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Media, News & Topics on prevention, diagnosis & treatment of cardiovascular disease
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Paul Ridker on Inflammation and Residual CV Risk

Paul Ridker on Inflammation and Residual CV Risk | Heart and Vascular Health | Scoop.it

Dr. Bilazarian interviews Dr. Paul Ridker on the inflammation hypothesis and 2 ongoing trials in this area: the National Heart, Lung, and Blood Institute (NHLBI)-funded Cardiovascular Inflammation Reduction Trial (CIRT),[1] which is testing whether taking low-dose methotrexate reduces myocardial infarction (MI), stroke, or death in people with type 2 diabetes or metabolic syndrome who have had a heart attack or have stable coronary artery disease; and the Novartis-sponsored Canakinumab Anti-Inflammatory Thrombosis Outcomes Study (CANTOS),[2] which is assessing whether blocking the proinflammatory cytokine interleukin (IL)-1β with canakinumab, as compared with placebo, can reduce rates of recurrent MI, stroke, and cardiovascular death in patients post-MI with elevated high-sensitivity C-reactive protein (CRP; ≥ 2 mg/L).

Seth Bilazarian, MD's insight:

Paul Ridker provides a great primer for clinicians & patients on the status of trials investigating the links between inflammation and cardiovascular disease. He reviews the background and status of the two large randomized clinical outcomes trials he leads: CANTOS & CIRT.

 

Other resources:

1.  slides from Dr. Ridker at  https://my.americanheart.org/idc/groups/ahamah-public/@wcm/@sop/@scon/documents/downloadable/ucm_426676.pdf

 

2. CIRT trial http://www.thecirt.org/

 

3,  CANTOS trial http://www.thecantos.org/

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CRP tests for inflammation and gauges risk of cardiovascular disease

CRP tests for inflammation and gauges risk of cardiovascular disease | Heart and Vascular Health | Scoop.it

Blood test for high-sensitivity C-reactive protein (hs-CRP) —a marker for inflammation—is increasingly being used as a routine screening tool for patients who wonder if they are at risk of a heart attack or stroke.  Easily done at the same time as a cholesterol screening & covered by most insurance.  American Heart Association and American College of Cardiology both endorsed use of hs-CRP for "intermediate risk" individuals.

"We know that those with elevated hs-CRP are at high risk even if cholesterol levels are low, and that statin therapy can reduce the risk of heart attack and stroke in this group. While the JUPITER study showed inflammation contributes as much to cardiovascular risk as does high blood pressure or high cholesterol", Dr. Paul Ridker says "the core research question now is whether or not reducing inflammation per se will reduce that risk."

The ongoiing CANTOS trial will provide important information.  See my SCOOP IT at   http://www.scoop.it/t/heart-and-vascular-health/p/1559762525/inflammation-statin-therapy-and-hscrp-initial-observations ;

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Trying a New Line of Attack in Heart Disease

Trying a New Line of Attack in Heart Disease | Heart and Vascular Health | Scoop.it

Two major clinical trials are testing for the first time whether treating inflammation can reduce the risk of a heart attack or stroke, potentially opening up a new line of attack in the battle against cardiovascular disease.

Research over two decades has shown that people with chronic inflammation—detectable at low levels, for instance, with a high-sensitivity test for a marker called C-reactive protein—are at significantly higher risk of heart attack and stroke compared with those with evidence of little or no such inflammation.

These are especially high-risk patients for whom current optimal treatment often fails. "We've kind of run out of our tool kit for these individuals and yet they're still having events," said Gary Gibbons, director of the NIH's National Heart, Lung and Blood Institute, which officially funded the study.

The CANTOS trial sponsored by Novartis is testing the company's anti-inflammatory antibody called canakinumab, has already enrolled 3,000 patients of a planned 17,000 patients with stable cardiovascular disease and elevated levels of inflammation. (Ilaris is marketed for inflammatory disease called Muckle-Wells Syndrome.) In proof-of-concept studies, it yielded  "provocative" evidence of benefit in coronary arteries.

 

PMA is participating in the CANTOS trial.  For more information see http://www.pmaonline.com/PDF/CACZ885M2301_trial.pdf

 

 

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Inflammation, Statin Therapy, and hsCRP: Initial Observations

Lecture slides form Dr. Paul Ridker at  ATVB 2011 – Inflammation, Immunity, and Atherosclerosis on Inflammation and Atherothrombosis: Where will new trials take us?

 

Great slide set for review of Inflammation, Statin Therapy, and hsCRP: Initial Observations

 

It discusses the as yet unanswered question can targeted Anti-Inflammatory Therapy Reduce Cardiovascular Risk?

 

Builds the case for why IL-1β inhibition is an attractive target based on experimental data and models and the current understanding of IL-1 and its potential roles in atherogenesis.  Also reviews the candidate therapy, Canakinumab (Ilaris, Novartis) being investigagted in the CANTOS trial.

 

Brief conclusion:

Is there evidence that individuals with elevated levels of inflammatory biomarkers are at high vascular risk even when other risk factors are acceptable? => YES
Is there evidence that individuals identified at increased risk due to inflammation benefit from a therapy they otherwise would not have received? => YES
Is there evidence that reducing inflammation will reduce vascular events? =>

WE NEED TO FIND OUT 

 

For patients with a prior histroy of heart attack (MI) interested in learning more about the CANTOS trial being conducted at PMA, under the direction of Dr. Sunny Srivistava in Haverhill see...

 

http://www.pmaonline.com/clinical-trials.htm

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