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CLINICAL

NEWS JACC in a FLASH
stroke during follow-up with number of
events increasing with worsening renal
function. The researchers observed a
lower risk of MI after 3 years with ACE
inhibitors. In patients with de novo
ACE inhibitor/ARB, they observed an
even lower risk of MI regardless of
renal function. There was not a lower
risk of stroke in patients treated with
an ACE inhibitor or ARB.
In an accompanying editorial, Jay
N. Cohn, MD, notes that these findings
reaffirm the continued use of ACE
inhibitors and ARBs even if patients experience modest increases in creatinine
levels and that these drugs should be
standard therapy for patients suffering
from atherosclerotic disease. “Since
renal dysfunction may serve as a signal
for more severe vascular disease, its
presence should if anything, enhance
the message,” he writes.

with the higher risk, CAC of 4-12,
56% had high risk BAC, 17% had 1-3
BAC and 27% had 0 BAC.
The researchers also found that
BAC was superior to conventional risk
factors. The agreements of Framingham Risk Scores in the population
were only 57% for CAC and 55% for

BAC. The agreement of pooled cohort
equation risk categories were 47% for
CAC and 54% for BAC.
According to the authors, these
findings strongly suggest that BAC
should be studied further. It may
be reasonable to recommend that
BAC positive women receive further

Orenitram is indicated for the treatment of pulmonary arterial hypertension (PAH) (WHO Group 1) to improve exercise capacity

FOR pulmonary arterial hypertension

ORENITRAM DOSING

ADAPTS

Evan M, Carrero JJ, Szummer K, et al.
J Am Coll Cardiol. 2016;doi:10.1016/j.
jacc.2016.01.050.

Can a Mammogram Detect CV
Risk?
Breast arterial calcification (BAC), seen
on a digital mammography, is strongly
associated with coronary artery
calcium (CAC), an early sign of heart
disease, according to a study published
March 24 in JACC: Cardiovascular Imaging and presented at the ACC’s 65th Annual Scientific Session in Chicago, IL.
BAC was found in 42.5% of the
292 women included in the study
while CAC was found in 47.6% of
the cohort. The mean BAC score was
2.2 ± 2.9 and the mean CAC score
was 1.6 ± 2.5. The frequency of BAC
and CAC increased as the age of the
patients increased.
The positive predictive value
of BAC > 0 increased from 53% to
86% and the negative predictive
value decreased from 81% to 36%
with increasing age. There was an
increasing frequency of both BAC
and CAC with increasing age as well
as increasing percentages of higher
CAC in those with BAC. In 76% of
patients with 0 CAC also had 0 BAC,
and 10% had 1-3 BAC and 14% had
4-12 BAC. In the 1-3 CAC group, the
BAC was evenly distributed. In those

16

risk assessment for heart disease,
preferably with a CAC scan. It is also
important to note that the absence of
BAC does not assure low cardiovascular risk.
In an accompanying editorial comment, Khurram Nasir, MD, MPH
and John W. McEvoy, MB BCH BAO,

Introduce prostacyclin treatment early with Orenitram, which enables
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The only prostacyclin analogue in a tablet:
For PAH, a
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Early use in
FC II and III1

Ability to transition
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Orenitram allows you to initiate treatment with 0.125 mg TID (~8 hrs apart) or 0.25 mg BID (~12 hrs
apart), then titrate up or down every 3 to 4 days as needed per Full Prescribing Information (PI). In the
pivotal trial, dose was titrated based on clinical response and tolerability. If not tolerated, titrate slower or
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with food. If a dose is missed, please refer to the PI. Orenitram should not be used in patients with
moderate hepatic impairment. Dose adjustments required for mild hepatic impairment.
*In a 24-week, multicenter, open-label study to establish safety and tolerability of transition, WHO Group 1
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© 2016 Unit ed Therapeutics Corporation.
All rights reserved. US/ORE/DEC15/146a Printed in USA.

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