironolactone was greatest at the lower end of the LVEF spectrum. CLINICALTRIALSGOV NUMBER: NCT00094302."},{"id":"60aca5a95165","type":"article","url":"https://hartvaat.nl/2016/02/01/peri-infarctpacing-ter-preventie-van-linkerkamerremodellering-na-groot-myocardin/","title":"Peri-infarctpacing ter preventie van linkerkamerremodellering na groot myocardinfarct","title_en":"Peri-infarct zone pacing to prevent adverse left ventricular remodelling in patients with large myocardial infarction.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["linkerbundeltakpacing","myocardinfarct","ouderen","secundaire-preventie"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehv436","source_url":"https://doi.org/10.1093/eurheartj/ehv436","authors":["Gregg W Stone","Eugene S Chung","Branislav Stancak","Jesper H Svendsen","Trent M Fischer","Fred Kueffer","Thomas Ryan","Jeroen Bax","Angel Leon"],"significance":5,"published":"2016-02-01","source_date":"2016-02-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This randomized study of peri-infarct zone pacing in patients with large MI tested whether localized electrical stimulation prevents adverse LV remodeling, exploring a novel device-based approach to limit post-infarction heart failure.","created":"2026-07-03T10:25:55Z","updated":"2026-07-03T18:38:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde studie bij 126 patiënten met een groot eerste myocardinfarct die onderzocht of pacing in de peri-infarctzône linkerkamerremodellering en klinische uitkomsten kan verbeteren.","abstract_original":"AIMS: We sought to determine whether peri-infarct pacing prevents left ventricular (LV) remodelling and improves functional and clinical outcomes in patients with large first myocardial infarction (MI). METHODS AND RESULTS: A total of 126 patients at 27 international sites within 10 days of onset of anterior or non-anterior MI with creatine phosphokinase >3000 U/L and QRS duration ≤120 ms were randomized 1:1:1 to dual-site biventricular pacing vs. single-site LV only pacing vs. non-implanted control. The primary endpoint was the echocardiographic core laboratory-assessed change in LV end-diastolic volume (ΔLVEDV) from baseline to 18 months between the pooled pacing therapy groups and the control group. ΔLVEDV increased by 15.3 ± 28.6 mL in the control group and by 16.7 ± 30.5 mL in the pooled pacing groups during follow-up (adjusted mean difference (95% CI) = 0.6 (-12.3, 13.5) mL, P = 0.92). There were also no significant between-group differences in the change in LV end-systolic volume or ejection fraction over time. Quality of life, as assessed by the Minnesota Living with Heart Failure (HF) and European Quality of Life-5 Dimension questionnaires and New York Heart Association class, was also similar between groups during 18-month follow-up. Six-minute walk distance improved during follow-up to an equal degree between groups, and there were no significant differences in the 18-month rates of death or HF hospitalization between the pooled pacing therapy vs. control groups (17.4 vs. 21.7% respectively, P = 0.59). CONCLUSIONS: In the present multicentre, randomized trial, peri-infarct pacing did not prevent LV remodelling or improve functional or clinical outcomes during 18-month follow-up in patients with large first MI. CLINICALTRIALSGOV IDENTIFIER: NCT01213251."},{"id":"fd17f1eefa1a","type":"article","url":"https://hartvaat.nl/2016/02/01/sprint-resultaten-en-implicaties-voor-de-nefrologie/","title":"SPRINT-resultaten en implicaties voor de nefrologie","title_en":"A SPRINT to the finish, or just the beginning? Implications of the SPRINT results for nephrologists.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["atleten","ouderen","stride-trial"],"journal":"Kidney international","doi":"10.1016/j.kint.2015.12.024","source_url":"https://doi.org/10.1016/j.kint.2015.12.024","authors":["Michael V Rocco","Alfred K Cheung"],"significance":7,"published":"2016-02-01","source_date":"2016-02-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/"],"congress":"","summary_en":"This analysis assessed the implications of SPRINT results for nephrology practice, discussing how intensive blood pressure control affects kidney outcomes and the balance of cardiovascular benefit versus renal risk in CKD patients.","created":"2026-07-03T10:25:55Z","updated":"2026-07-03T13:25:17Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de SPRINT-trial vanuit nefrologisch perspectief. Intensieve bloeddrukcontrole reduceerde cardiovasculaire events en mortaliteit significant, ook bij patiënten met chronische nierziekte. Bespreekt implicaties voor de nefrologische praktijk.","abstract_original":"The Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated a significant reduction in major cardiovascular events and all-cause mortality with intensive blood pressure control in older individuals at high cardiovascular risk, including patients with chronic kidney disease and mild proteinuria. Nephrologists should consider the SPRINT results when determining the optimal blood pressure target for patients with chronic kidney disease."},{"id":"6f0eb157008c","type":"article","url":"https://hartvaat.nl/2016/02/01/spironolacton-versus-renale-denervatie-bij-therapieresistente-hypertensie-prague/","title":"Spironolacton versus renale denervatie bij therapieresistente hypertensie: PRAGUE-15 1-jaarsresultaten","title_en":"Role of Adding Spironolactone and Renal Denervation in True Resistant Hypertension: One-Year Outcomes of Randomized PRAGUE-15 Study.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["radiance-htn","renale-denervatie","resistente-hypertensie","resistente-hypertensie-aldosteronremmers"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.115.06526","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.115.06526","authors":["Ján Rosa","Petr Widimský","Petr Waldauf","Lukáš Lambert","Tomáš Zelinka","Miloš Táborský","Marian Branny","Petr Toušek","Ondřej Petrák","Karol Čurila","František Bednář","Robert Holaj","Branislav Štrauch","Jan Václavík","Igor Nykl","Zuzana Krátká","Eva Kociánová","Otakar Jiravský","Gabriela Rappová","Tomáš Indra","Jiří Widimský"],"significance":7,"published":"2016-02-01","source_date":"2016-02-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/mineralocorticoid-antagonisten-hypertensie/"],"congress":"","summary_en":"This randomized study compared renal denervation with spironolactone addition in patients with true resistant hypertension, providing the first head-to-head comparison of device-based versus pharmacological fourth-line antihypertensive strategies.","created":"2026-07-03T10:25:55Z","updated":"2026-07-03T13:25:17Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde multicenter studie die renale denervatie vergeleek met spironolactontoevoeging bij patiënten met echte therapieresistente hypertensie. Een van de eerste trials die deze twee strategieën direct vergeleek.","abstract_original":"This randomized, multicenter study compared the relative efficacy of renal denervation (RDN) versus pharmacotherapy alone in patients with true resistant hypertension and assessed the effect of spironolactone addition. We present here the 12-month data. A total of 106 patients with true resistant hypertension were enrolled in this study: 52 patients were randomized to RDN and 54 patients to the spironolactone addition, with baseline systolic blood pressure of 159±17 and 155±17 mm Hg and average number of drugs 5.1 and 5.4, respectively. Twelve-month results are available in 101 patients. The intention-to-treat analysis found a comparable mean 24-hour systolic blood pressure decline of 6.4 mm Hg, P=0.001 in RDN versus 8.2 mm Hg, P=0.002 in the pharmacotherapy group. Per-protocol analysis revealed a significant difference of 24-hour systolic blood pressure decline between complete RDN (6.3 mm Hg, P=0.004) and the subgroup where spironolactone was added, and this continued within the 12 months (15 mm Hg, P= 0.003). Renal artery computed tomography angiograms before and after 1 year post-RDN did not reveal any relevant changes. This study shows that over a period of 12 months, RDN is safe, with no serious side effects and no major changes in the renal arteries. RDN in the settings of true resistant hypertension with confirmed compliance is not superior to intensified pharmacological treatment. Spironolactone addition (if tolerated) seems to be more effective in blood pressure reduction."},{"id":"4e81c6d4f2aa","type":"article","url":"https://hartvaat.nl/2016/02/01/mineralocorticoidreceptoractivatie-draagt-bij-aan-supiene-hypertensie-bij-autono/","title":"Mineralocorticoïdreceptoractivatie draagt bij aan supiene hypertensie bij autonoom falen","title_en":"Mineralocorticoid Receptor Activation Contributes to the Supine Hypertension of Autonomic Failure.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["baxdrostat","bloeddrukbehandeling","lorundrostat","mra-aldosteronantagonisten","ras-remmers","resistente-hypertensie","resistente-hypertensie-aldosteronremmers"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.115.06617","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.115.06617","authors":["Amy C Arnold","Luis E Okamoto","Alfredo Gamboa","Bonnie K Black","Satish R Raj","Fernando Elijovich","David Robertson","Cyndya A Shibao","Italo Biaggioni"],"significance":5,"published":"2016-02-01","source_date":"2016-02-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/aldosteron-en-raas-farmacologie/","https://hartvaat.nl/kennis/hypertensie/pathofysiologie-hypertensie/"],"congress":"","summary_en":"This study showed that mineralocorticoid receptor activation contributes to paradoxical supine hypertension in primary autonomic failure, identifying a therapeutic target for this challenging condition.","created":"2026-07-03T10:25:55Z","updated":"2026-07-03T18:38:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die aantoont dat het renine-angiotensine-aldosteronsysteem bijdraagt aan de paradoxale supiene hypertensie bij primair autonoom falen. Mineralocorticoïdreceptorblokkade kan een therapeutische optie zijn.","abstract_original":"Primary autonomic failure is characterized by disabling orthostatic hypotension, but at least half of these patients have paradoxical supine hypertension. Renin-angiotensin mechanisms were not initially thought to contribute to this hypertension because plasma renin activity is often undetectable in autonomic failure. Plasma aldosterone levels are normal, however, and we recently showed that plasma angiotensin II is elevated and acts at AT1 (angiotensin type 1) receptors to contribute to hypertension in these patients. Because aldosterone and angiotensin II can also bind mineralocorticoid receptors to elevate blood pressure, we hypothesized that mineralocorticoid receptor activation plays a role in the hypertension of autonomic failure. To test this hypothesis, we determined the acute effects of the mineralocorticoid receptor antagonist eplerenone (50 mg, oral) versus placebo on supine blood pressure in a randomized, double-blind, crossover study. Medications were given at 8:00 pm with blood pressure recorded every 2 hours for 12 hours. Ten primary autonomic failure patients with supine hypertension completed this study (7 pure autonomic failure, 2 multiple system atrophy, 1 parkinson's disease; 7 male; 70±2 years of age). Eplerenone maximally reduced supine systolic blood pressure by 32±6 mm Hg at 8 hours after administration (versus 8±10 mm Hg placebo, P=0.016), with no effect on nocturia (12-hour urine volume: 985±134 mL placebo versus 931±94 mL eplerenone, P=0.492; nocturnal weight loss: -1.19±0.15 kg placebo versus -1.18±0.15 kg eplerenone, P=0.766). These findings suggest that inappropriate mineralocorticoid receptor activation contributes to the hypertension of autonomic failure, likely independent of canonical mineralocorticoid effects, and provides rationale for use of eplerenone in these patients."},{"id":"af75f31ee19d","type":"article","url":"https://hartvaat.nl/2016/02/01/betablokkers-met-en-zonder-vasodilaterende-eigenschappen-en-centrale-bloeddruk-m/","title":"Bètablokkers met en zonder vasodilaterende eigenschappen en centrale bloeddruk: meta-analyse","title_en":"Effects of β-Blockers With and Without Vasodilating Properties on Central Blood Pressure: Systematic Review and Meta-Analysis of Randomized Trials in Hypertension.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["aldosteronsynthaseremmers","angiotensinereceptorblokkers","baxdrostat","betablokkers","bisoprolol","bloeddrukbehandeling","carvedilol","ezetimibe","fidelity","lorundrostat","metoprolol","ras-remmers","resistente-hypertensie-aldosteronremmers","statines","tirzepatide","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.115.06467","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.115.06467","authors":["Giacomo Pucci","Maria Giovanna Ranalli","Francesca Battista","Giuseppe Schillaci"],"significance":6,"published":"2016-02-01","source_date":"2016-02-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/centrale-middelen-hypertensie/"],"congress":"","summary_en":"This systematic review and meta-analysis showed that vasodilating beta-blockers (nebivolol, carvedilol) lower central blood pressure more effectively than traditional beta-blockers, suggesting differential vascular effects within the drug class.","created":"2026-07-03T10:25:55Z","updated":"2026-07-03T18:38:20Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse die onderzocht of vasodilaterende bètablokkers de centrale systolische bloeddruk effectiever verlagen dan niet-vasodilaterende bètablokkers. Relevant voor de keuze van antihypertensiva.","abstract_original":"β-Blockers are less effective than other antihypertensive drug classes in reducing central systolic blood pressure (cSBP) as compared with peripheral SBP (pSBP). Whether this effect is less pronounced with vasodilating β-blockers (VBB) when compared with nonvasodilating β-blockers (NVBB) remains unsettled. We conducted a systematic review and meta-analysis of randomized trials exploring the effects of β-blockers on both pSBP and cSBP in hypertension. We selected 20 studies, for a total of 32 treatment arms (n=21 for NVBB, n=11 for VBB) and 1263 participants (n=962 for NVBB, n=301 for VBB). pSBP decreased from 150 to 133 mm Hg for NVBB and from 145 to 134 mm Hg for VBB. cSBP decreased from 137 to 126 mm Hg for NVBB and from 132 to 123 mm Hg for VBB. SBP amplification (pSBP-cSBP) decreased significantly under VBB (-5.6 mm Hg; 95% confidence interval, -7.8, -3.4 mm Hg), but not under NVBB (-1.1 mm Hg; 95% confidence interval, -3.4, +1.2 mm Hg; P<0.01 versus NVBB). There was high heterogeneity both within and between β-blockers subclasses. In a meta-regression model, the weighted difference in treatment-induced changes in SBP amplification between NVBB and VBB lost its significance after adjustment for mean age and baseline pSBP and heart rate (-2.9±2.3 mm Hg; P=0.22) and was almost abolished after adjustment for treatment-induced heart rate changes (-0.1±0.5 mm Hg; P=0.78). In conclusion, NVBBs, but not VBBs, determine a lower reduction in cSBP than in pSBP. However, the difference in treatment-induced SBP amplification changes between NVBB and VBB is nearly abolished after accounting for differences in heart rate changes."},{"id":"a7602ddf6351","type":"article","url":"https://hartvaat.nl/2016/02/01/nicotinezuurtherapie-en-het-risico-op-diabetes-meta-analyse-van-gerandomiseerde-/","title":"Nicotinezuurtherapie en het risico op diabetes: meta-analyse van gerandomiseerde trials","title_en":"Niacin therapy and the risk of new-onset diabetes: a meta-analysis of randomised controlled trials.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["diabetes-en-hart","diabetes-type-1","diabetes-type-2","ezetimibe","fidelio-dkd","figaro-dkd","niet-statine-therapie","roken","soul-trial"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2015-308055","source_url":"https://doi.org/10.1136/heartjnl-2015-308055","authors":["Christina Goldie","Allen J Taylor","Peter Nguyen","Cody McCoy","Xue-Qiao Zhao","David Preiss"],"significance":6,"published":"2016-02-01","source_date":"2016-02-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/"],"congress":"","summary_en":"This meta-analysis confirmed that niacin therapy raises glucose levels and increases the risk of new-onset diabetes, a finding that contributed to the decline of niacin use for cardiovascular prevention.","created":"2026-07-03T10:25:55Z","updated":"2026-07-03T13:25:17Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse die het effect van nicotinezuur (niacine) op glucosespiegels en het risico op het ontwikkelen van diabetes mellitus onderzocht. Klinisch relevant voor de afweging van lipidenbehandeling bij patiënten met verhoogd diabetesrisico.","abstract_original":"OBJECTIVE: Previous studies have suggested that niacin treatment raises glucose levels in patients with diabetes and may increase the risk of developing diabetes. We undertook a meta-analysis of published and unpublished data from randomised trials to confirm whether an association exists between niacin and new-onset diabetes. METHODS: We searched Medline, EMBASE and the Cochrane Central Register of Controlled Trials, from 1975 to 2014, for randomised controlled trials of niacin primarily designed to assess its effects on cardiovascular endpoints and cardiovascular surrogate markers. We included trials with ≥50 non-diabetic participants and average follow-up of ≥24 weeks. Published data were tabulated and unpublished data sought from investigators. We calculated risk ratios (RR) for new-onset diabetes with random-effects meta-analysis. Heterogeneity between trials was assessed using the I(2) statistic. RESULTS: In 11 trials with 26 340 non-diabetic participants, 1371 (725/13 121 assigned niacin; 646/13 219 assigned control) were diagnosed with diabetes during a weighted mean follow-up of 3.6 years. Niacin therapy was associated with a RR of 1.34 (95% CIs 1.21 to 1.49) for new-onset diabetes, with limited heterogeneity between trials (I(2)=0.0%, p=0.87). This equates to one additional case of diabetes per 43 (95% CI 30 to 70) initially non-diabetic individuals who are treated with niacin for 5 years. Results were consistent regardless of whether participants received background statin therapy (p for interaction=0.88) or combined therapy with laropiprant (p for interaction=0.52). CONCLUSIONS: Niacin therapy is associated with a moderately increased risk of developing diabetes regardless of background statin or combination laropiprant therapy."},{"id":"3d7e9111b6b1","type":"article","url":"https://hartvaat.nl/2016/01/30/hemodynamische-telemonitoring-bij-chronisch-hartfalen-volledige-champion-resulta/","title":"Hemodynamische telemonitoring bij chronisch hartfalen: volledige CHAMPION-resultaten","title_en":"Sustained efficacy of pulmonary artery pressure to guide adjustment of chronic heart failure therapy: complete follow-up results from the CHAMPION randomised trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(15)00723-0","source_url":"https://doi.org/10.1016/S0140-6736(15)00723-0","authors":["William T Abraham","Lynne W Stevenson","Robert C Bourge","Jo Ann Lindenfeld","Jordan G Bauman","Philip B Adamson"],"significance":8,"published":"2016-01-30","source_date":"2016-01-30","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/nhg-standaard-hartfalen-2021/","https://hartvaat.nl/kennis/farmacologie/lisdiuretica-furosemide-bumetanide/"],"congress":"","summary_en":"Complete follow-up results from the CHAMPION trial confirmed that pulmonary artery pressure-guided management sustained reductions in heart failure hospitalization over the full study period. The data strengthened the evidence for implantable hemodynamic monitoring in chronic heart failure.","created":"2026-07-03T10:25:55Z","updated":"2026-07-03T18:38:20Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Complete follow-upresultaten van de CHAMPION-trial naar pulmonalisdrukgeleide behandeling van chronisch hartfalen. De significante reductie in hartfalengerelateerde ziekenhuisopnames bleef behouden op de lange termijn.","abstract_original":"BACKGROUND: In the CHAMPION trial, significant reductions in admissions to hospital for heart failure were seen after 6 months of pulmonary artery pressure guided management compared with usual care. We examine the extended efficacy of this strategy over 18 months of randomised follow-up and the clinical effect of open access to pressure information for an additional 13 months in patients formerly in the control group. METHODS: The CHAMPION trial was a prospective, parallel, single-blinded, multicentre study that enrolled participants with New York Heart Association (NYHA) Class III heart failure symptoms and a previous admission to hospital. Patients were randomly assigned (1:1) by centre in block sizes of four by a secure validated computerised randomisation system to either the treatment group, in which daily uploaded pulmonary artery pressures were used to guide medical therapy, or to the control group, in which daily uploaded pressures were not made available to investigators. Patients in the control group received all standard medical, device, and disease management strategies available. Patients then remained masked in their randomised study group until the last patient enrolled completed at least 6 months of study follow-up (randomised access period) for an average of 18 months. During the randomised access period, patients in the treatment group were managed with pulmonary artery pressure and patients in the control group had usual care only. At the conclusion of randomised access, investigators had access to pulmonary artery pressure for all patients (open access period) averaging 13 months of follow-up. The primary outcome was the rate of hospital admissions between the treatment group and control group in both the randomised access and open access periods. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00531661. FINDINGS: Between Sept 6, 2007, and Oct 7, 2009, 550 patients were randomly assigned to either the treatment group (n=270) or to the control group (n=280). 347 patients (177 in the former treatment group and 170 in the former control group) completed the randomised access period in August, 2010, and transitioned to the open access period which ended April 30, 2012. Over the randomised access period, rates of admissions to hospital for heart failure were reduced in the treatment group by 33% (hazard ratio [HR] 0·67 [95% CI 0·55-0·80]; p<0·0001) compared with the control group. After pulmonary artery pressure information became available to guide therapy during open access (mean 13 months), rates of admissions to hospital for heart failure in the former control group were reduced by 48% (HR 0·52 [95% CI 0·40-0·69]; p<0·0001) compared with rates of admissions in the control group during randomised access. Eight (1%) device-related or system related complications and seven (1%) procedure-related adverse events were reported. INTERPRETATION: Management of NYHA Class III heart failure based on home transmission of pulmonary artery pressure with an implanted pressure sensor has significant long-term benefit in lowering hospital admission rates for heart failure. FUNDING: St Jude Medical Inc."},{"id":"a81a0c00b4e4","type":"article","url":"https://hartvaat.nl/2016/01/30/intensieve-bloeddrukverlaging-en-cardiovasculaire-en-renale-uitkomsten-systemati/","title":"Intensieve bloeddrukverlaging en cardiovasculaire en renale uitkomsten: systematische review en meta-analyse","title_en":"Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":["acuut-hartfalen","alcoholgebruik","ambulante-bloeddrukmeting","anemie-ckd","biomarkers-cardiovasculair","bloeddrukbehandeling","bradycardie","cardio-renaal-metabool","cardiorenal-behandelstrategie","credence-trial","diabetes-en-hart","diabetes-type-1","diabetes-type-2","dyslipidemie","farmaco-economie","fidelio-dkd","fidelity","figaro-dkd","flow-trial","menopauze","microbioom","obesitas","ouderen","ras-remmers","roken","slaapapneu","soul-trial","vrouwen"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(15)00805-3","source_url":"https://doi.org/10.1016/S0140-6736(15)00805-3","authors":["Xinfang Xie","Emily Atkins","Jicheng Lv","Alexander Bennett","Bruce Neal","Toshiharu Ninomiya","Mark Woodward","Stephen MacMahon","Fiona Turnbull","Graham S Hillis","John Chalmers","Jonathan Mant","Abdul Salam","Kazem Rahimi","Vlado Perkovic","Anthony Rodgers"],"significance":9,"published":"2016-01-30","source_date":"2016-01-30","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/sglt2-remmers-cardiovasculaire-trials/"],"congress":"","summary_en":"This updated Lancet meta-analysis showed that intensive blood pressure lowering reduces cardiovascular events and mortality proportionally to the magnitude of blood pressure reduction, even at levels previously considered normal. The findings supported more aggressive targets than those endorsed by contemporary guidelines.","created":"2026-07-03T10:25:54Z","updated":"2026-07-03T18:38:20Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet-publicatie met geactualiseerde meta-analyse naar het effect van intensieve bloeddrukverlaging op cardiovasculaire en renale uitkomsten. Resultaten relevant voor het debat over streefwaarden bij hoogrisicopatiënten met diabetes, nierziekte of cardiovasculaire aandoeningen.","abstract_original":"BACKGROUND: Recent hypertension guidelines have reversed previous recommendations for lower blood pressure targets in high-risk patients, such as those with cardiovascular disease, renal disease, or diabetes. This change represents uncertainty about whether more intensive blood pressure-lowering strategies are associated with greater reductions in risk of major cardiovascular and renal events. We aimed to assess the efficacy and safety of intensive blood pressure-lowering strategies. METHODS: For this updated systematic review and meta-analysis, we systematically searched MEDLINE, Embase, and the Cochrane Library for trials published between Jan 1, 1950, and Nov 3, 2015. We included randomised controlled trials with at least 6 months' follow-up that randomly assigned participants to more intensive versus less intensive blood pressure-lowering treatment, with different blood pressure targets or different blood pressure changes from baseline. We did not use any age or language restrictions. We did a meta-analysis of blood pressure reductions on relative risk (RR) of major cardiovascular events (myocardial infarction, stroke, heart failure, or cardiovascular death, separately and combined), and non-vascular and all-cause mortality, end-stage kidney disease, and adverse events, as well as albuminuria and progression of retinopathy in trials done in patients with diabetes. FINDINGS: We identified 19 trials including 44,989 participants, in whom 2496 major cardiovascular events were recorded during a mean 3·8 years of follow-up (range 1·0-8·4 years). Our meta-analysis showed that after randomisation, patients in the more intensive blood pressure-lowering treatment group had mean blood pressure levels of 133/76 mm Hg, compared with 140/81 mm Hg in the less intensive treatment group. Intensive blood pressure-lowering treatment achieved RR reductions for major cardiovascular events (14% [95% CI 4-22]), myocardial infarction (13% [0-24]), stroke (22% [10-32]), albuminuria (10% [3-16]), and retinopathy progression (19% [0-34]). However, more intensive treatment had no clear effects on heart failure (15% [95% CI -11 to 34]), cardiovascular death (9% [-11 to 26]), total mortality (9% [-3 to 19]), or end-stage kidney disease (10% [-6 to 23]). The reduction in major cardiovascular events was consistent across patient groups, and additional blood pressure lowering had a clear benefit even in patients with systolic blood pressure lower than 140 mm Hg. The absolute benefits were greatest in trials in which all enrolled patients had vascular disease, renal disease, or diabetes. Serious adverse events associated with blood pressure lowering were only reported by six trials and had an event rate of 1·2% per year in intensive blood pressure-lowering group participants, compared with 0·9% in the less intensive treatment group (RR 1·35 [95% CI 0·93-1·97]). Severe hypotension was more frequent in the more intensive treatment regimen (RR 2·68 [1·21-5·89], p=0·015), but the absolute excess was small (0·3% vs 0·1% per person-year for the duration of follow-up). INTERPRETATION: Intensive blood pressure lowering provided greater vascular protection than standard regimens. In high-risk patients, there are additional benefits from more intensive blood pressure lowering, including for those with systolic blood pressure below 140 mmHg. The net absolute benefits of intensive blood pressure lowering in high-risk individuals are large. FUNDING: National Health and Medical Research Council of Australia."},{"id":"6bf36743b68d","type":"article","url":"https://hartvaat.nl/2016/01/28/mitralisklepchirurgie-bij-ernstige-ischemische-mitralisklepinsufficientie-2-jaar/","title":"Mitralisklepchirurgie bij ernstige ischemische mitralisklepinsufficiëntie: 2-jaarsresultaten","title_en":"Two-Year Outcomes of Surgical Treatment of Severe Ischemic Mitral Regurgitation.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["mitralisinsufficiëntie"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1512913","source_url":"https://doi.org/10.1056/NEJMoa1512913","authors":["Daniel Goldstein","Alan J Moskowitz","Annetine C Gelijns","Gorav Ailawadi","Michael K Parides","Louis P Perrault","Judy W Hung","Pierre Voisine","Francois Dagenais","A Marc Gillinov","Vinod Thourani","Michael Argenziano","James S Gammie","Michael Mack","Philippe Demers","Pavan Atluri","Eric A Rose","Karen O'Sullivan","Deborah L Williams","Emilia Bagiella","Robert E Michler","Richard D Weisel","Marissa A Miller","Nancy L Geller","Wendy C Taddei-Peters","Peter K Smith","Ellen Moquete","Jessica R Overbey","Irving L Kron","Patrick T O'Gara","Michael A Acker"],"significance":8,"published":"2016-01-28","source_date":"2016-01-28","image":"","kennis":[],"congress":"","summary_en":"This NEJM trial found that at 2 years, mitral valve replacement was associated with better outcomes than repair in patients with severe ischemic mitral regurgitation, driven by a high rate of recurrent MR after repair. The results challenged the repair-first dogma in functional mitral regurgitation.","created":"2026-07-03T10:25:54Z","updated":"2026-07-03T13:25:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM-trial die mitralisklepherstel vergeleek met klepvervanging bij patiënten met ernstige ischemische mitralisklepinsufficiëntie. Na twee jaar was er geen significant verschil in linkerkamervolume, overleving of complicaties tussen beide strategieën.","abstract_original":"BACKGROUND: In a randomized trial comparing mitral-valve repair with mitral-valve replacement in patients with severe ischemic mitral regurgitation, we found no significant difference in the left ventricular end-systolic volume index (LVESVI), survival, or adverse events at 1 year after surgery. However, patients in the repair group had significantly more recurrences of moderate or severe mitral regurgitation. We now report the 2-year outcomes of this trial. METHODS: We randomly assigned 251 patients to mitral-valve repair or replacement. Patients were followed for 2 years, and clinical and echocardiographic outcomes were assessed. RESULTS: Among surviving patients, the mean (±SD) 2-year LVESVI was 52.6±27.7 ml per square meter of body-surface area with mitral-valve repair and 60.6±39.0 ml per square meter with mitral-valve replacement (mean changes from baseline, -9.0 ml per square meter and -6.5 ml per square meter, respectively). Two-year mortality was 19.0% in the repair group and 23.2% in the replacement group (hazard ratio in the repair group, 0.79; 95% confidence interval, 0.46 to 1.35; P=0.39). The rank-based assessment of LVESVI at 2 years (incorporating deaths) showed no significant between-group difference (z score=-1.32, P=0.19). The rate of recurrence of moderate or severe mitral regurgitation over 2 years was higher in the repair group than in the replacement group (58.8% vs. 3.8%, P<0.001). There were no significant between-group differences in rates of serious adverse events and overall readmissions, but patients in the repair group had more serious adverse events related to heart failure (P=0.05) and cardiovascular readmissions (P=0.01). On the Minnesota Living with Heart Failure questionnaire, there was a trend toward greater improvement in the replacement group (P=0.07). CONCLUSIONS: In patients undergoing mitral-valve repair or replacement for severe ischemic mitral regurgitation, we observed no significant between-group difference in left ventricular reverse remodeling or survival at 2 years. Mitral regurgitation recurred more frequently in the repair group, resulting in more heart-failure-related adverse events and cardiovascular admissions. (Funded by the National Institutes of Health and Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT00807040.)."},{"id":"00ff3dd3b77b","type":"article","url":"https://hartvaat.nl/2016/01/26/p-selectine-antagonist-inclacumab-bij-coronaire-bypasschirurgie-select-cabg-tria/","title":"P-selectine-antagonist inclacumab bij coronaire bypasschirurgie: SELECT-CABG-trial","title_en":"Effects of P-Selectin Antagonist Inclacumab in Patients Undergoing Coronary Artery Bypass Graft Surgery: SELECT-CABG Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["newton-cabg"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2015.10.071","source_url":"https://doi.org/10.1016/j.jacc.2015.10.071","authors":["Barbara E Stähli","Jean-Claude Tardif","Michel Carrier","Richard Gallo","Robert W Emery","Stephen Robb","Daniel Cournoyer","Lucie Blondeau","Dominique Johnson","Jessica Mann","Jacques Lespérance","Marie-Claude Guertin","Philippe L L'Allier"],"significance":5,"published":"2016-01-26","source_date":"2016-01-26","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/cabg-bypasschirurgie/","https://hartvaat.nl/kennis/vasculair/vaatchirurgie-perioperatief-cardiologisch-beleid/"],"congress":"","summary_en":"The SELECT-CABG trial tested inclacumab, a P-selectin antagonist, for reducing perioperative myocardial injury during CABG, exploring anti-adhesion molecule therapy for surgical cardioprotection.","created":"2026-07-03T10:25:54Z","updated":"2026-07-03T13:25:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial die het effect onderzocht van inclacumab, een P-selectine-antagonist, op myocardschade bij patiënten die CABG ondergingen. Onderzocht of remming van leukocyt-endotheelinteractie perioperatieve schade kan verminderen.","abstract_original":""},{"id":"7bd6498752d2","type":"article","url":"https://hartvaat.nl/2016/01/26/relatieve-wanddikte-en-risico-op-ventriculaire-tachyaritmieen-bij-linkerkamerdis/","title":"Relatieve wanddikte en risico op ventriculaire tachyaritmieën bij linkerkamerdisfunctie","title_en":"Relative Wall Thickness and the Risk for Ventricular Tachyarrhythmias in Patients With Left Ventricular Dysfunction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["bradycardie","cardiale-resynchronisatie","katheterablatie","laminopathie","pulmonaalvenenisolatie","rechterventrikelfalen","supraventriculaire-tachycardie","ventriculaire-tachycardie","ventrikelfibrilleren"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2015.10.076","source_url":"https://doi.org/10.1016/j.jacc.2015.10.076","authors":["Yitschak Biton","Ilan Goldenberg","Valentina Kutyifa","Jayson R Baman","Scott Solomon","Arthur J Moss","Barbara Szepietowska","Scott McNitt","Bronislava Polonsky","Wojciech Zareba","Alon Barsheshet"],"significance":5,"published":"2016-01-26","source_date":"2016-01-26","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/transthoracale-echocardiografie/"],"congress":"","summary_en":"This study showed that relative wall thickness, a measure of left ventricular geometry, predicts ventricular tachyarrhythmias in patients with LV dysfunction, potentially improving risk stratification for ICD therapy.","created":"2026-07-03T10:25:54Z","updated":"2026-07-03T13:25:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar relatieve wanddikte (RWT) als maat voor linkerkamergeometrie en voorspeller van ventriculaire tachyaritmieën bij patiënten met LV-disfunctie. RWT kan een aanvullende risicomarker zijn bovenop de ejectiefractie.","abstract_original":"BACKGROUND: Relative wall thickness (RWT), defined as 2 times posterior wall thickness divided by the left ventricular (LV) diastolic diameter, is a measure of LV geometry and may be a marker for adverse events in patients with LV dysfunction. OBJECTIVES: The aim of this study was to investigate the relationship between RWT and the risk for ventricular tachyarrhythmia (VA) in patients enrolled in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy) study. METHODS: The study population comprised 1,260 patients with mild heart failure and left bundle branch block. RESULTS: In a multivariable model, RWT was the most powerful echocardiographic measure for estimating the risk of VAs compared with commonly used echocardiographic variables. Patients with low RWT (<0.24) had 83% (p < 0.001) increased risk for VA and 68% (p < 0.001) increase in VA risk or death (VA/death) compared with patients with higher RWT values. Each 0.01-unit decrease in RWT was associated with 12% (p < 0.001) and 10% (p < 0.001) increases in the risk of VA and VA/death, respectively. Treatment with cardiac resynchronization therapy with defibrillator (CRT-D; CRT with implantable cardioverter-defibrillator) was associated with a greater increase in RWT compared with implantable cardioverter-defibrillator at 12 months (4.6 ± 6.8% vs. 1.5 ± 2.7%; p < 0.001), and every 10% increase in RWT in CRT-D patients was associated with 34% (p = 0.027) and 36% (p = 0.009) reductions in the risk of subsequent VA and VA/death, respectively. CONCLUSIONS: In patients with mild heart failure and left bundle branch block, decreased RWT was associated with an increase in the risk of VA and VA/death. CRT-D therapy was associated with a favorable increase in RWT and reduction in risk of VA and VA/death. (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy [MADIT-CRT]; NCT00180271)."},{"id":"3919e86531cd","type":"article","url":"https://hartvaat.nl/2016/01/26/langketen-acylcarnitines-bij-hartfalen-prognostische-waarde-en-reversibiliteit-m/","title":"Langketen-acylcarnitines bij hartfalen: prognostische waarde en reversibiliteit met mechanische ondersteuning","title_en":"Prognostic Implications of Long-Chain Acylcarnitines in Heart Failure and Reversibility With Mechanical Circulatory Support.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","anemie-ckd","carvedilol","cystatine-c","emperor-trials","nt-probnp"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2015.10.079","source_url":"https://doi.org/10.1016/j.jacc.2015.10.079","authors":["Tariq Ahmad","Jacob P Kelly","Robert W McGarrah","Anne S Hellkamp","Mona Fiuzat","Jeffrey M Testani","Teresa S Wang","Amanda Verma","Marc D Samsky","Mark P Donahue","Olga R Ilkayeva","Dawn E Bowles","Chetan B Patel","Carmelo A Milano","Joseph G Rogers","G Michael Felker","Christopher M O'Connor","Svati H Shah","William E Kraus"],"significance":5,"published":"2016-01-26","source_date":"2016-01-26","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/lvad-ventrikelondersteunende-systemen/","https://hartvaat.nl/kennis/hartfalen/bnp-en-nt-probnp/"],"congress":"","summary_en":"This study showed that long-chain acylcarnitines in heart failure have prognostic value and are partially reversible with mechanical circulatory support, linking metabolic perturbations to disease severity and therapeutic response.","created":"2026-07-03T10:25:54Z","updated":"2026-07-03T13:25:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar metabole profielen bij hartfalen die aantoont dat langketen-acylcarnitines prognostische waarde hebben en reversibel zijn na plaatsing van een mechanisch circulatieondersteuningssysteem (LVAD). Biedt inzicht in energiehomeostase bij hartfalen.","abstract_original":"BACKGROUND: Heart failure (HF) is characterized by perturbations in energy homeostasis and metabolism. The reversibility and prognostic value of circulating markers associated with these changes remain unclear. OBJECTIVES: This study sought to describe the metabolomic profiles of patients along the spectrum of systolic HF, determine their association with adverse outcomes in a clinical trial of HF, and evaluate whether identified metabolites change with treatment for end-stage systolic HF. METHODS: To assess association of metabolites with clinical outcomes, we evaluated a population of 453 chronic systolic HF patients who had been randomized to exercise training versus usual care. To assess change in metabolites with mechanical circulatory support, 41 patients with end-stage HF who underwent left ventricular assist device (LVAD) placement were studied. Targeted, quantitative profiling of 60 metabolites using tandem flow injection mass spectrometry was performed on frozen plasma samples obtained prior to randomization, as well as prior to and ≥90 days post-placement in the LVAD group. Principal components analysis was used for data reduction. RESULTS: Five principal components analysis-derived factors were significantly associated with peak Vo2 levels at baseline in fully adjusted models. Of these, factor 5 (composed of long-chain acylcarnitines) was associated with increased risk of all 3 pre-specified clinical trial outcomes: all-cause mortality/all-cause hospitalization, all cause-hospitalization, and cardiovascular death or cardiovascular hospitalization. Individual components of factor 5 were significantly higher in patients with end-stage HF prior to LVAD placement and decreased significantly post-implantation. CONCLUSIONS: In chronic HF patients, circulating long-chain acylcarnitine metabolite levels were independently associated with adverse clinical outcomes and decreased after long-term mechanical circulatory support. These metabolites may serve as potential targets for new diagnostics or therapeutic interventions. (Exercise Training Program to Improve Clinical Outcomes in Individuals With Congestive Heart Failure; NCT00047437)."},{"id":"b4bc43c8a661","type":"article","url":"https://hartvaat.nl/2016/01/26/polyfarmacie-en-werkzaamheid-van-rivaroxaban-versus-warfarine-bij-atriumfibrille/","title":"Polyfarmacie en werkzaamheid van rivaroxaban versus warfarine bij atriumfibrilleren","title_en":"Polypharmacy and the Efficacy and Safety of Rivaroxaban Versus Warfarin in the Prevention of Stroke in Patients With Nonvalvular Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","huisarts"],"tags":["aperitif-trial","bloeddrukbehandeling","farmaco-economie","kanker-en-hart","myocardinfarct","ouderen","rivaroxaban","warfarine"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.115.018544","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.115.018544","authors":["Jonathan P Piccini","Anne S Hellkamp","Jeffrey B Washam","Richard C Becker","Günter Breithardt","Scott D Berkowitz","Jonathan L Halperin","Graeme J Hankey","Werner Hacke","Kenneth W Mahaffey","Christopher C Nessel","Daniel E Singer","Keith A A Fox","Manesh R Patel"],"significance":6,"published":"2016-01-26","source_date":"2016-01-26","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This ROCKET AF analysis showed that polypharmacy does not significantly modify the relative efficacy and safety of rivaroxaban versus warfarin in AF, supporting DOAC use regardless of the number of concomitant medications.","created":"2026-07-03T10:25:54Z","updated":"2026-07-03T18:38:20Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de ROCKET AF-trial naar het effect van polyfarmacie op de relatieve werkzaamheid en veiligheid van rivaroxaban versus warfarine bij patiënten met niet-valvulair atriumfibrilleren. Concomitant medicatiegebruik komt frequent voor en kan uitkomsten beïnvloeden.","abstract_original":"BACKGROUND: Patients with atrial fibrillation (AF) often take multiple medications. METHODS AND RESULTS: We examined characteristics and compared adjusted outcomes between rivaroxaban and warfarin according to number of concomitant baseline medications and the presence of combined cytochrome P450 3A4 and P-glycoprotein inhibitors in the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study. At baseline, 5101 patients (36%) were on 0 to 4 medications, 7298 (51%) were on 5 to 9, and 1865 (13%) were on ≥ 10. Although polypharmacy was not associated with higher risk of stroke or non-central nervous system embolism (adjusted hazard ratio, 1.02 for ≥ 10 versus 0-4 medications; 95% confidence interval, 0.76-1.38), it was associated with higher risks of the combined end point of stroke, non-central nervous system embolism, vascular death, or myocardial infarction (adjusted hazard ratio, 1.41 for ≥ 10 versus 0-4 medications; 95% confidence interval, 1.18-1.68) and nonmajor clinically relevant or major bleeding (adjusted hazard ratio, 1.47 for ≥ 10 versus 0-4 medications; 95% confidence interval, 1.31-1.65). There was no significant difference in primary efficacy (adjusted interaction P=0.99) or safety outcomes (adjusted interaction P=0.87) between treatment groups by number of medications. Patients treated with 0 to 4 medications had lower rates of major bleeding with rivaroxaban (adjusted hazard ratio, 0.71; 95% confidence interval, 0.52-0.95; interaction P=0.0074). There was no evidence of differential outcomes in those treated with ≥ 1 combined cytochrome P450 3A4 and P-glycoprotein inhibitors. CONCLUSIONS: In a population of patients with atrial fibrillation, two thirds were on ≥ 5 medications. Increasing medication use was associated with higher risk of bleeding but not stroke. Rivaroxaban was tolerated across complex patients on multiple medications. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00403767."},{"id":"ebcf6bca3023","type":"article","url":"https://hartvaat.nl/2016/01/23/reg1-anticoagulatiesysteem-versus-bivalirudine-bij-pci-de-regulate-pci-trial/","title":"REG1-anticoagulatiesysteem versus bivalirudine bij PCI: de REGULATE-PCI-trial","title_en":"Effect of the REG1 anticoagulation system versus bivalirudin on outcomes after percutaneous coronary intervention (REGULATE-PCI): a randomised clinical trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["anticoagulantia"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(15)00515-2","source_url":"https://doi.org/10.1016/S0140-6736(15)00515-2","authors":["A Michael Lincoff","Roxana Mehran","Thomas J Povsic","Steven L Zelenkofske","Zhen Huang","Paul W Armstrong","P Gabriel Steg","Christoph Bode","Mauricio G Cohen","Christopher Buller","Peep Laanmets","Marco Valgimigli","Toomas Marandi","Viliam Fridrich","Warren J Cantor","Bela Merkely","Jose Lopez-Sendon","Jan H Cornel","Jaroslaw D Kasprzak","Michael Aschermann","Victor Guetta","Joao Morais","Peter R Sinnaeve","Kurt Huber","Rod Stables","Mary Ann Sellers","Marilyn Borgman","Lauren Glenn","Arnold I Levinson","Renato D Lopes","Vic Hasselblad","Richard C Becker","John H Alexander"],"significance":6,"published":"2016-01-23","source_date":"2016-01-23","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/","https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This randomized trial evaluated the REG1 anticoagulation system, a novel RNA aptamer-based factor IXa inhibitor with its reversal agent, versus bivalirudin during PCI, testing a fundamentally new anticoagulation mechanism.","created":"2026-07-03T10:25:54Z","updated":"2026-07-03T13:25:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial die het REG1-anticoagulatiesysteem, bestaande uit een RNA-aptameer factor IXa-remmer met reversibiliteit, vergeleek met bivalirudine tijdens PCI. Onderzocht een nieuw concept van controleerbare anticoagulatie.","abstract_original":"BACKGROUND: REG1 is a novel anticoagulation system consisting of pegnivacogin, an RNA aptamer inhibitor of coagulation factor IXa, and anivamersen, a complementary sequence reversal oligonucleotide. We tested the hypothesis that near complete inhibition of factor IXa with pegnivacogin during percutaneous coronary intervention, followed by partial reversal with anivamersen, would reduce ischaemic events compared with bivalirudin, without increasing bleeding. METHODS: We did a randomised, open-label, active-controlled, multicentre, superiority trial to compare REG1 with bivalirudin at 225 hospitals in North America and Europe. We planned to randomly allocate 13,200 patients undergoing percutaneous coronary intervention in a 1:1 ratio to either REG1 (pegnivacogin 1 mg/kg bolus [>99% factor IXa inhibition] followed by 80% reversal with anivamersen after percutaneous coronary intervention) or bivalirudin. Exclusion criteria included ST segment elevation myocardial infarction within 48 h. The primary efficacy endpoint was the composite of all-cause death, myocardial infarction, stroke, and unplanned target lesion revascularisation by day 3 after randomisation. The principal safety endpoint was major bleeding. Analysis was by intention to treat. This trial is registered at ClinicalTrials.gov, identifier NCT01848106. The trial was terminated early after enrolment of 3232 patients due to severe allergic reactions. FINDINGS: 1616 patients were allocated REG1 and 1616 were assigned bivalirudin, of whom 1605 and 1601 patients, respectively, received the assigned treatment. Severe allergic reactions were reported in ten (1%) of 1605 patients receiving REG1 versus one (<1%) of 1601 patients treated with bivalirudin. The composite primary endpoint did not differ between groups, with 108 (7%) of 1616 patients assigned REG1 and 103 (6%) of 1616 allocated bivalirudin reporting a primary endpoint event (odds ratio [OR] 1·05, 95% CI 0·80-1·39; p=0·72). Major bleeding was similar between treatment groups (seven [<1%] of 1605 receiving REG1 vs two [<1%] of 1601 treated with bivalirudin; OR 3·49, 95% CI 0·73-16·82; p=0·10), but major or minor bleeding was increased with REG1 (104 [6%] vs 65 [4%]; 1·64, 1·19-2·25; p=0·002). INTERPRETATION: The reversible factor IXa inhibitor REG1, as currently formulated, is associated with severe allergic reactions. Although statistical power was limited because of early termination, there was no evidence that REG1 reduced ischaemic events or bleeding compared with bivalirudin. FUNDING: Regado Biosciences Inc."},{"id":"b0269e47eed6","type":"article","url":"https://hartvaat.nl/2016/01/23/everolimus-eluting-stent-versus-bare-metal-stent-bij-stemi-5-jaarsresultaten-exa/","title":"Everolimus-eluting stent versus bare-metal stent bij STEMI: 5-jaarsresultaten EXAMINATION-trial","title_en":"Clinical outcomes in patients with ST-segment elevation myocardial infarction treated with everolimus-eluting stents versus bare-metal stents (EXAMINATION): 5-year results of a randomised trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(15)00548-6","source_url":"https://doi.org/10.1016/S0140-6736(15)00548-6","authors":["Manel Sabaté","Salvatore Brugaletta","Angel Cequier","Andrés Iñiguez","Antonio Serra","Pilar Jiménez-Quevedo","Vicente Mainar","Gianluca Campo","Maurizio Tespili","Peter den Heijer","Armando Bethencourt","Nicolás Vazquez","Gerrit Anne van Es","Bianca Backx","Marco Valgimigli","Patrick W Serruys"],"significance":7,"published":"2016-01-23","source_date":"2016-01-23","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"Long-term results from the EXAMINATION trial showed that everolimus-eluting stents provide durable clinical benefit compared with bare-metal stents in patients with STEMI, supporting universal drug-eluting stent use in primary PCI.","created":"2026-07-03T10:25:54Z","updated":"2026-07-03T13:25:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Langetermijnresultaten van de EXAMINATION-trial die everolimus-eluting stents vergeleek met bare-metal stents bij STEMI. Een van de eerste studies met 5-jaarsdata over nieuwe-generatie drug-eluting stents bij acuut myocardinfarct.","abstract_original":"BACKGROUND: Data for the safety and efficacy of new-generation drug-eluting stents at long-term follow-up, and specifically in patients with ST-segment elevation myocardial infarction, are scarce. In the EXAMINATION trial, we compared everolimus-eluting stents (EES) with bare-metal stents (BMS) in an all-comer population with ST-segment elevation myocardial infarction. In this study, we assessed the 5-year outcomes of the population in the EXAMINATION trial. METHODS: In the multicentre EXAMINATION trial, done in Italy, Spain, and the Netherlands, patients with ST-segment elevation myocardial infarction were randomly assigned in a 1:1 ratio to receive EES or BMS. The random allocation schedule was computer-generated and central randomisation (by telephone) was used to allocate patients in blocks of four or six, stratified by centre. Patients were masked to treatment assignment. At 5 years, we assessed the combined patient-oriented outcome of all-cause death, any myocardial infarction, or any revascularisation. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00828087. FINDINGS: 1498 patients were randomly assigned to receive either EES (n=751) or BMS (n=747). At 5 years, complete clinical follow-up data were obtained for 731 patients treated with EES and 727 treated with BMS (97% of both groups). The patient-oriented endpoint occurred in 159 (21%) patients in the EES group versus 192 (26%) in the BMS group (hazard ratio 0·80, 95% CI 0·65-0·98; p=0·033). This difference was mainly driven by a reduced rate of all-cause mortality (65 [9%] vs 88 [12%]; 0·72, 0·52-0·10; p=0·047). INTERPRETATION: Our findings should be taken as a point of reference for the assessment of new bioresorbable polymer-based metallic stents or bioresorbable scaffolds in patients with ST-segment elevation myocardial infarction. FUNDING: Spanish Heart Foundation."},{"id":"e97e7e80cb63","type":"article","url":"https://hartvaat.nl/2016/01/21/neoplasiedetectie-bij-langdurige-dapt-met-prasugrel-versus-clopidogrel-triton-ti/","title":"Neoplasiedetectie bij langdurige DAPT met prasugrel versus clopidogrel: TRITON-TIMI 38-analyse","title_en":"Ascertainment, classification, and impact of neoplasm detection during prolonged treatment with dual antiplatelet therapy with prasugrel vs. clopidogrel following acute coronary syndrome.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["dubbele-trombocytenremming","trombocytenaggregatieremmers"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehv611","source_url":"https://doi.org/10.1093/eurheartj/ehv611","authors":["Matthew T Roe","Derek D Cyr","Debra Eckart","Phillip J Schulte","Michael A Morse","Kimberly L Blackwell","Neal E Ready","S Yousuf Zafar","Anne W Beaven","John H Strickler","Jane E Onken","Kenneth J Winters","Lisa Houterloot","Dmitry Zamoryakhin","Stephen D Wiviott","Harvey D White","Dorairaj Prabhakaran","Keith A A Fox","Paul W Armstrong","E Magnus Ohman"],"significance":5,"published":"2016-01-21","source_date":"2016-01-21","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/dual-antiplatelet-therapy-dapt/","https://hartvaat.nl/kennis/coronairlijden/wat-is-coronairlijden/"],"congress":"","summary_en":"This TRITON-TIMI 38 analysis evaluated neoplasm detection during prolonged DAPT for ACS, finding no significant increase in cancer incidence with prasugrel compared with clopidogrel, addressing an early safety concern.","created":"2026-07-03T10:25:53Z","updated":"2026-07-03T13:25:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de TRITON-TIMI 38-trial naar kankerincidentie bij langdurige duale antiplaatjestherapie voor acuut coronair syndroom. Onderzoekt of er een verband bestaat tussen DAPT-duur en neoplasmeontwikkeling.","abstract_original":"AIMS: Studies have suggested increased cancer incidence associated with long-term dual antiplatelet therapy (DAPT) for acute coronary syndrome (ACS). We evaluated cancer incidence and treatment-related differences in an analysis of DAPT for ACS. METHODS AND RESULTS: The Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes trial enrolled 9326 participants with ACS, who received aspirin plus clopidogrel or prasugrel. Median treatment exposure was 15 months. Cancer history and screening procedures were collected. Suspected non-benign neoplasm events were reported and adjudicated. The primary outcome was detection of new, non-benign neoplasm. Factors associated with neoplasm events, the relationship of these events to cardiovascular and bleeding endpoints, and treatment-related differences in neoplasm detection were studied. Among 9240 participants who received ≥1 dose of study drug, 1.8% had a confirmed neoplasm event. The efficacy composite of cardiovascular death, myocardial infarction, or stroke occurred more frequently among those with a neoplasm event vs. those without (18.2 vs. 13.5%) as did Global Use of Strategies to Open Occluded Coronary Arteries severe/moderate bleeding (11.2 vs. 1.5%). Screening rates were substantially higher in North America and Western Europe/Scandinavia vs. other regions. Factors most strongly associated with detection of neoplasm events were older age, region, male sex, and current/recent smoking. Among the pre-specified population without a history of neoplasm or previous curative treatment for neoplasm (n = 9105), the incidence of neoplasm events was similar with prasugrel vs. clopidogrel (1.8 vs. 1.7%; HR = 1.04; 95% CI 0.77-1.42; P = 0.79). CONCLUSIONS: Neoplasm events were infrequent during long-term DAPT after ACS, were associated with differential cancer-screening practices across regions, and the frequency of neoplasm detection was similar with prasugrel vs. clopidogrel. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00699998."},{"id":"0cbc47f0b653","type":"article","url":"https://hartvaat.nl/2016/01/21/doodsoorzaken-bij-langdurige-dapt-na-coronaire-stents/","title":"Doodsoorzaken bij langdurige DAPT na coronaire stents","title_en":"Causes of late mortality with dual antiplatelet therapy after coronary stents.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehv614","source_url":"https://doi.org/10.1093/eurheartj/ehv614","authors":["Laura Mauri","Sammy Elmariah","Robert W Yeh","Donald E Cutlip","P Gabriel Steg","Stephan Windecker","Stephen D Wiviott","David J Cohen","Joseph M Massaro","Ralph B D'Agostino","Eugene Braunwald","Dean J Kereiakes"],"significance":7,"published":"2016-01-21","source_date":"2016-01-21","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/pci-percutane-coronaire-interventie/"],"congress":"","summary_en":"This DAPT study analysis examined specific causes of late mortality in patients receiving prolonged thienopyridine after drug-eluting stents, identifying the mechanisms underlying the all-cause mortality signal with extended dual antiplatelet therapy.","created":"2026-07-03T10:25:53Z","updated":"2026-07-03T13:25:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de DAPT-studie naar specifieke doodsoorzaken bij patiënten die langer dan 12 maanden thienopyridine kregen na DES-plaatsing. Onderzoekt de bevinding van verhoogde mortaliteit met verlengde DAPT en de onderliggende oorzaken.","abstract_original":"AIMS: In the dual antiplatelet therapy (DAPT) study, continued thienopyridine beyond 12 months after drug-eluting stent placement was associated with increased mortality compared with placebo. We sought to evaluate factors related to mortality in randomized patients receiving either drug-eluting or bare metal stents in the DAPT study. METHODS AND RESULTS: Patients were enrolled after coronary stenting, given thienopyridine and aspirin for 12 months, randomly assigned to continued thienopyridine or placebo for an additional 18 months (while taking aspirin), and subsequently treated with aspirin alone for another 3 months. A blinded independent adjudication committee evaluated deaths. Among 11 648 randomized patients, rates of all-cause mortality rates were 1.9 vs. 1.5% (continued thienopyridine vs. placebo, P = 0.07), cardiovascular mortality, 1.0 vs. 1.0% (P = 0.97), and non-cardiovascular mortality, 0.9 vs. 0.5% (P = 0.01) over the randomized period (Months 12-30). Rates of fatal bleeding were 0.2 vs. 0.1% (P = 0.81), and deaths related to any prior bleeding were 0.3 vs. 0.2% (P = 0.36), Months 12-33). Cancer incidence did not differ (2.0 vs. 1.6%, P = 0.12). Cancer-related deaths occurred in 0.6 vs. 0.3% (P = 0.02) and were rarely related to bleeding (0.1 vs. 0, P = 0.25). After excluding those occurring in patients with cancer diagnosed before enrolment, rates were 0.4 vs. 0.3% (P = 0.16). CONCLUSION: Bleeding accounted for a minority of deaths among patients treated with continued thienopyridine. Cancer-related death in association with thienopyridine therapy was mainly not related to bleeding and may be a chance finding. Caution is warranted when considering extended thienopyridine in patients with advanced cancer. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00977938."},{"id":"84f2c01af4cb","type":"article","url":"https://hartvaat.nl/2016/01/21/ticagrelor-bij-nierfunctiestoornissen-langetermijnpreventie-na-myocardinfarct-pe/","title":"Ticagrelor bij nierfunctiestoornissen: langetermijnpreventie na myocardinfarct (PEGASUS-TIMI 54)","title_en":"Efficacy and safety of ticagrelor for long-term secondary prevention of atherothrombotic events in relation to renal function: insights from the PEGASUS-TIMI 54 trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["myocardinfarct","trombocytenaggregatieremmers"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehv482","source_url":"https://doi.org/10.1093/eurheartj/ehv482","authors":["Giulia Magnani","Robert F Storey","Gabriel Steg","Deepak L Bhatt","Marc Cohen","Julia Kuder","Kyungah Im","Philip Aylward","Diego Ardissino","Daniel Isaza","Alexander Parkhomenko","Assen R Goudev","Mikael Dellborg","Frederic Kontny","Ramon Corbalan","Felix Medina","Eva C Jensen","Peter Held","Eugene Braunwald","Marc S Sabatine","Marc P Bonaca"],"significance":6,"published":"2016-01-21","source_date":"2016-01-21","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/aspirine-primaire-preventie/"],"congress":"","summary_en":"This PEGASUS-TIMI 54 analysis examined the interaction between renal function and the efficacy of long-term ticagrelor therapy, showing consistent benefit across kidney function categories with an expected increase in bleeding at lower eGFR.","created":"2026-07-03T10:25:53Z","updated":"2026-07-03T13:25:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van PEGASUS-TIMI 54 naar de relatie tussen nierfunctie, ischemisch risico en bloedingsrisico, en de werkzaamheid van ticagrelor bij stabiele patiënten met een eerder myocardinfarct. Nierfunctie beïnvloedt het risicoprofiel significant.","abstract_original":"AIMS: We evaluated the relationship of renal function and ischaemic and bleeding risk as well as the efficacy and safety of ticagrelor in stable patients with prior myocardial infarction (MI). METHODS AND RESULTS: Patients with a history of MI 1-3 years prior from PEGASUS-TIMI 54 were stratified based on estimated glomerular filtration rate (eGFR), with <60 mL/min/1.73 m(2) pre-specified for analysis of the effect of ticagrelor on the primary efficacy composite of cardiovascular death, MI, or stroke (major adverse cardiovascular events, MACE) and the primary safety endpoint of TIMI major bleeding. Of 20 898 patients, those with eGFR <60 (N = 4849, 23.2%) had a greater risk of MACE at 3 years relative to those without, which remained significant after multivariable adjustment (hazard ratio, HRadj 1.54, 95% confidence interval, CI 1.27-1.85, P < 0.001). The relative risk reduction in MACE with ticagrelor was similar in those with eGFR <60 (ticagrelor pooled vs. placebo: HR 0.81; 95% CI 0.68-0.96) vs. ≥60 (HR 0.88; 95% CI 0.77-1.00, Pinteraction = 0.44). However, due to the greater absolute risk in the former group, the absolute risk reduction with ticagrelor was higher: 2.7 vs. 0.63%. Bleeding tended to occur more frequently in patients with renal dysfunction. The absolute increase in TIMI major bleeding with ticagrelor was similar in those with and without eGFR <60 (1.19 vs. 1.43%), whereas the excess of minor bleeding tended to be more pronounced (1.93 vs. 0.69%). CONCLUSION: In patients with a history of MI, patients with renal dysfunction are at increased risk of MACE and consequently experience a particularly robust absolute risk reduction with long-term treatment with ticagrelor."},{"id":"09396022cd3b","type":"article","url":"https://hartvaat.nl/2016/01/21/stoppen-of-doorgaan-met-clopidogrel-12-maanden-na-drug-eluting-stent-optidual-tr/","title":"Stoppen of doorgaan met clopidogrel 12 maanden na drug-eluting stent: OPTIDUAL-trial","title_en":"Stopping or continuing clopidogrel 12 months after drug-eluting stent placement: the OPTIDUAL randomized trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["trombocytenaggregatieremmers"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehv481","source_url":"https://doi.org/10.1093/eurheartj/ehv481","authors":["Gérard Helft","Philippe Gabriel Steg","Claude Le Feuvre","Jean-Louis Georges","Didier Carrie","Xavier Dreyfus","Alain Furber","Florence Leclercq","Hélène Eltchaninoff","Jean-François Falquier","Patrick Henry","Simon Cattan","Laurent Sebagh","Pierre-Louis Michel","Albert Tuambilangana","Nadjib Hammoudi","Franck Boccara","Guillaume Cayla","Hervé Douard","Abdourahmane Diallo","Emmanuel Berman","Michel Komajda","Jean-Philippe Metzger","Eric Vicaut"],"significance":7,"published":"2016-01-21","source_date":"2016-01-21","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/pci-percutane-coronaire-interventie/"],"congress":"","summary_en":"The OPTIDUAL randomized trial investigated whether continuing clopidogrel beyond 12 months after drug-eluting stent placement is superior to stopping it. The open-label study contributed to the ongoing debate about optimal DAPT duration.","created":"2026-07-03T10:25:53Z","updated":"2026-07-03T13:25:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Open-label gerandomiseerde multicenter trial die onderzocht of voortzetting van clopidogrel na 12 maanden na DES-implantatie superieur is aan stoppen. De resultaten dragen bij aan de discussie over de optimale duur van DAPT.","abstract_original":"AIM: This open-label, randomized, and multicentre trial tested the hypothesis that, on a background of aspirin, continuing clopidogrel would be superior to stopping clopidogrel at 12 months following drug-eluting stent (DES) implantation. METHODS AND RESULTS: Patients (N = 1799) who had undergone placement of ≥1 DES for stable coronary artery disease or acute coronary syndrome were included in 58 French sites (January 2009-January 2013). Patients (N = 1385) free of major cardiovascular/cerebrovascular events or major bleeding and on aspirin and clopidogrel 12 months after stenting were eligible for randomization (1:1) between continuing clopidogrel 75 mg daily (extended-dual antiplatelet therapy, DAPT, group) or discontinuing clopidogrel (aspirin group). The primary outcome was net adverse clinical events defined as the composite of death, myocardial infarction, stroke, or major bleeding. Follow-up was planned from a minimum of 6 to a maximum of 36 months after randomization. Owing to slow recruitment, the study was stopped after enrolment of 1385 of a planned 1966 patients. Median follow-up after stenting was 33.4 months. The primary outcome occurred in 40 patients (5.8%) in the extended-DAPT group and 52 in the aspirin group (7.5%; hazard ratio 0.75, 95% confidence interval 0.50-1.28; P = 0.17). Rates of death were 2.3% in the extended-DAPT group and 3.5% in the aspirin group (HR 0.65, 95% CI 0.34-1.22; P = 0.18). Rates of major bleeding were identical (2.0%, P = 0.95). CONCLUSIONS: Extended DAPT did not achieve superiority in reducing net adverse clinical events compared to 12 months of DAPT after DES placement. The power of the OPTIDUAL trial was however low and reduced by premature termination of enrolment. CLINICALTRIALSGOV NUMBER: NCT00822536."},{"id":"0c6eaab9cbf5","type":"article","url":"https://hartvaat.nl/2016/01/21/langdurige-duale-antiplaatjestherapie-bij-patienten-met-eerder-myocardinfarct-me/","title":"Langdurige duale antiplaatjestherapie bij patiënten met eerder myocardinfarct: meta-analyse","title_en":"Long-term dual antiplatelet therapy for secondary prevention of cardiovascular events in the subgroup of patients with previous myocardial infarction: a collaborative meta-analysis of randomized trials.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","aperitif-trial","bloeddrukbehandeling","dapa-hf","dubbele-trombocytenremming","iaso-dcm","myocardinfarct"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehv443","source_url":"https://doi.org/10.1093/eurheartj/ehv443","authors":["Jacob A Udell","Marc P Bonaca","Jean-Philippe Collet","A Michael Lincoff","Dean J Kereiakes","Francesco Costa","Cheol Whan Lee","Laura Mauri","Marco Valgimigli","Seung-Jung Park","Gilles Montalescot","Marc S Sabatine","Eugene Braunwald","Deepak L Bhatt"],"significance":7,"published":"2016-01-21","source_date":"2016-01-21","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/aspirine-primaire-preventie/"],"congress":"","summary_en":"This meta-analysis examined prolonged dual antiplatelet therapy in patients with prior MI, showing that extended DAPT provides particular benefit in this high-risk subgroup by reducing recurrent ischemic events at the cost of increased bleeding.","created":"2026-07-03T10:25:53Z","updated":"2026-07-03T13:25:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse van gerandomiseerde trials naar het effect van verlengde duale antiplaatjestherapie (DAPT) bij patiënten met een eerder myocardinfarct. Onderzoekt de balans tussen ischemische bescherming en bloedingsrisico bij langdurige behandeling.","abstract_original":"AIMS: Recent trials have examined the effect of prolonged dual antiplatelet therapy (DAPT) in a variety of patient populations, with heterogeneous results regarding benefit and safety, specifically with regard to cardiovascular and non-cardiovascular mortality. We performed a meta-analysis of randomized trials comparing more than a year of DAPT with aspirin alone in high-risk patients with a history of prior myocardial infarction (MI). METHODS AND RESULTS: A total of 33 435 patients were followed over a mean 31 months among one trial of patients with prior MI (63.3% of total) and five trials with a subgroup of patients that presented with, or had a history of, a prior MI (36.7% of total). Extended DAPT decreased the risk of major adverse cardiovascular events compared with aspirin alone (6.4 vs. 7.5%; risk ratio, RR 0.78, 95% confidence intervals, CI, 0.67-0.90; P = 0.001) and reduced cardiovascular death (2.3 vs. 2.6%; RR 0.85, 95% CI 0.74-0.98; P = 0.03), with no increase in non-cardiovascular death (RR 1.03, 95% CI 0.86-1.23; P = 0.76). The resultant effect on all-cause mortality was an RR of 0.92 (95% CI 0.83-1.03; P = 0.13). Extended DAPT also reduced MI (RR 0.70, 95% CI 0.55-0.88; P = 0.003), stroke (RR 0.81, 95% CI 0.68-0.97; P = 0.02), and stent thrombosis (RR 0.50, 95% CI 0.28-0.89; P = 0.02). There was an increased risk of major bleeding (1.85 vs. 1.09%; RR 1.73, 95% CI 1.19-2.50; P = 0.004) but not fatal bleeding (0.14 vs. 0.17%; RR 0.91, 95% CI 0.53-1.58; P = 0.75). CONCLUSION: Compared with aspirin alone, DAPT beyond 1 year among stabilized high-risk patients with prior MI decreases ischaemic events, including significant reductions in the individual endpoints of cardiovascular death, recurrent MI, and stroke. Dual antiplatelet therapy beyond 1 year increases major bleeding, but not fatal bleeding or non-cardiovascular death."},{"id":"79498d1b3686","type":"article","url":"https://hartvaat.nl/2016/01/19/werkzaamheid-en-veiligheid-van-cangrelor-bij-vrouwen-versus-mannen-tijdens-pci-c/","title":"Werkzaamheid en veiligheid van cangrelor bij vrouwen versus mannen tijdens PCI: CHAMPION-analyse","title_en":"Efficacy and Safety of Cangrelor in Women Versus Men During Percutaneous Coronary Intervention: Insights From the Cangrelor versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition (CHAMPION PHOENIX) Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.115.017300","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.115.017300","authors":["Michelle L O'Donoghue","Deepak L Bhatt","Gregg W Stone","Ph Gabriel Steg","C Michael Gibson","Christian W Hamm","Matthew J Price","Jayne Prats","Tiepu Liu","Efthymios N Deliargyris","Kenneth W Mahaffey","Harvey D White","Robert A Harrington"],"significance":5,"published":"2016-01-19","source_date":"2016-01-19","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This CHAMPION trials subgroup analysis showed that cangrelor provides similar efficacy and safety in women and men during PCI, confirming sex-neutral benefit of this intravenous antiplatelet agent.","created":"2026-07-03T10:25:53Z","updated":"2026-07-03T13:25:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subgroepanalyse van de CHAMPION-trials naar sekseverschillen in werkzaamheid en veiligheid van cangrelor, een intraveneuze ADP-receptorantagonist, tijdens PCI. Onderzoekt of de relatieve effectiviteit vergelijkbaar is bij vrouwen en mannen.","abstract_original":"BACKGROUND: Cangrelor is an intravenous ADP receptor antagonist that leads to potent and reversible inhibition of platelet aggregation. The relative safety and efficacy of some antiplatelet drugs in women has been disputed. METHODS AND RESULTS: The Cangrelor versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition (CHAMPION PHOENIX) trial randomized 11,145 patients undergoing elective or urgent percutaneous coronary intervention to cangrelor or clopidogrel. The primary efficacy end point was the composite of death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis at 48 hours; the key secondary end point was stent thrombosis at 48 hours. The primary safety end point was GUSTO severe bleeding at 48 hours. Of subjects analyzed, 3051 (28%) were female. Cangrelor reduced the odds of the primary end point by 35% in women (adjusted odds ratio [OR], 0.65; 95% confidence interval [CI], 0.48-0.89) and by 14% in men (OR, 0.86; 95% CI, 0.70-1.05; P interaction=0.23) compared with clopidogrel. Cangrelor reduced the odds of stent thrombosis by 61% in women (OR, 0.39; 95% CI, 0.20-0.77) and 16% in men (OR, 0.84; 95% CI, 0.53-1.33; P interaction=0.11). The odds of severe bleeding were similar in both women and men treated with cangrelor (0.3% versus 0.2%, P=0.30 [women]; 0.1% versus 0.1%, P=0.41 [men]; P interaction=0.88) versus clopidogrel. Cangrelor increased the odds of moderate bleeding in women (0.9% versus 0.3%, P=0.02), but not in men (0.2% versus 0.2%, P=0.68; P interaction=0.040). The net clinical benefit (primary efficacy and safety end point) favored cangrelor in both women (OR, 0.68; 95% CI, 0.50-0.92) and men (OR, 0.87; 95% CI, 0.71-1.06; P interaction=0.26). CONCLUSIONS: In CHAMPION PHOENIX, cangrelor reduced the odds of major adverse cardiovascular events and stent thrombosis in women and men and appeared to offer greater net clinical benefit than clopidogrel. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01156571."},{"id":"4d47e683b9b1","type":"article","url":"https://hartvaat.nl/2016/01/14/morfine-vertraagt-en-vermindert-de-werking-van-ticagrelor-bij-myocardinfarct-de-/","title":"Morfine vertraagt en vermindert de werking van ticagrelor bij myocardinfarct: de IMPRESSION-trial","title_en":"Morphine delays and attenuates ticagrelor exposure and action in patients with myocardial infarction: the randomized, double-blind, placebo-controlled IMPRESSION trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["abelacimab","anticoagulantia","aperitif-trial","colcot-trial","iaso-dcm","myocardinfarct","ouderen","soul-trial","summit-trial","trombocytenaggregatieremmers"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehv547","source_url":"https://doi.org/10.1093/eurheartj/ehv547","authors":["Jacek Kubica","Piotr Adamski","Małgorzata Ostrowska","Joanna Sikora","Julia Maria Kubica","Wiktor Dariusz Sroka","Katarzyna Stankowska","Katarzyna Buszko","Eliano Pio Navarese","Bernd Jilma","Jolanta Maria Siller-Matula","Michał Piotr Marszałł","Danuta Rość","Marek Koziński"],"significance":7,"published":"2016-01-14","source_date":"2016-01-14","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/","https://hartvaat.nl/kennis/vasculair/ischemische-beroerte-tia/"],"congress":"","summary_en":"This randomized placebo-controlled trial demonstrated that intravenous morphine delays and attenuates ticagrelor exposure and antiplatelet effect in patients with myocardial infarction, highlighting a clinically important drug-drug interaction during acute ACS management.","created":"2026-07-03T10:25:53Z","updated":"2026-07-03T13:25:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde dubbelblinde placebogecontroleerde trial die aantoonde dat intraveneus morfine de farmacokinetiek en farmacodynamiek van ticagrelor significant beïnvloedt. Klinisch relevante geneesmiddelinteractie bij de behandeling van het acute myocardinfarct.","abstract_original":"AIMS: The currently available data indicate a drug-drug interaction between morphine and oral P2Y12 receptor inhibitors, when administered together. The aim of this trial was to assess the influence of infused morphine on pharmacokinetics and pharmacodynamics of ticagrelor and its active metabolite (AR-C124910XX) in patients with acute myocardial infarction. METHODS AND RESULTS: In a single-centre, randomized, double-blind trial, patients were assigned in a 1:1 ratio to receive intravenously either morphine (5 mg) or placebo, followed by a 180 mg loading dose of ticagrelor. Pharmacokinetics was determined with liquid chromatography tandem mass spectrometry and ticagrelor antiplatelet effects were measured with up to three different platelet function tests: vasodilator-stimulated phosphoprotein phosphorylation assay, multiple electrode aggregometry and VerifyNow. The pharmacokinetic and pharmacodynamic assessment was performed in 70 patients (35 in each study group). Morphine lowered the total exposure to ticagrelor and its active metabolite by 36% (AUC(0-12): 6307 vs. 9791 ng h/mL; P = 0.003), and 37% (AUC(0-12): 1503 vs. 2388 ng h/mL; P = 0.008), respectively, with a concomitant delay in maximal plasma concentration of ticagrelor (4 vs. 2 h; P = 0.004). Multiple regression analysis showed that lower AUC(0-12) values for ticagrelor were independently associated with the administration of morphine (P = 0.004) and the presence of ST-segment elevation myocardial infarction (P = 0.014). All three methods of platelet reactivity assessment showed a stronger antiplatelet effect in the placebo group and a greater prevalence of high platelet reactivity in patients receiving morphine. CONCLUSIONS: Morphine delays and attenuates ticagrelor exposure and action in patients with myocardial infarction. ClinicalTrials.gov Identifier: NCT02217878."},{"id":"98b6fd3f1a8b","type":"article","url":"https://hartvaat.nl/2016/01/14/intracoronaire-beenmergcelinfusie-bij-acuut-myocardinfarct-de-regenerate-ami-tri/","title":"Intracoronaire beenmergcelinfusie bij acuut myocardinfarct: de REGENERATE-AMI-trial","title_en":"A randomized double-blind control study of early intra-coronary autologous bone marrow cell infusion in acute myocardial infarction: the REGENERATE-AMI clinical trial†.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["acuut-hartfalen","aperitif-trial","colcot-trial","harttransplantatie","myocardinfarct"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehv493","source_url":"https://doi.org/10.1093/eurheartj/ehv493","authors":["Fizzah Choudry","Stephen Hamshere","Natalie Saunders","Jessry Veerapen","Katrine Bavnbek","Charles Knight","Denis Pellerin","Didier Locca","Mark Westwood","Roby Rakhit","Tom Crake","Jens Kastrup","Mahesh Parmar","Samir Agrawal","Daniel Jones","John Martin","Anthony Mathur"],"significance":6,"published":"2016-01-14","source_date":"2016-01-14","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"This double-blind randomized study of early intracoronary bone marrow cell infusion after acute MI found no significant improvement in left ventricular function, contributing to the growing neutral evidence for stem cell therapy in acute cardiac disease.","created":"2026-07-03T10:25:53Z","updated":"2026-07-03T13:25:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Dubbelblinde gerandomiseerde studie naar het effect van vroege intracoronaire toediening van autologe beenmergcellen na een acuut myocardinfarct op de linkerkamerfunctie. Onderzocht een eerder tijdstip dan eerdere trials.","abstract_original":"AIMS: Clinical trials suggest that intracoronary delivery of autologous bone marrow-derived cells (BMCs) 1-7 days post-acute myocardial infarction (AMI) may improve left ventricular (LV) function. Earlier time points have not been evaluated. We sought to determine the effect of intracoronary autologous BMC on LV function when delivered within 24 h of successful reperfusion therapy. METHODS AND RESULTS: A multi-centre phase II randomized, double-blind, and placebo-controlled trial. One hundred patients with anterior AMI and significant regional wall motion abnormality were randomized to receive either intracoronary infusion of BMC or placebo (1:1) within 24 h of successful primary percutaneous intervention (PPCI). The primary endpoint was the change in left ventricular ejection fraction (LVEF) between baseline and 1 year as determined by advanced cardiac imaging. At 1 year, although LVEF increased compared with baseline in both groups, the between-group difference favouring BMC was small (2.2%; 95% confidence interval, CI: -0.5 to 5.0; P = 0.10). However, there was a significantly greater myocardial salvage index in the BMC-treated group compared with placebo (0.1%; 95% CI: 0.0-0.20; P = 0.048). Major adverse events were rare in both treatment groups. CONCLUSION: The early infusion of intracoronary BMC following PPCI for patients with AMI and regional wall motion abnormality leads to a small non-significant improvement in LVEF when compared with placebo; however, it may play an important role in infarct remodelling and myocardial salvage."},{"id":"278d677b952a","type":"article","url":"https://hartvaat.nl/2016/01/14/bioresorbeerbare-versus-metallic-everolimus-eluting-stent-bij-stemi-gerandomisee/","title":"Bioresorbeerbare versus metallic everolimus-eluting stent bij STEMI: gerandomiseerde trial","title_en":"Everolimus-eluting bioresorbable stent vs. durable polymer everolimus-eluting metallic stent in patients with ST-segment elevation myocardial infarction: results of the randomized ABSORB ST-segment elevation myocardial infarction-TROFI II trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehv500","source_url":"https://doi.org/10.1093/eurheartj/ehv500","authors":["Manel Sabaté","Stephan Windecker","Andres Iñiguez","Lisette Okkels-Jensen","Angel Cequier","Salvatore Brugaletta","Sjoerd H Hofma","Lorenz Räber","Evald Høi Christiansen","Maarten Suttorp","Thomas Pilgrim","Gerrit Anne van Es","Yohei Sotomi","Hector M García-García","Yoshinobu Onuma","Patrick W Serruys"],"significance":6,"published":"2016-01-14","source_date":"2016-01-14","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This randomized study compared the bioresorbable Absorb scaffold with metallic everolimus-eluting stents specifically in STEMI patients, testing the first-generation bioresorbable technology in the thrombotic acute MI setting.","created":"2026-07-03T10:25:52Z","updated":"2026-07-03T13:25:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde studie die de bioresorbeerbare Absorb-scaffold vergeleek met de duurzame metallic everolimus-eluting stent bij STEMI-patiënten. Onderzocht of bioresorbeerbare technologie voordelen biedt bij trombusrijke laesies.","abstract_original":"AIMS: Patients with ST-segment elevation myocardial infarction (STEMI) feature thrombus-rich lesions with large necrotic core, which are usually associated with delayed arterial healing and impaired stent-related outcomes. The use of bioresorbable vascular scaffolds (Absorb) has the potential to overcome these limitations owing to restoration of native vessel lumen and physiology at long term. The purpose of this randomized trial was to compare the arterial healing response at short term, as a surrogate for safety and efficacy, between the Absorb and the metallic everolimus-eluting stent (EES) in patients with STEMI. METHODS AND RESULTS: ABSORB-STEMI TROFI II was a multicentre, single-blind, non-inferiority, randomized controlled trial. Patients with STEMI who underwent primary percutaneous coronary intervention were randomly allocated 1:1 to treatment with the Absorb or EES. The primary endpoint was the 6-month optical frequency domain imaging healing score (HS) based on the presence of uncovered and/or malapposed stent struts and intraluminal filling defects. Main secondary endpoint included the device-oriented composite endpoint (DOCE) according to the Academic Research Consortium definition. Between 06 January 2014 and 21 September 2014, 191 patients (Absorb [n = 95] or EES [n = 96]; mean age 58.6 years old; 17.8% females) were enrolled at eight centres. At 6 months, HS was lower in the Absorb arm when compared with EES arm [1.74 (2.39) vs. 2.80 (4.44); difference (90% CI) -1.06 (-1.96, -0.16); Pnon-inferiority < 0.001]. Device-oriented composite endpoint was also comparably low between groups (1.1% Absorb vs. 0% EES). One case of definite subacute stent thrombosis occurred in the Absorb arm (1.1% vs. 0% EES; P = ns). CONCLUSION: Stenting of culprit lesions with Absorb in the setting of STEMI resulted in a nearly complete arterial healing which was comparable with that of metallic EES at 6 months. These findings provide the basis for further exploration in clinically oriented outcome trials."},{"id":"2e47b0503c61","type":"article","url":"https://hartvaat.nl/2016/01/14/2015-esc-richtlijn-voor-acute-coronaire-syndromen-zonder-persisterende-st-elevat/","title":"2015 ESC-richtlijn voor acute coronaire syndromen zonder persisterende ST-elevatie","title_en":"2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC).","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":["acuut-coronair-syndroom","hartkatheterisatie","richtlijnen-esc"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehv320","source_url":"https://doi.org/10.1093/eurheartj/ehv320","authors":["Marco Roffi","Carlo Patrono","Jean-Philippe Collet","Christian Mueller","Marco Valgimigli","Felicita Andreotti","Jeroen J Bax","Michael A Borger","Carlos Brotons","Derek P Chew","Baris Gencer","Gerd Hasenfuss","Keld Kjeldsen","Patrizio Lancellotti","Ulf Landmesser","Julinda Mehilli","Debabrata Mukherjee","Robert F Storey","Stephan Windecker"],"significance":9,"published":"2016-01-14","source_date":"2016-01-14","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/nstemi-en-instabiele-angina/","https://hartvaat.nl/kennis/coronairlijden/stabiele-angina-pectoris/"],"congress":"","summary_en":"The 2015 ESC guidelines for NSTEMI and unstable angina pectoris updated risk stratification tools, the timing of invasive management, and antithrombotic strategies. The document provided structured pathways for diagnosis, early risk assessment, and treatment selection based on individual patient risk profiles.","created":"2026-07-03T10:25:52Z","updated":"2026-07-03T13:25:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ESC-richtlijn voor de diagnostiek en behandeling van NSTEMI en instabiele angina pectoris. Omvat risicostratificatie, timing van invasieve strategie, antitrombotica en secundaire preventie.","abstract_original":""},{"id":"90d73deb2fc7","type":"article","url":"https://hartvaat.nl/2016/01/09/trombusaspiratie-bij-stemi-1-jaarsfollow-up-van-de-total-trial/","title":"Trombusaspiratie bij STEMI: 1-jaarsfollow-up van de TOTAL-trial","title_en":"Outcomes after thrombus aspiration for ST elevation myocardial infarction: 1-year follow-up of the prospective randomised TOTAL trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(15)00448-1","source_url":"https://doi.org/10.1016/S0140-6736(15)00448-1","authors":["Sanjit S Jolly","John A Cairns","Salim Yusuf","Michael J Rokoss","Peggy Gao","Brandi Meeks","Sasko Kedev","Goran Stankovic","Raul Moreno","Anthony Gershlick","Saqib Chowdhary","Shahar Lavi","Kari Niemela","Ivo Bernat","Warren J Cantor","Asim N Cheema","Philippe Gabriel Steg","Robert C Welsh","Tej Sheth","Olivier F Bertrand","Alvaro Avezum","Ravinay Bhindi","Madhu K Natarajan","David Horak","Raymond C M Leung","Saleem Kassam","Sunil V Rao","Magdi El-Omar","Shamir R Mehta","James L Velianou","Samir Pancholy","Vladimír Džavík"],"significance":8,"published":"2016-01-09","source_date":"2016-01-09","image":"","kennis":[],"congress":"","summary_en":"One-year follow-up of the largest randomized thrombus aspiration trial in STEMI showed no benefit on clinical outcomes, consistent with the neutral primary results. The extended data helped resolve the debate about long-term effects of routine thrombectomy during primary PCI.","created":"2026-07-03T10:25:52Z","updated":"2026-07-03T13:25:14Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Eénjaarsfollow-up van de grootste gerandomiseerde trial naar trombusaspiratie bij STEMI. De resultaten helpen het debat over de langetermijnvoordelen van routinematige trombusaspiratie tijdens primaire PCI te verduidelijken.","abstract_original":"BACKGROUND: Two large trials have reported contradictory results at 1 year after thrombus aspiration in ST elevation myocardial infarction (STEMI). In a 1-year follow-up of the largest randomised trial of thrombus aspiration, we aimed to clarify the longer-term benefits, to help guide clinical practice. METHODS: The trial of routine aspiration ThrOmbecTomy with PCI versus PCI ALone in Patients with STEMI (TOTAL) was a prospective, randomised, investigator-initiated trial of routine manual thrombectomy versus percutaneous coronary intervention (PCI) alone in 10,732 patients with STEMI. Eligible adult patients (aged ≥18 years) from 87 hospitals in 20 countries were enrolled and randomly assigned (1:1) within 12 h of symptom onset to receive routine manual thrombectomy with PCI or PCI alone. Permuted block randomisation (with variable block size) was done by a 24 h computerised central system, and was stratified by centre. Participants and investigators were not masked to treatment assignment. The trial did not show a difference at 180 days in the primary outcome of cardiovascular death, myocardial infarction, cardiogenic shock, or heart failure. However, the results showed improvements in the surrogate outcomes of ST segment resolution and distal embolisation, but whether or not this finding would translate into a longer term benefit remained unclear. In this longer-term follow-up of the TOTAL study, we report the results on the primary outcome (cardiovascular death, myocardial infarction, cardiogenic shock, or heart failure) and secondary outcomes at 1 year. Analyses of the primary outcome were by modified intention to treat and only included patients who underwent index PCI. This trial is registered with ClinicalTrials.gov, number NCT01149044. FINDINGS: Between Aug 5, 2010, and July 25, 2014, 10,732 eligible patients were enrolled and randomly assigned to thrombectomy followed by PCI (n=5372) or to PCI alone (n=5360). After exclusions of patients who did not undergo PCI in each group (337 in the PCI and thrombectomy group and 331 in the PCI alone group), the final study population comprised 10,064 patients (5035 thrombectomy and 5029 PCI alone). The primary outcome at 1 year occurred in 395 (8%) of 5035 patients in the thrombectomy group compared with 394 (8%) of 5029 in the PCI alone group (hazard ratio [HR] 1·00 [95% CI 0·87-1·15], p=0·99). Cardiovascular death within 1 year occurred in 179 (4%) of the thrombectomy group and in 192 (4%) of 5029 in the PCI alone group (HR 0·93 [95% CI 0·76-1·14], p=0·48). The key safety outcome, stroke within 1 year, occurred in 60 patients (1·2%) in the thrombectomy group compared with 36 (0·7%) in the PCI alone group (HR 1·66 [95% CI 1·10-2·51], p=0·015). INTERPRETATION: Routine thrombus aspiration during PCI for STEMI did not reduce longer-term clinical outcomes and might be associated with an increase in stroke. As a result, thrombus aspiration can no longer be recommended as a routine strategy in STEMI. FUNDING: Canadian Institutes of Health Research, Canadian Network and Centre for Trials Internationally, and Medtronic Inc."},{"id":"823313368992","type":"article","url":"https://hartvaat.nl/2016/01/09/ranolazine-bij-incomplete-revascularisatie-na-pci-de-river-pci-trial/","title":"Ranolazine bij incomplete revascularisatie na PCI: de RIVER-PCI-trial","title_en":"Ranolazine in patients with incomplete revascularisation after percutaneous coronary intervention (RIVER-PCI): a multicentre, randomised, double-blind, placebo-controlled trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(15)00459-6","source_url":"https://doi.org/10.1016/S0140-6736(15)00459-6","authors":["Giora Weisz","Philippe Généreux","Andres Iñiguez","Aleksander Zurakowski","Michael Shechter","Karen P Alexander","Ovidiu Dressler","Anna Osmukhina","Stefan James","E Magnus Ohman","Ori Ben-Yehuda","Ramin Farzaneh-Far","Gregg W Stone"],"significance":7,"published":"2016-01-09","source_date":"2016-01-09","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/antistolling-bij-kankerpatienten/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"The RIVER-PCI trial showed that ranolazine did not improve outcomes in patients with incomplete revascularization after PCI, a common clinical scenario associated with increased mortality and recurrent ischemia.","created":"2026-07-03T10:25:52Z","updated":"2026-07-03T13:25:14Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Multicenter dubbelblinde RCT die onderzocht of ranolazine de prognose verbetert bij patiënten met incomplete revascularisatie na PCI. Incomplete revascularisatie komt frequent voor en is geassocieerd met verhoogde mortaliteit.","abstract_original":"BACKGROUND: Incomplete revascularisation is common after percutaneous coronary intervention and is associated with increased mortality and adverse cardiovascular events. We aimed to assess whether adjunctive anti-ischaemic pharmacotherapy with ranolazine would improve the prognosis of patients with incomplete revascularisation after percutaneous coronary intervention. METHODS: We performed this multicentre, randomised, parallel-group, double-blind, placebo-controlled, event-driven trial at 245 centres in 15 countries in Europe, Israel, Russia, and the USA. Patients (aged ≥18 years) with a history of chronic angina with incomplete revascularisation after percutaneous coronary intervention (defined as one or more lesions with ≥50% diameter stenosis in a coronary artery ≥2 mm diameter) were randomly assigned (1:1), via an interactive web-based block randomisation system (block sizes of ten), to receive either twice-daily oral ranolazine 1000 mg or matching placebo. Randomisation was stratified by diabetes history (presence vs absence) and acute coronary syndrome presentation (acute coronary syndrome vs non-acute coronary syndrome). Study investigators, including all research teams, and patients were masked to treatment allocation. The primary endpoint was time to first occurrence of ischaemia-driven revascularisation or ischaemia-driven hospitalisation without revascularisation. Analysis was by intention to treat. This study is registered at ClinicalTrials.gov, number NCT01442038. FINDINGS: Between Nov 3, 2011, and May 27, 2013, we randomly assigned 2651 patients to receive ranolazine (n=1332) or placebo (n=1319); 2604 (98%) patients comprised the full analysis set. After a median follow-up of 643 days (IQR 575-758), the composite primary endpoint occurred in 345 (26%) patients assigned to ranolazine and 364 (28%) patients assigned to placebo (hazard ratio 0·95, 95% CI 0·82-1·10; p=0·48). Incidence of ischaemia-driven revascularisation and ischaemia-driven hospitalisation did not differ significantly between groups. 189 (14%) patients in the ranolazine group and 137 (11%) patients in the placebo group discontinued study drug because of an adverse event (p=0·04). INTERPRETATION: Ranolazine did not reduce the composite rate of ischaemia-driven revascularisation or hospitalisation without revascularisation in patients with a history of chronic angina who had incomplete revascularisation after percutaneous coronary intervention. Further studies are warranted to establish whether other treatment could be effective in improving the prognosis of high-risk patients in this population. FUNDING: Gilead Sciences, Menarini."},{"id":"8b898930dfbf","type":"article","url":"https://hartvaat.nl/2016/01/07/preoperatief-statinegebruik-en-cardiovasculaire-complicaties-bij-niet-cardiale-c/","title":"Preoperatief statinegebruik en cardiovasculaire complicaties bij niet-cardiale chirurgie: de VISION-studie","title_en":"Association between pre-operative statin use and major cardiovascular complications among patients undergoing non-cardiac surgery: the VISION study.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["farmaco-economie","obesitas","ouderen","secundaire-preventie","select-trial"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehv456","source_url":"https://doi.org/10.1093/eurheartj/ehv456","authors":["Otavio Berwanger","Yannick Le Manach","Erica Aranha Suzumura","Bruce Biccard","Sadeesh K Srinathan","Wojciech Szczeklik","Jose A Espirito Santo","Eliana Santucci","Alexandre B Cavalcanti","R Andrew Archbold","P J Devereaux"],"significance":6,"published":"2016-01-07","source_date":"2016-01-07","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This international prospective cohort study examined the association between preoperative statin use and major cardiovascular complications within 30 days of non-cardiac surgery, informing perioperative medication management.","created":"2026-07-03T10:25:52Z","updated":"2026-07-03T13:25:14Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Internationale prospectieve cohortstudie bij patiënten ≥45 jaar die niet-cardiale chirurgie ondergingen. Onderzocht het effect van preoperatieve statinetherapie op cardiovasculaire events in de eerste 30 dagen na operatie.","abstract_original":"AIMS: The aim of this study was to assess the effects of pre-operative statin therapy on cardiovascular events in the first 30-days after non-cardiac surgery. METHODS AND RESULTS: We conducted an international, prospective, cohort study of patients who were ≥45 years having in-patient non-cardiac surgery. We estimated the probability of receiving statins pre-operatively using a multivariable logistic model and conducted a propensity score analysis to correct for confounding. A total of 15 478 patients were recruited at 12 centres in eight countries from August 2007 to January 2011. The matched population consisted of 2845 patients (18.4%) treated with a statin and 4492 (29.0%) controls. The pre-operative use of statins was associated with lower risk of the primary outcome, a composite of all-cause mortality, myocardial injury after non-cardiac surgery (MINS), or stroke at 30 days [relative risk (RR), 0.83; 95% confidence interval (CI), 0.73-0.95; P = 0.007]. Statins were also associated with a significant lower risk of all-cause mortality (RR, 0.58; 95% CI, 0.40-0.83; P = 0.003), cardiovascular mortality (RR, 0.42; 95% CI, 0.23-0.76; P = 0.004), and MINS (RR, 0.86; 95% CI, 0.73-0.98; P = 0.02). There were no statistically significant differences in the risk of myocardial infarction or stroke. CONCLUSION: Among patients undergoing non-cardiac surgery, pre-operative statin therapy was independently associated with a lower risk of cardiovascular outcomes at 30 days. These results require confirmation in a large randomized trial. CLINICAL TRIAL REGISTRATION: Clinical Trials.gov NCT00512109."},{"id":"fad073f8da98","type":"article","url":"https://hartvaat.nl/2016/01/05/doodsoorzaken-na-pci-versus-cabg-bij-complex-coronairlijden-5-jaarsfollow-up-van/","title":"Doodsoorzaken na PCI versus CABG bij complex coronairlijden: 5-jaarsfollow-up van SYNTAX","title_en":"Causes of Death Following PCI Versus CABG in Complex CAD: 5-Year Follow-Up of SYNTAX.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2015.10.043","source_url":"https://doi.org/10.1016/j.jacc.2015.10.043","authors":["Milan Milojevic","Stuart J Head","Catalina A Parasca","Patrick W Serruys","Friedrich W Mohr","Marie-Claude Morice","Michael J Mack","Elisabeth Ståhle","Ted E Feldman","Keith D Dawkins","Antonio Colombo","A Pieter Kappetein","David R Holmes"],"significance":8,"published":"2016-01-05","source_date":"2016-01-05","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/pci-vs-cabg-afweging/","https://hartvaat.nl/kennis/coronairlijden/esc-richtlijn-chronisch-coronairlijden-2024/"],"congress":"","summary_en":"This first analysis of specific causes of death from a randomized PCI versus CABG trial showed that the 5-year mortality difference in complex coronary disease was driven by a higher rate of cardiac death with PCI. The SYNTAX data informed subsequent revascularization decision-making based on anatomical complexity.","created":"2026-07-03T10:25:52Z","updated":"2026-07-03T13:25:14Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Eerste analyse van specifieke doodsoorzaken uit een gerandomiseerde trial die CABG vergeleek met PCI. Na 5 jaar bleek het mortaliteitsverschil vooral gedreven door hartdood en cerebrovasculaire oorzaken, met implicaties voor de keuze tussen beide revascularisatiestrategieën.","abstract_original":"BACKGROUND: There are no data available on specific causes of death from randomized trials that have compared coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI). OBJECTIVES: The purpose of this study was to investigate specific causes of death, and its predictors, after revascularization for complex coronary disease in patients. METHODS: An independent Clinical Events Committee consisting of expert physicians who were blinded to the study treatment subclassified causes of death as cardiovascular (cardiac and vascular), noncardiovascular, or undetermined according to the trial protocol. Cardiac deaths were classified as sudden cardiac, related to myocardial infarction (MI), and other cardiac deaths. RESULTS: In the randomized cohort, there were 97 deaths after CABG and 123 deaths after PCI during a 5-year follow-up. After CABG, 49.4% of deaths were cardiovascular, with the greatest cause being heart failure, arrhythmia, or other causes (24.6%), whereas after PCI, the majority of deaths were cardiovascular (67.5%) and as a result of MI (29.3%). The cumulative incidence rates of all-cause death were not significantly different between CABG and PCI (11.4% vs. 13.9%, respectively; p = 0.10), whereas there were significant differences in terms of cardiovascular (5.8% vs. 9.6%, respectively; p = 0.008) and cardiac death (5.3% vs. 9.0%, respectively; p = 0.003), which were caused primarily by a reduction in MI-related death with CABG compared with PCI (0.4% vs. 4.1%, respectively; p <0.0001). Treatment with PCI versus CABG was an independent predictor of cardiac death (hazard ratio: 1.55; 95% confidence interval: 1.09 to 2.33; p = 0.045). The difference in MI-related death was seen largely in patients with diabetes, 3-vessel disease, or high SYNTAX (TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries) trial scores. CONCLUSIONS: During a 5-year follow-up, CABG in comparison with PCI was associated with a significantly reduced rate of MI-related death, which was the leading cause of death after PCI. Treatments following PCI should target reducing post-revascularization spontaneous MI. Furthermore, secondary preventive medication remains essential in reducing events post-revascularization. (TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX]; NCT00114972)."},{"id":"b6ebd9ac8a7d","type":"article","url":"https://hartvaat.nl/2016/01/05/ct-coronairangiografie-bij-verdenking-acs-in-het-tijdperk-van-hoog-sensitief-tro/","title":"CT-coronairangiografie bij verdenking ACS in het tijdperk van hoog-sensitief troponine","title_en":"Coronary CT Angiography for Suspected ACS in the Era of High-Sensitivity Troponins: Randomized Multicenter Study.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["acuut-coronair-syndroom","coronaire-ct-angiografie","hartkatheterisatie","iaso-dcm","troponine"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2015.10.045","source_url":"https://doi.org/10.1016/j.jacc.2015.10.045","authors":["Admir Dedic","Marisa M Lubbers","Jeroen Schaap","Jeronymus Lammers","Evert J Lamfers","Benno J Rensing","Richard L Braam","Hendrik M Nathoe","Johannes C Post","Tim Nielen","Driek Beelen","Marie-Claire le Cocq d'Armandville","Pleunie P M Rood","Carl J Schultz","Adriaan Moelker","Mohamed Ouhlous","Eric Boersma","Koen Nieman"],"significance":7,"published":"2016-01-05","source_date":"2016-01-05","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/wat-is-coronairlijden/","https://hartvaat.nl/kennis/diagnostiek/cardiale-biomarkers-overzicht/"],"congress":"","summary_en":"This randomized multicenter study evaluated whether early coronary CT angiography improves outcomes compared with contemporary standard care in patients with suspected acute coronary syndrome in the era of high-sensitivity troponin assays.","created":"2026-07-03T10:25:52Z","updated":"2026-07-03T13:25:14Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde multicenter studie die onderzoekt of een diagnostische strategie met vroege CT-coronairangiografie superieur is aan standaard optimale zorg met hoog-sensitieve troponine-assays bij verdenking op acuut coronair syndroom.","abstract_original":"BACKGROUND: It is uncertain whether a diagnostic strategy supplemented by early coronary computed tomography angiography (CCTA) is superior to contemporary standard optimal care (SOC) encompassing high-sensitivity troponin assays (hs-troponins) for patients suspected of acute coronary syndrome (ACS) in the emergency department (ED). OBJECTIVES: This study assessed whether a diagnostic strategy supplemented by early CCTA improves clinical effectiveness compared with contemporary SOC. METHODS: In a prospective, open-label, multicenter, randomized trial, we enrolled patients presenting with symptoms suggestive of an ACS at the ED of 5 community and 2 university hospitals in the Netherlands. Exclusion criteria included the need for urgent cardiac catheterization and history of ACS or coronary revascularization. The primary endpoint was the number of patients identified with significant coronary artery disease requiring revascularization within 30 days. RESULTS: The study population consisted of 500 patients, of whom 236 (47%) were women (mean age 54 ± 10 years). There was no difference in the primary endpoint (22 [9%] patients underwent coronary revascularization within 30 days in the CCTA group and 17 [7%] in the SOC group [p = 0.40]). Discharge from the ED was not more frequent after CCTA (65% vs. 59%, p = 0.16), and length of stay was similar (6.3 h in both groups; p = 0.80). The CCTA group had lower direct medical costs (€337 vs. €511, p < 0.01) and less outpatient testing after the index ED visit (10 [4%] vs. 26 [10%], p < 0.01). There was no difference in incidence of undetected ACS. CONCLUSIONS: CCTA, applied early in the work-up of suspected ACS, is safe and associated with less outpatient testing and lower costs. However, in the era of hs-troponins, CCTA does not identify more patients with significant CAD requiring coronary revascularization, shorten hospital stay, or allow for more direct discharge from the ED. (Better Evaluation of Acute Chest Pain with Computed Tomography Angiography [BEACON]; NCT01413282)."},{"id":"10e693191685","type":"article","url":"https://hartvaat.nl/2016/01/05/calorierestrictie-of-aerobe-training-bij-obese-ouderen-met-hfpef-effect-op-vo2-p/","title":"Calorierestrictie of aerobe training bij obese ouderen met HFpEF: effect op VO2-piek en kwaliteit van leven","title_en":"Effect of Caloric Restriction or Aerobic Exercise Training on Peak Oxygen Consumption and Quality of Life in Obese Older Patients With Heart Failure With Preserved Ejection Fraction: A Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":["hfpef","obesitas","summit-trial"],"journal":"JAMA","doi":"10.1001/jama.2015.17346","source_url":"https://doi.org/10.1001/jama.2015.17346","authors":["Dalane W Kitzman","Peter Brubaker","Timothy Morgan","Mark Haykowsky","Gregory Hundley","William E Kraus","Joel Eggebeen","Barbara J Nicklas"],"significance":8,"published":"2016-01-05","source_date":"2016-01-05","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfpef-hartfalen-met-behouden-ejectie/","https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"This JAMA trial compared caloric restriction with aerobic exercise training for improving peak oxygen consumption and quality of life in obese older patients with HFpEF. The study provided early evidence that targeted weight management and exercise can improve the functional capacity of obesity-related heart failure.","created":"2026-07-03T10:25:52Z","updated":"2026-07-03T13:25:14Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA-studie die het effect vergeleek van calorierestrictie versus aerobe inspanningstraining op piekcapaciteit en kwaliteit van leven bij obese oudere patiënten met hartfalen met behouden ejectiefractie. Beide interventies verbeterden de inspanningstolerantie.","abstract_original":"IMPORTANCE: More than 80% of patients with heart failure with preserved ejection fraction (HFPEF), the most common form of heart failure among older persons, are overweight or obese. Exercise intolerance is the primary symptom of chronic HFPEF and a major determinant of reduced quality of life (QOL). OBJECTIVE: To determine whether caloric restriction (diet) or aerobic exercise training (exercise) improves exercise capacity and QOL in obese older patients with HFPEF. DESIGN, SETTING, AND PARTICIPANTS: Randomized, attention-controlled, 2 × 2 factorial trial conducted from February 2009 through November 2014 in an urban academic medical center. Of 577 initially screened participants, 100 older obese participants (mean [SD]: age, 67 years [5]; body mass index, 39.3 [5.6]) with chronic, stable HFPEF were enrolled (366 excluded by inclusion and exclusion criteria, 31 for other reasons, and 80 declined participation). INTERVENTIONS: Twenty weeks of diet, exercise, or both; attention control consisted of telephone calls every 2 weeks. MAIN OUTCOMES AND MEASURES: Exercise capacity measured as peak oxygen consumption (V̇O2, mL/kg/min; co-primary outcome) and QOL measured by the Minnesota Living with Heart Failure (MLHF) Questionnaire (score range: 0-105, higher scores indicate worse heart failure-related QOL; co-primary outcome). RESULTS: Of the 100 enrolled participants, 26 participants were randomized to exercise; 24 to diet; 25 to exercise + diet; 25 to control. Of these, 92 participants completed the trial. Exercise attendance was 84% (SD, 14%) and diet adherence was 99% (SD, 1%). By main effects analysis, peak V̇O2 was increased significantly by both interventions: exercise, 1.2 mL/kg body mass/min (95% CI, 0.7 to 1.7), P < .001; diet, 1.3 mL/kg body mass/min (95% CI, 0.8 to 1.8), P < .001. The combination of exercise + diet was additive (complementary) for peak V̇O2 (joint effect, 2.5 mL/kg/min). There was no statistically significant change in MLHF total score with exercise and with diet (main effect: exercise, -1 unit [95% CI, -8 to 5], P = .70; diet, -6 units [95% CI, -12 to 1], P = .08). The change in peak V̇O2 was positively correlated with the change in percent lean body mass (r = 0.32; P = .003) and the change in thigh muscle:intermuscular fat ratio (r = 0.27; P = .02). There were no study-related serious adverse events. Body weight decreased by 7% (7 kg [SD, 1]) in the diet group, 3% (4 kg [SD, 1]) in the exercise group, 10% (11 kg [SD, 1] in the exercise + diet group, and 1% (1 kg [SD, 1]) in the control group. CONCLUSIONS AND RELEVANCE: Among obese older patients with clinically stable HFPEF, caloric restriction or aerobic exercise training increased peak V̇O2, and the effects may be additive. Neither intervention had a significant effect on quality of life as measured by the MLHF Questionnaire. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00959660."},{"id":"594bdc58e67f","type":"article","url":"https://hartvaat.nl/2016/01/05/ranolazine-bij-angina-en-kwaliteit-van-leven-na-pci-met-incomplete-revascularisa/","title":"Ranolazine bij angina en kwaliteit van leven na PCI met incomplete revascularisatie","title_en":"Effects of Ranolazine on Angina and Quality of Life After Percutaneous Coronary Intervention With Incomplete Revascularization: Results From the Ranolazine for Incomplete Vessel Revascularization (RIVER-PCI) Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.115.019768","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.115.019768","authors":["Karen P Alexander","Giora Weisz","Kristi Prather","Stefan James","Daniel B Mark","Kevin J Anstrom","Linda Davidson-Ray","Adam Witkowski","Angel J Mulkay","Anna Osmukhina","Ramin Farzaneh-Far","Ori Ben-Yehuda","Gregg W Stone","E Magnus Ohman"],"significance":5,"published":"2016-01-05","source_date":"2016-01-05","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/coronairlijden/ranolazine-bij-angina/"],"congress":"","summary_en":"This RIVER-PCI post-hoc analysis found that ranolazine does not significantly improve angina or quality of life in patients with incomplete revascularization after PCI, a negative result for this anti-ischemic agent.","created":"2026-07-03T10:25:51Z","updated":"2026-07-03T13:25:14Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Post-hoc analyse van de RIVER-PCI-trial naar het effect van ranolazine op angina en kwaliteit van leven bij patiënten met incomplete revascularisatie na PCI. Onderzoekt of aanvullende anti-ischemische therapie klinisch relevant voordeel biedt.","abstract_original":"BACKGROUND: Angina often persists or returns in populations following percutaneous coronary intervention (PCI). We hypothesized that ranolazine would be effective in reducing angina and improving quality of life (QOL) in incomplete revascularization (ICR) post-PCI patients. METHODS AND RESULTS: In RIVER-PCI, 2604 patients with a history of chronic angina who had ICR post-PCI were randomized 1:1 to oral ranolazine versus placebo; QOL analyses included 2389 randomized subjects. Angina and QOL questionnaires were collected at baseline and months 1, 6, and 12. Ranolazine patients were more likely than placebo to discontinue study drug by month 6 (20.4% versus 14.1%, P<0.001) and 12 (27.2% versus 21.3%, P<0.001). Following qualifying index PCI, the primary QOL outcome (Seattle Angina Questionnaire [SAQ] angina frequency score) improved markedly, but similarly, in the ranolazine and placebo groups, respectively, from baseline (67.3±24.5 versus 69.7±24.0, P=0.01) to month 1 (86.6±18.1 versus 85.8±18.5, P=0.27) and month 12 (88.4±17.8 versus 88.5±17.8, P=0.94). SAQ angina frequency repeated measures did not differ in adjusted analysis between groups post baseline (mean difference 1.0; 95% CI -0.2, 2.2; P=0.11). Improvement in SAQ angina frequency was observed with ranolazine at month 6 among diabetics (mean difference 3.3; 95% CI 0.6, 6.1; P=0.02) and those with more angina (baseline SAQ angina frequency ≤60; mean difference 3.4; 95% CI 0.6, 6.2; P=0.02), but was not maintained at month 12. CONCLUSIONS: Despite ICR following PCI, there was no incremental benefit in angina or QOL measures by adding ranolazine in this angiographically-identified population. These measures markedly improved within 1 month of PCI and persisted up to 1 year in both treatment arms. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01442038."},{"id":"fe238faea49f","type":"article","url":"https://hartvaat.nl/2016/01/05/varenicline-voor-stoppen-met-roken-bij-patienten-opgenomen-met-acuut-coronair-sy/","title":"Varenicline voor stoppen met roken bij patiënten opgenomen met acuut coronair syndroom","title_en":"Varenicline for Smoking Cessation in Hospitalized Patients With Acute Coronary Syndrome.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":["acuut-coronair-syndroom","roken","rosuvastatine"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.115.019634","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.115.019634","authors":["Mark J Eisenberg","Sarah B Windle","Nathalie Roy","Wayne Old","François R Grondin","Iqbal Bata","Ayman Iskander","Claude Lauzon","Nalin Srivastava","Adam Clarke","Daniel Cassavar","Danielle Dion","Herbert Haught","Shamir R Mehta","Jean-François Baril","Charles Lambert","Mina Madan","Beth L Abramson","Payam Dehghani"],"significance":6,"published":"2016-01-05","source_date":"2016-01-05","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/wat-is-coronairlijden/","https://hartvaat.nl/kennis/coronairlijden/ecg-bij-acs/"],"congress":"","summary_en":"This multicenter randomized trial showed that varenicline initiated during hospitalization for ACS significantly improves smoking cessation rates at 6 months, demonstrating the effectiveness of in-hospital smoking intervention.","created":"2026-07-03T10:25:51Z","updated":"2026-07-03T13:25:14Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Multicenter dubbelblinde RCT naar de effectiviteit van varenicline, gestart tijdens ziekenhuisopname, voor rookstop na een acuut coronair syndroom. De studie onderzoekt of vroege farmacologische interventie de abstinentie na ontslag kan verbeteren.","abstract_original":"BACKGROUND: Less than one-third of smokers hospitalized with an acute coronary syndrome (ACS) remain abstinent following discharge. We assessed whether varenicline, begun in-hospital, is efficacious for smoking cessation following ACS. METHODS AND RESULTS: We conducted a multi-center, double-blind, randomized, placebo-controlled trial in which smokers hospitalized with an ACS were randomized to varenicline or placebo for 12 weeks. All patients received low-intensity counseling. The primary end point was point-prevalence smoking abstinence assessed at 24 weeks by 7-day recall and biochemical validation using expired carbon monoxide. A total of 302 patients were randomized (mean age 55±9 years; 75% male; 56% ST-segment elevation myocardial infarction; 38% non-ST-segment elevation myocardial infarction; 6% unstable angina). Patients smoked a mean of 21±11 cigarettes/d at the time of hospitalization and had been smoking for a mean of 36±12 years. At 24 weeks, patients randomized to varenicline had significantly higher rates of smoking abstinence and reduction than patients randomized to placebo. Point-prevalence abstinence rates were 47.3% in the varenicline group and 32.5% in the placebo group (P=0.012; number needed to treat=6.8). Continuous abstinence rates were 35.8% and 25.8%, respectively (P=0.081; number needed to treat=10.0), and rates of reduction ≥50% in daily cigarette consumption were 67.4% and 55.6%, respectively (P=0.05; number needed to treat=8.5). Adverse event rates within 30 days of study drug discontinuation were similar between groups (serious adverse events: varenicline 11.9%, placebo 11.3%; major adverse cardiovascular events: varenicline 4.0%, placebo 4.6%). CONCLUSIONS: Varenicline, initiated in-hospital following ACS, is efficacious for smoking cessation. Future studies are needed to establish safety in these patients. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00794573."},{"id":"23cbb658a2d1","type":"article","url":"https://hartvaat.nl/2016/01/01/persisterende-echocardiografische-dyssynchronie-voorspelt-ongunstige-uitkomsten-/","title":"Persisterende echocardiografische dyssynchronie voorspelt ongunstige uitkomsten bij hartfalen met smal QRS","title_en":"Association of persistent or worsened echocardiographic dyssynchrony with unfavourable clinical outcomes in heart failure patients with narrow QRS width: a subgroup analysis of the EchoCRT trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["acuut-hartfalen","cardiale-resynchronisatie","emperor-trials","hfpef","hfref","supraventriculaire-tachycardie","ventrikelfibrilleren","vericiguat"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehv418","source_url":"https://doi.org/10.1093/eurheartj/ehv418","authors":["John Gorcsan","Peter Sogaard","Jeroen J Bax","Jagmeet P Singh","William T Abraham","Jeffrey S Borer","Kenneth Dickstein","Daniel Gras","Henry Krum","Josep Brugada","Michele Robertson","Ian Ford","Johannes Holzmeister","Frank Ruschitzka"],"significance":6,"published":"2016-01-01","source_date":"2016-01-01","image":"","kennis":["https://hartvaat.nl/kennis/ritmestoornissen/bundeltakblok/","https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This EchoCRT analysis showed that persistent or worsened echocardiographic dyssynchrony in heart failure patients with narrow QRS is associated with unfavorable outcomes, exploring the mechanistic basis of the trial's negative result.","created":"2026-07-03T10:25:51Z","updated":"2026-07-03T18:38:20Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de EchoCRT-trial bij hartfalenpatiënten met smal QRS (<130 ms) en echocardiografische dyssynchronie. Persisterende of verergerde dyssynchronie was geassocieerd met ongunstige klinische uitkomsten, ongeacht CRT-behandeling.","abstract_original":"AIMS: EchoCRT was a randomized trial of cardiac resynchronization therapy (CRT) in severely symptomatic heart failure (HF) patients with narrow QRS width <130 ms, ejection fraction ≤35%, and echocardiographic dyssynchrony. All received CRT implants which were then randomized to CRT-On or CRT-Off. While the trial showed no benefit of CRT to these patients, the aim of this subgroup analysis was to test the hypothesis that persistent or worsening dyssynchrony is associated with unfavourable clinical outcomes. METHODS AND RESULTS: We studied 614 EchoCRT patients with baseline and 6-month echocardiograms. Baseline dyssynchrony required for study inclusion was either tissue Doppler imaging longitudinal velocity delay ≥80 ms or speckle-tracking radial strain delay ≥130 ms. Persistent dyssynchrony at 6 months was observed similarly in both groups (77% in CRT-On; 76% in CRT-Off). Persistent dyssynchrony was associated with a significantly higher primary end point of death or HF hospitalization (HR = 1.54, 95% CI 1.03-2.30, P = 0.03), and in particular secondary endpoint of HF hospitalization (HR = 1.66, 95% CI 1.07-2.57, P = 0.02). HF hospitalizations were also associated with worsening longitudinal dyssynchrony (HR = 1.45, 95% CI 1.02-2.05, P = 0.037), and worsening radial dyssynchrony (HR = 1.81, 95% CI 1.16-2.81, P = 0.008). Associations of persistent or worsening dyssynchrony with outcomes were similar in CRT-Off and CRT-On groups. CONCLUSIONS: Persistent or worsening echocardiographic dyssynchrony in HF patients with narrow QRS width was a marker for unfavourable clinical outcomes unaffected by CRT. In particular, echocardiographic dyssynchrony on follow-up was strongly associated with HF hospitalizations and appears to be a prognostic marker of disease severity."},{"id":"b5fee209ef84","type":"article","url":"https://hartvaat.nl/2016/01/01/2015-esc-ers-richtlijn-voor-diagnostiek-en-behandeling-van-pulmonale-hypertensie/","title":"2015 ESC/ERS-richtlijn voor diagnostiek en behandeling van pulmonale hypertensie","title_en":"2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT).","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["pulmonale-hypertensie","richtlijnen-esc"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehv317","source_url":"https://doi.org/10.1093/eurheartj/ehv317","authors":["Nazzareno Galiè","Marc Humbert","Jean-Luc Vachiery","Simon Gibbs","Irene Lang","Adam Torbicki","Gérald Simonneau","Andrew Peacock","Anton Vonk Noordegraaf","Maurice Beghetti","Ardeschir Ghofrani","Miguel Angel Gomez Sanchez","Georg Hansmann","Walter Klepetko","Patrizio Lancellotti","Marco Matucci","Theresa McDonagh","Luc A Pierard","Pedro T Trindade","Maurizio Zompatori","Marius Hoeper"],"significance":9,"published":"2016-01-01","source_date":"2016-01-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/secundaire-hypertensie/","https://hartvaat.nl/kennis/hypertensie/witte-jas-hypertensie/"],"congress":"","summary_en":"The 2015 ESC/ERS guidelines for pulmonary hypertension established a comprehensive framework for classification, diagnosis, and treatment of all forms of pulmonary hypertension. The document defined hemodynamic criteria, diagnostic pathways, and evidence-based treatment algorithms including combination therapy.","created":"2026-07-03T10:25:51Z","updated":"2026-07-03T13:25:13Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De gezamenlijke ESC/ERS-richtlijn voor pulmonale hypertensie biedt een uitgebreid kader voor classificatie, diagnostiek en behandeling van alle vormen van pulmonale hypertensie. Bevat herziene hemodynamische definities en behandelalgoritmen.","abstract_original":""},{"id":"65800416d60b","type":"article","url":"https://hartvaat.nl/2016/01/01/inspanningstraining-verbetert-zuurstofopname-en-hemodynamiek-bij-ernstige-pulmon/","title":"Inspanningstraining verbetert zuurstofopname en hemodynamiek bij ernstige pulmonale hypertensie","title_en":"Exercise training improves peak oxygen consumption and haemodynamics in patients with severe pulmonary arterial hypertension and inoperable chronic thrombo-embolic pulmonary hypertension: a prospective, randomized, controlled trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog"],"tags":["bloeddrukbehandeling","fractional-flow-reserve","pulmonale-hypertensie"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehv337","source_url":"https://doi.org/10.1093/eurheartj/ehv337","authors":["Nicola Ehlken","Mona Lichtblau","Hans Klose","Johannes Weidenhammer","Christine Fischer","Robert Nechwatal","Sören Uiker","Michael Halank","Karen Olsson","Werner Seeger","Henning Gall","Stephan Rosenkranz","Heinrike Wilkens","Dirk Mertens","Hans-Jürgen Seyfarth","Christian Opitz","Silvia Ulrich","Benjamin Egenlauf","Ekkehard Grünig"],"significance":7,"published":"2016-01-01","source_date":"2016-01-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/","https://hartvaat.nl/kennis/nierziekte/raas-blokkade-bij-nierziekte/"],"congress":"","summary_en":"This prospective randomized study was the first to invasively assess the effects of exercise training on right heart hemodynamics and pulmonary circulation in patients with severe pulmonary arterial hypertension, demonstrating improvements in peak oxygen consumption and cardiac output.","created":"2026-07-03T10:25:51Z","updated":"2026-07-03T18:38:20Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Prospectieve gerandomiseerde studie die voor het eerst invasief de effecten van inspanningstraining op het rechterhart en de longcirculatie onderzocht bij patiënten met pulmonale hypertensie. Training verbeterde de piek-VO2 en hemodynamische parameters significant.","abstract_original":"AIMS: The impact of exercise training on the right heart and pulmonary circulation has not yet been invasively assessed in patients with pulmonary hypertension (PH) and right heart failure. This prospective randomized controlled study investigates the effects of exercise training on peak VO2/kg, haemodynamics, and further clinically relevant parameters in PH patients. METHODS AND RESULTS: Eighty-seven patients with pulmonary arterial hypertension and inoperable chronic thrombo-embolic PH (54% female, 56 ± 15 years, 84% World Health Organization functional class III/IV, 53% combination therapy) on stable disease-targeted medication were randomly assigned to a control and training group. Medication remained unchanged during the study period. Non-invasive assessments and right heart catheterization at rest and during exercise were performed at baseline and after 15 weeks. Primary endpoint was the change in peak VO2/kg. Secondary endpoints included changes in haemodynamics. For missing data, multiple imputation and responder analyses were performed. The study results showed a significant improvement of peak VO2/kg in the training group (difference from baseline to 15 weeks: training +3.1 ± 2.7 mL/min/kg equals +24.3% vs. control -0.2 ± 2.3 mL/min/kg equals +0.9%, P < 0.001). Cardiac index (CI) at rest and during exercise, mean pulmonary arterial pressure, pulmonary vascular resistance, 6 min walking distance, quality of life, and exercise capacity significantly improved by exercise training. CONCLUSION: Low-dose exercise training at 4-7 days/week significantly improved peak VO2/kg, haemodynamics, and further clinically relevant parameters. The improvements of CI at rest and during exercise indicate that exercise training may improve the right ventricular function. Further, large multicentre trials are necessary to confirm these results."},{"id":"11c2eef4c408","type":"article","url":"https://hartvaat.nl/2016/01/01/centrale-versus-perifere-bloeddruk-en-doelorgaanschade-systematische-review-en-m/","title":"Centrale versus perifere bloeddruk en doelorgaanschade: systematische review en meta-analyse","title_en":"Association of Central Versus Brachial Blood Pressure With Target-Organ Damage: Systematic Review and Meta-Analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.115.06066","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.115.06066","authors":["Anastasios Kollias","Styliani Lagou","Maria Elena Zeniodi","Nadia Boubouchairopoulou","George S Stergiou"],"significance":6,"published":"2016-01-01","source_date":"2016-01-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/wat-is-hypertensie/","https://hartvaat.nl/kennis/farmacologie/betablokkers-farmacologie/"],"congress":"","summary_en":"This systematic review and meta-analysis compared the association of central versus brachial blood pressure with preclinical target organ damage, providing evidence that central pressure may be a more accurate marker of hemodynamic stress on vital organs.","created":"2026-07-03T10:25:51Z","updated":"2026-07-03T18:38:20Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse die het verband onderzocht tussen centrale en perifere bloeddruk en preklinische doelorgaanschade. Centrale bloeddruk lijkt de hemodynamische belasting op doelorganen nauwkeuriger te weerspiegelen dan brachiaal gemeten bloeddruk.","abstract_original":"Accumulating evidence suggests that central blood pressure (BP) may reflect the hemodynamic stress on target organs more accurately than brachial BP. A systematic review assessing the relationship of central versus brachial BP with preclinical target-organ damage was performed. Meta-analysis of cross-sectional data showed that central compared with brachial systolic BP was more closely associated with (1) left ventricular mass index (12 studies, n=6431; weighted age [SD], 49.9 [13.1] years; 51% hypertensives): pooled correlation coefficients r=0.30; 95% confidence interval (CI), 0.23-0.37 versus r=0.26; 95% CI, 0.19-0.33, respectively; P<0.01 for difference; (2) carotid intima-media thickness (7 studies, n=6136; weighted age, 55.6 [13.2] years; 48% hypertensives): r=0.27; 95% CI, 0.19-0.34 versus r=0.23; 95% CI, 0.16-0.30, respectively; P<0.01 for difference; (3) pulse-wave velocity (14 studies, n=3699; weighted age, 53.9 [13.3] years; 53% hypertensives): r=0.42; 95% CI, 0.37-0.47 versus r=0.39; 95% CI, 0.33-0.45, respectively; P<0.01 for difference. Four studies assessing urine albumin excretion (n=3718; weighted age, 56.4 [5] years; 69% hypertensives) reported similar correlations (P=not significant) with central (r=0.22; 95% CI, 0.14-0.29) and brachial systolic BP (r=0.22; 95% CI, 0.12-0.32). Similar findings were observed for central compared with brachial pulse pressure in terms of relationship with target-organ damage. Metaregression analyses did not reveal any significant effect of age. In conclusion, central compared with brachial BP seems to be more strongly associated with most of the investigated indices of preclinical organ damage."},{"id":"f87e9dd2786a","type":"article","url":"https://hartvaat.nl/2016/01/01/bereikte-bloeddruk-en-uitkomsten-in-de-sps3-trial-bij-lacunaire-herseninfarcten/","title":"Bereikte bloeddruk en uitkomsten in de SPS3-trial bij lacunaire herseninfarcten","title_en":"Achieved Blood Pressure and Outcomes in the Secondary Prevention of Small Subcortical Strokes Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","myocardinfarct","ouderen","secundaire-preventie","select-trial","summit-trial"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.115.06480","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.115.06480","authors":["Michelle C Odden","Leslie A McClure","B Peter Sawaya","Carole L White","Carmen A Peralta","Thalia S Field","Robert G Hart","Oscar R Benavente","Pablo E Pergola"],"significance":6,"published":"2016-01-01","source_date":"2016-01-01","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/hypertensie/wat-is-hypertensie/"],"congress":"","summary_en":"This SPS3 trial analysis examined the relationship between achieved systolic blood pressure and cardiovascular outcomes in patients with small subcortical strokes, exploring the J-curve phenomenon in secondary stroke prevention.","created":"2026-07-03T10:25:51Z","updated":"2026-07-03T13:25:13Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de SPS3-trial naar het verband tussen bereikte systolische bloeddruk en cardiovasculaire events bij patiënten met een lacunair herseninfarct. De studie draagt bij aan het debat over de J-curverelatie bij intensieve bloeddrukverlaging.","abstract_original":"UNLABELLED: Studies suggest a J-shaped association between blood pressure and cardiovascular events in the setting of intensive systolic blood pressure control; whether there is a similar association with stroke remains less well established. The Secondary Prevention of Small Subcortical Strokes was a randomized trial to evaluate higher (130-149 mm Hg) versus lower (<130 mm Hg) systolic blood pressure targets in participants with recent lacunar infarcts. We evaluated the association of mean achieved blood pressure, 6 months after randomization, and recurrent stroke, major vascular events, and all-cause mortality. After a mean follow up of 3.7 years, there was a J-shaped association between achieved blood pressure and outcomes; the lowest risk was at ≈124 and 67 mm Hg systolic and diastolic blood pressure, respectively. For example, above a systolic blood pressure of 124 mm Hg, 1 standard deviation higher (11.1 mm Hg) was associated with increased mortality (adjusted hazard ratio: 1.9; 95% confidence interval: 1.4, 2.7), whereas below this level, this relationship was inverted (0.29; 0.10, 0.79), P<0.001 for interaction. Above a diastolic blood pressure of 67 mm Hg, a 1 standard deviation higher (8.2 mm Hg) was associated with an increased risk of stroke (2.2; 1.4, 3.6), whereas below this level, the association was in the opposite direction (0.34; 0.13, 0.89), P=0.02 for interaction. The lowest risk of all events occurred at a nadir of ≈120 to 128 mm Hg systolic blood pressure and 65 to 70 mm Hg diastolic blood pressure. Future studies should evaluate the impact of excessive blood pressure reduction, especially in older populations with preexisting vascular disease. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00059306."},{"id":"a74b68cf6e6f","type":"article","url":"https://hartvaat.nl/2016/01/01/point-of-care-echografie-voor-volumebeoordeling-bij-hartfalen-in-een-verpleegkun/","title":"Point-of-care echografie voor volumebeoordeling bij hartfalen in een verpleegkundig geleide polikliniek","title_en":"Adding point of care ultrasound to assess volume status in heart failure patients in a nurse-led outpatient clinic. A randomised study.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","echocardiografie"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2015-307798","source_url":"https://doi.org/10.1136/heartjnl-2015-307798","authors":["Guri Holmen Gundersen","Tone M Norekval","Hilde Haugberg Haug","Kyrre Skjetne","Jens Olaf Kleinau","Torbjorn Graven","Havard Dalen"],"significance":5,"published":"2016-01-01","source_date":"2016-01-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/diagnose-hartfalen-stappenplan/","https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"This randomized study showed that adding point-of-care ultrasound (pleural effusion, IVC assessment) by specialized nurses to routine heart failure outpatient care improves volume status assessment beyond standard clinical evaluation.","created":"2026-07-03T10:25:51Z","updated":"2026-07-03T18:38:20Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde studie naar de meerwaarde van gerichte echografie (pleuravocht en vena cava inferior) door gespecialiseerde verpleegkundigen bij poliklinische hartfalenpatiënten. De toevoeging van echografie kan de beoordeling van de volumestatus verbeteren ten opzichte van standaard lichamelijk onderzoek.","abstract_original":"OBJECTIVES: Medical history, physical examination and laboratory testing are not optimal for the assessment of volume status in heart failure (HF) patients. We aimed to study the clinical influence of focused ultrasound of the pleural cavities and inferior vena cava (IVC) performed by specialised nurses to assess volume status in HF patients at an outpatient clinic. METHODS: HF outpatients were prospectively included and underwent laboratory testing, history recording and clinical examination by two nurses with and without an ultrasound examination of the pleural cavities and IVC using a pocket-size imaging device, in random order. Each nurse worked in a team with a cardiologist. The influence of the different diagnostic tests on diuretic dosing was assessed descriptively and in linear regression analyses. RESULTS: Sixty-two patients were included and 119 examinations were performed. Mean±SD age was 74±12 years, EF was 34±14%, and N-terminal pro-brain natriuretic peptide (NT-proBNP) value was 3761±3072 ng/L. Dosing of diuretics differed between the teams in 31 out of 119 consultations. Weight change and volume status assessed clinically with and without ultrasound predicted dose adjustment of diuretics at follow-up (p<0.05). Change of oedema, NT-proBNP, creatinine, and symptoms did not (p≥0.10). In adjusted analyses, only volume status based on ultrasound predicted dose adjustments of diuretics at first visit and follow-up (all ultrasound p≤0.01, all other p≥0.2). CONCLUSIONS: Ultrasound examinations of the pleural cavities and IVC by nurses may improve diagnostics and patient care in HF patients at an outpatient clinic, but more studies are needed to determine whether these examinations have an impact on clinical outcomes. TRIAL REGISTRATION NUMBER: NCT01794715."},{"id":"31d0b6e012f8","type":"article","url":"https://hartvaat.nl/2016/01/01/gesimuleerde-obstructieve-slaapapneu-bevordert-ritmestoornissen-bij-paroxysmaal-/","title":"Gesimuleerde obstructieve slaapapneu bevordert ritmestoornissen bij paroxysmaal atriumfibrilleren","title_en":"Intrathoracic pressure swings induced by simulated obstructive sleep apnoea promote arrhythmias in paroxysmal atrial fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["acuut-hartfalen","aficamten","bradycardie","gedilateerde-cardiomyopathie","hypertrofische-cardiomyopathie","katheterablatie","laminopathie","linkerhartoorsluiting","slaapapneu"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euv122","source_url":"https://doi.org/10.1093/europace/euv122","authors":["Christian Schlatzer","Esther I Schwarz","Noriane A Sievi","Christian F Clarenbach","Thomas Gaisl","Laurent M Haegeli","Firat Duru","John R Stradling","Malcolm Kohler"],"significance":5,"published":"2016-01-01","source_date":"2016-01-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ecg-herkenning-af/","https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This interventional crossover study simulated obstructive sleep apnea-induced intrathoracic pressure swings during AF catheter ablation, demonstrating that OSA-like mechanical stress can directly trigger arrhythmias in susceptible atria.","created":"2026-07-03T10:25:51Z","updated":"2026-07-03T18:38:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"In deze interventionele cross-overstudie werden intrathoracale drukschommelingen, kenmerkend voor obstructieve slaapapneu, gesimuleerd bij patiënten met paroxysmaal AF. De resultaten bevestigen een mechanistisch verband tussen slaapapneu en het ontstaan van boezemfibrilleren.","abstract_original":"AIMS: There is preliminary evidence for a link between obstructive sleep apnoea (OSA) and arrhythmias such as paroxysmal atrial fibrillation (PAF) and sudden cardiac death but underlying mechanisms remain largely unknown. METHODS AND RESULTS: In this interventional crossover study, we evaluated whether intrathoracic pressure changes, induced by simulated OSA, trigger premature cardiac beats, and alter measures of ventricular repolarization [QTc and Tpeak-to-Tend (TpTec) intervals] in patients with PAF. 12-Lead-electrocardiograms were recorded continuously in 44 patients, while simulating obstructive apnoea (Mueller manoeuvre, MM), obstructive hypopnoea (inspiration through a threshold load, ITH), end-expiratory central apnoea (AP), and during normal breathing (NB) in randomized order. The prevalence of OSA in these 44 patients was assessed by a sleep study. Atrial premature beats (APBs) occurred more frequently during MM (55% of patients) and ITH (32%), but not during AP (14%), compared with NB (9%) (P < 0.001, P = 0.006 and P = 0.688, respectively). Mueller manoeuvre led to a significant prolongation of QTc and TpTec intervals (+17.3 ms, P < 0.001 and +4.3 ms, P = 0.005). Inspiration through a threshold load significantly increased QTc (+9.6 ms, P < 0.001) but not TpTec. End-expiratory central apnoea did not alter QTc and TpTec intervals. According to the sleep study, 56% of patients had OSA (apnoea hypopnoea index ≥5). CONCLUSION: Simulated OSA induces APBs which may be important in patients with PAF, because the majority of episodes of PAF has been shown to be triggered by APBs. Simulated OSA leads to a significant prolongation of ventricular repolarization."},{"id":"950967c629f1","type":"article","url":"https://hartvaat.nl/2016/01/01/katheterablatie-herstelt-verlaagde-plasma-mir-409-3p-en-mir-432-bij-atriumfibril/","title":"Katheterablatie herstelt verlaagde plasma miR-409-3p en miR-432 bij atriumfibrilleren","title_en":"Catheter ablation restores decreased plasma miR-409-3p and miR-432 in atrial fibrillation patients.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["biomarkers-cardiovasculair"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euu366","source_url":"https://doi.org/10.1093/europace/euu366","authors":["Tian Liu","Shilong Zhong","Fang Rao","Yumei Xue","Zhoucuo Qi","Shulin Wu"],"significance":4,"published":"2016-01-01","source_date":"2016-01-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/atriumfibrilleren/af-en-hartfalen/"],"congress":"","summary_en":"This study identified specific plasma microRNA expression changes in atrial fibrillation patients before and after catheter ablation. Ablation restored decreased miR-409-3p and miR-432 levels, offering potential biomarkers for monitoring therapeutic response.","created":"2026-07-03T10:25:50Z","updated":"2026-07-03T13:25:13Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Deze studie onderzocht veranderingen in plasma-microRNA-expressie bij patiënten met atriumfibrilleren vóór en na katheterablatie. De resultaten tonen aan dat ablatie specifieke miRNA-niveaus kan herstellen, wat nieuwe inzichten biedt in de pathofysiologie van AF en potentiële biomarkers voor therapierespons.","abstract_original":"AIMS: Despite numerous studies identifying specific microRNA (miRNA) expression profiles associated with atrial fibrillation (AF), changes in plasma miRNA expression in pre- and post-operative AF patients who have received catheter ablation, remain poorly characterized. This study aimed to reveal disease-related biomarkers by detecting plasma miRNA expression in AF patients, and examining the levels of AF-specific miRNAs in patients after catheter ablation, in order to help gauge therapeutic effects and assess prognosis. METHODS AND RESULTS: A total of 100 Han Chinese patients with AF who had received catheter ablation, and 100 healthy individuals, were sequentially recruited to the study. Atrial fibrillation-specific plasma miRNAs were detected by Solexa sequencing and quantitative reverse transcription polymerase chain reaction. The expression levels of AF-specific miRNAs were also investigated in 40 post-operative patients (24-48 h) and 20 patients followed up (58.52 ± 36.00 days) after catheter ablation, to explore changes in miRNA expression. The expressions of miR-409-3p and miR-432 in the plasma of AF patients were lower than healthy individuals. In binary logistic regression analyses, reduced miR-409-3p and miR-432 levels were independently associated with AF (95% confidence interval: 1.02-2.22 and 1.09-2.43, P = 0.040 and 0.018, respectively). The levels of miR-409-3p and miR-432 showed no significant difference between post-operative patients and healthy individuals (P = 0.411 and 0.681, respectively), or between followed-up patients and healthy individuals (P = 0.720 and 0.073, respectively). CONCLUSION: We suggest that plasma miR-409-3p and miR-432 are potential markers of AF, and catheter ablation restores their decreased levels in AF patients."}]}