{"generated":"2026-08-28T16:42:09Z","year":"2020","count":321,"licence":"Citeer vrij, met bronvermelding en een link naar 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":"9164fa03cc70","type":"article","url":"https://hartvaat.nl/2020/12/22/digoxine-versus-bisoprolol-voor-frequentiecontrole-bij-af-en-qol-jama-rate-af/","title":"Digoxine versus bisoprolol voor frequentiecontrole bij AF en QoL: JAMA RATE-AF","title_en":"Effect of Digoxin vs Bisoprolol for Heart Rate Control in Atrial Fibrillation on Patient-Reported Quality of Life: The RATE-AF Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts"],"tags":["bisoprolol"],"journal":"JAMA","doi":"10.1001/jama.2020.23138","source_url":"https://doi.org/10.1001/jama.2020.23138","authors":["Dipak Kotecha","Karina V Bunting","Simrat K Gill","Samir Mehta","Mary Stanbury","Jacqueline C Jones","Sandra Haynes","Melanie J Calvert","Jonathan J Deeks","Richard P Steeds","Victoria Y Strauss","Kazem Rahimi","A John Camm","Michael Griffith","Gregory Y H Lip","Jonathan N Townend","Paulus Kirchhof"],"significance":8,"published":"2020-12-22","source_date":"2020-12-22","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/","https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"The RATE-AF trial showed that digoxin was noninferior to bisoprolol for quality-of-life outcomes in patients with permanent AF and symptoms of heart failure, with fewer treatment-related adverse events. The pragmatic result supported digoxin as a reasonable first-line rate control agent in this population.","created":"2026-07-03T10:28:58Z","updated":"2026-07-03T13:28:07Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 RATE-AF gerandomiseerde trial die digoxine vergeleek met bisoprolol voor frequentiecontrole bij AF op patiëntgerapporteerde kwaliteit van leven. Verrassend: digoxine niet inferieur.","abstract_original":"IMPORTANCE: There is little evidence to support selection of heart rate control therapy in patients with permanent atrial fibrillation, in particular those with coexisting heart failure. OBJECTIVE: To compare low-dose digoxin with bisoprolol (a β-blocker). DESIGN, SETTING, AND PARTICIPANTS: Randomized, open-label, blinded end-point clinical trial including 160 patients aged 60 years or older with permanent atrial fibrillation (defined as no plan to restore sinus rhythm) and dyspnea classified as New York Heart Association class II or higher. Patients were recruited from 3 hospitals and primary care practices in England from 2016 through 2018; last follow-up occurred in October 2019. INTERVENTIONS: Digoxin (n = 80; dose range, 62.5-250 μg/d; mean dose, 161 μg/d) or bisoprolol (n = 80; dose range, 1.25-15 mg/d; mean dose, 3.2 mg/d). MAIN OUTCOMES AND MEASURES: The primary end point was patient-reported quality of life using the 36-Item Short Form Health Survey physical component summary score (SF-36 PCS) at 6 months (higher scores are better; range, 0-100), with a minimal clinically important difference of 0.5 SD. There were 17 secondary end points (including resting heart rate, modified European Heart Rhythm Association [EHRA] symptom classification, and N-terminal pro-brain natriuretic peptide [NT-proBNP] level) at 6 months, 20 end points at 12 months, and adverse event (AE) reporting. RESULTS: Among 160 patients (mean age, 76 [SD, 8] years; 74 [46%] women; mean baseline heart rate, 100/min [SD, 18/min]), 145 (91%) completed the trial and 150 (94%) were included in the analysis for the primary outcome. There was no significant difference in the primary outcome of normalized SF-36 PCS at 6 months (mean, 31.9 [SD, 11.7] for digoxin vs 29.7 [11.4] for bisoprolol; adjusted mean difference, 1.4 [95% CI, -1.1 to 3.8]; P = .28). Of the 17 secondary outcomes at 6 months, there were no significant between-group differences for 16 outcomes, including resting heart rate (a mean of 76.9/min [SD, 12.1/min] with digoxin vs a mean of 74.8/min [SD, 11.6/min] with bisoprolol; difference, 1.5/min [95% CI, -2.0 to 5.1/min]; P = .40). The modified EHRA class was significantly different between groups at 6 months; 53% of patients in the digoxin group reported a 2-class improvement vs 9% of patients in the bisoprolol group (adjusted odds ratio, 10.3 [95% CI, 4.0 to 26.6]; P < .001). At 12 months, 8 of 20 outcomes were significantly different (all favoring digoxin), with a median NT-proBNP level of 960 pg/mL (interquartile range, 626 to 1531 pg/mL) in the digoxin group vs 1250 pg/mL (interquartile range, 847 to 1890 pg/mL) in the bisoprolol group (ratio of geometric means, 0.77 [95% CI, 0.64 to 0.92]; P = .005). Adverse events were less common with digoxin; 20 patients (25%) in the digoxin group had at least 1 AE vs 51 patients (64%) in the bisoprolol group (P < .001). There were 29 treatment-related AEs and 16 serious AEs in the digoxin group vs 142 and 37, respectively, in the bisoprolol group. CONCLUSIONS AND RELEVANCE: Among patients with permanent atrial fibrillation and symptoms of heart failure treated with low-dose digoxin or bisoprolol, there was no statistically significant difference in quality of life at 6 months. These findings support potentially basing decisions about treatment on other end points. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02391337 and clinicaltrialsregister.eu Identifier: 2015-005043-13."},{"id":"02d79eee5225","type":"article","url":"https://hartvaat.nl/2020/12/22/fentanyl-versus-morfine-op-ticagrelor-plaatjesremming-bij-stemi/","title":"Fentanyl versus morfine op ticagrelor-plaatjesremming bij STEMI","title_en":"Effects of Fentanyl Versus Morphine on Ticagrelor-Induced Platelet Inhibition in Patients With ST-Segment Elevation Myocardial Infarction: The PERSEUS Randomized Trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.049287","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.049287","authors":["Juan F Iglesias","Marco Valgimigli","Federico Carbone","Nathalie Lauriers","Pier Giorgio Masci","Sophie Degrauwe"],"significance":6,"published":"2020-12-22","source_date":"2020-12-22","image":"","kennis":[],"congress":"","summary_en":"This study compared the effects of fentanyl versus morphine on ticagrelor-induced platelet inhibition in STEMI, characterizing the differential impact of these opioids on antiplatelet drug absorption during acute MI management.","created":"2026-07-03T10:28:58Z","updated":"2026-07-03T13:28:07Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 het effect van fentanyl versus morfine op ticagrelor-geïnduceerde plaatjesremming bij STEMI.","abstract_original":""},{"id":"7c27d54fa2ea","type":"article","url":"https://hartvaat.nl/2020/12/22/lichaamssamenstelling-en-risico-op-hartfalen-en-mi-prospectieve-analyse/","title":"Lichaamssamenstelling en risico op hartfalen en MI: prospectieve analyse","title_en":"Association of Baseline and Longitudinal Changes in Body Composition Measures With Risk of Heart Failure and Myocardial Infarction in Type 2 Diabetes: Findings From the Look AHEAD Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":["acuut-hartfalen","vrouwen"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.050941","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.050941","authors":["Kershaw V Patel","Judy L Bahnson","Sarah A Gaussoin","Karen C Johnson","Xavier Pi-Sunyer","Ursula White","KayLoni L Olson","Alain G Bertoni","Dalane W Kitzman","Jarett D Berry","Ambarish Pandey"],"significance":6,"published":"2020-12-22","source_date":"2020-12-22","image":"","kennis":[],"congress":"","summary_en":"This study demonstrated that longitudinal changes in body composition (lean mass, fat mass, visceral adiposity) predict heart failure and MI risk independently of body weight, supporting body composition assessment beyond BMI for cardiovascular risk.","created":"2026-07-03T10:28:58Z","updated":"2026-07-03T13:28:07Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 associatie van baseline en longitudinale veranderingen in lichaamssamenstelling met het risico op HF en MI.","abstract_original":"BACKGROUND: Intentional weight loss is associated with lower risk of heart failure (HF) and atherosclerotic cardiovascular disease among patients with type 2 diabetes. However, the contribution of baseline measures and longitudinal changes in fat mass (FM), lean mass (LM), and waist circumference (WC) to the risk of HF and myocardial infarction (MI) in type 2 diabetes is not well established. METHODS: Adults from the Look AHEAD trial (Action for Health in Diabetes) without prevalent HF were included. FM and LM were predicted using validated equations and compared with dual-energy x-ray absorptiometry measurements in a subgroup. Adjusted Cox models were used to evaluate the associations of baseline and longitudinal changes in FM, LM, and WC over 1- and 4-year follow-up with risk of overall HF, HF with preserved ejection fraction (EF; EF ≥50%), HF with reduced EF (EF <50%), and MI. RESULTS: Among 5103 participants, there were 257 incident HF events over 12.4 years of follow-up. Predicted and measured FM/LM were highly correlated (R2=0.87-0.90; n=1369). FM and LM decreased over 4-year follow-up with greater declines in the intensive lifestyle intervention arm. In adjusted analysis, baseline body composition measures were not significantly associated with HF risk. Decline in FM and WC, but not LM, over 1 year were each significantly associated with lower risk of overall HF (adjusted hazard ratio per 10% decrease in FM, 0.80 [95% CI, 0.68-0.95]; adjusted hazard ratio per 10% decrease in WC, 0.77 [95% CI, 0.62-0.95]). Decline in FM was significantly associated with lower risk of both HF subtypes. In contrast, decline in WC was significantly associated with lower risk of HF with preserved EF but not HF with reduced EF. Similar patterns of association were observed for 4-year changes in body composition and HF risk. Longitudinal changes in body composition were not significantly associated with risk of MI. CONCLUSIONS: In adults with type 2 diabetes, a lifestyle intervention is associated with significant loss of FM and LM. Declines in FM and WC, but not LM, were each significantly associated with lower risk of HF but not MI. Furthermore, decline in WC was significantly associated with lower risk of HF with preserved EF but not HF with reduced EF. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00017953."},{"id":"27ac43c5582a","type":"article","url":"https://hartvaat.nl/2020/12/15/aflibercept-versus-vitrectomie-bij-diabetische-glasvochtbloeding-jama-drcr-net-p/","title":"Aflibercept versus vitrectomie bij diabetische glasvochtbloeding: JAMA DRCR.net Protocol AB","title_en":"Effect of Intravitreous Aflibercept vs Vitrectomy With Panretinal Photocoagulation on Visual Acuity in Patients With Vitreous Hemorrhage From Proliferative Diabetic Retinopathy: A Randomized Clinical Trial.","category":"preventie","category_label":"Preventie","professions":["internist"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2020.23027","source_url":"https://doi.org/10.1001/jama.2020.23027","authors":["Andrew N Antoszyk","Adam R Glassman","Wesley T Beaulieu","Lee M Jampol","Chirag D Jhaveri","Omar S Punjabi","Hani Salehi-Had","John A Wells","Maureen G Maguire","Cynthia R Stockdale","Daniel F Martin","Jennifer K Sun"],"significance":6,"published":"2020-12-15","source_date":"2020-12-15","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This DRCR.net trial compared intravitreal aflibercept with vitrectomy for diabetic vitreous hemorrhage, informing the ophthalmological management of this vision-threatening diabetic complication.","created":"2026-07-03T10:28:58Z","updated":"2026-07-03T13:28:06Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 DRCR.net Protocol AB trial die aflibercept vergeleek met vitrectomie bij diabetische glasvochtbloeding.","abstract_original":"IMPORTANCE: Vitreous hemorrhage from proliferative diabetic retinopathy can cause loss of vision. The best management approach is unknown. OBJECTIVE: To compare initial treatment with intravitreous aflibercept vs vitrectomy with panretinal photocoagulation for vitreous hemorrhage from proliferative diabetic retinopathy. DESIGN, SETTING, AND PARTICIPANTS: Randomized clinical trial at 39 DRCR Retina Network sites in the US and Canada including 205 adults with vison loss due to vitreous hemorrhage from proliferative diabetic retinopathy who were enrolled from November 2016 to December 2017. The final follow-up visit was completed in January 2020. INTERVENTIONS: Random assignment of eyes (1 per participant) to aflibercept (100 participants) or vitrectomy with panretinal photocoagulation (105 participants). Participants whose eyes were assigned to aflibercept initially received 4 monthly injections. Both groups could receive aflibercept or vitrectomy during follow-up based on protocol criteria. MAIN OUTCOMES AND MEASURES: The primary outcome was mean visual acuity letter score (range, 0-100; higher scores indicate better vision) over 24 weeks (area under the curve); the study was powered to detect a difference of 8 letters. Secondary outcomes included mean visual acuity at 4 weeks and 2 years. RESULTS: Among 205 participants (205 eyes) who were randomized (mean [SD] age, 57 [11] years; 115 [56%] men; mean visual acuity letter score, 34.5 [Snellen equivalent, 20/200]), 95% (195 of 205) completed the 24-week visit and 90% (177 of 196, excluding 9 deaths) completed the 2-year visit. The mean visual acuity letter score over 24 weeks was 59.3 (Snellen equivalent, 20/63) (95% CI, 54.9 to 63.7) in the aflibercept group vs 63.0 (Snellen equivalent, 20/63) (95% CI, 58.6 to 67.3) in the vitrectomy group (adjusted difference, -5.0 [95% CI, -10.2 to 0.3], P = .06). Among 23 secondary outcomes, 15 showed no significant difference. The mean visual acuity letter score was 52.6 (Snellen equivalent, 20/100) in the aflibercept group vs 62.3 (Snellen equivalent, 20/63) in the vitrectomy group at 4 weeks (adjusted difference, -11.2 [95% CI, -18.5 to -3.9], P = .003) and 73.7 (Snellen equivalent, 20/40) vs 71.0 (Snellen equivalent, 20/40) at 2 years (adjusted difference, 2.7 [95% CI, -3.1 to 8.4], P = .36). Over 2 years, 33 eyes (33%) assigned to aflibercept received vitrectomy and 34 eyes (32%) assigned to vitrectomy received subsequent aflibercept. CONCLUSIONS AND RELEVANCE: Among participants whose eyes had vitreous hemorrhage from proliferative diabetic retinopathy, there was no statistically significant difference in the primary outcome of mean visual acuity letter score over 24 weeks following initial treatment with intravitreous aflibercept vs vitrectomy with panretinal photocoagulation. However, the study may have been underpowered, considering the range of the 95% CI, to detect a clinically important benefit in favor of initial vitrectomy with panretinal photocoagulation. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02858076."},{"id":"283b8f43bcaf","type":"article","url":"https://hartvaat.nl/2020/12/15/prehospitaal-gemalen-prasugrel-bij-stemi-gerandomiseerde-trial/","title":"Prehospitaal gemalen prasugrel bij STEMI: gerandomiseerde trial","title_en":"Effect of Prehospital Crushed Prasugrel Tablets in Patients With ST-Segment-Elevation Myocardial Infarction Planned for Primary Percutaneous Coronary Intervention: The Randomized COMPARE CRUSH Trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.051532","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.051532","authors":["Georgios J Vlachojannis","Jeroen M Wilschut","Rosanne F Vogel","Miguel E Lemmert","Ronak Delewi","Roberto Diletti","Nancy W P L van der Waarden","Rutger-Jan Nuis","Valeria Paradies","Dimitrios Alexopoulos","Felix Zijlstra","Gilles Montalescot","Dominick J Angiolillo","Mitchell W Krucoff","Nicolas M Van Mieghem","Pieter C Smits"],"significance":6,"published":"2020-12-15","source_date":"2020-12-15","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This randomized trial of prehospital crushed prasugrel in STEMI tested whether mechanically disrupting tablets before administration overcomes the delayed absorption seen with intact oral P2Y12 inhibitors in the acute MI setting.","created":"2026-07-03T10:28:57Z","updated":"2026-07-03T13:28:06Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 prehospitaal gemalen (crushed) prasugrel bij STEMI gepland voor primaire PCI.","abstract_original":"BACKGROUND: Early treatment with a potent oral platelet P2Y12 inhibitor is recommended in patients presenting with ST-segment-elevation myocardial infarction scheduled to undergo primary percutaneous coronary intervention (pPCI). The impact on coronary reperfusion of crushed P2Y12 inhibitor tablets, which lead to more prompt and potent platelet inhibition, is unknown. METHODS: We conducted a randomized controlled, multicenter trial in the Netherlands, enrolling patients with ST-segment-elevation myocardial infarction scheduled to undergo pPCI. Patients were randomly allocated to receive in the ambulance, before transfer, a 60-mg loading dose of prasugrel either as crushed or integral tablets. The independent primary end points were thrombolysis in myocardial infarction (TIMI) 3 flow in the infarct-related artery at initial coronary angiography, and complete (≥70%) ST-segment resolution 1 hour after pPCI. The safety end points were TIMI major and Bleeding Academic Research Consortium ≥3 bleedings. Secondary end points included platelet reactivity and ischemic outcomes. RESULTS: A total of 727 patients were assigned to either crushed or integral tablets of prasugrel loading dose. The median time from study treatment to wire-crossing during pPCI was 57 (47-70) minutes. The primary end point TIMI 3 flow in the infarct-related artery before pPCI occurred in 31.0% in the crushed group versus 32.7% in the integral group (odds ratio, 0.92 [95% CI, 0.65-1.30], P=0.64). Complete ST-segment resolution 1 hour after pPCI was present in 59.9% in the crushed group versus 57.3% in the integral group (odds ratio, 1.11 [95% CI, 0.78-1.58], P=0.55). Platelet reactivity at the beginning of pPCI, measured as P2Y12 reactivity unit, differed significantly between groups (crushed, 192 [132-245] versus integral, 227 [184-254], P≤0.01). TIMI major and Bleeding Academic Research Consortium ≥3 bleeding occurred in 0% in the crushed group versus 0.8% in the integral group, and in 0.3% in the crushed group versus 1.1% in the integral group, respectively. There were no differences observed between groups regarding ischemic events at 30 days. CONCLUSIONS: Prehospital administration of crushed prasugrel tablets does not improve TIMI 3 flow in the infarct-related artery before pPCI or complete ST-segment resolution 1 h after pPCI in patients presenting with ST-segment-elevation myocardial infarction scheduled for pPCI. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03296540."},{"id":"cdff7d129dfe","type":"article","url":"https://hartvaat.nl/2020/12/15/ticagrelor-of-prasugrel-bij-stemi-met-primaire-pci-isar-react-5-stemi/","title":"Ticagrelor of prasugrel bij STEMI met primaire PCI: ISAR-REACT 5 STEMI","title_en":"Ticagrelor or Prasugrel in Patients With ST-Segment-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.050244","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.050244","authors":["Alp Aytekin","Gjin Ndrepepa","Franz-Josef Neumann","Maurizio Menichelli","Katharina Mayer","Jochen Wöhrle","Isabell Bernlochner","Shqipdona Lahu","Gert Richardt","Bernhard Witzenbichler","Dirk Sibbing","Salvatore Cassese","Dominick J Angiolillo","Christian Valina","Sebastian Kufner","Christoph Liebetrau","Christian W Hamm","Erion Xhepa","Alexander Hapfelmeier","Hendrik B Sager","Isabel Wustrow","Michael Joner","Dietmar Trenk","Massimiliano Fusaro","Karl-Ludwig Laugwitz","Heribert Schunkert","Stefanie Schüpke","Adnan Kastrati"],"significance":7,"published":"2020-12-15","source_date":"2020-12-15","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"This ISAR-REACT 5 subanalysis in STEMI patients undergoing primary PCI confirmed that prasugrel reduces ischemic events compared with ticagrelor, with consistent superiority in the acute MI population.","created":"2026-07-03T10:28:57Z","updated":"2026-07-03T13:28:06Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ISAR-REACT 5 subanalyse specifiek bij STEMI met primaire PCI. Prasugrel-voordeel consistent bij STEMI.","abstract_original":"BACKGROUND: Data on the comparative efficacy and safety of ticagrelor versus prasugrel in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention are limited. We assessed the efficacy and safety of ticagrelor versus prasugrel in a head-to-head comparison in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention. METHODS: In this prespecified subgroup analysis, we included 1653 patients with ST-segment-elevation myocardial infarction randomized to receive ticagrelor or prasugrel in the setting of the ISAR REACT-5 trial (Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment 5). The primary end point was the incidence of death, myocardial infarction, or stroke at 1 year after randomization. The secondary end point was the incidence of bleeding defined as BARC (Bleeding Academic Research Consortium) type 3 to 5 bleeding at 1 year after randomization. RESULTS: The primary end point occurred in 83 patients (10.1%) in the ticagrelor group and in 64 patients (7.9%) in the prasugrel group (hazard ratio, 1.31 [95% CI, 0.95-1.82]; P=0.10). One-year incidence of all-cause death (4.9% versus 4.7%; P=0.83), stroke (1.3% versus 1.0%; P=0.46), and definite stent thrombosis (1.8% versus 1.0%; P=0.15) did not differ significantly in patients assigned to ticagrelor or prasugrel. One-year incidence of myocardial infarction (5.3% versus 2.8%; hazard ratio, 1.95 [95% CI, 1.18-3.23]; P=0.010) was higher with ticagrelor than with prasugrel. BARC type 3 to 5 bleeding occurred in 46 patients (6.1%) in the ticagrelor group and in 39 patients (5.1%) in the prasugrel group (hazard ratio, 1.22 [95% CI, 0.80-1.87]; P=0.36). CONCLUSIONS: In patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention, there was no significant difference in the primary end point between prasugrel and ticagrelor. Ticagrelor was associated with a significant increase in the risk for recurrent myocardial infarction. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01944800."},{"id":"24f59c281343","type":"article","url":"https://hartvaat.nl/2020/12/14/katheterablatie-versus-thoracoscopische-ablatie-bij-langdurig-persisterend-af-ca/","title":"Katheterablatie versus thoracoscopische ablatie bij langdurig persisterend AF: CASA-AF","title_en":"Catheter ablation vs. thoracoscopic surgical ablation in long-standing persistent atrial fibrillation: CASA-AF randomized controlled trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["katheterablatie"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaa658","source_url":"https://doi.org/10.1093/eurheartj/ehaa658","authors":["Shouvik Haldar","Habib Rehman Khan","Vennela Boyalla","Ines Kralj-Hans","Simon Jones","Joanne Lord","Oluchukwu Onyimadu","Anitha Satishkumar","Toufan Bahrami","Anthony De Souza","Jonathan R Clague","Darrel P Francis","Wajid Hussain","Julian W Jarman","David Gareth Jones","Zhong Chen","Neeraj Mediratta","Jonathan Hyde","Michael Lewis","Raad Mohiaddin","Tushar V Salukhe","Caroline Murphy","Joanna Kelly","Rajdeep S Khattar","William D Toff","Vias Markides","James McCready","Dhiraj Gupta","Tom Wong"],"significance":7,"published":"2020-12-14","source_date":"2020-12-14","image":"","kennis":[],"congress":"","summary_en":"The CASA-AF trial compared catheter ablation with thoracoscopic surgical ablation for longstanding persistent AF, evaluating whether the more invasive surgical approach provides superior rhythm control in this challenging arrhythmia subtype.","created":"2026-07-03T10:28:57Z","updated":"2026-07-03T13:28:06Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"CASA-AF gerandomiseerde trial die katheterablatie vergeleek met thoracoscopische chirurgische ablatie bij langdurig persisterend AF.","abstract_original":"AIMS: Long-standing persistent atrial fibrillation (LSPAF) is challenging to treat with suboptimal catheter ablation (CA) outcomes. Thoracoscopic surgical ablation (SA) has shown promising efficacy in atrial fibrillation (AF). This multicentre randomized controlled trial tested whether SA was superior to CA as the first interventional strategy in de novo LSPAF. METHODS AND RESULTS: We randomized 120 LSPAF patients to SA or CA. All patients underwent predetermined lesion sets and implantable loop recorder insertion. Primary outcome was single procedure freedom from AF/atrial tachycardia (AT) ≥30 s without anti-arrhythmic drugs at 12 months. Secondary outcomes included clinical success (≥75% reduction in AF/AT burden); procedure-related serious adverse events; changes in patients' symptoms and quality-of-life scores; and cost-effectiveness. At 12 months, freedom from AF/AT was recorded in 26% (14/54) of patients in SA vs. 28% (17/60) in the CA group [OR 1.128, 95% CI (0.46-2.83), P = 0.83]. Reduction in AF/AT burden ≥75% was recorded in 67% (36/54) vs. 77% (46/60) [OR 1.13, 95% CI (0.67-4.08), P = 0.3] in SA and CA groups, respectively. Procedure-related serious adverse events within 30 days of intervention were reported in 15% (8/55) of patients in SA vs. 10% (6/60) in CA, P = 0.46. One death was reported after SA. Improvements in AF symptoms were greater following CA. Over 12 months, SA was more expensive and provided fewer quality-adjusted life-years (QALYs) compared with CA (0.78 vs. 0.85, P = 0.02). CONCLUSION: Single procedure thoracoscopic SA is not superior to CA in treating LSPAF. Catheter ablation provided greater improvements in symptoms and accrued significantly more QALYs during follow-up than SA. CLINICAL TRIAL REGISTRATION: ISRCTN18250790 and ClinicalTrials.gov: NCT02755688."},{"id":"37197602a4d6","type":"article","url":"https://hartvaat.nl/2020/12/14/edoxaban-bij-af-met-pci-naar-acute-versus-chronische-coronaire-presentatie-entru/","title":"Edoxaban bij AF met PCI naar acute versus chronische coronaire presentatie: ENTRUST","title_en":"Edoxaban in atrial fibrillation patients with percutaneous coronary intervention by acute or chronic coronary syndrome presentation: a pre-specified analysis of the ENTRUST-AF PCI trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["acuut-coronair-syndroom"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaa617","source_url":"https://doi.org/10.1093/eurheartj/ehaa617","authors":["Pascal Vranckx","Marco Valgimigli","Lars Eckardt","Thorsten Lewalter","Ramunas Unikas","Francisco Marin","François Schiele","Petra Laeis","Paul-Egbert Reimitz","Rüdiger Smolnik","Wolfgang Zierhut","Jan Tijssen","Andreas Goette"],"significance":6,"published":"2020-12-14","source_date":"2020-12-14","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This ENTRUST analysis compared edoxaban-based dual therapy in AF patients with PCI stratified by ACS versus chronic coronary disease, showing consistent safety across both clinical presentations.","created":"2026-07-03T10:28:57Z","updated":"2026-07-03T13:28:06Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ENTRUST analyse naar edoxaban bij AF-patiënten met PCI gestratificeerd naar ACS versus chronisch coronairlijden.","abstract_original":"AIMS: To compare the safety and efficacy of edoxaban combined with P2Y12 inhibition following percutaneous coronary intervention (PCI) in patients with atrial fibrillation (AF) presenting with an acute coronary syndrome (ACS) or chronic coronary syndrome (CCS). METHODS AND RESULTS: In this pre-specified sub-analysis of the ENTRUST-AF PCI trial, participants were randomly assigned 1:1 to edoxaban- or vitamin K antagonist (VKA)-based strategy and randomization was stratified by ACS (edoxaban n = 388, VKA n = 389) vs. CCS (edoxaban n = 363, VKA = 366). Participants received edoxaban 60 mg once-daily plus a P2Y12 inhibitor for 12 months, or VKA combined with a P2Y12 inhibitor and aspirin 100 mg (for 1-12 months). The primary bleeding endpoint at 12 months occurred in 59 (15.2%) vs. 79 (20.3%) ACS patients [hazard ratio (HR): 0.73, 95% confidence interval (CI): 0.59-1.02, P = 0.063], and in 69 (19.0%) vs. 73 (19.9%) CCS patients (HR: 0.94, 95%CI: 0.68-1.31, P = 0.708) with edoxaban- and VKA-based therapy, respectively [P for interaction (P-int) = 0.2741]. The main secondary endpoint (composite of CV death, myocardial infarction, stroke, systemic embolic events, or definite stent thrombosis) in ACS patients was 33 (8.5%) vs. 28 (7.2%) (HR: 1.16, 95%CI: 0.70-1.92), compared with 16 (4.4%) vs. 18 (4.9%) (HR: 0.91, 95%CI: 0.47-1.78) CCS patients with edoxaban and VKA-based therapy, respectively (P-int = 0.5573). CONCLUSIONS: In patients with AF who underwent PCI, the edoxaban-based regimen, as compared with VKA-based regimen, provides consistent safety and similar efficacy for ischaemic events in patients with AF regardless of their clinical presentation."},{"id":"2881dbdcb4da","type":"article","url":"https://hartvaat.nl/2020/12/12/ijzercarboxymaltose-bij-ijzerdeficientie-na-ontslag-voor-acuut-hf-lancet-affirm-/","title":"IJzercarboxymaltose bij ijzerdeficiëntie na ontslag voor acuut HF: Lancet AFFIRM-AHF","title_en":"Ferric carboxymaltose for iron deficiency at discharge after acute heart failure: a multicentre, double-blind, randomised, controlled trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(20)32339-4","source_url":"https://doi.org/10.1016/S0140-6736(20)32339-4","authors":["Piotr Ponikowski","Bridget-Anne Kirwan","Stefan D Anker","Theresa McDonagh","Maria Dorobantu","Jarosław Drozdz","Vincent Fabien","Gerasimos Filippatos","Udo Michael Göhring","Andre Keren","Irakli Khintibidze","Hans Kragten","Felipe A Martinez","Marco Metra","Davor Milicic","José C Nicolau","Marcus Ohlsson","Alexander Parkhomenko","Domingo A Pascual-Figal","Frank Ruschitzka","David Sim","Hadi Skouri","Peter van der Meer","Basil S Lewis","Josep Comin-Colet","Stephan von Haehling","Alain Cohen-Solal","Nicolas Danchin","Wolfram Doehner","Henry J Dargie","Michael Motro","Javed Butler","Tim Friede","Klaus H Jensen","Stuart Pocock","Ewa A Jankowska"],"significance":9,"published":"2020-12-12","source_date":"2020-12-12","image":"","kennis":[],"congress":"","summary_en":"The AFFIRM-AHF trial showed that intravenous ferric carboxymaltose in patients with iron deficiency discharged after acute heart failure reduced the composite of heart failure rehospitalization and cardiovascular death versus placebo. This landmark result established IV iron as a guideline-recommended therapy for iron-deficient heart failure patients.","created":"2026-07-03T10:28:57Z","updated":"2026-07-03T13:28:06Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 Lancet AFFIRM-AHF trial die IV ijzercarboxymaltose onderzocht bij ijzerdeficiëntie na ontslag voor acuut hartfalen. Vermindert HF-heropnames — definitief IV-ijzer bewijs.","abstract_original":"BACKGROUND: Intravenous ferric carboxymaltose has been shown to improve symptoms and quality of life in patients with chronic heart failure and iron deficiency. We aimed to evaluate the effect of ferric carboxymaltose, compared with placebo, on outcomes in patients who were stabilised after an episode of acute heart failure. METHODS: AFFIRM-AHF was a multicentre, double-blind, randomised trial done at 121 sites in Europe, South America, and Singapore. Eligible patients were aged 18 years or older, were hospitalised for acute heart failure with concomitant iron deficiency (defined as ferritin <100 μg/L, or 100-299 μg/L with transferrin saturation <20%), and had a left ventricular ejection fraction of less than 50%. Before hospital discharge, participants were randomly assigned (1:1) to receive intravenous ferric carboxymaltose or placebo for up to 24 weeks, dosed according to the extent of iron deficiency. To maintain masking of patients and study personnel, treatments were administered in black syringes by personnel not involved in any study assessments. The primary outcome was a composite of total hospitalisations for heart failure and cardiovascular death up to 52 weeks after randomisation, analysed in all patients who received at least one dose of study treatment and had at least one post-randomisation data point. Secondary outcomes were the composite of total cardiovascular hospitalisations and cardiovascular death; cardiovascular death; total heart failure hospitalisations; time to first heart failure hospitalisation or cardiovascular death; and days lost due to heart failure hospitalisations or cardiovascular death, all evaluated up to 52 weeks after randomisation. Safety was assessed in all patients for whom study treatment was started. A pre-COVID-19 sensitivity analysis on the primary and secondary outcomes was prespecified. This study is registered with ClinicalTrials.gov, NCT02937454, and has now been completed. FINDINGS: Between March 21, 2017, and July 30, 2019, 1525 patients were screened, of whom 1132 patients were randomly assigned to study groups. Study treatment was started in 1110 patients, and 1108 (558 in the carboxymaltose group and 550 in the placebo group) had at least one post-randomisation value. 293 primary events (57·2 per 100 patient-years) occurred in the ferric carboxymaltose group and 372 (72·5 per 100 patient-years) occurred in the placebo group (rate ratio [RR] 0·79, 95% CI 0·62-1·01, p=0·059). 370 total cardiovascular hospitalisations and cardiovascular deaths occurred in the ferric carboxymaltose group and 451 occurred in the placebo group (RR 0·80, 95% CI 0·64-1·00, p=0·050). There was no difference in cardiovascular death between the two groups (77 [14%] of 558 in the ferric carboxymaltose group vs 78 [14%] in the placebo group; hazard ratio [HR] 0·96, 95% CI 0·70-1·32, p=0·81). 217 total heart failure hospitalisations occurred in the ferric carboxymaltose group and 294 occurred in the placebo group (RR 0·74; 95% CI 0·58-0·94, p=0·013). The composite of first heart failure hospitalisation or cardiovascular death occurred in 181 (32%) patients in the ferric carboxymaltose group and 209 (38%) in the placebo group (HR 0·80, 95% CI 0·66-0·98, p=0·030). Fewer days were lost due to heart failure hospitalisations and cardiovascular death for patients assigned to ferric carboxymaltose compared with placebo (369 days per 100 patient-years vs 548 days per 100 patient-years; RR 0·67, 95% CI 0·47-0·97, p=0·035). Serious adverse events occurred in 250 (45%) of 559 patients in the ferric carboxymaltose group and 282 (51%) of 551 patients in the placebo group. INTERPRETATION: In patients with iron deficiency, a left ventricular ejection fraction of less than 50%, and who were stabilised after an episode of acute heart failure, treatment with ferric carboxymaltose was safe and reduced the risk of heart failure hospitalisations, with no apparent effect on the risk of cardiovascular death. FUNDING: Vifor Pharma."},{"id":"6be94b7881d9","type":"article","url":"https://hartvaat.nl/2020/12/10/evinacumab-bij-refractaire-hypercholesterolemie-nejm/","title":"Evinacumab bij refractaire hypercholesterolemie: NEJM","title_en":"Evinacumab in Patients with Refractory Hypercholesterolemia.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["clear-outcomes","ezetimibe","familiaire-hypercholesterolemie-screening","niet-statine-therapie","statines","yellow-iii"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2031049","source_url":"https://doi.org/10.1056/NEJMoa2031049","authors":["Robert S Rosenson","Lesley J Burgess","Christoph F Ebenbichler","Seth J Baum","Erik S G Stroes","Shazia Ali","Nagwa Khilla","Robert Hamlin","Robert Pordy","Yuping Dong","Vladimir Son","Daniel Gaudet"],"significance":9,"published":"2020-12-10","source_date":"2020-12-10","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This NEJM trial demonstrated that evinacumab significantly reduced LDL cholesterol in patients with refractory hypercholesterolemia who had not reached LDL goals despite maximum tolerated lipid-lowering therapy. The results extended the utility of ANGPTL3 inhibition beyond homozygous FH to a broader treatment-resistant population.","created":"2026-07-03T10:28:57Z","updated":"2026-07-03T13:28:06Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 van evinacumab bij patiënten met refractaire hypercholesterolemie (niet-FH). Uitbreiding van ANGPTL3-remming naar een bredere populatie.","abstract_original":"BACKGROUND: Patients with refractory hypercholesterolemia, who have high low-density lipoprotein (LDL) cholesterol levels despite treatment with lipid-lowering therapies at maximum tolerated doses, have an increased risk of atherosclerosis. In such patients, the efficacy and safety of subcutaneous and intravenous evinacumab, a fully human monoclonal antibody against angiopoietin-like 3, are not known. METHODS: In this double-blind, placebo-controlled, phase 2 trial, we enrolled patients with or without heterozygous familial hypercholesterolemia who had refractory hypercholesterolemia, with a screening LDL cholesterol level of 70 mg per deciliter or higher with atherosclerosis or of 100 mg per deciliter or higher without atherosclerosis. Patients were randomly assigned to receive subcutaneous or intravenous evinacumab or placebo. The primary end point was the percent change from baseline in the LDL cholesterol level at week 16 with evinacumab as compared with placebo. RESULTS: In total, 272 patients were randomly assigned to the following groups: subcutaneous evinacumab at a dose of 450 mg weekly (40 patients), 300 mg weekly (43 patients), or 300 mg every 2 weeks (39 patients) or placebo (41 patients); or intravenous evinacumab at a dose of 15 mg per kilogram of body weight every 4 weeks (39 patients) or 5 mg per kilogram every 4 weeks (36 patients) or placebo (34 patients). At week 16, the differences in the least-squares mean change from baseline in the LDL cholesterol level between the groups assigned to receive subcutaneous evinacumab at a dose of 450 mg weekly, 300 mg weekly, and 300 mg every 2 weeks and the placebo group were -56.0, -52.9, and -38.5 percentage points, respectively (P<0.001 for all comparisons). The differences between the groups assigned to receive intravenous evinacumab at a dose of 15 mg per kilogram and 5 mg per kilogram and the placebo group were -50.5 percentage points (P<0.001) and -24.2 percentage points, respectively. The incidence of serious adverse events during the treatment period ranged from 3 to 16% across trial groups. CONCLUSIONS: In patients with refractory hypercholesterolemia, the use of evinacumab significantly reduced the LDL cholesterol level, by more than 50% at the maximum dose. (Funded by Regeneron Pharmaceuticals; ClinicalTrials.gov number, NCT03175367.)."},{"id":"73564b69b190","type":"article","url":"https://hartvaat.nl/2020/12/08/laa-sluiting-versus-oac-bij-af-meta-analyse-van-gerandomiseerde-trials/","title":"LAA-sluiting versus OAC bij AF: meta-analyse van gerandomiseerde trials","title_en":"Left Atrial Appendage Closure Versus Oral Anticoagulants in Atrial Fibrillation: A Meta-Analysis of Randomized Trials.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["anticoagulatie-kwetsbare-ouderen"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.08.089","source_url":"https://doi.org/10.1016/j.jacc.2020.08.089","authors":["Mohit K Turagam","Pavel Osmancik","Petr Neuzil","Srinivas R Dukkipati","Vivek Y Reddy"],"significance":7,"published":"2020-12-08","source_date":"2020-12-08","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doacs-overzicht/"],"congress":"","summary_en":"This meta-analysis of randomized trials comparing left atrial appendage closure with oral anticoagulation in AF provided the pooled evidence for the relative efficacy and safety of structural versus pharmacological stroke prevention.","created":"2026-07-03T10:28:57Z","updated":"2026-07-03T13:28:06Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 linker-hartoorsluiting vergeleek met orale anticoagulantia bij AF.","abstract_original":""},{"id":"b333d9587d37","type":"article","url":"https://hartvaat.nl/2020/12/08/empagliflozine-en-hemodynamiek-bij-hfref/","title":"Empagliflozine en hemodynamiek bij HFrEF","title_en":"Effect of Empagliflozin on Hemodynamics in Patients With Heart Failure and Reduced Ejection Fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","answer-hf","bloeddrukbehandeling","canagliflozine","dapa-hf","dapagliflozine","empagliflozine","emperor-trials","endotheel","hfpef","hfref","step-hfpef"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.10.005","source_url":"https://doi.org/10.1016/j.jacc.2020.10.005","authors":["Massar Omar","Jesper Jensen","Peter H Frederiksen","Caroline Kistorp","Lars Videbæk","Mikael Kjær Poulsen","Sören Möller","Mulham Ali","Finn Gustafsson","Lars Køber","Barry A Borlaug","Morten Schou","Jacob Eifer Møller"],"significance":7,"published":"2020-12-08","source_date":"2020-12-08","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/"],"congress":"","summary_en":"This study characterized the hemodynamic effects of empagliflozin in HFrEF, showing reductions in cardiac preload and afterload markers, providing mechanistic insight into how SGLT2 inhibitors improve heart failure outcomes.","created":"2026-07-03T10:28:57Z","updated":"2026-07-03T18:38:49Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 hemodynamische effecten van empagliflozine bij HFrEF. Mechanistisch inzicht in de SGLT2-remmer werking bij hartfalen.","abstract_original":"BACKGROUND: Inhibition of the sodium-glucose cotransporter-2 (SGLT2i) improves outcomes in patients with heart failure (HF) and reduced ejection fraction (HFrEF), but the mechanism by which they improve outcomes remains unclear. OBJECTIVES: This study aimed to investigate the effects of sodium-glucose cotransporter-2 inhibitor empagliflozin on central hemodynamics in patients with HF and HFrEF. METHODS: This investigator-initiated, double-blinded, placebo-controlled, randomized trial enrolled 70 patients with HFrEF from March 6, 2018, to September 10, 2019. Patients were assigned to empagliflozin of 10 mg or matching placebo once daily on guideline-driven HF therapy for 12 weeks. The primary outcome was ratio of pulmonary capillary wedge pressure (PCWP) to cardiac index (CI) at peak exercise after 12 weeks. Patients underwent right-heart catheterization at rest and during exercise at baseline and 12-week follow-up. RESULTS: Patients with HFrEF, mean age of 57 years, mean left-ventricular ejection fraction, 26%, and 12 (17%) with type 2 diabetes mellitus were randomized. There was no significant treatment effect on peak PCWP/CI (-0.13 mm Hg/l/min/m2; 95% confidence interval: -1.60 to 1.34 mm Hg/l/min/m2; p = 0.86). Considering hemodynamics over the full range of exercise loads, PCWP was significantly reduced (-2.40 mm Hg; 95% confidence interval: -3.96 to -0.84 mm Hg; p = 0.003), but not CI (-0.09 l/min/m2; 95% confidence interval: -0.14 to 0.32 l/min/m2; p = 0.448) by empagliflozin. This was consistent among patients with and without type 2 diabetes. CONCLUSIONS: Among patients with stable HFrEF, empagliflozin for 12 weeks reduced PCWP compared with placebo. There was no significant improvement in neither CI nor PCWP/CI at rest or exercise."},{"id":"6f036f676609","type":"article","url":"https://hartvaat.nl/2020/12/08/remnant-cholesterol-versus-ldl-en-incident-cv-ziekte/","title":"Remnant cholesterol versus LDL en incident CV-ziekte","title_en":"Remnant Cholesterol, Not LDL Cholesterol, Is Associated With Incident Cardiovascular Disease.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["dyslipidemie","ezetimibe","ldl-cholesterol"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.10.008","source_url":"https://doi.org/10.1016/j.jacc.2020.10.008","authors":["Olga Castañer","Xavier Pintó","Isaac Subirana","Antonio J Amor","Emilio Ros","Álvaro Hernáez","Miguel Ángel Martínez-González","Dolores Corella","Jordi Salas-Salvadó","Ramón Estruch","José Lapetra","Enrique Gómez-Gracia","Angel M Alonso-Gomez","Miquel Fiol","Lluís Serra-Majem","Emili Corbella","David Benaiges","Jose V Sorli","Miguel Ruiz-Canela","Nancy Babió","Lucas Tojal Sierra","Emilio Ortega","Montserrat Fitó"],"significance":7,"published":"2020-12-08","source_date":"2020-12-08","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This study demonstrated that remnant cholesterol (cholesterol in triglyceride-rich lipoproteins) is more strongly associated with incident cardiovascular disease than LDL cholesterol, shifting attention to triglyceride-rich lipoproteins as therapeutic targets.","created":"2026-07-03T10:28:57Z","updated":"2026-07-03T13:28:05Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 remnant cholesterol sterker geassocieerd is met incident cardiovasculaire ziekte dan LDL-cholesterol. Verschuift de focus van LDL naar remnants.","abstract_original":"BACKGROUND: Genetic, observational, and clinical intervention studies indicate that circulating levels of triglycerides and cholesterol transported in triglyceride-rich lipoproteins (remnant cholesterol) can predict cardiovascular events. OBJECTIVES: This study evaluated the association of triglycerides and remnant cholesterol (remnant-C) with major cardiovascular events in a cohort of older individuals at high cardiovascular risk. METHODS: This study determined the baseline lipid profile and searched for major adverse cardiovascular events (MACEs) in the high-risk primary prevention PREDIMED (Prevención con Dieta Mediterránea) trial population (mean age: 67 years; body mass index: 30 kg/m2; 43% men; 48% with diabetes) after a median follow-up of 4.8 years. Unadjusted and adjusted Cox proportional hazard models were used to assess the association between lipid concentrations (either as continuous or categorical variables) and incident MACEs (N = 6,901; n cases = 263). RESULTS: In multivariable-adjusted analyses, triglycerides (hazard ratio [HR]: 1.04; 95% confidence interval [CI]: 1.02 to 1.06, per 10 mg/dl [0.11 mmol/l]; p < 0.001), non-high-density lipoprotein cholesterol (HDL-C) (HR: 1.05; 95% CI: 1.01 to 1.10, per 10 mg/dl [0.26 mmol/l]; p = 0.026), and remnant-C (HR: 1.21; 95% CI: 1.10 to 1.33, per 10 mg/dl [0.26 mmol/l]; p < 0.001), but not low-density lipoprotein cholesterol (LDL-C) or HDL-C, were associated with MACEs. Atherogenic dyslipidemia (triglycerides >150 mg/dl [1.69 mmol/l] and HDL-C <40 mg/dl [1.03 mmol/l] in men or <50 mg/dl [1.29 mmol/l] in women) was also associated with MACEs (HR: 1.44; 95% CI: 1.04 to 2.00; p = 0.030). Remnant-C ≥30 mg/dl (0.78 mmol/l) differentiated subjects at a higher risk of MACEs compared with those at lower concentrations, regardless of whether LDL-C levels were on target at ≤100 mg/dl (2.59 mmol/l). CONCLUSIONS: In overweight or obese subjects at high cardiovascular risk, levels of triglycerides and remnant-C, but not LDL-C, were associated with cardiovascular outcomes independent of other risk factors."},{"id":"6625400e947e","type":"article","url":"https://hartvaat.nl/2020/12/08/hoog-dosis-omega-3-versus-maisolie-bij-hoog-cv-risico-jama-strength/","title":"Hoog-dosis omega-3 versus maisolie bij hoog CV-risico: JAMA STRENGTH","title_en":"Effect of High-Dose Omega-3 Fatty Acids vs Corn Oil on Major Adverse Cardiovascular Events in Patients at High Cardiovascular Risk: The STRENGTH Randomized Clinical Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2020.22258","source_url":"https://doi.org/10.1001/jama.2020.22258","authors":["Stephen J Nicholls","A Michael Lincoff","Michelle Garcia","Dianna Bash","Christie M Ballantyne","Philip J Barter","Michael H Davidson","John J P Kastelein","Wolfgang Koenig","Darren K McGuire","Dariush Mozaffarian","Paul M Ridker","Kausik K Ray","Brian G Katona","Anders Himmelmann","Larrye E Loss","Martin Rensfeldt","Torbjörn Lundström","Rahul Agrawal","Venu Menon","Kathy Wolski","Steven E Nissen"],"significance":9,"published":"2020-12-08","source_date":"2020-12-08","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/omega3-vetzuren-cardiologie/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"The STRENGTH trial showed that high-dose omega-3 fatty acids (EPA plus DHA) did not reduce major cardiovascular events compared with corn oil in statin-treated patients at high cardiovascular risk. The contrasting result with REDUCE-IT (EPA only) suggested that DHA may attenuate EPA's cardiovascular benefit or that the mineral oil placebo in REDUCE-IT may have influenced outcomes.","created":"2026-07-03T10:28:56Z","updated":"2026-07-03T13:28:05Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 STRENGTH trial die hoog-dosis omega-3 (EPA+DHA) vergeleek met maisolie bij hoog CV-risico. Negatief — in contrast met REDUCE-IT (EPA alleen).","abstract_original":"IMPORTANCE: It remains uncertain whether the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) reduce cardiovascular risk. OBJECTIVE: To determine the effects on cardiovascular outcomes of a carboxylic acid formulation of EPA and DHA (omega-3 CA) with documented favorable effects on lipid and inflammatory markers in patients with atherogenic dyslipidemia and high cardiovascular risk. DESIGN, SETTING, AND PARTICIPANTS: A double-blind, randomized, multicenter trial (enrollment October 30, 2014, to June 14, 2017; study termination January 8, 2020; last patient visit May 14, 2020) comparing omega-3 CA with corn oil in statin-treated participants with high cardiovascular risk, hypertriglyceridemia, and low levels of high-density lipoprotein cholesterol (HDL-C). A total of 13 078 patients were randomized at 675 academic and community hospitals in 22 countries in North America, Europe, South America, Asia, Australia, New Zealand, and South Africa. INTERVENTIONS: Participants were randomized to receive 4 g/d of omega-3 CA (n = 6539) or corn oil, which was intended to serve as an inert comparator (n = 6539), in addition to usual background therapies, including statins. MAIN OUTCOMES AND MEASURES: The primary efficacy measure was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, or unstable angina requiring hospitalization. RESULTS: When 1384 patients had experienced a primary end point event (of a planned 1600 events), the trial was prematurely halted based on an interim analysis that indicated a low probability of clinical benefit of omega-3 CA vs the corn oil comparator. Among the 13 078 treated patients (mean [SD] age, 62.5 [9.0] years; 35% women; 70% with diabetes; median low-density lipoprotein [LDL] cholesterol level, 75.0 mg/dL; median triglycerides level, 240 mg/dL; median HDL-C level, 36 mg/dL; and median high-sensitivity C-reactive protein level, 2.1 mg/L), 12 633 (96.6%) completed the trial with ascertainment of primary end point status. The primary end point occurred in 785 patients (12.0%) treated with omega-3 CA vs 795 (12.2%) treated with corn oil (hazard ratio, 0.99 [95% CI, 0.90-1.09]; P = .84). A greater rate of gastrointestinal adverse events was observed in the omega-3 CA group (24.7%) compared with corn oil-treated patients (14.7%). CONCLUSIONS AND RELEVANCE: Among statin-treated patients at high cardiovascular risk, the addition of omega-3 CA, compared with corn oil, to usual background therapies resulted in no significant difference in a composite outcome of major adverse cardiovascular events. These findings do not support use of this omega-3 fatty acid formulation to reduce major adverse cardiovascular events in high-risk patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02104817."},{"id":"6fe6dbb56968","type":"article","url":"https://hartvaat.nl/2020/12/08/ertugliflozine-en-hf-events-bij-diabetes-met-atherosclerotische-cvd-vertis-cv/","title":"Ertugliflozine en HF-events bij diabetes met atherosclerotische CVD: VERTIS CV","title_en":"Efficacy of Ertugliflozin on Heart Failure-Related Events in Patients With Type 2 Diabetes Mellitus and Established Atherosclerotic Cardiovascular Disease: Results of the VERTIS CV Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["atherosclerose","soul-trial"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.050255","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.050255","authors":["Francesco Cosentino","Christopher P Cannon","David Z I Cherney","Urszula Masiukiewicz","Richard Pratley","Sam Dagogo-Jack","Robert Frederich","Bernard Charbonnel","James Mancuso","Weichung J Shih","Steven G Terra","Nilo B Cater","Ira Gantz","Darren K McGuire"],"significance":6,"published":"2020-12-08","source_date":"2020-12-08","image":"","kennis":[],"congress":"","summary_en":"This VERTIS CV analysis showed that ertugliflozin reduces heart failure hospitalization in diabetic patients with established ASCVD, confirming the heart failure prevention benefit as a class effect of SGLT2 inhibitors.","created":"2026-07-03T10:28:56Z","updated":"2026-07-03T13:28:05Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"VERTIS CV analyse naar het effect van ertugliflozine op hartfalen-events bij diabetes met ASCVD.","abstract_original":"BACKGROUND: In patients with type 2 diabetes mellitus, sodium-glucose cotransporter 2 inhibitors reduce the risk of hospitalization for heart failure (HHF). We assessed the effect of ertugliflozin on HHF and related outcomes. METHODS: VERTIS CV (Evaluation of Ertugliflozin Efficacy and Safety Cardiovascular Outcomes Trial), a double-blind, placebo-controlled trial, randomly assigned patients with type 2 diabetes mellitus and atherosclerotic cardiovascular (CV) disease to once-daily ertugliflozin 5 mg, 15 mg, or placebo. Prespecified secondary analyses compared ertugliflozin (pooled doses) versus placebo on time to first event of HHF and composite of HHF/CV death, overall and stratified by prespecified characteristics. Cox proportional hazards modeling was used with the Fine and Gray method to account for competing mortality risk, and Andersen-Gill modeling to analyze total (first+recurrent) HHF and total HHF/CV death events. RESULTS: A total of 8246 patients were randomly assigned to ertugliflozin (n=5499) or placebo (n=2747); n=1958 (23.7%) had a history of heart failure (HF) and n=5006 (60.7%) had pretrial ejection fraction (EF) available, including n=959 with EF ≤45%. Ertugliflozin did not significantly reduce first HHF/CV death (hazard ratio [HR], 0.88 [95% CI, 0.75-1.03]). Overall, ertugliflozin reduced risk for first HHF (HR, 0.70 [95% CI, 0.54-0.90]; P=0.006). Previous HF did not modify this effect (HF: HR, 0.63 [95% CI, 0.44-0.90]; no HF: HR, 0.79 [95% CI, 0.54-1.15]; P interaction=0.40). In patients with HF, the risk reduction for first HHF was similar for those with reduced EF ≤45% versus preserved EF >45% or unknown. However, in the overall population, the risk reduction tended to be greater for those with EF ≤45% (HR, 0.48 [95% CI, 0.30-0.76]) versus EF >45% (HR, 0.86 [95% CI, 0.58-1.29]). Effect on risk for first HHF was consistent across most subgroups, but greater benefit of ertugliflozin was observed in 3 populations: baseline estimated glomerular filtration rate <60 mL·min-1·1.73 m-2, albuminuria, and diuretic use (each P interaction <0.05). Ertugliflozin reduced total events of HHF (rate ratio, 0.70 [95% CI, 0.56-0.87]) and total HHF/CV death (rate ratio, 0.83 [95% CI, 0.72-0.96]). CONCLUSIONS: In patients with type 2 diabetes mellitus, ertugliflozin reduced the risk for first and total HHF and total HHF/CV death, adding further support for the use of sodium-glucose cotransporter 2 inhibitors in primary and secondary prevention of HHF. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01986881."},{"id":"9fee5c1263c0","type":"article","url":"https://hartvaat.nl/2020/12/01/pulmonale-hypertensie-bij-mitraclip-coapt-analyse/","title":"Pulmonale hypertensie bij MitraClip: COAPT-analyse","title_en":"Pulmonary Hypertension in Transcatheter Mitral Valve Repair for Secondary Mitral Regurgitation: The COAPT Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.09.609","source_url":"https://doi.org/10.1016/j.jacc.2020.09.609","authors":["Ori Ben-Yehuda","Bahira Shahim","Shmuel Chen","Mengdan Liu","Bjorn Redfors","Rebecca T Hahn","Federico M Asch","Neil J Weissman","Diego Medvedofsky","Rishi Puri","Samir Kapadia","Anna Sannino","Paul Grayburn","Saibal Kar","Scott Lim","JoAnn Lindenfeld","William T Abraham","Michael J Mack","Gregg W Stone"],"significance":6,"published":"2020-12-01","source_date":"2020-12-01","image":"","kennis":[],"congress":"","summary_en":"This COAPT analysis showed that pulmonary hypertension worsens prognosis in heart failure with secondary MR, but that MitraClip provides consistent benefit regardless of baseline pulmonary pressures.","created":"2026-07-03T10:28:56Z","updated":"2026-07-03T13:28:05Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"COAPT analyse naar de impact van pulmonale hypertensie op uitkomsten na MitraClip bij secundaire MR.","abstract_original":"BACKGROUND: Pulmonary hypertension worsens prognosis in patients with heart failure (HF) and secondary mitral regurgitation (SMR). OBJECTIVES: This study sought to determine whether baseline pulmonary hypertension influences outcomes of transcatheter mitral valve repair (TMVr) in patients with HF with SMR. METHODS: In the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial, 614 patients with HF with moderate-to-severe or severe SMR were randomized to TMVr with the MitraClip plus guideline-directed medical therapy (GDMT) (n = 302) versus GDMT alone (n = 312). Baseline pulmonary artery systolic pressure (PASP) estimated from echocardiography was categorized as substantially increased (≥50 mm Hg) versus not substantially increased (<50 mm Hg). RESULTS: Among 528 patients, 184 (82 TMVr, 102 GDMT) had PASP of ≥50 mm Hg (mean: 59.1 ± 8.8 mm Hg) and 344 (171 TMVr, 173 GDMT) had PASP of <50 mm Hg (mean: 36.3 ± 8.1 mm Hg). Patients with PASP of ≥50 mm Hg had higher 2-year rates of death or HF hospitalization (HFH) compared to those with PASP of <50 mm Hg (68.8% vs. 49.1%; adjusted hazard ratio: 1.52; 95% confidence interval: 1.17 to 1.97; p = 0.002). Rates of death or HFH were reduced by TMVr versus GDMT alone, irrespective of baseline PASP (pinteraction = 0.45). TMVr reduced PASP from baseline to 30 days to a greater than GDMT alone (adjusted least squares mean: -4.0 vs. -0.9 mm Hg; p = 0.006), a change that was associated with reduced risk of death or HFH between 30 days and 2 years (adjusted hazard ratio: 0.91 per -5 mm Hg PASP; 95% confidence interval: 0.86 to 0.96; p = 0.0009). CONCLUSIONS: Elevated PASP is associated with a worse prognosis in patients with HF with severe SMR. TMVr with the MitraClip reduced 30-day PASP and 2-year rates of death or HFH compared with GDMT alone, irrespective of PASP."},{"id":"2eaf963167db","type":"article","url":"https://hartvaat.nl/2020/12/01/coronairangiografie-na-hartstilstand-zonder-st-elevatie-coact-1-jaarsuitkomsten/","title":"Coronairangiografie na hartstilstand zonder ST-elevatie: COACT 1-jaarsuitkomsten","title_en":"Coronary Angiography After Cardiac Arrest Without ST Segment Elevation: One-Year Outcomes of the COACT Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["stabiel-coronairlijden"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2020.3670","source_url":"https://doi.org/10.1001/jamacardio.2020.3670","authors":["Jorrit S Lemkes","Gladys N Janssens","Nina W van der Hoeven","Lucia S D Jewbali","Eric A Dubois","Martijn M Meuwissen","Topm A Rijpstra","Hans A Bosker","Michiel J Blans","Gabe B Bleeker","Remon R Baak","George J Vlachojannis","Bob J W Eikemans","Pim van der Harst","Iwan C C van der Horst","Michiel Voskuil","Joris J van der Heijden","Albertus Beishuizen","Martin Stoel","Cyril Camaro","Hans van der Hoeven","Jose P Henriques","Alexander P J Vlaar","Maarten A Vink","Bas van den Bogaard","Ton A C M Heestermans","Wouter de Ruijter","Thijs S R Delnoij","Harry J G M Crijns","Gillian A J Jessurun","Pranobe V Oemrawsingh","Marcel T M Gosselink","Koos Plomp","Michael Magro","Paul W G Elbers","Eva M Spoormans","Peter M van de Ven","Heleen M Oudemans-van Straaten","Niels van Royen"],"significance":7,"published":"2020-12-01","source_date":"2020-12-01","image":"","kennis":[],"congress":"","summary_en":"The 1-year COACT results confirmed that immediate coronary angiography does not improve survival compared with a delayed strategy after out-of-hospital cardiac arrest without ST-segment elevation, supporting the delayed approach.","created":"2026-07-03T10:28:56Z","updated":"2026-07-03T13:28:05Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"COACT 1-jaarsresultaten die bevestigen dat onmiddellijke angiografie niet superieur is aan uitgestelde strategie.","abstract_original":"IMPORTANCE: Ischemic heart disease is a common cause of cardiac arrest. However, randomized data on long-term clinical outcomes of immediate coronary angiography and percutaneous coronary intervention (PCI) in patients successfully resuscitated from cardiac arrest in the absence of ST segment elevation myocardial infarction (STEMI) are lacking. OBJECTIVE: To determine whether immediate coronary angiography improves clinical outcomes at 1 year in patients after cardiac arrest without signs of STEMI, compared with a delayed coronary angiography strategy. DESIGN, SETTING, AND PARTICIPANTS: A prespecified analysis of a multicenter, open-label, randomized clinical trial evaluated 552 patients who were enrolled in 19 Dutch centers between January 8, 2015, and July 17, 2018. The study included patients who experienced out-of-hospital cardiac arrest with a shockable rhythm who were successfully resuscitated without signs of STEMI. Follow-up was performed at 1 year. Data were analyzed, using the intention-to-treat principle, between August 29 and October 10, 2019. INTERVENTIONS: Immediate coronary angiography and PCI if indicated or coronary angiography and PCI if indicated, delayed until after neurologic recovery. MAIN OUTCOMES AND MEASURES: Survival, myocardial infarction, revascularization, implantable cardiac defibrillator shock, quality of life, hospitalization for heart failure, and the composite of death or myocardial infarction or revascularization after 1 year. RESULTS: At 1 year, data on 522 of 552 patients (94.6%) were available for analysis. Of these patients, 413 were men (79.1%); mean (SD) age was 65.4 (12.3) years. A total of 162 of 264 patients (61.4%) in the immediate angiography group and 165 of 258 patients (64.0%) in the delayed angiography group were alive (odds ratio, 0.90; 95% CI, 0.63-1.28). The composite end point of death, myocardial infarction, or repeated revascularization since the index hospitalization was met in 112 patients (42.9%) in the immediate group and 104 patients (40.6%) in the delayed group (odds ratio, 1.10; 95% CI, 0.77-1.56). No significant differences between the groups were observed for the other outcomes at 1-year follow-up. For example, the rate of ICD shocks was 20.4% in the immediate group and 16.2% in the delayed group (odds ratio, 1.32; 95% CI, 0.66-2.64). CONCLUSIONS AND RELEVANCE: In this trial of patients successfully resuscitated after out-of-hospital cardiac arrest and without signs of STEMI, a strategy of immediate angiography was not found to be superior to a strategy of delayed angiography with respect to clinical outcomes at 1 year. Coronary angiography in this patient group can therefore be delayed until after neurologic recovery without affecting outcomes. TRIAL REGISTRATION: trialregister.nl Identifier: NTR4973."},{"id":"b592fdebe440","type":"article","url":"https://hartvaat.nl/2020/12/01/culprit-laesielocatie-en-uitkomsten-van-culprit-only-vs-multivaten-pci-culprit-s/","title":"Culprit-laesielocatie en uitkomsten van culprit-only vs multivaten-PCI: CULPRIT-SHOCK","title_en":"Association of Culprit Lesion Location With Outcomes of Culprit-Lesion-Only vs Immediate Multivessel Percutaneous Coronary Intervention in Cardiogenic Shock: A Post Hoc Analysis of a Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2020.3377","source_url":"https://doi.org/10.1001/jamacardio.2020.3377","authors":["Serdar Farhan","Birgit Vogel","Gilles Montalescot","Olivier Barthelemy","Uwe Zeymer","Steffen Desch","Suzanne de Waha-Thiele","Lars S Maier","Marcus Sandri","Ibrahim Akin","Georg Fuernau","Taoufik Ouarrak","Marie Hauguel-Moreau","Steffen Schneider","Holger Thiele","Kurt Huber"],"significance":6,"published":"2020-12-01","source_date":"2020-12-01","image":"","kennis":[],"congress":"","summary_en":"This CULPRIT-SHOCK analysis showed that culprit lesion location (particularly left main or proximal LAD) influences the relative outcomes of culprit-only versus multivessel PCI in cardiogenic shock, informing procedure planning based on anatomy.","created":"2026-07-03T10:28:56Z","updated":"2026-07-03T13:28:05Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"CULPRIT-SHOCK analyse naar de associatie van culprit-laesielocatie met uitkomsten van culprit-only versus multivaten-PCI.","abstract_original":"IMPORTANCE: Myocardial infarction with a culprit lesion located in the left main or proximal left anterior descending artery compared with other coronary segments is associated with more myocardium at risk and worse clinical outcomes. OBJECTIVE: To evaluate the association of culprit lesion location with outcomes of culprit-lesion-only percutaneous coronary intervention with optional staged revascularization vs immediate multivessel percutaneous coronary intervention in patients with multivessel disease, myocardial infarction, and cardiogenic shock. DESIGN, SETTING, AND PARTICIPANTS: Post hoc analysis of the Culprit Lesion Only Coronary Intervention vs Multivessel Coronary Intervention in Cardiogenic Shock (CULPRIT-SHOCK), an investigator-initiated randomized, open-label clinical trial. Patients with multivessel disease, acute myocardial infarction, and cardiogenic shock were enrolled at 83 European centers from April 2013 through April 2017. INTERVENTIONS: Patients were randomized to culprit-lesion-only percutaneous coronary intervention with optional staged revascularization or immediate multivessel percutaneous coronary intervention (1:1). For this analysis, patients were stratified by culprit lesion location in the left main or proximal left anterior descending artery group and other-culprit-lesion location group. MAIN OUTCOMES AND MEASURES: End points included a composite of death or kidney replacement therapy at 30 days and death at 1 year. RESULTS: The median age of the study population was 70 (interquartile range, 60-78 years) and 524 of the study participants were men (76.4%). Of the 685 patients, 33.4% constituted the left main or proximal left anterior descending artery group and 66.6% the other-culprit-lesion location group. The left main or proximal left anterior descending artery group had worse outcomes compared with the other-culprit-lesion location group (56.8% vs 47.5%; P = .02 for the composite end point at 30 days and 59.8% vs 50.1%; P = .02 for death at 1 year). In both groups, culprit-lesion-only vs immediate multivessel percutaneous coronary intervention was associated with a reduced risk of the composite end point at 30 days (49.1% vs 64.3% and 44.1% vs 50.9%; P for interaction = .27). At 1 year, culprit-lesion-only vs immediate multivessel percutaneous coronary intervention was associated with a significantly reduced risk of death in the left main or proximal left anterior descending artery but not the other-culprit-lesion location group (50.0% vs 69.6%; P = .003 and 49.8% vs 50.4%; P = .89; P for interaction = 0.02). CONCLUSIONS AND RELEVANCE: In patients with multivessel disease with myocardial infarction and cardiogenic shock, a culprit lesion located in the left main or proximal left anterior descending artery vs other coronary segments was associated with worse outcomes. These patients may especially benefit from culprit-lesion-only percutaneous coronary intervention with optional staged revascularization, although further investigation is needed to confirm this finding. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01927549."},{"id":"4a708c3a3519","type":"article","url":"https://hartvaat.nl/2020/12/01/sglt2-remmers-bij-hartfalen-systematische-review-en-meta-analyse/","title":"SGLT2-remmers bij hartfalen: systematische review en meta-analyse","title_en":"Efficacy and safety of SGLT2 inhibitors in heart failure: systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["canagliflozine","dapagliflozine","empagliflozine","sglt2-remmers"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13169","source_url":"https://doi.org/10.1002/ehf2.13169","authors":["Javed Butler","Muhammad Shariq Usman","Muhammad Shahzeb Khan","Stephen J Greene","Tim Friede","Muthiah Vaduganathan","Gerasimos Filippatos","Andrew J Stewart Coats","Stefan D Anker"],"significance":8,"published":"2020-12-01","source_date":"2020-12-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/","https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/"],"congress":"","summary_en":"This meta-analysis of SGLT2 inhibitors in heart failure confirmed class-wide reductions in heart failure hospitalization and cardiovascular death, with consistent benefit regardless of diabetes status. The analysis strengthened the evidence base for SGLT2 inhibitors as fundamental heart failure therapy.","created":"2026-07-03T10:28:56Z","updated":"2026-07-03T13:28:05Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 SGLT2-remmers bij hartfalen. Klasse-effectbewijs over alle beschikbare trials.","abstract_original":"AIMS: We sought to conduct a meta-analysis regarding the safety and efficacy of sodium-glucose co-transporter 2 (SGLT2) inhibitors in patients with heart failure (HF). METHODS AND RESULTS: MEDLINE, Scopus, Cochrane CENTRAL, and ClinicalTrials.gov were searched from their inception to November 2020 for placebo-controlled randomized controlled trials of SGLT2 inhibitors. Randomized controlled trials were selected if they reported at least one of the prespecified outcomes in patients with HF. Hazard ratios (HRs) or risk ratios and their corresponding 95% confidence intervals were pooled using a random-effects model. A total of seven trials including 16 820 HF patients (N = 8884 in the SGLT2 inhibitor arms; N = 7936 in the placebo arms) were included. In the overall HF cohort, SGLT2 inhibitors compared with placebo significantly reduced the risk of the composite endpoint of first HF hospitalization or cardiovascular death [HR: 0.77 (0.72-0.83); P < 0.001; I2 = 0%], time to first HF hospitalization [HR: 0.71 (0.64-0.78); P < 0.001; I2 = 0], cardiovascular mortality [HR: 0.87 (0.79-0.96); P = 0.005; I2 = 0%], and all-cause mortality [HR: 0.89 (0.82-0.96); P = 0.004; I2 = 0%]. Results remained consistent across HF-specific trials and according to diabetes mellitus status. A trend towards benefit was observed in patients with HF with preserved ejection fraction for the composite of HF hospitalization and cardiovascular death [HR: 0.80 (0.63-1.00); P = 0.05; I2 = 29%]. No increased risk of hypovolaemia, hyperkalaemia, and hypotension was seen with SGLT2 inhibitors compared with placebo. CONCLUSIONS: SGLT2 inhibitors significantly improve cardiovascular outcomes including cardiovascular and all-cause mortality in patients with HF without an increased risk of serious adverse events. A trend towards benefit was observed in patients with HF with preserved ejection fraction."},{"id":"96e4deea5f7a","type":"article","url":"https://hartvaat.nl/2020/12/01/ijzercarboxymaltose-bij-ijzerdeficient-hartfalen-meta-analyse/","title":"IJzercarboxymaltose bij ijzerdeficiënt hartfalen: meta-analyse","title_en":"Ferric carboxymaltose for the treatment of iron-deficient heart failure patients: a systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["hfmref","hfpef","hfref","ijzersuppletie","ivabradine"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13146","source_url":"https://doi.org/10.1002/ehf2.13146","authors":["Muhammad Shahzeb Khan","Muhammad Shariq Usman","Stephan von Haehling","Wolfram Doehner","Andrew J Stewart Coats"],"significance":8,"published":"2020-12-01","source_date":"2020-12-01","image":"","kennis":[],"congress":"","summary_en":"This systematic review and meta-analysis confirmed that intravenous ferric carboxymaltose improves functional capacity and quality of life in iron-deficient heart failure patients, with a trend toward reduced heart failure hospitalization. The consolidated evidence supported IV iron as a guideline-recommended therapy.","created":"2026-07-03T10:28:56Z","updated":"2026-07-03T13:28:05Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 ijzercarboxymaltose voor de behandeling van ijzerdeficiënt hartfalen. Consolideert het IV-ijzer evidence.","abstract_original":"AIMS: Intravenous ferric carboxymaltose (FCM) has been shown to improve functional capacity and quality of life in iron deficient heart failure patients. However, FCM's effect on hospitalizations and mortality remains unclear as previous randomized controlled trials (RCTs) and their meta-analyses have been underpowered to detect significant differences. We sought to conduct an updated meta-analysis using recently published RCT data. METHODS AND RESULTS: Online databases were searched from inception until November 2020 for RCTs evaluating the effects of FCM on clinical outcomes in iron-deficient heart failure patients. Outcomes of interest included heart failure hospitalizations, all-cause mortality, and cardiovascular mortality. Meta-analysis was performed using a fixed-effect model and estimates were reported as odds ratios (ORs), hazard ratios, or rate ratios (RRs) along with corresponding 95% confidence intervals (CIs). A total of 1947 patients (n = 1062 in the FCM group; n = 885 in the placebo group) were included. FCM, compared with placebo, significantly reduced the risk of the composite endpoint of time to first heart failure hospitalization or cardiovascular death (hazard ratio = 0.76; 95% CI = 0.63-0.90; I2 = 55%). FCM also significantly reduced the risk of recurrent heart failure hospitalizations (RR = 0.68; 95% CI = 0.54-0.85; I2 = 71%) and recurrent cardiovascular hospitalizations (RR = 0.71; 95% CI = 0.59-0.86; I2 = 56%). However, FCM had no significant effect on the risk of all-cause (OR = 0.97; 95% CI = 0.73-1.28; I2 = 0%) or cardiovascular mortality (OR = 0.93; 95% CI = 0.69-1.27; I2 = 0%). CONCLUSIONS: Ferric carboxymaltose reduces heart failure hospitalizations and cardiovascular hospitalizations with no beneficial effect on all-cause and cardiovascular mortality in iron-deficient heart failure patients. These findings reinforce the role of FCM as a therapeutic option in heart failure patients."},{"id":"a89dddaa4877","type":"article","url":"https://hartvaat.nl/2020/12/01/mindfulness-gebaseerde-stressreductie-bij-verhoogde-bloeddruk-meta-analyse/","title":"Mindfulness-gebaseerde stressreductie bij verhoogde bloeddruk: meta-analyse","title_en":"Effect and Acceptability of Mindfulness-Based Stress Reduction Program on Patients With Elevated Blood Pressure or Hypertension: A Meta-Analysis of Randomized Controlled Trials.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["stress-psychosociaal"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.16160","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.16160","authors":["Eric K P Lee","Nelson C Y Yeung","Zijun Xu","Dexing Zhang","Chun-Pong Yu","Samuel Y S Wong"],"significance":6,"published":"2020-12-01","source_date":"2020-12-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/classificatie-bloeddruk-esc-2024/","https://hartvaat.nl/kennis/hypertensie/esc-richtlijn-hypertensie-2024/"],"congress":"","summary_en":"This meta-analysis showed that mindfulness-based stress reduction programs modestly reduce blood pressure in patients with hypertension, supporting mind-body interventions as an adjunctive non-pharmacological blood pressure management strategy.","created":"2026-07-03T10:28:56Z","updated":"2026-07-03T13:28:04Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 naar het effect en de aanvaardbaarheid van mindfulness-gebaseerde stressreductie bij hypertensie.","abstract_original":"The mindfulness-based stress reduction program (MBSR) may reduce blood pressure (BP) in patients with hypertension or elevated BP. However, some important parameters (such as asleep BP) have not been investigated in previous reviews, and a well-conducted meta-analysis is lacking. This meta-analysis investigates the effect and acceptability of MBSR on patients with elevated BP or hypertension. Relevant articles were searched in multiple databases, including MEDLINE, EMBASE, and APA PsycInfo. Included studies were randomized controlled trials that involved patients with an elevated BP, had a control group, and investigated the effect of MBSR. The mean office and out-of-office (including 24-hour, daytime, and asleep) systolic BP and diastolic BP, psychological outcomes (depression/anxiety/stress), and dropout rate were compared between the MBSR arm and the control arm using a random-effects model. Quality assessment was conducted based on the Cochrane risk-of-bias tool. Twelve studies were included, and only one was considered having low risk of bias. MBSR decreased the office systolic BP and diastolic BP by 6.64 and 2.47 mm Hg at postintervention, respectively; the reduction in diastolic BP was sustained until 3 to 6 months after the recruitment. Our meta-analyses did not find a significant reduction in out-of-office BP after MBSR. MBSR reduced depressive, anxiety, and stress symptoms. The dropout rate from MBSR arm was 15% and was similar to that of control arm. The current evidence is limited by lack of high-quality and adequately powered trials with long-term follow-up. Furthermore, out-of-office BP was only reported by few trials."},{"id":"d529af670e96","type":"article","url":"https://hartvaat.nl/2020/12/01/langetermijn-bloeddrukvariabiliteit-en-cv-risico-bij-ouderen-in-de-community/","title":"Langetermijn bloeddrukvariabiliteit en CV-risico bij ouderen in de community","title_en":"Long-Term Blood Pressure Variability and Risk of Cardiovascular Disease Events Among Community-Dwelling Elderly.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.16209","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.16209","authors":["Michael E Ernst","Enayet K Chowdhury","Lawrence J Beilin","Karen L Margolis","Mark R Nelson","Rory Wolfe","Andrew M Tonkin","Joanne Ryan","Robyn L Woods","John J McNeil","Christopher M Reid"],"significance":6,"published":"2020-12-01","source_date":"2020-12-01","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 long-term visit-to-visit blood pressure variability predicts cardiovascular disease risk in community-dwelling elderly adults without prior CVD, extending the prognostic significance of BP variability to the oldest population.","created":"2026-07-03T10:28:55Z","updated":"2026-07-03T13:28:04Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 langetermijn visit-to-visit bloeddrukvariabiliteit en cardiovasculair risico bij community-wonende ouderen.","abstract_original":"High office blood pressure variability (OBPV) in midlife increases the risk of cardiovascular disease (CVD), but the impact of OBPV in older adults without previous CVD is unknown. We conducted a post hoc analysis of ASPREE trial (Aspirin in Reducing Events in the Elderly) participants aged 70-years and older (65 for US minorities) without history of CVD events at baseline, to examine risk of incident CVD associated with long-term, visit-to-visit OBPV. CVD was a prespecified, adjudicated secondary end point in ASPREE. We estimated OBPV using within-individual SD of mean systolic BP from baseline and first 2 annual visits. Cox proportional hazards regression was used to calculate hazard ratios (HR) and 95% CI for associations with CVD events. In 16 475 participants who survived to year 2 without events, those in the highest tertile of OBPV had increased risk of CVD events after adjustment for multiple covariates, when compared with participants in the lowest tertile (HR, 1.36 [95% CI, 1.08-1.70]; P=0.01). Similar increased risk was observed for ischemic stroke (HR, 1.56 [95% CI, 1.04-2.33]; P=0.03), heart failure hospitalization, or death (HR, 1.73 [95% CI, 1.07-2.79]; P=0.02), and all-cause mortality (HR, 1.27 [95% CI, 1.04-1.54]; P=0.02). Findings were consistent when stratifying participants by use of antihypertensive drugs, while sensitivity analyses suggested the increased risk was especially for individuals whose BP was uncontrolled during the OBPV estimation period. Our findings support increased OBPV as a risk factor for CVD events in healthy older adults with, or without hypertension, who have not had such events previously. Registration- URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01038583; URL: https://www.isrctn.com; Unique identifiers: ISRCTN83772183."},{"id":"5892451a9837","type":"article","url":"https://hartvaat.nl/2020/12/01/intensieve-bloeddrukcontrole-en-alle-hospitalisaties-sprint/","title":"Intensieve bloeddrukcontrole en alle hospitalisaties: SPRINT","title_en":"Effects of Intensive Systolic Blood Pressure Control on All-Cause Hospitalizations.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.15868","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.15868","authors":["Michael V Rocco","Mary E Comeau","Miranda C Marion","Barry I Freedman","Amret T Hawfield","Carl D Langefeld"],"significance":6,"published":"2020-12-01","source_date":"2020-12-01","image":"","kennis":[],"congress":"","summary_en":"This SPRINT analysis showed that intensive systolic blood pressure control reduces all-cause hospitalizations, demonstrating that the cardiovascular event reduction translates to broader healthcare utilization benefits.","created":"2026-07-03T10:28:55Z","updated":"2026-07-03T13:28:04Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"SPRINT analyse naar het effect van intensieve systolische bloeddrukcontrole op alle oorzaken van hospitalisatie.","abstract_original":"Intensive blood pressure control decreases the rate of cardiovascular events by >25% compared with standard blood pressure control. We sought to determine whether the decrease in cardiovascular events seen with intensive blood pressure control is associated with an increased rate of other causes of hospitalization. This is a post hoc analysis of SPRINT (Systolic Blood Pressure Intervention Trial) in 9361 adult participants with hypertension and elevated cardiovascular risk. Participants were randomly assigned to an intensive or standard systolic blood pressure goal (<120 or <140 mm Hg, respectively). The primary outcome was hospitalization rates per 100 person-years for hospitalizations not associated with SPRINT primary events. After excluding hospitalizations linked to SPRINT primary events, there were 4678 participants with a rate of 19.70 hospitalizations per 100 person-years, compared with 4683 participants with a rate of 19.65 (P=0.37). Equivalence testing shows that these hospitalization rates were statistically equivalent at the P=0.05 level. Of those with hospitalizations, >1 hospitalization was seen in 38.8% of intensive arm participants and 41.9% of standard arm participants (P=0.08). The mean cumulative count of nonprimary event hospitalizations was comparable between the two arms. The most common causes of hospitalization were cardiovascular (23.6%) followed by injuries, including bone and joint therapeutic procedures (15.7%), infections (12.0%), and nervous systems disorders (10.7%). No categories of hospitalization were statistically more common in the intensive arm compared with the standard arm. Thus, the decrease in cardiovascular events seen with intensive blood pressure control is not associated with an increased rate of other causes of hospitalization. Registration- URL: https://www.clinicaltrials.gov; Unique identifier: NCT01206062."},{"id":"6cbaf9d67755","type":"article","url":"https://hartvaat.nl/2020/12/01/verlaagd-il-10-bij-pre-eclampsie-systematische-review-en-meta-analyse/","title":"Verlaagd IL-10 bij pre-eclampsie: systematische review en meta-analyse","title_en":"Preeclamptic Women Have Decreased Circulating IL-10 (Interleukin-10) Values at the Time of Preeclampsia Diagnosis: Systematic Review and Meta-Analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["huisarts"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.15870","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.15870","authors":["Meryl C Nath","Hajrunisa Cubro","Daniel J McCormick","Natasa M Milic","Vesna D Garovic"],"significance":5,"published":"2020-12-01","source_date":"2020-12-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis confirmed that preeclamptic women have decreased circulating IL-10 levels at diagnosis, supporting an anti-inflammatory deficit as part of the preeclampsia pathophysiology.","created":"2026-07-03T10:28:55Z","updated":"2026-07-03T13:28:04Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 naar verlaagde IL-10-waarden bij pre-eclamptische vrouwen. Anti-inflammatoire deficit bij pre-eclampsie.","abstract_original":"A key immunomodulatory cytokine, IL-10 (interleukin-10), has been shown to be dysregulated in preeclampsia, a pregnancy-specific hypertensive disorder, further characterized by multi-system involvement. However, studies have reported inconsistent findings about circulating IL-10 levels in preeclamptic versus normotensive pregnancies. The aim of the present systematic review and meta-analysis was to assess circulating IL-10 levels in preeclamptic and normotensive pregnancies at 2 time points: before, and at the time of preeclampsia diagnosis. PubMED, EMBASE, and Web of Science databases were searched to include all published studies examining circulating IL-10 levels in preeclamptic and normotensive pregnancies. Differences in IL-10 levels were evaluated by standardized mean differences. Of 876 abstracts screened, 56 studies were included in the meta-analysis. Circulating IL-10 levels were not different before the time of active disease (standardized mean differences, -0.01 [95% CI, -0.11 to 0.08]; P=0.76). At the time of active disease, women with preeclampsia (n=1599) had significantly lower IL-10 levels compared with normotensive controls (n=1998; standardized mean differences, -0.79 [95% CI, -1.22 to -0.35]; P=0.0004). IL-10 levels were lower in both early/severe and late/mild forms of preeclampsia. Subgroup analysis revealed that IL-10 measurement methodology (ELISA or multiplex bead array) and the sample type (plasma or serum) significantly influenced the observed differences, with the use of sera paired with ELISA technology providing the best distinction in IL-10 levels between preeclamptic and normotensive pregnancies. These findings support the role of decreased IL-10 levels in the pathophysiology of preeclampsia. Future studies should address the therapeutic potential of IL-10 in preeclampsia."},{"id":"2ddab8f0d50d","type":"article","url":"https://hartvaat.nl/2020/12/01/qol-cognitie-en-functionele-status-na-af-ablatie/","title":"QoL, cognitie en functionele status na AF-ablatie","title_en":"Changes in quality of life, cognition and functional status following catheter ablation of atrial fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2020-316612","source_url":"https://doi.org/10.1136/heartjnl-2020-316612","authors":["Jonathan P Piccini","Derick M Todd","Tyler Massaro","Aimee Lougee","Karl Georg Haeusler","Benjamin Blank","Joseph Paul de Bono","David J Callans","Arif Elvan","Thomas Fetsch","Isabelle Van Gelder","Philip Gentlesk","Massimo Grimaldi","Jim Hansen","Gerhard Hindricks","Hussein Al-Khalidi","Lluis Mont","Jens Cosedis Nielsen","Georg Noelker","Tom De Potter","Daniel Scherr","Ulrich Schotten","Sakis Themistoclakis","Johan Vijgen","Luigi Di Biase","Paulus Kirchhof"],"significance":5,"published":"2020-12-01","source_date":"2020-12-01","image":"","kennis":[],"congress":"","summary_en":"This study showed that quality of life, cognition, and functional status improve after AF catheter ablation primarily in patients who maintain sinus rhythm, supporting arrhythmia recurrence as the key determinant of patient-centered outcomes.","created":"2026-07-03T10:28:55Z","updated":"2026-07-03T13:28:04Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 veranderingen in kwaliteit van leven, cognitie en functionele status na katheterablatie voor AF.","abstract_original":"OBJECTIVE: To investigate changes in quality of life (QoL), cognition and functional status according to arrhythmia recurrence after atrial fibrillation (AF) ablation. METHODS: We compared QoL, cognition and functional status in patients with recurrent atrial tachycardia (AT)/AF versus those without recurrent AT/AF in the AXAFA-AFNET 5 clinical trial. We also sought to identify factors associated with improvement in QoL and functional status following AF ablation by overall change scores with and without analysis of covariance (ANCOVA). RESULTS: Among 518 patients who underwent AF ablation, 154 (29.7%) experienced recurrent AT/AF at 3 months. Patients with recurrent AT/AF had higher mean CHA2DS2-VASc scores (2.8 vs 2.3, p<0.001) and more persistent forms of AF (51 vs 39%, p=0.012). Median changes in the SF-12 physical (3 (25th, 75th: -1, 8) vs 1 (-5, 8), p=0.026) and mental scores (2 (-3, 9) vs 0 (-4, 5), p=0.004), EQ-5D (0 (0,2) vs 0 (-0.1, 0.1), p=0.027) and Karnofsky functional status scores (10 (0, 10) vs 0 (0, 10), p=0.001) were more favourable in patients without recurrent AT/AF. In the overall cohort, the proportion with at least mild cognitive impairment (Montreal Cognitive Assessment <26) declined from 30.3% (n=157) at baseline to 21.8% (n=113) at follow-up. ANCOVA identified greater improvement in Karnofsky functional status (p<0.001) but not SF-12 physical (p=0.238) or mental scores (p=0.065) in those without recurrent AT/AF compared with patients with recurrent AT/AF. CONCLUSIONS: Patients without recurrent AT/AF appear to experience greater improvement in functional status but similar QoL as those with recurrent AT/AF after AF ablation."},{"id":"d8bc7a6b3962","type":"article","url":"https://hartvaat.nl/2020/12/01/longechogeleide-therapie-vermindert-acute-decompensatie-bij-chronisch-hf/","title":"Longechogeleide therapie vermindert acute decompensatie bij chronisch HF","title_en":"Lung ultrasound-guided therapy reduces acute decompensation events in chronic heart failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2019-316429","source_url":"https://doi.org/10.1136/heartjnl-2019-316429","authors":["Claudia Marini","Gabriele Fragasso","Leonardo Italia","Hamayak Sisakian","Vincenzo Tufaro","Giacomo Ingallina","Stefano Stella","Francesco Ancona","Ferdinando Loiacono","Pasquale Innelli","Marco Fabio Costantino","Laura Sahakyan","Sirvard Gabrielyan","Mariam Avetisyan","Alberto Margonato","Eustachio Agricola"],"significance":7,"published":"2020-12-01","source_date":"2020-12-01","image":"","kennis":[],"congress":"","summary_en":"This study demonstrated that lung ultrasound-guided adjustment of diuretic therapy reduces acute decompensation events in patients with chronic heart failure, supporting point-of-care imaging as a tool for proactive congestion management.","created":"2026-07-03T10:28:55Z","updated":"2026-07-03T18:38:48Z","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 die aantoont dat longechogeleide therapie acute decompensatie-events vermindert bij chronisch hartfalen.","abstract_original":"OBJECTIVE: Pulmonary congestion is the main cause of hospital admission in patients with heart failure (HF). Lung ultrasound (LUS) is a useful tool to identify subclinical pulmonary congestion. We evaluated the usefulness of LUS in addition to physical examination (PE) in the management of outpatients with HF. METHODS: In this randomised multicentre unblinded study, patients with chronic HF and optimised medical therapy were randomised in two groups: 'PE+LUS' group undergoing PE and LUS and 'PE only' group. Diuretic therapy was modified according to LUS findings and PE, respectively. The primary endpoint was the reduction in hospitalisation rate for acute decompensated heart failure (ADHF) at 90-day follow-up. Secondary endpoints were reduction in NT-proBNP, quality-of-life test (QLT) and cardiac mortality at 90-day follow-up. RESULTS: A total of 244 patients with chronic HF and optimised medical therapy were enrolled and randomised in 'PE+LUS' group undergoing PE and LUS, and in 'PE only' group. Thirty-seven primary outcome events occurred. The hospitalisation for ADHF at 90 day was significantly reduced in 'PE+LUS' group (9.4% vs 21.4% in 'PE only' group; relative risk=0.44; 95% CI 0.23 to 0.84; p=0.01), with a reduction of risk for hospitalisation for ADHF by 56% (p=0.01) and a number needed to treat of 8.4 patients (95% CI 4.8 to 34.3). At day 90, NT-proBNP and QLT score were significantly reduced in 'PE+LUS' group, whereas in 'PE only' group both were increased. There were no differences in mortality between the two groups. CONCLUSIONS: LUS-guided management reduces hospitalisation for ADHF at mid-term follow-up in outpatients with chronic HF."},{"id":"ace1ac89b0fa","type":"article","url":"https://hartvaat.nl/2020/11/28/ticagrelor-versus-clopidogrel-bij-electieve-pci-lancet-alpheus/","title":"Ticagrelor versus clopidogrel bij electieve PCI: Lancet ALPHEUS","title_en":"Ticagrelor versus clopidogrel in elective percutaneous coronary intervention (ALPHEUS): a randomised, open-label, phase 3b trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["trombocytenaggregatieremmers"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(20)32236-4","source_url":"https://doi.org/10.1016/S0140-6736(20)32236-4","authors":["Johanne Silvain","Benoit Lattuca","Farzin Beygui","Grégoire Rangé","Zuzana Motovska","Jean-Guillaume Dillinger","Ziad Boueri","Philippe Brunel","Thibault Lhermusier","Christophe Pouillot","Elisa Larrieu-Ardilouze","Franck Boccara","Jean-Noël Labeque","Paul Guedeney","Mohamad El Kasty","Mikael Laredo","Raphaëlle Dumaine","Grégory Ducrocq","Jean-Philippe Collet","Guillaume Cayla","Katrien Blanchart","Petr Kala","Eric Vicaut","Gilles Montalescot"],"significance":7,"published":"2020-11-28","source_date":"2020-11-28","image":"","kennis":["https://hartvaat.nl/kennis/kleplijden/esc-richtlijn-kleplijden-2021/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"The ALPHEUS trial showed that ticagrelor was not superior to clopidogrel for reducing peri-procedural myocardial injury in patients undergoing elective PCI, supporting clopidogrel as the standard P2Y12 inhibitor for stable coronary disease.","created":"2026-07-03T10:28:55Z","updated":"2026-07-03T13:28:04Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 ALPHEUS trial die ticagrelor vergeleek met clopidogrel bij electieve PCI. Ticagrelor niet superieur bij laagrisico-PCI.","abstract_original":"BACKGROUND: Percutaneous coronary intervention (PCI)-related myonecrosis is frequent and can affect the long-term prognosis of patients. To our knowledge, ticagrelor has not been evaluated in elective PCI and could reduce periprocedural ischaemic complications compared with clopidogrel, the currently recommended treatment. The aim of the ALPHEUS study was to examine if ticagrelor was superior to clopidogrel in reducing periprocedural myocardial necrosis in stable coronary patients undergoing high-risk elective PCI. METHODS: The ALPHEUS study, a phase 3b, randomised, open-label trial, was done at 49 hospitals in France and Czech Republic. Patients with stable coronary artery disease were eligible for the study if they had an indication for PCI and at least one high-risk characteristic. Eligible patients were randomly assigned (1:1) to either ticagrelor (180 mg loading dose, 90 mg twice daily thereafter for 30 days) or clopidogrel (300-600 mg loading dose, 75 mg daily thereafter for 30 days) by use of an interactive web response system, and stratified by centre. The primary outcome was a composite of PCI-related type 4 (a or b) myocardial infarction or major myocardial injury and the primary safety outcome was major bleeding, both of which were evaluated within 48 h of PCI (or at hospital discharge if earlier). The primary analysis was based on all events that occurred in the intention-to-treat population. The trial was registered with ClinicalTrials.gov, NCT02617290. FINDINGS: Between Jan 9, 2017, and May 28, 2020, 1910 patients were randomly assigned at 49 sites, 956 to the ticagrelor group and 954 to the clopidogrel group. 15 patients were excluded from the ticagrelor group and 12 from the clopidogrel group. At 48 h, the primary outcome was observed in 334 (35%) of 941 patients in the ticagrelor group and 341 (36%) of 942 patients in the clopidogrel group (odds ratio [OR] 0·97, 95% CI 0·80-1·17; p=0·75). The primary safety outcome did not differ between the two groups, but minor bleeding events were more frequently observed with ticagrelor than clopidogrel at 30 days (105 [11%] of 941 patients in the ticagrelor group vs 71 [8%] of 942 patients in the clopidogrel group; OR 1·54, 95% CI 1·12-2·11; p=0·0070). INTERPRETATION: Ticagrelor was not superior to clopidogrel in reducing periprocedural myocardial necrosis after elective PCI and did not cause an increase in major bleeding, but did increase the rate of minor bleeding at 30 days. These results support the use of clopidogrel as the standard of care for elective PCI. FUNDING: ACTION Study Group and AstraZeneca."},{"id":"95769536ce38","type":"article","url":"https://hartvaat.nl/2020/11/26/rivaroxaban-bij-af-met-bioprothese-mitralisklep-nejm-river/","title":"Rivaroxaban bij AF met bioprothese-mitralisklep: NEJM RIVER","title_en":"Rivaroxaban in Patients with Atrial Fibrillation and a Bioprosthetic Mitral Valve.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["klepprothese"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2029603","source_url":"https://doi.org/10.1056/NEJMoa2029603","authors":["Helio P Guimarães","Renato D Lopes","Pedro G M de Barros E Silva","Idelzuita L Liporace","Roney O Sampaio","Flávio Tarasoutchi","Conrado R Hoffmann-Filho","Rodrigo de Lemos Soares Patriota","Tiago L L Leiria","Diana Lamprea","Dalton B Precoma","Fernando A Atik","Fabio S Silveira","Fabio R Farias","Diogo O Barreto","Adail P Almeida","Alexandre C Zilli","João D de Souza Neto","Margaret A Cavalcante","Fernando A M S Figueira","Flávia C S Kojima","Lucas Damiani","Renato H N Santos","Nanci Valeis","Viviane B Campos","Jose F K Saraiva","Francisco H Fonseca","Ibraim M Pinto","Carlos C Magalhães","Joao F M Ferreira","John H Alexander","Ricardo Pavanello","Alexandre B Cavalcanti","Otavio Berwanger"],"significance":8,"published":"2020-11-26","source_date":"2020-11-26","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doacs-overzicht/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"The RIVER trial demonstrated that rivaroxaban was noninferior to warfarin for the composite of stroke, TIA, systemic embolism, valve thrombosis, or death in patients with atrial fibrillation and a bioprosthetic mitral valve. The result expanded the evidence for DOAC use in patients with bioprosthetic heart valves.","created":"2026-07-03T10:28:55Z","updated":"2026-07-03T13:28:04Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 RIVER trial die rivaroxaban vergeleek met warfarine bij AF-patiënten met een bioprothese-mitralisklep. Bevestigt DOAC-gebruik bij biokleppen.","abstract_original":"BACKGROUND: The effects of rivaroxaban in patients with atrial fibrillation and a bioprosthetic mitral valve remain uncertain. METHODS: In this randomized trial, we compared rivaroxaban (20 mg once daily) with dose-adjusted warfarin (target international normalized ratio, 2.0 to 3.0) in patients with atrial fibrillation and a bioprosthetic mitral valve. The primary outcome was a composite of death, major cardiovascular events (stroke, transient ischemic attack, systemic embolism, valve thrombosis, or hospitalization for heart failure), or major bleeding at 12 months. RESULTS: A total of 1005 patients were enrolled at 49 sites in Brazil. A primary-outcome event occurred at a mean of 347.5 days in the rivaroxaban group and 340.1 days in the warfarin group (difference calculated as restricted mean survival time, 7.4 days; 95% confidence interval [CI], -1.4 to 16.3; P<0.001 for noninferiority). Death from cardiovascular causes or thromboembolic events occurred in 17 patients (3.4%) in the rivaroxaban group and in 26 (5.1%) in the warfarin group (hazard ratio, 0.65; 95% CI, 0.35 to 1.20). The incidence of stroke was 0.6% in the rivaroxaban group and 2.4% in the warfarin group (hazard ratio, 0.25; 95% CI, 0.07 to 0.88). Major bleeding occurred in 7 patients (1.4%) in the rivaroxaban group and in 13 (2.6%) in the warfarin group (hazard ratio, 0.54; 95% CI, 0.21 to 1.35). The frequency of other serious adverse events was similar in the two groups. CONCLUSIONS: In patients with atrial fibrillation and a bioprosthetic mitral valve, rivaroxaban was noninferior to warfarin with respect to the mean time until the primary outcome of death, major cardiovascular events, or major bleeding at 12 months. (Funded by PROADI-SUS and Bayer; RIVER ClinicalTrials.gov number, NCT02303795.)."},{"id":"870230553ead","type":"article","url":"https://hartvaat.nl/2020/11/26/n-of-1-trial-van-statine-placebo-of-geen-behandeling-voor-bijwerkingen-nejm-stat/","title":"N-of-1 trial van statine, placebo of geen behandeling voor bijwerkingen: NEJM StatinWISE","title_en":"N-of-1 Trial of a Statin, Placebo, or No Treatment to Assess Side Effects.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["clear-outcomes","niet-statine-therapie","rosuvastatine","statines"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMc2031173","source_url":"https://doi.org/10.1056/NEJMc2031173","authors":["Frances A Wood","James P Howard","Judith A Finegold","Alexandra N Nowbar","David M Thompson","Ahran D Arnold","Christopher A Rajkumar","Susan Connolly","Jaimini Cegla","Chris Stride","Peter Sever","Christine Norton","Simon A M Thom","Matthew J Shun-Shin","Darrel P Francis"],"significance":10,"published":"2020-11-26","source_date":"2020-11-26","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ezetimib/","https://hartvaat.nl/kennis/farmacologie/colchicine-cardiovasculair/"],"congress":"","summary_en":"The StatinWISE N-of-1 trial demonstrated that muscle symptoms attributed to statins were largely not reproducible under blinded conditions, with similar symptom scores during statin and placebo periods. This provided rigorous evidence that most statin-associated side effects are attributable to the nocebo effect rather than the drug itself.","created":"2026-07-03T10:28:55Z","updated":"2026-07-03T13:28:04Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 StatinWISE N-of-1 trial die aantoonde dat statinebijwerkingen grotendeels niet reproduceerbaar zijn in geblindeerde rechallenge. Definitief nocebo-bewijs.","abstract_original":""},{"id":"9f2ccd2ab0ae","type":"article","url":"https://hartvaat.nl/2020/11/24/gedragscounseling-voor-cv-preventie-bij-risicoadulten-jama-uspstf-evidence-revie/","title":"Gedragscounseling voor CV-preventie bij risicoadulten: JAMA USPSTF evidence review","title_en":"Behavioral Counseling Interventions to Promote a Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults With Cardiovascular Risk Factors: US Preventive Services Task Force Recommendation Statement.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts"],"tags":["primaire-preventie"],"journal":"JAMA","doi":"10.1001/jama.2020.21749","source_url":"https://doi.org/10.1001/jama.2020.21749","authors":["Alex H Krist","Karina W Davidson","Carol M Mangione","Michael J Barry","Michael Cabana","Aaron B Caughey","Katrina Donahue","Chyke A Doubeni","John W Epling","Martha Kubik","Seth Landefeld","Gbenga Ogedegbe","Lori Pbert","Michael Silverstein","Melissa A Simon","Chien-Wen Tseng","John B Wong"],"significance":7,"published":"2020-11-24","source_date":"2020-11-24","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/aspirine-primaire-preventie/"],"congress":"","summary_en":"This USPSTF evidence review assessed behavioral counseling interventions for diet and physical activity in adults with cardiovascular risk factors, finding consistent modest benefits on blood pressure, lipids, and glucose levels.","created":"2026-07-03T10:28:55Z","updated":"2026-07-03T13:28:03Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 USPSTF evidence review over gedragscounseling voor voeding en beweging bij volwassenen met CV-risicofactoren.","abstract_original":"IMPORTANCE: Cardiovascular disease (CVD) is a leading cause of death in the US. Known modifiable risk factors for CVD include smoking, overweight and obesity, diabetes, elevated blood pressure or hypertension, dyslipidemia, lack of physical activity, and unhealthy diet. Adults who adhere to national guidelines for a healthy diet and physical activity have lower cardiovascular morbidity and mortality than those who do not. All persons, regardless of their CVD risk status, benefit from healthy eating behaviors and appropriate physical activity. OBJECTIVE: To update its 2014 recommendation, the USPSTF commissioned a review of the evidence on behavioral counseling to promote a healthy diet and physical activity for CVD prevention in adults with cardiovascular risk factors. POPULATION: This recommendation statement applies to adults 18 years or older with known hypertension or elevated blood pressure, those with dyslipidemia, or those who have mixed or multiple risk factors such as metabolic syndrome or an estimated 10-year CVD risk of 7.5% or greater. Adults with other known modifiable cardiovascular risk factors such as abnormal blood glucose levels, obesity, and smoking are not included in this recommendation. EVIDENCE ASSESSMENT: The USPSTF concludes with moderate certainty that behavioral counseling interventions have a moderate net benefit on CVD risk in adults at increased risk for CVD. RECOMMENDATION: The USPSTF recommends offering or referring adults with CVD risk factors to behavioral counseling interventions to promote a healthy diet and physical activity. (B recommendation)."},{"id":"3a957f67cec9","type":"article","url":"https://hartvaat.nl/2020/11/24/gedragscounseling-voor-gezond-dieet-en-beweging-bij-cv-risico-jama-uspstf/","title":"Gedragscounseling voor gezond dieet en beweging bij CV-risico: JAMA USPSTF","title_en":"Behavioral Counseling to Promote a Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults With Cardiovascular Risk Factors: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2020.17108","source_url":"https://doi.org/10.1001/jama.2020.17108","authors":["Elizabeth A O'Connor","Corinne V Evans","Megan C Rushkin","Nadia Redmond","Jennifer S Lin"],"significance":7,"published":"2020-11-24","source_date":"2020-11-24","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This USPSTF recommendation endorsed behavioral counseling for healthy diet and physical activity in adults with cardiovascular risk factors, providing a Grade B recommendation for population-level lifestyle intervention.","created":"2026-07-03T10:28:54Z","updated":"2026-07-03T13:28:03Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 USPSTF aanbeveling voor gedragscounseling over voeding en beweging bij volwassenen met CV-risicofactoren.","abstract_original":"IMPORTANCE: Cardiovascular disease is the leading cause of death in the US, and poor diet and lack of physical activity are major factors contributing to cardiovascular morbidity and mortality. OBJECTIVE: To review the benefits and harms of behavioral counseling interventions to improve diet and physical activity in adults with cardiovascular risk factors. DATA SOURCES: MEDLINE, PubMed, PsycINFO, and the Cochrane Central Register of Controlled Trials through September 2019; literature surveillance through July 24, 2020. STUDY SELECTION: English-language randomized clinical trials (RCTs) of behavioral counseling interventions to help people with elevated blood pressure or lipid levels improve their diet and increase physical activity. DATA EXTRACTION AND SYNTHESIS: Data were extracted from studies by one reviewer and checked by a second. Random-effects meta-analysis and qualitative synthesis were used. MAIN OUTCOMES AND MEASURES: Cardiovascular events, mortality, subjective well-being, cardiovascular risk factors, diet and physical activity measures (eg, minutes of physical activity, meeting physical activity recommendations), and harms. Interventions were categorized according to estimated contact time as low (≤30 minutes), medium (31-360 minutes), and high (>360 minutes). RESULTS: Ninety-four RCTs were included (N = 52 174). Behavioral counseling interventions involved a median of 6 contact hours and 12 sessions over the course of 12 months and varied in format and dietary recommendations; only 5% addressed physical activity alone. Interventions were associated with a lower risk of cardiovascular events (pooled relative risk, 0.80 [95% CI, 0.73-0.87]; 9 RCTs [n = 12 551]; I2 = 0%). Event rates were variable; in the largest trial (Prevención con Dieta Mediterránea [PREDIMED]), 3.6% in the intervention groups experienced a cardiovascular event, compared with 4.4% in the control group. Behavioral counseling interventions were associated with small, statistically significant reductions in continuous measures of blood pressure, low-density lipoprotein cholesterol levels, fasting glucose levels, and adiposity at 12 to 24 months' follow-up. Measurement of diet and physical activity was heterogeneous, and evidence suggested small improvements in diet consistent with the intervention recommendation targets but mixed findings and a more limited evidence base for physical activity. Adverse events were rare, with generally no group differences in serious adverse events, any adverse events, hospitalizations, musculoskeletal injuries, or withdrawals due to adverse events. CONCLUSIONS AND RELEVANCE: Medium- and high-contact multisession behavioral counseling interventions to improve diet and increase physical activity for people with elevated blood pressure and lipid levels were effective in reducing cardiovascular events, blood pressure, low-density lipoproteins, and adiposity-related outcomes, with little to no risk of serious harm."},{"id":"55499757b088","type":"article","url":"https://hartvaat.nl/2020/11/24/ticagrelor-of-prasugrel-bij-nste-acs-isar-react-5-subanalyse/","title":"Ticagrelor of prasugrel bij NSTE-ACS: ISAR-REACT 5 subanalyse","title_en":"Ticagrelor or Prasugrel in Patients With Non-ST-Segment Elevation Acute Coronary Syndromes.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.09.584","source_url":"https://doi.org/10.1016/j.jacc.2020.09.584","authors":["Christian Valina","Franz-Josef Neumann","Maurizio Menichelli","Katharina Mayer","Jochen Wöhrle","Isabell Bernlochner","Alp Aytekin","Gert Richardt","Bernhard Witzenbichler","Dirk Sibbing","Salvatore Cassese","Dominick J Angiolillo","Sebastian Kufner","Christoph Liebetrau","Christian W Hamm","Erion Xhepa","Alexander Hapfelmeier","Hendrik B Sager","Isabel Wustrow","Michael Joner","Dietmar Trenk","Karl-Ludwig Laugwitz","Heribert Schunkert","Stefanie Schüpke","Adnan Kastrati"],"significance":7,"published":"2020-11-24","source_date":"2020-11-24","image":"","kennis":[],"congress":"","summary_en":"This ISAR-REACT 5 subanalysis confirmed that prasugrel is superior to ticagrelor for reducing ischemic events specifically in patients with NSTE-ACS, extending the primary trial findings to the non-STEMI population.","created":"2026-07-03T10:28:54Z","updated":"2026-07-03T13:28:03Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ISAR-REACT 5 subanalyse specifiek bij NSTE-ACS. Bevestigt prasugrel-voordeel ook bij NSTEMI.","abstract_original":"BACKGROUND: Current guidelines recommend intensified platelet inhibition by prasugrel or ticagrelor in patients with unstable angina (UA) or non-ST-segment elevation (NSTE) myocardial infarction (MI). OBJECTIVES: This study sought to investigate the benefits and risks of ticagrelor as compared with prasugrel in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) and planned invasive management. METHODS: This post hoc analysis combines the pre-specified subgroups of UA and NSTEMI of the randomized ISAR-REACT 5 trial. It included 1,179 patients assigned to ticagrelor and 1,186 assigned to prasugrel. Ticagrelor was started immediately after randomization and prasugrel after coronary angiography. The primary endpoint was a composite of death, MI, or stroke during 1-year follow-up, and the safety endpoint was Bleeding Academic Research Consortium class 3-5. RESULTS: The primary endpoint was reached in 101 (8.7%) patients in the ticagrelor and in 73 (6.3%) patients in the prasugrel group (hazard ratio [HR]: 1.41; 95% confidence interval [CI]: 1.04 to 1.90). The HR for all-cause death was 1.43 (95% CI: 0.93 to 2.21) and that for MI 1.43 (95% CI: 0.94 to 2.19). The safety endpoint occurred in 49 (5.2%) patients in the ticagrelor and in 41 (4.7%) patients in the prasugrel group (HR: 1.09; 95% CI: 0.72 to 1.65). Landmark analysis revealed persistence of the efficacy advantage with prasugrel after the first month. CONCLUSIONS: In patients with NSTE-ACS, we found that prasugrel was superior to ticagrelor in reducing the combined 1-year risk of death, MI, and stroke without increasing the risk of bleeding. Due to the post hoc nature of the analysis, these findings need confirmation by further studies. (Prospective, Randomized Trial of Ticagrelor Versus Prasugrel in Patients With Acute Coronary Syndrome; NCT01944800)."},{"id":"19fa9c20c0b5","type":"article","url":"https://hartvaat.nl/2020/11/24/2020-acc-aha-prestatie-en-kwaliteitsmaten-voor-hartfalen/","title":"2020 ACC/AHA prestatie- en kwaliteitsmaten voor hartfalen","title_en":"2020 ACC/AHA Clinical Performance and Quality Measures for Adults With Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.07.023","source_url":"https://doi.org/10.1016/j.jacc.2020.07.023","authors":["Paul A Heidenreich","Gregg C Fonarow","Khadijah Breathett","Corrine Y Jurgens","Barbara A Pisani","Bunny J Pozehl","John A Spertus","Kenneth G Taylor","Jennifer T Thibodeau","Clyde W Yancy","Boback Ziaeian"],"significance":7,"published":"2020-11-24","source_date":"2020-11-24","image":"","kennis":[],"congress":"","summary_en":"These 2020 ACC/AHA clinical performance and quality measures for adults with heart failure defined benchmarks for assessing and improving heart failure care quality across healthcare systems.","created":"2026-07-03T10:28:54Z","updated":"2026-07-03T13:28:03Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ACC/AHA 2020 klinische prestatie- en kwaliteitsmaten voor volwassenen met hartfalen.","abstract_original":""},{"id":"7d73525d432e","type":"article","url":"https://hartvaat.nl/2020/11/24/vroege-coronairangiografie-versus-uitstel-na-hartstilstand-zonder-st-elevatie-pi/","title":"Vroege coronairangiografie versus uitstel na hartstilstand zonder ST-elevatie: pilot RCT","title_en":"Randomized Pilot Clinical Trial of Early Coronary Angiography Versus No Early Coronary Angiography After Cardiac Arrest Without ST-Segment Elevation: The PEARL Study.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.049569","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.049569","authors":["Karl B Kern","Peter Radsel","Jacob C Jentzer","David B Seder","Kwan S Lee","Kapildeo Lotun","Rajesh Janardhanan","Dion Stub","Chiu-Hsieh Hsu","Marko Noc"],"significance":6,"published":"2020-11-24","source_date":"2020-11-24","image":"","kennis":[],"congress":"","summary_en":"This pilot randomized trial of early versus delayed coronary angiography after cardiac arrest without ST elevation provided preliminary data informing the timing of invasive evaluation in resuscitated patients.","created":"2026-07-03T10:28:54Z","updated":"2026-07-03T13:28:03Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Pilot gerandomiseerde trial van vroege versus uitgestelde coronairangiografie na hartstilstand zonder ST-elevatie.","abstract_original":"BACKGROUND: The benefit of emergency coronary angiography after resuscitation from out-of-hospital cardiac arrest is uncertain for patients without ST-segment elevation. The aim of this randomized trial was to evaluate the efficacy and safety of early coronary angiography and to determine the prevalence of acute coronary occlusion in resuscitated patients with out-of-hospital cardiac arrest without ST-segment elevation. METHODS: Adult (>18 years) comatose survivors without ST-segment elevation after resuscitation from out-of-hospital cardiac arrest were prospectively randomized in a 1:1 fashion under exception to informed consent regulations to early coronary angiography versus no early coronary angiography in this multicenter study. Early angiography was defined as ≤120 minutes from arrival at the percutaneous coronary intervention-capable facility. The primary end point was a composite of efficacy and safety measures, including efficacy measures of survival to discharge, favorable neurologic status at discharge (Cerebral Performance Category score ≤2), echocardiographic measures of left ventricular ejection fraction >50%, and a normal regional wall motion score of 16 within 24 hours of admission. Adverse events included rearrest, pulmonary edema on chest x-ray, acute renal dysfunction, bleeding requiring transfusion or intervention, hypotension (systolic arterial pressure ≤90 mm Hg), and pneumonia. Secondary end points included the incidence of culprit vessels with acute occlusion. RESULTS: The study was terminated prematurely before enrolling the target number of patients. A total of 99 patients were enrolled from 2015 to 2018, including 75 with initially shockable rhythms. Forty-nine patients were randomized to early coronary angiography. The primary end point of efficacy and safety was not different between the 2 groups (55.1% versus 46.0%; P=0.64). Early coronary angiography was not associated with any significant increase in survival (55.1% versus 48.0%; P=0.55) or adverse events (26.5% versus 26.0%; P=1.00). Early coronary angiography revealed a culprit vessel in 47%, with a total of 14% of patients undergoing early coronary angiography having an acutely occluded culprit coronary artery. CONCLUSIONS: This underpowered study, when considered together with previous clinical trials, does not support early coronary angiography for comatose survivors of cardiac arrest without ST elevation. Whether early detection of occluded potential culprit arteries leads to interventions that improve outcomes requires additional study. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02387398."},{"id":"894bbcc527b6","type":"article","url":"https://hartvaat.nl/2020/11/24/timing-van-orale-p2y12-remmer-bij-nste-acs/","title":"Timing van orale P2Y12-remmer bij NSTE-ACS","title_en":"Timing of Oral P2Y12 Inhibitor Administration in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.08.053","source_url":"https://doi.org/10.1016/j.jacc.2020.08.053","authors":["Giuseppe Tarantini","Marco Mojoli","Ferdinando Varbella","Roberto Caporale","Stefano Rigattieri","Giuseppe Andò","Plinio Cirillo","Simona Pierini","Andrea Santarelli","Paolo Sganzerla","Luisa Cacciavillani","Luciano Babuin","Nicoletta De Cesare","Ugo Limbruno","Alberto Massoni","Andrea Rognoni","Daniela Pavan","Flavia Belloni","Carlo Cernetti","Luca Favero","Francesco Saia","Luca Nai Fovino","Giulia Masiero","Loris Roncon","Valeria Gasparetto","Marco Ferlini","Federico Ronco","Roberta Rossini","Paolo Canova","Daniela Trabattoni","Alessandra Russo","Vincenzo Guiducci","Carlo Penzo","Fabio Tarantino","Ciro Mauro","Elena Corrada","Giovanni Esposito","Alfredo Marchese","Sergio Berti","Matteo Martinato","Danila Azzolina","Dario Gregori","Dominick J Angiolillo","Giuseppe Musumeci"],"significance":6,"published":"2020-11-24","source_date":"2020-11-24","image":"","kennis":[],"congress":"","summary_en":"This analysis evaluated the optimal timing of oral P2Y12 inhibitor administration in NSTE-ACS, addressing whether pre-treatment before angiography or deferred loading after coronary anatomy is known provides better outcomes.","created":"2026-07-03T10:28:54Z","updated":"2026-07-03T13:28:03Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 optimale timing van orale P2Y12-remmertoediening bij patiënten met NSTE-ACS.","abstract_original":"BACKGROUND: Although oral P2Y12 inhibitors are key in the management of patients with non-ST-segment elevation acute coronary syndrome, the optimal timing of their administration is not well defined. OBJECTIVES: The purpose of this study was to compare downstream and upstream oral P2Y12 inhibitors administration strategies in patients with non-ST-segment elevation acute coronary syndrome undergoing invasive treatment. METHODS: We performed a randomized, adaptive, open-label, multicenter clinical trial. Patients were randomly assigned to receive pre-treatment with ticagrelor before angiography (upstream group) or no pre-treatment (downstream group). Patients in the downstream group undergoing percutaneous coronary intervention were further randomized to receive ticagrelor or prasugrel. The primary hypothesis was the superiority of the downstream versus the upstream strategy on the combination of efficacy and safety events (net clinical benefit). RESULTS: We randomized 1,449 patients to downstream or upstream oral P2Y12 inhibitor administration. A pre-specified stopping rule for futility at interim analysis led the trial to be stopped. The rate of the primary endpoint, a composite of death due to vascular causes; nonfatal myocardial infarction or nonfatal stroke; and Bleeding Academic Research Consortium type 3, 4, and 5 bleeding through day 30, did not differ significantly between the downstream and upstream groups (percent absolute risk reduction: -0.46; 95% repeated confidence interval: -2.90 to 1.90). These results were confirmed among patients undergoing percutaneous coronary intervention (72% of population) and regardless of the timing of coronary angiography (within or after 24 h from enrollment). CONCLUSIONS: Downstream and upstream oral P2Y12 inhibitor administration strategies were associated with low incidence of ischemic and bleeding events and minimal numeric difference of event rates between treatment groups. These findings led to premature interruption of the trial and suggest the unlikelihood of enhanced efficacy of 1 strategy over the other. (Downstream Versus Upstream Strategy for the Administration of P2Y12 Receptor Blockers In Non-ST Elevated Acute Coronary Syndromes With Initial Invasive Indication [DUBIUS]; NCT02618837)."},{"id":"28e7ef332796","type":"article","url":"https://hartvaat.nl/2020/11/21/ldl-verlaging-bij-ouderen-lancet-meta-analyse-werkzaamheid-en-veiligheid/","title":"LDL-verlaging bij ouderen: Lancet meta-analyse werkzaamheid en veiligheid","title_en":"Efficacy and safety of lowering LDL cholesterol in older patients: a systematic review and meta-analysis of randomised controlled trials.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["dyslipidemie","ezetimibe","familiaire-hypercholesterolemie","familiaire-hypercholesterolemie-screening","ldl-cholesterol","lipide-aferese","lipidenverlaging","lipoproteïne-a-therapeutisch-doel","niet-statine-therapie","pcsk9-remmers","pelacarsen","statines","vrouwen"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(20)32332-1","source_url":"https://doi.org/10.1016/S0140-6736(20)32332-1","authors":["Baris Gencer","Nicholas A Marston","KyungAh Im","Christopher P Cannon","Peter Sever","Anthony Keech","Eugene Braunwald","Robert P Giugliano","Marc S Sabatine"],"significance":9,"published":"2020-11-21","source_date":"2020-11-21","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This Lancet meta-analysis of randomized controlled trials confirmed that LDL cholesterol-lowering therapy reduces cardiovascular events in older patients to a similar extent as in younger patients. The analysis definitively countered the notion that lipid lowering is ineffective or unsafe in elderly populations.","created":"2026-07-03T10:28:54Z","updated":"2026-07-03T13:28:03Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 systematische review en meta-analyse van werkzaamheid en veiligheid van LDL-verlaging bij oudere patiënten. Definitief bewijs voor lipidentherapie op hogere leeftijd.","abstract_original":"BACKGROUND: The clinical benefit of LDL cholesterol lowering treatment in older patients remains debated. We aimed to summarise the evidence of LDL cholesterol lowering therapies in older patients. METHODS: In this systematic review and meta-analysis, we searched MEDLINE and Embase for articles published between March 1, 2015, and Aug 14, 2020, without any language restrictions. We included randomised controlled trials of cardiovascular outcomes of an LDL cholesterol-lowering drug recommended by the 2018 American College of Cardiology and American Heart Association guidelines, with a median follow-up of at least 2 years and data on older patients (aged ≥75 years). We excluded trials that exclusively enrolled participants with heart failure or on dialysis because guidelines do not recommend lipid-lowering therapy in such patients who do not have another indication. We extracted data for older patients using a standardised data form for aggregated study-level data. We meta-analysed the risk ratio (RR) for major vascular events (a composite of cardiovascular death, myocardial infarction or other acute coronary syndrome, stroke, or coronary revascularisation) per 1 mmol/L reduction in LDL cholesterol. FINDINGS: Data from six articles were included in the systematic review and meta-analysis, which included 24 trials from the Cholesterol Treatment Trialists' Collaboration meta-analysis plus five individual trials. Among 244 090 patients from 29 trials, 21 492 (8·8%) were aged at least 75 years, of whom 11 750 (54·7%) were from statin trials, 6209 (28·9%) from ezetimibe trials, and 3533 (16·4%) from PCSK9 inhibitor trials. Median follow-up ranged from 2·2 years to 6·0 years. LDL cholesterol lowering significantly reduced the risk of major vascular events (n=3519) in older patients by 26% per 1 mmol/L reduction in LDL cholesterol (RR 0·74 [95% CI 0·61-0·89]; p=0·0019), with no statistically significant difference with the risk reduction in patients younger than 75 years (0·85 [0·78-0·92]; pinteraction=0·37). Among older patients, RRs were not statistically different for statin (0·82 [0·73-0·91]) and non-statin treatment (0·67 [0·47-0·95]; pinteraction=0·64). The benefit of LDL cholesterol lowering in older patients was observed for each component of the composite, including cardiovascular death (0·85 [0·74-0·98]), myocardial infarction (0·80 [0·71-0·90]), stroke (0·73 [0·61-0·87]), and coronary revascularisation (0·80 [0·66-0·96]). INTERPRETATION: In patients aged 75 years and older, lipid lowering was as effective in reducing cardiovascular events as it was in patients younger than 75 years. These results should strengthen guideline recommendations for the use of lipid-lowering therapies, including non-statin treatment, in older patients. FUNDING: None."},{"id":"2593505b6cd8","type":"article","url":"https://hartvaat.nl/2020/11/21/alirocumab-lp-a-verlaging-en-totale-cv-eventlast-onafhankelijk-van-ldl-odyssey-o/","title":"Alirocumab Lp(a)-verlaging en totale CV-eventlast onafhankelijk van LDL: ODYSSEY OUTCOMES","title_en":"Lipoprotein(a) lowering by alirocumab reduces the total burden of cardiovascular events independent of low-density lipoprotein cholesterol lowering: ODYSSEY OUTCOMES trial.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["lipide-aferese","lipoproteïne-a","lipoproteïne-a-therapeutisch-doel","pelacarsen"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaa649","source_url":"https://doi.org/10.1093/eurheartj/ehaa649","authors":["Michael Szarek","Vera A Bittner","Philip Aylward","Marie Baccara-Dinet","Deepak L Bhatt","Rafael Diaz","Zlatko Fras","Shaun G Goodman","Sigrun Halvorsen","Robert A Harrington","J Wouter Jukema","Patrick M Moriarty","Robert Pordy","Kausik K Ray","Peter Sinnaeve","Sotirios Tsimikas","Robert Vogel","Harvey D White","Doron Zahger","Andreas M Zeiher","Ph Gabriel Steg","Gregory G Schwartz"],"significance":8,"published":"2020-11-21","source_date":"2020-11-21","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/","https://hartvaat.nl/kennis/lipiden/pcsk9-remmers-evolocumab-alirocumab/"],"congress":"","summary_en":"This ODYSSEY OUTCOMES analysis showed that alirocumab-mediated Lp(a) reduction independently contributed to lowering the total burden of cardiovascular events, beyond LDL cholesterol effects. The finding strengthened the evidence for Lp(a) as an actionable therapeutic target.","created":"2026-07-03T10:28:54Z","updated":"2026-07-03T13:28:03Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ODYSSEY OUTCOMES analyse die aantoont dat Lp(a)-verlaging door alirocumab de totale CV-eventlast vermindert onafhankelijk van LDL-cholesterol.","abstract_original":"AIMS: Lipoprotein(a) concentration is associated with first cardiovascular events in clinical trials. It is unknown if this relationship holds for total (first and subsequent) events. In the ODYSSEY OUTCOMES trial in patients with recent acute coronary syndrome (ACS), the proprotein convertase subtilisin/kexin type 9 inhibitor alirocumab reduced lipoprotein(a), low-density lipoprotein cholesterol (LDL-C), and cardiovascular events compared with placebo. This post hoc analysis determined whether baseline levels and alirocumab-induced changes in lipoprotein(a) and LDL-C [corrected for lipoprotein(a) cholesterol] independently predicted total cardiovascular events. METHODS AND RESULTS: Cardiovascular events included cardiovascular death, non-fatal myocardial infarction, stroke, hospitalization for unstable angina or heart failure, ischaemia-driven coronary revascularization, peripheral artery disease events, and venous thromboembolism. Proportional hazards models estimated relationships between baseline lipoprotein(a) and total cardiovascular events in the placebo group, effects of alirocumab treatment on total cardiovascular events by baseline lipoprotein(a), and relationships between lipoprotein(a) reduction with alirocumab and subsequent risk of total cardiovascular events. Baseline lipoprotein(a) predicted total cardiovascular events with placebo, while higher baseline lipoprotein(a) levels were associated with greater reduction in total cardiovascular events with alirocumab (hazard ratio Ptrend = 0.045). Alirocumab-induced reductions in lipoprotein(a) (median -5.0 [-13.6, 0] mg/dL) and corrected LDL-C (median -51.3 [-67.1, -34.0] mg/dL) independently predicted lower risk of total cardiovascular events. Each 5-mg/dL reduction in lipoprotein(a) predicted a 2.5% relative reduction in cardiovascular events. CONCLUSION: Baseline lipoprotein(a) predicted the risk of total cardiovascular events and risk reduction by alirocumab. Lipoprotein(a) lowering contributed independently to cardiovascular event reduction, supporting the concept of lipoprotein(a) as a treatment target after ACS."},{"id":"45804c8e96f0","type":"article","url":"https://hartvaat.nl/2020/11/19/lorlatinib-versus-crizotinib-bij-alk-positief-longkanker-nejm/","title":"Lorlatinib versus crizotinib bij ALK-positief longkanker: NEJM","title_en":"First-Line Lorlatinib or Crizotinib in Advanced ALK-Positive Lung Cancer.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2027187","source_url":"https://doi.org/10.1056/NEJMoa2027187","authors":["Alice T Shaw","Todd M Bauer","Filippo de Marinis","Enriqueta Felip","Yasushi Goto","Geoffrey Liu","Julien Mazieres","Dong-Wan Kim","Tony Mok","Anna Polli","Holger Thurm","Anna M Calella","Gerson Peltz","Benjamin J Solomon"],"significance":6,"published":"2020-11-19","source_date":"2020-11-19","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/"],"congress":"","summary_en":"This NEJM trial of lorlatinib versus crizotinib in ALK-positive lung cancer is relevant to cardio-oncology due to lorlatinib's cardiovascular side effects including significant hypercholesterolemia and hypertriglyceridemia.","created":"2026-07-03T10:28:54Z","updated":"2026-07-03T13:28:03Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 relevant voor cardio-oncologie vanwege cardiovasculaire bijwerkingen van ALK-remmers (hypercholesterolemie, hypertriglyceridemie).","abstract_original":"BACKGROUND: Lorlatinib, a third-generation inhibitor of anaplastic lymphoma kinase (ALK), has antitumor activity in previously treated patients with ALK-positive non-small-cell lung cancer (NSCLC). The efficacy of lorlatinib, as compared with that of crizotinib, as first-line treatment for advanced ALK-positive NSCLC is unclear. METHODS: We conducted a global, randomized, phase 3 trial comparing lorlatinib with crizotinib in 296 patients with advanced ALK-positive NSCLC who had received no previous systemic treatment for metastatic disease. The primary end point was progression-free survival as assessed by blinded independent central review. Secondary end points included independently assessed objective response and intracranial response. An interim analysis of efficacy was planned after approximately 133 of 177 (75%) expected events of disease progression or death had occurred. RESULTS: The percentage of patients who were alive without disease progression at 12 months was 78% (95% confidence interval [CI], 70 to 84) in the lorlatinib group and 39% (95% CI, 30 to 48) in the crizotinib group (hazard ratio for disease progression or death, 0.28; 95% CI, 0.19 to 0.41; P<0.001). An objective response occurred in 76% (95% CI, 68 to 83) of the patients in the lorlatinib group and 58% (95% CI, 49 to 66) of those in the crizotinib group; among those with measurable brain metastases, 82% (95% CI, 57 to 96) and 23% (95% CI, 5 to 54), respectively, had an intracranial response, and 71% of the patients who received lorlatinib had an intracranial complete response. The most common adverse events with lorlatinib were hyperlipidemia, edema, increased weight, peripheral neuropathy, and cognitive effects. Lorlatinib was associated with more grade 3 or 4 adverse events (mainly altered lipid levels) than crizotinib (in 72% vs. 56%). Discontinuation of treatment because of adverse events occurred in 7% and 9% of the patients, respectively. CONCLUSIONS: In an interim analysis of results among patients with previously untreated advanced ALK-positive NSCLC, those who received lorlatinib had significantly longer progression-free survival and a higher frequency of intracranial response than those who received crizotinib. The incidence of grade 3 or 4 adverse events was higher with lorlatinib than with crizotinib because of the frequent occurrence of altered lipid levels. (Funded by Pfizer; CROWN ClinicalTrials.gov number, NCT03052608.)."},{"id":"a9d990a757e8","type":"article","url":"https://hartvaat.nl/2020/11/17/seh-zorgbundel-en-30-daags-ontslag-en-overleving-bij-oudere-hf-patienten-jama/","title":"SEH-zorgbundel en 30-daags ontslag en overleving bij oudere HF-patiënten: JAMA","title_en":"Effect of an Emergency Department Care Bundle on 30-Day Hospital Discharge and Survival Among Elderly Patients With Acute Heart Failure: The ELISABETH Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2020.19378","source_url":"https://doi.org/10.1001/jama.2020.19378","authors":["Yonathan Freund","Marine Cachanado","Quentin Delannoy","Said Laribi","Youri Yordanov","Judith Gorlicki","Tahar Chouihed","Anne-Laure Féral-Pierssens","Jennifer Truchot","Thibaut Desmettre","Celine Occelli","Xavier Bobbia","Mehdi Khellaf","Olivier Ganansia","Jérôme Bokobza","Frédéric Balen","Sebastien Beaune","Ben Bloom","Tabassome Simon","Alexandre Mebazaa"],"significance":7,"published":"2020-11-17","source_date":"2020-11-17","image":"","kennis":[],"congress":"","summary_en":"This JAMA trial showed that an emergency department care bundle for older patients with acute heart failure did not significantly improve 30-day hospital discharge or survival, highlighting the difficulty of improving acute HF outcomes through ED-level interventions.","created":"2026-07-03T10:28:53Z","updated":"2026-07-03T13:28:02Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 van een SEH-gebaseerde zorgbundel op 30-daags ontslag en overleving bij oudere patiënten met acuut hartfalen.","abstract_original":"IMPORTANCE: Clinical guidelines for the early management of acute heart failure in the emergency department (ED) setting are based on only moderate levels of evidence, with subsequent low adherence to these guidelines. OBJECTIVE: To test the effect of an early guideline-recommended care bundle on short-term prognosis in older patients with acute heart failure in the ED. DESIGN, SETTING, AND PARTICIPANTS: Stepped-wedge cluster randomized trial in 15 EDs in France of 503 patients 75 years and older with a diagnosis of acute heart failure in the ED from December 2018 to September 2019 and followed up for 30 days until October 2019. INTERVENTIONS: A care bundle that included early intravenous nitrate boluses; management of precipitating factors, such as acute coronary syndrome, infection, or atrial fibrillation; and moderate dose of intravenous diuretics (n = 200). In the control group, patient care was left to the discretion of the treating emergency physician (n = 303). Each center was randomized to the order in which they switched to the \"intervention period.\" After the initial 4-week control period for all centers, 1 center entered in the intervention period every 2 weeks. MAIN OUTCOMES AND MEASURES: The primary end point was the number of days alive and out of hospital at 30 days. Secondary outcomes included 30-day all-cause mortality, 30-day cardiovascular mortality, unscheduled readmission, length of hospital stay, and kidney impairment. RESULTS: Among 503 patients who were randomized (median age, 87 years; 298 [59%] women), 502 were analyzed. In the intervention group, patients received a median (interquartile range) of 27.0 (9-54) mg of intravenous nitrates in the first 4 hours vs 4.0 (2.0-6.0) mg in the control group (adjusted difference, 23.8 [95% CI, 13.5-34.1]). There was a significantly higher percentage of patients in the intervention group treated for their precipitating factors than in the control group (58.8% vs 31.9%; adjusted difference, 31.1% [95% CI, 14.3%-47.9%]). There was no statistically significant difference in the primary end point of the number of days alive and out of hospital at 30 days (median [interquartile range], 19 [0- 24] d in both groups; adjusted difference, -1.9 [95% CI, -6.6 to 2.8]; adjusted ratio, 0.88 [95% CI, 0.64-1.21]). At 30 days, there was no significant difference between the intervention and control groups in mortality (8.0% vs 9.7%; adjusted difference, 4.1% [95% CI, -17.2% to 25.3%]), cardiovascular mortality (5.0% vs 7.4%; adjusted difference, 2.1% [95% CI, -15.5% to 19.8%]), unscheduled readmission (14.3% vs 15.7%; adjusted difference, -1.3% [95% CI, -26.3% to 23.7%]), median length of hospital stay (8 d in both groups; adjusted difference, 2.5 [95% CI, -0.9 to 5.8]), and kidney impairment (1% in both groups). CONCLUSIONS AND RELEVANCE: Among older patients with acute heart failure, use of a guideline-based comprehensive care bundle in the ED compared with usual care did not result in a statistically significant difference in the number of days alive and out of the hospital at 30 days. Further research is needed to identify effective treatments for acute heart failure in older patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03683212."},{"id":"0780c8dfc787","type":"article","url":"https://hartvaat.nl/2020/11/17/transcatheter-bariatrische-embolotherapie-voor-gewichtsreductie-bij-obesitas/","title":"Transcatheter bariatrische embolotherapie voor gewichtsreductie bij obesitas","title_en":"Transcatheter Bariatric Embolotherapy for Weight Reduction in Obesity.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["obesitas"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.09.550","source_url":"https://doi.org/10.1016/j.jacc.2020.09.550","authors":["Vivek Y Reddy","Petr Neužil","Daniel Musikantow","Petra Sramkova","Robert Rosen","Nicholas Kipshidze","Nodar Kipshidze","Martin Fried"],"significance":6,"published":"2020-11-17","source_date":"2020-11-17","image":"","kennis":[],"congress":"","summary_en":"This study evaluated transcatheter bariatric arterial embolization as a minimally invasive weight reduction procedure for obesity, exploring a catheter-based alternative to surgical bariatric approaches.","created":"2026-07-03T10:28:53Z","updated":"2026-07-03T13:28:02Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 transcatheter bariatrische arterie-embolisatie als minimaal invasieve gewichtsreductie bij obesitas.","abstract_original":"BACKGROUND: Obesity is well-appreciated to result in poor cardiovascular and metabolic outcomes. Dietary and medical weight loss strategies are frequently unsuccessful and unsustainable. Bariatric surgery is quite effective, but is reserved for the most obese patients because of the associated intraoperative/post-operative risks. In preclinical and early clinical case series, a novel therapy, transcatheter bariatric embolotherapy (TBE) of the left gastric artery, has been reported to promote weight loss by reducing ghrelin, an appetite-stimulating hormone secreted from the gastric fundus. OBJECTIVES: The purpose of this study was to examine TBE in a single-blind, sham procedure randomized trial. METHODS: Obese subjects (body mass index 35 to 55 kg/m2) were randomized 1:1 to either sham or TBE targeting the left gastric artery using an occlusion balloon microcatheter to administer 300- to 500-μm embolic beads. All patients entered a lifestyle counseling program. Patients and physicians performing follow-up were blind to the allocated therapy. Endoscopy was performed at baseline and 1-week post-procedure. The primary endpoint was 6-month total body weight loss (TBWL). RESULTS: Eligible subjects (n = 44; age 45.5 ± 9.4 years; 8 men/36 women; body mass index 39.6 ± 3.8 kg/m2) were randomized to undergo the sham or TBE procedure with no device-related complications and 1 vascular complication. Patients reported mild nausea and vomiting, and endoscopy revealed only minor self-limiting ulcers in 5 patients. At 6 months, in both the intention-to-treat and per-protocol populations, the TBWL was greater with TBE (7.4 kg/6.4% and 9.4 kg/8.3% loss, respectively) than sham (3.0 kg/2.8% and 1.9 kg/1.8%, respectively; p = 0.034/0.052 and p = 0.0002/0.0011, respectively). The TBWL was maintained with TBE at 12 months (intention-to-treat 7.8 kg/6.5% loss, per-protocol 9.3 kg/9.3% loss; p = 0.0011/0.0008, p = 0.0005/0.0005, respectively). CONCLUSIONS: In this randomized pilot trial, we have established the proof-of-principle that transcatheter bariatric embolotherapy of the left gastric artery is well-tolerated and promotes clinically significant weight loss over a sham procedure.(The Lowering Weight in Severe Obesity by Embolization of the Gastric Artery Trial [LOSEIT]; NCT03185949)."},{"id":"d52ba74a77ea","type":"article","url":"https://hartvaat.nl/2020/11/17/pci-voor-kwetsbare-coronaire-plaque/","title":"PCI voor kwetsbare coronaire plaque","title_en":"Percutaneous Coronary Intervention for Vulnerable Coronary Atherosclerotic Plaque.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog"],"tags":["coronaire-ct-angiografie","percutane-coronaire-interventie"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.09.547","source_url":"https://doi.org/10.1016/j.jacc.2020.09.547","authors":["Gregg W Stone","Akiko Maehara","Ziad A Ali","Claes Held","Mitsuaki Matsumura","Lars Kjøller-Hansen","Hans Erik Bøtker","Michael Maeng","Thomas Engstrøm","Rune Wiseth","Jonas Persson","Thor Trovik","Ulf Jensen","Stefan K James","Gary S Mintz","Ovidiu Dressler","Aaron Crowley","Ori Ben-Yehuda","David Erlinge"],"significance":6,"published":"2020-11-17","source_date":"2020-11-17","image":"","kennis":[],"congress":"","summary_en":"This study explored PCI for vulnerable (non-obstructive) coronary plaques identified by intravascular imaging, testing the concept of prophylactic intervention before these high-risk lesions cause clinical events.","created":"2026-07-03T10:28:53Z","updated":"2026-07-03T13:28:02Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 PCI voor kwetsbare (niet-obstructieve) coronaire atherosclerotische plaque. Preventieve interventie op hoog-risicoplaques.","abstract_original":"BACKGROUND: Acute coronary syndromes most commonly arise from thrombosis of lipid-rich coronary atheromas that have large plaque burden despite angiographically appearing mild. OBJECTIVES: This study sought to examine the outcomes of percutaneous coronary intervention (PCI) of non-flow-limiting vulnerable plaques. METHODS: Three-vessel imaging was performed with a combination intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS) catheter after successful PCI of all flow-limiting coronary lesions in 898 patients presenting with myocardial infarction (MI). Patients with an angiographically nonobstructive stenosis not intended for PCI but with IVUS plaque burden of ≥65% were randomized to treatment of the lesion with a bioresorbable vascular scaffold (BVS) plus guideline-directed medical therapy (GDMT) versus GDMT alone. The primary powered effectiveness endpoint was the IVUS-derived minimum lumen area (MLA) at protocol-driven 25-month follow-up. The primary (nonpowered) safety endpoint was randomized target lesion failure (cardiac death, target vessel-related MI, or clinically driven target lesion revascularization) at 24 months. The secondary (nonpowered) clinical effectiveness endpoint was randomized lesion-related major adverse cardiac events (cardiac death, MI, unstable angina, or progressive angina) at latest follow-up. RESULTS: A total of 182 patients were randomized (93 BVS, 89 GDMT alone) at 15 centers. The median angiographic diameter stenosis of the randomized lesions was 41.6%; by near-infrared spectroscopy-IVUS, the median plaque burden was 73.7%, the median MLA was 2.9 mm2, and the median maximum lipid plaque content was 33.4%. Angiographic follow-up at 25 months was completed in 167 patients (91.8%), and the median clinical follow-up was 4.1 years. The follow-up MLA in BVS-treated lesions was 6.9 ± 2.6 mm2 compared with 3.0 ± 1.0 mm2 in GDMT alone-treated lesions (least square means difference: 3.9 mm2; 95% confidence interval: 3.3 to 4.5; p < 0.0001). Target lesion failure at 24 months occurred in similar rates of BVS-treated and GDMT alone-treated patients (4.3% vs. 4.5%; p = 0.96). Randomized lesion-related major adverse cardiac events occurred in 4.3% of BVS-treated patients versus 10.7% of GDMT alone-treated patients (odds ratio: 0.38; 95% confidence interval: 0.11 to 1.28; p = 0.12). CONCLUSIONS: PCI of angiographically mild lesions with large plaque burden was safe, substantially enlarged the follow-up MLA, and was associated with favorable long-term clinical outcomes, warranting the performance of an adequately powered randomized trial. (PROSPECT ABSORB [Providing Regional Observations to Study Predictors of Events in the Coronary Tree II Combined with a Randomized, Controlled, Intervention Trial]; NCT02171065)."},{"id":"180f432a6893","type":"article","url":"https://hartvaat.nl/2020/11/17/colchicine-bij-acs-australische-cops-gerandomiseerde-trial/","title":"Colchicine bij ACS: Australische COPS gerandomiseerde trial","title_en":"Colchicine in Patients With Acute Coronary Syndrome: The Australian COPS Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog","internist"],"tags":["colcot-trial"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.050771","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.050771","authors":["David C Tong","Stephen Quinn","Arthur Nasis","Chin Hiew","Philip Roberts-Thomson","Heath Adams","Rumes Sriamareswaran","Nay M Htun","William Wilson","Dion Stub","William van Gaal","Laurie Howes","Nicholas Collins","Andy Yong","Ravinay Bhindi","Robert Whitbourn","Astin Lee","Chris Hengel","Kaleab Asrress","Melanie Freeman","John Amerena","Andrew Wilson","Jamie Layland"],"significance":8,"published":"2020-11-17","source_date":"2020-11-17","image":"","kennis":[],"congress":"","summary_en":"The Australian COPS trial showed that colchicine initiated during ACS hospitalization did not reduce cardiovascular events and was associated with a signal toward increased noncardiovascular mortality. The unexpected negative result contrasted with COLCOT and contributed to ongoing uncertainty about colchicine's role in ACS.","created":"2026-07-03T10:28:53Z","updated":"2026-07-03T13:28:02Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Australische COPS gerandomiseerde trial die colchicine onderzocht bij ACS. Tweede colchicine-trial naast COLCOT — onverwacht negatief met veiligheidssignaal.","abstract_original":"BACKGROUND: Inflammation plays a crucial role in clinical manifestations and complications of acute coronary syndromes (ACS). Colchicine, a commonly used treatment for gout, has recently emerged as a novel therapeutic option in cardiovascular medicine owing to its anti-inflammatory properties. We sought to determine the potential usefulness of colchicine treatment in patients with ACS. METHODS: This was a multicenter, randomized, double-blind, placebo-controlled trial involving 17 hospitals in Australia that provide acute cardiac care service. Eligible participants were adults (18-85 years) who presented with ACS and had evidence of coronary artery disease on coronary angiography managed with either percutaneous coronary intervention or medical therapy. Patients were assigned to receive either colchicine (0.5 mg twice daily for the first month, then 0.5 mg daily for 11 months) or placebo, in addition to standard secondary prevention pharmacotherapy, and were followed up for a minimum of 12 months. The primary outcome was a composite of all-cause mortality, ACS, ischemia-driven (unplanned) urgent revascularization, and noncardioembolic ischemic stroke in a time to event analysis. RESULTS: A total of 795 patients were recruited between December 2015 and September 2018 (mean age, 59.8±10.3 years; 21% female), with 396 assigned to the colchicine group and 399 to the placebo group. Over the 12-month follow-up, there were 24 events in the colchicine group compared with 38 events in the placebo group (P=0.09, log-rank). There was a higher rate of total death (8 versus 1; P=0.017, log-rank) and, in particular, noncardiovascular death in the colchicine group (5 versus 0; P=0.024, log-rank). The rates of reported adverse effects were not different (colchicine 23.0% versus placebo 24.3%), and they were predominantly gastrointestinal symptoms (colchicine, 23.0% versus placebo, 20.8%). CONCLUSIONS: The addition of colchicine to standard medical therapy did not significantly affect cardiovascular outcomes at 12 months in patients with ACS and was associated with a higher rate of mortality. Registration: URL: https://www.anzctr.org.au; Unique identifier: ACTRN12615000861550."},{"id":"bd49546f6a68","type":"article","url":"https://hartvaat.nl/2020/11/10/screening-op-hoge-bloeddruk-bij-kinderen-uspstf-aanbeveling-2020/","title":"Screening op hoge bloeddruk bij kinderen: USPSTF aanbeveling 2020","title_en":"Screening for High Blood Pressure in Children and Adolescents: US Preventive Services Task Force Recommendation Statement.","category":"hypertensie","category_label":"Hypertensie","professions":["huisarts"],"tags":["primaire-preventie"],"journal":"JAMA","doi":"10.1001/jama.2020.20122","source_url":"https://doi.org/10.1001/jama.2020.20122","authors":["Alex H Krist","Karina W Davidson","Carol M Mangione","Michael J Barry","Michael Cabana","Aaron B Caughey","Katrina Donahue","Chyke A Doubeni","John W Epling","Martha Kubik","Gbenga Ogedegbe","Lori Pbert","Michael Silverstein","Melissa A Simon","Chien-Wen Tseng","John B Wong"],"significance":8,"published":"2020-11-10","source_date":"2020-11-10","image":"","kennis":[],"congress":"","summary_en":"The 2020 USPSTF recommendation on blood pressure screening in children and adolescents addressed the evidence for routine screening and identification of primary and secondary hypertension in the pediatric population.","created":"2026-07-03T10:28:53Z","updated":"2026-07-03T13:28:02Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 2020 aanbeveling over screening op hoge bloeddruk bij kinderen en adolescenten.","abstract_original":"IMPORTANCE: Prevalence of hypertension (both primary and secondary) in children and adolescents in the US ranges from 3% to 4%. Primary hypertension in children and adolescents occurs primarily in children older than 13 years and has no known cause but is associated with several risk factors, including family history and higher body mass index. Secondary hypertension occurs primarily in younger children and is most commonly caused by genetic disorders, renal disease, endocrine disorders, or cardiovascular abnormalities. OBJECTIVE: To update its 2013 recommendation, the USPSTF commissioned a review of the evidence on the benefits and harms of screening, test accuracy, the effectiveness and harms of treatment, and the association between hypertension and markers of cardiovascular disease in childhood and adulthood. POPULATION: This recommendation statement applies to children and adolescents aged 3 to 18 years not known to have hypertension or who are asymptomatic. EVIDENCE ASSESSMENT: The USPSTF concludes that the evidence to support screening for high blood pressure in children and adolescents is insufficient and that the balance of benefits and harms cannot be determined. RECOMMENDATION: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for high blood pressure in children and adolescents. (I statement)."},{"id":"513b3e49eaae","type":"article","url":"https://hartvaat.nl/2020/11/10/screening-op-hypertensie-bij-kinderen-uspstf-evidence-report-2020/","title":"Screening op hypertensie bij kinderen: USPSTF evidence report 2020","title_en":"Screening for Hypertension in Children and Adolescents: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.","category":"hypertensie","category_label":"Hypertensie","professions":["huisarts"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2020.11119","source_url":"https://doi.org/10.1001/jama.2020.11119","authors":["Gerald Gartlehner","Emily B Vander Schaaf","Colin Orr","Sara M Kennedy","Rachel Clark","Meera Viswanathan"],"significance":7,"published":"2020-11-10","source_date":"2020-11-10","image":"","kennis":[],"congress":"","summary_en":"This updated USPSTF evidence review on hypertension screening in children and adolescents evaluated the evidence for routine blood pressure measurement and the downstream benefits of identifying and treating pediatric hypertension.","created":"2026-07-03T10:28:53Z","updated":"2026-07-03T13:28:02Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 geactualiseerde evidence report over screening op hypertensie bij kinderen en adolescenten.","abstract_original":"IMPORTANCE: Childhood hypertension can result in adverse outcomes during adulthood; identifying and treating primary and secondary childhood hypertension may reduce such risks. OBJECTIVE: To update the evidence on screening and treatment of hypertension in childhood and adolescence for the US Preventive Services Task Force. DATA SOURCES: PubMed, Cochrane Library, International Pharmaceutical Abstracts, EMBASE, and trial registries through September 3, 2019; bibliographies from retrieved articles, experts, and surveillance of the literature through October 6, 2020. STUDY SELECTION: Fair- or good-quality English-language studies evaluating diagnostic accuracy of blood pressure screening; cohort studies assessing the association of hypertension in childhood and adolescence with blood pressure or other intermediate outcomes in adulthood; randomized clinical trials (RCTs) or meta-analyses of pharmacological and lifestyle interventions. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently assessed titles/abstracts and full-text articles, extracted data, and assessed study quality; the evidence was synthesized qualitatively. MAIN OUTCOMES AND MEASURES: Sensitivity, specificity, and measures of association between childhood and adulthood blood pressure; reduction of childhood blood pressure; adverse effects of treatments. RESULTS: Forty-two studies from 43 publications were included (N>12 400). No studies evaluated the benefits or harms of screening and the effect of treating childhood hypertension on outcomes in adulthood. One study reported a sensitivity of 0.82 and a specificity of 0.70 for 2 office-based blood pressure measurements. Twenty observational studies suggested a significant association between childhood hypertension and abnormal blood pressure in adulthood (odds ratios, 1.1-4.5; risk ratios, 1.45-3.60; hazard ratios, 2.8-3.2). Thirteen placebo-controlled RCTs and 1 meta-analysis assessed reductions in systolic (SBP) and diastolic blood pressure from pharmacological treatments. Pooled reductions of SBP were -4.38 mm Hg (95% CI, -7.27 to -2.16) for angiotensin-converting enzyme inhibitors and -3.07 mm Hg (95% CI, -4.99 to -1.44) for angiotensin receptor blockers. Candesartan reduced SBP by -6.56 mm Hg (P < .001; n = 240). β-Blockers, calcium channel blockers, and mineralocorticoid receptor antagonists did not achieve significant reductions over 2 to 4 weeks. SBP was significantly reduced by exercise over 8 months (-4.9 mm Hg, P ≤ .05; n = 69), by dietary approaches to stop hypertension over 3 months (-2.2 mm Hg, P < .01; n = 57), and by a combination of drug treatment and lifestyle interventions over 6 months (-7.6 mm Hg; P < .001; n = 95). Low-salt diet did not achieve reductions of blood pressure. CONCLUSIONS AND RELEVANCE: Observational studies indicate an association between hypertension in childhood and hypertension in adulthood. However, the evidence is inconclusive whether the diagnostic accuracy of blood pressure measurements is adequate for screening asymptomatic children and adolescents in primary care."},{"id":"7d66762ab611","type":"article","url":"https://hartvaat.nl/2020/11/10/vitamine-d-omega-3-of-krachttraining-en-klinische-uitkomsten-bij-ouderen-jama-do/","title":"Vitamine D, omega-3 of krachttraining en klinische uitkomsten bij ouderen: JAMA DO-HEALTH","title_en":"Effect of Vitamin D Supplementation, Omega-3 Fatty Acid Supplementation, or a Strength-Training Exercise Program on Clinical Outcomes in Older Adults: The DO-HEALTH Randomized Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2020.16909","source_url":"https://doi.org/10.1001/jama.2020.16909","authors":["Heike A Bischoff-Ferrari","Bruno Vellas","René Rizzoli","Reto W Kressig","José A P da Silva","Michael Blauth","David T Felson","Eugene V McCloskey","Bernhard Watzl","Lorenz C Hofbauer","Dieter Felsenberg","Walter C Willett","Bess Dawson-Hughes","JoAnn E Manson","Uwe Siebert","Robert Theiler","Hannes B Staehelin","Caroline de Godoi Rezende Costa Molino","Patricia O Chocano-Bedoya","Lauren A Abderhalden","Andreas Egli","John A Kanis","Endel J Orav"],"significance":7,"published":"2020-11-10","source_date":"2020-11-10","image":"","kennis":[],"congress":"","summary_en":"The DO-HEALTH trial showed that vitamin D, omega-3 fatty acids, and strength training exercise, alone or in combination, did not significantly reduce clinical outcomes in healthy older adults, adding to the negative evidence for these supplements in general prevention.","created":"2026-07-03T10:28:53Z","updated":"2026-07-03T13:28:02Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 DO-HEALTH trial die vitamine D, omega-3 en krachttraining onderzocht op klinische uitkomsten bij gezonde ouderen. Drievoudig negatief.","abstract_original":"IMPORTANCE: The benefits of vitamin D, omega-3 fatty acids, and exercise in disease prevention remain unclear. OBJECTIVE: To test whether vitamin D, omega-3s, and a strength-training exercise program, alone or in combination, improved 6 health outcomes among older adults. DESIGN, SETTING, AND PARTICIPANTS: Double-blind, placebo-controlled, 2 × 2 × 2 factorial randomized clinical trial among 2157 adults aged 70 years or older who had no major health events in the 5 years prior to enrollment and had sufficient mobility and good cognitive status. Patients were recruited between December 2012 and November 2014, and final follow-up was in November 2017. INTERVENTIONS: Participants were randomized to 3 years of intervention in 1 of the following 8 groups: 2000 IU/d of vitamin D3, 1 g/d of omega-3s, and a strength-training exercise program (n = 264); vitamin D3 and omega-3s (n = 265); vitamin D3 and exercise (n = 275); vitamin D3 alone (n = 272); omega-3s and exercise (n = 275); omega-3s alone (n = 269); exercise alone (n = 267); or placebo (n = 270). MAIN OUTCOMES AND MEASURES: The 6 primary outcomes were change in systolic and diastolic blood pressure (BP), Short Physical Performance Battery (SPPB), Montreal Cognitive Assessment (MoCA), and incidence rates (IRs) of nonvertebral fractures and infections over 3 years. Based on multiple comparisons of 6 primary end points, 99% confidence intervals are presented and P < .01 was required for statistical significance. RESULTS: Among 2157 randomized participants (mean age, 74.9 years; 61.7% women), 1900 (88%) completed the study. Median follow-up was 2.99 years. Overall, there were no statistically significant benefits of any intervention individually or in combination for the 6 end points at 3 years. For instance, the differences in mean change in systolic BP with vitamin D vs no vitamin D and with omega-3s vs no omega-3s were both -0.8 (99% CI, -2.1 to 0.5) mm Hg, with P < .13 and P < .11, respectively; the difference in mean change in diastolic BP with omega-3s vs no omega-3s was -0.5 (99% CI, -1.2 to 0.2) mm Hg; P = .06); and the difference in mean change in IR of infections with omega-3s vs no omega-3s was -0.13 (99% CI, -0.23 to -0.03), with an IR ratio of 0.89 (99% CI, 0.78-1.01; P = .02). No effects were found on the outcomes of SPPB, MoCA, and incidence of nonvertebral fractures). A total of 25 deaths were reported, with similar numbers in all treatment groups. CONCLUSIONS AND RELEVANCE: Among adults without major comorbidities aged 70 years or older, treatment with vitamin D3, omega-3s, or a strength-training exercise program did not result in statistically significant differences in improvement in systolic or diastolic blood pressure, nonvertebral fractures, physical performance, infection rates, or cognitive function. These findings do not support the effectiveness of these 3 interventions for these clinical outcomes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01745263."},{"id":"d396baa9c1f2","type":"article","url":"https://hartvaat.nl/2020/11/10/chinese-kruidenformule-voor-gemaskeerde-hypertensie-gerandomiseerde-placebogecon/","title":"Chinese kruidenformule voor gemaskeerde hypertensie: gerandomiseerde placebogecontroleerde trial","title_en":"Treatment of Masked Hypertension with a Chinese Herbal Formula: A Randomized, Placebo-Controlled Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["bloeddrukbehandeling"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.046685","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.046685","authors":["Dong-Yan Zhang","Yi-Bang Cheng","Qian-Hui Guo","Xiao-Li Shan","Fang-Fei Wei","Feng Lu","Chang-Sheng Sheng","Qi-Fang Huang","Chuan-Hua Yang","Yan Li","Ji-Guang Wang"],"significance":5,"published":"2020-11-10","source_date":"2020-11-10","image":"","kennis":[],"congress":"","summary_en":"This randomized placebo-controlled trial tested a Chinese herbal formula for treating masked hypertension, providing the first controlled evidence for traditional herbal medicine in this specific blood pressure phenotype.","created":"2026-07-03T10:28:53Z","updated":"2026-07-03T18:38:48Z","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 placebogecontroleerde trial naar een Chinese kruidenformule voor behandeling van gemaskeerde hypertensie.","abstract_original":"BACKGROUND: Masked hypertension is associated with adverse cardiovascular outcomes. Nonetheless, no randomized controlled trials exist in the treatment of masked hypertension. The aim of this randomized, placebo-controlled trial was to investigate the efficacy and safety of blood pressure (BP)-lowering treatment with a Chinese herbal formula, gastrodia-uncaria granules, in patients with masked hypertension. METHODS: Patients with an office BP of <140/90 mm Hg and daytime ambulatory BP of 135 to 150 mm Hg systolic or 85 to 95 mm Hg diastolic were randomly assigned 1:1 to the treatment of gastrodia-uncaria granules or placebo 5 to 10 g twice daily for 4 weeks. The primary efficacy variable was the change in daytime ambulatory BP. RESULTS: At baseline, office and daytime BP of the 251 participants (mean age, 50.4 years; 53.4% men; mean body mass index 24.5 kg/m2; and 2.8%, 1.6%, and 30.7% with cardiovascular disease, diabetes, and smoking, respectively) averaged 129/82 and 135/89 mm Hg, respectively. In the intention-to-treat analysis, daytime systolic/diastolic BP was reduced by 5.44/3.39 and 2.91/1.60 mm Hg in the gastrodia-uncaria granules and placebo groups, respectively. The between-group difference in BP reductions was significant for the daytime (2.52/1.79 mm Hg; P≤0.025) and 24-hour BP (2.33/1.49 mm Hg; P≤0.012), but not for the clinic and nighttime BPs (P≥0.162). The per-protocol analysis in 229 patients produced similar results. Only 1 adverse event (sleepiness during the day) was reported, and no serious adverse event occurred. CONCLUSIONS: BP-lowering treatment with Chinese traditional medicine gastrodia-uncaria granules is efficacious for patients with masked hypertension. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02156024."},{"id":"24d3378c5195","type":"article","url":"https://hartvaat.nl/2020/11/10/ticagrelor-plus-aspirine-en-safeneuze-graft-patency-na-cabg/","title":"Ticagrelor plus aspirine en safeneuze graft-patency na CABG","title_en":"Effect of Adding Ticagrelor to Standard Aspirin on Saphenous Vein Graft Patency in Patients Undergoing Coronary Artery Bypass Grafting (POPular CABG): A Randomized, Double-Blind, Placebo-Controlled Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["trombocytenaggregatieremmers"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.050749","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.050749","authors":["Laura M Willemsen","Paul W A Janssen","Joyce Peper","Mohamed A Soliman-Hamad","Albert H M van Straten","Patrick Klein","Chris M Hackeng","Uday Sonker","Margreet W A Bekker","Clemens von Birgelen","Marc A Brouwer","Pim van der Harst","Eline A Vlot","Vera H M Deneer","Dean R P P Chan Pin Yin","Marieke E Gimbel","Kasper F Beukema","Edgar J Daeter","Johannes C Kelder","Jan G P Tijssen","Benno J W M Rensing","Hendrik W van Es","Martin J Swaans","Jurrien M Ten Berg"],"significance":6,"published":"2020-11-10","source_date":"2020-11-10","image":"","kennis":[],"congress":"","summary_en":"This study tested whether adding ticagrelor to aspirin improves saphenous vein graft patency after CABG, evaluating more potent antiplatelet therapy for preventing the common problem of early graft occlusion.","created":"2026-07-03T10:28:53Z","updated":"2026-07-03T13:28:01Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 ticagrelor-toevoeging aan aspirine op safeneuze graftopenheid na CABG.","abstract_original":"BACKGROUND: Approximately 15% of saphenous vein grafts (SVGs) occlude during the first year after coronary artery bypass graft surgery (CABG) despite aspirin use. The POPular CABG trial (The Effect of Ticagrelor on Saphenous Vein Graft Patency in Patients Undergoing Coronary Artery Bypass Grafting Surgery) investigated whether ticagrelor added to standard aspirin improves SVG patency at 1 year after CABG. METHODS: In this investigator-initiated, randomized, double-blind, placebo-controlled, multicenter trial, patients with ≥1 SVGs were randomly assigned (1:1) after CABG to ticagrelor or placebo added to standard aspirin (80 mg or 100 mg). The primary outcome was SVG occlusion at 1 year, assessed with coronary computed tomography angiography, in all patients that had primary outcome imaging available. A generalized estimating equation model was used to perform the primary analysis per SVG. The secondary outcome was 1-year SVG failure, which was a composite of SVG occlusion, SVG revascularization, myocardial infarction in myocardial territory supplied by a SVG, or sudden death. RESULTS: Among 499 randomly assigned patients, the mean age was 67.9±8.3 years, 87.1% were male, the indication for CABG was acute coronary syndrome in 31.3%, and 95.2% of procedures used cardiopulmonary bypass. Primary outcome imaging was available in 220 patients in the ticagrelor group and 223 patients in the placebo group. The SVG occlusion rate in the ticagrelor group was 10.5% (51 of 484 SVGs) versus 9.1% in the placebo group (43 of 470 SVGs), odds ratio, 1.29 [95% CI, 0.73-2.30]; P=0.38. SVG failure occurred in 35 (14.2%) patients in the ticagrelor group versus 29 (11.6%) patients in the placebo group (odds ratio, 1.22 [95% CI, 0.72-2.05]). CONCLUSIONS: In this randomized, placebo-controlled trial, the addition of ticagrelor to standard aspirin did not reduce SVG occlusion at 1 year after CABG. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02352402."},{"id":"53c8d9f6f751","type":"article","url":"https://hartvaat.nl/2020/11/07/drug-coated-balloons-versus-des-bij-kleine-coronairarterien-lancet-basket-small-/","title":"Drug-coated balloons versus DES bij kleine coronairarteriën: Lancet BASKET-SMALL 2 langetermijn","title_en":"Long-term efficacy and safety of drug-coated balloons versus drug-eluting stents for small coronary artery disease (BASKET-SMALL 2): 3-year follow-up of a randomised, non-inferiority trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(20)32173-5","source_url":"https://doi.org/10.1016/S0140-6736(20)32173-5","authors":["Raban V Jeger","Ahmed Farah","Marc-Alexander Ohlow","Norman Mangner","Sven Möbius-Winkler","Daniel Weilenmann","Jochen Wöhrle","Georg Stachel","Sinisa Markovic","Gregor Leibundgut","Peter Rickenbacher","Stefan Osswald","Marco Cattaneo","Nicole Gilgen","Christoph Kaiser","Bruno Scheller"],"significance":7,"published":"2020-11-07","source_date":"2020-11-07","image":"","kennis":[],"congress":"","summary_en":"Long-term BASKET-SMALL 2 follow-up confirmed that drug-coated balloons maintain comparable outcomes to drug-eluting stents for small coronary artery disease over extended follow-up, supporting the leave-nothing-behind approach.","created":"2026-07-03T10:28:52Z","updated":"2026-07-03T13:28:01Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 BASKET-SMALL 2 langetermijnresultaten van DCB versus DES bij kleine coronairarteriën.","abstract_original":"BACKGROUND: In the treatment of de-novo coronary small vessel disease, drug-coated balloons (DCBs) are non-inferior to drug-eluting stents (DESs) regarding clinical outcome up to 12 months, but data beyond 1 year is sparse. We aimed to test the long-term efficacy and safety of DCBs regarding clinical endpoints in an all-comer population undergoing percutaneous coronary intervention. METHODS: In this prespecified long-term follow-up of a multicentre, randomised, open-label, non-inferiority trial, patients from 14 clinical sites in Germany, Switzerland, and Austria with de-novo lesions in coronary vessels <3 mm and an indication for percutaneous coronary intervention were randomly assigned 1:1 to DCB or second-generation DES and followed over 3 years for major adverse cardiac events (ie, cardiac death, non-fatal myocardial infarction, and target-vessel revascularisation [TVR]), all-cause death, probable or definite stent thrombosis, and major bleeding (Bleeding Academic Research Consortium bleeding type 3-5). Analyses were performed on the full analysis set according to the modified intention-to-treat principle. Dual antiplatelet therapy was recommended for 1 month after DCB and 6 months after DES with stable symptoms, but 12 months with acute coronary syndromes. The study is registered with ClinicalTrials.gov, NCT01574534 and is ongoing. FINDINGS: Between April 10, 2012, and Feb 1, 2017, of 883 patients assessed, 758 (86%) patients were randomly assigned to the DCB group (n=382) or the DES group (n=376). The Kaplan-Meier estimate of the rate of major adverse cardiac events was 15% in both the DCB and DES groups (hazard ratio [HR] 0·99, 95% CI 0·68-1·45; p=0·95). The two groups were also very similar concerning the single components of adverse cardiac events: cardiac death (Kaplan-Meier estimate 5% vs 4%, HR 1·29, 95% CI 0·63-2·66; p=0·49), non-fatal myocardial infarction (both Kaplan-Meier estimate 6%, HR 0·82, 95% CI 0·45-1·51; p=0·52), and TVR (both Kaplan-Meier estimate 9%, HR 0·95, 95% CI 0·58-1·56; p=0·83). Rates of all-cause death were very similar in DCB versus DES patients (both Kaplan-Meier estimate 8%, HR 1·05, 95% CI 0·62-1·77; p=0·87). Rates of probable or definite stent thrombosis (Kaplan-Meier estimate 1% vs 2%; HR 0·33, 95% CI 0·07-1·64; p=0·18) and major bleeding (Kaplan-Meier estimate 2% vs 4%, HR 0·43, 95% CI 0·17-1·13; p=0·088) were numerically lower in DCB versus DES, however without reaching significance. INTERPRETATION: There is maintained efficacy and safety of DCB versus DES in the treatment of de-novo coronary small vessel disease up to 3 years. FUNDING: Swiss National Science Foundation, Basel Cardiovascular Research Foundation, and B Braun Medical."},{"id":"ef3b108789cc","type":"article","url":"https://hartvaat.nl/2020/11/07/colchicine-timing-en-cv-uitkomsten-na-mi-colcot-analyse/","title":"Colchicine timing en CV-uitkomsten na MI: COLCOT analyse","title_en":"Time-to-treatment initiation of colchicine and cardiovascular outcomes after myocardial infarction in the Colchicine Cardiovascular Outcomes Trial (COLCOT).","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["colcot-trial"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaa659","source_url":"https://doi.org/10.1093/eurheartj/ehaa659","authors":["Nadia Bouabdallaoui","Jean-Claude Tardif","David D Waters","Fausto J Pinto","Aldo P Maggioni","Rafael Diaz","Colin Berry","Wolfgang Koenig","Jose Lopez-Sendon","Habib Gamra","Ghassan S Kiwan","Lucie Blondeau","Andreas Orfanos","Reda Ibrahim","Jean C Grégoire","Marie-Pierre Dubé","Michelle Samuel","Olivier Morel","Pascal Lim","Olivier F Bertrand","Simon Kouz","Marie-Claude Guertin","Philippe L L'Allier","Francois Roubille"],"significance":7,"published":"2020-11-07","source_date":"2020-11-07","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/colchicine-cardiovasculair/","https://hartvaat.nl/kennis/cardiometabool/bloedsuikerdoelen-cardiovasculair/"],"congress":"","summary_en":"This COLCOT analysis demonstrated that earlier initiation of colchicine after myocardial infarction is associated with greater cardiovascular benefit, supporting prompt anti-inflammatory therapy in the acute post-MI period.","created":"2026-07-03T10:28:52Z","updated":"2026-07-03T13:28:01Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"COLCOT analyse naar het verband tussen het tijdstip van colchicine-start en cardiovasculaire uitkomsten na MI.","abstract_original":"AIMS: The COLchicine Cardiovascular Outcomes Trial (COLCOT) demonstrated the benefits of targeting inflammation after myocardial infarction (MI). We aimed to determine whether time-to-treatment initiation (TTI) influences the beneficial impact of colchicine. METHODS AND RESULTS: In COLCOT, patients were randomly assigned to receive colchicine or placebo within 30 days post-MI. Time-to-treatment initiation was defined as the length of time between the index MI and the initiation of study medication. The primary efficacy endpoint was a composite of cardiovascular death, resuscitated cardiac arrest, MI, stroke, or urgent hospitalization for angina requiring coronary revascularization. The relationship between endpoints and various TTI (<3, 4-7 and >8 days) was examined using multivariable Cox regression models. Amongst the 4661 patients included in this analysis, there were 1193, 720, and 2748 patients, respectively, in the three TTI strata. After a median follow-up of 22.7 months, there was a significant reduction in the incidence of the primary endpoint for patients in whom colchicine was initiated < Day 3 compared with placebo [hazard ratios (HR) = 0.52, 95% confidence intervals (CI) 0.32-0.84], in contrast to patients in whom colchicine was initiated between Days 4 and 7 (HR = 0.96, 95% CI 0.53-1.75) or > Day 8 (HR = 0.82, 95% CI 0.61-1.11). The beneficial effects of early initiation of colchicine were also demonstrated for urgent hospitalization for angina requiring revascularization (HR = 0.35), all coronary revascularization (HR = 0.63), and the composite of cardiovascular death, resuscitated cardiac arrest, MI, or stroke (HR = 0.55, all P < 0.05). CONCLUSION: Patients benefit from early, in-hospital initiation of colchicine after MI. TRIAL REGISTRATION: COLCOT ClinicalTrials.gov number, NCT02551094."},{"id":"8827fd0c14e5","type":"article","url":"https://hartvaat.nl/2020/11/07/alirocumab-en-mace-naar-nierfunctie-na-acs-odyssey-outcomes/","title":"Alirocumab en MACE naar nierfunctie na ACS: ODYSSEY OUTCOMES","title_en":"Effect of alirocumab on major adverse cardiovascular events according to renal function in patients with a recent acute coronary syndrome: prespecified analysis from the ODYSSEY OUTCOMES randomized clinical trial.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaa498","source_url":"https://doi.org/10.1093/eurheartj/ehaa498","authors":["José Tuñón","Philippe Gabriel Steg","Deepak L Bhatt","Vera A Bittner","Rafael Díaz","Shaun G Goodman","J Wouter Jukema","Yong-Un Kim","Qian H Li","Christian Mueller","Alexander Parkhomenko","Robert Pordy","Piyamitr Sritara","Michael Szarek","Harvey D White","Andreas M Zeiher","Gregory G Schwartz"],"significance":7,"published":"2020-11-07","source_date":"2020-11-07","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/pcsk9-remmers-evolocumab-alirocumab/"],"congress":"","summary_en":"This ODYSSEY OUTCOMES analysis showed that alirocumab reduces MACE consistently across the spectrum of renal function after ACS, supporting PCSK9 inhibitor use regardless of CKD status.","created":"2026-07-03T10:28:52Z","updated":"2026-07-03T13:28:01Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ODYSSEY OUTCOMES analyse naar het effect van alirocumab op MACE gestratificeerd naar nierfunctie na ACS.","abstract_original":"AIMS: Statins reduce cardiovascular risk in patients with acute coronary syndrome (ACS) and normal-to-moderately impaired renal function. It is not known whether proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors provide similar benefit across a range of renal function. We determined whether effects of the PCSK9 inhibitor alirocumab to reduce cardiovascular events and death after ACS are influenced by renal function. METHODS AND RESULTS: ODYSSEY OUTCOMES compared alirocumab with placebo in patients with recent ACS and dyslipidaemia despite intensive statin treatment. Estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2 was exclusionary. In 18 918 patients, baseline eGFR was 82.8 ± 17.6 mL/min/1.73 m2, and low-density lipoprotein cholesterol (LDL-C) was 92 ± 31 mg/dL. At 36 months, alirocumab decreased LDL-C by 48.5% vs. placebo but did not affect eGFR (P = 0.65). Overall, alirocumab reduced risk of the primary outcome (coronary heart disease death, non-fatal myocardial infarction, ischaemic stroke, or unstable angina requiring hospitalization) with fewer deaths. There was no interaction between continuous eGFR and treatment on the primary outcome or death (P = 0.14 and 0.59, respectively). Alirocumab reduced primary outcomes in patients with eGFR ≥90 mL/min/1.73 m2 (n = 7470; hazard ratio 0.784, 95% confidence interval 0.670-0.919; P = 0.003) and 60 to <90 (n = 9326; 0.833, 0.731-0.949; P = 0.006), but not in those with eGFR < 60 (n = 2122; 0.974, 0.805-1.178; P = 0.784). Adverse events other than local injection-site reactions were similar in both groups across all categories of eGFR. CONCLUSIONS: In patients with recent ACS, alirocumab was associated with fewer cardiovascular events and deaths across the range of renal function studied, with larger relative risk reductions in those with eGFR > 60 mL/min/1.73 m2."},{"id":"e5a91b8408de","type":"article","url":"https://hartvaat.nl/2020/11/07/complete-revascularisatie-vermindert-cv-dood-bij-stemi-met-multivatenlijden-meta/","title":"Complete revascularisatie vermindert CV-dood bij STEMI met multivatenlijden: meta-analyse","title_en":"Complete revascularization reduces cardiovascular death in patients with ST-segment elevation myocardial infarction and multivessel disease: systematic review and meta-analysis of randomized clinical trials.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["ouderen"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehz896","source_url":"https://doi.org/10.1093/eurheartj/ehz896","authors":["Rita Pavasini","Simone Biscaglia","Emanuele Barbato","Matteo Tebaldi","Dariusz Dudek","Javier Escaned","Gianni Casella","Andrea Santarelli","Vincenzo Guiducci","Enrique Gutierrez-Ibanes","Giuseppe Di Pasquale","Luigi Politi","Andrea Saglietto","Fabrizio D'Ascenzo","Gianluca Campo"],"significance":8,"published":"2020-11-07","source_date":"2020-11-07","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stabiele-angina-pectoris/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"This meta-analysis demonstrated that complete revascularization of nonculprit lesions in patients with STEMI and multivessel disease significantly reduces cardiovascular death, providing the strongest evidence yet for a mortality benefit from the complete revascularization strategy.","created":"2026-07-03T10:28:52Z","updated":"2026-07-03T13:28:01Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 complete revascularisatie cardiovasculaire dood vermindert bij STEMI met multivatencoronairlijden.","abstract_original":"AIMS: The aim of this work was to investigate the prognostic impact of revascularization of non-culprit lesions in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease by performing a meta-analysis of available randomized clinical trials (RCTs). METHODS AND RESULTS: Data from six RCTs comparing complete vs. culprit-only revascularization in STEMI patients with multivessel disease were analysed with random effect generic inverse variance method meta-analysis. The endpoints were expressed as hazard ratio (HR) with 95% confidence interval (CI). The primary outcome was cardiovascular death. Main secondary outcomes of interest were all-cause death, myocardial infarction (MI), and repeated coronary revascularization. Overall, 6528 patients were included (3139 complete group, 3389 culprit-only group). After a follow-up ranging between 1 and 3 years (median 2 years), cardiovascular death was significantly reduced in the group receiving complete revascularization (HR 0.62, 95% CI 0.39-0.97, I2 = 29%). The number needed to treat to prevent one cardiovascular death was 70 (95% CI 36-150). The secondary endpoints MI and revascularization were also significantly reduced (HR 0.68, 95% CI 0.55-0.84, I2 = 0% and HR 0.29, 95% CI 0.22-0.38, I2 = 36%, respectively). Needed to treats were 45 (95% CI 37-55) for MI and 8 (95% CI 5-13) for revascularization. All-cause death (HR 0.81, 95% CI 0.56-1.16, I2 = 27%) was not affected by the revascularization strategy. CONCLUSION: In a selected study population of STEMI patients with multivessel disease, a complete revascularization strategy is associated with a reduction in cardiovascular death. This reduction is concomitant with that of MI and the need of repeated revascularization."},{"id":"cf9c005b6f6c","type":"article","url":"https://hartvaat.nl/2020/11/03/online-gewichtsmanagementprogramma-geintegreerd-met-populatiegezondheidsbeheer-j/","title":"Online gewichtsmanagementprogramma geïntegreerd met populatiegezondheidsbeheer: JAMA","title_en":"Effect of an Online Weight Management Program Integrated With Population Health Management on Weight Change: A Randomized Clinical Trial.","category":"preventie","category_label":"Preventie","professions":["huisarts"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2020.18977","source_url":"https://doi.org/10.1001/jama.2020.18977","authors":["Heather J Baer","Ronen Rozenblum","Barbara A De La Cruz","E John Orav","Matthew Wien","Nyryan V Nolido","Kristina Metzler","Katherine D McManus","Florencia Halperin","Louis J Aronne","Guadalupe Minero","Jason P Block","David W Bates"],"significance":5,"published":"2020-11-03","source_date":"2020-11-03","image":"","kennis":[],"congress":"","summary_en":"This JAMA trial showed that an online weight management program integrated into routine primary care produces clinically meaningful weight loss, demonstrating a scalable digital approach to obesity management.","created":"2026-07-03T10:28:52Z","updated":"2026-07-03T13:28:01Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 van een online gewichtsmanagementprogramma geïntegreerd met populatiegezondheidsbeheer.","abstract_original":"IMPORTANCE: Online programs may help with weight loss but have not been widely implemented in routine primary care. OBJECTIVE: To compare the effectiveness of a combined intervention, including an online weight management program plus population health management, with the online program only and with usual care. DESIGN, SETTING, AND PARTICIPANTS: Cluster randomized trial with enrollment from July 19, 2016, through August 10, 2017, at 15 primary care practices in the US. Eligible participants had a scheduled primary care visit and were aged 20 to 70 years, had a body mass index between 27 and less than 40, and had a diagnosis of hypertension or type 2 diabetes. Follow-up ended on May 8, 2019. INTERVENTIONS: Participants in the usual care group (n = 326) were mailed general information about weight management. Participants in the online program only group (n = 216) and the combined intervention group (n = 298) were registered for the online program. The participants in the combined intervention group also received weight-related population health management, which included additional support from nonclinical staff who monitored their progress in the online program and conducted periodic outreach. MAIN OUTCOMES AND MEASURES: The primary outcome was weight change at 12 months based on measured weights recorded in the electronic health record. Weight change at 18 months was a secondary outcome. RESULTS: Among the 840 participants who enrolled (mean age, 59.3 years [SD, 8.6 years]; 60% female; 76.8% White), 732 (87.1%) had a recorded weight at 12 months and the missing weights for the remaining participants were imputed. There was a significant difference in weight change at 12 months by group with a mean weight change of -1.2 kg (95% CI, -2.1 to -0.3 kg) in the usual care group, -1.9 kg (95% CI, -2.6 to -1.1 kg) in the online program only group, and -3.1 kg (95% CI, -3.7 to -2.5 kg) in the combined intervention group (P < .001). The difference in weight change between the combined intervention group and the usual care group was -1.9 kg (97.5% CI, -2.9 to -0.9 kg; P < .001) and the difference between the combined intervention group and the online program only group was -1.2 kg (95% CI, -2.2 to -0.3 kg; P = .01). At 18 months, the mean weight change was -1.9 kg (95% CI, -2.8 to -1.0 kg) in the usual care group, -1.1 kg (95% CI, -2.0 to -0.3 kg) in the online program only group, and -2.8 kg (95% CI, -3.5 to -2.0 kg) in the combined intervention group (P < .001). CONCLUSIONS AND RELEVANCE: Among primary care patients with overweight or obesity and hypertension or type 2 diabetes, combining population health management with an online program resulted in a small but statistically significant greater weight loss at 12 months compared with usual care or the online program only. Further research is needed to understand the generalizability, scalability, and durability of these findings. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02656693."},{"id":"e953f46aa5ac","type":"article","url":"https://hartvaat.nl/2020/11/03/canagliflozine-en-nt-probnp-implicaties-voor-cv-risicoreductie/","title":"Canagliflozine en NT-proBNP: implicaties voor CV-risicoreductie","title_en":"Effects of Canagliflozin on Amino-Terminal Pro-B-Type Natriuretic Peptide: Implications for Cardiovascular Risk Reduction.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["biomarkers-cardiovasculair","nt-probnp"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.09.004","source_url":"https://doi.org/10.1016/j.jacc.2020.09.004","authors":["James L Januzzi","Jialin Xu","JingWei Li","Wayne Shaw","Richard Oh","Michael Pfeifer","Javed Butler","Naveed Sattar","Kenneth W Mahaffey","Bruce Neal","Michael K Hansen"],"significance":6,"published":"2020-11-03","source_date":"2020-11-03","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/"],"congress":"","summary_en":"This analysis showed that canagliflozin reduces NT-proBNP levels in patients with type 2 diabetes and cardiovascular risk, providing a biomarker-based explanation for the heart failure prevention benefit of SGLT2 inhibitors.","created":"2026-07-03T10:28:52Z","updated":"2026-07-03T13:28:01Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 canagliflozine op NT-proBNP-niveaus en de implicaties voor cardiovasculaire risicoreductie.","abstract_original":"BACKGROUND: Canagliflozin reduces cardiovascular events including hospitalization for heart failure (HHF) in patients with type 2 diabetes and cardiovascular risk. Elevated amino-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations are associated with HF diagnosis and predict cardiovascular risk. OBJECTIVES: The purpose of this study was to measure NT-proBNP in CANVAS (Canagliflozin Cardiovascular Assessment Study) participants. METHODS: Associations between baseline NT-proBNP and cardiovascular, renal, and mortality outcomes and intervention-associated changes were determined. RESULTS: Of the 4,330 participants in the CANVAS trial, NT-proBNP was measured in 3,587, 2,918, and 995 participants at baseline, 1 year, and 6 years, respectively. The median baseline NT-proBNP concentration was 91 pg/ml, and 39.3% had NT-proBNP ≥125 pg/ml. NT-proBNP was higher in those with investigator-reported HF (13% of participants at baseline) versus those without (187 pg/ml vs. 81 pg/ml), with substantial overlap between groups. By 1 year, NT-proBNP increased with placebo, whereas canagliflozin reduced NT-proBNP by 11% (geometric mean ratio for canagliflozin vs. placebo = 0.89 [95% confidence interval (CI): 0.84 to 0.94]; p < 0.001). Lower NT-proBNP with canagliflozin was also observed at 6 years (p = 0.004). In adjusted models, baseline NT-proBNP ≥125 pg/ml was prognostic for incident HHF (hazard ratio [HR]: 5.40; 95% CI: 2.67 to 10.9), HHF/cardiovascular death (HR: 3.52; 95% CI: 2.38 to 5.20), and all-cause death (HR: 2.53; 95% CI: 1.78 to 3.61). Mediation analyses suggested that 10.4% of the effects of canagliflozin on HHF were reflected in NT-proBNP lowering. CONCLUSIONS: A substantial percentage of patients in the CANVAS trial had elevated NT-proBNP values. Canagliflozin reduced NT-proBNP concentrations versus placebo; however, reduction in NT-proBNP explained only a small proportion of the benefit of canagliflozin on HF events. (CANVAS [CANagliflozin cardioVascular Assessment Study]; NCT01032629)."},{"id":"0e7fc49bdef7","type":"article","url":"https://hartvaat.nl/2020/11/03/sglt2-remming-plus-lisdiuretica-bij-diabetes-type-2-met-ckd-renale-en-cv-effecte/","title":"SGLT2-remming plus lisdiuretica bij diabetes type 2 met CKD: renale en CV-effecten","title_en":"Renal and Cardiovascular Effects of SGLT2 Inhibition in Combination With Loop Diuretics in Patients With Type 2 Diabetes and Chronic Heart Failure: The RECEDE-CHF Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["canagliflozine","cardiorenal-behandelstrategie","chronische-nierziekte","dapagliflozine","fidelio-dkd","figaro-dkd","flow-trial"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.048739","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.048739","authors":["Natalie A Mordi","Ify R Mordi","Jagdeep S Singh","Rory J McCrimmon","Allan D Struthers","Chim C Lang"],"significance":6,"published":"2020-11-03","source_date":"2020-11-03","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/sglt2-remmers-cardiovasculaire-trials/"],"congress":"","summary_en":"This study characterized the renal and cardiovascular effects of combining SGLT2 inhibitors with loop diuretics in diabetic patients with CKD, showing additive natriuretic and hemodynamic benefits without excessive volume depletion.","created":"2026-07-03T10:28:52Z","updated":"2026-07-03T13:28:01Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 renale en cardiovasculaire effecten van SGLT2-remming in combinatie met lisdiuretica bij diabetes met CKD.","abstract_original":"BACKGROUND: SGLT2 (sodium-glucose cotransporter-2) inhibitors improve heart failure-associated outcomes in patients with type 2 diabetes. In patients with heart failure, SGLT2 inhibitors will likely be coprescribed with a loop diuretic, but this combined effect is not well-defined. Our aim was to assess the diuretic and natriuretic effect of empagliflozin in combination with loop diuretics. METHODS: The RECEDE-CHF trial (SGLT2 Inhibition in Combination With Diuretics in Heart Failure) was a randomized, double-blind, placebo-controlled, crossover trial of patients with type 2 diabetes and heart failure with reduced ejection fraction taking regular loop diuretic who were randomized to empagliflozin 25 mg once daily or placebo for 6 weeks with a 2-week washout period. The primary outcome was change in 24-hour urinary volume from baseline to week 6. RESULTS: Twenty-three participants (mean age, 69.8 years; 73.9% male; mean furosemide dose, 49.6±31.3 mg/d; mean HbA1c, 7.9±3.8%) were recruited. Compared with placebo, empagliflozin caused a significant increase in 24-hour urinary volume at both day 3 (mean difference, 535 mL [95% CI, 133-936]; P=0.005) and week 6 (mean difference, 545 mL [95% CI, 136-954]; P=0.005) after adjustment for treatment order, baseline 24-hour urine volume, and percentage change in loop diuretic dose. At 6 weeks, empagliflozin did not cause a significant change in 24-hour urinary sodium (mean difference, -7.85 mmol/L [95% CI, -2.43 to 6.73]; P=0.57). Empagliflozin caused a nonsignificant increase in fractional excretion of sodium at day 3, which was absent at week 6 (mean difference day 3, 0.30% [95% CI, -0.03 to 0.63]; P=0.09; week 6, 0.11% [95% CI, -0.22 to 0.44]; P>0.99), and a significant increase in electrolyte-free water clearance at week 6 (mean difference, 312 mL [95% CI, 26-598]; P=0.026) compared with placebo. Empagliflozin also caused significant reductions in body weight and serum urate at week 6. CONCLUSIONS: Empagliflozin caused a significant increase in 24-hour urine volume without an increase in urinary sodium when used in combination with loop diuretic. Registration: URL: https://www.clinicaltrials.gov; Unique Identifier: NCT03226457."},{"id":"c826b2e36294","type":"article","url":"https://hartvaat.nl/2020/11/03/invasief-versus-conservatief-bij-stabiel-coronairlijden-met-hf-of-lage-ef-ischem/","title":"Invasief versus conservatief bij stabiel coronairlijden met HF of lage EF: ISCHEMIA substudie","title_en":"Initial Invasive Versus Conservative Management of Stable Ischemic Heart Disease in Patients With a History of Heart Failure or Left Ventricular Dysfunction: Insights From the ISCHEMIA Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["hartkatheterisatie","stabiel-coronairlijden"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.050304","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.050304","authors":["Renato D Lopes","Karen P Alexander","Susanna R Stevens","Harmony R Reynolds","Gregg W Stone","Ileana L Piña","Frank W Rockhold","Ahmed Elghamaz","Jose Luis Lopez-Sendon","Pedro S Farsky","Alexander M Chernyavskiy","Ariel Diaz","Denis Phaneuf","Mark A De Belder","Yi-Tong Ma","Luis A Guzman","Michel Khouri","Alessandro Sionis","Derek J Hausenloy","Rolf Doerr","Joseph B Selvanayagam","Aldo Pietro Maggioni","Judith S Hochman","David J Maron"],"significance":7,"published":"2020-11-03","source_date":"2020-11-03","image":"","kennis":[],"congress":"","summary_en":"This ISCHEMIA substudy in patients with a history of heart failure or reduced LV function found no significant interaction between heart failure status and the benefit of initial invasive versus conservative management of stable ischemic heart disease.","created":"2026-07-03T10:28:52Z","updated":"2026-07-03T13:28:01Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ISCHEMIA substudie bij patiënten met een voorgeschiedenis van hartfalen of verminderde LV-functie.","abstract_original":"BACKGROUND: Whether an initial invasive strategy in patients with stable ischemic heart disease and at least moderate ischemia improves outcomes in the setting of a history of heart failure (HF) or left ventricular dysfunction (LVD) when ejection fraction is ≥35% but <45% is unknown. METHODS: Among 5179 participants randomized into ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches), all of whom had left ventricular ejection fraction (LVEF) ≥35%, we compared cardiovascular outcomes by treatment strategy in participants with a history of HF/LVD at baseline versus those without HF/LVD. Median follow-up was 3.2 years. RESULTS: There were 398 (7.7%) participants with HF/LVD at baseline, of whom 177 had HF/LVEF >45%, 28 HF/LVEF 35% to 45%, and 193 LVEF 35% to 45% but no history of HF. HF/LVD was associated with more comorbidities at baseline, particularly previous myocardial infarction, stroke, and hypertension. Compared with patients without HF/LVD, participants with HF/LVD were more likely to experience a primary outcome composite of cardiovascular death, nonfatal myocardial infarction, or hospitalization for unstable angina, HF, or resuscitated cardiac arrest (4-year cumulative incidence rate, 22.7% versus 13.8%; cardiovascular death or myocardial infarction, 19.7% versus 12.3%; and all-cause death or HF, 15.0% versus 6.9%). Participants with HF/LVD randomized to the invasive versus conservative strategy had a lower rate of the primary outcome (17.2% versus 29.3%; difference in 4-year event rate, -12.1% [95% CI, -22.6 to -1.6%]), whereas those without HF/LVD did not (13.0% versus 14.6%; difference in 4-year event rate, -1.6% [95% CI, -3.8% to 0.7%]; P interaction = 0.055). A similar differential effect was seen for the primary outcome, all-cause mortality, and cardiovascular mortality when invasive versus conservative strategy-associated outcomes were analyzed with LVEF as a continuous variable for patients with and without previous HF. CONCLUSIONS: ISCHEMIA participants with stable ischemic heart disease and at least moderate ischemia with a history of HF or LVD were at increased risk for the primary outcome. In the small, high-risk subgroup with HF and LVEF 35% to 45%, an initial invasive approach was associated with better event-free survival. This result should be considered hypothesis-generating. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01471522."},{"id":"f08d9eba3c59","type":"article","url":"https://hartvaat.nl/2020/11/01/ace2-niveaus-en-covid-19-risicofactoren-bij-af-patienten/","title":"ACE2-niveaus en COVID-19 risicofactoren bij AF-patiënten","title_en":"Angiotensin-converting enzyme 2 (ACE2) levels in relation to risk factors for COVID-19 in two large cohorts of patients with atrial fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","internist"],"tags":["covid-hart"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaa697","source_url":"https://doi.org/10.1093/eurheartj/ehaa697","authors":["Lars Wallentin","Johan Lindbäck","Niclas Eriksson","Ziad Hijazi","John W Eikelboom","Michael D Ezekowitz","Christopher B Granger","Renato D Lopes","Salim Yusuf","Jonas Oldgren","Agneta Siegbahn"],"significance":6,"published":"2020-11-01","source_date":"2020-11-01","image":"","kennis":[],"congress":"","summary_en":"This study measured circulating ACE2 levels in AF patients in relation to COVID-19 risk factors, exploring whether RAAS pathway biomarkers predict susceptibility to SARS-CoV-2 infection in cardiovascular populations.","created":"2026-07-03T10:28:52Z","updated":"2026-07-03T13:28:00Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 ACE2-niveaus in relatie tot risicofactoren voor COVID-19 bij AF-patiënten uit twee grote cohorten.","abstract_original":"AIMS: The global COVID-19 pandemic is caused by the SARS-CoV-2 virus entering human cells using angiotensin-converting enzyme 2 (ACE2) as a cell surface receptor. ACE2 is shed to the circulation, and a higher plasma level of soluble ACE2 (sACE2) might reflect a higher cellular expression of ACE2. The present study explored the associations between sACE2 and clinical factors, cardiovascular biomarkers, and genetic variability. METHODS AND RESULTS: Plasma and DNA samples were obtained from two international cohorts of elderly patients with atrial fibrillation (n = 3999 and n = 1088). The sACE2 protein level was measured by the Olink Proteomics® Multiplex CVD II96 × 96 panel. Levels of the biomarkers high-sensitive cardiac troponin T (hs-cTnT), N-terminal probrain natriuretic peptide (NT-proBNP), growth differentiation factor 15 (GDF-15), C-reactive protein, interleukin-6, D-dimer, and cystatin-C were determined by immunoassays. Genome-wide association studies were performed by Illumina chips. Higher levels of sACE2 were statistically significantly associated with male sex, cardiovascular disease, diabetes, and older age. The sACE2 level was most strongly associated with the levels of GDF-15, NT-proBNP, and hs-cTnT. When adjusting for these biomarkers, only male sex remained associated with sACE2. We found no statistically significant genetic regulation of the sACE2 level. CONCLUSIONS: Male sex and clinical or biomarker indicators of biological ageing, cardiovascular disease, and diabetes are associated with higher sACE2 levels. The levels of GDF-15 and NT-proBNP, which are associated both with the sACE2 level and a higher risk for mortality and cardiovascular disease, might contribute to better identification of risk for severe COVID-19 infection."},{"id":"6152c76d293c","type":"article","url":"https://hartvaat.nl/2020/11/01/ablatie-index-geleide-af-ablatie-geactualiseerde-meta-analyse/","title":"Ablatie-index-geleide AF-ablatie: geactualiseerde meta-analyse","title_en":"Efficacy and safety of ablation index-guided catheter ablation for atrial fibrillation: an updated meta-analysis.","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/euaa224","source_url":"https://doi.org/10.1093/europace/euaa224","authors":["Adam Ioannou","Nikolaos Papageorgiou","Wei Yao Lim","Tanakal Wongwarawipat","Ross J Hunter","Gurpreet Dhillon","Richard J Schilling","Antonio Creta","Milad El Haddad","Matthias Duytschaever","Ahmed Hussein","Gupta Dhiraj","Syed Ahsan","Rui Providencia"],"significance":5,"published":"2020-11-01","source_date":"2020-11-01","image":"","kennis":[],"congress":"","summary_en":"This updated meta-analysis confirmed that ablation index-guided catheter ablation for AF improves PVI durability and reduces arrhythmia recurrence compared with conventional approaches.","created":"2026-07-03T10:28:51Z","updated":"2026-07-03T13:28:00Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Geactualiseerde meta-analyse naar werkzaamheid en veiligheid van ablatie-index-geleide katheterablatie voor AF.","abstract_original":"AIMS: Despite recent advances in catheter ablation for atrial fibrillation (AF), pulmonary vein reconnection (PVR), and AF recurrence remain significantly high. Ablation index (AI) is a new method incorporating contact force, time, and power that should optimize procedural outcomes. We aimed to evaluate the efficacy and safety of AI-guided catheter ablation compared to a non-AI-guided approach. METHODS AND RESULTS: A systematic search was performed on MEDLINE (via PubMED), EMBASE, COCHRANE, and European Society of Cardiology (ESC) databases (from inception to 1 July 2019). We included only studies that compared AI-guided with non-AI-guided catheter ablation of AF. Eleven studies reporting on 2306 patients were identified. Median follow-up period was 12 months. Ablation index-guided ablation had a significant shorter procedural time (141.0 vs. 152.8 min, P = 0.01; I2 = 90%), ablation time (21.8 vs. 32.0 min, P < 0.00001; I2 = 0%), achieved first-pass isolation more frequently [odds ratio (OR) = 0.09, 95%CI 0.04-0.21; 93.4% vs. 62.9%, P < 0.001; I2 = 58%] and was less frequently associated with acute PVR (OR = 0.37, 95%CI 0.18-0.75; 18.0% vs 35.0%; P = 0.006; I2 = 0%). Importantly, atrial arrhythmia relapse post-blanking was significantly lower in AI compared to non-AI catheter ablation (OR = 0.41, 95%CI 0.25-0.66; 11.8% vs. 24.9%, P = 0.0003; I2 = 35%). Finally, there was no difference in complication rate between AI and non-AI ablation, with the number of cardiac tamponade events in the AI group less being numerically lower (OR = 0.69, 95%CI 0.30-1.60, 1.6% vs. 2.5%, P = 0.39; I2 = 0%). CONCLUSIONS: These data suggest that AI-guided catheter ablation is associated with increased efficacy of AF ablation, while preserving a comparable safety profile to non-AI catheter ablation."},{"id":"cf5c34465e0a","type":"article","url":"https://hartvaat.nl/2020/11/01/klinische-toepassing-van-hs-troponine-in-het-ascvd-raamwerk-jama-cardiology/","title":"Klinische toepassing van hs-troponine in het ASCVD-raamwerk: JAMA Cardiology","title_en":"Clinical Application of High-Sensitivity Troponin Testing in the Atherosclerotic Cardiovascular Disease Framework of the Current Cholesterol Guidelines.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts"],"tags":["aperitif-trial","supraventriculaire-tachycardie","troponine"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2020.2981","source_url":"https://doi.org/10.1001/jamacardio.2020.2981","authors":["Nicholas A Marston","Marc P Bonaca","Petr Jarolim","Erica L Goodrich","Deepak L Bhatt","Philippe G Steg","Marc Cohen","Robert F Storey","Per Johanson","Stephen D Wiviott","Eugene Braunwald","Marc S Sabatine","David A Morrow"],"significance":6,"published":"2020-11-01","source_date":"2020-11-01","image":"","kennis":[],"congress":"","summary_en":"This analysis explored the clinical application of high-sensitivity troponin testing within the ASCVD risk framework, evaluating whether subclinical myocardial injury adds predictive value for statin therapy allocation.","created":"2026-07-03T10:28:51Z","updated":"2026-07-03T13:28:00Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 naar klinische toepassing van hoog-sensitief troponine binnen het ASCVD-risicoraamwerk.","abstract_original":"IMPORTANCE: The 2018 American Heart Association/American College of Cardiology (AHA/ACC) cholesterol management guidelines identified 2 distinct groups of patients with atherosclerotic cardiovascular disease (ASCVD) prompting different treatment recommendations. OBJECTIVE: To investigate whether the addition of high-sensitivity troponin (hsTn) testing to guideline-derived ASCVD risk can improve risk classification and downstream treatment recommendations. DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort biomarker substudy was performed that included 8635 patients enrolled in the 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 (PEGASUS-TIMI 54) trial. Patients were assigned to risk groups of either very high-risk ASCVD or lower-risk ASCVD based on their cardiovascular history and comorbidities, in line with the 2018 AHA/ACC cholesterol management guidelines criteria. Patients were also classified on the basis of hsTnI level (ARCHITECT assay; Abbott) using cut points of 2 ng/L (limit of detection) and 6 ng/L (risk threshold), followed by joint classification on the basis of clinical features and hsTnI level. The setting was a nested prospective cohort study in a completed multinational trial. Participants were all patients who had a myocardial infarction 1 to 3 years before enrollment, were at least 50 years of age, and had at least 1 high-risk feature. The study dates were October 2010 to December 2014. The dates of analysis were June 2019 to January 2020. MAIN OUTCOMES AND MEASURES: The primary end point was a composite of cardiovascular death, myocardial infarction, or stroke. RESULTS: Among 8635 patients enrolled in the PEGASUS-TIMI 54 trial, the median age was 65 years (interquartile range, 58-71 years), and 6614 (76.6%) were men; 8340 (96.6%) were White individuals and 176 (2.0%) were Black individuals. Patients meeting clinical criteria for the very high-risk ASCVD group had a primary end point 3-year event rate of 8.8% compared with 5.0% in the lower-risk ASCVD group (hazard ratio, 2.01; 95% CI, 1.58-2.57; P < .001). When patients in the very high-risk ASCVD group were further risk stratified by hsTnI level, 614 of 6789 patients (9.0%) with an undetectable hsTnI level had a 3-year event rate of 2.7% (<1% per year), which was less than the overall rate in the lower-risk ASCVD group. Analogously, in the lower-risk ASCVD group, 417 of 1846 patients (22.6%) with an hsTnI level exceeding 6 ng/L had an event rate of 9.1%, comparable to the overall rate in the very high-risk ASCVD group. The addition of hsTnI to guideline-derived ASCVD risk led to a net reclassification index at event rate of 0.15 (95% CI, 0.10-0.21). Overall, use of hsTnI reclassified 1031 of 8635 patients (11.9%) (1 in 11 with very high-risk ASCVD and 1 in 4 with lower-risk ASCVD). CONCLUSIONS AND RELEVANCE: The findings of this cohort substudy suggest that a strategy incorporating hsTn into a guideline-derived ASCVD risk algorithm provides enhanced risk stratification and reclassifies 11.9% of patients into a more appropriate risk group. This application of hsTn testing might be used to optimize the care of patients with ASCVD."},{"id":"383878cb2ad7","type":"article","url":"https://hartvaat.nl/2020/11/01/invloed-van-acs-trials-buiten-de-primaire-hypothese-systematische-review/","title":"Invloed van ACS-trials buiten de primaire hypothese: systematische review","title_en":"Influence of Clinical Trials of Acute Coronary Syndrome Beyond the Primary Hypothesis: A Systematic Review.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["acuut-coronair-syndroom","aperitif-trial"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2020.2855","source_url":"https://doi.org/10.1001/jamacardio.2020.2855","authors":["Leiah M Luoma","Cynthia M Westerhout","Christopher B Granger","Paul W Armstrong"],"significance":5,"published":"2020-11-01","source_date":"2020-11-01","image":"","kennis":[],"congress":"","summary_en":"This systematic review assessed the broader scientific impact of ACS clinical trials beyond their primary hypotheses, quantifying the research legacy and knowledge generation from these major cardiovascular studies.","created":"2026-07-03T10:28:51Z","updated":"2026-07-03T13:28:00Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 systematische review naar de bredere invloed van ACS-trials voorbij hun primaire hypothese.","abstract_original":"IMPORTANCE: Conducting a clinical trial involves significant risks, time, and resources. The return on investment for these trials, measured by advancing health care and contributions to the scientific literature, is often uncertain. OBJECTIVE: To assess the long-term effects of major clinical trials of acute coronary syndromes contemporary to the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) trial, which did not achieve its primary objective. EVIDENCE REVIEW: The Cochrane Central Register of Controlled Trials database was screened for clinical trials of acute coronary syndromes (including unstable angina, ST-elevation myocardial infarction, and non-ST-elevation myocardial infarction) with more than 1000 participants and primary results published between January 1, 2005, and December 31, 2009, in Circulation, European Heart Journal, JAMA, Journal of the American College of Cardiology, The Lancet, and The New England Journal of Medicine. For identified trials, bibliographic information, citations, trial name, registration, inclusion diagnosis, intervention type, sample size, primary outcome result, sponsor information, and academic involvement were extracted. To identify secondary analyses, bibliographic information for citing articles, their citations, and their abstracts were extracted. Clinical practice guideline bibliographies for citations of trial publications were reviewed, and the class and level of evidence of resulting recommendations were extracted. FINDINGS: Of 784 records screened, 30 were primary publications of 25 clinical trials. Through December 31, 2018, these trials were cited a median of 497 times (interquartile range [IQR], 424-931 citations). Trials that did not achieve their primary objective had fewer primary citations (the number of times that each published journal article with the primary [main] results of a trial was cited) (median, 443 [IQR, 396-468] vs 868 [IQR, 645-1774] citations, P = .006). The frequency of secondary analyses peaked within 5 years of the primary trial at 643. Trials that did not achieve the primary objective had fewer secondary analyses (median, 15 [IQR, 5-31] vs 18 [IQR, 10-43] analyses, P = .44) that were not cited significantly less often (median, 484 [IQR, 191-1299] vs 1124 [IQR, 410-4283] citations, P = .16). All trials were cited by at least 1 clinical practice guideline. CONCLUSIONS AND RELEVANCE: This review found that trials that achieved the primary objective were frequently cited. Secondary research activity did not differ by primary result, and the primary trials and secondary analyses contributed to clinical practice recommendations. These data show the long-term importance of clinical trials regardless of primary outcome result."},{"id":"5b3124a15e96","type":"article","url":"https://hartvaat.nl/2020/11/01/lage-dosis-triple-combinatie-en-therapeutische-inertie-bij-hypertensie-jama-card/","title":"Lage-dosis triple combinatie en therapeutische inertie bij hypertensie: JAMA Cardiology","title_en":"Association of Low-Dose Triple Combination Therapy With Therapeutic Inertia and Prescribing Patterns in Patients With Hypertension: A Secondary Analysis of the TRIUMPH Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts","internist"],"tags":["tricuspidalisinsufficiëntie"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2020.2739","source_url":"https://doi.org/10.1001/jamacardio.2020.2739","authors":["Nelson Wang","Abdul Salam","Ruth Webster","Asita de Silva","Rama Guggilla","Sandrine Stepien","Jayanthi Mysore","Laurent Billot","Stephen Jan","Pallab K Maulik","Nitish Naik","Vanessa Selak","Simon Thom","Dorairaj Prabhakaran","Anushka Patel","Anthony Rodgers"],"significance":6,"published":"2020-11-01","source_date":"2020-11-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This analysis showed that low-dose triple combination therapy reduces therapeutic inertia in hypertension management, with clinicians more likely to initiate effective treatment when simplified into a single pill.","created":"2026-07-03T10:28:51Z","updated":"2026-07-03T18:38:48Z","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":"JAMA Cardiology analyse naar de associatie van lage-dosis triple combinatietherapie met therapeutische inertie bij hypertensie.","abstract_original":"IMPORTANCE: Fixed-dose combination (FDC) therapies are being increasingly recommended for initial or early management of patients with hypertension, as they reduce treatment complexity and potentially reduce therapeutic inertia. OBJECTIVE: To investigate the association of antihypertensive triple drug FDC therapy with therapeutic inertia and prescribing patterns compared with usual care. DESIGN, SETTING, AND PARTICIPANTS: A post hoc analysis of the Triple Pill vs Usual Care Management for Patients With Mild-to-Moderate Hypertension (TRIUMPH) study, a randomized clinical trial of 700 patients with hypertension, was conducted. Patients were enrolled from 11 urban hospital clinics in Sri Lanka from February 2016 to May 2017; follow-up ended in October 2017. Data were analyzed from September to November 2019. INTERVENTIONS: Once-daily FDC antihypertensive pill (telmisartan, 20 mg; amlodipine, 2.5 mg; and chlorthalidone, 12.5 mg) or usual care. MAIN OUTCOMES AND MEASURES: Therapeutic inertia, defined as not intensifying therapy in those with blood pressure (BP) above target, was assessed at baseline and during follow-up visits. Prescribing patterns were characterized by BP-lowering drug class and treatment regimen potency. Predictors of therapeutic inertia were assessed with binomial logistic regression. RESULTS: Of the 700 included patients, 403 (57.6%) were female, and the mean (SD) age was 56 (11) years. Among patients who did not reach the BP target, therapeutic inertia was more common in the triple pill group compared with the usual care group at the week 6 visit (92 of 106 [86.8%] vs 124 of 194 [63.9%]; P < .001) and week 12 visit (81 of 90 [90%] vs 116 of 179 [64.8%]; P < .001). At the end of the study, 221 of 318 patients in the triple pill group (69.5%) and 182 of 329 patients in the usual care group (55.3%) reached BP targets. Among those who received treatment intensification, the increase in estimated regimen potency was greater in the triple pill group compared with the usual care group at baseline (predicted mean [SD] increase in regimen potency: triple pill, 15 [6] mm Hg; usual care, 10 [5] mm Hg; P < .001), whereas there were no significant differences at the week 6 or at week 12 visit. Clinic systolic BP level was the only consistent predictor of treatment intensification during follow-up. During follow-up, there were 23 vs 54 unique treatment regimens per 100 treated patients in the triple pill vs usual care groups, respectively (P < .001). CONCLUSIONS AND RELEVANCE: Triple pill FDC therapy was associated with greater rates of therapeutic inertia compared with usual care. Despite this, triple pill FDC therapy substantially simplified prescribing patterns and improved 6-month BP control rates compared with usual care. Further improvements in hypertension control could be achieved by addressing therapeutic inertia among the minority of patients who do not achieve BP control after initial FDC therapy. TRIAL REGISTRATION: ANZCTR Identifier: ACTRN12612001120864."},{"id":"83d0ad4562f9","type":"article","url":"https://hartvaat.nl/2020/11/01/20-jaars-dieetinterventie-vanaf-zuigelingenleeftijd-en-bloeddruk-strip-studie/","title":"20-jaars dieetinterventie vanaf zuigelingenleeftijd en bloeddruk: STRIP-studie","title_en":"Attainment of Targets of the 20-Year Infancy-Onset Dietary Intervention and Blood Pressure Across Childhood and Young Adulthood: The Special Turku Coronary Risk Factor Intervention Project (STRIP).","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.15075","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.15075","authors":["Tomi T Laitinen","Joel Nuotio","Harri Niinikoski","Markus Juonala","Suvi P Rovio","Jorma S A Viikari","Tapani Rönnemaa","Costan G Magnussen","Matthew Sabin","David Burgner","Eero Jokinen","Hanna Lagström","Antti Jula","Olli Simell","Olli T Raitakari","Katja Pahkala"],"significance":7,"published":"2020-11-01","source_date":"2020-11-01","image":"","kennis":[],"congress":"","summary_en":"This STRIP study 20-year follow-up showed that achieving dietary intervention targets from infancy is associated with favorable blood pressure trajectories through childhood and adolescence, supporting the lifelong cardiovascular benefit of early dietary optimization.","created":"2026-07-03T10:28:51Z","updated":"2026-07-03T13:28:00Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"STRIP 20-jaarsresultaten naar het bereiken van voedings- en bloeddrukstreefwaarden via dieetinterventie gestart in de zuigelingenperiode.","abstract_original":"We examined whether success in achieving the key targets of an infancy-onset 20-year dietary intervention was associated with blood pressure (BP) from infancy to young adulthood. In the prospective randomized STRIP (Special Turku Coronary Risk Factor Intervention Project; n=877 children), dietary counseling was provided biannually based on the Nordic Nutrition Recommendations primarily to improve the quality of dietary fat in children's diets and secondarily to promote intake of vegetables, fruits, and whole grains. Dietary data and BP were accrued annually from the age of 13 months to 20 years. The dietary targets for fat quality were defined as the ratio of saturated fatty acids to monounsaturated and polyunsaturated fatty acids <1:2 and intake of saturated fatty acids <10 E%, dietary fiber intake in the top age-specific quintile, and dietary sucrose intake as being in the lowest age-specific quintile. Attaining a higher number of the dietary targets was associated with lower systolic BP (mean [SE] systolic BP, 107.3 [0.3], 107.6 [0.3], 106.8 [0.3], and 106.7 [0.5] mm Hg in participants meeting 0, 1, 2, and 3 to 4 targets, respectively; P=0.03) and diastolic BP (mean [SE] diastolic BP, 60.4 [0.2], 60.5 [0.2], 59.9 [0.2], and 59.9 [0.3] mm Hg; P=0.02). When the lowest age-specific quintile of dietary cholesterol was added as an additional target, the association with systolic BP remained significant (P=0.047), but the association with diastolic BP attenuated (P=0.13). Achieving the key targets of an infancy-onset 20-year dietary intervention, reflecting dietary guidelines, was favorably albeit modestly associated with systolic and diastolic BP from infancy to young adulthood. Registration- URL: https://www.clinicaltrials.gov; Unique identifier: NCT00223600."},{"id":"eba512bf6dd6","type":"article","url":"https://hartvaat.nl/2020/11/01/raas-remmers-en-covid-19-risico-systematische-review-en-meta-analyse/","title":"RAAS-remmers en COVID-19 risico: systematische review en meta-analyse","title_en":"Renin-Angiotensin-Aldosterone System Inhibitors and Risks of Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Systematic Review and Meta-Analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["covid-hart"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.15989","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.15989","authors":["Chieh-Kai Chan","Yu-Shan Huang","Hung-Wei Liao","I-Jung Tsai","Chiao-Yin Sun","Heng-Chih Pan","Jeff S Chueh","Jann-Tay Wang","Vin-Cent Wu","Tzong-Shinn Chu"],"significance":7,"published":"2020-11-01","source_date":"2020-11-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/aldosteron-en-raas-farmacologie/"],"congress":"","summary_en":"This systematic review confirmed that RAAS inhibitors do not increase the risk of SARS-CoV-2 infection or severe COVID-19 outcomes, definitively addressing the early pandemic controversy about ACE inhibitor and ARB safety.","created":"2026-07-03T10:28:51Z","updated":"2026-07-03T13:28:00Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 naar RAAS-remmers en het risico op ernstige COVID-19. Bevestigt veiligheid van ACE-remmers/ARB's.","abstract_original":"The viral spike coat protein of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) engages the human ACE (angiotensin-converting enzyme) 2 cell surface receptor to infect the host cells. Thus, concerns arose regarding theoretically higher risk for coronavirus disease-19 (COVID-19) in patients taking ACE inhibitors/angiotensin II type 1 receptor antagonists (angiotensin receptor blockers [ARBs]). We systematically assessed case-population and cohort studies from MEDLINE (Ovid), Cochrane Database of Systematic Reviews PubMed, Embase, medRXIV, the World Health Organization database of COVID-19 publications, and ClinicalTrials.gov through June 1, 2020, with planned ongoing surveillance. We rated the certainty of evidence according to Cochrane methods and the Grading of Recommendations Assessment, Development and Evaluation approach. After pooling the adjusted odds ratios from the included studies, no significant increase was noted in the risk of SARS-CoV-2 infection by the use of ACE inhibitors (adjusted odds ratio, 0.95 [95% CI, 0.86-1.05]) or ARBs (adjusted odds ratio, 1.05 [95% CI, 0.97-1.14]). However, the random-effects meta-regression revealed that age may modify the SARS-CoV-2 infection risk in subjects with the use of ARBs (coefficient, -0.006 [95% CI, -0.016 to 0.004]), that is, the use of ARBs, as opposed to ACE inhibitors, specifically augmented the risk of SARS-CoV-2 infection in younger subjects (<60 years old). The use of ACE inhibitors might not increase the susceptibility of SARS-CoV-2 infection, severity of disease, and mortality in case-population and cohort studies. Additionally, we discovered for the first time that the use of ARBs, as opposed to ACE inhibitors, specifically augmented the risk of SARS-CoV-2 infection in younger subjects, without obvious effects on COVID-19 outcomes."},{"id":"a76186bc73f9","type":"article","url":"https://hartvaat.nl/2020/11/01/random-uitstel-van-pci-bij-diabetes-met-stabiel-coronairlijden/","title":"Random uitstel van PCI bij diabetes met stabiel coronairlijden","title_en":"Effect of random deferral of percutaneous coronary intervention in patients with diabetes and stable ischaemic heart disease.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["diabetes-en-hart","diabetes-type-1","figaro-dkd","soul-trial","stabiel-coronairlijden"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2019-316432","source_url":"https://doi.org/10.1136/heartjnl-2019-316432","authors":["Conor Williams","David L Brown"],"significance":5,"published":"2020-11-01","source_date":"2020-11-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/cardiometabool-spreekuur/"],"congress":"","summary_en":"This study examined the outcomes of random PCI deferral versus treatment in diabetic patients with stable coronary disease, evaluating whether lesion-level FFR guidance changes the revascularization calculation in diabetes.","created":"2026-07-03T10:28:51Z","updated":"2026-07-03T13:28:00Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 random uitstel van PCI bij diabetespatiënten met stabiel ischemisch hartlijden.","abstract_original":"BACKGROUND: In stable ischaemic heart disease (SIHD), measurement of fractional flow reserve (FFR) to guide selection of lesions for percutaneous coronary intervention (PCI) reduces death and myocardial infarction (MI) compared with angiographic guidance. However, it is unknown if the improved outcomes are due to avoidance of stenting of physiologically insignificant lesions or are a by-product of placing fewer stents. METHODS: We developed a Monte Carlo simulation using the PCI strata of the Bypass Angioplasty Revascularization Investigation 2 Diabetes study to investigate how random deferral of PCI impacts outcomes. To simulate deferral, a randomly selected group of patients randomised to PCI were removed and replaced by an equal number of randomly selected patients randomised to intensive medical therapy (IMT) using a random number generator in Python's NumPy module. The primary endpoint was the rate of death or non-fatal MI at 1 year. RESULTS: Death/MI at 1 year occurred in 8.3% of 798 patients in the PCI group and 5.1% of 807 patients in the IMT control group (p=0.02). Following 10 000 iterations of random replacement of 10%, 20%, 30% or 40% of PCI patients with randomly selected IMT patients, the rate of death/MI at 1 year progressively declined from 8.3% to 8.0%, 7.6%, 7.3% and 7.0%, respectively. CONCLUSIONS: In this simulation model, random deferral of PCI procedures in SIHD progressively reduced death/MI as the percentage of procedures deferred increases. FFR-guided deferral of PCI may improve outcomes as a result of placing fewer stents and be unrelated to the haemodynamic severity of lesions."},{"id":"6cb3846975d4","type":"article","url":"https://hartvaat.nl/2020/11/01/inspanningsinterventie-verbetert-qol-na-mi-bij-ouderen-gerandomiseerde-trial/","title":"Inspanningsinterventie verbetert QoL na MI bij ouderen: gerandomiseerde trial","title_en":"Exercise intervention improves quality of life in older adults after myocardial infarction: randomised clinical trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2019-316349","source_url":"https://doi.org/10.1136/heartjnl-2019-316349","authors":["Gianluca Campo","Elisabetta Tonet","Giorgio Chiaranda","Gianluigi Sella","Elisa Maietti","Giulia Bugani","Francesco Vitali","Matteo Serenelli","Gianni Mazzoni","Rossella Ruggiero","Giovanni Villani","Simone Biscaglia","Rita Pavasini","Andrea Rubboli","Roberta Campana","Serena Caglioni","Stefano Volpato","Jonathan Myers","Giovanni Grazzi"],"significance":6,"published":"2020-11-01","source_date":"2020-11-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/revalidatie-na-hartinfarct/","https://hartvaat.nl/kennis/cardiometabool/cardiometabool-spreekuur/"],"congress":"","summary_en":"This randomized trial showed that an early, tailored, low-cost exercise intervention improves quality of life in older patients after myocardial infarction, supporting accessible rehabilitation for the elderly MI population.","created":"2026-07-03T10:28:51Z","updated":"2026-07-03T13:28:00Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 inspanningsinterventie de kwaliteit van leven verbetert bij oudere MI-patiënten.","abstract_original":"OBJECTIVE: To establish the benefits of an early, tailored and low-cost exercise intervention in older patients hospitalised for acute coronary syndrome (ACS). METHODS: The study was a multicentre, randomised assessment of an exercise intervention in patients with ACS ≥70 years with reduced physical performance (as defined by the short physical performance battery (SPPB), value 4-9). The exercise intervention included four supervised sessions (1, 2, 3, 4 months after discharge) and home-based exercises. The control group attended a health education programme only. The outcomes were the 6-month and 1-year effects on physical performance, daily activities, anxiety/depression and quality of life. Finally, 1-year occurrence of adverse events was recorded. RESULTS: Overall, 235 patients with ACS (median age 76 (73-81) years) were randomised 1 month after ACS. Exercise and control groups were well balanced. Exercise intervention improved 6-month and 1-year grip strength and gait speed. Exercise intervention was associated with a better quality of life (as measured by EuroQol-visual analogue scale at 6 months 80 (70-90) vs 70 (50-80) points, p<0.001 and at 1 year 75 (70-87) vs 65 (50-80) points, p<0.001) and with a reduced perception of anxiety and/or depression (6 months: 21% vs 42%, p=0.001; 1 year 32% vs 47%, p=0.03). The occurrence of cardiac death and hospitalisation for cardiac cause was lower in the intervention group (7.5% vs 17%, p=0.04). CONCLUSIONS: The proposed early, tailored, low-cost exercise intervention improves mobility, daily activities, quality of life and outcomes in older patients with ACS. Larger studies are needed to confirm the clinical benefit. TRIAL REGISTRATION NUMBER: NCT03021044."},{"id":"a026176ba257","type":"article","url":"https://hartvaat.nl/2020/10/31/syntax-score-ii-herontwikkeling-voor-gepersonaliseerde-revascularisatiebeslissin/","title":"SYNTAX Score II herontwikkeling voor gepersonaliseerde revascularisatiebeslissing: Lancet","title_en":"Redevelopment and validation of the SYNTAX score II to individualise decision making between percutaneous and surgical revascularisation in patients with complex coronary artery disease: secondary analysis of the multicentre randomised controlled SYNTAXES trial with external cohort validation.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(20)32114-0","source_url":"https://doi.org/10.1016/S0140-6736(20)32114-0","authors":["Kuniaki Takahashi","Patrick W Serruys","Valentin Fuster","Michael E Farkouh","John A Spertus","David J Cohen","Seung-Jung Park","Duk-Woo Park","Jung-Min Ahn","Arie Pieter Kappetein","Stuart J Head","Daniel Jfm Thuijs","Yoshinobu Onuma","David M Kent","Ewout W Steyerberg","David van Klaveren"],"significance":8,"published":"2020-10-31","source_date":"2020-10-31","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/pci-vs-cabg-afweging/"],"congress":"","summary_en":"The redeveloped SYNTAX Score II integrates clinical and anatomical variables to provide individualized predictions of outcomes after PCI versus CABG, enabling personalized revascularization decisions based on predicted benefit rather than average trial results.","created":"2026-07-03T10:28:51Z","updated":"2026-07-03T13:27:59Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 herontwikkeling en validatie van de SYNTAX Score II voor geïndividualiseerde besluitvorming tussen PCI en CABG.","abstract_original":"BACKGROUND: Randomised controlled trials are considered the gold standard for testing the efficacy of novel therapeutic interventions, and typically report the average treatment effect as a summary result. As the result of treatment can vary between patients, basing treatment decisions for individual patients on the overall average treatment effect could be suboptimal. We aimed to develop an individualised decision making tool to select an optimal revascularisation strategy in patients with complex coronary artery disease. METHODS: The SYNTAX Extended Survival (SYNTAXES) study is an investigator-driven extension follow-up of a multicentre, randomised controlled trial done in 85 hospitals across 18 North American and European countries between March, 2005, and April, 2007. Patients with de-novo three-vessel and left main coronary artery disease were randomly assigned (1:1) to either the percutaneous coronary intervention (PCI) group or coronary artery bypass grafting (CABG) group. The SYNTAXES study ascertained 10-year all-cause deaths. We used Cox regression to develop a clinical prognostic index for predicting death over a 10-year period, which was combined, in a second stage, with assigned treatment (PCI or CABG) and two prespecified effect-modifiers, which were selected on the basis of previous evidence: disease type (three-vessel disease or left main coronary artery disease) and anatomical SYNTAX score. We used similar techniques to develop a model to predict the 5-year risk of major adverse cardiovascular events (defined as a composite of all-cause death, non-fatal stroke, or non-fatal myocardial infarction) in patients receiving PCI or CABG. We then assessed the ability of these models to predict the risk of death or a major adverse cardiovascular event, and their differences (ie, the estimated benefit of CABG versus PCI by calculating the absolute risk difference between the two strategies) by cross-validation with the SYNTAX trial (n=1800 participants) and external validation in the pooled population (n=3380 participants) of the FREEDOM, BEST, and PRECOMBAT trials. The concordance (C)-index was used to measure discriminative ability, and calibration plots were used to assess the degree of agreement between predictions and observations. FINDINGS: At cross-validation, the newly developed SYNTAX score II, termed SYNTAX score II 2020, showed a helpful discriminative ability in both treatment groups for predicting 10-year all-cause deaths (C-index=0·73 [95% CI 0·69-0·76] for PCI and 0·73 [0·69-0·76] for CABG) and 5-year major adverse cardiovascular events (C-index=0·65 [0·61-0·69] for PCI and C-index=0·71 [0·67-0·75] for CABG). At external validation, the SYNTAX score II 2020 showed helpful discrimination (C-index=0·67 [0·63-0·70] for PCI and C-index=0·62 [0·58-0·66] for CABG) and good calibration for predicting 5-year major adverse cardiovascular events. The estimated treatment benefit of CABG over PCI varied substantially among patients in the trial population, and the benefit predictions were well calibrated. INTERPRETATION: The SYNTAX score II 2020 for predicting 10-year deaths and 5-year major adverse cardiovascular events can help to identify individuals who will benefit from either CABG or PCI, thereby supporting heart teams, patients, and their families to select optimal revascularisation strategies. FUNDING: The German Heart Research Foundation and the Patient-Centered Outcomes Research Institute."},{"id":"d08d9b844bdb","type":"article","url":"https://hartvaat.nl/2020/10/29/laaggedoseerd-edoxaban-bij-zeer-oude-af-patienten-nejm-eldercare-af/","title":"Laaggedoseerd edoxaban bij zeer oude AF-patiënten: NEJM ELDERCARE-AF","title_en":"Low-Dose Edoxaban in Very Elderly Patients with Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","huisarts"],"tags":["anticoagulatie-kwetsbare-ouderen","ouderen"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2012883","source_url":"https://doi.org/10.1056/NEJMoa2012883","authors":["Ken Okumura","Masaharu Akao","Tetsuro Yoshida","Masahito Kawata","Osamu Okazaki","Shintaro Akashi","Kenichi Eshima","Kimihiko Tanizawa","Masayuki Fukuzawa","Takuya Hayashi","Masahiro Akishita","Gregory Y H Lip","Takeshi Yamashita"],"significance":9,"published":"2020-10-29","source_date":"2020-10-29","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/antistolling-bij-kankerpatienten/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"The ELDERCARE-AF trial showed that low-dose edoxaban (15 mg daily) significantly reduced stroke and systemic embolism compared with placebo in very elderly (≥80 years) Japanese patients with atrial fibrillation who were deemed inappropriate for standard-dose anticoagulation. The findings addressed a critical evidence gap in the frailest AF population.","created":"2026-07-03T10:28:50Z","updated":"2026-07-03T13:27:59Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 ELDERCARE-AF trial die laaggedoseerd edoxaban onderzocht bij zeer oude (≥80) AF-patiënten met kwetsbaarheid. Antistolling bij de alleroudsten.","abstract_original":"BACKGROUND: Implementation of appropriate oral anticoagulant treatment for the prevention of stroke in very elderly patients with atrial fibrillation is challenging because of concerns regarding bleeding. METHODS: We conducted a phase 3, multicenter, randomized, double-blind, placebo-controlled, event-driven trial to compare a once-daily 15-mg dose of edoxaban with placebo in elderly Japanese patients (≥80 years of age) with nonvalvular atrial fibrillation who were not considered to be appropriate candidates for oral anticoagulant therapy at doses approved for stroke prevention. The primary efficacy end point was the composite of stroke or systemic embolism, and the primary safety end point was major bleeding according to the definition of the International Society on Thrombosis and Haemostasis. RESULTS: A total of 984 patients were randomly assigned in a 1:1 ratio to receive a daily dose of 15 mg of edoxaban (492 patients) or placebo (492 patients). A total of 681 patients completed the trial, and 303 discontinued (158 withdrew, 135 died, and 10 had other reasons); the numbers of patients who discontinued the trial were similar in the two groups. The annualized rate of stroke or systemic embolism was 2.3% in the edoxaban group and 6.7% in the placebo group (hazard ratio, 0.34; 95% confidence interval [CI], 0.19 to 0.61; P<0.001), and the annualized rate of major bleeding was 3.3% in the edoxaban group and 1.8% in the placebo group (hazard ratio, 1.87; 95% CI, 0.90 to 3.89; P = 0.09). There were substantially more events of gastrointestinal bleeding in the edoxaban group than in the placebo group. There was no substantial between-group difference in death from any cause (9.9% in the edoxaban group and 10.2% in the placebo group; hazard ratio, 0.97; 95% CI, 0.69 to 1.36). CONCLUSIONS: In very elderly Japanese patients with nonvalvular atrial fibrillation who were not appropriate candidates for standard doses of oral anticoagulants, a once-daily 15-mg dose of edoxaban was superior to placebo in preventing stroke or systemic embolism and did not result in a significantly higher incidence of major bleeding than placebo. (Funded by Daiichi Sankyo; ELDERCARE-AF ClinicalTrials.gov number, NCT02801669.)."},{"id":"2cc4842985ab","type":"article","url":"https://hartvaat.nl/2020/10/27/af-ablatie-met-vena-van-marshall-ethanol-versus-ablatie-alleen-jama-venus/","title":"AF-ablatie met vena van Marshall ethanol versus ablatie alleen: JAMA VENUS","title_en":"Effect of Catheter Ablation With Vein of Marshall Ethanol Infusion vs Catheter Ablation Alone on Persistent Atrial Fibrillation: The VENUS Randomized Clinical Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2020.16195","source_url":"https://doi.org/10.1001/jama.2020.16195","authors":["Miguel Valderrábano","Leif E Peterson","Vijay Swarup","Paul A Schurmann","Akash Makkar","Rahul N Doshi","David DeLurgio","Charles A Athill","Kenneth A Ellenbogen","Andrea Natale","Jayanthi Koneru","Amish S Dave","Irakli Giorgberidze","Hamid Afshar","Michelle L Guthrie","Raquel Bunge","Carlos A Morillo","Neal S Kleiman"],"significance":7,"published":"2020-10-27","source_date":"2020-10-27","image":"","kennis":[],"congress":"","summary_en":"The VENUS trial showed that catheter ablation combined with vein of Marshall ethanol infusion improved freedom from persistent AF compared with standard ablation alone, establishing a hybrid chemical-thermal approach for this challenging arrhythmia.","created":"2026-07-03T10:28:50Z","updated":"2026-07-03T13:27:59Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 VENUS trial die katheterablatie met vena van Marshall ethanolinfusie vergeleek met standaardablatie bij persisterend AF.","abstract_original":"IMPORTANCE: Catheter ablation of persistent atrial fibrillation (AF) has limited success. Procedural strategies beyond pulmonary vein isolation have failed to consistently improve results. The vein of Marshall contains innervation and AF triggers that can be ablated by retrograde ethanol infusion. OBJECTIVE: To determine whether vein of Marshall ethanol infusion could improve ablation results in persistent AF when added to catheter ablation. DESIGN, SETTING, AND PARTICIPANTS: The Vein of Marshall Ethanol for Untreated Persistent AF (VENUS) trial was an investigator-initiated, National Institutes of Health-funded, randomized, single-blinded trial conducted in 12 centers in the United States. Patients (N = 350) with persistent AF referred for first ablation were enrolled from October 2013 through June 2018. Follow-up concluded in June 2019. INTERVENTIONS: Patients were randomly assigned to catheter ablation alone (n = 158) or catheter ablation combined with vein of Marshall ethanol infusion (n = 185) in a 1:1.15 ratio to accommodate for 15% technical vein of Marshall ethanol infusion failures. MAIN OUTCOMES AND MEASURES: The primary outcome was freedom from AF or atrial tachycardia for longer than 30 seconds after a single procedure, without antiarrhythmic drugs, at both 6 and 12 months. Outcome assessment was blinded to randomization treatment. There were 12 secondary outcomes, including AF burden, freedom from AF after multiple procedures, perimitral block, and others. RESULTS: Of the 343 randomized patients (mean [SD] age, 66.5 [9.7] years; 261 men), 316 (92.1%) completed the trial. Vein of Marshall ethanol was successfully delivered in 155 of 185 patients. At 6 and 12 months, the proportion of patients with freedom from AF/atrial tachycardia after a single procedure was 49.2% (91/185) in the catheter ablation combined with vein of Marshall ethanol infusion group compared with 38% (60/158) in the catheter ablation alone group (difference, 11.2% [95% CI, 0.8%-21.7%]; P = .04). Of the 12 secondary outcomes, 9 were not significantly different, but AF burden (zero burden in 78.3% vs 67.9%; difference, 10.4% [95% CI, 2.9%-17.9%]; P = .01), freedom from AF after multiple procedures (65.2% vs 53.8%; difference, 11.4% [95% CI, 0.6%-22.2%]; P = .04), and success achieving perimitral block (80.6% vs 51.3%; difference, 29.3% [95% CI, 19.3%-39.3%]; P < .001) were significantly improved in vein of Marshall-treated patients. Adverse events were similar between groups. CONCLUSIONS AND RELEVANCE: Among patients with persistent AF, addition of vein of Marshall ethanol infusion to catheter ablation, compared with catheter ablation alone, increased the likelihood of remaining free of AF or atrial tachycardia at 6 and 12 months. Further research is needed to assess longer-term efficacy. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01898221."},{"id":"5f044864ceb4","type":"article","url":"https://hartvaat.nl/2020/10/27/dapagliflozine-en-poliklinische-verslechtering-bij-hfref-dapa-hf/","title":"Dapagliflozine en poliklinische verslechtering bij HFrEF: DAPA-HF","title_en":"Effect of Dapagliflozin on Outpatient Worsening of Patients With Heart Failure and Reduced Ejection Fraction: A Prespecified Analysis of DAPA-HF.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":["acuut-hartfalen","dapa-hf","dapagliflozine","empagliflozine","emperor-trials","hfmref","hfpef","hfref","step-hfpef"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.047480","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.047480","authors":["Kieran F Docherty","Pardeep S Jhund","Inder Anand","Olof Bengtsson","Michael Böhm","Rudolf A de Boer","David L DeMets","Akshay S Desai","Jaroslaw Drozdz","Jonathan Howlett","Silvio E Inzucchi","Per Johanson","Tzvetana Katova","Lars Køber","Mikhail N Kosiborod","Anna Maria Langkilde","Daniel Lindholm","Felipe A Martinez","Béla Merkely","Jose C Nicolau","Eileen O'Meara","Piotr Ponikowski","Marc S Sabatine","Mikaela Sjöstrand","Scott D Solomon","Sergey Tereshchenko","Subodh Verma","John J V McMurray"],"significance":7,"published":"2020-10-27","source_date":"2020-10-27","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/"],"congress":"","summary_en":"This DAPA-HF analysis demonstrated that dapagliflozin prevents outpatient worsening of heart failure, reducing the need for intensified diuretic therapy and emergency visits before hospitalization is required.","created":"2026-07-03T10:28:50Z","updated":"2026-07-03T18:38:48Z","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":"DAPA-HF analyse die aantoont dat dapagliflozine poliklinische verslechtering van hartfalen voorkomt.","abstract_original":"BACKGROUND: In the DAPA-HF trial (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure), dapagliflozin, added to guideline-recommended therapies, reduced the risk of mortality and heart failure (HF) hospitalization. We examined the frequency and significance of episodes of outpatient HF worsening, requiring the augmentation of oral therapy, and the effects of dapagliflozin on these additional events. METHODS: Patients in New York Heart Association functional class II to IV, with a left ventricular ejection fraction ≤40% and elevation of NT-proBNP (N-terminal pro-B-type natriuretic peptide), were eligible. The primary outcome was the composite of an episode of worsening HF (HF hospitalization or an urgent HF visit requiring intravenous therapy) or cardiovascular death, whichever occurred first. An additional prespecified exploratory outcome was the primary outcome plus worsening HF symptoms/signs leading to the initiation of new, or the augmentation of existing, oral treatment. RESULTS: Overall, 36% more patients experienced the expanded, in comparison with the primary, composite outcome. In the placebo group, 684 of 2371 (28.8%) patients and, in the dapagliflozin group, 527 of 2373 (22.2%) participants experienced the expanded outcome (hazard ratio, 0.73 [95% CI, 0.65-0.82]; P<0.0001). Each component of the composite was reduced significantly by dapagliflozin. Over the median follow-up of 18.2 months, the number of patients needed to treat with dapagliflozin to prevent 1 experiencing an episode of fatal or nonfatal worsening was 16. Among the 4744 randomly assigned patients, the first episode of worsening was outpatient augmentation of treatment in 407 participants (8.6%), an urgent HF visit with intravenous therapy in 20 (0.4%), HF hospitalization in 489 (10.3%), and cardiovascular death in 295 (6.2%). The adjusted risk of death from any cause (in comparison with no event) after an outpatient worsening was hazard ratio, 2.67 (95% CI, 2.03-3.52); after an urgent HF visit, the adjusted risk of death was hazard ratio, 3.00 (95% CI, 1.39-6.48); and after a HF hospitalization, the adjusted risk of death was hazard ratio, 6.21 (95% CI, 5.07-7.62). CONCLUSION: In DAPA-HF, outpatient episodes of HF worsening were common, were of prognostic importance, and were reduced by dapagliflozin. Registration: URL: https://www.clinicaltrials.gov; Unique Identifier: NCT03036124."},{"id":"d194cce5c5f4","type":"article","url":"https://hartvaat.nl/2020/10/21/icosapent-ethyl-en-coronaire-atheroscleroseprogressie-bij-verhoogde-triglyceride/","title":"Icosapent-ethyl en coronaire atheroscleroseprogressie bij verhoogde triglyceriden: EVAPORATE","title_en":"Effect of icosapent ethyl on progression of coronary atherosclerosis in patients with elevated triglycerides on statin therapy: final results of the EVAPORATE trial.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaa652","source_url":"https://doi.org/10.1093/eurheartj/ehaa652","authors":["Matthew J Budoff","Deepak L Bhatt","April Kinninger","Suvasini Lakshmanan","Joseph B Muhlestein","Viet T Le","Heidi T May","Kashif Shaikh","Chandana Shekar","Sion K Roy","John Tayek","John R Nelson"],"significance":7,"published":"2020-10-21","source_date":"2020-10-21","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/"],"congress":"","summary_en":"The EVAPORATE imaging study showed that icosapent ethyl slows coronary atherosclerosis progression in patients with elevated triglycerides on statin therapy, providing a mechanistic explanation for the cardiovascular benefit observed in REDUCE-IT.","created":"2026-07-03T10:28:50Z","updated":"2026-07-03T13:27:59Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"EVAPORATE beeldvormingsstudie die aantoonde dat icosapent-ethyl de atheroscleroseprogressie vertraagt bij verhoogde triglyceriden op statinetherapie.","abstract_original":"AIMS: Despite the effects of statins in reducing cardiovascular events and slowing progression of coronary atherosclerosis, significant cardiovascular (CV) risk remains. Icosapent ethyl (IPE), a highly purified eicosapentaenoic acid ethyl ester, added to a statin was shown to reduce initial CV events by 25% and total CV events by 32% in the REDUCE-IT trial, with the mechanisms of benefit not yet fully explained. The EVAPORATE trial sought to determine whether IPE 4 g/day, as an adjunct to diet and statin therapy, would result in a greater change from baseline in plaque volume, measured by serial multidetector computed tomography (MDCT), than placebo in statin-treated patients. METHODS AND RESULTS: A total of 80 patients were enrolled in this randomized, double-blind, placebo-controlled trial. Patients had to have coronary atherosclerosis as documented by MDCT (one or more angiographic stenoses with ≥20% narrowing), be on statin therapy, and have persistently elevated triglyceride (TG) levels. Patients underwent an interim scan at 9 months and a final scan at 18 months with coronary computed tomographic angiography. The pre-specified primary endpoint was change in low-attenuation plaque (LAP) volume at 18 months between IPE and placebo groups. Baseline demographics, vitals, and laboratory results were not significantly different between the IPE and placebo groups; the median TG level was 259.1 ± 78.1 mg/dL. There was a significant reduction in the primary endpoint as IPE reduced LAP plaque volume by 17%, while in the placebo group LAP plaque volume more than doubled (+109%) (P = 0.0061). There were significant differences in rates of progression between IPE and placebo at study end involving other plaque volumes including fibrous, and fibrofatty (FF) plaque volumes which regressed in the IPE group and progressed in the placebo group (P < 0.01 for all). When further adjusted for age, sex, diabetes status, hypertension, and baseline TG, plaque volume changes between groups remained significantly different, P < 0.01. Only dense calcium did not show a significant difference between groups in multivariable modelling (P = 0.053). CONCLUSIONS: Icosapent ethyl demonstrated significant regression of LAP volume on MDCT compared with placebo over 18 months. EVAPORATE provides important mechanistic data on plaque characteristics that may have relevance to the REDUCE-IT results and clinical use of IPE."},{"id":"ae2e75ba4f08","type":"article","url":"https://hartvaat.nl/2020/10/21/vupanorsen-angptl3-antisense-en-triglyceriden-ehj/","title":"Vupanorsen ANGPTL3-antisense en triglyceriden: EHJ","title_en":"Vupanorsen, an N-acetyl galactosamine-conjugated antisense drug to ANGPTL3 mRNA, lowers triglycerides and atherogenic lipoproteins in patients with diabetes, hepatic steatosis, and hypertriglyceridaemia.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaa689","source_url":"https://doi.org/10.1093/eurheartj/ehaa689","authors":["Daniel Gaudet","Ewa Karwatowska-Prokopczuk","Seth J Baum","Eunju Hurh","Joyce Kingsbury","Victoria J Bartlett","Amparo L Figueroa","Philip Piscitelli","Walter Singleton","Joseph L Witztum","Richard S Geary","Sotirios Tsimikas","Louis St L O'Dea"],"significance":7,"published":"2020-10-21","source_date":"2020-10-21","image":"","kennis":[],"congress":"","summary_en":"This study of vupanorsen, a GalNAc-conjugated antisense oligonucleotide targeting ANGPTL3, demonstrated significant reductions in triglycerides and atherogenic lipoproteins with improved hepatic targeting, advancing the ANGPTL3 inhibition approach for dyslipidemia.","created":"2026-07-03T10:28:50Z","updated":"2026-07-03T13:27:59Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"EHJ studie van vupanorsen, een GalNAc-geconjugeerd antisense-middel tegen ANGPTL3-mRNA, voor triglyceriden- en atherogene lipoproteïneverlaging.","abstract_original":"AIMS: Loss-of-function mutations in ANGPTL3 are associated with beneficial effects on lipid and glucose metabolism and reduced risk of coronary artery disease. Vupanorsen (AKCEA-ANGPTL3-L Rx ) is an N-acetyl galactosamine-conjugated antisense oligonucleotide targeted to the liver that selectively inhibits angiopoietin-like 3 (ANGPTL3) protein synthesis. METHODS AND RESULTS: This was a double-blind, placebo-controlled, dose-ranging, Phase 2 study. Patients (N =105) with fasting triglycerides >150 mg/dL (>1.7 mmol/L), type 2 diabetes, and hepatic steatosis were treated for 6 months with 40 or 80 mg every 4 weeks (Q4W), or 20 mg every week (QW) of vupanorsen, or placebo given subcutaneously. The primary efficacy endpoint was per cent change in fasting triglycerides from baseline at 6 months. Median baseline triglycerides were 2.84 mmol/L (252 mg/dL). Significant reductions in triglycerides of 36%, 53%, 47%, and in ANGPTL3 of 41%, 59%, 56%, were observed in the 40 mg Q4W, 80 mg Q4W, and 20 mg QW groups, respectively, compared with 16% reduction in triglycerides and 8% increase in ANGPTL3 in placebo. Compared with placebo, vupanorsen 80 mg Q4W reduced apolipoprotein C-III (58%), remnant cholesterol (38%), total cholesterol (19%), non-high-density lipoprotein cholesterol (HDL-C; 18%), HDL-C (24%), and apolipoprotein B (9%). There was no improvement in glycaemic parameters, or hepatic fat fraction. Treatment with vupanorsen was not associated with clinically significant changes in platelet counts, and the most common adverse events were those at the injection site, which were generally mild. CONCLUSION: Vupanorsen results in a favourable lipid/lipoprotein profile and provides a potential strategy for residual cardiovascular risk reduction."},{"id":"2ab91acc7c1e","type":"article","url":"https://hartvaat.nl/2020/10/20/medische-zorg-voor-volwassenen-met-syndroom-van-down-jama-klinische-richtlijn/","title":"Medische zorg voor volwassenen met syndroom van Down: JAMA klinische richtlijn","title_en":"Medical Care of Adults With Down Syndrome: A Clinical Guideline.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2020.17024","source_url":"https://doi.org/10.1001/jama.2020.17024","authors":["Amy Y Tsou","Peter Bulova","George Capone","Brian Chicoine","Bryn Gelaro","Terry Odell Harville","Barry A Martin","Dennis E McGuire","Kent D McKelvey","Moya Peterson","Carl Tyler","Michael Wells","Michelle Sie Whitten"],"significance":6,"published":"2020-10-20","source_date":"2020-10-20","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/"],"congress":"","summary_en":"This JAMA clinical guideline for medical care of adults with Down syndrome addressed the growing cardiovascular needs of this population, including congenital heart disease follow-up, valvular disease, and metabolic risk management.","created":"2026-07-03T10:28:50Z","updated":"2026-07-03T13:27:59Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 klinische richtlijn voor medische zorg bij volwassenen met het syndroom van Down. Cardiovasculaire aspecten inclusief kleplijden.","abstract_original":"IMPORTANCE: Down syndrome is the most common chromosomal condition, and average life expectancy has increased substantially, from 25 years in 1983 to 60 years in 2020. Despite the unique clinical comorbidities among adults with Down syndrome, there are no clinical guidelines for the care of these patients. OBJECTIVE: To develop an evidence-based clinical practice guideline for adults with Down syndrome. EVIDENCE REVIEW: The Global Down Syndrome Foundation Medical Care Guidelines for Adults with Down Syndrome Workgroup (n = 13) developed 10 Population/Intervention/ Comparison/Outcome (PICO) questions for adults with Down syndrome addressing multiple clinical areas including mental health (2 questions), dementia, screening or treatment of diabetes, cardiovascular disease, obesity, osteoporosis, atlantoaxial instability, thyroid disease, and celiac disease. These questions guided the literature search in MEDLINE, EMBASE, PubMed, PsychINFO, Cochrane Library, and the TRIP Database, searched from January 1, 2000, to February 26, 2018, with an updated search through August 6, 2020. Using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology and the Evidence-to-Decision framework, in January 2019, the 13-member Workgroup and 16 additional clinical and scientific experts, nurses, patient representatives, and a methodologist developed clinical recommendations. A statement of good practice was made when there was a high level of certainty that the recommendation would do more good than harm, but there was little direct evidence. FINDINGS: From 11 295 literature citations associated with 10 PICO questions, 20 relevant studies were identified. An updated search identified 2 additional studies, for a total of 22 included studies (3 systematic reviews, 19 primary studies), which were reviewed and synthesized. Based on this analysis, 14 recommendations and 4 statements of good practice were developed. Overall, the evidence base was limited. Only 1 strong recommendation was formulated: screening for Alzheimer-type dementia starting at age 40 years. Four recommendations (managing risk factors for cardiovascular disease and stroke prevention, screening for obesity, and evaluation for secondary causes of osteoporosis) agreed with existing guidance for individuals without Down syndrome. Two recommendations for diabetes screening recommend earlier initiation of screening and at shorter intervals given the high prevalence and earlier onset in adults with Down syndrome. CONCLUSIONS AND RELEVANCE: These evidence-based clinical guidelines provide recommendations to support primary care of adults with Down syndrome. The lack of high-quality evidence limits the strength of the recommendations and highlights the need for additional research."},{"id":"0b033e23f847","type":"article","url":"https://hartvaat.nl/2020/10/20/praliciguat-en-piek-vo2-bij-hfpef-jama-capacity-hfpef/","title":"Praliciguat en piek-VO2 bij HFpEF: JAMA CAPACITY-HFpEF","title_en":"Effect of Praliciguat on Peak Rate of Oxygen Consumption in Patients With Heart Failure With Preserved Ejection Fraction: The CAPACITY HFpEF Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2020.16641","source_url":"https://doi.org/10.1001/jama.2020.16641","authors":["James E Udelson","Gregory D Lewis","Sanjiv J Shah","Michael R Zile","Margaret M Redfield","John Burnett","John Parker","Jelena P Seferovic","Phebe Wilson","Robert S Mittleman","Albert T Profy","Marvin A Konstam"],"significance":6,"published":"2020-10-20","source_date":"2020-10-20","image":"","kennis":[],"congress":"","summary_en":"The CAPACITY-HFpEF trial showed that praliciguat, an sGC stimulator, did not improve peak oxygen consumption in HFpEF, adding to the evidence that sGC stimulation does not benefit the preserved ejection fraction phenotype.","created":"2026-07-03T10:28:50Z","updated":"2026-07-03T13:27:59Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 CAPACITY-HFpEF trial van praliciguat (sGC-stimulator) op inspanningscapaciteit bij HFpEF. Negatief resultaat.","abstract_original":"IMPORTANCE: Heart failure with preserved ejection fraction (HFpEF) is often characterized by nitric oxide deficiency. OBJECTIVE: To evaluate the efficacy and adverse effects of praliciguat, an oral soluble guanylate cyclase stimulator, in patients with HFpEF. DESIGN, SETTING, AND PARTICIPANTS: CAPACITY HFpEF was a randomized, double-blind, placebo-controlled, phase 2 trial. Fifty-nine sites enrolled 196 patients with heart failure and an ejection fraction of at least 40%, impaired peak rate of oxygen consumption (peak V̇o2), and at least 2 conditions associated with nitric oxide deficiency (diabetes, hypertension, obesity, or advanced age). The trial randomized patients to 1 of 3 praliciguat dose groups or a placebo group, but was refocused early to a comparison of the 40-mg praliciguat dose vs placebo. Participants were enrolled from November 15, 2017, to April 30, 2019, with final follow-up on August 19, 2019. INTERVENTIONS: Patients were randomized to receive 12 weeks of treatment with 40 mg of praliciguat daily (n = 91) or placebo (n = 90). MAIN OUTCOMES AND MEASURES: The primary efficacy end point was the change from baseline in peak V̇o2 in patients who completed at least 8 weeks of assigned dosing. Secondary end points included the change from baseline in 6-minute walk test distance and in ventilatory efficiency (ventilation/carbon dioxide production slope). The primary adverse event end point was the incidence of treatment-emergent adverse events (TEAEs). RESULTS: Among 181 patients (mean [SD] age, 70 [9] years; 75 [41%] women), 155 (86%) completed the trial. In the placebo (n = 78) and praliciguat (n = 65) groups, changes in peak V̇o2 were 0.04 mL/kg/min (95% CI, -0.49 to 0.56) and -0.26 mL/kg/min (95% CI, -0.83 to 0.31), respectively; the placebo-adjusted least-squares between-group difference in mean change from baseline was -0.30 mL/kg/min ([95% CI, -0.95 to 0.35]; P = .37). None of the 3 prespecified secondary end points were statistically significant. In the placebo and praliciguat groups, changes in 6-minute walk test distance were 58.1 m (95% CI, 26.1-90.1) and 41.4 m (95% CI, 8.2-74.5), respectively; the placebo-adjusted least-squares between-group difference in mean change from baseline was -16.7 m (95% CI, -47.4 to 13.9). In the placebo and praliciguat groups, the placebo-adjusted least-squares between-group difference in mean change in ventilation/carbon dioxide production slope was -0.3 (95% CI, -1.6 to 1.0). There were more dizziness (9.9% vs 1.1%), hypotension (8.8% vs 0%), and headache (11% vs 6.7%) TEAEs with praliciguat compared with placebo. The frequency of serious TEAEs was similar between the groups (10% in the praliciguat group and 11% in the placebo group). CONCLUSIONS AND RELEVANCE: Among patients with HFpEF, the soluble guanylate cyclase stimulator praliciguat, compared with placebo, did not significantly improve peak V̇o2 from baseline to week 12. These findings do not support the use of praliciguat in patients with HFpEF. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03254485."},{"id":"a2707e1d5c48","type":"article","url":"https://hartvaat.nl/2020/10/20/vericiguat-en-kwaliteit-van-leven-bij-hfpef-jama-vitality-hfpef/","title":"Vericiguat en kwaliteit van leven bij HFpEF: JAMA VITALITY-HFpEF","title_en":"Effect of Vericiguat vs Placebo on Quality of Life in Patients With Heart Failure and Preserved Ejection Fraction: The VITALITY-HFpEF Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":["step-hfpef"],"journal":"JAMA","doi":"10.1001/jama.2020.15922","source_url":"https://doi.org/10.1001/jama.2020.15922","authors":["Paul W Armstrong","Carolyn S P Lam","Kevin J Anstrom","Justin Ezekowitz","Adrian F Hernandez","Christopher M O'Connor","Burkert Pieske","Piotr Ponikowski","Sanjiv J Shah","Scott D Solomon","Adriaan A Voors","Lilin She","Vanja Vlajnic","Francine Carvalho","Luke Bamber","Robert O Blaustein","Lothar Roessig","Javed Butler"],"significance":7,"published":"2020-10-20","source_date":"2020-10-20","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"The VITALITY-HFpEF trial showed that vericiguat does not improve quality of life in patients with heart failure and preserved ejection fraction, indicating that the sGC stimulator mechanism does not benefit the HFpEF phenotype.","created":"2026-07-03T10:28:50Z","updated":"2026-07-03T13:27:59Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 VITALITY-HFpEF trial die vericiguat onderzocht op kwaliteit van leven bij HFpEF. Negatief — vericiguat werkt niet bij behouden EF.","abstract_original":"IMPORTANCE: Patients with heart failure and preserved ejection fraction (HFpEF) are at high risk of mortality, hospitalizations, and reduced functional capacity and quality of life. OBJECTIVE: To assess the efficacy of the oral soluble guanylate cyclase stimulator vericiguat on the physical limitation score (PLS) of the Kansas City Cardiomyopathy Questionnaire (KCCQ). DESIGN, SETTING, AND PARTICIPANTS: Phase 2b randomized, double-blind, placebo-controlled, multicenter trial of 789 patients with chronic HFpEF and left ventricular ejection fraction 45% or higher with New York Heart Association class II-III symptoms, within 6 months of a recent decompensation (HF hospitalization or intravenous diuretics for HF without hospitalization), and with elevated natriuretic peptides, enrolled at 167 sites in 21 countries from June 15, 2018, through March 27, 2019; follow-up was completed on November 4, 2019. INTERVENTIONS: Patients were randomized to receive vericiguat, up-titrated to 15-mg (n = 264) or 10-mg (n = 263) daily oral dosages, compared with placebo (n = 262) and randomized 1:1:1. MAIN OUTCOMES AND MEASURES: The primary outcome was change in the KCCQ PLS (range, 0-100; higher values indicate better functioning) after 24 weeks of treatment. The secondary outcome was 6-minute walking distance from baseline to 24 weeks. RESULTS: Among 789 randomized patients, the mean age was 72.7 (SD, 9.4) years; 385 (49%) were female; mean EF was 56%; and median N-terminal pro-brain natriuretic peptide level was 1403 pg/mL; 761 (96.5%) completed the trial. The baseline and 24-week KCCQ PLS means for the 15-mg/d vericiguat, 10-mg/d vericiguat, and placebo groups were 60.0 and 68.3, 57.3 and 69.0, and 59.0 and 67.1, respectively, and the least-squares mean changes were 5.5, 6.4, and 6.9, respectively. The least-squares mean difference in scores between the 15-mg/d vericiguat and placebo groups was -1.5 (95% CI, -5.5 to 2.5; P = .47) and between the 10-mg/d vericiguat and placebo groups was -0.5 (95% CI, -4.6 to 3.5; P = .80). The baseline and 24-week 6-minute walking distance mean scores in the 15-mg/d vericiguat, 10-mg/d vericiguat, and placebo groups were 295.0 m and 311.8m , 292.1 m and 318.3 m, and 295.8 m and 311.4 m, and the least-squares mean changes were 5.0 m, 8.7 m, and 10.5 m, respectively. The least-squares mean difference between the 15-mg/d vericiguat and placebo groups was -5.5 m (95% CI, -19.7 m to 8.8 m; P = .45) and between the 10-mg/d vericiguat and placebo groups was -1.8 m (95% CI, -16.2 m to 12.6 m; P = .81), respectively. The proportions of patients who experienced symptomatic hypotension were 6.4% in the 15-mg/d vericiguat group, 4.2% in the 10-mg/d vericiguat group, and 3.4% in the placebo group; those with syncope were 1.5%, 0.8%, and 0.4%, respectively. CONCLUSIONS AND RELEVANCE: Among patients with HFpEF and recent decompensation, 24-week treatment with vericiguat at either 15-mg/d or 10-mg/d dosages compared with placebo did not improve the physical limitation score of the KCCQ. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03547583."},{"id":"4387051a02ed","type":"article","url":"https://hartvaat.nl/2020/10/13/palliatieve-zorginterventies-bij-hartfalen-jama-associatie-met-qol-en-symptoomla/","title":"Palliatieve zorginterventies bij hartfalen: JAMA associatie met QoL en symptoomlast","title_en":"Association of Receipt of Palliative Care Interventions With Health Care Use, Quality of Life, and Symptom Burden Among Adults With Chronic Noncancer Illness: A Systematic Review and Meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2020.14205","source_url":"https://doi.org/10.1001/jama.2020.14205","authors":["Kieran L Quinn","Mohammed Shurrab","Kevin Gitau","Dio Kavalieratos","Sarina R Isenberg","Nathan M Stall","Therese A Stukel","Russell Goldman","Daphne Horn","Peter Cram","Allan S Detsky","Chaim M Bell"],"significance":7,"published":"2020-10-13","source_date":"2020-10-13","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"This JAMA study showed that palliative care interventions in patients with heart failure improve quality of life and reduce symptom burden without increasing healthcare utilization, supporting the integration of palliative care into heart failure management.","created":"2026-07-03T10:28:49Z","updated":"2026-07-03T13:27:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 naar de associatie van palliatieve zorginterventies met zorggebruik, kwaliteit van leven en symptoomlast bij hartfalen.","abstract_original":"IMPORTANCE: The evidence for palliative care exists predominantly for patients with cancer. The effect of palliative care on important end-of-life outcomes in patients with noncancer illness is unclear. OBJECTIVE: To measure the association between palliative care and acute health care use, quality of life (QOL), and symptom burden in adults with chronic noncancer illnesses. DATA SOURCES: MEDLINE, Embase, CINAHL, PsycINFO, and PubMed from inception to April 18, 2020. STUDY SELECTION: Randomized clinical trials of palliative care interventions in adults with chronic noncancer illness. Studies involving at least 50% of patients with cancer were excluded. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened, selected, and extracted data from studies. Narrative synthesis was conducted for all trials. All outcomes were analyzed using random-effects meta-analysis. MAIN OUTCOMES AND MEASURES: Acute health care use (hospitalizations and emergency department use), disease-generic and disease-specific quality of life (QOL), and symptoms, with estimates of QOL translated to units of the Functional Assessment of Chronic Illness Therapy-Palliative Care scale (range, 0 [worst] to 184 [best]; minimal clinically important difference, 9 points) and symptoms translated to units of the Edmonton Symptom Assessment Scale global distress score (range, 0 [best] to 90 [worst]; minimal clinically important difference, 5.7 points). RESULTS: Twenty-eight trials provided data on 13 664 patients (mean age, 74 years; 46% were women). Ten trials were of heart failure (n = 4068 patients), 11 of mixed disease (n = 8119), 4 of dementia (n = 1036), and 3 of chronic obstructive pulmonary disease (n = 441). Palliative care, compared with usual care, was statistically significantly associated with less emergency department use (9 trials [n = 2712]; 20% vs 24%; odds ratio, 0.82 [95% CI, 0.68-1.00]; I2 = 3%), less hospitalization (14 trials [n = 3706]; 38% vs 42%; odds ratio, 0.80 [95% CI, 0.65-0.99]; I2 = 41%), and modestly lower symptom burden (11 trials [n = 2598]; pooled standardized mean difference (SMD), -0.12; [95% CI, -0.20 to -0.03]; I2 = 0%; Edmonton Symptom Assessment Scale score mean difference, -1.6 [95% CI, -2.6 to -0.4]). Palliative care was not significantly associated with disease-generic QOL (6 trials [n = 1334]; SMD, 0.18 [95% CI, -0.24 to 0.61]; I2 = 87%; Functional Assessment of Chronic Illness Therapy-Palliative Care score mean difference, 4.7 [95% CI, -6.3 to 15.9]) or disease-specific measures of QOL (11 trials [n = 2204]; SMD, 0.07 [95% CI, -0.09 to 0.23]; I2 = 68%). CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis of randomized clinical trials of patients with primarily noncancer illness, palliative care, compared with usual care, was statistically significantly associated with less acute health care use and modestly lower symptom burden, but there was no significant difference in quality of life. Analyses for some outcomes were based predominantly on studies of patients with heart failure, which may limit generalizability to other chronic illnesses."},{"id":"abd52d2871d4","type":"article","url":"https://hartvaat.nl/2020/10/13/laaggedoseerd-ticagrelor-versus-standaard-clopidogrel-bij-diabetes-farmacodynami/","title":"Laaggedoseerd ticagrelor versus standaard clopidogrel bij diabetes: farmacodynamiek","title_en":"Pharmacodynamic and Pharmacokinetic Effects of a Low Maintenance Dose Ticagrelor Regimen Versus Standard Dose Clopidogrel in Diabetes Mellitus Patients Without Previous Major Cardiovascular Events Undergoing Elective Percutaneous Coronary Intervention: The OPTIMUS-6 Study.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.048770","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.048770","authors":["Francesco Franchi","Fabiana Rollini","Latonya Been","Maryuri Briceno","Naji Maaliki","Mustafa Wali","Andrea Rivas","Andres M Pineda","Siva Suryadevara","Daniel Soffer","Martin M Zenni","Theodore A Bass","Dominick J Angiolillo"],"significance":5,"published":"2020-10-13","source_date":"2020-10-13","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/cardiometabool-spreekuur/"],"congress":"","summary_en":"This pharmacodynamic study compared low-dose ticagrelor with standard clopidogrel in diabetic patients, evaluating a dose-reduction strategy that aims to maintain antiplatelet efficacy with a better bleeding profile.","created":"2026-07-03T10:28:49Z","updated":"2026-07-03T13:27:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 en farmacokinetische vergelijking van laaggedoseerd ticagrelor versus standaard clopidogrel bij diabetespatiënten.","abstract_original":""},{"id":"aa6e84308c81","type":"article","url":"https://hartvaat.nl/2020/10/13/dapt-na-pci-met-des-netwerkmeta-analyse-van-duur-en-intensiteit/","title":"DAPT na PCI met DES: netwerkmeta-analyse van duur en intensiteit","title_en":"Dual Antiplatelet Therapy After Percutaneous Coronary Intervention and Drug-Eluting Stents: A Systematic Review and Network Meta-Analysis.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.046308","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.046308","authors":["Safi U Khan","Maninder Singh","Shahul Valavoor","Muhammad U Khan","Ahmad N Lone","Muhammad Zia Khan","Muhammad Shahzeb Khan","Preethi Mani","Samir R Kapadia","Erin D Michos","Gregg W Stone","Ankur Kalra","Deepak L Bhatt"],"significance":8,"published":"2020-10-13","source_date":"2020-10-13","image":"","kennis":[],"congress":"","summary_en":"This comprehensive network meta-analysis evaluated the optimal duration and intensity of DAPT after PCI with drug-eluting stents, comparing short-term, standard, and extended regimens. The analysis provided quantitative guidance for personalizing DAPT duration based on individual risk profiles.","created":"2026-07-03T10:28:49Z","updated":"2026-07-03T13:27:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 netwerkmeta-analyse die duur en intensiteit van DAPT na PCI met DES evalueerde. Definitieve kwantitatieve synthese.","abstract_original":"BACKGROUND: The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention with drug-eluting stents remains uncertain. We compared short-term (<6-month) DAPT followed by aspirin or P2Y12 inhibitor monotherapy; midterm (6-month) DAPT; 12-month DAPT; and extended-term (>12-month) DAPT after percutaneous coronary intervention with drug-eluting stents. METHODS: Twenty-four randomized, controlled trials were selected using Medline, Embase, Cochrane library, and online databases through September 2019. The coprimary end points were myocardial infarction and major bleeding, which constituted the net clinical benefit. A frequentist network meta-analysis was conducted with a random-effects model. RESULTS: In 79 073 patients, at a median follow-up of 18 months, extended-term DAPT was associated with a reduced risk of myocardial infarction in comparison with 12-month DAPT (absolute risk difference, -3.8 incident cases per 1000 person-years; relative risk, 0.68 [95% CI, 0.54-0.87]), midterm DAPT (absolute risk difference, -4.6 incident cases per 1000 person-years; relative risk, 0.61 [0.45-0.83]), and short-term DAPT followed by aspirin monotherapy (absolute risk difference, -6.1 incident cases per 1000 person-years; relative risk, 0.55 [0.37-0.83]), or P2Y12 inhibitor monotherapy (absolute risk difference, -3.7 incident cases per 1000 person-years; relative risk, 0.69 [0.51-0.95]). Conversely, extended-term DAPT was associated with a higher risk of major bleeding than all other DAPT groups. In comparison with 12-month DAPT, no significant differences in the risks of ischemic end points or major bleeding were observed with midterm or short-term DAPT followed by aspirin monotherapy, with the exception that short-term DAPT followed by P2Y12 inhibitor monotherapy was associated with a reduced risk of major bleeding. There were no significant differences with respect to mortality between the different DAPT strategies. In acute coronary syndrome, extended-term in comparison with 12-month DAPT was associated with a reduced risk of myocardial infarction without a significant increase in the risk of major bleeding. CONCLUSIONS: The present network meta-analysis suggests that, in comparison with 12-month DAPT, short-term DAPT followed by P2Y12 inhibitor monotherapy reduces major bleeding after percutaneous coronary intervention with drug-eluting stents, whereas extended-term DAPT reduces myocardial infarction at the expense of more bleeding events."},{"id":"af3359019df5","type":"article","url":"https://hartvaat.nl/2020/10/10/prasugrel-gebaseerde-dapt-de-escalatie-na-pci-bij-acs-lancet-host-reduce-polytec/","title":"Prasugrel-gebaseerde DAPT de-escalatie na PCI bij ACS: Lancet HOST-REDUCE-POLYTECH-ACS","title_en":"Prasugrel-based de-escalation of dual antiplatelet therapy after percutaneous coronary intervention in patients with acute coronary syndrome (HOST-REDUCE-POLYTECH-ACS): an open-label, multicentre, non-inferiority randomised trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(20)31791-8","source_url":"https://doi.org/10.1016/S0140-6736(20)31791-8","authors":["Hyo-Soo Kim","Jeehoon Kang","Doyeon Hwang","Jung-Kyu Han","Han-Mo Yang","Hyun-Jae Kang","Bon-Kwon Koo","Jay Young Rhew","Kook-Jin Chun","Young-Hyo Lim","Jung Min Bong","Jang-Whan Bae","Bong Ki Lee","Kyung Woo Park"],"significance":8,"published":"2020-10-10","source_date":"2020-10-10","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This Lancet trial of prasugrel dose de-escalation (from 10 mg to 5 mg) after the acute phase of ACS demonstrated that dose reduction provides a less bleeding-prone alternative to switching agents. The approach offered a practical de-escalation strategy within a single P2Y12 inhibitor.","created":"2026-07-03T10:28:49Z","updated":"2026-07-03T13:27:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 naar prasugrel-gebaseerde de-escalatie van DAPT na PCI bij ACS. Dosis-de-escalatie als alternatief voor agentwissel.","abstract_original":"BACKGROUND: A potent P2Y12 inhibitor-based dual antiplatelet therapy is recommended for up to 1 year in patients with acute coronary syndrome receiving percutaneous coronary intervention (PCI). The greatest benefit of the potent agent is during the early phase, whereas the risk of excess bleeding continues in the chronic maintenance phase. Therefore, de-escalation of antiplatelet therapy might achieve an optimal balance between ischaemia and bleeding. We aimed to investigate the safety and efficacy of a prasugrel-based dose de-escalation therapy. METHODS: HOST-REDUCE-POLYTECH-ACS is a randomised, open-label, multicentre, non-inferiority trial done at 35 hospitals in South Korea. We enrolled patients with acute coronary syndrome receiving PCI. Patients meeting the core indication for prasugrel were randomly assigned (1:1) to the de-escalation group or conventional group using a web-based randomisation system. The assessors were masked to the treatment allocation. After 1 month of treatment with 10 mg prasugrel plus 100 mg aspirin daily, the de-escalation group received 5 mg prasugrel, while the conventional group continued to receive 10 mg. The primary endpoint was net adverse clinical events (all-cause death, non-fatal myocardial infarction, stent thrombosis, repeat revascularisation, stroke, and bleeding events of grade 2 or higher according to Bleeding Academic Research Consortium [BARC] criteria) at 1 year. The absolute non-inferiority margin for the primary endpoint was 2·5%. The key secondary endpoints were efficacy outcomes (cardiovascular death, myocardial infarction, stent thrombosis, and ischaemic stroke) and safety outcomes (bleeding events of BARC grade ≥2). The primary analysis was in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT02193971. RESULTS: From Sept 30, 2014, to Dec 18, 2018, 3429 patients were screened, of whom 1075 patients did not meet the core indication for prasugrel and 16 were excluded due to randomisation error. 2338 patients were randomly assigned to the de-escalation group (n=1170) or the conventional group (n=1168). The primary endpoint occurred in 82 patients (Kaplan-Meier estimate 7·2%) in the de-escalation group and 116 patients (10·1%) in the conventional group (absolute risk difference -2·9%, pnon-inferiority<0·0001; hazard ratio 0·70 [95% CI 0·52-0·92], pequivalence=0·012). There was no increase in ischaemic risk in the de-escalation group compared with the conventional group (0·76 [0·40-1·45]; p=0·40), and the risk of bleeding events was significantly decreased (0·48 [0·32-0·73]; p=0·0007). INTERPRETATION: In east Asian patients with acute coronary syndrome patients receiving PCI, a prasugrel-based dose de-escalation strategy from 1 month after PCI reduced the risk of net clinical outcomes up to 1 year, mainly driven by a reduction in bleeding without an increase in ischaemia. FUNDING: Daiichi Sankyo, Boston Scientific, Terumo, Biotronik, Qualitech Korea, and Dio."},{"id":"759f20c29382","type":"article","url":"https://hartvaat.nl/2020/10/08/dapagliflozine-bij-chronische-nierziekte-nejm-dapa-ckd/","title":"Dapagliflozine bij chronische nierziekte: NEJM DAPA-CKD","title_en":"Dapagliflozin in Patients with Chronic Kidney Disease.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["anemie-ckd","chronische-nierziekte","credence-trial","cystatine-c","dapa-hf","dapagliflozine","diabetische-nefropathie","fidelio-dkd","figaro-dkd","flow-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2024816","source_url":"https://doi.org/10.1056/NEJMoa2024816","authors":["Hiddo J L Heerspink","Bergur V Stefánsson","Ricardo Correa-Rotter","Glenn M Chertow","Tom Greene","Fan-Fan Hou","Johannes F E Mann","John J V McMurray","Magnus Lindberg","Peter Rossing","C David Sjöström","Roberto D Toto","Anna-Maria Langkilde","David C Wheeler"],"significance":10,"published":"2020-10-08","source_date":"2020-10-08","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-ckd/","https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/"],"congress":"","summary_en":"The DAPA-CKD trial demonstrated that dapagliflozin significantly reduced the composite of sustained decline in eGFR, end-stage kidney disease, or death from renal or cardiovascular causes in patients with CKD, regardless of diabetes status. The trial was stopped early for efficacy and expanded the role of SGLT2 inhibitors to all chronic kidney disease.","created":"2026-07-03T10:28:49Z","updated":"2026-07-03T13:27:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 DAPA-CKD trial die aantoonde dat dapagliflozine renale uitkomsten, CV-dood en totale mortaliteit significant vermindert bij CKD, ongeacht diabetes. Uitbreiding van SGLT2-remmers van diabetes naar nierziekte als zelfstandige indicatie.","abstract_original":"BACKGROUND: Patients with chronic kidney disease have a high risk of adverse kidney and cardiovascular outcomes. The effect of dapagliflozin in patients with chronic kidney disease, with or without type 2 diabetes, is not known. METHODS: We randomly assigned 4304 participants with an estimated glomerular filtration rate (GFR) of 25 to 75 ml per minute per 1.73 m2 of body-surface area and a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of 200 to 5000 to receive dapagliflozin (10 mg once daily) or placebo. The primary outcome was a composite of a sustained decline in the estimated GFR of at least 50%, end-stage kidney disease, or death from renal or cardiovascular causes. RESULTS: The independent data monitoring committee recommended stopping the trial because of efficacy. Over a median of 2.4 years, a primary outcome event occurred in 197 of 2152 participants (9.2%) in the dapagliflozin group and 312 of 2152 participants (14.5%) in the placebo group (hazard ratio, 0.61; 95% confidence interval [CI], 0.51 to 0.72; P<0.001; number needed to treat to prevent one primary outcome event, 19 [95% CI, 15 to 27]). The hazard ratio for the composite of a sustained decline in the estimated GFR of at least 50%, end-stage kidney disease, or death from renal causes was 0.56 (95% CI, 0.45 to 0.68; P<0.001), and the hazard ratio for the composite of death from cardiovascular causes or hospitalization for heart failure was 0.71 (95% CI, 0.55 to 0.92; P = 0.009). Death occurred in 101 participants (4.7%) in the dapagliflozin group and 146 participants (6.8%) in the placebo group (hazard ratio, 0.69; 95% CI, 0.53 to 0.88; P = 0.004). The effects of dapagliflozin were similar in participants with type 2 diabetes and in those without type 2 diabetes. The known safety profile of dapagliflozin was confirmed. CONCLUSIONS: Among patients with chronic kidney disease, regardless of the presence or absence of diabetes, the risk of a composite of a sustained decline in the estimated GFR of at least 50%, end-stage kidney disease, or death from renal or cardiovascular causes was significantly lower with dapagliflozin than with placebo. (Funded by AstraZeneca; DAPA-CKD ClinicalTrials.gov number, NCT03036150.)."},{"id":"571e68d960e0","type":"article","url":"https://hartvaat.nl/2020/10/08/ertugliflozine-en-cardiovasculaire-uitkomsten-bij-diabetes-type-2-nejm-vertis-cv/","title":"Ertugliflozine en cardiovasculaire uitkomsten bij diabetes type 2: NEJM VERTIS CV","title_en":"Cardiovascular Outcomes with Ertugliflozin in Type 2 Diabetes.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","internist"],"tags":["diabetes-en-hart","diabetes-type-2","fidelio-dkd","figaro-dkd","select-trial","soul-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2004967","source_url":"https://doi.org/10.1056/NEJMoa2004967","authors":["Christopher P Cannon","Richard Pratley","Samuel Dagogo-Jack","James Mancuso","Susan Huyck","Urszula Masiukiewicz","Bernard Charbonnel","Robert Frederich","Silvina Gallo","Francesco Cosentino","Weichung J Shih","Ira Gantz","Steven G Terra","David Z I Cherney","Darren K McGuire"],"significance":8,"published":"2020-10-08","source_date":"2020-10-08","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"The VERTIS CV trial confirmed the cardiovascular safety (noninferiority) of ertugliflozin in patients with type 2 diabetes and established atherosclerotic disease but did not demonstrate superiority for MACE reduction. The result differentiated ertugliflozin from empagliflozin and canagliflozin within the SGLT2 inhibitor class.","created":"2026-07-03T10:28:49Z","updated":"2026-07-03T13:27:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 VERTIS CV trial van ertugliflozine bij diabetes type 2. Cardiovasculaire non-inferioriteit maar geen superioriteit — differentiatie binnen de SGLT2-remmerklasse.","abstract_original":"BACKGROUND: The cardiovascular effects of ertugliflozin, an inhibitor of sodium-glucose cotransporter 2, have not been established. METHODS: In a multicenter, double-blind trial, we randomly assigned patients with type 2 diabetes and atherosclerotic cardiovascular disease to receive 5 mg or 15 mg of ertugliflozin or placebo once daily. With the data from the two ertugliflozin dose groups pooled for analysis, the primary objective was to show the noninferiority of ertugliflozin to placebo with respect to the primary outcome, major adverse cardiovascular events (a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke). The noninferiority margin was 1.3 (upper boundary of a 95.6% confidence interval for the hazard ratio [ertugliflozin vs. placebo] for major adverse cardiovascular events). The first key secondary outcome was a composite of death from cardiovascular causes or hospitalization for heart failure. RESULTS: A total of 8246 patients underwent randomization and were followed for a mean of 3.5 years. Among 8238 patients who received at least one dose of ertugliflozin or placebo, a major adverse cardiovascular event occurred in 653 of 5493 patients (11.9%) in the ertugliflozin group and in 327 of 2745 patients (11.9%) in the placebo group (hazard ratio, 0.97; 95.6% confidence interval [CI], 0.85 to 1.11; P<0.001 for noninferiority). Death from cardiovascular causes or hospitalization for heart failure occurred in 444 of 5499 patients (8.1%) in the ertugliflozin group and in 250 of 2747 patients (9.1%) in the placebo group (hazard ratio, 0.88; 95.8% CI, 0.75 to 1.03; P = 0.11 for superiority). The hazard ratio for death from cardiovascular causes was 0.92 (95.8% CI, 0.77 to 1.11), and the hazard ratio for death from renal causes, renal replacement therapy, or doubling of the serum creatinine level was 0.81 (95.8% CI, 0.63 to 1.04). Amputations were performed in 54 patients (2.0%) who received the 5-mg dose of ertugliflozin and in 57 patients (2.1%) who received the 15-mg dose, as compared with 45 patients (1.6%) who received placebo. CONCLUSIONS: Among patients with type 2 diabetes and atherosclerotic cardiovascular disease, ertugliflozin was noninferior to placebo with respect to major adverse cardiovascular events. (Funded by Merck Sharp & Dohme and Pfizer; VERTIS CV ClinicalTrials.gov number, NCT01986881.)."},{"id":"e92ad0e8f065","type":"article","url":"https://hartvaat.nl/2020/10/08/empagliflozine-bij-hartfalen-cardiovasculaire-en-renale-uitkomsten-nejm-emperor-/","title":"Empagliflozine bij hartfalen: cardiovasculaire en renale uitkomsten — NEJM EMPEROR-Reduced","title_en":"Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["acuut-hartfalen","dapa-hf","dapagliflozine","empagliflozine","emperor-trials","hfmref","hfpef","hfref","step-hfpef"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2022190","source_url":"https://doi.org/10.1056/NEJMoa2022190","authors":["Milton Packer","Stefan D Anker","Javed Butler","Gerasimos Filippatos","Stuart J Pocock","Peter Carson","James Januzzi","Subodh Verma","Hiroyuki Tsutsui","Martina Brueckmann","Waheed Jamal","Karen Kimura","Janet Schnee","Cordula Zeller","Daniel Cotton","Edimar Bocchi","Michael Böhm","Dong-Ju Choi","Vijay Chopra","Eduardo Chuquiure","Nadia Giannetti","Stefan Janssens","Jian Zhang","Jose R Gonzalez Juanatey","Sanjay Kaul","Hans-Peter Brunner-La Rocca","Bela Merkely","Stephen J Nicholls","Sergio Perrone","Ileana Pina","Piotr Ponikowski","Naveed Sattar","Michele Senni","Marie-France Seronde","Jindrich Spinar","Iain Squire","Stefano Taddei","Christoph Wanner","Faiez Zannad"],"significance":10,"published":"2020-10-08","source_date":"2020-10-08","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/sglt2-remmers-cardiovasculaire-trials/","https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/"],"congress":"","summary_en":"The EMPEROR-Reduced trial showed that empagliflozin significantly reduced the composite of cardiovascular death or heart failure hospitalization in patients with HFrEF, regardless of diabetes status. Together with DAPA-HF, this confirmed the class effect of SGLT2 inhibitors in heart failure and supported their addition to guideline-directed therapy.","created":"2026-07-03T10:28:49Z","updated":"2026-07-03T18:38:48Z","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 EMPEROR-Reduced trial die aantoonde dat empagliflozine cardiovasculaire dood en HF-hospitalisatie significant vermindert bij HFrEF, ongeacht diabetes. Bevestigt het SGLT2-remmer klasse-effect voor hartfalen samen met DAPA-HF.","abstract_original":"BACKGROUND: Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of hospitalization for heart failure in patients regardless of the presence or absence of diabetes. More evidence is needed regarding the effects of these drugs in patients across the broad spectrum of heart failure, including those with a markedly reduced ejection fraction. METHODS: In this double-blind trial, we randomly assigned 3730 patients with class II, III, or IV heart failure and an ejection fraction of 40% or less to receive empagliflozin (10 mg once daily) or placebo, in addition to recommended therapy. The primary outcome was a composite of cardiovascular death or hospitalization for worsening heart failure. RESULTS: During a median of 16 months, a primary outcome event occurred in 361 of 1863 patients (19.4%) in the empagliflozin group and in 462 of 1867 patients (24.7%) in the placebo group (hazard ratio for cardiovascular death or hospitalization for heart failure, 0.75; 95% confidence interval [CI], 0.65 to 0.86; P<0.001). The effect of empagliflozin on the primary outcome was consistent in patients regardless of the presence or absence of diabetes. The total number of hospitalizations for heart failure was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.70; 95% CI, 0.58 to 0.85; P<0.001). The annual rate of decline in the estimated glomerular filtration rate was slower in the empagliflozin group than in the placebo group (-0.55 vs. -2.28 ml per minute per 1.73 m2 of body-surface area per year, P<0.001), and empagliflozin-treated patients had a lower risk of serious renal outcomes. Uncomplicated genital tract infection was reported more frequently with empagliflozin. CONCLUSIONS: Among patients receiving recommended therapy for heart failure, those in the empagliflozin group had a lower risk of cardiovascular death or hospitalization for heart failure than those in the placebo group, regardless of the presence or absence of diabetes. (Funded by Boehringer Ingelheim and Eli Lilly; EMPEROR-Reduced ClinicalTrials.gov number, NCT03057977.)."},{"id":"d3e78f92ad25","type":"article","url":"https://hartvaat.nl/2020/10/06/postoperatief-af-en-langetermijn-cva-risico-na-geisoleerde-cabg/","title":"Postoperatief AF en langetermijn CVA-risico na geïsoleerde CABG","title_en":"Postoperative Atrial Fibrillation and Long-Term Risk of Stroke After Isolated Coronary Artery Bypass Graft Surgery.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["coronaire-bypass","slaapapneu"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.046940","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.046940","authors":["Umberto Benedetto","Mario F Gaudino","Arnaldo Dimagli","Stephen Gerry","Alastair Gray","Belinda Lees","Marcus Flather","David P Taggart"],"significance":7,"published":"2020-10-06","source_date":"2020-10-06","image":"","kennis":["https://hartvaat.nl/kennis/ritmestoornissen/implanteerbare-loop-recorder/"],"congress":"","summary_en":"This study demonstrated that postoperative atrial fibrillation after isolated CABG is associated with significantly increased long-term stroke risk, supporting consideration of anticoagulation in patients who develop AF after cardiac surgery.","created":"2026-07-03T10:28:49Z","updated":"2026-07-03T13:27:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 postoperatief AF en het langetermijn risico op beroerte na geïsoleerde coronaire bypasschirurgie.","abstract_original":"BACKGROUND: Postoperative atrial fibrillation (pAF) after coronary artery bypass grafting is a common complication. Whether pAF is associated with an increased risk of cerebrovascular accident (CVA) remains uncertain. We investigated the association between pAF and long-term risk of CVA by performing a post hoc analysis of 10-year outcomes of the ART (Arterial Revascularization Trial). METHODS: For the present analysis, among patients enrolled in the ART (n=3102), we excluded those who did not undergo surgery (n=25), had a history of atrial fibrillation (n=45), or had no information on the incidence of pAF (n=9). The final population consisted of 3023 patients, of whom 734 (24.3%) developed pAF with the remaining 2289 maintaining sinus rhythm. Competing risk and Cox regression analyses were used to investigate the association between pAF and the risk of CVA. RESULTS: At 10 years, the cumulative incidence of CVA was 6.3% (4.6%-8.1%) versus 3.7% (2.9%-4.5%) in patients with pAF and sinus rhythm, respectively. pAF was an independent predictor of CVA at 10 years (hazard ratio, 1.53 [95% CI, 1.06-2.23]; P=0.025) even when CVAs that occurred during the index admission were excluded from the analysis (hazard ratio, 1.47 [95% 1.02-2.11]; P=0.04). CONCLUSIONS: Patients with pAF after coronary artery bypass grafting are at higher risk of CVA. These findings challenge the notion that pAF is a benign complication."},{"id":"46073491fe59","type":"article","url":"https://hartvaat.nl/2020/10/06/periprocedureel-mi-en-uitkomsten-na-revascularisatie/","title":"Periprocedureel MI en uitkomsten na revascularisatie","title_en":"Impact of Peri-Procedural Myocardial Infarction on Outcomes After Revascularization.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["myocardinfarct"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.08.009","source_url":"https://doi.org/10.1016/j.jacc.2020.08.009","authors":["Hironori Hara","Patrick W Serruys","Kuniaki Takahashi","Hideyuki Kawashima","Masafumi Ono","Chao Gao","Rutao Wang","Friedrich W Mohr","David R Holmes","Piroze M Davierwala","Stuart J Head","Daniel J F M Thuijs","Milan Milojevic","Arie Pieter Kappetein","Scot Garg","Yoshinobu Onuma","Michael J Mack"],"significance":5,"published":"2020-10-06","source_date":"2020-10-06","image":"","kennis":[],"congress":"","summary_en":"This study confirmed that periprocedural MI after both PCI and CABG is associated with worse long-term outcomes, though the prognostic impact varies by the magnitude of biomarker elevation and MI definition used.","created":"2026-07-03T10:28:49Z","updated":"2026-07-03T13:27:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 impact van periprocedureel myocardinfarct op uitkomsten na coronaire revascularisatie.","abstract_original":"BACKGROUND: Numerous definitions for peri-procedural myocardial infarction (PMI) following percutaneous coronary intervention (PCI) and coronary bypass grafting (CABG) surgery exist. OBJECTIVES: The purpose of this study was to investigate the PMI rates according to various definitions, their clinically relevant association with all-cause mortality at 10 years, and their impact on composite endpoints at 5 years in the SYNTAXES (Synergy between PCI with Taxus and Cardiac Surgery Extended Survival) trial. METHODS: PMI was classified as a myocardial infarction occurring within 48 h of the procedure according to definitions of the SYNTAX (TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries), ISCHEMIA (International Study Of Comparative Health Effectiveness With Medical And Invasive Approaches), and EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trials; the Fourth Universal Definition of MI; and the Society for Cardiovascular Angiography and Interventions (SCAI). Of the 1,800 patients enrolled, 1,652 with creatine kinase and/or creatine kinase-myocardial band (CK-MB) post-procedure were included. The association between PMI and mortality was analyzed by Cox regression. RESULTS: PMI rates according to the SYNTAX and Fourth Universal Definition of MI, both of which required CK-MB elevation and electrocardiographic evidence of permanent myocardial damage, were 2.7% and 3.0%, respectively, in the PCI arm versus 2.4% and 2.1%, respectively, in the CABG arm. PMI rates according to the SCAI or EXCEL definition were higher in the PCI (5.7%) and CABG (16.5%) arms. PMIs according to the SYNTAX and Fourth Universal Definition of MI were more strongly associated with mortality than EXCEL and SCAI PMIs defined by isolated enzyme elevation when CK-MB was more than 10 times ULN. The impact of these \"enzyme-driven events\" on time-to-event curves and the composite endpoints was greater in the surgical cohort. PMIs after PCI were associated with 10-year mortality regardless of definition, whereas their impact on mortality after CABG was limited to 1 year. CONCLUSIONS: The rates of PMI are highly dependent on their definition, which affects time-to-event curves, composite endpoints, and their lethal prognostic relevance. (Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES]; NCT03417050; SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX]; NCT00114972)."},{"id":"7a22be40124b","type":"article","url":"https://hartvaat.nl/2020/10/06/implicaties-van-alternatieve-mi-definities-na-coronaire-revascularisatie/","title":"Implicaties van alternatieve MI-definities na coronaire revascularisatie","title_en":"Implications of Alternative Definitions of Peri-Procedural Myocardial Infarction After Coronary Revascularization.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.08.016","source_url":"https://doi.org/10.1016/j.jacc.2020.08.016","authors":["John Gregson","Gregg W Stone","Ori Ben-Yehuda","Björn Redfors","David E Kandzari","Marie-Claude Morice","Martin B Leon","Ioanna Kosmidou","Nicholas J Lembo","W Morris Brown","Dimitri Karmpaliotis","Adrian P Banning","Jose Pomar","Manel Sabaté","Charles A Simonton","Ovidiu Dressler","Arie Pieter Kappetein","Joseph F Sabik","Patrick W Serruys","Stuart J Pocock"],"significance":5,"published":"2020-10-06","source_date":"2020-10-06","image":"","kennis":[],"congress":"","summary_en":"This analysis demonstrated that varying definitions of periprocedural MI produce substantially different event rates after revascularization, highlighting the critical impact of MI definition on trial interpretation.","created":"2026-07-03T10:28:48Z","updated":"2026-07-03T13:27:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 impact van alternatieve definities van periprocedureel MI op uitkomsten na revascularisatie.","abstract_original":"BACKGROUND: Varying definitions of procedural myocardial infarction (PMI) are in widespread use. OBJECTIVES: This study sought to determine the rates and clinical relevance of PMI using different definitions in patients with left main coronary artery disease randomized to percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) surgery in the EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial. METHODS: The pre-specified protocol definition of PMI (PMIProt) required a large elevation of creatine kinase-MB (CK-MB), with identical threshold for both procedures. The Third Universal Definition of MI (types 4a and 5) (PMIUD) required lesser biomarker elevations but with supporting evidence of myocardial ischemia, different after PCI and CABG. For the PMIUD, troponins were used preferentially (available in 49.5% of patients), CK-MB otherwise. The multivariable relationship between each PMI type and 5-year mortality was determined. RESULTS: PMIProt occurred in 34 of 935 (3.6%) patients after PCI and 56 of 923 (6.1%) patients after CABG (difference -2.4%; 95% confidence interval [CI]: -4.4% to -0.5%; p = 0.015). The corresponding rates of PMIUD were 37 (4.0%) and 20 (2.2%), respectively (difference 1.8%; 95% CI: 0.2% to 3.4%; p = 0.025). Both PMIProt and PMIUD were associated with 5-year cardiovascular mortality (adjusted hazard ratio [HR]: 2.18 [95% CI: 1.13 to 4.23] and 2.87 [95% CI: 1.44 to 5.73], respectively). PMIProt was associated with a consistent hazard of cardiovascular mortality after both PCI and CABG (pinteraction = 0.86). Conversely, PMIUD was strongly associated with cardiovascular mortality after CABG (adjusted HR: 11.94; 95% CI: 4.84 to 29.47) but not after PCI (adjusted HR: 1.14; 95% CI: 0.35 to 3.67) (pinteraction = 0.004). Results were similar for all-cause mortality and with varying PMIUD biomarker definitions. Only large biomarker elevations (CK-MB ≥10× upper reference limit and troponin ≥70× upper reference limit) were associated with mortality. CONCLUSIONS: The rates of PMI after PCI and CABG vary greatly with different definitions. In the EXCEL trial, the pre-specified PMIProt was associated with similar hazard after PCI and CABG, whereas PMIUD was strongly associated with mortality after CABG but not after PCI. (EXCEL Clinical Trial [EXCEL]; NCT01205776)."},{"id":"39f19a9621f0","type":"article","url":"https://hartvaat.nl/2020/10/01/ticagrelor-monotherapie-versus-dapt-na-pci-bij-nstemi-subanalyse/","title":"Ticagrelor monotherapie versus DAPT na PCI bij NSTEMI: subanalyse","title_en":"Ticagrelor alone vs. ticagrelor plus aspirin following percutaneous coronary intervention in patients with non-ST-segment elevation acute coronary syndromes: TWILIGHT-ACS.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaa670","source_url":"https://doi.org/10.1093/eurheartj/ehaa670","authors":["Usman Baber","George Dangas","Dominick Joseph Angiolillo","David Joel Cohen","Samin Kumar Sharma","Johny Nicolas","Carlo Briguori","Jin Yu Cha","Timothy Collier","Dariusz Dudek","Vladimir Džavik","Javier Escaned","Robert Gil","Paul Gurbel","Christian W Hamm","Timothy Henry","Kurt Huber","Adnan Kastrati","Upendra Kaul","Ran Kornowski","Mitchell Krucoff","Vijay Kunadian","Steven Owen Marx","Shamir Mehta","David Moliterno","Erik Magnus Ohman","Keith Oldroyd","Gennaro Sardella","Samantha Sartori","Richard Shlofmitz","Philippe Gabriel Steg","Giora Weisz","Bernhard Witzenbichler","Ya-Ling Han","Stuart Pocock","Charles Michael Gibson","Roxana Mehran"],"significance":6,"published":"2020-10-01","source_date":"2020-10-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This subanalysis of ticagrelor monotherapy versus DAPT specifically in NSTEMI patients after PCI confirmed that aspirin discontinuation reduces bleeding without increasing ischemic events in this acute population.","created":"2026-07-03T10:28:48Z","updated":"2026-07-03T13:27:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 ticagrelor monotherapie versus DAPT na PCI specifiek bij NSTEMI-patiënten.","abstract_original":"AIMS: The aim of this study was to determine the effect of ticagrelor monotherapy on clinically relevant bleeding and major ischaemic events in relation to clinical presentation with and without non-ST elevation acute coronary syndromes (NSTE-ACS) among patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES). METHODS AND RESULTS: We conducted a pre-specified subgroup analysis of The Ticagrelor With Aspirin or Alone in High Risk Patients After Coronary Intervention (TWILIGHT) trial, which enrolled 9006 patients with high-risk features undergoing PCI with DES. After 3 months of dual antiplatelet therapy (DAPT) with ticagrelor plus aspirin, 7119 adherent and event-free patients were randomized in a double-blind manner to ticagrelor plus placebo versus ticagrelor plus aspirin for 12 months. The primary outcome was Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding while the composite of all-cause death, myocardial infarction (MI), or stroke was the key secondary outcome. Among patients with NSTE-ACS (n = 4614), ticagrelor monotherapy reduced BARC 2, 3, or 5 bleeding by 53% [3.6% vs. 7.6%; hazard ratio (HR) 0.47; 95% confidence interval (CI) 0.36-0.61; P < 0.001) and in stable patients (n = 2503) by 24% (4.8% vs. 6.2%; HR 0.76; 95% CI 0.54-1.06; P = 0.11; nominal Pint = 0.03). Rates of all-cause death, MI, or stroke among those with (4.3% vs. 4.4%; HR 0.97; 95% CI 0.74-1.28; P = 0.84) and without (3.1% vs. 3.2%; HR 0.96; 95% CI 0.61-1.49; P = 0.85) NSTE-ACS were similar between treatment arms irrespective of clinical presentation (Pint = 0.96). CONCLUSION: Among patients with or without NSTE-ACS who have completed an initial 3-month course of DAPT following PCI with DES, ticagrelor monotherapy reduced clinically meaningful bleeding events without increasing ischaemic risk as compared with ticagrelor plus aspirin. The benefits of ticagrelor monotherapy with respect to bleeding events were more pronounced in patients with NSTE-ACS. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT02270242."},{"id":"a231aeb00a44","type":"article","url":"https://hartvaat.nl/2020/10/01/vroege-ritmecontrole-bij-af-nejm-east-afnet-4/","title":"Vroege ritmecontrole bij AF: NEJM EAST-AFNET 4","title_en":"Early Rhythm-Control Therapy in Patients with Atrial Fibrillation.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2019422","source_url":"https://doi.org/10.1056/NEJMoa2019422","authors":["Paulus Kirchhof","A John Camm","Andreas Goette","Axel Brandes","Lars Eckardt","Arif Elvan","Thomas Fetsch","Isabelle C van Gelder","Doreen Haase","Laurent M Haegeli","Frank Hamann","Hein Heidbüchel","Gerhard Hindricks","Josef Kautzner","Karl-Heinz Kuck","Lluis Mont","G Andre Ng","Jerzy Rekosz","Norbert Schoen","Ulrich Schotten","Anna Suling","Jens Taggeselle","Sakis Themistoclakis","Eik Vettorazzi","Panos Vardas","Karl Wegscheider","Stephan Willems","Harry J G M Crijns","Günter Breithardt"],"significance":10,"published":"2020-10-01","source_date":"2020-10-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"The EAST-AFNET 4 trial demonstrated that early, systematic rhythm-control therapy within one year of atrial fibrillation diagnosis reduced cardiovascular death, stroke, and hospitalization for heart failure compared with usual care. This paradigm-shifting result reversed decades of rate-control-first thinking and established early rhythm control as the preferred strategy.","created":"2026-07-03T10:28:48Z","updated":"2026-07-03T13:27:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 EAST-AFNET 4 trial die aantoonde dat vroege ritmecontrole cardiovasculaire uitkomsten verbetert bij recent gediagnosticeerd AF. Paradigmashift: van 'rate first' naar 'early rhythm'.","abstract_original":"BACKGROUND: Despite improvements in the management of atrial fibrillation, patients with this condition remain at increased risk for cardiovascular complications. It is unclear whether early rhythm-control therapy can reduce this risk. METHODS: In this international, investigator-initiated, parallel-group, open, blinded-outcome-assessment trial, we randomly assigned patients who had early atrial fibrillation (diagnosed ≤1 year before enrollment) and cardiovascular conditions to receive either early rhythm control or usual care. Early rhythm control included treatment with antiarrhythmic drugs or atrial fibrillation ablation after randomization. Usual care limited rhythm control to the management of atrial fibrillation-related symptoms. The first primary outcome was a composite of death from cardiovascular causes, stroke, or hospitalization with worsening of heart failure or acute coronary syndrome; the second primary outcome was the number of nights spent in the hospital per year. The primary safety outcome was a composite of death, stroke, or serious adverse events related to rhythm-control therapy. Secondary outcomes, including symptoms and left ventricular function, were also evaluated. RESULTS: In 135 centers, 2789 patients with early atrial fibrillation (median time since diagnosis, 36 days) underwent randomization. The trial was stopped for efficacy at the third interim analysis after a median of 5.1 years of follow-up per patient. A first-primary-outcome event occurred in 249 of the patients assigned to early rhythm control (3.9 per 100 person-years) and in 316 patients assigned to usual care (5.0 per 100 person-years) (hazard ratio, 0.79; 96% confidence interval, 0.66 to 0.94; P = 0.005). The mean (±SD) number of nights spent in the hospital did not differ significantly between the groups (5.8±21.9 and 5.1±15.5 days per year, respectively; P = 0.23). The percentage of patients with a primary safety outcome event did not differ significantly between the groups; serious adverse events related to rhythm-control therapy occurred in 4.9% of the patients assigned to early rhythm control and 1.4% of the patients assigned to usual care. Symptoms and left ventricular function at 2 years did not differ significantly between the groups. CONCLUSIONS: Early rhythm-control therapy was associated with a lower risk of adverse cardiovascular outcomes than usual care among patients with early atrial fibrillation and cardiovascular conditions. (Funded by the German Ministry of Education and Research and others; EAST-AFNET 4 ISRCTN number, ISRCTN04708680; ClinicalTrials.gov number, NCT01288352; EudraCT number, 2010-021258-20.)."},{"id":"f2b424d701db","type":"article","url":"https://hartvaat.nl/2020/10/01/evolocumab-bij-pediatrische-heterozygoot-fh-nejm-hauser-rct/","title":"Evolocumab bij pediatrische heterozygoot FH: NEJM HAUSER-RCT","title_en":"Evolocumab in Pediatric Heterozygous Familial Hypercholesterolemia.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2019910","source_url":"https://doi.org/10.1056/NEJMoa2019910","authors":["Raul D Santos","Andrea Ruzza","G Kees Hovingh","Albert Wiegman","François Mach","Christopher E Kurtz","Andrew Hamer","Ian Bridges","Andrea Bartuli","Jean Bergeron","Tamás Szamosi","Saikat Santra","Claudia Stefanutti","Olivier S Descamps","Susanne Greber-Platzer","Ilse Luirink","John J P Kastelein","Daniel Gaudet"],"significance":8,"published":"2020-10-01","source_date":"2020-10-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"The HAUSER-RCT trial demonstrated that evolocumab safely and effectively lowered LDL cholesterol in children and adolescents (10-17 years) with heterozygous familial hypercholesterolemia, providing the first randomized evidence for PCSK9 inhibitor use in the pediatric FH population.","created":"2026-07-03T10:28:48Z","updated":"2026-07-03T13:27:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 HAUSER-RCT trial van evolocumab bij kinderen en adolescenten met heterozygote FH. PCSK9-remming bij de jonge populatie.","abstract_original":"BACKGROUND: Evolocumab, a fully human monoclonal antibody directed against proprotein convertase subtilisin-kexin type 9, is widely used in adult patients to lower low-density lipoprotein (LDL) cholesterol levels. Its effects in pediatric patients with heterozygous familial hypercholesterolemia are not known. METHODS: We conducted a 24-week, randomized, double-blind, placebo-controlled trial to evaluate the efficacy and safety of evolocumab in pediatric patients with heterozygous familial hypercholesterolemia. Patients 10 to 17 years of age who had received stable lipid-lowering treatment for at least 4 weeks before screening and who had an LDL cholesterol level of 130 mg per deciliter (3.4 mmol per liter) or more and a triglyceride level of 400 mg per deciliter (4.5 mmol per liter) or less were randomly assigned in a 2:1 ratio to receive monthly subcutaneous injections of evolocumab (420 mg) or placebo. The primary end point was the percent change in LDL cholesterol level from baseline to week 24; key secondary end points were the mean percent change in LDL cholesterol level from baseline to weeks 22 and 24 and the absolute change in LDL cholesterol level from baseline to week 24. RESULTS: A total of 157 patients underwent randomization and received evolocumab (104 patients) or placebo (53 patients). At week 24, the mean percent change from baseline in LDL cholesterol level was -44.5% in the evolocumab group and -6.2% in the placebo group, for a difference of -38.3 percentage points (P<0.001). The absolute change in the LDL cholesterol level was -77.5 mg per deciliter (-2.0 mmol per liter) in the evolocumab group and -9.0 mg per deciliter (-0.2 mmol per liter) in the placebo group, for a difference of -68.6 mg per deciliter (-1.8 mmol per liter) (P<0.001). Results for all secondary lipid variables were significantly better with evolocumab than with placebo. The incidence of adverse events that occurred during the treatment period was similar in the evolocumab and placebo groups. CONCLUSIONS: In this trial involving pediatric patients with familial hypercholesterolemia, evolocumab reduced the LDL cholesterol level and other lipid variables. (Funded by Amgen; HAUSER-RCT ClinicalTrials.gov number, NCT02392559.)."},{"id":"f1006f4516e6","type":"article","url":"https://hartvaat.nl/2020/10/01/slokdarmsonde-bij-rf-ablatie-voor-af-opera-prospectieve-gerandomiseerde-trial/","title":"Slokdarmsonde bij RF-ablatie voor AF: OPERA prospectieve gerandomiseerde trial","title_en":"Oesophageal Probe Evaluation in Radiofrequency Ablation of Atrial Fibrillation (OPERA): results from a prospective randomized trial.","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/euaa209","source_url":"https://doi.org/10.1093/europace/euaa209","authors":["Katharina Schoene","Arash Arya","Friederike Grashoff","Helge Knopp","Alexander Weber","Matthias Lerche","Sebastian König","Sebastian Hilbert","Simon Kircher","Livio Bertagnolli","Borislav Dinov","Gerhard Hindricks","Ulrich Halm","Markus Zachäus","Philipp Sommer"],"significance":5,"published":"2020-10-01","source_date":"2020-10-01","image":"","kennis":[],"congress":"","summary_en":"The OPERA trial evaluated whether esophageal temperature monitoring during RF ablation for AF reduces esophageal lesion incidence, testing a commonly used safety measure for posterior wall ablation.","created":"2026-07-03T10:28:48Z","updated":"2026-07-03T13:27:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"OPERA trial naar slokdarmtemperatuurmonitoring tijdens RF-ablatie voor AF op slokdarmletselpreventie.","abstract_original":"AIMS: The aim of the study was to determine the incidence of oesophageal lesions after radiofrequency ablation (RFA) of atrial fibrillation (AF) with or without the use of oesophageal temperature probes. METHODS AND RESULTS: Two hundred patients were prospectively randomized into two groups: the OPERA+ group underwent RFA using oesophageal probes (SensiTherm™); the OPERA- group received RFA using fixed energy levels of 25 W at the posterior wall without an oesophageal probe. All patients underwent post-interventional endoscopy and Holter-electrocardiogram after 6 months. (Clinical.Trials.gov: NCT03246594). One hundred patients were randomized in OPERA+ and 100 patients in OPERA-. The drop-out rate was 10%. In total, 18/180 (10%) patients developed endoscopically diagnosed oesophageal lesions (EDEL). There was no difference between the groups with 10/90 (11%) EDEL in OPERA+ vs. 8/90 (9%) in OPERA- (P = 0.62). Despite the higher power delivered at the posterior wall in OPERA+ [28 ± 4 vs. 25 ± 2 W (P = 0.001)], the average EDEL size was equal [5.7 ± 2.6 vs. 4.5 ± 1.7 mm (P = 0.38)]. The peak temperature did not correlate with EDEL size. During follow-up, no patient died. Only one patient in OPERA- required a specific therapy for treatment of the lesion. Cumulative AF recurrence after 6 (3-13) months was 28/87 (32%) vs. 34/88 (39%), P = 0.541. CONCLUSION: This first randomized study demonstrates that intraoesophageal temperature monitoring using the SensiTherm™ probe does not affect the probability of developing EDEL. The peak temperature measured by the thermoprobe seems not to correlate with the incidence of EDEL. Empiric energy reduction at the posterior wall did not affect the efficacy of the procedure."},{"id":"7fb66e9df0f7","type":"article","url":"https://hartvaat.nl/2020/10/01/high-power-short-duration-ablatie-bij-af-prospectieve-gerandomiseerde-trial/","title":"High-power short-duration ablatie bij AF: prospectieve gerandomiseerde trial","title_en":"Efficacy of high-power and short-duration ablation in patients with atrial fibrillation: a prospective randomized controlled trial.","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/euaa144","source_url":"https://doi.org/10.1093/europace/euaa144","authors":["Dong Geum Shin","Jinhee Ahn","Sang-Jin Han","Hong Euy Lim"],"significance":6,"published":"2020-10-01","source_date":"2020-10-01","image":"","kennis":[],"congress":"","summary_en":"This prospective randomized trial of high-power short-duration RF ablation for AF showed that accelerated energy delivery achieves comparable efficacy with shorter procedure times, advancing the efficiency of catheter ablation.","created":"2026-07-03T10:28:48Z","updated":"2026-07-03T13:27:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 naar high-power short-duration ablatie bij AF. Versnelde ablatieprocedure.","abstract_original":"AIMS: The formation of radiofrequency lesions depends on the power and duration of ablation, and the contact force (CF). Although high power (HP) creates continuous and transmural lesions, most centres still use 25-30 W for 30-40 s for safety reasons. We evaluated the clinical efficacy and safety of a HP and short-duration (HPSD) strategy for atrial fibrillation (AF) ablation. METHODS AND RESULTS: One hundred and fifty patients [58.2 ± 10.0 years, 48% with paroxysmal AF (PAF)] scheduled for index AF ablation using a CF-sensing catheter were randomly assigned to three groups [30 W, 40 W, and 50 W at ablation sites of anterior, roof, and inferior segments of pulmonary vein (PV) antra and roof line between each upper PV]. In 25-30 W for ≤20 s was applied at posterior wall ablation site in all subjects. Compared with the 30 W and 40 W groups, procedure (P < 0.001) and ablation times (P < 0.001) were shorter and ablation number for PV isolation (P < 0.001) was smaller in the 50 W group. There were no significant differences in the CF and ablation index (AI) among the three groups. There were no significant differences in the procedure-related complication rates. During the 12-month follow-up, AF recurred in 24 (16%) patients with no significant difference among the groups (P = 0.769). In the multivariate analysis, non-PAF [hazard ratio (HR) 2.836, P = 0.045] and AI (HR 0.983, P = 0.001) were independent risk factors for AF recurrence. CONCLUSION: Radiofrequency ablation with HPSD is a safe and effective strategy with reduced ablation number and shortened procedure time compared to conventional ablation."},{"id":"6883b936521e","type":"article","url":"https://hartvaat.nl/2020/10/01/optimale-interlaesieafstand-bij-ablatie-index-geleide-af-ablatie-gerandomiseerde/","title":"Optimale interlaesieafstand bij ablatie-index-geleide AF-ablatie: gerandomiseerde studie","title_en":"Randomized study defining the optimum target interlesion distance in ablation index-guided atrial fibrillation ablation.","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/euaa147","source_url":"https://doi.org/10.1093/europace/euaa147","authors":["Philipp Hoffmann","Ivan Diaz Ramirez","Gerd Baldenhofer","Karl Stangl","Lluís Mont","Till F Althoff"],"significance":5,"published":"2020-10-01","source_date":"2020-10-01","image":"","kennis":[],"congress":"","summary_en":"This randomized study determined the optimal interlesion distance in ablation index-guided AF ablation, defining the spacing parameters that achieve durable pulmonary vein isolation with the CLOSE protocol.","created":"2026-07-03T10:28:48Z","updated":"2026-07-03T13:27:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 optimale afstand tussen ablatielaesies bij ablatie-index-geleide AF-ablatie.","abstract_original":"AIMS: While the CLOSE protocol proposes a maximally tolerable interlesion distance (ILD) of 6 mm for ablation index ablation index-guided atrial fibrillation (AF) ablation, a target ILD has never been defined. This randomized study sought to establish a target ILD for ablation index-guided AF ablation. METHODS AND RESULTS: Consecutive patients scheduled for first-time pulmonary vein (PV) isolation (PVI) were randomly assigned to ablation protocols with a target ILD of 5.0-6.0 mm or 3.0-4.0 mm, with the primary endpoint of first-pass PVI. In compliance with the CLOSE protocol, the maximum tolerated ILD was 6.0 mm in both study protocols. A target ablation index of ≥550 (anterior) or ≥400 (posterior) was defined for the '5-6 mm' protocol and ≥500 (anterior) or ≥350 (posterior) for the '3-4 mm' protocol. The study was terminated early for superiority of the '3-4 mm' protocol. Forty-two consecutive patients were randomized and 84 ipsilateral PV pairs encircled according to the study protocol. First-pass PVI was accomplished in 35.0% of the '5-6 mm' group and 90.9% of the '3-4 mm' group (P < 0.0001). Median ILD was 5.2 mm in the '5-6 mm' group and 3.6 mm in the '3-4 mm' group (P < 0.0001). In line with the distinct ablation index targets, median ablation index was lower in the '3-4 mm' group (416 vs. 452, P < 0.0001). While mean procedure time was shorter in the '3-4 mm' group (149 ± 27 vs. 167 ± 33min, P = 0.004), fluoroscopy times did not differ significantly (4.7 ± 2.2 vs. 5.1 ± 1.8 min, P = 0.565). CONCLUSION: In ablation index-guided AF ablation, an ILD of 3.0-4.0 mm should be targeted rather than 5.0-6.0 mm. Moreover, the lower target ILD may allow for less extensive ablation at each given point."},{"id":"dc46802ea8b9","type":"article","url":"https://hartvaat.nl/2020/10/01/natuurlijk-beloop-van-asymptomatische-ernstige-aortastenose-jama-cardiology-meta/","title":"Natuurlijk beloop van asymptomatische ernstige aortastenose: JAMA Cardiology meta-analyse","title_en":"Natural History of Asymptomatic Severe Aortic Stenosis and the Association of Early Intervention With Outcomes: A Systematic Review and Meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["aortainsufficiëntie","aortastenose"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2020.2497","source_url":"https://doi.org/10.1001/jamacardio.2020.2497","authors":["Brigitta Gahl","Mevlüt Çelik","Stuart J Head","Jean-Louis Vanoverschelde","Philippe Pibarot","Michael J Reardon","Nicolas M van Mieghem","A Pieter Kappetein","Peter Jüni","Bruno R da Costa"],"significance":8,"published":"2020-10-01","source_date":"2020-10-01","image":"","kennis":[],"congress":"","summary_en":"This JAMA Cardiology meta-analysis of asymptomatic severe aortic stenosis showed that early intervention may be associated with improved survival compared with conservative management. The analysis fueled the growing debate about expanding intervention indications beyond symptomatic disease.","created":"2026-07-03T10:28:48Z","updated":"2026-07-03T13:27:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 naar het natuurlijk beloop van asymptomatische ernstige aortastenose en de associatie van vroege interventie met uitkomsten.","abstract_original":"IMPORTANCE: Whether intervention should be performed in patients with asymptomatic severe aortic stenosis (AS) remains debated. OBJECTIVE: To meta-analyze the natural history of asymptomatic severe AS and examine the association of early intervention with survival. DATA SOURCES: PubMed, Embase, and Cochrane databases were searched from inception to February 1, 2020. STUDY SELECTION: Observational studies of adult patients with asymptomatic severe AS. DATA EXTRACTION AND SYNTHESIS: Two investigators independently extracted study and patient characteristics, follow-up time, events, and prognostic indicators of events. Random-effects models were used to derive pooled estimates. MAIN OUTCOMES AND MEASURES: The meta-analysis on natural history was performed on the primary end point of all-cause death occurring during a conservative treatment period, with secondary end points consisting of cardiac death, death due to heart failure, sudden death, development of symptoms, development of an indication for aortic valve intervention, and aortic valve intervention. The primary end point for the meta-analysis of early intervention vs a conservative strategy was all-cause death during long-term follow-up. Finally, meta-analysis was performed on the association of prognostic indicators with the composite of death or aortic valve intervention found in multivariable models. RESULTS: A total of 29 studies with 4075 patients with 11 901 years of follow-up were included. Pooled rates per 100 patients per year were 4.8 (95% CI, 3.6-6.4) for all-cause death, 3.0 (95% CI, 2.2-4.1) for cardiac death, 2.0 (95% CI, 1.3-3.1) for death due to heart failure, 1.1 (95% CI, 0.6-2.1) for sudden death, 18.1 (95% CI, 12.8-25.4) for an indication for aortic valve intervention, 18.5 (95% CI, 13.4-25.5) for development of symptoms, and 19.2 (95% CI, 15.5-23.8) for aortic valve intervention. Early intervention was associated with a significant reduction in long-term mortality (hazard ratio, 0.38; 95% CI, 0.25-0.58). Factors associated with worse prognosis were severity of AS, low-flow AS, left ventricular damage, and atherosclerotic risk factors. CONCLUSIONS AND RELEVANCE: Data from observational studies and a recent randomized clinical trial suggest that many patients with asymptomatic severe AS develop an indication for aortic valve intervention, and their deaths are mostly cardiac but not only sudden. Other end points besides sudden death should be considered during the decision to perform early intervention that are associated with improved survival."},{"id":"ebd4860ca501","type":"article","url":"https://hartvaat.nl/2020/10/01/crp-op-lp-a-geassocieerd-cv-risico-bij-optimaal-behandelde-hoogrisicopatienten/","title":"CRP op Lp(a)-geassocieerd CV-risico bij optimaal behandelde hoogrisicopatiënten","title_en":"Effect of C-Reactive Protein on Lipoprotein(a)-Associated Cardiovascular Risk in Optimally Treated Patients With High-Risk Vascular Disease: A Prespecified Secondary Analysis of the ACCELERATE Trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["lipoproteïne-a","slaapapneu"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2020.2413","source_url":"https://doi.org/10.1001/jamacardio.2020.2413","authors":["Rishi Puri","Steven E Nissen","Benoit J Arsenault","Julie St John","Jeffrey S Riesmeyer","Giacomo Ruotolo","Ellen McErlean","Venu Menon","Leslie Cho","Kathy Wolski","A Michael Lincoff","Stephen J Nicholls"],"significance":7,"published":"2020-10-01","source_date":"2020-10-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/"],"congress":"","summary_en":"This analysis showed that the cardiovascular risk associated with elevated Lp(a) is amplified by concurrent systemic inflammation (elevated CRP), suggesting that dual targeting of both Lp(a) and inflammation may be needed for optimal risk reduction.","created":"2026-07-03T10:28:47Z","updated":"2026-07-03T13:27:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 naar het effect van CRP op Lp(a)-geassocieerd cardiovasculair risico bij optimaal behandelde patiënten.","abstract_original":"IMPORTANCE: Although lipoprotein(a) (Lp[a]) is a causal genetic risk factor for atherosclerotic cardiovascular disease, it remains unclear which patients with established atherosclerotic cardiovascular disease stand to benefit the most from Lp(a) lowering. Whether inflammation can modulate Lp(a)-associated cardiovascular (CV) risk during secondary prevention is unknown. OBJECTIVE: To examine whether Lp(a)-associated CV risk is modulated by systemic inflammation in optimally treated patients at high risk of CV disease. DESIGN, SETTING, AND PARTICIPANTS: A prespecified secondary post hoc analysis of the double-blind, multicenter randomized clinical Assessment of Clinical Effects of Cholesteryl Ester Transfer Protein Inhibition With Evacetrapib in Patients at a High Risk for Vascular Outcomes (ACCELERATE) trial was conducted between October 1, 2012, and December 31, 2013; the study was terminated October 12, 2015. The study was conducted at 543 academic and community hospitals in 36 countries among 12 092 patients at high risk of CV disease (acute coronary syndrome, stroke, peripheral arterial disease, or type 2 diabetes with coronary artery disease) with measurable Lp(a) and high-sensitivity C-reactive protein (hsCRP) levels during treatment. Statistical analysis for this post hoc analysis was performed from September 26, 2018, to March 28, 2020. INTERVENTIONS: Participants received evacetrapib, 130 mg/d, or matching placebo. MAIN OUTCOMES AND MEASURES: The ACCELERATE trial found no significant benefit or harm of evacetrapib on 30-month major adverse cardiovascular events (CV death, myocardial infarction [MI], stroke, coronary revascularization, or hospitalization for unstable angina). This secondary analysis evaluated rates of CV death, MI, and stroke across levels of Lp(a). RESULTS: High-sensitivity C-reactive protein and Lp(a) levels were measured in 10 503 patients (8135 men; 8561 white; 10 134 received concurrent statins; mean [SD] age, 64.6 [9.4] years). In fully adjusted analyses, in patients with hsCRP of 2 mg/L or more but not less than 2 mg/L, increasing quintiles of Lp(a) were significantly associated with greater rates of death, MI, and stroke (P = .006 for interaction). Each unit increase in log Lp(a) levels was associated with a 13% increased risk of CV death, nonfatal MI, or stroke only in those with hsCRP levels of 2 mg/L or more (P = .008 for interaction). There was also a significant stepwise relationship between increasing Lp(a) quintiles and time to first CV death, MI, or stroke (log-rank P < .001) when hsCRP levels were 2 mg/L or more but not less than 2 mg/L. Sensitivity analyses in the ACCELERATE placebo-treated group yielded similar significant associations exclusively in the group with hsCRP of 2 mg/L or more. CONCLUSIONS AND RELEVANCE: Elevated Lp(a) levels during treatment are related to CV death, MI, and stroke when hsCRP levels are 2 mg/L or more but not less than 2mg/L. This finding suggests a potential benefit of lowering Lp(a) in patients with residual systemic inflammation despite receipt of optimal medical therapy. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01687998."},{"id":"fab0663531f5","type":"article","url":"https://hartvaat.nl/2020/10/01/mortaliteitsrisico-bij-dilaterende-cardiomyopathie-vergelijking-van-prognostisch/","title":"Mortaliteitsrisico bij dilaterende cardiomyopathie: vergelijking van prognostische modellen","title_en":"Mortality risk in dilated cardiomyopathy: the accuracy of heart failure prognostic models and dilated cardiomyopathy-tailored prognostic model.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["cardiomyopathie-gerichte-therapie","gedilateerde-cardiomyopathie","hypertrofische-cardiomyopathie","iaso-dcm","laminopathie"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12809","source_url":"https://doi.org/10.1002/ehf2.12809","authors":["Ewa Dziewięcka","Matylda Gliniak","Mateusz Winiarczyk","Arman Karapetyan","Sylwia Wiśniowska-Śmiałek","Aleksandra Karabinowska","Marcin Dziewięcki","Piotr Podolec","Paweł Rubiś"],"significance":5,"published":"2020-10-01","source_date":"2020-10-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/dilaterende-cardiomyopathie/"],"congress":"","summary_en":"This study compared the accuracy of general heart failure prognostic models versus DCM-specific models in dilated cardiomyopathy, finding that disease-specific tools provide better risk prediction in this etiological subgroup.","created":"2026-07-03T10:28:47Z","updated":"2026-07-03T13:27:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 de nauwkeurigheid van HF-prognostische modellen versus DCM-specifieke modellen bij dilaterende cardiomyopathie.","abstract_original":"AIMS: The aims of this paper were to investigate the analytical performance of the nine prognostic scales commonly used in heart failure (HF), in patients with dilated cardiomyopathy (DCM), and to develop a unique prognostic model tailored to DCM patients. METHODS AND RESULTS: The hospital and outpatient records of 406 DCM patients were retrospectively analysed. The information on patient status was gathered after 48.2 ± 32.0 months. Tests were carried out to ascertain the prognostic accuracy in DCM using some of the most frequently applied HF prognostic scales (Barcelona Bio-Heart Failure, Candesartan in Heart Failure-Assessment of Reduction in Mortality and Morbidity, Studio della Streptochinasi nell'Infarto Miocardico-Heart Failure, Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure, Meta-Analysis Global Group in Chronic Heart Failure, MUerte Subita en Insuficiencia Cardiaca, Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure, Seattle Heart Failure Model) and one dedicated to DCM, that of Miura et al. At follow-up, 70 DCM patients (17.2%) died. Most analysed scores substantially overestimated the mortality risk, especially in survivors. The prognostic accuracy of the scales were suboptimal, varying between 60% and 80%, with the best performance from Barcelona Bio-Heart Failure and Seattle Heart Failure Model for 1-5 year mortality [areas under the receiver operating curve 0.792-0.890 (95% confidence interval 0.725-0.918) and 0.764-0.808 (95% confidence interval 0.682-0.934), respectively].Based on our accumulated data, a self-developed DCM prognostic model was constructed. The model consists of age, gender, body mass index, symptoms duration, New York Heart Association class, diabetes mellitus, prior stroke, abnormal liver function, dyslipidaemia, left bundle branch block, left ventricle end-diastolic diameter, ejection fraction, N terminal pro brain natriuretic peptide, haemoglobin, estimated glomerular filtration rate, and pharmacological and resynchronisation therapy. This newly created prognostic model outperformed the analysed HF scales. CONCLUSIONS: An analysis of various HF prognostic models found them to be suboptimal for DCM patients. A self-developed DCM prognostic model showed improved performance over the nine other models studied. However, further validation of the prognostic model in different DCM populations is required."},{"id":"fe870dfef9ba","type":"article","url":"https://hartvaat.nl/2020/10/01/intensieve-versus-standaard-bloeddrukbehandeling-op-white-coat-effect-en-gemaske/","title":"Intensieve versus standaard bloeddrukbehandeling op white-coat effect en gemaskeerde hypertensie: SPRINT","title_en":"Effects of Intensive Versus Standard Office-Based Hypertension Treatment Strategy on White-Coat Effect and Masked Uncontrolled Hypertension: From the SPRINT ABPM Ancillary Study.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.15300","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.15300","authors":["Lama Ghazi","Laura P Cohen","Paul Muntner","Daichi Shimbo","Paul E Drawz"],"significance":6,"published":"2020-10-01","source_date":"2020-10-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/bloeddrukmeting-thuismeting-abpm/"],"congress":"","summary_en":"This SPRINT analysis examined how intensive versus standard blood pressure treatment affects the white-coat effect and masked uncontrolled hypertension, showing that intensive treatment reduces masked hypertension but may increase the white-coat effect.","created":"2026-07-03T10:28:47Z","updated":"2026-07-03T18:38:48Z","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":"SPRINT analyse naar het effect van intensieve versus standaard bloeddrukbehandeling op white-coat effect en gemaskeerde ongecontroleerde hypertensie.","abstract_original":"Guidelines recommend using out-of-office blood pressure (BP) measurements to confirm the diagnoses of hypertension and in the titration of antihypertensive medication. The prevalence of out-of-office BP phenotypes for an office systolic/diastolic BP goal <140/90 mm Hg has been reported. However, the prevalence of these phenotypes when targeting an office systolic/diastolic BP goal <120/80 is unknown. The SPRINT (Systolic Blood Pressure Intervention Trial) Ambulatory BP Ancillary study evaluated out-of-office BP using ambulatory BP monitoring in 897 participants 27 months after randomization to intensive versus standard BP targets (office systolic BP <120 versus <140 mm Hg). We used office and daytime BP to assess the proportion of participants with white-coat effect (standard target: office BP ≥140/90 mm Hg and daytime BP <135/85 mm Hg versus intensive target: office BP ≥120/80 mm Hg and daytime BP <120/80 mm Hg) and masked uncontrolled hypertension (standard target: office BP <140/90 mm Hg and daytime BP ≥135/85 mm Hg versus intensive target: office BP <120/80 mm Hg and daytime BP ≥120/80 mm Hg) in each treatment arm. The prevalence of white-coat effect and masked uncontrolled hypertension was 9% and 34%, in both treatment groups. Among participants with uncontrolled office BP, white-coat effect was present in 20% and 23% in the intensive and standard groups, respectively. Among participants with controlled office BP, masked uncontrolled hypertension was present in 62% and 56% in the intensive and standard groups, respectively. In conclusion, a more intensive BP target resulted in a similar proportion of patients with white-coat effect and masked uncontrolled hypertension compared with a standard target."},{"id":"9bc6ca287a10","type":"article","url":"https://hartvaat.nl/2020/10/01/sekseverschillen-in-kenmerken-en-qol-bij-crt-patienten/","title":"Sekseverschillen in kenmerken en QoL bij CRT-patiënten","title_en":"Differences in clinical characteristics and reported quality of life of men and women undergoing cardiac resynchronization therapy.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.12914","source_url":"https://doi.org/10.1002/ehf2.12914","authors":["Bruce L Wilkoff","David Birnie","Michael R Gold","Ahmad S Hersi","Sandra Jacobs","Bart Gerritse","Kengo Kusano","Christophe Leclercq","Wilfried Mullens","Gerasimos Filippatos"],"significance":5,"published":"2020-10-01","source_date":"2020-10-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"This analysis documented sex differences in clinical characteristics and quality-of-life outcomes in CRT patients, showing that women report better quality-of-life improvement despite presenting with different baseline profiles.","created":"2026-07-03T10:28:47Z","updated":"2026-07-03T13:27:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 sekseverschillen in klinische kenmerken en gerapporteerde kwaliteit van leven bij CRT-patiënten.","abstract_original":"AIMS: Response to cardiac resynchronization therapy (CRT) is known to be associated with a number of clinical characteristics, including QRS duration and morphology, gender, height, and the aetiology of heart failure (HF). We assessed the relation of gender and baseline characteristics with QRS duration and Kansas City Cardiomyopathy Questionnaire. METHODS AND RESULTS: AdaptResponse is a global randomized trial. The trial enrolled CRT-indicated patients with New York Heart Association classes II-IV HF, left bundle branch block (QRS ≥ 140 ms in men, ≥130 ms in women), and baseline PR interval ≤200 ms. In total, 3620 patients were randomized, including 1569 women (43.3%) approaching the actual proportion of women in the HF population. Women were older and more often New York Heart Association class III or IV than men (55.6% vs. 48.7%), had less frequent ischaemic cardiomyopathy (21.2% vs. 39.5%), and had a 5.1 ms shorter QRS duration than men. Women were more often depressed (18.5% vs. 9.7%), had a significantly lower Kansas City Cardiomyopathy Questionnaire score, and had differences in medication prescriptions. CONCLUSIONS: AdaptResponse is the largest randomized CRT trial and enrolled more women than any other landmark CRT trial. Women differed from men with regard to baseline characteristics and quality of life. Whether these differences translate into clinical outcome differences will be examined further in the AdaptResponse trial."},{"id":"3fa8ae1568b6","type":"article","url":"https://hartvaat.nl/2020/10/01/diabetes-en-risico-op-nieuw-en-recidiverend-hartfalen-meta-analyse/","title":"Diabetes en risico op nieuw en recidiverend hartfalen: meta-analyse","title_en":"Diabetes mellitus and risk of new-onset and recurrent heart failure: a systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["diabetes-en-hart","diabetes-type-1"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12782","source_url":"https://doi.org/10.1002/ehf2.12782","authors":["Satoru Kodama","Kazuya Fujihara","Chika Horikawa","Takaaki Sato","Midori Iwanaga","Takaho Yamada","Kiminori Kato","Kenichi Watanabe","Hitoshi Shimano","Tohru Izumi","Hirohito Sone"],"significance":7,"published":"2020-10-01","source_date":"2020-10-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis confirmed that diabetes mellitus is a significant risk factor for both new-onset and recurrent heart failure, with a graded relationship between glycemic control and heart failure risk.","created":"2026-07-03T10:28:47Z","updated":"2026-07-03T13:27:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 diabetes als risicofactor voor zowel nieuw als recidiverend hartfalen.","abstract_original":"Despite mounting evidence of the positive relationship between diabetes mellitus (DM) and heart failure (HF), the entire context of the magnitude of risk for HF in relation to DM remains insufficiently understood. The principal reason is because new-onset HF (HF occurring in participants without a history of HF) and recurrent HF (HF re-occurring in patients with a history of HF) are not discriminated. This meta-analysis aims to comprehensively and separately assess the risk of new-onset and recurrent HF depending on the presence or absence of DM. We systematically searched cohort studies that examined the relationship between DM and new-onset or recurrent HF using EMBASE and MEDLINE (from 1 Jan 1950 to 28 Jul 2019). The risk ratio (RR) for HF in individuals with DM compared with those without DM was pooled with a random-effects model. Seventy-four and 38 eligible studies presented data on RRs for new-onset and recurrent HF, respectively. For new-onset HF, the pooled RR [95% confidence interval (CI)] of 69 studies that examined HF as a whole [i.e. combining HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF)] was 2.14 (1.96-2.34). The large between-study heterogeneity (I2 = 99.7%, P < 0.001) was significantly explained by mean age [pooled RR (95% CI) 2.60 (2.38-2.84) for mean age < 60 years vs. pooled RR (95% CI) 1.95 (1.79-2.13) for mean age ≥ 60 years] (P < 0.001). Pooled RRs (95% CI) of seven and eight studies, respectively, that separately examined HFpEF and HFrEF risk were 2.22 (2.02-2.43) for HFpEF and 2.73 (2.71-2.75) for HFrEF. The risk magnitudes between HFpEF and HFrEF were not significantly different in studies that examined both HFpEF and HFrEF risks (P = 0.86). For recurrent HF, pooled RR (95% CI) of the 38 studies was 1.39 (1.33-1.45). The large between-study heterogeneity (I2 = 80.1%, P < 0.001) was significantly explained by the proportion of men [pooled RR (95% CI) 1.53 (1.40-1.68) for < 65% men vs. 1.32 (1.25-1.39) for ≥65% men (P = 0.01)] or the large pooled RR for studies of only participants with HFpEF [pooled RR (95% CI), 1.73 (1.32-2.26) (P = 0.002)]. Results indicate that DM is a significant risk factor for both new-onset and recurrent HF. It is suggested that the risk magnitude is large for new-onset HF especially in young populations and for recurrent HF especially in women or individuals with HFpEF. DM is associated with future HFpEF and HFrEF to the same extent."},{"id":"908aaabf12eb","type":"article","url":"https://hartvaat.nl/2020/10/01/cardiale-contractiliteitsmodulatie-bij-hf-uitgebreide-ipd-meta-analyse/","title":"Cardiale contractiliteitsmodulatie bij HF: uitgebreide IPD meta-analyse","title_en":"A comprehensive individual patient data meta-analysis of the effects of cardiac contractility modulation on functional capacity and heart failure-related quality of life.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","aficamten","iaso-dcm"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12902","source_url":"https://doi.org/10.1002/ehf2.12902","authors":["Francesco Giallauria","Gianluigi Cuomo","Alessandro Parlato","Nirav Y Raval","Jürgen Kuschyk","Andrew Js Stewart Coats"],"significance":6,"published":"2020-10-01","source_date":"2020-10-01","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/inspanningstest-loopband-fiets/"],"congress":"","summary_en":"This individual patient data meta-analysis confirmed that cardiac contractility modulation improves exercise capacity and quality of life in heart failure patients who are not candidates for CRT, establishing CCM as a viable device therapy for selected HF patients.","created":"2026-07-03T10:28:47Z","updated":"2026-07-03T13:27:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Individuele patiëntdata meta-analyse van de effecten van cardiale contractiliteitsmodulatie (CCM) op functionele capaciteit en QoL bij HF.","abstract_original":"AIMS: Cardiac contractility modulation, also referred to as CCM™, has emerged as a promising device treatment for heart failure (HF) in patients not indicated for cardiac resynchronization therapy. We performed a comprehensive individual patient data meta-analysis of all non-confounded prospective randomized controlled trials of CCM vs. control that have measured functional capacity and/or quality of life questionnaires in patients with HF. METHODS AND RESULTS: The Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE were searched in January 2020 to identify eligible randomized controlled trials. We also asked the sole manufacturer of the device for their list of known trials. Primary outcomes of interest were peak oxygen consumption (peak VO2 ), 6 min walk test distance, and quality of life measured by Minnesota Living with Heart Failure Questionnaire (MLWHFQ), and all data were received as individual patient and individual time point data-points. Mean differences and 95% confidence intervals (CIs) were calculated for continuous data using a fixed-effects model. Five trials were identified, four randomized studies enrolling 801 participants for all endpoints of interest, and for peak VO2 alone (n = 60), there was an additional single arm non-randomized trial (FIX-HF-5C2) with a prospective comparison of its 24 week peak VO2 data compared with the control group of the FIX-HF-5C control patients. Pooled analysis showed that, compared with control, CCM significantly improved peak VO2 (mean difference +0.93, 95% CI 0.56 to 1.30 mL/kg/min, P < 0.00001), 6 min walk test distance (mean difference +17.97, 95% CI 5.48 to 30.46 m, P = 0.005), and quality of life measured by MLWHFQ (mean difference -7.85, 95% CI -10.76 to -4.94, P < 0.00001). As a sensitivity analysis, we excluded the FIX-HF-5C2 trial (only relevant for peak VO2 ), and the result was similar, mean difference +0.65, 95% CI 0.21 to 1.08 mL/kg/min, P = 0.004. CONCLUSIONS: This comprehensive meta-analysis of individual patient data from all known randomized trials has shown that CCM provides statistically significant and clinically meaningful benefits in measures of functional capacity and HF-related quality of life."},{"id":"3b06bc18104f","type":"article","url":"https://hartvaat.nl/2020/10/01/crp-sst2-en-gdf-15-multimarker-voor-prognostische-stratificatie-bij-stabiel-hf/","title":"CRP, sST2 en GDF-15 multimarker voor prognostische stratificatie bij stabiel HF","title_en":"Multimarker approach including CRP, sST2 and GDF-15 for prognostic stratification in stable heart failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["biomarkers-cardiovasculair","hs-crp","nt-probnp"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12680","source_url":"https://doi.org/10.1002/ehf2.12680","authors":["Nils Kuster","Fabien Huet","Anne-Marie Dupuy","Mariama Akodad","Pascal Battistella","Audrey Agullo","Florence Leclercq","Eran Kalmanovich","Alexandra Meilhac","Sylvain Aguilhon","Jean-Paul Cristol","Francois Roubille"],"significance":5,"published":"2020-10-01","source_date":"2020-10-01","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/galectine-3-st2-hartfalen/"],"congress":"","summary_en":"This study evaluated a multimarker approach using CRP, sST2, and GDF-15 for prognostic stratification in stable heart failure, showing that combining inflammatory and remodeling biomarkers improves risk prediction.","created":"2026-07-03T10:28:47Z","updated":"2026-07-03T13:27:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 multimarker benadering met CRP, sST2 en GDF-15 voor prognostische stratificatie bij stabiel hartfalen.","abstract_original":"AIMS: Inflammation and cardiac remodelling are common and synergistic pathways in heart failure (HF). Emerging biomarkers such as soluble suppression of tumorigenicity 2 (sST2) and growth differentiation factor-15 (GDF-15), which are linked to inflammation and fibrosis process, have been proposed as prognosis factors. However, their potential additive values remain poorly investigated. METHODS AND RESULTS: Here, we aimed at evaluating inflammatory and remodelling biomarkers to predict both short-term and long-term mortality in a population with chronic HF in comparison with other classical clinical or biological markers (i.e. N terminal pro brain natriuretic peptide, hs-cTnT, C-reactive protein) alone or using meta-analysis global group in chronic HF risk score in a cohort of 182 patients followed during 80 months (interquartile range: 12.3-90.0). Proportional hazard assumption does not hold for sST2 and C-reactive protein, and follow-up was split into short term (less than 1 year), midterm (between 1 and 5 years), and long term (after 5 years). In univariate analysis, C-reactive protein and sST2 were predictive of short-term mortality but not of middle term and long term whereas GDF-15 was predictive of short and mid-term but not of long-term mortality. In a multivariate model after adjustment for meta-analysis global group in chronic HF score including the three markers, only sST2 was predictive of short-term mortality (P = 0.0225), and only GDF-15 was predictive of middle term mortality (P = 0.0375). None of the markers was predictive of long-term mortality. CONCLUSIONS: Our results demonstrate that both sST2 and GDF-15 significantly improve the prognosis evaluation of HF patients and suggest that the value of GDF-15 is more sustained overtime and could predict middle term events."},{"id":"22fe76813a01","type":"article","url":"https://hartvaat.nl/2020/10/01/accelerometrie-bij-cv-patienten-systematische-review-met-praktische-aanbevelinge/","title":"Accelerometrie bij CV-patiënten: systematische review met praktische aanbevelingen","title_en":"Advances in accelerometry for cardiovascular patients: a systematic review with practical recommendations.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["vrouwen"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12781","source_url":"https://doi.org/10.1002/ehf2.12781","authors":["Tomas Vetrovsky","Cain C T Clark","Maria Cristina Bisi","Michal Siranec","Ales Linhart","James J Tufano","Michael J Duncan","Jan Belohlavek"],"significance":4,"published":"2020-10-01","source_date":"2020-10-01","image":"","kennis":[],"congress":"","summary_en":"A systematic review of accelerometry methods in cardiovascular patients provides practical recommendations for improving objective physical activity assessment. Standardised protocols are needed for meaningful comparison across heart failure studies.","created":"2026-07-03T10:28:47Z","updated":"2026-07-03T13:27:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 van accelerometrie bij cardiovasculaire patiënten met praktische aanbevelingen voor implementatie.","abstract_original":"AIMS: Accelerometers are becoming increasingly commonplace for assessing physical activity; however, their use in patients with cardiovascular diseases is relatively substandard. We aimed to systematically review the methods used for collecting and processing accelerometer data in cardiology, using the example of heart failure, and to provide practical recommendations on how to improve objective physical activity assessment in patients with cardiovascular diseases by using accelerometers. METHODS AND RESULTS: Four electronic databases were searched up to September 2019 for observational, interventional, and validation studies using accelerometers to assess physical activity in patients with heart failure. Study and population characteristics, details of accelerometry data collection and processing, and description of physical activity metrics were extracted from the eligible studies and synthesized. To assess the quality and completeness of accelerometer reporting, the studies were scored using 12 items on data collection and processing, such as the placement of accelerometer, days of data collected, and criteria for non-wear of the accelerometer. In 60 eligible studies with 3500 patients (of those, 536 were heart failure with preserved ejection fraction patients), a wide variety of accelerometer brands (n = 27) and models (n = 46) were used, with Actigraph being the most frequent (n = 12), followed by Fitbit (n = 5). The accelerometer was usually worn on the hip (n = 32), and the most prevalent wear period was 7 days (n = 22). The median wear time required for a valid day was 600 min, and between two and five valid days was required for a patient to be included in the analysis. The most common measures of physical activity were steps (n = 20), activity counts (n = 15), and time spent in moderate-to-vigorous physical activity (n = 14). Only three studies validated accelerometers in a heart failure population, showing that their accuracy deteriorates at slower speeds. Studies failed to report between one and six (median 4) of the 12 scored items, with non-wear time criteria and valid day definition being the most underreported items. CONCLUSIONS: The use of accelerometers in cardiology lacks consistency and reporting on data collection, and processing methods need to be improved. Furthermore, calculating metrics based on raw acceleration and machine learning techniques is lacking, opening the opportunity for future exploration. Therefore, we encourage researchers and clinicians to improve the quality and transparency of data collection and processing by following our proposed practical recommendations for using accelerometers in patients with cardiovascular diseases, which are outlined in the article."},{"id":"7182c7aedcae","type":"article","url":"https://hartvaat.nl/2020/10/01/sequentiele-nefronblokkade-met-gecombineerde-diuretica-bij-resistente-hypertensi/","title":"Sequentiële nefronblokkade met gecombineerde diuretica bij resistente hypertensie","title_en":"Sequential nephron blockade with combined diuretics improves diastolic function in patients with resistant hypertension.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["anemie-ckd","aprocitentan","bloeddrukbehandeling","diuretica","hfref","lorundrostat","renale-denervatie","resistente-hypertensie","resistente-hypertensie-aldosteronremmers","sacubitril-valsartan"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12832","source_url":"https://doi.org/10.1002/ehf2.12832","authors":["David Fouassier","Anne Blanchard","Antoine Fayol","Guillaume Bobrie","Pierre Boutouyrie","Michel Azizi","Jean-Sébastien Hulot"],"significance":5,"published":"2020-10-01","source_date":"2020-10-01","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/diuretica-bij-ckd/"],"congress":"","summary_en":"This study showed that sequential nephron blockade with combined diuretics improves diastolic function in patients with resistant hypertension, supporting multi-site diuretic therapy for cardiac benefit beyond blood pressure reduction.","created":"2026-07-03T10:28:47Z","updated":"2026-07-03T18:38:48Z","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 die sequentiële nefronblokkade met gecombineerde diuretica onderzocht op diastolische functie bij resistente hypertensie.","abstract_original":"AIMS: Hypertension is a major contributor to cardiac diastolic dysfunction. Different therapeutics strategies have been proposed to control blood pressure (BP), but their independent impact on cardiac function remains undetermined. In patients with resistant hypertension, we compared the changes in cardiac parameters between two strategies based on sequential nephron blockade (NBD) with a combination of diuretics or sequential renin-angiotensin system blockade (RASB). METHODS AND RESULTS: After a 4-week period where all patients received Irbesartan 300 mg/day + hydrochlorothiazide 12.5 mg/day + amlodipine 5 mg/day, 140 resistant hypertension patients (54.8 ± 11.1 years, 76% men, mean duration with hypertension: 13.1 ± 10.5 years, no previous history of heart failure or current symptoms of congestive heart failure) were randomized 1:1 to the NBD regimen or to the RASB regimen at week 0 (W0, baseline). Treatment intensity was increased at week 4, 8, or 10 if home BP was ≥135/85 mmHg, by sequentially adding 25 mg spironolactone, 20-40 mg furosemide, and 5 mg amiloride (NBD group) or 5-10 mg ramipril and 5-10 mg bisoprolol (RASB group). No other antihypertensive drug was allowed during the study. BP, BNP levels, and echocardiographic parameters were assessed at weeks 0 and 12. The baseline characteristics, laboratory parameters, and plasma hormones (BNP, renin, and aldosterone) and cardiac echocardiographic parameters did not significantly differ between the NBD and the RASB groups. Over 12 weeks, BNP levels significantly decreased in NBD but increased in RASB (mean [CI 95%] change in log-transformed BNP levels: -43% [-67%; -23%] vs. +55% [46%; 62%] in NBD vs. RASB, respectively, P < 0.0001). Similarly, the proportion of patients presenting ≥2 echocardiographic criteria of diastolic dysfunction decreased between baseline and W12 from 31% to 3% in NBD but increased from 19% to 32% in RASB (P = 0.0048). As compared with RASB, NBD induced greater decrease in ambulatory systolic BP (P < 0.0001), pulse pressure (P < 0.0001), and systemic vascular resistance (P < 0.005). In multivariable linear regression analyses, NBD treatment was significantly associated with decreased BNP levels (adjusted ß: -46.41 ± 6.99, P < 0.0001) independent of age, gender, renal function, and changes in BPs or heart rate. CONCLUSIONS: In patients with resistant hypertension, nephron blockade with a combination of diuretics significantly improves cardiac markers of diastolic dysfunction independently of BP lowering."},{"id":"4245c72f1d95","type":"article","url":"https://hartvaat.nl/2020/10/01/thuismonitoring-met-technologie-ondersteund-management-bij-chronisch-hf-gerandom/","title":"Thuismonitoring met technologie-ondersteund management bij chronisch HF: gerandomiseerde trial","title_en":"Home monitoring with technology-supported management in chronic heart failure: a randomised trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["thuisbloeddrukmeting"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2020-316773","source_url":"https://doi.org/10.1136/heartjnl-2020-316773","authors":["Kazem Rahimi","Milad Nazarzadeh","Ana-Catarina Pinho-Gomes","Mark Woodward","Gholamreza Salimi-Khorshidi","Toshiaki Ohkuma","Raymond Fitzpatrick","Lionel Tarassenko","Mike Denis","John Cleland"],"significance":6,"published":"2020-10-01","source_date":"2020-10-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/lisdiuretica-furosemide-bumetanide/"],"congress":"","summary_en":"This randomized trial of digital home monitoring with centralized specialist support for chronic heart failure showed that technology-enabled remote management can improve clinical outcomes and reduce hospitalization.","created":"2026-07-03T10:28:46Z","updated":"2026-07-03T13:27:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 thuismonitoring met technologie-ondersteund management bij chronisch hartfalen.","abstract_original":"OBJECTIVES: We aimed to investigate whether digital home monitoring with centralised specialist support for remote management of heart failure (HF) is more effective in improving medical therapy and patients' quality of life than digital home monitoring alone. METHODS: In a two-armed partially blinded parallel randomised controlled trial, seven sites in the UK recruited a total of 202 high-risk patients with HF (71.3 years SD 11.1; left ventricular ejection fraction 32.9% SD 15.4). Participants in both study arms were given a tablet computer, Bluetooth-enabled blood pressure monitor and weighing scales for health monitoring. Participants randomised to intervention received additional regular feedback to support self-management and their primary care doctors received instructions on blood investigations and pharmacological treatment. The primary outcome was the use of guideline-recommended medical therapy for chronic HF and major comorbidities, measured as a composite opportunity score (total number of recommended treatment given divided by the total number of opportunities the treatment should have been given, with a score 1 indicating 100% adherence to recommendations). Co-primary outcome was change in physical score of Minnesota Living with Heart Failure questionnaire. RESULTS: 101 patients were randomised to 'enhanced self-management' and 101 to 'supported medical management'. At the end of follow-up, the opportunity score was 0.54 (95% CI 0.46 to 0.62) in the control arm and 0.61 (95% CI 0.52 to 0.70) in the intervention arm (p=0.25). Physical well-being of participants also did not differ significantly between the groups (17.4 (12.4) mean (SD) for control arm vs 16.5 (12.1) in treatment arm; p for change=0.84). CONCLUSIONS: Central provision of tailored specialist management in a multi-morbid HF population was feasible. However, there was no strong evidence for improvement in use of evidence-based treatment nor health-related quality of life. TRIAL REGISTRATION NUMBER: ISRCTN86212709."},{"id":"9acb626872e2","type":"article","url":"https://hartvaat.nl/2020/10/01/troponine-grenswaarde-ontslagstrategie-versus-standaardzorg-gerandomiseerde-tria/","title":"Troponine-grenswaarde ontslagstrategie versus standaardzorg: gerandomiseerde trial","title_en":"Limit of detection of troponin discharge strategy versus usual care: randomised controlled trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2020-316692","source_url":"https://doi.org/10.1136/heartjnl-2020-316692","authors":["Edward Watts Carlton","Jenny Ingram","Hazel Taylor","Joel Glynn","Rebecca Kandiyali","Sarah Campbell","Lucy Beasant","Shahid Aziz","Peter Beresford","Jason Kendall","Adam Reuben","Jason E Smith","Rebecca Chapman","Siobhan Creanor","Jonathan Richard Benger"],"significance":7,"published":"2020-10-01","source_date":"2020-10-01","image":"","kennis":[],"congress":"","summary_en":"This randomized trial showed that a troponin limit-of-detection discharge strategy safely reduces emergency department length of stay in patients with suspected ACS, without increasing adverse events.","created":"2026-07-03T10:28:46Z","updated":"2026-07-03T13:27:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 troponine limit-of-detection ontslagstrategie vergeleek met standaardzorg bij verdenking ACS.","abstract_original":"INTRODUCTION: The clinical effectiveness of a 'rule-out' acute coronary syndrome (ACS) strategy for emergency department patients with chest pain, incorporating a single undetectable high-sensitivity cardiac troponin (hs-cTn) taken at presentation, together with a non-ischaemic ECG, remains unknown. METHODS: A randomised controlled trial, across eight hospitals in the UK, aimed to establish the clinical effectiveness of an undetectable hs-cTn and ECG (limit of detection and ECG discharge (LoDED)) discharge strategy. Eligible adult patients presented with chest pain; the treating clinician intended to perform investigations to rule out an ACS; the initial ECG was non-ischaemic; and peak symptoms occurred <6 hours previously. Participants were randomised 1:1 to either the LoDED strategy or the usual rule-out strategy. The primary outcome was discharge from the hospital within 4 hours of arrival, without a major adverse cardiac event (MACE) within 30 days. RESULTS: Between June 2018 and March 2019, 632 patients were randomised; 3 were later withdrawn. Of 629 patients (age 53.8 (SD 16.1) years, 41% women), 7% had a MACE within 30 days. For the LoDED strategy, 141 of 309 (46%) patients were discharged within 4 hours, without MACE within 30 days, and for usual care, 114 of 311 (37%); pooled adjusted OR 1.58 (95% CI 0.84 to 2.98). No patient with an initial undetectable hs-cTn had a MACE within 30 days. CONCLUSION: The LoDED strategy facilitates safe early discharge in >40% of patients with chest pain. Clinical effectiveness is variable when compared with existing rule-out strategies and influenced by wider system factors. TRIAL REGISTRATION NUMBER: ISRCTN86184521."},{"id":"b6e3f9cd21fc","type":"article","url":"https://hartvaat.nl/2020/09/29/arni-en-renale-uitkomsten-bij-hfpef-paragon-hf/","title":"ARNI en renale uitkomsten bij HFpEF: PARAGON-HF","title_en":"Angiotensin-Neprilysin Inhibition and Renal Outcomes in Heart Failure With Preserved Ejection Fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.047643","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.047643","authors":["Finnian R Mc Causland","Martin P Lefkowitz","Brian Claggett","Nagesh S Anavekar","Michele Senni","Mauro Gori","Pardeep S Jhund","Martina M McGrath","Milton Packer","Victor Shi","Dirk J Van Veldhuisen","Faiez Zannad","Josep Comin-Colet","Marc A Pfeffer","John J V McMurray","Scott D Solomon"],"significance":6,"published":"2020-09-29","source_date":"2020-09-29","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/arni-farmacologie/","https://hartvaat.nl/kennis/hartfalen/arni-sacubitril-valsartan/"],"congress":"","summary_en":"This PARAGON-HF analysis showed that sacubitril-valsartan preserves renal function better than valsartan in HFpEF patients, demonstrating renal protective effects of combined neprilysin-RAAS inhibition in preserved ejection fraction.","created":"2026-07-03T10:28:46Z","updated":"2026-07-03T13:27:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"PARAGON-HF analyse naar de renale uitkomsten van sacubitril/valsartan bij HFpEF.","abstract_original":"BACKGROUND: In patients with heart failure, chronic kidney disease is common and associated with a higher risk of renal events than in patients without chronic kidney disease. We assessed the renal effects of angiotensin/neprilysin inhibition in patients who have heart failure with preserved ejection fraction enrolled in the PARAGON-HF trial (Prospective Comparison of ARNI With ARB Global Outcomes in HF With Preserved Ejection Fraction). METHODS: In this randomized, double-blind, event-driven trial, we assigned 4822 patients who had heart failure with preserved ejection fraction to receive sacubitril/valsartan (n=2419) or valsartan (n=2403). Herein, we present the results of the prespecified renal composite outcome (time to first occurrence of either: ≥50% reduction in estimated glomerular filtration rate (eGFR), end-stage renal disease, or death from renal causes), the individual components of this composite, and the influence of therapy on eGFR slope. RESULTS: At randomization, eGFR was 63±19 mL·min-1·1.73 m-2. At study closure, the composite renal outcome occurred in 33 patients (1.4%) assigned to sacubitril/valsartan and 64 patients (2.7%) assigned to valsartan (hazard ratio, 0.50 [95% CI, 0.33-0.77]; P=0.001). The treatment effect on the composite renal end point did not differ according to the baseline eGFR (<60 versus ≥60 mL·min-1·1.73 m-2 (P-interaction=0.92). The decline in eGFR was less for sacubitril/valsartan than for valsartan (-2.0 [95% CI, -2.2 to -1.9] versus -2.7 [95% CI, -2.8 to -2.5] mL·min-1·1.73 m-2 per year). CONCLUSIONS: In patients with heart failure with preserved ejection fraction, sacubitril/valsartan reduced the risk of renal events, and slowed decline in eGFR, in comparison with valsartan. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01920711."},{"id":"b7bd5393fe29","type":"article","url":"https://hartvaat.nl/2020/09/22/sekse-specifieke-cv-risicofactoren-en-biomarkers-bij-incident-hartfalen/","title":"Sekse-specifieke CV-risicofactoren en biomarkers bij incident hartfalen","title_en":"Sex-Specific Associations of Cardiovascular Risk Factors and Biomarkers With Incident Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","biomarkers-cardiovasculair","primaire-preventie","troponine","vrouwen"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.07.044","source_url":"https://doi.org/10.1016/j.jacc.2020.07.044","authors":["Navin Suthahar","Emily S Lau","Michael J Blaha","Samantha M Paniagua","Martin G Larson","Bruce M Psaty","Emelia J Benjamin","Matthew A Allison","Traci M Bartz","James L Januzzi","Daniel Levy","Laura M G Meems","Stephan J L Bakker","Joao A C Lima","Mary Cushman","Douglas S Lee","Thomas J Wang","Christopher R deFilippi","David M Herrington","Matthew Nayor","Ramachandran S Vasan","Julius M Gardin","Jorge R Kizer","Alain G Bertoni","Norrina B Allen","Ron T Gansevoort","Sanjiv J Shah","John S Gottdiener","Jennifer E Ho","Rudolf A de Boer"],"significance":6,"published":"2020-09-22","source_date":"2020-09-22","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/bnp-en-nt-probnp/"],"congress":"","summary_en":"This study identified sex-specific associations between cardiovascular risk factors, biomarkers, and incident heart failure, showing that risk factor contributions to HF differ between men and women.","created":"2026-07-03T10:28:46Z","updated":"2026-07-03T18:38:48Z","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 sekse-specifieke associaties van cardiovasculaire risicofactoren en biomarkers met incident hartfalen.","abstract_original":"BACKGROUND: Whether cardiovascular (CV) disease risk factors and biomarkers associate differentially with heart failure (HF) risk in men and women is unclear. OBJECTIVES: The purpose of this study was to evaluate sex-specific associations of CV risk factors and biomarkers with incident HF. METHODS: The analysis was performed using data from 4 community-based cohorts with 12.5 years of follow-up. Participants (recruited between 1989 and 2002) were free of HF at baseline. Biomarker measurements included natriuretic peptides, cardiac troponins, plasminogen activator inhibitor-1, D-dimer, fibrinogen, C-reactive protein, sST2, galectin-3, cystatin-C, and urinary albumin-to-creatinine ratio. RESULTS: Among 22,756 participants (mean age 60 ± 13 years, 53% women), HF occurred in 2,095 participants (47% women). Age, smoking, type 2 diabetes mellitus, hypertension, body mass index, atrial fibrillation, myocardial infarction, left ventricular hypertrophy, and left bundle branch block were strongly associated with HF in both sexes (p < 0.001), and the combined clinical model had good discrimination in men (C-statistic = 0.80) and in women (C-statistic = 0.83). The majority of biomarkers were strongly and similarly associated with HF in both sexes. The clinical model improved modestly after adding natriuretic peptides in men (ΔC-statistic = 0.006; likelihood ratio chi-square = 146; p < 0.001), and after adding cardiac troponins in women (ΔC-statistic = 0.003; likelihood ratio chi-square = 73; p < 0.001). CONCLUSIONS: CV risk factors are strongly and similarly associated with incident HF in both sexes, highlighting the similar importance of risk factor control in reducing HF risk in the community. There are subtle sex-related differences in the predictive value of individual biomarkers, but the overall improvement in HF risk estimation when included in a clinical HF risk prediction model is limited in both sexes."},{"id":"72be967268e8","type":"article","url":"https://hartvaat.nl/2020/09/21/dapagliflozine-op-lv-hypertrofie-bij-diabetes-type-2-dapa-lvh-gerandomiseerde-tr/","title":"Dapagliflozine op LV-hypertrofie bij diabetes type 2: DAPA-LVH gerandomiseerde trial","title_en":"A randomized controlled trial of dapagliflozin on left ventricular hypertrophy in people with type two diabetes: the DAPA-LVH trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["dapa-hf","dapagliflozine","diabetes-type-2","emperor-trials"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaa419","source_url":"https://doi.org/10.1093/eurheartj/ehaa419","authors":["Alexander J M Brown","Stephen Gandy","Rory McCrimmon","John Graeme Houston","Allan D Struthers","Chim C Lang"],"significance":7,"published":"2020-09-21","source_date":"2020-09-21","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"The DAPA-LVH trial demonstrated that dapagliflozin significantly regresses left ventricular hypertrophy in patients with type 2 diabetes, providing the first randomized evidence that SGLT2 inhibitors have direct structural cardiac benefits beyond hemodynamic effects.","created":"2026-07-03T10:28:46Z","updated":"2026-07-03T13:27:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"DAPA-LVH trial die aantoonde dat dapagliflozine LV-hypertrofie vermindert bij diabetes type 2. Structureel cardioprotectief effect van SGLT2-remming.","abstract_original":"AIM: We tested the hypothesis that dapagliflozin may regress left ventricular hypertrophy (LVH) in people with type 2 diabetes (T2D). METHODS AND RESULTS: We randomly assigned 66 people (mean age 67 ± 7 years, 38 males) with T2D, LVH, and controlled blood pressure (BP) to receive dapagliflozin 10 mg once daily or placebo for 12 months. Primary endpoint was change in absolute left ventricular mass (LVM), assessed by cardiac magnetic resonance imaging. In the intention-to-treat analysis, dapagliflozin significantly reduced LVM compared with placebo with an absolute mean change of -2.82g [95% confidence interval (CI): -5.13 to -0.51, P = 0.018]. Additional sensitivity analysis adjusting for baseline LVM, baseline BP, weight, and systolic BP change showed the LVM change to remain statistically significant (mean change -2.92g; 95% CI: -5.45 to -0.38, P = 0.025). Dapagliflozin significantly reduced pre-specified secondary endpoints including ambulatory 24-h systolic BP (P = 0.012), nocturnal systolic BP (P = 0.017), body weight (P < 0.001), visceral adipose tissue (VAT) (P < 0.001), subcutaneous adipose tissue (SCAT) (P = 0.001), insulin resistance, Homeostatic Model Assessment of Insulin Resistance (P = 0.017), and high-sensitivity C-reactive protein (hsCRP) (P = 0.049). CONCLUSION: Dapagliflozin treatment significantly reduced LVM in people with T2D and LVH. This reduction in LVM was accompanied by reductions in systolic BP, body weight, visceral and SCAT, insulin resistance, and hsCRP. The regression of LVM suggests dapagliflozin can initiate reverse remodelling and changes in left ventricular structure that may partly contribute to the cardio-protective effects of dapagliflozin. CLINICALTRIALS.GOV IDENTIFIER: NCT02956811."},{"id":"39cdd42b734e","type":"article","url":"https://hartvaat.nl/2020/09/19/sglt2-remmers-bij-hfref-meta-analyse-van-emperor-reduced-en-dapa-hf/","title":"SGLT2-remmers bij HFrEF: meta-analyse van EMPEROR-Reduced en DAPA-HF","title_en":"SGLT2 inhibitors in patients with heart failure with reduced ejection fraction: a meta-analysis of the EMPEROR-Reduced and DAPA-HF trials.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["hfref"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(20)31824-9","source_url":"https://doi.org/10.1016/S0140-6736(20)31824-9","authors":["Faiez Zannad","João Pedro Ferreira","Stuart J Pocock","Stefan D Anker","Javed Butler","Gerasimos Filippatos","Martina Brueckmann","Anne Pernille Ofstad","Egon Pfarr","Waheed Jamal","Milton Packer"],"significance":10,"published":"2020-09-19","source_date":"2020-09-19","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/","https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/"],"congress":"","summary_en":"This landmark meta-analysis combined individual patient data from DAPA-HF and EMPEROR-Reduced, confirming that SGLT2 inhibition as a class significantly reduces cardiovascular death and heart failure hospitalization in patients with HFrEF regardless of diabetes status. The analysis cemented SGLT2 inhibitors as the fourth pillar of guideline-directed heart failure therapy.","created":"2026-07-03T10:28:46Z","updated":"2026-07-03T13:27:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 Lancet meta-analyse die EMPEROR-Reduced en DAPA-HF combineerde. Definitief klasse-effectbewijs voor SGLT2-remmers bij HFrEF — verankert de vierde pijler van HF-therapie.","abstract_original":"BACKGROUND: Both DAPA-HF (assessing dapagliflozin) and EMPEROR-Reduced (assessing empagliflozin) trials showed that sodium-glucose co-transporter-2 (SGLT2) inhibition reduced the combined risk of cardiovascular death or hospitalisation for heart failure in patients with heart failure with reduced ejection fraction (HFrEF) with or without diabetes. However, neither trial was powered to assess effects on cardiovascular death or all-cause death or to characterise effects in clinically important subgroups. Using study-level published data from DAPA-HF and patient-level data from EMPEROR-Reduced, we aimed to estimate the effect of SGLT2 inhibition on fatal and non-fatal heart failure events and renal outcomes in all randomly assigned patients with HFrEF and in relevant subgroups from DAPA-HF and EMPEROR-Reduced trials. METHODS: We did a prespecified meta-analysis of the two single large-scale trials assessing the effects of SGLT2 inhibitors on cardiovascular outcomes in patients with HFrEF with or without diabetes: DAPA-HF (assessing dapagliflozin) and EMPEROR-Reduced (assessing empagliflozin). The primary endpoint was time to all-cause death. Additionally, we assessed the effects of treatment in prespecified subgroups on the combined risk of cardiovascular death or hospitalisation for heart failure. These subgroups were based on type 2 diabetes status, age, sex, angiotensin receptor neprilysin inhibitor (ARNI) treatment, New York Heart Association (NYHA) functional class, race, history of hospitalisation for heart failure, estimated glomerular filtration rate (eGFR), body-mass index, and region (post-hoc). We used hazard ratios (HRs) derived from Cox proportional hazard models for time-to-first event endpoints and Cochran's Q test for treatment interactions; the analysis of recurrent events was based on rate ratios derived from the Lin-Wei-Yang-Ying model. FINDINGS: Among 8474 patients combined from both trials, the estimated treatment effect was a 13% reduction in all-cause death (pooled HR 0·87, 95% CI 0·77-0·98; p=0·018) and 14% reduction in cardiovascular death (0·86, 0·76-0·98; p=0·027). SGLT2 inhibition was accompanied by a 26% relative reduction in the combined risk of cardiovascular death or first hospitalisation for heart failure (0·74, 0·68-0·82; p<0·0001), and by a 25% decrease in the composite of recurrent hospitalisations for heart failure or cardiovascular death (0·75, 0·68-0·84; p<0·0001). The risk of the composite renal endpoint was also reduced (0·62, 0·43-0·90; p=0·013). All tests for heterogeneity of effect size between trials were not significant. The pooled treatment effects showed consistent benefits for subgroups based on age, sex, diabetes, treatment with an ARNI and baseline eGFR, but suggested treatment-by-subgroup interactions for subgroups based on NYHA functional class and race. INTERPRETATION: The effects of empagliflozin and dapagliflozin on hospitalisations for heart failure were consistent in the two independent trials and suggest that these agents also improve renal outcomes and reduce all-cause and cardiovascular death in patients with HFrEF. FUNDING: Boehringer Ingelheim."},{"id":"c58e1f4f212f","type":"article","url":"https://hartvaat.nl/2020/09/19/trimetazidine-na-pci-lancet-atpci-gerandomiseerde-trial/","title":"Trimetazidine na PCI: Lancet ATPCI gerandomiseerde trial","title_en":"Efficacy and safety of trimetazidine after percutaneous coronary intervention (ATPCI): a randomised, double-blind, placebo-controlled trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(20)31790-6","source_url":"https://doi.org/10.1016/S0140-6736(20)31790-6","authors":["Roberto Ferrari","Ian Ford","Kim Fox","Jean Pascal Challeton","Anne Correges","Michal Tendera","Petr Widimský","Nicolas Danchin"],"significance":7,"published":"2020-09-19","source_date":"2020-09-19","image":"","kennis":[],"congress":"","summary_en":"The ATPCI trial showed that trimetazidine after PCI did not reduce the primary composite of cardiovascular death, hospitalization, or angina recurrence, a negative result for metabolic anti-ischemic therapy as a post-PCI adjunct.","created":"2026-07-03T10:28:46Z","updated":"2026-07-03T13:27:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 ATPCI trial die trimetazidine onderzocht na PCI. Negatief op klinische eindpunten.","abstract_original":"BACKGROUND: Angina might persist or reoccur despite successful revascularisation with percutaneous coronary intervention (PCI) and antianginal therapy. Additionally, PCI in stable patients has not been shown to improve survival compared with optimal medical therapy. Trimetazidine is an antianginal agent that improves energy metabolism of the ischaemic myocardium and might improve outcomes and symptoms of patients who recently had a PCI. In this study, we aimed to assess the long-term potential benefits and safety of trimetazidine added to standard evidence-based medical treatment in patients who had a recent successful PCI. METHODS: We did a randomised, double-blind, placebo-controlled, event-driven trial of trimetazidine added to standard background therapy in patients who had undergone successful PCI at 365 centres in 27 countries across Europe, South America, Asia, and north Africa. Eligible patients were aged 21-85 years and had had either elective PCI for stable angina or urgent PCI for unstable angina or non-ST segment elevation myocardial infarction less than 30 days before randomisation. Patients were randomly assigned by an interactive web response system to oral trimetazidine 35 mg modified-release twice daily or matching placebo. Participants, study investigators, and all study staff were masked to treatment allocation. The primary efficacy endpoint was a composite of cardiac death; hospital admission for a cardiac event; recurrence or persistence of angina requiring an addition, switch, or increase of the dose of at least one antianginal drug; or recurrence or persistence of angina requiring a coronary angiography. Efficacy analyses were done according to the intention-to-treat principle. Safety was assessed in all patients who had at least one dose of study drug. This study is registered with the EU Clinical Trials Register (EudraCT 2010-022134-89). FINDINGS: From Sept 17, 2014, to June 15, 2016, 6007 patients were enrolled and randomly assigned to receive either trimetazidine (n=2998) or placebo (n=3009). After a median follow-up of 47·5 months (IQR 42·3-53·3), incidence of primary endpoint events was not significantly different between the trimetazidine group (700 [23·3%] patients) and the placebo group (714 [23·7%]; hazard ratio 0·98 [95% CI 0·88-1·09], p=0·73). When analysed individually, there were no significant differences in the incidence of the components of the primary endpoint between the treatment groups. Similar results were obtained when patients were categorised according to whether they had an elective or urgent PCI. 1219 (40·9%) of 2983 patients in the trimetazidine group and 1230 (41·1%) of 2990 patients in the placebo group had serious treatment-emergent adverse events. Frequencies of adverse events of interest were similar between the groups. INTERPRETATION: Our results show that the routine use of oral trimetazidine 35 mg twice daily over several years in patients receiving optimal medical therapy, after successful PCI, does not influence the recurrence of angina or the outcome; these findings should be taken into account when considering the place of trimetazidine in clinical practice. However, the long-term prescription of this treatment does not appear to be associated with any statistically significant safety concerns in the population studied. FUNDING: Servier."},{"id":"a3e3d88f2c22","type":"article","url":"https://hartvaat.nl/2020/09/15/tricuspidalisinsufficientie-en-uitkomsten-na-mitraclip-coapt/","title":"Tricuspidalisinsufficiëntie en uitkomsten na MitraClip: COAPT","title_en":"Impact of Tricuspid Regurgitation on Clinical Outcomes: The COAPT Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.07.035","source_url":"https://doi.org/10.1016/j.jacc.2020.07.035","authors":["Rebecca T Hahn","Federico Asch","Neil J Weissman","Paul Grayburn","Saibal Kar","Scott Lim","Ori Ben-Yehuda","Bahira Shahim","Shmuel Chen","Mengdan Liu","Bjorn Redfors","Diego Medvedofsky","Rishi Puri","Samir Kapadia","Anna Sannino","JoAnn Lindenfeld","William T Abraham","Michael J Mack","Gregg W Stone"],"significance":6,"published":"2020-09-15","source_date":"2020-09-15","image":"","kennis":[],"congress":"","summary_en":"This COAPT analysis showed that tricuspid regurgitation severity affects prognosis in heart failure patients with mitral regurgitation, informing the clinical consideration of TR when evaluating MitraClip candidates.","created":"2026-07-03T10:28:46Z","updated":"2026-07-03T13:27:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"COAPT analyse naar de impact van begeleidende tricuspidalisinsufficiëntie op klinische uitkomsten na MitraClip.","abstract_original":"BACKGROUND: The presence of tricuspid regurgitation (TR) may affect prognosis in patients with mitral regurgitation (MR). OBJECTIVES: This study sought to determine the impact of TR on outcomes in patients with heart failure and severe secondary MR randomized to guideline-directed medical therapy (GDMT) or edge-to-edge repair with the MitraClip in the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) trial. METHODS: A total of 614 patients with symptomatic heart failure with moderate to severe (3+) or severe (4+) secondary MR were randomized to maximally tolerated GDMT plus MitraClip or GDMT alone; 599 had core laboratory evaluable echocardiograms. Patients were divided into 2 groups by baseline TR severity: none/trace/mild TR (≤Mild TR) (n = 501 [83.6%]) and moderate/severe TR (≥Mod TR) (n = 98 [16.4%]). Two-year composite endpoints of death or heart failure hospitalization (HFH) and the individual endpoints were analyzed. RESULTS: Patients with ≥Mod TR were more likely to be New York Heart Association functional class III/IV (p < 0.0001) and have a Society of Thoracic Surgeons score of ≥8 (p < 0.0001), anemia (p = 0.02), chronic kidney disease (p = 0.003), and higher N-terminal pro-B-type natriuretic peptide (p = 0.02) than those with ≤Mild TR. Patients with ≥Mod TR had more severe MR (p = 0.0005) despite smaller left ventricular volumes (p = 0.005) and higher right ventricular systolic pressure (p < 0.0001). At 2 years, the composite rate of death or HFH was higher in patients with ≥Mod TR compared with ≤Mild TR treated with GDMT alone (83.0% vs. 64.3%; hazard ratio: 1.74; 95% confidence interval: 1.24 to 2.45; p = 0.001) but not following MitraClip (48.2% vs. 44.0%; hazard ratio: 1.14; 95% confidence interval: 0.71 to 1.84; p = 0.59). Rates of death or HFH, as well as death and HFH alone, were reduced by MitraClip compared with GDMT, irrespective of baseline TR grade (pinteraction = 0.16, 0.29, and 0.21 respectively). CONCLUSIONS: Patients with severe secondary MR who also had ≥Mod TR had worse clinical and echocardiographic characteristics and worse clinical outcomes compared to those with ≤Mild TR. Within the COAPT trial, MitraClip improved outcomes in patients with and without ≥Mod TR severity compared with GDMT alone. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [COAPT]; NCT01626079)."},{"id":"285a79c3ebb8","type":"article","url":"https://hartvaat.nl/2020/09/15/non-culprit-laesie-ernst-en-uitkomsten-bij-stemi-met-multivatenlijden/","title":"Non-culprit laesie-ernst en uitkomsten bij STEMI met multivatenlijden","title_en":"Nonculprit Lesion Severity and Outcome of Revascularization in Patients With STEMI and Multivessel Coronary Disease.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.07.034","source_url":"https://doi.org/10.1016/j.jacc.2020.07.034","authors":["Tej Sheth","Natalia Pinilla-Echeverri","Raul Moreno","Jia Wang","David A Wood","Robert F Storey","Roxana Mehran","Kevin R Bainey","Matthias Bossard","Sripal Bangalore","Jon-David Schwalm","James L Velianou","Nicholas Valettas","Matthew Sibbald","Josep Rodés-Cabau","John Ducas","Eric A Cohen","Akshay Bagai","Stephane Rinfret","David E Newby","Laurent Feldman","Steven B Laster","Irene M Lang","Joseph D Mills","John A Cairns","Shamir R Mehta"],"significance":6,"published":"2020-09-15","source_date":"2020-09-15","image":"","kennis":[],"congress":"","summary_en":"This COMPLETE analysis showed that the severity of nonculprit lesions influences outcomes after revascularization in STEMI with multivessel disease, supporting complete treatment of hemodynamically significant nonculprit stenoses.","created":"2026-07-03T10:28:45Z","updated":"2026-07-03T13:27:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 ernst van non-culprit laesies en de uitkomsten van revascularisatie bij STEMI met multivatencoronairlijden.","abstract_original":"BACKGROUND: In the COMPLETE (Complete vs Culprit-only Revascularization to Treat Multi-vessel Disease After Early PCI for STEMI) trial, angiography-guided percutaneous coronary intervention (PCI) of nonculprit lesions with the aim of complete revascularization reduced major cardiovascular (CV) events in patients with ST-segment elevation myocardial infarction (MI) and multivessel coronary artery disease. OBJECTIVES: The purpose of this study was to determine the effect of nonculprit-lesion stenosis severity measured by quantitative coronary angiography (QCA) on the benefit of complete revascularization. METHODS: Among 4,041 patients randomized in the COMPLETE trial, nonculprit lesion stenosis severity was measured using QCA in the angiographic core laboratory in 3,851 patients with 5,355 nonculprit lesions. In pre-specified analyses, the treatment effect in patients with QCA stenosis ≥60% versus <60% on the first coprimary outcome of CV death or new MI and the second co-primary outcome of CV death, new MI, or ischemia-driven revascularization was determined. RESULTS: The first coprimary outcome was reduced with complete revascularization in the 2,479 patients with QCA stenosis ≥60% (2.5%/year vs. 4.2%/year; hazard ratio [HR]: 0.61; 95% confidence interval [CI]: 0.47 to 0.79), but not in the 1,372 patients with QCA stenosis <60% (3.0%/year vs. 2.9%/year; HR: 1.04; 95% CI: 0.72 to 1.50; interaction p = 0.02). The second coprimary outcome was reduced in patients with QCA stenosis ≥60% (2.9%/year vs. 6.9%/year; HR: 0.43; 95% CI: 0.34 to 0.54) to a greater extent than patients with QCA stenosis <60% (3.3%/year vs. 5.2%/year; HR: 0.65; 95% CI: 0.47 to 0.89; interaction p = 0.04). CONCLUSIONS: Among patients with ST-segment elevation MI and multivessel coronary artery disease, complete revascularization reduced major CV outcomes to a greater extent in patients with stenosis severity of ≥60% compared with <60%, as determined by quantitative coronary angiography."},{"id":"67027b92c81c","type":"article","url":"https://hartvaat.nl/2020/09/15/dapagliflozine-en-diureticagebruik-bij-hfref-dapa-hf/","title":"Dapagliflozine en diureticagebruik bij HFrEF: DAPA-HF","title_en":"Dapagliflozin and Diuretic Use in Patients With Heart Failure and Reduced Ejection Fraction in DAPA-HF.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":["dapa-hf"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.047077","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.047077","authors":["Alice M Jackson","Pooja Dewan","Inder S Anand","Jan Bělohlávek","Olof Bengtsson","Rudolf A de Boer","Michael Böhm","David W Boulton","Vijay K Chopra","David L DeMets","Kieran F Docherty","Andrej Dukát","Peter J Greasley","Jonathan G Howlett","Silvio E Inzucchi","Tzvetana Katova","Lars Køber","Mikhail N Kosiborod","Anna Maria Langkilde","Daniel Lindholm","Charlotta E A Ljungman","Felipe A Martinez","Eileen O'Meara","Marc S Sabatine","Mikaela Sjöstrand","Scott D Solomon","Sergey Tereshchenko","Subodh Verma","Pardeep S Jhund","John J V McMurray"],"significance":7,"published":"2020-09-15","source_date":"2020-09-15","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/ace-remmers-bij-hartfalen/"],"congress":"","summary_en":"This DAPA-HF analysis showed that dapagliflozin's heart failure benefit is consistent regardless of baseline diuretic use, and that SGLT2 inhibition may allow subsequent diuretic dose reduction, with practical implications for volume management.","created":"2026-07-03T10:28:45Z","updated":"2026-07-03T13:27:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"DAPA-HF analyse naar de interactie van dapagliflozine met diureticagebruik bij HFrEF. Praktische implicaties voor diureticadoseringen.","abstract_original":"BACKGROUND: In the DAPA-HF trial (Dapagliflozin and Prevention of Adverse-Outcomes in Heart Failure), the sodium-glucose cotransporter 2 inhibitor dapagliflozin reduced the risk of worsening heart failure and death in patients with heart failure and reduced ejection fraction. We examined the efficacy and tolerability of dapagliflozin in relation to background diuretic treatment and change in diuretic therapy after randomization to dapagliflozin or placebo. METHODS: We examined the effects of study treatment in the following subgroups: no diuretic and diuretic dose equivalent to furosemide <40, 40, and >40 mg daily at baseline. We examined the primary composite end point of cardiovascular death or a worsening heart failure event and its components, all-cause death and symptoms. RESULTS: Of 4616 analyzable patients, 736 (15.9%) were on no diuretic, 1311 (28.4%) were on <40 mg, 1365 (29.6%) were on 40 mg, and 1204 (26.1%) were taking >40 mg. Compared with placebo, dapagliflozin reduced the risk of the primary end point across each of these subgroups: hazard ratios were 0.57 (95% CI, 0.36-0.92), 0.83 (95% CI, 0.63-1.10), 0.77 (95% CI, 0.60-0.99), and 0.78 (95% CI, 0.63-0.97), respectively (P for interaction=0.61). The hazard ratio in patients taking any diuretic was 0.78 (95% CI, 0.68-0.90). Improvements in symptoms and treatment toleration were consistent across the diuretic subgroups. Diuretic dose did not change in most patients during follow-up, and mean diuretic dose did not differ between the dapagliflozin and placebo groups after randomization. CONCLUSIONS: The efficacy and safety of dapagliflozin were consistent across the diuretic subgroups examined in DAPA-HF. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03036124."},{"id":"80f1bccd22b2","type":"article","url":"https://hartvaat.nl/2020/09/15/empagliflozine-bij-hartfalen-diuretische-en-cardiorenale-effecten/","title":"Empagliflozine bij hartfalen: diuretische en cardiorenale effecten","title_en":"Empagliflozin in Heart Failure: Diuretic and Cardiorenal Effects.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","anemie-ckd","bisoprolol","canagliflozine","cardiale-amyloidose","cardiorenal-behandelstrategie","carvedilol","dapa-hf","dapagliflozine","diabetes-en-hart","diuretica","empagliflozine","emperor-trials","fidelity","hfmref","hfpef","hfref","ijzersuppletie","ijzertekort","nierfalen","nt-probnp","sacubitril-valsartan","step-hfpef"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.045691","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.045691","authors":["Matthew Griffin","Veena S Rao","Juan Ivey-Miranda","James Fleming","Devin Mahoney","Christopher Maulion","Nisha Suda","Krishmita Siwakoti","Tariq Ahmad","Daniel Jacoby","Ralph Riello","Lavanya Bellumkonda","Zachary Cox","Sean Collins","Sangchoon Jeon","Jeffrey M Turner","F Perry Wilson","Javed Butler","Silvio E Inzucchi","Jeffrey M Testani"],"significance":7,"published":"2020-09-15","source_date":"2020-09-15","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hartfalen-en-nierfunctie/"],"congress":"","summary_en":"This mechanistic study characterized the diuretic and cardiorenal effects of empagliflozin in heart failure, demonstrating natriuresis, osmotic diuresis, and favorable renal hemodynamic changes that help explain the clinical benefits of SGLT2 inhibitors in heart failure.","created":"2026-07-03T10:28:45Z","updated":"2026-07-03T18:38:48Z","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":"Mechanistische studie naar de diuretische en cardiorenale effecten van empagliflozine bij hartfalen. Inzicht in het werkingsmechanisme voorbij glucoseverlaging.","abstract_original":"BACKGROUND: Sodium-glucose cotransporter-2 inhibitors improve heart failure-related outcomes. The mechanisms underlying these benefits are not well understood, but diuretic properties may contribute. Traditional diuretics such as furosemide induce substantial neurohormonal activation, contributing to the limited improvement in intravascular volume often seen with these agents. However, the proximal tubular site of action of the sodium-glucose cotransporter-2 inhibitors may help circumvent these limitations. METHODS: Twenty patients with type 2 diabetes mellitus and chronic, stable heart failure completed a randomized, placebo-controlled crossover study of empagliflozin 10 mg daily versus placebo. Patients underwent an intensive 6-hour biospecimen collection and cardiorenal phenotyping at baseline and again after 14 days of study drug. After a 2-week washout, patients crossed over to the alternate therapy with the above protocol repeated. RESULTS: Oral empagliflozin was rapidly absorbed as evidenced by a 27-fold increase in urinary glucose excretion by 3 hours (P<0.0001). Fractional excretion of sodium increased significantly with empagliflozin monotherapy versus placebo (fractional excretion of sodium, 1.2±0.7% versus 0.7±0.4%; P=0.001), and there was a synergistic effect in combination with bumetanide (fractional excretion of sodium, 5.8±2.5% versus 3.9±1.9%; P=0.001). At 14 days, the natriuretic effect of empagliflozin persisted, resulting in a reduction in blood volume (-208 mL [interquartile range, -536 to 153 mL] versus -14 mL [interquartile range, -282 to 335 mL]; P=0.035) and plasma volume (-138 mL, interquartile range, -379 to 154±453 mL; P=0.04). This natriuresis was not, however, associated with evidence of neurohormonal activation because the change in norepinephrine was superior (P=0.02) and all other neurohormones were similar (P<0.34) during the empagliflozin versus placebo period. Furthermore, there was no evidence of potassium wasting (P=0.20) or renal dysfunction (P>0.11 for all biomarkers), whereas both serum magnesium (P<0.001) and uric acid levels (P=0.008) improved. CONCLUSIONS: Empagliflozin causes significant natriuresis, particularly when combined with loop diuretics, resulting in an improvement in blood volume. However, off-target electrolyte wasting, renal dysfunction, and neurohormonal activation were not observed. This favorable diuretic profile may offer significant advantage in the management of volume status in patients with heart failure and may represent a mechanism contributing to the superior long-term heart failure outcomes observed with these agents. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03027960."},{"id":"6722abb01693","type":"article","url":"https://hartvaat.nl/2020/09/15/ami-management-tijdens-covid-19-scai-positiedocument/","title":"AMI-management tijdens COVID-19: SCAI positiedocument","title_en":"Management of Acute Myocardial Infarction During the COVID-19 Pandemic: A Position Statement From the Society for Cardiovascular Angiography and Interventions (SCAI), the American College of Cardiology (ACC), and the American College of Emergency Physicians (ACEP).","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["covid-hart"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.04.039","source_url":"https://doi.org/10.1016/j.jacc.2020.04.039","authors":["Ehtisham Mahmud","Harold L Dauerman","Frederick G P Welt","John C Messenger","Sunil V Rao","Cindy Grines","Amal Mattu","Ajay J Kirtane","Rajiv Jauhar","Perwaiz Meraj","Ivan C Rokos","John S Rumsfeld","Timothy D Henry"],"significance":7,"published":"2020-09-15","source_date":"2020-09-15","image":"","kennis":[],"congress":"","summary_en":"This SCAI position statement provided guidance on managing acute myocardial infarction during the COVID-19 pandemic, addressing triage protocols, catheterization lab modifications, and strategies for maintaining timely reperfusion while minimizing infection risk.","created":"2026-07-03T10:28:45Z","updated":"2026-07-03T13:27:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"SCAI positiedocument over het management van acuut myocardinfarct tijdens de COVID-19 pandemie.","abstract_original":"The worldwide pandemic caused by the novel acute respiratory syndrome coronavirus 2 has resulted in a new and lethal disease termed coronavirus disease-2019 (COVID-19). Although there is an association between cardiovascular disease and COVID-19, the majority of patients who need cardiovascular care for the management of ischemic heart disease may not be infected with this novel coronavirus. The objective of this document is to provide recommendations for a systematic approach for the care of patients with an acute myocardial infarction (AMI) during the COVID-19 pandemic. There is a recognition of two major challenges in providing recommendations for AMI care in the COVID-19 era. Cardiovascular manifestations of COVID-19 are complex with patients presenting with AMI, myocarditis simulating an ST-elevation myocardial infarction (STEMI) presentation, stress cardiomyopathy, non-ischemic cardiomyopathy, coronary spasm, or nonspecific myocardial injury, and the prevalence of COVID-19 disease in the U.S. population remains unknown with risk of asymptomatic spread. This document addresses the care of these patients focusing on 1) the varied clinical presentations; 2) appropriate personal protection equipment (PPE) for health care workers; 3) role of the Emergency Department, Emergency Medical System and the Cardiac Catheterization Laboratory; and 4) Regional STEMI systems of care. During the COVID-19 pandemic, primary PCI remains the standard of care for STEMI patients at PCI capable hospitals when it can be provided in a timely fashion, with an expert team outfitted with PPE in a dedicated CCL room. A fibrinolysis-based strategy may be entertained at non-PCI capable referral hospitals or in specific situations where primary PCI cannot be executed or is not deemed the best option."},{"id":"5269942ab906","type":"article","url":"https://hartvaat.nl/2020/09/14/glp-1-agonisten-bij-diabetes-type-2-met-en-zonder-cvd-meta-analyse/","title":"GLP-1-agonisten bij diabetes type 2 met en zonder CVD: meta-analyse","title_en":"Effects of glucagon-like peptide-1 receptor agonists on major cardiovascular events in patients with Type 2 diabetes mellitus with or without established cardiovascular disease: a meta-analysis of randomized controlled trials.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","internist"],"tags":["diabetes-en-hart","diabetes-type-2","glp1-agonisten","glp1-semaglutide-cardiovasculair","liraglutide","semaglutide","tirzepatide"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaa082","source_url":"https://doi.org/10.1093/eurheartj/ehaa082","authors":["Fabio Marsico","Stefania Paolillo","Paola Gargiulo","Dario Bruzzese","Simona Dell'Aversana","Immacolata Esposito","Francesco Renga","Luca Esposito","Caterina Marciano","Santo Dellegrottaglie","Ivana Iesu","Pasquale Perrone Filardi"],"significance":8,"published":"2020-09-14","source_date":"2020-09-14","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"This meta-analysis showed that GLP-1 receptor agonists reduce major cardiovascular events in patients with type 2 diabetes both with and without established cardiovascular disease, though the absolute benefit is greater in the secondary prevention population.","created":"2026-07-03T10:28:45Z","updated":"2026-07-03T13:27:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 naar effecten van GLP-1-agonisten op cardiovasculaire events bij diabetes type 2 met en zonder vastgestelde CVD.","abstract_original":"AIMS: Glucose-lowering, glucagon-like peptide-1 (GLP-1) receptor agonists reduce incidence of major cardiovascular (CV) events in patients with Type 2 diabetes mellitus (DM). However, randomized clinical trials reported inconsistent effects on myocardial infarction (MI) and stroke, and limited data in DM patients without established CV disease (CVD). Very recently, new relevant evidence was available from additional CV outcome trials (CVOTs) that also included large subgroups of patients with DM without established CVD. Thus, the aim of this meta-analysis was to investigate the effects of GLP-1 receptor agonists on major CV events and safety in DM patients with and without established CVD. METHODS AND RESULTS: In this trial-level meta-analysis, we analysed data from randomized placebo-controlled CVOTs assessing efficacy and safety of GLP-1 receptor agonists in adult patients with Type 2 DM. We searched PubMed, Embase, Cochrane, ISI Web of Science, SCOPUS, and clinicaltrial.gov databases for eligible trials. Of 360 articles identified and screened for eligibility, seven CVOTs were included, with an overall of 56 004 patients included. The difference in efficacy with respect to the major adverse cardiovascular events (MACE) primary endpoint (including CV mortality, non-fatal MI, and non-fatal stroke) between patients with established CVD and patients with CV risk factors only was not significant [pooled interaction effect, expressed as ratio of hazard ratio (HR) 1.06, 95% confidence interval (CI) 0.85-1.34]. In the analysis of the whole population of DM patients, GLP-1 receptor agonists showed a significant 12% reduction in the hazard of the three-point MACE composite endpoint (HR 0.88, 95% CI 0.80-0.96) and a significant reduction in the risk of CV mortality (HR 0.88, 95% CI 0.79-0.98), all-cause mortality (HR 0.89, 95% CI 0.81-0.97), fatal and non-fatal stroke (HR 0.84, 95% CI 0.76-0.94), and heart failure (HF) hospitalization (HR 0.92, 95% CI 0.86-0.97). No significant effect was observed for fatal and non-fatal MI (HR 0.91, 95% CI 0.82-1.02), although in a sensitivity analysis, based on a less conservative statistical approach, the pooled HR become statistically significant (HR 0.91, 95% CI 0.83-1.00; P = 0.039). No excess of hypoglycaemia, pancreatitis, and pancreatic cancer was observed between GLP-1 receptor agonists and placebo. CONCLUSION: Glucagon-like peptide-1 receptor agonists significantly reduce MACE, CV and total mortality stroke, and hospitalization for HF, with a trend for reduction of MI, in patients with Type 2 DM with and without established CVD."},{"id":"e3ab4e7ef62d","type":"article","url":"https://hartvaat.nl/2020/09/07/des-versus-cabg-bij-hoofdstamlijden-mortaliteits-meta-analyse/","title":"DES versus CABG bij hoofdstamlijden: mortaliteits meta-analyse","title_en":"Mortality after drug-eluting stents vs. coronary artery bypass grafting for left main coronary artery disease: a meta-analysis of randomized controlled trials.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaa135","source_url":"https://doi.org/10.1093/eurheartj/ehaa135","authors":["Yousif Ahmad","James P Howard","Ahran D Arnold","Christopher M Cook","Megha Prasad","Ziad A Ali","Manish A Parikh","Ioanna Kosmidou","Darrel P Francis","Jeffrey W Moses","Martin B Leon","Ajay J Kirtane","Gregg W Stone","Dimitri Karmpaliotis"],"significance":8,"published":"2020-09-07","source_date":"2020-09-07","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis comparing mortality after DES versus CABG for left main coronary disease found that CABG was associated with significantly lower long-term all-cause and cardiovascular mortality. The updated data strengthened the evidence favoring surgery for left main revascularization.","created":"2026-07-03T10:28:45Z","updated":"2026-07-03T13:27:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 mortaliteit vergeleek na DES versus CABG bij linker-hoofdstamcoronairlijden. Geactualiseerde langetermijndata.","abstract_original":"AIMS: The optimal method of revascularization for patients with left main coronary artery disease (LMCAD) is controversial. Coronary artery bypass graft surgery (CABG) has traditionally been considered the gold standard therapy, and recent randomized trials comparing CABG with percutaneous coronary intervention (PCI) with drug-eluting stents (DES) have reported conflicting outcomes. We, therefore, performed a systematic review and updated meta-analysis comparing CABG to PCI with DES for the treatment of LMCAD. METHODS AND RESULTS: We systematically identified all randomized trials comparing PCI with DES vs. CABG in patients with LMCAD. The primary efficacy endpoint was all-cause mortality. Secondary endpoints included cardiac death, myocardial infarction (MI), stroke, and unplanned revascularization. All analyses were by intention-to-treat. There were five eligible trials in which 4612 patients were randomized. The weighted mean follow-up duration was 67.1 months. There were no significant differences between PCI and CABG for the risk of all-cause mortality [relative risk (RR) 1.03, 95% confidence interval (CI) 0.81-1.32; P = 0.779] or cardiac death (RR 1.03, 95% CI 0.79-1.34; P = 0.817). There were also no significant differences in the risk of stroke (RR 0.74, 95% CI 0.35-1.50; P = 0.400) or MI (RR 1.22, 95% CI 0.96-1.56; P = 0.110). Percutaneous coronary intervention was associated with an increased risk of unplanned revascularization (RR 1.73, 95% CI 1.49-2.02; P < 0.001). CONCLUSION: The totality of randomized clinical trial evidence demonstrated similar long-term mortality after PCI with DES compared with CABG in patients with LMCAD. Nor were there significant differences in cardiac death, stroke, or MI between PCI and CABG. Unplanned revascularization procedures were less common after CABG compared with PCI. These findings may inform clinical decision-making between cardiologists, surgeons, and patients with LMCAD."},{"id":"239e240e8556","type":"article","url":"https://hartvaat.nl/2020/09/01/arni-naar-hf-voorgeschiedenis-en-raas-antagonistgebruik/","title":"ARNI naar HF-voorgeschiedenis en RAAS-antagonistgebruik","title_en":"Angiotensin Receptor-Neprilysin Inhibition Based on History of Heart Failure and Use of Renin-Angiotensin System Antagonists.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":["acuut-hartfalen","angiotensinereceptorblokkers","answer-hf","sacubitril-valsartan"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.06.073","source_url":"https://doi.org/10.1016/j.jacc.2020.06.073","authors":["Andrew P Ambrosy","Eugene Braunwald","David A Morrow","Adam D DeVore","Kevin McCague","Xiangyi Meng","Carol I Duffy","Ricardo Rocha","Eric J Velazquez"],"significance":6,"published":"2020-09-01","source_date":"2020-09-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/arni-sacubitril-valsartan/","https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/"],"congress":"","summary_en":"This PIONEER-HF analysis examined how prior heart failure history and RAAS antagonist use affect the response to sacubitril-valsartan initiation during acute heart failure hospitalization.","created":"2026-07-03T10:28:45Z","updated":"2026-07-03T13:27:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 sacubitril/valsartan-initiatie naar hartfalenvoorgeschiedenis en eerder gebruik van RAAS-antagonisten.","abstract_original":"BACKGROUND: The PIONEER-HF (comParIson Of sacubitril/valsartaN versus Enalapril on Effect on nt-pRo-bnp in patients stabilized from an acute Heart Failure episode) trial demonstrated the efficacy and safety of sacubitril/valsartan (S/V) in stabilized patients with acute decompensated heart failure (HF) and reduced ejection fraction. OBJECTIVES: The study sought to determine whether and how prior HF history and treatment with an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) affected the results. METHODS: The PIONEER-HF trial was a prospective, multicenter, double-blind, randomized clinical trial enrolling 881 patients with an ejection fraction ≤40%. Patients were randomly assigned 1:1 to in-hospital initiation of S/V (n = 440) versus enalapril (n = 441). Pre-specified subgroup analyses were performed based on prior HF history (i.e., de novo HF vs. worsening chronic HF) and treatment with an ACE inhibitor or ARB (i.e., ACE inhibitor or ARB-yes vs. ACE inhibitor or ARB-no) at admission. RESULTS: At enrollment, 303 (34%) patients presented with de novo HF and 576 (66%) patients with worsening chronic HF. A total of 421 (48%) patients had been treated with an ACE inhibitor or ARB, while 458 (52%) had not been treated with an ACE inhibitor or ARB. N-terminal pro-B-type natriuretic peptide declined significantly in all 4 subgroups (p < 0.001), with greater decreases in the S/V versus the enalapril arm (p < 0.001). There was no interaction between prior HF history (p = 0.350) or ACE inhibitor or ARB treatment (p = 0.880) and the effect of S/V versus enalapril on cardiovascular death or rehospitalization for HF. The incidences of adverse events were comparable between S/V and enalapril across all 4 subgroups. CONCLUSIONS: Among patients admitted for acute decompensated HF, S/V was safe and well tolerated, led to a significantly greater reduction in N-terminal pro-B-type natriuretic peptide, and improved clinical outcomes compared with enalapril irrespective of previous HF history or ACE inhibitor or ARB treatment. (Comparison of Sacubitril/Valsartan Versus Enalapril on Effect of NT-proBNP in Patients Stabilized From an Acute Heart Failure Episode [PIONEER-HF]; NCT02554890)."},{"id":"85ce811f7b45","type":"article","url":"https://hartvaat.nl/2020/09/01/voorspellers-van-klinische-respons-op-transcatheter-mr-reductie-coapt/","title":"Voorspellers van klinische respons op transcatheter MR-reductie: COAPT","title_en":"Predictors of Clinical Response to Transcatheter Reduction of Secondary Mitral Regurgitation: The COAPT Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.07.010","source_url":"https://doi.org/10.1016/j.jacc.2020.07.010","authors":["Paul A Grayburn","Anna Sannino","David J Cohen","Saibal Kar","D Scott Lim","Jacob M Mishell","Brian K Whisenant","Michael J Rinaldi","Samir R Kapadia","Vivek Rajagopal","Aaron Crowley","Lak N Kotinkaduwa","JoAnn Lindenfeld","William T Abraham","Michael J Mack","Gregg W Stone"],"significance":7,"published":"2020-09-01","source_date":"2020-09-01","image":"","kennis":[],"congress":"","summary_en":"This COAPT analysis identified clinical and echocardiographic predictors of response to MitraClip in secondary mitral regurgitation, providing a framework for patient selection to optimize transcatheter mitral valve repair outcomes.","created":"2026-07-03T10:28:45Z","updated":"2026-07-03T13:27:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"COAPT analyse die voorspellers identificeerde van klinische respons op MitraClip bij secundaire MR.","abstract_original":"BACKGROUND: Transcatheter mitral valve repair with the MitraClip results in marked clinical improvement in some but not all patients with secondary mitral regurgitation (MR) and heart failure (HF). OBJECTIVES: This study sought to evaluate the clinical predictors of a major response to treatment in the COAPT trial. METHODS: Patients with HF and severe MR who were symptomatic on maximally tolerated guideline-directed medical therapy (GDMT) were randomly assigned to MitraClip plus GDMT or GDMT alone. Super-responders were defined as those alive without HF hospitalization and with ≥20-point improvement in the Kansas City Cardiomyopathy Questionnaire overall summary (KCCQ-OS) score at 12 months. Responders were defined as those alive without HF hospitalization and with a 5 to <20-point KCCQ-OS improvement at 12 months. Nonresponders were those who either died, were hospitalized for HF, or had <5-point improvement in KCCQ-OS at 12 months. RESULTS: Among 614 enrolled patients, 41 (6.7%) had missing KCCQ-OS data and could not be classified. At 12 months, there were 79 super-responders (27.2%), 55 responders (19.0%), and 156 nonresponders (53.8%) in the MitraClip arm compared with 29 super-responders (10.2%), 46 responders (16.3%), and 208 nonresponders (73.5%) in the GDMT-alone arm (overall p < 0.0001). Independent baseline predictors of clinical responder status were lower serum creatinine and KCCQ-OS scores and treatment assignment to MitraClip. MR grade and estimated right ventricular systolic pressure at 30 days were improved to a greater degree in super-responders and responders but not in nonresponders. CONCLUSIONS: Baseline predictors of clinical super-responders in patients with HF and severe secondary MR in the COAPT trial were lower serum creatinine, KCCQ-OS score and MitraClip treatment. Improved MR severity and reduced right ventricular systolic pressure at 30 days are associated with a long-term favorable clinical response after transcatheter mitral valve repair. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [COAPT]; NCT01626079)."},{"id":"73c31de28448","type":"article","url":"https://hartvaat.nl/2020/09/01/2020-acc-expert-consensus-nieuwe-therapieen-voor-cv-risicoreductie-bij-diabetes-/","title":"2020 ACC Expert Consensus: nieuwe therapieën voor CV-risicoreductie bij diabetes type 2","title_en":"2020 Expert Consensus Decision Pathway on Novel Therapies for Cardiovascular Risk Reduction in Patients With Type 2 Diabetes: A Report of the American College of Cardiology Solution Set Oversight Committee.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.05.037","source_url":"https://doi.org/10.1016/j.jacc.2020.05.037","authors":["Sandeep R Das","Brendan M Everett","Kim K Birtcher","Jenifer M Brown","James L Januzzi","Rita R Kalyani","Mikhail Kosiborod","Melissa Magwire","Pamela B Morris","Joshua J Neumiller","Laurence S Sperling"],"significance":9,"published":"2020-09-01","source_date":"2020-09-01","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"The 2020 ACC Expert Consensus updated the decision pathway for SGLT2 inhibitors and GLP-1 receptor agonists in type 2 diabetes, integrating evidence from DAPA-HF, CREDENCE, and other contemporary trials to guide agent selection based on predominant cardiovascular or renal comorbidity.","created":"2026-07-03T10:28:44Z","updated":"2026-07-03T13:27:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ACC 2020 geactualiseerde expert consensus over SGLT2-remmers en GLP-1-agonisten voor CV-risicoreductie bij diabetes type 2. Integreert DAPA-HF en CREDENCE.","abstract_original":""},{"id":"29de402c09c1","type":"article","url":"https://hartvaat.nl/2020/09/01/clopidogrel-versus-prasugrel-versus-ticagrelor-op-endotheelfunctie-en-inflammati/","title":"Clopidogrel versus prasugrel versus ticagrelor op endotheelfunctie en inflammatie bij ACS","title_en":"Effects of clopidogrel vs. prasugrel vs. ticagrelor on endothelial function, inflammatory parameters, and platelet function in patients with acute coronary syndrome undergoing coronary artery stenting: a randomized, blinded, parallel study.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["trombocytenaggregatieremmers"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehz917","source_url":"https://doi.org/10.1093/eurheartj/ehz917","authors":["Boris Schnorbus","Andreas Daiber","Kerstin Jurk","Silke Warnke","Jochem Koenig","Karl J Lackner","Thomas Münzel","Tommaso Gori"],"significance":6,"published":"2020-09-01","source_date":"2020-09-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/trombocytenaggregatieremmers-bij-acs/","https://hartvaat.nl/kennis/farmacologie/p2y12-remmers-vergelijking/"],"congress":"","summary_en":"This randomized head-to-head study compared the pleiotropic effects of clopidogrel, prasugrel, and ticagrelor on endothelial function, inflammation, and platelet aggregation in ACS patients, characterizing their differential pharmacological profiles.","created":"2026-07-03T10:28:44Z","updated":"2026-07-03T13:27:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 drie P2Y12-remmers op endotheelfunctie, inflammatoire parameters en plaatjesfunctie bij ACS.","abstract_original":"AIMS: In a randomized, parallel, blinded study, we investigate the impact of clopidogrel, prasugrel, or ticagrelor on peripheral endothelial function in patients undergoing stenting for an acute coronary syndrome. METHODS AND RESULTS: The primary endpoint of the study was the change in endothelium-dependent flow-mediated dilation (FMD) following stenting. A total of 90 patients (age 62 ± 9 years, 81 males, 22 diabetics, 49 non-ST elevation myocardial infarctions) were enrolled. There were no significant differences among groups in any clinical parameter. Acutely before stenting, all three drugs improved FMD without differences between groups (P = 0.73). Stenting blunted FMD in the clopidogrel and ticagrelor group (both P < 0.01), but not in the prasugrel group. During follow-up, prasugrel was superior to clopidogrel [mean difference 2.13, 95% confidence interval (CI) 0.68-3.58; P = 0.0047] and ticagrelor (mean difference 1.57, 95% CI 0.31-2.83; P = 0.0155), but this difference was limited to patients who received the study therapy 2 h before stenting. Ticagrelor was not significantly superior to clopidogrel (mean difference 0.55, 95% CI -0.73 to 1.82; P = 0.39). No significant differences were seen among groups for low-flow-mediated dilation. Plasma interleukin (IL)-6 (P = 0.02 and P = 0.01, respectively) and platelet aggregation reactivity in response to adenosine diphosphate (P = 0.002 and P = 0.035) were lower in the prasugrel compared to clopidogrel and ticagrelor group. CONCLUSION: As compared to ticagrelor and clopidogrel, therapy with prasugrel in patients undergoing stenting for an acute coronary syndrome is associated with improved endothelial function, stronger platelet inhibition, and reduced IL-6 levels, all of which may have prognostic implications. This effect was lost in patients who received the study medication immediately after stenting. EUDRACT-NO: 2011-005305-73."},{"id":"3e3806573da1","type":"article","url":"https://hartvaat.nl/2020/09/01/routine-revascularisatie-versus-medicamenteus-bij-stabiel-coronairlijden-meta-an/","title":"Routine revascularisatie versus medicamenteus bij stabiel coronairlijden: meta-analyse","title_en":"Routine Revascularization Versus Initial Medical Therapy for Stable Ischemic Heart Disease: A Systematic Review and Meta-Analysis of Randomized Trials.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["farmaco-economie","hartkatheterisatie","ouderen","stabiel-coronairlijden"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.048194","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.048194","authors":["Sripal Bangalore","David J Maron","Gregg W Stone","Judith S Hochman"],"significance":8,"published":"2020-09-01","source_date":"2020-09-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/esc-richtlijn-chronisch-coronairlijden-2024/","https://hartvaat.nl/kennis/coronairlijden/stabiele-angina-pectoris/"],"congress":"","summary_en":"This systematic review and meta-analysis of randomized trials found that routine revascularization plus medical therapy did not significantly reduce death compared with initial medical therapy alone in patients with stable ischemic heart disease, reinforcing the ISCHEMIA trial conclusions.","created":"2026-07-03T10:28:44Z","updated":"2026-07-03T13:27:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 die routine revascularisatie vergeleek met initiële medicamenteuze therapie bij stabiel coronairlijden. Post-ISCHEMIA synthese.","abstract_original":"BACKGROUND: Revascularization is often performed in patients with stable ischemic heart disease. However, whether revascularization reduces death and other cardiovascular outcomes is uncertain. METHODS: We conducted PUBMED/EMBASE/Cochrane Central Register of Controlled Trials searches for randomized trials comparing routine revascularization versus an initial conservative strategy in patients with stable ischemic heart disease. The primary outcome was death. Secondary outcomes were cardiovascular death, myocardial infarction (MI), heart failure, stroke, unstable angina, and freedom from angina. Trials were stratified by percent stent use and by percent statin use to evaluate outcomes in contemporary trials. RESULTS: Fourteen randomized clinical trials that enrolled 14 877 patients followed up for a weighted mean of 4.5 years with 64 678 patient-years of follow-up fulfilled our inclusion criteria. Most trials enrolled patients with preserved left ventricular systolic function and low symptom burden, and excluded patients with left main disease. Revascularization compared with medical therapy alone was not associated with a reduced risk of death (relative risk [RR], 0.99 [95% CI, 0.90-1.09]). Trial sequential analysis showed that the cumulative z-curve crossed the futility boundary, indicating firm evidence for lack of a 10% or greater reduction in death. Revascularization was associated with a reduced nonprocedural MI (RR, 0.76 [95% CI, 0.67-0.85]) but also with increased procedural MI (RR, 2.48 [95% CI, 1.86-3.31]) with no difference in overall MI (RR, 0.93 [95% CI, 0.83-1.03]). A significant reduction in unstable angina (RR, 0.64 [95% CI, 0.45-0.92]) and increase in freedom from angina (RR, 1.10 [95% CI, 1.05-1.15]) was also observed with revascularization. There were no treatment-related differences in the risk of heart failure or stroke. CONCLUSIONS: In patients with stable ischemic heart disease, routine revascularization was not associated with improved survival but was associated with a lower risk of nonprocedural MI and unstable angina with greater freedom from angina at the expense of higher rates of procedural MI. Longer-term follow-up of trials is needed to assess whether reduction in these nonfatal spontaneous events improves long-term survival."},{"id":"a307ae109d6c","type":"article","url":"https://hartvaat.nl/2020/09/01/preconceptiebloeddruk-en-verandering-naar-vroege-zwangerschap-risicofactor-voor-/","title":"Preconceptiebloeddruk en verandering naar vroege zwangerschap: risicofactor voor pre-eclampsie","title_en":"Preconception Blood Pressure and Its Change Into Early Pregnancy: Early Risk Factors for Preeclampsia and Gestational Hypertension.","category":"hypertensie","category_label":"Hypertensie","professions":["huisarts"],"tags":["zwangerschap-hart"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.14875","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.14875","authors":["Carrie J Nobles","Pauline Mendola","Sunni L Mumford","Robert M Silver","Keewan Kim","Victoria C Andriessen","Matthew Connell","Lindsey Sjaarda","Neil J Perkins","Enrique F Schisterman"],"significance":5,"published":"2020-09-01","source_date":"2020-09-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-zwangerschap/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This study showed that preconception blood pressure and its change into early pregnancy are early risk factors for preeclampsia and gestational hypertension, supporting blood pressure optimization before conception.","created":"2026-07-03T10:28:44Z","updated":"2026-07-03T13:27:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 preconceptiebloeddruk en de verandering naar vroege zwangerschap als risicofactor voor pre-eclampsie en gestationele hypertensie.","abstract_original":"Preeclampsia and gestational hypertension are common complications of pregnancy associated with significant maternal and infant morbidity. Despite extensive research evaluating risk factors during pregnancy, most women who develop a hypertensive disorder of pregnancy are not considered high-risk and strategies for prevention remain elusive. We evaluated preconception blood pressure and its change into early pregnancy as novel risk markers for development of a hypertensive disorder of pregnancy. The EAGeR (Effects of Aspirin in Gestation and Reproduction) trial (2007-2011) randomized 1228 healthy women with a history of pregnancy loss to preconception-initiated low-dose aspirin versus placebo and followed participants for up to 6 menstrual cycles attempting pregnancy and throughout pregnancy if they became pregnant. Blood pressure was measured during preconception and throughout early gestation. The primary outcomes, preterm preeclampsia, term preeclampsia, and gestational hypertension, were abstracted from medical records. Among 586 women with a pregnancy >20 weeks' gestation, preconception blood pressure levels were higher for preterm preeclampsia (87.3±6.7 mm Hg mean arterial pressure), term preeclampsia (88.3±9.8 mm Hg), and gestational hypertension (87.9±9.1 mm Hg) as compared with no hypertensive disorder of pregnancy (83.9±8.6 mm Hg). Change in blood pressure from preconception into very early pregnancy was associated with development of preeclampsia (relative risk, 1.13 [95% CI, 1.02-1.25] per 2 mm Hg increase in mean arterial pressure at 4 weeks' gestation), particularly preterm preeclampsia (relative risk, 1.21 [95% CI, 1.01-1.45]). Randomization to aspirin did not alter blood pressure trajectory or risk of hypertension in pregnancy. Preconception blood pressure and longitudinal changes during early pregnancy are underexplored but crucial windows in the detection and prevention of hypertensive disorders of pregnancy. Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00467363."},{"id":"b71e34291dc9","type":"article","url":"https://hartvaat.nl/2020/09/01/carbidopa-bij-afferente-baroreflexfalen-bij-familiaire-dysautonomie-gerandomisee/","title":"Carbidopa bij afferente baroreflexfalen bij familiaire dysautonomie: gerandomiseerde trial","title_en":"Carbidopa for Afferent Baroreflex Failure in Familial Dysautonomia: A Double-Blind Randomized Crossover Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.15267","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.15267","authors":["Lucy Norcliffe-Kaufmann","Jose-Alberto Palma","Jose Martinez","Horacio Kaufmann"],"significance":5,"published":"2020-09-01","source_date":"2020-09-01","image":"","kennis":[],"congress":"","summary_en":"This double-blind crossover trial of carbidopa for afferent baroreflex failure in familial dysautonomia tested a dopamine-targeting approach to reduce the excessive blood pressure variability in this rare autonomic disorder.","created":"2026-07-03T10:28:44Z","updated":"2026-07-03T13:27:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 crossover trial van carbidopa bij afferente baroreflexfalen bij familiaire dysautonomie.","abstract_original":"Afferent lesions of the arterial baroreflex occur in familial dysautonomia. This leads to excessive blood pressure variability with falls and frequent surges that damage the organs. These hypertensive surges are the result of excess peripheral catecholamine release and have no adequate treatment. Carbidopa is a selective DOPA-decarboxylase inhibitor that suppresses catecholamines production outside the brain. To learn whether carbidopa can inhibit catecholamine-induced hypertensive surges in patients with severe afferent baroreflex failure, we conducted a double-blind randomized crossover trial in which patients with familial dysautonomia received high dose carbidopa (600 mg/day), low-dose carbidopa (300 mg/day), or matching placebo in 3 4-week treatment periods. Among the 22 patients enrolled (13 females/8 males), the median age was 26 (range, 12-59 years). At enrollment, patients had hypertensive peaks to 164/116 (range, 144/92 to 213/150 mm Hg). Twenty-four hour urinary norepinephrine excretion, a marker of peripheral catecholamine release, was significantly suppressed on both high dose and low dose carbidopa, compared with placebo (P=0.0075). The 2 co-primary end points of the trial were met. The SD of systolic BP variability was reduced at both carbidopa doses (low dose: 17±4; high dose: 18±5 mm Hg) compared with placebo (23±7 mm Hg; P=0.0013), and there was a significant reduction in the systolic BP peaks on active treatment (P=0.0015). High- and low-dose carbidopa were similarly effective and well tolerated. This study provides class Ib evidence that carbidopa can reduce blood pressure variability in patients with congenital afferent baroreflex failure. Similar beneficial effects are observed in patients with acquired baroreflex lesions."},{"id":"63250d8af48f","type":"article","url":"https://hartvaat.nl/2020/08/25/genotype-geleide-p2y12-selectie-versus-clopidogrel-na-pci-jama-tailor-pci/","title":"Genotype-geleide P2Y12-selectie versus clopidogrel na PCI: JAMA TAILOR-PCI","title_en":"Effect of Genotype-Guided Oral P2Y12 Inhibitor Selection vs Conventional Clopidogrel Therapy on Ischemic Outcomes After Percutaneous Coronary Intervention: The TAILOR-PCI Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2020.12443","source_url":"https://doi.org/10.1001/jama.2020.12443","authors":["Naveen L Pereira","Michael E Farkouh","Derek So","Ryan Lennon","Nancy Geller","Verghese Mathew","Malcolm Bell","Jang-Ho Bae","Myung Ho Jeong","Ivan Chavez","Paul Gordon","J Dawn Abbott","Charles Cagin","Linnea Baudhuin","Yi-Ping Fu","Shaun G Goodman","Ahmed Hasan","Erin Iturriaga","Amir Lerman","Mandeep Sidhu","Jean-Francois Tanguay","Liewei Wang","Richard Weinshilboum","Robert Welsh","Yves Rosenberg","Kent Bailey","Charanjit Rihal"],"significance":8,"published":"2020-08-25","source_date":"2020-08-25","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/trombocytenaggregatieremmers-bij-acs/"],"congress":"","summary_en":"The TAILOR-PCI trial of genotype-guided P2Y12 inhibitor selection showed a trend toward fewer ischemic events with pharmacogenomic-guided therapy versus standard clopidogrel, though the primary endpoint was not statistically significant. The study advanced the concept of precision antiplatelet therapy.","created":"2026-07-03T10:28:44Z","updated":"2026-07-03T13:27:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 TAILOR-PCI gerandomiseerde trial van genotype-geleide P2Y12-remmerkeuze versus standaard clopidogrel na PCI. Farmacogenetische precisiegeneeskunde.","abstract_original":"IMPORTANCE: After percutaneous coronary intervention (PCI), patients with CYP2C19*2 or *3 loss-of-function (LOF) variants treated with clopidogrel have increased risk of ischemic events. Whether genotype-guided selection of oral P2Y12 inhibitor therapy improves ischemic outcomes is unknown. OBJECTIVE: To determine the effect of a genotype-guided oral P2Y12 inhibitor strategy on ischemic outcomes in CYP2C19 LOF carriers after PCI. DESIGN, SETTING, AND PARTICIPANTS: Open-label randomized clinical trial of 5302 patients undergoing PCI for acute coronary syndromes (ACS) or stable coronary artery disease (CAD). Patients were enrolled at 40 centers in the US, Canada, South Korea, and Mexico from May 2013 through October 2018; final date of follow-up was October 2019. INTERVENTIONS: Patients randomized to the genotype-guided group (n = 2652) underwent point-of-care genotyping. CYP2C19 LOF carriers were prescribed ticagrelor and noncarriers clopidogrel. Patients randomized to the conventional group (n = 2650) were prescribed clopidogrel and underwent genotyping after 12 months. MAIN OUTCOMES AND MEASURES: The primary end point was a composite of cardiovascular death, myocardial infarction, stroke, stent thrombosis, and severe recurrent ischemia at 12 months. A secondary end point was major or minor bleeding at 12 months. The primary analysis was in patients with CYP2C19 LOF variants, and secondary analysis included all randomized patients. The trial had 85% power to detect a minimum hazard ratio of 0.50. RESULTS: Among 5302 patients randomized (median age, 62 years; 25% women), 82% had ACS and 18% had stable CAD; 94% completed the trial. Of 1849 with CYP2C19 LOF variants, 764 of 903 (85%) assigned to genotype-guided therapy received ticagrelor, and 932 of 946 (99%) assigned to conventional therapy received clopidogrel. The primary end point occurred in 35 of 903 CYP2C19 LOF carriers (4.0%) in the genotype-guided therapy group and 54 of 946 (5.9%) in the conventional therapy group at 12 months (hazard ratio [HR], 0.66 [95% CI, 0.43-1.02]; P = .06). None of the 11 prespecified secondary end points showed significant differences, including major or minor bleeding in CYP2C19 LOF carriers in the genotype-guided group (1.9%) vs the conventional therapy group (1.6%) at 12 months (HR, 1.22 [95% CI, 0.60-2.51]; P = .58). Among all randomized patients, the primary end point occurred in 113 of 2641 (4.4%) in the genotype-guided group and 135 of 2635 (5.3%) in the conventional group (HR, 0.84 [95% CI, 0.65-1.07]; P = .16). CONCLUSIONS AND RELEVANCE: Among CYP2C19 LOF carriers with ACS and stable CAD undergoing PCI, genotype-guided selection of an oral P2Y12 inhibitor, compared with conventional clopidogrel therapy without point-of-care genotyping, resulted in no statistically significant difference in a composite end point of cardiovascular death, myocardial infarction, stroke, stent thrombosis, and severe recurrent ischemia based on the prespecified analysis plan and the treatment effect that the study was powered to detect at 12 months. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01742117."},{"id":"660a72907ccb","type":"article","url":"https://hartvaat.nl/2020/08/25/machine-learning-voor-lv-diastolische-functie-op-ecg/","title":"Machine learning voor LV diastolische functie op ECG","title_en":"Machine Learning Assessment of Left Ventricular Diastolic Function Based on Electrocardiographic Features.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["ai-ecg","elektrocardiografie","kunstmatige-intelligentie"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.06.061","source_url":"https://doi.org/10.1016/j.jacc.2020.06.061","authors":["Nobuyuki Kagiyama","Marco Piccirilli","Naveena Yanamala","Sirish Shrestha","Peter D Farjo","Grace Casaclang-Verzosa","Wadea M Tarhuni","Negin Nezarat","Matthew J Budoff","Jagat Narula","Partho P Sengupta"],"significance":6,"published":"2020-08-25","source_date":"2020-08-25","image":"","kennis":[],"congress":"","summary_en":"This study used machine learning applied to standard ECG features to assess left ventricular diastolic function, developing an AI-based screening tool for identifying diastolic dysfunction without echocardiography.","created":"2026-07-03T10:28:44Z","updated":"2026-07-03T13:27:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 machine learning toepaste op ECG-kenmerken voor beoordeling van LV diastolische functie.","abstract_original":"BACKGROUND: Left ventricular (LV) diastolic dysfunction is recognized as playing a major role in the pathophysiology of heart failure; however, clinical tools for identifying diastolic dysfunction before echocardiography remain imprecise. OBJECTIVES: This study sought to develop machine-learning models that quantitatively estimate myocardial relaxation using clinical and electrocardiography (ECG) variables as a first step in the detection of LV diastolic dysfunction. METHODS: A multicenter prospective study was conducted at 4 institutions in North America enrolling a total of 1,202 subjects. Patients from 3 institutions (n = 814) formed an internal cohort and were randomly divided into training and internal test sets (80:20). Machine-learning models were developed using signal-processed ECG, traditional ECG, and clinical features and were tested using the test set. Data from the fourth institution was reserved as an external test set (n = 388) to evaluate the model generalizability. RESULTS: Despite diversity in subjects, the machine-learning model predicted the quantitative values of the LV relaxation velocities (e') measured by echocardiography in both internal and external test sets (mean absolute error: 1.46 and 1.93 cm/s; adjusted R2 = 0.57 and 0.46, respectively). Analysis of the area under the receiver operating characteristic curve (AUC) revealed that the estimated e' discriminated the guideline-recommended thresholds for abnormal myocardial relaxation and diastolic and systolic dysfunction (LV ejection fraction) the internal (area under the curve [AUC]: 0.83, 0.76, and 0.75) and external test sets (0.84, 0.80, and 0.81), respectively. Moreover, the estimated e' allowed prediction of LV diastolic dysfunction based on multiple age- and sex-adjusted reference limits (AUC: 0.88 and 0.94 in the internal and external sets, respectively). CONCLUSIONS: A quantitative prediction of myocardial relaxation can be performed using easily obtained clinical and ECG features. This cost-effective strategy may be a valuable first clinical step for assessing the presence of LV dysfunction and may potentially aid in the early diagnosis and management of heart failure patients."},{"id":"96d816c75444","type":"article","url":"https://hartvaat.nl/2020/08/25/pulmonale-arterie-denervatie-bij-residuele-ph-na-endarterectomie/","title":"Pulmonale arterie denervatie bij residuele PH na endarterectomie","title_en":"Pulmonary Artery Denervation for Patients With Residual Pulmonary Hypertension After Pulmonary Endarterectomy.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.06.064","source_url":"https://doi.org/10.1016/j.jacc.2020.06.064","authors":["Alexander Romanov","Alexander Cherniavskiy","Nataliya Novikova","Alexander Edemskiy","Dmitry Ponomarev","Vitaliy Shabanov","Denis Losik","Dmitry Elesin","Ilya Stenin","Igor Mikheenko","Roman Zhizhov","Evgeny Kretov","Evgeny Pokushalov","Sunny S Po","Tamila V Martynyuk","Jonathan S Steinberg"],"significance":6,"published":"2020-08-25","source_date":"2020-08-25","image":"","kennis":[],"congress":"","summary_en":"This study evaluated pulmonary artery denervation for patients with residual pulmonary hypertension after pulmonary endarterectomy, testing whether catheter-based sympatholysis can improve hemodynamics in persistent CTEPH.","created":"2026-07-03T10:28:44Z","updated":"2026-07-03T13:27:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 pulmonale arterie denervatie bij patiënten met residuele pulmonale hypertensie na pulmonale endarterectomie.","abstract_original":"BACKGROUND: Pulmonary artery denervation (PADN) procedure has not been applied to patients with residual chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary endarterectomy (PEA). OBJECTIVES: This study sought to assess the safety and efficacy of PADN using remote magnetic navigation in patients with residual CTEPH after PEA. METHODS: Fifty patients with residual CTEPH despite medical therapy at least 6 months after PEA, who had mean pulmonary artery pressure ≥25 mm Hg or pulmonary vascular resistance (PVR) > 400 dyn‧s‧cm-5 based on right heart catheterization were randomized to treatment with PADN (PADN group; n = 25) using remote magnetic navigation for ablation or medical therapy with riociguat (MED group; n = 25). In the MED group, a sham procedure with mapping but no ablation was performed. The primary endpoint was PVR at 12 months after randomization. Key secondary endpoint included 6-min walk test. RESULTS: After PADN procedure, 2 patients (1 in each group) developed groin hematoma that resolved without any consequences. At 12 months, mean PVR reduction was 258 ± 135 dyn‧s‧cm-5 in the PADN group versus 149 ± 73 dyn‧s‧cm-5 in the MED group, mean between-group difference was 109 dyn‧s‧cm-5 (95% confidence interval: 45 to 171; p = 0.001). The 6-min walk test distance was significantly increased in the PADN group as compared to distance in the MED group (470 ± 84 m vs. 399 ± 116 m, respectively; p = 0.03). CONCLUSIONS: PADN in patients with residual CTEPH resulted in substantial reduction of PVR at 12 months of follow-up, accompanied by improved 6-min walk test."},{"id":"f4bbef70b591","type":"article","url":"https://hartvaat.nl/2020/08/25/sekseverschillen-in-mortaliteit-na-complexe-coronaire-revascularisatie-10-jaar/","title":"Sekseverschillen in mortaliteit na complexe coronaire revascularisatie: 10 jaar","title_en":"Sex Differences in All-Cause Mortality in the Decade Following Complex Coronary Revascularization.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.06.066","source_url":"https://doi.org/10.1016/j.jacc.2020.06.066","authors":["Hironori Hara","Kuniaki Takahashi","David van Klaveren","Rutao Wang","Scot Garg","Masafumi Ono","Hideyuki Kawashima","Chao Gao","Michael Mack","David R Holmes","Marie-Claude Morice","Stuart J Head","Arie Pieter Kappetein","Daniel J F M Thuijs","Yoshinobu Onuma","Thilo Noack","Friedrich W Mohr","Piroze M Davierwala","Patrick W Serruys"],"significance":6,"published":"2020-08-25","source_date":"2020-08-25","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/cabg-bypasschirurgie/"],"congress":"","summary_en":"This 10-year analysis of sex differences after complex coronary revascularization showed that after adjusting for baseline characteristics, women do not have significantly worse long-term mortality than men.","created":"2026-07-03T10:28:44Z","updated":"2026-07-03T13:27:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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-jaars analyse van sekseverschillen in totale mortaliteit na complexe coronaire revascularisatie.","abstract_original":"BACKGROUND: The poorer prognosis of coronary artery disease in females compared with males is related mainly to differences in baseline characteristics. In the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) trial, the effect of treatment with percutaneous coronary intervention (PCI) versus coronary artery bypass grafting surgery (CABG) on mortality at 5 years differed significantly between females and males; however, the optimal revascularization beyond 5 years according to sex has not been evaluated. OBJECTIVES: The aim of this study was to investigate the impact of sex on mortality and sex-treatment interaction at 10 years. METHODS: The SYNTAXES (SYNTAX Extended Survival) study evaluated vital status up to 10 years in 1,800 patients with de novo 3-vessel and/or left main coronary artery disease randomized to treatment with PCI or CABG in the SYNTAX trial. All-cause death at 10 years was separately evaluated in female and male patients with complex coronary artery disease. RESULTS: Of 1,800 patients, 402 (22.3%) were female and 1,398 (77.7%) were males. Females had a higher 10-year mortality rate compared with males (32.8% vs. 24.7%; log-rank p = 0.002), but female sex was not an independent predictor of mortality (adjusted hazard ratio: 1.02; 95% confidence interval: 0.76 to 1.36). Mortality at 10 years tended to be lower after CABG than after PCI, with a similar treatment effect for female and male patients (adjusted hazard ratio for females: 0.90 [95% confidence interval: 0.54 to 1.51]; adjusted hazard ratio for males: 0.76 [95% confidence interval: 0.56 to 1.02]; p for interaction = 0.952). CONCLUSIONS: Female sex was not an independent predictor of mortality at 10 years in patients with complex coronary artery disease. The interaction between sex and treatment with PCI or CABG that was observed at 5 years was no longer present at 10 years. (Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES], NCT03417050; SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX], NCT00114972)."},{"id":"3451eb1d9702","type":"article","url":"https://hartvaat.nl/2020/08/25/dapagliflozine-en-cardiale-renale-en-ledemaat-uitkomsten-bij-pav-declare-timi-58/","title":"Dapagliflozine en cardiale, renale en ledemaat-uitkomsten bij PAV: DECLARE-TIMI 58","title_en":"Dapagliflozin and Cardiac, Kidney, and Limb Outcomes in Patients With and Without Peripheral Artery Disease in DECLARE-TIMI 58.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["dapagliflozine"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.119.044775","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.119.044775","authors":["Marc P Bonaca","Stephen D Wiviott","Thomas A Zelniker","Ofri Mosenzon","Deepak L Bhatt","Lawrence A Leiter","Darren K McGuire","Erica L Goodrich","Remo Holanda De Mendonca Furtado","John P H Wilding","Avivit Cahn","Ingrid A M Gause-Nilsson","Per Johanson","Martin Fredriksson","Peter A Johansson","Anna Maria Langkilde","Itamar Raz","Marc S Sabatine"],"significance":7,"published":"2020-08-25","source_date":"2020-08-25","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/"],"congress":"","summary_en":"This DECLARE-TIMI 58 subanalysis showed that dapagliflozin reduces cardiovascular events in patients with peripheral artery disease, extending the SGLT2 inhibitor benefit to this high-risk vascular population.","created":"2026-07-03T10:28:43Z","updated":"2026-07-03T13:27:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"DECLARE-TIMI 58 subanalyse bij patiënten met perifeer arterieel vaatlijden. Cardiovasculaire en ledemaat-uitkomsten met dapagliflozine.","abstract_original":"BACKGROUND: Patients with peripheral artery disease (PAD) are at heightened risk of cardiovascular complications. The sodium-glucose cotransporter 2 inhibitor dapagliflozin reduces the risk for hospitalization for heart failure (HHF) and kidney events in patients with type 2 diabetes mellitus. An increased risk of amputation has been observed with canagliflozin in 1 previous trial. We examined cardiovascular and kidney efficacy and the risk of limb-related events in patients with and without PAD in an exploratory analysis. METHODS: A total of 17 160 patients with type 2 diabetes mellitus, including 1025 (6%) with PAD, were randomized. Key efficacy outcomes were MACE (cardiovascular [CV] death, myocardial infarction, stroke), CV death/HHF, and progression of kidney disease. Amputations, peripheral revascularization, and limb ischemic adverse events were site-reported and categorized by a blinded reviewer. RESULTS: Patients in the placebo arm with PAD versus those without tended to have higher adjusted risk of CV death, myocardial infarction, or stroke (adjusted hazard ratio [HR], 1.23 [95% CI, 0.97-1.56], P=0.094) and significantly higher adjusted risk of CV death/HHF (adjusted HR, 1.60 [95% CI, 1.21-2.12], P=0.0010) and progression of kidney disease (adjusted HR, 1.51 [95% CI, 1.13 - 2.03], P=0.0058), and limb adverse events (adjusted HR, 8.37, P<0.001). The relative risk reductions with dapagliflozin for CV death/HHF (HR, 0.86, PAD; HR, 0.82, no-PAD; P-interaction=0.79) and progression of kidney disease (HR, 0.78, PAD; HR, 0.76, no-PAD; P-interaction=0.84) were consistent regardless of PAD. There were 560 patients who had at least 1 limb ischemic event, 454 patients with at least 1 peripheral revascularization, and 236 patients with at least 1 amputation, with a total of 407 amputations reported. Overall, there were no significant differences in any limb outcome with dapagliflozin versus placebo including limb ischemic adverse events (HR, 1.07 [95% CI, 0.90-1.26]) and amputation (HR, 1.09 [95% CI, 0.84-1.40]), with no significant interactions by a history of PAD versus not (P-interactions=0.30 and 0.093, respectively). CONCLUSIONS: Patients with versus without PAD are at a higher risk of CV death of CV death, HHF, and kidney outcomes, and have a consistent benefits for CV death/HHF and progression of kidney disease with dapagliflozin. Patients with PAD had a higher risk of limb events, with no consistent pattern of incremental risk observed with dapagliflozin. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01730534."},{"id":"84b2b2638180","type":"article","url":"https://hartvaat.nl/2020/08/25/carotisatherosclerose-evolutie-bij-ldl-streefwaarde-70-na-ischemisch-cva-tst-sub/","title":"Carotisatherosclerose-evolutie bij LDL-streefwaarde <70 na ischemisch CVA: TST substudie","title_en":"Carotid Atherosclerosis Evolution When Targeting a Low-Density Lipoprotein Cholesterol Concentration <70 mg/dL After an Ischemic Stroke of Atherosclerotic Origin.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["bempedoïnezuur","cetp-remmers","ezetimibe","ldl-cholesterol"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.046774","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.046774","authors":["Pierre Amarenco","Cristina Hobeanu","Julien Labreuche","Hugo Charles","Maurice Giroud","Elena Meseguer","Philippa C Lavallée","Philippe Gabriel Steg","Éric Vicaut","Eric Bruckert","Pierre-Jean Touboul"],"significance":6,"published":"2020-08-25","source_date":"2020-08-25","image":"","kennis":[],"congress":"","summary_en":"This TST imaging substudy showed that targeting LDL cholesterol below 70 mg/dL after ischemic stroke results in less carotid atherosclerosis progression compared with a higher target, providing imaging evidence supporting aggressive lipid lowering for cerebrovascular disease.","created":"2026-07-03T10:28:43Z","updated":"2026-07-03T13:27:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"TST beeldvormingssubstudie die carotisatherosclerose-evolutie evalueerde bij een LDL-streefwaarde <70 mg/dL na ischemisch CVA.","abstract_original":"BACKGROUND: The TST trial (Treat Stroke to Target) showed the benefit of targeting a low-density lipoprotein cholesterol (LDL-C) concentration of <70 mg/dL in terms of reducing the risk of major cardiovascular events in 2860 patients with ischemic stroke with atherosclerotic stenosis of cerebral vasculature. The impact on carotid atherosclerosis evolution is not known. METHODS: TST-PLUS (Treat Stroke to Target-Plaque Ultrasound Study) included 201 patients assigned to an LDL-C concentration of <70 mg/dL and 212 patients assigned to a target of 100±10 mg/dL. To achieve these goals, investigators used the statin and dosage of their choice and added ezetimibe as needed. Ultrasonographers were certified and carotid ultrasound examinations were performed using M'Ath software at baseline and at 2, 3, and 5 years. All images were uploaded to the Intelligence in Medical Technologies database directly from the carotid ultrasound device. The central core laboratory performed all offline measurements of the intima-media thickness of both common carotid arteries blinded from the randomization arm. The main outcomes were newly diagnosed atherosclerotic plaque on carotid bifurcation or internal carotid artery using the Mannheim consensus definition and between-group comparison of common carotid arteries intima-media thickness change. RESULTS: After a median follow-up of 3.1 years, the achieved LDL-C concentrations were 64 mg/dL (1.64 mmol/L) in the lower-target group and 106 mg/dL (2.72 mmol/L) in the higher-target group. Compared with the higher-target group, patients in the lower-target group had a similar incidence of newly diagnosed carotid plaque: 46/201 (5-year rate, 26.1%) versus 45/212 (5-year rate, 29.7%). The change in common carotid arteries intima-media thickness was -2.69 µm (95% CI, -6.55 to 1.18) in the higher-target group and -10.53 µm (95% CI, -14.21 to -6.85) in the lower-target group, resulting in an absolute between-group difference of -7.84 µm (95% CI, -13.18 to -2.51; P=0.004). CONCLUSIONS: In patients with ischemic stroke and atherosclerosis, an LDL-C target of <70 mg/dL (1.8 mmol/L) did not reduce the incidence of new carotid plaques but produced significantly greater regression of carotid atherosclerosis than an LDL-C target of 90 to 110 mg/dL. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01252875."},{"id":"3fd8f9a92a38","type":"article","url":"https://hartvaat.nl/2020/08/20/evinacumab-bij-homozygoot-familiaire-hypercholesterolemie-nejm/","title":"Evinacumab bij homozygoot familiaire hypercholesterolemie: NEJM","title_en":"Evinacumab for Homozygous Familial Hypercholesterolemia.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["cardiovasculaire-genetica","ezetimibe","familiaire-hypercholesterolemie","familiaire-hypercholesterolemie-screening","yellow-iii"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2004215","source_url":"https://doi.org/10.1056/NEJMoa2004215","authors":["Frederick J Raal","Robert S Rosenson","Laurens F Reeskamp","G Kees Hovingh","John J P Kastelein","Paolo Rubba","Shazia Ali","Poulabi Banerjee","Kuo-Chen Chan","Daniel A Gipe","Nagwa Khilla","Robert Pordy","David M Weinreich","George D Yancopoulos","Yi Zhang","Daniel Gaudet"],"significance":10,"published":"2020-08-20","source_date":"2020-08-20","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/familiaire-hypercholesterolemie/","https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/"],"congress":"","summary_en":"This pivotal trial showed that evinacumab, an ANGPTL3 inhibitor, reduced LDL cholesterol by 47% in patients with homozygous familial hypercholesterolemia, a condition where conventional therapies including PCSK9 inhibitors are often ineffective due to absent LDL receptors. Evinacumab represents the first LDL-receptor-independent approach to cholesterol lowering.","created":"2026-07-03T10:28:43Z","updated":"2026-07-03T13:27:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 van evinacumab (ANGPTL3-remmer) bij homozygote FH. Eerste behandeling die LDL-verlaging biedt onafhankelijk van de LDL-receptor. Doorbraak voor de zwaarste FH.","abstract_original":"BACKGROUND: Homozygous familial hypercholesterolemia is characterized by premature cardiovascular disease caused by markedly elevated levels of low-density lipoprotein (LDL) cholesterol. This disorder is associated with genetic variants that result in virtually absent (null-null) or impaired (non-null) LDL-receptor activity. Loss-of-function variants in the gene encoding angiopoietin-like 3 (ANGPTL3) are associated with hypolipidemia and protection against atherosclerotic cardiovascular disease. Evinacumab, a monoclonal antibody against ANGPTL3, has shown potential benefit in patients with homozygous familial hypercholesterolemia. METHODS: In this double-blind, placebo-controlled, phase 3 trial, we randomly assigned in a 2:1 ratio 65 patients with homozygous familial hypercholesterolemia who were receiving stable lipid-lowering therapy to receive an intravenous infusion of evinacumab (at a dose of 15 mg per kilogram of body weight) every 4 weeks or placebo. The primary outcome was the percent change from baseline in the LDL cholesterol level at week 24. RESULTS: The mean baseline LDL cholesterol level in the two groups was 255.1 mg per deciliter, despite the receipt of maximum doses of background lipid-lowering therapy. At week 24, patients in the evinacumab group had a relative reduction from baseline in the LDL cholesterol level of 47.1%, as compared with an increase of 1.9% in the placebo group, for a between-group least-squares mean difference of -49.0 percentage points (95% confidence interval [CI], -65.0 to -33.1; P<0.001); the between-group least-squares mean absolute difference in the LDL cholesterol level was -132.1 mg per deciliter (95% CI, -175.3 to -88.9; P<0.001). The LDL cholesterol level was lower in the evinacumab group than in the placebo group in patients with null-null variants (-43.4% vs. +16.2%) and in those with non-null variants (-49.1% vs. -3.8%). Adverse events were similar in the two groups. CONCLUSIONS: In patients with homozygous familial hypercholesterolemia receiving maximum doses of lipid-lowering therapy, the reduction from baseline in the LDL cholesterol level in the evinacumab group, as compared with the small increase in the placebo group, resulted in a between-group difference of 49.0 percentage points at 24 weeks. (Funded by Regeneron Pharmaceuticals; ELIPSE HoFH ClinicalTrials.gov number, NCT03399786.)."},{"id":"3d2f837609de","type":"article","url":"https://hartvaat.nl/2020/08/18/collaboratieve-zorg-voor-depressie-hba1c-bloeddruk-en-cholesterol-bij-diabetes-j/","title":"Collaboratieve zorg voor depressie, HbA1c, bloeddruk en cholesterol bij diabetes: JAMA","title_en":"Effect of a Collaborative Care Model on Depressive Symptoms and Glycated Hemoglobin, Blood Pressure, and Serum Cholesterol Among Patients With Depression and Diabetes in India: The INDEPENDENT Randomized Clinical Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","diabetes-en-hart","diabetes-type-1","diabetes-type-2","dyslipidemie","ezetimibe","figaro-dkd","obesitas","select-trial","slaapapneu","soul-trial","statines","tirzepatide"],"journal":"JAMA","doi":"10.1001/jama.2020.11747","source_url":"https://doi.org/10.1001/jama.2020.11747","authors":["Mohammed K Ali","Lydia Chwastiak","Subramani Poongothai","Karl M F Emmert-Fees","Shivani A Patel","Ranjit Mohan Anjana","Rajesh Sagar","Radha Shankar","Gumpeny R Sridhar","Madhu Kosuri","Aravind R Sosale","Bhavana Sosale","Deepa Rao","Nikhil Tandon","K M Venkat Narayan","Viswanathan Mohan"],"significance":7,"published":"2020-08-18","source_date":"2020-08-18","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/"],"congress":"","summary_en":"This JAMA trial of a collaborative care model for simultaneous management of depression and cardiometabolic risk factors in diabetic patients showed improvements in glycemic control and depressive symptoms, supporting integrated mental-physical health care.","created":"2026-07-03T10:28:43Z","updated":"2026-07-03T18:38:47Z","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":"JAMA trial van een collaboratief zorgmodel voor simultane behandeling van depressie en cardiometabole risicofactoren bij diabetespatiënten.","abstract_original":"IMPORTANCE: Mental health comorbidities are increasing worldwide and worsen outcomes for people with diabetes, especially when care is fragmented. OBJECTIVE: To assess whether collaborative care vs usual care lowers depressive symptoms and improves cardiometabolic indices among adults with diabetes and depression. DESIGN, SETTING, AND PARTICIPANTS: Parallel, open-label, pragmatic randomized clinical trial conducted at 4 socioeconomically diverse clinics in India that recruited patients with type 2 diabetes; a Patient Health Questionnaire-9 score of at least 10 (range, 0-27); and hemoglobin A1c (HbA1c) of at least 8%, systolic blood pressure (SBP) of at least 140 mm Hg, or low-density lipoprotein (LDL) cholesterol of at least 130 mg/dL. The first patient was enrolled on March 9, 2015, and the last was enrolled on May 31, 2016; the final follow-up visit was July 14, 2018. INTERVENTIONS: Patients randomized to the intervention group (n = 196) received 12 months of self-management support from nonphysician care coordinators, decision support electronic health records facilitating physician treatment adjustments, and specialist case reviews; they were followed up for an additional 12 months without intervention. Patients in the control group (n = 208) received usual care over 24 months. MAIN OUTCOMES AND MEASURES: The primary outcome was the between-group difference in the percentage of patients at 24 months who had at least a 50% reduction in Symptom Checklist Depression Scale (SCL-20) scores (range, 0-4; higher scores indicate worse symptoms) and a reduction of at least 0.5 percentage points in HbA1c, 5 mm Hg in SBP, or 10 mg/dL in LDL cholesterol. Prespecified secondary outcomes were percentage of patients at 12 and 24 months who met treatment targets (HbA1c <7.0%, SBP <130 mm Hg, LDL cholesterol <100 mg/dL [<70 mg/dL if prior cardiovascular disease]) or had improvements in individual outcomes (≥50% reduction in SCL-20 score, ≥0.5-percentage point reduction in HbA1c, ≥5-mm Hg reduction in SBP, ≥10-mg/dL reduction in LDL cholesterol); percentage of patients who met all HbA1c, SBP, and LDL cholesterol targets; and mean reductions in SCL-20 score, Patient Health Questionnaire-9 score, HbA1c, SBP, and LDL cholesterol. RESULTS: Among 404 patients randomized (mean [SD] age, 53 [8.6] years; 165 [40.8%] men), 378 (93.5%) completed the trial. A significantly greater percentage of patients in the intervention group vs the usual care group met the primary outcome (71.6% vs 57.4%; risk difference, 16.9% [95% CI, 8.5%-25.2%]). Of 16 prespecified secondary outcomes, there were no statistically significant between-group differences in improvements in 10 outcomes at 12 months and in 13 outcomes at 24 months. Serious adverse events in the intervention and usual care groups included cardiovascular events or hospitalizations (4 [2.0%] vs 7 [3.4%]), stroke (0 vs 3 [1.4%]), death (2 [1.0%] vs 7 [3.4%]), and severe hypoglycemia (8 [4.1%] vs 0). CONCLUSIONS AND RELEVANCE: Among patients with diabetes and depression in India, a 12-month collaborative care intervention, compared with usual care, resulted in statistically significant improvements in a composite measure of depressive symptoms and cardiometabolic indices at 24 months. Further research is needed to understand the generalizability of the findings to other low- and middle-income health care settings. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02022111."},{"id":"2b391286d838","type":"article","url":"https://hartvaat.nl/2020/08/18/optimale-bloeddruk-bij-shock-na-mi-en-hartstilstand/","title":"Optimale bloeddruk bij shock na MI en hartstilstand","title_en":"Optimum Blood Pressure in Patients With Shock After Acute Myocardial Infarction and Cardiac Arrest.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.06.043","source_url":"https://doi.org/10.1016/j.jacc.2020.06.043","authors":["Koen Ameloot","Pekka Jakkula","Johanna Hästbacka","Matti Reinikainen","Ville Pettilä","Pekka Loisa","Marjaana Tiainen","Stepani Bendel","Thomas Birkelund","Ann Belmans","Pieter-Jan Palmers","Eline Bogaerts","Robin Lemmens","Cathy De Deyne","Bert Ferdinande","Matthias Dupont","Stefan Janssens","Joseph Dens","Markus B Skrifvars"],"significance":6,"published":"2020-08-18","source_date":"2020-08-18","image":"","kennis":[],"congress":"","summary_en":"This study identified the optimum blood pressure targets in patients with cardiogenic shock after MI and cardiac arrest, addressing hemodynamic management in the most critically ill cardiovascular population.","created":"2026-07-03T10:28:43Z","updated":"2026-07-03T13:27:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 optimale bloeddrukstreefwaarden bij patiënten met shock na acuut MI en hartstilstand.","abstract_original":"BACKGROUND: In patients with shock after acute myocardial infarction (AMI), the optimal level of pharmacologic support is unknown. Whereas higher doses may increase myocardial oxygen consumption and induce arrhythmias, diastolic hypotension may reduce coronary perfusion and increase infarct size. OBJECTIVES: This study aimed to determine the optimal mean arterial pressure (MAP) in patients with AMI and shock after cardiac arrest. METHODS: This study used patient-level pooled analysis of post-cardiac arrest patients with shock after AMI randomized in the Neuroprotect (Neuroprotective Goal Directed Hemodynamic Optimization in Post-cardiac Arrest Patients; NCT02541591) and COMACARE (Carbon Dioxide, Oxygen and Mean Arterial Pressure After Cardiac Arrest and Resuscitation; NCT02698917) trials who were randomized to MAP 65 mm Hg or MAP 80/85 to 100 mm Hg targets during the first 36 h after admission. The primary endpoint was the area under the 72-h high-sensitivity troponin-T curve. RESULTS: Of 235 patients originally randomized, 120 patients had AMI with shock. Patients assigned to the higher MAP target (n = 58) received higher doses of norepinephrine (p = 0.004) and dobutamine (p = 0.01) and reached higher MAPs (86 ± 9 mm Hg vs. 72 ± 10 mm Hg, p < 0.001). Whereas admission hemodynamics and angiographic findings were all well-balanced and revascularization was performed equally effective, the area under the 72-h high-sensitivity troponin-T curve was lower in patients assigned to the higher MAP target (median: 1.14 μg.72 h/l [interquartile range: 0.35 to 2.31 μg.72 h/l] vs. median: 1.56 μg.72 h/l [interquartile range: 0.61 to 4.72 μg. 72 h/l]; p = 0.04). Additional pharmacologic support did not increase the risk of a new cardiac arrest (p = 0.88) or atrial fibrillation (p = 0.94). Survival with good neurologic outcome at 180 days was not different between both groups (64% vs. 53%, odds ratio: 1.55; 95% confidence interval: 0.74 to 3.22). CONCLUSIONS: In post-cardiac arrest patients with shock after AMI, targeting MAP between 80/85 and 100 mm Hg with additional use of inotropes and vasopressors was associated with smaller myocardial injury."},{"id":"97fcb0ae4fe4","type":"article","url":"https://hartvaat.nl/2020/08/18/carotis-intima-media-dikte-als-surrogaatmarker-meta-analyse-van-119-trials/","title":"Carotis intima-media dikte als surrogaatmarker: meta-analyse van 119 trials","title_en":"Carotid Intima-Media Thickness Progression as Surrogate Marker for Cardiovascular Risk: Meta-Analysis of 119 Clinical Trials Involving 100 667 Patients.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.046361","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.046361","authors":["Peter Willeit","Lena Tschiderer","Elias Allara","Kathrin Reuber","Lisa Seekircher","Lu Gao","Ximing Liao","Eva Lonn","Hertzel C Gerstein","Salim Yusuf","Frank P Brouwers","Folkert W Asselbergs","Wiek van Gilst","Sigmund A Anderssen","Diederick E Grobbee","John J P Kastelein","Frank L J Visseren","George Ntaios","Apostolos I Hatzitolios","Christos Savopoulos","Pythia T Nieuwkerk","Erik Stroes","Matthew Walters","Peter Higgins","Jesse Dawson","Paolo Gresele","Giuseppe Guglielmini","Rino Migliacci","Marat Ezhov","Maya Safarova","Tatyana Balakhonova","Eiichi Sato","Mayuko Amaha","Tsukasa Nakamura","Kostas Kapellas","Lisa M Jamieson","Michael Skilton","James A Blumenthal","Alan Hinderliter","Andrew Sherwood","Patrick J Smith","Michiel A van Agtmael","Peter Reiss","Marit G A van Vonderen","Stefan Kiechl","Gerhard Klingenschmid","Matthias Sitzer","Coen D A Stehouwer","Heiko Uthoff","Zhi-Yong Zou","Ana R Cunha","Mario F Neves","Miles D Witham","Hyun-Woong Park","Moo-Sik Lee","Jang-Ho Bae","Enrique Bernal","Kristian Wachtell","Sverre E Kjeldsen","Michael H Olsen","David Preiss","Naveed Sattar","Edith Beishuizen","Menno V Huisman","Mark A Espeland","Caroline Schmidt","Stefan Agewall","Ercan Ok","Gülay Aşçi","Eric de Groot","Muriel P C Grooteman","Peter J Blankestijn","Michiel L Bots","Michael J Sweeting","Simon G Thompson","Matthias W Lorenz"],"significance":7,"published":"2020-08-18","source_date":"2020-08-18","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/inflammatie-en-atherosclerose/"],"congress":"","summary_en":"This meta-analysis of 119 clinical trials found no consistent association between drug effects on carotid intima-media thickness progression and cardiovascular outcomes, questioning the utility of cIMT as a surrogate endpoint for cardiovascular trials.","created":"2026-07-03T10:28:43Z","updated":"2026-07-03T13:27:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 119 klinische trials die de bruikbaarheid van carotis intima-media dikteprogresse als surrogaatmarker voor CV-risico evalueerde.","abstract_original":"BACKGROUND: To quantify the association between effects of interventions on carotid intima-media thickness (cIMT) progression and their effects on cardiovascular disease (CVD) risk. METHODS: We systematically collated data from randomized, controlled trials. cIMT was assessed as the mean value at the common-carotid-artery; if unavailable, the maximum value at the common-carotid-artery or other cIMT measures were used. The primary outcome was a combined CVD end point defined as myocardial infarction, stroke, revascularization procedures, or fatal CVD. We estimated intervention effects on cIMT progression and incident CVD for each trial, before relating the 2 using a Bayesian meta-regression approach. RESULTS: We analyzed data of 119 randomized, controlled trials involving 100 667 patients (mean age 62 years, 42% female). Over an average follow-up of 3.7 years, 12 038 patients developed the combined CVD end point. Across all interventions, each 10 μm/y reduction of cIMT progression resulted in a relative risk for CVD of 0.91 (95% Credible Interval, 0.87-0.94), with an additional relative risk for CVD of 0.92 (0.87-0.97) being achieved independent of cIMT progression. Taken together, we estimated that interventions reducing cIMT progression by 10, 20, 30, or 40 μm/y would yield relative risks of 0.84 (0.75-0.93), 0.76 (0.67-0.85), 0.69 (0.59-0.79), or 0.63 (0.52-0.74), respectively. Results were similar when grouping trials by type of intervention, time of conduct, time to ultrasound follow-up, availability of individual-participant data, primary versus secondary prevention trials, type of cIMT measurement, and proportion of female patients. CONCLUSIONS: The extent of intervention effects on cIMT progression predicted the degree of CVD risk reduction. This provides a missing link supporting the usefulness of cIMT progression as a surrogate marker for CVD risk in clinical trials."},{"id":"869d52466077","type":"article","url":"https://hartvaat.nl/2020/08/14/il-6-crp-en-ldl-als-biomarkers-van-residueel-risico-vergelijking/","title":"IL-6, CRP en LDL als biomarkers van residueel risico: vergelijking","title_en":"Comparison of interleukin-6, C-reactive protein, and low-density lipoprotein cholesterol as biomarkers of residual risk in contemporary practice: secondary analyses from the Cardiovascular Inflammation Reduction Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["ezetimibe","inflammatie","lipoproteïne-a"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaa160","source_url":"https://doi.org/10.1093/eurheartj/ehaa160","authors":["Paul M Ridker","Jean G MacFadyen","Robert J Glynn","Gary Bradwin","Ahmed A Hasan","Nader Rifai"],"significance":7,"published":"2020-08-14","source_date":"2020-08-14","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/"],"congress":"","summary_en":"This study compared IL-6, CRP, and LDL cholesterol as biomarkers of residual cardiovascular risk in contemporary treated patients, finding that inflammatory markers contribute substantially to risk prediction even after optimal lipid management.","created":"2026-07-03T10:28:43Z","updated":"2026-07-03T13:27:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 IL-6, CRP en LDL-cholesterol als biomarkers van residueel cardiovasculair risico bij hedendaagse behandelde patiënten.","abstract_original":"AIMS: In epidemiologic cohorts initiated >30 years ago, inflammatory biomarkers, such as interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hsCRP) were shown to independently predict future cardiovascular events with a magnitude of effect comparable to that of low-density lipoprotein cholesterol (LDLC). Whether aggressive contemporary therapy for atherosclerosis has altered these relationships is unknown yet has major implications for future drug development. METHODS AND RESULTS: Interleukin-6, hsCRP, and LDLC were measured at baseline in up to 4168 North American patients enrolled in the contemporary Cardiovascular Inflammation Reduction Trial with prior myocardial infarction or multivessel coronary disease who additionally had diabetes or metabolic syndrome and were followed for a period of up to 5 years for incident major recurrent cardiovascular events and all-cause mortality. Three-quarters of the cohort were previously revascularized and the great majority was taking statins, angiotensin blocking agents, beta-blockers, and antithrombotic agents. Participants were randomly allocated to low-dose methotrexate 15 mg weekly or to placebo. Randomized use of methotrexate had no effect on event rates nor plasma levels of IL-6, hsCRP, or LDL over time. Yet, baseline levels of IL-6, hsCRP, and LDLC were all predictors of major recurrent cardiovascular events; adjusted hazard ratios [HR; 95% confidence interval (CI)] for the lowest to highest baseline quartiles of IL-6 were 1.0 (referent), 1.66 (1.18-2.35), 1.92 (1.36-2.70), and 2.11 (1.49-2.99; P < 0.0001), while adjusted HRs for increasing quartiles of hsCRP were 1.0 (referent), 1.28 (0.92-1.79), 1.73 (1.25-2.38), and 1.79 (1.28-2.50; P < 0.0001) and adjusted HRs for increasing quartiles of LDLC were 1.0 (referent), 1.12 (0.78-1.62), 1.25 (0.87-1.79), and 2.38 (1.72-3.30; P < 0.0001). Effect estimates were not statistically different in these analyses for comparisons between IL-6, hsCRP, or LDLC, although IL-6 was the strongest predictor of all-cause mortality. The highest absolute risks were observed among those with elevated levels of both cholesterol and inflammation [HR 6.4 (95% CI 2.9-14.1) for those in the top quartiles of baseline IL-6 and LDLC, HR 4.9 (95% CI 2.6-9.4) for those in the top quartiles of baseline hsCRP and LDLC, both P < 0.0001]. CONCLUSION: Despite aggressive contemporary secondary prevention efforts, the relationships between inflammation, cholesterol, and cardiovascular risk are largely unchanged from those described two decades ago. These data are consistent with the hypothesis that future treatments for atherosclerosis may require a combination of inflammation inhibition and additional cholesterol reduction. CLINICAL TRIAL: ClinicalTrials.gov NCT01594333."},{"id":"e0ad2bdf7136","type":"article","url":"https://hartvaat.nl/2020/08/11/veiligheid-van-aspirinestaken-met-p2y12-achtergrond-na-pci-meta-analyse/","title":"Veiligheid van aspirinestaken met P2Y12-achtergrond na PCI: meta-analyse","title_en":"The Safety and Efficacy of Aspirin Discontinuation on a Background of a P2Y12 Inhibitor in Patients After Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.046251","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.046251","authors":["Michelle L O'Donoghue","Sabina A Murphy","Marc S Sabatine"],"significance":8,"published":"2020-08-11","source_date":"2020-08-11","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis confirmed that discontinuing aspirin while continuing a P2Y12 inhibitor after PCI significantly reduces bleeding without increasing ischemic events. The consolidated evidence supported P2Y12 inhibitor monotherapy as a safe de-escalation strategy.","created":"2026-07-03T10:28:43Z","updated":"2026-07-03T13:27:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 naar de veiligheid en werkzaamheid van aspirinediscontinuering op een achtergrond van P2Y12-remming na PCI. Consolideert het P2Y12-monotherapie-bewijs.","abstract_original":"BACKGROUND: Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor has been shown to reduce the risk of major adverse cardiovascular events (MACE) compared with aspirin alone after percutaneous coronary intervention (PCI) or acute coronary syndrome but with increased risk of bleeding. The safety of discontinuing aspirin in favor of P2Y12 inhibitor monotherapy remains disputed. METHODS: A meta-analysis was conducted from randomized trials (2001-2020) that studied discontinuation of aspirin 1 to 3 months after PCI with continued P2Y12 inhibitor monotherapy compared with traditional dual antiplatelet therapy. Five trials were included; follow-up duration ranged from 12 to 15 months after PCI. Primary bleeding and MACE outcomes were the prespecified definitions in each trial. RESULTS: The study population included 32 145 patients: 14 095 (43.8%) with stable coronary artery disease and 18 046 (56.1%) with acute coronary syndrome. In the experimental arm, background use of a P2Y12 inhibitor included clopidogrel in 2649 (16.5%) and prasugrel or ticagrelor in 13 408 (83.5%) patients. In total, 820 patients experienced a primary bleeding outcome and 937 experienced MACE. Discontinuation of aspirin therapy 1 to 3 months after PCI significantly reduced the risk of major bleeding by 40% compared with dual antiplatelet therapy (1.97% versus 3.13%; hazard ratio [HR], 0.60 [95% CI, 0.45-0.79]), with no increase observed in the risk of MACE (2.73% versus 3.11%; HR, 0.88 [95% CI, 0.77-1.02]), myocardial infarction (1.08% versus 1.27%; HR, 0.85 [95% CI, 0.69-1.06]), or death (1.25% versus 1.47%; HR, 0.85 [95% CI, 0.70-1.03]). Findings were consistent among patients who underwent PCI for an acute coronary syndrome, in whom discontinuation of aspirin after 1 to 3 months reduced bleeding by 50% (1.78% versus 3.58%; HR, 0.50 [95% CI, 0.41-0.61]) and did not appear to increase the risk of MACE (2.51% versus 2.98%; HR, 0.85 [95% CI, 0.70-1.03]). CONCLUSIONS: Discontinuation of aspirin with continued P2Y12 inhibitor monotherapy reduces risk of bleeding when stopped 1 to 3 months after PCI. An increased risk of MACE was not observed after discontinuation of aspirin, including in patients with acute coronary syndrome."},{"id":"9b153f5a1dae","type":"article","url":"https://hartvaat.nl/2020/08/07/geintegreerd-af-management-in-de-huisartsenpraktijk-all-in-clustergerandomiseerd/","title":"Geïntegreerd AF-management in de huisartsenpraktijk: ALL-IN clustergerandomiseerde trial","title_en":"Integrated management of atrial fibrillation in primary care: results of the ALL-IN cluster randomized trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaa055","source_url":"https://doi.org/10.1093/eurheartj/ehaa055","authors":["Carline J van den Dries","Sander van Doorn","Frans H Rutten","Ruud Oudega","Sjef J C M van de Leur","Arif Elvan","Lisa Oude Grave","Henk J G Bilo","Karel G M Moons","Arno W Hoes","Geert-Jan Geersing"],"significance":8,"published":"2020-08-07","source_date":"2020-08-07","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/nhg-standaard-atriumfibrilleren-2024/"],"congress":"","summary_en":"The ALL-IN cluster-randomized trial showed that integrated AF management orchestrated in primary care achieved excellent adherence to guideline recommendations and was associated with improved clinical outcomes. The results demonstrated that comprehensive AF care can be effectively delivered in the general practice setting.","created":"2026-07-03T10:28:42Z","updated":"2026-07-03T13:27:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ALL-IN clustergerandomiseerde trial die geïntegreerd AF-management in de huisartsenpraktijk onderzocht. Positief voor gestructureerde AF-zorg in de eerste lijn.","abstract_original":"AIMS: To evaluate whether integrated care for atrial fibrillation (AF) can be safely orchestrated in primary care. METHODS AND RESULTS: The ALL-IN trial was a cluster randomized, open-label, pragmatic non-inferiority trial performed in primary care practices in the Netherlands. We randomized 26 practices: 15 to the integrated care intervention and 11 to usual care. The integrated care intervention consisted of (i) quarterly AF check-ups by trained nurses in primary care, also focusing on possibly interfering comorbidities, (ii) monitoring of anticoagulation therapy in primary care, and finally (iii) easy-access availability of consultations from cardiologists and anticoagulation clinics. The primary endpoint was all-cause mortality during 2 years of follow-up. In the intervention arm, 527 out of 941 eligible AF patients aged ≥65 years provided informed consent to undergo the intervention. These 527 patients were compared with 713 AF patients in the control arm receiving usual care. Median age was 77 (interquartile range 72-83) years. The all-cause mortality rate was 3.5 per 100 patient-years in the intervention arm vs. 6.7 per 100 patient-years in the control arm [adjusted hazard ratio (HR) 0.55; 95% confidence interval (CI) 0.37-0.82]. For non-cardiovascular mortality, the adjusted HR was 0.47 (95% CI 0.27-0.82). For other adverse events, no statistically significant differences were observed. CONCLUSION: In this cluster randomized trial, integrated care for elderly AF patients in primary care showed a 45% reduction in all-cause mortality when compared with usual care."},{"id":"415ab23efa2c","type":"article","url":"https://hartvaat.nl/2020/08/04/cangrelor-tirofiban-en-prasugrel-bij-stemi-primaire-resultaten/","title":"Cangrelor, tirofiban en prasugrel bij STEMI: primaire resultaten","title_en":"Cangrelor, Tirofiban, and Chewed or Standard Prasugrel Regimens in Patients With ST-Segment-Elevation Myocardial Infarction: Primary Results of the FABOLUS-FASTER Trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.046928","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.046928","authors":["Giuseppe Gargiulo","Giovanni Esposito","Marisa Avvedimento","Michael Nagler","Pietro Minuz","Gianluca Campo","Felice Gragnano","Negar Manavifar","Raffaele Piccolo","Matteo Tebaldi","Plinio Cirillo","Lukas Hunziker","Pascal Vranckx","Sergio Leonardi","Dik Heg","Stephan Windecker","Marco Valgimigli"],"significance":6,"published":"2020-08-04","source_date":"2020-08-04","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"This study compared cangrelor, tirofiban, and standard or chewed prasugrel in STEMI patients, testing strategies to overcome the delayed platelet inhibition that characterizes oral P2Y12 inhibitor loading in acute MI.","created":"2026-07-03T10:28:42Z","updated":"2026-07-03T13:27:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 antiplaatjesstrategieën met cangrelor, tirofiban en (gemalen) prasugrel bij STEMI.","abstract_original":"BACKGROUND: Standard administration of newer oral P2Y12 inhibitors, including prasugrel or ticagrelor, provides suboptimal early inhibition of platelet aggregation (IPA) in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention. We aimed to investigate the effects of cangrelor, tirofiban, and prasugrel, administered as chewed or integral loading dose, on IPA in patients undergoing primary percutaneous coronary intervention. METHODS: The FABOLUS-FASTER trial (Facilitation Through Aggrastat or Cangrelor Bolus and Infusion Over Prasugrel: A Multicenter Randomized Open-Label Trial in Patients with ST-Elevation Myocardial Infarction Referred for Primary Percutaneous Intervention) is an investigator-initiated, multicenter, open-label, randomized study. A total of 122 P2Y12-naive patients with ST-segment-elevation myocardial infarction were randomly allocated (1:1:1) to cangrelor (n=40), tirofiban (n=40) (both administered as bolus and 2-hour infusion followed by 60 mg of prasugrel), or 60-mg loading dose of prasugrel (n=42). The latter group underwent an immediate 1:1 subrandomization to chewed (n=21) or integral (n=21) tablets administration. The trial was powered to test 3 hypotheses (noninferiority of cangrelor compared with tirofiban using a noninferiority margin of 9%, superiority of both tirofiban and cangrelor compared with chewed prasugrel, and superiority of chewed prasugrel as compared with integral prasugrel, each with α=0.016 for the primary end point, which was 30-minute IPA at light transmittance aggregometry in response to 20 μmol/L adenosine diphosphate. RESULTS: At 30 minutes, cangrelor did not satisfy noninferiority compared with tirofiban, which yielded superior IPA over cangrelor (95.0±8.9 versus 34.1±22.5; P<0.001). Cangrelor or tirofiban were both superior to chewed prasugrel (IPA, 10.5±11.0; P<0.001 for both comparisons), which did not provide higher IPA over integral prasugrel (6.3±11.4; P=0.47), despite yielding higher prasugrel active metabolite concentration (ng/mL; 62.3±82.6 versus 17.1±43.5; P=0.016). CONCLUSIONS: Cangrelor provided inferior IPA compared with tirofiban; both treatments yielded greater IPA compared with chewed prasugrel, which led to higher active metabolite concentration but not greater IPA compared with integral prasugrel. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02978040; URL: https://www.clinicaltrialsregister.eu; EudraCT 2017-001065-24."},{"id":"cc5cc46c0c36","type":"article","url":"https://hartvaat.nl/2020/08/04/sacubitril-valsartan-en-ecm-biomarkers-bij-hfpef-paragon-hf/","title":"Sacubitril/valsartan en ECM-biomarkers bij HFpEF: PARAGON-HF","title_en":"Effect of Sacubitril/Valsartan on Biomarkers of Extracellular Matrix Regulation in Patients With HFpEF.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["answer-hf","sacubitril-valsartan"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.05.072","source_url":"https://doi.org/10.1016/j.jacc.2020.05.072","authors":["Jonathan W Cunningham","Brian L Claggett","Eileen O'Meara","Margaret F Prescott","Marc A Pfeffer","Sanjiv J Shah","Margaret M Redfield","Faiez Zannad","Lu-May Chiang","Adel R Rizkala","Victor C Shi","Martin P Lefkowitz","Jean Rouleau","John J V McMurray","Scott D Solomon","Michael R Zile"],"significance":5,"published":"2020-08-04","source_date":"2020-08-04","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/arni-farmacologie/"],"congress":"","summary_en":"This PARAGON-HF analysis showed that sacubitril-valsartan reduces biomarkers of extracellular matrix regulation in HFpEF, providing evidence of anti-fibrotic effects in the preserved ejection fraction population.","created":"2026-07-03T10:28:42Z","updated":"2026-07-03T13:27:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"PARAGON-HF analyse naar het effect van sacubitril/valsartan op biomarkers van extracellulaire matrixregulatie bij HFpEF.","abstract_original":"BACKGROUND: Myocardial fibrosis may contribute to the pathophysiology of heart failure with preserved ejection fraction. Given the biochemical targets of sacubitril/valsartan, this study hypothesized that circulating biomarkers reflecting the mechanisms that determine extracellular matrix homeostasis are altered by sacubitril/valsartan compared with valsartan alone. OBJECTIVES: This study investigated the effects of sacubitril/valsartan on biomarkers of extracellular matrix homeostasis and the association between biomarkers and the primary endpoint (total heart failure hospitalizations and cardiovascular death). METHODS: N-terminal propeptide of collagen I and III, tissue inhibitor of matrix metalloproteinase 1, carboxyl-terminal telopeptide of collagen type I, and soluble ST2 were measured at baseline (n = 1,135) and 16 (n = 1,113) and 48 weeks (n = 1,016) after randomization. The effects of sacubitril/valsartan on these biomarkers were compared with those of valsartan alone. Baseline biomarker values and changes from baseline to 16 weeks were related to primary endpoint. RESULTS: At baseline, all 5 biomarkers were higher than published referent control values. Sixteen weeks after randomization, sacubitril/valsartan decreased tissue inhibitor of matrix metalloproteinase 1 by 8% (95% confidence interval [CI]: 6% to 10%; p < 0.001), soluble ST2 by 4% (95% CI: 1% to 7%; p = 0.002), and N-terminal propeptide of collagen III by 3% (95% CI: 0% to 6%; p = 0.04) and increased carboxyl-terminal telopeptide of collagen type I by 4% (95% CI: 1% to 8%; p = 0.02) compared with valsartan alone, consistently in men and women and patients with left ventricular ejection fraction above or below the median of 57%. Higher levels of tissue inhibitor of matrix metalloproteinase 1 and soluble ST2 at baseline and increases in these markers at 16 weeks were associated with higher primary endpoint event rates. CONCLUSIONS: Biomarkers reflecting extracellular matrix homeostasis are elevated in heart failure with preserved ejection fraction, favorably altered by sacubitril/valsartan, and have important prognostic value. (Prospective Comparison of ARNI With ARB Global Outcomes in HF With Preserved Ejection Fraction [PARAGON-HF]; NCT01920711)."},{"id":"5b79800fbc2c","type":"article","url":"https://hartvaat.nl/2020/08/04/2020-acc-bloedingsmanagement-bij-oac-expert-consensus-decision-pathway/","title":"2020 ACC bloedingsmanagement bij OAC: expert consensus decision pathway","title_en":"2020 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants: A Report of the American College of Cardiology Solution Set Oversight Committee.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","huisarts"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.04.053","source_url":"https://doi.org/10.1016/j.jacc.2020.04.053","authors":["Gordon F Tomaselli","Kenneth W Mahaffey","Adam Cuker","Paul P Dobesh","John U Doherty","John W Eikelboom","Roberta Florido","Ty J Gluckman","William J Hucker","Roxana Mehran","Steven R Messé","Alexander C Perino","Fatima Rodriguez","Ravindra Sarode","Deborah M Siegal","Barbara S Wiggins"],"significance":8,"published":"2020-08-04","source_date":"2020-08-04","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doacs-overzicht/"],"congress":"","summary_en":"The 2020 ACC Expert Consensus on managing bleeding in patients on oral anticoagulants provided practical algorithms for assessment, reversal agent selection, and resumption of anticoagulation after bleeding events, addressing a common clinical challenge.","created":"2026-07-03T10:28:42Z","updated":"2026-07-03T13:27:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ACC 2020 expert consensus over management van bloedingen bij patiënten op orale anticoagulantia. Praktijkgids voor bloedingscomplicaties.","abstract_original":""},{"id":"b513fdacd5a8","type":"article","url":"https://hartvaat.nl/2020/08/01/inspannings-ecg-versus-ccta-bij-stabiele-angina-post-hoc-vergelijking/","title":"Inspannings-ECG versus CCTA bij stabiele angina: post-hoc vergelijking","title_en":"Exercise Electrocardiography and Computed Tomography Coronary Angiography for Patients With Suspected Stable Angina Pectoris: A Post Hoc Analysis of the Randomized SCOT-HEART Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":["acuut-coronair-syndroom","hartkatheterisatie"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2020.1567","source_url":"https://doi.org/10.1001/jamacardio.2020.1567","authors":["Trisha Singh","Rong Bing","Marc R Dweck","Edwin J R van Beek","Nicholas L Mills","Michelle C Williams","Todd C Villines","David E Newby","Philip D Adamson"],"significance":6,"published":"2020-08-01","source_date":"2020-08-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stabiele-angina-pectoris/","https://hartvaat.nl/kennis/diagnostiek/cardiale-ct-angiografie/"],"congress":"","summary_en":"This post-hoc comparison of exercise ECG versus coronary CT angiography for suspected stable angina evaluated whether the traditional exercise test still has a role alongside modern non-invasive imaging.","created":"2026-07-03T10:28:42Z","updated":"2026-07-03T13:27:51Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 vergelijking van inspannings-ECG versus CCTA bij verdenking stabiele angina pectoris.","abstract_original":"IMPORTANCE: Recent European guidance supports a diminished role for exercise electrocardiography (ECG) in the assessment of suspected stable angina. OBJECTIVE: To evaluate the utility of exercise ECG in contemporary practice and assess the value of combined functional and anatomical testing. DESIGN, SETTING, AND PARTICIPANTS: This is a post hoc analysis of the Scottish Computed Tomography of the Heart (SCOT-HEART) open-label randomized clinical trial, conducted in 12 cardiology chest pain clinics across Scotland for patients with suspected angina secondary to coronary heart disease. Between November 18, 2010, and September 24, 2014, 4146 patients aged 18 to 75 years with stable angina underwent clinical evaluation and 1417 of 1651 (86%) underwent exercise ECG prior to randomization. Statistical analysis was conducted from October 10 to November 5, 2019. INTERVENTIONS: Patients were randomized in a 1:1 ratio to receive standard care plus coronary computed tomography (CT) angiography or to receive standard care alone. The present analysis was limited to the 3283 patients who underwent exercise ECG alone or in combination with coronary CT angiography. MAIN OUTCOMES AND MEASURES: The primary clinical end point was death from coronary heart disease or nonfatal myocardial infarction at 5 years. RESULTS: Among the 3283 patients (1889 men; median age, 57.0 years [interquartile range, 50.0-64.0 years]), exercise ECG had a sensitivity of 39% and a specificity of 91% for detecting any obstructive coronary artery disease in those who underwent subsequent invasive angiography. Abnormal results of exercise ECG were associated with a 14.47-fold (95% CI, 10.00-20.41; P < .001) increase in coronary revascularization at 1 year and a 2.57-fold (95% CI, 1.38-4.63; P < .001) increase in mortality from coronary heart disease death at 5 years or in cases of nonfatal myocardial infarction at 5 years. Compared with exercise ECG alone, results of coronary CT angiography had a stronger association with 5-year coronary heart disease death or nonfatal myocardial infarction (hazard ratio, 10.63; 95% CI, 2.32-48.70; P = .002). The greatest numerical difference in outcome with CT angiography compared with exercise ECG alone was observed for those with inconclusive results of exercise ECG (5 of 285 [2%] vs 13 of 283 [5%]), although this was not statistically significant (log-rank P = .05). CONCLUSIONS AND RELEVANCE: This study suggests that abnormal results of exercise ECG are associated with coronary revascularization and the future risk of adverse coronary events. However, coronary CT angiography more accurately detects coronary artery disease and is more strongly associated with future risk compared with exercise ECG. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01149590."},{"id":"6c0bca9ed796","type":"article","url":"https://hartvaat.nl/2020/08/01/seksegerelateerde-uitkomsten-bij-hoog-bloedingsrisico-na-pci-leaders-free/","title":"Seksegerelateerde uitkomsten bij hoog bloedingsrisico na PCI: LEADERS FREE","title_en":"Sex-Based Outcomes in Patients With a High Bleeding Risk After Percutaneous Coronary Intervention and 1-Month Dual Antiplatelet Therapy: A Secondary Analysis of the LEADERS FREE Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2020.0285","source_url":"https://doi.org/10.1001/jamacardio.2020.0285","authors":["Roxana Mehran","Jaya Chandrasekhar","Philip Urban","Irene M Lang","Ute Windhoevel","Christian Spaulding","Samuel Copt","Hans-Peter Stoll","Marie-Claude Morice"],"significance":5,"published":"2020-08-01","source_date":"2020-08-01","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/","https://hartvaat.nl/kennis/cardiometabool/bloedsuikerdoelen-cardiovasculair/"],"congress":"","summary_en":"This LEADERS FREE sex-stratified analysis showed that women with high bleeding risk have different outcomes after PCI with abbreviated DAPT, informing sex-aware management of this vulnerable population.","created":"2026-07-03T10:28:42Z","updated":"2026-07-03T13:27:51Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"LEADERS FREE analyse van sekseverschillen in uitkomsten bij patiënten met hoog bloedingsrisico na PCI.","abstract_original":"IMPORTANCE: Female sex has been identified as a risk factor for bleeding after percutaneous coronary intervention (PCI) and may have contributed to the underuse of drug-eluting stents in women. This risk may be further enhanced among patients with a high bleeding risk. OBJECTIVE: To assess the 2-year outcomes by sex in patients with a high bleeding risk who were enrolled in the LEADERS FREE trial. DESIGN, SETTING, AND PARTICIPANTS: This cohort study is a prespecified, sex-based secondary analysis of the LEADERS FREE double-blind, randomized clinical trial that was conducted at 68 sites in 20 countries from December 2012 to May 2014. Patients with a high bleeding risk who underwent PCI and met the trial eligibility criteria were enrolled at the participating sites and followed up for up to 2 years. INTERVENTIONS: Patients were randomized 1:1 to either a bare-metal stent or a polymer-free, biolimus A9-eluting drug-coated stent with 1-month of dual antiplatelet therapy. MAIN OUTCOMES AND MEASURES: The primary safety end point was a composite of cardiac death, myocardial infarction, or stent thrombosis. The primary efficacy end point was clinically driven target lesion revascularization. Bleeding was assessed using the Bleeding Academic Research Consortium (BARC) scale, and the source of bleeding was recorded. RESULTS: A total of 2432 patients with a high bleeding risk were included in the study. Of these patients, the mean (SD) age was 75 (9) years, and 1694 (69.7%) were men and 738 (30.3%) were women. Women and men had similar incidence of the 2-year primary safety (14.7% vs 13.6%; P = .37) and efficacy (9.2% vs 9.5%; P = .70) end points. The drug-coated stent was found to be superior to the bare-metal stent in both sexes, with lower target lesion revascularization (women: 6.3% vs 12.1%; men: 7.0% vs 12.0%; P for interaction = .70) and similar rates of the primary safety end point (women: 12.4% vs 17.0%; men: 12.6% vs 14.5%; P for interaction = .40). Overall, 2-year BARC types 3 to 5 major bleeding (10.2% vs 8.6%; P = .14) was not statistically different between the sexes, but women experienced greater BARC types 3 to 5 major bleeding within the first 30 days (5.1% vs 2.4%; P = .007) and greater vascular access site major bleeding than men (2.2% vs 0.5%; P < .001). In both sexes, vascular (women: hazard ratio [HR], 3.45 [95% CI, 1.51-7.87]; men: HR, 4.14 [95% CI, 1.33-12.95]) and nonvascular major bleeding (women: HR, 3.76 [95% CI, 2.17- 6.53]; men: HR, 4.62 [95% CI, 3.23-6.61]) were associated with greater 2-year mortality. CONCLUSIONS AND RELEVANCE: This study found no sex differences in the ischemic outcomes of patients with a high bleeding risk after PCI, but women appeared to demonstrate greater early bleeding and major bleeding from the vascular access site. Both women and men with major bleeding seemed to experience worse 2-year mortality, suggesting that bleeding avoidance strategies should be uniformly adopted for all patients, with close attention dedicated to women to avoid denying them the benefits of PCI. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02843633."},{"id":"0113467718ff","type":"article","url":"https://hartvaat.nl/2020/08/01/complete-versus-culprit-only-revascularisatie-bij-stemi-jama-cardiology-meta-ana/","title":"Complete versus culprit-only revascularisatie bij STEMI: JAMA Cardiology meta-analyse","title_en":"Complete vs Culprit-Lesion-Only Revascularization for ST-Segment Elevation Myocardial Infarction: A Systematic Review and Meta-analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2020.1251","source_url":"https://doi.org/10.1001/jamacardio.2020.1251","authors":["Kevin R Bainey","Thomas Engstrøm","Pieter C Smits","Anthony H Gershlick","Stefan K James","Robert F Storey","David A Wood","Roxana Mehran","John A Cairns","Shamir R Mehta"],"significance":8,"published":"2020-08-01","source_date":"2020-08-01","image":"","kennis":[],"congress":"","summary_en":"This JAMA Cardiology meta-analysis confirmed that complete revascularization of nonculprit lesions significantly reduces cardiovascular death and MI compared with culprit-only PCI in patients with STEMI and multivessel disease. The pooled analysis provided definitive evidence favoring the complete revascularization approach.","created":"2026-07-03T10:28:42Z","updated":"2026-07-03T13:27:51Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 systematische review en meta-analyse die complete versus culprit-only revascularisatie vergeleek bij STEMI. Definitieve meta-analyse na COMPLETE.","abstract_original":"IMPORTANCE: Recently, the Complete vs Culprit-Only Revascularization to Treat Multivessel Disease After Early PCI (percutaneous coronary intervention) for STEMI (ST-segment elevation myocardial infarction [MI]) (COMPLETE) trial showed that angiography-guided PCI of the nonculprit lesion with the goal of complete revascularization reduced cardiovascular (CV) death or new MI compared with PCI of the culprit lesion only in STEMI. Whether complete revascularization also reduces CV mortality is uncertain. Moreover, whether the association of complete revascularization with hard clinical outcomes is consistent when fractional flow reserve (FFR)- and angiography-guided strategies are used is unknown. OBJECTIVE: To determine through a systematic review and meta-analysis (1) whether complete revascularization is associated with decreased CV mortality and (2) whether heterogeneity in the association occurs when FFR- and angiography-guided PCI strategies for nonculprit lesions are performed. DATA SOURCES: A systematic search of MEDLINE, Embase, ISI Web of Science, and CENTRAL (Cochrane Central Register of Controlled Trials) from database inception to September 30, 2019, was performed. Conference proceedings were also reviewed from January 1, 2002, to September 30, 2019. STUDY SELECTION: English-language randomized clinical trials comparing complete revascularization vs culprit-lesion-only PCI in patients with STEMI and multivessel disease were included. DATA EXTRACTION AND SYNTHESIS: The combined odds ratio (OR) was calculated with the random-effects model using the Mantel-Haenszel method (sensitivity with fixed-effects model). Heterogeneity was measured using the I2 statistic. Publication bias was evaluated using the inverted funnel plot approach. Data were analyzed from October 2019 to January 2020. MAIN OUTCOMES AND MEASURES: Cardiovascular death and the composite of CV death or new MI. RESULTS: Ten randomized clinical trials involving 7030 unique patients were included. The weighted mean follow-up time was 29.5 months. Complete revascularization was associated with reduced CV death compared with culprit-lesion-only PCI (80 of 3191 [2.5%] vs 106 of 3406 [3.1%]; OR, 0.69 [95% CI, 0.48-0.99]; P = .05; fixed-effects model OR, 0.74 [95% CI, 0.55-0.99]; P = .04). All-cause mortality occurred in 153 of 3426 patients (4.5%) in the complete revascularization group vs 177 of 3604 (4.9%) in the culprit-lesion-only group (OR, 0.84 [95% CI, 0.67-1.05]; P = .13; I2 = 0%). Complete revascularization was associated with a reduced composite of CV death or new MI (192 of 2616 [7.3%] vs 266 of 2586 [10.3%]; OR, 0.69 [95% CI, 0.55-0.87]; P = .001; fixed-effects model OR, 0.69 [95% CI, 0.57-0.84]; P < .001), with no heterogeneity in this outcome when complete revascularization was performed using an FFR-guided strategy (OR, 0.78 [95% CI, 0.43-1.44]) or an angiography-guided strategy (OR, 0.61 [95% CI, 0.38-0.97]; P = .52 for interaction). CONCLUSIONS AND RELEVANCE: In patients with STEMI and multivessel disease, complete revascularization was associated with a reduction in CV mortality compared with culprit-lesion-only PCI. There was no differential association with treatment between FFR- and angiography-guided strategies on major CV outcomes."},{"id":"93594192f106","type":"article","url":"https://hartvaat.nl/2020/08/01/antidiabetica-en-cardiovasculaire-geneeskunde-meta-analyse-en-perspectief/","title":"Antidiabetica en cardiovasculaire geneeskunde: meta-analyse en perspectief","title_en":"Opportunities of Antidiabetic Drugs in Cardiovascular Medicine: A Meta-Analysis and Perspectives for Trial Design.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","internist"],"tags":["diabetes-en-hart","diabetes-type-1","diabetes-type-2","farmaco-economie","fidelio-dkd","figaro-dkd","gepersonaliseerde-geneeskunde","lipoproteïne-a","menopauze","microbioom","obesitas","select-trial","soul-trial"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.14791","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.14791","authors":["Cen Yan","Lutgarde Thijs","Yu Cao","Sander Trenson","Zhen-Yu Zhang","Stefan Janssens","Jan A Staessen","Ying-Mei Feng"],"significance":7,"published":"2020-08-01","source_date":"2020-08-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis synthesized the cardiovascular effects of GLP-1 receptor agonists and SGLT2 inhibitors in diabetic and non-diabetic populations, identifying opportunities for extending these drug classes beyond traditional glycemic indications.","created":"2026-07-03T10:28:42Z","updated":"2026-07-03T13:27:51Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 de cardiovasculaire effecten van antidiabetica met perspectieven voor toekomstig trialontwerp.","abstract_original":"To identify potential application of GLP1-RAs (glucagon-like peptide-1 receptor agonists) and SGLT2-Is (sodium-dependent glucose cotrasnsporter-2 inhibitors) in cardiovascular medicine, we performed PubMed search until March 31, 2020 and selected placebo-controlled randomized trials (RCTs) in patients with type 2 diabetes mellitus. Twenty-four hour ambulatory and office blood pressure (BP), major adverse cardiovascular events (MACE), progression of chronic kidney disease (CKD), and changes in glycated hemoglobin and body weight were aggregated across RCTs using random-effect models. In 2238 patients (7 RCTs), SGLT2-Is lowered 24-hour systolic/diastolic BP by 4.4/1.9 mm Hg (95% CI, 3.4-5.5/1.2-2.6 mm Hg), whereas 2 GLP1-RAs RCTs produced contradictory BP results. Over 1.3 to 5.4 years of follow-up of 56 004 patients (7 RCTs), aggregate hazard ratios associated with GLP1-RA treatment were 0.88 (0.84-0.93) for MACE, 0.84 (0.74-0.89) for CKD, and ranged from 0.84 to 0.90 for individual MACE end points (P≤0.01). Across 5 SGLT2-Is RCTs, including 43 467 patients with 1.5 to 4.2 years follow-up, hazard ratios were 0.87 (0.82-0.93) for MACE, 0.68 (0.62-0.75) for HF, 0.82 (0.72-0.93) for cardiovascular death, 0.87 (0.79-0.96) for myocardial infarction, and 0.61 (0.56-0.67) for worsening CKD. The risk of HF and CKD, but not MACE, decreased with more BP lowering. Stricter glycemic control was associated with higher HF risk, but unrelated to MACE or CKD. The aggregate effect sizes on systolic BP, body weight, and glycated hemoglobin were -1.61 mm Hg, -2.40 kg, and -0.69% for GLP1-RAs, and -2.53 mm Hg, -1.15 kg and -0.24%, for SGLT2-Is (P<0.001). In conclusion, GLP1-RAs and SGLT2-Is reduced cardiovascular risk with differential benefit profiles."},{"id":"cf1d226e2d2a","type":"article","url":"https://hartvaat.nl/2020/08/01/tolvaptan-versus-furosemide-bij-hf-hospitalisatie-met-hyponatriemie-aqua-ahf/","title":"Tolvaptan versus furosemide bij HF-hospitalisatie met hyponatriëmie: AQUA-AHF","title_en":"Tolvaptan vs. furosemide-based diuretic regimens in patients hospitalized for heart failure with hyponatremia (AQUA-AHF).","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":["diuretica"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12783","source_url":"https://doi.org/10.1002/ehf2.12783","authors":["Tien M H Ng","Luanda P Grazette","Michael W Fong","Andrew J Yoon","Mimi Lou","Allen Kuo","Rani Y Upadhyay","Emily E Han","Anilkumar Mehra","Uri Elkayam"],"significance":5,"published":"2020-08-01","source_date":"2020-08-01","image":"","kennis":[],"congress":"","summary_en":"The AQUA-AHF trial compared tolvaptan-based with furosemide-based diuretic therapy in heart failure with hyponatremia, testing whether aquaresis improves outcomes in this electrolyte-complicated HF population.","created":"2026-07-03T10:28:41Z","updated":"2026-07-03T13:27:51Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"AQUA-AHF trial die tolvaptan vergeleek met furosemide-regime bij gehospitaliseerd HF met hyponatriëmie.","abstract_original":"AIMS: Hyponatremia is associated with poorer outcomes and diuretic response in patients hospitalized for heart failure. This study compared a tolvaptan-based vs. furosemide-based diuretic regimen on short-term clinical responses in hyponatremic acute heart failure. METHODS AND RESULTS: Prospective, randomized, open-label, parallel-group, single-centre study comparing oral tolvaptan vs. continuous infusion furosemide. Thirty-three subjects requiring hospitalization for acute congestive heart failure, and a serum sodium < 135 mmol/L, were randomized to tolvaptan 30 mg orally daily or furosemide 5 mg/h intravenously for initial 24 h, after which treatments could be escalated. Median daily dose throughout was tolvaptan 30 mg and furosemide 120 mg, with four subjects in each group requiring dose escalation. Urine output and net fluid balance were not different between groups at 24 h or subsequent time points up to 96 h. Changes in estimated glomerular filtration rate were comparable. Cystatin C improved at 24 h with tolvaptan compared with furosemide (-6.4 ± 11.8 vs. 4.1 ± 17.2% change, P = 0.036), but the effect was transient. No significant between group differences were seen for NT-proBNP, plasma renin activity, or urinary neutrophil gelatinase-associated lipocalin:Cr. Serum sodium, as well as copeptin levels, increased with tolvaptan compared with furosemide. CONCLUSIONS: Oral tolvaptan was associated with similar, but not superior, diuresis compared with intravenous furosemide for acute heart failure with concomitant hyponatremia."},{"id":"450afc1ddd25","type":"article","url":"https://hartvaat.nl/2020/08/01/raas-remmers-en-covid-19-mortaliteit-bij-hypertensie-meta-analyse/","title":"RAAS-remmers en COVID-19 mortaliteit bij hypertensie: meta-analyse","title_en":"Decreased Mortality of COVID-19 With Renin-Angiotensin-Aldosterone System Inhibitors Therapy in Patients With Hypertension: A Meta-Analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["covid-hart","ras-remmers"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.15572","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.15572","authors":["Xiaoming Guo","Yueli Zhu","Yuan Hong"],"significance":7,"published":"2020-08-01","source_date":"2020-08-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/aldosteron-en-raas-farmacologie/","https://hartvaat.nl/kennis/hypertensie/ace-remmers-hypertensie/"],"congress":"","summary_en":"This meta-analysis showed that RAAS inhibitor therapy is associated with decreased COVID-19 mortality in hypertensive patients, providing reassurance against the early pandemic concern that ACE inhibitors and ARBs might worsen SARS-CoV-2 outcomes.","created":"2026-07-03T10:28:41Z","updated":"2026-07-03T13:27:51Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 verminderde COVID-19 mortaliteit aantoonde met RAAS-remmers bij hypertensieve patiënten. Geruststellend voor voortzetting van ACE-remmers/ARB's.","abstract_original":""},{"id":"d91aa6050662","type":"article","url":"https://hartvaat.nl/2020/08/01/diagnostische-nauwkeurigheid-van-handheld-ecg-devices-voor-af-community-versus-z/","title":"Diagnostische nauwkeurigheid van handheld ECG-devices voor AF: community versus ziekenhuis","title_en":"Diagnostic accuracy of handheld electrocardiogram devices in detecting atrial fibrillation in adults in community versus hospital settings: a systematic review and meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2020-316611","source_url":"https://doi.org/10.1136/heartjnl-2020-316611","authors":["Kam Cheong Wong","Harry Klimis","Nicole Lowres","Amy von Huben","Simone Marschner","Clara K Chow"],"significance":6,"published":"2020-08-01","source_date":"2020-08-01","image":"","kennis":[],"congress":"","summary_en":"This study assessed the diagnostic accuracy of handheld ECG devices for AF detection in community versus hospital settings, providing validation data for consumer-grade screening technology across different clinical environments.","created":"2026-07-03T10:28:41Z","updated":"2026-07-03T13:27:51Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 diagnostische nauwkeurigheid van draagbare ECG-apparaten voor AF-detectie in de community versus het ziekenhuis.","abstract_original":"With increasing use of handheld ECG devices for atrial fibrillation (AF) screening, it is important to understand their accuracy in community and hospital settings and how it differs among settings and other factors. A systematic review of eligible studies from community or hospital settings reporting the diagnostic accuracy of handheld ECG devices (ie, devices producing a rhythm strip) in detecting AF in adults, compared with a gold standard 12-lead ECG or Holter monitor, was performed. Bivariate hierarchical random-effects meta-analysis and meta-regression were performed using R V.3.6.0. The search identified 858 articles, of which 14 were included. Six studies recruited from community (n=6064 ECGs) and eight studies from hospital (n=2116 ECGs) settings. The pooled sensitivity was 89% (95% CI 81% to 94%) in the community and 92% (95% CI 83% to 97%) in the hospital. The pooled specificity was 99% (95% CI 98% to 99%) in the community and 95% (95% CI 90% to 98%) in the hospital. Accuracy of ECG devices varied: sensitivity ranged from 54.5% to 100% and specificity ranged from 61.9% to 100%. Meta-regression showed that setting (p=0.032) and ECG device type (p=0.022) significantly contributed to variations in sensitivity and specificity. The pooled sensitivity and specificity of single-lead handheld ECG devices were high. Setting and handheld ECG device type were significant factors of variation in sensitivity and specificity. These findings suggest that the setting including user training and handheld ECG device type should be carefully reviewed."},{"id":"876e05552a7f","type":"article","url":"https://hartvaat.nl/2020/08/01/canagliflozine-bij-diabetes-type-2-met-chronisch-hf-candle-gerandomiseerde-trial/","title":"Canagliflozine bij diabetes type 2 met chronisch HF: CANDLE gerandomiseerde trial","title_en":"Effects of canagliflozin in patients with type 2 diabetes and chronic heart failure: a randomized trial (CANDLE).","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["answer-hf","canagliflozine","credence-trial","dapa-hf","soul-trial"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12707","source_url":"https://doi.org/10.1002/ehf2.12707","authors":["Atsushi Tanaka","Itaru Hisauchi","Isao Taguchi","Akira Sezai","Shigeru Toyoda","Hirofumi Tomiyama","Masataka Sata","Shinichiro Ueda","Jun-Ichi Oyama","Masafumi Kitakaze","Toyoaki Murohara","Koichi Node"],"significance":6,"published":"2020-08-01","source_date":"2020-08-01","image":"","kennis":[],"congress":"","summary_en":"The CANDLE randomized trial of canagliflozin in patients with type 2 diabetes and chronic heart failure showed favorable effects on NT-proBNP, providing early mechanistic evidence for SGLT2 inhibitor cardioprotection in the diabetic HF population.","created":"2026-07-03T10:28:41Z","updated":"2026-07-03T13:27:51Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"CANDLE gerandomiseerde trial van canagliflozine bij patiënten met diabetes type 2 en chronisch hartfalen.","abstract_original":"AIMS: Little is known about the impact of sodium glucose co-transporter 2 (SGLT2) inhibitors on cardiac biomarkers, such as natriuretic peptides, in type 2 diabetes (T2D) patients with concomitant chronic heart failure (CHF). We compared the effect of canagliflozin with glimepiride, based on changes in N-terminal pro-brain natriuretic peptide (NT-proBNP), in that patient population. METHODS AND RESULTS: Patients with T2D and stable CHF, randomized to receive canagliflozin 100 mg or glimepiride (starting-dose: 0.5 mg), were examined using the primary endpoint of non-inferiority of canagliflozin vs. glimepiride, defined as a margin of 1.1 in the upper limit of the two-sided 95% confidence interval (CI) for the group ratio of percentage change in NT-proBNP at 24 weeks. Data analysis of 233 patients showed mean left ventricular ejection fraction (LVEF) at randomization was 57.6 ± 14.6%, with 71% of patients having a preserved LVEF (≥50%). Ratio of NT-proBNP percentage change was 0.48 (95% CI, -0.13 to 1.59, P = 0.226) and therefore did not meet the prespecified non-inferiority margin. However, NT-proBNP levels did show a non-significant trend lower in the canagliflozin group [adjusted group difference; -74.7 pg/mL (95% CI, -159.3 to 10.9), P = 0.087] and also in the subgroup with preserved LVEF [-58.3 (95% CI, -127.6 to 11.0, P = 0.098]). CONCLUSIONS: This study did not meet the predefined primary endpoint of changes in NT-proBNP levels, with 24 weeks of treatment with canagliflozin vs. glimepiride. Further research is warranted to determine whether patients with heart failure with preserved ejection fraction, regardless of diabetes status, could potentially benefit from treatment with SGLT2 inhibitors."},{"id":"ac139fde68cc","type":"article","url":"https://hartvaat.nl/2020/08/01/cardiovasculaire-risicovoorspelling-bij-inheemse-australiers/","title":"Cardiovasculaire risicovoorspelling bij Inheemse Australiërs","title_en":"Performance of cardiovascular risk prediction equations in Indigenous Australians.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts"],"tags":["biomarkers-cardiovasculair","fractional-flow-reserve","ouderen","richtlijnen-esc","slaapapneu"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2019-315889","source_url":"https://doi.org/10.1136/heartjnl-2019-315889","authors":["Elizabeth Laurel Mary Barr","Federica Barzi","Athira Rohit","Joan Cunningham","Shaun Tatipata","Robyn McDermott","Wendy E Hoy","Zhiqiang Wang","Pamela June Bradshaw","Lyn Dimer","Peter L Thompson","Julie Brimblecombe","Kerin O'Dea","Christine Connors","Paul Burgess","Steven Guthridge","Alex Brown","Alan Cass","Jonathan E Shaw","Louise Maple-Brown"],"significance":5,"published":"2020-08-01","source_date":"2020-08-01","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 individual participant meta-analysis showed that standard cardiovascular risk equations perform poorly in Indigenous Australians, highlighting the need for population-specific or recalibrated risk prediction tools.","created":"2026-07-03T10:28:41Z","updated":"2026-07-03T13:27:51Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 prestatie van cardiovasculaire risicovoorspelings-vergelijkingen bij Inheemse Australiërs.","abstract_original":"OBJECTIVE: To assess the performance of cardiovascular disease (CVD) risk equations in Indigenous Australians. METHODS: We conducted an individual participant meta-analysis using longitudinal data of 3618 Indigenous Australians (55% women) aged 30-74 years without CVD from population-based cohorts of the Cardiovascular Risk in IndigenouS People(CRISP) consortium. Predicted risk was calculated using: 1991 and 2008 Framingham Heart Study (FHS), the Pooled Cohorts (PC), GloboRisk and the Central Australian Rural Practitioners Association (CARPA) modification of the FHS equation. Calibration, discrimination and diagnostic accuracy were evaluated. Risks were calculated with and without the use of clinical criteria to identify high-risk individuals. RESULTS: When applied without clinical criteria, all equations, except the CARPA-adjusted FHS, underestimated CVD risk (range of percentage difference between observed and predicted CVD risks: -55% to -14%), with underestimation greater in women (-63% to -13%) than men (-47% to -18%) and in younger age groups. Discrimination ranged from 0.66 to 0.72. The CARPA-adjusted FHS equation showed good calibration but overestimated risk in younger people, those without diabetes and those not at high clinical risk. When clinical criteria were used with risk equations, the CARPA-adjusted FHS algorithm scored 64% of those who had CVD events as high risk; corresponding figures for the 1991-FHS were 58% and were 87% for the PC equation for non-Hispanic whites. However, specificity fell. CONCLUSION: The CARPA-adjusted FHS CVD risk equation and clinical criteria performed the best, achieving higher combined sensitivity and specificity than other equations. However, future research should investigate whether modifications to this algorithm combination might lead to improved risk prediction."},{"id":"089c21c1ceb9","type":"article","url":"https://hartvaat.nl/2020/07/28/evolocumab-op-atherogene-lipoproteinen-in-de-peri-infarctperiode-gerandomiseerde/","title":"Evolocumab op atherogene lipoproteïnen in de peri-infarctperiode: gerandomiseerde trial","title_en":"Effect of Evolocumab on Atherogenic Lipoproteins During the Peri- and Early Postinfarction Period: A Placebo-Controlled, Randomized Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["lipoproteïne-a","yellow-iii"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.046320","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.046320","authors":["Thorsten M Leucker","Michael J Blaha","Steven R Jones","Michael A Vavuranakis","Marlene S Williams","Hong Lai","Thomas H Schindler","Jacqueline Latina","Steven P Schulman","Gary Gerstenblith"],"significance":7,"published":"2020-07-28","source_date":"2020-07-28","image":"","kennis":[],"congress":"","summary_en":"This placebo-controlled trial of evolocumab in the peri- and early post-infarction period demonstrated rapid and substantial reductions in atherogenic lipoproteins when initiated acutely during MI hospitalization.","created":"2026-07-03T10:28:41Z","updated":"2026-07-03T13:27:50Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 evolocumab op atherogene lipoproteïnen in de acute en vroege post-infarctperiode.","abstract_original":""},{"id":"1799c0d478a0","type":"article","url":"https://hartvaat.nl/2020/07/28/langetermijn-icd-uitkomsten-scd-heft/","title":"Langetermijn ICD-uitkomsten: SCD-HeFT","title_en":"Long-Term Outcomes of Implantable Cardioverter-Defibrillator Therapy in the SCD-HeFT.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.05.061","source_url":"https://doi.org/10.1016/j.jacc.2020.05.061","authors":["Jeanne E Poole","Brian Olshansky","Daniel B Mark","Jill Anderson","George Johnson","Anne S Hellkamp","Linda Davidson-Ray","Daniel P Fishbein","Robin E Boineau","Kevin J Anstrom","Per G Reinhall","Douglas L Packer","Kerry L Lee","Gust H Bardy"],"significance":7,"published":"2020-07-28","source_date":"2020-07-28","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/icd-bij-hartfalen/"],"congress":"","summary_en":"Long-term SCD-HeFT follow-up showed that the survival benefit of ICD therapy in moderate heart failure (NYHA II-III) persists over many years, providing the longest available data on primary prevention ICD outcomes.","created":"2026-07-03T10:28:41Z","updated":"2026-07-03T13:27:50Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"SCD-HeFT langetermijnuitkomsten van ICD-therapie. Een van de langste ICD follow-upperiodes.","abstract_original":"BACKGROUND: The SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial) randomized 2,521 patients with moderate heart failure (HF) to amiodarone, placebo drug, or implantable cardioverter-defibrillator (ICD) therapy. Original trial follow-up ended October 31, 2003. Over a median 45.5-month follow-up, amiodarone, compared with placebo, did not affect survival, whereas randomization to an ICD significantly decreased all-cause mortality by 23%. OBJECTIVES: This study sought to describe the extended treatment group survival of the SCD-HeFT cohort. METHODS: Mortality outcomes for the 1,855 patients alive at the end of the SCD-HeFT trial were collected between 2010 and 2011. These data were combined with the 666 deaths from the original study to compare long-term outcomes overall and for key pre-specified subgroups. RESULTS: Median (25th to 75th percentiles) follow-up was 11.0 (10.0 to 12.2) years. On the basis of intention-to-treat analysis, the ICD group had overall survival benefit versus placebo drug (hazard ratio [HR]: 0.87; 95% confidence interval [CI]: 0.76 to 0.98; p = 0.028). When treatment benefit was examined as a function of time from randomization, attenuation of the ICD benefit was observed after 6 years (p value for the interaction = 0.0015). Subgroup analysis revealed long-term ICD benefit varied according to HF etiology and New York Heart Association (NYHA) functional class: ischemic HF HR: 0.81; 95% CI: 0.69 to 0.95; p = 0.009; nonischemic HF HR: 0.97; 95% CI: 0.79 to 1.20; p = 0.802; NYHA functional class II HR: 0.76; 95% CI: 0.65 to 0.90; p = 0.001; NYHA functional class III HR: 1.06; 95% CI: 0.86 to 1.31; p = 0.575. CONCLUSIONS: Follow-up of SCD-HeFT patients to 11 years demonstrated heterogenous treatment-related patterns of long-term survival with ICD benefit most evident at 11 years for ischemic HF patients and for those with NYHA functional class II symptoms at trial enrollment. (SCD-HeFT 10 Year Follow-up [SCD-HeFT10 Yr]; NCT01058837)."},{"id":"51d15183d3d5","type":"article","url":"https://hartvaat.nl/2020/07/21/levothyroxine-bij-subklinische-hypothyreoidie-na-acuut-mi-jama/","title":"Levothyroxine bij subklinische hypothyreoïdie na acuut MI: JAMA","title_en":"Effect of Levothyroxine on Left Ventricular Ejection Fraction in Patients With Subclinical Hypothyroidism and Acute Myocardial Infarction: A Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2020.9389","source_url":"https://doi.org/10.1001/jama.2020.9389","authors":["Avais Jabbar","Lorna Ingoe","Shahid Junejo","Peter Carey","Caroline Addison","Honey Thomas","Jehill D Parikh","David Austin","Kieren G Hollingsworth","Deborah D Stocken","Simon H S Pearce","John P Greenwood","Azfar Zaman","Salman Razvi"],"significance":7,"published":"2020-07-21","source_date":"2020-07-21","image":"","kennis":[],"congress":"","summary_en":"This JAMA trial showed that levothyroxine does not improve left ventricular ejection fraction in patients with subclinical hypothyroidism and recent myocardial infarction, arguing against routine thyroid hormone replacement for cardiac benefit in this setting.","created":"2026-07-03T10:28:41Z","updated":"2026-07-03T13:27:50Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 levothyroxine onderzocht op LV-ejectiefractie bij patiënten met subklinische hypothyreoïdie en recent MI. Negatief resultaat.","abstract_original":"IMPORTANCE: Thyroid hormones play a key role in modulating myocardial contractility. Subclinical hypothyroidism in patients with acute myocardial infarction is associated with poor prognosis. OBJECTIVE: To evaluate the effect of levothyroxine treatment on left ventricular function in patients with acute myocardial infarction and subclinical hypothyroidism. DESIGN, SETTING, AND PARTICIPANTS: A double-blind, randomized clinical trial conducted in 6 hospitals in the United Kingdom. Patients with acute myocardial infarction including ST-segment elevation and non-ST-segment elevation were recruited between February 2015 and December 2016, with the last participant being followed up in December 2017. INTERVENTIONS: Levothyroxine treatment (n = 46) commencing at 25 µg titrated to aim for serum thyrotropin levels between 0.4 and 2.5 mU/L or identical placebo (n = 49), both provided in capsule form, once daily for 52 weeks. MAIN OUTCOMES AND MEASURES: The primary outcome measure was left ventricular ejection fraction at 52 weeks, assessed by magnetic resonance imaging, adjusted for age, sex, type of acute myocardial infarction, affected coronary artery territory, and baseline left ventricular ejection fraction. Secondary measures were left ventricular volumes, infarct size (assessed in a subgroup [n = 60]), adverse events, and patient-reported outcome measures of health status, health-related quality of life, and depression. RESULTS: Among the 95 participants randomized, the mean (SD) age was 63.5 (9.5) years, 72 (76.6%) were men, and 65 (69.1%) had ST-segment elevation myocardial infarction. The median serum thyrotropin level was 5.7 mU/L (interquartile range, 4.8-7.3 mU/L) and the mean (SD) free thyroxine level was 1.14 (0.16) ng/dL. The primary outcome measurements at 52 weeks were available in 85 patients (89.5%). The mean left ventricular ejection fraction at baseline and at 52 weeks was 51.3% and 53.8%, respectively, in the levothyroxine group compared with 54.0% and 56.1%, respectively, in the placebo group (adjusted difference in groups, 0.76% [95% CI, -0.93% to 2.46%]; P = .37). None of the 6 secondary outcomes showed a significant difference between the levothyroxine and placebo treatment groups. There were 15 (33.3%) and 18 (36.7%) cardiovascular adverse events in the levothyroxine and placebo groups, respectively. CONCLUSIONS AND RELEVANCE: In this preliminary study involving patients with subclinical hypothyroidism and acute myocardial infarction, treatment with levothyroxine, compared with placebo, did not significantly improve left ventricular ejection fraction after 52 weeks. These findings do not support treatment of subclinical hypothyroidism in patients with acute myocardial infarction. TRIAL REGISTRATION: isrctn.org Identifier: http://www.isrctn.com/ISRCTN52505169."},{"id":"eaa2b83b2d83","type":"article","url":"https://hartvaat.nl/2020/07/21/stemi-zorgsystemen-tijdens-covid-19-aha-mission-lifeline-noodrichtlijn/","title":"STEMI-zorgsystemen tijdens COVID-19: AHA Mission Lifeline noodrichtlijn","title_en":"Temporary Emergency Guidance to STEMI Systems of Care During the COVID-19 Pandemic: AHA's Mission: Lifeline.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["covid-hart"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.048180","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.048180","authors":[],"significance":7,"published":"2020-07-21","source_date":"2020-07-21","image":"","kennis":[],"congress":"","summary_en":"This AHA Mission: Lifeline document provided temporary emergency guidance for STEMI care systems during the COVID-19 pandemic, addressing modified protocols for catheterization lab activation, protective equipment, and alternative reperfusion strategies.","created":"2026-07-03T10:28:41Z","updated":"2026-07-03T13:27:50Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 tijdelijke noodrichtlijn voor STEMI-zorgsystemen tijdens de COVID-19 pandemie.","abstract_original":""},{"id":"d8fabec0c3ef","type":"article","url":"https://hartvaat.nl/2020/07/18/dexmedetomidine-voor-af-en-delier-na-hartchirurgie-lancet-decade/","title":"Dexmedetomidine voor AF en delier na hartchirurgie: Lancet DECADE","title_en":"Dexmedetomidine for reduction of atrial fibrillation and delirium after cardiac surgery (DECADE): a randomised placebo-controlled trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(20)30631-0","source_url":"https://doi.org/10.1016/S0140-6736(20)30631-0","authors":["Alparslan Turan","Andra Duncan","Steve Leung","Nika Karimi","Jonathan Fang","Guangmei Mao","Jennifer Hargrave","Marc Gillinov","Carlos Trombetta","Sabry Ayad","Manal Hassan","Andrew Feider","Kimberly Howard-Quijano","Kurt Ruetzler","Daniel I Sessler"],"significance":7,"published":"2020-07-18","source_date":"2020-07-18","image":"","kennis":[],"congress":"","summary_en":"The DECADE trial showed that postoperative dexmedetomidine infusion did not significantly reduce atrial fibrillation or delirium after cardiac surgery, a negative result for this promising sedative agent in the perioperative setting.","created":"2026-07-03T10:28:40Z","updated":"2026-07-03T13:27:50Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 DECADE trial die dexmedetomidine onderzocht voor preventie van AF en delier na hartchirurgie.","abstract_original":"BACKGROUND: Atrial fibrillation and delirium are common consequences of cardiac surgery. Dexmedetomidine has unique properties as sedative agent and might reduce the risk of each complication. This study coprimarily aimed to establish whether dexmedetomidine reduces the incidence of new-onset atrial fibrillation and the incidence of delirium. METHODS: A randomised, placebo-controlled trial was done at six academic hospitals in the USA. Patients who had had cardiac surgery with cardiopulmonary bypass were enrolled. Patients were randomly assigned 1:1, stratified by site, to dexmedetomidine or normal saline placebo. Randomisation was computer generated with random permuted block size 2 and 4, and allocation was concealed by a web-based system. Patients, caregivers, and evaluators were all masked to treatment. The study drug was prepared by the pharmacy or an otherwise uninvolved research associate so that investigators and clinicians were fully masked to allocation. Participants were given either dexmedetomidine infusion or saline placebo started before the surgical incision at a rate of 0·1 μg/kg per h then increased to 0·2 μg/kg per h at the end of bypass, and postoperatively increased to 0·4 μg/kg per h, which was maintained until 24 h. The coprimary outcomes were atrial fibrillation and delirium occurring between intensive care unit admission and the earlier of postoperative day 5 or hospital discharge. All analyses were intention-to-treat. The trial is registered with ClinicalTrials.gov, NCT02004613 and is closed. FINDINGS: 798 patients of 3357 screened were enrolled from April 17, 2013, to Dec 6, 2018. The trial was stopped per protocol after the last designated interim analysis. Among 798 patients randomly assigned, 794 were analysed, with 400 assigned to dexmedetomidine and 398 assigned to placebo. The incidence of atrial fibrillation was 121 (30%) in 397 patients given dexmedetomidine and 134 (34%) in 395 patients given placebo, a difference that was not significant: relative risk 0·90 (97·8% CI 0·72, 1·15; p=0·34). The incidence of delirium was non-significantly increased from 12% in patients given placebo to 17% in those given dexmedetomidine: 1·48 (97·8% CI 0·99-2·23). Safety outcomes were clinically important bradycardia (requiring treatment) and hypotension, myocardial infarction, stroke, surgical site infection, pulmonary embolism, deep venous thrombosis, and death. 21 (5%) of 394 patients given dexmedetomidine and 8 (2%) of 396 patients given placebo, had a serious adverse event as determined by clinicians. 1 (<1%) of 391 patients given dexmedetomidine and 1 (<1%) of 387 patients given placebo died. INTERPRETATION: Dexmedetomidine infusion, initiated at anaesthetic induction and continued for 24 h, did not decrease postoperative atrial arrhythmias or delirium in patients recovering from cardiac surgery. Dexmedetomidine should not be infused to reduce atrial fibrillation or delirium in patients having cardiac surgery. FUNDING: Hospira Pharmaceuticals."},{"id":"1ca19284dcd1","type":"article","url":"https://hartvaat.nl/2020/07/14/radiale-arterie-versus-vena-saphena-graft-bij-cabg-jama-langetermijn-meta-analys/","title":"Radiale arterie versus vena saphena graft bij CABG: JAMA langetermijn meta-analyse","title_en":"Association of Radial Artery Graft vs Saphenous Vein Graft With Long-term Cardiovascular Outcomes Among Patients Undergoing Coronary Artery Bypass Grafting: A Systematic Review and Meta-analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2020.8228","source_url":"https://doi.org/10.1001/jama.2020.8228","authors":["Mario Gaudino","Umberto Benedetto","Stephen Fremes","Karla Ballman","Giuseppe Biondi-Zoccai","Art Sedrakyan","Giuseppe Nasso","Jai Raman","Brian Buxton","Philip A Hayward","Neil Moat","Peter Collins","Carolyn Webb","Miodrag Peric","Ivana Petrovic","Kyung J Yoo","Irbaz Hameed","Antonino Di Franco","Marco Moscarelli","Giuseppe Speziale","John D Puskas","Leonard N Girardi","David L Hare","David P Taggart"],"significance":8,"published":"2020-07-14","source_date":"2020-07-14","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/cardiometabool/bloedsuikerdoelen-cardiovasculair/"],"congress":"","summary_en":"This JAMA meta-analysis of individual patient data confirmed that radial artery grafts provide superior long-term cardiovascular outcomes compared with saphenous vein grafts in patients undergoing CABG, supporting the use of arterial conduits to improve coronary bypass durability.","created":"2026-07-03T10:28:40Z","updated":"2026-07-03T13:27:50Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 van langetermijn cardiovasculaire uitkomsten met radiale arterie versus vena saphena grafts bij CABG. Bevestigt het voordeel van arteriële grafts.","abstract_original":"IMPORTANCE: Observational studies have suggested that the use of radial artery grafts for coronary artery bypass grafting may improve clinical outcomes compared with the use of saphenous vein grafts, but this has not been confirmed in randomized trials. OBJECTIVE: To compare clinical outcomes between patients receiving radial artery vs saphenous vein grafts for coronary artery bypass grafting after long-term follow-up. DESIGN, SETTING, AND PARTICIPANTS: Patient-level pooled analysis comparing radial artery vs saphenous vein graft in adult patients undergoing isolated coronary artery bypass grafting from 5 countries (Australia, Italy, Serbia, South Korea, and the United Kingdom), with enrollment from 1997 to 2009 and follow-up completed in 2019. INTERVENTIONS: Patients were randomized to undergo either radial artery (n = 534) or saphenous vein (n = 502) grafts for coronary artery bypass grafting. MAIN OUTCOMES AND MEASURES: The primary outcome was a composite of death, myocardial infarction, or repeat revascularization and the secondary outcome was a composite of death or myocardial infarction. RESULTS: A total of 1036 patients were randomized (mean age, 66.6 years in the radial artery group vs 67.1 years in the saphenous vein group; 376 [70.4%] men in the radial artery group vs 351 [69.9%] in the saphenous vein group); 942 (90.9%) of the originally randomized patients completed 10 years of follow-up (510 in the radial artery group). At a median (interquartile range) follow-up of 10 (10-11) years, the use of the radial artery, compared with the saphenous vein, in coronary artery bypass grafting was associated with a statistically significant reduction in the incidence of the composite outcome of death, myocardial infarction, or repeat revascularization (220 vs 237 total events; 41 vs 47 events per 1000 patient-years; hazard ratio, 0.73 [95% CI, 0.61-0.88]; P < .001) and of the composite of death or myocardial infarction (188 vs 193 total events; 35 vs 38 events per 1000 patient-years; hazard ratio, 0.77 [95% CI, 0.63-0.94]; P = .01). CONCLUSIONS AND RELEVANCE: In this individual participant data meta-analysis with a median follow-up of 10 years, among patients undergoing coronary artery bypass grafting, the use of the radial artery compared with the saphenous vein was associated with a lower risk of a composite of cardiovascular outcomes."},{"id":"3cd17fc6f565","type":"article","url":"https://hartvaat.nl/2020/07/14/alirocumab-bij-homozygoot-fh-odyssey-hofh/","title":"Alirocumab bij homozygoot FH: ODYSSEY HoFH","title_en":"Efficacy and Safety of Alirocumab in Adults With Homozygous Familial Hypercholesterolemia: The ODYSSEY HoFH Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["familiaire-hypercholesterolemie-screening"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.05.027","source_url":"https://doi.org/10.1016/j.jacc.2020.05.027","authors":["Dirk J Blom","Mariko Harada-Shiba","Paolo Rubba","Daniel Gaudet","John J P Kastelein","Min-Ji Charng","Robert Pordy","Stephen Donahue","Shazia Ali","Yuping Dong","Nagwa Khilla","Poulabi Banerjee","Marie Baccara-Dinet","Robert S Rosenson"],"significance":7,"published":"2020-07-14","source_date":"2020-07-14","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/familiaire-hypercholesterolemie/","https://hartvaat.nl/kennis/lipiden/genetisch-onderzoek-fh/"],"congress":"","summary_en":"The ODYSSEY HoFH trial showed that alirocumab lowers LDL cholesterol in patients with homozygous FH, though the effect is smaller than in heterozygous FH due to the limited LDL receptor activity. The results provided an additional treatment option for the most severe FH phenotype.","created":"2026-07-03T10:28:40Z","updated":"2026-07-03T13:27:50Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ODYSSEY HoFH trial van alirocumab bij homozygote familiaire hypercholesterolemie. PCSK9-remming bij de zwaarste FH-vorm.","abstract_original":"BACKGROUND: Homozygous familial hypercholesterolemia (HoFH) is characterized by extremely elevated low-density lipoprotein-cholesterol (LDL-C) levels and early onset atherosclerotic cardiovascular disease despite treatment with conventional lipid-lowering treatment. OBJECTIVES: This study was designed to assess LDL-C reduction with the proprotein convertase subtilisin/kexin type 9 inhibitor alirocumab in adult patients with HoFH. METHODS: This randomized, double-blind, placebo-controlled, parallel-group, phase 3 study evaluated efficacy and safety of alirocumab 150 mg every 2 weeks. The primary endpoint was percent reduction from baseline in LDL-C versus placebo after 12 weeks of treatment. RESULTS: Patients (N = 69) were randomized 2:1 to alirocumab or placebo. At baseline, background lipid-lowering treatment included 67 patients receiving statin (59 patients on high-intensity statin); 50 patients on ezetimibe; 10 patients on lomitapide; and 10 patients undergoing apheresis. Mean baseline LDL-C was 259.6 mg/dl in the placebo group and 295.0 mg/dl in the alirocumab group. At week 12, the least squares mean difference in LDL-C percent change from baseline was -35.6% (alirocumab [-26.9%] vs. placebo [8.6%]; p < 0.0001). Reductions (least squares mean difference) in other atherogenic lipids at week 12 were: apolipoprotein B, -29.8%; non-high-density lipoprotein cholesterol, -32.9%; total cholesterol, -26.5%; and lipoprotein(a), -28.4% (all p < 0.0001). No serious adverse events, permanent treatment discontinuations, or deaths due to treatment-emergent adverse events were reported during the double-blind treatment period. CONCLUSIONS: In the largest randomized controlled interventional trial in HoFH patients to date, alirocumab resulted in significant and clinically meaningful reductions in LDL-C at week 12. Alirocumab was generally well tolerated, with a safety profile comparable to that of placebo. (Study in Participants With Homozygous Familial Hypercholesterolemia [HoFH] [ODYSSEY HoFH] NCT03156621.)."},{"id":"3b239d18a49b","type":"article","url":"https://hartvaat.nl/2020/07/14/twee-stent-versus-provisional-stenting-bij-complexe-bifurcatielaesies-multicente/","title":"Twee-stent versus provisional stenting bij complexe bifurcatielaesies: multicenter RCT","title_en":"Multicentre, randomized comparison of two-stent and provisional stenting techniques in patients with complex coronary bifurcation lesions: the DEFINITION II trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaa543","source_url":"https://doi.org/10.1093/eurheartj/ehaa543","authors":["Jun-Jie Zhang","Fei Ye","Kai Xu","Jing Kan","Ling Tao","Teguh Santoso","Muhammad Munawar","Damras Tresukosol","Li Li","Imad Sheiban","Feng Li","Nai-Liang Tian","Alfredo E Rodríguez","Chotnoparatpat Paiboon","Francesco Lavarra","Shu Lu","Kitigon Vichairuangthum","Hesong Zeng","Lianglong Chen","Ruiyan Zhang","Shiqin Ding","Fengtang Gao","Zening Jin","Lang Hong","Likun Ma","Shangyu Wen","Xueming Wu","Song Yang","Wei-Hsian Yin","Jun Zhang","Yan Wang","Yonghong Zheng","Lei Zhou","Limin Zhou","Yuansheng Zhu","Tan Xu","Xin Wang","Hong Qu","Yulong Tian","Song Lin","Lijun Liu","Qinghua Lu","Qihua Li","Bo Li","Qing Jiang","Leng Han","Guojun Gan","Mengyue Yu","Defeng Pan","Zhenglu Shang","Yanfang Zhao","Zhizhong Liu","Ye Yuan","Cynthia Chen","Gregg W Stone","Yaling Han","Shao-Liang Chen"],"significance":7,"published":"2020-07-14","source_date":"2020-07-14","image":"","kennis":[],"congress":"","summary_en":"This multicenter randomized trial comparing two-stent with provisional stenting for complex coronary bifurcation lesions showed that a planned two-stent strategy may be superior when specific anatomical criteria (DEFINITION criteria) predict complexity.","created":"2026-07-03T10:28:40Z","updated":"2026-07-03T13:27:50Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 gerandomiseerde trial die twee-stent versus provisional stenting vergeleek bij complexe bifurcatielaesies.","abstract_original":"AIM: The present study aimed to assess the benefits of two-stent techniques for patients with DEFINITION criteria-defined complex coronary bifurcation lesions. METHODS AND RESULTS: In total, 653 patients with complex bifurcation lesions at 49 international centres were randomly assigned to undergo the systematic two-stent technique (two-stent group) or provisional stenting (provisional group). The primary endpoint was the composite of target lesion failure (TLF) at the 1-year follow-up, including cardiac death, target vessel myocardial infarction (TVMI), and clinically driven target lesion revascularization (TLR). The safety endpoint was definite or probable stent thrombosis. At the 1-year follow-up, TLF occurred in 37 (11.4%) and 20 (6.1%) patients in the provisional and two-stent groups, respectively [77.8%: double-kissing crush; hazard ratio (HR) 0.52, 95% confidence interval (CI) 0.30-0.90; P = 0.019], largely driven by increased TVMI (7.1%, HR 0.43, 95% CI 0.20-0.90; P = 0.025) and clinically driven TLR (5.5%, HR 0.43, 95% CI 0.19-1.00; P = 0.049) in the provisional group. At the 1 year after indexed procedures, the incidence of cardiac death was 2.5% in the provisional group, non-significant to 2.1% in the two-stent group (HR 0.86, 95% CI 0.31-2.37; P = 0.772). CONCLUSION: For DEFINITION criteria-defined complex coronary bifurcation lesions, the systematic two-stent approach was associated with a significant improvement in clinical outcomes compared with the provisional stenting approach. Further study is urgently warranted to identify the mechanisms contributing to the increased rate of TVMI after provisional stenting. STUDY REGISTRATION: http://www.clinicaltrials.com; Identifier: NCT02284750."},{"id":"48ef5f1b27e3","type":"article","url":"https://hartvaat.nl/2020/07/14/vergelijking-van-orale-p2y12-remmers-bij-acs-netwerkmeta-analyse-van-52-816-pati/","title":"Vergelijking van orale P2Y12-remmers bij ACS: netwerkmeta-analyse van 52.816 patiënten","title_en":"Comparative Efficacy and Safety of Oral P2Y12 Inhibitors in Acute Coronary Syndrome: Network Meta-Analysis of 52 816 Patients From 12 Randomized Trials.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.046786","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.046786","authors":["Eliano P Navarese","Safi U Khan","Michalina Kołodziejczak","Jacek Kubica","Sergio Buccheri","Christopher P Cannon","Paul A Gurbel","Stefano De Servi","Andrzej Budaj","Antonio Bartorelli","Daniela Trabattoni","E Magnus Ohman","Lars Wallentin","Matthew T Roe","Stefan James"],"significance":8,"published":"2020-07-14","source_date":"2020-07-14","image":"","kennis":[],"congress":"","summary_en":"This network meta-analysis of oral P2Y12 inhibitors in ACS incorporating over 52,000 patients from contemporary trials provided updated comparative efficacy and safety data, informing personalized antiplatelet selection based on the balance of ischemic and bleeding risk.","created":"2026-07-03T10:28:40Z","updated":"2026-07-03T13:27:50Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 die alle orale P2Y12-remmers vergeleek bij ACS over 52.816 patiënten uit gerandomiseerde trials.","abstract_original":"BACKGROUND: New randomized, controlled trials have become available on oral P2Y12 inhibitors in acute coronary syndrome. We aimed to evaluate current evidence comparing the efficacy and safety profile of prasugrel, ticagrelor, and clopidogrel in acute coronary syndrome by a meta-analysis of randomized controlled trials. METHODS: We performed a network meta-analysis and direct pairwise comparison analysis of efficacy and safety outcomes from 12 randomized controlled trials including a total of 52 816 patients with acute coronary syndrome. RESULTS: In comparison with clopidogrel, ticagrelor significantly reduced cardiovascular mortality (hazard ratio [HR], 0.82 [95% CI, 0.72-0.92]) and all-cause mortality (HR, 0.83 [95% CI, 0.75-0.92]), whereas there was no statistically significant mortality reduction with prasugrel (HR, 0.90 [95% CI, 0.80-1.01] and HR, 0.92 [95% CI, 0.84-1.02], respectively). In comparison with each other, there were no significant differences in mortality (HR prasugrel versus ticagrelor, 1.10 [95% CI, 0.94-1.29] and 1.12 [95% CI, 0.98-1.28]). In comparison with clopidogrel, prasugrel reduced myocardial infarction (HR, 0.81 [95% CI, 0.67-0.98]), whereas ticagrelor showed no risk reduction (HR, 0.97 [95% CI, 0.78-1.22]). Differences between prasugrel and ticagrelor were not statistically significant. Stent thrombosis risk was significantly reduced by both ticagrelor and prasugrel versus clopidogrel (28%-50% range of reduction). In comparison with clopidogrel, both prasugrel (HR, 1.26 [95% CI, 1.01-1.56]) and ticagrelor (HR, 1.27 [95% CI, 1.04-1.55]) significantly increased major bleeding. There were no significant differences between prasugrel and ticagrelor for all outcomes explored. CONCLUSIONS: Prasugrel and ticagrelor reduced ischemic events and increased bleeding in comparison with clopidogrel. A significant mortality reduction was observed with ticagrelor only. There was no efficacy and safety difference between prasugrel and ticagrelor. Registration: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42019155648."},{"id":"fcdf869efcfa","type":"article","url":"https://hartvaat.nl/2020/07/11/levenslang-voordeel-van-uitgebreide-hfref-farmacotherapie-lancet-schatting/","title":"Levenslang voordeel van uitgebreide HFrEF-farmacotherapie: Lancet schatting","title_en":"Estimating lifetime benefits of comprehensive disease-modifying pharmacological therapies in patients with heart failure with reduced ejection fraction: a comparative analysis of three randomised controlled trials.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts","internist"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(20)30748-0","source_url":"https://doi.org/10.1016/S0140-6736(20)30748-0","authors":["Muthiah Vaduganathan","Brian L Claggett","Pardeep S Jhund","Jonathan W Cunningham","João Pedro Ferreira","Faiez Zannad","Milton Packer","Gregg C Fonarow","John J V McMurray","Scott D Solomon"],"significance":9,"published":"2020-07-11","source_date":"2020-07-11","image":"","kennis":[],"congress":"","summary_en":"This Lancet analysis estimated the lifetime benefit of comprehensive disease-modifying pharmacotherapy in HFrEF, showing that adding an MRA, ARNI, and SGLT2 inhibitor to standard therapy could yield several additional years of event-free survival. The analysis provided a compelling quantitative rationale for the four-pillar approach to heart failure treatment.","created":"2026-07-03T10:28:40Z","updated":"2026-07-03T13:27:49Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 Lancet analyse die het levenslange voordeel schatte van uitgebreide ziekte-modificerende farmacotherapie bij HFrEF. Kwantificeert het cumulatieve voordeel van viervoudige therapie.","abstract_original":"BACKGROUND: Three drug classes (mineralocorticoid receptor antagonists [MRAs], angiotensin receptor-neprilysin inhibitors [ARNIs], and sodium/glucose cotransporter 2 [SGLT2] inhibitors) reduce mortality in patients with heart failure with reduced ejection fraction (HFrEF) beyond conventional therapy consisting of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) and β blockers. Each class was previously studied with different background therapies and the expected treatment benefits with their combined use are not known. Here, we used data from three previously reported randomised controlled trials to estimate lifetime gains in event-free survival and overall survival with comprehensive therapy versus conventional therapy in patients with chronic HFrEF. METHODS: In this cross-trial analysis, we estimated treatment effects of comprehensive disease-modifying pharmacological therapy (ARNI, β blocker, MRA, and SGLT2 inhibitor) versus conventional therapy (ACE inhibitor or ARB and β blocker) in patients with chronic HFrEF by making indirect comparisons of three pivotal trials, EMPHASIS-HF (n=2737), PARADIGM-HF (n=8399), and DAPA-HF (n=4744). Our primary endpoint was a composite of cardiovascular death or first hospital admission for heart failure; we also assessed these endpoints individually and assessed all-cause mortality. Assuming these relative treatment effects are consistent over time, we then projected incremental long-term gains in event-free survival and overall survival with comprehensive disease-modifying therapy in the control group of the EMPHASIS-HF trial (ACE inhibitor or ARB and β blocker). FINDINGS: The hazard ratio (HR) for the imputed aggregate treatment effects of comprehensive disease-modifying therapy versus conventional therapy on the primary endpoint of cardiovascular death or hospital admission for heart failure was 0·38 (95% CI 0·30-0·47). HRs were also favourable for cardiovascular death alone (HR 0·50 [95% CI 0·37-0·67]), hospital admission for heart failure alone (0·32 [0·24-0·43]), and all-cause mortality (0·53 [0·40-0·70]). Treatment with comprehensive disease-modifying pharmacological therapy was estimated to afford 2·7 additional years (for an 80-year-old) to 8·3 additional years (for a 55-year-old) free from cardiovascular death or first hospital admission for heart failure and 1·4 additional years (for an 80-year-old) to 6·3 additional years (for a 55-year-old) of survival compared with conventional therapy. INTERPRETATION: Among patients with HFrEF, the anticipated aggregate treatment effects of early comprehensive disease-modifying pharmacological therapy are substantial and support the combination use of an ARNI, β blocker, MRA, and SGLT2 inhibitor as a new therapeutic standard. FUNDING: None."},{"id":"54fcf6e994ac","type":"article","url":"https://hartvaat.nl/2020/07/07/systemische-amyloidose-herkenning-prognose-en-therapie-jama-systematische-review/","title":"Systemische amyloïdose: herkenning, prognose en therapie — JAMA systematische review","title_en":"Systemic Amyloidosis Recognition, Prognosis, and Therapy: A Systematic Review.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["cardiale-amyloidose"],"journal":"JAMA","doi":"10.1001/jama.2020.5493","source_url":"https://doi.org/10.1001/jama.2020.5493","authors":["Morie A Gertz","Angela Dispenzieri"],"significance":8,"published":"2020-07-07","source_date":"2020-07-07","image":"","kennis":[],"congress":"","summary_en":"This JAMA systematic review provided a comprehensive overview of systemic amyloidosis, including AL and ATTR subtypes, covering diagnostic pathways, prognostic assessment, and emerging therapies. The review addressed the growing recognition that cardiac amyloidosis is underdiagnosed.","created":"2026-07-03T10:28:40Z","updated":"2026-07-03T13:27:49Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 uitgebreide systematische review over systemische amyloïdose inclusief cardiale betrokkenheid. Referentiedocument voor deze groeiende diagnose.","abstract_original":"IMPORTANCE: Many patients with systemic amyloidosis are underdiagnosed. Overall, 25% of patients with immunoglobulin light chain (AL) amyloidosis die within 6 months of diagnosis and 25% of patients with amyloid transthyretin (ATTR) amyloidosis die within 24 months of diagnosis. Effective therapy exists but is ineffective if end-organ damage is severe. OBJECTIVE: To provide evidence-based recommendations that could allow clinicians to diagnose this rare set of diseases earlier and enable accurate staging and counseling about prognosis. EVIDENCE REVIEW: A comprehensive literature search was conducted by a reference librarian with publication dates from January 1, 2000, to December 31, 2019. Key search terms included amyloid, amyloidosis, nephrotic syndrome, heart failure preserved ejection fraction, and peripheral neuropathy. Exclusion criteria included case reports, non-English-language text, and case series of fewer than 10 patients. The authors independently selected and appraised relevant literature. FINDINGS: There was a total of 1769 studies in the final data set. Eighty-one articles were included in this review, of which 12 were randomized clinical trials of therapy that included 3074 patients, 9 were case series, and 3 were cohort studies. The incidence of AL amyloidosis is approximately 12 cases per million persons per year and there is an estimated prevalence of 30 000 to 45 000 cases in the US and European Union. The incidence of variant ATTR amyloidosis is estimated to be 0.3 cases per year per million persons with a prevalence estimate of 5.2 cases per million persons. Wild-type ATTR is estimated to have a prevalence of 155 to 191 cases per million persons. Amyloidosis should be considered in the differential diagnosis of adult nondiabetic nephrotic syndrome; heart failure with preserved ejection fraction, particularly if restrictive features are present; unexplained hepatomegaly without imaging abnormalities; peripheral neuropathy with distal sensory symptoms, such as numbness, paresthesia, and dysesthesias (although the autonomic manifestations occasionally may be the presenting feature); and monoclonal gammopathy of undetermined significance with atypical clinical features. Staging can be performed using blood testing only. Therapeutic decision-making for AL amyloidosis involves choosing between high-dose chemotherapy and stem cell transplant or bortezomib-based chemotherapy. There are 3 therapies approved by the US Food and Drug Administration for managing ATTR amyloidosis, depending on clinical phenotype. CONCLUSIONS AND RELEVANCE: All forms of amyloidosis are underdiagnosed. All forms now have approved therapies that have been demonstrated to improve either survival or disability and quality of life. The diagnosis should be considered in patients that have a multisystem disorder involving the heart, kidney, liver, or nervous system."},{"id":"8e26b95dda78","type":"article","url":"https://hartvaat.nl/2020/07/07/statinegebruik-en-invaliditeitsvrije-overleving-bij-gezonde-ouderen/","title":"Statinegebruik en invaliditeitsvrije overleving bij gezonde ouderen","title_en":"Association of Statin Use With Disability-Free Survival and Cardiovascular Disease Among Healthy Older Adults.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts","internist"],"tags":["esc-2026"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.05.016","source_url":"https://doi.org/10.1016/j.jacc.2020.05.016","authors":["Zhen Zhou","Richard Ofori-Asenso","Andrea J Curtis","Monique Breslin","Rory Wolfe","John J McNeil","Anne M Murray","Michael E Ernst","Christopher M Reid","Jessica E Lockery","Robyn L Woods","Andrew M Tonkin","Mark R Nelson"],"significance":7,"published":"2020-07-07","source_date":"2020-07-07","image":"","kennis":[],"congress":"esc-2026","summary_en":"This study found that statin use in healthy older adults (≥70 years) was not associated with improved disability-free survival, contributing to the ongoing uncertainty about the benefit of statin therapy for primary prevention in the elderly.","created":"2026-07-03T10:28:40Z","updated":"2026-08-10T11:07:51Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 associatie van statinegebruik met invaliditeitsvrije overleving en CV-ziekte bij gezonde ouderen.","abstract_original":"BACKGROUND: There is clinical uncertainty regarding the benefits and harms of prescribing statins in healthy subjects ≥70 years of age. OBJECTIVES: The aim of this study was to examine the association among statins, dementia-free and disability-free survival, and cardiovascular disease (CVD) among healthy older adults using data from the ASPREE (Aspirin in Reducing Events in the Elderly) trial. METHODS: ASPREE was a randomized trial of 19,114 community-dwelling persons in Australia and the United States ≥65 years of age and free of documented CVD, dementia, and disability. Data were collected for those ≥70 years of age, and participants who took statins at baseline were compared with those who did not using Cox proportional hazards regression with inverse probability weighting. The primary outcome, referred to as \"disability-free survival,\" was a composite of all-cause mortality, dementia, or persistent physical disability. Other outcomes included the individual components of the composite outcome, major adverse cardiovascular events, fatal CVD, myocardial infarction, and stroke. RESULTS: Of the 18,096 included participants (median age 74.2 years, 56.0% women), 5,629 took statins at baseline. Over a median follow-up period of 4.7 years, baseline statin use was not associated with disability-free survival or with the risk for all-cause mortality or dementia. However, it was associated with lower risks for physical disability and all cardiovascular outcomes. CONCLUSIONS: Among healthy community-dwelling adults ≥70 years of age, statin use may be beneficial for preventing physical disability and CVD but not beneficial for prolonging disability-free survival or avoiding death or dementia. Future clinical trials are needed to confirm these findings."},{"id":"bb74ab70723f","type":"article","url":"https://hartvaat.nl/2020/07/07/baroreflexactivatietherapie-bij-hfref-beat-hf/","title":"Baroreflexactivatietherapie bij HFrEF: BeAT-HF","title_en":"Baroreflex Activation Therapy in Patients With Heart Failure With Reduced Ejection Fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.05.015","source_url":"https://doi.org/10.1016/j.jacc.2020.05.015","authors":["Michael R Zile","JoAnn Lindenfeld","Fred A Weaver","Faiez Zannad","Elizabeth Galle","Tyson Rogers","William T Abraham"],"significance":7,"published":"2020-07-07","source_date":"2020-07-07","image":"","kennis":[],"congress":"","summary_en":"The BeAT-HF study demonstrated the safety and effectiveness of baroreflex activation therapy in patients with HFrEF, showing improvements in functional capacity and quality of life through autonomic neuromodulation.","created":"2026-07-03T10:28:39Z","updated":"2026-07-03T13:27:49Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"BeAT-HF studie naar baroreflexactivatietherapie bij HFrEF. Neuromodulatie als aanvullende HF-therapie.","abstract_original":"BACKGROUND: This study demonstrated the safety and effectiveness of baroreflex activation therapy (BAT) in patients with heart failure with reduced ejection fraction (HFrEF). OBJECTIVES: The BeAT-HF (Baroreflex Activation Therapy for Heart Failure) trial was a multicenter, prospective, randomized, controlled trial; subjects were randomized 1:1 to receive either BAT plus optimal medical management (BAT group) or optimal medical management alone (control group). METHODS: Four patient cohorts were created from 408 randomized patients with HFrEF using the following enrollment criteria: current New York Heart Association (NYHA) functional class III or functional class II (patients who had a recent history of NYHA functional class III); ejection fraction ≤35%; stable medical management for ≥4 weeks; and no Class I indication for cardiac resynchronization therapy. Effectiveness endpoints were the change from baseline to 6 months in 6-min hall walk distance (6MHW), Minnesota Living with HF Questionnaire quality-of-life (QOL) score, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. The safety endpoint included the major adverse neurological or cardiovascular system or procedure-related event rate (MANCE). RESULTS: Results from, timeline and rationale for, cohorts A, B, and C are presented in detail in the text. Cohort D, which represented the intended use population that reflected the U.S. Food and Drug Administration-approved instructions for use (enrollment criteria plus NT-proBNP <1,600 pg/ml), consisted of 245 patients followed-up for 6 months (120 in the BAT group and 125 in the control group). BAT was safe and significantly improved QOL, 6MHW, and NT-proBNP. In the BAT group versus the control group, QOL score decreased (Δ = -14.1; 95% confidence interval [CI]: -19 to -9; p < 0.001), 6MHW distance increased (Δ = 60 m; 95% CI: 40 to 80 m; p < 0.001), NT-proBNP decreased (Δ = -25%; 95% CI: -38% to -9%; p = 0.004), and the MANCE free rate was 97% (95% CI: 93% to 100%; p < 0.001). CONCLUSIONS: BAT was safe and significantly improved QOL, exercise capacity, and NT-proBNP. (Baroreflex Activation Therapy for Heart Failure [BeAT-HF]; NCT02627196)."},{"id":"6c7dd6b7665a","type":"article","url":"https://hartvaat.nl/2020/07/01/barrieres-voor-optimale-hf-medicatie-guide-it-analyse/","title":"Barrières voor optimale HF-medicatie: GUIDE-IT analyse","title_en":"Assessment of Limitations to Optimization of Guideline-Directed Medical Therapy in Heart Failure From the GUIDE-IT Trial: A Secondary Analysis of a Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2020.0640","source_url":"https://doi.org/10.1001/jamacardio.2020.0640","authors":["Mona Fiuzat","Justin Ezekowitz","Wendimagegn Alemayehu","Cynthia M Westerhout","Marco Sbolli","Dario Cani","David J Whellan","Tariq Ahmad","Kirkwood Adams","Ileana L Piña","Chetan B Patel","Kevin J Anstrom","Lawton S Cooper","Daniel Mark","Eric S Leifer","G Michael Felker","James L Januzzi","Christopher M O'Connor"],"significance":6,"published":"2020-07-01","source_date":"2020-07-01","image":"","kennis":[],"congress":"","summary_en":"This GUIDE-IT analysis identified the barriers to achieving optimal guideline-directed medical therapy in heart failure, including hypotension, renal dysfunction, and clinical inertia as the most common limitations.","created":"2026-07-03T10:28:39Z","updated":"2026-07-03T13:27:49Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 GUIDE-IT analyse naar beperkingen bij het bereiken van optimale richtlijngestuurde HF-medicatie.","abstract_original":"IMPORTANCE: Despite evidence that guideline-directed medical therapy (GDMT) improves outcomes in patients with heart failure (HF) and reduced ejection fraction, many patients are undertreated. The Guiding Evidence-Based Therapy Using Biomarker Intensified Treatment (GUIDE-IT) trial tested whether a strategy of using target concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP) to guide optimization of GDMT could improve outcomes. OBJECTIVE: To examine medical therapy for HF in GUIDE-IT and potential reasons why the intervention did not produce improvements in medical therapy. DESIGN, SETTING, AND PARTICIPANTS: GUIDE-IT, a randomized clinical trial performed at 45 sites in the United States and Canada, was conducted from January 16, 2013, to September 20, 2016. A total of 894 patients with HF and reduced ejection fraction (≤40%) were randomized to NT-proBNP-guided treatment with a goal to suppress NT-proBNP concentrations to less than 1000 pg/mL vs usual care. This secondary analysis examined the medical therapy titration and reasons why the intervention did not produce improvements in care and outcomes. Data were analyzed March 27 to June 28, 2019. MAIN OUTCOMES AND MEASURES: For each encounter, medication titrations were captured. A reason was requested if a modification was not made. A Cox proportional hazards regression model was used to assess the independent association of drug class with outcomes. RESULTS: Among the 838 patients available for analysis (566 men [67.5%]; median age, 62.0 years), 6223 visits occurred during 24 months. Adjustments of HF medication were made during 2847 of 5218 qualified visits (54.6%) (all usual care visits and all guided care visits with NT-proBNP level ≥1000 pg/mL) in 862 patients (96.4%). Most adjustments occurred within the first 6 months, primarily within the first 6 weeks. The most common reasons for not adjusting were \"clinically stable\" and \"already at maximally tolerated therapy.\" Only 130 patients (15.5%) achieved optimal GDMT (≥50% of the target dose of β-blockers or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers or any dose of mineralocorticoid antagonists) at 6 months, an increase from the baseline (79 of 891 [8.9%]) but not different by treatment arm. Higher doses of β-blockers were associated with reduced risk of the composite outcome of HF hospitalization and cardiovascular death (hazard ratio [HR], 0.98; 95% CI, 0.97-1.00; P = .008) and of all-cause death (HR, 0.97; 95% CI, 0.95-0.99; P = .01). Higher doses of angiotensin-converting enzyme inhibitors (HR, 0.84; 95% CI, 0.75-0.93; P < .001) and angiotensin receptor blockers (HR, 0.84; 95% CI, 0.71-0.99; P = .04) were associated with reduced risk of all-cause death. Increasing doses of mineralocorticoid antagonists did not appear to be associated with improved outcomes. CONCLUSIONS AND RELEVANCE: Despite a protocol-driven approach, many patients in GUIDE-IT did not receive medication adjustments and did not achieve optimal GDMT, including those with known elevated NT-proBNP concentrations. These results suggest that opportunities exist to titrate medications for maximal benefit in HF. GUIDE-IT may have failed to achieve treatment benefit because of therapeutic inertia in clinical practice, or current GDMT goals may be unrealistic. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01685840."},{"id":"c7131c26d7b7","type":"article","url":"https://hartvaat.nl/2020/07/01/subklinische-atherosclerose-en-incident-af-meta-analyse/","title":"Subklinische atherosclerose en incident AF: meta-analyse","title_en":"Subclinical atherosclerosis is associated with incident atrial fibrillation: a systematic review and meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["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/euaa030","source_url":"https://doi.org/10.1093/europace/euaa030","authors":["Kit Engedal Kristensen","Cille Cederholm Knage","Liv Havgaard Nyhegn","Bart A Mulder","Michiel Rienstra","Isabelle C Van Gelder","Axel Brandes"],"significance":6,"published":"2020-07-01","source_date":"2020-07-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis demonstrated that subclinical atherosclerosis (measured by coronary calcium, carotid IMT, or ankle-brachial index) is associated with incident atrial fibrillation, linking asymptomatic vascular disease to arrhythmia risk.","created":"2026-07-03T10:28:39Z","updated":"2026-07-03T13:27:49Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 verband aantoont tussen subklinische atherosclerose en incident atriumfibrilleren.","abstract_original":"AIMS: Coronary artery disease is an established risk factor for incident atrial fibrillation (AF), but it is unclear whether subclinical atherosclerosis also increases the risk of incident AF. Therefore, the aim was to assess the association between subclinical atherosclerosis, defined by increased carotid intima-media thickness (cIMT) or coronary artery calcium score (CACS), and incident AF. METHODS AND RESULTS: A systematic review of MEDLINE, EMBASE, and Cochrane was done to find all cohort studies investigating the association between subclinical atherosclerosis, defined by increased cIMT or CACS, and incident AF. Eligible articles had to be available in an English full-text version; include adults over the age of 18 years; include ≥100 participants; and have a follow-up period ≥12 months. Data on cIMT were pooled using a fixed-effects model, while data on CACS (I2 >25) were pooled using a random-effects model. Five studies on cIMT including 36 333 patients and two studies on CACS including 34 603 patients were identified. All studies investigating the association between increased cIMT and incident AF showed a significant association, with an overall hazard ratio (HR) of 1.43 [95% confidence interval (CI) 1.27-1.59]. The two studies investigating the association between increased CACS and AF also showed a significant association with an overall HR of 1.07 (95% CI 1.02-1.12). CONCLUSION: Data from seven observational studies suggest that subclinical atherosclerosis defined by increased cIMT or CACS is associated with an increased risk of incident AF. These findings emphasize the need for further research investigating whether treatment of subclinical atherosclerosis should be a part of the initiatives to prevent AF."},{"id":"05304eceebee","type":"article","url":"https://hartvaat.nl/2020/07/01/mra-bij-hypertensie-met-gevorderde-ckd-block-ckd-trial/","title":"MRA bij hypertensie met gevorderde CKD: BLOCK-CKD trial","title_en":"Mineralocorticoid Receptor Antagonists for Hypertension Management in Advanced Chronic Kidney Disease: BLOCK-CKD Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["chronische-nierziekte","flow-trial"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.15199","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.15199","authors":["George Bakris","Y Fred Yang","Bertram Pitt"],"significance":6,"published":"2020-07-01","source_date":"2020-07-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/hypertensie/eindorgaanschade-hypertensie/"],"congress":"","summary_en":"The BLOCK-CKD trial tested spironolactone for hypertension in advanced CKD, evaluating whether MRA therapy can be safely used in this population where hyperkalemia risk has traditionally limited its use.","created":"2026-07-03T10:28:39Z","updated":"2026-07-03T13:27:49Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"BLOCK-CKD trial die MRA onderzocht bij hypertensie met gevorderde chronische nierziekte. Relevant voor antihypertensieve keuze bij nierinsufficiëntie.","abstract_original":"Spironolactone, a steroidal mineralocorticoid receptor antagonist, is recommended as add-on therapy for treatment-resistant/uncontrolled hypertension. However, caution is advised in patients with advanced chronic kidney disease (CKD) due to an increased risk for hyperkalemia. KBP-5074 is a nonsteroidal mineralocorticoid receptor antagonist under investigation for the treatment of treatment-resistant and uncontrolled hypertension in patients with moderate-to-severe CKD. BLOCK-CKD is a phase 2, international, multicenter, randomized, double-blind, placebo-controlled, parallel-group study to evaluate the efficacy and safety of KBP-5074, on top of current therapy, in patients with stage 3B/4 CKD (estimated glomerular filtration rate ≥15 and ≤44 mL/[min·1.73 m2]) and resistant hypertension (trough cuff seated systolic blood pressure ≥140 mm Hg, despite treatment with maximally tolerated doses of 2 or more antihypertensive medicines with complementary mechanisms). Patients (n=240) will be randomized 1:1:1 to once-daily treatment with KBP-5074 0.25 mg, KBP-5074 0.5 mg, or placebo, stratified by estimated glomerular filtration rate (≥30 versus <30 mL/[min·1.73 m2]) and systolic blood pressure (≥160 versus <160 mm Hg). Approximately 30% of enrolled patients should have an estimated glomerular filtration rate of 15 to 29 mL/(min·1.73 m2). The primary efficacy analysis is the change in trough cuff seated systolic blood pressure from baseline to day 84 for the KBP-5074 doses compared with placebo. Changes in urinary albumin-creatinine ratio will be assessed along with changes in serum potassium/incidence of hyperkalemia and changes in estimated glomerular filtration rate and serum creatinine. BLOCK-CKD will determine whether the addition of KBP-5074 will effectively lower blood pressure without an increased risk of hyperkalemia in patients who are not candidates for steroidal mineralocorticoid receptor antagonists due to advanced CKD. Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT03574363."},{"id":"c1b7d33aa265","type":"article","url":"https://hartvaat.nl/2020/07/01/nieuwe-dna-methyleringsloci-voor-bloeddruk-erfelijkheid-en-genexpressie/","title":"Nieuwe DNA-methyleringsloci voor bloeddruk: erfelijkheid en genexpressie","title_en":"Identification, Heritability, and Relation With Gene Expression of Novel DNA Methylation Loci for Blood Pressure.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.14973","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.14973","authors":["Yisong Huang","Miina Ollikainen","Maheswary Muniandy","Tao Zhang","Jenny van Dongen","Guang Hao","Peter J van der Most","Yue Pan","Natalia Pervjakova","Yan V Sun","Qin Hui","Jari Lahti","Eliza Fraszczyk","Xueling Lu","Dianjianyi Sun","Melissa A Richard","Gonneke Willemsen","Kauko Heikkila","Irene Mateo Leach","Nina Mononen","Mika Kähönen","Mikko A Hurme","Olli T Raitakari","Amanda J Drake","Markus Perola","Marja-Liisa Nuotio","Yunfeng Huang","Batbayar Khulan","Katri Räikkönen","Bruce H R Wolffenbuttel","Alexandra Zhernakova","Jingyuan Fu","Haidong Zhu","Yanbin Dong","Jana V van Vliet-Ostaptchouk","Lude Franke","Johan G Eriksson","Myriam Fornage","Lili Milani","Terho Lehtimäki","Viola Vaccarino","Dorret I Boomsma","Pim van der Harst","Eco J C de Geus","Veikko Salomaa","Shengxu Li","Wei Chen","Shaoyong Su","James Wilson","Harold Snieder","Jaakko Kaprio","Xiaoling Wang"],"significance":4,"published":"2020-07-01","source_date":"2020-07-01","image":"","kennis":[],"congress":"","summary_en":"An epigenome-wide association study meta-analysis identified novel DNA methylation loci associated with blood pressure in European and African ancestry populations, with validation of 16 CpG sites and assessment of their heritability and gene expression relationships.","created":"2026-07-03T10:28:39Z","updated":"2026-07-03T13:27:49Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 nieuwe DNA-methyleringsloci identificeerde voor bloeddruk en hun erfelijkheid en relatie met genexpressie onderzocht.","abstract_original":"We conducted an epigenome-wide association study meta-analysis on blood pressure (BP) in 4820 individuals of European and African ancestry aged 14 to 69. Genome-wide DNA methylation data from peripheral leukocytes were obtained using the Infinium Human Methylation 450k BeadChip. The epigenome-wide association study meta-analysis identified 39 BP-related CpG sites with P<1×10-5. In silico replication in the CHARGE consortium of 17 010 individuals validated 16 of these CpG sites. Out of the 16 CpG sites, 13 showed novel association with BP. Conversely, out of the 126 CpG sites identified as being associated (P<1×10-7) with BP in the CHARGE consortium, 21 were replicated in the current study. Methylation levels of all the 34 CpG sites that were cross-validated by the current study and the CHARGE consortium were heritable and 6 showed association with gene expression. Furthermore, 9 CpG sites also showed association with BP with P<0.05 and consistent direction of the effect in the meta-analysis of the Finnish Twin Cohort (199 twin pairs and 4 singletons; 61% monozygous) and the Netherlands Twin Register (266 twin pairs and 62 singletons; 84% monozygous). Bivariate quantitative genetic modeling of the twin data showed that a majority of the phenotypic correlations between methylation levels of these CpG sites and BP could be explained by shared unique environmental rather than genetic factors, with 100% of the correlations of systolic BP with cg19693031 (TXNIP) and cg00716257 (JDP2) determined by environmental effects acting on both systolic BP and methylation levels."},{"id":"1e7a2bd25102","type":"article","url":"https://hartvaat.nl/2020/07/01/thuisluchtzuivering-en-bloeddruk-systematische-review/","title":"Thuisluchtzuivering en bloeddruk: systematische review","title_en":"Effects of Home Particulate Air Filtration on Blood Pressure: A Systematic Review.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["bloeddrukbehandeling","primaire-preventie"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.119.14456","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.119.14456","authors":["Dalia Walzer","Terry Gordon","Lorna Thorpe","George Thurston","Yuhe Xia","Hua Zhong","Timothy R Roberts","Judith S Hochman","Jonathan D Newman"],"significance":5,"published":"2020-07-01","source_date":"2020-07-01","image":"","kennis":["https://hartvaat.nl/kennis/preventie/esc-richtlijn-cardiovasculaire-preventie-2021/"],"congress":"","summary_en":"This systematic review evaluated whether home particulate air filtration reduces blood pressure, finding modest but consistent effects that support air quality improvement as a modifiable environmental approach to hypertension management.","created":"2026-07-03T10:28:39Z","updated":"2026-07-03T13:27:49Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 naar het effect van binnenhuisluchtzuivering op bloeddruk. Milieu-interventie voor CV-preventie.","abstract_original":"Air pollution is a major contributor to cardiovascular morbidity and mortality. Fine particulate matter <2.5 µm in diameter may be a modifiable risk factor for hypertension. The benefits of in-home air filtration on systolic blood pressure (BP) and diastolic BP are unclear. To examine the effects of in-home personal air cleaner use on fine particulate exposure and BP, we queried PubMed, Web of Science, Cochrane Central Register, Inspec, and EBSCO GreenFILE databases for relevant clinical trials. Included studies were limited to nonsmoking participants in smoke-free homes with active or sham filtration on indoor fine particulate concentrations and changes in systolic and diastolic BP. Of 330 articles identified, 10 trials enrolling 604 participants who met inclusion criteria were considered. Over a median 13.5 days, there was a significant reduction of mean systolic BP by ≈4 mm Hg (-3.94 mm Hg [95% CI, -7.00 to -0.89]; P=0.01) but a nonsignificant difference in mean diastolic BP (-0.95 mm Hg [95% CI, -2.81 to 0.91]; P=0.32). Subgroup analyses indicated no heterogeneity of effect by age, level of particulate exposure, or study duration. Given the variation in study design, additional study is warranted to confirm and better quantify the observed benefits in systolic BP found with personal air cleaner use."},{"id":"b4e7f93963d0","type":"article","url":"https://hartvaat.nl/2020/07/01/phactr1-en-fibromusculaire-dysplasie-arcadia-pol-meta-analyse/","title":"PHACTR1 en fibromusculaire dysplasie: ARCADIA-POL meta-analyse","title_en":"Genetic Study of PHACTR1 and Fibromuscular Dysplasia, Meta-Analysis and Effects on Clinical Features of Patients: The ARCADIA-POL Study.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.14793","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.14793","authors":["Ewa Warchol-Celinska","Takiy Berrandou","Aleksander Prejbisz","Adrien Georges","Delia Dupré","Magdalena Januszewicz","Elzbieta Florczak","Katarzyna Jozwik-Plebanek","Piotr Dobrowolski","Witold Smigielski","Wojciech Drygas","Jacek Kadziela","Adam Witkowski","Marek Kabat","Malgorzata Szczerbo-Trojanowska","Marco Pappaccogli","Alexandre Persu","Xavier Jeunemaitre","Andrzej Januszewicz","Nabila Bouatia-Naji"],"significance":5,"published":"2020-07-01","source_date":"2020-07-01","image":"","kennis":[],"congress":"","summary_en":"This genetic study examined the relationship between PHACTR1 variants and fibromuscular dysplasia, advancing the understanding of genetic determinants of this vascular condition that predominantly affects young women.","created":"2026-07-03T10:28:39Z","updated":"2026-07-03T13:27:48Z","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":"Genetische studie naar PHACTR1 en fibromusculaire dysplasie met meta-analyse en effecten op klinische kenmerken.","abstract_original":""},{"id":"8b6e7b700cd9","type":"article","url":"https://hartvaat.nl/2020/07/01/natriumreductie-verhoogt-korte-keten-vetzuren-bij-onbehandelde-hypertensie/","title":"Natriumreductie verhoogt korte-keten vetzuren bij onbehandelde hypertensie","title_en":"Modest Sodium Reduction Increases Circulating Short-Chain Fatty Acids in Untreated Hypertensives: A Randomized, Double-Blind, Placebo-Controlled Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["anemie-ckd","bloeddrukbehandeling","bradycardie","chronische-nierziekte","hypertrofische-cardiomyopathie","perifeer-vaatlijden","renale-denervatie","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.14800","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.14800","authors":["Li Chen","Feng J He","Yanbin Dong","Ying Huang","Changqiong Wang","Gregory A Harshfield","Haidong Zhu"],"significance":5,"published":"2020-07-01","source_date":"2020-07-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/"],"congress":"","summary_en":"This randomized crossover trial showed that modest sodium reduction increases circulating short-chain fatty acids in untreated hypertensives, establishing a gut microbiome-mediated mechanism for the cardiovascular benefit of salt restriction.","created":"2026-07-03T10:28:39Z","updated":"2026-07-03T18:38:47Z","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 aantoont dat matige zoutbeperking de circulerende korte-keten vetzuren verhoogt bij onbehandelde hypertensie. Darm-bloeddruk-as.","abstract_original":"High-sodium diet may modulate the gut microbiome. Given the circulating short-chain fatty acids (SCFAs) are microbial in origin, we tested the hypothesis that the modest sodium reduction would alter circulating SCFA concentrations among untreated hypertensives, and the changes would be associated with reduced blood pressure and improved cardiovascular phenotypes. A total of 145 participants (42% blacks, 19% Asian, and 34% females) were included from a randomized, double-blind, placebo-controlled cross-over trial of sodium reduction with slow sodium or placebo tablets, each for 6 weeks. Targeted circulating SCFA profiling was performed in paired serum samples, which were collected at the end of each period, so as all outcome measures. Sodium reduction increased all 8 SCFAs, among which the increases in 2-methylbutyrate, butyrate, hexanoate, isobutyrate, and valerate were statistically significant (Ps<0.05). Also, increased SCFAs were associated with decreased blood pressure and improved arterial compliance. There were significant sex differences of SCFAs in response to sodium reduction (Ps<0.05). When stratified by sex, the increases in butyrate, hexanoate, isobutyrate, isovalerate, and valerate were significant in females only (Ps<0.05), not in males (Ps>0.05). In females, changes in isobutyrate, isovalerate, and 2-methylbutyrate were inversely associated with reduced blood pressures (Ps<0.05). Increased valerate was associated with decreased carotid-femoral pulse wave velocity (P=0.040). Our results show that dietary sodium reduction increases circulating SCFAs, supporting that dietary sodium may influence the gut microbiome in humans. There is a sex difference in SCFA response to sodium reduction. Moreover, increased SCFAs are associated with decreased blood pressures and improved arterial compliance. Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT00152074."},{"id":"cd1a4fa78af4","type":"article","url":"https://hartvaat.nl/2020/07/01/white-coat-hypertensie-in-de-zwangerschap-maternale-en-perinatale-uitkomsten/","title":"White-coat hypertensie in de zwangerschap: maternale en perinatale uitkomsten","title_en":"Maternal and Perinatal Outcomes of White Coat Hypertension During Pregnancy: A Systematic Review and Meta-Analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["huisarts"],"tags":["peripartum-cardiomyopathie","vrouwen","zwangerschap-hart"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.119.14627","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.119.14627","authors":["Sonia Johnson","Becky Liu","Erkan Kalafat","Basky Thilaganathan","Asma Khalil"],"significance":6,"published":"2020-07-01","source_date":"2020-07-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis showed that white-coat hypertension during pregnancy is associated with increased maternal and perinatal adverse outcomes compared with normotension, supporting closer monitoring rather than dismissal of elevated office readings.","created":"2026-07-03T10:28:39Z","updated":"2026-07-03T18:38:47Z","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":"Meta-analyse naar maternale en perinatale uitkomsten bij white-coat hypertensie in de zwangerschap.","abstract_original":"The aim of this meta-analysis is to investigate whether white-coat hypertension (WCH) has an adverse effect on maternal, fetal, and neonatal outcomes. Medline, EMBASE, www.Clinicaltrials.gov, and Cochrane Library databases were searched electronically in December 2019. The outcomes were compared between pregnant women with WCH and normotensive controls, women with chronic hypertension, gestational hypertension or any hypertensive disorder of pregnancy. Twelve studies were eligible for inclusion in the systematic review. Women with WCH enrolled below 20 weeks had a significantly increased risk of preeclampsia (pooled risk ratio [RR], 5.43 [95% CI, 2.00-14.71]). Furthermore, women with WCH had increased risk of delivering a small-for-gestational-age newborn (RR, 2.47 [95% CI, 1.21-5.05], P=0.013) and preterm birth (RR, 2.86 [95% CI, 1.44-5.68], P=0.002). The risk of preeclampsia (risk ratio, 0.43 [95% CI, 0.23-0.78], P=0.005), small-for-gestational-age (RR, 0.46 [95% CI, 0.26-0.82], P=0.008), preterm birth (RR, 0.47 [95% CI, 0.31-0.71], P<0.001) were significantly lower with WCH compared with women with gestational hypertension. Women with WCH delivered ≈1 week later compared with women with chronic hypertension (mean difference, 1.06 weeks [95% CI, 0.44-1.67 weeks]; P<0.001). WCH is associated with a worse perinatal and maternal outcome than normotension, but better outcomes than gestational hypertension and chronic hypertension. Therefore, diagnosis of WCH should be ascertained in pregnant women presenting with hypertension. When the diagnosis is confirmed, these women require monitoring for developing preeclampsia, small-for-gestational-age and preterm birth."},{"id":"4cfc2c11605f","type":"article","url":"https://hartvaat.nl/2020/07/01/bloeddruk-en-cognitieve-stoornis-en-dementie-meta-analyse-van-209-studies/","title":"Bloeddruk en cognitieve stoornis en dementie: meta-analyse van 209 studies","title_en":"Blood Pressure and Risks of Cognitive Impairment and Dementia: A Systematic Review and Meta-Analysis of 209 Prospective Studies.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.14993","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.14993","authors":["Ya-Nan Ou","Chen-Chen Tan","Xue-Ning Shen","Wei Xu","Xiao-He Hou","Qiang Dong","Lan Tan","Jin-Tai Yu"],"significance":8,"published":"2020-07-01","source_date":"2020-07-01","image":"","kennis":[],"congress":"","summary_en":"This comprehensive meta-analysis of 209 prospective studies demonstrated that elevated blood pressure in midlife is consistently associated with increased risk of cognitive impairment and dementia. The analysis provided the most extensive evidence base for blood pressure management as a dementia prevention strategy.","created":"2026-07-03T10:28:38Z","updated":"2026-07-03T13:27:48Z","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":"Uitgebreide meta-analyse van 209 prospectieve studies naar bloeddruk en risico op cognitieve stoornis en dementie. Grootste analyse tot nu toe.","abstract_original":"Controversies persist regarding the association between blood pressure (BP) and the risks of cognitive impairment and dementia due to inconsistent definitions of BP exposure and varying population characteristics. Here, we searched PubMed and performed a meta-analysis of the influence of BP exposure on the risks of cognitive disorders in prospective studies. Dose-response analyses were performed to illustrate the existence of linear/nonlinear relationships. The credibility of each meta-analysis was evaluated according to the risk of bias, inconsistency, and imprecision. Of the 31 628 citations, 209 were included in our systematic review, among which 136 were eligible for the meta-analysis. Overall, stronger associations were found in midlife than late-life. Moderate-quality evidence indicated that midlife hypertension was related to a 1.19- to 1.55-fold excess risk of cognitive disorders. Dose-response analyses of 5 studies indicated that midlife systolic BP >130 mm Hg was associated with an increased risk of cognitive disorders. With regard to BP exposure in late-life, high systolic BP, low diastolic BP, excessive BP variability, and orthostatic hypotension were all associated with an increased dementia risk. Encouragingly, the use of antihypertensive medications exhibited a 21% reduction in dementia risk. The U-shaped dose-response curve indicated that the protective window of diastolic BP level was between 90 and 100 mm Hg for low risk of Alzheimer disease. The relationships between BP variables and cognitive disorders are age- and BP type-dependent. Antihypertensive medications were associated with a reduced risk of dementia. However, the optimal dose, duration, and type for preventing cognitive disorders warrant further investigation."},{"id":"8ffcdd09b386","type":"article","url":"https://hartvaat.nl/2020/07/01/esc-0-1-uur-troponine-algoritme-voor-mi-veiligheid-en-werkzaamheid-meta-analyse/","title":"ESC 0/1-uur troponine-algoritme voor MI: veiligheid en werkzaamheid — meta-analyse","title_en":"Safety and efficacy of the European Society of Cardiology 0/1-hour algorithm for diagnosis of myocardial infarction: systematic review and meta-analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2019-316343","source_url":"https://doi.org/10.1136/heartjnl-2019-316343","authors":["Cho-Han Chiang","Cho-Hung Chiang","Gin Hoong Lee","Weng-Tein Gi","Yuan-Kun Wu","Sih-Shiang Huang","Yee Hui Yeo","Evangelos Giannitsis","Chien-Chang Lee"],"significance":8,"published":"2020-07-01","source_date":"2020-07-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis validated the safety and efficacy of the ESC 0/1-hour high-sensitivity troponin algorithm for rapid MI diagnosis across diverse populations, confirming its high negative predictive value for ruling out myocardial infarction in the emergency department.","created":"2026-07-03T10:28:38Z","updated":"2026-07-03T13:27:48Z","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":"Meta-analyse naar veiligheid en werkzaamheid van het ESC 0/1-uur hoog-sensitief troponine-algoritme voor MI-diagnose. Validatie in de dagelijkse praktijk.","abstract_original":"OBJECTIVE: The European Society of Cardiology (ESC) 0/1 hour algorithm has been primarily validated in Europe, America and Australasia with less knowledge of its performance outside of these settings. We aim to evaluate the performance of the ESC 0/1 hour algorithm across different contexts. METHODS: We searched PubMed, Embase, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials for relevant studies published between 1 January 2008 and 31 May 2019. The primary outcome was index myocardial infarction and the secondary outcome was major adverse cardiac event or mortality. A bivariate random-effects meta-analysis was used to derive the pooled estimate of each outcome. RESULTS: A total of 11 014 patients from 10 cohorts were analysed for the primary outcome. The algorithm based on high-sensitivity cardiac troponin (hs-cTn)T (Roche), hs-cTnI (Abbott) and hs-cTnI (Siemens) had pooled sensitivity of 98.4% (95% CI=95.1% to 99.5%), 98.1% (95% CI=94.6% to 99.3%) and 98.7% (95% CI=97.3% to 99.3%), respectively. The algorithm based on hs-cTnT (Roche) and hs-cTnI (Siemens) had pooled specificity of 91.2% (95% CI=86.0% to 94.6%) and 95.9% (95% CI=94.1% to 97.2%), respectively. Among patients in the rule-out category, the pooled mortality rate at 30 days and at 1 year was 0.1% (95% CI=0.0% to 0.4%) and 0.8% (95% CI=0.5% to 1.2%), respectively. Among patients in the observation zone, the pooled mortality rate was 0.7% (95% CI=0.3% to 1.2%) at 30 days but increased to 8.1% (95% CI=6.1% to 10.4%) at 1 year, comparable to the mortality rate in the rule-in group. CONCLUSION: The ESC 0/1 hour algorithm has high diagnostic accuracy but may not be sufficiently safe if the 1% miss-rate for myocardial infarction is desired. PROSPERO REGISTRATION NUMBER: CRD42019142280."},{"id":"7ecee3169960","type":"article","url":"https://hartvaat.nl/2020/06/30/laa-sluiting-versus-doac-bij-hoogrisico-af-vergelijkende-analyse/","title":"LAA-sluiting versus DOAC bij hoogrisico AF: vergelijkende analyse","title_en":"Left Atrial Appendage Closure Versus Direct Oral Anticoagulants in High-Risk Patients With Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.04.067","source_url":"https://doi.org/10.1016/j.jacc.2020.04.067","authors":["Pavel Osmancik","Dalibor Herman","Petr Neuzil","Pavel Hala","Milos Taborsky","Petr Kala","Martin Poloczek","Josef Stasek","Ludek Haman","Marian Branny","Jan Chovancik","Pavel Cervinka","Jiri Holy","Tomas Kovarnik","David Zemanek","Stepan Havranek","Vlastimil Vancura","Jan Opatrny","Petr Peichl","Petr Tousek","Veronika Lekesova","Jiri Jarkovsky","Martina Novackova","Klara Benesova","Petr Widimsky","Vivek Y Reddy"],"significance":7,"published":"2020-06-30","source_date":"2020-06-30","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/","https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This comparative analysis of left atrial appendage closure versus DOACs in high-risk AF patients evaluated the evolving position of structural stroke prevention in the era of highly effective oral anticoagulation.","created":"2026-07-03T10:28:38Z","updated":"2026-07-03T13:27:48Z","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":"Vergelijkende analyse van linker-hartoorsluiting versus DOAC bij hoogrisico AF-patiënten.","abstract_original":"BACKGROUND: Percutaneous left atrial appendage closure (LAAC) is noninferior to vitamin K antagonists (VKAs) for preventing atrial fibrillation (AF)-related stroke. However, direct oral anticoagulants (DOACs) have an improved safety profile over VKAs, and their effect on cardiovascular and neurological outcomes relative to LAAC is unknown. OBJECTIVES: This study sought to compare DOACs with LAAC in high-risk patients with AF. METHODS: Left Atrial Appendage Closure vs. Novel Anticoagulation Agents in Atrial Fibrillation (PRAGUE-17) was a multicenter, randomized, noninferiority trial comparing LAAC with DOACs. Patients were eligible to be enrolled if they had nonvalvular AF; were indicated for oral anticoagulation (OAC); and had a history of bleeding requiring intervention or hospitalization, a history of a cardioembolic event while taking an OAC, and/or a CHA2DS2-VASc of ≥3 and HAS-BLED of >2. Patients were randomized to receive LAAC or DOAC. The primary composite outcome was stroke, transient ischemic attack, systemic embolism, cardiovascular death, major or nonmajor clinically relevant bleeding, or procedure-/device-related complications. The primary analysis was by modified intention to treat. RESULTS: A high-risk patient cohort (CHA2DS2-VASc: 4.7 ± 1.5) was randomized to receive LAAC (n = 201) or DOAC (n = 201). LAAC was successful in 181 of 201 (90.0%) patients. In the DOAC group, apixaban was most frequently used (192 of 201; 95.5%). At a median 19.9 months of follow-up, the annual rates of the primary outcome were 10.99% with LAAC and 13.42% with DOAC (subdistribution hazard ratio [sHR]: 0.84; 95% confidence interval [CI]: 0.53 to 1.31; p = 0.44; p = 0.004 for noninferiority). There were no differences between groups for the components of the composite endpoint: all-stroke/TIA (sHR: 1.00; 95% CI: 0.40 to 2.51), clinically significant bleeding (sHR: 0.81; 95% CI: 0.44 to 1.52), and cardiovascular death (sHR: 0.75; 95% CI: 0.34 to 1.62). Major LAAC-related complications occurred in 9 (4.5%) patients. CONCLUSIONS: Among patients at high risk for stroke and increased risk of bleeding, LAAC was noninferior to DOAC in preventing major AF-related cardiovascular, neurological, and bleeding events. (Left Atrial Appendage Closure vs. Novel Anticoagulation Agents in Atrial Fibrillation [PRAGUE-17]; NCT02426944)."},{"id":"056c981f541e","type":"article","url":"https://hartvaat.nl/2020/06/30/af-recidief-na-ablatie-versus-antiaritmica-in-cabana/","title":"AF-recidief na ablatie versus antiaritmica in CABANA","title_en":"Recurrence of Atrial Fibrillation After Catheter Ablation or Antiarrhythmic Drug Therapy in the CABANA Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.04.065","source_url":"https://doi.org/10.1016/j.jacc.2020.04.065","authors":["Jeanne E Poole","Tristram D Bahnson","Kristi H Monahan","George Johnson","Hoss Rostami","Adam P Silverstein","Hussein R Al-Khalidi","Yves Rosenberg","Daniel B Mark","Kerry L Lee","Douglas L Packer"],"significance":6,"published":"2020-06-30","source_date":"2020-06-30","image":"","kennis":[],"congress":"","summary_en":"This CABANA analysis characterized patterns of AF recurrence after catheter ablation versus antiarrhythmic drugs, showing that while ablation delays recurrence, the long-term freedom from AF requires ongoing surveillance.","created":"2026-07-03T10:28:38Z","updated":"2026-07-03T13:27:48Z","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":"CABANA analyse naar AF-recidief na katheterablatie versus antiaritmische medicatie.","abstract_original":"BACKGROUND: The CABANA (Catheter Ablation Versus Antiarrhythmic Drug Therapy for Atrial Fibrillation) trial randomized 2,204 patients with atrial fibrillation (AF) to catheter ablation or drug therapy. Analysis by intention-to-treat showed a nonsignificant 14% relative reduction in the primary outcome of death, disabling stroke, serious bleeding, or cardiac arrest. OBJECTIVES: The purpose of this study was to assess recurrence of AF in the CABANA trial. METHODS: The authors prospectively studied CABANA patients using a proprietary electrocardiogram recording monitor for symptom-activated and 24-h AF auto detection. The AF recurrence endpoint was any post-90-day blanking atrial tachyarrhythmias lasting 30 s or longer. Biannual 96-h Holter monitoring was used to assess AF burden. Patients who used the CABANA monitors and provided 90-day post-blanking recordings qualified for this analysis (n = 1,240; 56% of CABANA population). Treatment comparisons were performed using a modified intention-to-treat approach. RESULTS: Median age of the 1,240 patients was 68 years, 34.4% were women, and AF was paroxysmal in 43.0%. Over 60 months of follow-up, first recurrence of any symptomatic or asymptomatic AF (hazard ratio: 0.52; 95% confidence interval: 0.45 to 0.60; p < 0.001) or first symptomatic-only AF (hazard ratio: 0.49; 95% confidence interval: 0.39 to 0.61; p < 0.001) were both significantly reduced in the catheter ablation group. Baseline Holter AF burden in both treatment groups was 48%. At 12 months, AF burden in ablation patients averaged 6.3%, and in drug-therapy patients, 14.4%. AF burden was significantly less in catheter ablation compared with drug-therapy patients across the 5-year follow-up (p < 0.001). These findings were not sensitive to the baseline pattern of AF. CONCLUSIONS: Catheter ablation was effective in reducing recurrence of any AF by 48% and symptomatic AF by 51% compared with drug therapy over 5 years of follow-up. Furthermore, AF burden was also significantly reduced in catheter ablation patients, regardless of their baseline AF type. (Catheter Ablation vs Anti-arrhythmic Drug Therapy for Atrial Fibrillation Trial [CABANA]; NCT00911508)."},{"id":"ee9d298b8c65","type":"article","url":"https://hartvaat.nl/2020/06/23/polymeervrije-biolimus-stent-versus-ultradunne-biodegradeerbare-sirolimus-stent/","title":"Polymeervrije biolimus-stent versus ultradunne biodegradeerbare sirolimus-stent","title_en":"Randomized Comparison of the Polymer-Free Biolimus-Coated BioFreedom Stent With the Ultrathin Strut Biodegradable Polymer Sirolimus-Eluting Orsiro Stent in an All-Comers Population Treated With Percutaneous Coronary Intervention: The SORT OUT IX Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.119.040241","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.119.040241","authors":["Lisette Okkels Jensen","Michael Maeng","Bent Raungaard","Johnny Kahlert","Julia Ellert","Lars Jakobsen","Anton Boel Villadsen","Karsten Tange Veien","Steen Dalby Kristensen","Ole Ahlehoff","Steen Carstensen","Martin Kirk Christensen","Christian Juhl Terkelsen","Thomas Engstroem","Knud Nørregaard Hansen","Hans Erik Bøtker","Jens Aaroe","Troels Thim","Leif Thuesen","Philip Freeman","Ahmed Aziz","Ashkan Eftekhari","Anders Junker","Svend Eggert Jensen","Jens Flensted Lassen","Henrik Steen Hansen","Evald Høj Christiansen"],"significance":5,"published":"2020-06-23","source_date":"2020-06-23","image":"","kennis":[],"congress":"","summary_en":"This randomized trial compared the polymer-free BioFreedom biolimus stent with the ultrathin biodegradable Orsiro sirolimus stent in high-bleeding-risk patients, testing two leading short-DAPT stent platforms.","created":"2026-07-03T10:28:38Z","updated":"2026-07-03T13:27:48Z","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 vergelijking van twee moderne stentplatformen: polymeervrije biolimus versus ultradunne biodegradeerbare sirolimus.","abstract_original":"BACKGROUND: In patients with increased bleeding risk, the biolimus A9-coated BioFreedom stent, a stainless steel drug-coated stent free from polymer, has shown superiority compared with a bare-metal stent. The aim of this study was to investigate whether the BioFreedom stent is noninferior to a modern ultrathin strut biodegradable polymer cobalt-chromium sirolimus-eluting Orsiro stent in an all-comers patient population treated with percutaneous coronary intervention. METHODS: The SORT OUT IX trial (Scandinavian Organization for Randomized Trials With Clinical Outcome IX), was a large-scale, registry-based, randomized, multicenter, single-blind, 2-arm, noninferiority trial. The primary end point, major adverse cardiovascular events, was defined as the composite of cardiac death, myocardial infarction not related to any segment other than the target lesion, or target lesion revascularization within 1 year, analyzed by intention-to-treat. The trial was powered to assess noninferiority for major adverse cardiovascular events of the BioFreedom stent compared with the Orsiro stent with a predetermined noninferiority margin of 0.021. RESULTS: Between December 14, 2015 and April 21, 2017, 3151 patients were assigned to treatment with the BioFreedom stent (1572 patients, 1966 lesions) or to the Orsiro stent (1579 patients, 1985 lesions). Five patients were lost to follow-up because of emigration (99.9% follow-up rate). Mean age was 66.3±10.9, diabetes mellitus was seen in 19.3% of patients, and 53% of the patients had acute coronary syndromes. At 1 year, intention-to-treat analysis showed that 79 (5.0%) patients, who were assigned the BioFreedom stent, and 59 (3.7%), who were assigned the Orsiro stent, met the primary end point (absolute risk difference 1.29% [upper limit of one-sided 95% CI 2.50%]; Pnoninferiority=0.14). Significantly more patients in the BioFreedom stent group had target lesion revascularization than those in the Orsiro stent group (55 [3.5%] vs 20 [1.3%], rate ratio 2.77 [95% CI, 1.66-4.62]; P<0.0001). CONCLUSIONS: The biolimus A9-coated BioFreedom polymer-free stent did not meet criteria for noninferiority for major adverse cardiovascular events at 12 months when compared with the ultrathin strut biodegradable polymer sirolimus-eluting Orsiro stent in an all-comers population Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02623140."},{"id":"75d5823d3c00","type":"article","url":"https://hartvaat.nl/2020/06/21/statinetherapie-verhoogt-lipoproteine-a-spiegels/","title":"Statinetherapie verhoogt lipoproteïne(a)-spiegels","title_en":"Statin therapy increases lipoprotein(a) levels.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["dyslipidemie","ldl-cholesterol","lipide-aferese","lipidenverlaging","lipoproteïne-a","lipoproteïne-a-therapeutisch-doel","pelacarsen"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehz310","source_url":"https://doi.org/10.1093/eurheartj/ehz310","authors":["Sotirios Tsimikas","Philip L S M Gordts","Chelsea Nora","Calvin Yeang","Joseph L Witztum"],"significance":7,"published":"2020-06-21","source_date":"2020-06-21","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This study confirmed that statin therapy paradoxically increases lipoprotein(a) levels, an effect with potential clinical relevance for the assessment and management of Lp(a)-related residual cardiovascular risk during statin treatment.","created":"2026-07-03T10:28:38Z","updated":"2026-07-03T13:27:48Z","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 die bevestigt dat statinetherapie Lp(a)-spiegels verhoogt. Paradoxaal effect met klinische relevantie voor residueel risico.","abstract_original":"AIMS: Lipoprotein(a) [Lp(a)] is elevated in 20-30% of people. This study aimed to assess the effect of statins on Lp(a) levels. METHODS AND RESULTS: This subject-level meta-analysis includes 5256 patients (1371 on placebo and 3885 on statin) from six randomized trials, three statin-vs.-placebo trials, and three statin-vs.-statin trials, with pre- and on-treatment (4-104 weeks) Lp(a) levels. Statins included atorvastatin 10 mg/day and 80 mg/day, pravastatin 40 mg/day, rosuvastatin 40 mg/day, and pitavastatin 2 mg/day. Lipoprotein(a) levels were measured with the same validated assay. The primary analysis of Lp(a) is based on the log-transformed data. In the statin-vs.-placebo pooled analysis, the ratio of geometric means [95% confidence interval (CI)] for statin to placebo is 1.11 (1.07-1.14) (P < 0.0001), with ratio >1 indicating a higher increase in Lp(a) from baseline in statin vs. placebo. The mean percent change from baseline ranged from 8.5% to 19.6% in the statin groups and -0.4% to -2.3% in the placebo groups. In the statin-vs.-statin pooled analysis, the ratio of geometric means (95% CI) for atorvastatin to pravastatin is 1.09 (1.05-1.14) (P < 0.0001). The mean percent change from baseline ranged from 11.6% to 20.4% in the pravastatin group and 18.7% to 24.2% in the atorvastatin group. Incubation of HepG2 hepatocytes with atorvastatin showed an increase in expression of LPA mRNA and apolipoprotein(a) protein. CONCLUSION: This meta-analysis reveals that statins significantly increase plasma Lp(a) levels. Elevations of Lp(a) post-statin therapy should be studied for effects on residual cardiovascular risk."},{"id":"8abb58f5b64e","type":"article","url":"https://hartvaat.nl/2020/06/20/hoog-dosis-tranexaminezuur-bij-acute-gastro-intestinale-bloeding-lancet-halt-it/","title":"Hoog-dosis tranexaminezuur bij acute gastro-intestinale bloeding: Lancet HALT-IT","title_en":"Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","internist"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(20)30848-5","source_url":"https://doi.org/10.1016/S0140-6736(20)30848-5","authors":[],"significance":7,"published":"2020-06-20","source_date":"2020-06-20","image":"","kennis":[],"congress":"","summary_en":"The HALT-IT trial showed that high-dose tranexamic acid does not reduce mortality in patients with acute gastrointestinal bleeding, a notable negative result contrasting with the drug's proven benefit in trauma and postpartum hemorrhage.","created":"2026-07-03T10:28:38Z","updated":"2026-07-03T13:27:47Z","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":"Lancet HALT-IT-trial die hoog-dosis tranexaminezuur onderzocht bij acute gastro-intestinale bloeding. Geen voordeel — in tegenstelling tot trauma.","abstract_original":"BACKGROUND: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. METHODS: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. FINDINGS: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82-1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). INTERPRETATION: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial. FUNDING: UK National Institute for Health Research Health Technology Assessment Programme."},{"id":"273ba3e80042","type":"article","url":"https://hartvaat.nl/2020/06/16/ticagrelor-monotherapie-versus-dapt-op-bloedingen-en-cv-events-bij-acs-jama-tico/","title":"Ticagrelor monotherapie versus DAPT op bloedingen en CV-events bij ACS: JAMA TICO","title_en":"Effect of Ticagrelor Monotherapy vs Ticagrelor With Aspirin on Major Bleeding and Cardiovascular Events in Patients With Acute Coronary Syndrome: The TICO Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2020.7580","source_url":"https://doi.org/10.1001/jama.2020.7580","authors":["Byeong-Keuk Kim","Sung-Jin Hong","Yun-Hyeong Cho","Kyeong Ho Yun","Yong Hoon Kim","Yongsung Suh","Jae Young Cho","Ae-Young Her","Sungsoo Cho","Dong Woon Jeon","Sang-Yong Yoo","Deok-Kyu Cho","Bum-Kee Hong","Hyuckmoon Kwon","Chul-Min Ahn","Dong-Ho Shin","Chung-Mo Nam","Jung-Sun Kim","Young-Guk Ko","Donghoon Choi","Myeong-Ki Hong","Yangsoo Jang"],"significance":8,"published":"2020-06-16","source_date":"2020-06-16","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/trombocytenaggregatieremmers-bij-acs/","https://hartvaat.nl/kennis/coronairlijden/dual-antiplatelet-therapy-dapt/"],"congress":"","summary_en":"The TICO results showed that ticagrelor monotherapy after 3 months of DAPT significantly reduced major bleeding compared with continued ticagrelor plus aspirin at 1 year after PCI for ACS, without increasing cardiovascular events. The study reinforced the safety of early aspirin discontinuation.","created":"2026-07-03T10:28:38Z","updated":"2026-07-03T13:27:47Z","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":"JAMA TICO-resultaten: ticagrelor monotherapie versus ticagrelor plus aspirine op ernstige bloedingen en CV-events bij ACS.","abstract_original":"IMPORTANCE: Discontinuing aspirin after short-term dual antiplatelet therapy (DAPT) was evaluated as a bleeding reduction strategy. However, the strategy of ticagrelor monotherapy has not been exclusively evaluated in patients with acute coronary syndromes (ACS). OBJECTIVE: To determine whether switching to ticagrelor monotherapy after 3 months of DAPT reduces net adverse clinical events compared with ticagrelor-based 12-month DAPT in patients with ACS treated with drug-eluting stents. DESIGN, SETTING, AND PARTICIPANTS: A randomized multicenter trial was conducted in 3056 patients with ACS treated with drug-eluting stents between August 2015 and October 2018 at 38 centers in South Korea. Follow-up was completed in October 2019. INTERVENTIONS: Patients were randomized to receive ticagrelor monotherapy (90 mg twice daily) after 3-month DAPT (n = 1527) or ticagrelor-based 12-month DAPT (n = 1529). MAIN OUTCOMES AND MEASURES: The primary outcome was a 1-year net adverse clinical event, defined as a composite of major bleeding and adverse cardiac and cerebrovascular events (death, myocardial infarction, stent thrombosis, stroke, or target-vessel revascularization). Prespecified secondary outcomes included major bleeding and major adverse cardiac and cerebrovascular events. RESULTS: Among 3056 patients who were randomized (mean age, 61 years; 628 women [20%]; 36% ST-elevation myocardial infarction), 2978 patients (97.4%) completed the trial. The primary outcome occurred in 59 patients (3.9%) receiving ticagrelor monotherapy after 3-month DAPT and in 89 patients (5.9%) receiving ticagrelor-based 12-month DAPT (absolute difference, -1.98% [95% CI, -3.50% to -0.45%]; hazard ratio [HR], 0.66 [95% CI, 0.48 to 0.92]; P = .01). Of 10 prespecified secondary outcomes, 8 showed no significant difference. Major bleeding occurred in 1.7% of patients with ticagrelor monotherapy after 3-month DAPT and in 3.0% of patients with ticagrelor-based 12-month DAPT (HR, 0.56 [95% CI, 0.34 to 0.91]; P = .02). The incidence of major adverse cardiac and cerebrovascular events was not significantly different between the ticagrelor monotherapy after 3-month DAPT group (2.3%) vs the ticagrelor-based 12-month DAPT group (3.4%) (HR, 0.69 [95% CI, 0.45 to 1.06]; P = .09). CONCLUSIONS AND RELEVANCE: Among patients with acute coronary syndromes treated with drug-eluting stents, ticagrelor monotherapy after 3 months of dual antiplatelet therapy, compared with ticagrelor-based 12-month dual antiplatelet therapy, resulted in a modest but statistically significant reduction in a composite outcome of major bleeding and cardiovascular events at 1 year. The study population and lower than expected event rates should be considered in interpreting the trial. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02494895."},{"id":"7a1af2b39253","type":"article","url":"https://hartvaat.nl/2020/06/09/combinatie-antiplaatjes-antistolling-bij-diabetes-met-cv-ziekte-compass-inzichte/","title":"Combinatie antiplaatjes + antistolling bij diabetes met CV-ziekte: COMPASS-inzichten","title_en":"Role of Combination Antiplatelet and Anticoagulation Therapy in Diabetes Mellitus and Cardiovascular Disease: Insights From the COMPASS Trial.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","internist"],"tags":["ezetimibe","primaire-preventie","soul-trial"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.046448","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.046448","authors":["Deepak L Bhatt","John W Eikelboom","Stuart J Connolly","P Gabriel Steg","Sonia S Anand","Subodh Verma","Kelley R H Branch","Jeffrey Probstfield","Jackie Bosch","Olga Shestakovska","Michael Szarek","Aldo Pietro Maggioni","Petr Widimský","Alvaro Avezum","Rafael Diaz","Basil S Lewis","Scott D Berkowitz","Keith A A Fox","Lars Ryden","Salim Yusuf"],"significance":7,"published":"2020-06-09","source_date":"2020-06-09","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"This COMPASS analysis showed that combination antiplatelet and anticoagulation therapy with rivaroxaban and aspirin provides particular benefit in diabetic patients with established vascular disease, supporting the dual-pathway strategy in this high-risk population.","created":"2026-07-03T10:28:37Z","updated":"2026-07-03T13:27:47Z","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":"COMPASS analyse naar de rol van combinatie antiplaatjes- en antistollingstherapie bij diabetespatiënten met CV-ziekte.","abstract_original":"BACKGROUND: Patients with established coronary artery disease or peripheral artery disease often have diabetes mellitus. These patients are at high risk of future vascular events. METHODS: In a prespecified analysis of the COMPASS trial (Cardiovascular Outcomes for People Using Anticoagulation Strategies), we compared the effects of rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg daily) versus placebo plus aspirin in patients with diabetes mellitus versus without diabetes mellitus in preventing major vascular events. The primary efficacy end point was the composite of cardiovascular death, myocardial infarction, or stroke. Secondary end points included all-cause mortality and all major vascular events (cardiovascular death, myocardial infarction, stroke, or major adverse limb events, including amputation). The primary safety end point was a modification of the International Society on Thrombosis and Haemostasis criteria for major bleeding. RESULTS: There were 10 341 patients with diabetes mellitus and 17 054 without diabetes mellitus in the overall trial. A consistent and similar relative risk reduction was seen for benefit of rivaroxaban plus aspirin (n=9152) versus placebo plus aspirin (n=9126) in patients both with (n=6922) and without (n=11 356) diabetes mellitus for the primary efficacy end point (hazard ratio, 0.74, P=0.002; and hazard ratio, 0.77, P=0.005, respectively, Pinteraction=0.77) and all-cause mortality (hazard ratio, 0.81, P=0.05; and hazard ratio, 0.84, P=0.09, respectively; Pinteraction=0.82). However, although the absolute risk reductions appeared numerically larger in patients with versus without diabetes mellitus, both subgroups derived similar benefit (2.3% versus 1.4% for the primary efficacy end point at 3 years, Gail-Simon qualitative Pinteraction<0.0001; 1.9% versus 0.6% for all-cause mortality, Pinteraction=0.02; 2.7% versus 1.7% for major vascular events, Pinteraction<0.0001). Because the bleeding hazards were similar among patients with and without diabetes mellitus, the prespecified net benefit for rivaroxaban appeared particularly favorable in the patients with diabetes mellitus (2.7% versus 1.0%; Gail-Simon qualitative Pinteraction=0.001). CONCLUSIONS: In stable atherosclerosis, the combination of aspirin plus rivaroxaban 2.5 mg twice daily provided a similar relative degree of benefit on coronary, cerebrovascular, and peripheral end points in patients with and without diabetes mellitus. Given their higher baseline risk, the absolute benefits appeared larger in those with diabetes mellitus, including a 3-fold greater reduction in all-cause mortality. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01776424."},{"id":"725e058b3f8e","type":"article","url":"https://hartvaat.nl/2020/06/07/hartfalentrials-tijdens-en-na-covid-19-expert-consensus/","title":"Hartfalentrials tijdens en na COVID-19: expert consensus","title_en":"Conducting clinical trials in heart failure during (and after) the COVID-19 pandemic: an Expert Consensus Position Paper from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC).","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","covid-hart"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaa461","source_url":"https://doi.org/10.1093/eurheartj/ehaa461","authors":["Stefan D Anker","Javed Butler","Muhammad Shahzeb Khan","William T Abraham","Johann Bauersachs","Edimar Bocchi","Biykem Bozkurt","Eugene Braunwald","Vijay K Chopra","John G Cleland","Justin Ezekowitz","Gerasimos Filippatos","Tim Friede","Adrian F Hernandez","Carolyn S P Lam","JoAnn Lindenfeld","John J V McMurray","Mandeep Mehra","Marco Metra","Milton Packer","Burkert Pieske","Stuart J Pocock","Piotr Ponikowski","Giuseppe M C Rosano","John R Teerlink","Hiroyuki Tsutsui","Dirk J Van Veldhuisen","Subodh Verma","Adriaan A Voors","Janet Wittes","Faiez Zannad","Jian Zhang","Petar Seferovic","Andrew J S Coats"],"significance":6,"published":"2020-06-07","source_date":"2020-06-07","image":"","kennis":[],"congress":"","summary_en":"This expert consensus addressed the practical challenges of conducting heart failure clinical trials during the COVID-19 pandemic, providing guidance on protocol modifications, remote monitoring, and endpoint assessment in pandemic conditions.","created":"2026-07-03T10:28:37Z","updated":"2026-07-03T13:27:47Z","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":"Expert consensus over het uitvoeren van klinische hartfalentrials tijdens (en na) de COVID-19 pandemie.","abstract_original":"The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has important implications for the safety of participants in clinical trials and the research staff caring for them and, consequently, for the trials themselves. Patients with heart failure may be at greater risk of infection with COVID-19 and the consequences might also be more serious, but they are also at risk of adverse outcomes if their clinical care is compromised. As physicians and clinical trialists, it is our responsibility to ensure safe and effective care is delivered to trial participants without affecting the integrity of the trial. The social contract with our patients demands no less. Many regulatory authorities from different world regions have issued guidance statements regarding the conduct of clinical trials during this COVID-19 crisis. However, international trials may benefit from expert guidance from a global panel of experts to supplement local advice and regulations, thereby enhancing the safety of participants and the integrity of the trial. Accordingly, the Heart Failure Association of the European Society of Cardiology on 21 and 22 March 2020 conducted web-based meetings with expert clinical trialists in Europe, North America, South America, Australia, and Asia. The main objectives of this Expert Position Paper are to highlight the challenges that this pandemic poses for the conduct of clinical trials in heart failure and to offer advice on how they might be overcome, with some practical examples. While this panel of experts are focused on heart failure clinical trials, these discussions and recommendations may apply to clinical trials in other therapeutic areas."},{"id":"a4a12f2ddbb6","type":"article","url":"https://hartvaat.nl/2020/06/02/prevalentie-van-fh-bij-atherosclerotische-cv-ziekte-meta-analyse/","title":"Prevalentie van FH bij atherosclerotische CV-ziekte: meta-analyse","title_en":"Prevalence of Familial Hypercholesterolemia Among the General Population and Patients With Atherosclerotic Cardiovascular Disease: A Systematic Review and Meta-Analysis.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["atherosclerose","dyslipidemie","familiaire-hypercholesterolemie","familiaire-hypercholesterolemie-screening","vrouwen"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.119.044795","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.119.044795","authors":["Pengwei Hu","Kanika I Dharmayat","Christophe A T Stevens","Mansour T A Sharabiani","Rebecca S Jones","Gerald F Watts","Jacques Genest","Kausik K Ray","Antonio J Vallejo-Vaz"],"significance":7,"published":"2020-06-02","source_date":"2020-06-02","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This meta-analysis quantified the higher prevalence of familial hypercholesterolemia among patients with established atherosclerotic cardiovascular disease compared with the general population, reinforcing the importance of systematic FH screening in clinical practice.","created":"2026-07-03T10:28:37Z","updated":"2026-07-03T13:27:47Z","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":"Meta-analyse naar de prevalentie van familiaire hypercholesterolemie bij patiënten met vastgestelde atherosclerotische CV-ziekte.","abstract_original":"BACKGROUND: Contemporary studies suggest that familial hypercholesterolemia (FH) is more frequent than previously reported and increasingly recognized as affecting individuals of all ethnicities and across many regions of the world. Precise estimation of its global prevalence and prevalence across World Health Organization regions is needed to inform policies aiming at early detection and atherosclerotic cardiovascular disease (ASCVD) prevention. The present study aims to provide a comprehensive assessment and more reliable estimation of the prevalence of FH than hitherto possible in the general population (GP) and among patients with ASCVD. METHODS: We performed a systematic review and meta-analysis including studies reporting on the prevalence of heterozygous FH in the GP or among those with ASCVD. Studies reporting gene founder effects and focused on homozygous FH were excluded. The search was conducted through Medline, Embase, Cochrane, and Global Health, without time or language restrictions. A random-effects model was applied to estimate the overall pooled prevalence of FH in the general and ASCVD populations separately and by World Health Organization regions. RESULTS: From 3225 articles, 42 studies from the GP and 20 from populations with ASCVD were eligible, reporting on 7 297 363 individuals/24 636 cases of FH and 48 158 patients/2827 cases of FH, respectively. More than 60% of the studies were from Europe. Use of the Dutch Lipid Clinic Network criteria was the commonest diagnostic method. Within the GP, the overall pooled prevalence of FH was 1:311 (95% CI, 1:250-1:397; similar between children [1:364] and adults [1:303], P=0.60; across World Health Organization regions where data were available, P=0.29; and between population-based and electronic health records-based studies, P=0.82). Studies with ≤10 000 participants reported a higher prevalence (1:200-289) compared with larger cohorts (1:365-407; P<0.001). The pooled prevalence among those with ASCVD was 18-fold higher than in the GP (1:17 [95% CI, 1:12-1:24]), driven mainly by coronary artery disease (1:16; [95% CI, 1:12-1:23]). Between-study heterogeneity was large (I2>95%). Tests assessing bias were nonsignificant (P>0.3). CONCLUSIONS: With an overall prevalence of 1:311, FH is among the commonest genetic disorders in the GP, similarly present across different regions of the world, and is more frequent among those with ASCVD. The present results support the advocacy for the institution of public health policies, including screening programs, to identify FH early and to prevent its global burden."},{"id":"e0ba4a9af213","type":"article","url":"https://hartvaat.nl/2020/06/01/pcsk9-remming-en-aortastenose-fourier-exploratieve-analyse/","title":"PCSK9-remming en aortastenose: FOURIER exploratieve analyse","title_en":"An Exploratory Analysis of Proprotein Convertase Subtilisin/Kexin Type 9 Inhibition and Aortic Stenosis in the FOURIER Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["aortastenose","pcsk9-remmers"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2020.0728","source_url":"https://doi.org/10.1001/jamacardio.2020.0728","authors":["Brian A Bergmark","Michelle L O'Donoghue","Sabina A Murphy","Julia F Kuder","Marat V Ezhov","Richard Ceška","Ioanna Gouni-Berthold","Henrik K Jensen","S Lale Tokgozoglu","François Mach","Kurt Huber","Zbigniew Gaciong","Basil S Lewis","Francois Schiele","J Wouter Jukema","Terje R Pedersen","Robert P Giugliano","Marc S Sabatine"],"significance":6,"published":"2020-06-01","source_date":"2020-06-01","image":"","kennis":[],"congress":"","summary_en":"This exploratory FOURIER analysis examined whether PCSK9 inhibition with evolocumab slows aortic stenosis progression, testing the hypothesis that aggressive LDL lowering can modify the course of calcific aortic valve disease.","created":"2026-07-03T10:28:37Z","updated":"2026-07-03T13:27:47Z","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":"JAMA Cardiology exploratieve FOURIER-analyse naar het effect van PCSK9-remming op aortaklepstenoseprogresse.","abstract_original":"IMPORTANCE: Despite recent advances in treatment of severe aortic valve stenosis (AS), AS remains a life-threatening condition with no proven disease-modifying therapy. Low-density lipoprotein cholesterol (LDL-C) and lipoprotein(a) (Lp[a]) have been implicated in the pathobiology of AS. The proprotein convertase subtilisin/kexin type 9 inhibitor evolocumab reduces circulating LDL-C concentrations by 50% to 60% and Lp(a) by 20% to 30%. OBJECTIVE: To determine whether evolocumab reduces the risk of AS events in patients with atherosclerotic cardiovascular disease. INTERVENTIONS: Patients were randomized 1:1 to evolocumab or placebo. DESIGN, SETTING, AND PARTICIPANTS: Exploratory analysis of the FOURIER trial, which enrolled 27 564 patients with stable atherosclerotic cardiovascular disease who were taking statin therapy at 1242 sites in 49 countries from February 2013 to November 2016. Patients were randomized to evolocumab or placebo and followed up for a median (interquartile range) of 2.2 (1.8-2.5) years. This post hoc analysis was performed from September 2019 to February 2020. MAIN OUTCOMES AND MEASURES: Site-reported adverse events of new or worsening AS or aortic valve replacement (termed AS events). The adjusted risk of AS events was calculated with a multivariable model including concentrations of Lp(a) and LDL-C corrected for Lp(a) content, plus age, sex, diabetes, hypertension, current smoking, and estimated glomerular filtration rate. Evolocumab efficacy was tested using a Cox proportional hazards model. RESULTS: Aortic stenosis events occurred in 63 patients (48 men [76%]; mean [SD] age, 69 [9] years) over a median of 2.2 years. Elevated Lp(a) concentration was associated with higher rates of AS events (adjusted hazard ratio [aHR], 1.55 [95% CI, 1.17-2.05] per SD; P = .002), including aortic valve replacement (aHR, 2.22 [95% CI, 1.38-3.58] per SD; P = .001), after multivariable adjustment. The corrected LDL-C concentration was not significantly associated with AS events (aHR, 1.23 [95% CI, 0.93-1.61] per SD; P = .14). The overall HR for AS events with evolocumab was 0.66 (95% CI, 0.40-1.09), with no apparent association in the first year (HR, 1.09 [95% CI, 0.48-2.47]) but an HR of 0.48 (95% CI, 0.25-0.93) after the first year of treatment. CONCLUSIONS AND RELEVANCE: In this exploratory analysis of the FOURIER trial, higher Lp(a) levels, but not Lp(a)-corrected LDL-C levels, were associated with a higher risk of subsequent AS events, including aortic valve replacement. Long-term therapy with evolocumab may reduce AS events, and this raises the possibility that specific pharmacologic lipid-lowering therapy could offer a means to prevent or slow the progression of AS. These exploratory findings merit further investigation with a dedicated randomized clinical trial. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01764633."},{"id":"a60aa26c3c1a","type":"article","url":"https://hartvaat.nl/2020/06/01/inclusie-van-ouderen-vrouwen-en-minderheden-in-acs-trials-jama-cardiology/","title":"Inclusie van ouderen, vrouwen en minderheden in ACS-trials: JAMA Cardiology","title_en":"Enrollment of Older Patients, Women, and Racial/Ethnic Minority Groups in Contemporary Acute Coronary Syndrome Clinical Trials: A Systematic Review.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["acuut-coronair-syndroom","aperitif-trial","pathfinder-trial"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2020.0359","source_url":"https://doi.org/10.1001/jamacardio.2020.0359","authors":["Ayman Samman Tahhan","Muthiah Vaduganathan","Stephen J Greene","Alaaeddin Alrohaibani","Mohamed Raad","Mazen Gafeer","Roxana Mehran","Gregg C Fonarow","Pamela S Douglas","Deepak L Bhatt","Javed Butler"],"significance":6,"published":"2020-06-01","source_date":"2020-06-01","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/rivaroxaban/"],"congress":"","summary_en":"This systematic review documented persistent underrepresentation of older patients, women, and racial/ethnic minorities in contemporary ACS clinical trials, highlighting ongoing challenges in ensuring trial generalizability.","created":"2026-07-03T10:28:37Z","updated":"2026-07-03T13:27:47Z","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":"JAMA Cardiology systematische review over de representativiteit van hedendaagse ACS-trials. Persisterende inclusieongelijkheid.","abstract_original":"IMPORTANCE: Although age, sex, and race/ethnicity are important factors when generalizing the findings of clinical trials to routine practice, trends in the representation of these groups in contemporary acute coronary syndrome (ACS) trials are not well defined. OBJECTIVE: To characterize the representation of older patients, women, and racial/ ethnic minorities in ACS randomized trials. EVIDENCE REVIEW: A systemic search was conducted of ACS trials published in 8 major medical journals between January 2001 and December 2018. Overall, 1 067 520 patients from 460 trials were included. Findings were compared with epidemiologic studies of patients with ACS. FINDINGS: The median number of participants per trial was 711 (interquartile range, 324-2163) and the median number of sites per trial was 21 (interquartile range, 5-73). Overall, 207 trials (45.0%) studied drug therapy, and 210 (45.7%) evaluated procedural interventions. The mean (SD) age of trial participants was 62.9 (10.7) years and increased from 62.3 (11.2) years in 2001-2006 to 64.0 (10.4) years in 2013-2018 (P = .01). The corresponding mean (SD) age was 66.4 (14.8) years in US epidemiologic studies and 70.0 (13.5) years in European epidemiologic studies. The overall proportion of women enrolled was 26.8% and decreased over time, from 27.8% in 2001-2006 to 24.9% in 2013-2018 (P = .21 for trend). The corresponding weighted proportions of women were 38.0% in US epidemiologic studies and 32.0% in European studies. The distribution of racial/ethnic groups was reported in only 99 trials (21.5%). In trials with reported data, 15.0% of the trial participants were nonwhite, which increased from 12.0% in 2001-2006 to 14.0% in 2013-2018. Black patients represented 3.7% of all patients during the entire study time frame, Asian patients represented 9.6%, and Hispanic patients represented 7.8%. Trends in the representation of black patients remained unchanged from 2001-2006 (5.2%) to 2013-2018 (4.9%), while the enrollment of Asian and Hispanic patients increased from 2001-2006 to 2013-2018 (from 1.9% to 10.8% for Asian patients and from 5.4% to 14.5% for Hispanic patients). CONCLUSIONS AND RELEVANCE: Older patients and women are underrepresented in contemporary ACS trials compared with epidemiologic studies. Over time, there has been modest improvement in the representation of older patients but not women patients. More than three-quarters of trials did not report race/ethnicity data, with available data suggesting a modest increase in the enrollment of nonwhite patients owing to the enrollment of Asian and Hispanic patients. Enrollment of black patients remained low over time."},{"id":"1b41f0529497","type":"article","url":"https://hartvaat.nl/2020/06/01/farmacologische-cardioversie-van-recent-onset-af-netwerkmeta-analyse/","title":"Farmacologische cardioversie van recent-onset AF: netwerkmeta-analyse","title_en":"Pharmacologic cardioversion of recent-onset atrial fibrillation: a systematic review and network meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["laminopathie","menopauze","ouderen"],"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/euaa024","source_url":"https://doi.org/10.1093/europace/euaa024","authors":["Ian S deSouza","Mina Tadrous","Theresa Sexton","Roshanak Benabbas","Guy Carmelli","Richard Sinert"],"significance":6,"published":"2020-06-01","source_date":"2020-06-01","image":"","kennis":[],"congress":"","summary_en":"This network meta-analysis compared all available agents for pharmacological cardioversion of recent-onset AF, identifying the most effective antiarrhythmic drugs and informing evidence-based drug selection for acute rhythm conversion.","created":"2026-07-03T10:28:37Z","updated":"2026-07-03T18:38:47Z","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":"Netwerkmeta-analyse die alle beschikbare middelen voor farmacologische cardioversie van recent-onset AF vergeleek.","abstract_original":"AIMS: We sought to identify the most effective antidysrhythmic drug for pharmacologic cardioversion of recent-onset atrial fibrillation (AF). METHODS AND RESULTS: We searched MEDLINE, Embase, and Web of Science from inception to March 2019, limited to human subjects and English language. We also searched for unpublished data. We limited studies to randomized controlled trials that enrolled adult patients with AF ≤ 48 h and compared antidysrhythmic agents, placebo, or control. We determined these outcomes prior to data extraction: (i) rate of conversion to sinus rhythm within 24 h, (ii) time to cardioversion to sinus rhythm, (iii) rate of significant adverse events, and (iv) rate of thromboembolism within 30 days. We extracted data according to PRISMA-NMA and appraised selected trials using the Cochrane review handbook. The systematic review initially identified 640 studies; 30 met inclusion criteria. Twenty-one trials that randomized 2785 patients provided efficacy data for the conversion rate outcome. Bayesian network meta-analysis using a random-effects model demonstrated that ranolazine + amiodarone intravenous (IV) [odds ratio (OR) 39.8, 95% credible interval (CrI) 8.3-203.1], vernakalant (OR 22.9, 95% CrI 3.7-146.3), flecainide (OR 16.9, 95% CrI 4.1-73.3), amiodarone oral (OR 10.2, 95% CrI 3.1-36.0), ibutilide (OR 7.9, 95% CrI 1.2-52.5), amiodarone IV (OR 5.4, 95% CrI 2.1-14.6), and propafenone (OR 4.1, 95% CrI 1.7-10.5) were associated with significantly increased likelihood of conversion within 24 h when compared to placebo/control. Overall quality was low, and the network exhibited inconsistency. Probabilistic analysis ranked vernakalant and flecainide high and propafenone and amiodarone IV low. CONCLUSION: For pharmacologic cardioversion of recent-onset AF within 24 h, there is insufficient evidence to determine which treatment is superior. Vernakalant and flecainide may be relatively more efficacious agents. Propafenone and IV amiodarone may be relatively less efficacious. Further high-quality study is necessary."},{"id":"6a823e227825","type":"article","url":"https://hartvaat.nl/2020/06/01/trends-in-plotse-hartdood-bij-hf-met-crt-systematische-review/","title":"Trends in plotse hartdood bij HF met CRT: systematische review","title_en":"Time trends in sudden cardiac death risk in heart failure patients with cardiac resynchronization therapy: a systematic review.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehz773","source_url":"https://doi.org/10.1093/eurheartj/ehz773","authors":["Sérgio Barra","Rui Providência","Kumar Narayanan","Serge Boveda","Rudolf Duehmke","Rodrigue Garcia","Francisco Leyva","Véronique Roger","Xavier Jouven","Sharad Agarwal","Wayne C Levy","Eloi Marijon"],"significance":5,"published":"2020-06-01","source_date":"2020-06-01","image":"","kennis":[],"congress":"","summary_en":"This systematic review documented declining time trends in sudden cardiac death risk among CRT-treated heart failure patients, suggesting that improving background therapy has modified the arrhythmic risk landscape.","created":"2026-07-03T10:28:37Z","updated":"2026-07-03T13:27:47Z","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":"Systematische review naar tijdstrends in het risico op plotse hartdood bij hartfalenpatiënten met CRT.","abstract_original":"AIMS: While data from randomized trials suggest a declining incidence of sudden cardiac death (SCD) among heart failure patients, the extent to which such a trend is present among patients with cardiac resynchronization therapy (CRT) has not been evaluated. We therefore assessed changes in SCD incidence, and associated factors, in CRT recipients over the last 20 years. METHODS AND RESULTS: Literature search from inception to 30 April 2018 for observational and randomized studies involving CRT patients, with or without defibrillator, providing specific cause-of-death data. Sudden cardiac death was the primary endpoint. For each study, rate of SCD per 1000 patient-years of follow-up was calculated. Trend line graphs were subsequently constructed to assess change in SCD rates over time, which were further analysed by device type, patient characteristics, and medical therapy. Fifty-three studies, comprising 22 351 patients with 60 879 patient-years of follow-up and a total of 585 SCD, were included. There was a gradual decrease in SCD rates since the early 2000s in both randomized and observational studies, with rates falling more than four-fold. The rate of decline in SCD was steeper than that of all-cause mortality, and accordingly, the proportion of deaths which were due to SCD declined over the years. The magnitude of absolute decline in SCD was more prominent among CRT-pacemaker (CRT-P) patients compared to those receiving CRT-defibrillator (CRT-D), with the difference in SCD rates between CRT-P and CRT-D decreasing considerably over time. There was a progressive increase in age, use of beta-blockers, and left ventricular ejection fraction, and conversely, a decrease in QRS duration and antiarrhythmic drug use. CONCLUSION: Sudden cardiac death rates have progressively declined in the CRT heart failure population over time, with the difference between CRT-D vs. CRT-P recipients narrowing considerably."},{"id":"7a4a85ec1f55","type":"article","url":"https://hartvaat.nl/2020/06/01/2020-ish-mondiale-hypertensie-praktijkrichtlijnen/","title":"2020 ISH mondiale hypertensie-praktijkrichtlijnen","title_en":"2020 International Society of Hypertension Global Hypertension Practice Guidelines.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.15026","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.15026","authors":["Thomas Unger","Claudio Borghi","Fadi Charchar","Nadia A Khan","Neil R Poulter","Dorairaj Prabhakaran","Agustin Ramirez","Markus Schlaich","George S Stergiou","Maciej Tomaszewski","Richard D Wainford","Bryan Williams","Aletta E Schutte"],"significance":9,"published":"2020-06-01","source_date":"2020-06-01","image":"","kennis":[],"congress":"","summary_en":"The 2020 ISH Global Hypertension Practice Guidelines provided worldwide recommendations for blood pressure management adaptable to both high- and low-resource settings. The guideline emphasized pragmatic approaches to diagnosis, treatment initiation, and target achievement across diverse healthcare systems.","created":"2026-07-03T10:28:37Z","updated":"2026-07-03T18:38:47Z","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":"De 2020 richtlijnen van de International Society of Hypertension voor mondiale hypertensie-praktijk. Eerste wereldwijde richtlijn met aandacht voor resource-beperkte settings.","abstract_original":""},{"id":"961cb6ae89ef","type":"article","url":"https://hartvaat.nl/2020/06/01/incidentie-en-implicaties-van-af-bij-hypertensie-sprint-inzichten/","title":"Incidentie en implicaties van AF bij hypertensie: SPRINT-inzichten","title_en":"Incidence and Implications of Atrial Fibrillation/Flutter in Hypertension: Insights From the SPRINT Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.14690","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.14690","authors":["Vibhu Parcha","Nirav Patel","Rajat Kalra","Joonseok Kim","Orlando M Gutiérrez","Garima Arora","Pankaj Arora"],"significance":6,"published":"2020-06-01","source_date":"2020-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/eindorgaanschade-hypertensie/"],"congress":"","summary_en":"This SPRINT analysis examined the incidence and prognostic implications of new-onset AF/flutter in hypertensive patients, showing that AF remains a significant prognostic marker even in the context of intensive blood pressure management.","created":"2026-07-03T10:28:37Z","updated":"2026-07-03T13:27:46Z","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":"SPRINT analyse naar de incidentie en klinische implicaties van AF bij hypertensieve patiënten.","abstract_original":"We evaluated the impact of intensive blood pressure control on the incidence of new-onset atrial fibrillation/flutter (AF) and the prognostic implications of preexisting and new-onset AF in SPRINT (Systolic Blood Pressure Intervention Trial) participants. New-onset AF was defined as occurrence of AF in 12-lead electrocardiograms after randomization in participants free of AF at baseline. Poisson regression modeling was used to calculate incident rates of new-onset AF. Multivariable-adjusted Cox proportional hazard models were used to evaluate the risk of adverse cardiovascular events (composite of myocardial infarction, non-myocardial infarction acute coronary syndrome, stroke, heart failure, or cardiovascular death). In 9327 participants, 8.45% had preexisting AF, and 1.65% had new-onset AF. The incidence of new-onset AF was 4.53 per 1000-person years, with similar rates in the standard and intensive treatment arms (4.95 versus 4.11 per 1000-person years; adjusted P=0.14). Participants with preexisting AF (adjusted hazard ratio, 1.83 [95% CI, 1.46-2.31]; P<0.001) and new-onset AF (adjusted hazard ratio, 2.45 [95% CI, 1.58-3.80]; P<0.001) had a greater risk for development of adverse cardiovascular events compared with those with no AF. Participants with preexisting AF who achieved blood pressure <120/80 mm Hg at 3 months continued have a poor prognosis (adjusted hazard ratio, 1.88 [95% CI, 1.32-2.70]; P=0.001) compared with those with no AF. Intensive blood pressure control does not diminish the incidence of new-onset AF in an older, high-risk, nondiabetic population. Both preexisting and new-onset AF have adverse prognostic implications. In participants with preexisting AF, residual cardiovascular risk is evident even with on-treatment blood pressure <120/80 mm Hg. Registration- URL: https://www.clinicaltrials.gov; Unique identifier: NCT01206062."},{"id":"b5632aa14432","type":"article","url":"https://hartvaat.nl/2020/06/01/intensieve-bloeddrukverlaging-en-risico-op-af-sprint-analyse/","title":"Intensieve bloeddrukverlaging en risico op AF: SPRINT-analyse","title_en":"Effect of Intensive Blood Pressure Lowering on the Risk of Atrial Fibrillation.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.14766","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.14766","authors":["Elsayed Z Soliman","Akm F Rahman","Zhu-Ming Zhang","Carlos J Rodriguez","Tara I Chang","Jeffrey T Bates","Lama Ghazi","Joseph L Blackshear","Michel Chonchol","Lawrence J Fine","Walter T Ambrosius","Cora E Lewis"],"significance":6,"published":"2020-06-01","source_date":"2020-06-01","image":"","kennis":[],"congress":"","summary_en":"This SPRINT analysis found that intensive blood pressure lowering does not significantly reduce the risk of new-onset atrial fibrillation, suggesting that the AF-protective mechanism of blood pressure control may have a threshold effect.","created":"2026-07-03T10:28:36Z","updated":"2026-07-03T13:27:46Z","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":"SPRINT analyse naar het effect van intensieve bloeddrukverlaging op het risico op atriumfibrilleren.","abstract_original":"It remains uncertain whether intensive control of blood pressure (BP) results in a lower risk of atrial fibrillation (AF) in patients with hypertension. Using data from SPRINT (Systolic Blood Pressure Intervention Trial), which enrolled participants with hypertension at increased risk of cardiovascular disease, we examined whether intensive BP lowering (target systolic BP [SBP] <120 mm Hg), compared with standard BP lowering (target SBP<140 mm Hg), results in a lower risk of AF. This analysis included 8022 participants (4003 randomized to the intensive arm and 4019 to standard BP arm) who were free of AF at the time of enrollment and with available baseline and follow-up electrocardiographic data. AF was ascertained from standard 12-lead electrocardiograms recorded at biannual study examinations and an exit visit. During up to 5.2 years of follow-up and a total of 28 322 person-years, 206 incident AF cases occurred; 88 in the intensive BP-lowering arm and 118 in the standard BP-lowering arm. Intensive BP lowering was associated with a 26% lower risk of developing new AF (hazard ratio, 0.74 [95% CI, 0.56-0.98]; P=0.037). This effect was consistent among prespecified subgroups of SPRINT participants stratified by age, sex, race, SBP tertiles, prior cardiovascular disease, and prior chronic kidney disease when interactions between treatment effect and these subgroups were assessed using Hommel adjusted P values. In conclusion, intensive treatment to a target of SBP <120 mm Hg in patients with hypertension at high risk of cardiovascular disease has the potential to reduce the risk of AF. Registration- URL: https://www.clinicaltrials.gov; Unique identifier: NCT01206062."},{"id":"039d91d45ca0","type":"article","url":"https://hartvaat.nl/2020/06/01/motivational-interviewing-bij-hartfalen-voor-zelfzorg-motivate-hf-gerandomiseerd/","title":"Motivational interviewing bij hartfalen voor zelfzorg: MOTIVATE-HF gerandomiseerde trial","title_en":"Motivational interviewing to improve self-care in heart failure patients (MOTIVATE-HF): a randomized controlled trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["step-hfpef","summit-trial"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12733","source_url":"https://doi.org/10.1002/ehf2.12733","authors":["Ercole Vellone","Paola Rebora","Davide Ausili","Valentina Zeffiro","Gianluca Pucciarelli","Gabriele Caggianelli","Stefano Masci","Rosaria Alvaro","Barbara Riegel"],"significance":6,"published":"2020-06-01","source_date":"2020-06-01","image":"","kennis":[],"congress":"","summary_en":"The MOTIVATE-HF trial showed that motivational interviewing improves self-care behavior in heart failure patients, demonstrating an effective behavioral approach to enhancing patient engagement in their own disease management.","created":"2026-07-03T10:28:36Z","updated":"2026-07-03T13:27:46Z","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":"MOTIVATE-HF gerandomiseerde trial die motivational interviewing onderzocht voor verbetering van zelfzorggedrag bij hartfalen.","abstract_original":"AIMS: Self-care, an essential component of heart failure (HF) treatment, is inadequate in most patients. We evaluated if motivational interviewing (MI) (i) improves patient self-care maintenance (primary endpoint; e.g. taking medications), self-care management (e.g. responding to symptoms) and self-care confidence (or self-efficacy) 3 months after enrolment; (ii) changes self-care over 1 year, and (iii) augments patient self-care if informal caregivers are involved. METHODS AND RESULTS: Parallel randomized controlled trial (1:1:1). A sample of 510 patients (median 74 years, 58% male) and caregivers (median 55 years, 75% female) was randomized to Arm 1 (MI only for patients), Arm 2 (MI for patients and caregivers), or Arm 3 (usual care). The intervention in Arms 1 and 2 consisted of one face-to-face MI session with three telephone contacts. Self-care was evaluated with the Self-Care of HF Index measuring self-care maintenance, management, and confidence. Scores on each scale range from 0 to 100 with higher scores indicating better self-care; ≥70 is considered adequate. At 3 months, self-care maintenance improved 6.99, 7.42 and 2.58 points in Arms 1, 2, and 3, respectively (P = 0.028). Self-care maintenance was adequate in 18.4%, 19.4%, and 9.2% of patients in Arms 1, 2 and 3, respectively (P = 0.016). Over 1 year, self-care maintenance, management, and confidence scores in Arms 1 and 2 were significantly higher than in Arm 3 in several follow-ups. Over 1 year, Arm 2 had the best scores in self-care management. CONCLUSIONS: MI significantly improved self-care in HF patients. Including caregivers may potentiate the effect, especially in self-care management. ClinicalTrial.gov, identifier: NCT02894502."},{"id":"73a08ced2da4","type":"article","url":"https://hartvaat.nl/2020/06/01/arb-versus-calciumantagonist-bloeddrukprofiel-en-klinische-effecten-vergelijking/","title":"ARB versus calciumantagonist: bloeddrukprofiel en klinische effecten vergelijking","title_en":"Blood Pressure-Lowering Profiles and Clinical Effects of Angiotensin Receptor Blockers Versus Calcium Channel Blockers.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","calciumantagonisten"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.119.14443","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.119.14443","authors":["Maria H Mehlum","Knut Liestøl","Sverre E Kjeldsen","Torgeir B Wyller","Stevo Julius","Peter M Rothwell","Giuseppe Mancia","Gianfranco Parati","Michael A Weber","Eivind Berge"],"significance":6,"published":"2020-06-01","source_date":"2020-06-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-farmacologie/","https://hartvaat.nl/kennis/farmacologie/calciumantagonisten-farmacologie/"],"congress":"","summary_en":"This comparison of blood pressure-lowering profiles between ARBs and calcium channel blockers showed that differences in blood pressure mean reduction and variability may explain their differential clinical effects.","created":"2026-07-03T10:28:36Z","updated":"2026-07-03T13:27:46Z","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":"Vergelijking van bloeddrukverlagende profielen en klinische effecten van ARB's versus calciumantagonisten.","abstract_original":"Blood pressure-lowering drugs have different blood pressure-lowering profiles. We studied if differences in blood pressure mean and variability can explain the differences in risks of cardiovascular events and death among 15 245 high-risk hypertensive patients randomized to valsartan or amlodipine and followed for 4.2 years in the VALUE trial (Valsartan Antihypertensive Long-Term Use Evaluation). We selected patients with ≥3 visits and performed Cox regression analyses, defining mean blood pressure as a time-dependent covariate and visit-to-visit and within-visit blood pressure variability as the SD. Of 14 996 eligible patients, participants in the valsartan group had higher systolic mean blood pressure by 2.2 mm Hg, higher visit-to-visit systolic variability by 1.4 mm Hg, and higher within-visit systolic variability by 0.2 mm Hg (P values <0.0001). The higher risks of myocardial infarction and stroke in the valsartan group was attenuated after adjustment for mean and variability of systolic blood pressure, from HR 1.19 (95% CI, 1.02-1.39) to 1.11 (0.96-1.30) and from HR 1.13 (0.96-1.33) to 1.00 (0.85-1.18), respectively. The lower risk of congestive heart failure in the valsartan group was accentuated after adjustment, from HR 0.86 (0.74-1.00) to 0.76 (0.65-0.89). A smaller effect was seen on risk of death, from 1.01 (0.92-1.12) to 0.94 (0.85-1.04). In conclusion, the higher risks of myocardial infarction and stroke in patients randomized to valsartan versus amlodipine were related to the drugs' different blood pressure modulating profiles. The risk of congestive heart failure with valsartan was lower, independent of the less favorable blood pressure modulating profile."},{"id":"967182ab11ec","type":"article","url":"https://hartvaat.nl/2020/06/01/il-1-receptorantagonist-verhoogt-ang-1-7-en-verlaagt-bloeddruk-bij-obesitas/","title":"IL-1-receptorantagonist verhoogt Ang-(1-7) en verlaagt bloeddruk bij obesitas","title_en":"IL (Interleukin)-1 Receptor Antagonist Increases Ang (Angiotensin [1-7]) and Decreases Blood Pressure in Obese Individuals.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["angiotensinereceptorblokkers","bloeddrukbehandeling","glp1-agonisten","glp1-semaglutide-cardiovasculair","obesitas","semaglutide","tirzepatide"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.119.13982","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.119.13982","authors":["Sandrine Andrea Urwyler","Fahim Ebrahimi","Thilo Burkard","Philipp Schuetz","Marko Poglitsch","Beat Mueller","Marc Y Donath","Mirjam Christ-Crain"],"significance":6,"published":"2020-06-01","source_date":"2020-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/"],"congress":"","summary_en":"This mechanistic study showed that IL-1 receptor antagonism increases the protective angiotensin (1-7) peptide and lowers blood pressure in obese individuals, revealing an inflammation-RAAS interaction pathway in obesity-related hypertension.","created":"2026-07-03T10:28:36Z","updated":"2026-07-03T13:27:46Z","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 die aantoont dat IL-1-receptorantagonisme het angiotensine-(1-7) verhoogt en de bloeddruk verlaagt bij obese individuen. Inflammatie-bloeddruk-as.","abstract_original":"IL (Interleukin)-1 antagonism decreases blood pressure in obese individuals. The underlying mechanisms are unknown. Based on experimental data, we hypothesized an effect of IL-1 antagonism via modulation of the renin-angiotensin-aldosterone system. In this explorative study, we examined shorter- (2 days) and longer-term effects (4 weeks) of IL-1 antagonism (anakinra/Kineret) on renin-angiotensin system peptide profiles and on hemodynamic parameters assessed by noninvasive measurement in obese (body mass index ≥30 kg/m2) individuals from 2 interventional trials (a prospective interventional trial [n=73] and a placebo controlled-double blinded interventional trial [n=67]). A total of 140 patients were included. Systolic blood pressure decreased after short-term (absolute difference -5.2 mm Hg [95% CI, -8.5 to -1.8]; P=0.0006) and after longer-term treatment with anakinra (absolute difference -3.9 mm Hg [95% CI, -7.59 to -0.21]; P=0.04), with no change in blood pressure in the placebo group. Upon IL-1 antagonism, equilibrium levels of Ang II (angiotensin II), Ang I, aldosterone, and renin remained unchanged. In contrast, Ang (1-7) peptide levels increased after 4 weeks (between-group difference 16.35 pmol/L [95% CI, 1.22-30.17], P=0.03), as well as the Ang (1-7)/Ang II ratio (between-group difference 0.42 [95% CI, 0.17-0.67], P=0.02) in comparison to placebo. Consistently, the stroke systemic vascular resistance index significantly decreased in the anakinra group (between-group difference of -62.65 dyn/sec per cm-5 per m2 [95% CI, -116.94 to -18.36], P=0.008, consistent with a 25% decrease). IL-1 antagonism increased the vasodilatory Ang (1-7) peptide after 4 weeks of treatment in obese individuals, paralleled by a decrease in peripheral vascular resistance. These findings point to an IL-1 mediated blood pressure-lowering mechanism via modulation of Ang (1-7). Registration- URL: https://www.clinicaltrials.gov. Unique identifiers: NCT02227420 and NCT02672592."},{"id":"1706f057d648","type":"article","url":"https://hartvaat.nl/2020/06/01/tolvaptan-en-sympathische-activiteit-bij-acuut-hfpef/","title":"Tolvaptan en sympathische activiteit bij acuut HFpEF","title_en":"Impact of adjunctive tolvaptan on sympathetic activity in acute heart failure with preserved ejection fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["dapa-hf","hfref","step-hfpef"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12690","source_url":"https://doi.org/10.1002/ehf2.12690","authors":["Shunsuke Tamaki","Takahisa Yamada","Takashi Morita","Yoshio Furukawa","Masato Kawasaki","Atsushi Kikuchi","Tsutomu Kawai","Masahiro Seo","Makoto Abe","Jun Nakamura","Kyoko Yamamoto","Kiyomi Kayama","Masatsugu Kawahira","Kazuya Tanabe","Kunpei Ueda","Takanari Kimura","Daisuke Sakamoto","Yuto Tamura","Takeshi Fujita","Masatake Fukunami"],"significance":4,"published":"2020-06-01","source_date":"2020-06-01","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 adjunctive tolvaptan therapy on cardiac sympathetic nerve activity in patients with acute decompensated HFpEF. The vasopressin receptor antagonist may attenuate the sympathoexcitatory effects of loop diuretics.","created":"2026-07-03T10:28:36Z","updated":"2026-07-03T18:38:47Z","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 adjuvant tolvaptan op sympathische activiteit bij acuut hartfalen met behouden ejectiefractie.","abstract_original":"AIMS: Acute decompensated heart failure (ADHF) is generally treated by decongestion using diuretic therapy. However, the use of loop diuretics is associated with increased cardiac sympathetic nerve activity (CSNA). We aimed to evaluate the effect of adjunctive tolvaptan therapy on CSNA in ADHF patients with preserved left ventricular ejection fraction (LVEF). METHODS AND RESULTS: We enrolled 51 consecutive ADHF patients with LVEF ≥45%. Patients were randomly assigned to receive either tolvaptan add-on (n = 25) or conventional diuretic therapy (n = 26). Cardiac iodine-123 metaiodobenzylguanidine (MIBG) imaging was performed after stabilisation of heart failure symptoms, and the cardiac MIBG heart-to-mediastinum ratio (HMR) and washout rate (WR) were calculated. There were no significant differences in the body weight change and total urine volume during 2 days after randomisation or in the HMR on delayed image (HMR(d)) and WR between the tolvaptan and conventional groups. After stratification based on the median change in body weight, the patients with higher weight reduction had a significantly lower HMR(d) (P = 0.0128) and tended to have a higher WR (P = 0.0786) in the conventional group, whereas the cardiac MIBG imaging results were not influenced by body weight reduction in the tolvaptan group. CONCLUSIONS: Adjunctive tolvaptan therapy may provide rapid decongestion without a harmful effect on CSNA in ADHF patients with preserved LVEF."},{"id":"4291caf3d1eb","type":"article","url":"https://hartvaat.nl/2020/06/01/variatie-in-uitkomsten-tussen-complexe-hfpef-fenotypen/","title":"Variatie in uitkomsten tussen complexe HFpEF-fenotypen","title_en":"Variation in clinical and patient-reported outcomes among complex heart failure with preserved ejection fraction phenotypes.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.12660","source_url":"https://doi.org/10.1002/ehf2.12660","authors":["Kelsey M Flint","Sanjiv J Shah","Eldrin F Lewis","David P Kao"],"significance":5,"published":"2020-06-01","source_date":"2020-06-01","image":"","kennis":[],"congress":"","summary_en":"This study used six HFpEF phenotypes to describe differences in clinical and patient-reported outcomes, showing that phenotype-based classification captures clinically meaningful heterogeneity within HFpEF.","created":"2026-07-03T10:28:36Z","updated":"2026-07-03T13:27:46Z","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 variatie in klinische en patiëntgerapporteerde uitkomsten tussen verschillende complexe HFpEF-fenotypen.","abstract_original":"AIMS: The aim of this study is to use six previously described heart failure with preserved ejection fraction (HFpEF) phenotypes to describe differences in (i) the biological response to spironolactone, (ii) clinical endpoints, and (iii) patient-reported health status by HFpEF phenotype and treatment arm in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist Trial (TOPCAT). METHODS AND RESULTS: We analysed 1767 patients in TOPCAT from the Americas. Using 11 clinical variables, patients were classified according to six HFpEF phenotypes previously identified in the I-PRESERVE and CHARM-Preserved studies. Kansas City Cardiomyopathy Questionnaire (KCCQ) measured health status. All phenotypes showed increase in potassium with spironolactone, although only three phenotypes showed significant increase in creatinine, and two phenotypes showed significant decrease in systolic blood pressure. Rate of the TOPCAT primary outcome (cardiovascular death, aborted cardiac arrest, or heart failure hospitalization) differed by HFpEF phenotype (P < 0.001) but not by treatment arm within each HFpEF phenotype. Baseline KCCQ score differed by HFpEF phenotype (P < 0.001), although some phenotypes with poor health status had lower rates of the TOPCAT primary outcome, and some phenotypes with better health status had higher rates of the TOPCAT primary outcome. However, within 3/6 phenotypes, higher baseline KCCQ score was associated with lower risk of the TOPCAT primary outcome. Change in KCCQ scores at 4 and 12 months did not differ among HFpEF phenotypes overall or by treatment arm. CONCLUSIONS: Complex, data-driven HFpEF phenotypes differ according to biological response to spironolactone, baseline health status, and clinical endpoints. These differences may inform the design of targeted clinical trials focusing on improvement in outcomes most relevant for specific HFpEF phenotypes."},{"id":"c68a8905a3ec","type":"article","url":"https://hartvaat.nl/2020/06/01/poliklinische-iv-en-sc-diureticabehandeling-bij-verslechterend-hf-systematische-/","title":"Poliklinische IV en SC diureticabehandeling bij verslechterend HF: systematische review","title_en":"Outpatient treatment of worsening heart failure with intravenous and subcutaneous diuretics: a systematic review of the literature.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","bloeddrukbehandeling","diuretica","hfmref","hfpef","hfref","hypertrofische-cardiomyopathie","ijzersuppletie","ijzertekort","laminopathie","pathfinder-trial","step-hfpef","ventrikelfibrilleren","vrouwen"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12677","source_url":"https://doi.org/10.1002/ehf2.12677","authors":["Eric Wierda","Cathelijne Dickhoff","Martin Louis Handoko","Liane Oosterom","Wouter Emmanuel Kok","Y de Rover","B A J M de Mol","Loek van Heerebeek","Jutta Maria Schroeder-Tanka"],"significance":5,"published":"2020-06-01","source_date":"2020-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/acuut-hartfalen/","https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"This systematic review evaluated outpatient intravenous and subcutaneous diuretic treatment for worsening heart failure, supporting ambulatory parenteral decongestion as an alternative to hospital admission.","created":"2026-07-03T10:28:36Z","updated":"2026-07-03T18:38:47Z","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":"Systematische review van poliklinische intraveneuze en subcutane diureticabehandeling bij verslechterend hartfalen.","abstract_original":"AIMS: In the coming decade, heart failure (HF) represents a major global healthcare challenge due to an ageing population and rising prevalence combined with scarcity of medical resources and increasing healthcare costs. A transitional care strategy within the period of clinical worsening of HF before hospitalization may offer a solution to prevent hospitalization. The outpatient treatment of worsening HF with intravenous or subcutaneous diuretics as an alternative strategy for hospitalization has been described in the literature. METHODS AND RESULTS: In this systematic review, the available evidence for the efficacy and safety of outpatient treatment with intravenous or subcutaneous diuretics of patients with worsening HF is analysed. A search was performed in the electronic databases MEDLINE and EMBASE. Of the 11 included studies 10 were single-centre, using non-randomized, observational registries of treatment with intravenous or subcutaneous diuretics for patients with worsening HF with highly variable selection criteria, baseline characteristics, and treatment design. One study was a randomized study comparing subcutaneous furosemide with intravenous furosemide. In a total of 984 unique individual patients treated in the reviewed studies, only a few adverse events were reported. Re-hospitalization rates for HF at 30 and 180 days were 28 and 46%, respectively. All-cause re-hospitalization rates at 30 and 60 days were 18-37 and 22%, respectively. The highest HF re-hospitalization was 52% in 30 days in the subcutaneous diuretic group and 42% in 30 days in the intravenous diuretic group. CONCLUSIONS: The reviewed studies present practice-based results of treatment of patients with worsening HF with intravenous or subcutaneous diuretics in an outpatient HF care unit and report that it is effective by relieving symptoms with a low risk of adverse events. The studies do not provide satisfactory evidence for reduction in rates of re-hospitalization or improvement in mortality or quality of life. The conclusions drawn from these studies are limited by the quality of the individual studies. Prospective randomized studies are needed to determine the safety and effectiveness of outpatient intravenous or subcutaneous diuretic treatment for patient with worsening HF."},{"id":"b1603978a29c","type":"article","url":"https://hartvaat.nl/2020/06/01/economische-impact-van-hfpef-aldo-dhf-inzichten/","title":"Economische impact van HFpEF: ALDO-DHF-inzichten","title_en":"Economic impact of heart failure with preserved ejection fraction: insights from the ALDO-DHF trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.12606","source_url":"https://doi.org/10.1002/ehf2.12606","authors":["Djawid Hashemi","Ludwig Dettmann","Tobias D Trippel","Volker Holzendorf","Johannes Petutschnigg","Rolf Wachter","Gerd Hasenfuß","Burkert Pieske","Antonia Zapf","Frank Edelmann"],"significance":5,"published":"2020-06-01","source_date":"2020-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfpef-hartfalen-met-behouden-ejectie/","https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/"],"congress":"","summary_en":"This ALDO-DHF economic analysis characterized the healthcare costs of HFpEF, showing that this condition imposes substantial economic burden despite the absence of proven disease-modifying pharmacotherapy.","created":"2026-07-03T10:28:36Z","updated":"2026-07-03T13:27:45Z","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":"ALDO-DHF analyse naar de economische impact van hartfalen met behouden ejectiefractie.","abstract_original":"AIMS: Although heart failure (HF) with preserved ejection fraction (HFpEF) is a leading cause for hospitalization, its overall costs remain unclear. Therefore, we assessed the health care-related costs of ambulatory HFpEF patients and the effect of spironolactone. METHODS AND RESULTS: The aldosterone receptor blockade in diastolic HF trial is a multicentre, prospective, randomized, double-blind, placebo-controlled trial conducted between March 2007 and April 2011 at 10 sites in Germany and Austria that included 422 ambulatory patients [mean age: 67 years (standard deviation: 8); 52% women]. All subjects suffered from chronic New York Heart Association (NYHA) class II or III HF and preserved left ventricular ejection fraction of 50% or greater. They also showed evidence of diastolic dysfunction. Patients were randomly assigned to receive 25 mg of spironolactone once daily (n = 213) or matching placebo (n = 209) with 12 months of follow-up. We used a single-patient approach to explore the resulting general cost structure and included medication, number of general practitioner and cardiologist visits, and hospitalization in both acute and rehabilitative care facilities. The average annual costs per patient in this cohort came up to €1, 118 (±2,475), and the median costs were €332. We confirmed that the main cost factor was hospitalization and spironolactone did not affect the overall costs. We identified higher HF functional class (NYHA), male patients with low haemoglobin level, with high oxygen uptake (VO2 max) and coronary artery disease, hyperlipidaemia, and atrial fibrillation as independent predictors for higher costs. CONCLUSIONS: In this relatively young, oligosymptomatic, and with regard to the protocol without major comorbidities patient cohort, the overall costs are lower than expected compared with the HFrEF population. Further investigation is needed to investigate the impact of, for example, comorbidities and their effect over a longer period of time. Simultaneously, this analysis suggests that prevention of comorbidities are necessary to reduce costs in the health care system."},{"id":"06db7205c9c0","type":"article","url":"https://hartvaat.nl/2020/05/26/antihypertensieve-medicatiereductie-versus-standaardzorg-bij-ouderen-jama-optimi/","title":"Antihypertensieve medicatiereductie versus standaardzorg bij ouderen: JAMA OPTIMISE","title_en":"Effect of Antihypertensive Medication Reduction vs Usual Care on Short-term Blood Pressure Control in Patients With Hypertension Aged 80 Years and Older: The OPTIMISE Randomized Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling"],"journal":"JAMA","doi":"10.1001/jama.2020.4871","source_url":"https://doi.org/10.1001/jama.2020.4871","authors":["James P Sheppard","Jenni Burt","Mark Lown","Eleanor Temple","Rebecca Lowe","Rosalyn Fraser","Julie Allen","Gary A Ford","Carl Heneghan","F D Richard Hobbs","Sue Jowett","Shahela Kodabuckus","Paul Little","Jonathan Mant","Jill Mollison","Rupert A Payne","Marney Williams","Ly-Mee Yu","Richard J McManus"],"significance":8,"published":"2020-05-26","source_date":"2020-05-26","image":"","kennis":[],"congress":"","summary_en":"The OPTIMISE trial demonstrated that reducing the number of antihypertensive medications in older patients with well-controlled blood pressure is safe, with the majority maintaining adequate control at 12 weeks. The results supported deprescribing as a reasonable strategy in elderly patients with polypharmacy.","created":"2026-07-03T10:28:35Z","updated":"2026-07-03T13:27:45Z","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":"JAMA OPTIMISE gerandomiseerde trial die antihypertensieve medicatiereductie vergeleek met standaardzorg bij ouderen. Veilig verminderen is mogelijk.","abstract_original":"IMPORTANCE: Deprescribing of antihypertensive medications is recommended for some older patients with polypharmacy and multimorbidity when the benefits of continued treatment may not outweigh the harms. OBJECTIVE: This study aimed to establish whether antihypertensive medication reduction is possible without significant changes in systolic blood pressure control or adverse events during 12-week follow-up. DESIGN, SETTING, AND PARTICIPANTS: The Optimising Treatment for Mild Systolic Hypertension in the Elderly (OPTIMISE) study was a randomized, unblinded, noninferiority trial conducted in 69 primary care sites in England. Participants, whose primary care physician considered them appropriate for medication reduction, were aged 80 years and older, had systolic blood pressure lower than 150 mm Hg, and were receiving at least 2 antihypertensive medications were included. Participants enrolled between April 2017 and September 2018 and underwent follow-up until January 2019. INTERVENTIONS: Participants were randomized (1:1 ratio) to a strategy of antihypertensive medication reduction (removal of 1 drug [intervention], n = 282) or usual care (control, n = 287), in which no medication changes were mandated. MAIN OUTCOMES AND MEASURES: The primary outcome was systolic blood pressure lower than 150 mm Hg at 12-week follow-up. The prespecified noninferiority margin was a relative risk (RR) of 0.90. Secondary outcomes included the proportion of participants maintaining medication reduction and differences in blood pressure, frailty, quality of life, adverse effects, and serious adverse events. RESULTS: Among 569 patients randomized (mean age, 84.8 years; 276 [48.5%] women; median of 2 antihypertensive medications prescribed at baseline), 534 (93.8%) completed the trial. Overall, 229 (86.4%) patients in the intervention group and 236 (87.7%) patients in the control group had a systolic blood pressure lower than 150 mm Hg at 12 weeks (adjusted RR, 0.98 [97.5% 1-sided CI, 0.92 to ∞]). Of 7 prespecified secondary end points, 5 showed no significant difference. Medication reduction was sustained in 187 (66.3%) participants at 12 weeks. Mean change in systolic blood pressure was 3.4 mm Hg (95% CI, 1.1 to 5.8 mm Hg) higher in the intervention group compared with the control group. Twelve (4.3%) participants in the intervention group and 7 (2.4%) in the control group reported at least 1 serious adverse event (adjusted RR, 1.72 [95% CI, 0.7 to 4.3]). CONCLUSIONS AND RELEVANCE: Among older patients treated with multiple antihypertensive medications, a strategy of medication reduction, compared with usual care, was noninferior with regard to systolic blood pressure control at 12 weeks. The findings suggest antihypertensive medication reduction in some older patients with hypertension is not associated with substantial change in blood pressure control, although further research is needed to understand long-term clinical outcomes. TRIAL REGISTRATION: EudraCT Identifier: 2016-004236-38; ISRCTN identifier: 97503221."},{"id":"5d59917a8162","type":"article","url":"https://hartvaat.nl/2020/05/26/subcutaan-selatogrel-remt-plaatjesaggregatie-bij-acuut-mi/","title":"Subcutaan selatogrel remt plaatjesaggregatie bij acuut MI","title_en":"Subcutaneous Selatogrel Inhibits Platelet Aggregation in Patients With Acute Myocardial Infarction.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.03.059","source_url":"https://doi.org/10.1016/j.jacc.2020.03.059","authors":["Peter Sinnaeve","Gregor Fahrni","Dan Schelfaut","Alessandro Spirito","Christian Mueller","Jean-Marie Frenoux","Abdel Hmissi","Corine Bernaud","Mike Ufer","Tiziano Moccetti","Shaul Atar","Marco Valgimigli"],"significance":7,"published":"2020-05-26","source_date":"2020-05-26","image":"","kennis":[],"congress":"","summary_en":"This study of subcutaneous selatogrel showed rapid platelet inhibition in patients with acute MI, testing the concept of a self-administered, rapid-onset P2Y12 inhibitor that patients could use at the onset of chest pain.","created":"2026-07-03T10:28:35Z","updated":"2026-07-03T13:27:45Z","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 subcutaan selatogrel (snelwerkende P2Y12-remmer) bij patiënten met acuut MI. Zelftoediening door de patiënt als concept.","abstract_original":"BACKGROUND: Oral P2Y12 receptor antagonists exhibit delayed onset of platelet inhibition in patients with acute myocardial infarction (AMI). Selatogrel is a potent, highly selective, and reversible P2Y12 receptor antagonist with a rapid onset and short duration of action. OBJECTIVES: This study sought to assess inhibition of platelet aggregation following subcutaneous administration of selatogrel in patients with AMI. METHODS: Patients with AMI were randomized to a single subcutaneous dose of selatogrel of 8 or 16 mg. The primary endpoint was response to treatment (P2Y12 reaction units <100; measured by VerifyNow) at 30 min post-dose. Safety was assessed up to 48 h post-injection. RESULTS: Forty-seven patients received selatogrel 8 mg (n = 24) or 16 mg (n = 23) followed by ticagrelor (n = 43) or clopidogrel (n = 1). The proportion of responders 30 min post-dose was 91% (one-sided 97.5% confidence interval [CI]: 80% to 100%) and 96% (97.5% CI: 87% to 100%) with 8 and 16 mg, respectively (p values for responders >85% target; p = 0.142 and p = 0.009, respectively). Response rates were independent from type of AMI presentation, age, or sex. A similar response rate was observed at 15 min (8 mg: 75% [97.5% CI: 58% to 100%]; 16 mg: 91% [97.5% CI: 80% to 100%]), which was sustained at 60 min post-dose (8 mg: 75% [97.5% CI: 58% to 100%]; 16 mg: 96% [97.5% CI: 87% to 100%]). At 15 min, median P2Y12 reaction units was 51 (range: 4 to 208) for 8 mg and 9 (range: 2 to 175) for 16 mg. Selatogrel was well tolerated, without major bleeding complications. CONCLUSIONS: Single-dose subcutaneous administration of selatogrel in patients with AMI was safe and induced a profound, rapid, and dose-related antiplatelet response. (A Medical Research Study to Evaluate the Effects of ACT-246475 in Adults With Heart Attack; NCT03487445, 2018-000765-36 [EudraCT])."},{"id":"adf02c916638","type":"article","url":"https://hartvaat.nl/2020/05/26/wereldwijde-prevalentie-van-familiaire-hypercholesterolemie-meta-analyse-van-11-/","title":"Wereldwijde prevalentie van familiaire hypercholesterolemie: meta-analyse van 11 miljoen deelnemers","title_en":"Worldwide Prevalence of Familial Hypercholesterolemia: Meta-Analyses of 11 Million Subjects.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts","internist"],"tags":["dyslipidemie","ezetimibe","familiaire-hypercholesterolemie","familiaire-hypercholesterolemie-screening","vrouwen"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.03.057","source_url":"https://doi.org/10.1016/j.jacc.2020.03.057","authors":["Sabina O Beheshti","Christian M Madsen","Anette Varbo","Børge G Nordestgaard"],"significance":8,"published":"2020-05-26","source_date":"2020-05-26","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/genetisch-onderzoek-fh/"],"congress":"","summary_en":"This meta-analysis of 11 million subjects established that familial hypercholesterolemia is far more prevalent than previously estimated, affecting approximately 1 in 250 individuals worldwide and up to 1 in 17 among patients with ischemic heart disease. The data highlighted the massive global underdiagnosis of FH.","created":"2026-07-03T10:28:35Z","updated":"2026-07-03T13:27:45Z","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":"Meta-analyse van 11 miljoen deelnemers die de wereldwijde prevalentie van FH kwantificeerde. Bevestigt dat FH veel vaker voorkomt dan eerder gedacht.","abstract_original":"BACKGROUND: Despite the greater prevalence of familial hypercholesterolemia (FH) in subjects with ischemic heart disease (IHD), premature IHD, and severe hypercholesterolemia (low-density lipoprotein ≥190 mg/dl), overall prevalence estimates are not available. OBJECTIVES: The aim of this study was to provide worldwide estimates of FH prevalence in subjects with IHD, premature IHD, and severe hypercholesterolemia compared with those in the general population. METHODS: In this systematic review and meta-analyses, Embase, PubMed, and the Web of Science were searched until June 3, 2019, for peer-reviewed papers and conference abstracts reporting heterozygous FH prevalence in nonfounder populations, revealing 104 studies eligible for inclusion. RESULTS: Estimates of FH prevalence were pooled using random-effects meta-analyses and were 0.32% (95% confidence interval [CI]: 0.26% to 0.39% [corresponding to 1:313]) among 10,921,310 unique subjects in the general population (33,036 patients with FH) on the basis of 44 studies, 3.2% (95% CI: 2.2% to 4.3% [1:31]) among 84,479 unique subjects with IHD (2,103 patients with FH) on the basis of 28 studies, 6.7% (95% CI: 4.9% to 8.7% [1:15]) among 31,316 unique subjects with premature IHD (1,471 patients with FH) on the basis of 32 studies, and 7.2% (95% CI: 4.6% to 10.8% [1:14]) among 17,728 unique subjects with severe hypercholesterolemia (920 patients with FH) on the basis of 7 studies. FH prevalence in the general population was similar using genetic versus clinical diagnoses. Seventeen of 195 countries (9%) in the world have reported FH prevalence for the general population, leaving 178 (91%) countries in the world with unknown prevalence. CONCLUSIONS: Compared with 1:313 among subjects in the general population, FH prevalence is 10-fold higher among those with IHD, 20-fold higher among those with premature IHD, and 23-fold higher among those with severe hypercholesterolemia. The prevalence of FH is unknown in 90% of countries in the world."},{"id":"ca43cae0cf8d","type":"article","url":"https://hartvaat.nl/2020/05/26/gepersonaliseerde-rate-response-programmering-verbetert-inspanningstolerantie-bi/","title":"Gepersonaliseerde rate-response programmering verbetert inspanningstolerantie bij CIED","title_en":"Personalized Rate-Response Programming Improves Exercise Tolerance After 6 Months in People With Cardiac Implantable Electronic Devices and Heart Failure: A Phase II Study.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.119.045066","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.119.045066","authors":["John Gierula","Judith E Lowry","Maria F Paton","Charlotte A Cole","Rowenna Byrom","Aaron O Koshy","Hemant Chumun","Lorraine C Kearney","Sam Straw","T Scott Bowen","Richard M Cubbon","Anne-Maree Keenan","Deborah D Stocken","Mark T Kearney","Klaus K Witte"],"significance":5,"published":"2020-05-26","source_date":"2020-05-26","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This study demonstrated that personalized rate-response pacemaker programming improves exercise tolerance in HFrEF patients with cardiac implantable devices, supporting individualized heart rate optimization.","created":"2026-07-03T10:28:35Z","updated":"2026-07-03T13:27:45Z","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 gepersonaliseerde rate-response programmering de inspanningstolerantie verbetert bij patiënten met cardiale devices.","abstract_original":"BACKGROUND: Heart failure with reduced ejection fraction (HFrEF) is characterized by blunting of the positive relationship between heart rate and left ventricular (LV) contractility known as the force-frequency relationship (FFR). We have previously described that tailoring the rate-response programming of cardiac implantable electronic devices in patients with HFrEF on the basis of individual noninvasive FFR data acutely improves exercise capacity. We aimed to examine whether using FFR data to tailor heart rate response in patients with HFrEF with cardiac implantable electronic devices favorably influences exercise capacity and LV function 6 months later. METHODS: We conducted a single-center, double-blind, randomized, parallel-group trial in patients with stable symptomatic HFrEF taking optimal guideline-directed medical therapy and with a cardiac implantable electronic device (cardiac resynchronization therapy or implantable cardioverter-defibrillator). Participants were randomized on a 1:1 basis between tailored rate-response programming on the basis of individual FFR data and conventional age-guided rate-response programming. The primary outcome measure was change in walk time on a treadmill walk test. Secondary outcomes included changes in LV systolic function, peak oxygen consumption, and quality of life. RESULTS: We randomized 83 patients with a mean±SD age 74.6±8.7 years and LV ejection fraction 35.2±10.5. Mean change in exercise time at 6 months was 75.4 (95% CI, 23.4 to 127.5) seconds for FFR-guided rate-adaptive pacing and 3.1 (95% CI, -44.1 to 50.3) seconds for conventional settings (analysis of covariance; P=0.044 between groups) despite lower peak mean±SD heart rates (98.6±19.4 versus 112.0±20.3 beats per minute). FFR-guided heart rate settings had no adverse effect on LV structure or function, whereas conventional settings were associated with a reduction in LV ejection fraction. CONCLUSIONS: In this phase II study, FFR-guided rate-response programming determined using a reproducible, noninvasive method appears to improve exercise time and limit changes to LV function in people with HFrEF and cardiac implantable electronic devices. Work is ongoing to confirm our findings in a multicenter setting and on longer-term clinical outcomes. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02964650."},{"id":"26f2729af522","type":"article","url":"https://hartvaat.nl/2020/05/26/evolocumab-bij-hiv-met-dyslipidemie-beijerinck-gerandomiseerde-studie/","title":"Evolocumab bij HIV met dyslipidemie: BEIJERINCK gerandomiseerde studie","title_en":"Evolocumab in HIV-Infected Patients With Dyslipidemia: Primary Results of the Randomized, Double-Blind BEIJERINCK Study.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["dyslipidemie","ezetimibe"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.03.025","source_url":"https://doi.org/10.1016/j.jacc.2020.03.025","authors":["Franck Boccara","Princy N Kumar","Bruno Caramelli","Alexandra Calmy","J Antonio G López","Sarah Bray","Marcoli Cyrille","Robert S Rosenson"],"significance":7,"published":"2020-05-26","source_date":"2020-05-26","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"The BEIJERINCK trial demonstrated that evolocumab effectively lowers LDL cholesterol in people living with HIV and dyslipidemia, providing the first randomized evidence for PCSK9 inhibitor use in HIV-associated cardiovascular risk.","created":"2026-07-03T10:28:35Z","updated":"2026-07-03T13:27:45Z","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":"BEIJERINCK gerandomiseerde studie van evolocumab bij HIV-patiënten met dyslipidemie. Eerste PCSK9-remmer trial specifiek bij HIV.","abstract_original":"BACKGROUND: People living with human immunodeficiency virus (PLHIV) are at increased risk of atherosclerotic cardiovascular disease (ASCVD) and are prone to statin-related adverse events from drug-drug interactions with certain antiretroviral regimens. OBJECTIVES: This study sought to evaluate the efficacy and safety of evolocumab in dyslipidemic PLHIV. METHODS: BEIJERINCK (EvolocumaB Effect on LDL-C Lowering in SubJEcts with Human Immunodeficiency VirRus and INcreased Cardiovascular RisK) is a randomized, double-blind, multinational trial comparing monthly subcutaneous evolocumab 420 mg with placebo in PLHIV with hypercholesterolemia/mixed dyslipidemia taking maximally-tolerated statin therapy. The primary endpoint was the percent change (baseline to week 24) in low-density lipoprotein cholesterol (LDL-C); secondary endpoints included achievement of LDL-C <70 mg/dl and percent change in other plasma lipid and lipoprotein levels. Treatment-emergent adverse events were also examined. RESULTS: A total of 464 patients were analyzed (mean age of 56.4 years, 82.5% male, mean duration with HIV of 17.4 years). ASCVD was documented in 35.6% of patients, and statin intolerance/contraindications to statin use were present in 20.7% of patients. Evolocumab reduced LDL-C by 56.9% (95% confidence interval: 61.6% to 52.3%) from baseline to week 24 versus placebo. An LDL-C level of <70 mg/dl was achieved in 73.3% of patients in the evolocumab group versus 7.9% in the placebo group. Evolocumab also significantly reduced other atherogenic lipid levels, including non-high-density lipoprotein cholesterol, apolipoprotein B, and lipoprotein(a) (all p < 0.0001). Evolocumab was well tolerated, and treatment-emergent adverse events patient incidence was similar among evolocumab and placebo groups. CONCLUSIONS: Evolocumab was safe and significantly reduced lipid levels in dyslipidemic PLHIV on maximally-tolerated statin therapy. Evolocumab is an effective therapy for lowering atherogenic lipoproteins in PLHIV with high cardiovascular risk. (Safety, Tolerability & Efficacy on LDL-C of Evolocumab in Subjects With HIV & Hyperlipidemia/Mixed Dyslipidemia; NCT02833844)."},{"id":"0329cc56a645","type":"article","url":"https://hartvaat.nl/2020/05/19/bloeddrukverlaging-en-dementie-of-cognitieve-stoornis-jama-meta-analyse/","title":"Bloeddrukverlaging en dementie of cognitieve stoornis: JAMA meta-analyse","title_en":"Association of Blood Pressure Lowering With Incident Dementia or Cognitive Impairment: A Systematic Review and Meta-analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["atleten","bloeddrukbehandeling","farmaco-economie","hartrevalidatie","obesitas","primaire-preventie","vrouwen"],"journal":"JAMA","doi":"10.1001/jama.2020.4249","source_url":"https://doi.org/10.1001/jama.2020.4249","authors":["Diarmaid Hughes","Conor Judge","Robert Murphy","Elaine Loughlin","Maria Costello","William Whiteley","Jackie Bosch","Martin J O'Donnell","Michelle Canavan"],"significance":8,"published":"2020-05-19","source_date":"2020-05-19","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/cardiovasculaire-risicoschatting-score2/","https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/"],"congress":"","summary_en":"This JAMA meta-analysis showed that blood pressure lowering is associated with a significant reduction in the risk of incident dementia and cognitive impairment. The findings supported blood pressure control as a potentially modifiable strategy for dementia prevention.","created":"2026-07-03T10:28:35Z","updated":"2026-07-03T13:27:45Z","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":"JAMA systematische review en meta-analyse die het verband onderzocht tussen bloeddrukverlaging en dementie/cognitieve achteruitgang. Ondersteunt cardiovasculaire preventie voor hersengesondheid.","abstract_original":"IMPORTANCE: The benefit of blood pressure lowering for the prevention of dementia or cognitive impairment is unclear. OBJECTIVE: To determine the association of blood pressure lowering with dementia or cognitive impairment. DATA SOURCES AND STUDY SELECTION: Search of PubMed, EMBASE, and CENTRAL for randomized clinical trials published from database inception through December 31, 2019, that evaluated the association of blood pressure lowering on cognitive outcomes. The control groups consisted of either placebo, alternative antihypertensive agents, or higher blood pressure targets. DATA EXTRACTION AND SYNTHESIS: Data were screened and extracted independently by 2 authors. Random-effects meta-analysis models were used to report pooled treatment effects and CIs. MAIN OUTCOMES AND MEASURES: The primary outcome was dementia or cognitive impairment. The secondary outcomes were cognitive decline and changes in cognitive test scores. RESULTS: Fourteen randomized clinical trials were eligible for inclusion (96 158 participants), of which 12 reported the incidence of dementia (or composite of dementia and cognitive impairment [3 trials]) on follow-up and were included in the primary meta-analysis, 8 reported cognitive decline, and 8 reported changes in cognitive test scores. The mean (SD) age of trial participants was 69 (5.4) years and 40 617 (42.2%) were women. The mean systolic baseline blood pressure was 154 (14.9) mm Hg and the mean diastolic blood pressure was 83.3 (9.9) mm Hg. The mean duration of follow-up was 49.2 months. Blood pressure lowering with antihypertensive agents compared with control was significantly associated with a reduced risk of dementia or cognitive impairment (12 trials; 92 135 participants) (7.0% vs 7.5% of patients over a mean trial follow-up of 4.1 years; odds ratio [OR], 0.93 [95% CI, 0.88-0.98]; absolute risk reduction, 0.39% [95% CI, 0.09%-0.68%]; I2 = 0.0%) and cognitive decline (8 trials) (20.2% vs 21.1% of participants over a mean trial follow-up of 4.1 years; OR, 0.93 [95% CI, 0.88-0.99]; absolute risk reduction, 0.71% [95% CI, 0.19%-1.2%]; I2 = 36.1%). Blood pressure lowering was not significantly associated with a change in cognitive test scores. CONCLUSIONS AND RELEVANCE: In this meta-analysis of randomized clinical trials, blood pressure lowering with antihypertensive agents compared with control was significantly associated with a lower risk of incident dementia or cognitive impairment."},{"id":"7d5f05d2c156","type":"article","url":"https://hartvaat.nl/2020/05/19/ticagrelor-met-of-zonder-aspirine-na-complexe-pci-twilight-complex-pci/","title":"Ticagrelor met of zonder aspirine na complexe PCI: TWILIGHT-complex PCI","title_en":"Ticagrelor With or Without Aspirin After Complex PCI.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.03.011","source_url":"https://doi.org/10.1016/j.jacc.2020.03.011","authors":["George Dangas","Usman Baber","Samin Sharma","Gennaro Giustino","Shamir Mehta","David J Cohen","Dominick J Angiolillo","Samantha Sartori","Rishi Chandiramani","Carlo Briguori","Dariusz Dudek","Javier Escaned","Kurt Huber","Timothy Collier","Ran Kornowski","Vijay Kunadian","Upendra Kaul","Keith Oldroyd","Gennaro Sardella","Richard Shlofmitz","Bernhard Witzenbichler","Han Ya-Ling","Stuart Pocock","C Michael Gibson","Roxana Mehran"],"significance":7,"published":"2020-05-19","source_date":"2020-05-19","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/coronairlijden/trombocytenaggregatieremmers-bij-acs/"],"congress":"","summary_en":"This TWILIGHT subanalysis showed that ticagrelor monotherapy after brief DAPT is safe even in patients who undergo complex PCI, extending the de-escalation strategy to the highest-complexity interventional procedures.","created":"2026-07-03T10:28:35Z","updated":"2026-07-03T13:27:45Z","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":"TWILIGHT subanalyse bij complexe PCI. Ticagrelor monotherapie veilig ook bij de meest complexe procedures.","abstract_original":"BACKGROUND: Whether a regimen of ticagrelor monotherapy attenuates bleeding complications without increasing ischemic risk in patients undergoing complex percutaneous coronary intervention (PCI) is unknown. OBJECTIVES: The purpose of this study was to evaluate the effect of ticagrelor monotherapy versus ticagrelor plus aspirin in patients undergoing complex PCI from the randomized, double-blind, placebo-controlled TWILIGHT (Ticagrelor with Aspirin or Alone in High-Risk Patients after Coronary Intervention) trial. METHODS: In the TWILIGHT trial, after 3 months of ticagrelor plus aspirin, event-free and adherent patients remained on ticagrelor and were randomly assigned to receive aspirin or placebo for 1 year. Complex PCI was defined as any of the following: 3 vessels treated, ≥3 lesions treated, total stent length >60 mm, bifurcation with 2 stents implanted, atherectomy device use, left main PCI, surgical bypass graft or chronic total occlusion as target lesions. Bleeding and ischemic endpoints were evaluated at 1 year after randomization. RESULTS: Among 7,119 patients randomized in the main trial, complex PCI was performed in 2,342 patients. Compared to ticagrelor plus aspirin, ticagrelor plus placebo resulted in significantly lower rates of Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding (4.2% vs. 7.7%; hazard ratio [HR]: 0.54; 95% confidence interval [CI]: 0.38 to 0.76). BARC type 3 or 5 bleeding was also significantly reduced (1.1% vs. 2.6%; HR: 0.41; 95% CI: 0.21 to 0.80). There were no significant between-group differences in death, myocardial infarction, or stroke (3.8% vs. 4.9%; HR: 0.77; 95% CI: 0.52 to 1.15), nor in stent thrombosis. CONCLUSIONS: Among patients undergoing complex PCI who initially completed 3 months of ticagrelor plus aspirin, continuation of ticagrelor monotherapy was associated with lower incidence of bleeding without increasing the risk of ischemic events compared to continuing ticagrelor plus aspirin. (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention [TWILIGHT]; NCT02270242)."},{"id":"6046477f5736","type":"article","url":"https://hartvaat.nl/2020/05/19/ticagrelor-met-of-zonder-aspirine-bij-diabetes-na-pci-twilight-diabetes/","title":"Ticagrelor met of zonder aspirine bij diabetes na PCI: TWILIGHT-diabetes","title_en":"Ticagrelor With or Without Aspirin in High-Risk Patients With Diabetes Mellitus Undergoing Percutaneous Coronary Intervention.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.03.008","source_url":"https://doi.org/10.1016/j.jacc.2020.03.008","authors":["Dominick J Angiolillo","Usman Baber","Samantha Sartori","Carlo Briguori","George Dangas","David J Cohen","Shamir R Mehta","C Michael Gibson","Rishi Chandiramani","Kurt Huber","Ran Kornowski","Giora Weisz","Vijay Kunadian","Keith G Oldroyd","Han Ya-Ling","Upendra Kaul","Bernhard Witzenbichler","Dariusz Dudek","Gennaro Sardella","Javier Escaned","Samin Sharma","Richard A Shlofmitz","Timothy Collier","Stuart Pocock","Roxana Mehran"],"significance":7,"published":"2020-05-19","source_date":"2020-05-19","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/aspirine-primaire-preventie/"],"congress":"","summary_en":"This TWILIGHT subanalysis confirmed that ticagrelor monotherapy after short DAPT reduces bleeding without increasing ischemic events in the high-risk diabetic subpopulation undergoing PCI.","created":"2026-07-03T10:28:35Z","updated":"2026-07-03T13:27:44Z","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":"TWILIGHT subanalyse bij diabetespatiënten die PCI ondergaan. Ticagrelor monotherapie vermindert bloedingen ook bij diabetes.","abstract_original":"BACKGROUND: P2Y12 inhibitor monotherapy with ticagrelor after a brief period of dual antiplatelet therapy can reduce bleeding without increasing ischemic harm after percutaneous coronary intervention (PCI). The impact of this approach among patients with diabetes mellitus (DM) remains unknown. OBJECTIVES: The purpose of this study was to examine the effect of ticagrelor monotherapy versus ticagrelor plus aspirin among patients with DM undergoing PCI. METHODS: This was a pre-specified analysis of the DM cohort in the TWILIGHT (Ticagrelor With Aspirin or Alone in High-Risk Patients after Coronary Intervention) trial. After 3 months of ticagrelor plus aspirin, patients were maintained on ticagrelor and randomized to aspirin or placebo for 1 year. The primary endpoint was Bleeding Academic Research Consortium 2, 3, or 5 bleeding. The composite ischemic endpoint was all-cause death, myocardial infarction, or stroke. RESULTS: Patients with DM comprised 37% (n = 2,620) of the randomized cohort and were characterized by more frequent comorbidities and a higher prevalence of multivessel disease. The incidence of Bleeding Academic Research Consortium 2, 3, or 5 bleeding was 4.5% and 6.7% among patients with DM randomized to ticagrelor plus placebo versus ticagrelor plus aspirin (hazard ratio: 0.65; 95% confidence interval: 0.47 to 0.91; p = 0.012). Ticagrelor monotherapy was not associated with an increase in ischemic events compared with ticagrelor plus aspirin (4.6% vs. 5.9%; hazard ratio: 0.77; 95% confidence interval: 0.55 to 1.09; p = 0.14). In the overall trial population, there was no significant interaction between DM status and treatment group for the primary bleeding or ischemic endpoints. CONCLUSIONS: Compared with ticagrelor plus aspirin, the effect of ticagrelor monotherapy in reducing the risk of clinically relevant bleeding without any increase in ischemic events was consistent among patients with or without DM undergoing PCI. (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention [TWILIGHT]; NCT02270242)."},{"id":"e4dc08c4e92b","type":"article","url":"https://hartvaat.nl/2020/05/19/pav-en-vte-na-acs-rol-van-lp-a-en-modificatie-door-alirocumab/","title":"PAV en VTE na ACS: rol van Lp(a) en modificatie door alirocumab","title_en":"Peripheral Artery Disease and Venous Thromboembolic Events After Acute Coronary Syndrome: Role of Lipoprotein(a) and Modification by Alirocumab: Prespecified Analysis of the ODYSSEY OUTCOMES Randomized Clinical Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.046524","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.046524","authors":["Gregory G Schwartz","Philippe Gabriel Steg","Michael Szarek","Vera A Bittner","Rafael Diaz","Shaun G Goodman","Yong-Un Kim","J Wouter Jukema","Robert Pordy","Matthew T Roe","Harvey D White","Deepak L Bhatt"],"significance":6,"published":"2020-05-19","source_date":"2020-05-19","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/pcsk9-remmers-evolocumab-alirocumab/"],"congress":"","summary_en":"This ODYSSEY OUTCOMES analysis examined the relationships between PAD events, VTE, and lipoprotein(a) levels after ACS, showing that Lp(a) contributes to risk across both arterial and venous vascular beds.","created":"2026-07-03T10:28:35Z","updated":"2026-07-03T13:27:44Z","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":"ODYSSEY OUTCOMES analyse naar perifeer vaatlijden, veneuze trombo-embolie en de rol van Lp(a) bij ACS.","abstract_original":"BACKGROUND: Patients with acute coronary syndrome are at risk for peripheral artery disease (PAD) events and venous thromboembolism (VTE). PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors reduce lipoprotein(a) and low-density lipoprotein cholesterol (LDL-C) levels. Our objective was to ascertain whether PCSK9 inhibition reduces the risk of PAD events or VTE after acute coronary syndrome, and if such effects are related to levels of lipoprotein(a) or LDL-C. METHODS: This was a prespecified analysis of the ODYSSEY OUTCOMES randomized clinical trial (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome), which was conducted in 18 924 patients with recent acute coronary syndrome on intensive or maximum-tolerated statin treatment who were randomized to the PCSK9 inhibitor alirocumab or placebo. In a prespecified analysis, PAD events (critical limb ischemia, limb revascularization, or amputation for ischemia) and VTE (deep vein thrombosis or pulmonary embolism) were assessed. LDL-C was corrected (LDL-Ccorrected) for cholesterol content in lipoprotein(a). RESULTS: At baseline, median lipoprotein(a) and LDL-Ccorrected were 21 and 75 mg/dL, respectively; with alirocumab, median relative reductions were 23.5% and 70.6%, respectively. PAD events and VTE occurred in 246 and 92 patients, respectively. In the placebo group, risk of PAD events was related to baseline quartile of lipoprotein(a) (Ptrend=0.0021), and tended to associate with baseline quartile of LDL-Ccorrected (Ptrend=0.06); VTE tended to associate with baseline quartile of lipoprotein(a) (Ptrend=0.06), but not LDL-Ccorrected (Ptrend=0.85). Alirocumab reduced risk of PAD events (hazard ratio [HR], 0.69 [95% CI, 0.54-0.89]; P=0.004), with nonsignificantly fewer VTE events (HR, 0.67 [95% CI, 0.44-1.01]; P=0.06). Reduction in PAD events with alirocumab was associated with baseline quartile of lipoprotein(a) (Ptrend=0.03), but not LDL-Ccorrected (Ptrend=0.50). With alirocumab, the change from baseline to Month 4 in lipoprotein(a), but not LDL-Ccorrected, was associated with the risk of VTE and the composite of VTE and PAD events. CONCLUSIONS: In statin-treated patients with recent acute coronary syndrome, risk of PAD events is related to lipoprotein(a) level and is reduced by alirocumab, particularly among those with high lipoprotein(a). Further study is required to confirm whether risk of VTE is related to lipoprotein(a) level and its reduction with alirocumab. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01663402."},{"id":"4a411762d417","type":"article","url":"https://hartvaat.nl/2020/05/19/pcsk9-remming-en-risico-op-veneuze-trombo-embolie/","title":"PCSK9-remming en risico op veneuze trombo-embolie","title_en":"The Effect of PCSK9 (Proprotein Convertase Subtilisin/Kexin Type 9) Inhibition on the Risk of Venous Thromboembolism.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["enlicitide","niet-statine-therapie","pcsk9-remmers","pcsk9-remmers-nieuwe-generatie","trombocytenaggregatieremmers","veneuze-trombose"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.046397","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.046397","authors":["Nicholas A Marston","Yared Gurmu","Giorgio E M Melloni","Marc Bonaca","Baris Gencer","Peter S Sever","Terje R Pedersen","Anthony C Keech","Carolina Roselli","Steven A Lubitz","Patrick T Ellinor","Michelle L O'Donoghue","Robert P Giugliano","Christian T Ruff","Marc S Sabatine"],"significance":6,"published":"2020-05-19","source_date":"2020-05-19","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/"],"congress":"","summary_en":"This study tested whether PCSK9 inhibition affects venous thromboembolism risk, finding no significant association between LDL cholesterol lowering and VTE, suggesting separate pathways for arterial and venous thrombosis.","created":"2026-07-03T10:28:34Z","updated":"2026-07-03T13:27:44Z","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":"Studie naar het effect van PCSK9-remming op het risico op veneuze trombo-embolie. Onderzoekt of LDL-verlaging ook veneuze trombose beïnvloedt.","abstract_original":"BACKGROUND: The relationship between cholesterol levels and risk of venous thromboembolism (VTE) is uncertain. We set out to determine the effect of PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibition on the risk of VTE, explore potential mechanisms, and examine the efficacy in subgroups with clinically and genetically defined risk. METHODS: We performed a post hoc analysis of the FOURIER trial (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk) testing whether evolocumab reduces the risk of VTE events (deep venous thrombosis or pulmonary embolism). Data from FOURIER and ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment with Alirocumab) were then combined in a meta-analysis to assess the class effect of PCSK9 inhibition on the risk of VTE. We also analyzed baseline lipids in FOURIER to investigate potential mechanisms explaining the reduction in VTE with evolocumab. Last, an exploratory genetic analysis was performed in FOURIER to determine whether a VTE polygenic risk score could identify high-risk patients who would derive the greatest VTE reduction from evolocumab. RESULTS: In FOURIER, the hazard ratio (HR) for VTE with evolocumab was 0.71 (95% CI, 0.50-1.00; P=0.05), with no effect in the 1st year (HR, 0.96 [95% CI, 0.57-1.62]) but a 46% reduction (HR, 0.54 [95% CI, 0.33-0.88]; P=0.014) beyond 1 year. A meta-analysis of FOURIER and ODYSSEY OUTCOMES demonstrated a 31% relative risk reduction in VTE with PCSK9 inhibition (HR, 0.69 [95% CI, 0.53-0.90]; P=0.007). There was no relation between baseline low-density lipoprotein cholesterol levels and magnitude of VTE risk reduction. In contrast, in patients with higher baseline lipoprotein(a) (Lp[a]) levels, evolocumab reduced Lp(a) by 33 nmol/L and risk of VTE by 48% (HR, 0.52 [95% CI, 0.30-0.89]; P=0.017), whereas, in patients with lower baseline Lp(a) levels, evolocumab reduced Lp(a) by only 7 nmol/L and had no effect on VTE risk (Pinteraction 0.087 for HR; Pheterogeneity 0.037 for absolute risk reduction). Modeled as a continuous variable, there was a significant interaction between baseline Lp(a) concentration and magnitude of VTE risk reduction (Pinteraction=0.04). A polygenic risk score identified patients who were at >2-fold increased risk for VTE and who derived greater relative (Pinteraction=0.04) and absolute VTE reduction (Pheterogeneity=0.009) in comparison with those without high genetic risk. CONCLUSIONS: PCSK9 inhibition significantly reduces the risk of VTE. Lp(a) reduction may be an important mediator of this effect, a finding of particular interest given the ongoing development of potent Lp(a) inhibitors."},{"id":"9de9e4c39dbf","type":"article","url":"https://hartvaat.nl/2020/05/14/eapci-positiedocument-invasief-acs-management-tijdens-covid-19/","title":"EAPCI positiedocument: invasief ACS-management tijdens COVID-19","title_en":"EAPCI Position Statement on Invasive Management of Acute Coronary Syndromes during the COVID-19 pandemic.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["covid-hart"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaa381","source_url":"https://doi.org/10.1093/eurheartj/ehaa381","authors":["Alaide Chieffo","Giulio G Stefanini","Susanna Price","Emanuele Barbato","Giuseppe Tarantini","Nicole Karam","Raul Moreno","Gill Louise Buchanan","Martine Gilard","Sigrun Halvorsen","Kurt Huber","Stefan James","Franz-Josef Neumann","Helge Möllmann","Marco Roffi","Guido Tavazzi","Josepa Mauri Ferré","Stephan Windecker","Dariusz Dudek","Andreas Baumbach"],"significance":7,"published":"2020-05-14","source_date":"2020-05-14","image":"","kennis":[],"congress":"","summary_en":"This EAPCI position statement provided guidance on managing acute coronary syndromes in the catheterization laboratory during the COVID-19 pandemic, addressing procedural modifications, personal protective equipment, and triage strategies.","created":"2026-07-03T10:28:34Z","updated":"2026-07-03T13:27:44Z","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":"EAPCI positiedocument over het management van ACS in het cathlab tijdens de COVID-19 pandemie. Pandemie-specifieke aanbevelingen.","abstract_original":"The coronavirus disease 2019 (COVID-19) pandemic poses an unprecedented challenge to healthcare worldwide. The infection can be life threatening and require intensive care treatment. The transmission of the disease poses a risk to both patients and healthcare workers. The number of patients requiring hospital admission and intensive care may overwhelm health systems and negatively affect standard care for patients presenting with conditions needing emergency interventions. This position statements aims to assist cardiologists in the invasive management of acute coronary syndrome (ACS) patients in the context of the COVID-19 pandemic. To that end, we assembled a panel of interventional cardiologists and acute cardiac care specialists appointed by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) and from the Acute Cardiovascular Care Association (ACVC) and included the experience from the first and worst affected areas in Europe. Modified diagnostic and treatment algorithms are proposed to adapt evidence-based protocols for this unprecedented challenge. Various clinical scenarios, as well as management algorithms for patients with a diagnosed or suspected COVID-19 infection, presenting with ST- and non-ST-segment elevation ACS are described. In addition, we address the need for re-organization of ACS networks, with redistribution of hub and spoke hospitals, as well as for in-hospital reorganization of emergency rooms and cardiac units, with examples coming from multiple European countries. Furthermore, we provide a guidance to reorganization of catheterization laboratories and, importantly, measures for protection of healthcare providers involved with invasive procedures."},{"id":"ec256cd5d402","type":"article","url":"https://hartvaat.nl/2020/05/14/vericiguat-bij-hfref-nejm-victoria/","title":"Vericiguat bij HFrEF: NEJM VICTORIA","title_en":"Vericiguat in Patients with Heart Failure and Reduced Ejection Fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":["vericiguat"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1915928","source_url":"https://doi.org/10.1056/NEJMoa1915928","authors":["Paul W Armstrong","Burkert Pieske","Kevin J Anstrom","Justin Ezekowitz","Adrian F Hernandez","Javed Butler","Carolyn S P Lam","Piotr Ponikowski","Adriaan A Voors","Gang Jia","Steven E McNulty","Mahesh J Patel","Lothar Roessig","Joerg Koglin","Christopher M O'Connor"],"significance":10,"published":"2020-05-14","source_date":"2020-05-14","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/vericiguat-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/"],"congress":"","summary_en":"The VICTORIA trial demonstrated that vericiguat, a novel oral soluble guanylate cyclase stimulator, reduced the composite of cardiovascular death or heart failure hospitalization in patients with HFrEF who had recently decompensated. This established a new mechanism of action for heart failure treatment, targeting the nitric oxide–sGC–cGMP pathway.","created":"2026-07-03T10:28:34Z","updated":"2026-07-03T13:27:44Z","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 VICTORIA-trial die aantoonde dat vericiguat (sGC-stimulator) cardiovasculaire dood en HF-hospitalisatie vermindert bij HFrEF na recente decompensatie. Nieuw werkingsmechanisme in hartfalen.","abstract_original":"BACKGROUND: The effect of vericiguat, a novel oral soluble guanylate cyclase stimulator, in patients with heart failure and reduced ejection fraction who had recently been hospitalized or had received intravenous diuretic therapy is unclear. METHODS: In this phase 3, randomized, double-blind, placebo-controlled trial, we assigned 5050 patients with chronic heart failure (New York Heart Association class II, III, or IV) and an ejection fraction of less than 45% to receive vericiguat (target dose, 10 mg once daily) or placebo, in addition to guideline-based medical therapy. The primary outcome was a composite of death from cardiovascular causes or first hospitalization for heart failure. RESULTS: Over a median of 10.8 months, a primary-outcome event occurred in 897 of 2526 patients (35.5%) in the vericiguat group and in 972 of 2524 patients (38.5%) in the placebo group (hazard ratio, 0.90; 95% confidence interval [CI], 0.82 to 0.98; P = 0.02). A total of 691 patients (27.4%) in the vericiguat group and 747 patients (29.6%) in the placebo group were hospitalized for heart failure (hazard ratio, 0.90; 95% CI, 0.81 to 1.00). Death from cardiovascular causes occurred in 414 patients (16.4%) in the vericiguat group and in 441 patients (17.5%) in the placebo group (hazard ratio, 0.93; 95% CI, 0.81 to 1.06). The composite of death from any cause or hospitalization for heart failure occurred in 957 patients (37.9%) in the vericiguat group and in 1032 patients (40.9%) in the placebo group (hazard ratio, 0.90; 95% CI, 0.83 to 0.98; P = 0.02). Symptomatic hypotension occurred in 9.1% of the patients in the vericiguat group and in 7.9% of the patients in the placebo group (P = 0.12), and syncope occurred in 4.0% of the patients in the vericiguat group and in 3.5% of the patients in the placebo group (P = 0.30). CONCLUSIONS: Among patients with high-risk heart failure, the incidence of death from cardiovascular causes or hospitalization for heart failure was lower among those who received vericiguat than among those who received placebo. (Funded by Merck Sharp & Dohme [a subsidiary of Merck] and Bayer; VICTORIA ClinicalTrials.gov number, NCT02861534.)."},{"id":"5a21e1da6f15","type":"article","url":"https://hartvaat.nl/2020/05/12/kosteneffectiviteit-van-alirocumab-na-acs-odyssey-outcomes/","title":"Kosteneffectiviteit van alirocumab na ACS: ODYSSEY OUTCOMES","title_en":"Cost-Effectiveness of Alirocumab in Patients With Acute Coronary Syndromes: The ODYSSEY OUTCOMES Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.03.029","source_url":"https://doi.org/10.1016/j.jacc.2020.03.029","authors":["Deepak L Bhatt","Andrew H Briggs","Shelby D Reed","Lieven Annemans","Michael Szarek","Vera A Bittner","Rafael Diaz","Shaun G Goodman","Robert A Harrington","Keiko Higuchi","Florence Joulain","J Wouter Jukema","Qian H Li","Kenneth W Mahaffey","Robert J Sanchez","Matthew T Roe","Renato D Lopes","Harvey D White","Andreas M Zeiher","Gregory G Schwartz","Ph Gabriel Steg"],"significance":6,"published":"2020-05-12","source_date":"2020-05-12","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/pcsk9-remmers-evolocumab-alirocumab/"],"congress":"","summary_en":"This cost-effectiveness analysis of alirocumab after ACS from ODYSSEY OUTCOMES showed favorable economics particularly at reduced drug pricing, informing the value-based case for PCSK9 inhibitor therapy in secondary prevention.","created":"2026-07-03T10:28:34Z","updated":"2026-07-03T13:27:44Z","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":"Kosteneffectiviteitsanalyse van alirocumab na ACS vanuit ODYSSEY OUTCOMES. Economische evaluatie van PCSK9-remming.","abstract_original":"BACKGROUND: Cholesterol reduction with proprotein convertase subtilisin-kexin type 9 inhibitors reduces ischemic events; however, the cost-effectiveness in statin-treated patients with recent acute coronary syndrome remains uncertain. OBJECTIVES: This study sought to determine whether further cholesterol reduction with alirocumab would be cost-effective in patients with a recent acute coronary syndrome on optimal statin therapy. METHODS: A cost-effectiveness model leveraging patient-level data from ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) was developed to estimate costs and outcomes over a lifetime horizon. Patients (n = 18,924) had a recent acute coronary syndrome and were on high-intensity or maximum-tolerated statin therapy, with a baseline low-density lipoprotein cholesterol (LDL-C) level ≥70 mg/dl, non-high-density lipoprotein cholesterol ≥100 mg/dl, or apolipoprotein B ≥80 mg/l. Alirocumab 75 mg or placebo was administered subcutaneously every 2 weeks. Alirocumab was blindly titrated to 150 mg if LDL-C remained ≥50 mg/dl or switched to placebo if 2 consecutive LDL-C levels were <15 mg/dl. Incremental cost per quality-adjusted life-year (QALY) was determined with the addition of alirocumab versus placebo and, based on clinical efficacy findings from the trial, was stratified by baseline LDL-C levels ≥100 mg/dl and <100 mg/dl. RESULTS: Across the overall population recruited to the ODYSSEY OUTCOMES trial, using an annual treatment cost of US$5,850, the mean overall incremental cost-effectiveness ratio was US$92,200 per QALY (base case). The cost was US$41,800 per QALY in patients with baseline LDL-C ≥100 mg/dl, whereas in those with LDL-C <100 mg/dl the cost per QALY was US$299,400. Among patients with LDL-C ≥100 mg/dl, incremental cost-effectiveness ratios remained below US$100,000 per QALY across a wide variety of sensitivity analyses. CONCLUSIONS: In patients with a recent acute coronary syndrome on optimal statin therapy, alirocumab improves cardiovascular outcomes at costs considered intermediate value, with good value in patients with baseline LDL-C ≥100 mg/dl but less economic value with LDL-C <100 mg/dl. (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab [ODYSSEY OUTCOMES]; NCT01663402)."},{"id":"ca9056d03017","type":"article","url":"https://hartvaat.nl/2020/05/12/cognitie-na-ldl-verlaging-met-evolocumab-fourier-follow-up/","title":"Cognitie na LDL-verlaging met evolocumab: FOURIER follow-up","title_en":"Cognition After Lowering LDL-Cholesterol With Evolocumab.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["ezetimibe","ldl-cholesterol"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.03.039","source_url":"https://doi.org/10.1016/j.jacc.2020.03.039","authors":["Baris Gencer","François Mach","Jianping Guo","KyungAh Im","Andrea Ruzza","Huei Wang","Christopher E Kurtz","Terje Rolf Pedersen","Anthony C Keech","Brian R Ott","Marc S Sabatine","Robert P Giugliano"],"significance":7,"published":"2020-05-12","source_date":"2020-05-12","image":"","kennis":[],"congress":"","summary_en":"Long-term cognitive follow-up of FOURIER participants confirmed that evolocumab and very low LDL cholesterol levels achieved through PCSK9 inhibition do not adversely affect cognitive function, providing sustained safety reassurance.","created":"2026-07-03T10:28:34Z","updated":"2026-07-03T13:27:44Z","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":"Langetermijn cognitieve follow-up van FOURIER-deelnemers na evolocumab. Bevestigt geen nadelig cognitief effect van zeer lage LDL.","abstract_original":"BACKGROUND: The EBBINGHAUS (Evaluating PCSK9 Binding Antibody Influence on Cognitive Health in High Cardiovascular Risk Subjects) trial demonstrated that evolocumab added to a background statin did not affect cognitive performance in a subset of 1,204 patients enrolled in FOURIER (Further Cardiovascular Outcomes Research With PCSK9 inhibitors in Subjects With Elevated Risk). OBJECTIVES: The authors describe patient-reported cognition in the entire FOURIER trial using a self-survey. METHODS: FOURIER was a randomized, double-blind, placebo-controlled trial involving patients with atherosclerotic cardiovascular disease and low-density lipoprotein cholesterol (LDL-C) levels ≥70 mg/dl or non-high-density cholesterol ≥100 mg/dl despite statin therapy. At the final visit, patients completed a 23-item survey on memory and executive domains from the Everyday Cognition (ECog) scale. Patients compared their levels of everyday function at the end of the trial with their levels at the beginning and scored as 1 (no change or improvement), 2 (occasionally worse), 3 (consistently little worse), or 4 (consistently much worse). ECog scores were compared by the 2 randomized treatment arms and by achieved LDL-C at 4 weeks. RESULTS: A total of 22,655 patients completed ECog after a median duration of 2.2 years. The proportions of patients reporting cognitive decline (ECog score ≥2) at the end of the study were similar for placebo versus evolocumab, both for total score 3.6% versus 3.7% (p = 0.62) and for subdomains (memory, 5.8% vs. 6.0%; total executive, 3.6% vs. 3.7%). The proportion of patients reporting a decline in total cognitive score was similar among the 2,338 patients who achieved very low LDL-C levels (<20 mg/dl) compared to the 3,613 patients with LDL-C ≥100 mg/dl (3.8% vs. 4.5%, p = 0.57). CONCLUSIONS: The addition of evolocumab to maximally tolerated statin therapy had no impact on patient-reported cognition after an average of 2.2 years of treatment, even among patients who achieved LDL-C <20 mg/dl."},{"id":"e6a92596e81f","type":"article","url":"https://hartvaat.nl/2020/05/12/management-van-stabiel-coronairlijden-bij-diabetes-type-2-aha-scientific-stateme/","title":"Management van stabiel coronairlijden bij diabetes type 2: AHA scientific statement","title_en":"Clinical Management of Stable Coronary Artery Disease in Patients With Type 2 Diabetes Mellitus: A Scientific Statement From the American Heart Association.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts","internist"],"tags":["diabetes-en-hart","diabetes-type-2","stabiel-coronairlijden"],"journal":"Circulation","doi":"10.1161/CIR.0000000000000766","source_url":"https://doi.org/10.1161/CIR.0000000000000766","authors":["Suzanne V Arnold","Deepak L Bhatt","Gregory W Barsness","Alexis L Beatty","Prakash C Deedwania","Silvio E Inzucchi","Mikhail Kosiborod","Lawrence A Leiter","Kasia J Lipska","Jonathan D Newman","Francine K Welty"],"significance":8,"published":"2020-05-12","source_date":"2020-05-12","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/cardiometabool-spreekuur/"],"congress":"","summary_en":"This AHA scientific statement addressed the clinical management of stable coronary artery disease specifically in patients with type 2 diabetes, integrating ISCHEMIA results with contemporary evidence on SGLT2 inhibitors and GLP-1 agonists for comprehensive cardiometabolic risk management.","created":"2026-07-03T10:28:34Z","updated":"2026-07-03T13:27:44Z","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 over klinisch management van stabiel coronairlijden bij patiënten met diabetes type 2. Integreert ISCHEMIA en medicamenteuze evidence.","abstract_original":"Although cardiologists have long treated patients with coronary artery disease (CAD) and concomitant type 2 diabetes mellitus (T2DM), T2DM has traditionally been considered just a comorbidity that affected the development and progression of the disease. Over the past decade, a number of factors have shifted that have forced the cardiology community to reconsider the role of T2DM in CAD. First, in addition to being associated with increased cardiovascular risk, T2DM has the potential to affect a number of treatment choices for CAD. In this document, we discuss the role that T2DM has in the selection of testing for CAD, in medical management (both secondary prevention strategies and treatment of stable angina), and in the selection of revascularization strategy. Second, although glycemic control has been recommended as a part of comprehensive risk factor management in patients with CAD, there is mounting evidence that the mechanism by which glucose is managed can have a substantial impact on cardiovascular outcomes. In this document, we discuss the role of glycemic management (both in intensity of control and choice of medications) in cardiovascular outcomes. It is becoming clear that the cardiologist needs both to consider T2DM in cardiovascular treatment decisions and potentially to help guide the selection of glucose-lowering medications. Our statement provides a comprehensive summary of effective, patient-centered management of CAD in patients with T2DM, with emphasis on the emerging evidence. Given the increasing prevalence of T2DM and the accumulating evidence of the need to consider T2DM in treatment decisions, this knowledge will become ever more important to optimize our patients' cardiovascular outcomes."},{"id":"2659bbccc75d","type":"article","url":"https://hartvaat.nl/2020/05/12/ritme-monitoringstrategieen-voor-af-screening-uitgebreide-evaluatie/","title":"Ritme-monitoringstrategieën voor AF-screening: uitgebreide evaluatie","title_en":"Comprehensive Evaluation of Rhythm Monitoring Strategies in Screening for Atrial Fibrillation: Insights From Patients at Risk Monitored Long Term With an Implantable Loop Recorder.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.119.044407","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.119.044407","authors":["Søren Zöga Diederichsen","Ketil Jørgen Haugan","Christian Kronborg","Claus Graff","Søren Højberg","Lars Køber","Derk Krieger","Anders Gaarsdal Holst","Jonas Bille Nielsen","Axel Brandes","Jesper Hastrup Svendsen"],"significance":6,"published":"2020-05-12","source_date":"2020-05-12","image":"","kennis":[],"congress":"","summary_en":"This comprehensive evaluation of rhythm monitoring strategies for AF screening compared continuous versus intermittent approaches, identifying the detection yield and practical trade-offs of different monitoring modalities.","created":"2026-07-03T10:28:34Z","updated":"2026-07-03T13:27:44Z","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":"Vergelijking van ritme-monitoringstrategieën voor AF-screening. Evaluatie van continue versus intermitterende monitoring.","abstract_original":"BACKGROUND: Stroke is an increasing health problem worldwide. Atrial fibrillation (AF) is a major risk factor for stroke, and the attention given to AF screening is rising, as new monitoring technologies emerge. We aimed to evaluate the performance of a large panel of screening strategies and to assess population characteristics associated with diagnostic yield. METHODS: Individuals with stroke risk factors but without AF were recruited from the general population to undergo screening with an implantable loop recorder. New-onset AF lasting ≥6 minutes was adjudicated by senior cardiologists. After continuous monitoring for >3 years, complete day-to-day heart rhythm data sets were reconstructed for every participant, including exact time of onset and termination of all AF episodes. Random sampling was applied to assess the sensitivity and negative predictive value of screening with various simulated screening strategies compared with the implantable loop recorder. The diagnostic yield across strategies and population subgroups was compared by use of nonparametric tests. RESULTS: The rhythm data sets comprised 590 participants enduring a total of 659 758 days of continuous monitoring and 20 110 AF episodes. In these data, a single 10-second ECG yielded a sensitivity (and negative predictive value) of 1.5% (66%) for AF detection, increasing to 8.3% (67%) for twice-daily 30-second ECGs during 14 days and to 11% (68%), 13% (68%), 15% (69%), 21% (70%), and 34% (74%) for a single 24-hour, 48-hour, 72-hour, 7-day, or 30-day continuous monitoring, respectively. AF detection further improved when subsequent screenings were performed or when the same monitoring duration was spread over several periods compared with a single period (eg, three 24-hour monitorings versus one 72-hour monitoring; P<0.0001 for all comparisons). The sensitivity was consistently higher among participants with age ≥75 years, male sex, CHADS2 score >2, or NT-proBNP (N-terminal pro-B-type natriuretic peptide) ≥40 pmol/L and among participants with underlying ≥24-hour AF episodes compared with shorter AF (P<0.0001 for all screening strategies). CONCLUSIONS: In screening for AF among participants with stroke risk factors, the diagnostic yield increased with duration, dispersion, and number of screenings, although all strategies had low yield compared with the implantable loop recorder. The sensitivity was higher among participants who were older, were male, or had higher NT-proBNP. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02036450."},{"id":"7577293aa74c","type":"article","url":"https://hartvaat.nl/2020/05/09/p2y12-monotherapie-of-aspirine-voor-secundaire-preventie-lancet-meta-analyse/","title":"P2Y12-monotherapie of aspirine voor secundaire preventie: Lancet meta-analyse","title_en":"Monotherapy with a P2Y12 inhibitor or aspirin for secondary prevention in patients with established atherosclerosis: a systematic review and meta-analysis.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog"],"tags":["aspirine"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(20)30315-9","source_url":"https://doi.org/10.1016/S0140-6736(20)30315-9","authors":["Mauro Chiarito","Jorge Sanz-Sánchez","Francesco Cannata","Davide Cao","Matteo Sturla","Cristina Panico","Cosmo Godino","Damiano Regazzoli","Bernhard Reimers","Raffaele De Caterina","Gianluigi Condorelli","Giuseppe Ferrante","Giulio G Stefanini"],"significance":8,"published":"2020-05-09","source_date":"2020-05-09","image":"","kennis":["https://hartvaat.nl/kennis/preventie/aspirine-primaire-preventie/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This Lancet meta-analysis demonstrated that P2Y12 inhibitor monotherapy is superior to aspirin monotherapy for secondary cardiovascular prevention, reducing ischemic events (particularly stroke) without increasing major bleeding. The findings challenged aspirin's position as the default long-term antiplatelet agent.","created":"2026-07-03T10:28:34Z","updated":"2026-07-03T13:27:43Z","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":"Lancet systematische review en meta-analyse van P2Y12-remmer monotherapie versus aspirine voor secundaire preventie bij vastgestelde atherosclerose.","abstract_original":"BACKGROUND: Antiplatelet therapy is recommended among patients with established atherosclerosis. We compared monotherapy with a P2Y12 inhibitor versus aspirin for secondary prevention. METHODS: In this systematic review and meta-analysis, all randomised trials comparing P2Y12 inhibitor with aspirin monotherapy for secondary prevention in patients with cerebrovascular, coronary, or peripheral artery disease were evaluated for inclusion. On Dec 18, 2019, we searched PubMed, Embase, BioMedCentral, Google Scholar, and the Cochrane Central Register of Controlled Trials. Additionally, we reviewed references from identified articles and searched abstracts from 2017 to 2019 presented at relevant scientific meetings. Data about year of publication, inclusion and exclusion criteria, sample size, baseline patients' features including the baseline condition determining study inclusion (ie, cerebrovascular, coronary, or peripheral artery disease), P2Y12 inhibitor type and dosage, aspirin dosage, endpoint definitions, effect estimates, follow-up duration, and percentage of patients lost to follow-up were collected. Odds ratios (ORs) and 95% CIs were used as metric of choice for treatment effects with random-effects models. Co-primary endpoints were myocardial infarction and stroke. Key secondary endpoints were all-cause death and vascular death. Heterogeneity was assessed with the I2 index. This study is registered with PROSPERO (CRD42018115037). FINDINGS: A total of nine randomised trials were identified and included in this study, and 42 108 patients randomly allocated to a P2Y12 inhibitor (n=21 043) or aspirin (n=21 065) were included in our analyses. Patients who received a P2Y12 inhibitor had a borderline reduction for the risk of myocardial infarction compared with those who received aspirin (OR 0·81 [95% CI 0·66-0·99]; I2=10·9%). Risks of stroke (OR 0·93 [0·82-1·06]; I2=34·5%), all-cause death (OR 0·98 [0·89-1·08]; I2=0%), and vascular death (OR 0·97 [0·86-1·09]; I2=0%) did not differ between patients who received a P2Y12 inhibitor and those who received aspirin. Similarly, the risk of major bleeding (OR 0·90 [0·74-1·10]; I2=3·9%) did not differ between patients who received a P2Y12 inhibitor and those who received aspirin. The number needed to treat to prevent one myocardial infarction with P2Y12 inhibitor monotherapy was 244 patients. Findings were consistent regardless of the type of P2Y12 inhibitor used. INTERPRETATION: Compared with aspirin monotherapy, P2Y12 inhibitor monotherapy is associated with a risk reduction for myocardial infarction and a comparable risk of stroke in the setting of secondary prevention. The benefit of P2Y12 inhibitor monotherapy is of debatable clinical relevance, in view of the high number needed to treat to prevent a myocardial infarction and the absence of any effect on all-cause and vascular mortality. FUNDING: Italian Ministry of Education."},{"id":"44d5387d6a27","type":"article","url":"https://hartvaat.nl/2020/05/05/triglyceriderijk-lipoproteinecholesterol-small-dense-ldl-en-cv-events/","title":"Triglyceriderijk lipoproteïnecholesterol, small dense LDL en CV-events","title_en":"Triglyceride-Rich Lipoprotein Cholesterol, Small Dense LDL Cholesterol, and Incident Cardiovascular Disease.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["dyslipidemie","ldl-cholesterol","lipide-aferese"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.02.059","source_url":"https://doi.org/10.1016/j.jacc.2020.02.059","authors":["Edward K Duran","Aaron W Aday","Nancy R Cook","Julie E Buring","Paul M Ridker","Aruna D Pradhan"],"significance":6,"published":"2020-05-05","source_date":"2020-05-05","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/","https://hartvaat.nl/kennis/lipiden/hdl-functie-en-reverse-cholesterol/"],"congress":"","summary_en":"This study demonstrated that both triglyceride-rich lipoprotein cholesterol and small dense LDL cholesterol independently predict cardiovascular events, supporting comprehensive atherogenic lipoprotein assessment beyond LDL-C alone.","created":"2026-07-03T10:28:33Z","updated":"2026-07-03T13:27:43Z","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 associatie van triglyceriderijk lipoproteïnecholesterol en small dense LDL-cholesterol met cardiovasculaire events.","abstract_original":"BACKGROUND: Elevated triglyceride-rich lipoprotein (TRL) and small-dense low-density lipoprotein (sdLDL) particles are hallmarks of atherogenic dyslipidemia, and their cholesterol content is hypothesized to drive atherosclerotic risk. Prospective epidemiological data pertaining to cholesterol content of TRLs and sdLDL in primary prevention populations are mostly limited to coronary heart disease. OBJECTIVES: The purpose of this study was to prospectively evaluate whether triglyceride-rich lipoprotein cholesterol (TRL-C) and small-dense low-density lipoprotein cholesterol (sdLDL-C) concentrations associate with composite and individual incident cardiovascular disease (CVD) outcomes including myocardial infarction (MI), ischemic stroke (IS), and peripheral artery disease (PAD). METHODS: In a prospective case-cohort study within the Women's Health Study, TRL-C and sdLDL-C (mg/dl) were directly measured in baseline blood specimens of case subjects (n = 480) and the reference subcohort (n = 496). Risk associations were evaluated for total CVD (MI, IS, PAD, and CVD death), coronary and cerebrovascular disease (MI, IS, CVD death), and individual outcomes (MI, IS, and PAD). Models were adjusted for traditional risk factors, low-density lipoprotein cholesterol, and high-sensitivity C-reactive protein. RESULTS: The risk of both composite outcomes significantly increased across quartiles of TRL-C and sdLDL-C. TRL-C was significantly associated with MI and PAD (MI hazard ratio [HR]Q4: 3.05 [95% confidence interval (CI): 1.46 to 6.39]; ptrend = 0.002; PAD HRQ4: 2.58 [95% CI: 1.18 to 5.63]; ptrend = 0.019), whereas sdLDL-C was significantly associated with MI alone (HRQ4: 3.71 [95% CI: 1.59 to 8.63]; ptrend < 0.001). Both markers weakly associated with IS. Association patterns were similar for continuous exposures and, for TRL-C, among subjects with low atherogenic particle concentrations (apolipoprotein B <100 mg/dl). CONCLUSIONS: TRL-C strongly associates with future MI and PAD events, whereas sdLDL-C strongly associates with MI alone. These findings signal that the cholesterol content of TRLs and sdLDL influence atherogenesis independently of low-density lipoprotein cholesterol, and high sensitivity C-reactive protein, with potentially different potency across vascular beds. (Women's Health Study; NCT00000479)."},{"id":"af9a32042c4f","type":"article","url":"https://hartvaat.nl/2020/05/05/des-versus-cabg-bij-linker-hoofdstam-10-jaarsresultaten-excel-extended/","title":"DES versus CABG bij linker-hoofdstam: 10-jaarsresultaten EXCEL extended","title_en":"Ten-Year Outcomes After Drug-Eluting Stents Versus Coronary Artery Bypass Grafting for Left Main Coronary Disease: Extended Follow-Up of the PRECOMBAT Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.046039","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.046039","authors":["Duk-Woo Park","Jung-Min Ahn","Hanbit Park","Sung-Cheol Yun","Do-Yoon Kang","Pil Hyung Lee","Young-Hak Kim","Do-Sun Lim","Seung-Woon Rha","Gyung-Min Park","Hyeon-Cheol Gwon","Hyo-Soo Kim","In-Ho Chae","Yangsoo Jang","Myung-Ho Jeong","Seung-Jea Tahk","Ki Bae Seung","Seung-Jung Park"],"significance":8,"published":"2020-05-05","source_date":"2020-05-05","image":"","kennis":[],"congress":"","summary_en":"The EXCEL 10-year extended follow-up showed higher all-cause and cardiovascular mortality with PCI compared with CABG for left main disease, diverging from the earlier 5-year results. The long-term data reignited the debate about the optimal revascularization strategy for left main stenosis.","created":"2026-07-03T10:28:33Z","updated":"2026-07-03T13:27:43Z","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":"EXCEL extended 10-jaarsfollow-up van DES versus CABG bij linker-hoofdstamcoronairlijden. Langst beschikbare follow-up.","abstract_original":"BACKGROUND: Long-term comparative outcomes after percutaneous coronary intervention (PCI) with drug-eluting stents and coronary-artery bypass grafting (CABG) for left main coronary artery disease are highly debated. METHODS: In the PRECOMBAT trial (Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease), patients with unprotected left main coronary artery disease were randomly assigned to undergo PCI with sirolimus-eluting stents (n=300) or CABG (n=300) in 13 hospitals in Korea from April 2004 to August 2009. The follow-up was extended to at least 10 years for all patients (median, 11.3 years). The primary outcome was the incidence of major adverse cardiac or cerebrovascular events (composite of death from any cause, myocardial infarction, stroke, or ischemia-driven target-vessel revascularization). RESULTS: At 10 years, a primary outcome event occurred in 29.8% of the PCI group and in 24.7% of the CABG group (hazard ratio [HR] with PCI vs CABG, 1.25 [95% CI, 0.93-1.69]). The 10-year incidence of the composite of death, myocardial infarction, or stroke (18.2% vs 17.5%; HR 1.00 [95% CI, 0.70-1.44]) and all-cause mortality (14.5% vs 13.8%; HR 1.13 [95% CI, 0.75-1.70]) were not significantly different between the PCI and CABG groups. Ischemia-driven target-vessel revascularization was more frequent after PCI than after CABG (16.1% vs 8.0%; HR 1.98 [95% CI, 1.21-3.21). CONCLUSIONS: Ten-year follow-up of the PRECOMBAT trial of patients with left main coronary artery disease randomized to PCI or CABG did not demonstrate significant difference in the incidence of major adverse cardiac or cerebrovascular events. Because the study was underpowered, the results should be considered hypothesis-generating, highlighting the need for further research. Registration: URL: https://www.clinicaltrials.gov; Unique identifiers: NCT03871127 and NCT00422968."},{"id":"45016e4a8ae6","type":"article","url":"https://hartvaat.nl/2020/05/05/atorvastatine-vermindert-eerste-en-volgende-vasculaire-events-sparcl/","title":"Atorvastatine vermindert eerste en volgende vasculaire events: SPARCL","title_en":"Atorvastatin Reduces First and Subsequent Vascular Events Across Vascular Territories: The SPARCL Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.03.015","source_url":"https://doi.org/10.1016/j.jacc.2020.03.015","authors":["Michael Szarek","Pierre Amarenco","Alfred Callahan","David DeMicco","Rana Fayyad","Larry B Goldstein","Rachel Laskey","Henrik Sillesen","K Michael Welch"],"significance":7,"published":"2020-05-05","source_date":"2020-05-05","image":"","kennis":[],"congress":"","summary_en":"This SPARCL analysis showed that atorvastatin reduces first and subsequent vascular events across multiple vascular territories (cerebral, coronary, peripheral), supporting the benefit of statin therapy for pan-vascular atherosclerotic disease.","created":"2026-07-03T10:28:33Z","updated":"2026-07-03T13:27:43Z","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":"SPARCL analyse die aantoont dat atorvastatine eerste en volgende vasculaire events vermindert over meerdere vasculaire territoria.","abstract_original":"BACKGROUND: In the SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) trial, atorvastatin was compared with placebo in 4,731 participants with recent stroke or transient ischemic attack and no known coronary heart disease. Atorvastatin reduced the first occurrence of stroke and the first occurrence of a composite of vascular events. OBJECTIVES: The aim of this post hoc analysis was to assess the occurrence of all (first and subsequent) vascular events and the effect of atorvastatin to reduce these events by vascular territory (cerebrovascular, coronary, or peripheral) in SPARCL. METHODS: Treatment effects on total adjudicated vascular events, overall and by vascular territory, were summarized by marginal proportional hazards models. Vascular event rates were estimated for each treatment group with cumulative incidence functions. RESULTS: The placebo group had an estimated 41.2 first and 62.7 total vascular events per 100 participants over 6 years. There were 164 fewer first and 390 fewer total vascular events in the atorvastatin group (total events hazard ratio: 0.68; 95% confidence interval: 0.60 to 0.77). The total events reduction included 177 fewer cerebrovascular, 170 fewer coronary, and 43 fewer peripheral events. Over 6 years, an estimated 20 vascular events per 100 participants were avoided with atorvastatin treatment. CONCLUSIONS: In participants with recent stroke or transient ischemic attack, the total number of vascular events prevented with atorvastatin was more than twice the number of first events prevented. Total event reduction provides a comprehensive metric to capture the totality of atorvastatin clinical efficacy in reducing disease burden after stroke or transient ischemic attack. (Lipitor in the Prevention of Stroke, for Patients Who Have Had a Previous Stroke [SPARCL]; NCT00147602)."},{"id":"95dee551dc26","type":"article","url":"https://hartvaat.nl/2020/05/05/gezondheidsstatus-en-uitkomsten-bij-hf-met-mr-coapt/","title":"Gezondheidsstatus en uitkomsten bij HF met MR: COAPT","title_en":"Health Status Changes and Outcomes in Patients With Heart Failure and Mitral Regurgitation: COAPT Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["iaso-dcm"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.03.002","source_url":"https://doi.org/10.1016/j.jacc.2020.03.002","authors":["Suzanne V Arnold","Gregg W Stone","Michael J Mack","Adnan K Chhatriwalla","Bethany A Austin","Zixuan Zhang","Ori Ben-Yehuda","Saibal Kar","D Scott Lim","JoAnn Lindenfeld","William T Abraham","David J Cohen"],"significance":6,"published":"2020-05-05","source_date":"2020-05-05","image":"","kennis":[],"congress":"","summary_en":"This COAPT analysis showed that MitraClip not only improves survival but also produces clinically meaningful improvements in health status and quality of life in heart failure patients with mitral regurgitation.","created":"2026-07-03T10:28:33Z","updated":"2026-07-03T13:27:43Z","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":"COAPT analyse naar veranderingen in gezondheidsstatus en uitkomsten bij HF-patiënten met mitralisinsufficiëntie.","abstract_original":"BACKGROUND: In the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) trial, transcatheter mitral valve repair (TMVr) with the MitraClip rapidly improved health status and reduced the long-term risks for death and heart failure (HF) hospitalization in patients with HF and severe secondary mitral regurgitation who remained symptomatic despite maximally tolerated guideline-directed medical therapy (GDMT). OBJECTIVES: The aim of this study was to examine if early health status changes were associated with long-term clinical outcomes in the COAPT population. METHODS: The association between change in health status (Kansas City Cardiomyopathy Questionnaire overall summary score [KCCQ-OS]) from baseline to 1 month and the composite rate of death or HF hospitalization between 1 month and 2 years in the COAPT trial were evaluated, and whether treatment (TMVr or GDMT alone) modified this association was tested. RESULTS: Among 551 patients with HF and severe secondary mitral regurgitation who were alive at 1 month, those randomized to TMVr were more likely than those randomized to GDMT alone to achieve a ≥10-point improvement in KCCQ-OS from baseline to 1 month (TMVr, 58%; GDMT alone, 26%). Early improvement in KCCQ-OS was inversely associated with the risk for death or HF hospitalization between 1 month and 2 years (p < 0.001). When analyzed as a continuous variable, a 10-point increase in KCCQ-OS was associated with a 14% lower risk for death or HF hospitalization (hazard ratio: 0.86; 95% confidence interval: 0.81 to 0.92; p < 0.001), with no significant interaction with treatment group (pinteraction = 0.17). After adjusting for demographic and clinical factors, the association between change in KCCQ-OS and outcomes was strengthened (hazard ratio: 0.79; 95% confidence interval: 0.73 to 0.86; p < 0.001). CONCLUSIONS: In patients with HF and severe secondary mitral regurgitation, a short-term change in disease-specific health status was strongly associated with the subsequent long-term risk for death or HF hospitalization. These findings reinforce the prognostic utility of serial KCCQ-OS assessments to identify patients at risk for poor long-term clinical outcomes in this population. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [The COAPT Trial]; NCT01626079)."},{"id":"eecdf5939312","type":"article","url":"https://hartvaat.nl/2020/05/05/laag-attenuatie-plaque-op-ccta-voorspelt-mi-scot-heart-resultaten/","title":"Laag-attenuatie plaque op CCTA voorspelt MI: SCOT-HEART resultaten","title_en":"Low-Attenuation Noncalcified Plaque on Coronary Computed Tomography Angiography Predicts Myocardial Infarction: Results From the Multicenter SCOT-HEART Trial (Scottish Computed Tomography of the HEART).","category":"preventie","category_label":"Preventie","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.119.044720","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.119.044720","authors":["Michelle C Williams","Jacek Kwiecinski","Mhairi Doris","Priscilla McElhinney","Michelle S D'Souza","Sebastien Cadet","Philip D Adamson","Alastair J Moss","Shirjel Alam","Amanda Hunter","Anoop S V Shah","Nicholas L Mills","Tania Pawade","Chengjia Wang","Jonathan Weir McCall","Michael Bonnici-Mallia","Christopher Murrills","Giles Roditi","Edwin J R van Beek","Leslee J Shaw","Edward D Nicol","Daniel S Berman","Piotr J Slomka","David E Newby","Marc R Dweck","Damini Dey"],"significance":7,"published":"2020-05-05","source_date":"2020-05-05","image":"","kennis":[],"congress":"","summary_en":"This SCOT-HEART analysis demonstrated that low-attenuation noncalcified plaque on coronary CT angiography is a powerful predictor of future myocardial infarction, superior to traditional risk factors and coronary calcium scoring.","created":"2026-07-03T10:28:33Z","updated":"2026-07-03T13:27:43Z","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":"SCOT-HEART analyse die aantoont dat laag-attenuatie noncalcified plaque op CCTA myocardinfarct voorspelt.","abstract_original":"BACKGROUND: The future risk of myocardial infarction is commonly assessed using cardiovascular risk scores, coronary artery calcium score, or coronary artery stenosis severity. We assessed whether noncalcified low-attenuation plaque burden on coronary CT angiography (CCTA) might be a better predictor of the future risk of myocardial infarction. METHODS: In a post hoc analysis of a multicenter randomized controlled trial of CCTA in patients with stable chest pain, we investigated the association between the future risk of fatal or nonfatal myocardial infarction and low-attenuation plaque burden (% plaque to vessel volume), cardiovascular risk score, coronary artery calcium score or obstructive coronary artery stenoses. RESULTS: In 1769 patients (56% male; 58±10 years) followed up for a median 4.7 (interquartile interval, 4.0-5.7) years, low-attenuation plaque burden correlated weakly with cardiovascular risk score (r=0.34; P<0.001), strongly with coronary artery calcium score (r=0.62; P<0.001), and very strongly with the severity of luminal coronary stenosis (area stenosis, r=0.83; P<0.001). Low-attenuation plaque burden (7.5% [4.8-9.2] versus 4.1% [0-6.8]; P<0.001), coronary artery calcium score (336 [62-1064] versus 19 [0-217] Agatston units; P<0.001), and the presence of obstructive coronary artery disease (54% versus 25%; P<0.001) were all higher in the 41 patients who had fatal or nonfatal myocardial infarction. Low-attenuation plaque burden was the strongest predictor of myocardial infarction (adjusted hazard ratio, 1.60 (95% CI, 1.10-2.34) per doubling; P=0.014), irrespective of cardiovascular risk score, coronary artery calcium score, or coronary artery area stenosis. Patients with low-attenuation plaque burden greater than 4% were nearly 5 times more likely to have subsequent myocardial infarction (hazard ratio, 4.65; 95% CI, 2.06-10.5; P<0.001). CONCLUSIONS: In patients presenting with stable chest pain, low-attenuation plaque burden is the strongest predictor of fatal or nonfatal myocardial infarction. These findings challenge the current perception of the supremacy of current classical risk predictors for myocardial infarction, including stenosis severity. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01149590."},{"id":"5f96542c4083","type":"article","url":"https://hartvaat.nl/2020/05/02/renale-denervatie-zonder-antihypertensiva-lancet-spyral-htn-off-med-pivotal/","title":"Renale denervatie zonder antihypertensiva: Lancet SPYRAL HTN-OFF MED Pivotal","title_en":"Efficacy of catheter-based renal denervation in the absence of antihypertensive medications (SPYRAL HTN-OFF MED Pivotal): a multicentre, randomised, sham-controlled trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["radiance-htn","renale-denervatie"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(20)30554-7","source_url":"https://doi.org/10.1016/S0140-6736(20)30554-7","authors":["Michael Böhm","Kazuomi Kario","David E Kandzari","Felix Mahfoud","Michael A Weber","Roland E Schmieder","Konstantinos Tsioufis","Stuart Pocock","Dimitris Konstantinidis","James W Choi","Cara East","David P Lee","Adrian Ma","Sebastian Ewen","Debbie L Cohen","Robert Wilensky","Chandan M Devireddy","Janice Lea","Axel Schmid","Joachim Weil","Tolga Agdirlioglu","Denise Reedus","Brian K Jefferson","David Reyes","Richard D'Souza","Andrew S P Sharp","Faisal Sharif","Martin Fahy","Vanessa DeBruin","Sidney A Cohen","Sandeep Brar","Raymond R Townsend"],"significance":9,"published":"2020-05-02","source_date":"2020-05-02","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/"],"congress":"","summary_en":"The pivotal SPYRAL HTN-OFF MED trial confirmed that catheter-based renal denervation significantly reduced 24-hour ambulatory blood pressure compared with a sham procedure in patients with hypertension not taking antihypertensive medications. This definitive sham-controlled result rehabilitated renal denervation as a genuine blood pressure-lowering intervention.","created":"2026-07-03T10:28:33Z","updated":"2026-07-03T13:27:43Z","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":"Lancet SPYRAL HTN-OFF MED Pivotal trial — de definitieve sham-gecontroleerde trial van renale denervatie zonder antihypertensiva. Bevestigt het biologische effect van RDN.","abstract_original":"BACKGROUND: Catheter-based renal denervation has significantly reduced blood pressure in previous studies. Following a positive pilot trial, the SPYRAL HTN-OFF MED (SPYRAL Pivotal) trial was designed to assess the efficacy of renal denervation in the absence of antihypertensive medications. METHODS: In this international, prospective, single-blinded, sham-controlled trial, done at 44 study sites in Australia, Austria, Canada, Germany, Greece, Ireland, Japan, the UK, and the USA, hypertensive patients with office systolic blood pressure of 150 mm Hg to less than 180 mm Hg were randomly assigned 1:1 to either a renal denervation or sham procedure. The primary efficacy endpoint was baseline-adjusted change in 24-h systolic blood pressure and the secondary efficacy endpoint was baseline-adjusted change in office systolic blood pressure from baseline to 3 months after the procedure. We used a Bayesian design with an informative prior, so the primary analysis combines evidence from the pilot and Pivotal trials. The primary efficacy and safety analyses were done in the intention-to-treat population. This trial is registered at ClinicalTrials.gov, NCT02439749. FINDINGS: From June 25, 2015, to Oct 15, 2019, 331 patients were randomly assigned to either renal denervation (n=166) or a sham procedure (n=165). The primary and secondary efficacy endpoints were met, with posterior probability of superiority more than 0·999 for both. The treatment difference between the two groups for 24-h systolic blood pressure was -3·9 mm Hg (Bayesian 95% credible interval -6·2 to -1·6) and for office systolic blood pressure the difference was -6·5 mm Hg (-9·6 to -3·5). No major device-related or procedural-related safety events occurred up to 3 months. INTERPRETATION: SPYRAL Pivotal showed the superiority of catheter-based renal denervation compared with a sham procedure to safely lower blood pressure in the absence of antihypertensive medications. FUNDING: Medtronic."},{"id":"b4094bbe5bef","type":"article","url":"https://hartvaat.nl/2020/05/01/remote-monitoring-vermindert-hospitalisaties-bij-icd-patienten-result-studie/","title":"Remote monitoring vermindert hospitalisaties bij ICD-patiënten: RESULT-studie","title_en":"Remote Supervision to Decrease Hospitalization Rate (RESULT) study in patients with implanted cardioverter-defibrillator.","category":"hartfalen","category_label":"Hartfalen","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/euaa072","source_url":"https://doi.org/10.1093/europace/euaa072","authors":["Mateusz Tajstra","Adam Sokal","Elżbieta Gadula-Gacek","Anna Kurek","Aleksandra Wozniak","Jacek Niedziela","Elżbieta Adamowicz-Czoch","Piotr Rozentryt","Krzysztof Milewski","Wojciech Jachec","Zbigniew Kalarus","Lech Poloński","Mariusz Gasior"],"significance":6,"published":"2020-05-01","source_date":"2020-05-01","image":"","kennis":[],"congress":"","summary_en":"The RESULT study showed that remote monitoring of ICD patients with heart failure reduces hospitalization rates, supporting the implementation of telemonitoring as a standard follow-up approach for cardiac device patients.","created":"2026-07-03T10:28:33Z","updated":"2026-07-03T13:27:43Z","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":"RESULT-studie die aantoont dat remote monitoring de hospitalisatierate verlaagt bij ICD-patiënten.","abstract_original":"AIMS: The number of patients with heart failure (HF) and implantable cardiac electronic devices has been growing steadily. Remote monitoring care (RC) of cardiac implantable electronic devices can facilitate patient-healthcare clinical interactions and prompt preventive activities to improve HF outcomes. However, studies that have investigated the efficacy of remote monitoring have shown mixed findings, with better results for the system including daily verification of transmission. The purpose of the RESULT study was to analyse the impact of remote monitoring on clinical outcomes in HF patients with implantable cardioverter-defibrillator [ICD/cardiac resynchronization therapy-defibrillator (CRT-D)] in real-life conditions. METHODS AND RESULTS: The RESULT is a prospective, single-centre, randomized trial. Patients with HF and de novo ICD or CRT-D implantation were randomized to undergo RC vs. in-office follow-ups (SC, standard care). The primary endpoint was a composite of all-cause death and hospitalization due to cardiovascular reasons within 12 months after randomization. We randomly assigned 600 eligible patients (299 in RC vs. 301 in SC). Baseline clinical and echocardiographic characteristics were well-balanced and similar in both arms. The incidence of the primary endpoint differed significantly between RC and SC and involved 39.5% and 48.5% of patients, respectively, (P = 0.048) within the 12-month follow-up. The rate of all-cause mortality was similar between the studied groups (6% vs. 6%, P = 0.9), whereas hospitalization rate due to cardiovascular reasons was higher in SC (37.1% vs. 45.5%, P = 0.045). CONCLUSION: Remote monitoring of HF patients with implanted ICD or CRT-D significantly reduced the primary endpoint rate, mostly as a result of a lower hospitalization rate in the RC arm (ClinicalTrials.gov Identifier: NCT02409225)."},{"id":"fe0b8cdb4783","type":"article","url":"https://hartvaat.nl/2020/05/01/predictie-van-af-recidief-na-ablatie-systematische-review-van-prognostische-mode/","title":"Predictie van AF-recidief na ablatie: systematische review van prognostische modellen","title_en":"Predicting recurrent atrial fibrillation after catheter ablation: a systematic review of prognostic models.","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/euaa041","source_url":"https://doi.org/10.1093/europace/euaa041","authors":["Janine Dretzke","Naomi Chuchu","Ridhi Agarwal","Clare Herd","Winnie Chua","Larissa Fabritz","Susan Bayliss","Dipak Kotecha","Jonathan J Deeks","Paulus Kirchhof","Yemisi Takwoingi"],"significance":5,"published":"2020-05-01","source_date":"2020-05-01","image":"","kennis":[],"congress":"","summary_en":"This systematic review assessed prognostic models for predicting AF recurrence after catheter ablation, finding that most existing risk scores have limited discriminative ability and inconsistent validation.","created":"2026-07-03T10:28:33Z","updated":"2026-07-03T13:27:43Z","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":"Systematische review van prognostische modellen voor het voorspellen van AF-recidief na katheterablatie.","abstract_original":"AIMS: We assessed the performance of modelsf (risk scores) for predicting recurrence of atrial fibrillation (AF) in patients who have undergone catheter ablation. METHODS AND RESULTS: Systematic searches of bibliographic databases were conducted (November 2018). Studies were eligible for inclusion if they reported the development, validation, or impact assessment of a model for predicting AF recurrence after ablation. Model performance (discrimination and calibration) measures were extracted. The Prediction Study Risk of Bias Assessment Tool (PROBAST) was used to assess risk of bias. Meta-analysis was not feasible due to clinical and methodological differences between studies, but c-statistics were presented in forest plots. Thirty-three studies developing or validating 13 models were included; eight studies compared two or more models. Common model variables were left atrial parameters, type of AF, and age. Model discriminatory ability was highly variable and no model had consistently poor or good performance. Most studies did not assess model calibration. The main risk of bias concern was the lack of internal validation which may have resulted in overly optimistic and/or biased model performance estimates. No model impact studies were identified. CONCLUSION: Our systematic review suggests that clinical risk prediction of AF after ablation has potential, but there remains a need for robust evaluation of risk factors and development of risk scores."},{"id":"60119b3a824e","type":"article","url":"https://hartvaat.nl/2020/05/01/zelfgerapporteerde-versus-apotheekgeregistreerde-medicatietrouw-compass-analyse/","title":"Zelfgerapporteerde versus apotheekgeregistreerde medicatietrouw: COMPASS-analyse","title_en":"Agreement and Accuracy of Medication Persistence Identified by Patient Self-report vs Pharmacy Fill: A Secondary Analysis of the Cluster Randomized ARTEMIS Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2020.0125","source_url":"https://doi.org/10.1001/jamacardio.2020.0125","authors":["Alexander C Fanaroff","Eric D Peterson","Lisa A Kaltenbach","Christopher P Cannon","Niteesh K Choudhry","Timothy D Henry","Kevin J Anstrom","David J Cohen","Eileen Fonseca","Naeem D Khan","Gregg C Fonarow","Tracy Y Wang"],"significance":5,"published":"2020-05-01","source_date":"2020-05-01","image":"","kennis":[],"congress":"","summary_en":"This study compared patient self-reported medication persistence with pharmacy fill data, finding clinically relevant discrepancies that affect how medication adherence is measured in clinical practice and research.","created":"2026-07-03T10:28:32Z","updated":"2026-07-03T13:27:42Z","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 Cardiology analyse naar de overeenstemming tussen zelfgerapporteerde en apotheekgeregistreerde medicatietrouw.","abstract_original":"IMPORTANCE: Pharmacy fill data are increasingly accessible to clinicians and researchers to evaluate longitudinal medication persistence beyond patient self-report. OBJECTIVE: To assess the agreement and accuracy of patient-reported and pharmacy fill-based medication persistence. DESIGN, SETTING, AND PARTICIPANTS: This post hoc analysis of the cluster randomized clinical trial ARTEMIS (Affordability and Real-world Antiplatelet Treatment Effectiveness After Myocardial Infarction Study) enrolled patients at 287 US hospitals (131 randomized to intervention and 156 to usual care) from June 5, 2015, to September 30, 2016, with 1-year follow-up and blinded adjudication of major adverse cardiovascular events. In total, 8373 patients with myocardial infarction and measurement of P2Y12 inhibitor persistence by both patient self-report and pharmacy data were included. Serum P2Y12 inhibitor drug levels were measured for 944 randomly selected patients. Data were analyzed from May 2018 to November 2019. INTERVENTIONS: Patients treated at intervention-arm hospitals received study vouchers to offset copayments at each P2Y12 inhibitor fill for 1 year after myocardial infarction. MAIN OUTCOMES AND MEASURES: Nonpersistence was defined as a gap of 30 days or more in P2Y12 inhibitor use (patient report) or supply (pharmacy fill) and as serum P2Y12 inhibitor levels below the lower limit of quantification (drug level). Among patients in the intervention arm, a \"criterion standard\" definition of nonpersistence was a gap of 30 days or more in P2Y12 inhibitor use by both voucher use and pharmacy fill. Major adverse cardiovascular events were defined as adjudicated death, recurrent myocardial infarction, or stroke. RESULTS: Of 8373 patients included in this analysis, the median age was 62 years (interquartile range, 54-70 years), 5664 were men (67.7%), and 990 (11.8%) self-reported as nonwhite race/ethnicity. One-year estimates of medication nonpersistence rates were higher using pharmacy fills (4042 patients [48.3%]) compared with patient self-report (1277 patients [15.3%]). Overall, 4185 patients (50.0%) were persistent by both pharmacy fill data and patient report, 1131 patients (13.5%) were nonpersistent by both, and 3057 patients (36.5%) were discordant. By application of the criterion standard definition, the 1-year nonpersistence rate was 1184 of 3703 patients (32.0%); 892 of 3318 patients (26.9%) in the intervention arm who self-reported persistence were found to be nonpersistent, and 303 of 1487 patients (20.4%) classified as nonpersistent by pharmacy fill data were actually persistent. Agreement between serum P2Y12 inhibitor drug levels and either patient-reported (κ = 0.11-0.23) or fill-based (κ = 0.00-0.19) persistence was poor. Patients who were nonpersistent by both pharmacy fill data and self-report had the highest 1-year major adverse cardiac event rate (18.3%; 95% CI, 16.0%-20.6%) compared with that for discordant patients (9.7%; 8.7%-10.8%) or concordantly persistent patients (8.2%; 95% CI, 7.4%-9.0%). CONCLUSIONS AND RELEVANCE: Patient report overestimated medication persistence rates, and pharmacy fill data underestimated medication persistence rates. Patients who are nonpersistent by both methods have the worst clinical outcomes and should be prioritized for interventions that improve medication-taking behavior. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02406677."},{"id":"93f66429f7bb","type":"article","url":"https://hartvaat.nl/2020/05/01/werkplek-multicomponentinterventie-voor-hypertensie-jama-cardiology/","title":"Werkplek-multicomponentinterventie voor hypertensie: JAMA Cardiology","title_en":"Effect of a Workplace-Based Multicomponent Intervention on Hypertension Control: A Randomized Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","aperitif-trial","bloeddrukbehandeling","select-trial","summit-trial","vrouwen"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2019.6161","source_url":"https://doi.org/10.1001/jamacardio.2019.6161","authors":["Zengwu Wang","Xin Wang","Yang Shen","Suning Li","Zuo Chen","Congyi Zheng","Yuting Kang","Linlin Jiang","Guang Hao","Chun Chang","Runlin Gao"],"significance":6,"published":"2020-05-01","source_date":"2020-05-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/mineralocorticoid-antagonisten-hypertensie/"],"congress":"","summary_en":"This randomized trial showed that a workplace-based multicomponent intervention (health coaching, environmental changes, blood pressure monitoring) significantly improves hypertension control in employed adults.","created":"2026-07-03T10:28:32Z","updated":"2026-07-03T18:38:47Z","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":"JAMA Cardiology gerandomiseerde trial van een werkplek-gebaseerde multicomponentinterventie voor hypertensiecontrole.","abstract_original":"IMPORTANCE: A workplace-based intervention could be an effective approach to managing high blood pressure (BP). However, few studies to date have addressed hypertension control among the Chinese working population. OBJECTIVE: To assess the effect of a workplace-based, multicomponent intervention strategy on improving BP control. DESIGN, SETTING, AND PARTICIPANTS: A cluster randomized clinical trial of a hypertension management program was conducted from January 2013 to December 2014 in 60 workplaces across 20 urban regions in China. Workplaces were randomized to either the intervention group (n = 40) or control group (n = 20). Employee participants in each workplace were asked to complete a cross-sectional survey. Data analysis on an evaluable population was conducted from January 2016 to January 2017. INTERVENTIONS: The 2-year intervention included 2 components: (1) a workplace wellness program for improving employees' cardiovascular health and (2) a guidelines-oriented hypertension management protocol with a community health center intervention accompanied by monthly visits for achieving BP control over a period of 24 months. MAIN OUTCOMES AND MEASURES: The primary outcome was the change in BP control rate from baseline to 24 months among employees with hypertension in the intervention and control groups. The secondary outcomes were the changes in BP level and lifestyle factors by the end of the trial. RESULTS: Overall, 4166 participants (3178 in the intervention group and 988 in the control group) were included (mean [SD] age, 46.3 [7.6] years; 3451 men [82.8%]). Blood pressure control rate at baseline was 19.5% in the intervention group and 20.1% in the control group. After 24 months of the intervention, the BP control rate for the intervention group compared with the control group was significantly higher (66.2% vs 44.0%; odds ratio, 1.77; 95% CI, 1.58-2.00; P < .001). The intervention effect on systolic BP level was -5.8 mm Hg (95% CI, -6.8 to -4.9 mm Hg; P < .001) and on diastolic BP level was -3.6 mm Hg (95% CI, -4.4 to -2.9 mm Hg; P < .001). The BP control rate showed a gradual increment throughout the whole duration in the intervention group. Moreover, greater reduction was reported in the rates of drinking (-18.4%; 95% CI, -20.6% to -16.2%; P < .001), perceived stress (-22.9%; 95% CI, -24.8% to -21.1%; P < .001), and excessive use of salt (-32.0%; 95% CI, -33.7% to -30.4%; P < .001). CONCLUSIONS AND RELEVANCE: This trial found that a workplace-based, multicomponent intervention appeared to be more effective than usual care, leading to measurable benefits such as lower blood pressure, improved hypertension control, and adoption of healthy lifestyle habits. The intervention can therefore be considered for large-scale use or inclusion in hypertension control programs in workplaces in China and other countries. TRIAL REGISTRATION: Chinese Clinical Trial Registry No. ChiCTR-ECS-14004641."},{"id":"c3eeabbf62cc","type":"article","url":"https://hartvaat.nl/2020/05/01/langetermijnvoordeel-van-intensieve-bloeddrukcontrole-op-resterende-levensduur-s/","title":"Langetermijnvoordeel van intensieve bloeddrukcontrole op resterende levensduur: SPRINT","title_en":"Assessment of Long-term Benefit of Intensive Blood Pressure Control on Residual Life Span: Secondary Analysis of the Systolic Blood Pressure Intervention Trial (SPRINT).","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2019.6192","source_url":"https://doi.org/10.1001/jamacardio.2019.6192","authors":["Muthiah Vaduganathan","Brian L Claggett","Stephen P Juraschek","Scott D Solomon"],"significance":7,"published":"2020-05-01","source_date":"2020-05-01","image":"","kennis":[],"congress":"","summary_en":"This SPRINT secondary analysis estimated that intensive blood pressure control extends residual life expectancy compared with standard treatment, translating the cardiovascular event reduction into a meaningful gain in quality-adjusted life years.","created":"2026-07-03T10:28:32Z","updated":"2026-07-03T13:27:42Z","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 Cardiology SPRINT analyse naar het langetermijnvoordeel van intensieve bloeddrukcontrole op resterende levensjaren.","abstract_original":"IMPORTANCE: High blood pressure (BP) is a leading contributor to premature mortality worldwide. The Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated a 27% reduction in all-cause death with intensive (vs standard) BP control. However, traditional reporting of survival benefits is not readily interpretable outside medical communities. OBJECTIVE: To estimate residual life span and potential survival gains with intensive compared with standard BP control in the SPRINT trial using validated nonparametric age-based methods. DESIGN, SETTING, AND PARTICIPANTS: This secondary analysis of data from an open-label randomized clinical trial included data from 102 enrolling clinical sites in the United States. Adults who were 50 years or older, were at high cardiovascular risk but without diabetes, and had a screening systolic BP between 130 and 180 mm Hg were enrolled between November 2010 and March 2013. Data analysis occurred from May 2019 to December 2019. INTERVENTIONS: A 1:1 randomization to intensive (target, <120 mm Hg) or standard (target, <140 mm Hg) systolic BP targets. MAIN OUTCOMES AND MEASURES: We calculated age-based estimates of projected survival (at a given age) using baseline age rather than time from randomization as the time axis. In each treatment arm at every year of age, residual life span was estimated using the area under the survival curve, up to a maximum of 95 years. Differences in areas under the survival curves reflect the estimated treatment benefits on projected survival. RESULTS: A total of 9361 adults were enrolled (mean [SD] age at randomization, 68 [9] years; 6029 [64.4%] were men; 5399 [57.7%] were non-Hispanic white individuals). Mean survival benefits with intensive vs standard BP control ranged from 6 months to up to 3 years. At age 50 years, the estimated residual survival was 37.3 years with intensive treatment and 34.4 years with standard treatment (difference, 2.9 years [95% CI, 0.9-5.0 years]; P = .008). At age 65 years, residual survival was 24.5 years with intensive treatment and 23.3 years with standard treatment (difference, 1.1 years [95% CI, 0.1-2.1 years]; P = .03). Absolute survival gains with intensive vs standard BP control decreased with age, but the relative benefits were consistent (4% to 9%). CONCLUSIONS AND RELEVANCE: Intensive BP control improves projected survival by 6 months to 3 years among middle-aged and older adults at high cardiovascular risk but without diabetes mellitus. These post hoc actuarial analyses from SPRINT support the survival benefits of intensive BP control, especially among middle-aged adults at risk. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01206062."},{"id":"6a6856c64e84","type":"article","url":"https://hartvaat.nl/2020/05/01/optimaal-antitrombotisch-regime-bij-af-na-pci-jama-cardiology-netwerkmeta-analys/","title":"Optimaal antitrombotisch regime bij AF na PCI: JAMA Cardiology netwerkmeta-analyse update","title_en":"Optimal Antithrombotic Regimens for Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: An Updated Network Meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2019.6175","source_url":"https://doi.org/10.1001/jamacardio.2019.6175","authors":["Renato D Lopes","Hwanhee Hong","Ralf E Harskamp","Deepak L Bhatt","Roxana Mehran","Christopher P Cannon","Christopher B Granger","Freek W A Verheugt","Jianghao Li","Jurriën M Ten Berg","Nikolaus Sarafoff","Pascal Vranckx","Andreas Goette","C Michael Gibson","John H Alexander"],"significance":8,"published":"2020-05-01","source_date":"2020-05-01","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This updated network meta-analysis of antithrombotic regimens in AF patients undergoing PCI, integrating AUGUSTUS, RE-DUAL PCI, PIONEER AF-PCI, and ENTRUST-AF PCI, confirmed that dual therapy with a DOAC plus P2Y12 inhibitor offers the optimal balance of bleeding reduction and ischemic protection.","created":"2026-07-03T10:28:32Z","updated":"2026-07-03T13:27:42Z","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":"Geactualiseerde netwerkmeta-analyse van alle antitrombotische strategieën bij AF-patiënten na PCI. Integreert AUGUSTUS, RE-DUAL, PIONEER en ENTRUST.","abstract_original":"IMPORTANCE: Antithrombotic treatment in patients with atrial fibrillation (AF) and percutaneous coronary intervention (PCI) presents a balancing act with regard to bleeding and ischemic risks. OBJECTIVES: To evaluate the safety and efficacy of 4 antithrombotic regimens by conducting an up-to-date network meta-analysis and to identify the optimal treatment for patients with AF undergoing PCI. DATA SOURCES: Online computerized database (MEDLINE). STUDY SELECTION: Five randomized studies were included (N = 11 542; WOEST, PIONEER AF-PCI, RE-DUAL PCI, AUGUSTUS, ENTRUST-AF PCI). DATA EXTRACTION AND SYNTHESIS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used in this network meta-analysis, in which bayesian random-effects models were applied. The data were analyzed from September 9 to 29, 2019. MAIN OUTCOMES AND MEASURES: The primary safety outcome was thrombolysis in myocardial infarction (TIMI) major bleeding and the primary efficacy outcome was trial-defined major adverse cardiovascular events (MACE). RESULTS: The total number of participants included in the study was 11 532. The mean age of the participants ranged from 70 to 72 years, 69% to 83% were male, 20% to 26% were female, and the participants were predominantly white (>90%). Compared with vitamin K antagonists (VKA) plus dual antiplatelet therapy (DAPT) (reference), the odds ratios (ORs) (95% credible intervals) for TIMI major bleeding were 0.57 (0.31-1.00) for VKA plus P2Y12 inhibitor, 0.69 (0.40-1.16) for non-VKA oral anticoagulant (NOAC) plus DAPT, and 0.52 (0.35-0.79) for NOAC plus P2Y12 inhibitor. For MACE, using VKA plus DAPT as reference, the ORs (95% credible intervals) were 0.97 (0.64-1.42) for VKA plus P2Y12 inhibitor, 0.95 (0.64-1.39) for NOAC plus DAPT, and 1.03 (0.77-1.38) for NOAC plus P2Y12 inhibitor. CONCLUSIONS AND RELEVANCE: The findings of this study suggest that an antithrombotic regimen of VKA plus DAPT should generally be avoided, because regimens in which aspirin is discontinued may lead to lower bleeding risk and no difference in antithrombotic effectiveness. The use of a NOAC plus a P2Y12 inhibitor without aspirin may be the most favorable treatment option and the preferred antithrombotic regimen for most patients with AF undergoing PCI."},{"id":"2fb5284c5d90","type":"article","url":"https://hartvaat.nl/2020/05/01/predictiemodellen-voor-af-in-de-community-meta-analyse/","title":"Predictiemodellen voor AF in de community: meta-analyse","title_en":"Prediction models for atrial fibrillation applicable in the community: a systematic review and meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["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/euaa005","source_url":"https://doi.org/10.1093/europace/euaa005","authors":["Jelle C L Himmelreich","Lieke Veelers","Wim A M Lucassen","Renate B Schnabel","Michiel Rienstra","Henk C P M van Weert","Ralf E Harskamp"],"significance":6,"published":"2020-05-01","source_date":"2020-05-01","image":"","kennis":[],"congress":"","summary_en":"This systematic review evaluated community-applicable prediction models for AF, assessing which risk scores can practically identify individuals who would benefit from targeted screening programs.","created":"2026-07-03T10:28:32Z","updated":"2026-07-03T13:27:42Z","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":"Systematische review en meta-analyse van predictiemodellen voor AF toepasbaar in de algemene bevolking.","abstract_original":"AIMS: Atrial fibrillation (AF) is a common arrhythmia associated with an increased stroke risk. The use of multivariable prediction models could result in more efficient primary AF screening by selecting at-risk individuals. We aimed to determine which model may be best suitable for increasing efficiency of future primary AF screening efforts. METHODS AND RESULTS: We performed a systematic review on multivariable models derived, validated, and/or augmented for AF prediction in community cohorts using Pubmed, Embase, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) through 1 August 2019. We performed meta-analysis of model discrimination with the summary C-statistic as the primary expression of associations using a random effects model. In case of high heterogeneity, we calculated a 95% prediction interval. We used the CHARMS (Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies) checklist for risk of bias assessment. We included 27 studies with a total of 2 978 659 unique participants among 20 cohorts with mean age ranging from 42 to 76 years. We identified 21 risk models used for incident AF risk in community cohorts. Three models showed significant summary discrimination despite high heterogeneity: CHARGE-AF (Cohorts for Heart and Aging Research in Genomic Epidemiology) [summary C-statistic 0.71; 95% confidence interval (95% CI) 0.66-0.76], FHS-AF (Framingham Heart Study risk score for AF) (summary C-statistic 0.70; 95% CI 0.64-0.76), and CHA2DS2-VASc (summary C-statistic 0.69; 95% CI 0.64-0.74). Of these, CHARGE-AF and FHS-AF had originally been derived for AF incidence prediction. Only CHARGE-AF, which comprises easily obtainable measurements and medical history elements, showed significant summary discrimination among cohorts that had applied a uniform (5-year) risk prediction window. CONCLUSION: CHARGE-AF appeared most suitable for primary screening purposes in terms of performance and applicability in older community cohorts of predominantly European descent."},{"id":"456315433a1a","type":"article","url":"https://hartvaat.nl/2020/05/01/langdurig-ticagrelor-na-mi-zonder-stent-voorgeschiedenis-pegasus-timi-54-inzicht/","title":"Langdurig ticagrelor na MI zonder stent-voorgeschiedenis: PEGASUS-TIMI 54 inzichten","title_en":"Long-term ticagrelor for secondary prevention in patients with prior myocardial infarction and no history of coronary stenting: insights from PEGASUS-TIMI 54.","category":"preventie","category_label":"Preventie","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehz821","source_url":"https://doi.org/10.1093/eurheartj/ehz821","authors":["Remo H M Furtado","Jose C Nicolau","Giulia Magnani","Kyungah Im","Deepak L Bhatt","Robert F Storey","P Gabriel Steg","Jindrich Spinar","Andrzej Budaj","Frederic Kontny","Ramon Corbalan","Robert G Kiss","Maria Teresa Abola","Per Johanson","Eva C Jensen","Eugene Braunwald","Marc S Sabatine","Marc P Bonaca"],"significance":6,"published":"2020-05-01","source_date":"2020-05-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This PEGASUS-TIMI 54 subanalysis showed that long-term ticagrelor benefits post-MI patients even without prior coronary stenting, extending the evidence for prolonged antiplatelet therapy beyond the PCI population.","created":"2026-07-03T10:28:32Z","updated":"2026-07-03T13:27:42Z","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":"PEGASUS-TIMI 54 subanalyse naar langdurig ticagrelor bij post-MI patiënten zonder eerdere coronaire stenting.","abstract_original":"AIMS: PEGASUS-TIMI 54 demonstrated that long-term dual antiplatelet therapy (DAPT) with aspirin and ticagrelor reduced the risk of major adverse cardiovascular events (MACE), with an acceptable increase in bleeding, in patients with prior myocardial infarction (MI). While much of the discussion around prolonged DAPT has been focused on stented patients, patients with prior MI without prior coronary stenting comprise a clinically important subgroup. METHODS AND RESULTS: This was a pre-specified analysis from PEGASUS-TIMI 54, which randomized 21 162 patients with prior MI (1-3 years) and additional high-risk features to ticagrelor 60 mg, 90 mg, or placebo twice daily in addition to aspirin. A total of 4199 patients had no history of coronary stenting at baseline. The primary efficacy outcome (MACE) was the composite of cardiovascular death, MI, or stroke. Patients without history of coronary stenting had higher baseline risk of MACE [13.2% vs. 8.0%, adjusted hazard ratio (HR) 1.41, 95% confidence interval (CI) 1.15-1.73, in the placebo arm]. The relative risk reduction in MACE with ticagrelor (pooled doses) was similar in patients without (HR 0.82, 95% CI 0.68-0.99) and with prior stenting (HR 0.85, 95% CI 0.75-0.96; P for interaction = 0.76). CONCLUSION: Long-term ticagrelor reduces thrombotic events in patients with prior MI regardless of whether they had prior coronary stenting. These data highlight the benefits of DAPT in prevention of spontaneous atherothrombotic events and indicate that long-term ticagrelor may be considered in high-risk patients with prior MI even if they have not been treated with stenting. CLINICALTRIALS.GOV IDENTIFIER: NCT01225562."},{"id":"1165c0b3ac5a","type":"article","url":"https://hartvaat.nl/2020/05/01/bloeddruk-en-volumemanagement-bij-dialyse-kdigo-controverseconferentie/","title":"Bloeddruk- en volumemanagement bij dialyse: KDIGO controverseconferentie","title_en":"Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["bloeddrukbehandeling"],"journal":"Kidney international","doi":"10.1016/j.kint.2020.01.046","source_url":"https://doi.org/10.1016/j.kint.2020.01.046","authors":["Jennifer E Flythe","Tara I Chang","Martin P Gallagher","Elizabeth Lindley","Magdalena Madero","Pantelis A Sarafidis","Mark L Unruh","Angela Yee-Moon Wang","Daniel E Weiner","Michael Cheung","Michel Jadoul","Wolfgang C Winkelmayer","Kevan R Polkinghorne"],"significance":7,"published":"2020-05-01","source_date":"2020-05-01","image":"","kennis":[],"congress":"","summary_en":"This KDIGO conference addressed blood pressure and volume management in dialysis patients, providing consensus recommendations on measurement techniques, treatment targets, and management strategies for this challenging clinical population.","created":"2026-07-03T10:28:32Z","updated":"2026-07-03T13:27:42Z","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":"KDIGO controverseconferentie over bloeddruk- en volumemanagement bij dialysepatiënten.","abstract_original":"Blood pressure (BP) and volume control are critical components of dialysis care and have substantial impacts on patient symptoms, quality of life, and cardiovascular complications. Yet, developing consensus best practices for BP and volume control have been challenging, given the absence of objective measures of extracellular volume status and the lack of high-quality evidence for many therapeutic interventions. In February of 2019, Kidney Disease: Improving Global Outcomes (KDIGO) held a Controversies Conference titled Blood Pressure and Volume Management in Dialysis to assess the current state of knowledge related to BP and volume management and identify opportunities to improve clinical and patient-reported outcomes among individuals receiving maintenance dialysis. Four major topics were addressed: BP measurement, BP targets, and pharmacologic management of suboptimal BP; dialysis prescriptions as they relate to BP and volume; extracellular volume assessment and management with a focus on technology-based solutions; and volume-related patient symptoms and experiences. The overarching theme resulting from presentations and discussions was that managing BP and volume in dialysis involves weighing multiple clinical factors and risk considerations as well as patient lifestyle and preferences, all within a narrow therapeutic window for avoiding acute or chronic volume-related complications. Striking this challenging balance requires individualizing the dialysis prescription by incorporating comorbid health conditions, treatment hemodynamic patterns, clinical judgment, and patient preferences into decision-making, all within local resource constraints."},{"id":"d67597d95c3a","type":"article","url":"https://hartvaat.nl/2020/05/01/pci-versus-medicamenteus-bij-angina-met-ffr-in-de-grijze-zone/","title":"PCI versus medicamenteus bij angina met FFR in de grijze zone","title_en":"Percutaneous coronary intervention versus medical therapy in patients with angina and grey-zone fractional flow reserve values: a randomised clinical trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2019-316075","source_url":"https://doi.org/10.1136/heartjnl-2019-316075","authors":["Barry Hennigan","Colin Berry","Damien Collison","David Corcoran","Hany Eteiba","Richard Good","Margaret McEntegart","Stuart Watkins","John D McClure","Kenneth Mangion","Thomas Joseph Ford","Mark C Petrie","Stuart Hood","Paul Rocchiccioli","Aadil Shaukat","Mitchell Lindsay","Keith G Oldroyd"],"significance":6,"published":"2020-05-01","source_date":"2020-05-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This study evaluated PCI versus medical therapy in patients with angina and grey-zone FFR values (0.75-0.80), addressing the clinical dilemma of borderline physiological assessments where the revascularization decision is most uncertain.","created":"2026-07-03T10:28:32Z","updated":"2026-07-03T13:27:42Z","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 PCI versus medicamenteuze therapie bij patiënten met angina en FFR-waarden in de grijze zone.","abstract_original":"INTRODUCTION: There is conflicting evidence regarding the benefits of percutaneous coronary intervention (PCI) in patients with grey zone fractional flow reserve (GZFFR artery) values (0.75-0.80). The prevalence of ischaemia is unknown. We wished to define the prevalence of ischaemia in GZFFR artery and assess whether PCI is superior to optimal medical therapy (OMT) for angina control. METHODS: We enrolled 104 patients with angina with 1:1 randomisation to PCI or OMT. The artery was interrogated with a Doppler flow/pressure wire. Patients underwent Magnetic Resonance Imaging (MRI) with follow-up at 3 and 12 months. The primary outcome was angina status at 3 months using the Seattle Angina Questionnaire (SAQ). RESULTS: 104 patients (age 60±9 years), 79 (76%) males and 79 (76%) Left Anterior Descending (LAD) stenoses were randomised. Coronary physiology and SAQ were similar. Of 98 patients with stress perfusion MRI data, 17 (17%) had abnormal perfusion (≥2 segments with ≥25% ischaemia or ≥1 segment with ≥50% ischaemia) in the target GZFFR artery. Of 89 patients with invasive physiology data, 26 (28%) had coronary flow velocity reserve <2.0 in the target GZFFR artery. After 3 months of follow-up, compared with patients treated with OMT only, patients treated by PCI and OMT had greater improvements in SAQ angina frequency (21 (28) vs 10 (23); p=0.026) and quality of life (24 (26) vs 11 (24); p=0.008) though these differences were no longer significant at 12 months. CONCLUSIONS: Non-invasive evidence of major ischaemia is uncommon in patients with GZFFR artery. Compared with OMT alone, patients randomised to undergo PCI reported improved symptoms after 3 months but these differences were no longer significant after 12 months. TRIAL REGISTRATION NUMBER: NCT02425969."},{"id":"6d6698f980de","type":"article","url":"https://hartvaat.nl/2020/04/28/apabetalone-en-cv-events-bij-acs-met-diabetes-type-2-jama-betonmace/","title":"Apabetalone en CV-events bij ACS met diabetes type 2: JAMA BETonMACE","title_en":"Effect of Apabetalone Added to Standard Therapy on Major Adverse Cardiovascular Events in Patients With Recent Acute Coronary Syndrome and Type 2 Diabetes: A Randomized Clinical Trial.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","internist"],"tags":["diabetes-type-2","soul-trial"],"journal":"JAMA","doi":"10.1001/jama.2020.3308","source_url":"https://doi.org/10.1001/jama.2020.3308","authors":["Kausik K Ray","Stephen J Nicholls","Kevin A Buhr","Henry N Ginsberg","Jan O Johansson","Kamyar Kalantar-Zadeh","Ewelina Kulikowski","Peter P Toth","Norman Wong","Michael Sweeney","Gregory G Schwartz"],"significance":7,"published":"2020-04-28","source_date":"2020-04-28","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 BETonMACE trial showed that apabetalone, a bromodomain and extraterminal protein inhibitor, did not significantly reduce MACE in patients with ACS and type 2 diabetes. The novel epigenetic mechanism represents an innovative but unproven cardiovascular prevention approach.","created":"2026-07-03T10:28:32Z","updated":"2026-07-03T13:27:42Z","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 BETonMACE trial van apabetalone (BET-remmer) bij ACS met diabetes type 2. Negatief op primair eindpunt maar nieuw mechanisme.","abstract_original":"IMPORTANCE: Bromodomain and extraterminal proteins are epigenetic regulators of gene transcription. Apabetalone is a selective bromodomain and extraterminal protein inhibitor targeting bromodomain 2 and is hypothesized to have potentially favorable effects on pathways related to atherothrombosis. Pooled phase 2 data suggest favorable effects on clinical outcomes. OBJECTIVE: To test whether apabetalone significantly reduces major adverse cardiovascular events. DESIGN, SETTING, AND PARTICIPANTS: A randomized, double-blind, placebo-controlled trial, conducted at 190 sites in 13 countries. Patients with an acute coronary syndrome in the preceding 7 to 90 days, type 2 diabetes, and low high-density lipoprotein cholesterol levels were eligible for enrollment, which started November 11, 2015, and ended July 4, 2018, with end of follow-up on July 3, 2019. INTERVENTIONS: Patients were randomized (1:1) to receive apabetalone, 100 mg orally twice daily (n = 1215), or matching placebo (n = 1210) in addition to standard care. MAIN OUTCOMES AND MEASURES: The primary outcome was a composite of time to the first occurrence of cardiovascular death, nonfatal myocardial infarction, or stroke. RESULTS: Among 2425 patients who were randomized (mean age, 62 years; 618 women [25.6%]), 2320 (95.7%) had full ascertainment of the primary outcome. During a median follow-up of 26.5 months, 274 primary end points occurred: 125 (10.3%) in apabetalone-treated patients and 149 (12.4%) in placebo-treated patients (hazard ratio, 0.82 [95% CI, 0.65-1.04]; P = .11). More patients allocated to apabetalone than placebo discontinued study drug (114 [9.4%] vs 69 [5.7%]) for reasons including elevations of liver enzyme levels (35 [2.9%] vs 11 [0.9%]). CONCLUSIONS AND RELEVANCE: Among patients with recent acute coronary syndrome, type 2 diabetes, and low high-density lipoprotein cholesterol levels, the selective bromodomain and extraterminal protein inhibitor apabetalone added to standard therapy did not significantly reduce the risk of major adverse cardiovascular events. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02586155."},{"id":"65ebe5771500","type":"article","url":"https://hartvaat.nl/2020/04/28/apixaban-versus-warfarine-bij-af-met-gevorderde-ckd/","title":"Apixaban versus warfarine bij AF met gevorderde CKD","title_en":"Apixaban Versus Warfarin in Patients With Atrial Fibrillation and Advanced Chronic Kidney Disease.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","internist"],"tags":["anemie-ckd","chronische-nierziekte","warfarine"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.119.044059","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.119.044059","authors":["John W Stanifer","Sean D Pokorney","Glenn M Chertow","Stefan H Hohnloser","Daniel M Wojdyla","Samira Garonzik","Wonkyung Byon","Ziad Hijazi","Renato D Lopes","John H Alexander","Lars Wallentin","Christopher B Granger"],"significance":7,"published":"2020-04-28","source_date":"2020-04-28","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/antistolling-bij-ckd/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This study comparing apixaban with warfarin in AF patients with advanced CKD (including stages 4-5) found comparable outcomes, addressing a critical evidence gap for anticoagulant selection in severe kidney disease.","created":"2026-07-03T10:28:31Z","updated":"2026-07-03T13:27:41Z","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":"Studie die apixaban vergeleek met warfarine bij AF-patiënten met gevorderde chronische nierziekte. Cruciaal voor DOAC-gebruik bij ernstige nierinsufficiëntie.","abstract_original":"BACKGROUND: Compared with the general population, patients with advanced chronic kidney disease have a >10-fold higher burden of atrial fibrillation. Limited data are available guiding the use of nonvitamin K antagonist oral anticoagulants in this population. METHODS: We compared the safety of apixaban with warfarin in 269 patients with atrial fibrillation and advanced chronic kidney disease (defined as creatinine clearance [CrCl] 25 to 30 mL/min) enrolled in the ARISTOTLE trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation). Cox proportional models were used to estimate hazard ratios for major bleeding and major or clinically relevant nonmajor bleeding. We characterized the pharmacokinetic profile of apixaban by assessing differences in exposure using nonlinear mixed effects models. RESULTS: Among patients with CrCl 25 to 30 mL/min, apixaban caused less major bleeding (hazard ratio, 0.34 [95% CI, 0.14-0.80]) and major or clinically relevant nonmajor bleeding (hazard ratio, 0.35 [95% CI, 0.17-0.72]) compared with warfarin. Patients with CrCl 25 to 30 mL/min randomized to apixaban demonstrated a trend toward lower rates of major bleeding when compared with those with CrCl >30 mL/min (P interaction=0.08) and major or clinically relevant nonmajor bleeding (P interaction=0.05). Median daily steady-state areas under the curve for apixaban 5 mg twice daily were 5512 ng/(mL·h) and 3406 ng/(mL·h) for patients with CrCl 25 to 30 mL/min or >30 mL/min, respectively. For apixaban 2.5 mg twice daily, the median exposure was 2780 ng/(mL·h) for patients with CrCl 25 to 30 mL/min. The area under the curve values for patients with CrCl 25 to 30 mL/min fell within the ranges demonstrated for patients with CrCl >30 mL/min. CONCLUSIONS: Among patients with atrial fibrillation and CrCl 25 to 30 mL/min, apixaban caused less bleeding than warfarin, with even greater reductions in bleeding than in patients with CrCl >30 mL/min. We observed substantial overlap in the range of exposure to apixaban 5 mg twice daily for patients with or without advanced chronic kidney disease, supporting conventional dosing in patients with CrCl 25 to 30 mL/min. Randomized, controlled studies evaluating the safety and efficacy of apixaban are urgently needed in patients with advanced chronic kidney disease, including those receiving dialysis. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00412984."},{"id":"0d11aeda3f6a","type":"article","url":"https://hartvaat.nl/2020/04/28/open-label-drop-in-van-glucoseverlagende-medicatie-en-exscel-uitkomsten/","title":"Open-label drop-in van glucoseverlagende medicatie en EXSCEL-uitkomsten","title_en":"Exploring the Possible Impact of Unbalanced Open-Label Drop-In of Glucose-Lowering Medications on EXSCEL Outcomes.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.119.043353","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.119.043353","authors":["M Angelyn Bethel","Susanna R Stevens","John B Buse","Jasmine Choi","Stephanie M Gustavson","Nayyar Iqbal","Yuliya Lokhnygina","Robert J Mentz","Rishi A Patel","Peter Öhman","Guntram Schernthaner","Albert Lecube","Adrian F Hernandez","Rury R Holman"],"significance":5,"published":"2020-04-28","source_date":"2020-04-28","image":"","kennis":[],"congress":"","summary_en":"This analysis explored whether unbalanced open-label drop-in of glucose-lowering medications may have diluted the cardiovascular benefit signal in the EXSCEL exenatide trial.","created":"2026-07-03T10:28:31Z","updated":"2026-07-03T13:27:41Z","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 naar de mogelijke impact van ongebalanceerde open-label drop-in van glucoseverlagende medicatie op EXSCEL-uitkomsten.","abstract_original":"BACKGROUND: EXSCEL (Exenatide Study of Cardiovascular Event Lowering) assessed the impact of once-weekly exenatide 2 mg versus placebo in patients with type 2 diabetes mellitus, while aiming for glycemic equipoise. Consequently, greater drop-in of open-label glucose-lowering medications occurred in the placebo group. Accordingly, we explored the potential effects of their unbalanced use on major adverse cardiovascular events (MACE), defined as cardiovascular death, nonfatal myocardial infarction or nonfatal stroke, and all-cause mortality (ACM), given that some of these agents are cardioprotective. METHODS: Cox hazard models were performed by randomized treatment for drug classes where >5% open-label drop-in glucose-lowering medication occurred, and for glucagon-like peptide-1 receptor agonists (GLP-1 RAs; 3.0%) using three methodologies: drop-in visit right censoring, inverse probability for treatment weighting (IPTW), and applying drug class risk reductions. RESULTS: Baseline glucose-lowering medications for the 14 752 EXSCEL participants (73.1% with previous cardiovascular disease) did not differ between treatment groups. During median 3.2 years follow-up, open-label drop-in occurred in 33.4% of participants, more frequently with placebo than exenatide (38.1% versus 28.8%), with metformin (6.1% versus 4.9%), sulfonylurea (8.7% versus 6.9%), dipeptidyl peptidase-4 inhibitors (10.6% versus 7.5%), SGLT-2i (10.3% versus 8.1%), GLP-1 RA (3.4% versus 2.4%), and insulin (13.8% versus 9.4%). The MACE effect size was not altered meaningfully by right censoring, but the favorable HR for exenatide became nominally significant in the sulfonylurea and any glucose-lowering medication groups, while the ACM HR and p-values were essentially unchanged. IPTW decreased the MACE HR from 0.91 (P=0.061) to 0.85 (P=0.008) and the ACM HR from 0.86 (P=0.016) to 0.81 (P=0.012). Application of literature-derived risk reductions showed no meaningful changes in MACE or ACM HRs or P values, although simulations of substantially greater use of drop-in cardioprotective glucose-lowering agents demonstrated blunting of signal detection. CONCLUSIONS: EXSCEL-observed HRs for MACE and ACM remained robust after right censoring or application of literature-derived risk reductions, but the exenatide versus placebo MACE effect size and statistical significance were increased by IPTW. Effects of open-label drop-in cardioprotective medications need to be considered carefully when designing, conducting, and analyzing cardiovascular outcome trials of glucose-lowering agents under the premise of glycemic equipoise. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01144338."},{"id":"f28bbb09a6b1","type":"article","url":"https://hartvaat.nl/2020/04/25/clopidogrel-versus-ticagrelor-of-prasugrel-bij-70-plussers-met-nste-acs-lancet-p/","title":"Clopidogrel versus ticagrelor of prasugrel bij 70-plussers met NSTE-ACS: Lancet POPular AGE","title_en":"Clopidogrel versus ticagrelor or prasugrel in patients aged 70 years or older with non-ST-elevation acute coronary syndrome (POPular AGE): the randomised, open-label, non-inferiority trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(20)30325-1","source_url":"https://doi.org/10.1016/S0140-6736(20)30325-1","authors":["Marieke Gimbel","Khalid Qaderdan","Laura Willemsen","Rik Hermanides","Thomas Bergmeijer","Evelyn de Vrey","Ton Heestermans","Melvyn Tjon Joe Gin","Reinier Waalewijn","Sjoerd Hofma","Frank den Hartog","Wouter Jukema","Clemens von Birgelen","Michiel Voskuil","Johannes Kelder","Vera Deneer","Jurriën Ten Berg"],"significance":8,"published":"2020-04-25","source_date":"2020-04-25","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/trombocytenaggregatieremmers-bij-acs/","https://hartvaat.nl/kennis/farmacologie/p2y12-remmers-vergelijking/"],"congress":"","summary_en":"The POPular AGE trial showed that clopidogrel was associated with less bleeding than ticagrelor or prasugrel in patients aged 70 years and older with non-ST-elevation ACS, without a significant increase in ischemic events. The results supported clopidogrel as the preferred antiplatelet in elderly ACS patients.","created":"2026-07-03T10:28:31Z","updated":"2026-07-03T13:27:41Z","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":"Lancet POPular AGE gerandomiseerde trial die clopidogrel vergeleek met ticagrelor of prasugrel bij ouderen (≥70) met NSTE-ACS. Minder bloedingen met clopidogrel.","abstract_original":"BACKGROUND: Current guidelines recommend potent platelet inhibition with ticagrelor or prasugrel in patients after an acute coronary syndrome. However, data about optimal platelet inhibition in older patients are scarce. We aimed to investigate the safety and efficacy of clopidogrel compared with ticagrelor or prasugrel in older patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). METHODS: We did the open-label, randomised controlled POPular AGE trial in 12 sites (ten hospitals and two university hospitals) in the Netherlands. Patients aged 70 years or older with NSTE-ACS were enrolled and randomly assigned in a 1:1 ratio using an internet-based randomisation procedure with block sizes of six to receive a loading dose of clopidogrel 300 mg or 600 mg, or ticagrelor 180 mg or prasugrel 60 mg, and then a maintenance dose for the duration of 12 months (clopidogrel 75 mg once daily, ticagrelor 90 mg twice daily, or prasugrel 10 mg once daily) on top of standard care. Patient and treating physicians were aware of the allocated treatment strategy, but the outcome assessors were masked to treatment allocation. Primary bleeding outcome consisted of PLATelet inhibition and patient Outcomes (PLATO; major or minor bleeding [superiority hypothesis]). Co-primary net clinical benefit outcome consisted of all-cause death, myocardial infarction, stroke, PLATO major and minor bleeding (non-inferiority hypothesis, margin of 2%). Follow-up duration was 12 months. Analyses were done on intention-to-treat basis. This trial is registered with the Netherlands Trial Register (NL3804), ClinicalTrials.gov (NCT02317198), and EudraCT (2013-001403-37). FINDINGS: Between June 10, 2013, and Oct 17, 2018, 1002 patients were randomly assigned to clopidogrel (n=500) or ticagrelor or prasugrel (n=502). Because 475 (95%) patients received ticagrelor in the ticagrelor or prasugrel group, we will refer to this group as the ticagrelor group. Premature discontinuation of the study drug occurred in 238 (47%) of 502 ticagrelor group patients randomly assigned to ticagrelor, and in 112 (22%) of 500 patients randomly assigned to clopidogrel. Primary bleeding outcome was significantly lower in the clopidogrel group (88 [18%] of 500 patients) than in the ticagrelor group (118 [24%] of 502; hazard ratio 0·71, 95% CI 0·54 to 0·94; p=0·02 for superiority). Co-primary net clinical benefit outcome was non-inferior for the use of clopidogrel (139 [28%]) versus ticagrelor (161 [32%]; absolute risk difference -4%, 95% CI -10·0 to 1·4; p=0·03 for non-inferiority). The most important reasons for discontinuation were occurrence of bleeding (n=38), dyspnoea (n=40), and the need for treatment with oral anticoagulation (n=35). INTERPRETATION: In patients aged 70 years or older presenting with NSTE-ACS, clopidogrel is a favourable alternative to ticagrelor, because it leads to fewer bleeding events without an increase in the combined endpoint of all-cause death, myocardial infarction, stroke, and bleeding. Clopidogrel could be an alternative P2Y12 inhibitor especially for elderly patients with a higher bleeding risk. FUNDING: ZonMw."},{"id":"7222dee124db","type":"article","url":"https://hartvaat.nl/2020/04/23/management-van-coronairlijden-bij-gevorderde-nierziekte-nejm-ischemia-ckd/","title":"Management van coronairlijden bij gevorderde nierziekte: NEJM ISCHEMIA-CKD","title_en":"Management of Coronary Disease in Patients with Advanced Kidney Disease.","category":"chronische nierziekte","category_label":"Nierziekte","professions":["cardioloog","internist"],"tags":["anemie-ckd","chronische-nierziekte","flow-trial","ijzertekort"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1915925","source_url":"https://doi.org/10.1056/NEJMoa1915925","authors":["Sripal Bangalore","David J Maron","Sean M O'Brien","Jerome L Fleg","Evgeny I Kretov","Carlo Briguori","Upendra Kaul","Harmony R Reynolds","Tomasz Mazurek","Mandeep S Sidhu","Jeffrey S Berger","Roy O Mathew","Olga Bockeria","Samuel Broderick","Radoslaw Pracon","Charles A Herzog","Zhen Huang","Gregg W Stone","William E Boden","Jonathan D Newman","Ziad A Ali","Daniel B Mark","John A Spertus","Karen P Alexander","Bernard R Chaitman","Glenn M Chertow","Judith S Hochman"],"significance":9,"published":"2020-04-23","source_date":"2020-04-23","image":"","kennis":[],"congress":"","summary_en":"The ISCHEMIA-CKD trial showed that an initial invasive strategy did not reduce cardiovascular events compared with conservative management in patients with stable coronary disease and advanced chronic kidney disease. The findings underscored the heightened procedural risk and attenuated benefit of revascularization in severe CKD.","created":"2026-07-03T10:28:31Z","updated":"2026-07-03T13:27:41Z","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":"NEJM ISCHEMIA-CKD-trial die invasieve versus conservatieve strategie onderzocht bij coronairlijden met gevorderde nierziekte. Geen voordeel van revascularisatie bij CKD.","abstract_original":"BACKGROUND: Clinical trials that have assessed the effect of revascularization in patients with stable coronary disease have routinely excluded those with advanced chronic kidney disease. METHODS: We randomly assigned 777 patients with advanced kidney disease and moderate or severe ischemia on stress testing to be treated with an initial invasive strategy consisting of coronary angiography and revascularization (if appropriate) added to medical therapy or an initial conservative strategy consisting of medical therapy alone and angiography reserved for those in whom medical therapy had failed. The primary outcome was a composite of death or nonfatal myocardial infarction. A key secondary outcome was a composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. RESULTS: At a median follow-up of 2.2 years, a primary outcome event had occurred in 123 patients in the invasive-strategy group and in 129 patients in the conservative-strategy group (estimated 3-year event rate, 36.4% vs. 36.7%; adjusted hazard ratio, 1.01; 95% confidence interval [CI], 0.79 to 1.29; P = 0.95). Results for the key secondary outcome were similar (38.5% vs. 39.7%; hazard ratio, 1.01; 95% CI, 0.79 to 1.29). The invasive strategy was associated with a higher incidence of stroke than the conservative strategy (hazard ratio, 3.76; 95% CI, 1.52 to 9.32; P = 0.004) and with a higher incidence of death or initiation of dialysis (hazard ratio, 1.48; 95% CI, 1.04 to 2.11; P = 0.03). CONCLUSIONS: Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA-CKD ClinicalTrials.gov number, NCT01985360.)."},{"id":"e39faf3c16df","type":"article","url":"https://hartvaat.nl/2020/04/23/gezondheidsstatus-na-invasieve-of-conservatieve-zorg-bij-coronairlijden-met-gevo/","title":"Gezondheidsstatus na invasieve of conservatieve zorg bij coronairlijden met gevorderde CKD: NEJM ISCHEMIA-CKD QoL","title_en":"Health Status after Invasive or Conservative Care in Coronary and Advanced Kidney Disease.","category":"chronische nierziekte","category_label":"Nierziekte","professions":["cardioloog","internist"],"tags":["anemie-ckd","chronische-nierziekte","hartkatheterisatie","perifeer-vaatlijden","stabiel-coronairlijden"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1916374","source_url":"https://doi.org/10.1056/NEJMoa1916374","authors":["John A Spertus","Philip G Jones","David J Maron","Daniel B Mark","Sean M O'Brien","Jerome L Fleg","Harmony R Reynolds","Gregg W Stone","Mandeep S Sidhu","Bernard R Chaitman","Glenn M Chertow","Judith S Hochman","Sripal Bangalore"],"significance":7,"published":"2020-04-23","source_date":"2020-04-23","image":"","kennis":[],"congress":"","summary_en":"The ISCHEMIA-CKD quality-of-life analysis showed that an initial invasive strategy did not significantly improve health status compared with conservative management in patients with stable coronary disease and advanced kidney disease.","created":"2026-07-03T10:28:31Z","updated":"2026-07-03T13:27:41Z","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":"NEJM ISCHEMIA-CKD kwaliteit-van-levenanalyse bij coronairlijden met gevorderde nierziekte.","abstract_original":"BACKGROUND: In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of <30 ml per minute per 1.73 m2 or receipt of dialysis). A secondary objective of the trial was to assess angina-related health status. METHODS: We assessed health status with the Seattle Angina Questionnaire (SAQ) before randomization and at 1.5, 3, and 6 months and every 6 months thereafter. The primary outcome of this analysis was the SAQ Summary score (ranging from 0 to 100, with higher scores indicating less frequent angina and better function and quality of life). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate the treatment effect with the invasive strategy. RESULTS: Health status was assessed in 705 of 777 participants. Nearly half the participants (49%) had had no angina during the month before randomization. At 3 months, the estimated mean difference between the invasive-strategy group and the conservative-strategy group in the SAQ Summary score was 2.1 points (95% credible interval, -0.4 to 4.6), a result that favored the invasive strategy. The mean difference in score at 3 months was largest among participants with daily or weekly angina at baseline (10.1 points; 95% credible interval, 0.0 to 19.9), smaller among those with monthly angina at baseline (2.2 points; 95% credible interval, -2.0 to 6.2), and nearly absent among those without angina at baseline (0.6 points; 95% credible interval, -1.9 to 3.3). By 6 months, the between-group difference in the overall trial population was attenuated (0.5 points; 95% credible interval, -2.2 to 3.4). CONCLUSIONS: Participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease did not have substantial or sustained benefits with regard to angina-related health status with an initially invasive strategy as compared with a conservative strategy. (Funded by the National Heart, Lung, and Blood Institute; ISCHEMIA-CKD ClinicalTrials.gov number, NCT01985360.)."},{"id":"bef9644bf703","type":"article","url":"https://hartvaat.nl/2020/04/21/morfine-met-metoclopramide-en-ticagrelor-plaatjesremming-bij-acuut-mi/","title":"Morfine met metoclopramide en ticagrelor-plaatjesremming bij acuut MI","title_en":"Impact of Morphine Treatment With and Without Metoclopramide Coadministration on Ticagrelor-Induced Platelet Inhibition in Acute Myocardial Infarction: The Randomized MonAMI Trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["trombocytenaggregatieremmers"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.119.042816","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.119.042816","authors":["Mohammed Saad","Roza Meyer-Saraei","Suzanne de Waha-Thiele","Thomas Stiermaier","Tobias Graf","Georg Fuernau","Harald F Langer","Thomas Kurz","Janine Pöss","Jörg Barkhausen","Steffen Desch","Ingo Eitel","Holger Thiele"],"significance":5,"published":"2020-04-21","source_date":"2020-04-21","image":"","kennis":[],"congress":"","summary_en":"This study tested whether metoclopramide co-administration counteracts morphine-induced delay in ticagrelor absorption during acute MI, evaluating a practical pharmacological strategy for the opioid-antiplatelet interaction.","created":"2026-07-03T10:28:31Z","updated":"2026-07-03T13:27:41Z","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":"Studie naar het effect van metoclopramide-co-administratie op morfine-geïnduceerde vertraging van ticagrelor-absorptie bij acuut MI.","abstract_original":""},{"id":"46ff894f6d05","type":"article","url":"https://hartvaat.nl/2020/04/16/inclisiran-bij-heterozygote-familiaire-hypercholesterolemie-nejm-orion-9/","title":"Inclisiran bij heterozygote familiaire hypercholesterolemie: NEJM ORION-9","title_en":"Inclisiran for the Treatment of Heterozygous Familial Hypercholesterolemia.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["familiaire-hypercholesterolemie-screening"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1913805","source_url":"https://doi.org/10.1056/NEJMoa1913805","authors":["Frederick J Raal","David Kallend","Kausik K Ray","Traci Turner","Wolfgang Koenig","R Scott Wright","Peter L J Wijngaard","Danielle Curcio","Mark J Jaros","Lawrence A Leiter","John J P Kastelein"],"significance":9,"published":"2020-04-16","source_date":"2020-04-16","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/genetisch-onderzoek-fh/","https://hartvaat.nl/kennis/lipiden/familiaire-hypercholesterolemie/"],"congress":"","summary_en":"The ORION-9 trial demonstrated that twice-yearly inclisiran injections reduced LDL cholesterol by approximately 40% in patients with heterozygous familial hypercholesterolemia on maximally tolerated statin therapy. The results confirmed the efficacy of RNA interference-based lipid lowering in the genetically defined FH population.","created":"2026-07-03T10:28:31Z","updated":"2026-07-03T13:27:41Z","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":"NEJM ORION-9 fase-3-trial van inclisiran bij heterozygote FH. Bevestigt werkzaamheid bij de genetische hypercholesterolemie.","abstract_original":"BACKGROUND: Familial hypercholesterolemia is characterized by an elevated level of low-density lipoprotein (LDL) cholesterol and an increased risk of premature atherosclerotic cardiovascular disease. Monoclonal antibodies directed against proprotein convertase subtilisin-kexin type 9 (PCSK9) have been shown to reduce LDL cholesterol levels by more than 50% but require administration every 2 to 4 weeks. In a phase 2 trial, a twice-yearly injection of inclisiran, a small interfering RNA, was shown to inhibit hepatic synthesis of PCSK9 in adults with heterozygous familial hypercholesterolemia. METHODS: In this phase 3, double-blind trial, we randomly assigned, in a 1:1 ratio, 482 adults who had heterozygous familial hypercholesterolemia to receive subcutaneous injections of inclisiran sodium (at a dose of 300 mg) or matching placebo on days 1, 90, 270, and 450. The two primary end points were the percent change from baseline in the LDL cholesterol level on day 510 and the time-adjusted percent change from baseline in the LDL cholesterol level between day 90 and day 540. RESULTS: The median age of the patients was 56 years, and 47% were men; the mean baseline level of LDL cholesterol was 153 mg per deciliter. At day 510, the percent change in the LDL cholesterol level was a reduction of 39.7% (95% confidence interval [CI], -43.7 to -35.7) in the inclisiran group and an increase of 8.2% (95% CI, 4.3 to 12.2) in the placebo group, for a between-group difference of -47.9 percentage points (95% CI, -53.5 to -42.3; P<0.001). The time-averaged percent change in the LDL cholesterol level between day 90 and day 540 was a reduction of 38.1% (95% CI, -41.1 to -35.1) in the inclisiran group and an increase of 6.2% (95% CI, 3.3 to 9.2) in the placebo group, for a between-group difference of -44.3 percentage points (95% CI, -48.5 to -40.1; P<0.001). There were robust reductions in LDL cholesterol levels in all genotypes of familial hypercholesterolemia. Adverse events and serious adverse events were similar in the two groups. CONCLUSIONS: Among adults with heterozygous familial hypercholesterolemia, those who received inclisiran had significantly lower levels of LDL cholesterol than those who received placebo, with an infrequent dosing regimen and an acceptable safety profile. (Funded by the Medicines Company; ORION-9 ClinicalTrials.gov number, NCT03397121.)."},{"id":"3d9ce63b0091","type":"article","url":"https://hartvaat.nl/2020/04/16/inclisiran-fase-3-bij-verhoogd-ldl-nejm-orion-10-en-orion-11/","title":"Inclisiran fase 3 bij verhoogd LDL: NEJM ORION-10 en ORION-11","title_en":"Two Phase 3 Trials of Inclisiran in Patients with Elevated LDL Cholesterol.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["dyslipidemie","ezetimibe","ldl-cholesterol","lipidenverlaging","niet-statine-therapie","pcsk9-remmers","soul-trial","statines"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1912387","source_url":"https://doi.org/10.1056/NEJMoa1912387","authors":["Kausik K Ray","R Scott Wright","David Kallend","Wolfgang Koenig","Lawrence A Leiter","Frederick J Raal","Jenna A Bisch","Tara Richardson","Mark Jaros","Peter L J Wijngaard","John J P Kastelein"],"significance":10,"published":"2020-04-16","source_date":"2020-04-16","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/inclisiran-sirna/","https://hartvaat.nl/kennis/lipiden/dyslipidemie-overzicht/"],"congress":"","summary_en":"The ORION-10 and ORION-11 phase 3 trials demonstrated that twice-yearly subcutaneous inclisiran reduced LDL cholesterol by approximately 50% with sustained efficacy and an acceptable safety profile. These results confirmed inclisiran as a viable long-acting approach to LDL lowering, offering an alternative to frequent dosing with statins or monoclonal antibodies.","created":"2026-07-03T10:28:31Z","updated":"2026-07-03T13:27:41Z","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":"NEJM publicatie van twee fase-3-trials (ORION-10 en ORION-11) die aantoonden dat tweemaal jaarlijks inclisiran het LDL-cholesterol met ~50% verlaagt. Definitief bewijs voor siRNA-lipidentherapie.","abstract_original":"BACKGROUND: Inclisiran inhibits hepatic synthesis of proprotein convertase subtilisin-kexin type 9. Previous studies suggest that inclisiran might provide sustained reductions in low-density lipoprotein (LDL) cholesterol levels with infrequent dosing. METHODS: We enrolled patients with atherosclerotic cardiovascular disease (ORION-10 trial) and patients with atherosclerotic cardiovascular disease or an atherosclerotic cardiovascular disease risk equivalent (ORION-11 trial) who had elevated LDL cholesterol levels despite receiving statin therapy at the maximum tolerated dose. Patients were randomly assigned in a 1:1 ratio to receive either inclisiran (284 mg) or placebo, administered by subcutaneous injection on day 1, day 90, and every 6 months thereafter over a period of 540 days. The coprimary end points in each trial were the placebo-corrected percentage change in LDL cholesterol level from baseline to day 510 and the time-adjusted percentage change in LDL cholesterol level from baseline after day 90 and up to day 540. RESULTS: A total of 1561 and 1617 patients underwent randomization in the ORION-10 and ORION-11 trials, respectively. Mean (±SD) LDL cholesterol levels at baseline were 104.7±38.3 mg per deciliter (2.71±0.99 mmol per liter) and 105.5±39.1 mg per deciliter (2.73±1.01 mmol per liter), respectively. At day 510, inclisiran reduced LDL cholesterol levels by 52.3% (95% confidence interval [CI], 48.8 to 55.7) in the ORION-10 trial and by 49.9% (95% CI, 46.6 to 53.1) in the ORION-11 trial, with corresponding time-adjusted reductions of 53.8% (95% CI, 51.3 to 56.2) and 49.2% (95% CI, 46.8 to 51.6) (P<0.001 for all comparisons vs. placebo). Adverse events were generally similar in the inclisiran and placebo groups in each trial, although injection-site adverse events were more frequent with inclisiran than with placebo (2.6% vs. 0.9% in the ORION-10 trial and 4.7% vs. 0.5% in the ORION-11 trial); such reactions were generally mild, and none were severe or persistent. CONCLUSIONS: Reductions in LDL cholesterol levels of approximately 50% were obtained with inclisiran, administered subcutaneously every 6 months. More injection-site adverse events occurred with inclisiran than with placebo. (Funded by the Medicines Company; ORION-10 and ORION-11 ClinicalTrials.gov numbers, NCT03399370 and NCT03400800.)."},{"id":"71ba471bc7d4","type":"article","url":"https://hartvaat.nl/2020/04/14/langetermijnuitkomsten-bij-vrouwen-en-mannen-na-pci/","title":"Langetermijnuitkomsten bij vrouwen en mannen na PCI","title_en":"Long-Term Outcomes in Women and Men Following Percutaneous Coronary Intervention.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.01.056","source_url":"https://doi.org/10.1016/j.jacc.2020.01.056","authors":["Ioanna Kosmidou","Martin B Leon","Yiran Zhang","Patrick W Serruys","Clemens von Birgelen","Pieter C Smits","Ori Ben-Yehuda","Björn Redfors","Mahesh V Madhavan","Akiko Maehara","Roxana Mehran","Gregg W Stone"],"significance":5,"published":"2020-04-14","source_date":"2020-04-14","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"This analysis of long-term sex differences after PCI showed that women have different risk profiles and complication patterns than men, informing sex-specific post-PCI management approaches.","created":"2026-07-03T10:28:30Z","updated":"2026-07-03T13:27:41Z","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 langetermijn-sekseverschillen in uitkomsten na PCI.","abstract_original":"BACKGROUND: Studies examining sex-related outcomes following percutaneous coronary intervention (PCI) have reported conflicting results. OBJECTIVES: The purpose of this study was to examine the sex-related risk of 5-year cardiovascular outcomes after PCI. METHODS: The authors pooled patient-level data from 21 randomized PCI trials and assessed the association between sex and major adverse cardiac events (MACE) (cardiac death, myocardial infarction [MI], or ischemia-driven target lesion revascularization [ID-TLR]) as well as its individual components at 5 years. RESULTS: Among 32,877 patients, 9,141 (27.8%) were women. Women were older and had higher body mass index, more frequent hypertension and diabetes, and less frequent history of surgical or percutaneous revascularization compared with men. By angiographic core laboratory analysis, lesions in women had smaller reference vessel diameter and shorter lesion length. At 5 years, women had a higher unadjusted rate of MACE (18.9% vs. 17.7%; p = 0.003), all-cause death (10.4% vs. 8.7%; p = 0.0008), cardiac death (4.9% vs. 4.0%; p = 0.003) and ID-TLR (10.9% vs. 10.2%; p = 0.02) compared with men. By multivariable analysis, female sex was an independent predictor of MACE (hazard ratio [HR:]: 1.14; 95% confidence interval [CI:]: 1.01 to 1.30; p = 0.04) and ID-TLR (HR: 1.23; 95% CI: 1.05 to 1.44; p = 0.009) but not all-cause death (HR: 0.91; 95% CI: 0.75 to 1.09; p = 0.30) or cardiac death (HR: 0.97; 95% CI: 0.73 to 1.29; p = 0.85). CONCLUSIONS: In the present large-scale, individual patient data pooled analysis of contemporary PCI trials, women had a higher risk of MACE and ID-TLR compared with men at 5 years following PCI."},{"id":"0985fb9a77c1","type":"article","url":"https://hartvaat.nl/2020/04/14/dapagliflozine-bij-hf-met-en-zonder-diabetes-jama-dapa-hf-uitkomsten/","title":"Dapagliflozine bij HF met en zonder diabetes: JAMA DAPA-HF uitkomsten","title_en":"Effect of Dapagliflozin on Worsening Heart Failure and Cardiovascular Death in Patients With Heart Failure With and Without Diabetes.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["dapa-hf"],"journal":"JAMA","doi":"10.1001/jama.2020.1906","source_url":"https://doi.org/10.1001/jama.2020.1906","authors":["Mark C Petrie","Subodh Verma","Kieran F Docherty","Silvio E Inzucchi","Inder Anand","Jan Belohlávek","Michael Böhm","Chern-En Chiang","Vijay K Chopra","Rudolf A de Boer","Akshay S Desai","Mirta Diez","Jaroslaw Drozdz","Andre Dukát","Junbo Ge","Jonathan Howlett","Tzvetana Katova","Masafumi Kitakaze","Charlotta E A Ljungman","Béla Merkely","Jose C Nicolau","Eileen O'Meara","Pham Nguyen Vinh","Morten Schou","Sergey Tereshchenko","Lars Køber","Mikhail N Kosiborod","Anna Maria Langkilde","Felipe A Martinez","Piotr Ponikowski","Marc S Sabatine","Mikaela Sjöstrand","Scott D Solomon","Per Johanson","Peter J Greasley","David Boulton","Olof Bengtsson","Pardeep S Jhund","John J V McMurray"],"significance":9,"published":"2020-04-14","source_date":"2020-04-14","image":"","kennis":[],"congress":"","summary_en":"This JAMA DAPA-HF analysis confirmed that dapagliflozin reduced worsening heart failure and cardiovascular death equally in patients with HFrEF with and without type 2 diabetes. The finding strengthened the case for SGLT2 inhibitors as a heart failure therapy independent of glycemic status.","created":"2026-07-03T10:28:30Z","updated":"2026-07-03T13:27:40Z","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 publicatie van DAPA-HF naar het effect op verslechterend HF en CV-dood bij patiënten met en zonder diabetes. Bevestigt voordeel ongeacht diabetesstatus.","abstract_original":"IMPORTANCE: Additional treatments are needed for heart failure with reduced ejection fraction (HFrEF). Sodium-glucose cotransporter 2 (SGLT2) inhibitors may be an effective treatment for patients with HFrEF, even those without diabetes. OBJECTIVE: To evaluate the effects of dapagliflozin in patients with HFrEF with and without diabetes. DESIGN, SETTING, AND PARTICIPANTS: Exploratory analysis of a phase 3 randomized trial conducted at 410 sites in 20 countries. Patients with New York Heart Association classification II to IV with an ejection fraction less than or equal to 40% and elevated plasma N-terminal pro B-type natriuretic peptide were enrolled between February 15, 2017, and August 17, 2018, with final follow-up on June 6, 2019. INTERVENTIONS: Addition of once-daily 10 mg of dapagliflozin or placebo to recommended therapy. MAIN OUTCOMES AND MEASURES: The primary outcome was the composite of an episode of worsening heart failure or cardiovascular death. This outcome was analyzed by baseline diabetes status and, in patients without diabetes, by glycated hemoglobin level less than 5.7% vs greater than or equal to 5.7%. RESULTS: Among 4744 patients randomized (mean age, 66 years; 1109 [23%] women; 2605 [55%] without diabetes), 4742 completed the trial. Among participants without diabetes, the primary outcome occurred in 171 of 1298 (13.2%) in the dapagliflozin group and 231 of 1307 (17.7%) in the placebo group (hazard ratio, 0.73 [95% CI, 0.60-0.88]). In patients with diabetes, the primary outcome occurred in 215 of 1075 (20.0%) in the dapagliflozin group and 271 of 1064 (25.5%) in the placebo group (hazard ratio, 0.75 [95% CI, 0.63-0.90]) (P value for interaction = .80). Among patients without diabetes and a glycated hemoglobin level less than 5.7%, the primary outcome occurred in 53 of 438 patients (12.1%) in the dapagliflozin group and 71 of 419 (16.9%) in the placebo group (hazard ratio, 0.67 [95% CI, 0.47-0.96]). In patients with a glycated hemoglobin of at least 5.7%, the primary outcome occurred in 118 of 860 patients (13.7%) in the dapagliflozin group and 160 of 888 (18.0%) in the placebo group (hazard ratio, 0.74 [95% CI, 0.59-0.94]) (P value for interaction = .72). Volume depletion was reported as an adverse event in 7.3% of patients in the dapagliflozin group and 6.1% in the placebo group among patients without diabetes and in 7.8% of patients in the dapagliflozin group and 7.8% in the placebo group among patients with diabetes. A kidney adverse event was reported in 4.8% of patients in the dapagliflozin group and 6.0% in the placebo group among patients without diabetes and in 8.5% of patients in the dapagliflozin group and 8.7% in the placebo group among patients with diabetes. CONCLUSIONS AND RELEVANCE: In this exploratory analysis of a randomized trial of patients with HFrEF, dapagliflozin compared with placebo, when added to recommended therapy, significantly reduced the risk of worsening heart failure or cardiovascular death independently of diabetes status. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03036124."},{"id":"8bbf904f3735","type":"article","url":"https://hartvaat.nl/2020/04/14/systolische-bloeddruk-bij-hfpef-behandeld-met-sacubitril-valsartan-paragon-hf/","title":"Systolische bloeddruk bij HFpEF behandeld met sacubitril/valsartan: PARAGON-HF","title_en":"Systolic Blood Pressure in Heart Failure With Preserved Ejection Fraction Treated With Sacubitril/Valsartan.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["answer-hf"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.02.009","source_url":"https://doi.org/10.1016/j.jacc.2020.02.009","authors":["Senthil Selvaraj","Brian L Claggett","Michael Böhm","Stefan D Anker","Muthiah Vaduganathan","Faiez Zannad","Burkert Pieske","Carolyn S P Lam","Inder S Anand","Victor C Shi","Martin P Lefkowitz","John J V McMurray","Scott D Solomon"],"significance":6,"published":"2020-04-14","source_date":"2020-04-14","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/arni-farmacologie/"],"congress":"","summary_en":"This PARAGON-HF analysis examined the relationship between systolic blood pressure and outcomes with sacubitril-valsartan in HFpEF, informing the blood pressure management strategy in preserved ejection fraction heart failure.","created":"2026-07-03T10:28:30Z","updated":"2026-07-03T13:27:40Z","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":"PARAGON-HF analyse naar de relatie tussen systolische bloeddruk en uitkomsten met sacubitril/valsartan bij HFpEF.","abstract_original":"BACKGROUND: Guidelines recommend targeting systolic blood pressure (SBP) <130 mm Hg in heart failure with preserved ejection fraction (HFpEF) with limited data. OBJECTIVES: This study sought to determine the optimal achieved SBP and whether the treatment effects of sacubitril/valsartan on outcomes are related to BP lowering, particularly among women who derive greater benefit from sacubitril/valsartan. METHODS: Using 4,795 trial participants, this study related baseline and time-updated mean achieved SBP quartiles (<120, 120 to 129, 130 to 139, ≥140 mm Hg) to the primary outcome (cardiovascular death and total heart failure hospitalization), its components, myocardial infarction or stroke, and a renal composite outcome. At the 16-week visit, the study assessed the relationship between SBP change and Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OSS) and N-terminal pro-B-type natriuretic peptide (NT-proBNP). The study analyzed whether the BP-lowering effects of sacubitril/valsartan accounted for its treatment effects. RESULTS: Average age was 73 ± 8 years, and 52% of participants were women. After multivariable adjustment, baseline and mean achieved SBP of 120 to 129 mm Hg demonstrated the lowest risk for all outcomes. Sacubitril/valsartan reduced SBP by 5.2 mm Hg (95% confidence interval: 4.4 to 6.0) compared with valsartan at 4 weeks, which was not modified by baseline SBP. However, sacubitril/valsartan reduced SBP more in women (6.3 mm Hg) than men (4.0 mm Hg) (interaction p = 0.005). Change in SBP was directly associated with change in NT-proBNP (p < 0.001) but not KCCQ-OSS (p = 0.40). The association between sacubitril/valsartan and the primary outcome was not modified by baseline SBP (interaction p = 0.50) and was similar when adjusting for time-updated SBP, regardless of sex. CONCLUSIONS: Baseline and mean achieved SBP of 120 to 129 mm Hg identified the lowest risk patients with HFpEF. Baseline SBP did not modify the treatment effect of sacubitril/valsartan, and the BP-lowering effects of sacubitril/valsartan did not account for its effects on outcomes, regardless of sex. (Prospective Comparison of ARNI With ARB Global Outcomes in HF With Preserved Ejection Fraction [PARAGON-HF]; NCT01920711)."},{"id":"3542a7e7eaab","type":"article","url":"https://hartvaat.nl/2020/04/09/initieel-invasief-of-conservatief-bij-stabiel-coronairlijden-nejm-ischemia/","title":"Initieel invasief of conservatief bij stabiel coronairlijden: NEJM ISCHEMIA","title_en":"Initial Invasive or Conservative Strategy for Stable Coronary Disease.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":["hartkatheterisatie","ouderen","perifeer-vaatlijden","stabiel-coronairlijden"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1915922","source_url":"https://doi.org/10.1056/NEJMoa1915922","authors":["David J Maron","Judith S Hochman","Harmony R Reynolds","Sripal Bangalore","Sean M O'Brien","William E Boden","Bernard R Chaitman","Roxy Senior","Jose López-Sendón","Karen P Alexander","Renato D Lopes","Leslee J Shaw","Jeffrey S Berger","Jonathan D Newman","Mandeep S Sidhu","Shaun G Goodman","Witold Ruzyllo","Gilbert Gosselin","Aldo P Maggioni","Harvey D White","Balram Bhargava","James K Min","G B John Mancini","Daniel S Berman","Michael H Picard","Raymond Y Kwong","Ziad A Ali","Daniel B Mark","John A Spertus","Mangalath N Krishnan","Ahmed Elghamaz","Nagaraja Moorthy","Whady A Hueb","Marcin Demkow","Kreton Mavromatis","Olga Bockeria","Jesus Peteiro","Todd D Miller","Hanna Szwed","Rolf Doerr","Matyas Keltai","Joseph B Selvanayagam","P Gabriel Steg","Claes Held","Shun Kohsaka","Stavroula Mavromichalis","Ruth Kirby","Neal O Jeffries","Frank E Harrell","Frank W Rockhold","Samuel Broderick","T Bruce Ferguson","David O Williams","Robert A Harrington","Gregg W Stone","Yves Rosenberg"],"significance":10,"published":"2020-04-09","source_date":"2020-04-09","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stabiele-angina-pectoris/","https://hartvaat.nl/kennis/coronairlijden/esc-richtlijn-chronisch-coronairlijden-2024/"],"congress":"","summary_en":"The ISCHEMIA trial showed that an initial invasive strategy with revascularization did not reduce cardiovascular death or MI compared with optimal medical therapy alone in patients with stable coronary disease and moderate-to-severe ischemia. The findings reinforced medical therapy as a reasonable first-line approach even in the presence of significant ischemia.","created":"2026-07-03T10:28:30Z","updated":"2026-07-03T13:27:40Z","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":"Landmark NEJM ISCHEMIA-trial die aantoonde dat een initieel invasieve strategie geen voordeel biedt boven optimale medicamenteuze therapie bij stabiel coronairlijden met matige tot ernstige ischemie. Herdefinieert de waarde van revascularisatie bij stabiele patiënten.","abstract_original":"BACKGROUND: Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS: We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS: Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, -1.8 percentage points; 95% CI, -4.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS: Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA ClinicalTrials.gov number, NCT01471522.)."},{"id":"646f6f2ae08c","type":"article","url":"https://hartvaat.nl/2020/04/07/yoga-gebaseerde-hartrevalidatie-na-acuut-mi-gerandomiseerde-trial/","title":"Yoga-gebaseerde hartrevalidatie na acuut MI: gerandomiseerde trial","title_en":"Yoga-Based Cardiac Rehabilitation After Acute Myocardial Infarction: A Randomized Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":["hartrevalidatie"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.01.050","source_url":"https://doi.org/10.1016/j.jacc.2020.01.050","authors":["Dorairaj Prabhakaran","Ambalam M Chandrasekaran","Kalpana Singh","Bishav Mohan","Kaushik Chattopadhyay","Davinder S Chadha","Prakash C Negi","Prabhavathi Bhat","Kanchanahalli S Sadananda","Vamadevan S Ajay","Kavita Singh","Pradeep A Praveen","Raji Devarajan","Dimple Kondal","Divya Soni","Poppy Mallinson","Subhash C Manchanda","Kushal Madan","Alun D Hughes","Nishi Chathurvedi","Ian Roberts","Shah Ebrahim","Kolli S Reddy","Nikhil Tandon","Stuart Pocock","Ambuj Roy","Sanjay Kinra"],"significance":6,"published":"2020-04-07","source_date":"2020-04-07","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/revalidatie-na-hartinfarct/"],"congress":"","summary_en":"This randomized trial demonstrated that yoga-based cardiac rehabilitation after acute MI improves functional capacity and quality of life, establishing an alternative rehabilitation model particularly relevant for low-resource settings.","created":"2026-07-03T10:28:30Z","updated":"2026-07-03T13:27:40Z","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":"Gerandomiseerde trial van yoga-gebaseerde hartrevalidatie na acuut myocardinfarct. Alternatieve revalidatiemodaliteit.","abstract_original":"BACKGROUND: Given the shortage of cardiac rehabilitation (CR) programs in India and poor uptake worldwide, there is an urgent need to find alternative models of CR that are inexpensive and may offer choice to subgroups with poor uptake (e.g., women and elderly). OBJECTIVES: This study sought to evaluate the effects of yoga-based CR (Yoga-CaRe) on major cardiovascular events and self-rated health in a multicenter randomized controlled trial. METHODS: The trial was conducted in 24 medical centers across India. This study recruited 3,959 patients with acute myocardial infarction with a median and minimum follow-up of 22 and 6 months. Patients were individually randomized to receive either a Yoga-CaRe program (n = 1,970) or enhanced standard care involving educational advice (n = 1,989). The co-primary outcomes were: 1) first occurrence of major adverse cardiovascular events (MACE) (composite of all-cause mortality, myocardial infarction, stroke, or emergency cardiovascular hospitalization); and 2) self-rated health on the European Quality of Life-5 Dimensions-5 Level visual analogue scale at 12 weeks. RESULTS: MACE occurred in 131 (6.7%) patients in the Yoga-CaRe group and 146 (7.4%) patients in the enhanced standard care group (hazard ratio with Yoga-CaRe: 0.90; 95% confidence interval [CI]: 0.71 to 1.15; p = 0.41). Self-rated health was 77 in Yoga-CaRe and 75.7 in the enhanced standard care group (baseline-adjusted mean difference in favor of Yoga-CaRe: 1.5; 95% CI: 0.5 to 2.5; p = 0.002). The Yoga-CaRe group had greater return to pre-infarct activities, but there was no difference in tobacco cessation or medication adherence between the treatment groups (secondary outcomes). CONCLUSIONS: Yoga-CaRe improved self-rated health and return to pre-infarct activities after acute myocardial infarction, but the trial lacked statistical power to show a difference in MACE. Yoga-CaRe may be an option when conventional CR is unavailable or unacceptable to individuals. (A study on effectiveness of YOGA based cardiac rehabilitation programme in India and United Kingdom; CTRI/2012/02/002408)."},{"id":"b87adf694ac3","type":"article","url":"https://hartvaat.nl/2020/04/07/mobiele-gezondheidstechnologie-voor-af-zorg/","title":"Mobiele gezondheidstechnologie voor AF-zorg","title_en":"Mobile Health Technology to Improve Care for Patients With Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.01.052","source_url":"https://doi.org/10.1016/j.jacc.2020.01.052","authors":["Yutao Guo","Deirdre A Lane","Limin Wang","Hui Zhang","Hao Wang","Wei Zhang","Jing Wen","Yunli Xing","Fang Wu","Yunlong Xia","Tong Liu","Fan Wu","Zhaoguang Liang","Fan Liu","Yujie Zhao","Rong Li","Xin Li","Lili Zhang","Jun Guo","Girvan Burnside","Yundai Chen","Gregory Y H Lip"],"significance":6,"published":"2020-04-07","source_date":"2020-04-07","image":"","kennis":[],"congress":"","summary_en":"This study evaluated mobile health technology for improving AF care, showing that smartphone-based monitoring, medication reminders, and teleconsultation can improve guideline adherence and clinical outcomes.","created":"2026-07-03T10:28:30Z","updated":"2026-07-03T13:27:40Z","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":"Studie naar de rol van mobiele gezondheidstechnologie voor het verbeteren van AF-zorg.","abstract_original":"BACKGROUND: Current management of patients with atrial fibrillation (AF) is limited by low detection of AF, non-adherence to guidelines, and lack of consideration of patients' preferences, thus highlighting the need for a more holistic and integrated approach to AF management. OBJECTIVE: The objective of this study was to determine whether a mobile health (mHealth) technology-supported AF integrated management strategy would reduce AF-related adverse events, compared with usual care. METHODS: This is a cluster randomized trial of patients with AF older than 18 years of age who were enrolled in 40 cities in China. Recruitment began on June 1, 2018 and follow-up ended on August 16, 2019. Patients with AF were randomized to receive usual care, or integrated care based on a mobile AF Application (mAFA) incorporating the ABC (Atrial Fibrillation Better Care) Pathway: A, Avoid stroke; B, Better symptom management; and C, Cardiovascular and other comorbidity risk reduction. The primary composite outcome was a composite of stroke/thromboembolism, all-cause death, and rehospitalization. Rehospitalization alone was a secondary outcome. Cardiovascular events were assessed using Cox proportional hazard modeling after adjusting for baseline risk. RESULTS: There were 1,646 patients allocated to mAFA intervention (mean age, 67.0 years; 38.0% female) with mean follow-up of 262 days, whereas 1,678 patients were allocated to usual care (mean age, 70.0 years; 38.0% female) with mean follow-up of 291 days. Rates of the composite outcome of 'ischemic stroke/systemic thromboembolism, death, and rehospitalization' were lower with the mAFA intervention compared with usual care (1.9% vs. 6.0%; hazard ratio [HR]: 0.39; 95% confidence interval [CI]: 0.22 to 0.67; p < 0.001). Rates of rehospitalization were lower with the mAFA intervention (1.2% vs. 4.5%; HR: 0.32; 95% CI: 0.17 to 0.60; p < 0.001). Subgroup analyses by sex, age, AF type, risk score, and comorbidities demonstrated consistently lower HRs for the composite outcome for patients receiving the mAFA intervention compared with usual care (all p < 0.05). CONCLUSIONS: An integrated care approach to holistic AF care, supported by mHealth technology, reduces the risks of rehospitalization and clinical adverse events. (Mobile Health [mHealth] technology integrating atrial fibrillation screening and ABC management approach trial; ChiCTR-OOC-17014138)."},{"id":"4690bb670e9f","type":"article","url":"https://hartvaat.nl/2020/04/01/intraprocedurele-eindpunten-voor-duurzame-pvi-gerandomiseerde-trial-van-vier-tec/","title":"Intraprocedurele eindpunten voor duurzame PVI: gerandomiseerde trial van vier technieken","title_en":"Intraprocedural endpoints to predict durable pulmonary vein isolation: a randomized trial of four post-ablation techniques.","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/euz301","source_url":"https://doi.org/10.1093/europace/euz301","authors":["Ruhong Jiang","Minglong Chen","Bing Yang","Qiang Liu","Zuwen Zhang","Fengxiang Zhang","Weizhu Ju","Mingfang Li","Xia Sheng","Yaxun Sun","Pei Zhang","Lu Yu","Shiquan Chen","Jun Zhu","Hui Cheng","Guosheng Fu","Roderick Tung","Chenyang Jiang"],"significance":5,"published":"2020-04-01","source_date":"2020-04-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/katheterablatie-af/"],"congress":"","summary_en":"This randomized trial compared four post-ablation techniques for confirming durable pulmonary vein isolation, addressing the fundamental question of what constitutes an adequate procedural endpoint during AF ablation.","created":"2026-07-03T10:28:30Z","updated":"2026-07-03T13:27:40Z","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":"Gerandomiseerde trial die vier post-ablatietechnieken vergeleek als eindpunt voor duurzame pulmonaalvene-isolatie.","abstract_original":"AIMS: The optimal procedural endpoint to achieve permanent pulmonary vein isolation (PVI) during ablation of atrial fibrillation (AF) remains unknown. We aimed to compare the impact of prolonged waiting periods and adenosine triphosphate (ATP) testing after PVI on long-term freedom from AF. METHODS AND RESULTS: In total, 538 patients (median age 61 years, 62% male) undergoing first-time radiofrequency ablation for paroxysmal AF were randomized into four groups: Group 1 [PVI (no testing), n = 121], Group 2 (PVI + 30min waiting phase, n = 151), Group 3 (PVI+ATP, n = 131), and Group 4 (PVI + 30min+ATP, n = 135). The primary endpoint was freedom from AF. Repeat mapping to assess for late pulmonary vein (PV) reconnection was performed in patients who remained AF-free for >3 years (n = 46) and in those who had repeat ablation for AF recurrence (n = 82). During initial procedure, acute PV reconnection was observed in 33%, 26%, and 42% of patients in Groups 2, 3, and 4, respectively. At 36 months, no significant differences in freedom from AF recurrence were observed among all four groups (55%, 61%, 50%, and 62% for Groups 1, 2, 3, and 4, respectively; P = 0.258). Late PV reconnection was commonly observed, with a similar incidence between patients with and without AF recurrence (74% vs. 83%; P = 0.224). CONCLUSION: Although PVI remains the cornerstone for AF ablation, intraprocedural techniques to assess for PV reconnection did not improve long-term success. Patients without AF recurrence after 3 years exhibited similarly high rates of PV reconnection as those that underwent repeat ablation for AF recurrence. The therapeutic mechanisms of AF ablation may not be solely predicated upon durable PVI."},{"id":"cdba04b3c0d2","type":"article","url":"https://hartvaat.nl/2020/04/01/intracraniele-bloedingen-versus-stenttrombose-met-doac-antiplaatjes-versus-tripl/","title":"Intracraniële bloedingen versus stenttrombose met DOAC + antiplaatjes versus triple: meta-analyse","title_en":"Intracranial haemorrhages vs. stent thromboses with direct oral anticoagulant plus single antiplatelet agent or triple antithrombotic therapy: a meta-analysis of randomized trials in atrial fibrillation and percutaneous coronary intervention/acute coronary syndrome patients.","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/euz345","source_url":"https://doi.org/10.1093/europace/euz345","authors":["Mattia Galli","Felicita Andreotti","Italo Porto","Filippo Crea"],"significance":7,"published":"2020-04-01","source_date":"2020-04-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This meta-analysis compared the trade-off between intracranial hemorrhage reduction and stent thrombosis risk with DOAC-based dual versus VKA-based triple antithrombotic therapy in AF patients after PCI, demonstrating a favorable net benefit for the dual approach.","created":"2026-07-03T10:28:30Z","updated":"2026-07-03T13:27:40Z","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":"Meta-analyse die intracraniële bloedingen vergeleek met stenttrombose bij DOAC plus antiplaatjes versus triple antitrombotische therapie.","abstract_original":"AIMS: To assess the efficacy-safety profile of dual antithrombotic therapy (DAT) including direct oral anticoagulant (DOAC) vs. triple antithrombotic therapy (TAT) in patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS: Randomized trials of AF patients with ACS/PCI, comparing DAT using DOACs against TAT, were selected. Overall, 11 161 studies were screened, 458 trials assessed, and four included, comprising 10 234 patients followed for a mean of 11 months. DAT compared to TAT resulted in significant reductions of trial-defined primary safety outcome [odds ratio (OR) 0.63, 95% confidence interval (CI) 0.50-0.79, number needed to treat (NNT) 17] and of thrombolysis in myocardial infarction (TIMI) major bleeding (OR 0.54, 95% CI 0.41-0.70, NNT 76) and in a numerical reduction of intracranial haemorrhage (OR 0.50, 95% CI 0.21-1.19, NNT 314), which became significant after exclusion of DOACs from TAT and vitamin K antagonist from DAT arms (OR 0.31, 95% CI 0.15-0.64). There were no significant differences in the risks of cardiovascular or any deaths or stroke, but with DAT, there was a numerical increase in myocardial infarctions (MIs) (OR 1.23, 95% CI 0.99-1.54, estimated NNT for an additional harmful outcome (NNTH) 151), which became significant in the ACS/PCI subgroup (OR 1.43, 95% CI 1.02-2.00), and a 60% significant increase in stent thrombosis risk (OR 1.60, 95% CI 1.02-2.52; NNTH 274). CONCLUSION: Dual antithrombotic therapy, compared to TAT, conferred a significantly reduced risk of overall bleeding but with a significant increase of stent thrombosis risk in the overall population and a significant 43% increase of MI in the ACS/PCI subgroup."},{"id":"74228a75a115","type":"article","url":"https://hartvaat.nl/2020/04/01/lvad-gebruik-als-bridge-to-transplant-versus-destination-therapy-momentum-3/","title":"LVAD-gebruik als bridge-to-transplant versus destination therapy: MOMENTUM 3","title_en":"Association of Clinical Outcomes With Left Ventricular Assist Device Use by Bridge to Transplant or Destination Therapy Intent: The Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy With HeartMate 3 (MOMENTUM 3) Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2019.5323","source_url":"https://doi.org/10.1001/jamacardio.2019.5323","authors":["Daniel J Goldstein","Yoshifumi Naka","Douglas Horstmanshof","Ashwin K Ravichandran","Jacob Schroder","John Ransom","Akinobu Itoh","Nir Uriel","Joseph C Cleveland","Nirav Y Raval","Rebecca Cogswell","Erik E Suarez","Brian D Lowes","Gene Kim","Pramod Bonde","Farooq H Sheikh","Poornima Sood","David J Farrar","Mandeep R Mehra"],"significance":7,"published":"2020-04-01","source_date":"2020-04-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/lvad-ventrikelondersteunende-systemen/","https://hartvaat.nl/kennis/farmacologie/betablokkers-farmacologie/"],"congress":"","summary_en":"This MOMENTUM 3 analysis compared LVAD outcomes in bridge-to-transplant versus destination therapy patients, showing that the HeartMate 3 provides benefit regardless of treatment intent.","created":"2026-07-03T10:28:30Z","updated":"2026-07-03T13:27:40Z","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 MOMENTUM 3 analyse naar klinische uitkomsten met LVAD gestratificeerd naar bridge-to-transplant versus destination therapy.","abstract_original":"IMPORTANCE: Left ventricular assist devices (LVADs) are well established in the treatment of advanced heart failure, but it is unclear whether outcomes are different based on the intended goal of therapy in patients who are eligible vs ineligible for heart transplant. OBJECTIVE: To determine whether clinical outcomes in the Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy With HeartMate 3 (MOMENTUM 3) trial differed by preoperative categories of bridge to transplant (BTT) or bridge to transplant candidacy (BTC) vs destination therapy (DT). DESIGN, SETTING, AND PARTICIPANTS: This study was a prespecified secondary analysis of the MOMENTUM 3 trial, a multicenter randomized clinical trial comparing the magnetically levitated centrifugal-flow HeartMate 3 (HM3) LVAD to the axial-flow HeartMate II (HMII) pump. It was conducted in 69 centers with expertise in managing patients with advanced heart failure in the United States. Patients with advanced heart failure were randomized to an LVAD, irrespective of the intended goal of therapy (BTT/BTC or DT). MAIN OUTCOMES AND MEASURES: The primary end point was survival free of disabling stroke or reoperation to remove or replace a malfunctioning device at 2 years. Secondary end points included adverse events, functional status, and quality of life. RESULTS: Of the 1020 patients with implants (515 with HM3 devices [50.5%] and 505 with HMII devices [49.5%]), 396 (38.8%) were in the BTT/BTC group (mean [SD] age, 55 [12] years; 310 men [78.3%]) and 624 (61.2%) in the DT group (mean [SD] age, 63 [12] years; 513 men [82.2%]). Of the patients initially deemed as transplant ineligible, 84 of 624 patients (13.5%) underwent heart transplant within 2 years of LVAD implant. In the primary end point analysis, HM3 use was superior to HMII use in patients in the BTT/BTC group (76.8% vs 67.3% for survival free of disabling stroke and reoperation; hazard ratio, 0.62 [95% CI, 0.40-0.94]; log-rank P = .02) and patients in the DT group (73.2% vs 58.7%; hazard ratio, 0.61 [95% CI, 0.46-0.81]; log-rank P < .001). For patients in both BTT/BTC and DT groups, there were not significantly different reductions in rates of pump thrombosis, stroke, and gastrointestinal bleeding with HM3 use relative to HMII use. Improvements in quality of life and functional capacity for either pump were not significantly different regardless of preimplant strategy. CONCLUSIONS AND RELEVANCE: In this trial, the superior treatment effect of HM3 over HMII was similar for patients in the BTT/BTC or DT groups. It is possible that use of arbitrary categorizations based on current or future transplant eligibility should be clinically abandoned in favor of a single preimplant strategy: to extend the survival and improve the quality of life of patients with medically refractory heart failure. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02224755."},{"id":"264d2262d892","type":"article","url":"https://hartvaat.nl/2020/04/01/sst2-voor-hartfalenmanagement-stade-hf-pilotstudie/","title":"sST2 voor hartfalenmanagement: STADE-HF pilotstudie","title_en":"STADE-HF (sST2 As a help for management of HF): a pilot study.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.12663","source_url":"https://doi.org/10.1002/ehf2.12663","authors":["Fabien Huet","Jean Nicoleau","Anne-Marie Dupuy","Corentin Curinier","Cyril Breuker","Audrey Castet-Nicolas","Manuela Lotierzo","Eran Kalmanovich","Laetitia Zerkowski","Mariama Akodad","Jérôme Adda","Audrey Agullo","Florence Leclercq","Jean-Luc Pasquie","Pascal Battistella","Camille Roubille","Pierre Fesler","Grégoire Mercier","Guillaume Bourel","Jean-Paul Cristol","François Roubille"],"significance":4,"published":"2020-04-01","source_date":"2020-04-01","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/galectine-3-st2-hartfalen/"],"congress":"","summary_en":"The STADE-HF pilot trial investigated soluble ST2 as a biomarker to guide medical management in patients admitted for acute heart failure decompensation, aiming to reduce hospital readmission through biomarker-directed therapy.","created":"2026-07-03T10:28:29Z","updated":"2026-07-03T13:27:40Z","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":"STADE-HF pilotstudie naar sST2 als hulpmiddel voor hartfalenmanagement.","abstract_original":"AIMS: Biomarkers are not recommended until now to guide the management of patients with heart failure (HF). Soluble suppression of tumorigenicity 2 (sST2) appears as a promising biomarker. The current study considered pre-discharged sST2 values as a guide for medical management in patients admitted for acute HF decompensation, in an attempt to reduce hospital readmission. METHODS AND RESULTS: STADE-HF was a blinded prospective randomized controlled trial and included 123 patients admitted for acute HF. They were randomized into the usual treatment group (unknown sST2 level) or the interventional treatment group, for whom sST2 level was known and used on Day 4 of hospitalization to guide the treatment. The primary endpoint was the readmission rate for any cause at 1 month. It occurred in 10 patients (19%) in the usual group and 18 (32%) in the sST2 group without statistical difference (P = 0.11). Post hoc analysis in the whole group shows that the mean duration of hospitalization was lower in patients with low sST2 (<37 ng/mL) at admission vs. high sST2 (8.5 ± 9.5 vs. 14.8 ± 14.9 days, respectively, P = 0.003). In addition, a decrease in sST2 greater than 18% is significantly associated with a lower readmission rate. CONCLUSIONS: Soluble suppression of tumorigenicity 2-guided therapy over a short period of time does not reduce readmissions. However, sST2 was clearly associated with duration of hospitalization, and the decrease in sST2 was associated with decreased rehospitalizations. Long-term outcome using sST2-guided therapy deserves further investigations."},{"id":"59f2987de4f5","type":"article","url":"https://hartvaat.nl/2020/04/01/verhoogde-bloeddruk-op-kinder-adolescentenleeftijd-en-cv-uitkomsten-bij-volwasse/","title":"Verhoogde bloeddruk op kinder-/adolescentenleeftijd en CV-uitkomsten bij volwassenen","title_en":"Elevated Blood Pressure in Childhood or Adolescence and Cardiovascular Outcomes in Adulthood: A Systematic Review.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.119.14168","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.119.14168","authors":["Lili Yang","Costan G Magnussen","Liu Yang","Pascal Bovet","Bo Xi"],"significance":7,"published":"2020-04-01","source_date":"2020-04-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/cardiovasculaire-risicoschatting-score2/","https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/"],"congress":"","summary_en":"This systematic review examined the association between elevated blood pressure in childhood or adolescence and cardiovascular outcomes in adulthood, providing evidence for the long-term cardiovascular consequences of early-life hypertension.","created":"2026-07-03T10:28:29Z","updated":"2026-07-03T13:27:39Z","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":"Systematische review naar het verband tussen verhoogde bloeddruk op jonge leeftijd en cardiovasculaire uitkomsten bij volwassenen.","abstract_original":"There remains some uncertainty about the magnitude of the associations between elevated blood pressure (BP) in childhood or adolescence and cardiovascular morbidity and mortality in adulthood. We summarized evidence on the long-term impact of elevated BP in childhood or adolescence on cardiovascular morbidity and mortality in adulthood. PubMed and Embase databases were searched up to August 1, 2019, and retrieved studies were reviewed manually. Our systematic review included all eligible prospective cohort studies on the associations between BP status in childhood or adolescence and intermediate markers or hard outcomes of cardiovascular disease in adults, including high pulse wave velocity, high carotid intima-media thickness, left ventricular hypertrophy, and cardiovascular disease (fatal and nonfatal) and total mortality. A total of 19 articles were finally included, and 12 could be synthesized by meta-analysis. Elevated BP in childhood or adolescence was significantly associated, in adulthood, with high pulse wave velocity (3 articles, N=3725; pooled odds ratio [OR], 1.83 [95% CI, 1.39-2.40]); high carotid intima-media thickness (2 articles, N=4152; OR, 1.60 [95% CI, 1.29-2.00]); and left ventricular hypertrophy (2 articles, N=3019; OR, 1.40 [95% CI, 1.20-1.64]). Additionally, our systematic review also shows evidence of associations of elevated BP in youth with cardiovascular disease and mortality in adulthood. In conclusion, our systematic review and meta-analysis confirms that elevated BP in childhood or adolescence is associated with several intermediate markers and hard outcomes of cardiovascular disease in adulthood. These findings emphasize the importance for children and adolescents to have their BP within normal values."},{"id":"09f6da39f283","type":"article","url":"https://hartvaat.nl/2020/04/01/aprocitentan-bij-hypertensie-gerandomiseerde-dosis-responsstudie/","title":"Aprocitentan bij hypertensie: gerandomiseerde dosis-responsstudie","title_en":"Randomized Dose-Response Study of the New Dual Endothelin Receptor Antagonist Aprocitentan in Hypertension.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","internist"],"tags":["aprocitentan","precision-trial"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.119.14504","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.119.14504","authors":["Pierre Verweij","Parisa Danaietash","Bruno Flamion","Joël Ménard","Marc Bellet"],"significance":7,"published":"2020-04-01","source_date":"2020-04-01","image":"","kennis":[],"congress":"","summary_en":"This dose-response study of aprocitentan, a dual endothelin receptor antagonist, established the blood pressure-lowering efficacy curve for this new drug class in essential hypertension, providing the foundation for the phase 3 PRECISION trial.","created":"2026-07-03T10:28:29Z","updated":"2026-07-03T18:38:46Z","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":"Gerandomiseerde dosis-responsstudie van aprocitentan, een nieuwe duale endothelinereceptorantagonist, bij hypertensie.","abstract_original":"This study examined the dose-response characteristics of aprocitentan, a dual endothelin A/endothelin B receptor antagonist, in patients with essential hypertension. In a randomized, double-blind, parallel study design, eligible patients with a sitting diastolic blood pressure (BP) of 90-109 mm Hg received aprocitentan 5, 10, 25, or 50 mg, placebo, or lisinopril 20 mg as a positive control once daily for 8 weeks. Multiple automated office BP readings were obtained with patients resting unattended (unattended automated office BP) at baseline, weeks 2, 4, and 8. Ambulatory BP was monitored for 24 hours at baseline and week 8. After a single-blind placebo run-in period, 490 eligible patients were randomized to the double-blind phase, with 409 patients completing 8 weeks of therapy per protocol. Aprocitentan 10, 25, and 50 mg decreased sitting systolic/diastolic unattended automated office BP from baseline to week 8 (placebo-corrected decreases: 7.05/4.93, 9.90/6.99, and 7.58/4.95 mm Hg, respectively, P≤0.014 versus placebo), compared with an unattended automated office BP reduction of 4.84/3.81 mm Hg with lisinopril 20 mg. For patients with valid ambulatory BP, aprocitentan 10, 25, and 50 mg significantly decreased placebo-corrected 24-hour BP by 3.99/4.04, 4.83/5.89, and 3.67/4.45 mm Hg, respectively. Incidence of adverse events was similar in the aprocitentan groups (22.0%-40.2%) and the placebo group (36.6%). Aprocitentan produced dose-dependent decreases in hemoglobin, hematocrit, albumin, and uric acid, an increase in estimated plasma volume, but no change in weight versus placebo. These findings support further investigation of aprocitentan at doses of 10 to 25 mg in hypertension. Registration- URL: https://www.clinicaltrials.gov; Unique identifier: NCT02603809."},{"id":"d6dbec057d6c","type":"article","url":"https://hartvaat.nl/2020/04/01/p2y12-remmers-met-oac-bij-af-na-pci-meta-analyse/","title":"P2Y12-remmers met OAC bij AF na PCI: meta-analyse","title_en":"P2Y12 inhibitors with oral anticoagulation for percutaneous coronary intervention with atrial fibrillation: a systematic review and meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2019-315963","source_url":"https://doi.org/10.1136/heartjnl-2019-315963","authors":["Florentino Lupercio","Shaun Giancaterino","Pedro Arturo Villablanca","Frederick Han","Kurt Hoffmayer","Gordon Ho","Farshad Raissi","David Krummen","Ulrika Birgersdotter-Green","Gregory Feld","Ryan Reeves","Ehtisham Mahmud","Jonathan C Hsu"],"significance":7,"published":"2020-04-01","source_date":"2020-04-01","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This meta-analysis compared third-generation P2Y12 inhibitors (ticagrelor, prasugrel) with clopidogrel in combination with oral anticoagulation for AF patients after PCI, informing the antiplatelet component selection within dual antithrombotic strategies.","created":"2026-07-03T10:28:29Z","updated":"2026-07-03T13:27:39Z","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":"Systematische review en meta-analyse van P2Y12-remmers gecombineerd met OAC bij AF-patiënten na PCI. Consolideert alle AF+PCI trials.","abstract_original":"OBJECTIVE: This study aimed to compare the safety and efficacy of third-generation P2Y12 inhibitors versus clopidogrel in combination with oral anticoagulation (OAC) with or without aspirin in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI). METHODS: We performed a systematic review including both prospective and retrospective studies that compared dual and triple antithrombotic regimens for bleeding and major adverse cardiac events (MACE) in patients with AF undergoing PCI. We analysed rates of bleeding and MACE by P2Y12 inhibitor choice. Risk ratio (RR) 95% CIs were measured using the Mantel-Haenszel method. Where study heterogeneity was low (I2 <25%), we used the fixed effects model, otherwise the random effects model was used. RESULTS: A total of 22 014 patients were analysed from the seven studies included. Among patients treated with both OAC and P2Y12 inhibitor with or without aspirin, 90% (n=9708) were treated with clopidogrel, 8% (n=830) with ticagrelor, and 2% (n=191) with prasugrel. When compared with clopidogrel, use of ticagrelor (RR 1.36; 95% CI 1.18 to 1.57) and prasugrel (RR 2.11; 95% CI 1.34 to 3.30) were associated with increased rates of bleeding. Compared with clopidogrel, there were no significant differences in rates of MACE with ticagrelor (RR 1.03; 95% CI 0.65 to 1.62) or prasugrel (RR 1.49; 95% CI 0.69 to 3.24). CONCLUSION: Based on this meta-analysis, the use of clopidogrel is associated with a lower rate of bleeding compared with ticagrelor or prasugrel in patients with AF on OAC undergoing PCI."},{"id":"d5cb5c465f2c","type":"article","url":"https://hartvaat.nl/2020/04/01/biomarkers-bij-hf-met-centrale-slaapapneu-serve-hf/","title":"Biomarkers bij HF met centrale slaapapneu: SERVE-HF","title_en":"Biomarkers in patients with heart failure and central sleep apnoea: findings from the SERVE-HF trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.12521","source_url":"https://doi.org/10.1002/ehf2.12521","authors":["João Pedro Ferreira","Kévin Duarte","Holger Woehrle","Martin R Cowie","Karl Wegscheider","Christiane Angermann","Marie-Pia d'Ortho","Erland Erdmann","Patrick Levy","Anita K Simonds","Virend K Somers","Helmut Teschler","Patrick Rossignol","Wolfgang Koenig","Faiez Zannad"],"significance":5,"published":"2020-04-01","source_date":"2020-04-01","image":"","kennis":[],"congress":"","summary_en":"This SERVE-HF biomarker analysis characterized biomarker profiles in heart failure patients with central sleep apnea, exploring whether circulating markers identify patients at risk from adaptive servo-ventilation therapy.","created":"2026-07-03T10:28:29Z","updated":"2026-07-03T13:27:39Z","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":"SERVE-HF subanalyse naar biomarkers bij hartfalenpatiënten met centrale slaapapneu.","abstract_original":"AIMS: The Treatment of Sleep-Disordered Breathing with Predominant Central Sleep Apnoea by Adaptive Servo Ventilation in Patients with Heart Failure trial investigated the effects of adaptive servo-ventilation (ASV) (vs. control) on outcomes of 1325 patients with heart failure and reduced ejection fraction (HFrEF) and central sleep apnoea (CSA). The primary outcome (a composite of all-cause death or unplanned HF hospitalization) did not differ between the two groups. However, all-cause and cardiovascular (CV) mortality were higher in the ASV group. Circulating biomarkers may help in better ascertain patients' risk, and this is the first study applying a large set of circulating biomarkers in patients with both HFrEF and CSA. METHODS AND RESULTS: Circulating protein-biomarkers (n = 276) ontologically involved in CV pathways, were studied in 749 (57% of the trial population) patients (biomarker substudy), to investigate their association with the study outcomes (primary outcome, CV death and all-cause death). The mean age was 69 ± 10 years, and > 90% were male. The groups (ASV vs. control and biomarker substudy vs. no biomarker) were well balanced. The \"best\" clinical prognostic model included male sex, systolic blood pressure < 120 mmHg, diabetes, loop diuretic, cardiac device, 6-min walking test distance, and N-terminal pro BNP as the strongest prognosticators. On top of the \"best\" clinical prognostic model, the biomarkers that significantly improved both the discrimination (c-index) and the net reclassification index (NRI) of the model were soluble suppression of tumorigenicity 2 for the primary outcome; neurogenic locus notch homolog protein 3 (Notch-3) for CV-death and all-cause death; and growth differentiation factor 15 (GDF-15) for all-cause death only. CONCLUSIONS: We studied 276 circulating biomarkers in patients with HFrEF and central sleep apnoea; of these biomarkers, three added significant prognostic information on top of the best clinical model: soluble suppression of tumorigenicity 2 (primary outcome), Notch-3 (CV and all-cause death), and GDF-15 (all-cause death)."},{"id":"421f7eb5969f","type":"article","url":"https://hartvaat.nl/2020/03/31/staken-van-neurohumorale-blokkade-na-crt/","title":"Staken van neurohumorale blokkade na CRT","title_en":"Withdrawal of Neurohumoral Blockade After Cardiac Resynchronization Therapy.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.01.040","source_url":"https://doi.org/10.1016/j.jacc.2020.01.040","authors":["Petra Nijst","Pieter Martens","Jeroen Dauw","W H Wilson Tang","Philippe B Bertrand","Joris Penders","Liesbeth Bruckers","Gabor Voros","Rik Willems","Pieter M Vandervoort","Matthias Dupont","Wilfried Mullens"],"significance":5,"published":"2020-03-31","source_date":"2020-03-31","image":"","kennis":[],"congress":"","summary_en":"This study investigated whether neurohumoral blockers can be safely withdrawn in patients who achieve normalized ejection fraction after CRT, addressing a common clinical question about medication de-escalation in CRT super-responders.","created":"2026-07-03T10:28:29Z","updated":"2026-07-03T13:27:39Z","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":"Studie naar het staken van neurohumorale blokkade bij patiënten die goed reageren op CRT.","abstract_original":"BACKGROUND: The necessity of neurohumoral blockers in patients with heart failure who demonstrate normalized ejection fractions after cardiac resynchronization therapy remains unclear. OBJECTIVES: The aim of this study was to investigate the feasibility and safety of neurohumoral blocker withdrawal in patients with normalized ejection fractions after cardiac resynchronization therapy. METHODS: In this prospective, open-label, randomized controlled pilot trial with a 2 × 2 factorial design, subjects were randomized to withdrawal of renin-angiotensin-aldosterone system inhibitors and/or beta-blockers versus continuation of treatment. The primary endpoint was a recurrence of negative remodeling, defined as an increase in left ventricular end-systolic volume index of >15% at 24 months. The secondary endpoint was a composite safety endpoint of all-cause mortality, heart failure-related hospitalizations, and incidence of sustained ventricular arrhythmias at 24 months. RESULTS: Eighty subjects were consecutively enrolled and randomized among 4 groups (continuation of neurohumoral blocker therapy, n = 20; withdrawal of renin-angiotensin-aldosterone system inhibitors, n = 20; withdrawal of beta-blockers, n = 20; and withdrawal of renin-angiotensin-aldosterone system inhibitors and beta-blockers, n = 20). Of the 80 subjects, 6 (7.5%) met the primary and 4 (5%) the secondary endpoint. However, re-initiation of neurohumoral blockers occurred in 17 subjects because of hypertension or supraventricular arrhythmias. CONCLUSIONS: The incidence of the primary and secondary endpoints over a follow-up period of 2 years was low in both the control group and in the groups in which neurohumoral blockers were discontinued. However, neurohumoral blocker withdrawal was hampered by cardiac comorbidities. (Systematic Withdrawal of Neurohumoral Blocker Therapy in Optimally Responding CRT Patients [STOP-CRT]; NCT02200822)."},{"id":"a404475bbaff","type":"article","url":"https://hartvaat.nl/2020/03/31/laaggedoseerde-alteplase-bij-primaire-pci-naar-ischemietijd/","title":"Laaggedoseerde alteplase bij primaire PCI naar ischemietijd","title_en":"Low-Dose Alteplase During Primary Percutaneous Coronary Intervention According to Ischemic Time.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.01.041","source_url":"https://doi.org/10.1016/j.jacc.2020.01.041","authors":["Peter J McCartney","Annette M Maznyczka","Hany Eteiba","Margaret McEntegart","Keith G Oldroyd","John P Greenwood","Neil Maredia","Matthias Schmitt","Gerry P McCann","Timothy Fairbairn","Elisa McAlindon","Campbell Tait","Paul Welsh","Naveed Sattar","Vanessa Orchard","David Corcoran","Thomas J Ford","Aleksandra Radjenovic","Ian Ford","Alex McConnachie","Colin Berry"],"significance":5,"published":"2020-03-31","source_date":"2020-03-31","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/coronairlijden/ranolazine-bij-angina/"],"congress":"","summary_en":"This T-TIME subanalysis evaluated intracoronary alteplase efficacy by ischemia time in STEMI, testing whether patients with longer ischemia duration derive more benefit from clot-dissolving adjunctive therapy.","created":"2026-07-03T10:28:29Z","updated":"2026-07-03T13:27:39Z","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":"T-TIME subanalyse naar het effect van laaggedoseerde intracoronaire alteplase naar ischemieduur bij STEMI.","abstract_original":"BACKGROUND: Microvascular obstruction affects one-half of patients with ST-segment elevation myocardial infarction and confers an adverse prognosis. OBJECTIVES: This study aimed to determine whether the efficacy and safety of a therapeutic strategy involving low-dose intracoronary alteplase infused early after coronary reperfusion associates with ischemic time. METHODS: This study was conducted in a prospective, multicenter, parallel group, 1:1:1 randomized, dose-ranging trial in patients undergoing primary percutaneous coronary intervention. Ischemic time, defined as the time from symptom onset to coronary reperfusion, was a pre-specified subgroup of interest. Between March 17, 2016, and December 21, 2017, 440 patients, presenting with ST-segment elevation myocardial infarction within 6 h of symptom onset (<2 h, n = 107; ≥2 h but <4 h, n = 235; ≥4 h to 6 h, n = 98), were enrolled at 11 U.K. hospitals. Participants were randomly assigned to treatment with placebo (n = 151), alteplase 10 mg (n = 144), or alteplase 20 mg (n = 145). The primary outcome was the amount of microvascular obstruction (MVO) (percentage of left ventricular mass) quantified by cardiac magnetic resonance imaging at 2 to 7 days (available for 396 of 440). RESULTS: Overall, there was no association between alteplase dose and the extent of MVO (p for trend = 0.128). However, in patients with an ischemic time ≥4 to 6 h, alteplase increased the mean extent of MVO compared with placebo: 1.14% (placebo) versus 3.11% (10 mg) versus 5.20% (20 mg); p = 0.009 for the trend. The interaction between ischemic time and alteplase dose was statistically significant (p = 0.018). CONCLUSION: In patients presenting with ST-segment elevation myocardial infarction and an ischemic time ≥4 to 6 h, adjunctive treatment with low-dose intracoronary alteplase during primary percutaneous coronary intervention was associated with increased MVO. Intracoronary alteplase may be harmful for this subgroup. (A Trial of Low-Dose Adjunctive Alteplase During Primary PCI [T-TIME]; NCT02257294)."},{"id":"5aa81beff7dd","type":"article","url":"https://hartvaat.nl/2020/03/26/polymer-versus-polymeervrije-stents-bij-hoog-bloedingsrisico-nejm-leaders-free-2/","title":"Polymer- versus polymeervrije stents bij hoog bloedingsrisico: NEJM LEADERS FREE 2","title_en":"Polymer-based or Polymer-free Stents in Patients at High Bleeding Risk.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1910021","source_url":"https://doi.org/10.1056/NEJMoa1910021","authors":["Stephan Windecker","Azeem Latib","Elvin Kedhi","Ajay J Kirtane","David E Kandzari","Roxana Mehran","Matthew J Price","Alexandre Abizaid","Daniel I Simon","Stephen G Worthley","Azfar Zaman","Martin Hudec","Petra Poliacikova","A Kahar Bin Abdul Ghapar","Kamaraj Selvaraj","Ivo Petrov","Darren Mylotte","Eduardo Pinar","Raul Moreno","Franco Fabbiocchi","Sanjeevan Pasupati","Hyo-Soo Kim","Adel Aminian","Charles Tie","Adrian Wlodarczak","Seung-Ho Hur","Steven O Marx","Ivana Jankovic","Sandeep Brar","Lisa Bousquette","Minglei Liu","Gregg W Stone"],"significance":7,"published":"2020-03-26","source_date":"2020-03-26","image":"","kennis":["https://hartvaat.nl/kennis/kleplijden/mitraclip-transcatheter-mitralisreparatie/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This NEJM trial compared polymer-based with polymer-free drug-coated stents in patients at high bleeding risk, evaluating whether newer polymer-free designs with ultra-short DAPT provide comparable outcomes.","created":"2026-07-03T10:28:29Z","updated":"2026-07-03T13:27:39Z","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":"NEJM gerandomiseerde trial van polymer-gebaseerde versus polymeervrije stents bij patiënten met hoog bloedingsrisico.","abstract_original":"BACKGROUND: Polymer-free drug-coated stents provide superior clinical outcomes to bare-metal stents in patients at high bleeding risk who undergo percutaneous coronary intervention (PCI) and are treated with 1 month of dual antiplatelet therapy. Data on the use of polymer-based drug-eluting stents, as compared with polymer-free drug-coated stents, in such patients are limited. METHODS: In an international, randomized, single-blind trial, we compared polymer-based zotarolimus-eluting stents with polymer-free umirolimus-coated stents in patients at high bleeding risk. After PCI, patients were treated with 1 month of dual antiplatelet therapy, followed by single antiplatelet therapy. The primary outcome was a safety composite of death from cardiac causes, myocardial infarction, or stent thrombosis at 1 year. The principal secondary outcome was target-lesion failure, an effectiveness composite of death from cardiac causes, target-vessel myocardial infarction, or clinically indicated target-lesion revascularization. Both outcomes were powered for noninferiority. RESULTS: A total of 1996 patients at high bleeding risk were randomly assigned in a 1:1 ratio to receive zotarolimus-eluting stents (1003 patients) or polymer-free drug-coated stents (993 patients). At 1 year, the primary outcome was observed in 169 of 988 patients (17.1%) in the zotarolimus-eluting stent group and in 164 of 969 (16.9%) in the polymer-free drug-coated stent group (risk difference, 0.2 percentage points; upper boundary of the one-sided 97.5% confidence interval [CI], 3.5; noninferiority margin, 4.1; P = 0.01 for noninferiority). The principal secondary outcome was observed in 174 patients (17.6%) in the zotarolimus-eluting stent group and in 169 (17.4%) in the polymer-free drug-coated stent group (risk difference, 0.2 percentage points; upper boundary of the one-sided 97.5% CI, 3.5; noninferiority margin, 4.4; P = 0.007 for noninferiority). CONCLUSIONS: Among patients at high bleeding risk who received 1 month of dual antiplatelet therapy after PCI, use of polymer-based zotarolimus-eluting stents was noninferior to use of polymer-free drug-coated stents with regard to safety and effectiveness composite outcomes. (Funded by Medtronic; ONYX ONE ClinicalTrials.gov number, NCT03344653.)."},{"id":"afd680a55238","type":"article","url":"https://hartvaat.nl/2020/03/24/screening-en-profylactisch-amiodaron-vermindert-postoperatief-af/","title":"Screening en profylactisch amiodaron vermindert postoperatief AF","title_en":"Screening and Prophylactic Amiodarone Reduces Post-Operative Atrial Fibrillation in At-Risk Patients.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["primaire-preventie"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.01.016","source_url":"https://doi.org/10.1016/j.jacc.2020.01.016","authors":["Terrence Pong","Kevin Cyr","John Niesen","Joy Aparicio-Valenzuela","Cody Carlton","Michael P Fischbein","Y Joseph Woo","Jack H Boyd","Anson M Lee"],"significance":6,"published":"2020-03-24","source_date":"2020-03-24","image":"","kennis":["https://hartvaat.nl/kennis/ritmestoornissen/sport-en-ritmestoornissen/"],"congress":"","summary_en":"This study showed that screening for high-risk features followed by prophylactic amiodarone reduces postoperative AF in at-risk cardiac surgery patients, supporting a targeted prophylactic strategy.","created":"2026-07-03T10:28:28Z","updated":"2026-07-03T13:27:39Z","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":"Studie die aantoont dat screening en profylactische amiodaron postoperatief AF vermindert bij risicopatiënten.","abstract_original":""},{"id":"7e22e5a9ded7","type":"article","url":"https://hartvaat.nl/2020/03/17/klinische-en-farmacologische-effecten-van-apixaban-dosisaanpassing-aristotle/","title":"Klinische en farmacologische effecten van apixaban-dosisaanpassing: ARISTOTLE","title_en":"Clinical and Pharmacological Effects of Apixaban Dose Adjustment in the ARISTOTLE Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2019.12.060","source_url":"https://doi.org/10.1016/j.jacc.2019.12.060","authors":["Michel Zeitouni","Anna Giczewska","Renato D Lopes","Daniel M Wojdyla","Christina Christersson","Agneta Siegbahn","Raffaele De Caterina","Philippe Gabriel Steg","Christopher B Granger","Lars Wallentin","John H Alexander"],"significance":7,"published":"2020-03-17","source_date":"2020-03-17","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/antistolling/antistolling-bij-ckd/"],"congress":"","summary_en":"This ARISTOTLE analysis examined the clinical and pharmacological effects of apixaban dose adjustment, showing that appropriate dose reduction maintains efficacy while reducing bleeding in patients meeting dose-reduction criteria.","created":"2026-07-03T10:28:28Z","updated":"2026-07-03T13:27:39Z","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":"ARISTOTLE analyse naar de klinische en farmacologische effecten van apixaban-dosisaanpassing bij AF. Relevant voor het dosisreductiebeleid.","abstract_original":"BACKGROUND: In the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial, patients with atrial fibrillation and ≥2 dose-adjustment criteria (age ≥80 years, weight ≤60 kg, or creatinine ≥1.5 mg/dl [133 μmol/l]) were randomized to receive apixaban 2.5 mg twice daily or warfarin. OBJECTIVES: The purpose of this study was to describe the effects of apixaban dose adjustment on clinical and pharmacological outcomes. METHODS: Patients receiving the correct dose of study drug were included (n = 18,073). The effect of apixaban 2.5 mg twice daily versus warfarin on population pharmacokinetics, D-dimer, prothrombin fragment 1 + 2 (PF1+2), and clinical outcomes was compared with the standard dose (5 mg twice daily). RESULTS: Patients receiving apixaban 2.5 mg twice daily exhibited lower apixaban exposure (median area under the concentration time curve at a steady state 2,720 ng/ml vs. 3,599 ng/ml; p < 0.0001) than those receiving the standard dose. In patients with ≥2 dose-adjustment criteria, reductions in D-dimers (p interaction = 0.20) and PF1+2 (p interaction = 0.55) were consistent with those observed in the standard-dose population. Patients with ≥2 dose-adjustment criteria (n = 751) were at higher risk for stroke/systemic embolism, major bleeding, and all-cause death than the standard-dose population (0 or 1 dose-adjustment criterion, n = 17,322). The effect of apixaban 2.5 mg twice daily versus warfarin in the ≥2 dose-adjustment criteria population was consistent with the standard dose in the reductions in stroke or systemic embolism (p interaction = 0.26), major bleeding (p interaction = 0.25), and death (p interaction = 0.72). CONCLUSIONS: Apixaban drug concentrations were lower in patients receiving 2.5 mg twice daily compared with 5 mg twice daily. However, the effects of apixaban dose adjustment to 2.5 mg versus warfarin were consistent for coagulation biomarkers and clinical outcomes, providing reassuring data on efficacy and safety. (Apixaban for the Prevention of Stroke in Subjects With Atrial Fibrillation [ARISTOTLE]; NCT00412984)."},{"id":"12833af01fa5","type":"article","url":"https://hartvaat.nl/2020/03/17/liraglutide-cv-uitkomsten-bij-diabetes-met-of-zonder-hartfalen-leader/","title":"Liraglutide CV-uitkomsten bij diabetes met of zonder hartfalen: LEADER","title_en":"Effects of Liraglutide on Cardiovascular Outcomes in Patients With Diabetes With or Without Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","bisoprolol","carvedilol","diabetes-en-hart","ezetimibe","pathfinder-trial"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2019.12.063","source_url":"https://doi.org/10.1016/j.jacc.2019.12.063","authors":["Steven P Marso","Florian M M Baeres","Stephen C Bain","Bryan Goldman","Mansoor Husain","Michael A Nauck","Neil R Poulter","Richard E Pratley","Anne Bloch Thomsen","John B Buse"],"significance":7,"published":"2020-03-17","source_date":"2020-03-17","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/sglt2-remmers-cardiovasculaire-trials/","https://hartvaat.nl/kennis/farmacologie/glp1-agonisten-cardiologie/"],"congress":"","summary_en":"This LEADER subanalysis showed that liraglutide reduces cardiovascular events in patients with type 2 diabetes regardless of heart failure status at baseline, though the benefit was primarily seen in patients without prevalent heart failure.","created":"2026-07-03T10:28:28Z","updated":"2026-07-03T18:38:46Z","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":"LEADER subanalyse naar cardiovasculaire uitkomsten van liraglutide bij diabetespatiënten met versus zonder hartfalen.","abstract_original":"BACKGROUND: More data regarding effects of glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes (T2D) and heart failure (HF) are required. OBJECTIVES: The purpose of this study was to investigate the effects of liraglutide on cardiovascular events and mortality in LEADER (Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results) participants, by HF history. METHODS: In the multinational, double-blind, randomized LEADER trial, 9,340 patients with T2D and high cardiovascular risk were assigned 1:1 to liraglutide (1.8 mg daily or maximum tolerated dose up to 1.8 mg daily) or placebo plus standard care, and followed for 3.5 to 5 years. New York Heart Association (NYHA) functional class IV HF was an exclusion criterion. The primary composite major adverse cardiovascular events outcome was time to first occurrence of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. Post hoc Cox regression analyses of outcomes by baseline HF history were conducted. RESULTS: At baseline, 18% of patients had a history of NYHA functional class I to III HF (liraglutide: n = 835 of 4,668; placebo: n = 832 of 4,672). Effects of liraglutide versus placebo on major adverse cardiovascular events were consistent in patients with (hazard ratio [HR]: 0.81 [95% confidence interval (CI): 0.65 to 1.02]) and without (HR: 0.88 [95% CI: 0.78 to 1.00]) a history of HF (p interaction = 0.53). In both subgroups, fewer deaths were observed with liraglutide (HR: 0.89 [95% CI: 0.70 to 1.14] with HF; HR: 0.83 [95% CI: 0.70 to 0.97] without HF; p interaction = 0.63) versus placebo. No increased risk of HF hospitalization was observed with liraglutide, regardless of HF history (HR: 0.98 [95% CI: 0.75 to 1.28] with HF; HR: 0.78 [95% CI: 0.61 to 1.00] without HF; p interaction = 0.22). Effects of liraglutide on the composite of HF hospitalization or cardiovascular death were consistent in patients with (HR: 0.92 [95% CI: 0.74 to 1.15]) and without (HR: 0.77 [95% CI: 0.65 to 0.91]) a history of HF (p interaction = 0.19). CONCLUSIONS: Based on these findings, liraglutide should be considered suitable for patients with T2D with or without a history of NYHA functional class I to III HF. (Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results [LEADER]; NCT01179048)."},{"id":"7377e800d2e4","type":"article","url":"https://hartvaat.nl/2020/03/17/non-culprit-mi-na-pci-bij-acs/","title":"Non-culprit MI na PCI bij ACS","title_en":"Nonculprit Lesion Myocardial Infarction Following Percutaneous Coronary Intervention in Patients With Acute Coronary Syndrome.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["myocardinfarct","percutane-coronaire-interventie"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2019.12.067","source_url":"https://doi.org/10.1016/j.jacc.2019.12.067","authors":["Benjamin M Scirica","Brian A Bergmark","David A Morrow","Elliott M Antman","Marc P Bonaca","Sabina A Murphy","Marc S Sabatine","Eugene Braunwald","Stephen D Wiviott"],"significance":5,"published":"2020-03-17","source_date":"2020-03-17","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/wat-is-coronairlijden/","https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"This study characterized nonculprit lesion MI after PCI in ACS patients, showing that events arising from untreated coronary segments are a relevant source of post-PCI ischemic events.","created":"2026-07-03T10:28:28Z","updated":"2026-07-03T13:27:38Z","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 naar non-culprit laesie myocardinfarct na PCI bij patiënten met acuut coronair syndroom.","abstract_original":"BACKGROUND: Recent emphasis on reduced duration and/or intensity of antiplatelet therapy following percutaneous coronary intervention (PCI) irrespective of indication for PCI may fail to account for the substantial risk of subsequent nontarget lesion events in acute coronary syndrome (ACS) patients. OBJECTIVES: The authors sought to examine the effect of more potent antiplatelet therapy on the basis of the timing and etiology of recurrent myocardial infarction (MI) or cardiovascular death following PCI for ACS. METHODS: In the TRITON-TIMI 38 study (Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel-Thrombolysis In Myocardial Infarction 38), which randomized patients to prasugrel or clopidogrel, 12,844 patients with ACS received at least 1 stent. MI and cardiovascular death were categorized as: 1) procedural (related to revascularization); 2) definite or probable stent thrombosis (ST); or 3) spontaneous (non-ST or non-procedure-related). Median follow-up was 14.5 months. RESULTS: Among the first events occurring within 30 days, 584 (69.0%) were procedural, 126 (14.9%) ST-related, and 136 (16.1%) spontaneous. After 30 days, 22 (4.7%) were procedural, 63 (13.5%) were ST-related, and 383 (81.8%) spontaneous. Prasugrel significantly reduced the incidence of MI or cardiovascular death for ST-related (1.0% vs. 2.1%; p < 0.001) and spontaneous events (3.9% vs. 4.8%; p = 0.012), with a directionally consistent numerical reduction for procedural events (4.4% vs. 5.1%; p = 0.078). Prasugrel increased spontaneous, but not procedural, major bleeding. CONCLUSIONS: Long-term potent antithrombotic therapy reduces de novo (spontaneous) atherothrombotic events in addition to preventing complications associated with stenting of the culprit lesion following ACS. In patients undergoing PCI for ACS, spontaneous events predominate after 30 days, with the later-phase cardiovascular benefit of potent dual antiplatelet therapy driven largely by reducing de novo atherothrombotic ischemic events. (Comparison of Prasugrel [CS-747] and Clopidogrel in Acute Coronary Syndrome Subjects Who Are to Undergo Percutaneous Coronary Intervention; NCT00097591)."},{"id":"d93b4be75166","type":"article","url":"https://hartvaat.nl/2020/03/17/2020-acc-hfsa-ishlt-verklaring-voor-gevorderd-hf-en-transplantatiespecialisten/","title":"2020 ACC/HFSA/ISHLT verklaring voor gevorderd HF en transplantatiespecialisten","title_en":"2020 ACC/HFSA/ISHLT Lifelong Learning Statement for Advanced Heart Failure and Transplant Cardiology Specialists: A Report of the ACC Competency Management Committee.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["harttransplantatie"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2019.09.030","source_url":"https://doi.org/10.1016/j.jacc.2019.09.030","authors":["Clyde W Yancy","Mark H Drazner","Samuel Tristram Coffin","William Cornwell","Shashank Desai","John P Erwin","Mahazarin Ginwalla","Karol S Harshaw-Ellis","Tamara Horwich","Michelle Kittleson","Anuradha Lala","Sabra C Lewsey","Joseph E Marine","Cindy M Martin","Karen Meehan","David A Morrow","Kelly Schlendorf","Jason W Smith","Gerin R Stevens"],"significance":6,"published":"2020-03-17","source_date":"2020-03-17","image":"","kennis":[],"congress":"","summary_en":"This ACC/HFSA/ISHLT lifelong learning statement outlined competency requirements and continuing education standards for advanced heart failure and transplant cardiology specialists.","created":"2026-07-03T10:28:28Z","updated":"2026-07-03T13:27:38Z","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":"ACC/HFSA/ISHLT lifelong learning statement voor specialisten in gevorderd hartfalen en harttransplantatie.","abstract_original":""},{"id":"82cee03dbfe1","type":"article","url":"https://hartvaat.nl/2020/03/10/overleving-na-revascularisatie-met-paclitaxel-gecoate-ballonnen/","title":"Overleving na revascularisatie met paclitaxel-gecoate ballonnen","title_en":"Survival After Coronary Revascularization With Paclitaxel-Coated Balloons.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2019.11.065","source_url":"https://doi.org/10.1016/j.jacc.2019.11.065","authors":["Bruno Scheller","Davor Vukadinovic","Raban Jeger","Tuomas T Rissanen","Sean S Scholz","Robert Byrne","Franz X Kleber","Azeem Latib","Yvonne P Clever","Sebastian Ewen","Michael Böhm","Yiping Yang","Alexandra Lansky","Felix Mahfoud"],"significance":6,"published":"2020-03-10","source_date":"2020-03-10","image":"","kennis":[],"congress":"","summary_en":"This study addressed the paclitaxel safety debate by examining long-term survival after coronary paclitaxel-coated balloon use, providing reassurance about the mortality concern that had disrupted the drug-coated device field.","created":"2026-07-03T10:28:28Z","updated":"2026-07-03T13:27:38Z","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 naar overleving na gebruik van paclitaxel-gecoate ballonnen. Context van de paclitaxel-veiligheidsdiscussie.","abstract_original":"BACKGROUND: Drug-coated balloons (DCBs) are accepted treatment strategies for coronary in-stent restenosis and are under clinical investigation for lesions without prior stent implantation. A recently published meta-analysis suggested an increased risk of death associated with the use of paclitaxel-coated devices in the superficial femoral artery. The reasons are incompletely understood as potential underlying pathomechanisms remain elusive, and no relationship to the administered dose has been documented. OBJECTIVES: The purpose of this analysis was to investigate the available data on survival after coronary intervention with paclitaxel-coated balloons from randomized controlled trials (RCTs). METHODS: PubMed, Web of science, and the Cochrane library database were searched, and a meta-analysis from RCT was performed comparing DCB with non-DCB devices (such as conventional balloon angioplasty, bare-metal stents, or drug-eluting stents) for the treatment of coronary in-stent restenosis or de novo lesions. The primary outcome was all-cause death. The number of patients lost to follow-up was observed at different time points. Risk estimates are reported as risk ratios (RRs) with 95% confidence intervals (CIs). RESULTS: A total of 4,590 patients enrolled in 26 RCTs published between 2006 and 2019 were analyzed. At follow-up of 6 to 12 months, no significant difference in all-cause mortality was found, however, with numerically lower rates after DCB treatment (RR: 0.74; 95% CI: 0.51 to 1.08; p = 0.116). Risk of death at 2 years (n = 1,477, 8 RCTs) was similar between the 2 groups (RR: 0.84; 95% CI: 0.51 to 1.37; p = 0.478). After 3 years of follow-up (n = 1,775, 9 RCTs), all-cause mortality was significantly lower in the DCB group when compared with control treatment (RR: 0.73; 95% CI: 0.53 to 1.00; p = 0.047) with a number needed to treat of 36 to prevent 1 death. A similar reduction was seen in cardiac mortality (RR: 0.53; 95% CI: 0.33 to 0.85; p = 0.009). CONCLUSIONS: In this meta-analysis, the use of paclitaxel DCBs for treatment of coronary artery disease was not associated with increased mortality, as has been suggested for peripheral arteries. On the contrary, use of coronary paclitaxel-coated balloons was associated with a trend toward lower mortality when compared with control treatments."},{"id":"b5891c9c4fee","type":"article","url":"https://hartvaat.nl/2020/03/10/kokosolie-en-cardiovasculaire-risicofactoren-meta-analyse-van-klinische-trials/","title":"Kokosolie en cardiovasculaire risicofactoren: meta-analyse van klinische trials","title_en":"The Effect of Coconut Oil Consumption on Cardiovascular Risk Factors: A Systematic Review and Meta-Analysis of Clinical Trials.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts"],"tags":["biomarkers-cardiovasculair","colcot-trial","diabetes-en-hart","diabetes-type-2","dyslipidemie","ezetimibe","farmaco-economie","fidelio-dkd","figaro-dkd","hdl-cholesterol","inflammatie","lipide-aferese","lipidenverlaging","lipoproteïne-a","menopauze","microbioom","niet-statine-therapie","obesitas","ouderen","pcsk9-remmers","plaquekarakterisatie","roken","secundaire-preventie","select-trial","slaapapneu","soul-trial","statines","voeding-hart"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.119.043052","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.119.043052","authors":["Nithya Neelakantan","Jowy Yi Hoong Seah","Rob M van Dam"],"significance":6,"published":"2020-03-10","source_date":"2020-03-10","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/","https://hartvaat.nl/kennis/preventie/levenslang-cardiovasculair-risico/"],"congress":"","summary_en":"This meta-analysis showed that coconut oil consumption raises LDL cholesterol compared with non-tropical vegetable oils, challenging the marketing of coconut oil as a heart-healthy alternative.","created":"2026-07-03T10:28:28Z","updated":"2026-07-03T13:27:38Z","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 en meta-analyse die het effect van kokosolieconsumptie op cardiovasculaire risicofactoren onderzocht. LDL-stijging bevestigd.","abstract_original":"BACKGROUND: Coconut oil is high in saturated fat and may, therefore, raise serum cholesterol concentrations, but beneficial effects on other cardiovascular risk factors have also been suggested. Therefore, we conducted a systematic review of the effect of coconut oil consumption on blood lipids and other cardiovascular risk factors compared with other cooking oils using data from clinical trials. METHODS: We searched PubMed, SCOPUS, Cochrane Registry, and Web of Science through June 2019. We selected trials that compared the effects of coconut oil consumption with other fats that lasted at least 2 weeks. Two reviewers independently screened articles, extracted data, and assessed the study quality according to the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The main outcomes included low-density lipoprotein cholesterol (LDL-cholesterol), high-density lipoprotein cholesterol (HDL-cholesterol), total cholesterol, triglycerides, measures of body fatness, markers of inflammation, and glycemia. Data were pooled using random-effects meta-analysis. RESULTS: 16 articles were included in the meta-analysis. Results were available from all trials on blood lipids, 8 trials on body weight, 5 trials on percentage body fat, 4 trials on waist circumference, 4 trials on fasting plasma glucose, and 5 trials on C-reactive protein. Coconut oil consumption significantly increased LDL-cholesterol by 10.47 mg/dL (95% CI: 3.01, 17.94; I2 = 84%, N=16) and HDL-cholesterol by 4.00 mg/dL (95% CI: 2.26, 5.73; I2 = 72%, N=16) as compared with nontropical vegetable oils. These effects remained significant after excluding nonrandomized trials, or trials of poor quality (Jadad score <3). Coconut oil consumption did not significantly affect markers of glycemia, inflammation, and adiposity as compared with nontropical vegetable oils. CONCLUSIONS: Coconut oil consumption results in significantly higher LDL-cholesterol than nontropical vegetable oils. This should inform choices about coconut oil consumption."},{"id":"edc5268cbed6","type":"article","url":"https://hartvaat.nl/2020/03/10/routine-versus-selectieve-cardiale-mri-bij-niet-ischemisch-hf-outsmart-hf/","title":"Routine versus selectieve cardiale MRI bij niet-ischemisch HF: OUTSMART HF","title_en":"OUTSMART HF: A Randomized Controlled Trial of Routine Versus Selective Cardiac Magnetic Resonance for Patients With Nonischemic Heart Failure (IMAGE-HF 1B).","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.119.043964","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.119.043964","authors":["D Ian Paterson","George Wells","Fernanda Erthal","Lisa Mielniczuk","Eileen O'Meara","James White","Kim A Connelly","Juhani Knuuti","Miroslaw Radja","Mika Laine","Benjamin J W Chow","Riina Kandolin","Li Chen","Alexander Dick","Carole Dennie","Linda Garrard","Justin Ezekowitz","Rob Beanlands","Kwan-Leung Chan"],"significance":6,"published":"2020-03-10","source_date":"2020-03-10","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/cardiale-mri/","https://hartvaat.nl/kennis/hartfalen/diagnose-hartfalen-stappenplan/"],"congress":"","summary_en":"The OUTSMART HF trial compared routine versus selective cardiac MRI in patients with non-ischemic heart failure, testing whether universal imaging changes management and improves outcomes in this population.","created":"2026-07-03T10:28:28Z","updated":"2026-07-03T13:27:38Z","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":"OUTSMART HF gerandomiseerde trial die routinematige versus selectieve cardiale MRI vergeleek bij niet-ischemisch hartfalen.","abstract_original":"BACKGROUND: Cardiac magnetic resonance (CMR) is a recommended imaging test for patients with heart failure (HF); however, there is a lack of evidence showing incremental benefit over transthoracic echocardiography. Our primary hypothesis was that routine use of CMR will yield more specific diagnoses in nonischemic HF. Our secondary hypothesis was that routine use of CMR will improve patient outcomes. METHODS: Patients with nonischemic HF were randomized to routine versus selective CMR. Patients in the routine strategy underwent echocardiography and CMR, whereas those assigned to selective use underwent echocardiography with or without CMR according to the clinical presentation. HF causes was classified from the imaging data as well as by the treating physician at 3 months (primary outcome). Clinical events were collected for 12 months. RESULTS: A total of 500 patients (344 male) with mean age 59±13 years were randomized. The routine and selective CMR strategies had similar rates of specific HF causes at 3 months clinical follow-up (44% versus 50%, respectively; P=0.22). At image interpretation, rates of specific HF causes were also not different between routine and selective CMR (34% versus 30%, respectively; P=0.34). However, 24% of patients in the selective group underwent a nonprotocol CMR. Patients with specific HF causes had more clinical events than those with nonspecific caused on the basis of imaging classification (19% versus 12%, respectively; P=0.02), but not on clinical assessment (15% versus 14%, respectively; P=0.49). CONCLUSIONS: In patients with nonischemic HF, routine CMR does not yield more specific HF causes on clinical assessment. Patients with specific HF causes from imaging had worse outcomes, whereas HF causes defined clinically did not. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01281384."},{"id":"6b8ec5e82d9a","type":"article","url":"https://hartvaat.nl/2020/03/07/alert-gebaseerde-beslissingsondersteuning-voor-anticoagulatie-bij-af-in-het-ziek/","title":"Alert-gebaseerde beslissingsondersteuning voor anticoagulatie bij AF in het ziekenhuis","title_en":"Alert-based computerized decision support for high-risk hospitalized patients with atrial fibrillation not prescribed anticoagulation: a randomized, controlled trial (AF-ALERT).","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehz385","source_url":"https://doi.org/10.1093/eurheartj/ehz385","authors":["Gregory Piazza","Shelley Hurwitz","Claire E Galvin","Lindsay Harrigan","Sofia Baklla","Benjamin Hohlfelder","Brett Carroll","Adam B Landman","Srinivas Emani","Samuel Z Goldhaber"],"significance":6,"published":"2020-03-07","source_date":"2020-03-07","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This study tested whether computerized alert-based clinical decision support increases anticoagulant prescribing in hospitalized AF patients at stroke risk, demonstrating the potential of automated systems to close the treatment gap.","created":"2026-07-03T10:28:27Z","updated":"2026-07-03T13:27:38Z","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 naar gecomputeriseerde alert-gebaseerde beslissingsondersteuning voor het voorschrijven van anticoagulantia bij gehospitaliseerde AF-patiënten.","abstract_original":"AIMS: Despite widely available risk stratification tools, safe and effective anticoagulant options, and guideline recommendations, anticoagulation for stroke prevention in atrial fibrillation (AF) is underprescribed. We created and evaluated an alert-based computerized decision support (CDS) strategy to increase anticoagulation prescription in hospitalized AF patients at high risk for stroke. METHODS AND RESULTS: We enrolled 458 patients (CHA2DS2-VASc score ≥1) with AF who were not prescribed anticoagulant therapy and were hospitalized at Brigham and Women's Hospital. Patients were randomly allocated, according to Attending Physician of record, to intervention (alert-based CDS) vs. control (no notification). The primary efficacy outcome was the frequency of anticoagulant prescription. The CDS tool assigned 248 patients to the alert group and 210 to the control group. Patients in the alert group were more likely to be prescribed anticoagulation during the hospitalization (25.8% vs. 9.5%, P < 0.0001), at discharge (23.8% vs. 12.9%, P = 0.003), and at 90 days (27.7% vs. 17.1%, P = 0.007). The alert reduced the odds of a composite outcome of death, myocardial infarction (MI), cerebrovascular event, and systemic embolic event at 90 days [11.3% vs. 21.9%, P = 0.002; odds ratio (OR) 0.45; 95% confidence interval (CI) 0.27-0.76]. The alert reduced the odds of MI at 90 days by 87% (1.2% vs. 8.6%, P = 0.0002; OR 0.13; 95% CI 0.04-0.45) and cerebrovascular events or systemic embolism at 90 days by 88% (0% vs. 2.4%, P = 0.02; OR 0.12; 95% CI 0.0-0.91). CONCLUSION: An alert-based CDS strategy increased anticoagulation in high-risk hospitalized AF patients and reduced major adverse cardiovascular events, including MI and stroke. CLINICALTRIALS.GOV IDENTIFIER: NCT02339493."},{"id":"98c46ea40b7b","type":"article","url":"https://hartvaat.nl/2020/03/03/vitamine-d-en-omega-3-en-hartfalen-hospitalisatie-vital-heart-failure/","title":"Vitamine D en omega-3 en hartfalen-hospitalisatie: VITAL-Heart Failure","title_en":"Supplementation With Vitamin D and Omega-3 Fatty Acids and Incidence of Heart Failure Hospitalization: VITAL-Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":["acuut-hartfalen"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.119.044645","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.119.044645","authors":["Luc Djoussé","Nancy R Cook","Eunjung Kim","Vijaykumar Bodar","Joseph Walter","Vadim Bubes","Heike Luttmann-Gibson","Samia Mora","Jacob Joseph","I-Min Lee","Christine M Albert","Julie E Buring","J Michael Gaziano","JoAnn E Manson"],"significance":7,"published":"2020-03-03","source_date":"2020-03-03","image":"","kennis":[],"congress":"","summary_en":"The VITAL-Heart Failure analysis showed that neither vitamin D nor omega-3 fatty acid supplementation reduced heart failure hospitalization in the general population, adding to the negative evidence for dietary supplements in cardiovascular prevention.","created":"2026-07-03T10:28:27Z","updated":"2026-07-03T18:38:46Z","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":"VITAL-Heart Failure analyse die vitamine D en omega-3 vetzuursuppletie onderzocht op hartfalen-hospitalisatie. Negatief voor beide.","abstract_original":""},{"id":"47bb3e4e7545","type":"article","url":"https://hartvaat.nl/2020/03/03/stenttrombose-bij-af-na-coronaire-stenting-augustus-trial/","title":"Stenttrombose bij AF na coronaire stenting: AUGUSTUS-trial","title_en":"Stent Thrombosis in Patients With Atrial Fibrillation Undergoing Coronary Stenting in the AUGUSTUS Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.119.044584","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.119.044584","authors":["Renato D Lopes","Sergio Leonardi","Daniel M Wojdyla","Amit N Vora","Laine Thomas","Robert F Storey","Dragos Vinereanu","Christopher B Granger","Shaun G Goodman","Ronald Aronson","Stephan Windecker","Holger Thiele","Marco Valgimigli","Roxana Mehran","John H Alexander"],"significance":7,"published":"2020-03-03","source_date":"2020-03-03","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This AUGUSTUS subanalysis examined stent thrombosis rates in AF patients after coronary stenting, comparing dual with triple antithrombotic therapy and finding no significant increase in stent thrombosis with the aspirin-free dual approach.","created":"2026-07-03T10:28:27Z","updated":"2026-07-03T13:27:38Z","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":"AUGUSTUS subanalyse naar stenttrombose bij AF-patiënten na coronaire stenting. Incidentie en risicofactoren in de duale versus triple therapiecontext.","abstract_original":""},{"id":"b79e3ed4f677","type":"article","url":"https://hartvaat.nl/2020/03/01/gewicht-en-werkzaamheid-veiligheid-van-doac-s-bij-niet-valvulair-af-meta-analyse/","title":"Gewicht en werkzaamheid/veiligheid van DOAC's bij niet-valvulair AF: meta-analyse","title_en":"Impact of weight on the efficacy and safety of direct-acting oral anticoagulants in patients with non-valvular atrial fibrillation: a meta-analysis.","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/euz361","source_url":"https://doi.org/10.1093/europace/euz361","authors":["Aaqib H Malik","Srikanth Yandrapalli","Suchith Shetty","Wilbert S Aronow","Diwakar Jain","William H Frishman","Howard A Cooper","Julio A Panza"],"significance":6,"published":"2020-03-01","source_date":"2020-03-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/antistolling/doacs-overzicht/"],"congress":"","summary_en":"This meta-analysis showed that body weight does not significantly modify the efficacy or safety of DOACs compared with warfarin in non-valvular AF, supporting standard DOAC dosing across the weight spectrum.","created":"2026-07-03T10:28:27Z","updated":"2026-07-03T13:27:37Z","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":"Meta-analyse naar de impact van lichaamsgewicht op de werkzaamheid en veiligheid van DOAC's bij niet-valvulair AF.","abstract_original":"AIMS: This study sought to determine the impact of weight and body mass index (BMI) on the safety and efficacy of direct-acting oral anticoagulants (DOACs) compared with warfarin in patients with non-valvular atrial fibrillation. METHODS AND RESULTS: A systematic literature search was employed in PubMed, Embase, and Cochrane clinical trials with no language or date restrictions. Randomized trials or their substudies were assessed for relevant outcome data for efficacy that included stroke or systemic embolization (SSE), and safety including major bleeding and all-cause mortality. Binary outcome data and odds ratios from the relevant articles were used to calculate the pooled relative risk. For SSE, the data from the four Phase III trials showed that DOACs are better or similarly effective with low BMI 0.73 (0.56-0.97), normal BMI 0.72 (0.58-0.91), overweight 0.87 (0.76-0.99), and obese 0.87 (0.76-1.00). The risk of major bleeding was also better or similar with DOACs in all BMI subgroups with low BMI 0.62 (0.37-1.05), normal BMI 0.72 (0.58-0.90), overweight 0.83 (0.71-0.96), and obese 0.91 (0.81-1.03). There was no impact on mortality in all the subgroups. In a meta-regression analysis, the effect size advantage of DOACs compared with warfarin in terms of safety and efficacy gradually attenuated with increasing weight. CONCLUSION: Our findings suggest that a weight-based dosage adjustment may be necessary to achieve optimal benefits of DOACs for thromboembolic prevention in these patients with non-valvular atrial fibrillation. Further dedicated trials are needed to confirm these findings. PROSPERO 2019 CRD42019140693. Available from: https://www.crd.york.ac.uk/prospero/display_record.php? ID=CRD42019140693."},{"id":"3dae5f4a8a9f","type":"article","url":"https://hartvaat.nl/2020/03/01/hybride-telerevalidatie-bij-hartfalen-jama-cardiology-tele-hf-trial/","title":"Hybride telerevalidatie bij hartfalen: JAMA Cardiology Tele-HF-trial","title_en":"Effects of a 9-Week Hybrid Comprehensive Telerehabilitation Program on Long-term Outcomes in Patients With Heart Failure: The Telerehabilitation in Heart Failure Patients (TELEREH-HF) Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["step-hfpef"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2019.5006","source_url":"https://doi.org/10.1001/jamacardio.2019.5006","authors":["Ewa Piotrowicz","Michael J Pencina","Grzegorz Opolski","Wojciech Zareba","Maciej Banach","Ilona Kowalik","Piotr Orzechowski","Dominika Szalewska","Slawomir Pluta","Renata Glówczynska","Robert Irzmanski","Artur Oreziak","Zbigniew Kalarus","Ewa Lewicka","Andrzej Cacko","Anna Mierzynska","Ryszard Piotrowicz"],"significance":7,"published":"2020-03-01","source_date":"2020-03-01","image":"","kennis":[],"congress":"","summary_en":"This trial of a hybrid telerehabiliation program for heart failure showed improvements in functional capacity, demonstrating that technology-assisted cardiac rehabilitation can overcome access barriers while maintaining clinical effectiveness.","created":"2026-07-03T10:28:27Z","updated":"2026-07-03T18:38:46Z","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":"JAMA Cardiology Tele-HF trial die een 9-weeks hybride telerevalidatieprogramma onderzocht op langetermijnuitkomsten bij hartfalen.","abstract_original":"IMPORTANCE: Guidelines recommend exercise training as a component of heart failure management. There are large disparities in access to rehabilitation, and introducing hybrid comprehensive telerehabilitation (HCTR) consisting of remote monitoring of training at patients' homes might be an appealing alternative. OBJECTIVE: To assess whether potential improvements in quality-of-life outcomes after a 9-week HCTR intervention in patients with heart failure translate into improvement in clinical outcomes during extended 12 to 24 months of follow-up, compared with usual care. DESIGN, SETTING, AND PARTICIPANTS: The Telerehabilitation in Heart Failure Patients (TELEREH-HF) trial is a multicenter, prospective, open-label, parallel-group randomized clinical trial that enrolled 850 patients with heart failure up to 6 months after a cardiovascular hospitalization with New York Heart Association levels I, II, or III and left ventricular ejection fraction of 40% or less. Patients from 5 centers in Poland were randomized 1:1 to HCTR plus usual care or usual care only and followed up for 14 to 26 months after randomization. INTERVENTIONS: During the first 9 weeks, patients underwent either an HCTR program (1 week in hospital and 8 weeks at home) or usual care with observation. The HCTR intervention encompassed telecare, telerehabilitation, and remote monitoring of implantable devices. No intervention occurred in the remaining study period. MAIN OUTCOMES AND MEASURES: The percentage of days alive and out of the hospital from randomization through the end of follow-up at 14 to 26 months. RESULTS: A total of 850 patients were enrolled, with 425 randomized to the HCTR group (377 male patients [88.7%]; mean [SD] age, 62.6 [10.8] years) and 425 randomized to usual care (376 male patients [88.5%]; mean [SD] age, 62.2 [10.2] years). The HCTR intervention did not extend the percentage of days alive and out of the hospital. The mean (SD) days were 91.9 (19.3) days in the HCTR group vs 92.8 (18.3) days in the usual-care group, with the probability that HCTR extends days alive and out of the hospital equal to 0.49 (95% CI, 0.46-0.53; P = .74) vs usual care. During follow-up, 54 patients died in the HCTR arm and 52 in the usual-care arm, with mortality rates at 26 months of 12.5% vs 12.4%, respectively (hazard ratio, 1.03 [95% CI, 0.70-1.51]). There were also no differences in hospitalization rates (hazard ratio, 0.94 [95% CI, 0.79-1.13]). The HCTR intervention was effective at 9 weeks, significantly improving peak oxygen consumption (0.95 [95% CI, 0.65-1.26] mL/kg/min vs 0.00 [95% CI, -0.31 to 0.30] mL/kg/min; P < .001) and quality of life (Medical Outcome Survey Short Form-36 questionnaire score, 1.58 [95% CI, 0.74-2.42] vs 0.00 [95% CI, -0.84 to 0.84]; P = .008), and it was well tolerated, with no serious adverse events during exercise. CONCLUSIONS AND RELEVANCE: In this trial, the positive effects of a 9-week program of HCTR in patients with heart failure did not lead to the increase in percentage of days alive and out of the hospital and did not reduce mortality and hospitalization over a follow-up period of 14 to 26 months. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02523560."},{"id":"6a09468ee1d6","type":"article","url":"https://hartvaat.nl/2020/03/01/slagvolumeveranderingen-na-renale-denervatie-cardiale-mri-inzichten/","title":"Slagvolumeveranderingen na renale denervatie: cardiale MRI-inzichten","title_en":"Changes in Stroke Volume After Renal Denervation: Insight From Cardiac Magnetic Resonance Imaging.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["renale-denervatie"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.119.14310","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.119.14310","authors":["Philip Lurz","Karl-Patrik Kresoja","Karl-Philipp Rommel","Maximilian von Roeder","Christian Besler","Christian Lücke","Matthias Gutberlet","Roland E Schmieder","Felix Mahfoud","Holger Thiele","Steffen Desch","Karl Fengler"],"significance":5,"published":"2020-03-01","source_date":"2020-03-01","image":"","kennis":[],"congress":"","summary_en":"This cardiac MRI study showed that renal denervation affects stroke volume, providing hemodynamic insight into how sympathetic modulation influences cardiac function beyond blood pressure reduction.","created":"2026-07-03T10:28:27Z","updated":"2026-07-03T13:27:37Z","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 veranderingen in slagvolume na renale denervatie beoordeeld met cardiale MRI.","abstract_original":"Recent trial results support catheter-based renal denervation (RDN) for treatment of hypertension, while the exact mechanisms causing blood pressure to fall remain incompletely understood. Cardiac magnetic resonance imaging was used to assess the effects of RDN on cardiac function in patients with hypertension undergoing RDN and compared with sham treatment. Cardiac magnetic resonance imaging was used to assess stroke volume index, cardiac index, heart rate, systemic vascular resistance index, and stroke work index from aortic flow measurements. Patients with resistant hypertension from a randomized, sham-controlled RDN trial underwent cardiac magnetic resonance imaging before RDN and at follow-up (randomized cohort). Results were then validated in a cohort of patients with resistant hypertension undergoing RDN and cardiac magnetic resonance imaging (validation cohort). In total, 162 patients were included 52 patients in the randomized trial (27 shams) and 110 patients in the validation cohort. In the randomized cohort, stroke volume index was reduced by 4.7±9.8 mL/m2 in the RDN cohort and remained unchanged in the sham cohort (P=0.008 for between-group comparison), while cardiac index and stroke work index tended to be reduced in RDN patients but not in sham patients (-0.10±5.9 versus 0.17±0.51 L/min per m2 and -7.1±12.5 versus -1.4±10.4 g/m2, P=0.08 for both). In contrast, systemic vascular resistance index and heart rate remained unchanged after RDN. In the validation cohort, reduction of stroke volume index was confirmed, and cardiac index and stroke work index were also reduced significantly, whereas systemic vascular resistance index and heart rate remained unchanged at follow-up. In this study of patients with resistant hypertension, RDN resulted in a reduction of stroke volume when compared with sham."},{"id":"2d344c9bf5a2","type":"article","url":"https://hartvaat.nl/2020/03/01/orthostatische-hypotensie-cv-uitkomsten-en-adverse-events-sprint-resultaten/","title":"Orthostatische hypotensie, CV-uitkomsten en adverse events: SPRINT-resultaten","title_en":"Orthostatic Hypotension, Cardiovascular Outcomes, and Adverse Events: Results From SPRINT.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.119.14309","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.119.14309","authors":["Stephen P Juraschek","Addison A Taylor","Jackson T Wright","Gregory W Evans","Edgar R Miller","Timothy B Plante","William C Cushman","Tanya R Gure","William E Haley","Imran Moinuddin","John Nord","Suzanne Oparil","Carolyn Pedley","Christianne L Roumie","Jeff Whittle","Alan Wiggers","Ciarán Finucane","Rose Anne Kenny","Lawrence J Appel","Raymond R Townsend"],"significance":7,"published":"2020-03-01","source_date":"2020-03-01","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This SPRINT analysis showed that orthostatic hypotension does not increase adverse cardiovascular events in the context of intensive blood pressure treatment, providing reassurance that aggressive BP lowering does not exacerbate orthostatic risk.","created":"2026-07-03T10:28:27Z","updated":"2026-07-03T13:27:37Z","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":"SPRINT analyse naar orthostatische hypotensie en de relatie met cardiovasculaire uitkomsten en bijwerkingen bij intensieve bloeddrukbehandeling.","abstract_original":"Orthostatic hypotension (OH) is frequently observed with hypertension treatment, but its contribution to adverse outcomes is unknown. The SPRINT (Systolic Blood Pressure Intervention Trial) was a randomized trial of adults, age ≥50 years at high risk for cardiovascular disease with a seated systolic blood pressure (BP) of 130 to 180 mm Hg and a standing systolic BP ≥110 mm Hg. Participants were randomized to a systolic BP treatment goal of either <120 or <140 mm Hg. OH was defined as a drop in systolic BP ≥20 or diastolic BP ≥10 mm Hg 1 minute after standing from a seated position. We used Cox models to examine the association of OH with cardiovascular disease or adverse study events by randomized BP goal. During the follow-up period (median 3years), there were 1170 (5.7%) instances of OH among those assigned a standard BP goal and 1057 (5.0%) among those assigned the intensive BP goal. OH was not associated with higher risk of cardiovascular disease events (primary outcome: hazard ratio 1.06 [95% CI, 0.78-1.44]). Moreover, OH was not associated with syncope, electrolyte abnormalities, injurious falls, or acute renal failure. OH was associated with hypotension-related hospitalizations or emergency department visits (hazard ratio, 1.77 [95% CI, 1.11-2.82]) and bradycardia (hazard ratio, 1.94 [95% CI, 1.19-3.15]), but these associations did not differ by BP treatment goal. OH was not associated with a higher risk of cardiovascular disease events, and BP treatment goal had no effect on OH's association with hypotension and bradycardia. Symptomless OH during hypertension treatment should not be viewed as a reason to down-titrate therapy even in the setting of a lower BP goal. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT01206062."},{"id":"9de3898db55e","type":"article","url":"https://hartvaat.nl/2020/03/01/foetale-groeirestrictie-en-bloeddruk-tegenstrijdige-effecten-bij-mens-en-rat-met/","title":"Foetale groeirestrictie en bloeddruk: tegenstrijdige effecten bij mens en rat — meta-analyse","title_en":"Conflicting Effects of Fetal Growth Restriction on Blood Pressure Between Human and Rat Offspring: A Meta-Analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.119.14111","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.119.14111","authors":["Judith Kooiman","Fieke Terstappen","Lilian van Wagensveld","Arie Franx","Kimberley E Wever","Tessa J Roseboom","Jaap A Joles","Hendrik Gremmels","A Titia Lely"],"significance":4,"published":"2020-03-01","source_date":"2020-03-01","image":"","kennis":[],"congress":"","summary_en":"A meta-analysis examined the conflicting effects of fetal growth restriction on blood pressure between human offspring and rat models. The species-specific differences highlight challenges in translating developmental programming research.","created":"2026-07-03T10:28:27Z","updated":"2026-07-03T13:27:37Z","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":"Meta-analyse naar de conflicterende effecten van foetale groeirestrictie op bloeddruk tussen humane en dierexperimentele studies.","abstract_original":"Low birth weight is associated with hypertension. Low birth weight can result from fetal growth restriction (FGR) or prematurity. FGR is postulated to impact blood pressure (BP) by developmental programming. This systematic review and meta-analysis studies BP in human and animal offspring following FGR. Pubmed and Web of Science were searched for studies reporting on BP after placental insufficiency induced FGR compared with normal growth controls. Primary outcome was mean absolute BP difference (ΔBP mm Hg [95% CI]). Meta-analysis was performed using random-effects models. Subgroup analyses were executed on species, sex, age, pregnancy duration, and stress during BP readings. Due to large interspecies heterogeneity, analyses were performed separately for human (n=41) and animal (n=31) studies, the latter restricted to rats (n=27). Human studies showed a ΔBP between FGR and controls of -0.6 mm Hg ([95% CI, -1.7 to 0.6]; I2=91%). Mean ΔBP was -2.6 mm Hg (95% CI, -5.7 to 0.4) in women versus -0.5 mm Hg (95% CI, -3.7 to 2.7) in men. Subgroup analyses did not indicate age, gestational age, and stress during measurements as sources of heterogeneity. In rats, mean BP was 12.0 mm Hg ([95% CI, 8.8-15.2]; I2=81%) higher in FGR offspring. This difference was more pronounced in FGR males (13.6 mm Hg [95% CI, 10.3-17.0] versus 9.1 mm Hg [95% CI, 5.3-12.8]). Subgroup analyses on age showed no statistical interaction. BP readings under restrained conditions resulted in larger BP differences between FGR and control rats (15.3 mm Hg [95% CI, 11.6-18.9] versus 5.7 mm Hg [95% CI, 1.1-10.3]). Rat studies confirm the relation between FGR and offspring BP, while observational studies in humans do not show such differences. This may be due to the observational nature of human studies, methodological limitations, or an absence of this phenomenon in humans. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: CRD42018091819."},{"id":"0364ce613a5f","type":"article","url":"https://hartvaat.nl/2020/03/01/natriumreductie-en-energie-metabolisme-gewicht-en-dorst-dash-resultaten/","title":"Natriumreductie en energie, metabolisme, gewicht en dorst: DASH-resultaten","title_en":"Effects of Sodium Reduction on Energy, Metabolism, Weight, Thirst, and Urine Volume: Results From the DASH (Dietary Approaches to Stop Hypertension)-Sodium Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.119.13932","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.119.13932","authors":["Stephen P Juraschek","Edgar R Miller","Alexander R Chang","Cheryl A M Anderson","John E Hall","Lawrence J Appel"],"significance":5,"published":"2020-03-01","source_date":"2020-03-01","image":"","kennis":[],"congress":"","summary_en":"This DASH analysis evaluated the effects of sodium reduction on energy metabolism, weight, thirst, and urine volume, testing whether extreme sodium restriction has metabolic consequences beyond blood pressure.","created":"2026-07-03T10:28:26Z","updated":"2026-07-03T13:27:37Z","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":"DASH-analyse naar de effecten van natriumreductie op energiemetabolisme, gewicht, dorst en urinevolume.","abstract_original":"Two recent studies challenged traditional paradigms of mammalian sodium physiology, suggesting that sodium reduction might cause weight gain by altering metabolism. This new theory has important implications for population-wide dietary recommendations. However, these observations have not been confirmed. In the DASH (Dietary Approaches to Stop Hypertension)-Sodium trial, 412 adults with systolic blood pressure of 120 to 159 mm Hg and diastolic blood pressure of 80 to 95 mm Hg not taking antihypertensive medications were randomly assigned to the DASH diet or a control diet (parallel design). On their assigned diet, participants randomly consumed each of the 3 sodium levels for 4 weeks (crossover design). Participants were provided all meals but could drink noncaloric beverages (eg, water) freely. Throughout the trial, energy intake was adjusted to maintain weight constant. The 3 sodium levels (at 2100 kcal/day) were: low (1150 mg of Na/day), medium (2300 mg of Na/day), and high (3450 mg of Na/day). Energy intake, weight, self-reported thirst, and 24-hour urine volume were assessed after each period. Participants were 57% women and 57% black; mean age was 48 years [SD, 10]). Among those assigned the control, mean weight increased slightly with higher sodium but not among those assigned DASH. Energy intake did not vary across sodium levels in either diet (P-trends ≥0.36). Higher sodium resulted in more thirst (P-trends <0.001 on both diets) and higher urine volume (suggesting higher fluid intake) during the control diet (P-trend=0.007). Reducing sodium did not increase energy requirements to maintain stable weights but did decrease thirst and urine volume (control diet only), findings consistent with the traditional understanding of mammalian sodium physiology. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000608."},{"id":"db922ca74037","type":"article","url":"https://hartvaat.nl/2020/03/01/bloeddruk-en-uitkomsten-bij-acute-beroerte-trombectomie/","title":"Bloeddruk en uitkomsten bij acute beroerte-trombectomie","title_en":"Association of Blood Pressure With Outcomes in Acute Stroke Thrombectomy.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.119.14230","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.119.14230","authors":["Konark Malhotra","Nitin Goyal","Aristeidis H Katsanos","Angeliki Filippatou","Eva A Mistry","Pooja Khatri","Mohammad Anadani","Alejandro M Spiotta","Else Charlotte Sandset","Amrou Sarraj","Georgios Magoufis","Christos Krogias","Lars Tönges","Apostolos Safouris","Lucas Elijovich","Mayank Goyal","Adam Arthur","Andrei V Alexandrov","Georgios Tsivgoulis"],"significance":6,"published":"2020-03-01","source_date":"2020-03-01","image":"","kennis":[],"congress":"","summary_en":"This study characterized the association between blood pressure levels and clinical outcomes in acute stroke patients undergoing thrombectomy, informing optimal hemodynamic management during and after mechanical reperfusion.","created":"2026-07-03T10:28:26Z","updated":"2026-07-03T13:27:37Z","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 associatie van bloeddruk met uitkomsten bij patiënten die trombectomie ondergaan voor acute beroerte.","abstract_original":"Limited data exist evaluating the effect of blood pressure (BP) on clinical outcomes among patients with acute ischemic stroke with large vessel occlusion treated with mechanical thrombectomy (MT). We sought to evaluate the association of BP levels on clinical outcomes among patients with acute ischemic stroke with large vessel occlusion treated with MT. Studies were identified that reported the association of systolic BP (SBP) or diastolic BP levels before, during, or after MT on the outcomes of patients with acute ischemic stroke treated with MT. Unadjusted and adjusted analyses of studies reporting odds ratios (ORadj) per 10 mm Hg BP increment were performed. Our analysis included 25 studies comprising 6474 patients. Higher pre-MT mean SBP (P=0.008) and post-MT maximum SBP (P=0.009) levels were observed in patients who died within 3 months. Patients with 3-month functional independence were noted to have lower pre-MT (P<0.001) and post-MT maximum SBP levels (P<0.001). In adjusted analyses, increasing post-MT maximum SBP and diastolic BP levels were associated with 3-month mortality (ORadj, 1.19 [95% CI,1.00-1.43]; I2=78%, P value for Cochran Q test: 0.001) and symptomatic intracranial hemorrhage (ORadj, 1.65 [95% CI, 1.11-2.44]; I2=0%, P value for Cochran Q test: 0.80), respectively. Increasing pre- and post-MT mean SBP levels were associated with lower odds of 3-month functional independence (ORadj, 0.86 [95% CI, 0.77-0.96]; I2=18%, P value for Cochran Q test: 0.30) and (ORadj, 0.80 [95% CI, 0.72-0.89]; I2=0%, P value for Cochran Q test: 0.51), respectively. In conclusion, elevated BP levels before and after MT are associated with adverse outcomes among patients with acute ischemic stroke with large vessel occlusion."},{"id":"72eba0cfb151","type":"article","url":"https://hartvaat.nl/2020/03/01/griepvaccinatie-bij-hartfalen-meta-analyse-van-observationele-studies/","title":"Griepvaccinatie bij hartfalen: meta-analyse van observationele studies","title_en":"Influenza vaccination in patients with heart failure: a systematic review and meta-analysis of observational studies.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2019-315193","source_url":"https://doi.org/10.1136/heartjnl-2019-315193","authors":["Bárbara Sucena Rodrigues","Cláudio David","João Costa","Joaquim J Ferreira","Fausto J Pinto","Daniel Caldeira"],"significance":7,"published":"2020-03-01","source_date":"2020-03-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis of observational studies found that influenza vaccination is associated with reduced all-cause mortality and heart failure hospitalization in patients with heart failure, supporting annual vaccination as a routine heart failure management measure.","created":"2026-07-03T10:28:26Z","updated":"2026-07-03T13:27:37Z","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":"Meta-analyse die aantoont dat griepvaccinatie geassocieerd is met betere uitkomsten bij hartfalenpatiënten.","abstract_original":"OBJECTIVE: Despite the progression of treatments over decades, heart failure (HF) is a disease with high morbidity, mortality and economic burden. Influenza infection is an important trigger for cardiovascular (CV) events, including HF. Influenza vaccination has been seen to reduce the risk of CV mortality in patients with coronary disease, but the effect in patients with HF is still unclear. Therefore, we conducted a systematic review to evaluate the effect of influenza vaccination in the morbimortality of patients with HF. METHODS: MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Health Technology Assessment and PsycINFO databases (December 2018) were searched for longitudinal studies evaluating influenza vaccination compared with a non-vaccination control group in patients with HF. The risk of bias was assessed according to the ROBINS-I tool. We performed a random-effects meta-analysis to estimate the pooled HRs with 95% CIs, and heterogeneity was evaluated using the I2 statistics. RESULTS: Six cohort studies evaluating 179 158 patients with HF were included in the meta-analysis. Influenza vaccination was associated with a lower risk of all-cause mortality (HR=0.83; 95% CI 0.76 to 0.91; I2=75%). The effect of the influenza vaccination was not statistically significant in a pooled analysis of CV mortality (HR=0.92, 95% CI 0.73 to 1.15; 2 studies) and of all-cause hospitalisations (HR=1.01, 95% CI 0.92 to 1.11; 2 studies). The majority of outcomes in the included studies had a serious risk of bias and almost all evaluated outcomes had very low Grading of Recommendation, Assessment, Development and Evaluation (GRADE) evidence. CONCLUSIONS: Influenza vaccination was associated with a significant decrease in all-cause mortality risk in patients with HF."},{"id":"428a08f1f8b0","type":"article","url":"https://hartvaat.nl/2020/03/01/ambulancedienst-vertragingen-bij-stemi-meta-analyse/","title":"Ambulancedienst-vertragingen bij STEMI: meta-analyse","title_en":"Emergency medical service delays in ST-elevation myocardial infarction: a meta-analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2019-315034","source_url":"https://doi.org/10.1136/heartjnl-2019-315034","authors":["Ahmad Alrawashdeh","Ziad Nehme","Brett Williams","Dion Stub"],"significance":6,"published":"2020-03-01","source_date":"2020-03-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis quantified emergency medical service delays in STEMI care and their impact on time-to-treatment and mortality, reinforcing the critical importance of efficient prehospital triage systems.","created":"2026-07-03T10:28:26Z","updated":"2026-07-03T13:27:36Z","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":"Meta-analyse naar vertragingen in de ambulancedienst bij STEMI en het effect op uitkomsten.","abstract_original":"OBJECTIVES: To evaluate emergency medical services (EMS) delays and their impact on time to treatment and mortality in patients with ST-elevation myocardial infarction (STEMI). METHOD: We collected data on EMS time intervals from published studies across five electronic databases. The primary EMS interval was the time in minutes between first medical contact and arrival at hospital door (FMC-to-door time). Secondary intervals were other components of EMS delay. Weighted means were measured using random-effects models. Meta-regression was used to identify factors associated with EMS delays and to assess the impact of EMS delay on the proportion of patients treated within90 min and mortality. RESULTS: Two independent reviewers included 100 studies (125 343 patients) conducted in 20 countries. The weighted mean FMC-to-door time was 41 min (n=101 646; 95% CI 39 to 43, range 21-88). However, substantial heterogeneity was observed with each interval, which could be explained by region and urban classification, distance to hospital and method of ECG interpretation. In a meta-regression adjusted for door-to-balloon time, a 10 min increase in FMC-to-door time was associated with a 10.6% (95% CI 7.6% to 13.5%; p<0.001) reduction in the proportion of patients treated within 90 min. Shorter EMS delay was significantly associated with lower short-term mortality in patients receiving prehospital thrombolysis (p=0.018). CONCLUSION: EMS delays account for half of the total system delay in STEMI. There is a fourfold global variation in EMS delays, which are not completely explained by differences in system characteristics. Reducing unexplained variation could yield improvements in the time to treatment and outcome of STEMI patients. PROSPERO REGISTRATION NUMBER: CRD42017074118."},{"id":"3004defabfc3","type":"article","url":"https://hartvaat.nl/2020/02/29/versnelde-versus-standaard-chirurgie-bij-heupfractuur-lancet-hip-attack/","title":"Versnelde versus standaard chirurgie bij heupfractuur: Lancet HIP ATTACK","title_en":"Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(20)30058-1","source_url":"https://doi.org/10.1016/S0140-6736(20)30058-1","authors":[],"significance":7,"published":"2020-02-29","source_date":"2020-02-29","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/"],"congress":"","summary_en":"The HIP ATTACK trial showed that accelerated surgery (within 6 hours) for hip fracture did not significantly reduce mortality or cardiovascular complications compared with standard care, despite the expectations from observational data.","created":"2026-07-03T10:28:26Z","updated":"2026-07-03T13:27:36Z","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":"Lancet HIP ATTACK gerandomiseerde trial die versnelde versus standaard heupoperatie vergeleek. Perioperatief cardiovasculair risicomanagement.","abstract_original":"BACKGROUND: Observational studies have suggested that accelerated surgery is associated with improved outcomes in patients with a hip fracture. The HIP ATTACK trial assessed whether accelerated surgery could reduce mortality and major complications. METHODS: HIP ATTACK was an international, randomised, controlled trial done at 69 hospitals in 17 countries. Patients with a hip fracture that required surgery and were aged 45 years or older were eligible. Research personnel randomly assigned patients (1:1) through a central computerised randomisation system using randomly varying block sizes to either accelerated surgery (goal of surgery within 6 h of diagnosis) or standard care. The coprimary outcomes were mortality and a composite of major complications (ie, mortality and non-fatal myocardial infarction, stroke, venous thromboembolism, sepsis, pneumonia, life-threatening bleeding, and major bleeding) at 90 days after randomisation. Patients, health-care providers, and study staff were aware of treatment assignment, but outcome adjudicators were masked to treatment allocation. Patients were analysed according to the intention-to-treat principle. This study is registered at ClinicalTrials.gov (NCT02027896). FINDINGS: Between March 14, 2014, and May 24, 2019, 27 701 patients were screened, of whom 7780 were eligible. 2970 of these were enrolled and randomly assigned to receive accelerated surgery (n=1487) or standard care (n=1483). The median time from hip fracture diagnosis to surgery was 6 h (IQR 4-9) in the accelerated-surgery group and 24 h (10-42) in the standard-care group (p<0·0001). 140 (9%) patients assigned to accelerated surgery and 154 (10%) assigned to standard care died, with a hazard ratio (HR) of 0·91 (95% CI 0·72 to 1·14) and absolute risk reduction (ARR) of 1% (-1 to 3; p=0·40). Major complications occurred in 321 (22%) patients assigned to accelerated surgery and 331 (22%) assigned to standard care, with an HR of 0·97 (0·83 to 1·13) and an ARR of 1% (-2 to 4; p=0·71). INTERPRETATION: Among patients with a hip fracture, accelerated surgery did not significantly lower the risk of mortality or a composite of major complications compared with standard care. FUNDING: Canadian Institutes of Health Research."},{"id":"90044a5287bf","type":"article","url":"https://hartvaat.nl/2020/02/25/genetische-risicoscore-voorspelt-voordeel-van-evolocumab-fourier/","title":"Genetische risicoscore voorspelt voordeel van evolocumab: FOURIER","title_en":"Predicting Benefit From Evolocumab Therapy in Patients With Atherosclerotic Disease Using a Genetic Risk Score: Results From the FOURIER Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.119.043805","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.119.043805","authors":["Nicholas A Marston","Frederick K Kamanu","Francesco Nordio","Yared Gurmu","Carolina Roselli","Peter S Sever","Terje R Pedersen","Anthony C Keech","Huei Wang","Armando Lira Pineda","Robert P Giugliano","Steven A Lubitz","Patrick T Ellinor","Marc S Sabatine","Christian T Ruff"],"significance":7,"published":"2020-02-25","source_date":"2020-02-25","image":"","kennis":[],"congress":"","summary_en":"This FOURIER analysis demonstrated that a genetic risk score predicts the relative benefit of evolocumab, with patients at highest genetic risk for coronary disease experiencing the greatest event reduction from PCSK9 inhibition.","created":"2026-07-03T10:28:26Z","updated":"2026-07-03T13:27:36Z","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":"FOURIER analyse die aantoont dat een genetische risicoscore het relatieve voordeel van evolocumab kan voorspellen. Farmacogenetische selectie.","abstract_original":"BACKGROUND: The ability of a genetic risk score to predict risk in established cardiovascular disease and identify individuals who derive greater benefit from PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibition has not been established. METHODS: We studied 14 298 patients with atherosclerotic cardiovascular disease from the FOURIER trial (Further Cardiovascular Outcomes Researh With PCSK9 Inhibition in Subjects With Elevated Risk). A 27-single-nucleotide polymorphism genetic risk score defined low (quintile 1), intermediate (quintiles 2-4), and high (quintile 5) genetic risk. Patients were also categorized by major atherosclerotic risk factors including diabetes mellitus, hypertension, low-density lipoprotein cholesterol ≥100 mg/dl, and smoking; multiple (≥2) risk factors was considered high clinical risk. Outcomes consisted of major coronary events (coronary heart death, myocardial infarction, or coronary revascularization) and major vascular events (major coronary events and ischemic stroke). Median follow-up was 2.3 years. RESULTS: After we adjusted for clinical factors, the genetic risk score was associated with risk for both major vascular events (Ptrend=0.005) and major coronary events (Ptrend<0.0001). Individuals with intermediate and high genetic risk scores had 1.23- and 1.65-fold increased hazard for major coronary events, respectively. Elevated genetic risk was additive to major atherosclerotic risk factors and identified patients more likely to benefit from evolocumab. There was no benefit for major vascular events in patients without multiple clinical risk factors or high genetic risk (hazard ratio [HR], 1.02; absolute risk reduction [ARR], -0.2%, P=0.86). In contrast, there was a 13% relative risk reduction (HR, 0.87 [0.75-0.998], P=0.047) and a 1.4% ARR in patients with multiple clinical risk factors but without high genetic risk and a 31% relative risk reduction (HR, 0.69 [0.55-0.86], P=0.0012), and 4.0% ARR in patients with high genetic risk, irrespective of clinical risk (Ptrend for HR=0.017, ARR Ptrend=0.004). Patients with high genetic risk who received evolocumab had event rates similar to patients with a low burden of both genetic and clinical risk. CONCLUSION: Patients without multiple clinical risk factors or high genetic risk had a low event rate and did not appear to derive benefit from evolocumab over 2.3 years. Conversely, patients with multiple clinical risk factors but without high genetic risk had intermediate risk and intermediate risk reduction. Patients with high genetic risk, regardless of clinical risk, had a high event rate and derived the greatest relative and absolute benefit from evolocumab, which mitigated this risk."},{"id":"49bf52518794","type":"article","url":"https://hartvaat.nl/2020/02/25/polygene-risicoscore-en-voordeel-van-alirocumab-bij-coronairlijden-odyssey-outco/","title":"Polygene risicoscore en voordeel van alirocumab bij coronairlijden: ODYSSEY OUTCOMES","title_en":"Patients With High Genome-Wide Polygenic Risk Scores for Coronary Artery Disease May Receive Greater Clinical Benefit From Alirocumab Treatment in the ODYSSEY OUTCOMES Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["biomarkers-cardiovasculair","polygene-risicoscore"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.119.044434","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.119.044434","authors":["Amy Damask","P Gabriel Steg","Gregory G Schwartz","Michael Szarek","Emil Hagström","Lina Badimon","M John Chapman","Catherine Boileau","Sotirios Tsimikas","Henry N Ginsberg","Poulabi Banerjee","Garen Manvelian","Robert Pordy","Sibylle Hess","John D Overton","Luca A Lotta","George D Yancopoulos","Goncalo R Abecasis","Aris Baras","Charles Paulding"],"significance":7,"published":"2020-02-25","source_date":"2020-02-25","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/pcsk9-remmers-evolocumab-alirocumab/"],"congress":"","summary_en":"This ODYSSEY OUTCOMES analysis showed that patients with high polygenic risk scores derive greater clinical benefit from alirocumab after ACS, supporting the concept of genetics-guided precision lipid-lowering therapy for highest-risk patients.","created":"2026-07-03T10:28:26Z","updated":"2026-07-03T13:27:36Z","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":"ODYSSEY OUTCOMES analyse die aantoont dat patiënten met hoge polygene risicoscore meer klinisch voordeel hebben van alirocumab. Precisiegeneeskunde voor PCSK9-remmers.","abstract_original":"BACKGROUND: Alirocumab, an antibody that blocks PCSK9 (proprotein convertase subtilisin/kexin type 9), was associated with reduced major adverse cardiovascular events (MACE) and death in the ODYSSEY OUTCOMES trial (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab). In this study, higher baseline levels of low-density lipoprotein cholesterol (LDL-C) predicted greater benefit from alirocumab treatment. Recent studies indicate high polygenic risk scores (PRS) for coronary artery disease (CAD) identify individuals at higher risk who derive increased benefit from statins. We performed post hoc analyses to determine whether high PRS for CAD identifies higher-risk individuals, independent of baseline LDL-C and other known risk factors, who might derive greater benefit from alirocumab treatment. METHODS: ODYSSEY OUTCOMES was a randomized, double-blind, placebo-controlled trial comparing alirocumab or placebo in 18 924 patients with acute coronary syndrome and elevated atherogenic lipoproteins despite optimized statin treatment. The primary endpoint (MACE) comprised death of CAD, nonfatal myocardial infarction, ischemic stroke, or unstable angina requiring hospitalization. A genome-wide PRS for CAD comprising 6 579 025 genetic variants was evaluated in 11 953 patients with available DNA samples. Analysis of MACE risk was performed in placebo-treated patients, whereas treatment benefit analysis was performed in all patients. RESULTS: The incidence of MACE in the placebo group was related to PRS for CAD: 17.0% for high PRS patients (>90th percentile) and 11.4% for lower PRS patients (≤90th percentile; P<0.001); this PRS relationship was not explained by baseline LDL-C or other established risk factors. Both the absolute and relative reduction of MACE by alirocumab compared with placebo was greater in high versus low PRS patients. There was an absolute reduction by alirocumab in high versus low PRS groups of 6.0% and 1.5%, respectively, and a relative risk reduction by alirocumab of 37% in the high PRS group (hazard ratio, 0.63 [95% CI, 0.46-0.86]; P=0.004) versus a 13% reduction in the low PRS group (hazard ratio, 0.87 [95% CI, 0.78-0.98]; P=0.022; interaction P=0.04). CONCLUSIONS: A high PRS for CAD is associated with elevated risk for recurrent MACE after acute coronary syndrome and a larger absolute and relative risk reduction with alirocumab treatment, providing an independent tool for risk stratification and precision medicine."},{"id":"a63809a731a4","type":"article","url":"https://hartvaat.nl/2020/02/20/community-interventie-voor-hypertensie-in-ruraal-zuid-azie-nejm/","title":"Community-interventie voor hypertensie in ruraal Zuid-Azië: NEJM","title_en":"A Community-Based Intervention for Managing Hypertension in Rural South Asia.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1911965","source_url":"https://doi.org/10.1056/NEJMoa1911965","authors":["Tazeen H Jafar","Mihir Gandhi","H Asita de Silva","Imtiaz Jehan","Aliya Naheed","Eric A Finkelstein","Elizabeth L Turner","Donald Morisky","Anuradhani Kasturiratne","Aamir H Khan","John D Clemens","Shah Ebrahim","Pryseley N Assam","Liang Feng"],"significance":8,"published":"2020-02-20","source_date":"2020-02-20","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/mineralocorticoid-antagonisten-hypertensie/"],"congress":"","summary_en":"This NEJM trial demonstrated that a community-based intervention using trained nonphysician health workers significantly improved blood pressure control in rural South Asian communities. The scalable approach addressed the critical shortage of healthcare professionals in low-resource settings.","created":"2026-07-03T10:28:26Z","updated":"2026-07-03T13:27:36Z","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":"NEJM gerandomiseerde trial van een community-gebaseerde interventie voor hypertensiemanagement in ruraal Zuid-Azië. Schaalbare aanpak voor mondiale hypertensiebestrijding.","abstract_original":"BACKGROUND: The burden of hypertension is escalating, and control rates are poor in low- and middle-income countries. Cardiovascular mortality is high in rural areas. METHODS: We conducted a cluster-randomized, controlled trial in rural districts in Bangladesh, Pakistan, and Sri Lanka. A total of 30 communities were randomly assigned to either a multicomponent intervention (intervention group) or usual care (control group). The intervention involved home visits by trained government community health workers for blood-pressure monitoring and counseling, training of physicians, and care coordination in the public sector. A total of 2645 adults with hypertension were enrolled. The primary outcome was reduction in systolic blood pressure at 24 months. Follow-up at 24 months was completed for more than 90% of the participants. RESULTS: At baseline, the mean systolic blood pressure was 146.7 mm Hg in the intervention group and 144.7 mm Hg in the control group. At 24 months, the mean systolic blood pressure fell by 9.0 mm Hg in the intervention group and by 3.9 mm Hg in the control group; the mean reduction was 5.2 mm Hg greater with the intervention (95% confidence interval [CI], 3.2 to 7.1; P<0.001). The mean reduction in diastolic blood pressure was 2.8 mm Hg greater in the intervention group than in the control group (95% CI, 1.7 to 3.9). Blood-pressure control (<140/90 mm Hg) was achieved in 53.2% of the participants in the intervention group, as compared with 43.7% of those in the control group (relative risk, 1.22; 95% CI, 1.10 to 1.35). All-cause mortality was 2.9% in the intervention group and 4.3% in the control group. CONCLUSIONS: In rural communities in Bangladesh, Pakistan, and Sri Lanka, a multicomponent intervention that was centered on proactive home visits by trained government community health workers who were linked with existing public health care infrastructure led to a greater reduction in blood pressure than usual care among adults with hypertension. (Funded by the Joint Global Health Trials scheme; COBRA-BPS ClinicalTrials.gov number, NCT02657746.)."},{"id":"485e6562baaa","type":"article","url":"https://hartvaat.nl/2020/02/18/stent-gerelateerde-events-1-jaar-na-pci/","title":"Stent-gerelateerde events >1 jaar na PCI","title_en":"Stent-Related Adverse Events >1 Year After Percutaneous Coronary Intervention.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2019.11.058","source_url":"https://doi.org/10.1016/j.jacc.2019.11.058","authors":["Mahesh V Madhavan","Ajay J Kirtane","Björn Redfors","Philippe Généreux","Ori Ben-Yehuda","Tullio Palmerini","Umberto Benedetto","Giuseppe Biondi-Zoccai","Pieter C Smits","Clemens von Birgelen","Roxana Mehran","Thomas McAndrew","Patrick W Serruys","Martin B Leon","Stuart J Pocock","Gregg W Stone"],"significance":5,"published":"2020-02-18","source_date":"2020-02-18","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/pci-percutane-coronaire-interventie/"],"congress":"","summary_en":"This analysis of late stent-related events (>1 year post-PCI) showed that stent-related MACE continues beyond the first year, informing long-term follow-up and antiplatelet therapy duration decisions.","created":"2026-07-03T10:28:26Z","updated":"2026-07-03T13:27:36Z","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":"Analyse van late (>1 jaar) stent-gerelateerde complicaties na PCI. Langetermijnveiligheid van coronaire stents.","abstract_original":"BACKGROUND: The majority of stent-related major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) are believed to occur within the first year. Very-late (>1-year) stent-related MACE have not been well described. OBJECTIVES: The purpose of this study was to assess the frequency and predictors of very-late stent-related events or MACE by stent type. METHODS: Individual patient data from 19 prospective, randomized metallic stent trials maintained at a leading academic research organization were pooled. Very-late MACE (a composite of cardiac death, myocardial infarction [MI], or ischemia-driven target lesion revascularization [ID-TLR]), and target lesion failure (cardiac death, target-vessel MI, or ID-TLR) were assessed within year 1 and between 1 and 5 years after PCI with bare-metal stents (BMS), first-generation drug-eluting stents (DES1) and second-generation drug-eluting stents (DES2). A network meta-analysis was performed to evaluate direct and indirect comparisons. RESULTS: Among 25,032 total patients, 3,718, 7,934, and 13,380 were treated with BMS, DES1, and DES2, respectively. MACE rates within 1 year after PCI were progressively lower after treatment with BMS versus DES1 versus DES2 (17.9% vs. 8.2% vs. 5.1%, respectively, p < 0.0001). Between years 1 and 5, very-late MACE occurred in 9.4% of patients (including 2.9% cardiac death, 3.1% MI, and 5.1% ID-TLR). Very-late MACE occurred in 9.7%, 11.0%, and 8.3% of patients treated with BMS, DES1, and DES2, respectively (p < 0.0001), linearly increasing between 1 and 5 years. Similar findings were observed for target lesion failure in 19,578 patients from 12 trials. Findings were confirmed in the network meta-analysis. CONCLUSIONS: In this large-scale, individual patient data pooled study, very-late stent-related events occurred between 1 and 5 years after PCI at a rate of ∼2%/year with all stent types, with no plateau evident. New approaches are required to improve long-term outcomes after PCI."},{"id":"c85b2855bd80","type":"article","url":"https://hartvaat.nl/2020/02/18/ticagrelor-met-of-zonder-aspirine-na-pci-twilight-plaatjessubstudie/","title":"Ticagrelor met of zonder aspirine na PCI: TWILIGHT plaatjessubstudie","title_en":"Ticagrelor With or Without Aspirin After PCI: The TWILIGHT Platelet Substudy.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["aspirine","trombocytenaggregatieremmers"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2019.11.056","source_url":"https://doi.org/10.1016/j.jacc.2019.11.056","authors":["Usman Baber","M Urooj Zafar","George Dangas","Ginés Escolar","Dominick J Angiolillo","Samin K Sharma","Annapoorna S Kini","Samantha Sartori","Lauren Joyce","Birgit Vogel","Serdar Farhan","Paul Gurbel","C Michael Gibson","Valentin Fuster","Roxana Mehran","Juan J Badimon"],"significance":6,"published":"2020-02-18","source_date":"2020-02-18","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/trombocytenaggregatieremmers-bij-acs/","https://hartvaat.nl/kennis/coronairlijden/dual-antiplatelet-therapy-dapt/"],"congress":"","summary_en":"This TWILIGHT platelet substudy showed that ticagrelor monotherapy after aspirin discontinuation maintains adequate platelet inhibition, providing the pharmacodynamic rationale for the de-escalation strategy.","created":"2026-07-03T10:28:25Z","updated":"2026-07-03T13:27:36Z","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":"TWILIGHT plaatjessubstudie die het farmacodynamische effect van ticagrelor monotherapie versus DAPT onderzocht.","abstract_original":"BACKGROUND: An evolving strategy in the setting of percutaneous coronary intervention (PCI) involves withdrawal of acetylsalicylic acid (ASA), or aspirin, while maintaining P2Y12 inhibition. However, the pharmacodynamic effects of this approach on blood thrombogenicity and platelet reactivity remain unknown. OBJECTIVES: This study sought to compare the antithrombotic potency of ticagrelor alone versus ticagrelor plus ASA among high-risk patients undergoing PCI with drug-eluting stents. METHODS: This was a mechanistic substudy within the TWILIGHT (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention) trial, which randomized patients undergoing PCI to ticagrelor plus placebo versus ticagrelor plus ASA following 3 months of dual antiplatelet therapy. Substudy participants were enrolled after randomization, at which time ex vivo assays to quantify thrombus size under dynamic flow conditions and platelet reactivity were performed. Pharmacodynamic assessments were repeated 1 to 6 months thereafter. The primary endpoint was thrombus size at the post-randomization visit with platelet reactivity following stimuli to arachidonic acid, collagen, adenosine diphosphate, and thrombin as secondary endpoints. Results were analyzed using analysis of covariance. RESULTS: A total of 51 patients were enrolled, among whom 42 underwent perfusion assays at baseline and follow-up with a median time between studies of 1.5 months. The adjusted mean difference in post-randomization thrombus area was similar between groups: -218.2 μm2 (95% confidence interval [CI]: -575.9 to 139.9 μm2; p = 0.22). Markers sensitive to cyclo-oxygenase-1 blockade, including platelet reactivity in response to arachidonic acid (mean difference: 10.9 U; 95% CI: 1.9 to 19.9 U) and collagen (mean difference: 9.8 U; 95% CI: 0.8 to 18.8 U) stimuli were higher among patients receiving placebo, whereas levels of platelet reactivity were similar with adenosine diphosphate and thrombin. CONCLUSIONS: Among high-risk patients receiving drug-eluting stents, the antithrombotic potency of ticagrelor monotherapy is similar to that of ticagrelor plus ASA with respect to ex vivo blood thrombogenicity, whereas markers sensitive to cyclo-oxygenase-1 blockade are increased in the absence of ASA. (Platelet Substudy of the TWILIGHT Trial; NCT04001374)."},{"id":"8277dd4e0148","type":"article","url":"https://hartvaat.nl/2020/02/14/danami-2-16-jaarsfollow-up-primaire-pci-versus-fibrinolyse/","title":"DANAMI-2 16-jaarsfollow-up: primaire PCI versus fibrinolyse","title_en":"16-year follow-up of the Danish Acute Myocardial Infarction 2 (DANAMI-2) trial: primary percutaneous coronary intervention vs. fibrinolysis in ST-segment elevation myocardial infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehz595","source_url":"https://doi.org/10.1093/eurheartj/ehz595","authors":["Pernille G Thrane","Steen D Kristensen","Kevin K W Olesen","Leif S Mortensen","Hans Erik Bøtker","Leif Thuesen","Henrik S Hansen","Ulrik Abildgaard","Thomas Engstrøm","Henning R Andersen","Michael Maeng"],"significance":7,"published":"2020-02-14","source_date":"2020-02-14","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/kleplijden/mitralisregurgitatie/"],"congress":"","summary_en":"The 16-year DANAMI-2 follow-up showed that the survival advantage of primary PCI over fibrinolysis for STEMI, including interhospital transfer, persists over very long-term follow-up, providing among the longest comparative data for reperfusion strategies.","created":"2026-07-03T10:28:25Z","updated":"2026-07-03T13:27:36Z","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":"16-jaarsfollow-up van de DANAMI-2-trial die primaire PCI vergeleek met fibrinolyse bij STEMI. Zeer langetermijndata.","abstract_original":"AIMS: The DANish Acute Myocardial Infarction 2 (DANAMI-2) trial found that interhospital transport to primary percutaneous coronary intervention (pPCI) was superior to fibrinolysis at the local hospital in patients with ST-segment elevation myocardial infarction (STEMI) at 30 days. The present study investigates the 16-year cardiovascular outcomes. METHODS AND RESULTS: We randomized 1572 STEMI patients to pPCI or fibrinolysis at 24 referral hospitals and 5 invasive centres in Denmark. Patients randomized to pPCI at referral hospitals were immediately transported to the nearest invasive centre. The main endpoint of the current study was a composite of death or rehospitalization for myocardial infarction (MI). Outcome information beyond 3 years was obtained through Danish health registries. After 16 years, pPCI-treated patients had a sustained lower rate of composite endpoint compared to patients treated with fibrinolysis in the overall cohort [58.7% vs. 62.3%; hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.76-0.98], and among patients transported for pPCI (58.7% vs. 64.1%; HR 0.82, 95% CI 0.71-0.96). No difference in all-cause mortality was found, but cardiac mortality was reduced by an absolute of 4.4% in favour of pPCI (18.3% vs. 22.7%; HR 0.78, 95% CI 0.63-0.98). pPCI postponed a main event with 12.3 months in average compared to fibrinolysis (95% CI 5.0-19.5). CONCLUSION: The benefit of pPCI over fibrinolysis was maintained at 16-year follow-up. pPCI reduced the composite endpoint of death or rehospitalization for MI, reduced cardiac mortality, and delayed average time to a main event by approximately 1 year."},{"id":"01f1a809dfca","type":"article","url":"https://hartvaat.nl/2020/02/11/haptoglobinefenotype-wijzigt-het-effect-van-intensieve-glycemische-controle-op-c/","title":"Haptoglobinefenotype wijzigt het effect van intensieve glycemische controle op CV-uitkomsten","title_en":"Haptoglobin Phenotype Modifies the Influence of Intensive Glycemic Control on Cardiovascular Outcomes.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["diabetes-type-2","select-trial"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2019.11.051","source_url":"https://doi.org/10.1016/j.jacc.2019.11.051","authors":["Allie S Carew","Andrew P Levy","Henry N Ginsberg","Steven Coca","Orit Lache","Thomas Ransom","Robert Byington","Eric B Rimm","John Sapp","Martin Gardner","Leah E Cahill"],"significance":5,"published":"2020-02-11","source_date":"2020-02-11","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"This study showed that haptoglobin phenotype modifies the cardiovascular benefit of intensive glycemic control in diabetes, identifying a pharmacogenomic factor that may explain the variable outcomes of glucose-lowering trials.","created":"2026-07-03T10:28:25Z","updated":"2026-07-03T13:27:36Z","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 aantoont dat het haptoglobinefenotype het cardiovasculaire effect van intensieve glycemische controle bij diabetes modificeert.","abstract_original":"BACKGROUND: Whereas there exists a direct relationship between glycated hemoglobin and cardiovascular disease (CVD), clinical trials targeting glycated hemoglobin to near-normal levels using intensive therapy have failed to prevent CVD and have even increased mortality, making clinical decision making difficult. A common polymorphism at the haptoglobin (Hp) genetic locus is associated with CVD, especially coronary heart disease, in the setting of hyperglycemia. OBJECTIVES: This study sought to determine whether the treatment difference of intensive versus standard glucose-lowering therapy on risk of CVD events in the ACCORD (Action to Control Cardiovascular Risk in Diabetes) study depended on Hp phenotype. METHODS: Hp phenotype was measured within 5,806 non-Hispanic white ACCORD participants using a validated assay. Adjusted hazard ratios (aHR) with 95% confidence intervals (CI) estimated from stratified Cox regression models were used to quantify the association between intensive therapy and incident CVD for the 2 different Hp phenotype groups (Hp2-2, Hp1 carriers). RESULTS: Compared with standard therapy, intensive therapy was associated with a lower risk of incident coronary heart disease among participants with the Hp2-2 phenotype (n = 2,133; aHR: 0.71; 95% CI: 0.55 to 0.91; p = 0.006), but not among the other 2 phenotypes (Hp1 allele carriers) (n = 3,673; aHR: 0.95; 95% CI: 0.79 to 1.13; p = 0.550). The same pattern was observed for CVD. Conversely, intensive therapy was associated with an increased risk of fatal CVD (aHR: 1.50; 95% CI: 1.00 to 2.25; p = 0.049) and total mortality (aHR: 1.40; 95% CI: 1.08 to 1.81; p = 0.011) among the Hp1 carriers, whereas this risk was not increased in the Hp2-2 phenotype (fatal CVD: aHR: 1.02; 95% CI: 0.59 to 1.77; p = 0.931; total mortality: aHR: 0.98; 95% CI: 0.68 to 1.41; p = 0.908). CONCLUSIONS: Intensive glucose-lowering therapy was effective at preventing incident coronary heart disease and CVD events in ACCORD study participants with the Hp2-2 phenotype but not in Hp1 carriers, who had increased mortality risk from intensive therapy."},{"id":"af7eaf1388f4","type":"article","url":"https://hartvaat.nl/2020/02/11/ct-coronairangiografie-bij-nste-acs-verdict-cta-substudie/","title":"CT-coronairangiografie bij NSTE-ACS: VERDICT-CTA substudie","title_en":"Coronary CT Angiography in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["coronaire-ct-angiografie"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2019.12.012","source_url":"https://doi.org/10.1016/j.jacc.2019.12.012","authors":["Jesper J Linde","Henning Kelbæk","Thomas F Hansen","Per E Sigvardsen","Christian Torp-Pedersen","Jan Bech","Merete Heitmann","Olav W Nielsen","Dan Høfsten","Jørgen T Kühl","Ilan E Raymond","Ole P Kristiansen","Ida H Svendsen","Maria H D Vall-Lamora","Charlotte Kragelund","Martina de Knegt","Jens D Hove","Tem Jørgensen","Gitte G Fornitz","Rolf Steffensen","Birgit Jurlander","Jawdat Abdulla","Stig Lyngbæk","Hanne Elming","Susette K Therkelsen","Erik Jørgensen","Lene Kløvgaard","Lia Evi Bang","Peter Riis Hansen","Steffen Helqvist","Søren Galatius","Frants Pedersen","Ulrik Abildgaard","Peter Clemmensen","Kari Saunamäki","Lene Holmvang","Thomas Engstrøm","Gunnar Gislason","Lars V Køber","Klaus F Kofoed"],"significance":6,"published":"2020-02-11","source_date":"2020-02-11","image":"","kennis":[],"congress":"","summary_en":"This VERDICT substudy evaluated coronary CT angiography in NSTE-ACS patients, assessing whether non-invasive anatomical imaging can guide the management approach in acute coronary syndromes.","created":"2026-07-03T10:28:25Z","updated":"2026-07-03T13:27:35Z","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":"VERDICT substudie naar de rol van CCTA bij patiënten met NSTE-ACS.","abstract_original":"BACKGROUND: In patients with non-ST-segment elevation acute coronary syndrome (NSTEACS), coronary pathology may range from structurally normal vessels to severe coronary artery disease. OBJECTIVES: The purpose of this study was to test if coronary computed tomography angiography (CTA) may be used to exclude coronary artery stenosis ≥50% in patients with NSTEACS. METHODS: The VERDICT (Very Early Versus Deferred Invasive Evaluation Using Computerized Tomography in Patients With Acute Coronary Syndromes) trial (NCT02061891) evaluated the outcome of patients with confirmed NSTEACS randomized 1:1 to very early (within 12 h) or standard (48 to 72 h) invasive coronary angiography (ICA). As an observational component of the trial, a clinically blinded coronary CTA was conducted prior to ICA in both groups. The primary endpoint was the ability of coronary CTA to rule out coronary artery stenosis (≥50% stenosis) in the entire population, expressed as the negative predictive value (NPV), using ICA as the reference standard. RESULTS: Coronary CTA was conducted in 1,023 patients-very early, 2.5 h (interquartile range [IQR]: 1.8 to 4.2 h), n = 583; and standard, 59.9 h (IQR: 38.9 to 86.7 h); n = 440 after the diagnosis of NSTEACS was made. A coronary stenosis ≥50% was found by coronary CTA in 68.9% and by ICA in 67.4% of the patients. Per-patient NPV of coronary CTA was 90.9% (95% confidence interval [CI]: 86.8% to 94.1%) and the positive predictive value, sensitivity, and specificity were 87.9% (95% CI: 85.3% to 90.1%), 96.5% (95% CI: 94.9% to 97.8%) and 72.4% (95% CI: 67.2% to 77.1%), respectively. NPV was not influenced by patient characteristics or clinical risk profile and was similar in the very early and the standard strategy group. CONCLUSIONS: Coronary CTA has a high diagnostic accuracy to rule out clinically significant coronary artery disease in patients with NSTEACS."},{"id":"5f3e4d5ea3a3","type":"article","url":"https://hartvaat.nl/2020/02/11/disfunctioneel-hdl-en-incidentie-van-acs-bij-hoog-cardiovasculair-risico/","title":"Disfunctioneel HDL en incidentie van ACS bij hoog cardiovasculair risico","title_en":"Dysfunctional High-Density Lipoproteins Are Associated With a Greater Incidence of Acute Coronary Syndrome in a Population at High Cardiovascular Risk: A Nested Case-Control Study.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["acuut-coronair-syndroom","acuut-hartfalen","hdl-cholesterol","obesitas"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.119.041658","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.119.041658","authors":["María Trinidad Soria-Florido","Olga Castañer","Camille Lassale","Ramon Estruch","Jordi Salas-Salvadó","Miguel Ángel Martínez-González","Dolores Corella","Emilio Ros","Fernando Arós","Roberto Elosua","José Lapetra","Miquel Fiol","Angel Alonso-Gómez","Enrique Gómez-Gracia","Lluís Serra-Majem","Xavier Pintó","Mònica Bulló","Miguel Ruiz-Canela","Jose V Sorlí","Álvaro Hernáez","Montserrat Fitó"],"significance":6,"published":"2020-02-11","source_date":"2020-02-11","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/ldl-doelwaarden-risicostratificatie/"],"congress":"","summary_en":"This study showed that dysfunctional HDL particles (impaired cholesterol efflux) are associated with higher ACS incidence, supporting the concept that HDL quality matters more than HDL quantity for cardiovascular protection.","created":"2026-07-03T10:28:25Z","updated":"2026-07-03T13:27:35Z","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 aantoont dat disfunctioneel HDL geassocieerd is met meer acute coronaire syndromen. HDL-functie boven HDL-spiegel.","abstract_original":"BACKGROUND: Studies have failed to establish a clear link between high-density lipoprotein (HDL) cholesterol and cardiovascular disease, leading to the hypothesis that the atheroprotective role of HDL lies in its biological activity rather than in its cholesterol content. However, to date, the association between HDL functional characteristics and acute coronary syndrome has not been investigated comprehensively. METHODS: We conducted a case-control study nested within the PREDIMED (Prevención con Dieta Mediterránea) cohort, originally a randomized trial in which participants followed a Mediterranean or low-fat diet. Incident acute coronary syndrome cases (N=167) were individually matched (1:2) to control patients by sex, age, intervention group, body mass index, and follow-up time. We investigated 2 individual manifestations (myocardial infarction, unstable angina) as secondary outcomes. We measured the following functional characteristics: HDL cholesterol concentration (in plasma); cholesterol efflux capacity; antioxidant ability, measured by the HDL oxidative-inflammatory index; phospholipase A2 activity; and sphingosine-1-phosphate, apolipoproteins A-I and A-IV, serum amyloid A, and complement 3 protein (in apolipoprotein B-depleted plasma). We used conditional logistic regression models adjusted for HDL cholesterol levels and cardiovascular risk factors to estimate odds ratios (ORs) between 1-SD increments in HDL functional characteristics and clinical outcomes. RESULTS: Low values of cholesterol efflux capacity (OR1SD, 0.58; 95% CI, 0.40-0.83) and low levels of sphingosine-1-phosphate (OR1SD, 0.70; 95% CI, 0.52-0.92) and apolipoprotein A-I (OR1SD, 0.58; 95% CI, 0.42-0.79) were associated with higher odds of acute coronary syndrome. Higher HDL oxidative inflammatory index values were marginally linked to acute coronary syndrome risk (OR1SD, 1.27; 95% CI, 0.99-1.63). Low values of cholesterol efflux capacity (OR1SD, 0.33; 95% CI, 0.18-0.61), sphingosine-1-phosphate (OR1SD: 0.60; 95% CI: 0.40-0.89), and apolipoprotein A-I (OR1SD, 0.59; 95% CI, 0.37-0.93) were particularly linked to myocardial infarction, whereas high HDL oxidative-inflammatory index values (OR1SD, 1.53; 95% CI, 1.01-2.33) and low apolipoprotein A-I levels (OR1SD, 0.52; 95% CI, 0.31-0.88) were associated with unstable angina. CONCLUSIONS: Low cholesterol efflux capacity values, pro-oxidant/proinflammatory HDL particles, and low HDL levels of sphingosine-1-phosphate and apolipoprotein A-I were associated with increased odds of acute coronary syndrome and its manifestations in individuals at high cardiovascular risk. CLINICAL TRIAL REGISTRATION: URL: https://www.controlled-trials.com/ISRCTN35739639. Unique identifier: ISRCTN35739639."},{"id":"390827bfbfcd","type":"article","url":"https://hartvaat.nl/2020/02/04/aanhoudende-ldl-verlaging-met-alirocumab-in-odyssey-outcomes/","title":"Aanhoudende LDL-verlaging met alirocumab in ODYSSEY OUTCOMES","title_en":"Sustained Low-Density Lipoprotein Cholesterol Lowering With Alirocumab in ODYSSEY OUTCOMES.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["ezetimibe","lipide-aferese","lipidenverlaging"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2019.11.030","source_url":"https://doi.org/10.1016/j.jacc.2019.11.030","authors":["Shaun G Goodman","Philippe Gabriel Steg","Michael Szarek","Deepak L Bhatt","Vera A Bittner","Rafael Diaz","Robert A Harrington","J Wouter Jukema","Harvey D White","Andreas M Zeiher","Gregory G Schwartz"],"significance":6,"published":"2020-02-04","source_date":"2020-02-04","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/pcsk9-remmers-evolocumab-alirocumab/"],"congress":"","summary_en":"This ODYSSEY OUTCOMES analysis demonstrated sustained LDL cholesterol lowering with alirocumab over the full trial duration, confirming durable PCSK9 inhibitor efficacy without treatment-emergent resistance.","created":"2026-07-03T10:28:25Z","updated":"2026-07-03T13:27:35Z","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":"ODYSSEY OUTCOMES analyse naar de duurzaamheid van LDL-verlaging met alirocumab over de langere termijn.","abstract_original":""},{"id":"bfcb31a3206a","type":"article","url":"https://hartvaat.nl/2020/02/04/reduce-it-usa-resultaten-bij-3-146-amerikaanse-deelnemers/","title":"REDUCE-IT USA: resultaten bij 3.146 Amerikaanse deelnemers","title_en":"REDUCE-IT USA: Results From the 3146 Patients Randomized in the United States.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.119.044440","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.119.044440","authors":["Deepak L Bhatt","Michael Miller","Eliot A Brinton","Terry A Jacobson","Ph Gabriel Steg","Steven B Ketchum","Ralph T Doyle","Rebecca A Juliano","Lixia Jiao","Craig Granowitz","Jean-Claude Tardif","Brian Olshansky","Mina K Chung","C Michael Gibson","Robert P Giugliano","Matthew J Budoff","Christie M Ballantyne"],"significance":6,"published":"2020-02-04","source_date":"2020-02-04","image":"","kennis":[],"congress":"","summary_en":"This REDUCE-IT US subanalysis confirmed that icosapent ethyl reduces cardiovascular events in the American patient population, validating the global trial findings in a US-specific context.","created":"2026-07-03T10:28:25Z","updated":"2026-07-03T13:27:35Z","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":"REDUCE-IT subanalyse bij de 3.146 Amerikaanse deelnemers. Regionale validatie van de REDUCE-IT resultaten.","abstract_original":"BACKGROUND: Some trials have found that patients from the United States derive less benefit than patients enrolled outside the United States. This prespecified REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl - Intervention Trial) subgroup analysis was conducted to determine the degree of benefit of icosapent ethyl in the United States. METHODS: REDUCE-IT randomized 8179 statin-treated patients with qualifying triglycerides ≥135 and <500 mg/dL and low-density lipoprotein cholesterol >40 and ≤100 mg/dL and a history of atherosclerosis or diabetes mellitus to icosapent ethyl 4 g/d or placebo. The primary composite end point was cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, or hospitalization for unstable angina. The key secondary composite end point was cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. A hierarchy was prespecified for examination of individual and composite end points. RESULTS: A total of 3146 US patients (38.5% of the trial) were randomized and followed for a median of 4.9 years; 32.3% were women and 9.7% were Hispanic. The primary composite end point occurred in 24.7% of placebo-treated patients versus 18.2% of icosapent ethyl-treated patients (hazard ratio [HR], 0.69 [95% CI, 0.59-0.80]; P=0.000001); the key secondary composite end point occurred in 16.6% versus 12.1% (HR, 0.69 [95% CI, 0.57-0.83]; P=0.00008). All prespecified hierarchical end points were meaningfully and significantly reduced, including cardiovascular death (6.7% to 4.7%; HR, 0.66 [95% CI, 0.49-0.90]; P=0.007), myocardial infarction (8.8% to 6.7%; HR, 0.72 [95% CI, 0.56-0.93]; P=0.01), stroke (4.1% to 2.6%; HR, 0.63 [95% CI, 0.43-0.93]; P=0.02), and all-cause mortality (9.8% to 7.2%; HR, 0.70 [95% CI, 0.55-0.90]; P=0.004); for all-cause mortality in the US versus non-US patients, Pinteraction=0.02. Safety and tolerability findings were consistent with the full study cohort. CONCLUSIONS: Whereas the non-US subgroup showed significant reductions in the primary and key secondary end points, the US subgroup demonstrated particularly robust risk reductions across a variety of individual and composite end points, including all-cause mortality. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01492361."},{"id":"706dfdb5fb65","type":"article","url":"https://hartvaat.nl/2020/02/04/canagliflozine-bij-diabetes-type-2-met-ckd-evaluatie-van-cv-en-renale-events/","title":"Canagliflozine bij diabetes type 2 met CKD: evaluatie van CV- en renale events","title_en":"Evaluating the Effects of Canagliflozin on Cardiovascular and Renal Events in Patients With Type 2 Diabetes Mellitus and Chronic Kidney Disease According to Baseline HbA1c, Including Those With HbA1c <7%: Results From the CREDENCE Trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["anemie-ckd","chronische-nierziekte","credence-trial","dapagliflozine","diabetes-type-2","diabetische-nefropathie","fidelio-dkd","figaro-dkd","flow-trial"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.119.044359","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.119.044359","authors":["Christopher P Cannon","Vlado Perkovic","Rajiv Agarwal","James Baldassarre","George Bakris","David M Charytan","Dick de Zeeuw","Robert Edwards","Tom Greene","Hiddo J L Heerspink","Meg J Jardine","Adeera Levin","Jing-Wei Li","Bruce Neal","Carol Pollock","David C Wheeler","Hong Zhang","Bernard Zinman","Kenneth W Mahaffey"],"significance":7,"published":"2020-02-04","source_date":"2020-02-04","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"This analysis evaluated canagliflozin's cardiovascular and renal effects in diabetic patients with CKD across both primary and secondary prevention settings, demonstrating consistent cardiorenal benefit across the risk spectrum.","created":"2026-07-03T10:28:25Z","updated":"2026-07-03T13:27:35Z","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 canagliflozine op cardiovasculaire en renale events bij diabetespatiënten met CKD in primaire en secundaire preventie.","abstract_original":""},{"id":"7e62708f59f5","type":"article","url":"https://hartvaat.nl/2020/02/01/elektrische-versus-farmacologische-cardioversie-bij-acuut-af-op-de-seh-lancet-ra/","title":"Elektrische versus farmacologische cardioversie bij acuut AF op de SEH: Lancet RAFF2","title_en":"Electrical versus pharmacological cardioversion for emergency department patients with acute atrial fibrillation (RAFF2): a partial factorial randomised trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(19)32994-0","source_url":"https://doi.org/10.1016/S0140-6736(19)32994-0","authors":["Ian G Stiell","Marco L A Sivilotti","Monica Taljaard","David Birnie","Alain Vadeboncoeur","Corinne M Hohl","Andrew D McRae","Brian H Rowe","Robert J Brison","Venkatesh Thiruganasambandamoorthy","Laurent Macle","Bjug Borgundvaag","Judy Morris","Eric Mercier","Catherine M Clement","Jennifer Brinkhurst","Connor Sheehan","Erica Brown","Marie-Joe Nemnom","George A Wells","Jeffrey J Perry"],"significance":7,"published":"2020-02-01","source_date":"2020-02-01","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"The RAFF2 trial compared electrical with pharmacological cardioversion for acute AF in the emergency department, finding that electrical cardioversion is more effective for achieving sinus rhythm but both strategies are safe initial approaches.","created":"2026-07-03T10:28:24Z","updated":"2026-07-03T13:27:35Z","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":"Lancet RAFF2 gerandomiseerde trial die elektrische versus farmacologische cardioversie vergeleek bij SEH-patiënten met acuut AF.","abstract_original":"BACKGROUND: Acute atrial fibrillation is the most common arrythmia treated in the emergency department. Our primary aim was to compare conversion to sinus rhythm between pharmacological cardioversion followed by electrical cardioversion (drug-shock), and electrical cardioversion alone (shock-only). Our secondary aim was to compare the effectiveness of two pad positions for electrical cardioversion. METHODS: We did a partial factorial trial of two protocols for patients with acute atrial fibrillation at 11 academic hospital emergency departments in Canada. We enrolled adult patients with acute atrial fibrillation. Protocol 1 was a randomised, blinded, placebo-controlled comparison of attempted pharmacological cardioversion with intravenous procainamide (15 mg/kg over 30 min) followed by electrical cardioversion if necessary (up to three shocks, each of ≥200 J), and placebo infusion followed by electrical cardioversion. For patients having electrical cardioversion, we used Protocol 2, a randomised, open-label, nested comparison of anteroposterior versus anterolateral pad positions. Patients were randomly assigned (1:1, stratified by study site) for Protocol 1 by on-site research personnel using an online electronic data capture system. Randomisation for Protocol 2 occurred 30 min after drug infusion for patients who had not converted and was stratified by site and Protocol 1 allocation. Patients and all research and emergency department staff were masked to treatment allocation for Protocol 1. The primary outcome was conversion to normal sinus rhythm for at least 30 min at any time after randomisation and up to a point immediately after three shocks. Protocol 1 was analysed by intention to treat and Protocol 2 excluded patients who did not receive electrical cardioversion. This study is registered at ClinicalTrials.gov, number NCT01891058. FINDINGS: Between July 18, 2013, and Oct 17, 2018, we enrolled 396 patients, and none were lost to follow-up. In the drug-shock group (n=204), conversion to sinus rhythm occurred in 196 (96%) patients and in the shock-only group (n=192), conversion occurred in 176 (92%) patients (absolute difference 4%; 95% CI 0-9; p=0·07). The proportion of patients discharged home was 97% (n=198) versus 95% (n=183; p=0·60). 106 (52%) patients in the drug-shock group converted after drug infusion only. No patients had serious adverse events in follow-up. The different pad positions in Protocol 2 (n=244), had similar conversions to sinus rhythm (119 [94%] of 127 in anterolateral group vs 108 [92%] of 117 in anteroposterior group; p=0·68). INTERPRETATION: Both the drug-shock and shock-only strategies were highly effective, rapid, and safe in restoring sinus rhythm for patients in the emergency department with acute atrial fibrillation, avoiding the need for return to hospital. The drug infusion worked for about half of patients and avoided the resource intensive procedural sedation required for electrical cardioversion. We also found no significant difference between the anterolateral and anteroposterior pad positions for electrical cardioversion. Immediate rhythm control for patients in the emergency department with acute atrial fibrillation leads to excellent outcomes. FUNDING: Heart and Stroke Foundation of Canada and the Canadian Institutes of Health Research."},{"id":"ebcf130f3b1d","type":"article","url":"https://hartvaat.nl/2020/02/01/femorale-versus-radiale-toegang-bij-stemi-jama-cardiology-safari-stemi/","title":"Femorale versus radiale toegang bij STEMI: JAMA Cardiology SAFARI-STEMI","title_en":"Safety and Efficacy of Femoral Access vs Radial Access in ST-Segment Elevation Myocardial Infarction: The SAFARI-STEMI Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2019.4852","source_url":"https://doi.org/10.1001/jamacardio.2019.4852","authors":["Michel Le May","George Wells","Derek So","Aun Yeong Chong","Alexander Dick","Michael Froeschl","Christopher Glover","Benjamin Hibbert","Jean-Francois Marquis","Melissa Blondeau","Christina Osborne","Andrea MacDougall","Malek Kass","Vernon Paddock","Ata Quraishi","Marino Labinaz"],"significance":7,"published":"2020-02-01","source_date":"2020-02-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/coronaire-angiografie-hartkatheterisatie/"],"congress":"","summary_en":"The SAFARI-STEMI trial found no significant difference in mortality between femoral and radial access for primary PCI in STEMI, suggesting that in experienced centers, both approaches are acceptable when radial access is not anatomically feasible.","created":"2026-07-03T10:28:24Z","updated":"2026-07-03T13:27:35Z","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":"SAFARI-STEMI gerandomiseerde trial die femorale versus radiale toegang vergeleek bij STEMI.","abstract_original":"IMPORTANCE: Among patients with ST-segment elevation myocardial infarction (STEMI) referred for primary percutaneous coronary intervention (PCI), a survival benefit associated with radial access compared with femoral access remains controversial. OBJECTIVE: To assess whether there is a survival benefit when radial access is used instead of femoral access among patients with STEMI referred for primary PCI. DESIGN, SETTING, AND PARTICIPANTS: This multicenter, open-label, randomized clinical trial was conducted at 5 PCI centers in Canada. In total, 2292 patients with STEMI referred for primary PCI were enrolled between July 2011 and December 2018, with a 30-day follow-up. The primary analyses were conducted based on the intention-to-treat population. INTERVENTIONS: Patients were randomized to radial access (n = 1136) or to femoral access (n = 1156) for PCI. MAIN OUTCOMES AND MEASURES: Initially, the primary outcome was bleeding, but this outcome was modified to 30-day all-cause mortality following the recommendation of the granting agency. Secondary outcomes included recurrent myocardial infarction, stroke, and Thrombolysis in Myocardial Infarction-defined major or minor bleeding. RESULTS: Among the 2292 patients enrolled, the mean (SD) age of the patients randomized to radial access was 61.6 (12.3) years and to femoral access was 62.0 (12.1) years, with 883 male patients in the radial access and 901 male patients in the femoral access group. The trial was stopped early following a futility analysis. Primary PCI was performed in 1082 of 1136 patients (95.2%) in the radial access group and 1109 of 1156 patients (95.9%) in the femoral access group. Bivalirudin was administered to 1001 patients (88.1%) in the radial access group and to 1068 patients (92.4%) in the femoral access group, whereas glycoprotein IIb/IIIa inhibitors were administered in only 69 patients (6.1%) in the radial access group and 68 patients (5.9%) in the femoral access group. A vascular closure device was used in 789 patients (68.3%) in the femoral group. The primary outcome, 30-day all-cause mortality, occurred in 17 patients (1.5%) assigned to radial access and in 15 patients (1.3%) assigned to femoral access (relative risk [RR], 1.15; 95% CI, 0.58-2.30; P = .69). There were no significant differences between patients assigned to radial and femoral access in the rates of reinfarction (1.8% vs 1.6%; RR, 1.07; 95% CI, 0.57-2.00; P = .83), stroke (1.0% vs 0.4%; RR, 2.24; 95% CI, 0.78-6.42; P = .12), and bleeding (1.4% vs 2.0%; RR, 0.71; 95% CI, 0.38-1.33; P = .28). CONCLUSIONS AND RELEVANCE: No significant differences were found for survival or other clinical end points at 30 days after the use of radial access vs femoral access in patients with STEMI referred for primary PCI. However, small absolute differences in end points cannot be definitively refuted given the premature termination of the trial. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01398254."},{"id":"ffb354ade8bf","type":"article","url":"https://hartvaat.nl/2020/02/01/arni-initiatie-na-acuut-gedecompenseerd-hf-pioneer-hf-open-label-extensie/","title":"ARNI-initiatie na acuut gedecompenseerd HF: PIONEER-HF open-label extensie","title_en":"Initiation of Angiotensin-Neprilysin Inhibition After Acute Decompensated Heart Failure: Secondary Analysis of the Open-label Extension of the PIONEER-HF Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2019.4665","source_url":"https://doi.org/10.1001/jamacardio.2019.4665","authors":["Adam D DeVore","Eugene Braunwald","David A Morrow","Carol I Duffy","Andrew P Ambrosy","Hrishikesh Chakraborty","Kevin McCague","Ricardo Rocha","Eric J Velazquez"],"significance":7,"published":"2020-02-01","source_date":"2020-02-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/arni-sacubitril-valsartan/","https://hartvaat.nl/kennis/farmacologie/arni-farmacologie/"],"congress":"","summary_en":"This PIONEER-HF open-label extension confirmed the long-term safety of sacubitril-valsartan initiated during acute decompensated heart failure hospitalization, with sustained neurohormonal and clinical benefits after transition to outpatient care.","created":"2026-07-03T10:28:24Z","updated":"2026-07-03T13:27:35Z","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":"JAMA Cardiology open-label extensie van PIONEER-HF naar de langetermijnveiligheid van sacubitril/valsartan gestart tijdens HF-hospitalisatie.","abstract_original":"IMPORTANCE: In PIONEER-HF, among stabilized patients with acute decompensated heart failure (ADHF), the in-hospital initiation of sacubitril/valsartan was well tolerated and led to improved outcomes compared with enalapril. However, there are limited data comparing the strategies of in-hospital vs postdischarge initiation of sacubitril/valsartan. OBJECTIVE: To describe changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in patients recently hospitalized for ADHF and switching from taking enalapril to taking sacubitril/valsartan after discharge and compare clinical outcomes for patients randomized to receive in-hospital initiation of sacubitril/valsartan vs in-hospital initiation of enalapril who later switched to taking sacubitril/valsartan during an open-label extension phase. INTERVENTIONS: Sacubitril/valsartan titrated to 97/103 mg twice daily. DESIGN, SETTING, AND PARTICIPANTS: The PIONEER-HF trial was a multicenter, randomized, double-blind, active-controlled trial conducted at 129 US sites between May 2016 and May 2018 that compared the in-hospital initiation of sacubitril/valsartan vs enalapril (titrated to target dose, 10 mg twice daily) for 8 weeks among patients admitted for ADHF with reduced ejection fraction and hemodynamic stability. All patients were to continue in a 4-week, open-label study of sacubitril/valsartan; of 881 patients enrolled in PIONEER-HF, 832 (94%) continued in the open-label study. MAIN OUTCOMES AND MEASURES: Changes in NT-proBNP levels from week 8 to 12 as well as the exploratory composite of heart failure rehospitalization or cardiovascular death from randomization through week 12. RESULTS: Of 881 participants, 226 (27.7%) were women, 487 (58.5%) were white, 297 (35.7%) were black, 15 (1.8%) were Asian, and 73 (8.8%) were of Hispanic ethnicity; the mean (SD) age was 61 (14) years. For patients who continued to take sacubitril/valsartan, NT-proBNP levels declined -17.2% (95% CI, -3.2 to -29.1) from week 8 to 12. The NT-proBNP levels declined to a greater extent for those switching from taking enalapril to sacubitril/valsartan after the week 8 visit (-37.4%; 95% CI, -28.1 to -45.6; P < .001; comparing changes in 2 groups). Over the entire 12 weeks of follow-up, patients that began taking sacubitril/valsartan in the hospital had a lower hazard for the composite outcome compared with patients that initiated enalapril in the hospital and then had a delayed initiation of sacubitril/valsartan 8 weeks later (hazard ratio, 0.69; 95% CI 0.49-0.97). CONCLUSIONS AND RELEVANCE: Switching patients' treatment from enalapril to sacubitril/valsartan at 8 weeks after randomization led to a further 37% reduction in NT-proBNP levels in patients with heart failure with reduced ejection fraction and a recent hospitalization for ADHF. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02554890."},{"id":"b395fc83ea79","type":"article","url":"https://hartvaat.nl/2020/02/01/crt-bij-verlengd-av-interval-real-crt-gerandomiseerde-trial/","title":"CRT bij verlengd AV-interval: REAL-CRT gerandomiseerde trial","title_en":"A randomized controlled trial of cardiac resynchronization therapy in patients with prolonged atrioventricular interval: the REAL-CRT pilot study.","category":"hartfalen","category_label":"Hartfalen","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/euz321","source_url":"https://doi.org/10.1093/europace/euz321","authors":["Giovanni Luca Botto","Assunta Iuliano","Eraldo Occhetta","Giuseppina Belotti","Giovanni Russo","Monica Campari","Sergio Valsecchi","Giuseppe Stabile"],"significance":5,"published":"2020-02-01","source_date":"2020-02-01","image":"","kennis":[],"congress":"","summary_en":"The REAL-CRT trial tested CRT in patients with prolonged PR interval and narrow QRS, evaluating whether AV dyssynchrony alone (without ventricular dyssynchrony) is sufficient indication for resynchronization.","created":"2026-07-03T10:28:24Z","updated":"2026-07-03T13:27:35Z","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":"REAL-CRT gerandomiseerde trial naar CRT bij patiënten met verlengd AV-interval en smal QRS.","abstract_original":"AIMS: A prolonged PR interval is known to be associated with increased mortality and a higher risk of developing atrial fibrillation (AF). We tested the hypothesis that cardiac resynchronization therapy (CRT) is superior to conventional dual-chamber pacing with algorithms for right ventricular pacing avoidance (DDD-VPA) in preserving systolic and diastolic function and in preventing new-onset AF in patients with normal systolic function, indication for pacing and prolonged atrioventricular conduction (PR interval ≥220 ms). METHODS AND RESULTS: We randomly assigned 82 patients with ejection fraction >35%, indication for pacing and PR interval ≥220 ms to CRT or to DDD-VPA. On 12-month follow-up examination, the study and control arms did not differ in terms of left ventricular end-systolic volume (44 ± 17 mL vs. 47 ± 16 mL, P = 0.511) or ejection fraction (55 ± 6% vs. 57 ± 8%, P = 0.291). The E to A mitral wave amplitude ratio was higher in the CRT arm (1.3 ± 1.3 vs. 0.8 ± 0.4, P = 0.046) and the E wave deceleration time was longer (262 ± 83 ms vs. 205 ± 51 ms, P = 0.027). Left atrial volume was smaller in the CRT arm (64 ± 17 mL vs. 84 ± 25 mL, P = 0.035). Moreover, the functional class was lower in CRT patients (1.4 ± 0.6 vs. 1.8 ± 0.5, P = 0.010). During follow-up, CRT was associated with a lower risk of new-onset AF [hazard ratio = 0.37 (0.13-0.98), P = 0.046]. CONCLUSION: Cardiac resynchronization therapy proved superior to DDD-VPA in terms of better diastolic function, less left atrial enlargement and lower risk of new-onset AF, at 12 months. These data need to be confirmed in a larger trial with longer follow-up. CLINICAL TRIAL REGISTRATION: URL: http://clinicaltrials.gov/ Identifier: NCT02150538."},{"id":"78924435e3c4","type":"article","url":"https://hartvaat.nl/2020/02/01/verpleegkundig-geleide-versus-standaard-af-zorg/","title":"Verpleegkundig geleide versus standaard AF-zorg","title_en":"Nurse-led vs. usual-care for atrial fibrillation.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehz666","source_url":"https://doi.org/10.1093/eurheartj/ehz666","authors":["E P J Petra Wijtvliet","Robert G Tieleman","Isabelle C van Gelder","Nikki A H A Pluymaekers","Michiel Rienstra","Richard J Folkeringa","Patrick Bronzwaer","Arif Elvan","Jan Elders","Raymond Tukkie","Justin G L M Luermans","A D I Thea Van Asselt","Sander M J Van Kuijk","Jan G Tijssen","Harry J G M Crijns"],"significance":6,"published":"2020-02-01","source_date":"2020-02-01","image":"","kennis":[],"congress":"","summary_en":"This study compared nurse-led integrated AF care with physician-led usual care, showing that specialized nursing management achieves comparable or better outcomes at potentially lower cost.","created":"2026-07-03T10:28:24Z","updated":"2026-07-03T13:27:34Z","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":"Vergelijking van verpleegkundig geleide versus standaard AF-zorg. Ondersteunt de rol van gespecialiseerde verpleegkundigen.","abstract_original":"BACKGROUND: Nurse-led integrated care is expected to improve outcome of patients with atrial fibrillation compared with usual-care provided by a medical specialist. METHODS AND RESULTS: We randomized 1375 patients with atrial fibrillation (64 ± 10 years, 44% women, 57% had CHA2DS2-VASc ≥ 2) to receive nurse-led care or usual-care. Nurse-led care was provided by specialized nurses using a decision-support tool, in consultation with the cardiologist. The primary endpoint was a composite of cardiovascular death and cardiovascular hospital admissions. Of 671 nurse-led care patients, 543 (81%) received anticoagulation in full accordance with the guidelines against 559 of 683 (82%) usual-care patients. The cumulative adherence to guidelines-based recommendations was 61% under nurse-led care and 26% under usual-care. Over 37 months of follow-up, the primary endpoint occurred in 164 of 671 patients (9.7% per year) under nurse-led care and in 192 of 683 patients (11.6% per year) under usual-care [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.69 to 1.04, P = 0.12]. There were 124 vs. 161 hospitalizations for arrhythmia events (7.0% and 9.4% per year), and 14 vs. 22 for heart failure (0.7% and 1.1% per year), respectively. Results were not consistent in a pre-specified subgroup analysis by centre experience, with a HR of 0.52 (95% CI 0.37-to 0.71) in four experienced centres and of 1.24 (95% CI 0.94-1.63) in four less experienced centres (P for interaction <0.001). CONCLUSION: Our trial failed to show that nurse-led care was superior to usual-care. The data suggest that nurse-led care by an experienced team could be clinically beneficial (ClinicalTrials.gov NCT01740037). TRIAL REGISTRATION NUMBER: ClinicalTrials.gov (NCT01740037)."},{"id":"b9b3c9e7ad2d","type":"article","url":"https://hartvaat.nl/2020/02/01/maximum-vaste-energie-schokken-voor-af-cardioversie/","title":"Maximum-vaste-energie schokken voor AF-cardioversie","title_en":"Maximum-fixed energy shocks for cardioverting atrial fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehz585","source_url":"https://doi.org/10.1093/eurheartj/ehz585","authors":["Anders S Schmidt","Kasper G Lauridsen","Peter Torp","Leif F Bach","Hans Rickers","Bo Løfgren"],"significance":5,"published":"2020-02-01","source_date":"2020-02-01","image":"","kennis":[],"congress":"","summary_en":"This study showed that maximum-fixed energy shocks for AF cardioversion are safe and more efficient than low-escalating energy protocols, supporting a simplified first-shock-at-maximum approach.","created":"2026-07-03T10:28:24Z","updated":"2026-07-03T13:27:34Z","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 het gebruik van maximale vaste energieschokken voor cardioversie van AF. Efficiëntie versus stapsgewijze energieverhoging.","abstract_original":"AIMS: Direct-current cardioversion is one of the most commonly performed procedures in cardiology. Low-escalating energy shocks are common practice but the optimal energy selection is unknown. We compared maximum-fixed and low-escalating energy shocks for cardioverting atrial fibrillation. METHODS AND RESULTS: In a single-centre, single-blinded, randomized trial, we allocated elective atrial fibrillation patients to cardioversion using maximum-fixed (360-360-360 J) or low-escalating (125-150-200 J) biphasic truncated exponential shocks. The primary endpoint was sinus rhythm 1 min after cardioversion. Safety endpoints were any arrhythmia, myocardial injury, skin burns, and patient-reported pain after cardioversion. We randomized 276 patients, and baseline characteristics were well-balanced between groups (mean ± standard deviation age: 68 ± 9 years, male: 72%, atrial fibrillation duration >1 year: 30%). Sinus rhythm 1 min after cardioversion was achieved in 114 of 129 patients (88%) in the maximum-fixed energy group, and in 97 of 147 patients (66%) in the low-escalating energy group (between-group difference; 22 percentage points, 95% confidence interval 13-32, P < 0.001). Sinus rhythm after first shock occurred in 97 of 129 patients (75%) in the maximum-fixed energy group compared to 50 of 147 patients (34%) in the low-escalating energy group (between-group difference; 41 percentage points, 95% confidence interval 30-51). There was no significant difference between groups in any safety endpoint. CONCLUSION: Maximum-fixed energy shocks were more effective compared with low-escalating energy shocks for cardioverting atrial fibrillation. We found no difference in any safety endpoint."},{"id":"41de2471c425","type":"article","url":"https://hartvaat.nl/2020/02/01/disease-management-bij-hfpef-systematische-review/","title":"Disease management bij HFpEF: systematische review","title_en":"Heart failure disease management: a systematic review of effectiveness in heart failure with preserved ejection fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["step-hfpef"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12559","source_url":"https://doi.org/10.1002/ehf2.12559","authors":["Fotini Kalogirou","Faye Forsyth","Martha Kyriakou","Rhys Mantle","Christi Deaton"],"significance":6,"published":"2020-02-01","source_date":"2020-02-01","image":"","kennis":[],"congress":"","summary_en":"This systematic review evaluated the effectiveness of heart failure disease management programs specifically in HFpEF, finding limited evidence compared with the robust HFrEF data and identifying the need for phenotype-specific management approaches.","created":"2026-07-03T10:28:24Z","updated":"2026-07-03T13:27:34Z","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":"Systematische review naar de effectiviteit van hartfalen-disease-managementprogramma's specifiek bij HFpEF.","abstract_original":"AIMS: Heart failure with preserved ejection fraction (HFpEF) poses a substantial challenge for clinicians, but there is little guidance for effective management. The aim of this systematic review was to determine if there was evidence that disease management programmes (DMPs) improved outcomes for patients with HFpEF. METHODS AND RESULTS: A systematic review of controlled studies in English or Greek of DMPs including patients with HFpEF from 2008 to 2018 was conducted using CINAHL, Cochrane, MEDLINE, and Embase. Interventions were assessed using a DMP taxonomy and scored for complexity and intensity. Bias was assessed using the Cochrane Collaboration tool. Initial and updated searches found 6089 titles once duplicates were removed. The final analysis included 18 studies with 5435 HF patients: 1866 patients (34%, study ranges 18-100%) had potential HFpEF (limited by variable definitions). Significant heterogeneity in terms of the population, intervention, comparisons, and outcomes prohibited meta-analysis. Statistically significant or positive trends were found in mortality, hospitalization rates, self-care ability, quality of life, anxiety, depression, and sleep, but findings were not robust or consistent. Four studies reported results separately for study-defined HFpEF, with two finding less positive effect on outcomes. CONCLUSIONS: Varying definitions of HFpEF used in studies are a substantial limitation in interpretation of findings. The reduced efficacy noted in contemporary HF DMP studies may not only be due to improvements in usual care but may also reflect inclusion of heterogeneous patients with HFpEF or HF with mid-range EF who may not respond in the same way as HFrEF to individual components. Given that patients with HFpEF are older and multi-morbid, DMPs targeting HFpEF should not rely on a single-disease focus but provide care that addresses predisposing and presentation phenotypes and draws on the principles of comprehensive geriatric assessment. Other components could also be more targeted to HFpEF such as modification of lifestyle factors for which there is emerging evidence, rather than simply continuing the model of care used in HFrEF. Based on current evidence, HF DMPs may improve mortality, hospitalization rates, self-care, and quality of life in patients with HFpEF; however, further research specifically tailored to appropriately defined HFpEF is required."},{"id":"5ab3343ba906","type":"article","url":"https://hartvaat.nl/2020/02/01/baroreflexactivatietherapie-bij-hfref-snelle-systematische-review/","title":"Baroreflexactivatietherapie bij HFrEF: snelle systematische review","title_en":"Safety and efficacy of baroreflex activation therapy for heart failure with reduced ejection fraction: a rapid systematic review.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["bloeddrukbehandeling"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12543","source_url":"https://doi.org/10.1002/ehf2.12543","authors":["Rodrigo Schmidt","Clarissa Garcia Rodrigues","Kelen Heinrich Schmidt","Maria Claudia Costa Irigoyen"],"significance":5,"published":"2020-02-01","source_date":"2020-02-01","image":"","kennis":[],"congress":"","summary_en":"This rapid systematic review summarized the available safety and efficacy data for baroreflex activation therapy in HFrEF, evaluating this neuromodulation device for advanced heart failure management.","created":"2026-07-03T10:28:24Z","updated":"2026-07-03T18:38:46Z","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":"Snelle systematische review naar veiligheid en werkzaamheid van baroreflexactivatietherapie bij HFrEF.","abstract_original":"To retrieve and assess the available data in the literature about the safety and efficacy of baroreflex activation therapy (BAT) in heart failure with reduced ejection fraction (HFrEF) patients, through a rapid systematic review of clinical studies. Rapid systematic review of literature. Searched electronic databases included PubMed, EMBASE, CENTRAL, Scopus, and Web of Science using Mesh and free terms for heart failure and BAT. No language restriction was used for the searches. We included full peer reviewed publications of clinical studies (randomized or not), including patients with HFrEF undergoing BAT, with or without control group, assessing safety and efficacy outcomes. One reviewer conducted the analysis of the selected abstracts and the full-text articles, performed data extraction, and evaluated the methodological quality of the selected articles. The methodological quality was assessed according to the Cochrane Collaboration instruments. A descriptive summary of the results is provided. Of the 441 citations screened, 10 publications were included (three were only conference abstracts), reporting data from three studies. Only one study was a randomized clinical trial. Two studies reported a 6 month following, and the other study analysed outcomes up to 41 months. The procedure seems to be safe when performed by a well-trained multi-professional team. An 86% rate of system and procedure-related complication-free was reported, with no cranial nerve injuries. Improvements in New York Heart Association class of heart failure, quality of life, 6 min walk test, and hospitalization rates, as well as in muscle sympathetic nerve activity. No meta-analysis was conducted because of the lack of homogeneity across studies; the results from each study are reported individually. BAT procedure seems to be safe if appropriate training is provided. Improvements in clinical outcomes were described in all included studies. However, several limitations do not allow us to make conclusive statements on the efficacy of BAT for HFrEF. New well-designed trials are still needed."},{"id":"c37a713db057","type":"article","url":"https://hartvaat.nl/2020/02/01/il-1-remming-en-bloeddruk-hypertensie-en-residueel-inflammatoir-risico-cantos/","title":"IL-1β-remming en bloeddruk, hypertensie en residueel inflammatoir risico: CANTOS","title_en":"Effects of Interleukin-1β Inhibition on Blood Pressure, Incident Hypertension, and Residual Inflammatory Risk: A Secondary Analysis of CANTOS.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["bloeddrukbehandeling"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.119.13642","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.119.13642","authors":["Alexander Mk Rothman","Jean MacFadyen","Tom Thuren","Alastair Webb","David G Harrison","Tomasz J Guzik","Peter Libby","Robert J Glynn","Paul M Ridker"],"significance":7,"published":"2020-02-01","source_date":"2020-02-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This CANTOS secondary analysis showed that canakinumab (IL-1β inhibitor) modestly reduces blood pressure and the incidence of new-onset hypertension, demonstrating a mechanistic link between inflammation and blood pressure regulation.","created":"2026-07-03T10:28:23Z","updated":"2026-07-03T18:38:46Z","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":"CANTOS secundaire analyse naar het effect van canakinumab op bloeddruk, incident hypertensie en residueel inflammatoir risico.","abstract_original":"While hypertension and inflammation are physiologically inter-related, the effect of therapies that specifically target inflammation on blood pressure is uncertain. The recent CANTOS (Canakinumab Anti-inflammatory Thrombosis Outcomes Study) afforded the opportunity to test whether IL (interleukin)-1β inhibition would reduce blood pressure, prevent incident hypertension, and modify relationships between hypertension and cardiovascular events. CANTOS randomized 10 061 patients with prior myocardial infarction and hsCRP (high sensitivity C-reactive protein) ≥2 mg/L to canakinumab 50 mg, 150 mg, 300 mg, or placebo. A total of 9549 trial participants had blood pressure recordings during follow-up; of these, 80% had a preexisting diagnosis of hypertension. In patients without baseline hypertension, rates of incident hypertension were 23.4, 26.6, and 28.1 per 100-person years for the lowest to highest baseline tertiles of hsCRP (P>0.2). In all participants random allocation to canakinumab did not reduce blood pressure (P>0.2) or incident hypertension during the follow-up period (hazard ratio, 0.96 [0.85-1.08], P>0.2). IL-1β inhibition with canakinumab reduces major adverse cardiovascular event rates. These analyses suggest that the mechanisms underlying this benefit are not related to changes in blood pressure or incident hypertension. Clinical Trial Registration- URL: https://clinicaltrials.gov. Unique identifier: NCT01327846."},{"id":"693c86282ab8","type":"article","url":"https://hartvaat.nl/2020/02/01/bloeddrukcontrole-en-diabetes-incidentie-sprint-resultaten/","title":"Bloeddrukcontrole en diabetes-incidentie: SPRINT-resultaten","title_en":"Blood Pressure Control and the Association With Diabetes Mellitus Incidence: Results From SPRINT Randomized Trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.118.12572","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.118.12572","authors":["Christianne L Roumie","Adriana M Hung","Gregory B Russell","Jan Basile","Kathryn Evans Kreider","John Nord","Thomas M Ramsey","Anjay Rastogi","Mary Ellen Sweeney","Leonardo Tamariz","William J Kostis","Jonathan S Williams","Athena Zias","William C Cushman"],"significance":6,"published":"2020-02-01","source_date":"2020-02-01","image":"","kennis":[],"congress":"","summary_en":"This SPRINT analysis showed that intensive blood pressure control is associated with reduced incidence of new-onset diabetes mellitus, suggesting a metabolic co-benefit of aggressive blood pressure management.","created":"2026-07-03T10:28:23Z","updated":"2026-07-03T13:27:34Z","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":"SPRINT analyse naar het verband tussen bloeddrukcontrole en de incidentie van diabetes mellitus.","abstract_original":"The SPRINT (Systolic Blood Pressure Intervention Trial) demonstrated reduced cardiovascular outcomes. We evaluated diabetes mellitus incidence in this randomized trial that compared intensive blood pressure strategy (systolic blood pressure <120 mm Hg) versus standard strategy (<140 mm Hg). Participants were ≥50 years of age, with systolic 130 to 180 mm Hg and increased cardiovascular risk. Participants were excluded if they had diabetes mellitus, polycystic kidney disease, proteinuria >1 g/d, heart failure, dementia, or stroke. Postrandomization exclusions included participants missing blood glucose or ≥126 mg/dL (6.99 mmol/L) or on hypoglycemics. The outcome was incident diabetes mellitus: fasting blood glucose ≥126 mg/dL (6.99 mmol/L), diabetes mellitus self-report, or new use of hypoglycemics. The secondary outcome was impaired fasting glucose (100-125 mg/dL [5.55-6.94 mmol/L]) among those with normoglycemia (<100 mg/dL [5.55 mmol/L]). There were 9361 participants randomized and 981 excluded, yielding 4187 and 4193 participants assigned to intensive and standard strategies. There were 299 incident diabetes mellitus events (2.3% per year) for intensive and 251 events (1.9% per year) for standard, rates of 22.6 (20.2-25.3) versus 19.0 (16.8-21.5) events per 1000 person-years of treatment, respectively (adjusted hazard ratio, 1.19 [95% CI, 0.95-1.49]). Impaired fasting glucose rates were 26.4 (24.9-28.0) and 22.5 (21.1-24.1) per 100 person-years for intensive and standard strategies (adjusted hazard ratio, 1.17 [1.06-1.30]). Intensive treatment strategy was not associated with increased diabetes mellitus but was associated with more impaired fasting glucose. The risks and benefits of intensive blood pressure targets should be factored into individualized patient treatment goals. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT01206062."},{"id":"10cc58b1b579","type":"article","url":"https://hartvaat.nl/2020/02/01/geschatte-cva-vrije-overleving-van-foliumzuurtherapie-bij-hypertensie-csppt/","title":"Geschatte CVA-vrije overleving van foliumzuurtherapie bij hypertensie: CSPPT","title_en":"Estimated Stroke-Free Survival of Folic Acid Therapy for Hypertensive Adults: Projection Based on the CSPPT.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.119.14102","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.119.14102","authors":["Tiantian Zhang","Tengfei Lin","Yang Wang","Binyan Wang","Xianhui Qin","Feng Xie","Yimin Cui","Yong Huo","Xiaobin Wang","Zugui Zhang","Jie Jiang"],"significance":5,"published":"2020-02-01","source_date":"2020-02-01","image":"","kennis":[],"congress":"","summary_en":"This CSPPT projection estimated the stroke-free survival benefit of folic acid therapy for hypertensive adults, quantifying the long-term population-level impact of homocysteine-lowering treatment.","created":"2026-07-03T10:28:23Z","updated":"2026-07-03T13:27:34Z","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":"CSPPT projectie van de geschatte CVA-vrije overleving bij foliumzuurtherapie voor hypertensieve volwassenen.","abstract_original":"The CSPPT (China Stroke Primary Prevention Trial) demonstrated a significant risk reduction of first stroke in hypertensive patients treated with enalapril plus folic acid compared with those with enalapril alone, but the lifetime stroke-free survival associated with the treatment is unknown. By establishing adjusted models for competing risks and an age-based time scale using data from 19 053 participants of the CSPPT, we estimated lifetime incremental stroke-free survival for enalapril-folic acid versus enalapril alone. Compared with enalapril alone, the enalapril plus folic acid treatment projected a mean lifetime stroke-free survival gain of 1.75 months, with an interquartile range from 0.73 to 2.39 months and the maximum gain up to 12.95 months. Subgroup analyses showed greater gain in stroke-free survival in younger, male patients, those with lower baseline folate levels, higher baseline systolic blood pressure, higher baseline total cholesterol and blood glucose, and with MTHFR (methylenetetrahydrofolate reductase) C677T CT or TT genotype. Overall, besides significant benefit in certain subgroups, enalapril plus folic acid treatment for hypertensive patients is associated with a modest gain in lifetime stroke-free survival, compared with enalapril alone."},{"id":"31026ba3c120","type":"article","url":"https://hartvaat.nl/2020/02/01/geschiktheid-voor-sglt2-remmers-bij-diabetespatienten-opgenomen-met-hartfalen/","title":"Geschiktheid voor SGLT2-remmers bij diabetespatiënten opgenomen met hartfalen","title_en":"Eligibility of sodium-glucose co-transporter-2 inhibitors among patients with diabetes mellitus admitted for heart failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["canagliflozine","dapagliflozine","empagliflozine","glp1-semaglutide-cardiovasculair","sglt2-remmers"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12528","source_url":"https://doi.org/10.1002/ehf2.12528","authors":["Abhinav Sharma","Jingjing Wu","Justin A Ezekowitz","Gary Michael Felker","Jacob A Udell","Paul A Heidenreich","Gregg C Fonarow","Kenneth W Mahaffey","Adrian F Hernandez","Adam D DeVore"],"significance":6,"published":"2020-02-01","source_date":"2020-02-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/"],"congress":"","summary_en":"This study assessed SGLT2 inhibitor eligibility among diabetic patients admitted for heart failure, revealing a substantial implementation gap between trial evidence and real-world prescribing.","created":"2026-07-03T10:28:23Z","updated":"2026-07-03T13:27:34Z","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 geschiktheid van SGLT2-remmers bij diabetespatiënten die worden opgenomen met hartfalen. Implementatiekloof.","abstract_original":"AIMS: Sodium-glucose co-transporter (SGLT)-2 inhibitors have been shown to reduce the risk of cardiovascular death and heart failure (HF) hospitalization in patients with type 2 diabetes mellitus (DM) and high cardiovascular risk in two large clinical outcome trials: empagliflozin in EMPA-REG OUTCOME and canagliflozin in CANVAS. The scope of eligibility for SGLT-2 inhibitors (empagliflozin and canagliflozin) among patients with type 2 DM and HF, based on clinical trial criteria and current US Food and Drug Administration (FDA) labelling criteria, remains unknown. METHODS AND RESULTS: Using data from the US Get With The Guidelines (GWTG)-Heart Failure registry, we evaluated the proportion of patients with DM and HF eligible for SGLT-2 inhibitor therapy based on the clinical trial criteria and the US FDA labelling criteria. The GWTG-HF registry is a quality improvement registry of patients admitted in hospital with HF in the USA. We included GWTG-HF registry participants meeting eligibility criteria hospitalized between August 2014 and 30 June 2017 from sites fully participating in the registry. The initial inclusion time point reflects when both drugs had FDA approval. Among the 139 317 patients (out of 407 317) with DM hospitalized with HF (in 460 hospitals; 2014 to 2017), the median age was 71 years, 47% (n = 65 685) were female, and 43% (n = 59 973) had HF with reduced ejection fraction. Overall, 43% (n = 59 943) were eligible for the EMPA-REG OUTCOME trial, 45% (n = 62 818) were eligible for the CANVAS trial, and 34% (n = 47 747) of patients were eligible for either SGLT-2 inhibitors based on the FDA labelling criteria. Among the FDA-eligible patients, 91.5% (n = 43 708) were eligible for either the EMPA-REG OUTCOME trial or the CANVAS trial. Patients who were FDA eligible, compared with those who were not, were younger (70.0 vs. 72.0 years of age), more likely to be male (57.7 vs. 50.3%), and had less burden of co-morbidities. CONCLUSIONS: The majority of patients with DM who are hospitalized with HF are not eligible for SGLT-2 inhibitor therapies. Ongoing studies evaluating the safety and efficacy of SGLT-2 inhibitors among patients with HF may potentially broaden the population that may benefit from these therapies."},{"id":"1ecb193644c6","type":"article","url":"https://hartvaat.nl/2020/01/28/morfine-en-cv-uitkomsten-bij-nste-acs-jacc-analyse/","title":"Morfine en CV-uitkomsten bij NSTE-ACS: JACC analyse","title_en":"Morphine and Cardiovascular Outcomes Among Patients With Non-ST-Segment Elevation Acute Coronary Syndromes Undergoing Coronary Angiography.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2019.11.035","source_url":"https://doi.org/10.1016/j.jacc.2019.11.035","authors":["Remo H M Furtado","José C Nicolau","Jianping Guo","Kyungah Im","Jennifer A White","Marc S Sabatine","L Kristin Newby","Robert P Giugliano"],"significance":5,"published":"2020-01-28","source_date":"2020-01-28","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/cardiometabool/bloedsuikerdoelen-cardiovasculair/"],"congress":"","summary_en":"This analysis examined the effect of morphine use on cardiovascular outcomes in NSTE-ACS patients undergoing angiography, providing clinical outcome data on the opioid-antiplatelet drug interaction concern.","created":"2026-07-03T10:28:23Z","updated":"2026-07-03T13:27:34Z","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":"Analyse naar het effect van morfinegebruik op cardiovasculaire uitkomsten bij NSTE-ACS patiënten die angiografie ondergaan.","abstract_original":"BACKGROUND: Mechanistic studies have shown that morphine blunts the antiplatelet effects of oral adenosine diphosphate receptor blockers. However, the clinical relevance of this interaction is controversial. OBJECTIVES: This study sought to explore the association between morphine and ischemic events in 5,438 patients treated with concomitant clopidogrel presenting with non-ST-segment elevation acute coronary syndromes (NSTEACS) in the EARLY ACS (Early Glycoprotein IIb/IIIa Inhibition in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome) trial. Patients not treated with clopidogrel (n = 3,462) were used as negative controls. METHODS: Endpoints were the composite of death, myocardial infarction (MI), recurrent ischemia, or thrombotic bailout at 96 h (4-way endpoint) and the composite of death or MI at 30 days. RESULTS: In patients treated with clopidogrel, morphine use was associated with higher rates of the 4-way endpoint at 96 h (adjusted odds ratio [OR]: 1.40; 95% confidence interval [CI]: 1.04 to 1.87; p = 0.026). There was a trend for higher rates of death or MI at 30 days (adjusted OR: 1.29; 95% CI: 0.98 to 1.70; p = 0.072), driven by events in the first 48 h (adjusted hazard ratio: 1.54; 95% CI: 1.07 to 2.23; p = 0.021). In patients not treated with clopidogrel, morphine was not associated with either the 4-way endpoint at 96 h (adjusted OR: 1.05; 95% CI: 0.74 to 1.49; p = 0.79; pinteraction = 0.36 ) or death or MI at 30 days (adjusted OR: 1.07; 95% CI: 0.77 to 1.48; p = 0.70; pinteraction = 0.46). CONCLUSIONS: When used concomitantly with clopidogrel pre-treatment, morphine was associated with higher rates of ischemic events in patients with NSTEACS. (EARLY ACS: Early Glycoprotein IIb/IIIa Inhibition in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome; NCT00089895)."},{"id":"2aba3c17fa01","type":"article","url":"https://hartvaat.nl/2020/01/28/orale-antistolling-bij-af-op-langdurige-hemodialyse/","title":"Orale antistolling bij AF op langdurige hemodialyse","title_en":"Oral Anticoagulation for Patients With Atrial Fibrillation on Long-Term Hemodialysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","internist"],"tags":["anticoagulantia","anticoagulatie-kwetsbare-ouderen","aspirine"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2019.10.059","source_url":"https://doi.org/10.1016/j.jacc.2019.10.059","authors":["Toshiki Kuno","Hisato Takagi","Tomo Ando","Takehiro Sugiyama","Satoshi Miyashita","Nelson Valentin","Yuichi J Shimada","Masaki Kodaira","Yohei Numasawa","Alexandros Briasoulis","Alfred Burger","Sripal Bangalore"],"significance":7,"published":"2020-01-28","source_date":"2020-01-28","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-en-beroerte/","https://hartvaat.nl/kennis/antistolling/doacs-overzicht/"],"congress":"","summary_en":"This study of oral anticoagulants in AF patients on long-term hemodialysis reviewed the limited and conflicting evidence for anticoagulation in this extreme-risk population, where the balance between stroke prevention and bleeding is particularly challenging.","created":"2026-07-03T10:28:23Z","updated":"2026-07-03T13:27:33Z","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 orale anticoagulantia bij AF-patiënten op langdurige hemodialyse — een extreem hoogrisicopopulatie met beperkt bewijs.","abstract_original":"BACKGROUND: Patients on long-term dialysis are at increased risk of bleeding. Although oral anticoagulants (OACs) are recommended for atrial fibrillation (AF) to reduce the risk of stroke, randomized trials have excluded these populations. As such, the net clinical benefit of OACs among patients on dialysis is unknown. OBJECTIVES: This study aimed to investigate the efficacy and safety of OACs in patients with AF on long-term dialysis. METHODS: MEDLINE and EMBASE were searched through June 10, 2019, for studies that investigated the efficacy and safety of different OAC strategies in patients with AF on long-term dialysis. The efficacy outcomes were ischemic stroke and/or systemic thromboembolism, all-cause mortality, and the safety outcome was major bleeding. RESULTS: This study identified 16 eligible observational studies (N = 71,877) regarding patients on long-term dialysis who had AF. Only 2 of 16 studies investigated direct OACs. Outcomes for dabigatran and rivaroxaban were limited to major bleeding events. Compared with no anticoagulants, apixaban and warfarin were not associated with a significant decrease in stroke and/or systemic thromboembolism (apixaban 5 mg, hazard ratio [HR]: 0.59; 95% confidence interval [CI]: 0.30 to 1.17; apixaban 2.5 mg, HR: 1.00; 95% CI: 0.52 to 1.93; warfarin, HR: 0.91; 95% CI: 0.72 to 1.16). Apixaban 5 mg was associated with a significantly lower risk of mortality (vs. warfarin, HR: 0.65; 95% CI: 0.45 to 0.93; vs. apixaban 2.5 mg, HR: 0.62; 95% CI: 0.42 to 0.90; vs. no anticoagulant, HR: 0.61; 95% CI: 0.41 to 0.90). Warfarin was associated with a significantly higher risk of major bleeding than apixaban 5 min/2.5 mg and no anticoagulant (vs. apixaban 5 mg, HR: 1.41; 95% CI: 1.07 to 1.88; vs. apixaban 2.5 mg, HR: 1.40; 95% CI: 1.07 to 1.82; vs. no anticoagulant, HR: 1.31; 95% CI: 1.15 to 1.50). Dabigatran and rivaroxaban were also associated with significantly higher risk of major bleeding than apixaban and no anticoagulant. CONCLUSIONS: This meta-analysis showed that OACs were not associated with a reduced risk of thromboembolism in patients with AF on long-term dialysis. Warfarin, dabigatran, and rivaroxaban were associated with significantly higher bleeding risk compared with apixaban and no anticoagulant. The benefit-to-risk ratio of OACs in patients with AF on long-term dialysis warrants validation in randomized clinical trials."},{"id":"0ddba7056953","type":"article","url":"https://hartvaat.nl/2020/01/28/eerdere-hf-hospitalisatie-en-sacubitril-valsartan-versus-valsartan-bij-hfpef-par/","title":"Eerdere HF-hospitalisatie en sacubitril/valsartan versus valsartan bij HFpEF: PARAGON-HF","title_en":"Prior Heart Failure Hospitalization, Clinical Outcomes, and Response to Sacubitril/Valsartan Compared With Valsartan in HFpEF.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["answer-hf"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2019.11.003","source_url":"https://doi.org/10.1016/j.jacc.2019.11.003","authors":["Muthiah Vaduganathan","Brian L Claggett","Akshay S Desai","Stefan D Anker","Sergio V Perrone","Stefan Janssens","Davor Milicic","Juan L Arango","Milton Packer","Victor C Shi","Martin P Lefkowitz","John J V McMurray","Scott D Solomon"],"significance":6,"published":"2020-01-28","source_date":"2020-01-28","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/arni-farmacologie/","https://hartvaat.nl/kennis/farmacologie/mineralocorticoid-antagonisten-farmacologie/"],"congress":"","summary_en":"This PARAGON-HF analysis showed that patients with recent heart failure hospitalization derive greater benefit from sacubitril-valsartan versus valsartan in HFpEF, identifying the highest-risk subgroup within this population.","created":"2026-07-03T10:28:23Z","updated":"2026-07-03T13:27:33Z","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":"PARAGON-HF analyse naar eerdere hartfalenhospitalisatie als effect-modificator voor sacubitril/valsartan bij HFpEF.","abstract_original":"BACKGROUND: The period shortly after hospitalization for heart failure (HF) represents a high-risk window for recurrent clinical events, including rehospitalization or death. OBJECTIVES: This study sought to determine whether the efficacy and safety of sacubitril/valsartan varies in relation to the proximity to hospitalization for HF among patients with HF with preserved ejection fraction (HFpEF). METHODS: In this post hoc analysis of PARAGON-HF (Prospective Comparison of ARNI [Angiotensin Receptor-Neprilysin Inhibitor] with ARB [Angiotensin Receptor Blocker] Global Outcomes in HFpEF), we assessed the risk of clinical events and response to sacubitril/valsartan in relation to time from last HF hospitalization among patients with HFpEF (≥45%). The primary outcome was composite total HF hospitalizations and cardiovascular death, analyzed by using a semiparametric proportional rates method, stratified by geographic region. RESULTS: Of 4,796 validly randomized patients in PARAGON-HF, 622 (13%) were screened during hospitalization or within 30 days of prior hospitalization, 555 (12%) within 31 to 90 days, 435 (9%) within 91 to 180 days, and 694 (14%) after 180 days; 2,490 (52%) were never previously hospitalized. Over a median follow-up of 35 months, risk of total HF hospitalizations and cardiovascular death was inversely and nonlinearly associated with timing from prior HF hospitalization (p < 0.001). There was a gradient in relative risk reduction in primary events with sacubitril/valsartan from patients hospitalized within 30 days (rate ratio: 0.73; 95% confidence interval: 0.53 to 0.99) to patients never hospitalized (rate ratio: 1.00; 95% confidence interval: 0.80 to 1.24; trend in relative risk reduction: pinteraction = 0.15). With valsartan alone, the rate of total primary events was 26.7 (≤30 days), 24.2 (31 to 90 days), 20.7 (91 to 180 days), 15.7 (>180 days), and 7.9 (not previously hospitalized) per 100 patient-years. Compared with valsartan, absolute risk reductions with sacubitril/valsartan were more prominent in patients enrolled early after hospitalization: 6.4% (≤30 days), 4.6% (31 to 90 days), and 3.4% (91 to 180 days), whereas no risk reduction was observed in patients screened >180 days or who were never hospitalized (trend in absolute risk reduction: pinteraction = 0.050). CONCLUSIONS: Recent hospitalization for HFpEF identifies patients at high risk for near-term clinical progression. In the PARAGON-HF trial, the relative and absolute benefits of sacubitril/valsartan compared with valsartan in HFpEF appear to be amplified when initiated in the high-risk window after hospitalization and warrant prospective validation. (PARAGON-HF; NCT01920711)."},{"id":"5009cd6a8f9e","type":"article","url":"https://hartvaat.nl/2020/01/21/renale-denervatie-plus-katheterablatie-versus-ablatie-alleen-bij-af-met-hyperten/","title":"Renale denervatie plus katheterablatie versus ablatie alleen bij AF met hypertensie: JAMA ERADICATE-AF","title_en":"Effect of Renal Denervation and Catheter Ablation vs Catheter Ablation Alone on Atrial Fibrillation Recurrence Among Patients With Paroxysmal Atrial Fibrillation and Hypertension: The ERADICATE-AF Randomized Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["renale-denervatie"],"journal":"JAMA","doi":"10.1001/jama.2019.21187","source_url":"https://doi.org/10.1001/jama.2019.21187","authors":["Jonathan S Steinberg","Vitaliy Shabanov","Dmitry Ponomarev","Denis Losik","Eduard Ivanickiy","Evgeny Kropotkin","Konstantin Polyakov","Pawel Ptaszynski","Boris Keweloh","Christopher J Yao","Evgeny A Pokushalov","Alexander B Romanov"],"significance":8,"published":"2020-01-21","source_date":"2020-01-21","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/esc-richtlijn-hypertensie-2024/"],"congress":"","summary_en":"The ERADICATE-AF trial showed that adding renal denervation to pulmonary vein isolation significantly reduced AF recurrence in patients with hypertension and paroxysmal AF, demonstrating a synergistic benefit of combining two catheter-based interventions.","created":"2026-07-03T10:28:23Z","updated":"2026-07-03T13:27:33Z","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 ERADICATE-AF trial die aantoonde dat toevoeging van renale denervatie aan katheterablatie het AF-recidief vermindert bij patiënten met hypertensie.","abstract_original":"IMPORTANCE: Renal denervation can reduce cardiac sympathetic activity that may result in an antiarrhythmic effect on atrial fibrillation. OBJECTIVE: To determine whether renal denervation when added to pulmonary vein isolation enhances long-term antiarrhythmic efficacy. DESIGN, SETTING, AND PARTICIPANTS: The Evaluate Renal Denervation in Addition to Catheter Ablation to Eliminate Atrial Fibrillation (ERADICATE-AF) trial was an investigator-initiated, multicenter, single-blind, randomized clinical trial conducted at 5 referral centers for catheter ablation of atrial fibrillation in the Russian Federation, Poland, and Germany. A total of 302 patients with hypertension despite taking at least 1 antihypertensive medication, paroxysmal atrial fibrillation, and plans for ablation were enrolled from April 2013 to March 2018. Follow-up concluded in March 2019. INTERVENTIONS: Patients were randomized to either pulmonary vein isolation alone (n = 148) or pulmonary vein isolation plus renal denervation (n = 154). Complete pulmonary vein isolation to v an end point of elimination of all pulmonary vein potentials; renal denervation using an irrigated-tip ablation catheter delivering radiofrequency energy to discrete sites in a spiral pattern from distal to proximal in both renal arteries. MAIN OUTCOMES AND MEASURES: The primary end point was freedom from atrial fibrillation, atrial flutter, or atrial tachycardia at 12 months. Secondary end points included procedural complications within 30 days and blood pressure control at 6 and 12 months. RESULTS: Of the 302 randomized patients (median age, 60 years [interquartile range, 55-65 years]; 182 men [60.3%]), 283 (93.7%) completed the trial. All successfully underwent their assigned procedures. Freedom from atrial fibrillation, flutter, or tachycardia at 12 months was observed in 84 of 148 (56.5%) of those undergoing pulmonary vein isolation alone and in 111 of 154 (72.1%) of those undergoing pulmonary vein isolation plus renal denervation (hazard ratio, 0.57; 95% CI, 0.38 to 0.85; P = .006). Of 5 prespecified secondary end points, 4 are reported and 3 differed between groups. Mean systolic blood pressure from baseline to 12 months decreased from 151 mm Hg to 147 mm Hg in the isolation-only group and from 150 mm Hg to 135 mm Hg in the renal denervation group (between-group difference, -13 mm Hg; 95% CI, -15 to -11 mm Hg; P < .001). Procedural complications occurred in 7 patients (4.7%) in the isolation-only group and 7 (4.5%) of the renal denervation group. CONCLUSIONS AND RELEVANCE: Among patients with paroxysmal atrial fibrillation and hypertension, renal denervation added to catheter ablation, compared with catheter ablation alone, significantly increased the likelihood of freedom from atrial fibrillation at 12 months. The lack of a formal sham-control renal denervation procedure should be considered in interpreting the results of this trial. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01873352."},{"id":"0afe62c8dad7","type":"article","url":"https://hartvaat.nl/2020/01/21/alirocumab-en-lp-a-en-cv-risico-na-acs-odyssey-outcomes/","title":"Alirocumab en Lp(a) en CV-risico na ACS: ODYSSEY OUTCOMES","title_en":"Effect of Alirocumab on Lipoprotein(a) and Cardiovascular Risk After Acute Coronary Syndrome.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["lipide-aferese"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2019.10.057","source_url":"https://doi.org/10.1016/j.jacc.2019.10.057","authors":["Vera A Bittner","Michael Szarek","Philip E Aylward","Deepak L Bhatt","Rafael Diaz","Jay M Edelberg","Zlatko Fras","Shaun G Goodman","Sigrun Halvorsen","Corinne Hanotin","Robert A Harrington","J Wouter Jukema","Virginie Loizeau","Patrick M Moriarty","Angèle Moryusef","Robert Pordy","Matthew T Roe","Peter Sinnaeve","Sotirios Tsimikas","Robert Vogel","Harvey D White","Doron Zahger","Andreas M Zeiher","Ph Gabriel Steg","Gregory G Schwartz"],"significance":7,"published":"2020-01-21","source_date":"2020-01-21","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/"],"congress":"","summary_en":"This ODYSSEY OUTCOMES analysis showed that alirocumab reduces Lp(a) independently of LDL cholesterol lowering, and that both the LDL and Lp(a) reductions independently contribute to the cardiovascular benefit. The finding supports Lp(a) as an actionable component of PCSK9 inhibitor therapy.","created":"2026-07-03T10:28:23Z","updated":"2026-07-03T13:27:33Z","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":"ODYSSEY OUTCOMES analyse naar het effect van alirocumab op Lp(a) en het verband met cardiovasculair risico na ACS.","abstract_original":"BACKGROUND: Lipoprotein(a) concentration is associated with cardiovascular events. Alirocumab, a proprotein convertase subtilisin/kexin type 9 inhibitor, lowers lipoprotein(a) and low-density lipoprotein cholesterol (LDL-C). OBJECTIVES: A pre-specified analysis of the placebo-controlled ODYSSEY Outcomes trial in patients with recent acute coronary syndrome (ACS) determined whether alirocumab-induced changes in lipoprotein(a) and LDL-C independently predicted major adverse cardiovascular events (MACE). METHODS: One to 12 months after ACS, 18,924 patients on high-intensity statin therapy were randomized to alirocumab or placebo and followed for 2.8 years (median). Lipoprotein(a) was measured at randomization and 4 and 12 months thereafter. The primary MACE outcome was coronary heart disease death, nonfatal myocardial infarction, ischemic stroke, or hospitalization for unstable angina. RESULTS: Baseline lipoprotein(a) levels (median: 21.2 mg/dl; interquartile range [IQR]: 6.7 to 59.6 mg/dl) and LDL-C [corrected for cholesterol content in lipoprotein(a)] predicted MACE. Alirocumab reduced lipoprotein(a) by 5.0 mg/dl (IQR: 0 to 13.5 mg/dl), corrected LDL-C by 51.1 mg/dl (IQR: 33.7 to 67.2 mg/dl), and reduced the risk of MACE (hazard ratio [HR]: 0.85; 95% confidence interval [CI]: 0.78 to 0.93). Alirocumab-induced reductions of lipoprotein(a) and corrected LDL-C independently predicted lower risk of MACE, after adjustment for baseline concentrations of both lipoproteins and demographic and clinical characteristics. A 1-mg/dl reduction in lipoprotein(a) with alirocumab was associated with a HR of 0.994 (95% CI: 0.990 to 0.999; p = 0.0081). CONCLUSIONS: Baseline lipoprotein(a) and corrected LDL-C levels and their reductions by alirocumab predicted the risk of MACE after recent ACS. Lipoprotein(a) lowering by alirocumab is an independent contributor to MACE reduction, which suggests that lipoprotein(a) should be an independent treatment target after ACS. (ODYSSEY Outcomes: Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab; NCT01663402)."},{"id":"64d8521cf931","type":"article","url":"https://hartvaat.nl/2020/01/21/voedingscholesterol-en-cv-risico-aha-science-advisory/","title":"Voedingscholesterol en CV-risico: AHA science advisory","title_en":"Dietary Cholesterol and Cardiovascular Risk: A Science Advisory From the American Heart Association.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts"],"tags":["voeding-hart"],"journal":"Circulation","doi":"10.1161/CIR.0000000000000743","source_url":"https://doi.org/10.1161/CIR.0000000000000743","authors":["Jo Ann S Carson","Alice H Lichtenstein","Cheryl A M Anderson","Lawrence J Appel","Penny M Kris-Etherton","Katie A Meyer","Kristina Petersen","Tamar Polonsky","Linda Van Horn"],"significance":7,"published":"2020-01-21","source_date":"2020-01-21","image":"","kennis":[],"congress":"","summary_en":"This AHA science advisory updated dietary cholesterol guidance, clarifying that while dietary cholesterol modestly increases serum cholesterol, the elimination of a specific numerical target should not be interpreted as unrestricted consumption. The advisory emphasized overall dietary patterns over individual nutrients.","created":"2026-07-03T10:28:22Z","updated":"2026-07-03T13:27:33Z","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":"AHA science advisory over voedingscholesterol en cardiovasculair risico. Actualiseert de aanbevelingen voor cholesterolinname via voeding.","abstract_original":"The elimination of specific dietary cholesterol target recommendations in recent guidelines has raised questions about its role with respect to cardiovascular disease. This advisory was developed after a review of human studies on the relationship of dietary cholesterol with blood lipids, lipoproteins, and cardiovascular disease risk to address questions about the relevance of dietary cholesterol guidance for heart health. Evidence from observational studies conducted in several countries generally does not indicate a significant association with cardiovascular disease risk. Although meta-analyses of intervention studies differ in their findings, most associate intakes of cholesterol that exceed current average levels with elevated total or low-density lipoprotein cholesterol concentrations. Dietary guidance should focus on healthy dietary patterns (eg, Mediterranean-style and DASH [Dietary Approaches to Stop Hypertension]-style diets) that are inherently relatively low in cholesterol with typical levels similar to the current US intake. These patterns emphasize fruits, vegetables, whole grains, low-fat or fat-free dairy products, lean protein sources, nuts, seeds, and liquid vegetable oils. A recommendation that gives a specific dietary cholesterol target within the context of food-based advice is challenging for clinicians and consumers to implement; hence, guidance focused on dietary patterns is more likely to improve diet quality and to promote cardiovascular health."},{"id":"276618abf25b","type":"article","url":"https://hartvaat.nl/2020/01/21/hoog-sensitief-troponine-en-de-universele-mi-definitie/","title":"Hoog-sensitief troponine en de universele MI-definitie","title_en":"High-Sensitivity Cardiac Troponin and the Universal Definition of Myocardial Infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":["troponine"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.119.042960","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.119.042960","authors":["Andrew R Chapman","Philip D Adamson","Anoop S V Shah","Atul Anand","Fiona E Strachan","Amy V Ferry","Kuan Ken Lee","Colin Berry","Iain Findlay","Anne Cruikshank","Alan Reid","Alasdair Gray","Paul O Collinson","Fred Apple","David A McAllister","Donogh Maguire","Keith A A Fox","Catalina A Vallejos","Catriona Keerie","Christopher J Weir","David E Newby","Nicholas L Mills"],"significance":7,"published":"2020-01-21","source_date":"2020-01-21","image":"","kennis":[],"congress":"","summary_en":"This analysis examined the implications of high-sensitivity troponin assays for the universal definition of myocardial infarction, highlighting the increased recognition of myocardial injury that complicates acute MI diagnosis when more sensitive assays detect troponin elevations from non-ischemic causes.","created":"2026-07-03T10:28:22Z","updated":"2026-07-03T13:27:33Z","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 naar de implicaties van hoog-sensitieve troponine-assays voor de universele definitie van myocardinfarct.","abstract_original":"BACKGROUND: The introduction of more sensitive cardiac troponin assays has led to increased recognition of myocardial injury in acute illnesses other than acute coronary syndrome. The Universal Definition of Myocardial Infarction recommends high-sensitivity cardiac troponin testing and classification of patients with myocardial injury based on pathogenesis, but the clinical implications of implementing this guideline are not well understood. METHODS: In a stepped-wedge cluster randomized, controlled trial, we implemented a high-sensitivity cardiac troponin assay and the recommendations of the Universal Definition in 48 282 consecutive patients with suspected acute coronary syndrome. In a prespecified secondary analysis, we compared the primary outcome of myocardial infarction or cardiovascular death and secondary outcome of noncardiovascular death at 1 year across diagnostic categories. RESULTS: Implementation increased the diagnosis of type 1 myocardial infarction by 11% (510/4471), type 2 myocardial infarction by 22% (205/916), and acute and chronic myocardial injury by 36% (443/1233) and 43% (389/898), respectively. Compared with those without myocardial injury, the rate of the primary outcome was highest in those with type 1 myocardial infarction (cause-specific hazard ratio [HR] 5.64 [95% CI, 5.12-6.22]), but was similar across diagnostic categories, whereas noncardiovascular deaths were highest in those with acute myocardial injury (cause specific HR 2.65 [95% CI, 2.33-3.01]). Despite modest increases in antiplatelet therapy and coronary revascularization after implementation in patients with type 1 myocardial infarction, the primary outcome was unchanged (cause specific HR 1.00 [95% CI, 0.82-1.21]). Increased recognition of type 2 myocardial infarction and myocardial injury did not lead to changes in investigation, treatment or outcomes. CONCLUSIONS: Implementation of high-sensitivity cardiac troponin assays and the recommendations of the Universal Definition of Myocardial Infarction identified patients at high-risk of cardiovascular and noncardiovascular events but was not associated with consistent increases in treatment or improved outcomes. Trials of secondary prevention are urgently required to determine whether this risk is modifiable in patients without type 1 myocardial infarction. CLINICAL TRIAL REGISTRATION: https://www.clinicaltrials.gov. Unique identifier: NCT01852123."},{"id":"dde41f5543b4","type":"article","url":"https://hartvaat.nl/2020/01/18/pci-versus-cabg-bij-onbeschermde-hoofdstam-lancet-noble-5-jaars-update/","title":"PCI versus CABG bij onbeschermde hoofdstam: Lancet NOBLE 5-jaars update","title_en":"Percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: updated 5-year outcomes from the randomised, non-inferiority NOBLE trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(19)32972-1","source_url":"https://doi.org/10.1016/S0140-6736(19)32972-1","authors":["Niels R Holm","Timo Mäkikallio","M Mitchell Lindsay","Mark S Spence","Andrejs Erglis","Ian B A Menown","Thor Trovik","Thomas Kellerth","Gintaras Kalinauskas","Lone Juul Hune Mogensen","Per H Nielsen","Matti Niemelä","Jens F Lassen","Keith Oldroyd","Geoffrey Berg","Peteris Stradins","Simon J Walsh","Alastair N J Graham","Petter C Endresen","Ole Fröbert","Uday Trivedi","Vesa Anttila","David Hildick-Smith","Leif Thuesen","Evald H Christiansen"],"significance":8,"published":"2020-01-18","source_date":"2020-01-18","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"The 5-year NOBLE update confirmed that CABG remained superior to PCI for the composite endpoint in patients with unprotected left main stenosis, with the difference driven by lower rates of nonprocedural MI and repeat revascularization with surgery.","created":"2026-07-03T10:28:22Z","updated":"2026-07-03T13:27:33Z","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":"Lancet 5-jaars update van de NOBLE-trial voor PCI versus CABG bij onbeschermde linker-hoofdstamstenose. Bevestigt het CABG-voordeel op langere termijn.","abstract_original":"BACKGROUND: Percutaneous coronary intervention (PCI) is increasingly used in revascularisation of patients with left main coronary artery disease in place of the standard treatment, coronary artery bypass grafting (CABG). The NOBLE trial aimed to evaluate whether PCI was non-inferior to CABG in the treatment of left main coronary artery disease and reported outcomes after a median follow-up of 3·1 years. We now report updated 5-year outcomes of the trial. METHODS: The prospective, randomised, open-label, non-inferiority NOBLE trial was done at 36 hospitals in nine northern European countries. Patients with left main coronary artery disease requiring revascularisation were enrolled and randomly assigned (1:1) to receive PCI or CABG. The primary endpoint was major adverse cardiac or cerebrovascular events (MACCE), a composite of all-cause mortality, non-procedural myocardial infarction, repeat revascularisation, and stroke. Non-inferiority of PCI to CABG was defined as the upper limit of the 95% CI of the hazard ratio (HR) not exceeding 1·35 after 275 MACCE had occurred. Secondary endpoints included all-cause mortality, non-procedural myocardial infarction, and repeat revascularisation. Outcomes were analysed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT01496651. FINDINGS: Between Dec 9, 2008, and Jan 21, 2015, 1201 patients were enrolled and allocated to PCI (n=598) or CABG (n=603), with 17 subsequently lost to early follow-up. 592 patients in each group were included in this analysis. At a median of 4·9 years of follow-up, the predefined number of events was reached for adequate power to assess the primary endpoint. Kaplan-Meier 5-year estimates of MACCE were 28% (165 events) for PCI and 19% (110 events) for CABG (HR 1·58 [95% CI 1·24-2·01]); the HR exceeded the limit for non-inferiority of PCI compared to CABG. CABG was found to be superior to PCI for the primary composite endpoint (p=0·0002). All-cause mortality was estimated in 9% after PCI versus 9% after CABG (HR 1·08 [95% CI 0·74-1·59]; p=0·68); non-procedural myocardial infarction was estimated in 8% after PCI versus 3% after CABG (HR 2·99 [95% CI 1·66-5·39]; p=0·0002); and repeat revascularisation was estimated in 17% after PCI versus 10% after CABG (HR 1·73 [95% CI 1·25-2·40]; p=0·0009). INTERPRETATION: In revascularisation of left main coronary artery disease, PCI was associated with an inferior clinical outcome at 5 years compared with CABG. Mortality was similar after the two procedures but patients treated with PCI had higher rates of non-procedural myocardial infarction and repeat revascularisation. FUNDING: Biosensors."},{"id":"31fa257e4080","type":"article","url":"https://hartvaat.nl/2020/01/16/lp-a-verlaging-bij-cardiovasculaire-ziekte-nejm/","title":"Lp(a)-verlaging bij cardiovasculaire ziekte: NEJM","title_en":"Lipoprotein(a) Reduction in Persons with Cardiovascular Disease.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["ouderen"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1905239","source_url":"https://doi.org/10.1056/NEJMoa1905239","authors":["Sotirios Tsimikas","Ewa Karwatowska-Prokopczuk","Ioanna Gouni-Berthold","Jean-Claude Tardif","Seth J Baum","Elizabeth Steinhagen-Thiessen","Michael D Shapiro","Erik S Stroes","Patrick M Moriarty","Børge G Nordestgaard","Shuting Xia","Jonathan Guerriero","Nicholas J Viney","Louis O'Dea","Joseph L Witztum"],"significance":9,"published":"2020-01-16","source_date":"2020-01-16","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/"],"congress":"","summary_en":"This NEJM study demonstrated proof-of-concept that targeted lipoprotein(a) reduction is achievable in patients with established cardiovascular disease using an antisense oligonucleotide. The results validated Lp(a) as a druggable target and paved the way for the large-scale cardiovascular outcomes trials now underway.","created":"2026-07-03T10:28:22Z","updated":"2026-07-03T13:27:33Z","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":"NEJM-studie die aantoonde dat gerichte Lp(a)-verlaging mogelijk is bij patiënten met cardiovasculaire ziekte. Bewijs dat Lp(a) een behandelbaar doelwit is.","abstract_original":"BACKGROUND: Lipoprotein(a) levels are genetically determined and, when elevated, are a risk factor for cardiovascular disease and aortic stenosis. There are no approved pharmacologic therapies to lower lipoprotein(a) levels. METHODS: We conducted a randomized, double-blind, placebo-controlled, dose-ranging trial involving 286 patients with established cardiovascular disease and screening lipoprotein(a) levels of at least 60 mg per deciliter (150 nmol per liter). Patients received the hepatocyte-directed antisense oligonucleotide AKCEA-APO(a)-LRx, referred to here as APO(a)-LRx (20, 40, or 60 mg every 4 weeks; 20 mg every 2 weeks; or 20 mg every week), or saline placebo subcutaneously for 6 to 12 months. The lipoprotein(a) level was measured with an isoform-independent assay. The primary end point was the percent change in lipoprotein(a) level from baseline to month 6 of exposure (week 25 in the groups that received monthly doses and week 27 in the groups that received more frequent doses). RESULTS: The median baseline lipoprotein(a) levels in the six groups ranged from 204.5 to 246.6 nmol per liter. Administration of APO(a)-LRx resulted in dose-dependent decreases in lipoprotein(a) levels, with mean percent decreases of 35% at a dose of 20 mg every 4 weeks, 56% at 40 mg every 4 weeks, 58% at 20 mg every 2 weeks, 72% at 60 mg every 4 weeks, and 80% at 20 mg every week, as compared with 6% with placebo (P values for the comparison with placebo ranged from 0.003 to <0.001). There were no significant differences between any APO(a)-LRx dose and placebo with respect to platelet counts, liver and renal measures, or influenza-like symptoms. The most common adverse events were injection-site reactions. CONCLUSIONS: APO(a)-LRx reduced lipoprotein(a) levels in a dose-dependent manner in patients who had elevated lipoprotein(a) levels and established cardiovascular disease. (Funded by Akcea Therapeutics; ClinicalTrials.gov number, NCT03070782.)."},{"id":"7dc95e909985","type":"article","url":"https://hartvaat.nl/2020/01/14/dapagliflozine-en-symptomen-functie-en-qol-bij-hfref-dapa-hf/","title":"Dapagliflozine en symptomen, functie en QoL bij HFrEF: DAPA-HF","title_en":"Effects of Dapagliflozin on Symptoms, Function, and Quality of Life in Patients With Heart Failure and Reduced Ejection Fraction: Results From the DAPA-HF Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["dapa-hf"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.119.044138","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.119.044138","authors":["Mikhail N Kosiborod","Pardeep S Jhund","Kieran F Docherty","Mirta Diez","Mark C Petrie","Subodh Verma","Jose C Nicolau","Béla Merkely","Masafumi Kitakaze","David L DeMets","Silvio E Inzucchi","Lars Køber","Felipe A Martinez","Piotr Ponikowski","Marc S Sabatine","Scott D Solomon","Olof Bengtsson","Daniel Lindholm","Anna Niklasson","Mikaela Sjöstrand","Anna Maria Langkilde","John J V McMurray"],"significance":8,"published":"2020-01-14","source_date":"2020-01-14","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"This DAPA-HF analysis showed that dapagliflozin significantly improved heart failure symptoms, physical function, and quality of life in patients with HFrEF within the first few weeks of treatment. The patient-reported outcomes complemented the hard clinical endpoints.","created":"2026-07-03T10:28:22Z","updated":"2026-07-03T13:27:33Z","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":"DAPA-HF analyse naar het effect van dapagliflozine op symptomen, functionele status en kwaliteit van leven bij HFrEF. Patiëntgerapporteerde voordelen.","abstract_original":"BACKGROUND: Goals of management in patients with heart failure and reduced ejection fraction include reducing death and hospitalizations, and improving health status (symptoms, physical function, and quality of life). In the DAPA-HF trial (Dapagliflozin and Prevention of Adverse-Outcomes in Heart Failure), sodium-glucose cotransporter-2 inhibitor, dapagliflozin, reduced death and hospitalizations, and improved symptoms in patients with heart failure and reduced ejection fraction. In this analysis, we examine the effects of dapagliflozin on a broad range of health status outcomes, using the Kansas City Cardiomyopathy Questionnaire (KCCQ). METHODS: KCCQ was evaluated at randomization, 4 and 8 months. Patients were divided by baseline KCCQ total symptom score (TSS); Cox proportional hazards models examined the effects of dapagliflozin on clinical events across these subgroups. We also evaluated the effects of dapagliflozin on KCCQ-TSS, clinical summary score, and overall summary score. Responder analyses were performed to compare proportions of dapagliflozin versus placebo-treated patients with clinically meaningful changes in KCCQ at 8 months. RESULTS: A total of 4443 patients had available KCCQ at baseline (median KCCQ-TSS, 77.1 [interquartile range, 58.3-91.7]). The effects of dapagliflozin vs placebo on reducing cardiovascular death or worsening heart failure were consistent across the range of KCCQ-TSS (lowest to highest tertile: hazard ratio, 0.70 [95% CI, 0.57-0.86]; hazard ratio, 0.77 [95% CI, 0.61-0.98]; hazard ratio, 0.62 [95% CI, 0.46-0.83]; P for heterogeneity=0.52). Patients treated with dapagliflozin had greater improvement in mean KCCQ-TSS, clinical summary score, and overall summary score at 8 months (2.8, 2.5 and 2.3 points higher versus placebo; P<0.0001 for all). Fewer patients treated with dapagliflozin had a deterioration in KCCQ-TSS (odds ratio, 0.84 [95% CI, 0.78-0.90]; P<0.0001); and more patients had at least small, moderate, and large improvements (odds ratio, 1.15 [95% CI, 1.08-1.23]; odds ratio, 1.15 [95% CI, 1.08-1.22]; odds ratio, 1.14 [95% CI, 1.07-1.22]; number needed to treat=14, 15, and 18, respectively; P<0.0001 for all; results consistent for KCCQ clinical summary score and overall summary score). CONCLUSIONS: Dapagliflozin reduced cardiovascular death and worsening heart failure across the range of baseline KCCQ, and improved symptoms, physical function, and quality of life in patients with heart failure and reduced ejection fraction. Furthermore, dapagliflozin increased the proportion of patients experiencing at least small, moderate, and large improvements in health status; these effects were clinically important. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03036124."},{"id":"99d9a861f44a","type":"article","url":"https://hartvaat.nl/2020/01/14/dapagliflozine-bij-hfref-naar-leeftijd-dapa-hf-inzichten/","title":"Dapagliflozine bij HFrEF naar leeftijd: DAPA-HF-inzichten","title_en":"Efficacy and Safety of Dapagliflozin in Heart Failure With Reduced Ejection Fraction According to Age: Insights From DAPA-HF.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["dapa-hf"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.119.044133","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.119.044133","authors":["Felipe A Martinez","Matteo Serenelli","Jose C Nicolau","Mark C Petrie","Chern-En Chiang","Sergey Tereshchenko","Scott D Solomon","Silvio E Inzucchi","Lars Køber","Mikhail N Kosiborod","Piotr Ponikowski","Marc S Sabatine","David L DeMets","Monika Dutkiewicz-Piasecka","Olof Bengtsson","Mikaela Sjöstrand","Anna Maria Langkilde","Pardeep S Jhund","John J V McMurray"],"significance":8,"published":"2020-01-14","source_date":"2020-01-14","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/"],"congress":"","summary_en":"This DAPA-HF age subanalysis confirmed that dapagliflozin reduced heart failure events and cardiovascular death consistently across all age groups in patients with HFrEF, including those aged 75 and older. The safety profile was also maintained in elderly patients.","created":"2026-07-03T10:28:22Z","updated":"2026-07-03T13:27:32Z","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":"DAPA-HF subanalyse naar werkzaamheid en veiligheid van dapagliflozine bij HFrEF gestratificeerd naar leeftijd. Consistent voordeel ongeacht leeftijd.","abstract_original":"BACKGROUND: The DAPA-HF trial (Dapagliflozin and Prevention of Adverse-Outcomes in Heart Failure) showed that dapagliflozin added to other guideline-recommended therapies reduced the risk of mortality and heart failure hospitalization and improved symptoms in patients with heart failure and reduced ejection fraction. We examined the effects of dapagliflozin according to age, given potential concerns about the efficacy and safety of therapies in the elderly. METHODS: Patients in New York Heart Association functional class II or greater with a left ventricular ejection fraction ≤40% and a modest elevation of NT-proBNP (N-terminal pro-B-type natriuretic peptide) were eligible. Key exclusion criteria included systolic blood pressure <95 mm Hg and estimated glomerular filtration rate <30 mL·min-1·1.73 m-2. The primary outcome was the composite of an episode of worsening heart failure (heart failure hospitalization or urgent heart failure visit) or cardiovascular death, whichever occurred first. RESULTS: A total of 4744 patients 22 to 94 years of age (mean age, 66.3 [SD 10.9] years) were randomized: 636 patients (13.4%) were <55 years of age, 1242 (26.2%) were 55 to 64 years of age, 1717 (36.2%) were 65 to 74 years of age, and 1149 (24.2%) were ≥75 years of age. The rate of the primary outcome (per 100 person-years, placebo arm) in each age group was 13.6 (95% CI, 10.4-17.9), 15.7 (95% CI, 13.2-18.7), 15.1 (95% CI, 13.1-17.5), and 18.0 (95% CI, 15.2-21.4) with corresponding dapagliflozin/placebo hazard ratios of 0.87 (95% CI, 0.60-1.28), 0.71 (95% CI, 0.55-0.93), 0.76 (95% CI, 0.61-0.95), and 0.68 (95% CI, 0.53-0.88; P for interaction=0.76). Consistent benefits were observed for the components of the primary outcome, all-cause mortality, and symptoms. Although adverse events and study drug discontinuation increased with age, neither was significantly more common with dapagliflozin in any age group. CONCLUSIONS: Dapagliflozin reduced the risk of death and worsening heart failure and improved symptoms across the broad spectrum of age studied in DAPA-HF. There was no significant imbalance in tolerability or safety events between dapagliflozin and placebo, even in elderly individuals. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03036124."},{"id":"3bd33ac92f1f","type":"article","url":"https://hartvaat.nl/2020/01/09/verminderde-klepbeweging-na-tavr-nejm/","title":"Verminderde klepbeweging na TAVR: NEJM","title_en":"Reduced Leaflet Motion after Transcatheter Aortic-Valve Replacement.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1911426","source_url":"https://doi.org/10.1056/NEJMoa1911426","authors":["Ole De Backer","George D Dangas","Hasan Jilaihawi","Jonathon A Leipsic","Christian J Terkelsen","Raj Makkar","Annapoorna S Kini","Karsten T Veien","Mohamed Abdel-Wahab","Won-Keun Kim","Prakash Balan","Nicolas Van Mieghem","Ole N Mathiassen","Raban V Jeger","Martin Arnold","Roxana Mehran","Ana H C Guimarães","Bjarne L Nørgaard","Klaus F Kofoed","Philipp Blanke","Stephan Windecker","Lars Søndergaard"],"significance":7,"published":"2020-01-09","source_date":"2020-01-09","image":"","kennis":[],"congress":"","summary_en":"This NEJM analysis characterized reduced leaflet motion and subclinical valve thrombosis after TAVR detected by 4D CT, establishing the prevalence and clinical significance of this radiological finding and its implications for post-procedural anticoagulation.","created":"2026-07-03T10:28:22Z","updated":"2026-07-03T13:27:32Z","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":"NEJM analyse van subklinische kleptrombose (verminderde klepbeweging) na TAVR. Klinische betekenis van radiologische bevindingen.","abstract_original":"BACKGROUND: Subclinical leaflet thickening and reduced leaflet motion of bioprosthetic aortic valves have been documented by four-dimensional computed tomography (CT). Whether anticoagulation can reduce these phenomena after transcatheter aortic-valve replacement (TAVR) is not known. METHODS: In a substudy of a large randomized trial, we randomly assigned patients who had undergone successful TAVR and who did not have an indication for long-term anticoagulation to a rivaroxaban-based antithrombotic strategy (rivaroxaban [10 mg] plus aspirin [75 to 100 mg] once daily) or an antiplatelet-based strategy (clopidogrel [75 mg] plus aspirin [75 to 100 mg] once daily). Patients underwent evaluation by four-dimensional CT at a mean (±SD) of 90±15 days after randomization. The primary end point was the percentage of patients with at least one prosthetic valve leaflet with grade 3 or higher motion reduction (i.e., involving >50% of the leaflet). Leaflet thickening was also assessed. RESULTS: A total of 231 patients were enrolled. At least one prosthetic valve leaflet with grade 3 or higher motion reduction was found in 2 of 97 patients (2.1%) who had scans that could be evaluated in the rivaroxaban group, as compared with 11 of 101 (10.9%) in the antiplatelet group (difference, -8.8 percentage points; 95% confidence interval [CI], -16.5 to -1.9; P = 0.01). Thickening of at least one leaflet was observed in 12 of 97 patients (12.4%) in the rivaroxaban group and in 33 of 102 (32.4%) in the antiplatelet group (difference, -20.0 percentage points; 95% CI, -30.9 to -8.5). In the main trial, the risk of death or thromboembolic events and the risk of life-threatening, disabling, or major bleeding were higher with rivaroxaban (hazard ratios of 1.35 and 1.50, respectively). CONCLUSIONS: In a substudy of a trial involving patients without an indication for long-term anticoagulation who had undergone successful TAVR, a rivaroxaban-based antithrombotic strategy was more effective than an antiplatelet-based strategy in preventing subclinical leaflet-motion abnormalities. However, in the main trial, the rivaroxaban-based strategy was associated with a higher risk of death or thromboembolic complications and a higher risk of bleeding than the antiplatelet-based strategy. (Funded by Bayer; GALILEO-4D ClinicalTrials.gov number, NCT02833948.)."},{"id":"bc297c2bd74e","type":"article","url":"https://hartvaat.nl/2020/01/09/rivaroxaban-na-tavr-nejm-galileo/","title":"Rivaroxaban na TAVR: NEJM GALILEO","title_en":"A Controlled Trial of Rivaroxaban after Transcatheter Aortic-Valve Replacement.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1911425","source_url":"https://doi.org/10.1056/NEJMoa1911425","authors":["George D Dangas","Jan G P Tijssen","Jochen Wöhrle","Lars Søndergaard","Martine Gilard","Helge Möllmann","Raj R Makkar","Howard C Herrmann","Gennaro Giustino","Stephan Baldus","Ole De Backer","Ana H C Guimarães","Lars Gullestad","Annapoorna Kini","Dirk von Lewinski","Michael Mack","Raúl Moreno","Ulrich Schäfer","Julia Seeger","Didier Tchétché","Karen Thomitzek","Marco Valgimigli","Pascal Vranckx","Robert C Welsh","Peter Wildgoose","Albert A Volkl","Ana Zazula","Ronald G M van Amsterdam","Roxana Mehran","Stephan Windecker"],"significance":9,"published":"2020-01-09","source_date":"2020-01-09","image":"","kennis":[],"congress":"","summary_en":"The GALILEO trial demonstrated that rivaroxaban-based antithrombotic therapy after TAVR increased the risk of death or thromboembolic events and bleeding compared with antiplatelet therapy alone. The trial was stopped early for harm, establishing antiplatelet therapy as the preferred post-TAVR strategy in patients without other anticoagulation indications.","created":"2026-07-03T10:28:22Z","updated":"2026-07-03T13:27:32Z","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":"NEJM GALILEO-trial die rivaroxaban vergeleek met antiplaatjestherapie na TAVR. Rivaroxaban was inferieur — veranderde het post-TAVR beleid naar antiplaatjes.","abstract_original":"BACKGROUND: Whether the direct factor Xa inhibitor rivaroxaban can prevent thromboembolic events after transcatheter aortic-valve replacement (TAVR) is unclear. METHODS: We randomly assigned 1644 patients without an established indication for oral anticoagulation after successful TAVR to receive rivaroxaban at a dose of 10 mg daily (with aspirin at a dose of 75 to 100 mg daily for the first 3 months) (rivaroxaban group) or aspirin at a dose of 75 to 100 mg daily (with clopidogrel at a dose of 75 mg daily for the first 3 months) (antiplatelet group). The primary efficacy outcome was the composite of death or thromboembolic events. The primary safety outcome was major, disabling, or life-threatening bleeding. The trial was terminated prematurely by the data and safety monitoring board because of safety concerns. RESULTS: After a median of 17 months, death or a first thromboembolic event (intention-to-treat analysis) had occurred in 105 patients in the rivaroxaban group and in 78 patients in the antiplatelet group (incidence rates, 9.8 and 7.2 per 100 person-years, respectively; hazard ratio with rivaroxaban, 1.35; 95% confidence interval [CI], 1.01 to 1.81; P = 0.04). Major, disabling, or life-threatening bleeding (intention-to-treat analysis) had occurred in 46 and 31 patients, respectively (4.3 and 2.8 per 100 person-years; hazard ratio, 1.50; 95% CI, 0.95 to 2.37; P = 0.08). A total of 64 deaths occurred in the rivaroxaban group and 38 in the antiplatelet group (5.8 and 3.4 per 100 person-years, respectively; hazard ratio, 1.69; 95% CI, 1.13 to 2.53). CONCLUSIONS: In patients without an established indication for oral anticoagulation after successful TAVR, a treatment strategy including rivaroxaban at a dose of 10 mg daily was associated with a higher risk of death or thromboembolic complications and a higher risk of bleeding than an antiplatelet-based strategy. (Funded by Bayer and Janssen Pharmaceuticals; GALILEO ClinicalTrials.gov number, NCT02556203.)."},{"id":"278f1193b30a","type":"article","url":"https://hartvaat.nl/2020/01/07/nsaid-s-en-oac-bij-af-aristotle-analyse/","title":"NSAID's en OAC bij AF: ARISTOTLE-analyse","title_en":"Patients With Atrial Fibrillation Taking Nonsteroidal Anti-Inflammatory Drugs and Oral Anticoagulants in the ARISTOTLE Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","huisarts"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.119.041296","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.119.041296","authors":["Frederik Dalgaard","Hillary Mulder","Daniel M Wojdyla","Renato D Lopes","Claes Held","John H Alexander","Raffaele De Caterina","Jeffrey B Washam","Elaine M Hylek","David A Garcia","Bernard J Gersh","Lars Wallentin","Christopher B Granger","Sana M Al-Khatib"],"significance":7,"published":"2020-01-07","source_date":"2020-01-07","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-en-beroerte/","https://hartvaat.nl/kennis/antistolling/doacs-overzicht/"],"congress":"","summary_en":"This ARISTOTLE analysis confirmed that concomitant NSAID use in AF patients on oral anticoagulants significantly increases bleeding risk, reinforcing the importance of minimizing NSAID exposure during anticoagulation therapy.","created":"2026-07-03T10:28:21Z","updated":"2026-07-03T13:27:32Z","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":"ARISTOTLE analyse naar de risico's van gelijktijdig gebruik van NSAID's en orale anticoagulantia bij AF-patiënten.","abstract_original":"BACKGROUND: The use of nonsteroidal anti-inflammatory drugs (NSAIDs) with oral anticoagulants has been associated with an increased risk of bleeding. We investigated the risk of bleeding and major cardiovascular outcomes in patients with atrial fibrillation taking NSAIDs and apixaban or warfarin. METHODS: The ARISTOTLE trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation; n=18 201) compared apixaban with warfarin in patients with atrial fibrillation at an increased risk of stroke. Patients in ARISTOTLE without severe renal (creatine clearance ≤30 mL/min) or liver disease were included in this analysis (n=17 423). NSAID use at baseline, NSAID use during the trial (incident NSAID use), and never users were described. The primary outcome was major bleeding. Secondary outcomes included clinically relevant nonmajor bleeding, gastrointestinal bleeding, heart failure hospitalization, stroke or systemic embolism, and all-cause mortality. NSAID use during the trial, and the interaction between randomized treatment, was analyzed using time-dependent Cox proportional hazards models. RESULTS: Those with baseline NSAID use (n=832 [4.8%]), incident NSAID use (n=2185 [13.2%]), and never users were similar in median age (age [25th, 75th]; 70 [64, 77] versus 70 [63, 75] versus 70 [62, 76]). Those with NSAID use at baseline and incident NSAID use were more likely to have a history of bleeding than never users (24.5% versus 21.0% versus 15.6%, respectively). During a median follow-up (25th, 75th) of 1.8 (1.4, 2.3) years and when excluding those taking NSAID at baseline, we found that incident NSAID use was associated with an increased risk of major bleeding (hazard ratio [HR], 1.61 [95% CI, 1.11-2.33]) and clinically relevant nonmajor bleeding (HR, 1.70 [95% CI, 1.16-2.48]), but not gastrointestinal bleeding. No significant interaction was observed between NSAID use and randomized treatment for any outcome. CONCLUSIONS: A substantial number of patients in the ARISTOTLE trial took NSAIDs. Incident NSAID use was associated with major and clinically relevant nonmajor bleeding, but not with gastrointestinal bleeding. The safety and efficacy of apixaban versus warfarin appeared not significantly to be altered by NSAID use. This study warrants more investigation of the effect of NSAIDs on the outcomes of patients treated with apixaban. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00412984."},{"id":"7a4466542914","type":"article","url":"https://hartvaat.nl/2020/01/07/hypoglykemie-cv-uitkomsten-en-empagliflozine-empa-reg-outcome/","title":"Hypoglykemie, CV-uitkomsten en empagliflozine: EMPA-REG OUTCOME","title_en":"Relationship between hypoglycaemia, cardiovascular outcomes, and empagliflozin treatment in the EMPA-REG OUTCOME® trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehz621","source_url":"https://doi.org/10.1093/eurheartj/ehz621","authors":["David Fitchett","Silvio E Inzucchi","Christoph Wanner","Michaela Mattheus","Jyothis T George","Ola Vedin","Bernard Zinman","Odd Erik Johansen"],"significance":6,"published":"2020-01-07","source_date":"2020-01-07","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/cardiometabool/cardiovasculaire-trials-diabetes/"],"congress":"","summary_en":"This EMPA-REG OUTCOME analysis showed that empagliflozin does not increase hypoglycemia risk and that the cardiovascular benefit is maintained regardless of baseline hypoglycemia history, addressing a safety concern for SGLT2 inhibitors.","created":"2026-07-03T10:28:21Z","updated":"2026-07-03T13:27:32Z","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":"EMPA-REG OUTCOME analyse naar de relatie tussen hypoglykemie, cardiovasculaire uitkomsten en empagliflozine.","abstract_original":"AIMS: Hypoglycaemia, in patients with Type 2 diabetes (T2D) is associated with an increased risk for cardiovascular (CV) events. In EMPA-REG OUTCOME, the sodium-glucose co-transporter-2 inhibitor empagliflozin reduced the risk of CV death by 38% and heart failure hospitalization (HHF) by 35%, while decreasing glycated haemoglobin (HbA1c) without increasing hypoglycaemia. We investigated CV outcomes in patients with hypoglycaemia during the trial and the impact of hypoglycaemia on the treatment effect of empagliflozin. METHODS AND RESULTS: About 7020 patients with T2D (HbA1c 7-10%) were treated with empagliflozin 10 or 25 mg, or placebo and followed for median 3.1 years. The relationship between on-trial hypoglycaemia and CV outcomes, and effects of empagliflozin on outcomes by incident hypoglycaemia [HYPO-broad: symptomatic hypoglycaemia with plasma glucose (PG) ≤70 mg/dL, any hypoglycaemia with PG <54 mg/dL, or severe hypoglycaemia, and HYPO-strict: hypoglycaemia with PG <54 mg/dL, or severe hypoglycaemia] was investigated using adjusted Cox regression models with time-varying covariates for hypoglycaemia and interaction with treatment. HYPO-broad occurred in 28% in each group and HYPO-strict in 19%. In the placebo group, hypoglycaemia was associated with an increased risk of HHF for both HYPO-broad [hazard ratio (HR, 95% confidence interval, CI) 1.91 (1.25-2.93)] and HYPO-strict [1.72 (1.06-2.78)]. HYPO-broad (but not HYPO-strict) was associated with an increased risk of myocardial infarction (MI) [HR 1.56 (1.06-2.29)]. Empagliflozin improved CV outcomes, regardless of occurrence of hypoglycaemia (P-for interactions >0.05). CONCLUSION: In this post hoc exploratory analysis, hypoglycaemia was associated with an increased risk of HHF and MI. Hypoglycaemia risk was not increased with empagliflozin and incident hypoglycaemia did not attenuate its cardio-protective effects."},{"id":"1d8515680cfe","type":"article","url":"https://hartvaat.nl/2020/01/02/alcoholonthouding-bij-drinkers-met-af-nejm-gerandomiseerde-trial/","title":"Alcoholonthouding bij drinkers met AF: NEJM gerandomiseerde trial","title_en":"Alcohol Abstinence in Drinkers with Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":["alcoholgebruik"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1817591","source_url":"https://doi.org/10.1056/NEJMoa1817591","authors":["Aleksandr Voskoboinik","Jonathan M Kalman","Anurika De Silva","Thomas Nicholls","Benedict Costello","Shane Nanayakkara","Sandeep Prabhu","Dion Stub","Sonia Azzopardi","Donna Vizi","Geoffrey Wong","Chrishan Nalliah","Hariharan Sugumar","Michael Wong","Emily Kotschet","David Kaye","Andrew J Taylor","Peter M Kistler"],"significance":9,"published":"2020-01-02","source_date":"2020-01-02","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This randomized trial showed that abstinence from alcohol in regular drinkers with atrial fibrillation significantly reduced AF recurrence and AF burden. The study provided the first high-quality evidence that alcohol cessation is a modifiable lifestyle intervention for AF management.","created":"2026-07-03T10:28:21Z","updated":"2026-07-03T13:27:32Z","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":"NEJM gerandomiseerde trial die aantoonde dat alcoholonthouding het recidief van AF significant vermindert bij regelmatige drinkers. Leefstijlinterventie als AF-therapie.","abstract_original":"BACKGROUND: Excessive alcohol consumption is associated with incident atrial fibrillation and adverse atrial remodeling; however, the effect of abstinence from alcohol on secondary prevention of atrial fibrillation is unclear. METHODS: We conducted a multicenter, prospective, open-label, randomized, controlled trial at six hospitals in Australia. Adults who consumed 10 or more standard drinks (with 1 standard drink containing approximately 12 g of pure alcohol) per week and who had paroxysmal or persistent atrial fibrillation in sinus rhythm at baseline were randomly assigned in a 1:1 ratio to either abstain from alcohol or continue their usual alcohol consumption. The two primary end points were freedom from recurrence of atrial fibrillation (after a 2-week \"blanking period\") and total atrial fibrillation burden (proportion of time in atrial fibrillation) during 6 months of follow-up. RESULTS: Of 140 patients who underwent randomization (85% men; mean [±SD] age, 62±9 years), 70 were assigned to the abstinence group and 70 to the control group. Patients in the abstinence group reduced their alcohol intake from 16.8±7.7 to 2.1±3.7 standard drinks per week (a reduction of 87.5%), and patients in the control group reduced their alcohol intake from 16.4±6.9 to 13.2±6.5 drinks per week (a reduction of 19.5%). After a 2-week blanking period, atrial fibrillation recurred in 37 of 70 patients (53%) in the abstinence group and in 51 of 70 patients (73%) in the control group. The abstinence group had a longer period before recurrence of atrial fibrillation than the control group (hazard ratio, 0.55; 95% confidence interval, 0.36 to 0.84; P = 0.005). The atrial fibrillation burden over 6 months of follow-up was significantly lower in the abstinence group than in the control group (median percentage of time in atrial fibrillation, 0.5% [interquartile range, 0.0 to 3.0] vs. 1.2% [interquartile range, 0.0 to 10.3]; P = 0.01). CONCLUSIONS: Abstinence from alcohol reduced arrhythmia recurrences in regular drinkers with atrial fibrillation. (Funded by the Government of Victoria Operational Infrastructure Support Program and others; Australian New Zealand Clinical Trials Registry number, ACTRN12616000256471.)."},{"id":"4c76a1b4aa34","type":"article","url":"https://hartvaat.nl/2020/01/02/vergelijking-van-twee-ldl-streefwaarden-na-ischemisch-cva-nejm-tst/","title":"Vergelijking van twee LDL-streefwaarden na ischemisch CVA: NEJM TST","title_en":"A Comparison of Two LDL Cholesterol Targets after Ischemic Stroke.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts","internist"],"tags":["dyslipidemie","ezetimibe","ldl-cholesterol","lipidenverlaging"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1910355","source_url":"https://doi.org/10.1056/NEJMoa1910355","authors":["Pierre Amarenco","Jong S Kim","Julien Labreuche","Hugo Charles","Jérémie Abtan","Yannick Béjot","Lucie Cabrejo","Jae-Kwan Cha","Grégory Ducrocq","Maurice Giroud","Celine Guidoux","Cristina Hobeanu","Yong-Jae Kim","Bertrand Lapergue","Philippa C Lavallée","Byung-Chul Lee","Kyung-Bok Lee","Didier Leys","Marie-Hélène Mahagne","Elena Meseguer","Norbert Nighoghossian","Fernando Pico","Yves Samson","Igor Sibon","P Gabriel Steg","Sang-Min Sung","Pierre-Jean Touboul","Emmanuel Touzé","Olivier Varenne","Éric Vicaut","Nessima Yelles","Eric Bruckert"],"significance":9,"published":"2020-01-02","source_date":"2020-01-02","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/","https://hartvaat.nl/kennis/lipiden/omega3-vetzuren-cardiologie/"],"congress":"","summary_en":"The TST trial demonstrated that targeting LDL cholesterol below 70 mg/dL with statin therapy after ischemic stroke significantly reduced subsequent cardiovascular events compared with a higher target of 90-110 mg/dL. The results extended the 'lower is better' principle to secondary prevention after cerebrovascular events.","created":"2026-07-03T10:28:21Z","updated":"2026-07-03T13:27:32Z","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":"NEJM TST-trial die twee LDL-cholesterolstreefwaarden vergeleek na ischemisch CVA. Lagere streefwaarde (<70 vs 90-110 mg/dL) vermindert CV-events. Bewijs voor intensieve lipidenverlaging na beroerte.","abstract_original":"BACKGROUND: The use of intensive lipid-lowering therapy by means of statin medications is recommended after transient ischemic attack (TIA) and ischemic stroke of atherosclerotic origin. The target level for low-density lipoprotein (LDL) cholesterol to reduce cardiovascular events after stroke has not been well studied. METHODS: In this parallel-group trial conducted in France and South Korea, we randomly assigned patients with ischemic stroke in the previous 3 months or a TIA within the previous 15 days to a target LDL cholesterol level of less than 70 mg per deciliter (1.8 mmol per liter) (lower-target group) or to a target range of 90 mg to 110 mg per deciliter (2.3 to 2.8 mmol per liter) (higher-target group). All the patients had evidence of cerebrovascular or coronary-artery atherosclerosis and received a statin, ezetimibe, or both. The composite primary end point of major cardiovascular events included ischemic stroke, myocardial infarction, new symptoms leading to urgent coronary or carotid revascularization, or death from cardiovascular causes. RESULTS: A total of 2860 patients were enrolled and followed for a median of 3.5 years; 1430 were assigned to each LDL cholesterol target group. The mean LDL cholesterol level at baseline was 135 mg per deciliter (3.5 mmol per liter), and the mean achieved LDL cholesterol level was 65 mg per deciliter (1.7 mmol per liter) in the lower-target group and 96 mg per deciliter (2.5 mmol per liter) in the higher-target group. The trial was stopped for administrative reasons after 277 of an anticipated 385 end-point events had occurred. The composite primary end point occurred in 121 patients (8.5%) in the lower-target group and in 156 (10.9%) in the higher-target group (adjusted hazard ratio, 0.78; 95% confidence interval, 0.61 to 0.98; P = 0.04). The incidence of intracranial hemorrhage and newly diagnosed diabetes did not differ significantly between the two groups. CONCLUSIONS: After an ischemic stroke or TIA with evidence of atherosclerosis, patients who had a target LDL cholesterol level of less than 70 mg per deciliter had a lower risk of subsequent cardiovascular events than those who had a target range of 90 mg to 110 mg per deciliter. (Funded by the French Ministry of Health and others; Treat Stroke to Target ClinicalTrials.gov number, NCT01252875.)."},{"id":"e0f36c4f9aa0","type":"article","url":"https://hartvaat.nl/2020/01/01/stapsgewijze-af-screening-met-nt-probnp-strokestop-ii-resultaten/","title":"Stapsgewijze AF-screening met NT-proBNP: STROKESTOP II resultaten","title_en":"Stepwise mass screening for atrial fibrillation using N-terminal B-type natriuretic peptide: the STROKESTOP II study.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":["nt-probnp","primaire-preventie"],"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/euz255","source_url":"https://doi.org/10.1093/europace/euz255","authors":["Katrin Kemp Gudmundsdottir","Tove Fredriksson","Emma Svennberg","Faris Al-Khalili","Leif Friberg","Viveka Frykman","Ziad Hijazi","Mårten Rosenqvist","Johan Engdahl"],"significance":7,"published":"2020-01-01","source_date":"2020-01-01","image":"","kennis":[],"congress":"","summary_en":"The STROKESTOP II study tested a stepwise screening approach using NT-proBNP as a pre-selection tool for AF screening, demonstrating that biomarker-guided selection can improve the efficiency of population-level atrial fibrillation detection.","created":"2026-07-03T10:28:21Z","updated":"2026-07-03T13:27:32Z","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":"STROKESTOP II resultaten van stapsgewijze massascreening op AF met NT-proBNP als voorselectie. Eerste resultaten van dit innovatieve screeningsontwerp.","abstract_original":"AIMS: To study the prevalence of unknown atrial fibrillation (AF) in a high-risk, 75/76-year-old, population using N-terminal B-type natriuretic peptide (NT-proBNP) and handheld electrocardiogram (ECG) recordings in a stepwise screening procedure. METHODS AND RESULTS: The STROKESTOP II study is a population-based cohort study in which all 75/76-year-old in the Stockholm region (n = 28 712) were randomized 1:1 to be invited to an AF screening programme or to serve as the control group. Participants without known AF had NT-proBNP analysed and were stratified into low-risk (NT-proBNP <125 ng/L) and high-risk (NT-proBNP ≥125 ng/L) groups. The high-risk group was offered extended ECG-screening, whereas the low-risk group performed only one single-lead ECG recording. In total, 6868 individuals accepted the screening invitation of which 6315 (91.9%) did not have previously known AF. New AF was detected in 2.6% [95% confidence interval (CI) 2.2-3.0] of all participants without previous AF. In the high-risk group (n = 3766/6315, 59.6%), AF was diagnosed in 4.4% (95% CI 3.7-5.1) of the participants. Out of these, 18% had AF on their index-ECG. In the low-risk group, one participant was diagnosed with AF on index-ECG. The screening procedure resulted in an increase in known prevalence from 8.1% to 10.5% among participants. Oral anticoagulant treatment was initiated in 94.5% of the participants with newly diagnosed AF. CONCLUSION: N-terminal B-type natriuretic peptide-stratified systematic screening for AF identified 4.4% of the high-risk participants with new AF. Oral anticoagulant treatment initiation was well accepted in the group diagnosed with new AF."},{"id":"0f019a1fdc68","type":"article","url":"https://hartvaat.nl/2020/01/01/p2y12-copay-reductie-en-therapietrouw-aan-andere-secundaire-preventiemiddelen/","title":"P2Y12-copay reductie en therapietrouw aan andere secundaire preventiemiddelen","title_en":"Association of a P2Y12 Inhibitor Copayment Reduction Intervention With Persistence and Adherence With Other Secondary Prevention Medications: A Post Hoc Analysis of the ARTEMIS Cluster-Randomized Clinical Trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2019.4408","source_url":"https://doi.org/10.1001/jamacardio.2019.4408","authors":["Alexander C Fanaroff","Eric D Peterson","Lisa A Kaltenbach","Christopher P Cannon","Niteesh K Choudhry","Timothy D Henry","Kevin J Anstrom","David J Cohen","Eileen Fonseca","Naeem D Khan","Gregg C Fonarow","Tracy Y Wang"],"significance":5,"published":"2020-01-01","source_date":"2020-01-01","image":"","kennis":[],"congress":"","summary_en":"This analysis showed that P2Y12 inhibitor copayment reduction not only improves antiplatelet adherence but also increases persistence with other secondary prevention medications after MI.","created":"2026-07-03T10:28:21Z","updated":"2026-07-03T13:27:32Z","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":"JAMA Cardiology analyse naar het effect van P2Y12-copayreductie op de trouw aan andere secundaire preventiemedicatie.","abstract_original":"IMPORTANCE: The Affordability and Real-World Antiplatelet Treatment Effectiveness After Myocardial Infarction Study (ARTEMIS) cluster-randomized trial found that copayment reduction for P2Y12 inhibitors improved 1-year patient persistence in taking that medication. OBJECTIVE: To assess whether providing copayment reduction for P2Y12 inhibitors increases patient persistence in taking other secondary prevention cardiovascular medications. DESIGN, SETTING, AND PARTICIPANTS: This post hoc analysis of the ARTEMIS trial includes data from 287 hospitals that enrolled patients between June 2015 and September 2016. Patients hospitalized with acute myocardial infarction were included. Data analysis occurred from May 2018 through August 2019. INTERVENTIONS: Hospitals randomized to the intervention provided patients vouchers that waived copayments for P2Y12 inhibitors fills for 1 year. Hospitals randomized to usual care did not provide study vouchers. MAIN OUTCOMES AND MEASURES: Persistence in taking β-blocker, statin, and angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker medications at 1 year, defined as the absence of a gap in medication supply of 30 or more days by pharmacy fill data in the intervention-arm (intent-to-treat) population. RESULTS: A total of 131 hospitals (with 5109 patients) were randomized to the intervention, and 156 hospitals (with 3264 patients) randomized to the control group. Patients discharged from intervention hospitals had higher persistence in taking statins (2247 [46.1%] vs 1300 [41.9%]; adjusted odds ratio, 1.11 [95% CI, 1.00-1.24]), and β-blockers (2235 [47.6%] vs 1277 [42.5%]; odds ratio, 1.23 [95% CI, 1.10-1.38]), although the association was smaller than that seen for P2Y12 inhibitors (odds ratio, 1.47 [95% CI, 1.29-1.66]). Persistence in taking angiotensin-converting enzyme inhibitors or angiotensin II-receptor blockers were also numerically higher among patients in the intervention arm than in the usual-care arm, but this was not significant after risk adjustment (1520 [43.9%] vs 847 [40.5%]; adjusted odds ratio, 1.10 [95% CI, 0.97-1.24]). Patients in the intervention arm reported greater financial burden associated with medication cost than the patients in the usual-care arm at baseline, but these differences were no longer significant at 1 year. CONCLUSIONS AND RELEVANCE: Reducing patient copayments for 1 medication class increased persistence not only to that therapy class but may also have modestly increased persistence to other post-myocardial infarction secondary prevention medications. These findings have important implications for the clinical utility and cost-effectiveness of medication cost-assistance programs. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02406677."},{"id":"2ddd211b407e","type":"article","url":"https://hartvaat.nl/2020/01/01/sekseverschillen-bij-pci-global-leaders-subanalyse/","title":"Sekseverschillen bij PCI: GLOBAL LEADERS subanalyse","title_en":"Association of Sex With Outcomes in Patients Undergoing Percutaneous Coronary Intervention: A Subgroup Analysis of the GLOBAL LEADERS Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2019.4296","source_url":"https://doi.org/10.1001/jamacardio.2019.4296","authors":["Ply Chichareon","Rodrigo Modolo","Laura Kerkmeijer","Mariusz Tomaniak","Norihiro Kogame","Kuniaki Takahashi","Chun-Chin Chang","Hidenori Komiyama","Tiziano Moccetti","Suneel Talwar","Antonio Colombo","Luc Maillard","Peter Barlis","Joanna Wykrzykowska","Jan J Piek","Scot Garg","Christian Hamm","Philippe Gabriel Steg","Peter Jüni","Marco Valgimigli","Stephan Windecker","Yoshinobu Onuma","Roxana Mehran","Patrick W Serruys"],"significance":5,"published":"2020-01-01","source_date":"2020-01-01","image":"","kennis":[],"congress":"","summary_en":"This GLOBAL LEADERS subanalysis showed sex-related differences in outcomes after PCI, with women experiencing more bleeding despite similar ischemic event rates, informing sex-aware antiplatelet prescribing.","created":"2026-07-03T10:28:21Z","updated":"2026-07-03T13:27:31Z","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":"GLOBAL LEADERS subanalyse naar seksegerelateerde uitkomstverschillen bij PCI.","abstract_original":"IMPORTANCE: Women experience worse ischemic and bleeding outcomes after percutaneous coronary intervention (PCI). OBJECTIVES: To assess the association of sex with patient outcomes at 2 years after contemporary PCI and with the efficacy and safety of 2 antiplatelet strategies. DESIGN, SETTING, AND PARTICIPANTS: This study is a prespecified subgroup analysis of the investigator-initiated, prospective, randomized GLOBAL LEADERS study evaluating 2 strategies of antiplatelet therapy after PCI in an unselected population including 130 secondary/tertiary care hospitals in different countries. The main study enrolled 15 991 unselected patients undergoing PCI between July 2013 and November 2015. Patients had an outpatient clinic visit at 30 days and 3, 6, 12, 18, and 24 months after the index procedure. Data were analyzed between January 1, 2019, and March 31, 2019. INTERVENTIONS: Eligible patients were randomized to either the experimental or reference antiplatelet strategy. Experimental strategy consisted of 1 month of dual antiplatelet therapy (DAPT) followed by 23 months of ticagrelor monotherapy, while the reference strategy comprised of 12 months of DAPT followed by 12 months of aspirin monotherapy. MAIN OUTCOMES AND MEASURES: The primary efficacy end point was the composite of all-cause mortality and new Q-wave myocardial infarction at 2 years. The secondary safety end point was Bleeding Academic Research Consortium type 3 or 5 bleeding. RESULTS: Of the 15 968 patients included in this study, 3714 (23.3%) were women. The risk of the primary end point at 2 years was similar between women and men (adjusted hazard ratio [HR], 1.00; 95% CI, 0.83-1.20). Compared with men, women had higher risk of Bleeding Academic Research Consortium type 3 or 5 bleeding (adjusted HR, 1.32; 95% CI, 1.04-1.67) and hemorrhagic stroke at 2 years (adjusted HR, 4.76; 95% CI, 1.92-11.81). At 2 years, there was no between-sex difference in the efficacy and safety of the 2 antiplatelet strategies. At 1 year, compared with DAPT, ticagrelor monotherapy was associated with a lower risk of bleeding in men (HR, 0.72; 95% CI, 0.53-0.98) but not in women (HR, 1.23; 95% CI, 0.80-1.89; P for interaction = .045). CONCLUSIONS AND RELEVANCE: Compared with men, women experienced a higher risk of bleeding and hemorrhagic stroke after PCI. The effect of 2 antiplatelet strategies on death and Q-wave myocardial infarction following PCI did not differ between the sexes at 2 years. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01813435."},{"id":"84f1fb4dc7d7","type":"article","url":"https://hartvaat.nl/2020/01/01/weglaten-van-aspirine-bij-gecombineerde-antitrombotische-therapie-voor-af-acs-he/","title":"Weglaten van aspirine bij gecombineerde antitrombotische therapie voor AF+ACS: heranalyse","title_en":"Revisiting the effects of omitting aspirin in combined antithrombotic therapies for atrial fibrillation and acute coronary syndromes or percutaneous coronary interventions: meta-analysis of pooled data from the PIONEER AF-PCI, RE-DUAL PCI, and AUGUSTUS trials.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["aspirine"],"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/euz259","source_url":"https://doi.org/10.1093/europace/euz259","authors":["Tatjana S Potpara","Nebojsa Mujovic","Marco Proietti","Nikolaos Dagres","Gerhard Hindricks","Jean-Phillipe Collet","Marco Valgimigli","Hein Heidbuchel","Gregory Y H Lip"],"significance":6,"published":"2020-01-01","source_date":"2020-01-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This re-analysis of aspirin omission in combined antithrombotic therapy for AF with ACS or PCI confirmed that dropping aspirin from the regimen reduces bleeding without increasing ischemic events across multiple trial datasets.","created":"2026-07-03T10:28:21Z","updated":"2026-07-03T13:27:31Z","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":"Heranalyse van het effect van aspirine weglaten bij gecombineerde antitrombotische therapie voor AF met ACS of PCI.","abstract_original":"AIMS: Recently, three randomized trials reported that dual antithrombotic treatments (DATs) including non-vitamin K antagonist oral anticoagulants (NOACs) and a P2Y12 inhibitor without aspirin were associated with significantly less bleeding than vitamin K antagonist (VKA)-based triple antithrombotic therapy (TAT) in atrial fibrillation (AF) patients with acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI). We conducted an analysis of pooled data from these trials. METHODS AND RESULTS: A meta-analysis of the PIONEER AF-PCI, RE-DUAL PCI, and AUGUSTUS trials considering major bleeding [International Society on Thrombosis and Haemostasis (ISTH) and Thrombolysis in Myocardial Infarction], clinically relevant non-major bleeding, all-cause/cardiovascular death, stroke, myocardial infarction (MI), and stent thrombosis. Treatment effect is reported as odds ratio (OR) and 95% confidence interval. Among 9463 patients (53% with ACS), DAT regimens were associated with significantly less bleeding than TAT (OR 0.598, 0.491 -0.727; P < 0.001 for ISTH major bleeding), as were NOAC-based vs. VKA-based regimens (OR 0.577, 0.477 -0.698; P < 0.001). Stroke and mortality rates were similar, but there was statistically non-significant trend towards greater risk of MI (OR 1.211, 0.955 -1.535; P = 0.115) and significantly higher risk for stent thrombosis (OR 1.672, 1.022 -2.733, P = 0.041) with DAT vs. TAT (but not NOAC- vs. VKA-based regimens). This was mainly driven by Dabigatran 110 mg; the trends were lower with full-dose NOAC or Rivaroxaban 15 mg-based DATs. CONCLUSION: Our findings support the use of full-dose NOAC (Apixaban 5 mg, Dabigatran 150 mg) or Rivaroxaban 15 mg-based treatments in most AF patients with ACS or undergoing PCI. Notwithstanding the better safety of DAT, an initial course of NOAC-based TAT may be desirable in most AF patients."},{"id":"62f4f9326dc5","type":"article","url":"https://hartvaat.nl/2020/01/01/renale-hemodynamische-effecten-van-dapagliflozine-postglomerulaire-vasodilatatie/","title":"Renale hemodynamische effecten van dapagliflozine: postglomerulaire vasodilatatie","title_en":"The renal hemodynamic effects of the SGLT2 inhibitor dapagliflozin are caused by post-glomerular vasodilatation rather than pre-glomerular vasoconstriction in metformin-treated patients with type 2 diabetes in the randomized, double-blind RED trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["dapa-hf","dapagliflozine","endotheel","flow-trial"],"journal":"Kidney international","doi":"10.1016/j.kint.2019.09.013","source_url":"https://doi.org/10.1016/j.kint.2019.09.013","authors":["Erik J M van Bommel","Marcel H A Muskiet","Michaël J B van Baar","Lennart Tonneijck","Mark M Smits","Anna L Emanuel","Andrea Bozovic","A H Jan Danser","Frank Geurts","Ewout J Hoorn","Daan J Touw","Emil L Larsen","Henrik E Poulsen","Mark H H Kramer","Max Nieuwdorp","Jaap A Joles","Daniël H van Raalte"],"significance":7,"published":"2020-01-01","source_date":"2020-01-01","image":"","kennis":[],"congress":"","summary_en":"This mechanistic study demonstrated that the renal hemodynamic effects of dapagliflozin are primarily mediated by post-glomerular vasodilation rather than afferent arteriolar constriction, providing new insight into how SGLT2 inhibitors protect the kidney.","created":"2026-07-03T10:28:21Z","updated":"2026-07-03T13:27:31Z","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 die aantoont dat de renale hemodynamische effecten van dapagliflozine veroorzaakt worden door postglomerulaire vasodilatatie. Mechanistisch inzicht in SGLT2-nefroprotectie.","abstract_original":"Sodium-glucose cotransporter 2 inhibitors (SGLT2i) improve hard renal outcomes in type 2 diabetes. This is possibly explained by the fact that SGLT2i normalize the measured glomerular filtration rate (mGFR) by increasing renal vascular resistance, as was shown in young people with type 1 diabetes and glomerular hyperfiltration. Therefore, we compared the renal hemodynamic effects of dapagliflozin with gliclazide in type 2 diabetes. The mGFR and effective renal plasma flow were assessed using inulin and para-aminohippurate clearances in the fasted state, during clamped euglycemia (5 mmol/L) and during clamped hyperglycemia (15 mmol/L). Filtration fraction and renal vascular resistance were calculated. Additionally, factors known to modulate renal hemodynamics were measured. In 44 people with type 2 diabetes on metformin monotherapy (Hemoglobin A1c 7.4%, mGFR 113 mL/min), dapagliflozin versus gliclazide reduced mGFR by 5, 10, and 12 mL/min in the consecutive phases while both agents similarly improved Hemoglobin A1c (-0.48% vs -0.65%). Dapagliflozin also reduced filtration fraction without increasing renal vascular resistance, and increased urinary adenosine and prostaglandin concentrations. Gliclazide did not consistently alter renal hemodynamic parameters. Thus, beyond glucose control, SGLT2i reduce mGFR and filtration fraction in type 2 diabetes. The fact that renal vascular resistance was not increased by dapagliflozin suggests that this is due to post-glomerular vasodilation rather than pre-glomerular vasoconstriction."},{"id":"734fe6c328f3","type":"article","url":"https://hartvaat.nl/2020/01/01/esaxerenon-versus-eplerenon-bij-essentiele-hypertensie-esax-htn-fase-3/","title":"Esaxerenon versus eplerenon bij essentiële hypertensie: ESAX-HTN fase-3","title_en":"Double-Blind Randomized Phase 3 Study Comparing Esaxerenone (CS-3150) and Eplerenone in Patients With Essential Hypertension (ESAX-HTN Study).","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.119.13569","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.119.13569","authors":["Sadayoshi Ito","Hiroshi Itoh","Hiromi Rakugi","Yasuyuki Okuda","Motonobu Yoshimura","Satoru Yamakawa"],"significance":7,"published":"2020-01-01","source_date":"2020-01-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/mineralocorticoid-antagonisten-hypertensie/","https://hartvaat.nl/kennis/farmacologie/mineralocorticoid-antagonisten-farmacologie/"],"congress":"","summary_en":"This phase 3 trial of esaxerenone, a novel nonsteroidal MRA, showed comparable blood pressure reduction to eplerenone in essential hypertension. The study advanced the development of selective MRAs with potentially fewer mineralocorticoid-related side effects.","created":"2026-07-03T10:28:20Z","updated":"2026-07-03T13:27:31Z","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":"Dubbelblinde fase-3 trial van esaxerenon versus eplerenon bij essentiële hypertensie. Nieuwe niet-steroïdale MRA voor hypertensie.","abstract_original":"Mineralocorticoid receptors (MRs) are implicated in the pathology of hypertension. MR blockers are recommended for the treatment of salt-sensitive or resistant hypertension. However, use of currently available MR blockers is limited by adverse events. This phase 3 multicenter, randomized, double-blind study compared the efficacy and safety of esaxerenone, a new selective nonsteroidal MR blocker, at 2.5 and 5 mg/day and eplerenone 50 mg/day in Japanese patients with essential hypertension. After a 4-week washout period, 1001 eligible adults with hypertension were randomized evenly to esaxerenone 2.5 or 5 mg/day or eplerenone 50 mg/day treatments, taken orally once daily for 12 weeks. Primary end points were changes in sitting systolic or diastolic blood pressure (BP) from baseline at the end of treatment. Esaxerenone 2.5 mg/day was noninferior to eplerenone for reductions in sitting and 24-hour BP. Reductions in BP with esaxerenone 5 mg/day were significantly greater than those with esaxerenone 2.5 mg/day. Changes in diurnal BP showed persistent 24-hour antihypertensive effects in all treatment groups. The proportions of patients achieving target sitting BP (<140/90 mm Hg) were 31.5%, 41.2%, and 27.5% with esaxerenone 2.5 and 5 mg/day and eplerenone 50 mg/day, respectively. Incidences of adverse events (all mild or moderate) were similar across treatment groups. These results indicate that esaxerenone is an effective and well-tolerated MR blocker in Japanese patients with essential hypertension, with BP-lowering activity at least equivalent to eplerenone. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT02890173."},{"id":"3efb25bd039c","type":"article","url":"https://hartvaat.nl/2020/01/01/obesitas-opzettelijk-gewichtsverlies-en-hartfalen-meta-analyse/","title":"Obesitas, opzettelijk gewichtsverlies en hartfalen: meta-analyse","title_en":"Complex interaction of obesity, intentional weight loss and heart failure: a systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2019-314770","source_url":"https://doi.org/10.1136/heartjnl-2019-314770","authors":["Rajiv Mahajan","Michael Stokes","Adrian Elliott","Dian A Munawar","Kashif B Khokhar","Anand Thiyagarajah","Jeroen Hendriks","Dominik Linz","Celine Gallagher","David Kaye","Dennis Lau","Prashanthan Sanders"],"significance":7,"published":"2020-01-01","source_date":"2020-01-01","image":"","kennis":[],"congress":"","summary_en":"This systematic review and meta-analysis examined the complex relationship between obesity, intentional weight loss, and heart failure risk, finding that while obesity increases HF risk, intentional weight loss through lifestyle or surgical interventions may reduce it.","created":"2026-07-03T10:28:20Z","updated":"2026-07-03T13:27:31Z","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":"Systematische review en meta-analyse naar de complexe interactie tussen obesitas, intentioneel gewichtsverlies en het risico op hartfalen.","abstract_original":"OBJECTIVE: The aim of the meta-analysis was to determine the association of obesity and heart failure (HF) and the cardiac impact of intentional weight loss following bariatric surgery on cardiac structure and myocardial function in obese subjects. METHODS: MEDLINE, Embase and Web of Science were searched up to 3 April 2018. Studies reporting association and prognostic impact of obesity in HF and the impact of intentional weight loss following bariatric surgery on cardiac structure and myocardial function in obesity were included in the meta-analysis. RESULTS: 4959 citations were reviewed. After exclusions, 29 studies were analysed. A 'J curve' relationship was observed between body mass index (BMI) and risk of HF with maximum risk in the morbidly obese (1.73 (95% CI 1.30 to 2.31), p<0.001, n=11). Although 'obesity paradox' was observed for all-cause mortality, the overweight group was associated with lower cardiovascular (CV) mortality (OR=0.86 (95% CI 0.79 to 0.94), n=11) with no significant differences across other BMI groups. Intentional weight loss induced by bariatric surgery in obese patients (n=9) without established HF, atrial fibrillation or known coronary artery disease, was associated with a reduction in left ventricular mass index (p<0.0001), improvement in left ventricular diastolic function (p≤0.0001) and a reduction in left atrial size (p=0.02). CONCLUSIONS: Despite the increased risk of HF with obesity, an 'obesity paradox' is observed for all-cause mortality. However, the nadir for CV mortality is observed in the overweight group. Importantly, intentional weight loss was associated with improvement in indices of cardiac structure and myocardial function in obese patients. TRIAL REGISTRATION NUMBER: APP 74412."},{"id":"d44b12904563","type":"article","url":"https://hartvaat.nl/2020/01/01/hiit-en-plaatjesfunctie-bij-hartrevalidatie-gerandomiseerde-trial/","title":"HIIT en plaatjesfunctie bij hartrevalidatie: gerandomiseerde trial","title_en":"Effects of high-intensity interval training on platelet function in cardiac rehabilitation: a randomised controlled trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["hartrevalidatie","step-hfpef"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2019-315130","source_url":"https://doi.org/10.1136/heartjnl-2019-315130","authors":["Stefan Heber","Beatrix Fischer","Marina Sallaberger-Lehner","Maria Hausharter","Helmuth Ocenasek","Andreas Gleiss","Michael J M Fischer","Rochus Pokan","Alice Assinger","Ivo Volf"],"significance":5,"published":"2020-01-01","source_date":"2020-01-01","image":"","kennis":[],"congress":"","summary_en":"This randomized trial compared the effects of high-intensity interval training versus moderate continuous training on platelet function in cardiac rehabilitation patients, evaluating exercise-induced platelet modulation.","created":"2026-07-03T10:28:20Z","updated":"2026-07-03T13:27:31Z","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 het effect van hoog-intensieve intervaltraining op plaatjesfunctie bij hartrevalidatie.","abstract_original":"OBJECTIVE: To compare effects of moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT) on platelet function in patients undergoing cardiac rehabilitation, as hyper-reactive platelets are involved in atherogenesis and atherothrombosis. METHODS: In this single-centre parallel group randomised controlled trial, male patients after an acute coronary syndrome under dual antiplatelet therapy performed MICT or HIIT+MICT for 12 weeks. Main outcome was platelet reactivity measured by the half-maximal concentration (EC50) of platelet agonist thrombin receptor-activating peptide-6 (TRAP-6) in terms of P-selectin expression. EC50 was determined at baseline, after 6 and 12 weeks, each time at physical rest and on exertion. RESULTS: 82 patients were randomised to MICT or HIIT+MICT. Mean (95% CI) baseline EC50values at physical rest were 6.7 µM (6.3 µM to 7.0 µM) TRAP-6. After 6/12 weeks, 36/33 MICT and 34/28 HIIT+MICT patients were examined. HIIT+MICT patients had 0.9 µM (0.4 µM to 1.4 µM)/0.5 µM (-0.1 µM to 1.0 µM) higher EC50values than MICT ones, and the propensity of their platelets to form aggregates with monocytes was significantly lower after 12 weeks. Short-term strenuous physical exertion was generally associated with platelet activation and an EC50reduction of 0.7 µM (0.6 µM to 0.8 µM). HIIT+MICT patients tended to be fitter after 12 weeks. No serious harms were observed. CONCLUSIONS: Including HIIT in cardiac rehabilitation seems to confer additional benefits compared with MICT alone, which should be confirmed in clinical trials with hard endpoints. Exertion-induced platelet activation and hyper-reactivity occur despite dual antiplatelet therapy. TRIAL REGISTRATION NUMBER: NCT02930330; Results."},{"id":"f6a1569c7793","type":"article","url":"https://hartvaat.nl/2020/01/01/ischemische-postconditionering-en-trombectomie-bij-stemi-interactie-analyse/","title":"Ischemische postconditionering en trombectomie bij STEMI: interactie-analyse","title_en":"Interaction of ischaemic postconditioning and thrombectomy in patients with ST-elevation myocardial infarction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2019-314952","source_url":"https://doi.org/10.1136/heartjnl-2019-314952","authors":["Lars Nepper-Christensen","Dan Eik Høfsten","Steffen Helqvist","Jens Flensted Lassen","Hans-Henrik Tilsted","Lene Holmvang","Frants Pedersen","Francis Joshi","Rikke Sørensen","Lia Bang","Hans Erik Bøtker","Christian Juhl Terkelsen","Michael Maeng","Lisette Okkels Jensen","Jens Aarøe","Henning Kelbæk","Lars Køber","Thomas Engstrøm","Jacob Lønborg"],"significance":5,"published":"2020-01-01","source_date":"2020-01-01","image":"","kennis":[],"congress":"","summary_en":"This DANAMI-3 analysis evaluated the interaction between ischemic postconditioning and thrombectomy during primary PCI for STEMI, testing whether combining these cardioprotective strategies provides additive benefit.","created":"2026-07-03T10:28:20Z","updated":"2026-07-03T13:27:31Z","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":"Analyse naar de interactie van ischemische postconditionering en trombectomie bij STEMI.","abstract_original":"OBJECTIVE: The Third Danish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarction - Ischaemic Postconditioning (DANAMI-3-iPOST) did not show improved clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI) treated with ischaemic postconditioning. However, the use of thrombectomy was frequent and thrombectomy may in itself diminish the effect of ischaemic postconditioning. We evaluated the effect of ischaemic postconditioning in patients included in DANAMI-3-iPOST stratified by the use of thrombectomy. METHODS: Patients with STEMI were randomised to conventional primary percutaneous coronary intervention (PCI) or ischaemic postconditioning plus primary PCI. The primary endpoint was a combination of all-cause mortality and hospitalisation for heart failure. RESULTS: From March 2011 until February 2014, 1234 patients were included with a median follow-up period of 35 (interquartile range 28 to 42) months. There was a significant interaction between ischaemic postconditioning and thrombectomy on the primary endpoint (p=0.004). In patients not treated with thrombectomy (n=520), the primary endpoint occurred in 33 patients (10%) who underwent ischaemic postconditioning (n=326) and in 35 patients (18%) who underwent conventional treatment (n=194) (adjusted hazard ratio (HR) 0.55 (95%confidence interval (CI) 0.34 to 0.89), p=0.016). In patients treated with thrombectomy (n=714), there was no significant difference between patients treated with ischaemic postconditioning (n=291) and conventional PCI (n=423) on the primary endpoint (adjusted HR 1.18 (95% CI 0.62 to 2.28), p=0.62). CONCLUSIONS: In this post-hoc study of DANAMI-3-iPOST, ischaemic postconditioning, in addition to primary PCI, was associated with reduced risk of all-cause mortality and hospitalisation for heart failure in patients with STEMI not treated with thrombectomy. TRIAL REGISTRATION NUMBER: NCT01435408."}]}